Category Grades
30C- 27C-
Access to Emergency Care:
50F 49F
Quality/Patient Safety:
10A- 17C+
Medical Liability:
27C- 28C
Public Health/ Injury Prevention:
37D- 30D+
Disaster Preparedness:
10A- 16C+

Florida has implemented strong practices and policies to ensure quality care, patient safety, and Disaster Preparedness. However, the state is plagued by a health care workforce shortage, financial barriers to care, and limited hospital capacity, as well as a Medical Liability Environment that makes it exceedingly difficult to fill these gaps.

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Florida's Quality and Patient Safety Environment has many strengths, including dedicated funding for both quality improvement within the emergency medical services (EMS) system and a funded state EMS medical director. The state has instituted triage and destination policies for both stroke and ST-elevation myocardial infarction patients, and it maintains a statewide trauma registry. However, emergency physicians in the state warn of a risk that Florida's trauma system could become fragmented.

Florida has implemented some important Disaster Preparedness policies and procedures to ensure that the state is able to respond quickly to a disaster or mass casualty event. For licensure, all Florida long-term care facilities and nursing homes are required to have annual internal facility disaster drills and exercises in addition to the higher level drills and trainings conducted with state agencies. Florida has greatly improved its registration of health professionals in the Emergency System for Advance Registration of Volunteer Health Professionals, with high per capita rates of physicians, nurses, and behavioral health professionals registered. Continuing to show its dedication to improving its Disaster Preparedness, Florida is nearing implementation of a statewide high-tech solution for electronic patient tracking to improve on its current low-tech patient-tracking system.


Florida faces a triple challenge in Access to Emergency Care: physician shortages, insufficient hospital capacity, and a lack of adequate health insurance coverage. Florida is experiencing a severe physician workforce shortage, with specialty coverage for emergency departments (ED) posing a particular challenge. Florida has an inadequate supply of neurosurgeons; emergency physicians; orthopedists and hand surgeons; ear, nose, and throat specialists; and registered nurses. Florida ranks last in the nation for children who are able to see a provider (91.7%). With full implementation of the Patient Protection and Affordable Care Act and the current lack of Medicaid expansion, access to primary care physicians may be further limited in the near future. Florida already has one of the greatest needs for additional primary care providers in the nation (4.5 providers per 100,000 people) and one of the lowest Medicaid fee levels for office visits, at 57.6% of the national average.

Florida has few psychiatric care beds (13.3 per 100,000 people) and EDs (8.1 per 1 million people), which likely contribute to long ED wait times (315 minutes from ED arrival to ED departure). Financial barriers to care also persist in Florida, which has high rates of uninsured adults and children (21.6 and 13.0%, respectively). Additionally, Florida has reportedly experienced severe medication shortages in pre-hospital and emergency care settings.

Despite having some key medical liability reforms in place, Florida has failed to make significant progress with its Medical Liability Environment since the 2009 Report Card. While medical liability insurance premiums for primary care physicians and specialists decreased slightly, they are still the highest in the nation. Concurrently, the state has very few insurers writing medical liability policies (2.4 per 1,000 physicians) and still lacks pretrial screening panels.

Florida's challenges in accessing needed care are particularly worrisome when coupled with its subpar performance in Public Health and Injury Prevention. The state has the highest rate of pedestrian fatalities (17.0 per 100,000 pedestrians), which is more than three times the average across the states, while the rate of bicyclist fatalities is more than twice the national average. These rates point to a need for concentrated public education on safe driving and focused enforcement of these laws. The state is moving forward in this area, having passed legislation in 2013 that bans texting for all drivers.


Many critical gaps in Access to Emergency Care threaten to overburden the emergency care system in Florida. The state needs to recruit, train, and retain all types of health professionals, including emergency physicians and specialists willing to be on call in the ED. At the same time, the state must increase Medicaid reimbursement levels that have steadily declined for the past decade, support increased hospital capacity to reduce the likelihood of ED boarding and crowding, and improve health insurance coverage for adults and children.

Improving the Medical Liability Environment further may help Florida in attracting and retaining health care providers. The state must make an effort to encourage additional insurers to write medical liability policies in the state and reduce the highes-in-the-nation insurance premiums. Implementing pretrial screening panels and requiring that expert witnesses be licensed to practice medicine in the state also may discourage frivolous lawsuits.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 8.0 9.0
Emergency physicians per 100,000 pop 10.5 12.0
Neurosurgeons per 100,000 pop 1.9 2.1
Orthopedists and hand surgeon specialists per 100,000 pop 8.3 8.7
Plastic surgeons per 100,000 pop 3.3 3.3
ENT specialists per 100,000 pop 3.3 3.2
Registered nurses per 100,000 pop 820.6 836.6
Percent of children able to see provider 91.7
Level I or II trauma centers per 1M pop 1.0 0.8
Percent of population within 60 minutes of Level I or II trauma center 97.2 98.2
Accredited chest pain centers per 1M pop 1.6 4.0
Percent of population with an unmet need for substance abuse treatment 8.6 8.4
Pediatric specialty centers per 1M pop 2.2 2.4
Medicaid fee levels for office visits as a percent of the national average 70.8 57.6
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) -10.0 -3.8
Percent of adults with no health insurance 21.9 21.6
Percent of adults underinsured 9.9
Percent of children with no health insurance 18.9 13.0
Percent of children underinsured 19.2
Percent of adults with Medicaid 5.7 8.5
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 320.3 299.5
Hospital occupancy rate per 100 staffed beds 67.8 64.8
Psychiatric care beds per 100,000 pop 12.6 13.3
Median time from ED arrival to ED departure for admitted ED patients 315
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $8.26 $4.27
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process YES, YES YES
Public health and emergency physician input during an ESF-8 response YES
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) YES, ACCREDITED YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO YES
Medical response plan for supplying dialysis NO YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers STATE LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing YES
Just-in-time training systems in place STATEWIDE STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO YES
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 489.1 494.4
ICU beds per 1M pop 272.9 274.2
Burn unit beds per 1M pop 3.5 4.0
Verified burn centers per 1M pop 0.164372366 0.2
Physicians registered in ESAR-VHP per 1M pop 39.8 50.0
Nurses registered in ESAR-VHP per 1M pop 53.9 286.3
Behavioral health professionals registered in ESAR-VHP per 1M pop 27.1
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES NO
Percent of RNs that received emergency training 45.5 38.7

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 21.3 22.0
Lawyers per physician 0.8 0.8
Lawyers per emergency physician 20.1 18.3
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -4 -2
Malpractice award payments per 100,000 pop 0.5 3.6
Average malpractice award payments $231,737 $212,364
National Practitioner Databank reports per 1,000 physicians 22.9 29.0
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 2.1 2.4
Average medical liability insurance premiums for primary care physicians $41,947 $31,133
Average medical liability insurance premiums for specialists $171,231 $128,555
Presence of pretrial screening panels NONE NO
Pretrial screening panel's findings admissible as evidence N/A N/A
Periodic payments are: required, granted upon request, at court's discretion UPON REQUEST OR AGREEMENT OF PARTY(IES) UPON REQUEST
Medical liability cap on non-economic damages >$500,000 >$500,000
Additional liability protection for EMTALA-mandated emergency care YES YES
Joint and several liability abolished YES YES
Collateral Source Rule/Provides for Awards to be Offset YES
State provides for case certification YES YES
Expert witness required to be of the same specialty as the defendant YES YES
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 10.8
Pedestrian fatalities per 100,000 pedestrians 17.0
Percent of traffic fatalities alcohol-related 41.0 36.0
Percent of front occupants using restraints 79.1 88.1
Child safety seat/seat belt legislation - score out of a possible 10 points 1 3
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 1
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 81.4 77.8
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 61.5 57.6
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 62.9 69.8
Fatal occupational injuries per 1M workers 44.9 25.5
Homicides and suicides (non-motor vehicle)(per 100,000) 18.8 21.3
Unintentional fall-related fatal injuries (per 100,000) 9.4 11.5
Fire/burn related fatal injuries (per 100,000) 0.8 0.7
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.1 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 14.3
Total injury prevention funds per 1,000 persons $58.36 $29.83
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 2
Infant mortality rate per 1,000 live births 7.2 6.5
Percentage of adults who binge drink 13.8 17.1
Percentage of adults who currently smoke 21.0 19.3
Percentage of adult population who are obese (BMI > 30.0) 23.1 26.6
Percentage of children who are obese 13.4
Cardiovascular disease disparity ratio 1.7
HIV diagnosis disparity ratio 14.8
Infant mortality disparity ratio 2.4

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 6.4 9.9
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 100.0 100.0
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols NO
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients YES
State has or is working on a PCI network or a STEMI system of care YES YES
State has triage and destination policy in place for STEMI patients YES
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients YES
Prescription drug monitoring program score (range 0-4) 2
% of hospitals with computerized practitioner order entry 16.7 76.3
% of hospitals with electronic medical records 47.7 95.3
% of patients with AMI given PCI within 90 minutes of arrival 55 96
Median time to transfer to another facility for acute coronary intervention 58
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 37.9
% of hospitals with or planning to develop a diversity strategy or plan 34.4

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