Category Grades
40D+ 40D+
Access to Emergency Care:
29D 20D+
Quality/Patient Safety:
26C 29D
Medical Liability:
29D+ 23C
Public Health/ Injury Prevention:
41D- 35D
Disaster Preparedness:
31C 42F

Indiana has improved its Medical Liability Environment and Access to Emergency Care grades but still faces numerous challenges, including a need for state-level planning and coordination to improve the Quality and Patient Safety Environment, as well as Disaster Preparedness.

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Indiana's Medical Liability Environment improved somewhat since 2009 and now boasts the second lowest average malpractice award payment in the nation ($122,334). The state has implemented many important reforms that contribute to this low rate, including apology inadmissibility laws, mandatory pretrial screening panels, rules that require malpractice awards to be offset by collateral sources, and a medical liability cap on total damages. Indiana also has a patient compensation fund in place to help cover monetary awards in medical malpractice cases. Indiana providers enjoy lower-than-average medical liability insurance premiums for primary care physicians ($10,154) and specialists ($49,113).

Although Indiana faces significant workforce challenges with low per capita rates of neurosurgeons; orthopedists and hand surgeons; plastic surgeons; and ear, nose, and throat specialists, the state has some strengths in Access to Emergency Care. The state has a relatively adequate number of medical facilities, with a very low hospital occupancy rate (60.6 per 100 staffed beds) and better-than-average emergency department wait times (239 minutes), staffed inpatient beds (313.3 per 100,000 people), and psychiatric care beds (24.6 per 100,000). Indiana has some of the lowest rates of adults and children with no health insurance (14.2 and 5.6%, respectively). It has an unfortunately low Medicaid fee level for office visits, at 66.1% of the national average, though this represents a 16.8% fee level increase since 2007.


Indiana faces many challenges in Disaster Preparedness due to lack of written procedures for emergency response coordination and a fractured emergency response system. The state does not have an Emergency Support Function 8 (ESF-8) or all-hazards plan. Although Indiana has a statewide medical communication system and a statewide just-in-time training system, other statewide planning and coordination efforts are lacking, including statewide patient tracking and real-time syndromic surveillance systems. In terms of infrastructure, however, Indiana has a high per capita rate of intensive care unit beds and verified burn centers, although the state's bed surge capacity is quite low.

Indiana's Quality and Patient Safety Environment grade has declined, largely because of its failure to implement policies at a pace consistent with the rest of the nation. For instance, Indiana is one of few states that have not begun developing a stroke or a ST-elevation myocardial infarction (STEMI) system of care. The state also lacks destination policies for stroke and STEMI patients.

Indiana continues to face challenges related to Public Health and Injury Prevention, particularly in the area of child and infant health. For instance, the state has a relatively low percentage of young children who have received recommended immunizations (73.4%) and one of the higher infant mortality rates in the nation (7.6 per 1,000 live births). It also has a relatively high infant mortality disparity ratio, with non-Hispanic Black infants being 2.8 times more likely to die in the first year than the racial and ethnic group with the lowest infant mortality rate.


Indiana must address the severe shortage of specialists to improve care for its people. The positive changes to the Medical Liability Environment that have resulted in low insurance premiums are a good start toward recruiting and retaining more providers; however, a concerted effort is needed to significantly increase the number of providers available and willing to be on call in the emergency department.

Indiana's Disaster Preparedness planning is in need of substantial improvement, starting with improved coordination between the various agencies responsible for emergency response and involvement of the state's public health and emergency physicians in emergency response planning. Improving the state's medical response plans and implementing more training opportunities should follow from these first steps.

Indiana should work to improve its Quality and Patient Safety Environment by developing policies and procedures that ensure that patients get the care they need. A uniform system for providing pre-arrival instructions and destination policies for stroke and STEMI patients would go a long way toward improving the state's emergency medical system of care. The Indiana House of Representatives has established a taskforce to examine the need for and establishment of a state EMS physician medical director to improve the quality of services delivered. The findings of this taskforce must be thoughtfully considered, as it represents a potentially promising step toward improving the system of care.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 7.3 8.6
Emergency physicians per 100,000 pop 9.7 10.3
Neurosurgeons per 100,000 pop 1.4 1.5
Orthopedists and hand surgeon specialists per 100,000 pop 8.0 8.0
Plastic surgeons per 100,000 pop 1.6 1.6
ENT specialists per 100,000 pop 2.9 2.7
Registered nurses per 100,000 pop 869.0 938.4
Percent of children able to see provider 96.1
Level I or II trauma centers per 1M pop 1.0 0.9
Percent of population within 60 minutes of Level I or II trauma center 90.9 97.0
Accredited chest pain centers per 1M pop 2.8 7.2
Percent of population with an unmet need for substance abuse treatment 8.3 8.4
Pediatric specialty centers per 1M pop 3.3 3.5
Medicaid fee levels for office visits as a percent of the national average 69.5 66.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) NR 16.8
Percent of adults with no health insurance 13.1 14.2
Percent of adults underinsured 8.1
Percent of children with no health insurance 7.8 5.6
Percent of children underinsured 18.0
Percent of adults with Medicaid 6.0 10.9
Hospital closures in 2006/2011 1 0
Staffed inpatient beds per 100,000 pop 332.6 313.3
Hospital occupancy rate per 100 staffed beds 60.4 60.6
Psychiatric care beds per 100,000 pop 19.0 24.6
Median time from ED arrival to ED departure for admitted ED patients 239
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $7.69 $4.55
State budget line item health care surge YES
ESF-8 plan is shared with all EMS and essential hospital personnel YES STATE DOES NOT HAVE ESF-8 PLAN
Emergency physician input into the state planning process YES, YES NR
Public health and emergency physician input during an ESF-8 response NO
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO YES
Special needs patients included in medical response plan NR NO
Patients dependent on medication for chronic conditions in medical response plan NR NO
Medical response plan for supplying dialysis NR NO
Mental health patients included in medical response plan NO
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers LOCAL LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan NO
State able to report number of exercises involving long-term care facilities or nursing NO
Just-in-time training systems in place NR STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO NO
Statewide real-time or near real-time syndromic surveillance system YES NO
Real-time surveillance system in place for common ED presentations YES NO
Bed surge capacity per 1M pop 0.0 317.6
ICU beds per 1M pop 314.5 356.1
Burn unit beds per 1M pop 3.8 4.1
Verified burn centers per 1M pop 0.472791704 0.5
Physicians registered in ESAR-VHP per 1M pop 467.6 23.9
Nurses registered in ESAR-VHP per 1M pop 0.0 156.9
Behavioral health professionals registered in ESAR-VHP per 1M pop 1.5
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES NO, YES
Percent of RNs that received emergency training 34.9 28.8

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 11.5 11.0
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 11.7 10.7
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 1.2 2.5
Average malpractice award payments $310,431 $122,334
National Practitioner Databank reports per 1,000 physicians 21.3 27.9
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund YES YES
Number of insurers writing medical liability policies per 1,000 physicians 5.3 6.5
Average medical liability insurance premiums for primary care physicians $11,161 $10,154
Average medical liability insurance premiums for specialists $59,077 $49,113
Presence of pretrial screening panels MANDATORY MANDATORY
Pretrial screening panel's findings admissible as evidence YES YES
Periodic payments are: required, granted upon request, at court's discretion AT JUDGE'S OR COURT'S DESCRETION AT COURT'S DESCRETION
Medical liability cap on non-economic damages >$500,000 >$500,000
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished NO NO
Collateral Source Rule/Provides for Awards to be Offset YES
State provides for case certification NO NO
Expert witness required to be of the same specialty as the defendant NO NO
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 5.3
Pedestrian fatalities per 100,000 pedestrians 3.8
Percent of traffic fatalities alcohol-related 36.0 32.0
Percent of front occupants using restraints 87.9 93.2
Child safety seat/seat belt legislation - score out of a possible 10 points 8 8
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 2
Graduated drivers' licenses legislation score -out of a possible 5 points 1
Percentage of children aged 19-35 months who are immunized 79.6 73.4
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 65.3 60.6
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 63.8 70.5
Fatal occupational injuries per 1M workers 50.4 38.6
Homicides and suicides (non-motor vehicle)(per 100,000) 17.8 18.0
Unintentional fall-related fatal injuries (per 100,000) 4.8 5.6
Fire/burn related fatal injuries (per 100,000) 1.5 1.2
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.3 0.3
Rate of unintentional poisoning-related deaths (per 100,000) 11.0
Total injury prevention funds per 1,000 persons $5.67 $0.85
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding YES
Anti-smoking legislation score - score out of a possible 3 points 0
Infant mortality rate per 1,000 live births 8.0 7.6
Percentage of adults who binge drink 16.0 17.8
Percentage of adults who currently smoke 24.1 25.6
Percentage of adult population who are obese (BMI > 30.0) 27.8 30.8
Percentage of children who are obese 14.3
Cardiovascular disease disparity ratio 1.8
HIV diagnosis disparity ratio 8.7
Infant mortality disparity ratio 2.8

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system NO NO
Funded state EMS medical director NO NO
Emergency medicine residents per 1M pop 8.2 8.6
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 98.9 100.0
State has a uniform system for providing pre-arrival instructions YES NO
State uses CDC guidelines for state field triage protocols YES (2011)
State has or is working on a stroke system of care NO NO
State has triage and destination policy in place for stroke patients NO
State has or is working on a PCI network or a STEMI system of care NO NO
State has triage and destination policy in place for STEMI patients NO
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) 3
% of hospitals with computerized practitioner order entry 24.2 88.6
% of hospitals with electronic medical records 52.9 96.0
% of patients with AMI given PCI within 90 minutes of arrival 57 92
Median time to transfer to another facility for acute coronary intervention 63
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 53.4
% of hospitals with or planning to develop a diversity strategy or plan 46.0

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