Category Grades
7C+ 3B-
Access to Emergency Care:
2B+ 3B
Quality/Patient Safety:
15B+ 6B+
Medical Liability:
28D+ 21C
Public Health/ Injury Prevention:
16B- 7A-
Disaster Preparedness:
46D- 49F

Maine boasts the third strongest overall emergency care environment in the nation, bolstered by high levels of Access to Emergency Care; a dedication to improving the Quality and Patient Safety Environment; and low rates of health risk factors and fatal injuries. However, the state's poor Disaster Preparedness score indicates that it may not be adequately prepared for largescale emergencies.

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Maine continues its stellar performance in Access to Emergency Care, with the third highest mark in the nation. Only 11.0% of adults and 6.3% of children in the state have no health insurance. Additionally, only 8.2% of adults report an unmet need for substance abuse treatment. Overall the state's supply of health care providers compares favorably to most states, however gaps remain, including a lack of specialists such as neurosurgeons; plastic surgeons; ear, nose, and throat specialists; and, according to emergency physicians in the state, ophthalmologists and oral surgeons.

Maine has demonstrated a strong commitment to Public Health and Injury Prevention, with the fourth highest per capita injury prevention funds in the nation ($1,232.77 per 1,000 people) and funding that is dedicated to preventing injuries among both children and the elderly. Although Maine has a higher-than-average rate of traffic fatalities, few are alcohol-related, and the state has below-average rates of fatalities among bicyclists (2.7 per 100,000 cyclists) and pedestrians (2.0 per 100,000 pedestrians). In terms of health risk factors, Maine has relatively low rates of adult binge drinking and childhood obesity, although a high proportion of adults smoke cigarettes (22.8%).

Maine's dedication to its Quality and Patient Safety Environment has lifted the state to rank among the top 10 in the nation. Maine has dedicated funding for quality improvement within its emergency medical services (EMS) system, as well as an EMS medical director. It has destination policies in place for stroke, ST-elevation myocardial infarction, and trauma patients. In addition, Maine hospitals are more likely than those in most other states to have adopted computerized practitioner order entry (92.3%) and electronic medical records (97.4%).


While Maine has some of the highest rates of physicians and nurses registered in the Emergency System for Advance Registration of Volunteer Health Professionals (97.1 and 662.1 per 1 million people, respectively), the state has implemented very few elements of Disaster Preparedness planning at the state level. The state does not have an Emergency Support Function 8 (ESF-8) plan in place and conducts planning for hospital surge only at the regional level. Instead, Maine has three trauma referral centers that are charged with helping regional health care organizations to carry out emergency planning and exercises. While regional-level planning can be robust and effective, particularly in a rural state, the lack of state-level planning may be problematic in the event of a large disaster or mass casualty event. These challenges could be alleviated by providing clear guidelines in a medical response plan for addressing special-needs and medication-dependent patients in a disaster.

Maine's Medical Liability Environment reflects some positive reforms, although more work could be done. The state has relatively low average medical liability insurance premiums for primary care physicians ($8,563) and specialists ($38,035). Of concern is the state's relatively high average malpractice award payment ($443,372), which is a significant increase since the 2009 Report Card.

While Access to Emergency Care fares well overall, emergency physicians in the state report that there are often long waits for psychiatric care beds, especially for children. Some waits in the emergency department are reported to last 8 days.


Maine should consider instituting state-level policies and procedures for Disaster Preparedness to provide guidance to, enhance, and support the current regionalized efforts. In particular, a statewide medical communication system with redundancy could help coordinate the emergency responses in the event of a disaster impacting multiple regions. The ability to communicate quickly and securely between responding agencies and units could prove critical to providing quick and appropriate care in the event of a large disaster or mass casualty event.

Maine should work to strengthen its Medical Liability Environment by passing additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA) in which providers care for high-risk patients without a preexisting patient relationship and little to no knowledge of a patient's medical history. Instituting liability protections in these cases may attract additional specialists who provide critical on-call services to the emergency department. The state should also consider requiring expert witnesses to be of the same specialty as the defendant and licensed to practice medicine in Maine.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 12.8 14.7
Emergency physicians per 100,000 pop 16.6 19.6
Neurosurgeons per 100,000 pop 1.8 1.4
Orthopedists and hand surgeon specialists per 100,000 pop 10.5 10.4
Plastic surgeons per 100,000 pop 1.3 1.4
ENT specialists per 100,000 pop 2.6 2.6
Registered nurses per 100,000 pop 1,053.3 1,114.8
Percent of children able to see provider 96.5
Level I or II trauma centers per 1M pop 2.3 2.3
Percent of population within 60 minutes of Level I or II trauma center 79.1 88.6
Accredited chest pain centers per 1M pop 0.8 1.5
Percent of population with an unmet need for substance abuse treatment 8.8 8.2
Pediatric specialty centers per 1M pop 2.3 2.3
Medicaid fee levels for office visits as a percent of the national average 74.1 83.7
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 5 38.9
Percent of adults with no health insurance 10.1 11.0
Percent of adults underinsured 6.1
Percent of children with no health insurance 6.4 6.3
Percent of children underinsured 18.1
Percent of adults with Medicaid 14.9 19.0
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 304.3 303.6
Hospital occupancy rate per 100 staffed beds 68.7 64.4
Psychiatric care beds per 100,000 pop 39.0 29.6
Median time from ED arrival to ED departure for admitted ED patients 281
State collects data on diversion YES NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $11.55 $9.67
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel NR STATE DOES NOT HAVE AN ESF-8 PLAN
Emergency physician input into the state planning process YES, YES NO
Public health and emergency physician input during an ESF-8 response YES, NO
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO NO
Special needs patients included in medical response plan YES NO
Patients dependent on medication for chronic conditions in medical response plan NO NO
Medical response plan for supplying dialysis NO 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 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 ACROSS COALITIONS
Statewide medical communication system with one layer of redundancy YES NO
Statewide patient tracking system YES NO
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES YES, IN METROPOLITAN AREAS
Bed surge capacity per 1M pop NR 1,026.9
ICU beds per 1M pop 275.3 261.8
Burn unit beds per 1M pop 3.0 4.5
Verified burn centers per 1M pop 0.0 0.0
Physicians registered in ESAR-VHP per 1M pop NR 97.1
Nurses registered in ESAR-VHP per 1M pop NR 662.1
Behavioral health professionals registered in ESAR-VHP per 1M pop 13.5
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 36.8 37.6

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 14.5 12.3
Lawyers per physician 0.5 0.4
Lawyers per emergency physician 8.8 6.2
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 3.4 1.8
Average malpractice award payments $275,626 $443,372
National Practitioner Databank reports per 1,000 physicians 19.1 27.2
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 10.9 13.2
Average medical liability insurance premiums for primary care physicians $9,390 $8,563
Average medical liability insurance premiums for specialists $37,942 $38,035
Presence of pretrial screening panels MANDATORY MANDATORY
Pretrial screening panel's findings admissible as evidence NO NO
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 >$350,001-500,000
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 2.7
Pedestrian fatalities per 100,000 pedestrians 2.0
Percent of traffic fatalities alcohol-related 39.0 29
Percent of front occupants using restraints 79.8 81.6
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 79.8 79.1
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 72 61.6
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 67.9 72.7
Fatal occupational injuries per 1M workers 26.5 32.8
Homicides and suicides (non-motor vehicle)(per 100,000) 14.9 16.4
Unintentional fall-related fatal injuries (per 100,000) 6.9 6.3
Fire/burn related fatal injuries (per 100,000) 1.0 0.8
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.1 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 8.7
Total injury prevention funds per 1,000 persons $1,529.61 $1,232.77
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding YES
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 6.9 5.4
Percentage of adults who binge drink 16.1 17.3
Percentage of adults who currently smoke 20.9 22.8
Percentage of adult population who are obese (BMI > 30.0) 23.1 27.8
Percentage of children who are obese 12.5
Cardiovascular disease disparity ratio 2.2
HIV diagnosis disparity ratio 20.3
Infant mortality disparity ratio NR

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system NO YES
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 17.5 18.1
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 100 100
State has a uniform system for providing pre-arrival instructions YES YES
State uses CDC guidelines for state field triage protocols NO
State has or is working on a stroke system of care YES NO
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 NO
State has triage and destination policy in place for STEMI patients YES
State maintains statewide trauma registry NO NO
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 24.3 92.3
% of hospitals with electronic medical records 21.6 97.4
% of patients with AMI given PCI within 90 minutes of arrival 74 96
Median time to transfer to another facility for acute coronary intervention 48
% of patients with AMI who received aspirin within 24 hours 100
% of hospitals collecting data on race/ethnicity and primary language 85.7
% of hospitals with or planning to develop a diversity strategy or plan 50

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