Category Grades
4B- 10C
Access to Emergency Care:
25C- 23D
Quality/Patient Safety:
2A 1A
Medical Liability:
39D- 47F
Public Health/ Injury Prevention:
11B 9B+
Disaster Preparedness:
2A 10B-

Maryland has a statewide model of emergency care. The high grades in Quality and Patient Safety Environment, Public Health and Injury Prevention, and Disaster Preparedness reflect a relentless commitment to these areas. However, the state has not kept pace with other states regarding medical liability reform and faces some hospital capacity shortages.

More Information


Maryland has the highest Quality and Patient Safety Environment ranking in the nation. The state has enacted multiple policies and procedures to ensure that its patients receive swift and effective care, including triage and destination policies for trauma, stroke, and ST-elevation myocardial infarction (STEMI) patients. Maryland maintains a statewide trauma registry, and nearly all its hospitals have adopted computerized practitioner order entry (93.9%) and electronic medical records (95.9%). To ensure that the state's diverse population receives quality care, more than half its hospitals have or are planning for a diversity strategy, and 60.9% collect data on patient race and ethnicity and primary language. Finally, Maryland has made a financial commitment to Quality and Patient Safety, with dedicated funds for a state emergency medical services (EMS) medical director and for quality improvement in the EMS system.

Maryland is 10th in the nation in Disaster Preparedness and has incorporated many important state-level policies and procedures. The state has developed medical response plans that address the requirements of special needs patients and patients dependent on medication. Maryland's just-in-time training systems are in place statewide, and almost 40% of the state's registered nurses have received disaster training. Maryland's statewide patient tracking system and surveillance system for common emergency department (ED) presentations help ensure that the state is able to identify and respond to evolving disasters.

Maryland also rates highly in Public Health and Injury Prevention due to strong legislation aimed at improving public health and traffic safety, such as banning all smoking in bars, restaurants, and worksites; distracted driving bans; and child safety seat and seat belt legislation. The state also benefits from low rates of unintentional injury. Maryland has the lowest rate of poisoning deaths, which include drug overdoses, in the nation.


Maryland has not, however, kept pace with developments in the Medical Liability Environment, slipping to 47th in the nation. Although the state has implemented some needed medical liability reforms, such as a cap on non-economic damages and pretrial screening panels, it has relatively high average malpractice awards ($374,121) and a high per capita number of malpractice award payments (3.4 per 100,000 people). Maryland has one of the highest average medical liability insurance premiums for specialists at $96,807, more than 1.7 times the national average, and a relatively high average medical liability insurance premium for primary care physicians ($18,089).

In Access to Emergency Care, there are signs that Maryland's emergency medicine infrastructure is strained. The state has one of the longest median ED wait times (367 minutes from ED arrival to departure for admitted patients) and a high hospital occupancy rate (74.7 per 100 staffed beds). Maryland also has few EDs per capita (8.3 per 1 million people), despite relatively high rates of emergency physicians.


Maryland would benefit most from reforms aimed at lowering the state's high medical liability insurance rates and malpractice awards. Adopting structured settlements would better match the award to the ongoing needs of the plaintiff. Collateral source rule reform would help to ensure that plaintiffs are not doubly compensated and be advantageous to the state. Strengthening the state's currently weak apology law would protect physician apologies from being admissible in liability cases.

Maryland should support efforts to increase capacity for emergency care and alleviate crowding in EDs. A failure to address this growing issue may result in loss of quality of care and poor health outcomes for patients.

Although Maryland fared well in Public Health and Injury Prevention overall, the state lags in some traffic safety indicators. Maryland must work to reduce its high proportion of traffic fatalities that are alcohol-related (40.0%) and high rates of bicyclist and pedestrian fatalities. Maryland should concentrate on ensuring the safety of all road users, educating drivers on the dangers of drinking and driving.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 11 12.7
Emergency physicians per 100,000 pop 13.9 15.1
Neurosurgeons per 100,000 pop 2.7 2.9
Orthopedists and hand surgeon specialists per 100,000 pop 11.6 12
Plastic surgeons per 100,000 pop 3.2 3.3
ENT specialists per 100,000 pop 5.1 4.9
Registered nurses per 100,000 pop 871.8 849.7
Percent of children able to see provider 95.8
Level I or II trauma centers per 1M pop 1.1 0.7
Percent of population within 60 minutes of Level I or II trauma center 97 99.3
Accredited chest pain centers per 1M pop 1.2 1.5
Percent of population with an unmet need for substance abuse treatment 7.3 7.9
Pediatric specialty centers per 1M pop 2.5 2.7
Medicaid fee levels for office visits as a percent of the national average 115.6 99.4
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 3 5.7
Percent of adults with no health insurance 15.1 15
Percent of adults underinsured 6.5
Percent of children with no health insurance 9.9 10
Percent of children underinsured 17.4
Percent of adults with Medicaid 5.2 7.5
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 273.6 270.1
Hospital occupancy rate per 100 staffed beds 75.1 74.7
Psychiatric care beds per 100,000 pop 27 29.4
Median time from ED arrival to ED departure for admitted ED patients 367
State collects data on diversion YES YES

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $11.15 $6..20
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 YES YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications YES
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 YES 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 1,233.3 537.5
ICU beds per 1M pop 288.5 255.6
Burn unit beds per 1M pop 3.6 3.4
Verified burn centers per 1M pop 0.17798839 0.2
Physicians registered in ESAR-VHP per 1M pop 116.4 47.8
Nurses registered in ESAR-VHP per 1M pop 541.8 165.2
Behavioral health professionals registered in ESAR-VHP per 1M pop 29.6
Strike teams or medical assistance teams NO YES
Disaster training required for essential hospital/EMS personnel NO, YES NR
Percent of RNs that received emergency training 39.1 39.2

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 17.7 18.7
Lawyers per physician 0.4 0.4
Lawyers per emergency physician 12.7 12.4
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -2 -3
Malpractice award payments per 100,000 pop 1.3 3.4
Average malpractice award payments $319,977 $374,121
National Practitioner Databank reports per 1,000 physicians 13.4 27.6
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 3.1 3.8
Average medical liability insurance premiums for primary care physicians $17,665 $18,089
Average medical liability insurance premiums for specialists $100,625 $96,807
Presence of pretrial screening panels MANDATORY MANDATORY
Pretrial screening panel's findings admissible as evidence YES NO
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 NO
State provides for case certification YES YES
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 4.9
Pedestrian fatalities per 100,000 pedestrians 8.1
Percent of traffic fatalities alcohol-related 41 40
Percent of front occupants using restraints 93.1 94.2
Child safety seat/seat belt legislation - score out of a possible 10 points 7 8
Helmet use required for all motorcylce riders YES YES
Distracted driving legislation score - out of a possible 4 points 4
Graduated drivers' licenses legislation score -out of a possible 5 points 1
Percentage of children aged 19-35 months who are immunized 79.9 81.1
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 66.1 62.8
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 66 69.9
Fatal occupational injuries per 1M workers 35.3 22.6
Homicides and suicides (non-motor vehicle)(per 100,000) 18.8 17.3
Unintentional fall-related fatal injuries (per 100,000) 5.5 7.8
Fire/burn related fatal injuries (per 100,000) 1 1
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.1 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 2.1
Total injury prevention funds per 1,000 persons $169.33 $281.39
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 3
Infant mortality rate per 1,000 live births 7.3 6.8
Percentage of adults who binge drink 13.9 18
Percentage of adults who currently smoke 17.7 19.1
Percentage of adult population who are obese (BMI > 30.0) 24.9 28.3
Percentage of children who are obese 15.1
Cardiovascular disease disparity ratio 1.9
HIV diagnosis disparity ratio NR
Infant mortality disparity ratio 2.8

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 11.7 14.1
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 YES (2011)
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 33.3 93.9
% of hospitals with electronic medical records 81.3 95.9
% of patients with AMI given PCI within 90 minutes of arrival 37 91
Median time to transfer to another facility for acute coronary intervention NR
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 60.9
% of hospitals with or planning to develop a diversity strategy or plan 53.6

Share This Info

Contact Congress

Take federal action and get your national officials involved

Public ACEP Members