Category Grades
35C- 48D
Access to Emergency Care:
24C- 31F
Quality/Patient Safety:
40D+ 50F
Medical Liability:
7B 10B
Public Health/ Injury Prevention:
46F 39D-
Disaster Preparedness:
44D- 45F

Montana continues to rank among the top 10 states for its Medical Liability Environment and has high levels of injury prevention funding and low racial and ethnic health disparities in infant mortality. However, the state is weak in statewide planning for Disaster Preparedness, quality improvement, and patient safety assurances.

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Montana has one of the top Medical Liability Environments in the nation. The state has implemented many reforms that help protect its health care providers. Mandatory pretrial screening panels help ensure that meritless lawsuits do not go forward, and Montana's $250,000 medical liability cap on non-economic damages helps ensure that malpractice award payments will remain modest. Periodic payments are allowed upon request, and the state has partially reformed joint and several liability.

While faring poorly overall, Montana has improved somewhat in Public Health and Injury Prevention. With funds dedicated to injury prevention for both children and older adults, the state has the highest per capita level of injury prevention funding in the nation and has funding dedicated specifically for child and elderly injury prevention. It also has low fatality rates for bicyclists (1.8 per 100,000 cyclists) and pedestrians (2.7 per 100,000 pedestrians). Regarding health risk factors, Montana has better-than-average rates of adult and child obesity (24.6 and 14.3%, respectively) and a low infant mortality rate (5.9 per 1,000 live births).

Despite overall low scores for its Quality and Patient Safety Environment, Montana recently implemented a prescription drug registry, which is an important investment for the state in helping to curb illicit use of prescription drugs.


Montana ranks second worst in the nation for its Quality and Patient Safety Environment, largely due to a lack of state-level policies that promote quality of care. The state does not have triage and destination policies in place for trauma, stroke, or ST-elevation myocardial infarction (STEMI) patients and lacks a uniform system of providing pre-arrival instructions. Such policies and procedures can help streamline care and ensure that patients receive the most appropriate and effective treatments before arrival at the hospital. While more than 75% of Montana's hospitals have electronic medical records, they have fallen behind most other states in the adoption of computerized practitioner order entry (59.6%).

Montana also lags in terms of Disaster Preparedness. While the state has high per capita federal Disaster Preparedness funding levels ($11.75 per person), it lacks some important statewide policies and procedures that would ensure a systematic approach to disaster response. Montana does not have a statewide patient tracking system or a syndromic surveillance system. It also lacks guidance in its medical response plan specifically for medically fragile patients, including patients dependent on dialysis, medication for chronic disease, or psychotropic medication.

In terms of Access to Emergency Care, Montana has comparatively high per capita rates of medical specialists and hospital facilities, despite being a large and rural state. However, there are some troubling gaps in their systems. The state has the second highest proportion of adults reporting an unmet need for substance abuse treatment (10.7%). Montana also has one of the highest rates of children without health insurance (12.3%), with unreasonable costs being reported by the parents of 20% of children with health insurance. The state also has a relatively high proportion of children who could not always see a provider when needed.


Montana is a large, rural state with independent counties and cities, but state-level policies and procedures that ensure patient safety, quality improvement, and Disaster Preparedness are important safeguards that can be applied at the regional or local levels. These policies help ensure that the state can monitor and respond to emerging health issues, conduct a coordinated disaster response, and ensure that medically vulnerable patients receive prompt and evidence-based care.

Public Health and Injury Prevention efforts in Montana need to be strengthened and expanded. Montana has very high rates of binge drinking (20.8% of adults), and 42.0% of the state's traffic fatalities are alcohol-related, pointing to a need for education and enforcement. The state also has the third highest rate of traffic fatalities (18.2 per 100,000 people); low seatbelt usage rates; and weak traffic safety laws related to adult seat belt use, child safety seats, and distracted driving. Reform of these laws and targeted enforcement could help improve the overall safety and health of Montana's citizens.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 9.2 9.8
Emergency physicians per 100,000 pop 10.6 11.6
Neurosurgeons per 100,000 pop 2.2 2.4
Orthopedists and hand surgeon specialists per 100,000 pop 11.7 11.3
Plastic surgeons per 100,000 pop 1.7 1.7
ENT specialists per 100,000 pop 3.1 3
Registered nurses per 100,000 pop 756.2 872
Percent of children able to see provider 94.6
Level I or II trauma centers per 1M pop 4.2 4
Percent of population within 60 minutes of Level I or II trauma center 37.9 40.6
Accredited chest pain centers per 1M pop 1 1
Percent of population with an unmet need for substance abuse treatment 9.8 10.7
Pediatric specialty centers per 1M pop 8.4 7
Medicaid fee levels for office visits as a percent of the national average 112.6 137.9
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 7 50.5
Percent of adults with no health insurance 17.9 20
Percent of adults underinsured 7.8
Percent of children with no health insurance 14.5 12.3
Percent of children underinsured 20.3
Percent of adults with Medicaid 7.5 6.1
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 495.4 430.3
Hospital occupancy rate per 100 staffed beds 65.6 64
Psychiatric care beds per 100,000 pop 30.8 32.1
Median time from ED arrival to ED departure for admitted ED patients 219
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $14.90 $11.75
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, NO 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 NO
Special needs patients included in medical response plan NO YES
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 NO
Just-in-time training systems in place NONE NONE
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 YES, STATEWIDE
Bed surge capacity per 1M pop 1,761.2 563.1
ICU beds per 1M pop 294.7 312.4
Burn unit beds per 1M pop 0 0
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop 0 12.9
Nurses registered in ESAR-VHP per 1M pop 108.6 395
Behavioral health professionals registered in ESAR-VHP per 1M pop 5
Strike teams or medical assistance teams NO NO
Disaster training required for essential hospital/EMS personnel NO, NO NO
Percent of RNs that received emergency training 40.4 43.4

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 17.2 17.9
Lawyers per physician 0.8 0.8
Lawyers per emergency physician 16 15.4
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 5.4 3.4
Average malpractice award payments $287,945 $259,757
National Practitioner Databank reports per 1,000 physicians 30.6 38.5
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 24.4 31.2
Average medical liability insurance premiums for primary care physicians $14,257 $14,749
Average medical liability insurance premiums for specialists $68,280 $71,738
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 $250,000 $250,000
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished PARTIALLY PARTIALLY
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 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 1.8
Pedestrian fatalities per 100,000 pedestrians 2.7
Percent of traffic fatalities alcohol-related 48 42
Percent of front occupants using restraints 79.6 76.9
Child safety seat/seat belt legislation - score out of a possible 10 points 3 3
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 0
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 73.6 71
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 72.6 55.9
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 71.5 69.6
Fatal occupational injuries per 1M workers 103.1 81.7
Homicides and suicides (non-motor vehicle)(per 100,000) 25.6 25.6
Unintentional fall-related fatal injuries (per 100,000) 12.2 13
Fire/burn related fatal injuries (per 100,000) 1 1
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.6 0.5
Rate of unintentional poisoning-related deaths (per 100,000) 7.5
Total injury prevention funds per 1,000 persons $49.07 $9,538.38
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 7 5.9
Percentage of adults who binge drink 16 20.8
Percentage of adults who currently smoke 18.9 22.1
Percentage of adult population who are obese (BMI > 30.0) 21.2 24.6
Percentage of children who are obese 14.3
Cardiovascular disease disparity ratio 1.9
HIV diagnosis disparity ratio NR
Infant mortality disparity ratio 1.5

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES NO
Funded state EMS medical director NO YES
Emergency medicine residents per 1M pop 0 0
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 81.7 98.3
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols YES (2011)
State has or is working on a stroke system of care YES 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 YES 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 NO
Prescription drug monitoring program score (range 0-4) 3
% of hospitals with computerized practitioner order entry 5.5 59.6
% of hospitals with electronic medical records 18.5 75.4
% of patients with AMI given PCI within 90 minutes of arrival 73 90
Median time to transfer to another facility for acute coronary intervention 172
% of patients with AMI who received aspirin within 24 hours 100
% of hospitals collecting data on race/ethnicity and primary language 55.4
% of hospitals with or planning to develop a diversity strategy or plan 35.4

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