Category Grades
48D 36D+
Access to Emergency Care:
46F 51F
Quality/Patient Safety:
35D+ 48F
Medical Liability:
11C+ 15B-
Public Health/ Injury Prevention:
33D 28D+
Disaster Preparedness:
47F 5B

Despite a poor overall showing, Nevada managed to move up 12 places and improve its overall grade since 2009. This is due in large part to tremendous improvements in Disaster Preparedness; however, the state still faces a crisis in Access to Emergency Care and has seen further erosion of the Quality and Patient Safety Environment.

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Nevada should be applauded for having implemented a number of policies and practices that have helped make its Disaster Preparedness grade among the best in the nation. The state has invested in a statewide medical communication system with one layer of redundancy, has implemented a patient-tracking system, and has strike teams or medical assistance teams to provide support during a disaster. In addition, the state has passed Uniform Emergency Volunteer Health Practitioners Act, model legislation that includes specific liability protections for health care workers during a disaster. Nevada ranks first in the nation in the proportion of registered nurses who received Disaster Preparedness training (57.2%).

Nevada supports a strong Medical Liability Environment. The state has maintained its $350,000 medical liability cap on non-economic damages and provides for awards to be offset by collateral sources. Nevada also allows periodic payments of malpractice awards on the request of one or both parties, as well as case certification by an expert witness. In addition, expert witnesses are required to be of the same specialty as the defendant.


Nevada continues to face a crisis in Access to Emergency Care, for which it ranks last in the nation. The state has a severe shortage of specialists, ranking last or next to last for the number of neurosurgeons (1.1 per 100,000 people); orthopedists and hand surgeons (6.1 per 100,000); and ear, nose, and throat specialists (2.0 per 100,000). Compounding these issues are financial barriers to care, including high rates of children and adults without insurance or who are underinsured. Nevada ranks 51st for the proportion of children without insurance (21.0%) and 43rd for those who have inadequate insurance (20.1%). It has only 8.7 emergency departments (ED) per 1 million people, compared with an average of 18.9 per 1 million people nationally, which has likely contributed to long wait times in the emergency department; the median time from ED arrival to ED departure for admitted patients was 337 minutes or 5.6 hours. Compounding these issues, Nevada supports the smallest nursing population, with only 605.5 registered nurses per 100,000 people.

Nevada's Quality and Patient Safety Environment has worsened compared to other states since 2009. The state does not have field triage protocols or guidelines for emergency medical services (EMS) response or a uniform system for pre-arrival instructions. The state has failed to implement destination policies that let EMS teams bypass local hospitals to transport stroke and ST-elevation myocardial infarction (STEMI) patients directly to a hospital specialty care center, despite having one of the highest rates of accredited chest pain centers in the country (5.4 per 1 million people). Finally, while the state has increased the proportion of counties with enhanced 911 capability since 2009 (70.6% versus 52.9%, respectively), Nevada still lags far behind the average across the states (96.9% of counties).

Nevada's poor showing in Public Health and Injury Prevention is marked by both positive and negative results. The state has the worst child immunization rate (66.7%) and ranks 50th for influenza vaccination among the elderly (53.7%). It also has some of the highest rates of homicides and suicides (25.6 per 100,000 people) and unintentional poisoning-related deaths, which includes drug overdoses (18.3 per 100,000 people). At the same time, the state has the eighth lowest rate of fall-related deaths (5.7 per 100,000). Similarly, Nevada ranks 10th best in obesity among adults (24.5%) but 10th worst in the proportion of children who are obese (18.6%).


Nevada must take immediate steps to address the crisis in Access to Emergency Care, including the specialist workforce shortage and financial barriers to care that continue to threaten the state's entire emergency care system. Recruitment and retention of providers must become a priority for Nevada policymakers to ensure that quality care is available as the Patient Protection and Affordable Care Act takes full effect.

Despite Nevada's strong showing for the Medical Liability Environment, there is ample room for improvement. The state's average medical liability insurance premiums for primary care providers and specialists have both decreased since the previous Report Card, but they still rank 42nd in the nation for both. The state should consider providing additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act to further alleviate the burden on physicians who are willing to provide emergent, lifesaving care to patients. Nevada should also consider passing apology inadmissibility laws and implementing pretrial screening panels to create a more favorable Medical Liability Environment.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 9.2 10.1
Emergency physicians per 100,000 pop 10.9 11.6
Neurosurgeons per 100,000 pop 1.1 1.1
Orthopedists and hand surgeon specialists per 100,000 pop 6.1 6.1
Plastic surgeons per 100,000 pop 1.7 2
ENT specialists per 100,000 pop 1.9 2
Registered nurses per 100,000 pop 588.6 605.5
Percent of children able to see provider 95
Level I or II trauma centers per 1M pop 1.2 1.1
Percent of population within 60 minutes of Level I or II trauma center 93.9 94.2
Accredited chest pain centers per 1M pop 0.8 5.4
Percent of population with an unmet need for substance abuse treatment 8.5 9.9
Pediatric specialty centers per 1M pop 2.4 2.2
Medicaid fee levels for office visits as a percent of the national average 117.1 95.3
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 0 0
Percent of adults with no health insurance 19.8 23.2
Percent of adults underinsured 8.4
Percent of children with no health insurance 18.8 21
Percent of children underinsured 20.1
Percent of adults with Medicaid 4.1 5.8
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 254.3 259.4
Hospital occupancy rate per 100 staffed beds 73.7 69.2
Psychiatric care beds per 100,000 pop 19.3 23.8
Median time from ED arrival to ED departure for admitted ED patients 337
State collects data on diversion YES NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $13.08 $6.95
State budget line item health care surge YES
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) NO NO
Special needs patients included in medical response plan NR YES
Patients dependent on medication for chronic conditions in medical response plan NR YES
Medical response plan for supplying dialysis NR 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 NO 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 158.7 508.2
ICU beds per 1M pop 303.7 262.1
Burn unit beds per 1M pop 4.7 0
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop 0 14.5
Nurses registered in ESAR-VHP per 1M pop 0 117.8
Behavioral health professionals registered in ESAR-VHP per 1M pop 18.5
Strike teams or medical assistance teams NO YES
Disaster training required for essential hospital/EMS personnel NO, YES NO
Percent of RNs that received emergency training 44.9 57.2

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 17.6 17
Lawyers per physician 0.9 0.9
Lawyers per emergency physician 15.7 14.6
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -3 -2
Malpractice award payments per 100,000 pop 2.5 1.6
Average malpractice award payments $296,383 $219,408
National Practitioner Databank reports per 1,000 physicians 24.5 35.2
Apology laws: Apology is inadmissible as evidence in a court of law NO
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 12.2 15
Average medical liability insurance premiums for primary care physicians $19,427 $18,298
Average medical liability insurance premiums for specialists $84,511 $79,592
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 $250,001-350,000 $250,001-350,000
Additional liability protection for EMTALA-mandated emergency care NO NO
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 6
Pedestrian fatalities per 100,000 pedestrians 7.8
Percent of traffic fatalities alcohol-related 43 37
Percent of front occupants using restraints 92.2 94.1
Child safety seat/seat belt legislation - score out of a possible 10 points 3 3
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 64.7 66.7
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 57.7 53.7
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 69.1 68.9
Fatal occupational injuries per 1M workers 44.4 28.1
Homicides and suicides (non-motor vehicle)(per 100,000) 27.8 25.6
Unintentional fall-related fatal injuries (per 100,000) 6 5.7
Fire/burn related fatal injuries (per 100,000) 0.7 0.7
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.2 0.2
Rate of unintentional poisoning-related deaths (per 100,000) 18.3
Total injury prevention funds per 1,000 persons $158.26 $30.86
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 5.8 5.6
Percentage of adults who binge drink 15.7 18.6
Percentage of adults who currently smoke 22.2 22.9
Percentage of adult population who are obese (BMI > 30.0) 25 24.5
Percentage of children who are obese 18.6
Cardiovascular disease disparity ratio 1.8
HIV diagnosis disparity ratio 5.7
Infant mortality disparity ratio 2

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 3.5 9.4
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 52.9 70.6
State has a uniform system for providing pre-arrival instructions YES NO
State uses CDC guidelines for state field triage protocols NO PROTOCOLS
State has or is working on a stroke system of care YES YES
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 NR YES
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) 2
% of hospitals with computerized practitioner order entry 23.5 61.4
% of hospitals with electronic medical records 39.4 79.5
% of patients with AMI given PCI within 90 minutes of arrival 31 94
Median time to transfer to another facility for acute coronary intervention 142
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 50
% of hospitals with or planning to develop a diversity strategy or plan 36.2

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