New York

Category Grades
21C 13C
Access to Emergency Care:
36D- 17C-
Quality/Patient Safety:
12A- 23C+
Medical Liability:
43F 49F
Public Health/ Injury Prevention:
18B- 12B
Disaster Preparedness:
6A- 4B

While New York's overall grade remains unchanged, improved rankings in Access to Emergency Care, Public Health and Injury Prevention, and Disaster Preparedness have helped boost the state from 21st to a tie for 13th place overall. At the same time, New York has failed to pass meaningful medical liability reforms and has worsened in comparison to other states with regard to the Quality and Patient Safety Environment.

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New York continues to improve in Public Health and Injury Prevention, with a significant increase in the proportion of New Yorkers wearing seat belts, a requirement that motorcycle riders wear helmets, and distracted-driving laws prohibiting cellphone use and texting. These factors have likely contributed to the third lowest rate of traffic fatalities in the nation (4.4 per 100,000 people).

New York earned a solid mark in Disaster Preparedness. It is one of only 11 states with a budget line item specifically for health care surge and one of 14 that requires training in disaster management and response for emergency medical services (EMS) personnel. New York also has some of the highest per capita rates of physicians and behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals.

New York's Quality and Patient Safety Environment reflects generally positive results. The state ranks among the best with regard to hospital adoption of electronic medical records (99.0%) and computerized practitioner order entry (87.6%). The state has also implemented a prescription drug monitoring program and has destination policies in place for stroke, ST-elevation myocardial infarction (STEMI), and trauma patients.


New York's Medical Liability Environment continues to be among the worst in the nation with the highest number of malpractice award payments in the country (6.1 per 100,000 people), representing a twelve-fold increase since the 2009 Report Card. The average malpractice award payment has increased from $356,003 to $409,773 during the same period. New York has some of the highest average medical liability insurance premiums for primary care physicians and specialists and few insurers writing policies.

While New York has improved in Access to Emergency Care with more registered nurses, specialists, and board-certified emergency physicians since 2009, much more work needs to be done. The state has the highest hospital occupancy rate in the nation (80.3 per 100 staffed beds) and the fourth fewest emergency departments per capita (8.0 per 1 million people). The number of staffed inpatient beds has decreased since 2009. All these factors contribute to emergency department (ED) boarding and crowding and the fourth longest average ED wait time in the nation: 366 minutes, or 6.1 hours. The state also faces challenges with access to primary care, needing an additional 2.8 full-time primary care physicians per 100,000 people to meet the needs of its population. Despite an increase in Medicaid fee levels for office visits between 2007 and 2012, the state's fee levels are still only 77.3% of the national average, creating an additional barrier to care.


New York must work to improve the Medical Liability Environment to ensure access to timely, high-quality emergency care. The state should pursue legislation to provide special liability protections for care mandated by the Emergency Medical Treatment and Labor Act, recognizing the risks associated with providing immediate care in life-threatening situations, often without knowledge of the patient's medical history. Doing so would encourage specialists to provide on-call services to EDs and improve the quality of care for all New Yorkers. The state should also investigate pretrial screening panels, a cap on non-economic damages, and a requirement that expert witnesses be of the same specialty as the defendant.

Emergency department crowding remains a major concern in New York. The state must take immediate action to alleviate long ED wait times, boarding, and crowding in order to ensure the best patient outcomes. Efforts also need to be made to increase access to primary and mental health care to ensure that those who need it are not forced to delay seeking care.

New York should continue to build on progress that has been made with regard to Public Health and Injury Prevention by instituting graduated driver's license laws that require a greater number of supervised practice hours and a ban on teen passengers. The state should also make an aggressive effort to improve immunization rates for the elderly and for children.

New York should support a statewide quality improvement initiative to allow for standardization of care and to further align EMS with established quality improvement systems in other areas of medicine. Additionally, the state should identify and support a state EMS medical director to provide clinical leadership and align New York with nationally established best practices in out-of-hospital emergency medical care.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 8.1 10.5
Emergency physicians per 100,000 pop 12.8 15.6
Neurosurgeons per 100,000 pop 2 2.4
Orthopedists and hand surgeon specialists per 100,000 pop 10.3 10.8
Plastic surgeons per 100,000 pop 3.1 3.3
ENT specialists per 100,000 pop 4 4.2
Registered nurses per 100,000 pop 866 903.4
Percent of children able to see provider 95
Level I or II trauma centers per 1M pop 2.1 1.8
Percent of population within 60 minutes of Level I or II trauma center 96.8 98.1
Accredited chest pain centers per 1M pop 0.3 0.6
Percent of population with an unmet need for substance abuse treatment 7.6 8.1
Pediatric specialty centers per 1M pop 2.2 3.1
Medicaid fee levels for office visits as a percent of the national average 59.3 77.3
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 0 60.3
Percent of adults with no health insurance 15.7 13.8
Percent of adults underinsured 7.6
Percent of children with no health insurance 8.4 6.6
Percent of children underinsured 17.9
Percent of adults with Medicaid 14.5 18.3
Hospital closures in 2006/2011 2 2
Staffed inpatient beds per 100,000 pop 398.6 363.2
Hospital occupancy rate per 100 staffed beds 80.6 80.3
Psychiatric care beds per 100,000 pop 30.5 31.3
Median time from ED arrival to ED departure for admitted ED patients 366
State collects data on diversion NO N/A

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $14.74 $13.98
State budget line item for disaster preparedness funding specific to health care surge YES
ESF-8 or all-hazards 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 9 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 NO
Patients dependent on dialysis in medical response plan NO NO
Mental health patients included in medical response plan NO
Patients on psychotropic medication in medical response plan NO
Mutual aid agreements in place with behavioral health providers NONE
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to track and 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 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, STATEWIDE
Bed surge capacity per 1M pop 296.8 287.5
ICU beds per 1M pop 190.6 239.4
Burn unit beds per 1M pop 7.2 7.5
Verified burn centers per 1M pop 0.155458707 0.1
Physicians registered in ESAR-VHP per 1M pop 429.4 474.6
Nurses registered in ESAR-VHP per 1M pop 122.6 303.5
Behavioral health professionals registered in ESAR-VHP per 1M pop 60.3
State or regional strike teams or medical assistance teams NO YES
Training required in disaster management, and response to bio- and chemical terrorism for essentia YES, YES NO, YES
Percent of RNs that received emergency training 43.6 39.2

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 34.7 33.5
Lawyers per physician 0.9 0.8
Lawyers per emergency physician 27.2 21.4
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 -6
Malpractice award payments per 100,000 pop 0.5 6.1
Average malpractice award payments $356,004 $409,773
National Practitioner Databank reports per 1,000 physicians 29.9 35.3
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 1 1.5
Average medical liability insurance premiums for primary care physicians $20,482 $21,418
Average medical liability insurance premiums for specialists $95,568 $100,517
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 REQUIRED BY STATE REQUIRED
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished PARTIALLY YES
Collateral Source Rule Reform enacted YES
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 4.4
Pedestrian fatalities per 100,000 pedestrians 2.3
Percent of traffic fatalities alcohol-related 38 33
Percent of front occupants using restraints 83.5 90.5
Child safety seat/seat belt legislation - score out of a possible 10 points 6 7
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 82.4 70.3
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 64.7 60
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 61 65.2
Fatal occupational injuries per 1M workers 26.6 20.4
Rate of fatal non-MV intentional injuries (per 100,000) 10.8 12.1
Rate of fall-related unintentional fatal injuries (per 100,000) 5.5 6.3
Rate of unintentional fire/burn related fatal injuries (per 100,000) 1.1 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) 7.1
Total injury prevention funds per 1,000 persons $42.28 $53.71
Has funding source(s) specifically for child injury prevention YES
Has funding source(s) specifically for elderly injury prevention NO
Has funding source(s) specifically for occupational injury prevention NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 5.8 5.1
Percentage of adults who binge drink 15.8 19.6
Percentage of adults who currently smoke 18.2 18.1
Percentage of adult population who are obese (BMI > 30.0) 22.9 24.5
Percentage of children who are obese 14.5
Cardiovascular disease disparity ratio 1.2
HIV incidence disparity ratio 10.3
Infant mortality disparity ratio 3.5

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 NO
Emergency medicine residents per 1M pop 38.1 46.7
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 98.4 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 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) 3
% of hospitals with computerized practitioner order entry 36.4 87.6
% of hospitals with electronic medical records 53 99
% of patients with AMI given PCI within 90 minutes of arrival 57 92
Average number of minutes before outpatients with chest pain were transferred to another hospital 74
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 61.7
% of hospitals with/planning for diversity strategy or plan 52.3

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