South Carolina has worsened with regard to its overall emergency care environment, largely due to failing grades in Access to Emergency Care, Public Health and Injury Prevention, and Disaster Preparedness.
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Strengths
South Carolina continues to support one of the best Medical Liability Environments in the nation. The state has liability protections for the provision of care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), a medical liability cap on non-economic damages, and expert witness rules requiring case certification. South Carolina has also seen a dramatic decrease in the average malpractice award since the 2009 Report Card, from $218,482 to $176,366, the 10th lowest in the nation.
While South Carolina's overall grade dropped slightly from 2009, its Quality and Patient Safety rank improved, owing in part to having a funded state emergency medical services (EMS) medical director and implementing destination policies for ST-elevation myocardial infarction (STEMI) and trauma patients that allow EMS providers to bypass local hospitals to bring patients to specialty centers. Additionally, the proportion of patients with acute myocardial infarction given percutaneous coronary intervention within 90 minutes of arrival increased from 55% to 97%. South Carolina's hospitals are also among the most likely to collect data on patients' race and ethnicity and primary language (76.1%) and to be developing a diversity strategy or plan (58%).
Challenges
South Carolina fell one place to rank last in the nation in Public Health and Injury Prevention. This is due to a combination of poor public health outcomes and the failure of the state to pass key legislation to improve upon those measures. For instance, while the state has some of the highest rates of traffic fatalities (15.2 per 100,000 people), bicyclist fatalities (13.5 per 100,000 bicyclists), and pedestrian fatalities (11.7 per 100,000 pedestrians), it has not passed legislation banning texting or handheld cellphone use for all drivers. The state is also one of only seven to have failed to pass any antismoking legislation to discourage smoking and reduce secondhand smoke exposure in restaurants, bars, and worksites. South Carolina has some of the highest rates of adult and child obesity (30.8% and 21.5%, respectively).
Access to Emergency Care in South Carolina is impeded by growing financial barriers to care. Rates of uninsurance have increased dramatically for both adults and children since the last Report Card, resulting in South Carolina ranking 43rd and 48th on these measures, respectively. Uninsured rates for children have increased from 10.7% to 13.3%, and even those children with insurance face financial barriers to care, with 18.8% considered underinsured. Similarly, nearly one in five adults lack health insurance, with 9.2% of those who have insurance delaying or forgoing care due to cost. South Carolina's aging population also faces challenges in accessing care, with only 2.1 physicians accepting Medicare per 100 beneficiaries, the fifth lowest rate in the nation.
South Carolina faces challenges in Disaster Preparedness with regard to a lack of key policies and limited resources and hospital capacity for responding to a disaster or mass casualty event. The state has one of the lowest bed surge capacities (310.8 per 1 million people) and per capita rates of burn unit beds (2.1 per 1 million) in the nation. South Carolina does not require training in disaster management and response for hospital and EMS personnel, and only 31.9% of registered nurses reported receiving training related to disaster response. The state also lacks a Uniform Emergency Volunteer Health Practitioners Act or similar legislation that would provide appropriate protections for health care workers and the entities that sponsor them when responding to a disaster.
Recommendations
South Carolina must improve Access to Emergency Care for all by reducing financial barriers and increasing hospital and workforce capacity across the board. The state has a shortage of health care workers with below average rates of emergency physicians; neurosurgeons; orthopedists and hand surgeons; plastic surgeons; ear, nose, and throat specialists; and registered nurses. A concerted effort is needed to ensure that the people of South Carolina have access to the primary and specialty care that they need, especially with the expected increase in insured patients that will likely result from full implementation of the Patient Protection and Affordable Care Act.
While improving access to care, South Carolina must take immediate steps to address the poor public health outcomes of its population, specifically the high rates of traffic fatalities, infant mortality, and obesity. The state must work toward reducing these and other types of preventable deaths and chronic conditions that threaten to overburden the entire medical system.
South Carolina must work to maintain existing medical liability reforms. While its medical liability insurance premiums are below the national average for the states, they are slightly higher than in 2009. If this trend continues, insurance premiums may pose challenges to recruiting and retaining an adequate supply of on-call specialists and emergency physicians.