South Dakota

Category Grades
41D+ 39D+
Access to Emergency Care:
12C+ 21D+
Quality/Patient Safety:
51F 47F
Medical Liability:
21C 19C+
Public Health/ Injury Prevention:
48F 41D-
Disaster Preparedness:
43D 31D+

South Dakota has improved slightly in a number of categories since 2009 but continues to struggle to recruit an adequate health care workforce despite recent efforts to draw providers to rural areas of the state. The state has made little improvement in its Quality and Patient Safety Environment.

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While more work can be done, South Dakota has made admirable strides in Disaster Preparedness. The state has high per capita rates of physicians and nurses registered in the Emergency System for Advance Registration of Volunteer Health Professionals, and a relatively high proportion of registered nurses have received Disaster Preparedness training (42.0%). South Dakota also addresses the needs of mental health patients in its medical response plan and has mutual aid agreements in place with behavioral health providers for services during a disaster.

Although South Dakota scored poorly in Access to Emergency Care, emergency physicians in the state report a recent significant step forward in better meeting the needs of the state's rural population through the implementation of emergency medicine telemedicine programs. These programs allow small rural emergency departments (ED) to contact board-certified emergency physicians for immediate consultation and management services.

Little has changed in South Dakota's Medical Liability Environment. While the state lacks expert witness rules, it has a relatively large number of insurers writing medical liability policies (25.6 per 1,000 physicians) and the third lowest medical liability insurance premiums for primary care providers and specialists ($4,478 and $17,428, respectively). The state has maintained its medical liability cap on non-economic damages but has not abolished joint and several liability.


While making a few notable improvements since the 2009 Report Card, South Dakota faces a number of challenges to improving its Quality and Patient Safety Environment. The state has not provided funding for quality improvement of the emergency medical services (EMS) system or an EMS medical director. South Dakota also lacks a uniform system for providing pre-arrival instructions, which could be important in helping to save lives in a rural state, where EMS providers may have long response times. While South Dakota has implemented a statewide trauma registry and has worked to develop stroke and ST-elevation myocardial infarction (STEMI) systems of care, it still lacks destination policies for trauma and STEMI patients.

Access to Emergency Care in South Dakota has substantially worsened, with low levels of numerous types of providers and concerns regarding behavioral health care. The state ranks among the bottom 10 in per capita rates of emergency physicians and plastic surgeons and faces substantial unmet needs for both primary care and mental health providers. The number of psychiatric care beds in the state has plummeted since 2009, from 25.7 to 15.6 per 100,000 people, and the state has a large proportion of adults with an unmet need for substance abuse treatment (10.2%). Additionally, while South Dakota has the highest per capita rate of EDs and the lowest ED wait times in the nation, only 35.9% of the population is within 60 minutes of a level I or II trauma center.

Public Health and Injury Prevention continues to be a concern when considering South Dakota's limited access to primary and emergency care. Immunization rates for children and pneumococcal vaccinations for older adults are among the worst in the nation. South Dakota also has a high rate of traffic fatalities (15.7 per 100,000 people) and the weakest child safety seat and seatbelt laws in the country, resulting in the second lowest seatbelt use rate (73.4%). The state has failed to pass legislation banning handheld cellphone use and texting for all drivers.


South Dakota must continue to work toward increasing the health care workforce to meet the needs of its aging population. Addressing the need for primary care and mental health care providers across the state should be a priority in improving care for all. Although expansion of new emergency medicine telemedicine programs can be instrumental in improving access to quality care, South Dakota should continue to invest in health care education and recruitment programs to draw more providers to rural areas. The state should also address other concerns regarding preventable illness and death, such as improving vaccination rates through outreach and education.

Traffic fatalities are a major cause of preventable death and a driver of emergency care needs in South Dakota. The state should explore numerous avenues to address this issue, including strong seatbelt and child safety seat use laws, a requirement that all motorcycle riders wear helmets, and distracted-driving laws for all drivers.

Finally, South Dakota should build on the systems and infrastructure it has created for Disaster Preparedness to improve the Quality and Patient Safety Environment. Instituting a uniform system for pre-arrival instructions could improve emergency response outcomes, as could a destination policy for trauma patients.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 4.9 6
Emergency physicians per 100,000 pop 5.3 7.6
Neurosurgeons per 100,000 pop 2.3 2.3
Orthopedists and hand surgeon specialists per 100,000 pop 9 9.1
Plastic surgeons per 100,000 pop 1.6 1.4
ENT specialists per 100,000 pop 3.6 3.8
Registered nurses per 100,000 pop 1,226.4 1,350.2
Percent of children able to see provider 96.3
Level I or II trauma centers per 1M pop 2.5 2.4
Percent of population within 60 minutes of Level I or II trauma center 33.3 35.9
Accredited chest pain centers per 1M pop 1.3 3.6
Percent of population with an unmet need for substance abuse treatment 8.8 10.2
Pediatric specialty centers per 1M pop 5.1 3.6
Medicaid fee levels for office visits as a percent of the national average 103.4 90.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 39 7.1
Percent of adults with no health insurance 12.7 14.8
Percent of adults underinsured 6.3
Percent of children with no health insurance 9.2 7.5
Percent of children underinsured 17.2
Percent of adults with Medicaid 4.8 9.2
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 643 572.3
Hospital occupancy rate per 100 staffed beds 62 63.9
Psychiatric care beds per 100,000 pop 25.7 15.6
Median time from ED arrival to ED departure for admitted ED patients 176
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $17.55 $13.56
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel NO YES
Emergency physician input into the state planning process NR NO
Public health and emergency physician input during an ESF-8 response NO
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 NO YES
Patients dependent on medication for chronic conditions in medical response plan NO YES
Medical response plan for supplying dialysis NO YES
Mental health patients included in medical response plan YES
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 YES
Just-in-time training systems in place STATEWIDE COUNTY OR CITYWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO YES
Statewide real-time or near real-time syndromic surveillance system NO NO
Real-time surveillance system in place for common ED presentations NR NO
Bed surge capacity per 1M pop 1,433 1,196.4
ICU beds per 1M pop 375.4 332.4
Burn unit beds per 1M pop 7.5 7.2
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop 0 213.6
Nurses registered in ESAR-VHP per 1M pop 0 926.4
Behavioral health professionals registered in ESAR-VHP per 1M pop 21.6
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 44.1 42

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 7.5 9.1
Lawyers per physician 0.3 0.4
Lawyers per emergency physician 14 12.1
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 5.5 1.6
Average malpractice award payments $182,639 $235,926
National Practitioner Databank reports per 1,000 physicians 18.1 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 22.6 25.6
Average medical liability insurance premiums for primary care physicians $8,512 $4,478
Average medical liability insurance premiums for specialists $24,662 $17,428
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 $350,001-500,000 $350,001-500,000
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 YES, NO OFFSET
State provides for case certification NO NO
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 0
Pedestrian fatalities per 100,000 pedestrians 1.9
Percent of traffic fatalities alcohol-related 42 34
Percent of front occupants using restraints 73 73.4
Child safety seat/seat belt legislation - score out of a possible 10 points 1 1
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 82.1 71
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 74.1 68.3
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 65 67.1
Fatal occupational injuries per 1M workers 83.1 72.1
Homicides and suicides (non-motor vehicle)(per 100,000) 18.5 19
Unintentional fall-related fatal injuries (per 100,000) 14.8 15.6
Fire/burn related fatal injuries (per 100,000) 1.5 1.6
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.6 0.5
Rate of unintentional poisoning-related deaths (per 100,000) 3.8
Total injury prevention funds per 1,000 persons NR NR
Dedicated child injury prevention funding NR
Dedicate elderly injury prevention funding NR
Dedicated occupational injury prevention funding NR
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 7.2 6.9
Percentage of adults who binge drink 18.2 22.1
Percentage of adults who currently smoke 20.3 23
Percentage of adult population who are obese (BMI > 30.0) 25.4 28.1
Percentage of children who are obese 13.4
Cardiovascular disease disparity ratio 1.8
HIV diagnosis disparity ratio 56
Infant mortality disparity ratio 2.2

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 0 0
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 87.9 97
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols NR
State has or is working on a stroke system of care NO 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 NO YES
State has triage and destination policy in place for STEMI patients NO
State maintains statewide trauma registry NO YES
State has triage and destination policy in place for trauma patients NO
Prescription drug monitoring program score (range 0-4) 2
% of hospitals with computerized practitioner order entry 6.1 83
% of hospitals with electronic medical records 14.3 94.3
% of patients with AMI given PCI within 90 minutes of arrival 74 90
Median time to transfer to another facility for acute coronary intervention 60
% 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 29.7

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