Category Grades
33C- 17C-
Access to Emergency Care:
21C 26D
Quality/Patient Safety:
13B+ 29C
Medical Liability:
25C- 11B
Public Health/ Injury Prevention:
38D- 37D-
Disaster Preparedness:
51F 11B-

Tennessee has made notable progress in its Disaster Preparedness planning and response capacity, as well as admirable improvement to the Medical Liability Environment. However, the state is still challenged by high rates of preventable deaths and a reduced hospital capacity that are threatening Access to Emergency Care.

More Information


Tennessee's Medical Liability Environment has improved to 11th best in the nation. The state has rules requiring expert witnesses of the same specialty as the defendant and requiring case certification by an expert witness. Tennessee also placed a medical liability cap on non-economic damages in 2011, which helped to improve its rank. Malpractice awards are also offset by collateral sources received by defendants in Tennessee; this helps to reduce the overall burden of malpractice award payments. Providers in the state also benefit from below-average medical liability insurance premiums.

Tennessee scores favorably compared to other states in Disaster Preparedness. The state shares its Emergency Support Function 8 or all-hazards plan with all emergency medical services and essential hospital personnel and its medical response plan includes special-needs patients, mental health patients, and patients dependent on psychotropic medications or medications for chronic disease. The state also has a better-than-average bed surge capacity (908.7 per 1 million people) and ranks among the top 20 in the rates of physicians and nurses registered in the Emergency System for Advance Registration of Volunteer Health Professionals.


Tennessee faces increasing barriers in Access to Emergency Care, particularly for hospital capacity. For instance, the per capita rate of emergency departments has fallen from 13.8 per 1 million people in the 2009 Report Card to 10.5 per 1 million, well below the national average. Availability of psychiatric care beds has decreased (from 33.9 to 25.6 per 100,000 people), as has availability of staffed inpatient beds (from 414.0 to 352.5 per 100,000), which is likely the result of closing two hospitals in 2011. While health insurance coverage rates are on par with the nation, Tennessee has the highest proportion of adults with insurance who report cost as a barrier to receiving needed care (10.2%).

Public Health and Injury Prevention also remains a challenge for Tennessee policymakers. The state has high rates of traffic fatalities (14.7 per 100,000 people) and bicyclist fatalities (8.7 per 100,000 cyclists), despite relatively strong seatbelt and child safety seat use laws and a law requiring helmets for all motorcycle riders. Tennessee also has some of the highest rates of both fire- or burn-related and poisoning-related deaths, which include drug overdoses (1.6 and 15.3 per 100,000 people, respectively), and the third highest infant mortality rate in the nation. Compounding this issue, the infant mortality disparity ratio (3.1) indicates that non-Hispanic Black infants have rates that are three times higher than the racial or ethnic group with the lowest rate. At the same time, however, Tennessee has the lowest cardiovascular disease disparity ratio and the lowest number of adults engaging in binge drinking (10.0%).

Tennessee's Quality and Patient Safety Environment has slipped somewhat, largely due to a failure to keep pace with other states, but also due to the addition of new indicators that better measure progress in this category. While significantly more hospitals in Tennessee have adopted computerized practitioner order entry, compared with the 2009 Report Card, the state ranks sixth worst in the nation on this measure (56.2%). The state's hospitals are below average in the proportion collecting data on race and ethnicity and primary language (52.0%) and having or planning to develop a diversity strategy (36.7%). While Tennessee requires certification from a state-approved program for 911 dispatchers who provide pre-arrival instructions, not all 911 dispatchers provide those instructions.


Tennessee's rapidly decreasing hospital capacity is a major concern with dramatic decreases in inpatient and psychiatric care beds. The state must monitor diversion and emergency department wait times and act to minimize the impact of these reductions in infrastructure. Tennessee should also work to ensure that all adults are able to afford needed preventive and emergency health care.

Tennessee must act to reduce high rates of preventable deaths and lessen the racial and ethnic disparity in infant mortality. The state should explore the underlying causes of these issues and implement outreach and evidence-based education efforts to address them.

Additionally, Tennessee could significantly improve its Quality and Patient Safety Environment by working with hospitals and encouraging them to adopt technological advances at a faster pace. Tennessee should also explore options to implement a uniform system for providing pre-arrival instructions and destination policies for stroke and ST-elevation myocardial infarction (STEMI) patients.

The state must also protect and enhance medical liability reforms and enact protections for Emergency Medical Treatment and Labor Act (EMTALA)-mandated emergency care that will encourage specialists to provide critical on-call services to emergency patients.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop
Emergency physicians per 100,000 pop
Neurosurgeons per 100,000 pop
Orthopedists and hand surgeon specialists per 100,000 pop
Plastic surgeons per 100,000 pop
ENT specialists per 100,000 pop
Registered nurses per 100,000 pop
Percent of children able to see provider
Level I or II trauma centers per 1M pop
Percent of population within 60 minutes of Level I or II trauma center
Accredited chest pain centers per 1M pop
Percent of population with an unmet need for substance abuse treatment
Pediatric specialty centers per 1M pop
Medicaid fee levels for office visits as a percent of the national average
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012)
Percent of adults with no health insurance
Percent of adults underinsured
Percent of children with no health insurance
Percent of children underinsured
Percent of adults with Medicaid
Hospital closures in 2006/2011
Staffed inpatient beds per 100,000 pop
Hospital occupancy rate per 100 staffed beds
Psychiatric care beds per 100,000 pop
Median time from ED arrival to ED departure for admitted ED patients
State collects data on diversion

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds
State budget line item health care surge
ESF-8 plan is shared with all EMS and essential hospital personnel
Emergency physician input into the state planning process
Public health and emergency physician input during an ESF-8 response
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP)
Special needs patients included in medical response plan
Patients dependent on medication for chronic conditions in medical response plan
Medical response plan for supplying dialysis
Mental health patients included in medical response plan
Medical response plan for supplying psychotropic medications
Mutual aid agreements in place with behavioral health providers
State requires long-term care and nursing home facilities to have a written disaster plan
State able to report number of exercises involving long-term care facilities or nursing
Just-in-time training systems in place
Statewide medical communication system with one layer of redundancy
Statewide patient tracking system
Statewide real-time or near real-time syndromic surveillance system
Real-time surveillance system in place for common ED presentations
Bed surge capacity per 1M pop
ICU beds per 1M pop
Burn unit beds per 1M pop
Verified burn centers per 1M pop
Physicians registered in ESAR-VHP per 1M pop
Nurses registered in ESAR-VHP per 1M pop
Behavioral health professionals registered in ESAR-VHP per 1M pop
Strike teams or medical assistance teams
Disaster training required for essential hospital/EMS personnel
Percent of RNs that received emergency training

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop
Lawyers per physician
Lawyers per emergency physician
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6)
Malpractice award payments per 100,000 pop
Average malpractice award payments
National Practitioner Databank reports per 1,000 physicians
Apology laws: Apology is inadmissible as evidence in a court of law
State has implemented a patient compensation fund
Number of insurers writing medical liability policies per 1,000 physicians
Average medical liability insurance premiums for primary care physicians
Average medical liability insurance premiums for specialists
Presence of pretrial screening panels
Pretrial screening panel's findings admissible as evidence
Periodic payments are: required, granted upon request, at court's discretion
Medical liability cap on non-economic damages
Additional liability protection for EMTALA-mandated emergency care
Joint and several liability abolished
Collateral Source Rule/Provides for Awards to be Offset
State provides for case certification
Expert witness required to be of the same specialty as the defendant
Expert witness must be licensed to practice medicine in the state

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists
Pedestrian fatalities per 100,000 pedestrians
Percent of traffic fatalities alcohol-related
Percent of front occupants using restraints
Child safety seat/seat belt legislation - score out of a possible 10 points
Helmet use required for all motorcylce riders
Distracted driving legislation score - out of a possible 4 points
Graduated drivers' licenses legislation score -out of a possible 5 points
Percentage of children aged 19-35 months who are immunized
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine
Fatal occupational injuries per 1M workers
Homicides and suicides (non-motor vehicle)(per 100,000)
Unintentional fall-related fatal injuries (per 100,000)
Fire/burn related fatal injuries (per 100,000)
Rate of unintentional firearm-related fatal injuries (per 100,000)
Rate of unintentional poisoning-related deaths (per 100,000)
Total injury prevention funds per 1,000 persons
Dedicated child injury prevention funding
Dedicate elderly injury prevention funding
Dedicated occupational injury prevention funding
Anti-smoking legislation score - score out of a possible 3 points
Infant mortality rate per 1,000 live births
Percentage of adults who binge drink
Percentage of adults who currently smoke
Percentage of adult population who are obese (BMI > 30.0)
Percentage of children who are obese
Cardiovascular disease disparity ratio
HIV diagnosis disparity ratio
Infant mortality disparity ratio

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system
Funded state EMS medical director
Emergency medicine residents per 1M pop
Adverse event reporting required
% of counties with Enhanced 911 capability
State has a uniform system for providing pre-arrival instructions
State uses CDC guidelines for state field triage protocols
State has or is working on a stroke system of care
State has triage and destination policy in place for stroke patients
State has or is working on a PCI network or a STEMI system of care
State has triage and destination policy in place for STEMI patients
State maintains statewide trauma registry
State has triage and destination policy in place for trauma patients
Prescription drug monitoring program score (range 0-4)
% of hospitals with computerized practitioner order entry
% of hospitals with electronic medical records
% of patients with AMI given PCI within 90 minutes of arrival
Median time to transfer to another facility for acute coronary intervention
% of patients with AMI who received aspirin within 24 hours
% of hospitals collecting data on race/ethnicity and primary language
% of hospitals with or planning to develop a diversity strategy or plan

Share This Info

Contact Congress

Take federal action and get your national officials involved

Public ACEP Members