Category Grades
10C+ 9C+
Access to Emergency Care:
32D- 28D-
Quality/Patient Safety:
3A 2A
Medical Liability:
23C 14B-
Public Health/ Injury Prevention:
2A 4A-
Disaster Preparedness:
25C+ 44F

Utah continues to support an outstanding Quality and Patient Safety Environment and has made notable improvements to its Medical Liability Environment. However, Access to Emergency Care is threatened by financial barriers, including poor rates of health insurance coverage and low Medicaid reimbursement levels.

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Utah has among the best Quality and Patient Safety Environments in the nation, with numerous policies and practices in place to enhance emergency response systems. The state has a uniform system for providing pre-arrival instructions and state field trauma triage protocols based on Centers for Disease Control and Prevention guidelines. There are destination policies in place for stroke, ST-elevation myocardial infarction (STEMI), and trauma patients that allow emergency medical services teams to bypass local hospitals for medical specialty centers. Utah hospitals are second best in the nation for the time that it takes to transfer a chest pain patient to another facility (45 minutes).

Public Health and Injury Prevention in Utah surpass that of most of the nation, with solid marks for health risk factors. The state has the lowest proportion of adults who smoke (11.8%) and the third lowest percentage of adults engaging in binge drinking (12.0%). Utah has a low infant mortality rate (4.9 per 1,000 live births) and can boast among the lowest racial and ethnic health disparities in infant mortality and cardiovascular disease rates. The state also has relatively high levels of funding for injury prevention ($682.47 per 1,000 people) and has dedicated funding for injury prevention among children and the elderly.

Utah has also improved its Medical Liability Environment since the 2009 Report Card, largely due to passage of additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act, as well as an increase in insurers writing medical liability insurance premiums. The state has seen slight decreases in medical liability insurance premiums, although rates for specialists remain well above the national average. Utah also has a medical liability cap on non-economic damages and allows periodic payments of awards.


Utah's grade for Disaster Preparedness was affected by low rates of physicians and nurses registered in the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP; 15.4 and 143.2 per 1 million people, respectively). Data indicate a low bed surge capacity (412.9 beds per 1 million people) as reported to the U.S. Office of the Assistant Secretary for Preparedness and Response, although state law allows hospitals to surge internally to a higher level. The state also lacks a patient-tracking system during disasters.

Access to Emergency Care remains a major challenge in Utah, especially in relation to the adequacy of health insurance for children. A relatively large proportion of children in Utah are uninsured (10.7%), and more than one in five who do have insurance is underinsured, with parents reporting unreasonable out-of-pocket costs for accessing care (20.2%). Medicaid fee levels for office visits are also well below the national average (85.5%), despite a 12% increase since 2007. While the state has roughly average rates of many types of providers, there is a shortage of orthopedists and hand surgeons (8.5 per 100,000 people) and registered nurses (678.7 per 100,000 people).


Utah has the opportunity to implement statewide policies and procedures that would enhance its overall Disaster Preparedness. Outreach and education should be undertaken to increase the number of physicians and nurses who register with ESAR-VHP; this would significantly improve the state's ability to respond quickly and effectively during a disaster or mass casualty event. Utah could also improve in this category by exploring mutual aid agreements with behavioral health providers to provide care during a disaster.

The lack of access to adequate health insurance, especially for children, is a major concern for Utah. Utah policymakers and other stakeholders must take action to address this gap and ensure that this vulnerable population is able to receive needed care on time. Increasing childhood immunization rates would help improve the overall health of children by preventing the spread of life-threatening diseases.

Utah should build on previous successes in the Medical Liability Environment and implement rules that require all expert witnesses to be of the same specialty as the defendant and licensed to practice in the state.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 9.4 10.5
Emergency physicians per 100,000 pop 11.8 13.3
Neurosurgeons per 100,000 pop 2 1.8
Orthopedists and hand surgeon specialists per 100,000 pop 8.7 8.5
Plastic surgeons per 100,000 pop 2.9 2.8
ENT specialists per 100,000 pop 3.2 3.6
Registered nurses per 100,000 pop 646.2 678.7
Percent of children able to see provider 97.2
Level I or II trauma centers per 1M pop 1.5 1.8
Percent of population within 60 minutes of Level I or II trauma center 85 85.8
Accredited chest pain centers per 1M pop 0 2.5
Percent of population with an unmet need for substance abuse treatment 7.6 6.7
Pediatric specialty centers per 1M pop 5 4.6
Medicaid fee levels for office visits as a percent of the national average 93.8 85.5
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 23 12
Percent of adults with no health insurance 18.6 16.5
Percent of adults underinsured 8.2
Percent of children with no health insurance 15 10.7
Percent of children underinsured 20.2
Percent of adults with Medicaid 5.3 5.2
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 210.2 207.8
Hospital occupancy rate per 100 staffed beds 62 56.8
Psychiatric care beds per 100,000 pop 23.8 22.7
Median time from ED arrival to ED departure for admitted ED patients 215
State collects data on diversion YES NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $8.05 $6.08
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES NR
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) YES, ACCREDITED YES
Special needs patients included in medical response plan NO NR
Patients dependent on medication for chronic conditions in medical response plan NO NR
Medical response plan for supplying dialysis NO NR
Mental health patients included in medical response plan NR
Medical response plan for supplying psychotropic medications NR
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 YES NO
Statewide patient tracking system NO NO
Statewide real-time or near real-time syndromic surveillance system NO YES
Real-time surveillance system in place for common ED presentations NO NR
Bed surge capacity per 1M pop 366.7 412.9
ICU beds per 1M pop 286.9 266.5
Burn unit beds per 1M pop 4.5 4.2
Verified burn centers per 1M pop 0.37802467 0.4
Physicians registered in ESAR-VHP per 1M pop NR 15.4
Nurses registered in ESAR-VHP per 1M pop NR 143.2
Behavioral health professionals registered in ESAR-VHP per 1M pop 36.4
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES NO
Percent of RNs that received emergency training 47.3 48.8

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 14.7 16.4
Lawyers per physician 0.7 0.7
Lawyers per emergency physician 12.2 12.3
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 2 3.2
Average malpractice award payments $218,124 $219,793
National Practitioner Databank reports per 1,000 physicians 20.7 37.1
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 8.8 10.8
Average medical liability insurance premiums for primary care physicians $10,792 $10,630
Average medical liability insurance premiums for specialists $68,352 $66,554
Presence of pretrial screening panels VOLUNTARY MANDATORY
Pretrial screening panel's findings admissible as evidence NO NO
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 YES
Joint and several liability abolished YES YES
Collateral Source Rule/Provides for Awards to be Offset YES
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 2.4
Pedestrian fatalities per 100,000 pedestrians 3.5
Percent of traffic fatalities alcohol-related 24 26
Percent of front occupants using restraints 86.8 89.2
Child safety seat/seat belt legislation - score out of a possible 10 points 6 6
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 2
Graduated drivers' licenses legislation score -out of a possible 5 points 1
Percentage of children aged 19-35 months who are immunized 80.4 71.1
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 72.1 56.9
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 65.9 70
Fatal occupational injuries per 1M workers 45.7 29.4
Homicides and suicides (non-motor vehicle)(per 100,000) 16.5 17.9
Unintentional fall-related fatal injuries (per 100,000) 4.7 6.5
Fire/burn related fatal injuries (per 100,000) 0.5 0.4
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.1 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 9.9
Total injury prevention funds per 1,000 persons $683.98 $682.47
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding YES
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 4.5 4.9
Percentage of adults who binge drink 9.3 12
Percentage of adults who currently smoke 9.8 11.8
Percentage of adult population who are obese (BMI > 30.0) 21.9 24.4
Percentage of children who are obese 11.6
Cardiovascular disease disparity ratio 1.6
HIV diagnosis disparity ratio 11.7
Infant mortality disparity ratio 1.4

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 5.7 8.4
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 100 100
State has a uniform system for providing pre-arrival instructions YES YES
State uses CDC guidelines for state field triage protocols YES (2006)
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 39 80
% of hospitals with electronic medical records 64.3 94
% of patients with AMI given PCI within 90 minutes of arrival 59 97
Median time to transfer to another facility for acute coronary intervention 45
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 45.3
% of hospitals with or planning to develop a diversity strategy or plan 45.3

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