Category Grades
21C 33D+
Access to Emergency Care:
17C 25D
Quality/Patient Safety:
33C- 25C+
Medical Liability:
44F 39D-
Public Health/ Injury Prevention:
7B+ 13B
Disaster Preparedness:
16B 40F

Vermont's overall score has declined, largely due to a lack of statewide planning and policies in Disaster Preparedness, as well as declining hospital capacity. The state continues, however, to invest in and improve its Quality and Patient Safety Environment.

More Information


Vermont has improved its Quality and Patient Safety Environment by supporting measures to improve care and emergency response capabilities statewide. The state has continued funding for an emergency medical services (EMS) medical director, as well as quality improvement within the EMS system, and has worked to implement stroke and ST-elevation myocardial infarction (STEMI) systems of care. Vermont leads the nation in the time that it takes to transfer patients with chest pain or acute coronary intervention to another facility (28 minutes).

Vermont continues to fare well in Public Health and Injury Prevention, with high immunization rates and moderate health risk factors. The state boasts high vaccination rates for older adults, with 65.4% having received an annual influenza vaccination and 74.3% having ever received the pneumococcal vaccine. Vermont also has one of the lowest infant mortality rates (4.2 deaths per 1,000 live births) and below-average proportions of adults and children who are obese (25.4% and 11.3%, respectively).

In Access to Emergency Care, Vermont performs exceptionally in reducing financial barriers to care, boasting some of the highest rates of health insurance coverage for adults and children in the nation. The state has relatively high Medicaid fee levels for office visits (117.1% of the national average). Vermont also has adequate access to providers, including primary care providers, many types of specialists, and emergency physicians.


Vermont fares poorly overall in Access to Emergency Care because of the lack of specialty centers and declining hospital capacity. The state has no accredited chest pain centers and ranks second to last for the number of pediatric specialty centers (1.6 per 1 million people). Only 78.5% of the population is within 60 minutes of a level I or II trauma center, compared to an average of 82.1% nationally. Vermont has seen an overall decline since the previous Report Card in staffed inpatient beds, emergency departments (ED), and psychiatric care beds and an increase in the hospital occupancy rate. As such, the state has higher-than-average ED wait times: 295 minutes from ED arrival to ED departure for admitted patients.

While Vermont's Medical Liability Environment ranking has improved slightly since the 2009 Report Card, this is due only to minor improvements and the addition of apology inadmissibility laws, which is the only measured reform that Vermont is credited with having. The state lacks any expert witness rules requiring experts to practice in the same specialty as the defendant or to be licensed to practice in the state, rules that can prevent unfounded cases from proceeding. The state has also failed to enact special liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA). Vermont has seen an increase in its average malpractice award payment yet has no reforms in place that would help to rein in excessive payments.

Vermont's Disaster Preparedness grade declined significantly, due in part to the addition of new indicators and because of a lack of statewide policies and a low level of volunteer capacity compared to other states. Vermont's medical response plan lacks provisions for patients dependent on dialysis or medication for chronic diseases. It has no mutual aid agreements in place with behavioral health providers to provide services during a disaster and no behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals. Vermont also lacks strike teams or medical assistance teams to provide assistance during a disaster or mass casualty event.


Vermont policymakers must seriously consider the impact of such a poor Medical Liability Environment on both providers and patients. While the state has an adequate supply of many types of providers, day in and day out, emergency physicians and on-call specialists provide care to high-risk patients and must make quick decisions with little or no knowledge of their medical history. The state must support providers of EMTALA-mandated care by offering additional liability protections that recognize those risks and that at least require clear and convincing evidence of negligence in medical liability cases. Vermont could also consider pretrial screening panels and requiring that expert witnesses be of the same specialty as the defendant.

Vermont should continue to build upon existing improvements to the Quality and Patient Safety Environment by developing destination policies for stroke and STEMI patients that would allow EMS providers to bypass local hospitals for medical specialty centers when appropriate. Finally, Vermont must work with stakeholders to increase its hospital capacity and reduce the long ED wait times, which can lead to poor patient outcomes.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 10.8 12.9
Emergency physicians per 100,000 pop 12.6 13.4
Neurosurgeons per 100,000 pop 2.3 2.6
Orthopedists and hand surgeon specialists per 100,000 pop 13.7 13.6
Plastic surgeons per 100,000 pop 1.3 1.3
ENT specialists per 100,000 pop 4.5 4.6
Registered nurses per 100,000 pop 911.8 1,016.6
Percent of children able to see provider 96.9
Level I or II trauma centers per 1M pop 1.6 1.6
Percent of population within 60 minutes of Level I or II trauma center 67.3 78.5
Accredited chest pain centers per 1M pop 0 0
Percent of population with an unmet need for substance abuse treatment 9.7 9.2
Pediatric specialty centers per 1M pop 1.6 1.6
Medicaid fee levels for office visits as a percent of the national average 136.8 117.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 62 5.2
Percent of adults with no health insurance 10.8 9.7
Percent of adults underinsured 7.3
Percent of children with no health insurance 8 4
Percent of children underinsured 15.5
Percent of adults with Medicaid 13.6 18.9
Hospital closures in 2006/2011 0 1
Staffed inpatient beds per 100,000 pop 242.9 217.6
Hospital occupancy rate per 100 staffed beds 69.1 71.1
Psychiatric care beds per 100,000 pop 34 24.3
Median time from ED arrival to ED departure for admitted ED patients 295
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $22.11 $17.50
State budget line item health care surge NO
ESF-8 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 YES
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO NO
Medical response plan for supplying dialysis NO NO
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 NONE
State requires long-term care and nursing home facilities to have a written disaster plan NO
State able to report number of exercises involving long-term care facilities or nursing NO
Just-in-time training systems in place STATEWIDE STATEWIDE
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 YES NO
Real-time surveillance system in place for common ED presentations YES NO
Bed surge capacity per 1M pop 861.2 706.1
ICU beds per 1M pop 228.7 222
Burn unit beds per 1M pop 14.5 14.4
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop 9.7 11.2
Nurses registered in ESAR-VHP per 1M pop 8 63.9
Behavioral health professionals registered in ESAR-VHP per 1M pop 0
Strike teams or medical assistance teams YES NO
Disaster training required for essential hospital/EMS personnel NO, NO NO
Percent of RNs that received emergency training 45.3 33.4

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 16.1 18.4
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 12.8 13.7
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 7.2 1.1
Average malpractice award payments $131,878 $151,857
National Practitioner Databank reports per 1,000 physicians 17.9 15.3
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 19.7 24
Average medical liability insurance premiums for primary care physicians $8,285 $8,371
Average medical liability insurance premiums for specialists $37,045 $40,241
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 NO NO
Medical liability cap on non-economic damages NONE NONE
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 NO
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 0.9
Percent of traffic fatalities alcohol-related 33 42
Percent of front occupants using restraints 87.1 84.7
Child safety seat/seat belt legislation - score out of a possible 10 points 5 5
Helmet use required for all motorcylce riders YES YES
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 86.1 76.7
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 72.8 65.4
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 66.9 74.3
Fatal occupational injuries per 1M workers 30.7 26.3
Homicides and suicides (non-motor vehicle)(per 100,000) 14.5 17.1
Unintentional fall-related fatal injuries (per 100,000) 14 21.4
Fire/burn related fatal injuries (per 100,000) 1.2 1
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.3 NR
Rate of unintentional poisoning-related deaths (per 100,000) 6.2
Total injury prevention funds per 1,000 persons $230.18 $278.01
Dedicated child injury prevention funding NO
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding YES
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 6.7 4.2
Percentage of adults who binge drink 16.8 18.5
Percentage of adults who currently smoke 18 19.1
Percentage of adult population who are obese (BMI > 30.0) 21.2 25.4
Percentage of children who are obese 11.3
Cardiovascular disease disparity ratio 2.4
HIV diagnosis disparity ratio NR
Infant mortality disparity ratio NR

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 0 0
Adverse event reporting required NO YES
% of counties with Enhanced 911 capability 100 100
State has a uniform system for providing pre-arrival instructions YES NR
State uses CDC guidelines for state field triage protocols NO PROTOCOLS
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 NO
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 9.1 100
% of hospitals with electronic medical records 57.1 100
% of patients with AMI given PCI within 90 minutes of arrival 58 97
Median time to transfer to another facility for acute coronary intervention 28
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 68.8
% of hospitals with or planning to develop a diversity strategy or plan 31.1

Share This Info

Contact Congress

Take federal action and get your national officials involved

Public ACEP Members