Category Grades
23C 18C-
Access to Emergency Care:
38D- 29D-
Quality/Patient Safety:
22C+ 12B-
Medical Liability:
24C- 25C
Public Health/ Injury Prevention:
14B 19C+
Disaster Preparedness:
15B+ 23C

Virginia has made notable improvements in the Quality and Patient Safety Environment and in supporting medical liability reforms. However, there are signs that Virginia's emergency care infrastructure is under strain and in need of investment.

More Information


Virginia continues to support a strong Quality and Patient Safety Environment. The state is making significant progress in promoting and protecting the interests of emergency patients and physicians. The state continues to fund quality improvement efforts within the emergency medical services (EMS) system, as well as an EMS medical director. The state's destination policies allow EMS providers to bypass local hospitals to take stroke, ST-elevation myocardial infarction (STEMI), and trauma patients to appropriate facilities. In 2013, Virginia provided additional funds for the purchase of 12-lead electrocardiograms in ambulances for early detection of cardiac events. This allows EMS providers to better determine where patients need to be transported and has been shown to markedly decrease the time that it takes for patients to receive a potentially life-saving percutaneous coronary intervention.

Virginia has updated its Medical Liability Environment to better protect its health care workforce from unfounded lawsuits and excessive malpractice awards. Virginia provides for case certification and voluntary pretrial screening panels and has apology inadmissibility laws in place. In 2011, Virginia passed a comprehensive 20-year agreement on the medical malpractice cap on total damages that will result in the cap gradually increasing from $2 million to $3 million by the year 2032. Virginia recently passed tort reforms on where a lawsuit may be filed, recovery of expert witness fees and costs in certain situations, and clarification of the use of medical records to corroborate testimony in wrongful death cases.

While declining somewhat overall in Public Health and Injury Prevention, Virginia has implemented legislation to reduce traffic fatalities and improve traffic safety. In 2013, the state passed a new law to address texting while driving, making it a primary offense, with a $125 fine for the first offense and $250 for the second offense. The state also supports solid funding levels for injury prevention ($547.98 per 1,000 people) and dedicates funds specifically for child and elderly injury prevention efforts.


Virginia faces challenges in ensuring continued statewide Access to Emergency Care. The Department of Medical Assistance's PEND program treats emergency physicians differently from all other physicians taking care of Medicaid patients, retroactively reducing payments to slightly more than $22.06 for approximately 45,000 claims a year. Federal law requires emergency physicians to see Medicaid patients, but Virginia's PEND process means the state refuses to compensate physicians appropriately for the services that they provide.

Virginia faces shortages in hospital capacity, with a relatively high hospital occupancy rate (70.5 per 100 staffed beds) and below-average per capita rates of emergency departments (ED), staffed inpatient beds, and psychiatric care beds. Virginia EDs also struggle with relatively high ED wait times (286 minutes from ED arrival to ED departure). However, Virginia's health department and collaborators developed and adopted guidelines to help hospitals better manage emergency patients when inpatient beds are not available, with the ultimate goal of reducing ED wait times.

While Virginia has many important Disaster Preparedness practices and policies in place, it still faces some challenges. The state has a very low rate of intensive care unit beds (223.8 per 1 million) despite an above-average bed surge capacity. Virginia also lacks solid liability protections for volunteers and health care workers during a disaster and has roughly average rates of health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals.


Emergency doctors are required to treat Medicaid patients by federal law, yet Virginia's PEND program retroactively reduces payments without disputing that the services were provided. Elimination of the PEND program will help ensure that Virginia's emergency physicians are fairly compensated and that Access to Emergency Care will not be unnecessarily threatened.

There are strong signs that Virginia's emergency care system is under strain. Virginia faces shortages in nurses, hospital capacity, and Access to Emergency Care. Investments that bolster hospital capacity and the availability of frontline care providers like nurses will improve access to care both in a large disaster situation and for everyday trauma patients.

Emergency care is an essential public service that involves unique challenges and circumstances that lawmakers should recognize and address by strengthening medical liability protections for health care workers. Joint and several liability reform can limit the scope of medical liability cases to only those parties responsible, and collateral source rule reform can reduce duplicative damage payments, both of which may help to bring down Virginia's high malpractice award payments.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 9.4 11.1
Emergency physicians per 100,000 pop 12.5 14.9
Neurosurgeons per 100,000 pop 1.9 1.9
Orthopedists and hand surgeon specialists per 100,000 pop 8.8 8.9
Plastic surgeons per 100,000 pop 2.2 2.4
ENT specialists per 100,000 pop 3.4 3.4
Registered nurses per 100,000 pop 755.7 767.6
Percent of children able to see provider 95.7
Level I or II trauma centers per 1M pop 1 1.1
Percent of population within 60 minutes of Level I or II trauma center 93 97.2
Accredited chest pain centers per 1M pop 1.6 4.4
Percent of population with an unmet need for substance abuse treatment 7.4 8.4
Pediatric specialty centers per 1M pop 2.6 2.3
Medicaid fee levels for office visits as a percent of the national average 99.6 112.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 8 31.8
Percent of adults with no health insurance 14.4 15.7
Percent of adults underinsured 6.9
Percent of children with no health insurance 10.1 5.9
Percent of children underinsured 16.7
Percent of adults with Medicaid 3.9 6.6
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 302.2 285.7
Hospital occupancy rate per 100 staffed beds 70.7 70.5
Psychiatric care beds per 100,000 pop 25.1 22.5
Median time from ED arrival to ED departure for admitted ED patients 286
State collects data on diversion YES NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $9.09 $4.06
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) YES, ACCREDITED YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan YES YES
Medical response plan for supplying dialysis YES 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 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 YES
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 910.6 1,261.6
ICU beds per 1M pop 225.9 223.8
Burn unit beds per 1M pop 5.7 5.5
Verified burn centers per 1M pop 0 0.1
Physicians registered in ESAR-VHP per 1M pop 107.1 23.9
Nurses registered in ESAR-VHP per 1M pop 369.5 280.1
Behavioral health professionals registered in ESAR-VHP per 1M pop 20
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel NO, NO NR
Percent of RNs that received emergency training 35.2 34.3

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 18.1 18.5
Lawyers per physician 0.7 0.7
Lawyers per emergency physician 14.3 12.4
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 0.9 1.7
Average malpractice award payments $280,513 $342,670
National Practitioner Databank reports per 1,000 physicians 12.8 16.4
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 3.5 4.2
Average medical liability insurance premiums for primary care physicians $14,413 $11,719
Average medical liability insurance premiums for specialists $59,964 $53,804
Presence of pretrial screening panels VOLUNTARY VOLUNTARY
Pretrial screening panel's findings admissible as evidence YES YES
Periodic payments are: required, granted upon request, at court's discretion AT JUDGE'S OR COURT'S DESCRETION UPON REQUEST
Medical liability cap on non-economic damages >$500,000 >$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 NO
State provides for case certification YES YES
Expert witness required to be of the same specialty as the defendant YES YES
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 3.8
Pedestrian fatalities per 100,000 pedestrians 4.4
Percent of traffic fatalities alcohol-related 39 36
Percent of front occupants using restraints 79.9 81.8
Child safety seat/seat belt legislation - score out of a possible 10 points 4 4
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 0
Percentage of children aged 19-35 months who are immunized 81.6 77
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 69.1 63.3
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 66.8 72
Fatal occupational injuries per 1M workers 46.1 28.5
Homicides and suicides (non-motor vehicle)(per 100,000) 17.9 16.9
Unintentional fall-related fatal injuries (per 100,000) 4.8 6.8
Fire/burn related fatal injuries (per 100,000) 1.3 1
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.2 0.2
Rate of unintentional poisoning-related deaths (per 100,000) 6
Total injury prevention funds per 1,000 persons $636.40 $547.98
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 0
Infant mortality rate per 1,000 live births 7.5 6.8
Percentage of adults who binge drink 13.5 17.9
Percentage of adults who currently smoke 19.3 20.9
Percentage of adult population who are obese (BMI > 30.0) 25.1 29.2
Percentage of children who are obese 14.3
Cardiovascular disease disparity ratio 1.3
HIV diagnosis disparity ratio 10.5
Infant mortality disparity ratio 2.9

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 13.1 15.9
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 98.5 99.3
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols YES (2011)
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) 2
% of hospitals with computerized practitioner order entry 9.8 86.7
% of hospitals with electronic medical records 37 95.6
% of patients with AMI given PCI within 90 minutes of arrival 60 95
Median time to transfer to another facility for acute coronary intervention 58
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 57.9
% of hospitals with or planning to develop a diversity strategy or plan 50.4

Share This Info

Contact Congress

Take federal action and get your national officials involved

Public ACEP Members