Category Grades
19C 35D+
Access to Emergency Care:
43F 37F
Quality/Patient Safety:
1A 8B
Medical Liability:
40D- 42F
Public Health/ Injury Prevention:
4A 5A-
Disaster Preparedness:
33C 50F

Washington has made a strong commitment to the Quality and Patient Safety Environment and Public Health and Injury Prevention. However, the state lacks coordination for Disaster Preparedness and faces a challenging Medical Liability Environment.

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Washington earns an A- in Public Health and Injury Prevention, the fifth highest score in the nation. The state boasts low rates of fatal injuries and generally low levels of chronic disease risk factors. Traffic fatality rates in Washington are particularly low, thanks in part to its strong child safety seat and adult seatbelt legislation and strict laws against distracted driving. The state is first in the nation for seatbelt use, with 97.5% of vehicle front-seat occupants using seatbelts. The infant mortality rate (4.5 deaths per 1,000 live births) is the 6th lowest in the nation. Only 17.5% of the state's adults are current smokers and strong anti-smoking legislation keeps secondhand smoke out of bars, restaurants, and workplaces.

Washington continues to be a leader in the Quality and Patient Safety Environment, with patient care procedures, protocols, and triage guidelines in place for ST-elevation myocardial infarction (STEMI), trauma, and stroke patients. The state has a uniform system for providing pre-arrival instructions. Washington has a strong prescription drug monitoring program, which has been implemented statewide and monitors drug schedules II to V. While the state continues to fund quality improvement efforts within the emergency medical services (EMS) system, it does not have a funded state EMS medical director.

Washington has worked to improve some aspects of Access to Emergency Care. It has improved its Medicaid fee levels, with a 61.2% increase between 2007 and 2012 that has lifted the state's fees to 125.1% of the national average. A recent collaboration between state officials and the medical community resulted in implementation of best practices that protect Medicaid patients' Access to Emergency Care while better ensuring that Medicaid patients seek and receive treatment in appropriate care settings.


Washington's Disaster Preparedness rank fell, largely because the state did not implement improvements made in other states. Per capita federal Disaster Preparedness funds have dropped from $7.09 in the 2009 Report Card to $5.31, and the state does not have a budget line item for Disaster Preparedness funding specific for health care surge. Washington lacks many policies and procedures that ensure that medically vulnerable patients receive care in a disaster and that help coordinate responses between different responders. However, the state is conducting a pilot project for statewide electronic patient tracking software, which is a step in the right direction.

Washington has a challenging Medical Liability Environment, with few protections in place for the state's medical practitioners. Although the state maintains below-average medical liability insurance premiums for both primary care physicians ($11,128) and specialists ($52,935), practitioners are vulnerable to unfounded lawsuits. Washington does not provide for case certification or for pretrial screening panels, both of which can weed out frivolous or unsubstantiated lawsuits. It remains in the minority of states without any cap on non-economic damages in medical liability cases, which can lead to exorbitant malpractice award payments.

Despite some improvements noted above, Washington continues to receive a failing grade for Access to Emergency Care. One major area of concern is the lack of resources and inpatient capacity for mental health patients. The state ranks third worst in the nation for the number of psychiatric care beds (8.3 per 100,000 people).


Washington is a home rule state with authority for local response held by local health officers. While this is a logical setup for disaster response in a large and rural state, Washington could benefit from more attention to statewide planning and processes. A statewide medical communication system with redundancy would help ensure that different authorities can coordinate their response to an unfolding disaster. Washington also has some of the lowest rates of physicians, nurses, and behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals and should focus on recruiting these professionals in advance of a disaster event.

Washington should work to reform its Medical Liability Environment by passing a medical liability cap on non-economic damages to ensure that award payments do not rise uncontrollably. Another vital reform is special liability protection for care mandated by the Emergency Medical Treatment and Labor Act, which would protect emergency care workers who provide care in life-threatening situations, often to high-risk patients, without knowledge of their medical histories.

Washington needs greater investments in its hospital infrastructure. In addition to the paucity of psychiatric care beds, the state has some of the lowest levels of staffed inpatient and intensive care unit beds. There is also very low access to level I or II trauma centers, with only 83.2% of the population within 60 minutes of one.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 10.4 11.7
Emergency physicians per 100,000 pop 11.9 13.8
Neurosurgeons per 100,000 pop 1.7 1.7
Orthopedists and hand surgeon specialists per 100,000 pop 9.4 9.1
Plastic surgeons per 100,000 pop 1.8 2.1
ENT specialists per 100,000 pop 3.5 3.7
Registered nurses per 100,000 pop 782.9 798.6
Percent of children able to see provider 94.2
Level I or II trauma centers per 1M pop 1.1 0.7
Percent of population within 60 minutes of Level I or II trauma center 80.2 83.2
Accredited chest pain centers per 1M pop 0.8 1.3
Percent of population with an unmet need for substance abuse treatment 8.9 8.6
Pediatric specialty centers per 1M pop 2.8 2.8
Medicaid fee levels for office visits as a percent of the national average 95.4 125.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) -26 61.2
Percent of adults with no health insurance 13.4 16.2
Percent of adults underinsured 8.1
Percent of children with no health insurance 6.9 8.8
Percent of children underinsured 14.8
Percent of adults with Medicaid 8.4 9.0
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 208.7 208.3
Hospital occupancy rate per 100 staffed beds 65.4 65.2
Psychiatric care beds per 100,000 pop 8.2 8.3
Median time from ED arrival to ED departure for admitted ED patients 260
State collects data on diversion YES N/A

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $7.09 $5.31
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES NO
Emergency physician input into the state planning process YES, YES YES
Public health and emergency physician input during an ESF-8 response YES, 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 YES YES
Patients dependent on medication for chronic conditions in medical response plan YES NO
Medical response plan for supplying dialysis NO NO
Mental health patients included in medical response plan NO
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 YES
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 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 NR YES, IN METROPOLITAN AREAS
Bed surge capacity per 1M pop 188.8 747.4
ICU beds per 1M pop 184.5 200.5
Burn unit beds per 1M pop 7.7 7.2
Verified burn centers per 1M pop 0.154597163 0.1
Physicians registered in ESAR-VHP per 1M pop 26.9 3
Nurses registered in ESAR-VHP per 1M pop 77.1 45.7
Behavioral health professionals registered in ESAR-VHP per 1M pop 2.9
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 47.2 40.5

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 17.4 15.2
Lawyers per physician 0.7 0.6
Lawyers per emergency physician 14.5 11
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 -1
Malpractice award payments per 100,000 pop 1 2
Average malpractice award payments $259,302 $248,890
National Practitioner Databank reports per 1,000 physicians 20.7 27.9
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 4.1 4.7
Average medical liability insurance premiums for primary care physicians $15,272 $11,128
Average medical liability insurance premiums for specialists $61,317 $52,935
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 NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished PARTIALLY PARTIALLY
Collateral Source Rule/Provides for Awards to be Offset YES, NO OFFSET
State provides for case certification YES 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 1.9
Pedestrian fatalities per 100,000 pedestrians 2.6
Percent of traffic fatalities alcohol-related 47 40
Percent of front occupants using restraints 96.4 97.5
Child safety seat/seat belt legislation - score out of a possible 10 points 8 8
Helmet use required for all motorcylce riders YES YES
Distracted driving legislation score - out of a possible 4 points 4
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 77.6 76
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 70.6 60.7
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 69.6 74
Fatal occupational injuries per 1M workers 27.8 22.7
Homicides and suicides (non-motor vehicle)(per 100,000) 16.7 16.9
Unintentional fall-related fatal injuries (per 100,000) 9.1 11.6
Fire/burn related fatal injuries (per 100,000) 0.9 0.7
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.1 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 11.2
Total injury prevention funds per 1,000 persons $606.20 $214.28
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 5.1 4.5
Percentage of adults who binge drink 14.2 17.8
Percentage of adults who currently smoke 17.1 17.5
Percentage of adult population who are obese (BMI > 30.0) 24.2 26.5
Percentage of children who are obese 11
Cardiovascular disease disparity ratio 2.8
HIV diagnosis disparity ratio 7.5
Infant mortality disparity ratio 2.2

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 NO
Emergency medicine residents per 1M pop 5.7 7.8
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 (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) 3
% of hospitals with computerized practitioner order entry 20.5 81.1
% of hospitals with electronic medical records 50 93.7
% of patients with AMI given PCI within 90 minutes of arrival 65 91
Median time to transfer to another facility for acute coronary intervention 50
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 44.9
% of hospitals with or planning to develop a diversity strategy or plan 34.6

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