Category Grades
42D+ 51F
Access to Emergency Care:
13C+ 33F
Quality/Patient Safety:
43D- 51F
Medical Liability:
42D- 38D-
Public Health/ Injury Prevention:
45F 47F
Disaster Preparedness:
30C 47F

Wyoming has robust hospital capacity and some liability protections for health care providers. However, financial barriers to care, health care work force shortages, and a lack of statewide policies and practices for its Quality and Patient Safety Environment and Disaster Preparedness lands the state at the bottom of this year's rankings.

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Wyoming has some strong elements facilitating Access to Emergency Care with robust access to important medical facilities. The state is fourth in the nation for access to emergency departments (ED) and fifth for its high per capita rate of level I or II trauma centers; however, because of its geography, only 33% of the population is within 60 minutes of a trauma center. Wyoming has the second lowest hospital occupancy rate in the nation and ranks among the top 10 for per capita rates of psychiatric care beds and staffed inpatient beds. The state's median time from ED arrival to departure for admitted patients is only 216 minutes, well below the national average.

Wyoming has instituted some protections for practitioners in its Medical Liability Environment. Mandatory pretrial screening panels help discourage lawsuits that lack merit, and physician apologies are not admissible as evidence in court. Wyoming has abolished joint and several liability, reducing unfair liability payments. While its average malpractice award payments are among the highest in the nation ($545,729), the state does have one of the lowest rates of malpractice payments.

Finally, Wyoming has very low obesity rates, with a low proportion of children who are obese (10.7%) and a below-average proportion of adults who are obese (25.0%).


Wyoming has the lowest ranked Quality and Patient Safety Environment in the country, largely due to a lack of state-level investment in this area. Wyoming provides no funding for quality improvement within the emergency medical services (EMS) system or a state EMS medical director. Wyoming also lacks a uniform system for providing pre-arrival instructions and triage and destination policies for stroke, ST-elevation myocardial infarction (STEMI), and trauma patients.

Although Wyoming fares well in overall hospital capacity, lack of health insurance and a health care workforce shortage are troubling barriers to care. The state has high proportions of adults and children with no health insurance (20.3% and 10.0%, respectively) and the second highest proportion of children who are underinsured (22.5%). The state also has low per capita rates of emergency physicians; neurosurgeons; plastic surgeons; and ear, nose, and throat specialists which can affect the availability of on-call specialty care in the ED.

These numbers are troubling in light of Wyoming's challenges in Public Health and Injury Prevention. Wyoming has the highest rate of traffic fatalities in the country (26.9 per 100,000 people) and the second highest rate of fatal occupational injuries (99.0 per 1 million workers). The state also has high rates of homicide and suicide; firearm-related deaths; and poisoning-related deaths, which include drug overdoses. Wyoming also has extremely low rates of vaccination among children and older adults.

Wyoming has the second highest per capita federal investment in Disaster Preparedness at $18.84 but lags behind most other states, largely due to a lack of important statewide policies and plans. The state has no redundant medical communication system in place, which would be an asset in a large and rural state, and no statewide patient-tracking system. Wyoming's medical response plan does not include patients dependent on medications or dialysis to ensure these patients receive needed care.


Wyoming needs to invest in quality improvement in the emergency care system and in patient safety. In addition to developing state-level protocols for stroke, STEMI, and trauma patients, Wyoming should encourage more of its hospitals to adopt technological advances, such as computerized practitioner order entry and electronic medical records, which help reduce errors and improve the ability of doctors and hospitals to provide timely and appropriate care.

While many of Wyoming's challenges in Access to Emergency Care are due to being a large, rural state, Wyoming can and must take action to improve immunization rates and reduce traffic fatalities. The state should invest in outreach and education aimed at increasing seatbelt use and pass legislation to require helmets for all motorcycle riders. The state could also explore innovative approaches to increasing immunization rates among children and the elderly.

Wyoming can strengthen its Medical Liability Environment to help lower the average malpractice award payment and to aid in recruiting a skilled workforce. The state should explore a medical liability cap on non-economic damages and require periodic payments of malpractice awards. Wyoming should consider providing special liability protections for care mandated by the Emergency Medical Treatment and Labor Act to further alleviate the burden on physicians who are willing to provide emergent, life-saving care to patients.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 8.8 9.5
Emergency physicians per 100,000 pop 11.5 11.5
Neurosurgeons per 100,000 pop 1.5 1.7
Orthopedists and hand surgeon specialists per 100,000 pop 11.7 11.1
Plastic surgeons per 100,000 pop 0.8 0.5
ENT specialists per 100,000 pop 2.5 2.9
Registered nurses per 100,000 pop 828.9 846
Percent of children able to see provider 95.8
Level I or II trauma centers per 1M pop 3.8 3.5
Percent of population within 60 minutes of Level I or II trauma center 32.3 33
Accredited chest pain centers per 1M pop 0 0
Percent of population with an unmet need for substance abuse treatment 9.7 9.7
Pediatric specialty centers per 1M pop 3.9 3.5
Medicaid fee levels for office visits as a percent of the national average 162.7 136.6
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 33 3.2
Percent of adults with no health insurance 16.6 20.3
Percent of adults underinsured 7.3
Percent of children with no health insurance 8.2 10
Percent of children underinsured 22.5
Percent of adults with Medicaid 4.4 6.9
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 503 452.3
Hospital occupancy rate per 100 staffed beds 58.5 55.6
Psychiatric care beds per 100,000 pop 54.8 48.2
Median time from ED arrival to ED departure for admitted ED patients 216
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $25.96 $18.84
State budget line item health care surge NR
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) NO NO
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 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 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 YES YES
Real-time surveillance system in place for common ED presentations YES NR
Bed surge capacity per 1M pop 650.3 931.6
ICU beds per 1M pop 226.2 163.1
Burn unit beds per 1M pop 0 0
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop NR 6.9
Nurses registered in ESAR-VHP per 1M pop NR 150.9
Behavioral health professionals registered in ESAR-VHP per 1M pop 19.1
Strike teams or medical assistance teams NO NO
Disaster training required for essential hospital/EMS personnel YES, YES NO, YES
Percent of RNs that received emergency training 44.2 39.5

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 14.2 13
Lawyers per physician 0.7 0.7
Lawyers per emergency physician 12.2 11.4
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 8.8 1
Average malpractice award payments $427,763 $545,729
National Practitioner Databank reports per 1,000 physicians 27.2 30.5
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 43.3 54.5
Average medical liability insurance premiums for primary care physicians $20,087 $17,138
Average medical liability insurance premiums for specialists $79,482 $71,248
Presence of pretrial screening panels MANDATORY MANDATORY
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 AT COURT'S DESCRETION
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished YES YES
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 1.8
Pedestrian fatalities per 100,000 pedestrians 1.7
Percent of traffic fatalities alcohol-related 41 31
Percent of front occupants using restraints 72.2 82.6
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 0
Percentage of children aged 19-35 months who are immunized 755. 70.3
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 70.8 54.4
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 69.7 66.5
Fatal occupational injuries per 1M workers 149.6 99
Homicides and suicides (non-motor vehicle)(per 100,000) 20.8 24.6
Unintentional fall-related fatal injuries (per 100,000) 8.3 8.2
Fire/burn related fatal injuries (per 100,000) 0.7 1.1
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.6 0.5
Rate of unintentional poisoning-related deaths (per 100,000) 13.7
Total injury prevention funds per 1,000 persons 0 NR
Dedicated child injury prevention funding NR
Dedicate elderly injury prevention funding NR
Dedicated occupational injury prevention funding NR
Anti-smoking legislation score - score out of a possible 3 points 0
Infant mortality rate per 1,000 live births 6.8 6.8
Percentage of adults who binge drink 16.7 18.9
Percentage of adults who currently smoke 21.6 23
Percentage of adult population who are obese (BMI > 30.0) 23.3 25
Percentage of children who are obese 10.7
Cardiovascular disease disparity ratio 1.9
HIV diagnosis disparity ratio NR
Infant mortality disparity ratio 1.2

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system NO NO
Funded state EMS medical director YES NO
Emergency medicine residents per 1M pop 0 0
Adverse event reporting required NO YES
% of counties with Enhanced 911 capability 83.3 91.7
State has a uniform system for providing pre-arrival instructions YES NO
State uses CDC guidelines for state field triage protocols NO
State has or is working on a stroke system of care YES 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 YES YES
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 0 66.7
% of hospitals with electronic medical records 12 77.8
% of patients with AMI given PCI within 90 minutes of arrival 70 91
Median time to transfer to another facility for acute coronary intervention 178
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 53.1
% of hospitals with or planning to develop a diversity strategy or plan 40.6

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