ER Report Card: States Get Low Marks
Doctors' Group Gives Overall C Minus for Emergency Room Care
Jan. 10, 2006 -- A new report says states are lagging in maintaining the
ability of emergency rooms to care for patients and respond to crises like a
natural disaster or a terrorist attack.
Grades released by a doctors' group give states an overall C minus for not
doing enough to maintain staffing and funding for emergency rooms. The group
also says that many states have not done enough to rein in lawsuits against
doctors, a politically touchy issue that has divided the political parties in
Congress and in the states.
California earned the highest marks, though the group only gave the state a
grade of B. Massachusetts, Connecticut, and the District of Columbia also
Arkansas ranked last for what doctors said was weak public funding, a
shortage of trauma centers, and a high rate of traffic fatalities involving
Arkansas was followed by Idaho and Utah, which also earned D's in the
report, released by the American College of Emergency Physicians.
"Their beds are full, their hallways are full, their resources are being
stretched to the limit," says Frederick C. Blum, MD, the group's president.
"This is not a sustainable situation."
The overall grade was determined from analysis of four categories: access to
emergency care, quality and patient safety, the medical liability environment,
and public health and injury prevention.
Some of the specific areas looked at within those categories were the number
of hospital-staffed beds, state spending on health care, and whether or not
states have residency training programs in emergency medicine. The group also
took into account public health and safety factors like emergency preparedness
programs and seat belt and motorcycle helmet laws.
The Role of Malpractice Suits
It also emphasized state laws designed to cap jury awards against doctors in
malpractice suits. Some states, including Texas and California, cap awards for
pain and suffering at $250,000, while others have higher caps or none at
Doctors' lobbying groups have blamed liability costs for making it too
expensive for them to practice in some areas of the country. Others argue that
the awards have little overall impact on health care costs and that malpractice
premiums are feeding insurance company profits.
Georges Benjamin, MD, who heads the American Public Health Association,
points to the report as a warning that current overcrowding and lack of
capacity in emergency rooms could lead to chaos in the event of a regional or
national medical crisis.
"Our capacity to handle any kind of surge, like a disaster, is
questionable," he says. "How can we possibly be prepared for a disaster
or a terrorist attack?"
ER Care for the Uninsured
The report says increasing numbers of uninsured people are seeking care in
hospital emergency departments, which are required to stabilize patients
regardless of their ability to pay. And those with health insurance are finding
that many plans -- including Medicare and Medicaid -- are paying less for
medical care. The result is a growing financial burden for patients and
The group is asking Congress to provide direct funding to help bolster
emergency departments. Doctors say they do not now know whether long emergency
room waits had ever caused the death of a patient suffering an acute emergency
like a heart attack or accident trauma.
"There is no data out there," says Angela Gardner, MD, an ACEP board
member who practices in Plano, Texas.