Information and Resources

ER Report Card: States Get Low Marks

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 earned B's.

Low Grades

Arkansas ranked last for what doctors said was weak public funding, a shortage of trauma centers, and a high rate of traffic fatalities involving alcohol.

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 all.

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 hospitals.

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.