Emergency care in bad condition

BOISE – The nation’s emergency care system is ailing, and Idaho’s ranks next to last in the nation, a new health care analysis warns.

Washington state doesn’t fare much better, coming in at 40th among the states.

“The emergency health care system’s in serious condition. We have a safety net for health care that is frayed,” said Stephen Epstein, an emergency care physician at Beth Israel Deaconess Medical Center in Boston.

Epstein was a member of the American College of Emergency Physicians task force that studied the nation’s emergency care. Its report was released Tuesday.

The report measured access to medical care, quality and patient safety, public health and injury prevention, and the medical liability environment.

Idaho earned “D” grades in all areas. Washington received a D in quality and patient safety, a B-minus in public health and injury prevention and a D-minus in medical liability. Overall, Washington was graded D-plus.

In Idaho, specific problems noted by the panel were comparatively low spending on health care and public health insurance, and a low per capita number of registered nurses and trauma centers. Idaho’s grade also suffered from the high number of unvaccinated adults in the state.

Though Idaho’s low population and large geographic area put it at a disadvantage – most rural states fared badly in the report – the statistics were adjusted to take population into account, said Angela Gardner, the task force chairwoman. Still, she said, the report identifies several things state leaders could do to improve Idaho’s grade.

“These are large, rural areas, so how many trauma centers can you have in Idaho, realistically? But on the other hand, there are some changes that lawmakers could make that don’t have a lot to do with being rural,” Gardner said. “A seat belt law could be enacted, and given those vast expanses of highways, that might be a good decision to make – especially since there aren’t a lot of trauma centers in Idaho.”

But Steve Millard, the president of the Idaho Hospital Association, said much of the report appeared to be based on old or inaccurate data. For instance, the report recommended that Idaho enact a $250,000 liability award cap on noneconomic damages in malpractice cases. The state did enact such a cap a few years ago.

“The dollars spent don’t necessarily translate into services or a lack of services,” Millard said. Idaho hospitals treat the insured and the uninsured alike, and Idaho ambulances pick up the injured, regardless of their ability to pay, he said.

“So to suggest that lack of funding leads to poorer emergency care just doesn’t wash,” he said. “There’s 4,500 EMS (emergency medical service) providers in the entire state. That’s a lot of EMS folks, and that means access.”

For Washington’s report card, the panel noted that an earlier lack of statewide training for natural disasters and biological and chemical attacks has been improving at least in urban areas. Additional training would improve the state’s grade in quality and patient safety to about a B.

Washington ranked 47th in the nation in annual per capital spending on hospital care, and 49th for its contributions to health insurance programs for poor children.

Washington’s grade in health and injury prevention was helped by its bicycle helmet laws, seat belt usage enforcement, and immunization rates.

Concerning medical liability, “The state still needs to create a legal environment that supports its medical community. A $250,000 cap on noneconomic damages would greatly improve the state’s medical liability environment,” the report said.

Nationwide, the panel found a system that is overcrowded, with access to emergency care declining and with poor capacity to deal with public health or terrorist disasters.

“Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly that isn’t the case,” said Frederick C. Blum, president of the physicians group.

Overall, California, Massachusetts, Connecticut and the District of Columbia were rated best in emergency care, while the lowest grades went to Utah, Idaho and Arkansas.