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TALLAHASSEE-- A shortage of emergency departments and trauma centers, a poor medical liability environment, and weak public health and injury prevention efforts resulted in an overall C- grade for Florida, in the first comprehensive analysis of how much support states provide for their emergency medical care systems.
Florida shared its below-average standing with 12 other states, including Mississippi, Louisiana and Kentucky, in the American College of Emergency Physicians' (ACEP) National Report Card on the State of Emergency Medicine. The full report can be found at http://www.acep.org/.
All 50 states and the District of Columbia received an overall grade on a scale of A-F, plus separate weighted grades in four categories: Access to Emergency Care (40 percent), Quality of Care and Patient Safety (25 percent), Public Health and Injury Prevention (10 percent), and Medical Liability Environment (25 percent). ACEP began this intensive effort of grading the states more than a year ago by appointing a task force of experts. The task force developed 50 objective and quantifiable criteria to measure the performance of each state and the District of Columbia. Grades were then assigned based on a comparison to the best state's performance using weighted and aggregated measures.
In the most heavily weighted category, Access to Emergency Care, Florida earned a C- grade; 40 other states rated higher in this category. The report found Florida lacks emergency facilities, ranking near the bottom of the nation for its shortage of emergency departments and trauma centers. However, the state recently passed legislation appropriating additional funding for trauma care, which should improve the state's future Access grade. Despite Florida's healthy spending on health insurance for the elderly and children, the report found it still has a large uninsured population; only nine other states have larger populations without health insurance.
"The uninsured often wait until they are very sick before seeking care in emergency departments, and since much of the care provided to them goes uncompensated, hospitals are drained of the very resources needed to care for them," said Dr. Jorge Lopez, president of the Florida College of Emergency Physicians (FCEP), ACEP's state chapter. "Combine the uncompensated care burden with underpayment from private and public insurance and you get the current environment: overcrowded emergency departments, a lack of inpatient beds and a shortage of medical specialists."
In addition, in the Access category, Florida also was found to have a shortage of board-certified emergency physicians and registered nurses, which further shrinks the system's capacity to handle the growing demand for emergency care. The report's researchers noted, though, that a new emergency medicine residency program has been established in Tampa, and an additional residency program will begin in 2006 in Gainesville through the University of Florida. While these additional residency programs should increase the number of emergency physicians here, Florida's medical liability environment is forcing many of those residents out of state upon graduation, the report's researchers said.
Florida received its lowest grade of D- in the Public Health and Injury Prevention category, partly because it lacks primary seat belt law enforcement and an all-rider motorcycle helmet law, which may explain the state's high number of traffic fatalities. Florida also ranked last among all states for its small percentage of senior citizens receiving a flu vaccine, and 45th in the nation for its small number of older adults receiving their pneumococcal vaccine.
"The low vaccination rate among Florida's seniors is likely contributing to the state's high number of hospital admissions from emergency departments," said Dr. Lopez. "With flu season upon us, the state should make awareness programs about the importance of vaccinations a top priority given our lack of capacity to handle a huge influx of flu and pneumonia patients in our ERs."
Dr. Lopez urged Floridians to visit http://www.acep.org/ to ask policymakers to address the deficiencies outlined in the report card to protect their access to lifesaving emergency care.
In the Quality of Care and Patient Safety category, Florida earned a B- grade. The state provides training to hospital personnel for response to disaster including biological and chemical terrorist attacks. The state also does an excellent job of providing the majority of its citizens with access to Enhanced 911 services and advanced life support ambulances. In addition, all the pre-hospital personnel staffing those ambulances have access to online medical direction.
"FCEP applauds state policymakers for making Florida a national leader in disaster preparedness, which significantly raised the state's Quality of Care and Patient Safety grade," said Dr. Lopez.
For its Medical Liability Environment, Florida received a D grade. It earned critical marks in this category because Florida physicians have experienced huge hikes in their medical liability insurance rates over the last few years, resulting in some physicians leaving the state and others decreasing their availability to emergency departments. In the face of this dilemma, the report card found little has been done to improve the state's legal climate. Although legislation passed in 2003 giving emergency physicians and on-call specialists a $150,000 non-pierceable cap on non-economic damages, the law has yet to withstand an expected constitutional challenge and has not yet had an effect on curbing the rising medical liability insurance rates.
"FCEP urges state policymakers to ensure Florida's citizens have access to medical specialists in an emergency by enacting comprehensive medical liability reform legislation," said Dr. Lopez. "While the state has passed some medical liability reforms, they have not been fully tested in the courts, and it is still unclear whether they will affect insurance rates.
The Florida College of Emergency Physicians is the state chapter of ACEP, the national medical specialty society representing emergency medicine with more than 23,000 members. ACEP is committed to improving the quality of emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. 1-11-06
© 2005 North
Country Gazette
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