California moved into the top half of the nation with a rank of 23rd and a grade of C- in the 2014 American College of Emergency Physicians’ state-by-state report card on America’s emergency care environment (“Report Card”). The state still ranked near the bottom of the country at 42nd with an F in the category of Access to Emergency Care, the same grade it received in 2009. In 2009, California received a D+ and ranked 37th in the nation.
“Californians are known for being fit and health-conscious, which is reflected in the good grade we received for Public Health and Injury Prevention, but the lack of access to timely emergency care is troubling,” said Dr. Thomas Sugarman, president of CAL/ACEP. “Our huge and diverse state has complex problems that create barriers to medical care. Our state legislators need to make access to emergency care a top priority.”
The biggest contributors to California’s failing grade in the category of Access to Emergency Care are hospital and workforce shortages. The state has the lowest number of emergency departments per person and an inadequate number of hospital beds, as well as shortages of orthopedists, hand surgeons and registered nurses. Nearly one-quarter of adults in California (22.7 percent) lacks health insurance. To improve its grade, California must invest in increasing the health care workforce and expanding the supply of emergency departments and staffed inpatient and psychiatric beds, according to the Report Card.
The state received ‘C-’s in both the categories of Quality and Patient Safety Environment and Disaster Preparedness. California lacks a statewide trauma registry and a uniform system for providing pre-arrival instructions. According to the Report Card, given that the state is prone to natural disasters such as earthquakes and fires, it needs to implement statewide systems and procedures to ensure that all citizens are protected in the event of a disaster.
California’s C+ in Medical Liability Environment could be improved by pretrial screening panels to discourage frivolous lawsuits. The state’s best grade, a B+ for Public Health and Injury Prevention, was due to low rates of smoking and obesity, strong seat belt and safety belt legislation, and outstanding trauma care located within 60 minutes of nearly everyone in the state.
“California’s emergency departments are overcrowded, and people are waiting more than five hours for care,” said Dr. Sugarman. “For a state rich in so many things, we are poor in our ability to deliver care to emergency patients. The best medicine in the world can’t help you if you can’t get to it in a timely manner.”
“America’s Emergency Care Environment: A State-by-State Report Card – 2014” evaluates conditions under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers. It has 136 measures in five categories: access to emergency care (30 percent of the grade), quality and patient safety (20 percent), medical liability environment (20 percent), public health and injury prevention (15 percent) and disaster preparedness (15 percent). While America earned an overall mediocre grade of C- on the Report Card issued in 2009, this year the country received a near-failing grade of D+.
ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing 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.