State gets poor marks for emergency medicine

When it comes to the state of emergency-medicine systems around the country, there really isn't much good news.

At least, that's the assessment of the American College of Emergency Physicians (ACEP), a group of more than 23,000 emergency-medicine doctors, which has given the country a C- in its first "National Report Card on the State of Emergency Medicine."

And Washington did even worse, getting a D+ and ranking 40th in the nation.

The state's emergency medicine got a relatively good grade in "public health and injury prevention." But it got bad grades in access to emergency care, quality and patient safety, and the medical-liability environment.

The group rated 42 criteria, such as the number of registered nurses and board-certified emergency physicians per capita, the prevalence of injury-prevention programs, state funding of health insurance, and liability reforms.

"All of these issues are so intertwined it's hard to say it's just one issue," said Dr. Dean Gushee, president of the state chapter of ACEP, which sent delegates to Olympia on Tuesday to ask lawmakers for changes to the system.

Read the report

American College of Emergency Physicians: www.acep.org

For example, low reimbursement for Medicaid and Medicare, combined with poor liability protection, discourages specialists from treating emergency patients, Gushee said. And a lot of uninsured people seeking care in emergency rooms, along with a nursing shortage, creates a "major safety issue" for patients, he said.

One of the group's delegates to Olympia, Dr. John Milne, an emergency physician at Swedish Medical Center in Seattle, said Washington's low grade is a "grave indication of just how frayed our state's health-care safety net has become."

The doctors are asking lawmakers to raise the burden of proof in malpractice lawsuits against emergency-medicine providers. They're also seeking more funding for training nurses and providing disaster training for hospital workers, and more funding for public health insurance.

Washington's Medicare reimbursement rate ranks 40th in the nation, the report said, and state contribution to the State Children's Health Insurance Program (SCHIP) ranks 49th.

The report gave Washington a D- for its "medical-liability environment." Last fall, voters turned down competing initiatives to change the medical-malpractice system.

Gushee noted that emergency physicians feel especially vulnerable to lawsuits because ER doctors must treat everyone who comes in, despite not knowing their medical histories or what medications they've taken, among other issues.

Firefighters and paramedics have immunity from malpractice lawsuits, he noted. "But once the patients cross my doorstep, I have unlimited liability," said Gushee, an emergency doctor at Mason General Hospital in Shelton, Mason County.

No state got an A grade overall. The best-performing were California, Massachusetts, Connecticut and the District of Columbia, which received B grades. The lowest were Arkansas, Idaho and Utah, with D's.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com