Pennsylvania gets mixed grades for access and quality of emergency care


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Pennsylvania's overall national ranking for supporting emergency care has improved, but the state remains "kind of at a stalemate" as far as making progress in key problem areas.

"Almost daily, we operate at a full capacity and a continuous state of crisis," said Charles Barbera, president of the Pennsylvania chapter of the American College of Emergency Physicians.

What's more, he added, the problem may only get worse because emergency room visits are expected to rise as more people gain insurance coverage under the Affordable Care Act while some emergency departments close.

Dr. Barbera's comments Thursday followed the release of the American College of Emergency Physicians' national report, which ranked Pennsylvania sixth on the strength of access and quality of care, up from 23rd in the last report released in 2009.

The report gave the state an overall grade of C+, however, citing its unfavorable medical liability environment and ongoing bed capacity problems, particularly for psychiatric patients.

In individual categories, Pennsylvania dropped to 17th place for disaster preparedness, down from a fourth-place ranking in 2009. The report attributed that to "heavy declines" in intensive care unit and other emergency department beds, plus a drop in the proportion of nurses who said they had received training in disaster preparedness.

High infant mortality rates and poisoning deaths led to a C- grade for public health and injury prevention, and the report also found that Pennsylvania has an above-average rate of smoking among adults.

Its best grade, an A and third-place ranking nationally, came in the category of quality and patient safety environment based on Pennsylvania's statewide systems and policies for treating heart attack, stroke and trauma patients.

Pennsylvania's lowest score, an F, was for its unfavorable medical liability environment as the eventual phase-out of the Mcare liability insurance program could force doctors and hospitals to assume the program's anticipated $1.3 billion unfunded liability needed for future judgments and settlements. The program is re-evaluated by the Pennsylvania Insurance Department every two years.

A related issue noted by Bruce MacLeod, director of West Penn Hospital's emergency department and current president of the Pennsylvania Medical Society, is that emergency room physicians are held to the same liability standards as primary care physicians and surgeons, even though they may need to treat patients without knowing their medical histories.

"We have not kept up with the rest of the country" in protecting ER doctors, Dr. MacLeod said, by instituting a "clear and convincing" threshold for proving negligence.

The physicians also favor a statewide registry for psychiatric beds so appropriate placements can be found quickly. Currently, Dr. MacLeod said, patients with mental health problems may go to the nearest emergency room and wait 16 to 24 hours for a bed in a psychiatric unit.

"It clearly is not the best care."

A copy of the report can be viewed on the Pennsylvania Medical Society's website at http://www.pamedsoc.org/mediarelations

Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


Steve Twedt: stwedt@post-gazette.com or 412-263-1963. First Published January 16, 2014 11:20 AM

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