State earns C-minus on emergency care system
Hawaii ranked near the bottom for hospital staffing
Hawaii has some of the country's lowest numbers of registered nurses, hospital-staffed beds and trauma centers per capita, earning the state a C-minus for its emergency medical care system, according to a national report released yesterday.
The state's grade is the same as the one the American College of Emergency Physicians gave the nation as a whole in The National Report Card on the State of Emergency Medicine. Hawaii was 34th among all 50 states and the District of Columbia.
But state Department of Health Director Chiyome Fukino disagrees with Hawaii's ranking.
"I think we're probably in the middle, probably the upper middle," Fukino said.
Even if Hawaii moved up in the ranking, its grade would have improved just slightly. The states in the middle received a grade of C.
ISLES GET C- FOR EMERGENCY CARE
Source: The National Report Card on the State of Emergency Medicine, American College of Emergency Physicians (www.acep.org)
|Access to emergency care
|Quality and patient safety
|Public health and injury prevention
|Medical liability environment
The grades and ranking were determined by how the states fared in 50 evaluation criteria divided into four categories, each weighted differently in the final grade.
No state received an A or F.
California, Massachusetts, Connecticut and the District of Columbia each received an overall grade of B, the highest awarded. Arkansas, Idaho and Utah each received an overall grade of D, the lowest given.
The Queen's Medical Center is the only trauma center in Hawaii. Fukino said the state is working to upgrade the level of service at Maui Memorial Medical Center to serve eventually as the state's second trauma center.
Fukino agreed the state has a shortage of registered nurses, which is closely related to the number of hospital beds.
But she said low numbers in both measures is not necessarily a bad thing, since it means the beds are being used and providing income for hospitals. She said hospitals on the mainland are shutting down because they are underutilized.
Other criteria that contributed to Hawaii's low overall grade include how much it pays for services for each Medicare member -- the lowest in the country -- and its lack of a "hard" cap on non-economic damages for medical liability. The state has a cap on damages, but there are exceptions, the report said.
Fukino said the state's annual Medicare payments are historically lower than the rest of the country because its elderly population is healthier.
And she said a lack of limits to medical liability leads to decreased access to health care as doctors close or move their practices to other states.* But she said tort reform provides the greatest potential for improving Hawaii's emergency care system.
The report did list some of the state's bright spots, including its best-in-the-nation ranking for annual emergency visits per board-certified physicians, the second-highest number of board-certified emergency physicians per capita and its availability to advanced life-support ambulance service -- ninth-highest in the country.
Sunday, January 15, 2006
» State Health Director Chiyome Fukino said a lack of limits to medical liability leads to decreased access to health care as doctors close or move their practices to other states. An article on Page A1 on Wednesday incorrectly quoted Fukino as saying that limits on liability leads to decreased access.