Although Montana has worked to create a favorable Medical Liability Environment, the state must address an array of serious problems including high rates of fatal occupational injuries and traffic fatalities, and a lack of disaster training requirements for EMS and essential hospital personnel.
Strengths. With regard to the Medical Liability Environment, Montana has average medical liability insurance premiums for primary care physicians ($14,256) and specialists ($68,279) that are slightly lower than the averages across the states ($16,042 and $65,489, respectively). The state has also passed a variety of liability reforms. Montana has imposed a $250,000 medical liability cap on non-economic damages, has partially abolished joint and several liability, requires expert witnesses to be of the same specialty as the defendant, and has imposed mandatory pretrial screening panels.
Despite its vast frontier areas, Montana has a number of positive indicators regarding Access to Emergency Care. The state ranks among the top 10 for its high rates of emergency departments (54.9 per 1 million people), pediatric specialty centers (8.4 per 1 million people), and staffed inpatient beds (495.4 per 100,000 people). The state also has relatively high rates of orthopedists and hand surgeons (11.7 per 100,000 people) and neurosurgeons (2.2 per 100,000). In contrast, however, the state has low rates of emergency physicians, including board-certified emergency physicians; plastic surgeons; ear, nose, and throat specialists; and registered nurses per capita.
Challenges. The state’s poor performance with regard to the Quality and Patient Safety Environment reflects numerous issues, including the lack of a funded state EMS medical director position and a uniform system for providing pre-arrival instructions, as well as a disproportionately low percentage of counties that have Enhanced 911 capability. In addition, the state lacks adverse event and hospital-based infections reporting requirements. Montana hospitals have also shown relatively low use of computerized practitioner order entry and electronic medical records, for which the state ranks 48th.
Montana faces numerous challenges related to Public Health and Injury Prevention. The state has among the five highest rates of traffic fatalities (27.8 per 100,000 people), homicides and suicides (25.6 per 100,000), and fatal occupational injuries (103.1 per 1 million workers). Despite the state’s high immunization rates for influenza and pneumonia among the older adult population, Montana has the third lowest percentage of children aged 19-35 months who are up-to-date on their immunizations (73.6 percent).
While Montana benefits from a relatively high level of federal funding for Disaster Preparedness ($14.90 per capita), this category poses a number of problems for the state. The state has an all-hazards medical response plan; however, there is no written plan for the coordination of the State Emergency Operations Center or local emergency management agencies to provide security to hospitals during an emergency event. The state also lacks written plans specifically for patients with special needs, dialysis patients, and those needing medications for chronic conditions. Montana has also failed to implement a “just-in-time” training system and statewide patient and victim tracking systems. While the state ranks first in the nation for bed surge capacity (1,761.2 per 1 million people), Montana lacks any burn unit beds and has an average number of ICU beds (294.7 per 1 million).
Recommendations. To improve the state of emergency medicine throughout Montana, the state should invest more fully in tools, programs, and systems to promote greater disaster preparedness and coordination, improve injury prevention and public health outcomes, and effectively monitor the quality and safety environment.
Despite the strong effort Montana has made to institute effective and meaningful medical liability reforms, the state’s average malpractice award remains slightly higher than the average across the states ($287,944 versus $285,218). The state should consider instituting further reforms, such as providing additional liability protections for EMTALA-mandated emergency care, which could also help draw more specialists and emergency physicians to the state, filling that critical need.