A wide array of problems plagues the emergency care environment in Oklahoma which receives poor or failing scores in four of the five categories and ranks among the bottom 10 states in Disaster Preparedness and the Quality and Patient Safety Environment.
Strengths. Oklahoma supports a relatively favorable Medical Liability Environment. The state deserves to be credited as being one of only six that provide some additional liability protections for EMTALA-mandated emergency care. The state also requires case certification by an expert witness to determine whether the case has merit. The average malpractice award payment ($230,787) is significantly lower than average across the states ($285,218).
While Oklahoma fares poorly overall with respect to Public Health and Injury Prevention, there are some noteworthy high points. The state has a relatively low percentage of adults who engage in binge drinking (13.4 percent) as well as a low percentage of traffic fatalities involving alcohol (34.0 percent). The state also has a relatively high percentage of adults aged 65 and older who have ever received the pneumococcal vaccine (70.2 percent).
Challenges. The Quality and Patient Safety Environment in Oklahoma could benefit from substantial improvement. The state does not provide funding for quality improvement within the EMS system. Perhaps reflective of the lack of financial support is the low percentage of counties with Enhanced 911 capability (76.9 percent) and the lack of a uniform system for providing pre-arrival instructions. The state should be credited, however, for the establishment of an allopathic emergency medicine residency program since the release of the 2006 Report Card. (The data presented reflect the 2006-2007 school year, prior to residents entering the new program).
Access to Emergency Care in Oklahoma is plagued by a workforce shortage and a high rate of uninsured adults. While the new emergency medicine residency program may improve the workforce issue in the future, the state currently ranks among the bottom 10 for low rates of emergency physicians; orthopedists and hand surgeons; plastic surgeons; ear, nose, and throat specialists; and registered nurses. Oklahoma ranks in the bottom ten for the number of Level I or II trauma centers per 1 million people and almost one-third of the population does not live within 60 minutes of a Level I or II trauma center. More than 21 percent of Oklahoma’s adult population is uninsured compared to 17.2 percent of adults nationwide.
Oklahoma’s Disaster Preparedness grade suffers from a lack of real-time surveillance and communication systems, as well as a lack of planning for special needs patients. Oklahoma does not have patient or victim tracking systems or a real-time syndromic surveillance system. The state also lacks a statewide medical communication system with one layer of redundancy. Oklahoma could also benefit from implementing written plans specifically for special needs patients, for supplying medications for chronic conditions, and for supplying dialysis to patients during a disaster event.
Recommendations. As noted above, Oklahoma suffers from a severe shortage of specialists and nurses. These issues have likely contributed to hospital crowding and the boarding of patients in emergency departments, which have been reported as serious concerns by emergency physicians in the state. Oklahoma should act immediately to address these issues and work toward attracting, recruiting, and maintaining a broader workforce. The state should also continue to support the maintenance and expansion of emergency medicine residency programs in the state.
The state must take action with regard to the high rates of uninsured children and adults. Patients who are unable to find affordable health insurance are less likely to be able to access preventive care and treatments and may delay necessary care until it has reached emergency status, further contributing to crowding. Access to preventive care, however, is also dependent upon a workforce sizeable enough to care for the entire population.
While the Medical Liability Environment is generally favorable compared to other states, Oklahoma may further improve in this area by implementing additional expert witness rules and a $250,000 hard cap on non-economic damages. Such actions may decrease insurance premiums and encourage specialists to remain in or relocate to the state. The state may want to strengthen existing liability protections for providers of EMTALA mandated-care to help encourage specialists to provide on-call services to emergency patients.