Kentucky's emergency rooms rank among the worst in the nation, but health officials say it's policy, not patient care, that accounts for the low score.
"The report isn't a judgment on the quality of care," said Dr. Ryan Stanton, a member of the American College of Emergency Physicians, which released a state-by-state report card this month.
Kentucky ranked 47th, dropping from 44th when the last report was issued in 2009. The reports covered not only quality of care but access to care, public health, disaster preparedness and medical liability.
Across the board the report showed there is work to be done in emergency rooms. Top ranking District of Columbia received only a B- score and the national average, according to the report, as a D+. Kentucky scored a D overall.
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There were some bright spots for the state. Kentucky scored 12th for access to care, said Stanton, who practices emergency medicine in Kentucky.
But, he said, the state suffered because of a failing grade for issues surrounding medical liability. Stanton said current law allows for unqualified experts to testify in malpractice cases on behalf of patients and families. Kentucky, he said, has "a terrible state of medical liability."
The fear of an unfounded lawsuit can keep emergency room doctors from coming to Kentucky to practice, he said.
A newly formed group made up of health care organizations and business groups called the Care First Kentucky Coalition, is pushing for legislation this year that would create medical panels to review proposed claims against health care providers before lawsuits are filed. Similar legislation has failed to pass in previous sessions.
Dick Bartlett, emergency preparedness/trauma coordinator for the Kentucky Hospital Association, said the malpractice issues have been tough to deal with.
But, he said, the report doesn't reflect a lot of work that is going on to improve Kentucky's emergency rooms.
For example, there is a ongoing movement to standardize trauma protocols among first responders, such as EMTs, and hospital emergency rooms throughout the state, he said.
Because of the geography of the mountains and the remote locations of some folks in rural areas, Kentucky faces some special challenges, he said, adding that while the state had only three designated trauma centers in 2008, there are now 11.
"I believe we are going in the right direction," he said.