Emergency care in Maine eighth in U.S.

Need emergency health care? If you live in Maine, chances are good that the treatment you’ll receive in your local hospital’s emergency department will be just about the best in the nation.

That’s the conclusion of a yearlong survey of emergency health care systems in each of the 50 states and the District of Columbia, released Tuesday morning by the American Academy of Emergency Physicians.

According to the study report, emergency care in Maine ranks eighth behind California, Massachusetts, Connecticut, the District of Columbia, South Carolina, Michigan and Pennsylvania.

States were scored in four areas: access to emergency care; quality and patient safety; public health and injury prevention; and medical liability environment. Maine scored an A for access to care, receiving high marks for the number of hospital emergency departments and the number of board-certified emergency department physicians per capita. Strong state support for providing Medicaid coverage to children also won points.

In the quality and patient safety category, Maine scored a C-plus. Credit was given for the high percentage of ambulance services with advanced life support capability, the widespread access to emergency 911 telephone service, and disaster response training opportunities for health care professionals. Maine lost points for not having more opportunities for medical residents to practice emergency care.

The report awarded Maine a grade of C-minus in the area of public health and injury prevention, faulting the state’s lack of a motorcycle helmet law and the percentage of traffic fatalities in which no seat belts or other physical restraints were in use. The survey also found that only 78 percent of Maine children between 19 and 35 months old were adequately immunized. Maine received high scores for having a high percentage of live births and for the number of adults age 65 and older receiving flu and pneumococcal vaccines.

Maine’s medical liability environment earned a score of D from the physician group’s report. Specifically, the state was advised to enact a $250,000 cap on noneconomic jury awards in medical malpractice cases. Maine’s pretrial screening process, which eliminates a number of malpractice suits before they get started, was among the factors that kept the state from failing this category altogether.

Physicians and health officials in Maine were quick to support the need for medical liability reform. Retired physician Dr. Dennis Shubert, who heads the state’s effort to define a comprehensive statewide health plan, said unchecked malpractice awards force doctors to pay higher insurance premiums, a cost they have no choice but to pass on to patients in one form or another. “In Maine, it presents a real recruiting challenge,” he said.

Dr. Kevin Kendall, president of the Maine chapter of the American College of Emergency Physicians, agreed. “Our insurance costs are going through the roof,” he said Tuesday afternoon. Because he is employed at Central Maine Medical Center in Lewiston, his insurance premiums are paid by the hospital. He estimated CMMC spends $30,000 each year to insure his practice. “We really need to get a handle on these costs,” he said.

Gordon Smith, executive director of the Maine Medical Association, said his organization has been trying for more than 20 years to pass legislation that would make it easier for all physicians to practice in Maine. “It’s largely a partisan issue,” he said Tuesday afternoon. “It’s virtually impossible to get liability reform passed in a Democratic legislature.” Most of Maine’ s roughly 200 emergency room physicians experienced a 30 percent increase in their liability insurance rates effective Oct. 1, 2005, Smith said.

At Eastern Maine Medical Center in Bangor, Dr. Eric Steele, vice president for patient care, also endorsed liability reform. In the future, he said, “the number one challenge for the provision of emergency department care in rural Maine will be having enough emergency physicians available. Almost every emergency department I know in Maine is short.”

In addition to capping noneconomic awards at $250,000, Steele said, physicians who practice according to established guidelines should have some protection from lawsuits.

Steele also pointed out the report’s criticism of Maine’s failure to enact a motorcycle helmet law or enforce seat belt laws adequately. “There’s no question that Maine suffers many unnecessary injuries due to the absence of helmets and seat belts,” he said. “Anyone who says otherwise is thinking wishfully and flat-out wrong.”

Dr. Dora Ann Mills, director of Maine’s Bureau of Health, said she was surprised at the report’s finding of low childhood immunization rates. Maine’s immunization rate, which in the late 1990s was the highest in the country, has declined in recent years, she admitted.

But Mills thinks the low 78 percent immunization rate reported in the study is inaccurate. Some states require children to receive more vaccines than Maine does, she said, and if the study included those vaccines, it would misrepresent Maine’s compliance rate.

Mills said the state has held back from increasing the number of immunizations it recommends for children because parents are already reluctant to subject their children to a barrage of uncomfortable injections. A growing number of Maine parents also are needlessly wary of all vaccines, she said, because they fear the mercury-based preservative used in some will cause autism or other health problems. Mills said the state soon will launch a television campaign to encourage parents to seek immunizations for their children.