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									The National Report Card on the State of Emergency Medicine                                                                           SC
        South Carolina                                                                                                                 C
Despite having relatively good Quality and       tively high rate of traffic fatalities (24.0 per
Patient Safety and Medical Liability Envi-       100,000 people), 50.0 percent of which                                        RANK   GRADE
ronments, South Carolina needs to address        are alcohol-related. While South Carolina
some significant public health concerns          is successful in immunizing a relatively
                                                                                                    ACCESS TO
and the ability of patients to access the care   high percentage of children aged 19–35                                          45       F
                                                                                                    EMERGENCY CARE
they need.                                       months, the state falls well below the na-
                                                 tional rate with regard to vaccinating older
Strengths. South Carolina has instituted         adults. Fewer than 63 percent of adults            QUALITY & PATIENT SAFETY
a number of effective medical liability re-      aged 65 and older receive the influenza            ENVIRONMENT                  16       B+
forms over the years which contribute to         vaccine, while only 61.5 percent have ever
the state’s success in this category. South      received the pneumococcal vaccine.
Carolina is one of only six states that pro-                                                        MEDICAL LIABILITY
                                                                                                    ENVIRONMENT                   5       A
vide additional liability protections for        A number of aspects of Access to Emergency
EMTALA-mandated emergency care, and              Care in South Carolina may be negatively
one of only four states that have imple-         affecting the population’s health outcomes.        PUBLIC HEALTH & INJURY
mented all three of the following expert         The state, like many others, is facing a           PREVENTION                   50       F
witness rules: case certification, requiring     workforce shortage in many areas, includ-
witnesses to be of the same specialty as the     ing primary care, mental health, and spe-
defendant, and requiring or providing for        cialty medicine. For instance, South Caro-         DISASTER
                                                                                                    PREPAREDNESS                 34       C
witnesses to be licensed to practice medi-       lina needs an additional 123.0 full-time
cine in the state.                               equivalent primary care providers to serve
                                                 its population, as well as an additional
While South Carolina does not excel with         33.3 mental health providers. While the            OVERALL                      26       C
regard to Disaster Preparedness, the state       state’s Medicaid fee levels for office visits
has made noteworthy strides in this area,        are 111.8 percent of the national average,
despite receiving relatively low levels of       South Carolina has seen a 21.0 percent de-
federal funding ($6.91 per capita). The          cline in reimbursement rates since 2004.           South Carolina could improve its Qual-
state has written plans for special needs pa-                                                       ity and Patient Safety Environment further
tients, as well as a written plan to supply Recommendations. South Carolina                         by focusing on its emergency medical sys-
dialysis for patients during a disaster. In should work to address the numerous                     tems. A funded state EMS medical direc-
addition, South Carolina has a state-based  public health risk factors present, includ-             tor could lend considerable expertise in
Emergency System for Advance Registra-      ing obesity, the high infant mortality rate,            this area.
tion of Volunteer Health Professionals      and the low rates of vaccination among
(ESAR-VHP) program and civil liability      older adults. South Carolina might con-                 While the state continues to have a good
protections for health care workers during  sider tackling these issues through social              Medical Liability Environment, South Car-
a disaster event.                           marketing campaigns, interventions, and                 olina must be vigilant in maintaining this
                                            improving access to medical care, especial-             environment that is critical in helping to
Challenges. South Carolina scores poorly ly with regard to minorities and the older                 provide on-call specialist care. Additional
on a number of public health indica- population, who may face additional bar-                       enhancements are possible, including low-
tors. The state has                                             riers to care. As part of           ering the cap on non-economic damages
the fourth highest South Carolina should the effort to reduce bar-                                  to $250,000, completely abolishing joint
infant     mortality
rate in the nation
                        work to address the riers to access, South
                                                                Carolina should work
                                                                                                    and several liability, and instituting man-
                                                                                                    datory pretrial screening panels.
(9.4 per 1,000 live numerous public health to reverse the declin-
births), well above
the national rate of risk factors present in reimbursement rates
                                                                ing trend in Medicaid

6.9 per 1,000 live the state.                                   for office visits and in-
births, and nearly                                              crease the number of
30 percent of South Carolina’s adult popu- physicians accepting Medicare (2.4 per
lation is obese. The state also has a rela- 100 beneficiaries).




For additional information, visit www.acep.org.                                                                                               97
The National Report Card on the State of Emergency Medicine                                                               SOUTH CAROLINA: INDICATORS

                                                        QUAliTy & PATiEnT SAFETy
ACCESS TO EMErGEnCy CArE                           F    EnVirOnMEnT                                        B+    DiSASTEr PrEPArEDnESS                                   C
Board-certified emergency physicians per                Funding for quality improvement within                   Per capita federal disaster
100,000 pop.                                     8.7    the EMS system                                     Yes   preparedness funds                                 $6.91
Emergency physicians per 100,000 pop.           11.8    Funded state EMS medical director                   No   Disaster preparedness funds used
Neurosurgeons per 100,000 pop.                   1.4    Emergency medicine residents per                         specifically for health care-related
                                                        1M pop.                                           6.6    preparedness are tracked                              Yes
Orthopedists and hand surgeon specialists
per 100,000 pop.                                 8.8    Adverse event reporting required                  Yes    All-hazards medical response plan or ESF-8
                                                        Hospital-based infections reporting                      plan?                                                 Yes
Plastic surgeons per 100,000 pop.                1.8
                                                        required                                          Yes    Plan shared with all EMS and essential
ENT specialists per 100,000 pop.                 3.1
                                                        Mandatory quality reporting requirement                  hospital personnel?                                   Yes
Registered nurses per 100,000 pop.             809.2                                                      Yes
                                                        % of counties with E-911 capability                      Public health and emergency physician
Additional primary care FTEs needed            123.0                                                    100.0
                                                                                                                 input into the state planning process             Yes, No
Additional mental health FTEs needed            33.3    Uniform system for providing pre-arrival
                                                        instructions                                             Public health and emergency physician
Level I or II trauma centers per 1M pop.                                                                   No
                                                 1.1                                                             input into the daily operations of the SEOC Yes, No
                                                        State has or is working on a stroke system
% of population within 60 minutes of Level                                                                       Written plan for the coordination of the
                                                        of care                                            Yes
I or II trauma center                           79.2                                                             SEOC or local EMAs to provide security to
                                                        State has or is working on a PCI network or              hospitals in case of emergency events                  No
Accredited chest pain centers per 1M pop.        1.6    a STEMI system of care                             Yes
% of population with an unmet need for                                                                           Number of drills and exercises conducted
                                                        Statewide trauma registry                          Yes   involving hospital personnel, equipment, or
substance abuse treatment                         8.2
                                                        % of hospitals with computerized                         facilities                                             47
Pediatric specialty centers per 1M pop.           2.1   practitioner order entry                         21.9    Accredited by the Emergency Management
Physicians accepting Medicare per 100
                                                        % of hospitals with electronic medical                   Accreditation Program                       Conditionally
beneficiaries                                     2.4   records                                          63.5    Written plan specifically for special needs
Medicaid fee levels for office visits as a %
                                                        % of patients with acute myocardial                      patients                                              Yes
of the national average                        111.8    infarction given PCI within 90 minutes of                Written plan to supply medications
% change in Medicaid fees for office visits             arrival                                            55
(2004-05 to 2007)                              -21.0
                                                                                                                 for chronic conditions                                 No
                                                        Number of Joint Commission reviewed                      Written plan to supply dialysis
% of adults with no health insurance            17.6    sentinel events per 1M pop. (1995–2006)            15    for patients                                          Yes
% of children with no health insurance          10.7
                                                                                                                 Real-time notification system in place
% of adults with Medicaid                        8.7                                                             to notify identified health care providers of
Emergency departments per 1M pop.               13.9    PUBliC HEAlTH & injUry                                   an event                                              Yes
Hospital closures in 2006                          0
                                                        PrEVEnTiOn                                          F
                                                                                                                 “Just-in-time” training systems in place      Statewide
Staffed inpatient beds per 100,000 pop.                 Traffic fatalities per 100,000 pop.               24.0
                                               311.8                                                             Statewide medical communication system
Hospital occupancy rate per 100 staffed                 % of traffic fatalities alcohol related       	50.0     with one layer of redundancy                           No
beds                                            71.1    Front occupant restraint use (%)                  74.5   Statewide patient tracking system                     Yes
Psychiatric care beds per 100,000 pop.          25.7    Helmet use required for all motorcycle                   Statewide victim tracking system                       No
State collects data on diversion                        riders                                          	No
                                                 No                                                              Statewide real-time or near real-time
                                                        Child safety seat/seat belt legislation                  syndromic surveillance system                         Yes
MEDiCAl liABiliTy EnVirOnMEnT                           (10 points possible)                                 6
                                                   A                                                             Real-time surveillance system in place for
Lawyers per 10,000 pop.                                 % of children immunized, aged                            common ED presentations
                                                11.9                                                                                                                   Yes
                                                        19–35 months                                      83.2
Lawyers per physician                             0.5                                                            Bed surge capacity per 1M pop.                     791.6
                                                        % of adults aged 65+ who received flu
Lawyers per emergency physician                   9.9   vaccine in the last 12 months                            Burn unit beds per 1M pop.                            1.6
                                                                                                          62.9
ATRA judicial hellholes (range 0 to -7)             0   % of adults aged 65+ who ever received                   ICU beds per 1M pop.                               316.2
Malpractice award payments/100,000 pop.           1.2   pneumococcal vaccine                              61.5   Verified burn centers per 1M pop.                     0.0
Average malpractice award payments          $218,482    Fatal occupational injuries per                          State able to verify credentials and assign
Databank reports per 1,000 physicians           23.6    1M workers                                        58.9   volunteer health professionals to four
Patient compensation fund                               Homicides and suicides (non-motor vehicle)               ESAR-VHP levels                                       Yes
                                              	Yes
Health court pilot project grant                        per 100,000 pop.                                  19.9   Nurses registered in ESAR-VHP per
                                                  No
                                                        Unintentional fall-related fatal injuries                1M pop.                                             73.3
Number of insurers writing medical liability
policies per 1,000 physicians                           per 100,000 pop.                                   4.9   Physicians registered in ESAR-VHP per 1M
                                                  5.0
                                                        Unintentional fire/burn-related fatal injuries           pop.                                                12.9
Average medical liability insurance
premium for primary care physicians                     per 100,000 pop.                                   2.2   Training required in disaster management
                                              $9,788
                                                        Unintentional firearm-related fatal                      and response to bio- and chem terrorism
Average medical liability insurance                                                                              for essential hospital personnel, EMS
premiums for specialists                     $40,936    injuries per 100,000 pop.                          0.6
                                                                                                                 personnel                                        Yes, Yes
Pretrial screening panels                         No    Gun-purchasing legislation
                                                        (8 points possible)                                  1
                                                                                                                 State or regional strike teams or medical
Are pretrial screening panels’ findings                                                                          assistance teams                                      Yes
admissible as evidence?                          N/A    % of tobacco settlement funds
                                                        spent on health-related services                         Additional liability protections for health
Periodic payments                                                                                                care workers during a disaster                  Yes, civil
                                                        and programs                                     100.0
                                                        Total injury prevention funds                            % of RNs that received any emergency
                                                  No                                                             training                                            38.2
Medical liability cap on                                per 1,000 pop.                                 $186.97
                                            $350,001-                                                            State requires EMS and essential ED
non-economic damages                         500,000    Unintentional injury prevention funds
                                                        per 1,000 pop.                                  $63.38
                                                                                                                 personnel to be NIMS compliant                        Yes
Additional liability protection for EMTALA-
mandated emergency care                       	Yes     Intentional injury prevention funds
Joint and several liability abolished                   per 1,000 pop.                                   $0.00                 Improved since 2006
                                          	Partially
State provides for case certification                   Fall injury prevention funds per 1,000 pop. $0.00                      Worsened since 2006
                                                  Yes
Expert witness required to be of the same               Infant mortality rate per 1,000 live births        9.4            	 No change since 2006
specialty as the defendant                        Yes   % of adults with BMI > 30                         29.4
                                                                                                                          NR Not reported
Expert witness must be licensed to practice             Current smokers, % of adults                      22.3
medicine in the state                                   Binge alcohol drinkers, % of adults                               N/A Not applicable
                                                  Yes                                                     13.5
                                                                                                                          See Summary Statistics for State Comparisons

98                                                                                                                                        Report Card: South Carolina

								
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