Medical care in emergencies gets low marks.

Byline: Tim Christie The Register-Guard

The nation's system of emergency medicine is overcrowded and ill-prepared to deal with public health or terrorist disasters, according to a report card to be released today.

Oregon's system earned a C-minus grade, the same as the average grade given to the nation's emergency medicine system by the American College of Emergency Physicians. Overall, Oregon ranked 35th for its support of emergency medicine.

"The emergency health care system's in serious condition,'' said Boston emergency physician Stephen Epstein, a member of the task force that studied the nation's emergency care. `We have a safety net for health care that is frayed.'

California, Massachusetts, Connecticut and the District of Columbia were rated best in emergency care. The lowest grades went to Utah, Idaho and Arkansas.

Oregon's C-minus was based on grades in four areas: A C-plus for access to emergency care; a D for quality and patient safety; a B-plus for public health and injury prevention; and a D-minus for medical liability environment.

The report said Oregon ranked 40th in the ratio of registered nurses to population; 49th for the ratio of staffed hospital beds to population; 48th for annual per capita expenditure on hospital care; 42nd for annual payments per fee-for-service enrollee in Medicare; and 40th in annual state contributions to the State Children's Health Insurance Program.

Oregon also lags in the emergency medicine residency programs and percentage of the population with access to advanced life support services.

On the positive side, Oregon ranked eighth among all states for its public health and injury prevention programs, and had the lowest percentage of traffic fatalities in which no restraint was used. The state also ranked fourth for annual emergency visits per board-certified emergency physician; seventh in board certified emergency physicians per 100,000 people; and eighth for trauma centers per 1 million people.

Kathleen Barr, manager of the McKenzie-Willamette Medical Center emergency room and an ER nurse for 30 years, said she was not surprised by Oregon's C-minus grade.

"Emergency departments have been struggling for years to meet the needs of the public. They've been overcrowded and underbedded for years."

As more people lose access to insurance coverage and primary health care, more turn to ERs for primary care, Barr said.

Portland emergency physician John Moorhead, past president of ACEP and the Oregon Medical Association, said overcrowding of ERs is an overriding issue.

"Access is a major issue and the biggest threat to Oregon citizens," he said. "If we can't accommodate day-to-day traffic, we're certainly not well-pre- pared to deal with some major unforeseen disaster."

Policymakers should view ERs as extension of public safety, such as fire and police services, and provide some public funding, he said.

"Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly that isn't the case," said Dr. Frederick Blum, president of the physicians' group.

The number of emergency departments has declined by 14 percent nationwide since 1993 despite an increasing number of people coming to them for treatment, the report said.

Hurricane Katrina showed the critical need for surge capacity in emergency medical care when a disaster occurs, the report noted. In addition, people suffering from the flu crowd emergency rooms every year.

The compact District of Columbia, which includes several emergency care centers, ranked first for access to emergency care, along with Connecticut, Maine, Massachusetts, Ohio, Pennsylvania and Rhode Island. No state received a failing mark for access.

Emergency patients tend to be sicker and more unstable than others, causing some specialists to be reluctant to see them because of the higher liability and higher malpractice insurance rates, said Epstein, the Boston doctor and task force member.

The result is that some specialists, such as neurosurgeons, leave certain states or refuse to provide emergency care.

In addition to access to emergency care, the report also looked at quality of care, efforts to prevent injuries and improve public health so emergency care wouldn't be needed, and the medical liability climate in states, such as caps on noneconomic damage awards and protection for physicians who provide emergency care.

The Associated Press contributed to this report