PROVIDENCE – A new report card on emergency medicine ranks Rhode Island second in the nation, tied with the District of Columbia for a “B-” grade overall. Massachusetts came in first, scoring a “B,” while the nation as a whole received a “C-.”

The report card, issued last week by the American College of Emergency Physicians, paints a bleak picture of emergency medicine across the country, with conditions worsening as economic woes and a failing health care system drive more people to rely on emergency rooms for care.

Demand for emergency care is growing due to the economy and also because of the aging population, Gardner noted, and “emergency departments are already crowded to the point where patients experience life-threatening delays in care. With crowding forecasts described as ‘catastrophic’ in the near future, the time for action is now.”

But while the same trends affect Rhode Island, which also ranks high in national studies of ER use, the report card found conditions are better here than elsewhere.

The state got an “A” for quality and patient safety (as did Massachusetts), a “B+” for public health and injury prevention and for disaster preparedness, and a “B-” for access – but an “F” for the medical liability environment, a reflection of the state’s resistance to tort reform.

In a news release, Dr. Gary Bubly, president of the Rhode Island Chapter of ACEP, expressed pride in the No. 2 overall ranking, but added: “If the state does not enact medical liability reform, we may lose physicians to states with better environments, which will hurt access for our patients.”

The Rhode Island Association for Justice, meanwhile, a group that includes trial lawyers who have fought tort-reform efforts as potentially harmful to patients’ rights, issued a statement arguing that patient safety is actually enhanced by patients’ ability to sue when there’s a lapse in safety practices. The ACEP report actually backs this up, the group noted, with the 10 states with the “best liability environment” also scoring “D+” on safety.

Rhode Island’s relatively high score on access – it ranked 10th in the nation – was attributed in part to its extensive work force, with the second-highest rate of emergency physicians per capita (18.4 per 100,000 people) and a very high rate of specialists such as neurosurgeons, orthopedists and hand surgeons.

Rhode Island’s seventh-place ranking in quality and patient safety was attributed to its high rate of emergency medicine residents (44.4 per one million people), a funded state EMS medical director position, and a statewide trauma registry.

High immunization rates among older adults, adequate funding for injury prevention programs and low rates of fatal occupation injuries and homicide and suicides all contributed to Rhode Island’s No. 8 ranking in public health and injury prevention, ACEP said.

The Rhode Island report card made several recommendations for improvement, including to register more doctors and nurses in the Emergency System for Advance Registration of Volunteer Health Professionals program and to address the state’s high rate of untreated substance abuse with more programs, treatment centers and mental health care professionals.