WASHINGTON, D.C. - The nation's emergency care system itself is ailing, warns a new health care analysis that gives Illinois a "C" grade for emergency medicine. "The emergency health care system's in serious condition. We have a safety net for health care that is frayed," said Dr. Stephen Epstein, an emergency care physician at Beth Israel Deaconess Medical Center in Boston.

Epstein was a member of the American College of Emergency Physicians task force that studied the nation's emergency care. Their report was released Tuesday.

In Illinois, the panel cited a shrinking number of hospital beds able to admit seriously ill emergency room patients and a malpractice environment that discourages medical specialists from serving as emergency room consultants.

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, Epstein said.

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

Illinois ranked 13th in the nation in the number of board-certified emergency physicians per 100,000 people.

Dr. Tom Nielsen, an emergency physician at BroMenn Regional Medical Center and a member of American College of Emergency Physicians, said McLean County is probably closer to a "B" rating than many other areas of the state. He said he can't give the state an "A" because no state earned one.

Nielsen said Illinois' scores suffered because of public health and injury prevention issues, specifically those related vaccinations and immunization.

"This county, in general, would have a much higher level of immunizations for adults and kids than the general Illinois population," Nielsen said.

And he said access to emergency care in the Twin Cities is very good.

"We obviously have two different hospitals in town here that both have board-certified emergency physicians with good coverage," Nielsen said.

"We have double coverage at both hospitals - in other words, there are two physicians on duty at times - and then we actually have triple coverage over at BroMenn."

Despite reports of declining numbers of emergency hospital beds, Nielsen said the county has not seen the same decrease.

"We've actually increased the number of emergency beds, so we have much less waiting time relative to Chicago," Nielsen said.

But Nielsen said county physicians face the same problems as those in the rest of the state: lawsuits and rising malpractice insurance premiums. He said physicians want to care for all people, but the cost is driving many away.

"The physicians are not coming to Illinois anymore because of the malpractice climate," Nielsen said.

Nationwide, the panel found an overcrowded system, with declining access to emergency care and poor capacity to deal with public health or terrorist disasters.

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

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

Illinois' emergency room visits increased 14 percent between 1998 and 2004, while the number of hospital beds dropped by 11 percent during the same period, according to the American Hospital Association.

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.

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 non-economic damage awards and protection for physicians who provide emergency care.