The nation's emergency care system is ailing, warns a new health care analysis that gives Utah a D, one of the lowest grades in the country.

The report by an American College of Emergency Physicians task force studied the nation's emergency care. Its report describes a system that is overcrowded, with access to emergency care declining and with 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 chief recommendations for Utah: Spend more on hospital care, increase the number of registered nurses and create more hospital beds.

The report includes the first-ever national survey on diversion - how often overloaded hospitals must send patients elsewhere. Only 10 states keep diversion numbers, which the college says are crucial to understanding the scope of "this rapidly growing symptom of the gridlock in emergency departments."

Utah does not track diversions, but health care providers say it is not a significant problem in Utah.

"Occasionally, there are times when we divert to [University Health Care] or the U. diverts to us because of capacity issues," said Jess Gomez, spokesman for LDS Hospital in Salt Lake City. "You don't want to overload one center."

Gomez said Intermountain Healthcare is expanding its Level 1 Trauma Center emergency room hospital beds from 24 at LDS Hospital to 56 at Intermountain Medical Center in Murray, which is set to open in late 2007.

"We thing that will increase access to trauma services and decrease the time it takes to transport people because it is in the center of the valley," he said.

He said the additional beds should alleviate the need to divert patients to University Hospital during busy times.

Eric Barton, chief of emergency medicine for University Health Care, said the number of emergency room visits at University Hospital has risen by 20 percent over the past five years. To keep up with the demand, the hospital increased its emergency room beds from 20 to 27 and plans to add observation beds.

The U. and LDS Hospital also started a new emergency medical residency program last year.

"We want to be able to provide our patients with board-certified physicians who are locally trained as we continue to grow in the future," Barton said.

Regarding a large disaster, Barton said: "It's hard to be prepared for every contingency, but we have developed internal disaster plans."

Utah also fared poorly when it came to certain Medicare and Medicaid spending. Beneficiaries who are turned away by doctors wind up in hospital emergency rooms, which must absorb the costs of treating them, argues a Utah lawmaker who wants to boost reimbursement rates to doctors who treat these patients.

Legislation sponsored by Rep. Steve Mascaro, R-West Jordan, also would permanently set aside an extra $2.7 million for children's dental services, bringing reimbursement to 75 percent of market rates.

Marc Babitz, director of the Utah Department of Health's Division of Health Systems Improvement, was surprised by Utah's poor grades and said the report contained inaccuracies. For example, the report said the state doesn't train hospital personnel for response to disasters, biological attacks and chemical attacks.

"We do that and will continue to do that," Babitz said. "There's lots of room for interpretation. There's a lot of generalities [in the report] and no benchmark that is proven to improve health. I'm not saying there are not areas where we could improve, but one of the problems there is money."

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

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

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

Emergency patients tend to be sicker and more unstable than others, making some specialists reluctant to see them because of the higher liability and higher malpractice insurance rates, said task force member Stephen Epstein, an emergency care physician in Boston. 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.

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Tribune reporter Carey Hamilton contributed to this story.