Hospital Acquired Conditions Not Reimbursed by Medicaid or Medicare Often Constitute Medical Malpractice in Oregon

Medicaid recently announced a policy of not paying for certain medical conditions typically not present on admission, but only acquired in the hospital due to poor care, and thus could reasonably have been prevented (see sample coverage here). The new policy mirrors that of Medicare, which has already been refusing to reimburse hospitals for such conditions as of October 2008. The list of conditions is as follows:

Foreign Object Retained After Surgery
Air Embolism
Blood Incompatibility
Pressure Ulcers
Falls and Trauma (Fractures, Dislocations, Intracranial Injuries, Crushing Injuries, Burns, Electric Shock)
Manifestations of Poor Glycemic Control
Catheter-Associated Urinary Tract Infection (UTI)
Vascular Catheter-Associated Infection
Surgical Site Infection Following: Coronary Artery Bypass Graft, Bariatric Surgery, Orthopedic Procedures
Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

Under Oregon law, many of these conditions will constitute medical malpractice – the only question being whether expert testimony will be required to demonstrate negligence.

For example, it is well settled in Oregon that it is within the capability of a jury to ascertain that medical malpractice exists when a foreign object is left behind in a patient’s body after surgery without the benefit of a medical expert witness. See, e.g., Fieux v. Cardiovascular & Thoracic Clinic, P.C., 159 Or.App. 637, 978 P.2d 429 (Court of Appeals of Oregon, 1999).

On the other hand, the cause of a condition like pressure ulcers may require an expert witness.

An experienced medical malpractice attorney can help you navigate these and other complex issues of proof to position your case as effectively as possible for settlement or trial.

About the Author

Tom D'Amore is the founder of D'Amore Law Group and a trial attorney with over 30 years of experience representing injured people and their families across the West Coast, securing more than $325 million in recoveries. He handles cases involving car accidents, trucking accidents, construction injuries, medical malpractice, and sexual abuse. Licensed in Oregon, Washington, and California, Tom is the only NBTA board-certified truck accident attorney in Oregon. He is a national Board of Governors member, past Executive Committee member, and past Budget and Audit Chair of the American Association for Justice, as well as past President of the Oregon Trial Lawyers Association and an Eagle member of the Washington State Association for Justice.