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Hospital Acquired Conditions Not Reimbursed by Medicaid or Medicare Often Constitute Medical Malpractice in Oregon
Tuesday, August 2nd, 2011

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.

1 Comment » Comments on this Entry

One Response to “Hospital Acquired Conditions Not Reimbursed by Medicaid or Medicare Often Constitute Medical Malpractice in Oregon”

  1. A hospital or surgeon can be sued for medical malpractice, which would result in a substantial increase in insurance premiums.

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