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On July 17, 2021, a tourist trolley in St. Augustine, Florida, owned by Historic Tours of America flipped onto its side due its operator driving the trolley at an excessive speed.  The overturned trolley ejected multiple passengers and pinned others between the trolley and the road surface.  There are reports of numerous serious injuries.

The trolley had a total of three cars linked to a single engine.  The car that flipped was the rear trolley car.  Apparently, the driver attempted to “whip” the third trolley, presumably to provide a thrill to those passengers.  Witnesses have reported that the driver quickly accelerated as he turned into the parking lot for the Oldest House near the intersection of Charlotte and St. Francis streets. The driver has not been charged; however, the St. Augustine Police Department has referred charges for reckless driving to the State Attorneys office.

From the civil justice standpoint of our St. Augustine personal injury attorneys, the injured passengers will have claims against Historic Tours of America and its driver, whose name has not been published. Those who were injured will be entitled to recover for their medical bills, lost wages and pain and suffering.  In all likelihood, Historic Tours of America will have a large liability insurance policy or policies in place, likely with coverage limits in the $5m to $10m range. Historic Tours of America is a fairly large company that operates tourist trolleys in St. Augustine, Key West, San Diego, Nashville, Savannah, Washington DC and Boston.

This completely avoidable accident calls into question both the hiring and training practices of Historic Tours of America.  While Historic Tours of America is already responsible for the negligence of its driver, the complete factual background could give rise to punitive damages depending on the driving history and capabilities of the driver.  Also, as driving a three car trolley is much different than operating a normal passenger vehicle, sufficient training must be provided.  This is especially the case in St. Augustine which has numerous traffic difficulties including: congestion; narrow streets; numerous pedestrians; horse and buggies; and traffic snarls caused by the periodic raising of the Lions Bridge.

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The spine is probably the most commonly injured body part in accidents of all kinds.  As St. Augustine car accident attorneys, we see the result of spinal injuries far too often.  Spinal pain can be disabling and can be caused by injuries to intervertebral discs, ligaments and facet joints. Thankfully, medical practitioners have a host of alternatives that can help alleviate this pain.

Treating conservatively at first, people with neck or back pain are typically sent to physical therapy.  If physical therapy is not successful, the doctors may try medications to reduce inflammation or to decrease pain.

When a patient has unrelenting spinal pain, or if they have pain, numbness or tingling radiating into an extremity, doctors will often order magnetic resonance imaging, commonly referred to as an “MRI.”  MRIs are helpful in that they show the shape of the intervertebral discs, while x-rays do not.  MRIs can reveal a person suffered injury including bulging and herniated discs.

Patients with painful disc injuries are often referred to pain management physicians who commonly perform epidural steroid injections as a first effort.  If the disc itself is causing pain or pushing on the spinal cord or a nerve root, epidurals can be helpful.  However, more often than not, with our accident clients we see little long term symptom relief with epidurals.  If the doctor still suspects the injured disc to be the source of pain, the patient is typically then referred to a surgeon.

However, often we find that the facet joints are the source of the pain.  Facet joints are tiny joints where the vertebral spinous processes (the wing shaped extension of bone on the back side of each vertebra) connect with the vertebrae above and below.  Pain management doctors inject pain medication into the facet joints to determine if the joint is causing the pain.

Next, a medial branch block can be performed.  This is a diagnostic procedure during which short lived anesthetic is used to determine whether the nerves injected were causing the patient’s pain.  If they provide relief, medial branch blocks only last a matter of hours.  However, once the nerves that are generating pain have been identified, radio frequency ablations can then be used to deaden the offending nerve.

Using heat generated by radiofrequency waves, RFAs are used to sever the pain generating nerves.  The beneficial effects usually take several days to take effect.  Eventually, the nerve will regenerate and pain will return. This process usually takes about 6 to 8 months as the patient reports the gradual return of pain.

Cost is a significant factor to be mindful of when handling a personal injury claim involving RFAs.  Since the procedures cost several thousand dollars and must be repeated every 6 to 8 months, the expense of future RFAs can be astronomical. For example, we recently had a life care plan performed to determine the future medical expenses for our 45 year old client whose neck was injured in a rear end collision. RFAs almost completely eliminated his pain for months at a time and allowed him to return to normal life.  This helped to prove the honesty of the client as a person who is exaggerating would not report the near resolution of pain.  The life care plan revealed that the client will incur more than $300,000.00 for this future medical care.  This evidence was presented at mediation and the case resolved for over 10 times the amount previously offered by the insurer.

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In late March, Governor DeSantis signed Senate Bill 72 into law providing vast protections for nursing homes from liability for Covid infections.  The law applies to more than just nursing homes, it also applies to hospitals, schools, churches and state governmental agencies. As Jacksonville nursing home lawyers, our focus is on the effect this will have for residents or family members who suffered personal injury or death due to Covid infections.

Not surprisingly, we saw some of the worst outbreaks of Covid at the worst nursing homes in Jacksonville.  Nevertheless, nursing homes that were more careless than others may see no repercussions for their failure to respond to Covid.  We do not think that any legal protection from Covid claims was necessary for nursing homes.  Infectious disease concerns are nothing new in the nursing home realm.  Nursing homes must be constantly vigilant for contagious infections including: clostridium difficile (“c diff”); scabies; certain urinary tract infections; and tuberculosis, to name a few.

The new law provides many obstacles for a claimant asserting the nursing home ignored Covid concerns.  First, the claimant must establish that the nursing home was “grossly negligent.”  Normally, a plaintiff in a nursing home neglect lawsuit provide oridinary negligence, i.e., that the nursing home failed to meet general nursing standards of care.  Now, presumably, a nursing home operator that neglected coronavirus issues will not be responsible for residents who were unnecessarily infected, provided the nursing home operator did not act “grossly” negligent.

The difference is much more than semantics.  Instead of merely having to prove that the nursing home failed to satisfy general nursing home standards, the plaintiff must now prove that the nursing home operators had a deliberate and reckless disregard for the safety and reasonable treatment of residents.

Furthermore, a claimant must now obtain an affidavit from a physician and file that affidavit when suit is filed.  Previously, a claimant merely had to have the matter reviewed by a registered nurse. This makes the process more difficult and expensive for the nursing home attorneys representing nursing home injury cases related to Covid.  Our attorneys handling nursing home injury claims in Jacksonville front all costs associated with prosecuting a claim, but, at the end of the case, the money we spend is paid back from any settlement or judgment. So, we try to mindful of the expenses we incur as we pursue a case.

Once suit is filed, the court is required to make an initial determination whether the plaintiff pled the complaint with “particularity” (which means more facts than normal are required) and whether the defendant made a good faith effort to comply with government issued health standards. If the court finds that the nursing home operator made a good faith effort, the nursing home will be immune from liability and the lawsuit will be dismissed.

The burden of proof is on the claimant to establish that the nursing home operator failed to make a “good faith effort” to comply with the Covid health standards. If a court determines that the nursing home operator made a “good faith effort” to comply, then the nursing home is immune from civil liability.  What constitutes good faith will be determined on a case by case basis and the trial court’s determination in this regard will be very hard to overturn on appeal.

The law also applies retroactively, creating a one-year statute of limitations for all Covid claims. Normally, nursing home neglect claims have a two year statute of limitations. Continue reading

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Jacksonville, Clay County and Flagler County have a total of six nursing homes operated by Consulate Healthcare, which is a large national chain. In northeast Florida, Consulate operates: Harts Harbor Health and Rehabilitation; San Jose Health and Rehabilitation; Consulate Healthcare of Jacksonville; Governors Creek Health and Rehabilitation; Consulate Health Care of Orange Park; and Grand Oaks Health and Rehabilitation Center.

Our Jacksonville nursing home neglect lawyers have handled many cases against Consulate facilities, including five wrongful death cases.  Previously, our lawyers blogged about Consulate’s nursing homes’ poor rankings in 2019 and Consulate’s poor nursing home rankings in 2018.

Consulate manages many of its nursing homes through a company called “CMC II, LLC.”  Several years back, a judgment was entered against CMC II, LLC and several other Consulate entities in relation to a claim brought against it by a whistleblower alleging Medicare billing fraud.  After originally being set aside by the trial judge, last year the 11th Circuit Court of Appeals reinstated the judgment in excess of $257 million. This judgment led to the bankruptcy filing.

The Effect of CMC II’s Bankruptcy Filing on Nursing Home Neglect Cases

Ever since the judgment was reinstated, nursing home neglect lawyers have been uncertain what would become of CMC II, LLC, along with uncertainty about the pending claims against it for nursing home neglect or abuse.  Days before learning that CMC II, LLC, filed bankruptcy, we filed a wrongful death suit against the San Jose Health and Rehabilitation nursing home in Jacksonville.  Thankfully, we sued both the licensee and CMC II, LLC.  The licensee was a company related to CMC II, LLC; however, the licensee did not file bankruptcy.  As such, we are able to move forward with the lawsuit against the licensee, but the case against CMC II, LLC, is subject to the bankruptcy automatic stay provisions, meaning the lawsuit cannot move forward.

Each nursing home operated by Consulate has its own separate LLC, which is usually named after the address of the nursing home. For example, Governor’s Creek Health and Rehabilitation is a Consulate nursing home in Green Cove Springs.  The licensee for Governors Creek is 803 Oak Street Operations, LLC, which is a Consulate entity.  So, at least for the time being, our suits against Consulate nursing homes will proceed against the licensee LLC and not against the management company, CMC II, LLC.  The effect that this will have on future litigation is unknown.

Suspect you may have a claim against a Consulate nursing home?

As Jacksonville nursing home abuse lawyers, we typically receive calls from a concerned family member of a nursing home resident.  Often, family members have a suspicion that neglect occurred, without knowing exactly what happened.  If we agree that something does not seem right, we will obtain and review the nursing home records.  Typically, the injuries at issue will require EMT and hospital care.  We typically get those records as well.

If, after reviewing the records, we think there is a potential basis for a neglect claim, we will incur the expense of having a registered nurse review the records to determine whether the appropriate nursing standards of care were met.  If not, we typically accept the case at that point and initiate the claim process. Continue reading

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Three bicyclists were hit by a vehicle on US 1 at 2:30 am last Sunday.  Tragically, one of the bicyclists was killed and the other two suffered serious injuries.  It has been reported that all three were wearing helmets and were riding in the bike lane when they were struck.  The bicyclists were riding North on US 1, south of St. Augustine near the intersection with I-95.  The vehicle driver was driving in the outside lane before striking the bicyclists.  The bicyclists were involved in a bicycle adventure race.

St. Johns County Bicycle Accident Lawyers

Unfortunately, St. Johns County and St. Augustine have seen more than their fair share of serious bicycle accidents, many of them deadly.  With St. Johns county being close to Jacksonville, yet more rural, many people bike on St. Johns County roadways including US 1 and A1A.  While there is an extended bike path alongside State Road 207, there are not many other options for long distance road biking without traffic concerns.

The National Highway Traffic Safety Administration keeps statistics on bicycle accident deaths.  In 2018, there were 857 bicyclist deaths in collisions with vehicles nationwide.  Thirty-seven percent of these collisions involved alcohol consumed by either the vehicle driver or the bicyclist.  Fifty percent of the collisions happened at night.

Of all the states, Florida had the highest number of deaths at 151, followed by California and Texas.  Taking population into consideration, Florida also had the highest number of bicyclist deaths in the country with a rate of 7.56 deaths per 1 million residents.

Clearly there is more to be done to decrease these collisions.  Drivers can avoid collisions with bicyclists by: maintaining a proper lookout for bicyclists; providing three feet of clearance when passing bicyclists; avoiding distractions while driving; and obeying the rules of the road.

As bike accident attorneys in St. Augustine, we know all too well how serious the injuries are that result from a collision with a car or truck.  These injuries can be prevented by bicyclists by: wearing bright clothing, preferably with reflective patches when biking at night; obeying traffic laws as if driving a vehicle; wearing a helmet; using roadways with designated bike lanes; and by using front and tail lights at night.

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Nursing Home Ratings – St. Augustine Nursing Home Injury Attorneys

Every skilled nursing facility in the country that accepts payment from Medicare or Medicaid is rated by the Centers for Medicare and Medicaid Services (“CMS”) on a scale of one to five stars. St. Johns County has eight nursing homes.  The surrounding counties of Flagler and Putnam have two nursing homes each.  Three of the nursing homes in St. Johns County, one nursing home in Flagler County, and both of the nursing homes in Putnam County have poor ratings from CMS.

In St. Johns County, St. Augustine Health and Rehabilitation Center received two stars and the Clyde Vassen State Veterans Nursing Home received two stars.  In Flagler County, Grand Oaks Health and Rehabilitation received a one star rating. In Putnam County, Solaris Healthcare Palatka received a one star rating and Windsor Care and Rehab had no rating provided.  Rather, the following advisement is provided: This facility is not rated due to a history of serious quality issues and is included in the special focus facility program.”  The special focus program provides periodic inspections and recommendations in an effort to enhance the quality of care provided at the nursing home.  It may be best to steer clear of this nursing home until it has earned a better rating.

How Nursing Home Ratings are Determined

CMS’ nursing home ratings are based on numerous factors including: health inspections; staffing; and quality of resident care.  Health inspections are performed by state nursing home regulators employed by Florida’s Agency for Healthcare Administration.  Such inspections include complaint inspections; periodic health inspections; and infection control inspections.  The rating for staffing is based on: the number of hours LPNs and RNs are working on a per resident per day basis; the number of certified nurse assistants working on a per resident per day basis; and the working hours of physical therapists working on per resident per day basis. Quality of resident care considers the frequency that residents have to be sent to an emergency room, the number of residents who develop bedsores or suffer worsening bedsores, the percentage of residents whose mobility is increased and the number of residents who required antipsychotic medication for the first time in their lives.

As nursing home neglect and abuse lawyers in St. Augustine, we have found the rating system to be a fair, although not perfect, indicator of nursing home quality.  For example, we have only brought one claim against a five star facility. In comparison we have brought multiple claims against many of the one and two star facilities in the greater Jacksonville area.

We highly recommend that you include the CMS ratings when making a decision about which nursing home is best.  In addition to the ratings, we recommend you tour the facility before admission.  While doing so, look for telltale signs such as: whether the facility has an unpleasant smell; whether the floors, walls and bathrooms are clean; whether the nursing staff seems stressed and hurried; and the level of hygiene being provided to the residents.

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Earlier this week, Florida Highway Patrol reported a fatal crash on Interstate 95 in St. Johns County.  According to FHP, one person died and two other people suffered critical injuries in a multi vehicle crash.  The crash occurred when a sport utility vehicle traveling north crossed the grass median and collided with a tractor trailer headed south.  After the initial impact, a sedan travelling south collided with the SUV.  At least one vehicle caught fire.  FHP has not given any indication why the SUV crossed the median. Our condolences go out to all of those affected by this terrible crash.

As St. Augustine car accident attorneys, we have repeatedly written about the disproportionate number of fatal accidents that happen in the St. Johns County section of I-95 as reflected in our webpage titled “Car Accident Attorneys in St. Johns County.” Unfortunately, the portion of I-95 in Florida is considered the most dangerous interstate in the country with the Jacksonville portion representing the fifth most dangerous section of interstate in the country.

We cannot be sure why there are so many serious accidents on the St. Johns County section of I-95. Perhaps one reason is that there is frequent traffic congestion in this area due to traffic heading into, and coming out of, Jacksonville, which is directly north of St. Johns County.  Construction along this portion of I-95 may also be a factor.  Of course, texting and other distractions by cell phones have also become a very common cause for collisions in recent years.

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The Lawrence Law Group is proud to announce it has opened an office in St. Johns County located at 2225 Florida A1A, Suite C-16, St. Augustine Beach, FL 32080.  This location is on the west side of A1A, just south of the intersection with State Road 312. This location is convenient to all residents of St. Augustine and is a short drive from the hospital and majority of the medical facilities just south of downtown.  Expanding into St. Augustine is a natural result of Greg Lawrence’s move from Jacksonville Beach to North Beach, near Vilano.

As St. Augustine personal injury lawyers, we are familiar with local medical providers including primary care physicians, physical therapists, surgeons, pain management specialists and chiropractors.  As not all doctors will accept automobile personal injury protection insurance, it can be very helpful for an injured person to get a referral to a doctor who does.

We are also familiar with the intersections where car and truck crashes occur, the nursing homes, tourist attractions, businesses and hotels where accidents take place. Having this familiarity helps us understand how your accident happened and who may be liable to compensate you for your injuries, disability, lost wages and medical bills.

Our attorneys have handled personal injury cases in St. Augustine for years including: car accidents; tourist injuries; bicycle accidents; slip, trips or falls at business locations; injuries at hotels; and nursing home abuse. Previously, we handled these claims out of our Jacksonville office.  Now, clients can meet with us in St. Augustine.

St. Augustine has a number of areas where accidents tend to occur.  First, there are several intersections and roadways that have more than their fair share of auto accidents, including: State Road 16 and U.S 1; County Road 312 and U.S. 1; County Road 312 and A1A; and Interstate 95.  Bicycle accidents are unfortunately common on both A1A and U.S. 1.  With its high volume of tourists, St. Augustine also has a lot of accidents that happen in hotels including stairway accidents, preventable criminal assaults, and slip, trip and falls. Tourists also suffer injuries from scooter and bicycle rentals and when being struck by a vehicle while walking.

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Florida is well known as a place for retirees. What comes with that is an abundance of long term care facilities, also known as nursing homes or skilled nursing facilities.  In general, nursing home residents are at a very high risk of dying if they contract the cornonavirus due to their age and preexisting health issues.

To date, over 3,000 residents of Florida nursing homes have died from Covid.  This figure represents approximately 40% of Florida’s Covid deaths.  This is, of course, hugely disproportionate as less than 4% of Florida’s population resides in nursing homes at any one time. This demonstrates that more needs to be done.

Last week, the nursing homes located in St. Augustine, Jacksonville and the rest of Northeast Florida, reported 22 Covid deaths.  Before last week, the highest weekly total was 11.  So far, 109 Northeast Florida nursing home residents have died due to Covid.

Complicating the fight against coronavirus in nursing homes is that staff members, especially CNAs and LPNs, see many residents each day.  CNAs perform or assist with many of the personal activities of daily living, like eating, bathing, toileting and transferring in and out of bed.  Because of the close nature of this personal care, CNAs can easily spread the virus from one resident to another.

It is necessary that nursing homes take special precautions to ensure that none of its staff members bring coronavirus into the facilities.  Staff members who have the virus but asymptomatic present a disaster in the making.  Nursing homes must mandate mask wearing by its employees, must test even asymptomatic employees on a frequent basis, must provide (and require the use of) personal protective equipment for each resident to whom a staff member provides care.  Staff members must also be questioned daily on whether they have been in contact with anyone who has tested positive and whether they have had any symptoms consistent with Covid.  Of course, their temperatures must be taken before each work shift.  In addition, residents who test positive should be kept isolated from other residents.

Without these measures in place, nursing homes will continue to be hotbeds of Covid infections and death.  Whether nursing homes will be held liable for preventable Covid infections remains unknown due to the length of time it takes for a nursing home case to be litigated.  Furthermore, there has been mention of the possibility of legislation providing immunity for health care providers for coronavirus infections and resulting injuries or death.  Whether such legislation would violate constitutional rights to seek redress in the court system remains uncertain.  We do know from prior legislation that caps limiting damages have been held to be constitutional.  Lower caps would make nursing home claims economically infeasible due to the high expense in prosecuting nursing home cases and would effectively amount to a ban on such cases. Continue reading

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As of June 16, 2020, Duval County, Florida (Jacksonville), has had 59 deaths due to the coronavirus.  In all, there have been 2194 people diagnosed in Jacksonville with Covid.  Tragically, one Jacksonville nursing home has accounted for 30% of the Covid deaths in the county, which translates to 18 people.  That nursing home, Signature Healthcare of Jacksonville, is located at 2061 Hyde Park Road, Jacksonville, FL, 32210.

While nursing homes may represent one of the most challenging environments for dealing with the coronavirus, nursing home operators must respond accordingly.  It is simply not satisfactory for a nursing home to claim that the situation is difficult and that, as a result, it is not responsible for failing to appropriately respond to the virus. Our Jacksonville nursing home abuse attorneys have handled many claims against local nursing homes for failing to prevent or treat infections and we have seen many egregious situations.

The US Centers for Disease Control has issued guidelines for nursing homes dealing with coronavirus concerns.  Among the CDC’s “core practices” are the following: 1. assign at least one person with training in infection control to provide on-site management of the facility’s infection protection and control program; 2. report Covid cases to the national database on a weekly basis; 3. educate all residents, staff and other persons entering the facility about the precautions; 4. implement source control measures (all heathcare providers should wear facemasks and residents should wear masks when leaving their rooms); 5. have a plan for visitor restrictions; 6. create a plan for testing residents and health care providers; 7. manage healthcare personnel (sick leave policies, excluding non-essential personnel, and screening employees for infection by taking temperatures); 8. provide sufficient supplies of hand sanitizer, masks and personal protective equipment; 9. segregate a space in the facility for caring for residents with covid; 10. create a plan for dealing with the admission of new residents whose Covid status is unknown; and 11. evaluate and manage residents with Covid.

Some nursing homes will respond better than others to the coronavirus.  We have a feeling we already know which ones are going to do the worst, and, frankly, that is a shame.   Most often when we see neglect, we find out that the nursing home was understaffed.  Understaffing in nursing homes will only make coronavirus all the more deadly as overworked nurses and assistants try to juggle more than they can handle.  Continue reading

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