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Two certified nurse assistants working at the Macclenny Nursing and Rehab Center were arrested this week on charges of physically abusing a resident.  More specifically, the CNAs were accused of forcefully pushing the resident into her bed, pulling her up by a shirt wrapped around her neck, throwing her into a wheelchair and slapping her.  The resident is 85 years old, blind and suffering from a spinal injury.  The incident was captured on surveillance video footage.  The CNAs were fired.

Macclenny Nursing and Rehab Center is rated two out of five stars by the Centers for Medicaid and Medicare Services, which is considered “below average.”  It received only one star for “health inspections.”  Macclenny is located one county to the west of Jacksonville’s Duval County.  CMS’ website is located at www.medicare.gov/nursinghomecompare.

Video footage is much more common today than in the past and it is greatly changing how we perceive claims of abuse, whether it occurs in the context of nursing home care or the degree of forced used by law enforcement.  This is a very good thing. Our Jacksonville nursing home injury lawyers routinely investigate and prosecute nursing home abuse and neglect cases; however, unless there is video footage, situations in which intentional assault by nursing home staff can be proven is very rare.

When there is no footage of the actual abuse, these cases rarely see the light of day.  Often, the victims of abuse suffer from cognitive decline and make poor historians.  They may forget the abuse occurred or otherwise be unable to express themselves in a clear manner.  Of course, video footage changes all of this.

While it has not been reported how the video footage in this case was obtained, we have seen an increase in family members, who are suspicious of abuse, putting “nanny cams” in a resident’s room to catch an abuser.  News stories across the country reflect many instances of assault by nursing home staff being caught by hidden cameras.

When handling nursing home abuse cases, it is very important that an attorney investigate the hiring process used by the operators of the nursing home to determine the suitability of the candidate.  While criminal background checks are almost always done, is is common that contact to prior employers is not done.  When we contact those prior employers, we may learn of previous conduct on the part of the employee that would have been disqualifying had the nursing home performed its due diligence.

In addition, it is important to review other complaints of abuse against the same employees.  We often find that claims of abuse are not taken seriously by nursing home operators.  The failure to fully investigate prior allegations of abuse can lead to damning evidence against the managers and operators of the nursing home.

Macclenny Nursing and Rehab Center is a 120 bed nursing home operated by the Sovereign Healthcare Holdings, Inc., which manages 28 nursing homes in Florida and Georgia.  In the Northeast Florida area, Sovereign operates the following nursing homes: Jacksonville Nursing and Rehab Center located at 4134 Dunn Avenue Jacksonville;  Macclenny Nursing And Rehab Center located at 755 S 5th St, Macclenny; and Moultrie Creek Nursing And Rehab Center located at 200 Mariner Health Way in Saint Augustine.

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It is a common saying that a picture is worth a thousand words.  This saying is all the more true when trying to convey to a jury the pain and difficulty posed by various medical procedures.  Taking it a step further, if a picture is worth a thousand words, then video footage is worth an entire book.

Some people are “visual learners” meaning that they retain information best when they can view it.  For these people, a verbal explanation of injuries and medical procedures will have very little effect.  Other people learn by hearing information presented to them verbally.  Almost all people, however, learn most effectively when exposed to both verbal and visual information.

As Jacksonville injury lawyers, we have represented a multitude of clients who require pain management procedures.  Usually these cases involve injuries to the cervical or lumbar spine.  The pain management procedures include: epidural steroidal injections into the spine; nerve blocks; facet joint injections; and radiofrequency ablations.

If these procedures were described to you, they would certainly sound unpleasant; however, if I show you video footage of an epidural or radiofrequency ablation, you would probably cringe and wince.  In short, video footage of an invasive procedure makes a viewer feel something, whereas a description simply does not.

Florida has a prohibition on “golden rule” arguments at trial.  This means that a personal injury attorney cannot ask jurors to consider how  they would feel if they hand to endure the pain and medical procedures at issue.  Showing a video; however, is allowed, and the viewers cannot help but get a feeling of what it is like to endure these invasive procedures.

Because of this, when we have cases headed for trial, we make sure to have these types of procedures videotaped.  This, of course, takes coordination with the client’s pain management doctor and a videographer experienced in capturing the procedure without interfering with the doctor.  Finally, the video footage is shown at trial with the pain management doctor on the stand narrating the jury through the procedure steps.

Furthermore, using video footage of pain management procedures also helps to validate a person is genuinely suffering from severe pain.  These procedures are not simple and painless.  For example, an epidural steroid injection is inserted into the spinal canal and causes pain during and after the procedure, not to mention the serious side effects.  Is is hard to imagine someone would volunteer for such an invasive procedure if he or she was not in serious pain.

If you are in need of an injury lawyer in the Jacksonville area, we are happy to answer any questions about how we can demonstrate the full extent of your injuries to a jury, judge and mediator.

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As Jacksonville car accident lawyers, we see our fair share of  personal injury claims in which the insurer for the at-fault driver refuses to make a fair settlement offer.  A recent case we resolved highlights the consequences an insurer faces if the injured person’s attorney has the experience to set the foundation for a bad faith claim.

Our client suffered two herniated discs due to a head on, high impact, car crash in Jacksonville’s Arlington area.  Despite the severity of his injuries and his mounting medical bills, he gave the at-fault driver’s insurer the opportunity obtain a complete release of liability in his favor in exchange for payment of his minimal $25,000.00 bodily injury policy limit.  Instead, the insurer offered $9,000.00.  We stopped all negotiations and filed suit.  After years of litigation, the insurer agreed to pay our client $600,000.00 based on its exposure for a bad faith claim.

A “third party” bad faith claim allows an injured person to recover more than an alt-fault driver’s insurance coverage from that person’s auto insurer in limited circumstances.  Perhaps the easiest way to understand this is to place yourself in the shoes of the at-fault driver.  Imagine for an unpleasant moment that you made a mistake while driving and caused someone to suffer a badly broken leg.  Let’s say you had the foresight to purchase bodily injury insurance coverage just in case something like this were to happen.

Next, the person with the broken leg contacts your insurer and offers to settle all claims against you for the payment of the $100,000.00 in coverage that you purchased.  You are relieved to know you will be off the hook because that person’s medical bills alone after surgery came to $75,000.00, not to mention his or her entitlement to future medical expenses, lost wages, pain and suffering and disability.

Instead of settling the case, your insurer decides to “roll the dice” hoping that a jury will look unfavorably on the injured person.  The jury comes back with a judgment for $1.2 million.  Your insurer now pays the $100,000.00 in coverage, leaving a judgment against you for $1.1 million.  The judgment prevents you from selling real property (from which it would be paid first), negatively affects your credit, exposes you to collection activities (wage garnishments, seizure of value personal property, garnishment of bank or asset accounts) and post-judgment discovery to investigate the status of your assets.

You would rightfully be angry at your own auto insurance company.  It could have secured a release in your favor from all liability at no cost to you.  Instead, you are now going to be hounded by a judgment for decades to come. In this situation, the law allows for the injured person to obtain an assignment of your right to sue your auto insurer for failing to act in good faith in protecting you from having a judgment entered against you.  In so doing, the injured person can pursue the full amount of the judgment he or she received.

When our Jacksonville car accident lawyers provide a demand to an insurance company, we take specific steps designed to preserve the client’s right to seek bad faith damages in the future if the insurer does not make a fair offer.  To do so requires experience as there many nuances to accomplish this including creating a compelling and complete documentation of the personal injuries involved, the effects of those injuries, and the resulting medical expenses and lost wages.

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On April 9, 2019, a 71 year old veteran died after being attacked while residing at the St. Augustine Health and Rehabilitation nursing home.  The man’s 84 year old roommate was found on top of him striking him in the face and head.  The man was rushed to Orange Park Hospital and then to another hospital in Jacksonville; however, tragically, he died from his injuries.

According to the St. Johns County Sheriff’s Office, the medical examiner confirmed the man died from the attack due to blunt force trauma.  His injuries included a fractured skull, broken bones and injuries to his eyes.  The death has been ruled a homicide.

The victim had suffered a stroke years before that left him bed bound and partially paralyzed rendering him essentially defenseless. The reason for the attack has not been disclosed; however, the mental health of the other resident is, of course, being considered.

Tragic incidents such as this are largely preventable as an assault with this degree of violence is rarely a nursing home resident’s first sign of aggressive behavior.  Rather, aggression may begin with verbal threats and progress to physical acts such as shoving or pushing.  It is necessary that this type of behavior be recognized by nursing home staff and dealt with immediately in order to keep the other nursing home residents safe.

Resident on resident assaults can happen in nursing homes and steps must be taken by the nursing home operators in an effort to prevent these types of incidents.  Many nursing home residents suffer from a degree of dementia.  Some people suffering from dementia become aggressive even though they were never aggressive before.  As such, it is very important that nurses and nurse assistants at nursing homes are always on the lookout for aggressive behavior on the part of any resident in order that responsive measures can be taken to protect the other residents.

For a lawyer handling a resident on resident assault case against a nursing home, it is important to obtain a complete clinical picture of the assailant’s behavior prior to the assault.  Next, the attorney must determine what steps, if any, the nursing home took in response to any previous instances of aggression on the part of the assailant.  In addition, it is important to look at the assailant’s criminal background and any history of aggressive behavior.   Finally, the nursing home’s policies and training must be reviewed to determine if employees were properly trained and instructed on: screening residents to determine who is inappropriate for a nursing home setting; identifying signs of aggressive behavior on the part of a resident; and responding to such aggression.

Of the nursing homes we investigate, most of the time we find that they are understaffed.  Because of this, CNAs and nurses do not have time needed to tend to each resident.  Actions that require additional time, such as responding to, or reporting, the first signs of aggression by a resident, can often be pushed to the side with devastating consequences.  In fact, in our experience, understaffing is the most common cause of nursing home neglect injuries and death.

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When a person is injured in a car accident in Florida, no matter who is at fault, that person’s own auto insurance pays 80% of his or her medical expenses and 60% of lost wages up to a combined total of $10,000.00.  This coverage is called “personal injury protection” or “PIP,” for short.  This amount of insurance can be expended quickly for a person suffering serious car accident injuries.

Currently, most medical providers are only allowed to charge set rates when billing under PIP insurance.  Those rates are set at twice the rates paid by Medicare for the same services as identified by billing codes.  This means that a medical provider gets paid twice as much for treating a person injured in auto accident as compared to treating a person with Medicare coverage.

This limitation on the rates that can be charged has proven to be fair.  The rates are high enough that skilled medical providers are willing to see people injured in auto accidents, but low enough that the patient can receive several months of care before PIP is exhausted.

However, hospitals and emergency care providers are not subject to these rate limits. Rather, hospital rates are set at a very vague standard of 75% of “usual and customary” charges.  “Usual” hospital billing, before adjustments are made, are typically inflated by much more than 100% over what the hospital would accept from a private insurer.  Essentially, the hospital never gets paid anywhere near the amount of its original billed amounts.  Seventy-five percent of such amounts still comes to about twice of what is a fair charge for the services at issue.

Florida’s House of Representatives has proposed changing this.  Florida’ House Health and Human Services Committee proposes to include hospital and emergency care providers in the manner as post-acute medical providers by limiting the charges to 200% of Medicare rates.

A few other changes are proposed.  Currently, a person injured in a car accident in Florida has 14 days to see a medical provider in order to be entitled to benefits under a PIP auto policy.  The House proposal includes extending that period to 30 days; however, a provider will be required to submit treatment plans to the auto insurance company.  If a treatment plan is not submitted, then the PIP insurer will not be obligated to pay that provider.

Since originally enacted in 1972, PIP coverage has proven to have benefits and costs.  It ensures that people hurt in car accidents have some access to coverage for their medical bills and lost wages.  However, it also requires that a person suffer a permanent injury in order to recover anything more than the portion of medical expenses and lost wages that remain unpaid after PIP has paid its majority share.

This “permanency” requirement may sound fair; however, it can be misused by auto insurers.  In nearly every auto accident injury case we handle, once suit is filed, the insurer requires our client be seen by a doctor chosen the the insurance company.  There are four or five doctors here in the Jacksonville area that we see time and time again.  These doctors make hundreds of thousands of dollars per year doing these reviews and uniformly minimize clients injuries and often claim the client was never injured at all.

Sometimes, jurors agree with the insurance company’s doctor – meaning that a person injured in an accident may not only be denied compensation for pain and suffering, but might actually end up owing the insurance company for its expenses, and sometimes attorney fees, simply because a hired gun doctor claimed the person was not really injured.

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Using statistics for the year of 2017, the City of Jacksonville had the third highest number of fatalities per capita in car and truck accidents caused by a driver operating under the influence.  More specifically, Jacksonville suffered an alarming 5.6 DUI deaths per 100,000 residents in 2017.  Nationwide, the average for 2017 was 3.4 DUI related deaths per 100,000 people.

In Florida, 515 people died in DUI vehicle crashes in 2017.  Of all of the traffic fatalities in the United States in 2017, 29% involved drunk drivers.  Sixty-eight percent of car accidents with drunk driving fatalities involve at least one driver with a blood alcohol level of .15 or higher, nearly twice the legal limit.

From 2015 to 2017, there have been 138 DUI crash deaths in Jacksonville.  In Jacksonville, U.S. 1 (Philips Highway) has been the most common location of DUI accident fatalities with 15 people killed.

It is not known why Jacksonville has had such a high rate of DUI deaths.  Different factors may come into play.  First, Jacksonville has a great deal of interstate highway, with I-95 traversing the entire length of the county from north to south and I-10 spanning from the center of the county to its western border.  Interstates, with high speed limits and heavy trucking traffic are common sites of serious car and truck accidents.

Second, there has been an immense degree of road construction ongoing throughout the Jacksonville area for years, especially in the downtown and J.Turner Butler Boulevard areas.  Road construction projects are common locations for car accidents as: the normal flow pattern of traffic can catch a driver off guard; construction vehicles entering the roadways can cause accidents; and traffic slowdowns always lead to rear-end car accidents. Of course, drinking while driving only compounds these problems.

The National Highway Traffic Safety Administration has been recording the number of alcohol related car accidents since 1982.  Thankfully, the number of DUI fatalities has decreased 48% since 1982.  Of course, as an entirely preventable tragedy, no level of DUI fatalities is acceptable.

The heartbreak of losing a loved one in a collision caused by a drunk driver cannot be overstated.  Many emotions are involved.  Along with unimaginable grief, survivors often experience a wide array of emotions including anger at the drunk driver, anger towards any establishment that served the drunk driver and the legal system itself if that driver had prior DUI arrests.

It costs nothing out of pocket to hire an injury attorney early in the process and doing so can help protect your rights.  For example, many public areas and roadways are videotaped, which can be obtained and preserved if timely requests are made.  Likewise, most newer vehicles contain data recorders which help demonstrate the erratic nature of the driver prior to impact.

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Ten days ago, tragedy struck when a Jacksonville woman driving south on US 17 in Fleming Island was struck by a tractor trailer.  After being struck, the woman’s vehicle left the highway and impacted a support piling for the pedestrian walkway that spans from Pace Island to Black Creek.

The driver of the semi truck left the scene of the collision.  He was later pulled over by a Clay County Sheriff’s deputy who witnessed the collision.  The driver was arrested for leaving the scene of a crash resulting in a fatality.  The semi driver claimed he was unaware that the collision even happened.  Florida Highway Patrol relays that the semi driver was changing into the woman’s lane when the collision occurred.

Given the manner in which this collision occurred, it may have been due to the car being located in the driver’s blind spot.  The woman’s car was to the right of the semi driver and next to his trailer.  This puts the car in the classic location of a blind spot for the truck driver.

Due to the size of a tractor trailer, there are significant blind spots.  The height of the tractor adds to the problem as the driver and the mirrors make seeing a small car that is next,  and close, to the tractor on its right side very hard to see.

In order to prevent these types of collisions, defensive driving is a must.

In 1994, the Federal Motor Carrier Safety Administration (FMCSA) established a program related identifying “no zones” to educate the public on safely sharing the road with large commercial vehicles.  “No zones” are areas to avoid as they present blind spots where truck drivers may have a difficult time seeing you.   Advice for avoiding “no zones” includes:

-do not linger on the side of a semi truck, especially the right side, either speed up or slow down to get yourself away from a blind spot;

-when passing a semi truck, pass on the left side, again due to the larger blind spot on the right side of the truck; and

-stay far behind a semi truck as they cannot easily see you, semi trucks do not have rear view mirrors (as all that semi drivers would see in a rear view mirror is their trailers).

For their part, truck drivers switching lanes to their right also have a protocol for safety.  First, they are advised to signal lane changes at least five seconds in advance of their turn.  Next, they are to check their mirrors and to use a fender mounted mirror to provide maximum visibility.  Before turning, the driver must lean forward and over to look into the blind spot to make sure there are no cars in their right side blind spot.

Finally, truck drivers are advised to allow six seconds between the truck and the nearest vehicle they are following.  In this manner, the driver can safely stop and does not have to perform a sudden lane change to avoid rear ending another vehicle.  Such a sudden lane change usually does not allow time for properly checking for vehicles in the blind spot.

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We have previously blogged about the unfortunate frequency of sexual assault in nursing homes or skilled nursing facilities.  Sadly, this week a news story has grabbed headlines that highlights this problem.  A woman who has been in a vegetative state since she was three years old has recently gave birth in late December of 2018.  Given her condition, it is impossible for her to have consented to sexual activity.

Investigators ran DNA tests on the people working at the nursing home and found a match with a male licensed practical nurse who cared for the impregnated woman.  The thirty-six year old man has been arrested and charged with sexual assault.  That man has worked at the nursing home since 2011.  Police are uncertain at this time if there are other victims.

Police are also investigating whether the facility was aware of the assault.  The chief executive officer of the company that operated the nursing home has resigned.  In addition, one of the doctors that cared for the woman has resigned, and another doctor has been suspended.

The concerns involving the nursing home are not limited to the sexual assault itself as the nursing home was not even aware that the twenty-nine year old woman was pregnant until she unexpectedly gave birth.  This raises a host of concerns regarding how closely her health and conditions were being monitored.

Here in Jacksonville, the recent rape of a nursing home resident also made headlines.  No arrests have been made in that case and it is uncertain whether the perpetrator worked in the nursing home or entered posing as a visitor.

Residents of Florida nursing homes have, according to both common sense and Florida’s Nursing Home Resident’s Bill of Rights, the right to a safe environment.  More specifically, the Bill of Rights provides, in part: “Every resident of a facility shall have the right to: Live in a safe and decent living environment, free from abuse and neglect.”

Obviously, sexual assault is a violation of this right and nursing homes must take sufficient preventative measures.  First, every employee must be screened for any prior arrests or convictions.  Their prior employers must be consulted to make sure there were no concerns regarding the individual’s work history.  while the employee is working at the nursing home, all complaints of inappropriate behavior must be taken very seriously even if the victim is not certain of details as many nursing home residents suffer from cognitive impairment.  This is one reason why such perpetrators prey on the elderly.

These background investigations must also be performed for contract workers and independent contractors who do not work directly for the nursing home, but are nevertheless brought in to provide care.   Nursing homes commonly employ nurses and nurse assistants from  agencies if the nursing home is short on staff.  Due to the high level of employee turnover in Florida nursing homes, staffing agencies are commonly used to fill in gaps to meet statutorily mandated staffing levels.

In addition, nursing homes must not allow persons to enter the facility who have no business being there.  All points of entry must be conspicuously videotaped.  In this manner, potential assailants are made aware that evidence of their entry has been recorded.

Furthermore, resident on resident sexual assaults can occur in nursing homes.  For this reason, it is necessary that nursing homes be aware of the criminal past of residents before admission and must respond appropriately to any occurrences of sexual or aggressive misbehavior.  Finally, the nursing staff must monitor residents frequently so that a perpetrator does not have the time necessary to commit a sexual assault without being detected.  Continue reading

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A ninety-four year old woman reported being sexually assaulted by an unknown male at the Brookdale Atrium Way 2  nursing home in the Regency area of Jacksonville last April.  According to the victim, the perpetrator was wearing scrubs.  At the hospital, it was confirmed that she was sexually assaulted.  According to her lawyers, DNA testing suggests that the assailant may not have been an employee of the nursing home.  No one has been arrested.

The woman has hired lawyers to file a lawsuit for nursing home neglect. Notably, two other residents have reported being assaulted at the same nursing home this year, including one other rape and one attempted rape.  Descriptions of the perpetrator in each instance have been vague.  Family members and residents have expressed concerns and questions remain whether they were not fully informed of the nature of the attacks.

Assuming the assailant was not an employee, the woman’s lawsuit will focus on the security measures taken to ensure strangers do not walk into the nursing home without being screened – which can prove to be a difficult task for nursing home operators.   If it turns out that the assailant was an employee, the lawsuit will focus on whether that employee was appropriately screened and whether there were prior incidents or complaints regarding his behavior.

Nursing homes can provide an environment attractive to opportunistic predators.  There are a lot of people coming and going in a nursing home including family members, medical providers that are not employed by the nursing home, employees brought in from a temp agency, and private nurses and assistants hired by family members.  In addition, there is a lot of employee turnover at nursing homes so new people in scrubs are a common sight.   A person in scrubs can easily walk into almost any nursing home, past the information desk and into a resident’s room.

Sexual assaults in nursing homes are a significant problem.  Elderly people can be targeted due to physical and cognitive infirmities, making getting away with such a crime more likely.  All nursing homes are aware of this potential problem and are charged with the duty to take necessary measures in an effort to prevent sexual assaults.

Generally speaking, Brookdale Atrium Way 2 receives fairly good ratings from the Centers for Medicare and Medicaid Services as reflected on its Nursing Home Compare website, which has assigned it an overall rating of four out of five stars.  It received a “quality measures” rating of five stars, a “staffing rating” of four stars and a “health inspection rating” of only two stars.

“Quality measures” ratings are based on various factors regarding the health of residents including: how often residents have to be sent to a hospital; how often residents have to be sent to the emergency room; the number of residents receiving anti-psychotic medications; and the development or worsening of bedsores. “Staffing ratings” are based on each nursing home’s report of the number of nurses and nurse assistants that worked during a given time frame compared to the number of residents living at the nursing home.  The “health inspection” rating focuses on the safety of the building, food service, medication management, housekeeping and maintenance.  Continue reading

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Private nursing homes deserve to make a profit – a fair profit.  Nursing home operators, like those managing any other type of business, take steps necessary to maximize profit.  However, far too often, the methods used to do so run afoul of nursing homes’ statutory and moral obligation to “attain or maintain the highest practicable physical, mental and psycho-social well-being” for their residents.

Many of the expenses in operating a nursing home are fixed – meaning there is nothing the operators can do to decrease them.  Expenses such as rent, food, supplies, and electricity are not easily decreased. On the other hand, staffing is an area where money can be saved; however, often at the expense of the residents.

In the clinical setting, nursing homes typically have registered nurses, licensed professional nurses and certified nursing assistants.  They may also have physical therapists, occupational therapists and speech therapists. The highest expense for a nursing home is staffing and the most expensive employees are registered nurses.

Our Jacksonville nursing home abuse and neglect lawyers see the effects of understaffing in nearly every case we handle.  Most commonly, we see the number of registered nurses cut to the bare minimum. Why does this matter?  It takes at least two years of college to become a registered nurse and many have a four year bachelor’s degree.  In contrast, it takes about one year of schooling to become an LPN.

Florida’s Nurse Practice Act spells out the resulting difference: RNs are able to make assessments of patients’ conditions; while LPNs are not.  This means that an RN has the training and experience to consider what is going on with a nursing home resident and make, or suggest, changes to his or her care plan, medication or treatments.  LPNs, on the other hand, are not trained to make such assessments.

Many people think that the resident’s doctor will make rounds and perform global assessments on a frequent basis.  This is not accurate.  After an initial visit, it is common that doctors only see residents when a concern is brought to their attention.  Without registered nurses performing assessments, a patient’s decline, whether it be from infection, malnutrition or dehydration, often goes unnoticed until it is too late.

We have seen many examples of this here in Jacksonville.  In 2016, we resolved a wrongful death case against a large chain nursing home operator whose employees apparently did not notice its resident had an infection until it had gotten so bad that he was rendered unconscious by sepsis.  He died within a day of being transferred to Memorial Hospital Jacksonville.   Notably, the nursing home could not produce a single nurse’s note for the last week of his life.  Had a registered nurse seen him, his infection may have been caught and treated before he became terminally ill.  That nursing home was severely understaffed, and was found to be especially lacking in registered nurses.  The man was only 61 years old.

Attending doctors will not take up the slack.  It is important to understand that the doctors that make rounds at nursing homes are typically not employees of the nursing homes.  Most residents are assigned a doctor by the nursing home.  The nursing home chooses among several that it has contracts with; however, the doctor is not an employee of the nursing home.  Further, any neglect on the part of the doctor is not attributable to the nursing home.

Florida has standards that require a minimum number of LPNs and CNAs.  A nursing home’s failure to meet these standards can result in a moratorium on new admissions.  In just about every nursing home case we litigate, we find that the nursing home staffed only to the level of these minimums regardless of  how serious the needs of their residents are.  We have also found examples where a nursing home inflated the number of staff performing direct care to the residents in order to make it appear that the standards were met.  Continue reading