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Sexual abuse in nursing homes is a sad occurrence.  A CNN  investigation concluded that between the years of 2013 and 2016, the federal government cited over one thousand nursing homes failing to prevent, or otherwise mishandling, allegations of sexual abuse including rape. Even more disturbing is that nearly every instance of sexual abuse is preventable if nursing homes are properly staffed and if employees and residents are properly vetted and supervised.

Several years ago here in Jacksonville, a $750,000.00 verdict was rendered against a nursing home as a result of a female resident being sexually assaulted by a male resident.  The male resident had criminal record for past sexual crimes.  What is worse is that there were also complaints that he was engaging in inappropriate aggressive and sexual behavior at the nursing home before the rape occurred.

Many residents of nursing homes are unable to protect themselves due to dementia or physical limitations, or both.  This makes them vulnerable to resident on resident sexual abuse and abuse from nursing home employees.

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Approximately 20% of Florida’s population is over the age of 65. With Florida being a haven for retirees, the need for nursing home beds is on the rise.  However, the state does not currently allow free market forces to control whether new nursing homes are constructed.   Instead, in order to open a new nursing home, or enlarge an existing nursing home, a lengthy “certificate of need” process documenting the need for additional beds must be completed.  Furthermore, the State of Florida enacted a moratorium on any new nursing home beds (regardless of need) from 2001 through 2014. Finally, in 2014, a scant 3,750 new nursing home beds were allowed.

The Florida legislature is now considering repealing the entire certificate of need process allowing free market forces to determine how many nursing home beds are available.  The nursing home industry, represented by the Florida Health Care Association, is lobbying hard against doing away with the certificate of need process.  Why?  Because increased competition will narrow profit margins.

The Centers for Medicare and Medicaid Services provides a five star rating system for nursing homes.  Due to the lack of beds, the one star facilities typically have occupancy rates above 90%.  When there are not available beds in the five star facilities, the facilities providing substandard care fill up.  Our attorneys have brought claims for negligence causing death or injury against 8 of the 10 one star nursing homes in Jacksonville – Duval County.  In comparison, we have never had to bring a claim against a single five star facility.

Newer, nicer nursing homes will take residents from existing older facilities – which is exactly how it should be.  The industry’s position in this regard is not well disguised.  The Florida Heath Care association says that repealing the certificate of need process would lead to an increase in empty beds in “long-established” facilities.  Feel free to insert the words “old,” “out of date” or “no longer desirable to consumers” for “long-established.”  What the industry is saying is that consumers will choose newer, nicer facilities over the old ones. That is a bad thing?

In what industry is a lack of competition good for consumers? Imagine if car manufacturers were not allowed to create new models and sell the new cars in whatever quantity consumers desired.  Instead, the buyers could only choose from a limited number of outdated models.  Prices would be high and quality stymied.   While that sounds preposterous, that is the framework in which the nursing home industry in Florida operates.

Contrary to the nursing home industry’s claims, nursing homes are very profitable.  They are not providing a community service on the brink of bankruptcy.  Every time our lawyers investigate the financial status of for-profit nursing homes in the Jacksonville area, we find they operate with significant profits, much of it hidden from view in the form of “management fees” paid to a related company or outlandish rent paid to a related company that owns the nursing home building.  By doing so, their balance sheet appears to reflect limited or no profit.  Its no more complicated than a hustler’s shell game.

The sponsor of the House bill to do away with the certificate of need process, Alex Miller from Sarasota, details that the current process does not improve the quality of nursing home care, does not improve access and does not control costs.

The nursing home industry claims (apparently with a straight face) that adding more nursing homes will require them to compete for nurses resulting in decreased staffing.  What this really means is that the nurses lose right alongside the consumers.  Competition for nurses is good for nurses’ pay and working conditions – the same way it is very every other occupation.  Further, who provides data to show that the number of licensed nurses is too few to staff additional nursing homes?  No one.  Even if somehow new nursing homes created a void of nurses (which it would not), why wouldn’t free market forces result in more people getting a nursing degree?

In short, the certificate of need process was never a good idea.  Regulations designed to decrease competition have never been good for consumers and never will be.   Continue reading

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Clostridium difficile (commonly referred to as “C diff”), is a bacteria that is a common cause of severe illness in hospital and nursing home settings.  C diff is found naturally in many healthy peoples’ digestive tract, and, in such cases, it does not pose a health risk as the c diff bacteria are kept in check by the many other types of intestinal bacteria.

There are over 1000 types of bacteria commonly found in the human digestive system.  They serve an essential purpose in digestion and the various bacteria have symbiotic relationships among themselves. Some bacteria naturally create waste which can be toxic.  If unchecked by the other bacteria, the toxic buildup can cause severe illness.

C diff infections often occur after someone has been provided a broad spectrum antibiotic.  The use of antibiotics is common when a person undergoes surgery in order to prevent a post-surgical infection. Since many people, especially the elderly and infirm, reside in a nursing home after surgery to recuperate and receive physical therapy, a c diff infection will often appear at the nursing home.

C diff infections can also occur when someone requires a feeding tube.  A gastric tube (or “g tube”) is used to provide a liquefied diet, rich in nutrients, directly into the person’s small intestine where it is quickly absorbed.  However, when on such a diet, the large intestine is deprived of fiber, starches and sugar which can lead to the reduction of healthy bacteria.  A niche is left for c diff to run rampant as it is no longer kept in check by the other bacteria.

Similarly, total parenteral nutrition (“TPN”) or intravenous feeding, in which the person is fed intravenously, can cause the exact same problem.  Again, this is a common scenario in the nursing home environment as persons with feeding tubes or intravenous feeding typically require significant nursing care.

C diff is extremely contagious and can be transferred by person to person contact or through objects such as door handles, clothing, towels and bed linens.  As such, it is imperative that nursing homes be especially diligent in: washing hands after touching each resident; providing clean towels and bed linens; and thoroughly cleaning all potentially contaminated surfaces and objects.

According the the Centers for Disease Control, each year 500,000 Americans suffer from c diff infections.  Of those, approximately 29,000 die within 30 days.  The most vulnerable population is the elderly with 80% of the c diff related deaths occurring with people aged 65 or over. Not surprisingly, the CDC estimates that 100,000 nursing home residents contract c diff each year.

It is imperative that nursing home staff be well trained to identify the signs of a c diff infection. Symptoms include: prolonged diarrhea; an especially foul smell to the feces; feces with the consistency of coffee grounds; abdominal cramping; loss of appetite; weight loss; nausea; vomiting; fever; lethargy; and abdominal distension.  It is critical that such signs be reported immediately to the resident’s physician.  The early administration of antibiotics, such as Flagyl or Cipro, can prevent the infection from worsening.  Untreated, c diff can lead to: severe inflammation of the intestines; rupture of the intestines; septic shock; and death.

Our lawyers have handled two wrongful death cases resulting from c diff infections in Jacksonville nursing homes.  In both cases, our investigations found that the nursing homes ignored obvious signs of infection until it was too late.  If you or a loved one are experiencing the signs and symptoms of a c diff infection, it is necessary that you report the problem immediately to the nursing home’s director of nursing, the assistant director of nursing; the nurse unit manager; and the doctor.  If your complaints fall on deaf ears, go the the hospital.  Every hour counts when a vulnerable person is suffering from c diff.  Continue reading

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When a vehicle breaks down or runs of gas in a lane of traffic, especially on an interstate or expressway, the effects can be devastating.  Just today, a man from Orange Park died when his vehicle was struck from behind by an 18 wheeler on Interstate 95 in Flagler County near Palm Coast. The accident happened in the early morning hours and the car may not have had its lights on.  The reason for the car being stopped on the interstate is not currently known.

Our attorneys have handled numerous serious injury cases resulting from an accident with a vehicle broken down on an interstate or expressway.  Vehicle owners who fail to properly maintain their vehicles or who run out of gas will be responsible for personal injuries or wrongful death that results from an accident.  It is also necessary that the operator of the car or truck remove it from lanes of traffic as soon as possible. Commercial trucks, including tractor trailers, are also required to put out traffic cones so as to warn oncoming drivers of the lane obstruction ahead.

Our lawyers handled a case where a man suffered serious personal injuries after colliding with a moving truck broken down in the outside lane of I-95 in Nassau County, just north of the Duval County line.  The moving truck was broken down for hours before the collision occurred.  The insurer for the moving company tried to blame our injured client by claiming that he should have seen the truck and avoided it like so many other drivers did in the hours that the truck was obstructing I-95.

We were able to prevail by demonstrating that the truck failed to properly put out required warning signs and failed to have the truck removed in a timely fashion.  Also, the claim that our client was negligent was not credible due to the fact that the accident happened shortly after dark, during rush hour, and occurred just after our client changed from the middle lane to the outside lane immediately prior to the location of the truck, preventing him from being able to see it in time to react.

We also recently made a recovery for all of the available insurance coverage limits (both bodily injury and uninsured motorist coverages) for a woman who suffered serious spinal disc injuries when the car in which she was a passenger struck a vehicle broken down on the Dames Point Bridge.

Surprisingly, the car in which our client was riding had dash cam footage of the accident.  The footage showed the other car stopped in the outside lane.  As the Dames Point Bridge has no emergency lane, the broken down vehicle was obstructing more than half of the lane.  The owner of that car placed a cooler in the road to warn oncoming drivers; however, the cooler was only a few yards from the car, providing very little notice.

The driver of the car our client was in failed to observe the other car in the interstate and drove straight into it without braking our changing lanes.  With the dash cam, it was clear that that driver had several seconds to react before the collision.  As a result both the driver of the car our client was in and the driver of the broken down car were responsible for causing the accident. Continue reading

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The Centers for Medicare and Medicaid Services (“CMS”) recently enacted a new federal regulation [42 C.F.R. Section 483.70(n)(1)] that invalidates arbitration agreements signed at the time of a person’s admission to any nursing home that accepts reimbursement from either Medicare or Medicaid.  This covers essentially every nursing home in the country.

Through an arbitration agreement, a nursing home resident waives his or her constitutional right to a trial by jury in the event the nursing home is negligent and causes injury or death. Instead, through arbitration, one to three attorneys, acting as arbitrators, would decide whether nursing home neglect occurred and, if so, the amount to be awarded to compensate the injured person for medical expenses, funeral expenses (if death resulted from the neglect), and emotional losses.

Arbitration agreements have long been the bane of attorneys that handle nursing home injury and wrongful death cases because, generally speaking, arbitrators tend to be more conservative than juries.  Arbitrators deal with tragic claims routinely.  The thought is that, in doing so, they can become desensitized to neglect and the resulting injuries or death.  Jurors on the other hand, having not been exposed to such tragedies on a regular basis, may be shocked by neglect and have more sympathy with respect to the injury or wrongful death that resulted.

Arbitration agreements, which are usually presented by a nursing home employee along with a host of other paperwork at the time of admission, are controversial to begin with.  Many residents have some degree of dementia and their ability to fully understand the rights they are signing away can be questionable.  Further, with many admissions documents being signed at once, it is common that relatively little explanation is given to the new resident about the effect of the arbitration agreement.

Our law firm challenges the enforceability of arbitration agreements on numerous bases including: whether the resident had the mental capacity to understand the nature of the rights being waived; whether a family member that signed the agreement had the authority to sign on the resident’s behalf, which is usually conveyed by a pre-existing power of attorney; and whether the agreement is unambiguous in the language used to explain what is being waived.  Despite these challenges, it is common that there is no “out,” and the case proceeds to arbitration.

Acknowledging the unfairness of arbitration agreements, CMS enacted the new rule which was to take effect with respect to any arbitration agreements signed after November 27, 2016.

The legality of the new rule has already been challenged by the nursing home industry. Unfortunately, the Court hearing the case – the United States District Court for the Northern District of Mississippi – has made a preliminary finding that there is a “substantial likelihood” that CMS did not present sufficient justification for banning arbitration agreements in nursing home neglect cases. The necessary support, according to the Court, required objective proof that arbitration actually caused the harmful effects CMS relied on in making the rule.

Furthermore, the Court held that CMS overstepped its authority in enacting the rule.  Simply put, an agency, as part of the executive branch of government, cannot create legislation.  Instead, rules created by an agency are supposed to help implement the laws as enacted by Congress.  Citing the fact that Congress has considered, but not passed, bans on arbitration agreements for nursing home abuse or neglect claims, the Court found that CMS lacked the authority to ban arbitration agreements even though it is charged with the task of: “protecting and promoting the rights of each resident;” establishing “other rights” for residents; and promoting the “health, safety and welfare” of residents.

The Court’s ruling is only preliminary; however, the obstacles presented by its preliminary injunction Order present a very burdensome task.  Should the rule ultimately be ruled invalid on the basis that CMS overstepped its authority and effectively enacted legislation, it is unlikely that Congress will ban nursing home arbitration agreements any time in the near future, given the current Republican majority.

We will continue to monitor and report on developments regarding this issue. Continue reading

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Interstate 95 which runs through the length of Jacksonville’s Duval County and goes directly through downtown, is the country’s fifth deadliest interstate according to Everquote Auto Insurance Company.  Everquote compiled data provided by the National Highway Traffic Safety Administration.

I-95 had nearly one death per mile during the five year period of 2010 to 2015.  To put that in perspective, I-95 traverses approximately 30 miles in Duval County – meaning there were nearly 30 deaths on this stretch of interstate during the five year period.

Interstate 10, the eastern end of which begins in Jacksonville, was ranked the seventh most deadly with .85 deaths per mile.  Interstate 4, which runs from Tampa to Daytona, is Florida’s deadliest interstate with an astonishing 1.4 deaths per mile. I-4 is our nation’s fourth deadliest interstate.

The U.S. Department of Transportation also reports a greater than 10% increase in traffic deaths from January 1, 2016, compared to the same six months of 2015.  This may be an anomaly, it may result from an increase of vehicles on the road due to a sharp decrease in gas prices, or it may be due to an increase in distracted driving.  No matter what the cause, we should experience a decrease in collisions over time, not an increase.

What is worse is that 2015 brought the highest increase in traffic fatalities in fifty years according to the National Safety Council.  More than 38,000 people were killed in vehicle accidents in 2015 and another 4 million people required medical care for injuries.  Furthermore, 2014 showed an 8% increase over 2013.  Even though more miles are being driven in the years since the recession that began in 2008, the rate of fatal accidents has outpaced the increase in total miles driven.  The exact cause is not known; however, we suspect that texting, tweeting and using Facebook while driving have played a significant role.

We certainly seem to see more drivers than ever on their cell phones while driving at highway speeds. Whenever I notice someone using their phone while driving (typing, not talking), I take measures to make sure that person does not end up behind me.  Texters often fail to appreciate slowing traffic in time and frequently cause rear-end collisions.

Because interstates involve much higher speeds than local roads, the chances of suffering severe injury or death in a collision are higher than accidents that occur on local roadways.  Further complicating things is that the downtown Jacksonville portion of I-95 has been under constant construction for over ten years now.  Construction causes abrupt lane changes, sudden stops and confusion to motorists, all of which contribute to the chances an accident will occur. Continue reading

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Now that the danger from Hurricane Matthew has passed, the cleanup – and insurance claims – processes begin.  Hurricane Matthew skirted just east of Jacksonville as a category 3 storm, causing an estimated $70 million in damages in Duval County alone.  Counties further to the south, including St. Johns, Flagler and Volusia suffered even worse damage as the storm passed closer to their coasts.

Businesses and houses were flooded, roofs were damaged, oceanfront homes lost their entire backyards, trees fell, and signs were destroyed.  There will be thousands of insurance claims in the Jacksonville area.  Most of them will be adjusted and paid fairly; however, others will not.

Despite the fact that Floridians pay extraordinarily high insurance rates to take into account the threat of hurricanes, some insurers look for every excuse possible to avoid paying claims.  It is important that you don’t give them ammunition to do so.

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In January, a twenty-nine year old driver caused a fatal accident driving the wrong way on Interstate 295 near the intersection with Interstate 95 here in Jacksonville.  The car crash happened at 4:00 a.m.  Sadly, a sixty-nine year old military veteran and grandfather died as a result of the accident.  The wrong way driver was also critically injured in the crash.

Hours after the accident, the blood alcohol level of the wrong way driver was .117 – well above Florida’s .08 maximum blood alcohol level.  Given that alcohol in the blood dissipates at the rate of approximately .015% per hour, a two hour delay between the accident and blood testing would put the driver’s blood alcohol level at .147, nearly twice the legal limit.  The wrong way driver was not arrested for driving under the influence/manslaughter until last week – six months after the collision.

 

Wrong way car accidents are much more common than many people think. During 2015, there were 1490 wrong way crashes in Florida alone – more than four per day.  Because wrong way car accidents typically cause head-on collisions, the injuries that result are often tragic. This is illustrated by the 96 fatalities and 1454 injuries that resulted from 2015’s 1490 crashes. In more than two-thirds of wrong way car accidents, the driver was either injured or killed.

Whenever I hear of a wrong way accident, I tend to assume the driver going the wrong way was intoxicated; however, the statistics do not support this presumption.  With respect to Florida’s wrong way collisions in 2015, fifty-one percent of the at-fault drivers were not intoxicated at the time of the crash.

There are things you can do to minimize your chances of being involved in a wrong way car accident.  According to the Florida Department of Highway Safety and Motor Vehicles, interstate and freeway drivers should stay in the right lane, especially at night, to avoid the chances of being struck by a wrong way driver.  According to the Department, most fatal wrong way accidents take place in the left or center lane.

Of course, it is also very important to take steps to ensure you do not enter an expressway going the wrong way. As referenced above, many wrong way drivers were not intoxicated.   To prevent such mistakes it is important to: avoid driving while drowsy; avoid distractions, such a cellphones, while driving; and not driving after dark if your night vision is impaired.

In addition, Florida’s Department of Transportation is implementing new measures in an effort to reduce wrong way accidents.  FDOT is installing additional signage at expressway exit ramps warning drivers that they are proceeding in the wrong direction.  FDOT is also installing flashing lights at exit ramps and using radar to detect wrong way drivers headed up exit ramps. When the radar detects a wrong way driver, emergency alert signage warns others drivers to be on the look out for the wrong way vehicle.

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The Florida Agency for Health Care Administration regulates nursing homes throughout the state.  As part of this process, every six months, the agency releases its survey findings and this month it released its inspection ratings for the October of 2015 through March of 2016 period.

The ratings are based on a five star system and includes survey results for each nursing home in the following categories: dignity; decline; restraints and abuse; nutrition and hydration; administration; quality of life; and quality of care.  The end result is an “overall inspection” rating.

A “one star” overall inspection rating means a nursing home is in the bottom 20% of the facilities in the Jacksonville region.  “Two stars” means a nursing home ranked better than 20% but less than 40%.  Three, four and five star ratings follow a similar formula, with each bracketed in 20% divisions.

Many nursing homes in the Jacksonville region were ranked as one star facilities.  Those nursing homes include: Avante at Jacksonville Beach; Brookdale Atrium Way 2; Consulate Health Care of Jacksonville; Governor’s Creek Health and Rehabilitation; Heartland Health Care Center – Jacksonville; The Ponce Therapy Center; Signature Health Care of Jacksonville; and Woodland Grove Health and Rehabilitation Center.

Perhaps not surprisingly, our law firm has represented clients in claims of neglect against five of these eight nursing homes.  In comparison, we have not handled a single case against any of the five star rated nursing homes, yet every nursing home is paid in the same manner by Medcaid and Medicare.  What does this tell us? It tells us that nursing homes receive enough money to take proper care of residents.

We find many problems when nursing homes attempt to increase profits by decreasing the expense of hiring enough nurses and nurse assistants to take proper care of residents.  Florida has minimum standards that require a certain number of nurses and nurse assistants providing direct care to residents based on the resident population of the nursing home.

These are minimum standards, yet often we find that nursing homes cut as close to the minimum levels as possible and, in some instances, we have uncovered situations where nursing homes included time for nurses that did not provide direct care.

In one instance, we determined that a certified nurse assistant’s time was included for shifts she did not even work.  In another, we learned that a nurse assistant assigned to our client was disciplined for actually sleeping on the job instead of tending to our client.  Sadly, the woman died from a curable infection.

It takes a lot of digging to find such deficiencies.  Hiring a lawyer experienced in nursing home neglect cases is very important.

Nursing homes in the Jacksonville area with a two star ranking include: Heartland Health Care Center of South Jacksonville;  and San Jose Health
and Rehabilitation Center.

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A Jacksonville nursing home that our firm has sued on two occasions for causing the death of elderly residents has made the news for another death. As reported by Jacksonville’s Channel Four News , a resident at the Harts Harbor Health Care Center was hit in the head by another resident wielding a dresser drawer. The resident that struck him is reportedly suffers from dementia.

The victim suffered a very serious intracranial hematoma that required surgery.  Tragically, approximately three weeks after the incident, the man passed.  He was only 61 years old.

Nursing homes must be on the lookout for resident on resident violence, especially with residents suffering from dementia.  While some people suffering from dementia are very pleasant, others may exhibit aggressive behavior. Such behavior can be very uncharacteristic of the how the person acted before the onset of dementia.  Depending on the degree of dementia at issue, the person may not even be aware of the nature of his or her actions.

In cases like this, the nursing home must closely monitor the behavior of its residents suffering from dementia.  Often, aggressiveness caused by dementia will escalate over time, which may provide the nursing home the opportunity to catch the behavior before serious injuries occur.  An aggressive resident may not be a good fit in a nursing home environment, and, if other residents’ safety is being compromised, the aggressive resident must be placed elsewhere.

Resident on resident violence is a serious problem in nursing homes.  Several years back, a plaintiff received a judgment for $750,000.00 against a Jacksonville nursing home when a female resident was raped by another resident who had a long history of sexual misconduct.  Unfortunately, that judgment was never paid because shortly after the hard fought judment was received, the nursing home was transferred to new operators and the former company that owned was left essentially insolvent.

In this situation, it is unknown whether the aggressor had prior issues with violent behavior.  If that person demonstrated aggression or violence in the past, and the nursing home did nothing to prevent other residents from being assaulted, then Florida law will allow family members to seek a recovery for their emotional losses.

This incident has been reported to Florida’s Agency for Health Care Administration (AHCA), which oversees skilled nursing facilities and nursing homes in the state.  AHCA has previously fined this facility for insufficiencies regarding safety and resident care.

According to the Centers for Medicare and Medicaid Services Five Star Rating system, Harts Harbor Health Care Center has an overall rating of four stars; however, it has only two out of five stars on “quality measures.”  Quality measures track things like: the prevalence of bed sores or pressure ulcers; the frequency that residents are injured in falls; the number of residents that report the onset of pain; and the rate of infections.

Both of the lawsuits our firm has handled against the Harts Harbor nursing home also resulted from the death of residents.  One action is currently pending. Continue reading