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Recently, shocking video footage was captured at a South Florida nursing home showing a certified nursing assistant striking a resident, pouring mouthwash on him, pushing him and handling him very roughly.  The resident was ninety four years old and suffered from dementia.  The CNA involved claimed she knew nothing of the allegations – until the video surfaced.  Apparently, the resident’s family members were suspicious that he was being mistreated and hid the camera in his room.  Without the camera footage, the abuse would probably never have been proven.

It is common that family members of nursing home residents call us to express a concern that a resident is being abused or mistreated.  Without obvious signs of injury, abuse can be very hard to prove as some residents with dementia may be confused to the point of equating normal movement required for bathing and dressing as abuse.  With advances in technology, it is now economically possible for most people to purchase small video cameras that can be concealed in a room.  Consequently, we have seen a rise in hidden surveillance footage and it is certainly going to continue to increase.

Of course, the use of hidden surveillance cameras also raises ethical concerns.  While a resident certainly has the ability to use such a camera, when the camera is placed by a family member, what if the resident lacks the mental capacity to consent to being filmed?  Nothing in standard power of attorney or health care surrogacy documents addresses this issue.  We support the ethical use of surveillance cameras as one of many tools that can be used in an effort to ensure a resident is receiving safe and respectful care.

Some states have enacted legislation specifically allowing nursing home residents to install cameras, which means that a nursing home cannot remove, or refuse to admit, a resident on this basis.  Most states; however, have no laws addressing the issue.  Florida does not have such a law.  A nursing home industry group, the American Health Care Association, has fought legislation allowing for cameras as it claims that people placing the cameras are more interested in gathering evidence for a lawsuit than in protecting the resident.  They also claim that, with cameras in place, it will be more difficult to hire and keep qualified caregivers.

Our Jacksonville law firm focuses on nursing home neglect and abuse cases.  If you suspect nursing home abuse, we provide free no obligation consultations.  Often, we help guide family members dealing with the issue of whether to leave a resident in his or her current nursing home.  We frequently recommend that the family request a care plan meeting to be attended by the resident’s doctor, the nursing home’s director of nursing and the resident’s nurse unit manager.  When abuse, neglect or mistreatment is more certain, we recommend the resident be moved to a nursing home with strong ratings and we recommend the resident or the resident’s family members contact Florida’s Department of Children and Families abuse hotline at 1-800-96-ABUSE.  Nursing home ratings are published by the Centers for Medicare and Medicaid Services and can be found here.

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When Hurricane Irma plowed the length of Florida on September 10 and 11, it left a surprising amount of damage throughout the Jacksonville area given that the eye of the storm passed more than 60 miles to our west.  Heavy flooding occurred in downtown Jacksonville, Doctor’s Inlet, St. Augustine, San Marco, Jacksonville Beach, Orange Park and Middleburg.  Wind damaged thousands of roofs.  Falling trees damaged houses, fences and cars.  Rising waters flooded homes and destroyed bulkheads and docks.  In Vilano Beach, at least one home fell into the ocean.

Within a few days of Hurricane Irma, our phones starting ringing with people concerned that their homeowners insurance companies were not treating them fairly.  At least one caller was shocked to learn he did not have flood insurance after his broker assured him that flood coverage was in place.  Others have already received woefully insufficient offers to address their storm damage.  In one Hurricane Irma claim, our client was offered $9,000.00 by his homeowners insurer for repairs that are estimated to exceed $50,000.00.

The most common insurance disputes our lawyers handle following hurricanes or major storms include: whether damage (especially interior water damage) existed before the storm; whether out-buildings are covered under the insurance policy; whether docks, decks, boatlifts or bulkheads are covered under the insurance policy; whether appropriate mold remediation has been completed; whether the hurricane deductible has been applied correctly; whether the value of damaged personal property has been fully evaluated; and whether the full extent of required repairs have been determined.

Often, our attorneys resolve insurance claims without filing suit; however, when suit is necessary, we do not hesitate.  We find that proper preparation and using appropriate experts and contractors usually convinces an insurer that paying the claim in entirety is its best course of action.

If you have a dispute with your own insurance company regarding damage from Hurricane Irma, we recommend that you speak with an attorney experienced in hurricane damage claims without delay.  If your insurer asks you to submit to an examination under oath, we cannot stress highly enough the importance of discussing the matter with an attorney before the statement is taken.  These statements can be used by the insurer to deny or limit the claim.

 

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Nine residents of a Miami, Florida, nursing home suffered death by agonizing heat distress after Hurricane Irma interrupted the supply of electricity to the nursing home.  The people who lost their lives ranged in age from 71 to 99.  Many other residents were treated for dehydration, breathing difficulties and other heat related issues.

For days following the hurricane, the nursing home’s residents were left in Miami’s sweltering heat and humidity.  The day after the hurricane passed, the temperature rose to 98 degrees.  The fallout from this tragedy is just beginning as the deaths were entirely preventable. A criminal investigation is ongoing and civil damages are likely to exceed $10,000,000.00.

Following Hurricane Wilma in 2005, it became abundantly clear that nursing homes in the state needed to have a backup source of electricity in the event weather conditions cause an interruption of power.  In 2006, legislation was proposed to require that all nursing homes in the state have generators able to cool and run their facilities.  Of course, providing this level of resident safety and comfort came with a price tag.  The nursing home industry successfully lobbied against the bill. Now that there has been a tragedy of this magnitude it is likely that similar legislation will pass.

It should not require legislation for nursing homes to obtain backup electrical power.  Common sense dictates that the loss of air conditioning alone creates life-threatening circumstances for the elderly and infirm.  If a nursing home operator is being paid to provide a safe environment for its residents, it is axiomatic that the operator should make the investment necessary to provide an uninterrupted supply of electricity.

Nursing home operators claim that they operate on slim profits due to the limited amount they receive from the Medicare and Medicaid programs.  However, for the most part, this is not the case.  While balance sheets can make it look like there is little profit to the nursing home owners, many of the listed “expenses” for rent, consulting services, and management services are paid to corporations owned by the same people that own the nursing home itself.  With the average nursing home profiting well over $1,0000,000.00 per year, there are certainly enough funds to finance a backup generator system.

It is my hope that the families of these victims obtain a full measure of civil justice.  With large payments to the families, perhaps this nursing home operator and others will realize that, even if they do not feel morally obligated to provide a safe environment, the short term financial savings in not doing so are outweighed by the legal claims that result.  Continue reading

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On June 28, 2017, the United States House of Representatives passed H.R. 1215 titled, Protecting Access to Care Act of 2017.  Among other provisions in this bill is a limit on non-economic damages that can be recovered from a nursing home that accepts Medicare or Medicaid funds.  This encompasses essentially all nursing homes.  The bill will become law if passed by the Senate by a simple majority.  With the republican majority in the Senate and, with tort reform being a battle-cry campaign platform for the Republican party, the chances of this bill passing are a real concern.

What are the effects of this bill?

Non-economic damages compensate a person for the emotional harm he or she has suffered.  Non-economic damages do not include medical bills, funeral costs or lost wages that might result from injuries caused by neglect.   Economic losses are not subject to any cap or limitation and, under this bill, would remain uncapped.  With nursing home residents, this provides little assistance as there is almost never a lost wage claim given the age and infirmity of the residents.  Further, the medical bills resulting from injuries caused by neglect are typically paid by Medicare or Medicaid, and any sums recovered for medical bills must be turned over to the government.  As such, practically speaking, non-economic damages (i.e., pain and suffering) provide the only recovery that can compensate an injured victim of nursing home abuse or neglect.

Currently, the pain and suffering damages are uncapped.  If a jury is horrified by neglect or abuse, it can render a verdict that provides incentive for the nursing home to provide quality care for its residents.  Without this “check and balance” in place, the nursing homes’ financial incentive will be to minimize their costs.  As the single largest expense of operating a nursing home is staffing, an incentive to lower costs translates into fewer nurses and nurse assistants available to provide care.

The Practical Effects of a $250,000.00 Cap

At first blush, $250,000.00 may sound like a lot of money.  However, it is necessary to keep in mind that this is the worst case scenario for a negligent nursing home operator.  Why would the operator voluntarily agree to pay its worst day?  Rather, in all but the most egregious cases, the operator will offer only a fraction of that amount.  One reason for this is that they know going to trial is nearly impossible for the plaintiff’s attorney with such a cap in place.

Even if we were to achieve a verdict of $250,000.00 at trial, the years of work and tremendous amount of time we spend on these case make such a recovery unprofitable.  Add to that the uncertainty of winning when we decide to take a case and it quickly becomes obvious that agreeing to handle a nursing home neglect case is a poor business decision.

Some specifics may flesh this out.  Abuse or neglect in nursing homes almost always start at the top with a corporate culture of saving money at the expense of resident care.  This is typically done by under-staffing the nursing home leaving nurses and nurse assistants with more work than can be done during their shifts.  In order to prove that under-staffing is the root cause of neglect, we must perform a very thorough investigation.  The time records of every nurse and cna must be evaluation and matched with the shifts in question.  In addition, the census and overall acuity of the health needs of the nursing home residents must be considered.  Multiple expert witnesses are needed to perform this analysis, each with a hefty price.  Further, nursing home operators fight tooth and nail to try to keep the time records and budget information from being provided to us, creating delay and additional expense.

As an example, in a recent case, our law firm spent approximately $150,000.00 on experts and litigation expenses – this figure includes nothing the reflect the value of the time we spent on the case.  We worked on the case for four years.  The result of our work was nothing short of alarming – the nursing home understaffed the facility by: having employees listed as working when they were not; counting nurse managers as providing hands on care when they did not do so; and having a system in place designed to staff the facility at the bare minimums regardless of the overall complexity of the health needs of the facility’s residents.  Only upon the discovery of this damming information was the case was settled for a fair amount.  With the cap in place, we could not have done the investigation and we never would have uncovered the nefarious reason why the nursing staff failed to provide sufficient care.  Simply put, with the cap in place, we cannot prosecute these claims.

Nursing home neglect is a serious problem.  Capping damages decreases the incentive to provide quality care as plaintiff’s lawyers will no longer investigate these incidents.  With the aging of our country, this is the last thing Americans should support.  Continue reading

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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