Articles Posted in Uncategorized

Published on:

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.

Continue reading

Published on:

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.

Continue reading

Published on:

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.

Continue reading

Published on:

A licensed practical nurse working at Life Care Center of Orange Park nursing home was arrested this week for grand theft of a controlled substance.  The arrest came following an investigation into missing prescription painkillers.  Over one hundred hydrocodone and oxycodone pills were reported missing.

Life Care Centers operates hundreds of nursing homes in twenty-eight states.  In the Jacksonville area, it operates three nursing homes: Life Care Center of Jacksonville; Life Care Center at Wells Crossing (located in Orange Park); and Life Care Center of Orange Park.  These three nursing homes have received high rankings from the Centers for Medicare and Medicaid Services, respectively earning five stars, three stars and five stars on CMS’ one to five star rating system.  While certainly not an infallible measure of quality, our lawyers have noticed a strong correlation between the ranking system and the level of care provided.

Theft of prescription painkillers, or “drug diversion” as it is commonly called, at nursing homes is a nationwide problem.  The Controlled Substances Act of 1970 regulates narcotic pain medication. Nursing homes must maintain a Controlled Substances Log pursuant to  21 U.S.C. 827(a).  A Controlled Substances Log is used to track every dose of pain medication by recording the date and time the pill was obtained by a nurse, the name of the resident receiving the medication, the name of the nurse receiving the medication, and the name of the subscriber.  Pain medication must be kept in a separately locked cabinet in a secure area of the nursing home.

This level of documentation does not however, ensure that the nurse actually gives the pain medication to the resident.  Many residents of nursing homes suffer from a degree of confusion or dementia.  It is a simple enough task for a nurse to provide the resident an over the counter pain reliever while pocketing the actual narcotic.  Of course, such a practice is a clear violation of the nursing standard of care and a violation of the nursing home resident’s rights.

The effect on the defrauded nursing home resident is more than just having to temporarily endure needless pain.  The sudden cessation of regularly taken pain medication can cause serious withdrawal symptoms.  Further, unaddressed chronic pain causes a host of other problems including: depression; interruption of sleep; impaired cognitive function; compromised cardiovascular health; and decreased quality of life.

If you are concerned that a loved one is not receiving his or her pain medication, there are steps you can take.  First, we recommend a meeting with the resident’s doctor, the nursing home’s director of nursing and the resident’s unit manager to discuss the issue.   Second, a urinalysis can be performed to determine the amount of pain medication the person has metabolized.  Lastly, we always recommend that anyone concerned about nursing home neglect or abuse contact Florida’s Department of Children and Families abuse hotline at 1-800-96-ABUSE. Continue reading

Published on:

Under intense lobbying by the nursing home industry in 2001, the Florida legislature enacted legislation requiring a pre-suit investigative and notice period before a lawsuit could be filed seeking compensation for death or injury caused by nursing home neglect.  At first glance, the pre-suit requirements may have seemed like a good thing.

Before filing suit, a claimant must have the matter reviewed by a doctor or registered nurse expert.  If the expert comes to the conclusion that the nursing home did something wrong that caused harm to the resident, the case can progress.  After that, the parties are to engage in a 75 day period during which they are to exchange information.  Finally, the parties are required to mediate before suit can be filed.

The problem is that the statute provides no repercussions if a nursing home refuses to provide information and refuses to mediate – and, as a result, that is exactly what the nursing homes do.  In litigating nursing home injury and death claims for more than 10 years in Jacksonville, we have had only one nursing home willing to engage in the statutorily “required” pre-suit mediation.

The truth is that the pre-suit process provides no benefit whatsoever to injured residents.  Instead, it greatly increases the cost and length of time it takes to seek compensation.  Meanwhile, the nursing homes reap huge benefits from this process at no cost.

Florida Statute § 400.0233 requires that the claimant’s attorney conduct a good faith investigation.  To do so, the attorney must have the nursing home’s records for the client in question.  This is where the delay starts –  nursing homes are provided 30 “working days” to produce the records of a former resident.  Given weekends, this allows a nursing home approximately 40 days to simply make a copy of the records.

The lawyer must then review the records to determine what happened.  The records are not easy to read and typically involve hundreds of pages.  In short, the lawyer is working backwards to determine if the injury, illness or death could have been prevented.  To do so, we are scouring the record for signs and symptoms of the impending illness or incident along with any responses made by nursing home staff to prevent the injury or illness.

If the lawyer believes that the nursing home operator was neglectful or abusive, and, in so doing, caused serious harm or death, the statute requires the records be reviewed by a physician or registered nurse.  This is  expensive as a reviewing doctor or R.N. is going to charge expert witness fees on an hourly basis to review all of the pertinent records, typically including those from a receiving hospital.

If the expert comes to the conclusion that the nursing home was negligent or abusive, then a pre-suit notice must be sent by certified mail to every “prospective defendant.”  It can be difficult to determine who the prospective defendants are as nursing homes in Florida are typically operated by a maze of related limited liability companies.  This is purposefully done by nursing home operators in attempt to shield themselves from liability and to avoid transparency regarding their profits.

The statute allows for the parties to request documents and take statements from witnesses.   However, the nursing home operators refuse to comply with these requests.   They get away with this because Florida’s statutes on nursing home claims (unlike the medical malpractice statutes) provide no consequences for the nursing home’s refusal to comply with the statute.

After service of the pre-suit notice, nursing home operators have 75 days to review the claim.  At the end of this period, the operators, or their insurers, are supposed to provide a response either rejecting the claim or making a settlement offer.   The nursing homes almost never do  this as a failure to respond is considered the same as a rejection.

After the 75 day period expires, the statute requires that the parties mediate the case.   This provision is almost uniformly ignored by the nursing homes, and, again, it is because the statute provides no consequence for failing to do so.

In summary, throughout the entire statutory pre-suit process, the nursing home operators do essentially nothing and the injured victim spends an extraordinary amount of time and money for no reason.  The delay alone is a major injustice as victims of nursing home abuse and neglect tend to be elderly or infirm.  Further, after months of this needless delay, nursing home staff  members are no longer as able to recall all of the facts surrounding the resident’s situation.

All of the benefits supposedly provided by the statute – information sharing and an early mediation – are erased by a statute that contains no teeth.   It is time for the statute to be repealed. Continue reading

Published on:

The year on Jacksonville’s roadways has gotten off to a dangerous start.  To date this year, forty-nine people have died in traffic accidents in Jacksonville, according to the Jacksonville Sheriff’s Office.  This is thirteen more deaths than the average for this point in the year and the trend only seems like it will continue.  In separate incidents, two pedestrians were struck yesterday, one of whom was a woman who was killed while trying to cross 103rd Street on Jacksonville’s westside.

Pedestrian traffic fatalities are on the rise.  According to the Jacksonville Sheriff’s Office, there have been an average of thirty-nine pedestrian deaths per year during the last five years and roughly one in four traffic deaths in the city involve a pedestrian.

Jacksonville is not known to be a particularly pedestrian friendly city.  In fact, for the year of 2016, Jacksonville was rated as the fourth worst city in the country for pedestrian danger according to the National Complete Streets Coalition.  Many busy roadways in Jacksonville have no sidewalks, many roads are poorly lit, busy intersections have no crosswalks, crosswalks that do exist often do no provide enough time for slower walkers to get across and pedestrians and drivers often fail to pay attention.

The Florida Highway Patrol has designated April as “Distracted Driving Awareness Month”; however, the blame does not rest solely on drivers.  Pedestrians are becoming increasingly distracted by cellphones as they walk.  Texting, social media and surfing the net all play a role in “distracted walking,” which can be deadly.

There are things pedestrians can do to avoid being involved in an accident with a vehicle, including:

-wear brightly colored clothing at night;

-carry a flashlight at night;

-do not step out from beside a parked car or hedge when crossing the street;

-cross only at designated crosswalks;

-look left, then right, then left again before crossing;

-do not allow yourself to be distracted when crossing;

-walk on sidewalks when available;

-even if you have a “walk” signal at a crosswalk, make sure that drivers are stopped or coming to a stop;

– do not wear headphones while crossing the roadway;

– do not walk near roadways while intoxicated; and

– if there are no sidewalks, walk facing traffic.

Continue reading

Published on:

Early this morning, a female resident of a Jacksonville nursing home died after falling from her bed.  The incident occurred at the Woodland Grove Health and Rehabilitation Center near Belfort Road on Jacksonville’s Southside.  The Jacksonville Sheriff’s Office is investigating the incident as an accident.  Florida’s Agency of Healthcare Administration will also investigate the matter.

The Centers for Medicare and Medicaid Services ranks all nursing homes that accept payment from Medicare on a scale of one to five stars.  Overall, Woodland Grove Health and Rehabilitation Center scores three out of five stars and scores a two out of five with respect to health inspections.   It is a 120 bed facility owned, in part, by Greystone Healthcare Holdings, which has 26 nursing homes in Florida, with one in Jacksonville, one in Fleming Island (Orange Park), two in Daytona Beach and one in Starke.

Falls are one of the leading causes of injury and death of nursing home residents.  According to the Centers for Disease Control and Prevention, a typical nursing home with 100 beds will report between 100 and 200 falls per year.  In addition, falls are often not reported.  Between 50% to 75% of nursing home residents will experience a fall each year.  Roughly 35% of falls in nursing homes involve residents who cannot walk.

Not only are falls common, the consequences can be catastrophic.  Annually, approximately 1,800 people die as a result of a fall in a nursing home.  Falls also cause serious life-changing injuries including arm, leg and hip fractures.  The immobility that results from such a fracture can lead to functional decline that greatly shortens a person’s lifespan and diminishes his or her quality of life.

Falls in nursing homes have a host of causes including muscle weakness, cognitive problems, changes in medication, wet floors, a nursing home’s failure to provide assistance when transferring from a bed to a wheelchair or toilet, incorrect bed height and improper or missing assistive devices.

There are many ways that nursing homes can reduce the risk of falls.  First and foremost, each resident must be screened for their fall risk.  Residents with an increased fall risk require care plans that put in place appropriate safeguards.  Some residents will require a one person or two person assistance with transfers to and from the bed and toilet.  Others require assistive devices when moving around such as a cane, walker or wheelchair.

The facility itself must also be scrutinized to make sure that hand rails are in place in bathrooms, floors are level and clean and that call buttons work.  Socks, slippers and shoes should have non-slip surfaces.  Beds should be lowered for persons will a high fall risk and cushioned mats should be placed around the bed to minimize any injury that may occur.  Bed rails or anti-roll cushions should be used for persons at risk for falling out of bed.  Residents should be educated regarding common scenarios that lead to falls and how to avoid them.  Finally, the residents should receive physical therapy and nutrition sufficient to keep them as strong and able as possible.
Continue reading

Published on:

A video of a resident on resident beating that lasted for over two minutes finally culminated in the state shutting down a beleaguered assisted living facility in Williston, Florida.  Williston is located about 20 miles southwest of Gainesville. The video shows an 86 year old man being punched more than 50 times by a 52 year old resident.  The 86 year old suffers from dementia.  The 52 year old has a history of mental illness and aggression.  During the beating, there were no staff members present in the common area where the incident occurred.  Furthermore, no one was assigned to monitor the surveillance camera that captured the incident.

Florida’s Agency for Heathcare Administration (“AHCA”), which regulates both nursing homes and assisted living facilities, sanctioned the Good Samaritan Retirement Home 17 times over the last 5 years and fined it in excess of $70,000.00.  Despite these measures, the assisted living facility remained in business.

One month after the beating, a female resident fell in the parking lot and was neither taken to the hospital nor provided any medical treatment.  Later that night, the woman was found non-responsive and blood-soaked.  She later died at the hospital.  After that incident, AHCA put in place a moratorium preventing the assisted living facility from accepting new residents; however, it was allowed to continue to operate with the residents already living there.

Two weeks later, another incident occurred which resulted in the arrest of an administrator at the assisted living facility. On December 7, one of the residents had a medical procedure and had to be closely monitored to watch for changes in condition.  Over the next few days, staff reported to the administrator that the resident had deteriorated; however, the administrator took no responsive action.  He was charged with neglect of the elderly.

Citing additional concerns and medication errors, AHCA finally shut down the facility effective December 23, seven weeks after the videotaped two minute beating occurred.  Residents and their families are understandably frustrated by the lack of a more timely response by the state.

The bottom line here is that you cannot rely on the state to vet a nursing home or assisted living facility for you.  If you or a loved one is in need of assisted living or a nursing home, it pays to do your own homework.  As a starter, for nursing homes, we recommend you review the five star rating system created by the Centers for Medicare and Medicaid Services.  Next, you should visit the nursing home or assisted living facility.  While there, you should do your best to observe whether: the facility is clean; whether the facility has an unpleasant odor; whether there are common areas that meet your needs; and whether the staff is qualified to meet your healthcare requirements.  Continue reading

Published on:

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.

Continue reading

Published on:

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.

 

Continue reading