Jacksonville Injury Attorney Blog

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File this one under “believe someone the first time they show you who they are.”

Across the country, the nursing home industry has been lobbying for immunity from Covid-19 claims.  In fact, Florida’s governor is  considering such a proposal right now.  Immunity means that a nursing home can neglect your loved one and unnecessarily cause his or her death and have no consequences for doing so whatsoever.  None.

What is even more preposterous is that some states are also providing immunity for nursing homes that fail to keep resident records currently required by law.  Imagine that your loved one dies from Covid and you get no explanation from the nursing home as to what happened and there no records to review.  That’s it – your inquiry is over.

Highlighting this problem is that nursing home residents are our most vulnerable citizens, they need more protection, not less.  So far in Florida, Covid deaths in nursing homes represent 20% of all Covid deaths in the state.

Nursing homes that fail to take even the most basic precautions to prevent infections would have no consequences for doing so.  Failing to use PPE, failing to educate staff on simple infection protocols, failing to test and isolate sick residents – you name it – its open season.

In all but the absolute worst circumstances, they wont have any criminal responsibility either.  No repercussions whatsoever.  Sound like a good idea?  Has this industry demonstrated it doesn’t need oversight?

Are there nursing home operators who are conscientious and will do a good job?  Yes, and they don’t need protection.

Let me give you an example, the Centers for Medicare and Medicaid services rank every nursing home in the country that accept Medicare as a form of payment.  The ranking system is from one to five stars and is based on a host of categories relevant to resident health and safety.  Our Jacksonville nursing home abuse attorneys have brought claims against every one star facility in the greater Jacksonville area and, in some instances, we have brought multiple wrongful death claims against the same nursing home.  In contrast, to date, we have not handled a single claim against a five star facility.  Not one.

When we were not in a crisis, how did some of the nursing home operators act?  In other words, “who have they shown us to be?”

The cases handled by our Jacksonville nursing home neglect lawyers tell volumes:  a woman who died unnecessarily from a ruptured intestine after nursing home staff ignored weeks of diarrhea; a 52 year old woman who died because the nursing home refused to provide her with medication because the medication was too expensive; and a woman who died after her tracheostomy tube came out and no one at the nursing home knew it needed put it back in in order for her to breathe.  In all of these cases, the nursing homes were understaffed and its employees were poorly trained.

How will we feel when we learn that the nursing homes with one or two stars are the ones with the highest rate of Covid infections and Covid deaths?  I guarantee that there will be a positive correlation.  Is that okay?  Do those operators deserve immunity?

Also, don’t buy it when they try to tell you they don’t get enough money from the government to properly take care of people.  It is not true. One star facilities get paid exactly the same amount per resident as five star facilities. Continue reading

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The coronavirus presents new and challenging concerns for many sectors of our society.  This is all the more so with nursing homes. Because the virus is easily spread among people living in close proximity, and because it is especially deadly for older persons with health issues, nursing homes provide fertile ground for catastrophe.  As a stunning example, a Life Care Center nursing home in Seattle has had thirty residents test positive for the virus with another nineteen having already died.

Viral infections in nursing homes are nothing new; however, one big variant is that there is no vaccine currently available for the coronavirus.  Despite these challenges, nursing homes are required to take all measures possible to avoid the infection and spread of any virus.

It is not acceptable for a nursing home to claim that it cannot control the spread of the coronavirus because there is no vaccine.  As detailed below, nursing homes in Jacksonville are already routinely cited for failing to implement standard infection control measures.  This means that nursing home staff are not properly trained in preventing the spread of disease.  The result is that infection is spread by: unwashed hands; gloves used by staff on more than one resident; insufficient isolation protocols for contagious residents; improper housecleaning and laundry service; and a lack of training to identify residents suffering from a contagious illness.

Simply put, when you add a pre-existing wholesale lack of preparation with the challenges presented by a new illness, you get a disaster that could have been prevented or minimized.  The coronavirus was not unforeseeable.  To the contrary, new viruses appear all the time, with recent examples including SARS, MERS, Zika, the bird flu and the swine flu.  In fact, the coronavirus presents the exact scenario that infection control measures are designed to address.

In the greater Jacksonville and Northeast Florida area, fifty-two of the nursing homes have been cited for insufficient infection control measures. One of the measures used to rank nursing homes by the Centers for Medicare and Medicaid Services relate to infection control measures in place at each nursing home.

In assessing the nursing homes’ infection control measures, state inspectors employed by Florida’s Agency for Healthcare Administration focus on:

-transmission precautions;

-training of staff in transmission precautions to be taken;

-use of personal protective equipment;

-hand washing and glove use;

-laundering of linens and towels; and

-measures in place to detect the spread of infections.

Our lawyers have handled many infection cases against Jacksonville area nursing homes including: urinary tract infections; clostridium difficile (“C. diff.”) infections; pulmonary infections; scabies; and infected bedsores.  One thing we have noticed in almost every infection case is that signs and symptoms of the infection were overlooked or ignored.  With elderly and infirm people, it only takes a few days for an infection to turn into deadly septic shock.

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One of the most common types of nursing home abuse cases that our lawyers handle involve bedsores.  Bedsores, also known as decubitus ulcers, form when bony prominences of the body are subjected to prolonged pressure with a mattress, bedding or a medical device.  Most commonly, bedsores occur on the sacrum, which is the lower back just above the buttocks.  Other common locations for bedsores include the feet, ankles, toes and elbows.

Bedsores can be horrific. If not treated, they can lead to unrelenting pain, disfigurement, hospitalization, surgical procedures, severe infection and death.  Our Jacksonville nursing home abuse attorneys have seen cases of bedsores so large and deep that the affected body part is hard to recognize.

A nursing home must take precautions to prevent bedsores and must respond promptly if a bedsore does develop.

First, a resident must be assessed regarding his or her risk of skin breakdown.  The “Braden” assessment scale is the most common method for determining this risk. The Braden scale uses a point system for various risk factors including: the resident’s sensory perception (if a resident has a limited ability to feel pain, he or she will be less likely to move, or seek help moving, in order to relieve the pressure point); exposure to moisture (if a resident is likely to have consistently moist skin in an area, for ex., a person with urinary incontinence who is not using a catheter, that person is much more likely to develop a bedsore in the moist area); vascular status (a resident with restricted blood flow is more likely to develop bedsores); activity levels (residents who are bed-bound are more likely to develop sores than those who are more mobile); and nutrition (residents with nutrition challenges such as kidney disease which limits their protein intake are more likely to develop bedsores).

It is necessary that a nursing home complete the Braden scale for every resident. For those with medium or high risk scores, preventative measures must be taken.  A deflating air mattress can be used which, as it loses air, changes the areas of the body that are impacting the bed.  Further, nutrition must be monitored and blood tests should be performed to demonstrate that protein consumption is optimal (measured by albumin and pre-albumin levels).  Further, changing the resident’s position should be performed on every shift and documented in his or her chart.  Finally, frequent examinations of all skin areas must be made with charting reflecting any areas of concern.  Any areas of concern should be brought to the attention of the resident’s doctor so that all measures can be put in place to prevent the sore from worsening and to promote healing.

For some people, bedsores are inevitable.  Sometimes, when a person is near the end of life, his or her skin may be one of the first organs that fails.  In these circumstances, a nursing home is not negligent if non-healing bedsores develop.  However, it is critical that the nursing home chart all of the steps taken above and have the doctor chart regarding both the efforts being made and the support for the notion that the resident is experiencing bedsores that cannot be prevented or healed despite best efforts.

Unfortunately, the scenarios most often seen by our nursing home neglect lawyers for cases in the Jacksonville area, involve little to no compliance with: performing a proper Braden assessment; creating an appropriate care plan to address skin breakdown risks; following through with required precautions; and responding appropriately once a bedsore develops.  When we review a case, we study the records to look for such entries.  If they are not there, we then have the case reviewed by an expert witness who is a registered nurse.  If that expert finds neglect, then we are ready to start the pre-suit notice process.

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There have been a rash of cases filed lately by auto insurance companies in Florida attempting to escape liability following a car accident.  The insurers accept premiums for months or years, yet, when a crash occurs, they look for ways to avoid paying for the losses.  To do so, the insurers try to rescind insurance policies, meaning that, legally speaking, the customer never had insurance on his or her vehicle.

The result is nothing short of devastating for the consumer.  He or she will be: denied personal injury protection benefits to pay medical bills or lost wages resulting from injuries; denied coverage for damages caused to another vehicle; denied coverage for damage done to his or her own vehicle; denied coverage for bodily injuries suffered by someone else hurt in the collision; and denied uninsured motorist coverage for his or her own injuries.

As Jacksonville car insurance lawyers, we often hear from our clients that, among the first questions asked by an insurer following a crash, is  whether application questions were filled out correctly.  One of the most common methods used by these insurers is to claim that its customer failed to list all of his or her family members when completing the application.  Yet, the application itself may be extremely confusing about who is to be listed.

For example, we have a case pending now in which the application reads as follows:

Driver Information: Names of all drivers in household, all children and all persons that use the vehicles.  Coverage is provided only for the drivers listed below: 

Six pages later, the application contains a place to initial that reads:

I hereby certify that I have listed all persons in the household and all drivers of the vehicles, whether in my household or not, as well as all children, whether living with me or not.

These two provisions do not match.  The “Driver Information” section, the only place where names can be listed, does not request the applicant to list “all persons in the household.”  Further, it is very confusing as to whether children who do not drive need to be listed as it is titled “Driver Information” and merely specifies that “Coverage is provided only for the drivers listed below.”  It does not provide that “coverage will be denied if you fail to list all persons in your household.”  The insurer preys on people who list all drivers in this part of the application, but fail to list members of the household that do not drive.

Unfortunately, many of the affected policyholders do not know that the insurer’s position can be challenged in court.  Instead, they end up with a mountain of debt that should have been paid for by the insurance company.  If enough people challenge this type of conduct, the insurers will be forced to stop.  This is largely because, in Florida, if you sue your own insurance company and win, the insurer has to pay all of your attorney fees.  As a result, the insurers end up having to pay much more than just the covered damages, giving them incentive to act fairly in the future.

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Florida’s Agency for Health Care Administration is the state agency that licenses nursing homes.  The number of nursing homes in the state is strictly regulated through a “certificate of need” program, which greatly limits the number of new nursing homes in the state.  Creating an artificially low number of nursing homes is adverse to the free market and has a very negative effect on consumers of nursing home care.  As lawyers handling nursing home cases throughout the greater Jacksonville area, we have seen this firsthand.

The free market should dictate how many nursing homes are in operation through standard principles of supply and demand.  If there are too many nursing homes and they are having trouble filling their beds, investors will not be encouraged to open new ones.  On the reverse side, if investors see that poor quality nursing homes are essentially full, they will open new nursing homes to provide better care and obtain a significant market share.  This is how almost all commerce happens in the United States,whether it be restaurants, gas stations or new home construction.

However, this is not the case with nursing homes.  The total number of nursing home “beds” in the state is keep at such a low level that even the worst nursing homes have high occupancy rates.  This is because the nicer nursing homes are full and people are left with no other option but to reside in an inferior, underfunded and often outdated facility.

Here in the greater Jacksonville area, AHCA has received the highest number of new applications for nursing homes in St. Johns County, one of the fastest growing counties in the entire United States.  Close to 20% of St. Johns County residents are over 65 years old. There are currently 8 skilled nursing facilities in operation in the county.  Applications have been filed for six additional facilities in the county.  So far, only one application has been approved despite the quickly growing population.

One would think the State of Florida would be very accommodating to its senior population as the state derives significant economic benefit from the huge number of retirees that move into the state.  It is not.  This is because the nursing home lobby dwarfs the voices of the elder population.  That lobby, with its extensive connections and funding, has kept Florida friendly to nursing home operators at the expense of the quality of care provided to nursing home residents.

One example, is that, while the Florida legislature felt the obvious pressure to require that nursing homes carry professional liability insurance, it passed a law requiring such insurance; however, there is no minimum level of coverage required by the statute. Technically, a single dollar of coverage satisfies this condition, and, frankly, this is essentially what we see.

An insurance policy of nominal value, say $25,000.00 of single limit aggregate coverage for multiple nursing homes, is very common and satisfies the requirement yet provides no meaningful coverage whatsoever.  Sound farfetched?  In the majority of cases handled by our Jacksonville nursing home neglect attorneys, there is no recovery made from an insurer.  Rather, the recovery must come from the nursing home operators directly.

Many of the nursing home operators are merely shell companies designed to limit the parent companies’ legal exposure.  A shell company with little to no assets cannot fund settlements or pay verdicts in the event of neglect or abuse resulting in injury or death.  The end result is that the consequences of nursing home neglect are minimized resulting in a decreased incentive to provide high quality care. Continue reading

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-By the Jacksonville Car and Trucking Accident Lawyers at The Lawrence Law Group –

The National Highway Traffic Safety Administration recently published motor vehicle accident data compiled for 2018.  The report reflects that traffic fatalities in the United States decreased by 2.4% from 2017.  More good news: fatal drunk driving accidents in Florida dropped by 3%.   While these figures reflect some recent improvement, we have a long way to go towards increasing traffic safety.

In 2018, 36,560 people were killed in motor vehicle accidents.  To put that in perspective, approximately 58,000 U.S. soldiers were killed in the twenty year war in Vietnam.  In Florida, 3,133 people died in traffic accidents in 2018.  A whopping 26% of those fatalities involved impaired drivers.

While nearly every category of vehicle accidents reflected a decrease in fatalities, fatal accidents involving semi trucks, eighteen wheelers and other large trucks increased by nearly 1%, fatal accidents with pedestrians increased by 3.4%, and fatal accidents with bicyclists increased by 6.3%.  No explanation was provided for the precipitous increase in pedestrian and bicycle accidents.

For the last 40 years, traffic fatalities in the United States have steadily fallen.  Credit for the decrease is attributed to: the manufacture of safer vehicles including the use of airbags; the increased use of seat belts; and enforcement efforts to decrease driving under the influence.

Almost half of traffic fatalities involved persons who were not wearing seat belts despite the fact that approximately 90% of vehicle occupants do wear seat belts.   This extremely disproportionate number of fatalities for unrestrained drivers highlight the effectiveness of seat belts.  In other words, if seat belts were not effective, it would be expected that roughly 90% of traffic fatalities involved seatbelted occupants instead of only 54%.

Several measures can be taken to further decrease traffic fatalities including: 1. increasing the awareness of the effectiveness of seat belts; 2. decreasing distracted driving, especially cell phone use, texting and social media use; and 3. increasing the enforcement of impaired driving laws.  The day will come when we look back at the carnage on our roadways and wonder how we put up with it.  That day cannot come soon enough.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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