Automobile Accident Litigation: Overturning the Unfavorable Police Report

Introduction: The Police Report is against your client. Now what? Over the last sixteen years of practicing personal injury and automobile accident law, it has been our experience that the quality of traffic accident investigations has steadily declined, leaving many injured people further harmed by a poor or incomplete police report. The reasons are as follows: government budget issues, poor police officer training, and a lack of commitment to performing a complete accident investigation. Certain well meaning police officers are just not qualified to investigate a complicated catastrophic car, truck or pedestrian injury or death case.

If the police report is against your client an insurance adjuster may not want to make a reasonable settlement offer. As a result the case may be difficult to resolve in a positive way for an injured client. A lawsuit may need to be filed and depositions of the witnesses, drivers, and investigating police officers taken to rebut the police report’s conclusion. If the facts can be developed, it is the attorney’s job to show the insurance adjuster, a judge or jury that the police officer got it wrong.

As we unpack the issues involved in overturning the unfavorable police report we will be discussing the following topics:

A. What is a Traffic Collision Report?

B. Who Has Standing to Obtain a Copy of the Traffic Collision Report?

C. Is the Primary Reporting Officer’s Opinion Admissible at Trial?

D. Are the Witness Statements Within a Police Report Admissible at Trial?

E. Proving the Primary Reporting Officer’s Opinion Is Wrong.

A. What is a Traffic Collision Report?

The Traffic Collision Report or CHP 555 is the standard reporting tool for most all police officer traffic investigators in California. It is intended to satisfy the basic data requirement needs of all users of traffic collision information.

The box on page 2 of the CHP 555 identifies the Primary Collision Factor. Primary Collision factor is defined by the CHP as; “PRIMARY COLLISION FACTOR. Select the one element or driving action which in the officer’s opinion, best describes the primary or main cause of the collision. Whenever possible, this should be a Vehicle Code (VC) violation.”

The term Other Associated Factor is defined by the CHP as; “OTHER ASSOCIATED FACTORS(S). When a secondary violation has been determined to have contributed to the collision, write the VC section in the appropriate box.”

B. Who Has Standing to Obtain a Copy of the Traffic Collision Report?

Drivers involved in car accidents are required by statute to file reports with the California Highway Patrol or local police department, Vehicle Code section 20008. People with a “proper interest” can obtain copies of a police report, Vehicle Code section 20012.

The parties involved in the accident or any other persons having a “proper interest” may obtain copies of a police report. This includes persons involved in later accidents at the same location because the reports may disclose highway conditions causing or contributing to their own accident. See, California ex rel. Dept. of Transp. v. Sup.Ct. (Hall), 37 C3d at 855.

C. Is the Primary Reporting Officer’s Opinion Admissible at Trial?

There are two distinctions regarding admissibility. First is the admissibility of the report itself. The second issue is the admissibility of an officer’s ultimate opinion or conclusion. These are both separate and distinct evidentiary issues.

California Vehicle Code section 20013 states, “No such accident report shall be used as evidence in any trial, civil or criminal, arising out of an accident. The rule against admitting police reports into evidence is well established, Fernandez v. Di Salvo Appliance Co, 179 Cal App 2d 240; Summers v. Burdick 191 Cal App 2d 464 at 470. The policy behind Vehicle Code section 20013 is to protect against the danger of the jury giving more weight to the police report’s conclusion simply because of its “official” character. There is a danger that the “official” police report alone may be relied upon to determine the verdict. As a result the contents of a traffic collision report should be excluded. Sherrell v. Kelso 116 Cal App 3d Supp 22 at 31.

However a police officer witness disclosed in conformity with a California Evidence Code section 2034 demand, who also qualifies as an expert witness, with sufficient experience and training, may give an opinion on the factors involved in causing an accident. Hart v. Wielt 4 Cal App 3d 224. In Hart a 13 year veteran of the California Highway Patrol, with extensive training and schooling in accident investigation was allowed to given an opinion on the proper speed given the conditions. The case involved a vehicle which slid out of control while maneuvering a sharp curve on State Highway 32 going towards Chester. Before the officer gave his opinion on speed the trial judge admonished the Jury that it was up to them to make the final determination of a proper speed and also whether or not the CHP officer was qualified as an expert witness.

In the case of Kastner v. Los Angeles Metro. Transit Auth 63 Cal 2d 52, a police officer deemed qualified by reason of his special knowledge, training and experience was allowed to give an opinion on the point of impact between a bus and a pedestrian. The opinion was based almost entirely on a statement given to the officer by the defendant bus driver at the scene. The bus driver testified at trial identical to the statement given to the police officer at the scene. This removed any argument that the officer’s opinion was based on inadmissible hearsay. The Supreme Court in Kastner acknowledged that the trial judge must first determine whether or not the jury is aided by the expert opinion or if the question is within the common experience of an ordinary person, hence and expert’s opinion would not be necessary, see Kastner at page 57.

In summary, the hard copy of the police report itself stays out of evidence. However if the foundation is present for an expert opinion from the police officer, the ultimate opinion in some form may find its way into evidence. But first the offering party must establish the subject of the opinion is sufficiently beyond common experience, the police officer has the appropriate qualifications, and the opinion is based on reliable evidence, see California Evidence Code sections 720 and 801.

D. Are the Witness Statements Within a Police Report Admissible at Trial?

Generally police reports contain statements of plaintiff, defendant, and non-party percipient witnesses. Whether or not these statements are admissible depends on whether or not they are hearsay. California Evidence code section 1200 states, “Hearsay evidence” is evidence of a statement that was made other than by a witness while testifying at the hearing and that is offered to prove the truth of the matter stated.”

What is admissible? Most commonly statements in police reports made by the plaintiff or defendant will come into evidence via an established hearsay exception. Admissions from a plaintiff or defendant are the most commonly relied upon hearsay exceptions, Cal. Evidence Code Sections 1220-1227. Also statements of a non-party percipient witness may come into evidence as impeachment if the witnesses’ statement at trial is shown to be inconsistent with a statement given to the police officer, California Evidence Code section 791.

E. Proving the Primary Reporting Officer’s Opinion Is Wrong.

They key establishing a factual showing that the police officer got it wrong is a complete investigation of the foundation of the officer’s opinion. For accidents in congested urban areas it is common for an investigating officer to only speak to the one or two witnesses who are willing to wait around at the scene and talk to the officer. When a witness sees that other people have come forward to volunteer as witnesses, most people simply leave the scene thinking they are not needed.

Some witnesses that are actually spoken to by a police officer are only spoken to for a short period of time, in an abbreviated manner that leaves out critical details of how the witnesses’ attention was drawn to the accident, what they actually saw versus what they think may have happened. The typical police officer statement is a summary of what was said to the officer. An oral witness statement is noted by an officer in his notebook. These notes are then transferred into the typed up police report. The typical police officer procedure for taking and documenting witness statements is much less reliable than a taped audio recording of a witness. It is important to contact witnesses in the police report to determine the accuracy and foundation for the statements attributed to them by a police officer.

How do you find the witnesses who are not identified in the police report? The keys to finding additional witnesses are as follow: post signs in the surrounding area of the scene; return to the area and ask local store owners for the names of anyone they know may have see the event; look for surveillance videos that may have caught the collision itself on video; and secure the computer aided dispatch (CAD) printouts or audio recordings of the people calling in to report the accident via their cell phones. The CAD records will show the phone numbers for all of the people calling into the 911 dispatch system to report the accident. Many of these callers are good percipient witnesses whose names are not in the police report.

Any good accident investigation is not complete without a thorough accident reconstruction. In pedestrian injury cases a good time distance analysis of what the driver should have seen, at what distance from the point of impact, over what time period may be revealing. With known or estimated driving speeds an expert may be able to back up a driver’s field of view (line of sight) and determine if the driver reasonably had enough time to stop prior to the point of impact. It is extremely rare for an investigating police officer to conduct a time distance / sight line analysis, to determine whether or not a reasonable driver should have avoided the collision. A complete accident reconstruction is expensive. Think about whether or not a complete accident reconstruction is feasible given the damages involved in the case.

Conclusion: When confronted with a police report that is against your client remember the following. A police report is just a summary of the facts taken in an abbreviated manner and collected over a short period of time. Often the report is incomplete, misleading and lacking in factual foundation. If you believe in the case; do not stand down just because the police report is against your client. Conduction your own investigation and make your own determination of the extent of any driver negligence.

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Automobile Dealerships – Out of Trust – Keepers

The Necessity of a Keeper

When a lender feels its security is in jeopardy, it frequently places a keeper in the dealership. This action is usually precipitated by the lender losing its "comfort level" with the dealer.

While many dealers interpret the placing of a keeper in their dealership as a hostile action on the part of the lender, their reaction is based more upon emotion than logic. The lending officer works for a corporation and the corporation is owned by shareholders. The officer has a duty to the company and to the shareholders to protect their security.

"The act of (a lender) in placing its representatives at the plant of its debtor reflected only the natural instincts, interest and solicitude of any other creditor then in its position, and (the lender) is not on that account alone to be penalized by being declared the principal. " Commercial Credit Co. v. LA Benson Co., Inc. 184 A. 236, at 240 (Md. 1936).

See too: Cosoff v. Rodman (In re WT Grant Co.) , 699 F.2d 599 (2d Cir.) Cert. denied, at: 104 S.Ct. 89 (1983) where the court said the banks would have been derelict in their duty to their creditors and stockholders if they did not keep a careful watch on the debtor.

The lending officer did not wake up one morning and decide it would be a good idea to put a keeper in the dealership. In the typical case, the dealership had either been experiencing financial difficulties for a period of time, or a series of floor checks revealed the dealer had "sold and unpaid" vehicles of such an unusually high proportion to monthly sales, that the lender classified the vehicles as being sold out of trust. In either situation, a prudent lender must view the dealer from a different perspective.

No one can predict what a person will do under the continued pressure of serious financial difficulties. By the time a lender puts a keeper in a dealership, the burdens the dealer is shouldering have been growing for some time. The dealer usually does not fully comprehend the extent of the strain under which he or she has been functioning; but, when one faces numerous negotiations with creditors, endless days of chasing cash to make payroll and pay bills and does not have enough cash to purchase and keep a good trade, one's judgment becomes clouded. An experienced lender knows that a normally rational person can do most anything when placed under a sufficient amount pressure, for a sufficient amount of time.

When the keeper appears, the dealer rather than being vengeful or hurt should realize the dealership needs professional help and seek it. There are many ways to continue operating a dealership with a keeper and to resolve the situation, re-capitalize the store, or sell the dealership at a fair price, vis-à-vis a fire sale.

In most instances, a keeper is placed in a dealership upon the mutual consent of the dealer and the finance company. At the meeting preceding such an action, it is wise for the parties to identify, agree to and understand the specific duties and corresponding actions, of the keeper.

The Keeper's Affirmative Duties

Although the primary concern of the keeper lies in the care and custody of the floored vehicles, in most instances the lender also holds a security interest in all or part of the dealership's assets. Consequently, the keeper will want to be and should be aware of the dealer's attitude towards assets other than the floored vehicles and should report to the credit company any indication on the part of the dealer to dispose of any such assets.

The keeper, usually more than one person, will be at the dealership every business day from the time the first employee arrives, until the last employee leaves. The keeper should be responsible for:

(1) The condition, location and security of the pledged assets;

(2) Keeping the vehicles':
a. Ignition Keys
b. Dealer License Plates
c. MSOs and / or Invoices and other documentation required to transfer title.

(3) Being present when the mail is opened;

(4) Taking custody of the cash and checks;

(5) Taking custody of the unused check stock;

(6) Supervising preparation of the bank deposit and agreeing upon whom will make the deposit;

(7) The disposition of proceeds on contracts of sold vehicles, to be sure the money gets to the proper parties;

(8) Arranging for third party finance companies, which purchase the dealer's contracts, to include the lender's name on proceeds checks, or, in the alternative, to refuse to permit the dealer to contract a sale to other finance companies;

(9) Being responsible for protecting the vehicles after the dealership closes; if the vehicles cannot be blocked from exiting the facility, via a fence and "blockers", a security guard should be hired;

(10) Establishing a means of maintaining a running, daily, or semi-daily, inventory control of unsold vehicles. Only one vehicle at a time, for which the lender has not received payment, should leave the dealership, whether of not that vehicle is floored;

(11) Being aware of the activities in the Parts Department and its employees.

Courts have approved of lenders controlling the release of the bank's collateral, depositing all accounts receivable in a special banking account and requiring the counter-signature of the bank's agent for all payments from the special account [ Ford v. CE Wilson & Co. Inc. , 120 F.2d 614 (2d Cir. 1942)], receiving regular reports on the accounts payable activity, receiving estimated weekly expense budgets [ Edwards v. Northeastern Bank , 39 NC App. 261, 250 SE 2d 651 (1979)], proffering advice to the dealer, even coupled with a decision to withhold credit [ In re Beverages International, Ltd. , 50 Bankr 273 (D. Mass 1985), requiring the debtor to hire a consultant acceptable to the bank in the management and sale of the company, requiring the debtor to implement a lockbox with respect to its receivables and requiring certain individuals to pledge their stock in the debtor, to the bank [ In re. Technology for Energy Corp , 56 Bankr. 307 (ED Tenn. 1985).

Acts a Keeper Should Not Perform

If the work-out plan ever deteriorates and / or the relationship becomes hostile between the lender and the dealer, or creditors or employees of the dealer, the keeper's will come under the scrutiny of a court. In such a case, those actions could be the beginning of a basis of liability or exoneration for the lender. In order to best protect the lender, the keeper should be aware of the following:

(1) The lender has an affirmative duty not to unnecessarily, maliciously or promiscuously disclose the financial condition of its debtor and any unauthorized disclosure could be a basis for both compensatory and punitive damages. Rubenstein v. South Denver Nat'l Bank , Case No 86CA0840 (Colo. 1988);

(2) Participating in board meetings and exercising decision making authority with respect to the day to day operations of the business could make the lender liable for all of the debts of the debtor. Lurgen, Liability of a Creditor in a Control Relationship With Its Debtor , 67 Marq. Law Review 523 (1984); See too: Restatement (Second) Agency, Section 14-0, Comment "a";

(3) Evidence of personality conflicts with the borrower could support a bad faith claim by the debtor. KMC v. Irving Trust Co. , 757 F.2d 752 (6th Cir. 1985)

(4) Making threats which the lender is not prepared to carry-out, may support a fraud action against the lender. State Nat'l Bank of El Paso v. Farah Manufacturing Co. 678 SW2d 661 (Tex. App. El Paso 1984).

(5) Misleading a lender who intends to refinance the debtor, as to the debtor's financial condition may result in liability to the third party lender. General Motors Acceptance Corporation v Central National Bank of Mattoon , 773 F.2d 771 (7th Cir. 1985).

Note too: while a factory does not seem to owe a duty to protect a lender's floor plan status, to inform the lender of the fact that the dealer is going to sell, there is a triable issue of fact as to whether or not the factory has a duty to disclose the foreseeability of the dealer going out of trust. Beneficial Commercial Corp. v. Murray Glick Datsun, Inc. 601 F.Supp. 770 SDNY 1985).

Procedures for Handling Insurance and Service Contract Monies

Some lenders have experienced staffs, which understand the above issues and problems. In any case, the dealer should be aware of them and should open new trust accounts. The accounts should be opened at a separate bank, in order to avoid any misunderstandings. If the lender wishes to audit these new accounts, that is fair. If a lending officer threatens to penalize the dealer for protecting the customer's money, he or she is being unreasonable and the dealer should ascend the chain of command until reason prevails. If reason does not prevail, the dealer has hard evidence of the lender creating an untenable position, which evidence may prove useful at a later date.

The handling of the premiums for life, accident and health insurance, and for service contracts, does not create a problem, if a routine is established. Always, with respect to insurance premiums, and usually with service contracts, the sale is covered under a security agreement. The lender and dealer should agree that all "time sales" will be restricted to the lender, unless a third party financing company agrees to put the lender's name on the proceeds check, which usually does not happen.

When a time-sale is being arranged, advance approval of the lender is should be required. Subsequently, when the contract is offered to the lender for purchase, the lender should deduct the amount necessary to release the flooring. If the proceeds of sale are insufficient to clear the flooring, the keeper should have already deposited the cash down payment, and / or have taken possession of the title to the trade-in.

The proceeds of sale, in excess of the flooring, are given to the keeper, who supervises the deposit of the service contract and insurance monies to the trust account and the mailing of the premiums companies to the appropriate insurance companies. If possible, the pay-off for the traded vehicle is also made from the general account of the dealership.

The above process, while time consuming, is necessary. The parties should appreciate the understanding, patience and cooperation needed from each other in order to make the operation run smoothly. If either the keeper, or the dealer, has a problem working with the other, the problem should be discussed with the keeper's superior and resolved, or a new keeper assigned.

Procedures for Handling Payroll Monies

With respect to payroll monies, the dealership should continue with separate payroll account and the lender should agree to permit a payroll large enough for sufficient personnel to run the dealership in order to complete whatever stage of the work-out plan the parties have reached. If the dealership is winding-down sufficient payroll should be allowed for a "skeleton crew" to prepare the dealership for sale, or closing. Equipment will have to be guarded and maintained. Secretarial and accounting work will have to be completed. With respect to sales people, although they do fall within the minimum wage laws, they only get paid a commission if they make a sale and, if they do, they probably will have sold the asset for more money than the lender would get at an auction. The source of funds to cover the dealership operations is discussed in the next section.

Commissioned Salespeople

As mentioned, the commissioned salesperson gets paid a commission if and only if a contract for the sale of a vehicle cashes. They represent the best means of obtaining full value for the lender's security. Consequently, the lender, regardless of its security interest, would probably be wise to subordinate its interest to the extent necessary for the sales people to earn a reasonable commission.

Closing a dealership is covered in another article. At this point, it is enough to mention that a lender, liquidating foreclosed vehicles, would have to deduct transportation, insurance, storage and auction fees from the forced liquidation sales prices of any vehicles it sold, before receiving any monies itself. Therefore, the amount of a salesperson's commission for selling vehicles, net of the foreclosure costs, would appear to be a good investment, on the part of the lender.

An interesting question arises as to whether or not the lender has an implied duty, knowing the sales people are liquidating the inventory for the benefit of the lender, to inform the sales people that it, the lender, intends to keep all of the gross profit from the sale; and, further, if the lender, knowing it does not intend to allow the sales people to be reimbursed for their efforts, says nothing, do the sales people have an action against the lender?

In any event, the payment of employees (salaried or commissioned) should be made by the dealer from a separate payroll account. The account should be funded under the supervision of the keeper, but the lender's employees should not participate in distributing the funds. Note: Participation in distributing the company payroll could make the lender liable for taxes. 26 USC 3505 and 6672.

Division of the Discretionary Income

Vehicle Income

If a lender maintains a security interest in the dealer's vehicle inventory and if the dealership has collected and spent money for vehicles which have been sold, without reimbursing the lender for those vehicles, then the dealership's gross profits from all future vehicle sales should be applied to reduce the number of sold and unpaid units. The cash profits from such sales should be applied immediately to the lender's debt, such as vehicle gross profit, finance and insurance commissions and service contract profits. Factory rebate money and incentive monies should be assigned to the lender and applied to the borrower's debt only upon receipt of the actual cash.

Service Department Income

Unless the dealership is averaging a 100% service absorption rate of its fixed overhead expense, which is unlikely, trying to operate a dealership on the service department's income will be difficult, if not impossible. If the lender is unable or unwilling to allow these monies to be applied to the general operating fund of the dealership, it means the lender has decided to close the dealership, whether it believes so or not.

The service department monies include gross profits from parts, service, labor and the body shop, if the dealership has one. The percentage of all fixed overhead expenses covered by this profit reversing the dealership's absorption rate.

If the dealership is being sold or closed, these monies should be used to complete the payrolls necessary to accomplish an orderly transition or liquidation.

As always, consult with a qualified attorney whenever dealing with out of trust situations.

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The US Automotive Industry and The Big Three

We have a proud car culture in the United States but, surprisingly, not many people know too much about this country’s automotive history. For this history lesson, we are focusing on the automotive “industry” rather than the history of the automobile itself.

When It All Began

In the 1890s, the American automotive industry began and, thanks to the use of mass-production and the large size of the domestic market, quickly evolved into the largest automotive industry in the world (though this title would be taken from the U.S. by Japan in the 1980s and then from Japan by China in 2008).

The U.S. motor vehicle industry actually started with hundreds of manufacturers, but by the end of the 1920s, three companies stood apart from the rest:

  1. General Motors
  2. Ford
  3. Chrysler

The Big Three

These three companies continued to prosper, even after the Great Depression and World War II. Henry Ford began building cars back in 1896 and started the Ford-Motor Company in 1903. Ford utilized the first conveyor belt-based assembly line in 1913, improving mass production of its Model T. The assembly line decreased costs significantly and the Model T sold so well that it propelled Ford into the largest automobile company in the U.S.

General Motors was founded by William Durant (formerly a carriage maker)n in 1908. In the first couple of years, GM acquired Buick, Oldsmobile, Oakland (later to become Pontiac), Cadillac, and a number of other car companies. Durant also wanted to acquire Ford but Henry Ford opted to keep his company independent. Having become a little to “acquisition-happy,” Durant over-extended the company and was forced out by a group of banks who took controlling interest in the company. Durant then teamed up with Louis Chevrolet and founded Chevrolet in 1913, which became a quick success. Durant retook majority control in GM after acquiring enough stock and GM acquired Chevrolet in 1917. This did not last long, however. Durant was forced out again in 1921. In the late 1920s, GM overtook Ford as the largest automaker.

The former president of Buick and a former executive of GM, Walter Chrysler took control of the Maxwell Motor Company in 1920, revamped it, and reorganized it into Chrysler Corporation in 1925. Chrysler acquired Dodge Brothers in 1927 and, in 1928, introduced the DeSoto and Plymouth brands thanks to the dealer network and manufacturing facilities that came with the Dodge acquisition. By the 1930s, Chrysler overtook Ford and became the second largest automaker.

1950s and Beyond

By 1950, America produced almost 75 percent of all automobiles in the world. At the start of the 1970s, however, U.S. auto companies (especially the Big Three) were severely affected by increased competition from foreign auto manufacturers and high oil prices. In subsequent years, companies bounced back occasionally but the crisis reached its pinnacle in 2008, prompting Chrysler and General Motors to file for bankruptcy reorganization and be bailed out by the federal government. While Ford was also affected by the crisis, it decided to power through on its own and did not take the bail out. We actually have a lot of respect for Ford as a result of this. They did not take the easy way out.

The year 2014 saw saw the biggest (seasonally adjusted annualized) sales in history with 16.98 million vehicles.

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The Need for Hybrid Cars

Since the very conception of the automobile, engineers and designers have been searching for was to make them more efficient and save on fuel consumption. Petrol fuels the majority of vehicles and diesel fuel is used in heavier automotive equipment. The internal combustion engine is considered to be a major if not the biggest source of environmental pollution and the cost of fuel is increasing every day.

With a constant rise in fuel costs and the environmental concerns regarding automobiles, vehicle engineers have had to develop more economical and environmentally safer alternatives to the internal combustion engine that powers most cars. This has led to the birth of the hybrid automobile. These hybrid automobiles offer a number of benefits. The hybrid automobile is a car that is powered by both an electric motor and a gasoline engine. Compared to non hybrid vehicles, the hybrid car saves on the cost of fuel by being more fuel efficient and has a lower rate of fuel consumption.

Hybrid cars operate on a dual mode where the electric motor, powered by batteries, takes over once the gasoline engine has gotten the vehicle up to speed. Braking and deceleration generates energy that is used to charge the electric motor’s batteries. This system allows the hybrid car to provide better fuel efficiency. This also means that the engine of a hybrid vehicle is shut the moment the car is stopped. Considered the biggest advantage to the hybrid car is the reduction of environmental pollution due to fewer emissions of carbon dioxide and other harmful gases in to our atmosphere. Automobile manufactures such as Honda, Toyota, and Ford have already introduced hybrid car models to the commercial market and several others are in development.

Currently there are two types of hybrid vehicles on the market. The first is the “Series” hybrid. A battery powered electric motor powers the Series hybrid car. It also has a gasoline powered engine but it does not singularly power the vehicle. The gasoline engine powers a generator which is used in turn to charge the batteries of the electric motor. The electric motor is left on during the vehicles entire operation however the gasoline engine can be switched on or off depending on the needs of the vehicle. This type of hybrid automobile provides better mileage in city traffic.

The second type of hybrid vehicle on the market is called the “Parallel” hybrid. The Parallel hybrid car, like the Series type, has a gasoline engine and an electric motor. The electric motor and the electric motor can both be used to turn the transmission and power the vehicle. The major difference between the two types of hybrid cars is that the Parallel hybrid uses its electric motor to boost the vehicles power when required to increase the car’s speed. The Parallel hybrid car is considered better suited for the open highway.

Hybrid automobiles provide several benefits due to some very unique features. The construction of the hybrid vehicle uses more lightweight materials than traditional automobile. This saves energy by using less to propel the hybrid car. Hybrid cars also increase energy efficiency because of their more aerodynamic shapes. Tires used by hybrid vehicles run on a higher pressure and are made of a more rigid material than general car tires. The higher pressure helps to increase the vehicles gas mileage per gallon of gasoline used. The overall efficiency of the vehicle is increased by these tires because they reduce friction on road surfaces and provided a grip. The braking system provided an energy transfer from the electric motor to the vehicles batteries when ever the brakes are applied. The overall gas mileage of a hybrid varies from model to model. The EPA test numbers report that the Lexus RX400h receives 31 MPG in the city and 27 MPG the highway while the Honda Insight receives 61 MPG in the city and 68 MPG on the highway.

In conclusion, the future of automobiles is currently the hybrid car and purchasing a hybrid vehicle will not only save you money but will also allow you to take responsibility and do you part in creating a safer, cleaner and greener environment.

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The Automobile in Melody

Historical events are captured in the music of the era. ‘Over There,’ ‘How ‘Ya Gonna Keep ’em Down on the Farm after They’ve Seen Paree, and ‘When Johnny Comes Marching Home’ were some of the Doughboy songs of World War I. Al Jolson singing ‘Brother, Can You Spare a Dime’, and ‘Dust Bowl Blues’ marked the Great Depression. ‘Fightin Side of Me’ revealed the nation’s conflict over Vietnam in the ’60s. So it is only natural that the automobile, which changed American life forever would be immortalized in song and it was.

At first the automobile was only for the wealthy and this was reflected in early sheet music. Even though there were no lyrics, ‘The Swagger’ and ‘Up Broadway’ featured fashionably dressed urban couples with an automobile. Then came the song ‘The Auto Man’ with the lyrics implying that ownership of an automobile indicated wealth and prestige. But along came Henry Ford who pledged to manufacture an automobile that the man on the street could afford and he kept his promise. In October 1908 the first Model T’s, priced at $850, rolled off the assembly line. Over nineteen years of production, its price would drop to $260. The Model T was referred to as the Tin Lizzie and the Flivver and became the subject of many songs. Lizzie is a nickname for Elizabeth and was a popular name for horses at that time.

So then they sang:

Old Zeke Perkins sold his hogs the other day,

The gosh-darned fool threw his money right away;

Rode into town, sittin on a board,

Came home ridin’ in a brand-new Ford!

However, the roads were still designed for horses and did not easily accommodate the speed of the new tin horse so in 1912 along came the song, “Bump, Bump, Bump in Your Automobile.” While the song lyrics emphasized the poor road conditions, one line inferred that women were attracted to male car owners with the words “Molly May said she loved Willie Green. Best of all she loved Willie’s machine.” This theme was repeated in many of the early automobile songs.

And the poor road conditions often resulted in mechanical breakdowns that popularized the tune, ‘Get Out and Get Under’ with the cover sheet depicting a well dressed man under a cabriolet with his legs extended, wrench in hand and his fashionably dressed lady friend in the passenger seat looking down anxiously. The freedom provided by this new invention also carried over to courting customs allowing more opportunities for intimacy and privacy triggering some social anxiety about the relationships between unmarried couples. This together with the liberation of single women in the Roaring 20’s inspired tunes such as ‘Up and Down the Eight Mile Road,’ 1926.

There were also songs about particular models like ‘Cole 30 Flyer’ with the lyrics ‘You will win me Bill, heart and soul, if you buy a Cole.’ These may well have been early attempts at product-placement advertising. Since Ford was producing most of the automobiles of the era, they were popular song subjects. In 1928 when the Model A was introduced, Walter O’Keefe wrote ‘Henry’s Made a Lady out of Lizzie’. Abner Silver and Jack Meskell followed with ‘Poor Lizzie, what will become of you now that your sister is here.’

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Survey Shows US Families Who Can’t Pay Hospital Bills Still High

A study by the The Commonwealth Fund, a private institution in the United States which seeks to promote a better health system, showed that a third of American adults forgo a visit to the hospital because they either have no insurance or a plan that is inadequate for their true needs. Those who seek medical care and pay their hospital bills did not end up any better anyway because they have no money to purchase medicines. Contrast that with some areas in Europe such as United Kingdom and the Netherlands, for example, which boast of just 5-6 percent slippage in the number of patients in population who failed to seek medical care due to insurance concerns.

The same survey showed that one in five adults or about 20% in the US could not pay hospital bills. You know what’s the second developed country in the list? France, with a measly nine percent. The issues don’t stop there because the U.S. also has one of the highest out-of-pocket expenses-meaning the amount patients pay before insurance kicks in-for medical bills in the world, right up there (or to be more specific, right down there) with other third world countries with poor government allocation for health service.

The study compared the health care systems in 11 countries like Canada, Australia, U.K., Switzerland, Sweden, Norway, the Netherlands, Australia, France, U.S. and Germany. The gap between the rich and the poor has more impact on the capacity of the patient to pay hospital bills compared to other countries where the “haves” usually foot the bill for the “have-nots.”

The report result is nothing new, of course, because it only confirms what most of us already knows: there’s a need to reform the U.S. health system.

The study analyzes findings from the Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries, focusing on insurance and access to health care experiences reported by 19,700 adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The study reveals widespread disparities by income within the United States. Lower income U.S. adults were far more likely than those with above average incomes to report difficulty with medical bills and timely access to health care.

“We spend far more on health care than any of these countries, but this study highlights pervasive gaps in U.S. health insurance that put families’ health and budgets at risk,” said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article. “In fact, the U.S. is the only country in the study where having health insurance doesn’t guarantee you access to health care or financial protection when you’re sick. This is avoidable – other countries have designed their insurance systems to value access and limit out-of-pocket costs.”

A new 11-country survey from The Commonwealth Fund finds that adults in the United States are far more likely than those in 10 other industrialized nations to go without health care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with their insurers or discover insurance wouldn’t pay as they expected. According to the report, the findings highlight the need for Affordable Care Act reforms that will ensure access to health care, protect people from medical debt, and simplify health insurance.

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Giving Birth in Shaarei Zedek Hospital of Jerusalem, Israel

More pregnant women choose to give birth in Shaarei Zedek hospital, Jerusalem, than any other hospital in Israel. They must be doing something mothers like.

In 2012, there were more than 15,000 births in Shaarei Zedek. This figure does not include any births related to their taking over the management of Bikur Cholim hospital in late December 2012.

In 2013, the combined total of the two locations under their management was over 20,000 births! On average, there were 41 births a day in Shaarei Zedek alone, not including Bikur Cholim.

Shaarei Zedek’s magazine reports that the cesarean rate in 2013 was 11%. Professor Samuelov, the director of the department of obstetrics and gynecology, emphasized that “This is one of the lowest cesarean rates in the country, and the reason for it is that Jerusalem is a very supportive environment for normal birth. We provide assistance and ideal treatment for women who desire to give birth normally, and ensure ways to do it safely. We have a lot of experience, and we have the knowledge and ability to prevent cesareans in certain cases. We make it possible to have a normal birth even after two cesareans, for breech presentations and for twins, something that isn’t accepted in most places.”

As Professor Samuelov notes, “Jerusalem is a very supportive environment for normal birth” because many pregnant women in Jerusalem “desire to give birth normally”. Why is this desire stronger and more common in Jerusalem than it is in other parts of the country? Apparently, the reason is that more women in this locality belong to ethnic groups with a high birth rate. Simply, avoiding an unnecessary cesarean is much more important to mothers who intend to have many children than it is to women who don’t, because of the increased rate of complications in subsequent pregnancies for women with a previous cesarean.

Professor Samuelov explains that his department tries hard to keep the cesarean rate down in order to give pregnant women what they want most. In order to do this safely, Shaarei Zedek provides top-quality medical care, including a carefully supervised trial of labor after two cesareans, and breech births in selected cases.

Supplying what women want means that more pregnant women choose to give birth in Shaarei Zedek hospital, which increases its income, since Israel’s National Insurance Institute pays hospitals very well for births. The fact that Shaarei Zedek officially observes the Sabbath also helps the hospital to attract religious women who have a high birth rate. Two out of three pregnant women in Jerusalem choose one of the hospitals under their management, and only one in three choose one of the Hadassah hospitals. Attracting a greater market share of births is what keeps Shaarei Zedek’s finances in good condition, while the two Hadassah hospitals are having great financial difficulties. As a childbearing woman, you are likely to benefit from choosing a hospital that doesn’t have to cut back on services to patients.

The high birth rate itself provides an incentive to the hospital to keep the cesarean rate down, because the more cesareans a women had, the greater the risk of complications in subsequent pregnancies and deliveries, even if they are delivered by repeat cesarean. Obstetricians in Jerusalem have seen more of these complications than doctors in other places because they serve a population with a high birth rate. Providing the option of regular birth after one or two cesareans for women who want large families prevents a lot of risky high-order repeat cesareans, the kind of surgery that doctors in Jerusalem would rather avoid having to perform.

Presumably, the director of obstetrics in Shaarei Zedek terms Jerusalem “a very supportive atmosphere for normal birth” due to the combination of its high birth rate and competition between the local hospitals.

If it is important to you to participate in decision-making, Shaarei Zedek is very amenable to this. On a recent tour of the delivery suite, without being asked, the midwife leading the tour mentioned the importance of involving the mother in decision-making.

Dr. Abulafia, a retired obstetrician who worked in Shaarei Zedek, in an interview for Shaarei Zedek’s magazine, described the differences between the mother’s participation nowadays and in the past: “The involvement of the childbearing woman has changed noticeably. The accessibility of information, the calculators in the internet, the great variety of medical tests and the modern equipment for imaging and surveillance, have all made the mother into a real partner. In the past it was the doctor who knew and understood, and the patient put herself in his hands. Today, pregnant women come to us with a great deal of knowledge, and this obligates the doctor to keep updated in order to be able to answer any question.”

Shaarei Zedek’s magazine also interviewed the head midwife, Chava Chacham. She too addressed the topic of the mother’s participation: “In the course of the pregnancy, the couple is exposed to a lot of information. In many cases, they ask to be participants in planning the course of the birth and make special requests. We advise mothers to share her desires with us when she arrives at the delivery suite so we can coordinate expectations together. Some women are interested in delayed cutting of the umbilical cord, others request not to bathe the baby immediately. We respect every request. Our staff believes in the autonomy of the childbearing woman’s decisions, and we will do whatever is possible to answer her requests openly and in cooperation. As long as the birth proceeds safely and there is no medical problem, the decision is in the hands of the woman giving birth. There are some women interested in an epidural, others prefer that we decide for them. Many women choose to give birth naturally, and in order to help them to carry out their wishes, some of our midwives took continuing education courses in yoga and relaxation – techniques that help reduce both tension and pain.”

What this means for you as a childbearing woman is that on any given shift, there are likely to be some midwives who enjoy supporting natural birth, and you can probably get one if you request this. If you don’t say anything about your preferences, your midwife may presume that you would like her to recommend when she thinks you would benefit from an epidural. The head midwife of Shaarei Tzedek advises you to tell the staff in the examining room what approach you prefer, natural birth or epidural. If you follow her advice, they will be able to assign a midwife who is most appropriate for you. This will enable both you and the midwife will find the experience as rewarding as it can be.

Only 55% of all women giving birth in Shaarei Zedek request an epidural, but 80% of all first-time mothers get an epidural. In comparison, in hospitals in the center of the country, 80 to 90% receive epidural. One of the reasons for the low rate of epidural usage is that Shaarei Zedek serves a population with a high birth rate, meaning a high percentage of the births there are not first births.

Shaarei Zedek has its own nursing school. Of all departments in a hospital, the quality of the nursing staff is most important in the delivery suite, because medical care during normal uncomplicated childbirth is provided by midwives, not doctors. Having a staff of top midwives means a higher likelihood that childbirth will remain normal and uncomplicated.

You can choose to give birth on their birth stool, which makes the birth more modest and faster and may also be more comfortable for you.

Until recently, Sharei Zedek had three maternity wards with 134 beds. In early 2014, they opened a fourth maternity ward in their new building, with an additional 40 beds. The new ward offers full rooming-in, in which the baby is next to his/her mother almost all hours of the day, including at night. Babies in full rooming-in are taken to the newborn nursery for examinations four times a day. Every mother receives instructions how to care for her baby on her own, but if she wants a short break, she can bring him to the nursery. All three pre-existing maternity wards have partial rooming-in.

Shaarei Zedek also moved its neonatal special care unit to the new building in early 2014. The new unit has 70 beds, enough to handle expected growth in the next few years, as well as the most advanced equipment available today, including things that no other hospital in the country has. Although the old unit had only about 35 beds, almost immediately, the new unit began to care for an average of 50 babies at a time! Two reasons could be contributing to this sudden increase: more mothers whose babies were likely to need special care decided to give birth in Shaare Zedek and/or more babies born elsewhere were transferred here to get the best neonatal special care available in Israel, and among the best in the world.

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Hospitals in Chiang Mai, Thailand – Medical Tourism

Chiang Mai Ram Hospital

This is the premium private hospital in Chiang Mai, and with the price range to match: but then again, you get what you pay for, though the Ram is not necessarily where you might want to have your check-up or physician appointment if you are a backpacker traveling on a limited budget. The Ram has comprehensive departments: Obstetrics/Gynecology, neurosurgery, pediatrician, dentistry, and all the specialists you would expect to find at any modern hospital. Indeed, Thai doctors tend to come with much better bedside manners and as a rule are friendlier than their western counterparts thanks to the emphasis on hospitality in Thai culture as well as the Ram’s direction as part of the service sector. The staff speak fairly fluent English, usually give prompt, helpful service, and the hospital as a whole is one of the most reputable in the country (overseas patients who come to Thailand for cheaper medical expenses and operations are common). The Chiang Mai Ram is located in the Old City area, near the Central Kad Suan Kaew shopping mall, and boasts a roof that has been built to accommodate emergency helicopter landing. All reputable hotels in the city often have a contract with the Ram and default to them for ambulances and emergencies.

Rajavej Hospital

Located opposite a hotel, the Rajavej Hospital includes highly specialized service clinics, including liver disease clinic, hemorrhoids clinic, digestive system disease, diabetes/thyroid and cholesterol clinic, dermatology, geriatric clinic and a menopause clinic. Their service centers range from cancer to endoscopy, and they have surgeons who specialize in orthopedic surgery, oncology, and plastic surgery. Price range is somewhat less likely to traumatize your wallet, but the Rajavej Hospital’s lobby and waiting area is also considerably less glamorous to look at then the Ram’s.

McCormick Hospital

The McCormick Hospital is one of the few institutions in Chiang Mai and Thailand in general that are run under the umbrella of the Church of Christ, and as such is a Catholic hospital. Being considerably smaller than the Chiang Mai Ram, it accordingly offers rather fewer facilities and department, but the accommodation and nursing fees are also much cheaper, catering to more budget-conscious patients. General health check-ups, cancer check-ups, prenatal and postnatal care, cardiac care unit, and intensive care units are available. The McCormick is located in Wat Ket, on Kaeonawarat Road, close to the Dara Academy.

Lanna Hospital

The Lanna Hospital has been certified with ISO 9000. It offers 180 in-patient beds, and distinguishes itself by hiring staff who not only speak English but also Mandarin and Japanese in addition to, of course, Thai. While like others it offers general care across various health categories (cardiac care, back pain, Obstetrics/Gynecology, et cetera), it specializes in handling emergency cases. It is located on Chnag Klan Road, in the city center, and is one of the hospitals closest to the Night Market area.

All the hospitals listed adhere to ISO standards and are staffed by internationally trained doctors and nurses, many of which graduated from Ivy League schools and top medical universities of England and Switzerland. Combine this with the superior hospitality, cultural disposition toward friendliness, and the relatively low costs, and Chiang Mai easily proves one of the most attractive destinations for medical tourism.

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Kankakee Illinois Hospital Stomping Grounds For Al Capone

Al Capone – also known as one of Chicago’s most notorious gangster chiefs – had a vast number of retreats and vacation spots where he could unplug from his extremely busy life of murder and mayhem and enjoy a little peaceful R & R. These include St. Paul MN, Hot Springs AR, as well as some lesser known hideouts where he could maintain his anonymity such as French Lick IN, Brookfield WI, Olean NY, Lansing MI, Dubuque IA, and Johnson City, TN. But one of Scarface Al’s all-time favorite stomping grounds were much closer to his home, in Kankakee, since Kankakee Illinois hospital was well known to Chicagoans looking for a good time. Kankakee County’s towns had the reputation in the 1920’s and 30’s as being wide open fun spots where anything went.

The Kankakee County motto was “Just an hour from Chicago, but a world apart.” According to Jorie Walters, a researcher at Kankakee County’s Museum, there is not much written documentation of Al Capone’s influence in the area, but everyone knows the real truth. Walters’ information was gathered from books, history columns in the Kankakee Daily Journal Newspaper, oral histories, and from old museum files. She says that some of the local dives which were owned or frequented by Scarface Al include Bradley Illinois’ Hawaii Motel; a safe house in L’Erable on the Iroquois River which was extremely well fortified against unexpected and unwanted visitors; Nel Clark’s, a brothel in Kankakee which is now called the City Tavern; The Sahara Restaurant on Kankakee’s Fifth Avenue; and the Radeke Brewery, also in Kankakee, which was secretly owned by Al Capone in the 1920’s and 30’s. Kankakee was also the hometown of Fred Burke’s moll. Burke was Capone’s leading enforcer who planned and executed the St. Valentine’s Day massacre in 1929 against Bugs Moran’s gang.

Another of Scarface Al’s favorite hangouts was the Miami Gardens near Peotone Illinois hospital, which was both a bar and brothel in Prohibition Days and is called Edwin’s bar now. Scarface Al had the reputation of being the foremost sampler of the wares he purveyed in his brothels. The Miami Gardens had high, ornate ceilings made of tin, and there was a secret garage with room for twenty automobiles in the basement of the building which is scarred with bullet holes in its walls. It is rumored that gangland executions were carried out in this hidden garage. Another favored hangout was Club 54 Restaurant near the Manteno Illinois hospital (just south of Manteno where Governor’s Highway meets 500E). This restaurant was actually a brothel.

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Types of Underpads Used in Hospitals and Homes

The two primary types of underpad used in hospitals are disposable underpads and washable or reusable underpads. In this article, we will discuss the features of these two types of underpads in more detail. Here, it must be mentioned that although the largest consumers of these products are hospitals and nursing homes, individuals with bed-ridden patients, disabled or elderly individuals or even those with babies at home can and do use these pads.

The disposable underpads as their name suggests, are meant for one time use. They are available in a range of construction types and sizes. They usually contain a waterproof plastic material for the bottom, a middle layer designed to absorb liquid and a top layer made from a soft and comfortable fabric. The middle layer usually houses multiple layers of tissue to absorb fluids. The topmost layer of these units come in contact with the patient's body, therefore manufacturers use materials such as cotton that will make patients are comfortable while using their disposable underpads. You will also come across pieces in which the top sheets are made up of tissues or a tear-resistant spun-bond material that allows for movement without fear of ripping the pad.

There are some disposable underpads carrying top sheets attached to the plastic layer at the bottom by means of an adhesive. Then, there are others with two sides rolled and glued to ensure that the liquid comes out only from the side in case the pad overfills. Experts refer to this process as channeling. The pads adopting this process are known to be more absorbent compared to the other underpads available on the market. You can get all these disposable underpads in a range of sizes; so, purchasing pads that match your body, bed or chair size will be simple.

Now, we will be talking about the washable or reusable underpads. These pieces are classified based on factors such as absorbency, materials, and size. The term absorbency refers to the volume of urine or bodily fluid that an underpad is capable of holding. The material used for crafting the absorbent layer is a kind of absorbing polymer.

The quantity of polymer used and the material's density are two factors that decide how much liquid the underpad is capable of absorbing; Basically, the underpad's urine holding capacity. Here, it must be noted that one should never confuse an underpad's absorbency level with its size. A pad that's large in length and width might not absorb the most urine.

After absorbing the urine, reusable underpads need to secure it in a liquid-proof barrier. This is essential to prevent the urine from soaking through the bedding. These liquid proof barriers are made either of urethane or of vinyl. The vinyl structures, although more cost-effective, are not breathable; additionally; They can take a lot of time to fully dry. The urethane structures are more expensive, but don't have the issues we generally associate with vinyl underpads.

Now, let's discuss the appropriate size of underpads. When buying an underpad, you must ensure that you have at least 6 to 10 inches around your waist ie the target zone. This stands true for both underpad types, disposable and reusable and allows enough coverage to adequately contain fluids. Smaller sized pads are designed for use in chairs and make excellent absorbers in baby cribs or on diaper changing tables. Many hospitals use small pads in bassinets for easy clean up.

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