Press Coverage

by Jayne O'Donnell
USA TODAY

BOSTON — Kevin O'Connor, a spinal-cord doctor who teaches people how to use wheelchairs and control their bowels and bladder, has an unofficial specialty: car-crash victims, the ones who don't wear seat belts.

Before he came to Boston's Spaulding Rehabilitation Hospital last year, O'Connor worked in San Diego, where it was rare to see teens lying in traction after flying out of their cars and trucks. But now, he regularly treats people whose lives changed forever when crashes stopped their cars — and they kept going.

That's because only about half of Massachusetts motorists wear safety belts, and a greater percentage die unbelted than in any state but Rhode Island. In both states, three-fourths of those who die in car crashes are unbelted, a USA TODAY analysis shows.

Cars have had seat belts for more than 30 years, and states started requiring their use in 1984. But the risk of debilitating injury or death — or a ticket — has persuaded only 75% of Americans to buckle up. That gives the USA a lower rate than most of the developed world. Federal officials say if everyone wore belts, it would prevent up to a third — about 9,200 — of the 31,000 deaths in car and truck crashes each year.

Congestion, which slows traffic, helps Massachusetts maintain the country's lowest overall highway death toll. But the consequences of having the lowest seat-belt usage rate in the USA and one of the highest crash rates are seen in rehab hospitals across the state.

" You never think something like this could happen to you," says Michael Prestipino of Lowell, Mass., a quadriplegic since his unbelted body was ejected from his pickup on an icy road last year.

Federal and state officials share the $26 billion annual cost of Medicaid to care for unbelted drivers and cover their lost productivity. Still, states vary on the degree of importance they place on getting people to buckle up.

The National Highway Traffic Safety Administration is spearheading a massive two-week drive through Memorial Day to fire up the states to promote safety-belt use and encourage police officers to ticket the unbelted. The focus is on Memorial Day because it kicks off summer, the deadliest season on the road. NHTSA wants to achieve 78% usage this year.

The usage rate hasn't budged more than a few percentage points in the last decade, but it isn't for lack of trying. Federal officials encourage, cajole and threaten states to get them to pass laws that let police ticket unbelted motorists. Now, NHTSA wants Congress to let it force states to pass tougher belt laws or be required to spend highway construction money on highway safety.

NHTSA says data overwhelmingly show that the only way to make major strides in belt usage is education, coupled with strong police enforcement of so-called primary belt laws. These laws allow police to pull people over simply because they are not wearing seat belts. Federal data show that states passing these laws can expect an 8-percentage-point increase in usage. Still, although almost every state allows police to stop cars if young children aren't in child seats, only 19 states have primary belt-use laws.

Automakers and insurers also lobby for primary laws because seat-belt usage can save them money. Automakers are sued less because belts reduce injuries that might otherwise be attributed to the car, and insurers pay fewer and lower personal-injury claims. North Carolina insurance data show that drivers there have saved $132 million in premiums since its seat-belt usage jumped from 65% in 1993 to 84% in '95.

Higher belt use would also boost states' bottom lines. Massachusetts pays nearly $40 million a year to care for head- and spinal cord-injury patients who were unbelted, according to a new study for the Air Bag & Seat Belt Safety Campaign, funded by the auto and insurance industries. That's almost six times what Virginia, with 70% belt use, pays.

Why people don't wear belts

Working against high belt use:

• Apathy – When there's no Ford, Firestone or drunk driver to blame, there's little public outrage about car crash deaths. Americans have grown used to losing almost as many people every year in crashes as were lost during the entire Vietnam War.
     Although more people under 60 now die from injuries in car crashes than from injuries from any other cause, other misfortunes — breast cancer, heart disease and AIDS — have been far more effective rallying points for fundraising and lobbying.

• Civil libertarians – Laws in several states have been blocked or stymied by those who oppose government intrusion in citizens' lives. In Massachusetts, a now-deceased radio talk-show host almost single-handedly won two repeals of laws requiring belt use in 1986 and 1993, and his efforts echo in the current debate about whether police should be able to pull over the unbelted.
   "There's some bizarre equating of not wearing a seat belt with being a red-blooded American," says emergency room physician Richard Herman of Brockton (Mass.) Hospital. "Intellectually, you could almost understand the argument, but these are kids being killed. Aren't these people parents?"
   Massachusetts Republican State Rep. Brad Jones, who opposes a primary belt law although he wears a seat belt, doesn't find it so strange. "At what point is the impact of saving one life worth the trade-off in civil liberties?" he asks. He says there is a "mistrust of authority" in his state dating to the Boston Tea Party.

• Racial profiling – Concerns that belt laws will encourage police to unfairly target minority drivers have stalled or helped defeat primary belt laws in several states. African-American state legislators in Virginia cited these concerns in voting against a proposed primary law there this year.

• Misinformation – Many people who don't buckle up perpetuate what can be half truths about the dangers of seat belts. Cases in which people have been seriously injured or killed because they were wearing a belt are so rare that many doctors say they've never seen them. And although there are horrific crashes where the belts' estimated 50% effectiveness will not save you, medical experts say the benefits greatly outweigh the risks.

Herman says that any accident that had enough force to cause an internal injury from a seat belt would kill the person who wasn't belted.

Massachusetts has a so-called secondary law that requires wearing a belt but doesn't allow police to pull motorists over only for that violation. The state has been slow in enforcing the law and in advertising its belt-use campaign.

But Massachusetts highway safety spokesman Brook Chipman says that once the state started to push for usage last November, the expected outrage never developed. "After all the hesitancy we had, it was really encouraging," says Chipman, who says the state should have started sooner.

The state will tally its new usage rate early next month. But the push has come too late for thousands of motorists, including Prestipino. He says he was never told to wear a belt when he was young, so he never developed the habit. He was never pulled over for not wearing a belt and says he never saw any public service messages about belts.

Children follow parents

Many who don't buckle up say they're only putting themselves at risk. But Tim Hoyt, safety director at Nationwide Insurance, says the children of adults who don't buckle up are far less likely to use seat belts themselves.

NHTSA chief Jeffrey Runge, a former emergency room physician, says those who don't use seat belts don't take into account the emotional and economic toll placed on families or the price paid by taxpayers and insured motorists.

Prestipino, who managed a paint store before his January 2002 crash, says his family has paid less than $1,000 for his medical care. The rest has been paid by insurance and Medicaid. Treatment for severe spinal-cord injuries such as Prestipino's average up to $400,000 the first year and $40,000 a year after, helping explain why Massachusetts' auto insurance rates are the third-highest in the USA.

Prestipino's wife, Diane, found a teaching job recently to support her family, which includes a toddler who was 5 months old when her husband was injured. She has to get up two hours early to get her husband, who has regained some use of his hands, and daughter ready for their day. Their home has been redesigned — with money from friends and relatives — to accommodate Michael's wheelchair.

Among O'Connor's patients at Spaulding Rehab, Prestipino is one of the lucky ones. Some have brain injuries along with their paralyzed bodies. Sometimes it takes some convincing for them to realize they are lucky to be alive. "They go through a grieving process similar to when someone dies," O'Connor says. "Then they resolve things in their head .... and say 'I want to do the most I can do.' "

Massachusetts state Sen. Brian Lees, a Republican, has sponsored primary belt legislation twice and is fighting the battle again this summer. "Life-and-death issues don't come before the legislature very often," says Lees, who often gets hate mail because of his position. "I try not to just look at things in political terms. I think I'm going to win on this some day."

Larry Gentilello, trauma chief at Boston's Beth Israel Deaconess Medical Center, hopes so.

"Every day, I'm faced with speaking to a mother or a father whose young adult is in a coma," Gentilello says. "I think, 'Why didn't you educate your child about wearing seat belts?' They are experiencing the tragedy of their lives. You look in their eyes, and you realize they're not there anymore."

Contributing: Barbara Hansen