In the agonizing and uncertain days following the accident, it appeared 73-year-old Ruben Perez would only add to Hawaii’s status as the worst state for elderly pedestrian fatalities.

"It was real bad," his son, Edward, recalled. "We thought we were going to lose our dad."

But while the Ewa Beach man didn’t succumb to his severe injuries, it’s unlikely he will rebound into the same man, husband and father he was before he was struck by a pickup truck while crossing Paiea Street at North Nimitz Service Road on the morning of July 7.

Two months after the accident, the father of six is recovering slowly at a Kane­ohe rehabilitation facility, and the medical bills have reached into the hundreds of thousands of dollars.

Perez’s ordeal is no unfamiliar tale in the islands as hundreds of pedestrians are hit by cars and trucks each year — many of them seniors, as pointed out by a recent report that described Hawaii as the most dangerous state for pedestrians over age 65.

This year seems to be especially bad on Oahu’s roads. It’s only the beginning of September, and already the number of pedestrian deaths on Oahu this year — 21 — tops the number of pedestrian fatalities in all of 2013, according to the Hono­lulu Police Department.

More than 400 nonfatal pedestrians accidents occur each year on Oahu highways and streets, according to statistics from the state Department of Health, while the statewide average tops 500.

Senior citizens seem to bear the brunt of the carnage. According to a May report by Smart Growth America, Hawaii owns the highest fatality rate in the nation per capita for older pedestrians, with 6.81 deaths per 100,000 adults 65 and older from 2003 to 2010.

It’s even more dangerous for those 75 or older. They have a fatality rate of 9.75 per 100,000, according to the report’s analysis of injury statistics from the Centers for Disease Control and Prevention.

A separate National Highway Traffic Safety study listed the state as having the highest rate of fatalities involving pedestrians 65 or older from 2007 to 2011. During that period the state saw a rate of 5 deaths a year per 100,000 seniors, the study found.

"Too many people are racing to get from Point A to Point B," said Jackie Boland, AARP Hawaii director of community outreach. "Drivers here are frustrated and looking out for other cars but not always paying attention to pedestrians."

Boland, who has worked with the city to help create design guidelines aimed at making Hono­lulu’s streets safer, said Hawaii’s booming older population is more vulnerable in Oahu’s densely packed urban core, with its arterial roadways designed for both fast-moving traffic and pedestrians.

"There are bound to be conflicts," she said. "What’s troubling is the number of seniors who get hit in crosswalks."

On Oahu, Hono­lulu city officials passed a Complete Streets ordinance in 2012 — in part to help make the island safer for its aging population, and officials are working on design guidelines to make streets more pedestrian-friendly.

Some streets have been revamped with repainted lines, clearer crosswalks, new signs, back-in angled parking, and "bulb-outs," which are lines painted on the road to narrow the driver lanes and create a shorter crossing distance for pedestrians.

Boland said Honolulu has made strides planning for the future and making pedestrians a priority, but "there’s always room for improvement."

Honolulu attorney Richard Turbin, meanwhile, shakes his head at what he calls an epidemic.

"I’ve got so many of these cases. They’re coming in droves," said Turbin, who was retained by Perez’s family following the July accident.

"For whatever reason, it seems to be getting worse, not better. Most of the cases I get, the people are in the crosswalk or on the sidewalk. They’re doing everything right — and they’re getting run down like stray dogs. It’s an epidemic. I just don’t get it," he said.

With Turbin’s help, Perez and his wife, Betty, last week filed a claim in Circuit Court against the driver of the truck that hit him, accusing him of reckless negligence and asking for an unspecified amount in damages.

Family members still don’t know what Perez was doing on the day he was hit. His calendar indicated he may have been going to a doctor’s appointment, they said.

According to the claim, Perez was crossing Paiea Street in the crosswalk at about 10:30 a.m. when the pickup truck turned from North Nimitz Service Road and plowed into the man, dragging him under the vehicle for at least 10 feet.

Contacted by the Hono­­lulu Star-Advertiser, the driver, Ale­jan­dro Loren­zana, denied being reckless but admitted he didn’t see Perez. He said that when the light turned green, the car in front of him went straight and "everything was clear" as he turned right.

"Then suddenly I hit something," he said. "I don’t know where he came from."

Lorenzana claims Perez wasn’t in the crosswalk and wasn’t dragged. He said he stopped as soon as he realized he hit something.

"It was an accident," he said.

The police investigation remains open, the department said. According to a police accident report, a witness saw the pickup "dragging an older man under the front driver side tire."

Lorenzana was shaken up, the investigating officer wrote, but he didn’t appear to be under any influence of drugs or alcohol.

As for Perez, he was in bad shape. Family members said they first saw him in the Queen’s Medical Center emergency room, the victim of brain injuries, fractures and skin ripped off his lower leg.

The first few days his outlook was bleak. Doctors said that if he did survive, he might live in a vegetative state. They told the family to expect the worst and hope for the best.

He ended up spending 21 days in the Queen’s intensive care unit and 25 days in the acute care department before being transferred to a rehab facility in Kane­ohe.

"From the day of the accident, we have just been praying and believing for a miracle for our dad," said daughter Jeanne Tai. "Each day he’s alive has been a miracle for us."

For Tai and her brothers and sisters, the accident has turned their lives upside down.

Tai lives in Bangkok with her husband and two kids, but they were on Oahu visiting family when the accident happened. While her husband and children have since returned to Thailand, Tai, a nurse, stayed back to help with her father’s care.

"I’ve been at my dad’s bedside every day since the accident," she said. "It’s been exhausting. It’s been emotionally and physically exhausting."

Tai described her father — a retired 25-year employee and stock handler with Duty Free Shoppers — as an active, vibrant and independent person.

"He loved to cook and serve his family," Tai said. "My last memory before the accident was my daughter’s birthday at Ala Moana (Beach Park). My dad cooked a meal (in Ewa Beach), packed it up and hauled it on the bus to the beach. He came early looking for a spot on a crowded day."

It is deeply painful, family members said, to see him in his current condition — unable to walk or eat and barely able to talk or even recognize his loved ones.

Family members said they came forward to tell their story in hopes of changing the law or inspiring people to drive more carefully.

"We just have to urge people to pay better attention and to stop texting and stop using cellphones when driving," Turbin said.

He urged lawmakers to create more laws to protect pedestrians and called on police and prosecutors to get tough on inattentive drivers.

"We just want the right things done, you know," Tai said.

Edward Perez said, if nothing else, he wants the driver who hit his dad to be upfront about how the accident occurred, given the account from the witness.

"Step up and be a man about it," he said. "Take responsibility for what has happened."