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by Paul Kiel, ProPublica, and Russ Buettner, The New York Times

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Former President Donald Trump used a dubious accounting maneuver to claim improper tax breaks from his troubled Chicago tower, according to an IRS inquiry uncovered by ProPublica and The New York Times. Losing a yearslong audit battle over the claim could mean a tax bill of more than $100 million.

The 92-story, glass-sheathed skyscraper along the Chicago River is the tallest and, at least for now, the last major construction project by Trump. Through a combination of cost overruns and the bad luck of opening in the teeth of the Great Recession, it was also a vast money loser.

But when Trump sought to reap tax benefits from his losses, the IRS has argued, he went too far and in effect wrote off the same losses twice.

The first write-off came on Trump’s tax return for 2008. With sales lagging far behind projections, he claimed that his investment in the condo-hotel tower met the tax code definition of “worthless,” because his debt on the project meant he would never see a profit. That move resulted in Trump reporting losses as high as $651 million for the year, ProPublica and the Times found.

There is no indication the IRS challenged that initial claim, though that lack of scrutiny surprised tax experts consulted for this article. But in 2010, Trump and his tax advisers sought to extract further benefits from the Chicago project, executing a maneuver that would draw years of inquiry from the IRS. First, he shifted the company that owned the tower into a new partnership. Because he controlled both companies, it was like moving coins from one pocket to another. Then he used the shift as justification to declare $168 million in additional losses over the next decade.

The issues around Trump’s case were novel enough that, during his presidency, the IRS undertook a high-level legal review before pursuing it. ProPublica and the Times, in consultation with tax experts, calculated that the revision sought by the IRS would create a new tax bill of more than $100 million, plus interest and potential penalties.

Trump’s tax records have been a matter of intense speculation since the 2016 presidential campaign, when he defied decades of precedent and refused to release his returns, citing a long-running audit. A first, partial revelation of the substance of the audit came in 2020, when the Times reported that the IRS was disputing a $72.9 million tax refund that Trump had claimed starting in 2010. That refund, which appeared to be based on Trump’s reporting of vast losses from his long-failing casinos, equaled every dollar of federal income tax he had paid during his first flush of television riches, from 2005 through 2008, plus interest.

The reporting by ProPublica and the Times about the Chicago tower reveals a second component of Trump’s quarrel with the IRS. This account was pieced together from a collection of public documents, including filings from the New York attorney general’s suit against Trump in 2022, a passing reference to the audit in a congressional report that same year and an obscure 2019 IRS memorandum that explored the legitimacy of the accounting maneuver. The memorandum did not identify Trump, but the documents, along with tax records previously obtained by the Times and additional reporting, indicated that the former president was the focus of the inquiry.

It is unclear how the audit battle has progressed since December 2022, when it was mentioned in the congressional report. Audits often drag on for years, and taxpayers have a right to appeal the IRS’ conclusions. The case would typically become public only if Trump chose to challenge a ruling in court.

In response to questions for this article, Trump’s son Eric, executive vice president of the Trump Organization, said: “This matter was settled years ago, only to be brought back to life once my father ran for office. We are confident in our position, which is supported by opinion letters from various tax experts, including the former general counsel of the IRS.”

An IRS spokesperson said federal law prohibited the agency from discussing private taxpayer information.

The outcome of Trump’s dispute could set a precedent for wealthy people seeking tax benefits from the laws governing partnerships. Those laws are notoriously complex, riddled with uncertainty and under constant assault by lawyers pushing boundaries for their clients. The IRS has inadvertently further invited aggressive positions by rarely auditing partnership tax returns.

The audit represents yet another potential financial threat — albeit a more distant one — for Trump, the Republicans’ presumptive 2024 presidential nominee. In recent months, he has been ordered to pay $83.3 million in a defamation case and an additional $454 million in a civil fraud case brought by the New York attorney general, Letitia James. Trump has appealed both judgments. (He is also in the midst of a criminal trial in Manhattan, where he is accused of covering up a hush-money payment to a porn star in the weeks before the 2016 election.)

Beyond the two episodes under audit, reporting by the Times in recent years has found that, across his business career, Trump has often used what experts described as highly aggressive — and at times, legally suspect — accounting maneuvers to avoid paying taxes. To the six tax experts consulted for this article, Trump’s Chicago accounting maneuvers appeared to be questionable and unlikely to withstand scrutiny.

“I think he ripped off the tax system,” said Walter Schwidetzky, a law professor at the University of Baltimore and an expert on partnership taxation.

Trump’s Chicago tower (Nurphoto/Getty Images)

Trump struck a deal in 2001 to acquire land and a building that was then home to the Chicago Sun-Times newspaper. Two years later, after publicly toying with the idea of constructing the world’s tallest building there, he unveiled plans for a more modest tower, with 486 residences and 339 “hotel condominiums” that buyers could use for short stays and allow Trump’s company to rent out. He initially estimated that construction would last until 2007 and cost $650 million.

Trump placed the project at the center of the first season of “The Apprentice” in 2004, offering the winner a top job there under his tutelage. “It’ll be a mind-boggling job to manage,” Trump said during the season finale. “When it’s finished in 2007, the Trump International Hotel and Tower, Chicago, could have a value of $1.2 billion and will raise the standards of architectural excellence throughout the world.”

As his cost estimates increased, Trump arranged to borrow as much as $770 million for the project — $640 million from Deutsche Bank and $130 million from Fortress Investment Group, a hedge fund and private equity company. He personally guaranteed $40 million of the Deutsche loan. Both Deutsche and Fortress then sold off pieces of the loans to other institutions, spreading the risk and potential gain.

Trump planned to sell enough of the 825 units to pay off his loans when they came due in May 2008. But when that date came, he had sold only 133. At that point, he projected that construction would not be completed until mid-2009, at a revised cost of $859 million.

He asked his lenders for a six-month extension. A briefing document prepared for the lenders, obtained by the Times and ProPublica, said Trump would contribute $89 million of his own money, $25 million more than his initial plan. The lenders agreed.

But sales did not pick up that summer, with the nation plunged into the financial crisis that would become the Great Recession. When Trump asked for another extension in September, his lenders refused.

Two months later, Trump defaulted on his loans and sued his lenders, characterizing the financial crisis as the kind of catastrophe, like a flood or hurricane, covered by the “force majeure” clause of his loan agreement with Deutsche Bank. That, he said, entitled him to an indefinite delay in repaying his loans. Trump went so far as to blame the bank and its peers for “creating the current financial crisis.” He demanded $3 billion in damages.

At the time, Trump had paid down his loans with $99 million in sales but still needed more money to complete construction. At some point that year, he concluded that his investment in the tower was worthless, at least as the term is defined in partnership tax law.

Trump’s worthlessness claim meant only that his stake in 401 Mezz Venture, the LLC that held the tower, was without value because he expected that sales would never produce enough cash to pay off the mortgages, let alone turn a profit.

When he filed his 2008 tax return, he declared business losses of $697 million. Tax records do not fully show which businesses generated that figure. But working with tax experts, ProPublica and the Times calculated that the Chicago worthlessness deduction could have been as high as $651 million, the value of Trump’s stake in the partnership — about $94 million he had invested and the $557 million loan balance reported on his tax returns that year.

When business owners report losses greater than their income in any given year, they can retain the leftover negative amount as a credit to reduce their taxable income in future years. As it turned out, that tax-reducing power would be of increasing value to Trump. While many of his businesses continued to lose money, income from “The Apprentice” and licensing and endorsement agreements poured in: $33.3 million in 2009, $44.6 million in 2010 and $51.3 million in 2011.

Trump’s advisers girded for a potential audit of the worthlessness deduction from the moment they claimed it, according to the filings from the New York attorney general’s lawsuit. Starting in 2009 Trump’s team excluded the Chicago tower from the frothy annual “statements of financial condition” that Trump used to boast of his wealth, out of concern that assigning value to the building would conflict with its declared worthlessness, according to the attorney general’s filing. (Those omissions came even as Trump fraudulently inflated his net worth to qualify for low-interest loans, according to the ruling in the attorney general’s lawsuit.)

Trump had good reason to fear an audit of the deduction, according to the tax experts consulted for this article. They believe that Trump’s tax advisers pushed beyond what was defensible.

The worthlessness deduction serves as a way for a taxpayer to benefit from an expected total loss on an investment long before the final results are known. It occupies a fuzzy and counterintuitive slice of tax law. Three decades ago, a federal appeals court ruled that the judgment of a company’s worthlessness could be based in part on the opinion of its owner. After taking the deduction, the owner can keep the “worthless” company and its assets. Subsequent court decisions have only partly clarified the rules. Absent prescribed parameters, tax lawyers have been left to handicap the chances that a worthlessness deduction will withstand an IRS challenge.

There are several categories, with a declining likelihood of success, of money taxpayers can claim to have lost.

The tax experts consulted for this article universally assigned the highest level of certainty to cash spent to acquire an asset. The roughly $94 million that Trump’s tax returns show he invested in Chicago fell into this category.

Some gave a lower, though still probable, chance of a taxpayer prevailing in declaring a loss based on loans that a lender agreed to forgive. That’s because forgiven debt generally must be declared as income, which can offset that portion of the worthlessness deduction in the same year. A large portion of Trump’s worthlessness deduction fell in this category, though he did not begin reporting forgiven debt income until two years later, a delay that would have further reduced his chances of prevailing in an audit.

The tax experts gave the weakest chance of surviving a challenge for a worthlessness deduction based on borrowed money for which the outcome was not clear. It reflects a doubly irrational claim — that the taxpayer deserves a tax benefit for losing someone else’s money even before the money has been lost, and that those anticipated future losses can be used to offset real income from other sources. Most of the debt included in Trump’s worthlessness deduction was based on that risky position.

Including that debt in the deduction was “just not right,” said Monte Jackel, a veteran of the IRS and major accounting firms who often publishes analyses of partnership tax issues.

Trump continued to sell units at the Chicago tower, but still below his costs. Had he done nothing, his 2008 worthlessness deduction would have prevented him from claiming that shortfall as losses again. But in 2010, his lawyers attempted an end-run by merging the entity through which he owned the Chicago tower into another partnership, DJT Holdings LLC. In the following years, they piled other businesses, including several of his golf courses, into DJT Holdings.

Those changes had no apparent business purpose. But Trump’s tax advisers took the position that pooling the Chicago tower’s finances with other businesses entitled him to declare even more tax-reducing losses from his Chicago investment.

His financial problems there continued. More than 100 of the hotel condominiums never sold. Sales of all units totaled only $727 million, far below Trump’s budgeted costs of $859 million. And some 70,000 square feet of retail space remained vacant because it had been designed without access to foot or vehicle traffic. From 2011 through 2020, Trump reported $168 million in additional losses from the project.

Those additional write-offs helped Trump avoid tax liability for his continuing entertainment riches, as well as his unpaid debt from the tower. Starting in 2010, his lenders agreed to forgive about $270 million of those debts. But he was able to delay declaring that income until 2014 and spread it out over five years of tax returns, thanks to a provision in the Obama administration’s stimulus bill responding to the Great Recession. In 2018, Trump reported positive income for the first time in 11 years. But his income tax bill still amounted to only $1.9 million, even as he reported a $25 million gain from the sale of his late father’s assets.

It’s unclear when the IRS began to question the 2010 merger transaction, but the conflict escalated during Trump’s presidency.

The IRS explained its position in a Technical Advice Memorandum, released in 2019, that identified Trump only as “A.” Such memos, reserved for cases where the law is unclear, are rare and involve extensive review by senior IRS lawyers. The agency produced only two other such memos that year.

The memos are required to be publicly released with the taxpayer’s information removed, and this one was more heavily redacted than usual. Some partnership specialists wrote papers exploring its meaning and importance to other taxpayers, but none identified taxpayer “A” as the then-sitting president of the United States. ProPublica and the Times matched the facts of the memo to information from Trump’s tax returns and elsewhere.

The 20-page document is dense with footnotes, calculations and references to various statutes, but the core of the IRS’ position is that Trump’s 2010 merger violated a law meant to prevent double dipping on tax-reducing losses. If done properly, the merger would have accounted for the fact that Trump had already written off the full cost of the tower’s construction with his worthlessness deduction.

In the IRS memo, Trump’s lawyers vigorously disagreed with the agency’s conclusions, saying he had followed the law.

If the IRS prevails, Trump’s tax returns would look very different, especially those from 2011 to 2017. During those years, he reported $184 million in income from “The Apprentice” and agreements to license his name, along with $219 million from canceled debts. But he paid only $643,431 in income taxes thanks to huge losses on his businesses, including the Chicago tower. The revisions sought by the IRS would require amending his tax returns to remove $146 million in losses and add as much as $218 million in income from condominium sales. That shift of up to $364 million could swing those years out of the red and well into positive territory, creating a tax bill that could easily exceed $100 million.

The only public sign of the Chicago audit came in December 2022, when a congressional Joint Committee on Taxation report on IRS efforts to audit Trump made an unexplained reference to the section of tax law at issue in the Chicago case. It confirmed that the audit was still underway and could affect Trump’s tax returns from several years.

That the IRS did not initiate an audit of the 2008 worthlessness deduction puzzled the experts in partnership taxation. Many assumed the understaffed IRS simply had not realized what Trump had done until the deadline to investigate it had passed.

“I think the government recognized that they screwed up,” and then audited the merger transaction to make up for it, Jackel said.

The agency’s difficulty in keeping up with Trump’s maneuvers, experts said, showed that this gray area of tax law was too easy to exploit.

“Congress needs to radically change the rules for the worthlessness deduction,” Schwidetzky said.

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Susanne Craig of The New York Times contributed reporting.

by Doug Bock Clark

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

Ten months after Georgia officials said they would take steps to ensure that counties were correctly handling massive numbers of challenges to voter registrations, neither the secretary of state’s office nor the State Election Board has done so.

In July 2023, ProPublica reported that election officials in multiple Georgia counties were handling citizens’ challenges to voter registrations in different ways, with some potentially violating the National Voter Registration Act.

Instead of fixing the problem, the Republican-controlled Georgia legislature passed SB 189 at the end of March. The bill’s authors claim that it will help prevent voting fraud, while voting rights advocates warn that it could make the issue worse. Gov. Brian Kemp signed it into law on Monday.

“I see this as being pro-America, pro-accuracy, pro-transparency and pro-election integrity,” state Rep. John LaHood said of the bill, which he worked to help pass. “I don’t see it being” about voter suppression “whatsoever.”

When it takes effect in July, SB 189 will make it easier for Georgia residents to use questionable evidence when challenging fellow residents’ voter registrations. Voting rights activists also claim that the law could lead county officials to believe they can approve bulk challenges closer to election dates.

“It’s bad policy and bad law, and will open the floodgates to bad challenges,” said Caitlin May, a voting rights attorney for the American Civil Liberties Union of Georgia, which has threatened to sue over what it says is the law’s potential to violate the NVRA.

ProPublica previously reported on how just six right-wing advocates challenged the voter registrations of 89,000 Georgians following the 2021 passage of a controversial law that enabled residents to file unlimited voter challenges. We also revealed that county election officials may have been systematically approving challenges too close to election dates, which would violate the NVRA.

The Georgia secretary of state’s office said at the time that it was “thankful” for information provided by ProPublica, that it had been working on “uniform standards for voter challenges” and that it had “asked the state election board to provide rules” to help election officials handle the challenges. And the chair of the State Election Board told ProPublica last year that though the board hadn’t yet offered rules due to the demands of the 2022 election, “now that the election is over, we intend to do that.”

With the new law soon to be in effect, the State Election Board is determining its next steps. “We’re going to probably have to try and provide some instruction telling” election officials how to respond to SB 189, said John Fervier, who was appointed chair in January after the former chair stepped down. “I don’t know if that will come from the State Election Board or from the secretary of state’s office. But we’re one day past the signing of the legislation, so it’s still too early for me to comment on what kind of instruction will go out at this point.”

Mike Hassinger, a public information officer for the secretary of state’s office, said in a statement that it falls to the State Election Board to review laws and come up with rules. “Once the board moves forward with that process we are more than happy to extend help to rule making,” Hassinger said.

Conservative organizations have been vocal about their plans to file numerous challenges to voter registrations this year, providing training and other resources to help Georgians do so. Activists and Georgia Republican Party leadership publicly celebrated the passage of SB 189, with the GOP chair telling the Atlanta Journal-Constitution that this year’s legislative session was “a home run for those of us concerned about election integrity.”

But what has not gotten as much attention is how individuals who were involved in producing massive numbers of voter challenges managed to shape SB 189.

Jason Frazier, who in 2023 was a Republican nominee to the Fulton County election board, challenged the registrations of nearly 10,000 people in Fulton County, part of the Democratic stronghold of Atlanta. (Cheney Orr for ProPublica)

Courtney Kramer, the former executive director of True the Vote, a conservative organization that announced it was filing over 360,000 challenges in Georgia after the 2020 presidential election, played an instrumental role in getting the bill passed. She was the co-chair of the Election Confidence Task Force, a committee of the Georgia Republican Party that provided sample language to legislators crafting SB 189. An internal party email reviewed by ProPublica thanked Kramer for her dedication in helping bring “us to the final stages of pushing essential election integrity reform through the legislature.” Kramer said in a statement that “my goal was to restore confidence in Georgia’s elections process” and to “make it easy to vote and hard to cheat.”

Jason Frazier, who ProPublica previously found was one of the state’s six most prolific challengers, served on the Election Confidence Task Force. Frazier did not respond to requests for comment.

In late July, William Duffey, who was then the chair of Georgia’s State Election Board, was working on a paper to update county election officials on how to handle voter challenges. But when the board met in August 2023, a large crowd of right-wing activists packed the room, and dozens of people castigated the board for defending the legitimacy of the 2020 election. One mocked a multicultural invocation with which Duffey had started the meeting, declaring, “The only thing you left out was satanism!” A right-wing news outlet accused “the not so honorable Judge Duffey” of hiding “dirt” on the corruption of the 2020 election.

Less than a month later, Duffey stepped down. He denied that activists had driven him out, telling ProPublica that pressure from such activists “comes with the job.” But, he explained, the volunteer position had been taking “70% of my waking hours,” and “I wanted to get back to things for which I had scoped out my retirement.”

According to two sources knowledgeable about the board’s workings, who asked for anonymity to discuss confidential board matters, Duffey had been the primary force behind updating the rules about voter challenges, and without him, the effort stalled. One source also said that the board had realized that Republican legislators planned to rewrite voter-challenge laws, and members wanted to see what they would do.

In January 2024, Republican legislators began working on those bills. The one that succeeded, SB 189, introduces two especially important changes that would help challengers, according to voting rights activists.

First, it says a dataset kept by the U.S. Postal Service to track address changes provides sufficient grounds for election officials to approve challenges, if that data is backed up by secondary evidence from governmental sources. Researchers have found the National Change of Address dataset to be unreliable in establishing a person’s residence, as there are many reasons a person could be listed as living outside of Georgia but could still legally vote there. ProPublica found in 2023 that counties frequently dismissed challenges because of that unreliability. And voting rights activists claim that the secondary sources SB 189 specifies include swaths of unreliable data.

“My worry is” that the bill “will cause a higher success rate for the challenges,” said Anne Gray Herring, a policy analyst for nonprofit watchdog group Common Cause Georgia.

The new bill also states that starting 45 days before an election, county election boards cannot make a determination on a challenge. Advocates have expressed concerns that counties will interpret the law to mean that they can approve mass, or systematic, challenges up until 45 days before an election. The NVRA prohibits systematic removal of voters within 90 days of an election, and election boards commonly dismissed challenges that likely constituted systematic removal within the 90-day window, ProPublica previously found.

When True the Vote was challenging voters in the aftermath of the 2020 election, a judge issued a restraining order against the challenges for violating the 90-day window.

Whether SB 189 violates the NVRA could be settled in court, according to voting rights advocates and officials. On Tuesday, after SB 189 was signed, Gabriel Sterling, the chief operating officer for the Georgia secretary of state, disputed on social media that the new law would make voter challenges easier. But months earlier, he said that imprecision in the voter challenges process could lead to legal problems.

“When you do loose data matching, you get a lot of false positives,” Sterling said, testifying about voter list maintenance before the Senate committee that would pass a precursor to SB 189. “And when you get a lot of false positives and then move on them inside the NVRA environment, that’s when you get sued.”

by Lisa Song

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When I registered to attend last month’s United Nations conference in Canada, organizers insisted it would be a “plastic free meeting.” I wouldn’t even get a see-through sleeve for my name tag, they warned; I’d have to reuse an old lanyard.

After all, representatives from roughly 170 countries were gathering to tackle a crisis: The world churns out 400 million metric tons of plastic a year. It clogs landfills and oceans; its chemical trail seeps into our bodies. Delegates have been meeting since 2022 as part of the Intergovernmental Negotiating Committee on Plastic Pollution in hopes of ending this year with a treaty that addresses “the full life cycle of plastic, including its production, design and disposal.”

The challenge before delegates seemed daunting: How do you get hundreds of negotiators to agree on anything via live, group editing? Especially when representatives from fossil fuel and chemical companies would be vigorously working to shift the conversation away from what scientists say is the only solution to the crisis: curbing plastic production.

But when I got to the meeting, I discovered those industry reps were not the sideshow; they were welcomed into the main event.

They could watch closed-door sessions off limits to reporters. Some got high-level badges indistinguishable from those worn by country representatives negotiating the treaty. These badges allowed them access to exclusive discussions not open to some of the world’s leading health scientists.

In a setting that was supposed to level the inequalities among those present, I watched how country delegates and conference organizers did little to minimize them, making what was already going to be a challenging process needlessly opaque and avoidably contentious.

With such high stakes, I asked the INC Secretariat — the staff at the UN Environment Programme who facilitated the negotiations process — why they hadn’t set rules on conflict of interest or transparency. They told me that wasn’t their job, that it was up to countries to take the lead. But in some cases, countries pointed me right back to the UN.

Over five days, I would come to understand just how hard it will be to get meaningful action on plastics.

A pro-plastic ad (James Park for ProPublica) Day 1: Represent the Public? Stay Out.

From the moment I landed in Ottawa, the counter-argument of the plastics industry was inescapable, from wall-sized ads at the airport to billboards on trucks that cruised around the downtown convention center.

Their message: Curtailing plastic production would spell literal doom. (I could almost see the marketing pitch: Think of the children!)

These plastics deliver water, read one, depicting a girl drinking from a bottle in what was implied to be a disaster zone.

I headed to the media registration desk and got my green-striped badge, which placed me at the lowest rung of the pecking order.

At the top were people on official delegations. Their red-striped badges opened the door to every meeting, from the large “plenaries” where rows of country representatives spoke into microphones, to smaller working groups where negotiators hashed out specifics like whether to ban certain chemicals used in plastic.

The majority of the attendees wore orange badges. This hodgepodge of so-called observers included scientists, environmentalists, Indigenous peoples and some industry reps, though the color code made no distinction among them.

Observers were allowed into certain working groups at the discretion of government delegates.

Reporters could attend only plenaries.

These huge, open sessions were like the UN equivalent of Senate floor speeches: declarations and repetition to get ideas into the public record.

Veteran observers tracked the real action in the margins, standing in the back of the ballroom to watch who was talking to whom. It was an art, they said: You want to stroll close enough to read the small print on name tags, but you have to be chill about it.

I was not chill about the lack of access, which prevented sources from talking about what happened behind closed-door proceedings. They were governed by rules that prohibited those present from recording the meetings or revealing who had said what.

Reporters trying to inform the public and hold governments accountable were completely shut out. Yet somehow the rules allowed the industry whose survival depends on more plastic production to dispatch reps to watch negotiators at work.

The rules follow the “norms when it comes to fundamentals of negotiating, multilateralism, and diplomacy amongst UN Member States,” said a statement from the INC Secretariat. These meetings are managed by the countries negotiating the treaty, the statement said; the countries set the rules.

But when I asked the U.S. State Department, which led the U.S. delegation in Ottawa, whether journalists should have more access, a spokesperson directed me back to the UN.

An environmental health advocacy group near the Ottawa convention center (James Park for ProPublica) Day 2: “The Human Right to Science”

I heard about an exhibit at the nearby Westin hosted by the Alliance to End Plastic Waste. It sounded like an environmental group, but an online search showed it was founded by corporations including Dow and ExxonMobil. Dow didn’t respond to a request for comment. ExxonMobil said it attended the conference “to be a resource, bring solutions to the table and listen to a broad range of views by all stakeholders.”

As I wandered through the ballroom stocked with refreshments, shiny videos and diagrams promoted the potential of “circularity,” a marketing term that’s often focused on recycling. Independent research shows pollution will skyrocket if companies don’t curb production, but the industry has, for decades, shifted attention from that with false promises about waste management.

“The work we do is not the whole solution,” the alliance later told me in an email.

But I could easily see someone leaving the exhibit with that impression.

The finer points of plastic science, from its toxic manufacturing process to the limits of recycling, are highly technical and complex.

While countries like the United States could afford to fly in multiple experts to inform government delegates, other countries could not.

Later that day, I met Bethanie Carney Almroth, an ecotoxicologist from Sweden’s University of Gothenburg, who was among 60 independent, volunteer researchers who had traveled to Canada in hopes of bridging that gap in access to expertise.

As part of the Scientists’ Coalition for an Effective Plastics Treaty, they shared fact sheets and peer-reviewed studies and made themselves available for questions. Carney Almroth said ensuring the integrity of the group was vital. Members must have a proven track record of researching plastic pollution and follow a conflict-of-interest policy to prevent bias.

“The human right to science,” she said, “includes the right to transparency.”

Bethanie Carney Almroth, a professor of ecotoxicology at the University of Gothenburg in Sweden, is on the steering committee of the Scientists’ Coalition for an Effective Plastics Treaty. (James Park for ProPublica) Day 3: “No Such Thing as Conflict of Interest”

For the first two of these conferences, the INC Secretariat didn’t include the participants’ affiliations when they released the list of people who had registered for the event, making it hard to tell who worked for the industry. That has since changed, making it easier for advocacy groups to scour lists for fossil fuel and chemical company affiliations.

After the UN released the roster of the 4,000 people who had registered for Ottawa this year, the Center for International Environmental Law released its analysis of industry attendees. It found about 200 people with observer-level badges.

What’s more, the group said, 16 industry representatives had received the red badges usually reserved for government delegates. They were invited onto official delegations by China, the Dominican Republic, Iran, Kazakhstan, Kuwait, Malaysia, Thailand, Turkey and Uganda. I later learned an Indonesian delegate was listed as part of its Ministry of Industry; LinkedIn revealed him to be a director at a petrochemical firm.

I reached out to officials from all 10 countries. Most did not respond.

(The United States wasn’t on the list. “As a matter of policy, the United States does not include any industry or civil society representatives in our official delegation,” said a spokesperson from the State Department.)

There is “no such thing as conflict of interest in International negotiations,” the executive director of the Uganda National Environment Management Authority, Barirega Akankwasah, told me in a WhatsApp message. It’s “a matter of country positions and not individual positions,” he said, adding that the conference was “open and transparent” and stakeholders were “all welcome to participate.”

An official from the Dominican Republic, Claudia Taboada, told me that environmental groups and academic scientists had been consulted before the Ottawa conference and that the two industry reps on the country’s eight-member delegation had restricted privileges. They were barred from internal meetings where observers weren’t allowed, she said, and they couldn’t negotiate on behalf of the government.

Claudia Taboada was part of the official delegation from the Dominican Republic. She is director for science technology and environment at the Ministry of Foreign Affairs. (James Park for ProPublica)

Those industry reps weren’t trying to influence the government’s position, added Taboada, who is director for science, technology and environment at the Ministry of Foreign Affairs.

I found that hard to believe. Who would sit through days of bureaucratic meetings just to observe?

A red-striped badge provides tangible benefits, multiple attendees told me, like access to email lists and WhatsApp chats that are closed to observers. A university scientist who’s part of Fiji’s official delegation, Rufino Varea, said it’s easier to talk to official delegates from other countries when you have that badge. It shows only a person’s name and country, making it impossible to tell at a glance whether someone works for the government or for private interests.

A press release issued that day showed a counter-analysis of the entire list of attendees from the International Council of Chemical Associations, which said that industry observers were vastly outnumbered by more than 2,000 members from nongovernmental organizations like environmental advocacy groups.

Many of these groups are “incredibly well funded” and supported by billionaires, said a subsequent email from the American Chemistry Council, the country’s largest plastics lobby. It noted that at least eight countries had NGO representatives on their official delegations.

Rufino Varea is in his final semester as a doctoral student in ecotoxicology at the University of the South Pacific. Varea said Fiji’s delegation supports a strong treaty that limits plastic production. (James Park for ProPublica) Day 4: Fighting for Attention

For every NGO with millions in the bank, there were others whose members couldn’t afford the trip to Ottawa. Many had to compete for limited travel funds from sources like the UN or larger advocacy groups.

I sat down with John Chweya, a friendly man in a leather jacket who makes a living as a waste picker in Kenya. A single salad at the conference cost more than a day’s pay.

As president of the Waste Pickers Association of Kenya, he wanted delegates to understand how plastic impacts the millions around the world who collect garbage and sort the recyclables they can sell in places without formal waste disposal. Toxic fumes from plastic burning in landfills make his fellow workers sick, he told me. They wake up with swollen necks, joints that don’t work and mysterious tumors. Chweya wants the world to make less plastic; he came to Ottawa to fight for protective gear and health care.

The specificity of his story brought home how the experiences of front-line communities could inform the understanding of the plastics crisis.

John Chweya traveled to Ottawa to advocate for waste pickers in Kenya. (James Park for ProPublica)

Others like Chweya tried to give voice to huge portions of the world’s populations that are suffering from every step in the plastic life cycle: residents of Indigenous communities and Louisiana’s “Cancer Alley” breathing dangerous plant emissions; Pacific Islanders seeing their coral reefs entangled in abandoned fishing nets; activists from lower-income countries that are swimming in Americans’ discarded plastic.

I watched them trying to grab the attention of government officials with handwritten posters, events in cramped rooms and limited speaking slots during the plenary.

None of it matched the flash of the billboards I could not seem to avoid, which heralded their own impending health emergency.

These plastics save lives, one decreed, featuring a girl in a hospital bed, wearing an oxygen mask.

Negotiators couldn’t even agree on setting voluntary reductions for plastic production, I thought. Nobody was proposing to eliminate enough plastic to cause hospital shortages.

Chweya called the prevalent ads “traitorous.”

Day 5: The UN Isn’t Powerless

UN officials had warned against the inequities playing out in Ottawa.

In November 2022, the Office of the UN High Commissioner for Human Rights issued a statement during the first conference to negotiate the treaty, held in Uruguay.

Even though they weren’t hosting it, human rights officials had advice on how to proceed. “The plastic industry has disproportionate power and influence over policy relative to the general public,” they wrote. “Clear boundaries on conflict of interest should be established … drawing from existing good practices under international law.”

They recommended policies similar to those adopted by the World Health Organization Framework Convention on Tobacco Control, a separate UN treaty. Government representatives meet every two years to evaluate results. Recognizing that the tobacco industry’s presence was fundamentally incompatible with protecting public health, the countries agreed to virtually ban Big Tobacco from those meetings.

“It is irresponsible and inaccurate to liken plastics to tobacco,” the American Chemistry Council said in a statement in response to my questions about this comparison. “Unlike the tobacco industry, the plastics industry is playing a vital role in helping meet the UN’s sustainability goals by contributing to food safety, healthcare, renewable energy, telecommunications, clean drinking water, and much more. …

“Keeping plastic producers out means a less informed treaty,” the council said. “We are essential and constructive stakeholders in the global effort to prevent plastic pollution.”

Short of barring the plastics industry, many have wondered why the UN can’t start with smaller steps, like giving industry observers a different kind of badge.

The fossil fuel companies “that are manufacturing plastics” are “not coming to these negotiations with solutions,” Baskut Tuncak, a former UN special rapporteur for human rights and toxics, told me. They’re here “to throw a wrench in the process, or two, or three.”

When I asked if it intended to introduce conflict-of-interest controls, the INC Secretariat said it couldn’t impose rules unilaterally. Governments would have to decide for themselves.

Some U.S. and European politicians have requested such reforms. Negotiators should consider measures “to protect against undue influence of corporate actors with proven vested interests that contradict the goals of the global plastics treaty,” said a letter last month sent to President Joe Biden and the secretary-general of the United Nations.

It was signed by Sen. Sheldon Whitehouse, D-R.I., who’s often criticized the fossil fuel industry’s influence on public policy, along with 11 other members of Congress and a member of the European Parliament. Industry reps should be required to disclose lobbying records and campaign contributions, the letter suggested.

The UN isn’t powerless, said Tuncak and Ana Paula Souza, a UN human rights officer I met on my last day in Ottawa. There’s more the institution could do to raise the profile of the issue, they said. Souza said the UN could also increase funding to allow more of those most affected by plastic pollution to attend these meetings.

An art installation outside the Ottawa convention center (James Park for ProPublica) Looking Ahead

The Ottawa conference ended with limited progress. Negotiators have a long way to go to reach a final draft at the last scheduled conference this November in Busan, South Korea. Smaller groups of delegates will meet before then; it’s unclear how many observers will be able to attend.

It’s tempting to feel pessimistic. This could easily end up like the UN climate treaty — anemic, voluntary and dragging on forever.

And it’s not like a conflict-of-interest policy would magically solve everything. Countries with powerful plastics lobbies, including the United States, can still advocate for corporate interests.

But it’s worth stepping back to recognize the magnitude of what’s happening.

Nearly every government on Earth signed up for days of painstaking sessions on plastic as a global threat — even places confronting existential crises, like Haiti, Palestine, Sudan and Ukraine. The world recognizes the importance of figuring this out. And despite all the industry influence, capping plastic production remains a possibility.

Do You Have Experience in or With the Plastics Industry? Tell Us About It.

by Sergio Hernandez

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In the summer of 2021, New York Police Department officer Willie Thompson had sex at least twice with a witness to a Harlem carjacking that he was investigating. When a prosecutor questioned Thompson about his relationship with the witness, Thompson first lied, denying the relationship, before recanting and confessing the next day, according to an internal discipline report. About a week later, the woman, sounding upset, called the prosecutor and said Thompson had cornered her at a bodega, blaming her for getting him in trouble and threatening that officers from the precinct would be coming to her home, the document shows.

Thompson, who declined to comment, was found guilty by the NYPD on two misconduct charges and was placed on probation.

But if you looked up his disciplinary history on the department’s public database of uniformed officers, you would be unlikely to learn that.

ProPublica has found the NYPD site for allowing the public to track officers’ misconduct is shockingly unreliable. Cases against officers frequently vanish from the site for days — sometimes weeks — at a time. The issue affects nearly all of the officers in the database, with discipline disappearing from the profiles of patrol officers all the way up to its most senior uniformed officer.

ProPublica examined more than 1,000 daily snapshots of the database’s contents and found that, since the fall of 2022, the number of discipline cases that appear in the database has fluctuated often and wildly. Try to pull up the record for a disciplined officer and the site sometimes spits back, “This officer does not have any applicable entries.”

Since May 2021, at least 88% of the disciplinary cases that once appeared in the data have gone missing at some point, though some were later restored. As of this week, 54% of cases that had at one point been in the system were missing.

“It is really disconcerting to see that there are records that are there one day that are not the next,” said Jennvine Wong, a supervising attorney with the Legal Aid Society’s Cop Accountability Project.

In the NYPD’s Officer Database, Discipline Records Frequently Vanish

A ProPublica analysis of more than 1,000 daily snapshots of the NYPD’s Office Profile database found that, since fall 2022, cases have repeatedly disappeared and the number of publicly accessible cases fluctuates often and wildly.

Source: ProPublica analysis of archived NYPD data. (Chart by Sergio Hernandez)

The NYPD did not respond to repeated requests for interviews or comment.

Because the department’s database is designed to show discipline only for active officers, some cases relating to former officers might have been removed from the data over time. Yet that would only explain a fraction of the missing cases. For most of the past year, at least a third of cases that had previously appeared in the database were missing.

These missing cases have included Chief of Department Jeffrey Maddrey, the force’s highest-ranking uniformed officer, and six deputy chiefs whose assignments include the department’s transit bureau and the Joint Terrorism Task Force.

The allegations against these high-ranking officers include being “discourteous” to a suspect, drinking while on duty, improper use of department property, and wrongful searches, frisks and uses of force.

In the chief of department’s case, Maddrey was docked 45 vacation days over a 2015 incident in which he impeded internal affairs officials who were investigating an altercation with an ex-lover and fellow officer. The incident ended with the officer brandishing a gun at Maddrey. When a reporter looked up Maddrey’s discipline record on Wednesday, the department’s system reported no disciplinary cases against him.

In interviews, several advocates for police reform and accountability said the issues raised by ProPublica’s analysis renewed their concerns about the NYPD’s competence, legal compliance and accountability.

“It just continues to undermine the public confidence in that they care at all about discipline and police accountability,” said Lupe Aguirre, a senior staff attorney at the New York Civil Liberties Union. “Their track record shows that they are both unwilling and unable to hold their officers accountable.”

While people across the country rallied against police brutality in the aftermath of George Floyd’s murder by Minneapolis officers in 2020, reform advocates in New York scored a major victory. Capitalizing on the groundswell of public demand for accountability, they pushed lawmakers to repeal a state statute that, for more than four decades, prohibited the release of personnel information about police officers.

Early the next year, the NYPD published a searchable database of its uniformed officers, allowing the public to look up cops and see their training histories, departmental awards and, for the first time, internal discipline records. In a department-wide memo, agency brass reportedly touted the move as a “step that increases transparency and improves accountability.”

Despite a 2012 local law that requires agencies to publish their data on the city’s open-data platform, the police department chose a vendor best known for selling “athlete management” software for sports teams to run the officer lookup system.

The source code of the officer profile website reveals it runs on software from RockDaisy, a New York-based software company. A blog post on its site, first published in 2017 and updated last year, says it has been licensed to several teams in the NFL, NHL and NBA and “the world’s largest police department,” an apparent reference to the NYPD.

RockDaisy’s founders did not respond to ProPublica’s inquiries about the company’s relationship with the police department. While RockDaisy does appear in a database of qualified vendors, a spokesperson for the city comptroller, which audits agency spending and reviews city contracts, said her office could not find any contracts with or payments to the company.

Aguirre and Wong, the Legal Aid Society attorney, cited the department’s habit of resisting oversight to argue that disclosure of officer misconduct data should not be entrusted to the department itself.

“It all should be up on [NYC] Open Data,” Wong said, referring to the citywide portal that publishes data from various agencies, including the NYPD, on everything from 311 calls and filming permits to a census of the city’s trees.

A schedule of upcoming releases shows that the NYPD’s officer profile data was supposed to be added to Open Data by the end of last year, but that still has not happened.

A spokesperson for the city’s chief technology officer, whose agency operates the Open Data platform, did not respond to ProPublica’s request for comment.

Adrienne Schmoeker, who led the city’s Open Data program from 2016 to 2019 and served as New York City’s deputy chief analytics officer under former Mayor Bill de Blasio, said it was not unusual for data releases to fall behind schedule. But failing to publish quality data reliably, she said, risks losing the public’s trust, especially when New Yorkers assume the worst: that agencies are hiding unflattering information.

“That’s extremely problematic, even if it’s wrong,” Schmoeker said, “because it erodes the trust that is essential between New Yorkers and their government.”

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by Brett Murphy

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Years before Oct. 7, soldiers and officers in four Israeli security force units committed what the U.S. State Department would later determine to be serious human rights violations against Palestinians.

In one incident in 2019, an Israel Defense Forces soldier shot and killed an unarmed Palestinian man on the side of a road in the West Bank. That soldier was given no jail time — only three months of community service.

Under the U.S. Leahy Laws, the government must disqualify any military or law enforcement unit from receiving assistance if there’s credible information that the group had committed violations like rape or extrajudicial killings, unless the offending entity has taken adequate steps to punish the perpetrator.

On Friday, Secretary of State Antony Blinken told Congress he had determined the punishments for the soldiers and officers in all four cases — including the community service sentence — to be adequate, according to a State Department memo to Congress. The units won’t be disqualified from receiving American military assistance. The names of the units were previously reported by Al-Monitor. ProPublica obtained the memo with Blinken’s justifications.

Some experts disagreed with that decision, saying that the punishment Israel meted out in the 2019 case was not adequate. They said the decision to continue the support was another example of special treatment for Israel.

Community service is “not what would be considered appropriate punishment,” said Tim Rieser, a longtime aide to former Sen. Patrick Leahy, D-Vt., the chief author of 1997 laws that the State Department is meant to enforce.

Rieser said Blinken’s justification was “not consistent with how the law was written and how it was intended to be applied.” A former State Department official said it was a “mockery.” Both officials, along with another congressional aide, were especially troubled that during the years it had taken to assess whether Israel had sufficiently punished the perpetrators, the State Department had apparently not disqualified the units from U.S. support.

A State Department spokesperson did not answer questions about Blinken’s memo but told ProPublica the agency has taken “extensive steps to implement the Leahy law for all countries that receive applicable U.S. assistance, including Israel.” The spokesperson said the agency is continuing to review reports of violations. “Israel has a moral obligation and a strategic imperative to protect civilians,” the spokesperson added.

ProPublica previously reported that a panel of internal State Department experts, known as the Israel Leahy Vetting Forum, had sent Blinken multiple cases of violations, along with recommendations to cut units off from assistance, months ago. The recommendations were an unusual escalation after years of deferential treatment of Israel, according to people close to the forum’s activities.

Following the report three weeks ago, Blinken promised to announce his determinations “in the coming days.” At the time, several media outlets reported that the State Department was poised to sanction one of the units, Netzah Yehuda, the ultra-Orthodox military battalion that has operated in the West Bank and been accused of multiple human rights violations.

The vetting forum reviewed the unit for an incident in which commanders gagged, handcuffed and left an elderly Palestinian American man for dead. (The commanders were reprimanded and demoted but did not face prison time, according to the vetting forum’s meeting minutes.) Israel’s leaders responded by fiercely pushing back against U.S. plans to withhold American assistance from the battalion. Blinken has since delayed his decision on it, Axios reported.

Netzah Yehuda is not mentioned in Blinken’s Friday memo. In the meantime, the unit has apparently remained eligible for U.S. military assistance despite the finding that there was a violation.

“That’s an outrage and another example of special treatment for Israel,” said Charles Blaha, the former director of the State Department’s Office of Security and Human Rights and a former participant in the forum. The larger issue, he added, is that “there are literally dozens of Israeli security force units that have committed gross violations of human rights and remain eligible for assistance because of the State Department’s failure to apply the law.”

Blinken’s letter to Congress comes at a time of increasing tension between the U.S. and Israel. Last week, President Joe Biden withheld a shipment of 3,500 bombs to Israel after the country pledged to ignore international outcry and go forward with its incursion into the southern Gazan city of Rafah. It was the first known time since Hamas’ terrorist attack that the administration has halted an arms shipment. Then, on Wednesday, Biden told CNN he would not supply bombs and shells to Israel that it can use to attack Rafah, where there are 1 million civilians sheltering.

Blinken is required to inform Congress about any State Department findings of gross human rights violations that he considered to be remediated. His memo on Friday detailed four cases he apparently decided met that standard.

In one case, a senior officer in the Israeli National Police’s Ma’avarim unit deceived and coerced six women, including some in the Israeli military, to have sex with him. Another officer serving in the West Bank’s COGAT unit forced at least two Palestinian women who were seeking permits to work in Israel to have sex with him between 2013 and 2016. Both of those officers are currently serving significant prison sentences, punishments that experts said are an adequate response from the Israeli government.

In March 2016, Elor Azaria, a medic in the Israel Defense Forces’ 92nd Shimshon Battalion, killed a 20-year-old Palestinian, Abed al-Fatah al Sharif. Al Sharif was disarmed and handcuffed on the ground after stabbing an Israeli soldier when Azaria shot and killed him. Azaria was charged and convicted with manslaughter and appealed before serving nine months in prison.

The case received enormous attention in the Israeli media, spurring debate in Israel about whether the punishment was adequate.

However, experts, including some State Department officials, say the handling of the fourth case is egregious.

In that case in 2019, an unnamed officer from the Shahar Search and Rescue Battalion, which looks for Hamas weaponry and intelligence, shot and killed an unarmed Palestinian man named Ahmed Manasra. Manasra had pulled over on his way home from a wedding to help a woman on the side of the road. The soldier also shot and wounded another driver, who the soldier assumed had been throwing stones at Israeli motorists.

The soldier reached a plea deal with military judges, who acknowledged he had “made a mistake of fact when he shot the victim,” before sentencing him to three months of community service and a three-month suspended sentence. He was also removed from the military.

The Israeli military said during court proceedings that the soldier had “wrongly assumed” that Manasra was the stone thrower and that there was a report of a possible terror attack in the area before the incident, according to The Associated Press.

The Israeli Embassy declined to comment.

“To the best of the Department of State’s knowledge, the investigation and judicial processes were credible,” Blinken noted in his memo to Congress. He determined that the Israelis “are taking effective steps to bring to justice the responsible member of the Shahar Battalion.”

Blaha, one of the former forum members, said if any other country offered such a paltry punishment, his office never would have accepted it as adequate remediation. “The whole process has been such a disappointment to me,” he said.

by Jennifer Smith Richards and Jodi S. Cohen

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From the first months that Brett Ashinoff was at Shrub Oak International School in New York, his parents felt uneasy about the residential school for students with autism.

They worried that Brett, who already was thin, was losing weight. They said his nails weren’t getting cut. He would refuse to get into the car to return to Shrub Oak after visits home, sitting for hours on the porch until his father coaxed him into the vehicle.

His parents’ concerns, documented in email exchanges with school administrators, began soon after he started in April 2022 and grew over time. Brett’s speech therapy was reduced because of limited staff. He wasn’t given his medication for at least five days in a row. “Kindly accept our sincerest apologies,” Lauren Koffler, a member of the family that operates the school, wrote in an email to Brett’s mother about the medication. She said an error with the pharmacy was responsible for the lapse.

Then came a series of confrontations with overnight staff in February 2023. Brett, his parents said, had never been physically restrained at a school before going to Shrub Oak. But employees restrained the 18-year-old, who weighed 95 pounds, at least three times one week after he became aggressive with them. One of those nights, several employees took him to a padded room and held him down on the floor. He sustained injuries, including a cut on his leg, according to emails between the school and his parents.

When Brett called his mother crying and begging to leave, Russ Ashinoff, his father, got in his car and drove two hours from his home in New Jersey to Shrub Oak, located in Westchester County.

He said he arrived to find Brett shaking, his foot purple and swollen. His nose was bruised and cut. “He was inconsolable, not himself,” Ashinoff said. He took Brett to an emergency room, where he was sedated, records show. Brett had never before needed to be sedated, his father said.

Ashinoff said he tried to report suspected abuse to several agencies in New York. The attorney general’s office took his complaint but told him it didn’t have jurisdiction and referred him to the New York State Education Department, according to the attorney general’s office. The Education Department told Ashinoff that it, too, couldn’t do anything, he said.

Ashinoff scribbled notes on the back of an envelope as he was repeatedly turned away.

“I never imagined you could have a school with a bunch of kids who are vulnerable that would be a free-for-all,” said Ashinoff, a physician. “The health department comes in and looks at every McDonald’s, but nobody is going to check out a school?”

He’s right. No state agency oversees Shrub Oak, which enrolls a range of students with autism including those whom other schools declined to serve and who have severe behavioral challenges and complex medical needs. The private, for-profit school chose not to seek approval from New York’s Education Department.

That means it has gotten no meaningful oversight and state officials have had no authority over the school — over who works there, whether money is spent properly and if the curriculum and services are appropriate for students with disabilities.

Even without New York’s approval, Shrub Oak receives public money from school districts across the country that pay tuition for the students they send there.

Brett Ashinoff, 18, lived at Shrub Oak for nine months before his parents brought him home to New Jersey. (Liz Moughon/ProPublica)

Shrub Oak opened in 2018 with grand promises: beautiful dorms, an indoor therapy pool, an equestrian stable, a restaurant-quality kitchen, sophisticated security, round-the-clock care and cutting-edge education for students with autism from around the world.

Some of those promises never materialized. A ProPublica investigation — based on records from school districts, court documents and interviews with nearly 30 families and just as many workers — also found accusations of possible abuse and neglect: unexplained black eyes and bruises on students’ bodies, medication mix-ups, urine-soaked mattresses and deficient staffing. Many parents and workers, armed with confidential documents and photos of student injuries, described their futile efforts to get authorities to intervene.

Shrub Oak’s leaders declined to be interviewed. In written responses to questions from ProPublica, the school said it “handles some of the most complex cases” of students who have autism and who struggle with “significant self-injurious behaviors,” aggression and property destruction.

“Our success stories are now known among parents and many of the currently enrolled students were recommended to us via word of mouth,” the school wrote in its response, provided by crisis communications specialist Richard Bamberger. He arranged interviews with four families who said the school has been a godsend for their children.

Shrub Oak is among the most expensive therapeutic boarding schools in America. Tuition for residential students is $316,400 this school year. Many students require a dedicated aide for 16 hours a day, bringing the total to $573,200. Shrub Oak currently enrolls about 85 students, ages 7 to 23, from 13 states and Puerto Rico.

Though the school touts its expertise with students who need constant care, police records detail young people swallowing aluminum foil, plexiglass, diapers and their own feces; putting their heads or fists through windows; and running away as recently as late March.

Shrub Oak serves students on the autism spectrum who might also have challenging behavioral and medical needs. (Liz Moughon/ProPublica)

Last year, two Shrub Oak workers were criminally charged for abusing students, though one case has been dropped. The other worker is due in court on Thursday.

Shrub Oak struggles to maintain enough workers, particularly during evenings and weekends. It doesn’t always provide the dedicated aides it guarantees, records and interviews show. And the school’s leaders also have hired employees with criminal convictions for offenses including robbery and burglary — something that would be prohibited in many students’ home districts.

The New York Education Department said it does not track how many unapproved schools operate in the state. It oversees hundreds of approved private schools, which gives them the ability to issue diplomas and take tuition money directly from New York school districts.

New York’s position is that the states sending students to Shrub Oak are responsible for them. But some states and districts have struggled to monitor students’ progress or well-being or didn’t check on them in person, the ProPublica investigation found. The failures of oversight come at a time when more young people are being diagnosed with autism and school districts and families are desperate for help educating them.

Shrub Oak said the school has been working with New York to get approved. But the state Education Department and other agencies that would need to sign off said Shrub Oak has not filed applications with them.

The school said its tuition rates are reasonable, especially given all the services it provides. It defended its hiring practices, saying it gives individuals with criminal histories a second chance as long as their misconduct didn’t involve children. Shrub Oak investigates allegations of misconduct by staff members, involves police and “fires employees involved in an issue,” the school said.

Shrub Oak said it could not comment on incidents involving individual students, citing the need for confidentiality, and asked reporters to have families sign a broad waiver provided by the school’s lawyer. ProPublica’s lawyers modified the waiver to enable the school to release information relevant to ProPublica’s questions. One former adult student and a parent of another student signed that but two did not, including the Ashinoffs. Shrub Oak still declined to address individual cases without its version of the waiver.

Koffler, a top administrator at Shrub Oak, said the school uniquely serves all types of students with autism, from those learning basic life skills to others who will go to college. “It’s a beautiful thing to be able to service the entire spectrum,” she told reporters during a tour of the school.

The Ashinoffs never took their son back to Shrub Oak. They had a friend collect his things.

Brett, at home with his parents in New Jersey, would rather jump around in his bounce house or play with his dog, Otis, than talk about the nine months he spent at Shrub Oak.

“I hate Shrub Oak,” he said, barely above a whisper. He dropped his head. “It’s kind of sad,” he said, and then decided he didn’t want to talk anymore.

Brett Ashinoff plays in his inflatable bounce house in his family’s basement in New Jersey. (Liz Moughon/ProPublica)

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As Michael Koffler and his family were creating Shrub Oak in 2016, they were still dealing with the fallout from a state investigation into their alleged misuse of taxpayer money for personal gain.

That October, New York authorities publicly accused Koffler and his two sons, Brian and Daniel, of using state money intended for students with disabilities at Sunshine Developmental School, a special-education preschool in New York City, to pay family members’ inflated salaries, credit card bills and boat expenses. Some state money also paid Brian Koffler’s law school tuition, and Michael Koffler claimed maintenance on his Westhampton beach home and purchases in St. Barts as business expenses, according to the investigation by the New York state comptroller, attorney general and tax commissioner.

“We won’t allow special education programs to be exploited for personal financial gain,” then-Attorney General Eric Schneiderman said in a press release.

The family and its business, K3 Learning Inc., “launched a scheme” to avoid paying millions of dollars in personal and corporate income tax and had also created a real estate company that it used to mark up rent to Sunshine, the tax commissioner said at the time.

The family did not admit any wrongdoing but agreed to pay New York $4.3 million to settle the case. Michael Koffler’s sons have paid what they owed, records show. But Koffler and his wife are delinquent. The state issued a tax warrant, and with penalties and interest the couple now owe $2.9 million. Michael, Brian and Daniel Koffler did not respond to a request for comment. The school’s spokesperson said “the tax warrant case is unrelated to Shrub Oak.”

Sunshine Developmental School in Queens is a special-education preschool. New York state officials found in 2016 that it misspent public money. Its operators developed Shrub Oak. (Alex Bandoni/ProPublica)

Six weeks after the settlement was announced, Brian Koffler applied to establish Shrub Oak International School, the family’s first boarding school, as a business in New York. Michael Koffler used K3’s business address and his company email address in financing documents to open Shrub Oak, records show.

Shrub Oak said in its responses to ProPublica that “K3 is unrelated to Shrub Oak.” But some leaders are the same; Michael Koffler is the CEO, Brian Koffler is the general counsel and a consultant. Brian Koffler’s wife, Lauren, is head of admissions, communications and client relations. In his LinkedIn profile, Michael Koffler lists himself as K3’s CEO and under his experience there mentions Shrub Oak, calling it “a crowning achievement to date.”

Shrub Oak took over the property, a former seminary on 127 acres of rolling hills in Mohegan Lake about an hour outside of New York City, in late 2017. The goal was to enroll about 400 students, and Shrub Oak’s leaders worked to create buzz about their new project. Email blasts to school district officials touted the “extraordinary personal attention” that students would get. Advertisements promoted a luxe facility with impressive amenities. A piece in Architectural Digest extolled its renovation.

Michael Koffler in 2010, left, Lauren Koffler and Brian Koffler (Michael Koffler’s image: Jason Binn/WireImage/Getty Images. Lauren Koffler’s image: Shrub Oak leadership page. Brian Koffler’s image: Sunshine Developmental School Director’s Corner page.)

While the initial idea for Shrub Oak was to be a high-end school serving autistic students as they transitioned to adult life, leaders broadened the vision to include difficult-to-place students with immense challenges. The school then made direct pitches to public school districts, navigated states’ varying rules for funding and helped families understand how they could get public money to pay the tuition.

Shrub Oak’s leaders are currently responding to another market demand as they prepare to open their next venture this summer. The Pines at Shrub Oak, a 24-bed wing within the same building as the school, will enroll autistic students who are experiencing a psychiatric crisis.

In response to inquiries from ProPublica about Shrub Oak, the school’s spokesperson arranged interviews with families who described similar traumatic experiences that led them to send their children to Shrub Oak and why they believe the school is essential.

Ed Dasso described the pain of realizing his two autistic sons couldn’t stay at their local school or in his home because of their aggressive behavior. His school district, in a suburb west of Chicago, agreed that Shrub Oak was the best option after other schools closer to home turned them down.

As he prepared for an admissions call with the school, Dasso said he thought: “If this doesn’t work out, I think I have to give up custody of the boys.” His sons, who are 16 and 18, moved to Shrub Oak about eight months ago and Dasso said he feels that they are well cared for and are experiencing new things. “They basically saved our family and saved the boys.”

Kristin Buck expressed the same gratitude. Her 13-year-old son, Teddy, interviewed for a spot at Shrub Oak from a juvenile detention center after a violent outburst landed him in custody. He had been there for six months and was terrified, she said. At Shrub Oak, Teddy gets more attention and the school has figured out what triggers difficult behavior for him, Buck said.

“There were no other schools for Teddy,” said Buck, whose family lives in the suburbs of Chicago. “Everybody turned their back on us. What instance can you think of where the police can’t help you, hospitals can’t help you, schools can’t help you?”

A few other parents, including those not provided by the school’s spokesperson, said they are aware of troubles at the school but believe their children have done well.

“I know that it’s not perfect,” said Brandy Carbery, from Bartlett in suburban Chicago. She said that she doesn’t know where her family would be without Shrub Oak, and that her 14-year-old son Alex has taken trips into the community and enjoys the school’s sensory room. But, she added, “I know that some people have issues.”

As ProPublica was reporting on Shrub Oak, some state education officials and advocates for people with disabilities were looking more closely at the school.

Massachusetts acknowledged to ProPublica that it approved Shrub Oak two years ago in violation of its own requirements. The state allowed public money to pay students’ tuition there after it failed to realize that New York had an approval process — and that Shrub Oak had not sought that approval. The Massachusetts education department discovered the error after receiving complaints about the school from at least two districts and parents. It gave the seven districts with publicly funded students at Shrub Oak until July to find other placements for them.

And last year, Disability Rights New York, the federally appointed watchdog for people with disabilities in the state, launched an investigation and visited the school. DRNY said in recent court filings that it has received more than 40 complaints about the school, including students being denied medical attention and staff being discouraged from calling 911 — allegations the school said are false. The organization can release its findings publicly and sue to seek changes, but it does not have enforcement authority.

The group filed a lawsuit last month against the state Education Department after the agency denied responsibility for Shrub Oak and argued it didn’t have to provide records of any complaints. The department has cited the school’s nonapproved status as a reason for denying the records, saying it does not have responsibility for “investigating incidents of abuse or neglect, injury or death” or “any other oversight responsibility” at Shrub Oak.

Shrub Oak criticized the fairness of the investigation, saying DRNY and a similar agency in Connecticut have visited the school multiple times and requested documents and other information but have not shared their concerns, leaving the school unable to respond.

DRNY declined to comment to ProPublica. Disability Rights Connecticut would not comment except to say that the group has “information that is of great concern to us.”

There are currently about 85 students from 13 states and Puerto Rico enrolled at Shrub Oak. (Liz Moughon/ProPublica)

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Last October, soon after the school day ended, a Shrub Oak employee began menacing a student who was yelling, court records show. The man raised a desk over his head and threatened to throw it at the 22-year-old student from Chicago.

He also knocked on the student’s forehead with his knuckles four or five times “similar to a way a person would knock very hard on a door,” according to the sworn statement of an employee who said she witnessed the incident.

The student said, “Ouch, you are hurting me,” according to that statement, and the student at one point grabbed the right side of her stomach and cried out that she’d been hit.

The employee was fired then charged with three misdemeanors — menacing, harassment and endangering the welfare of a disabled person. He has pleaded not guilty.

A court filing describes what led to criminal charges against a former Shrub Oak worker last fall. (Obtained by ProPublica from the Yorktown Justice Court)

When the Chicago student’s mother picked up her daughter for a visit in December, she decided she wasn’t comfortable leaving her at Shrub Oak any longer. She called Chicago Public Schools and learned that Shrub Oak had not told the district that its student was the victim of the alleged abuse even though it should have, according to its contract with Shrub Oak. Chicago Public Schools confirmed the district learned of the alleged abuse of the student from her mother.

That same day, the student’s mother also called ProPublica. She and other parents spoke to reporters on the condition that their names not be used because they were afraid of retaliation by the school’s operators or feared being in the desperate position of needing to find another school and being penalized for speaking out.

“I just called Chicago Public Schools and said: ‘I’m not taking her back. This is not a safe place,’” the student’s mother told ProPublica.

Shrub Oak said it couldn’t comment about the incident or its communications with Chicago Public Schools because they are related to an individual student.

A 22-year-old student attended Shrub Oak until late last year when her family brought her home to Chicago. (Taylor Glascock, special to ProPublica)

The October incident was one of the more than 150 times that the local police responded to calls about the school since 2019 — from employees reporting student injuries to parents asking for well-being checks on their children.

In at least four other incidents involving suspected abuse, Shrub Oak told police that it had fired employees, records show. The school fired an employee in 2022 who was seen shoving a student “to the floor multiple times.” It fired another employee in November 2023 after a co-worker saw him hit a student in the head and chest and slam him to the floor.

In February of last year, Shrub Oak also fired a worker who reportedly punched two students in the stomach at night in their bedrooms. The school told police about the incident three days later. An employee who witnessed the incident told police he saw the worker punch both students and then justify it, saying, “Sometimes you have to (motioned punching) to get them to do what they have to do,” according to court records.

Listen to a 911 Call Related to the November 2023 Incident A security guard alerts authorities to the incident. (Yorktown Police Department. Edited by ProPublica for clarity and to preserve anonymity.)

The employee in the February incident was arrested, but the Westchester County district attorney’s office said it dismissed the case because of issues with gathering sufficient evidence within the required time frame for criminal cases.

The school told ProPublica that it calls the police to be transparent and impartial, and that some students make false allegations or call 911 as “negative attention-seeking behavior.”

Underlying many of the problems at Shrub Oak are staffing shortages, according to records and interviews. An internal email shows that one night, a “skeleton staff” was stretched too thin to attend to students’ hygiene. Employees provided ProPublica schedules that showed multiple students assigned to one worker even though the students required individual aides and the districts were paying for them.

Shrub Oak acknowledged the challenge of operating round-the-clock, but its spokesperson said that its staff of 400 is adequate and that the school “determines staffing levels based on student needs and contract parameters.” The school said that some students have advanced to where they can work without individual aides and that it passes any savings onto the districts.

James Roddy, a former Shrub Oak student, said the school sometimes was so short on staff “they’d literally ask other kids to watch over them.” He and another student ran away from the school one evening in January 2022 and spent the night hiding inside a Home Depot, police records show.

James Roddy, 18, is a former Shrub Oak student who lives in Utah. (Kim Raff for ProPublica)

Despite being a school that pledges to help students with intense behavioral challenges, Shrub Oak has only one certified behavioral therapist, employees and parents told ProPublica. Shrub Oak would not confirm the number.

“You send your kid to a residential school because you can’t handle all the things they need,” said the mother of one current student. “So they go to a school where they will have a team of experts, and you trust that the school will provide that. They are not providing that.”

A current employee described his concern over a student who was isolated in his bedroom as punishment. Like the Ashinoffs, he found he had nowhere to turn. He tried the state Education Department and the Justice Center, which investigates allegations that students with disabilities have been abused or neglected. He said both agencies told him they had no authority over unapproved schools.

“It broke my heart,” the employee said. “Who is watching out for these students?”

A note from Shrub Oak’s staff messaging system describes a student’s condition. (Obtained by ProPublica. Redactions by ProPublica.)

Other workers and parents expressed their alarm at failures to address students’ basic needs: medicine, hygiene and food.

“I had a student almost die because he had a seizure and almost stopped breathing. They had stopped giving him medicine,” said a former behavior specialist at the school. Police records and emails describe students taking the wrong medication or none at all. Shrub Oak told ProPublica that it has changed its medication practices.

Several parents also said their children uncharacteristically began urinating and defecating in their rooms because they were locked out of bathrooms overnight. Shrub Oak said some students have conditions that lead them to soil themselves — sometimes intentionally — and that staff are always available to let students in the locked bathrooms.

A student eats his takeout meal at Shrub Oak. (Obtained by ProPublica from the family)

And for years, Shrub Oak leaders have been telling parents that a “restaurant-quality kitchen” would be finished “by year end” or in a few months, records show.

Instead, the food mostly comes from a nearby deli, though the school says Shrub Oak’s chef and nutritionist “are beyond compare.” (The therapy pool and equestrian stable also have not been built.) Shrub Oak told ProPublica on April 12 that the kitchen is slated to open “within days,” pending completion of electrical work. As of Tuesday, the kitchen still was not open.

“The promise of this place was magic,” one mother from California said. She pulled her son from Shrub Oak last year and sent him to an approved residential school for autistic students.

“Why they’re even allowed to have a school, I have no idea,” she said.

A wing of the Shrub Oak campus is being renovated to include more dorm rooms. (Liz Moughon/ProPublica)

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Help ProPublica Report on Education

Mollie Simon contributed research.

by Anna Maria Barry-Jester

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

It was 2022 when pediatrician Tom Herr realized just how many babies on the Rosebud reservation in South Dakota were already infected with syphilis when they took their first breaths. He was seeing more and more patients who’d spent their first weeks in a tangle of tubes that pumped antibiotics into their tiny bodies. Some had died in the womb.

With growing alarm, Herr and other health officials spread the word, appealing to bosses at the federal Indian Health Service and tribal health authorities, writing op-eds and talking to reporters. But as the months ticked by, the crisis mounted.

By 2023, an astonishing 3% of all Native American babies born in South Dakota were infected.

Now, according to tribal leaders, the syphilis rate among American Indians and Alaska Natives in the Great Plains surpasses any recorded rate in the United States since 1941, when it was discovered that penicillin could treat the infection.

On a map of rising syphilis cases nationwide, some reservations stand out like a red alert.

Desperate for help, in late February of this year tribal leaders from four Great Plains states took the extreme step of asking U.S. Department of Health and Human Services Secretary Xavier Becerra to declare a public health emergency. The Great Plains Tribal Leaders’ Health Board asked the secretary to deploy commissioned officers from the U.S. Public Health Service to help diagnose and treat people for syphilis, and to provide emergency funding for the tribes to improve their response capabilities.

More than 10 weeks later, Becerra has not responded.

“We need to free up resources so we can take extraordinary measures to respond to these extraordinary circumstances,” said Meghan Curry O’Connell, chief public health officer for the tribal health board.

Syphilis, which is transmitted primarily through sexual intercourse, is easily treatable. But the disease is life-threatening when left unchecked. Babies infected in the womb can be born in excruciating pain, with deformed bones, brain damage or other serious complications. They can even die.

The emergency declaration may be the only way to get money in time to prevent more babies from getting sick or dying. The typical funding processes — which go through the federal budget or the Centers for Disease Control and Prevention — can lead to a delay of a year or more before money trickles down to communities.

In response to questions from ProPublica about why Becerra hasn’t replied to the emergency request, an HHS spokesperson wrote that “HHS has received the request and will respond directly” to the Great Plains tribes, but did not provide a time frame for doing so.

ProPublica also sent questions about the outbreak to Dr. Natalie Holt, chief medical officer for the Indian Health Service’s Great Plains office. In response, IHS provided written answers from both Holt and HHS.

The rise of syphilis cases among Native American communities, particularly in some Great Plains states, is “especially concerning,” Holt said. She said that Great Plains IHS is working with the South Dakota Department of Health and tribal partners to “maximize syphilis case identification, contract tracing and treatment efforts.”

HHS wrote that it was “taking action to slow the spread with a focus on those most significantly impacted,” noting that it had held a workshop for tribes and created a national task force to “leverage federal resources.” It also pointed to guidelines IHS had released in October 2023 about how to respond to the outbreak.

Syphilis has been on the rise nationwide for a decade, and the country has repeatedly run low on penicillin, the medicine used to cure it. But amid a shortage of health care providers and money the disease was spreading faster on reservations.

Because syphilis is treatable and can be so devastating to a baby, even one case of an infected infant is a sign that a health system is failing.

Alarms about health care in the area have been ringing for years, in large part due to neglect from various arms of the federal government, including chronic underfunding from Congress for the health care system for Native Americans.

Now, the silence from HHS is threatening to perpetuate what health workers say is a preventable outbreak that endangers the lives of children.

“The more you delay, the harder it is to contain. More people infected, more infant deaths,” O’Connell said.

The U.S. government is obligated to provide health care to many tribes, including several in the Great Plains, under a variety of treaties. It does so largely through the Indian Health Service, a series of clinics and hospitals on reservations and in cities primarily in the western United States.

Unlike other major health programs like Medicare, IHS funding is determined by a congressional vote each year. It has always fallen far short of the $50 billion tribes say is needed. The IHS spends a little over one-third of what the Veterans Health Administration spends per patient and half of what the government spends on health care for federal prisoners, according to the most recent data available.

When infectious diseases inevitably arrive, as they do in every community, the Indian Health Service is often ill equipped to respond, according to current and former employees. Those existing shortfalls have made the syphilis outbreak even more challenging.

Holt, the chief medical officer at IHS Great Plains, wrote, “Public health initiatives are chronically underfunded.” Responding to infectious diseases requires “substantial ‘boots-on-the-ground,’” she said, noting that the U.S. is experiencing a national health care staff shortage, including a dearth of nurses, providers and other support personnel.

At the end of 2020, HHS released a national strategic plan to tackle sexually transmitted infections, including syphilis. The report noted concerning rates of syphilis in Native American babies across the country, which by then were already three times higher than in the population as a whole. Officials set a goal to bring the rate down by more than 15% by 2025.

Instead, over the next two years, the rate of syphilis among Indigenous people in the Great Plains soared by 1,865%. Around 80% of the cases in South Dakota in recent years have been among Native people, who represent less than 10% of the state population.

At Rosebud, Herr started spending his weekends at work, poring over patient charts. He made a list, tracking those who had tested positive but gone untreated. He shared the list with colleagues and tried to figure out how to get people their penicillin.

“We just did this with COVID,” he thought. “We know what to do.”

Herr set up an alert in the electronic medical record system to flag patients who needed treatment. On the walls of reservation hospitals and clinics, staff hung colorful posters featuring pregnant bellies, encouraging people to get tested.

The more you delay, the harder it is to contain. More people infected, more infant deaths.

—Meghan Curry O’Connell, chief public health officer for the tribal health board

Nurses held a few testing events in the community, diagnosing several people. The tribal health board held testing events in Rapid City.

Other Native American reservations were struggling as well. Jessica Leston, then a director for the Northwest Portland Area Indian Health Board, was tracking infectious disease data throughout the West when she noticed a cluster of new syphilis cases at a reservation in Montana. In a community of under 10,000 people, a dozen patients had been diagnosed in one week. She alerted colleagues at Indian Health Service headquarters, and they learned that three of the cases were stillborn babies.

The Montana outbreak was detailed in the Indian Health Service’s budget justification to Congress last year. In 2023, the president’s budget proposal called for $9.3 billion for IHS, a modest increase from the previous year, with additional increases over the next decade. Congress approved $6.9 billion for the system that serves 2.6 million people.

“People always say we care about babies,” Leston said. “Now we aren’t even caring about babies.”

Last year, the tribal health board called in the CDC through a program that deploys the agency’s experts for one to three weeks during outbreaks. CDC staff concluded, as Vox reported last year, that there isn’t enough prenatal care in the area and that patients lack transportation to the few available clinics. CDC disease investigators provided care to 14 people during their visit, noting that all but one would have gone untreated without their help.

The CDC recommended that tribes test and treat people outside of clinics, transport patients to appointments and hire additional workers to find the sexual partners of those who’ve tested positive so that they can be treated as well. The officials also suggested the tribes consider the use of rapid tests, which can return results in time for a patient to be treated before they leave the clinic.

All of those suggestions are nearly impossible to implement, tribal health officials told ProPublica.

Prenatal care used to be more readily available at the Indian Health Service facilities across the Pine Ridge, Rosebud and Cheyenne River reservations, which span nearly 5 million acres, an area approximately the size of New Jersey.

Over the last two years, many staff left and weren’t replaced. Across the three reservations, only Pine Ridge had an obstetrician for much of the last year, according to several people with direct knowledge of the situation. Holt said that the IHS is working to hire more providers and that there is now an additional part-time obstetrician at Pine Ridge and another working two days a week at Cheyenne River.

People with any kind of pregnancy risk factor — including a patient over 34 and another with high blood pressure — have said they were told to drive up to three hours to Rapid City.

Tribal health officials lack the staff or money for mobile clinics and more testing events to find new cases.

They also struggle to track existing cases because three states and the Indian Health Service have refused to share contact information for patients who test positive. South Dakota recently began sharing this crucial information with the tribal health board, but the Indian Health Service and Iowa, North Dakota and Nebraska still do not. Health departments in Iowa, North Dakota and Nebraska did not respond to questions about data sharing.

As for the rapid tests, the Indian Health Service nationally recommends their use. But current and former staff in South Dakota said that area managers have denied their requests for these tests. Instead, providers said, they must use a test that has to be sent out to a lab and wait three to seven days for results. By that time, it can be hard to locate patients for treatment.

Holt said that the IHS “supports data sharing in the interest of improving population health” and that tribes must follow an established policy to request and receive the data. Regarding rapid tests, she wrote that the Great Plains IHS prefers to do the lab-based testing because “we feel this approach improves speedy access to treatment.”

The CDC also urged the tribes to research how punitive policies stop people from seeking medical care. In South Dakota and on several reservations, a pregnant person with illegal substances in their system can be charged with a felony. And providers are required to contact child protective services if they know a person has used drugs during pregnancy. Doctors described patients being screened for drug use at hospitals, with or without their consent, and then taken to jail. People in the area know this risk and sometimes avoid medical visits as a result, women and providers said.

The South Dakota tribes and state officials have shown no indication they are considering changing these policies.

Immediately after the CDC visit last summer, the tribes put in a formal request to the agency for more help. A few CDC staffers returned to the area in April to help find and treat patients who have tested positive. It’s an important step, O’Connell said. But given how far syphilis has reached into the community, a few days of help at few reservations is not enough to stop babies from dying.

The tribes also worry about the damage that’s already been done. In addition to asking for help preventing new infections, leaders asked for a longer-term plan to make sure that children born with syphilis get the care they need in years to come.

Herr remains haunted by one patient file from Rosebud. It belongs to a young woman who came to the hospital in labor and delivered a stillborn baby. A week later, when the patient was long gone, test results came back showing she had syphilis.

Hospital staff tried a few times to follow up to no avail. The woman returned to the hospital months later, this time in the midst of a miscarriage. Based on her medical records, Herr believes she lost both pregnancies due to untreated syphilis.

When Herr retired from IHS in January of this year, the woman still hadn’t been treated.

We plan to continue reporting on Native American health care and are looking for experts and sources. Help us make sure our journalism is responsible and focused on the right issues. We’d especially like to hear from tribal members about their experiences, along with employees of the Indian Health Service, and tribal leaders and elders. If this is you, please fill out the form below or reach out to reporter Anna Barry-Jester at anna.barryjester@propublica.org.

by ProPublica

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ProPublica won the prestigious public service Pulitzer Prize for what the judges described as “groundbreaking and ambitious reporting that pierced the thick wall of secrecy surrounding the Supreme Court to reveal how a small group of politically influential billionaires wooed justices with lavish gifts and travel, pushing the Court to adopt its first code of conduct.” The prize is given to the staff of a news organization that performed “meritorious public service.” It is the seventh Pulitzer Prize for ProPublica.

The Pulitzer Board also recognized a collaboration between The Texas Tribune, ProPublica and FRONTLINE as a finalist in the explanatory reporting category. The investigation provided a detailed analysis of the deeply flawed law enforcement response to the mass shooting at Robb Elementary School in Uvalde, Texas. The designation is ProPublica’s 17th Pulitzer finalist in 16 years.

ProPublica’s “Friends of the Court” series uncovered the biggest ethics scandal to hit the Supreme Court in the modern era. Reporters Justin Elliott, Joshua Kaplan, Alex Mierjeski, Brett Murphy and Kirsten Berg pierced decades of judicial secrecy and uncovered major gifts to justices from a small set of politically influential donors.

Senior editor Jesse Eisinger, left, and Murphy, Mierjeski, Elliott, Berg and Kaplan (Sarahbeth Maney/ProPublica)

The series began a national conversation about ethics and judicial reform of the Supreme Court. In response to ProPublica’s reporting, the court announced in November that it had unanimously adopted the first ethics code in its 234-year history. Justice Clarence Thomas for the first time acknowledged that he should have reported selling real estate to billionaire Harlan Crow in 2014, writing in his annual financial disclosure form that he “inadvertently failed to realize” that the deal needed to be disclosed. Thomas also disclosed receiving three private jet trips from Crow, two of which ProPublica had already reported. The Senate Judiciary Committee voted to authorize subpoenas of Crow and conservative legal activist Leonard Leo as part of its ongoing effort to investigate ethics lapses by justices.

In the series honored as a Pulitzer finalist in explanatory reporting, the Tribune, ProPublica and FRONTLINE used a trove of unreleased investigative files to produce a startling and exhaustive investigation of the Uvalde shooting, which included a documentary. It revealed what no one else had: States across the country are providing devastatingly insufficient training for law enforcement to confront a mass shooter, leaving critical and long-overlooked gaps in preparedness between children and the officers expected to protect them. The series involved the work of Lomi Kriel, Lexi Churchill, Perla Trevizo and Jessica Priest for ProPublica and the Tribune; Jinitzail Hernández and Zach Despart for the Tribune; and Juanita Ceballos, Michelle Mizner and Lauren Prestileo for FRONTLINE.

After the news investigation, U.S. Attorney General Merrick Garland unveiled the findings of a federal probe into the response. Garland pointed to missteps that led to delays in confronting the shooter. Then he turned to what he said was the biggest failure, one that required the most urgent action to avoid another colossal breakdown such as the one that cost lives that day: the lack of sufficient active shooter training for law enforcement. Garland’s comments validated the investigation’s finding that there is an astounding dearth of such instruction around the country.

ProPublica received Pulitzer Prizes for national reporting in 2020, feature writing in 2019, public service in 2017, explanatory reporting in 2016, national reporting in 2011 and investigative reporting in 2010. Local Reporting Network partner Anchorage Daily News won the Pulitzer Prize for public service in 2020.

by Mark Olalde, ProPublica, and Nick Bowlin, Capital & Main

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. This story was produced in partnership with Capital & Main and Gray Television/InvestigateTV.

The first sign of trouble bubbled up from gopher holes a stone’s throw from Stan Ledgerwood’s front door. The salt water left an oily sheen on the soil and a swath of dead grass in the yard.

It was June 2017, and Ledgerwood and his wife, Tina, had recently built a home on the family farm, 230 acres of green amidst the rolling hills and long horizons of south-central Oklahoma. There they planned to spend their retirement, close to Stan’s parents on land that has been in the family since 1920.

The view from the porch took in Stan’s parents’ house, two rows of pecan trees his great-grandfather had planted in the 1930s, and the forest shielding the Washita River, a muddy brown ribbon flowing along the southern edge of the farm. The nearest town, Maysville, has a population of 1,087.

“The only people who come down our road are either lost or the mailman,” said Stan, a husky man with a biting sense of humor.

Stan and Tina Ledgerwood in the family’s pecan grove (Mark Olalde/ProPublica)

Also visible from the porch was metal piping in a red-gated enclosure: an aging oil well.

Like many property owners in this rural farming community, the Ledgerwoods own their land but only a meager percentage of the oil beneath it. Pump jacks nod up and down in nearby fields of soybeans and alfalfa.

Stan’s 84-year-old parents, Don and Shirley Ledgerwood, have watched oil companies drill multiple wells on their farm, where the family had grown crops and run cattle. The family received small royalty payments from the oil production. And decades later, they had to allow a wastewater pipe to cross the farm when another company, Southcreek Petroleum Co. LLC, redrilled the well behind the red gate. The well, which plunged about 9,000 feet into the earth, was repurposed to inject salt water into the geologic formation and push any remaining oil up to other wells.

A new production boom never materialized for Southcreek in this slice of Garvin County, and the family didn’t hear much from the oil company.

“When they were through here,” Don said, “we thought we were finished with the oil business.”

But then a corroded valve malfunctioned underground, injecting brine into the soil, according to a report by a Southcreek contractor.

After salt water leaked from an oil well on the Ledgerwoods’ farm, fouling part of their land and their drinking water, the family struggled for years to hold oil companies accountable. (Jason Crow/InvestigateTV+)

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A few days after the release was discovered in June 2017, Stan met with Southcreek and the Oklahoma Corporation Commission, the state’s oil and gas regulatory agency. At the meeting, the company characterized the incident as a “small spill,” the Ledgerwoods later alleged in court. It was unclear how long the leak lasted, but the saltwater plume had already saturated the soil and killed 2 acres of vegetation by the time it broke the surface, according to state oil regulators.

Samples analyzed a month later by Oklahoma State University found that the soil’s concentration of chloride, which occurs in the type of salt water injected into the well, had risen to more than 12 times the state’s acceptable level and was “sufficiently high to reduce yield of even salt tolerant crops.”

Other tests showed that chloride levels in the family’s water well had spiked to more than five times what the Environmental Protection Agency deems safe. The tests didn’t look for other contaminants like heavy metals that are often left behind by the oil production process.

Watch “Drilled and Drained”

The Ledgerwoods entered a grim limbo, wondering what toxins might be in the cloudy water coming from their faucets and waiting for someone to address the problem.

They experienced firsthand the policy failures that have allowed the oil and gas industry to reap profits without ensuring there will be money to clean up drill sites when the wells run dry and the drillers flee. A recent ProPublica and Capital and Main investigation found a shortfall of about $150 billion between funds set aside to plug wells in major oil-producing states and the true cost of doing so. When the Ledgerwoods later sought to hold the drillers accountable, the family learned how easily oil companies can use bankruptcy to leave their mess to landowners.

Don began traveling 30 miles round-trip to Walmart to buy bottled water. Stan and Tina’s steel pots rusted after being washed, and their 2-year-old great-niece’s skin became irritated and inflamed after repeatedly washing her hands while they potty-trained her. In a text message, the girl’s mother described her hands as looking like they had “a burn.”

After an oil well leaked salt water just outside her front door, Tina Ledgerwood wondered what else was in the water flowing from her taps. (Mark Olalde/ProPublica)

Southcreek did not respond to ProPublica and Capital & Main’s requests for comment. In court, the company denied calling the release “small” and argued that the groundwater contamination was contained to the two impacted acres the state identified.

The Ledgerwoods watched in horror as the farm that represented their past and their hope for the future languished. Somehow it had to be fixed, they believed. The rest of the family had also considered retiring to the farm, said Steve Ledgerwood, Stan’s brother and a lawyer in nearby Norman, but that plan was going up in smoke.

“We’ve gone out and made our living and done what we were supposed to do, and we wanted to have a relaxed, peaceful life,” Steve said. “And it has been anything but that.”

“Our Only Source of Fresh Water”

The Ledgerwoods and other farmers in Garvin and McClain counties started worrying the moment the oil industry returned in 2012.

Southcreek and other oil companies wanted to resume extraction from the oil field underlying Maysville. But the reservoir was old, so they proposed flooding it with water to force the oil to the surface. Don Ledgerwood and other local farmers signed a petition beseeching the Corporation Commission to reject the companies’ plans.

“This aquifer is our only source of fresh water for our homes, families and livestock,” the farmers wrote. “We fear that any error in development and production could lead to devastating contamination to this critical freshwater supply.”

Cows graze in a pasture in Garvin County, Oklahoma, where farmers tried and failed to block renewed activity from oil companies over fears of water pollution. (Jason Crow/InvestigateTV+)

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As is common in American oil fields, property rights in this part of Oklahoma often create split estates, where one person owns the land while another owns the underlying minerals, such as oil and gas. The owner of the minerals has a right to drill, even if the landowner would prefer they didn’t.

The farmers didn’t sway the Corporation Commission, and in 2014, Southcreek redrilled the well on the Ledgerwoods’ land. The company was small but produced about $4 million worth of oil and gas from the area, adjusted for inflation, according to an analysis of Oklahoma Tax Commission data.

State regulators are supposed to minimize the risks that accompany oil and gas production, including by mandating that drillers plug old wells to prevent them from leaking greenhouse gases into the atmosphere or leaching toxic chemicals into the land and water.

In theory, cleanup is guaranteed by financial instruments called bonds that companies fund and that regulators can put toward the cost of retiring wells if drillers go bankrupt or walk away. Sufficient bonding creates an incentive for companies to plug their own wells: Once the work is completed, the company gets its bond back. But when bonding requirements are lax, there’s little to deter drillers from forfeiting their bonds and leaving their wells as “orphans.”

Oklahoma allows companies to cover an unlimited number of wells with a single $25,000 bond. Alternatively, companies can satisfy bonding requirements by proving they are worth at least $50,000, in which case they often do not have to set aside any real money in bonds. Corporation Commission spokesperson Matt Skinner said the agency was unable to find a single case where the state recouped enough money to plug a well from companies that relied solely on the latter option.

To cover all of its roughly 30 wells, Southcreek held a $25,000 bond and filed paperwork to show it was worth at least $50,000. (Different agencies disagree on how many wells Southcreek operated.)

The well that spoiled the Ledgerwoods’ drinking water is one of the 18,500 that the Corporation Commission classifies as orphaned. “We would not be surprised to see that number go higher,” Skinner said. State taxpayers will ultimately be on the hook to plug many of them, or the state can leave the wells unplugged, but many will continue leaking.

A state contractor plugs an orphan Southcreek Petroleum Co. LLC oil well on a farm across the road from the Ledgerwoods’ property. (Mark Olalde/ProPublica)

Some orphan well cleanup in Oklahoma is funded by a voluntary 0.1% fee paid by industry on the sale of oil and natural gas. The Oklahoma Energy Resources Board spent $156 million of the funds collected from this fee over the past three decades. The state has an additional orphan well fund with several million dollars in it.

But Oklahoma has more than 260,000 unplugged wells — behind only Texas — according to data from energy industry software firm Enverus. To plug and clean up the state’s wells could cost approximately $7.3 billion, according to an analysis of state records. Oklahoma has just $45 million in bonds.

The oil industry’s bonds are “shockingly inadequate,” said Peter Morgan, a Sierra Club senior attorney. “It’s clear that abandoning wells and leaving communities and taxpayers to foot the bill to clean them up is baked into the oil and gas industry business model.”

At the Capitol in Oklahoma City, which features repurposed oil derricks outside its main entrance, Republican state Rep. Brad Boles has tried for several years to address the shortfall. This year, he introduced a bill to create a tiered bonding system based on the number of wells a company operates, increasing the highest required bond to $150,000.

A monument to oil stands outside the Oklahoma Capitol. (Mark Olalde/ProPublica)

“We have a huge liability in our state that we’re trying to get better control of,” he said, acknowledging that his bill would only be a partial solution. “It’s a lot better than it was, but it’s nowhere near where we need to be.”

The Oklahoma House of Representatives and a Senate committee both passed it unanimously, but the bill didn’t receive a vote on the Senate floor. Boles pledged to run a similar bill next session.

“They’re Doing You a Favor If They Clean Up”

Shortly after the 2017 brine release, Southcreek began cleaning up with funds from an insurance policy. Fox Hollow Consultants Inc., an environmental consulting firm working with Southcreek, warned in a report that “the remediation of ground water impacted by saltwater is at best a difficult undertaking, costly, and often not effective.”

A stream of trucks rumbled down the Ledgerwoods’ once-quiet gravel road as workers removed enough dirt to fill 750 dump trucks and pumped more than 71,000 gallons from the Ledgerwoods’ water well.

Workers remove contaminated soil from the Ledgerwoods’ farm after the 2017 saltwater release. (Courtesy of Stan Ledgerwood)

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But the dangerous concentrations of chloride didn’t change, according to Fox Hollow’s report.

A family who leased the Ledgerwoods’ farmland decided not to plant a crop and removed their cattle.

Nearly two years after the spill was discovered, the company drilled new water wells next to each house, but questions about the safety of drinking the water persisted. Southcreek eventually halted its cleanup, and the Corporation Commission deemed the incident resolved.

“It’s your own property, but you’re made to feel like they’re doing you a favor if they clean up their pollution,” Stan Ledgerwood said.

The Ledgerwoods considered moving. A nearby farm was for sale. Although it was half the acreage with only one house, the water was clean and they could distance themselves from the debacle on their farm. So they held an auction for their farm in June 2019.

Their property had been appraised to be worth around $1 million before the spill. They feared bids would be low — they had disclosed the water issues to potential buyers — yet the offers from the auction were shocking, with bids for the whole farm coming in at $450,000.

Potential buyers’ “first question was about the water, and I couldn’t say it was safe,” Stan said.

Still, the Ledgerwoods needed to pay their attorneys, so they sold nearly all the land, about 200 acres, including the fields that earned them income. The family kept the two houses, with the injection well sitting in the field between them.

The same week as the auction, the Ledgerwoods sued Southcreek. The family’s lawsuit also named as defendants Wise Oil & Gas No. 10 Ltd. and Newkumet Exploration Inc. — which each owned an interest in the oil Southcreek was pumping — as well as the companies that manufactured and sold the well’s corroded valve. The family sought reimbursement for expenses related to the spill, monetary damages and an order that the oil companies finish removing the contaminated soil and water.

In court, Newkumet denied responsibility because it did not operate the well, while the other companies argued that the failed valve was not defective.

On a recent, unseasonably warm winter day, with a mackerel sky hanging over the property, Stan and Tina Ledgerwood talked about what brought them back to the farm. Stan had worked for three decades at the Oklahoma Electric Cooperative, a nonprofit utility, while Tina held an administrative role at the University of Oklahoma, and they looked forward to a peaceful retirement.

“There’s a draw to the beauty here,” Tina said.

Stan and Tina Ledgerwood at the failed injection well (Mark Olalde/ProPublica)

There were also family memories stretching back a century. Tina recalled taking her niece to camp along the Washita, where sandbars interrupt the river’s meandering flow and willows grow on the red dirt banks.

Her niece still talked about eating the best hamburger of her life on one of those excursions, Tina said with a laugh. “It’s frustrating,” she added, her tone shifting, “because you look out there and it’s not yours anymore.”

An Escape Hatch

Progress in the lawsuit was short-lived. In November 2019, shortly after the Ledgerwoods’ attorney sent discovery requests to Wise Oil & Gas, the company filed in a Texas court for voluntary Chapter 7 bankruptcy — a full liquidation of its assets.

Company executives acknowledged they declared bankruptcy to avoid legal fees associated with the Ledgerwoods’ suit, according to court records.

Bankruptcy court has become an easy escape hatch for the industry to shed its costly obligations. More than 250 oil and gas companies in the U.S. filed for bankruptcy protection between 2015 and 2021, bringing about $175 billion in debt with them, according to research from law firm Haynes and Boone. (Haynes and Boone is representing ProPublica in several Texas lawsuits.)

Sen. Jeff Merkley, an Oregon Democrat, said it is “outrageous” that oil executives can pay themselves handsomely before offloading liabilities via bankruptcy. He is preparing a Senate bill to amend the Bankruptcy Code to address this pattern in the oil industry.

“They privatize the profits, and then they dump the costs on the taxpayer, which is an outrageous arrangement that needs to end," Merkley said, adding that “this is not just one company in one place. This is a practice that has been exquisitely developed by the industry.”

Josh Macey, a University of Chicago law professor who studies bankruptcy, said that “one of the most significant benefits you get when you file for bankruptcy protection is the automatic stay,” which puts other cases on hold while the bankruptcy is ongoing.

The Wise Oil & Gas bankruptcy halted the Ledgerwoods’ suit.

So the Ledgerwoods ventured into labyrinthian bankruptcy court proceedings as creditors. But the bankruptcy filings for Wise Oil & Gas — which owned a 20% stake in the oil underlying the Ledgerwood farm — listed between $1 million and $10 million in liabilities against less than $33,000 in assets.

While Wise Oil & Gas appeared to be underwater, financial and legal documents showed that the company was one node in a sprawling business empire run by the wealthy Cocanougher family of North Texas.

Alongside their extended family, brothers Daniel and Robert Cocanougher own the web of businesses that included real estate holdings, golf courses, trash services, charitable organizations and more. A company representative estimated in court that the family controlled more than 100 companies. The entire operation was managed by Cocanougher Asset Management #1 LLC out of an office in North Richland Hills, Texas, near Fort Worth.

Wise Oil & Gas was kept afloat by more than 30 loans from other Cocanougher companies, chiefly Wise Resources Ltd., which shared an office with the oil company, according to records filed in court. The loans ensured the oil company had enough cash to operate, but it otherwise hovered around insolvency. Wise Oil & Gas periodically held less than $0 in its account, internal records revealed in court show.

The Ledgerwoods would never see any money from the Cocanoughers’ businesses.

“A Pretty Ordinary Situation”

In bankruptcy, secured creditors, whose debt is backed by collateral, are first in line to claim proceeds from the liquidating company’s assets. Unsecured creditors — such as the Ledgerwoods — are paid if there are funds left over. Even further back in line are environmental claims, such as money to plug wells.

One secured claim stood out: $1.9 million for Wise Resources. According to legal filings, a few months before declaring bankruptcy, Wise Oil & Gas had consolidated its “outstanding obligations” and transferred them to Wise Resources, although the deal was backdated to the previous year.

During one deposition, Jamie Downing, a lawyer for the Cocanoughers, went back and forth with Steve Ledgerwood, who occasionally represented his family, over whether Robert Cocanougher was “two different people” when he signed documents for Wise Oil & Gas and for Wise Resources.

“Robert Cocanougher is signing documents in his capacity as general partner of one entity or the manager of another entity,” Downing said. “They would not be the same person.”

Even though the Cocanoughers were wealthy, the layers of corporate entities between the family and the oil limited their liability for the saltwater spill. It is difficult to “pierce the corporate veil” and tie a company’s actions to individuals, so executives finding protection in bankruptcy is “a pretty ordinary situation,” Macey explained. “We’ve gone too far in shielding investors from the cost of corporate misconduct.”

Daniel and Robert Cocanougher and company attorneys did not respond to requests for comment. In court filings, the family and its companies argued that they were not responsible for the brine release and were within their rights to file for bankruptcy protection.

The Ledgerwoods soon realized the bankruptcy case would lead to neither the cleanup of their farm nor Wise Oil & Gas paying for the damage, so they filed a motion to dismiss it, sanction the Cocanoughers and force the company back into their Oklahoma lawsuit.

Southcreek tanks that formerly collected contaminated liquid near the Ledgerwoods’ farm are now leaking. (Jason Crow/InvestigateTV+)

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The judge overseeing the case was Mark X. Mullin, a former corporate bankruptcy attorney himself. At first, he acknowledged the Ledgerwoods’ plight. “To be clear, the court has a lot of empathy for what happened to the Ledgerwoods,” he said during an August 2021 hearing.

But two months later, Mullin ruled against the Ledgerwoods. He disagreed that Wise Oil & Gas had entered bankruptcy to shed bad investments and dodge cleanup obligations. He blasted the Ledgerwoods for requesting sanctions against the Cocanoughers.

“Merely because the Ledgerwood Creditors have been damaged by the saltwater contamination, this does not provide them with an unfettered right to retaliate or lash out against unrelated and far-removed targets, such as the Cocanougher Sanction Targets,” Mullin wrote.

If the Ledgerwoods wanted to continue seeking damages against the Cocanoughers and their businesses, they would have to pay the oil company’s attorneys’ fees, about $107,000, Mullin ruled.

Mullin declined to comment.

In September 2022, the trustee overseeing Wise’s liquidation reported that, after paying administrative fees, the company had no money for creditors. The Ledgerwoods withdrew their claim.

“I Can’t Afford to Come In and Clean It Up”

The Ledgerwoods weren’t the only ones taking a financial hit. Southcreek, the well’s operator, also entered bankruptcy protection and began offloading its wells. Cleaning them all up could cost taxpayers nearly $1 million, based on the Corporation Commission’s average cost to plug a well.

Even before the company liquidated, Southcreek executive Gus Lovelace admitted to the state that the company had stopped maintaining its wells, according to Corporation Commission records.

The company left some wells to the state as orphans, including the injection well that fouled the Ledgerwoods’ land. Some ended up in the hands of other oil companies, although those, too, appear to be on the verge of becoming wards of the state.

Michael Brooks, a neighbor of the Ledgerwoods, lives on a farm that his father-in-law worked before him — they’ve put in more than 50 years between the two generations. On a recent winter morning, Brooks showed ProPublica and Capital & Main a 3-acre drill site that scars his land and provides him no royalties.

The plot would be Bermuda grass pasture for cattle, but the paddock instead hosts two inactive oil wells and huge tanks that the Ledgerwoods believe held the salt water that fouled their land. Brooks has to retrieve cows that slip through the barbed wire fence around the site and chew the wells’ rusting metal and drink wastewater.

“I’m at a complete loss,” he said from beneath the brim of a hat embroidered with the logo of an oil and gas pipeline company. “I can’t afford to come in and clean it up. I wouldn’t even know where to start.”

Brooks has for years tried to reach the companies that own the wells, calling phone numbers on the signs posted around them. No one ever answered or called back, he said.

ProPublica and Capital & Main’s attempts to contact the owners were also fruitless. Court records indicate several of the Southcreek wells on Brooks’ farm and other nearby properties were sold out of bankruptcy. But the first company that purchased them is not a registered oil operator in Oklahoma, and the Corporation Commission has no record of the business taking them over.

The idle wells were then transferred to another oil company, but, when asked about that transfer, Corporation Commission staff said they had made a mistake in approving it and would try to revoke it. The best Brooks can now hope for is the state declaring that the wells are orphaned and plugging them.

“It’s just so frustrating because it’s just here. We look at it every day outside our windows,” Brooks said, adding, “It’s been nothing but a pain.”

“We’ll Never Have Back What We Had”

Nearly seven years after brine first poured from gopher holes on the Ledgerwood farm, most of the land has been sold. But the well is still there, rusting behind a curtain of dry weeds.

“We don’t get these years back,” Stan Ledgerwood said. “There’s no way to pay for that. We’ll never have back what we had.”

Stan and Tina drink from their new water well. But Don and Shirley Ledgerwood, Stan’s parents, don’t trust the water that flows from their faucets, as their house sits at a lower elevation than the injection well and water tests have shown occasional increases in the salt concentration.

Don Ledgerwood hauls clean water from a well at his son and daughter-in-law’s home. (Mark Olalde/ProPublica)

Don’s back is slightly hunched, but his sprightliness belies his 84 years. He still cuts the expanse of grass surrounding his old brick house, and Stan long ago gave up asking to do it for him. “He doesn’t do it right,” Don said, as he filled 5-gallon blue plastic jugs with water from Stan’s well. In one form or another, Don has been hauling water for six years.

As he hoisted the jugs into his off-road vehicle, Don lamented that landowners have to allow oil companies to drill on their property, only to see those operators avoid the costly cleanup.

“That’s not right,” he said.

The sun was rising higher, and Don had more chores to do. So he finished loading the water jugs and whisked them down the gravel road, kicking up dust that hung in the air alongside his parting words.

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Mariam Elba contributed research.

by Anna Clark and Sarahbeth Maney, Photography by Sarahbeth Maney

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Flint, Michigan, is less than 70 miles from the Great Lakes, the most abundant fresh water on the face of the planet. It’s laced with creeks and a broad river that bears its name. Yet in 2014, Flint’s drinking water became a threat — not because of scarcity, or a natural disaster, or even a familiar tale of corporate pollution.

Ten years ago this spring, public officials made catastrophic changes in the city’s water source and treatment, then used testing practices that hid dangers. As problems emerged, they failed to appropriately change course. Residents raised repeated concerns about the color, odor and taste of the water but struggled to get a sufficiently serious response, especially from state and federal authorities.

It didn’t help that the distressed city was under the authority of state-appointed emergency managers, an unusually expansive oversight system that residents decried. For a crucial period of about 3 1/2 years, local decision-making was not accountable to voters. The result: excess exposure to toxic lead, bacteria and a disinfection byproduct in Flint’s drinking water. An outbreak of Legionnaires’ disease sickened 90 people and killed 12. (The toll is likely higher, as Frontline documented.) The water, now drawn from the Flint River, wasn’t treated with corrosion control — a violation of federal law — so the pipes deteriorated more every day.

At one point, saying the water damaged its machinery, a General Motors plant switched to another community’s system. Flint’s emergency manager and other officials still insisted that nothing was seriously wrong with the water. But if the water was harming machines, many wondered, what was it doing to people?

The Flint River near Vietnam Veterans Park along East Fifth Avenue and James P. Cole Boulevard

It took about 18 months, and an extraordinary effort by residents and a few key researchers, before the state reconnected Flint with Detroit’s water, which is drawn from Lake Huron. In the years since, remediation efforts have included replacing corroded pipes, at-home filtration and infrastructure investments, which seem to have yielded promising results. Michigan’s Department of Environment, Great Lakes and Energy said in December that Flint’s water had met federal standards for more than seven straight years. Recent testing followed Michigan’s requirements, adopted in 2018, which are even tougher than federal standards. The state and city are working to resolve deficiencies to the supply system that can affect water safety.

Expired water bottles are scattered throughout the abandoned Northwestern High School in Flint. Flint Mayor Sheldon Neeley takes a tour of upgraded facilities at the Flint water plant. “It’s about establishing all the things that we need to be able to build back the trust,” Neeley said.

But no one can flip a switch on public trust. And Flint was vulnerable long before the water crisis.

Many point to the crisis as an extreme example of environmental injustice, where people of color and poor people, and especially those who are both, are disproportionately exposed to toxic conditions. A state commission acknowledged that race and class contributed to Flint not having “the same degree of protection from environmental and health hazards as that provided to other communities. Moreover, by virtue of their being subject to emergency management, Flint residents were not provided equal access to, and meaningful involvement in, the government decision-making process.”

That emergency manager law is still on the books. The work to replace the pipes is mostly done — but the city has blown repeated deadlines to complete it. Two state investigations under two administrations led to high-profile criminal charges, including allegations of involuntary manslaughter, official misconduct and willful neglect of duty. Primarily, state officials and employees were charged, including the former director of the state health agency and the former governor. Two emergency managers were also charged; both pleaded not guilty. One has said there was “overwhelming consensus” for the switch, and he was “grossly misled” by state water experts.

No case made it to trial. A new attorney general’s team dismissed the initial cases and started a new investigation. But the second wave of charges fell apart when courts rejected the use of a one-man grand jury to gain indictments.

The Environmental Protection Agency didn’t use its authority to effectively protect public health in Flint, according to the agency’s inspector general. The EPA has denied liability, however, and earlier this year asked a federal judge to dismiss a lawsuit alleging that it failed to properly intervene.

While it was announced in 2020, not one penny of the class-action settlement of more than $626 million has reached residents. With more than 40,000 claims and 30 compensation categories, a special master indicated recently that the initial review should be complete this summer, but there will still be more vetting to do before claims are paid. (Some lawyers and contractors, though, have already been paid preliminary fees and expenses.)

Water is Flint’s origin story. The city was founded on a riverbank, and water powered its rise. Each spring, the water turns neighborhoods and parks lush. But these days, the betrayal of trust by the very institutions meant to protect residents has made some extra cautious as they look to keep themselves and their community safe. Their relationship with water is forever changed.

A nonprofit promotes protection of fresh water in a parking lot across the street from the Flint River along James P. Cole Boulevard.

Pastor Robert McCathern of Flint’s Joy Tabernacle Church said he has a list of about 30 people who haven’t gotten baptized because they’re afraid of the water. They’re wondering, he said, “‘Am I still saved?’ And the answer is yes."

McCathern, 70, crosses the street in front of Joy Tabernacle Church in Flint. The church is also the site of the Urban Renaissance Center, a faith-based nonprofit designed to provide social and development services in the Civic Park neighborhood and broader Flint community.

McCathern’s church served as a bottled-water distribution site during the crisis, which, he said, strengthened relationships and community trust. But he worries for the next generation, especially their psychological well-being. And he has his own fears too. He said he often smells a “foul odor” from the water. He is apprehensive when showering and usually drinks bottled water, he said, but sometimes lets his guard down to make tea with tap water.

In recent years, McCathern was diagnosed with multiple myeloma cancer. He believes it’s connected to chemicals in the water but will never know for sure. Over his 22 years at Joy Tabernacle, McCathern said, he’s seen an uptick in youth suicide. He wonders about a connection between lead exposure and violence. He recalls sitting at one funeral and thinking, Oh my God, if it produces violent tendencies, that’s not just outward violent tendencies — that’s internal.

McCathern approaches Tayler Armstrong, 9, and his grandmother Patricia Stewart-Burton while preaching during a Sunday service at Joy Tabernacle Church.

An investigation published in Science Advances showed an 8% increase in the number of school-aged children in Flint with a qualified special educational need. But, the researchers indicated, it’s difficult to pinpoint to what extent lead is the direct cause.

A cross-sectional study backed by the federal Office of Victims of Crime found that five years after the onset of the crisis, an estimated 1 in 5 residents — roughly 22,600 people — had met the criteria for clinical depression in the past year. One in 4, or 25,000 people, were estimated to have had post-traumatic stress disorder. According to researchers, only 34.8% of residents were offered mental health services to assist with psychiatric symptoms related to the crisis. Most people used them, if offered.

“We’re very acquainted to human suffering. This community has been acquainted to abandonment — to not trusting health systems, not having relationships with health systems and not having access at a level of comfortability. People have to come out of their safe zones to access health. Marginalized communities, people of color, have to go on and survive. They have to go through it.” — Pastor Robert McCathern

McCathern becomes emotional while talking with a friend about the lasting health impacts of the Flint water crisis. “That’s the only reason I’m here [in Flint], is because so much injustice to humans, to humanity.”

Teagan Medlin was a teenager in Flint during the water crisis. Now, the 25-year-old is the mother of three, including a newborn named Audrina. She lives at a recovery house for people with substance use disorder. As she works through her own recovery, she also struggles with whether it’s OK to expose her children to the water.

Teagan Medlin, 25, holds her newborn baby, Audrina, at a recovery house where she lives temporarily. Medlin bathes Audrina using water from the bath faucet at the recovery house in Flint.

Medlin said she uses her food stamp benefits on bottled water deliveries from Walmart for Audrina’s bottles. For her first months, Medlin relied on the infant’s father to bathe her at his home outside the city.

“I’ve been through the wringer. I’m sure I can handle it, but my babies — I don’t know what that could do to them. I am already done growing. I’m 25 and my brain is done growing. My body is done growing, but they are still developing and I don’t want it to damage them. But I don’t have anywhere else to go, and I can’t afford to live anywhere else, honestly.” — Teagan Medlin

Medlin prepares tea for herself using bottled water.

Ambitious programs aim to support Flint’s most vulnerable residents. Medlin is enrolled in Rx Kids, which “prescribes” a no-strings-attached payment of $1,500 for pregnant Flint residents and $500 for each month of the baby’s first year. A Medicaid initiative that covers youth up to age 21 and pregnant parents who were exposed to Flint’s water was extended in 2021 for another five years. And the Flint Registry connects people with health services while monitoring the effectiveness of efforts to prevent lead poisoning.

“I’ve seen the struggle for Flint in a deep way. I’ve been on the streets. I’ve met a lot of people. There are beautiful people here and it’s a beautiful city. They deserve better. I don’t know if there is a way to make up for the actual damage that’s been done. The accountability needs to be there.” — Teagan Medlin

Medlin and Audrina

Jacquinne Reynolds lives with unanswered questions about possible connections between the water and her health. She said she takes only quick showers these days, and never any baths.

Jacquinne Reynolds, 73, prepares for her care routine, which involves washing, brushing and moisturizing her scalp multiple times per week. Reynolds holds her dreadlocks, which she believes fell out because of contaminated water.

Reynolds is the executive director of a local literacy organization, tutoring children and adults on reading, writing and African American culture. She said her hair began falling out during the water crisis. While she was diagnosed with alopecia, she said, another doctor later told her that the hair loss is likely connected to the water. She too feels like she’ll never know for sure. Because of the lack of information about the water at the time, she didn’t think to track her symptoms.

“Going through this, I didn’t know that I was being affected. Nobody was saying anything to us. We didn’t know what was going on.” — Jacquinne Reynolds

The water’s effect on hair and skin was among the earliest concerns raised by residents, though a direct correlation has been difficult to prove. A 2016 state and federal analysis — conducted after Flint switched back to Detroit’s system — identified nothing in the current water supply that affected hair loss. A survey of more than 300 residents by academic researchers found that more than 40% of respondents said they experienced hair loss beyond what they considered normal before the crisis. Black respondents reported significantly higher percentages of hair loss. The more physical symptoms respondents reported, the more likely they were to report psychological symptoms.

Reynolds inside the classroom where she tutors at Word of Life Christian Church

Having taught and tutored Flint families for decades, Reynolds feels the weight of the community’s unmet needs.

“When are we, the citizens, going to be thought about? When are our children who were affected by the water and who are having learning difficulties in school going to receive what they need?” — Jacquinne Reynolds

A photograph of Reynolds and her husband, Lawrence Reynolds, a retired pediatrician and former president and chief executive officer of Mott Children’s Health Center

Nearly 80,000 people now live in Flint, according to recent census data, a drop of about 20% in the past 10 years. Fifty-seven percent are Black, 34% are white and 4% are Hispanic. Median household income is $33,036. Nearly 38% are in poverty. Population loss and disinvestment make it difficult to maintain a water system, with fewer people paying for infrastructure designed for a much larger city.

Flint had almost 200,000 residents in 1960; it built water infrastructure to support 50,000 more, according to the city’s communications director. It connected to Detroit’s system in the first place because it expected continued growth. Vacancy can worsen water quality because water sits longer in pipes before reaching a tap — a problem made visible when metals from corroding pipes saturated the water more in some Flint neighborhoods than in others.

In addition to service-line replacement efforts, the city offers free filters to residents. Beyond legally mandated testing, a unique community water lab provides residents with a free way to learn about their water. Young people lead much of the work. As lab director and Flint City Council member Candice Mushatt put it, “We’re training the next generation to be prepared in a way that we were not.”

Results range from 0.031 parts per billion up to over 50 ppb of lead from water samples tested in Flint, according to Mushatt. Under federal law, if a community water system reaches 15 ppb of lead, based on the 90th percentile of samples, certain public health measures must be taken. No amount of lead is safe.

High school interns carefully transfer water from pipettes at the water lab. A mural is reflected in a window as analytical chemist Cassidy Goyette reviews charts at the McKenzie Patrice Croom Flint Community Water Lab.

Flint residents have emphasized the importance of determining for themselves when justice has been done. In a 2020 paper, a cohort of community advocates wrote that they expect accountability, policy reform and community-driven investments. “And we will be insisting,” they wrote, “as always, that people ask us and our fellow residents before concluding that Flint has been made whole.”

by Eli Hager

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

It is one of the enduring myths of the U.S. child support system: that payments made by fathers actually make it to their families. And yet, every year, hundreds of millions of dollars in child support is instead intercepted by federal and state governments — as reimbursement for the mother having received welfare at some point.

But that may be changing. Since a 2021 ProPublica investigation found that child support payments totaling $1.7 billion annually were taken from families and redirected into state coffers, at least six states have rewritten their laws and policies to allow the money to flow directly to kids.

New Mexico, where we focused our reporting, made such a change shortly after our story was published. From Wyoming to Illinois, Michigan to Vermont to California, more child support is now going to children. And several other states are considering similar reforms during their upcoming legislative sessions.

This July, Illinois will start “passing through” all child support paid by fathers to their families, instead of pocketing it as repayment for welfare. “The intent of this change is for more families to receive more support,” said Jamie Munks, spokesperson for the Illinois Department of Healthcare and Family Services. A state’s child support system should not be funded by withholding child support from the lowest-income families being served, she said.

“Not passing through money to a family who is already experiencing financial difficulties will likely exacerbate those difficulties and may make them more reliant on government assistance,” Munks added.

Nicole Darracq, assistant director at the California Department of Child Support Services, said that under a new state law her agency has roughly doubled the amount of child support that it is passing through to families currently receiving welfare. There was roughly a $44 million net increase in payments to families from 2019 to 2022, she said.

Darracq added that starting this week, another piece of new state legislation will allow child support that fathers pay to mothers who’ve previously received welfare to go to those moms and their kids, instead of being intercepted. This change will send an additional $160 million to families each year, she said.

According to the National Conference of State Legislatures’ most recent analysis of state laws, at least 26 states and Washington, D.C., pass through some or all child support payments made by fathers to their families that have received welfare, also known as Temporary Assistance for Needy Families. In the other states, the government takes the cash.

The practice of confiscating child support from poor families persists in part because some conservative policymakers believe that welfare provided to single mothers should be considered a loan from taxpayers, to later be repaid by the patriarch of the family.

“Legislators suggest to me that if a family gets both [welfare] and child support, they’re ‘double-dipping,’” Jim Fleming, past president of both the National Council of Child Support Directors and the National Child Support Enforcement Association, told ProPublica in 2021. “That argument is still out there,” he said, although it is “becoming more and more of a minority view.”

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by Gerardo del Valle

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This article is co-published with The Texas Tribune, a nonprofit, nonpartisan local newsroom that informs and engages with Texans. Sign up for The Brief Weekly to get up to speed on their essential coverage of Texas issues.

The Pabón family is among the nearly 8 million Venezuelans who have left their country in the last decade, fleeing an authoritarian regime and a collapsed economy — one of the largest population displacements in the world.

[Watch the film.]

The family arrived in Ciudad Juárez, Mexico — across the border from El Paso, Texas — on Dec. 1, 2022, following a six-month journey across seven countries and thousands of miles. They’d left their homeland at a time when the United States had agreed to suspend the deportations of Venezuelans who were already living in the country because Washington had broken diplomatic relations with that country’s president, Nicolás Maduro. Thousands of new Venezuelan migrants arrived in Mexican border cities like Juárez hoping to take advantage of the opening.

But by the time the Pabóns arrived, the U.S. had reversed course and subjected Venezuelans to many of the same immigration restrictions as people of other nationalities. They were required to use a special app, called CBP One, to make an appointment to enter the U.S. to seek asylum. In El Paso, there were about 150 appointments available a day. Suddenly, the Pabóns found themselves stranded with countless other tired and frustrated migrants in a city of 1.5 million residents that lacked the resources to provide for the staggering number of new arrivals.

The Border and the Election

Join us May 29 to discuss why immigration is a top issue for voters and the U.S. policies that gave rise to the deadly Juárez fire.

The pressure-cooker situation culminated in a fire on March 27, 2023, inside the city’s only immigration detention center. It killed 40 immigrants and injured more than two dozen others in one of the deadliest incidents involving immigrants in the country’s history.

Five months later, the Pabón family managed to get an appointment via the CBP One app and cross into the U.S. They eventually applied for asylum, but after joining a migrant population ever more numerous and visible and without family roots or acquaintances in the country, a clear path for them remains elusive.

Help ProPublica Reporters Investigate the Immigration System

by Robert Faturechi, Ellis Simani and Justin Elliott

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The IRS has launched a campaign to examine whether wealthy taxpayers are violating the law when using their ownership of sports teams to save large amounts in taxes.

The effort will focus on sports industry entities that are reporting “significant tax losses” to “determine if the income and deductions driving the losses” are lawful, according to the IRS announcement earlier this year. That announcement, which consisted of one sentence on a webpage devoted to compliance campaigns by the IRS division that focuses on large businesses, did not specify what kinds of abuses the agency will be looking for.

The initiative comes after ProPublica, drawing on leaked IRS data, revealed how billionaire team owners frequently report incomes for their teams that are vastly lower than their real-world earnings.

When someone buys a business, they’re often able to deduct almost the entire sale price against their income during the ensuing years. That allows them to pay less in taxes. The underlying logic is that the purchase price was composed of assets — buildings, equipment, patents and more — that degrade over time and should be counted as expenses. Owners of sports franchises routinely avail themselves of such deductions, which can be worth hundreds of millions of dollars.

But in few industries is that tax treatment more detached from economic reality than in professional sports. Teams’ most valuable assets, such as TV deals and player contracts, are virtually guaranteed to regenerate because sports franchises are essentially monopolies. There’s little risk that players will stop playing for their teams or that TV stations will stop airing their games. But the team owners still get to deduct the value of those assets over time, sometimes billions of dollars’ worth, from their taxable income.

It helps billionaire sports team owners pay far lower income tax rates than the athletes they employ or even the low-wage workers who sell food or clean their stadiums.

ProPublica’s 2021 article traced how owners, starting with the late baseball showman Bill Veeck decades ago, persuaded the IRS to accept a “gimmick” that allows owners to take massive depreciation write-offs.

Among those benefiting was Steve Ballmer, the billionaire owner of the Los Angeles Clippers and former CEO of Microsoft. His tax records showed that in recent years his basketball team had reported $700 million in losses for tax purposes, despite indications that the Clippers’ real-world financial results were often profitable.

That allowed Ballmer to legally not pay tax on any real-world Clippers profits, and to offset his other income and cut his tax bill. His spokesperson said at the time that Ballmer “has always paid the taxes he owes.”

The practice helps create a counterintuitive overall tax picture that upends conventional wisdom about how taxation works in America. ProPublica found that billionaire owners like Ballmer are consistently paying lower income tax rates than their millionaire players — and often lower even than the rates paid by the concessions workers who staff their stadiums.

The IRS did not immediately respond to questions from ProPublica about what prompted the initiative and what abuses it’s investigating.

In an analysis for clients, the law firm Morgan Lewis credited the IRS campaign to several factors: an increased enforcement budget, criticism that wealthy taxpayers are not audited frequently enough and ProPublica’s reporting.

“The IRS may be acting on its promise to restore ‘fairness’ in tax compliance by taking more shots at partnerships and high-wealth individuals, including sports team owners,” the firm wrote. “With the Sports Industry Losses campaign, the sports industry looks to be the next opponent in the IRS arena.”

Clay Hodges, a tax planning specialist at the firm Moss Adams, said in an interview that the IRS usually selects areas to focus enforcement efforts based on evidence that it will find unpaid taxes. While it’s impossible to judge the IRS’ motivation based on its public announcement, he said, he noted the regular headlines of sports team owners selling teams for huge profits.

“When they announce these campaigns, the IRS is very strategic,” he said. “It’s more than just a fishing expedition. They think it will bear fruit.”

by Sharon Lerner

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The Environmental Protection Agency unveiled a proposal this week to ban a controversial pesticide that is widely used on celery, tomatoes and other fruits and vegetables.

The EPA released its plan on Tuesday, nearly a week after a ProPublica investigation revealed the agency had laid out a justification for increasing the amount of acephate allowed on food by removing limits meant to protect children’s developing brains.

In calling for an end to all uses of the pesticide on food, the agency cited evidence that acephate harms workers who apply the chemical as well as the general public and young children, who may be exposed to the pesticide through contaminated drinking water.

Acephate, which was banned by the European Union more than 20 years ago, belongs to a class of chemicals called organophosphates. U.S. farmers have used these pesticides for decades because they efficiently kill aphids, fire ants and other pests. But what makes organophosphate pesticides good bug killers — their ability to interfere with signals sent between nerve cells — also makes them dangerous to people. Studies have linked acephate to reductions in IQ and verbal comprehension and autism with intellectual disability.

Environmental advocates, who have been pushing the agency to restrict and ban acephate for years, said they were not expecting the agency to make such a bold move.

“I’m surprised and very pleased,” said Patti Goldman, a senior attorney at Earthjustice, who has been part of a farmworker led group that expressed concerns to EPA officials over the past years about the ongoing use of acephate and other organophosphates.

As much as 12 million pounds of acephate were used on soybeans, Brussels sprouts and other crops in 2019, according to the most recent estimates from the U.S. Geological Survey. The federal agency estimates that up to 30% of celery, 35% of lettuce and 20% of cauliflower and peppers were grown with acephate.

A draft risk assessment issued in August by the EPA’s Office of Pesticide Programs found “little to no evidence” that acephate and a chemical created when it breaks down in the body harm the developing brain. The document said there was no justification to keep restrictions on the bug killer that are designed to protect children from developmental harm. Removing that layer of protection would allow 10 times more acephate on food than is acceptable under the current limits.

The draft risk assessment’s conclusion relied in large part on the results of a new battery of tests that are performed on disembodied cells rather than whole lab animals.

The tests have been in development for years, but the EPA’s review of acephate’s effects on the developing brain marked one of the first times the agency had recommended changing a legal safety threshold largely based on their results.

Multiple science groups, including panels the EPA created to help guide its work, had discouraged using the nonanimal tests to conclude a chemical is safe. A member of the Children’s Health Protection Advisory Committee, one of the panels providing guidance to EPA, described the earlier acephate proposal as “exactly what we recommended against.”

But even as it proposed a new outcome this week, the EPA did not change its stance on the use of the cell-based tests.

“Even in this good news proposal, the EPA continues to misuse the cell-based assays,” said Jennifer Sass, a senior scientist at the environmental advocacy organization Natural Resources Defense Council.

Sass said she believes that both pressure from advocates and questions from journalists helped the EPA decide to change course on acephate. ProPublica began submitting a series of detailed inquiries to the agency about the pesticide starting in January.

An EPA spokesperson said late Tuesday that the agency had been working for months on its proposal to ban acephate from food and that neither advocates nor journalists played a role in the decision.

The EPA proposal would ban acephate on all plants with the exception of trees that do not produce fruit or nuts.

While lauding the proposed ban, Nathan Donley, a scientist at the Center for Biological Diversity, expressed concern about the possibility that, after pesticide companies and agricultural groups respond to the proposal, the agency might not finalize its proposed ban. (The agency is accepting public comments through its portal until July 1.)

“The pushback on this is going to be really intense,” Donley said. “I hope they stick to their guns.”

by Aliyya Swaby

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

After a federal appeals court ruled this week that transgender people are legally entitled to the same access to medically necessary health care as everyone else, the immediate reaction of the states of North Carolina and West Virginia was to vow to appeal the decision to the U.S. Supreme Court.

The immediate reaction of Hann Henson, an employee of a North Carolina school district who’d spent years struggling to access gender-affirming care, was to break into tears. Last year, ProPublica wrote about his tumultuous journey seeking medical support in his gender transition while living in a state with a long history of discrimination against transgender people.

“Having something that you know is going to help you feel better, is going to help you feel whole, and having it constantly dangled above your head is just dehumanizing,” he said.

The 4th U.S. Circuit Court of Appeals, based in Virginia, ruled that the two states violated federal law by banning coverage of certain treatments for transgender people but allowing it for others. These cases were the first of their kind to reach a federal appeals court and the decision could influence states and courts in other parts of the country.

For years, transgender people have argued in court that the North Carolina state employee health plan and West Virginia Medicaid program discriminated against them by refusing to cover certain treatments when they are prescribed for transgender people. The court’s majority agreed with this argument, in line with previous district court rulings, highlighting that West Virginia’s Medicaid program “covers mastectomies to treat cancer, but not to treat gender dysphoria.”

Henson found out about the lawsuit in 2022 soon after he started his job as a communications specialist for a North Carolina school district. He realized he was sprinting against a clock, with the state under a court order to cover gender-affirming care while the legal fight was underway. He scheduled what he hoped would be his last major surgery for November 2023, two months after the appeals court heard oral arguments on the case.

But as he got closer to the date, he realized he had to delay the surgery due to a stomach ulcer. He said the looming court decision was all he could think about for months. He even considered trying to go ahead with the procedure despite his poor health. He finally got the surgery in late March.

Dale Folwell, the state treasurer and a named defendant, used the lawsuit in his campaign for governor. (He lost the Republican primary in March.) He maintained in interviews and court documents that the state health plan should have the authority to determine which employee benefits are covered. He reiterated those comments in a statement this week: “Untethered to the reality of the Plan’s fiscal situation, the majority opinion opens the way for any dissatisfied individual to override the Plan’s reasoned and responsible decisions and drive the Plan towards collapse.”

Hann Henson and his wife, Aly Young, in Asheville, North Carolina, last summer (Annie Flanagan, special to ProPublica)

Henson will need a follow-up surgery in five months, a common part of the process. He said he now feels a sense of relief knowing the appeals court decision ensures that he likely won’t lose access to his care at a critical time. But he worries about other transgender people seeking services and imagines them refreshing a court website compulsively just like he did.

For now, the ruling protects access to gender-affirming care for transgender people on both states’ health plans. The decision would apply to any federal court cases brought in other states in the 4th Circuit: South Carolina, Virginia and Maryland. The 11th Circuit is currently considering two similar cases out of Georgia and Florida.

All the active judges on the court heard oral arguments in the case in September. In their ruling Monday, eight of the 14, almost all of whom were appointed by Democratic presidents, ruled in favor of the transgender plaintiffs. “In addition to discriminating on the basis of gender identity, the exclusions discriminate on the basis of sex,” wrote Judge Roger Gregory, who was initially appointed by President Bill Clinton and confirmed under the George W. Bush administration.

The states argued that gender-affirming care cost too much and was medically ineffective, so they were justified in not covering it. The court’s majority opinion dismissed both arguments as lacking support. Evidence shows covering the care would likely cost states very little, and major medical associations support broad access to gender-affirming care, citing evidence that prohibiting it can harm transgender people’s mental and physical health.

The judges who signed the three dissenting opinions were all appointed by Republican presidents. “In the majority’s haste to champion plaintiffs’ cause, today’s result oversteps the bounds of the law,” Judge Julius Richardson, a President Donald Trump appointee, wrote in the principal dissent. “The majority asserts that the challenged exclusions use medical diagnosis as a proxy for transgender persons, despite the complete lack of evidence for this claim.”

North Carolina and West Virginia are planning to appeal the decision to the U.S. Supreme Court, according to press releases from each state. “We are confident in the merits of our case: that this is a flawed decision and states have wide discretion to determine what procedures their programs can cover based on cost and other concerns,” West Virginia Attorney General Patrick Morrisey said in a statement.

It remains to be seen how and whether other states and insurance companies with restrictive policies for covering gender-affirming care will act in response to the opinion.

“It should serve as a cautionary tale not just to states that implement state health plans and Medicaid programs but also to private insurers,” said Omar Gonzalez-Pagan with Lambda Legal, which represented the transgender plaintiffs in North Carolina and West Virginia. “I would hope that this serves as a determining factor in the adoption of any bad policies as an inspiration to get rid of policies that currently exist.”

by Perla Trevizo

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This article is co-published with The Texas Tribune, a nonprofit, nonpartisan local newsroom that informs and engages with Texans. Sign up for The Brief Weekly to get up to speed on their essential coverage of Texas issues.

Stefan Arango, a 31-year-old Venezuelan husband and father, felt immediately nauseated by the smells of sweat, urine and feces when Mexican guards ordered him into the cinder block cell in the border city of Ciudad Juárez. The tile floor was strewn with trash, and several men inside lay on flimsy mats that were incongruously covered in rainbow-colored vinyl. The windows were so small that they didn’t allow in much light or air. And, perhaps mercifully, they were so high that the men couldn’t see they were just a short stroll from El Paso, Texas, the destination they had risked everything to reach.

It was March 27, 2023, and Arango had been detained by Mexican authorities who had agreed to help the United States slow the record numbers of migrants crossing the border. A guard allowed Arango to make a one-minute call to his younger sister, who’d come to Juárez with him and whom he’d left waiting at a budget hotel nearby. She sobbed, worried that he was going to be deported back to Venezuela.

“Don’t cry, everything will be fine,” he assured her. “Whatever happens, don’t go anywhere. I’ll be back.”

He couldn’t tell exactly how many men were inside the temporary detention center, maybe more than 100, but new detainees were being brought in while others were being taken away. Those milling around him were grumbling. They said they hadn’t been given water for hours. They hadn’t been given enough food. No one was giving them answers. Why were they being held? What was Mexico going to do with them?

At about 9:20 that night, some of the men began banging on the metal bars that ran along the front wall of the cell, demanding to be released. One of them reached up and yanked down a surveillance camera; another climbed the door and pulled down a second camera. Others started to pile the sleeping mats against the bars until they blocked the guard’s view.

At least one of them flicked a lighter. Within minutes, the cell was engulfed in flames and smoke. Arango pleaded with a guard: “Brother, don’t leave us here.” But the guard turned his back, saying, “Good luck, dude,” as he fled.

Surveillance camera video taken from inside the detention center at the time of the fire shows the flames and smoke spreading through the cell as the guards scramble to open a side door before leaving the detainees trapped inside. (Obtained by ProPublica and The Texas Tribune)

Arango rushed to a bathroom, now filled with dozens of others, all screaming for help. He turned the shower on to wet his hoodie, thinking it would protect him from the heat. Then the lights went out. Everything stung — his eyes, his nose, his skin. He sat himself down and whispered a prayer. The detainees’ cries stopped, and he could hear the sounds of bodies hitting the floor.

When he opened his eyes, he was wrapped in a mylar blanket, lying in the parking lot amid rows of bodies. Arango pulled the cover off his face, gasped for air and raised his hand, hoping to be seen. He heard a woman’s voice shout, “Someone lives among the dead!”

Forty men were killed and more than two dozen were injured in one of the deadliest incidents involving immigrants in Mexico’s history. Investigators put the blame for the incident on the migrants who set the blaze and the guards who failed to help them. The United States urged immigrants to take heed of the tragedy and pursue legal methods for entering the U.S., without acknowledging that some of those caught in the fire were attempting to do just that when they were detained. However, an examination by ProPublica and The Texas Tribune underscores that it was the foreseen and foreseeable result of landmark shifts in U.S. border policies over the last decade, by which the Trump and Biden administrations put the bulk of the responsibility for detaining and deterring staggering numbers of immigrants from around the world onto a Mexican government that’s had trouble keeping its own people safe.

The bodies in the Juárez parking lot were not only evidence of the tragic consequences of U.S. policies, but they were also graphic representations of the violence and economic upheaval raging across the Americas. The dead had traveled there from Guatemala, Honduras, El Salvador, Colombia and, like Arango, Venezuela. Over the past decade, growing numbers of people from these countries have traversed Mexico and crossed the U.S. border to file claims for asylum that take years to resolve and allow them to live and work in the United States during that time.

When first running for president, Donald Trump used the scale of the arrivals to jolt American politics, vowing to build a wall between the United States and Mexico. As president, he effectively turned Mexico into a wall, pressuring that country’s president to take unprecedented steps that required nearly everyone applying for asylum to wait there as their cases went through U.S. immigration courts. And citing the pandemic, he ordered border officials to quickly return immigrants to Mexico or to their home countries under a little-known section of the public health code — Title 42 — that allows the government to limit the numbers of people allowed into the country in an emergency.

Democrats denounced the measures as inhumane, and early in his presidency, Joe Biden moved to loosen those policies, only to keep versions of some when the rising numbers of migrants coming into the United States started to cause political repercussions for him and his party.

The Border and the Election Join us May 29 to discuss why immigration is a top issue for voters and the U.S. policies that gave rise to the deadly Juárez fire.

The result was chaos on both sides of the border, although as numerous experts had predicted, the worst of it unfolded in Mexico. Squalid tent encampments sprouted in Mexican border cities that didn’t have sufficient shelters and other resources. Frustrations among migrants fueled protests that blocked major roads and bridges. Mexican officials cracked down harder by rounding up immigrants and packing them into already overcrowded detention centers.

A Biden administration official would not comment on the role U.S. policies played in the fire, except to say that it had taken place in a facility that “was not under the jurisdiction of the U.S. government.” A White House spokesperson expressed condolences to the families of those who died — but also didn’t answer questions about the policies that contributed to the incident and are still in place. Instead, he pointed to the ways that Biden had expanded legal pathways for immigration, calling it the largest such effort in decades.

U.S. Rep. Raúl Grijalva, a Democrat from Arizona, was among many legislators who’d warned Washington, and specifically Biden, that such a tragedy was inevitable. “The whole system in Mexico is partly a creation in response to initiatives that the United States began,” he said in an interview. “That’s why we should care, because we bear some responsibility.”

How We Got Here

Immigrants, many from Venezuela, sleep by the entrance of an international bridge that separates Ciudad Juárez from El Paso, Texas, as local residents walk by. Some of them were waiting in the border city while trying to get an appointment to enter the U.S. using the government app CBP One. (Paul Ratje for ProPublica and The Texas Tribune)

The dangers of outsourcing immigration enforcement to Mexico were clear to experts and political leaders on both sides of the border long before the Juárez detention center erupted in flames.

“Mexico is simply not safe for Central American asylum seekers,” wrote the union that represents the U.S. government’s asylum officers as part of a lawsuit against Trump’s “Remain in Mexico” program in 2019. “Despite professing a commitment to protecting the rights of people seeking asylum, the Mexican government has proven unable to provide this protection.”

Mexico’s National Human Rights Commission reported that year that migrants were being held in filthy, overcrowded detention centers, at times without sufficient food and water. Those conditions, the commission said, were spurring immigrants to protest, including by setting fires. Prior to the fatal Juárez fire, at least 13 such incidents had occurred at detention facilities across the country, including at the one in Juárez. The earlier incident there occurred in the summer of 2019 and was started in a similar manner, when disgruntled migrants set their sleeping mats on fire. About 60 detainees escaped unharmed.

The Trump administration rejected the warnings, saying that the system was clogged with meritless claims and that turning away people who didn’t qualify for protection made it easier to address the needs of those who did. The Trump campaign didn’t respond to questions about the impact of the former president’s policies, except to say it did a better job than Biden of keeping migrants safe by removing the incentives for them to make the journey to the border. In a statement, spokesperson Karoline Leavitt said that under a second Trump term, the message would be, “DO NOT COME. You will not be allowed to stay, and you will be promptly deported.”

Asylum is a thornier issue for Biden because of divisions within his own party, with some advocating for a more generous system and others worried that the existing backlog makes the system virtually impossible to fix. As a result, his presidency has been marked by moves aimed at placating both sides.

On his first day in office, Biden suspended Trump’s “Remain in Mexico” policy — officially called the Migrant Protection Protocols — which he’d said had “slammed the door shut in the face of families fleeing persecution and violence” and created humanitarian suffering in Mexico. And he began rolling back the Title 42 COVID-19 restrictions by exempting unaccompanied minors from the ban. All at once, a border that had nearly been shut to asylum seekers had a new opening at a time when historic numbers of immigrants were on the move globally. Among them were nearly eight million Venezuelans, fleeing an authoritarian government and a collapsed economy, in one of the largest displacements in the world.

The Pabón family is among the nearly 8 million Venezuelans who have fled their country over the last decade, constituting one of the largest population displacements in the world. This short documentary follows the family from Ciudad Juárez, Mexico, to their first months in the United States, where they’ve asked for asylum and struggle to build new lives. (Gerardo del Valle/ProPublica)

Within weeks, the numbers of people attempting to cross the southern border reached levels that hadn’t been seen in decades. Biden reached out to Mexican President Andrés Manuel López Obrador for help. After denouncing the conditions that migrant families had been forced to endure in Mexico, the Biden administration began pressuring that government to take them back. “We’re trying to work out now with Mexico their willingness to take more of those families back,” Biden said at a news conference, adding later, “I think we’re going to see that change. They should all be going back.”

On March 19, 2021, his administration announced the U.S. would send 2.5 million COVID-19 vaccines to Mexico. That same day, López Obrador declared that he’d close Mexico’s southern border to nonessential traffic, citing the pandemic.

Immigrants continued to come nonetheless. By the end of Biden’s first year in office, the Border Patrol reported that encounters with immigrants had soared to 1.7 million, compared with 859,000 in 2019. The numbers rose further, to 2.2 million, in 2022, the year that Biden announced plans to lift Title 42 entirely. Republican governors in 24 states immediately filed suit against the administration to stop the move. And one of those governors, Greg Abbott, began sending busloads of people who’d crossed the border into Texas to cities controlled by Democrats, including New York, Chicago and Denver.

Biden, faced with a political crisis on top of a humanitarian one, responded with an array of measures. While fighting to overturn Title 42 in court, his administration expanded its reach to allow U.S. officials to immediately expel to Mexico Venezuelan, Haitian, Cuban and Nicaraguan migrants. He required asylum seekers to use an app, CBP One, to make appointments for entry to the United States and authorized border officials to turn back those who hadn’t done so. He also barred some people from seeking refuge in the U.S. if they didn’t first apply for asylum in a country they passed through en route.

President Joe Biden speaks with Border Patrol agents in El Paso, Texas, on Jan. 8, 2023. The visit followed an announcement by the administration to expand the use of Title 42 to include Cubans, Nicaraguans and Haitians. (Kevin Lamarque/Reuters)

In a nod to immigrant advocates, he paired that move with a program that allowed about 30,000 people from the countries that were newly affected by Title 42 to apply for temporary humanitarian visas from home, as long as they passed a background check and had a financial sponsor in the U.S. He also opened centers in some Latin American countries from which migrants could apply to come legally. But none of it seemed to have a lasting effect on making his party happy, deterring new migrants from arriving at the border or keeping them safe.

In January 2023, two months before the fire, nearly 80 Democrats in Congress, including Grijalva, wrote Biden a letter to say that they remained concerned.

“As the administration well knows, current conditions in Mexico — the primary transit country — cannot ensure safety for the families seeking refuge in the United States,” the letter read. “We urge the Biden Administration to engage quickly and meaningfully with members of Congress to find ways to adequately address migration to our southern border that do not include violating asylum law and our international obligations.”

Days before the fire, the Congressional Research Service echoed that warning, saying that the buildup of immigrants in Mexico had “strained Mexican government resources and placed migrants at risk of harm.”

Maureen Meyer, a vice president at the Washington Office on Latin America, said, “There’s an enormous human cost to prioritizing enforcement over human wellbeing and safety. The fire is probably one of the most egregious examples of what could happen.”

Strips of paper bearing the names of the 40 men killed in the fire are tied with marigolds to the fence surrounding the immigration detention center where they died. (Paul Ratje for ProPublica and The Texas Tribune) A City on Edge

Arango had fled his country a decade ago because, he said, supporters of the country’s authoritarian President Nicolás Maduro had threatened him for campaigning on behalf of the opposition. He also found it impossible to make a living for himself and his two children on the roughly $40 he earned monthly as a soccer player and coach in Maracaibo, Venezuela’s second-largest city. He initially moved to Colombia but left there after struggling to find gainful employment and moved again to Bolivia, where he met a woman whom he married.

In early 2023, Arango was still playing soccer, and there were signs his wife might be pregnant. He’d been hearing upbeat stories from Venezuelan friends who had migrated to the United States and were settling into new jobs. Because the United States had broken relations with the Maduro government, Venezuelans did not have to clear the same immigration hurdles as other nationals. They were largely shielded from deportation and had not been subjected to Title 42.

Arango’s sister, Stefany, had a boyfriend who’d made it across the border and gotten a construction job in Austin. Arango believed he could do the same.

Stefan Arango, who survived the fatal fire, is among nearly eight million Venezuelans who have fled an authoritarian government and a collapsed economy in the past decade. (Paul Ratje for ProPublica and The Texas Tribune)

In about 36 grueling days — across hundreds of miles of inhospitable terrain — Arango and Stefany, 25, arrived in Juárez in mid-March 2023, riding on top of a cargo train. They found themselves in the middle of a city on edge. Juárez, with 1.5 million residents, had long been more of a way station for immigrants headed to the United States than a final destination. But the U.S. gateway that had been open to Venezuelans was now shut. They were subject to the same asylum restrictions as Central Americans. They couldn’t cross the border without an appointment, and there were only about 80 appointments available each day through El Paso.

Juárez’s shelters and hotels were filled beyond capacity, and thousands of migrants set up camps under bridges and along the banks of the Rio Grande. They crowded busy intersections and shopping districts, begging for food, money and work. Many complained that they had been robbed by Mexican criminal organizations and harassed by the police and immigration agents. The longer they stayed, the more frustrated they and the city struggling to accommodate them became.

The day Arango and his sister arrived, hundreds of migrants blocked one of the bridges that connected Juárez with El Paso and pleaded with U.S. officials to be let in. The United States deployed officers in riot gear and raised a curtain of concertina wire to keep them out, while Mexico used the national guard to disperse them on the other side. Juárez Mayor Cruz Pérez Cuéllar seemed to sum up his city’s sentiment the next day. “The truth is that our patience is running low,” he said. “We’ve reached a tipping point.”

Migrants wait in Ciudad Juárez alongside a barbed-wire fence that separates the city from El Paso, Texas. Frustrated with the low numbers of people who can get appointments through the CBP One app, some of those stranded in border cities decide not to wait and instead turn themselves in to Border Patrol agents. (Paul Ratje for ProPublica and The Texas Tribune)

The city went on heightened alert and began putting more immigrants in detention. During the first three months of 2023, officials in Juárez conducted at least 110 sweeps around the city — almost as many as they had done in the entire previous year. On the day of the fire, Arango had left his sister at the hotel to look for work and buy food. He was with a handful of other immigrants walking near the border fence when they were picked up by Mexican immigration agents and taken to the city’s only immigration detention facility.

Built in 1995, the facility sits on the banks of the Rio Grande, which forms the border between Mexico and the United States. The detention center was divided into two cells about 100 feet from each other. One was completely bare and was meant to hold no more than 80 men, while the other had bunk beds and could hold up to 25 women. Two former detainees said the men’s cell had four toilets and as many showers.

Alis Santos López, a 42-year-old Honduran, had been held in the facility for two days by the time Arango arrived — and according to Mexican law, which called for him to be released after 36 hours, he shouldn’t have been. Unlike Arango, he wasn’t hoping to start a new life in the United States. He was trying to get back to the life he’d already established. Santos had worked for 10 years as a roofer in New Jersey but was deported at the end of 2022 back to his native Honduras.

The economic hardships and violence that had pushed him to abandon his country before seemed to have worsened. The municipality where his family lived, Catacamas, was among the most violent in Honduras. When he and his wife discovered men lurking around their house one night, he thought they’d targeted him because he’d come home with money that he’d earned in the United States.

Within weeks, he’d set out again for New Jersey, this time with his wife, Delmis Jiménez; three children; daughter-in-law; and grandson in tow. The group said they had been robbed and extorted throughout the journey and had run out of money in southern Mexico. Santos went on without them, promising that he’d send for them. But Juárez officials at the local bus station intercepted him shortly after he arrived.

Alex Santos Jiménez, 20, from Honduras, shows a photo of his father, Alis Santos López, who was detained by Mexican immigration officials at the bus station in Ciudad Juárez and taken to the immigration detention center two days before the deadly fire. (Paul Ratje for ProPublica and The Texas Tribune)

Rodolfo Collazo, then 52, was one of two federal immigration agents and three private security guards on duty at the facility on the night of the fire. Trained as a computer engineer, he was still relatively new to the job and had taken it because he couldn’t find anything better in his field. It paid under $10,000 a year, but Collazo was able to cobble together enough to make ends meet by working a second job with a ride sharing company.

Records from Mexican prosecutors’ investigation into the fire, court testimony and interviews, including with officials who worked at the detention facility, indicate that it was woefully ill equipped to hold immigrants for long periods. Not only were there insufficient accommodations for the detainees to eat and sleep, the cell lacked basic safety equipment like working fire extinguishers and smoke detectors and had no emergency exits. Scuffles and hunger strikes among detainees were not uncommon.

About 6 feet tall, with salt-and-pepper hair, Collazo was sometimes torn between his sympathy with the immigrants’ plight and the responsibilities of his job. They’d sometimes complain that they’d run out of basic supplies like soap and shampoo, and he’d go out and buy them when he had a little extra money. On the night of the fire, he noticed that the detainees seemed more agitated than normal, and he tried to make small talk to calm them. But he was summoned away from the facility to transport a couple of Salvadoran children — brothers ages 10 and 14 — to a different facility for minors.

When he returned about half an hour later, thick black smoke was already billowing out of the building. The guards were scrambling outside and told him they couldn’t find the keys to the men’s cell. Collazo ran into the building but felt his eyes sting and his lungs fill with smoke. “I’ve never felt anything like it,” he said. “It was horrible.” Barely able to see or breathe, he turned back around. (In a surveillance camera video taken from inside the detention center at the time of the fire, which was made public as part of an investigation by La Verdad, El Paso Matters and Lighthouse Reports, an agent is heard saying that she had told the detainees she was not going to open the cell.)

Firefighters descended on the scene and managed to fight through the flames, break into the holding cell and attempt to rescue those inside. Paramedics rushed to care for those who were unconscious. The dead, including Santos, were laid together in four neat rows on the cold asphalt outside the building.

A Mexican soldier saw one of the bodies move. It was Arango.

Uncertain Future

To mark the first anniversary of the fire, there was a march in downtown El Paso. Across the border in Juárez, residents hung mylar blankets on the fence surrounding the detention facility to honor each of the immigrants who died there and celebrated a special Mass at Our Lady of Guadalupe Cathedral. “It’s a tremendous tragedy,” El Paso Bishop Mark Seitz said, citing the loss of “40 young, aspiring lives.” But the greater tragedy, he said, would be to “forget the persons and families that continue to suffer.”

The names of the migrants killed in the 2023 fire, including Alis Santos López, are written on mylar blankets on the fence surrounding the detention center that burned to mark the one-year anniversary of the incident. (Paul Ratje for ProPublica and The Texas Tribune)

By then, the Mexican government had closed the Juárez facility and temporarily suspended operations at 33 others across the country. The head of Mexico’s National Migration Institute, which enforces the country’s immigration laws, was charged criminally with failure to perform his duties, although he remains free and on the job. The institute didn’t respond to requests for comment. Agency officials have previously defended their treatment of immigrants in their custody.

The “Remain in Mexico” policy and Title 42 have been lifted, but Mexico still stands as a critical arm of U.S. immigration enforcement. With poll after poll showing that Americans consider securing the border a priority as the country prepares for this year’s presidential elections, the Biden administration continues to require asylum seekers to use an app to gain entry to the United States. It’s also fighting in court to be allowed to bar some people from seeking asylum if they hadn’t asked for refuge in countries they passed through en route to the United States. That rule is significant because nearly every asylum applicant has crossed through another country — especially Mexico — before reaching the U.S.

Stephanie Leutert, an immigration expert and former Biden administration official, said she’s not surprised that the fire hasn’t forced the administration to reverse course. “If migrant deaths would lead to policy change, we would have changed policies a long time ago," she said.

Seitz, who advocates for immigrants, lamented the same thing. “I wonder how many deaths it’s going to take,” he said in an interview. “Will there be a time when our country wakes up? What will it take for us to recognize that we need to head on a different course?”

Meanwhile, the repercussions of those policies continue to play out in the lives of those affected by the fire.

At a federal prison about 10 miles from where he once worked, Collazo is now the one behind bars, along with two Venezuelan immigrants and several of his former co-workers. He’s awaiting trial for involuntary manslaughter and causing injury to 67 men for his role in the fire. He says he is not guilty. If convicted, he could spend the rest of his life in prison. His wife, María Trujillo, and children have sold their cars and borrowed money to pay his legal fees, which so far exceed $50,000. Trujillo, 53, has begun cleaning houses and selling tamales. Meanwhile, his daughter, Tania Collazo, 35, works extra shifts at a local hospital as a medical assistant. She even traveled to Mexico City last year to appeal for help from López Obrador.

Because they have so little faith in the system, they often do some of the investigating themselves by speaking to other former officials and detainees who might have information that could help Rodolfo Collazo’s case.

“Every day I fall asleep and wake up with the agony of what if the system fails again,” Tania Collazo said. “He’s never getting out.”

First image: Mexican immigration agent Rodolfo Collazo’s wife, María Trujillo, left, and his daughter Tania Collazo say they try to stay positive, but the longer he’s behind bars, the harder it is to remain hopeful. Second image: A photo of Rodolfo Collazo sits atop a table at their home in Ciudad Juárez. (Paul Ratje for ProPublica and The Texas Tribune)

Arango spent about three weeks in an induced coma in a hospital in Mexico City after a respiratory arrest. He’d suffered carbon monoxide poisoning and severe damage to his lungs, kidneys and throat. During his monthslong recovery, his moods were as erratic as a ride on a roller coaster — giddy one moment to be alive, distraught to the point of trying to put his fist through a wall when the doctor laid out the complicated medical challenges that stood in the way of his recovery while his wife struggled back in Bolivia on her own. A devastating low point for both of them came when she miscarried their baby, a boy, while Arango was hospitalized.

In September of last year, the Biden administration allowed Arango and his wife, along with others who survived the fire, to enter the United States for humanitarian reasons. The couple traveled by bus to Austin. His sister had already made it there. When Arango, tall and slim, saw her, he smiled and wrapped her in a long, tight hug.

While he said he is thankful to be alive, there are still times he falls into a deep depression. “I’m still working on finding myself again,” he said. “I ask God for time to get back to the Stefan I was before. A better Stefan.”

Arango looks back to Mexico one last time before he crosses into the United States. Arango, along with his wife and others who survived the fire, were granted permission to enter the United States for humanitarian reasons. (Paul Ratje for ProPublica and The Texas Tribune) First image: Arango places his hands on a Bible he traveled with through seven countries and the Darién Gap, a stretch of jungle between Panama and Colombia. As the smoke and flames spread through the cell inside the detention center, Arango said, he fell to the floor and prayed. Second image: Arango and his wife, Patricia Moyano, from Bolivia, send voice messages to friends while waiting inside the Greyhound bus terminal in El Paso before traveling to Austin. (Paul Ratje for ProPublica and The Texas Tribune)

Jiménez didn’t know her husband had died in the fire until three days after, on her birthday. Santos’ body was sent back to Honduras. His family had returned from southern Mexico to receive it and bury him near their home in Catacamas. Jiménez picked a silver-colored coffin and wore a T-shirt with, “You will always live in my heart,” emblazoned on the front.

“All this suffering,” she thought during the ceremony. “For what?”

His death, however, didn’t deter her and her family from leaving Honduras again. She knew there was a chance that they might meet the same fate trying to get to the United States, but she said she felt even less safe staying in Honduras. So the family set out again, riding buses and walking along railroad tracks, trying to get an appointment through the CBP One app, not understanding they had to be in northern or central Mexico in order to use it. Their feet blistered and their bodies covered with bug bites, they slept in abandoned buildings or on the porches of people who took pity on their plight.

A Mexican nonprofit sent them money for bus tickets to Mexico City, where they continued trying their luck on CBP One. Eventually, after a month, they got an appointment, for last November, the day before Thanksgiving. And they were off to Juárez.

Jiménez, her long black hair tied back in a ponytail, stood atop the dividing line between Juárez and El Paso with her children and grandson. Her small frame tipped back under the weight of her backpack stuffed with clothes and some of her most precious possessions: their wedding rings, a silver watch Santos gave her for Mother’s Day and a framed picture of him. As she walked into the United States, she couldn’t get over how close he’d come.

“It was really just steps for him to fulfill his dreams.”

Delmis Jiménez stands on top of the international bridge that divides Ciudad Juárez and El Paso as her family waits for U.S. customs officers to allow them into the United States. Her husband died attempting to reach the U.S. eight months earlier. (Paul Ratje for ProPublica and The Texas Tribune)

Help ProPublica Reporters Investigate the Immigration System

Dan Keemahill contributed data reporting.

by Anna Clark

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The Food and Drug Administration issued a rule on Monday that brings new scrutiny to a vast array of critical lab tests, including some popular prenatal genetic screenings, that reach patients without any federal agency checking to ensure they work the way their makers claim.

“This is a significant step forward,” said Peter Lurie, president and executive director of the Center for Science in the Public Interest and a former FDA associate commissioner. These tests have “always been one of the remaining gaping holes in the FDA regulatory structure. And it’s great to see that the agency has taken concrete steps to close it.”

The new rule cites coverage of the issues with lab-developed tests by multiple media outlets and researchers, including ProPublica articles: one that revealed problems with prenatal genetic screenings, popularly known as NIPTs or NIPS and the other on faulty lab-testing for COVID-19 overseen by one company.

The move comes after decades of debate and stalled legislation on LDTs, which also include certain cancer screenings as well as some tests for rare diseases. Because these tests are designed, manufactured and used in a single lab, they escape most federal oversight over marketing and accuracy.

A large coalition of labs, associations and academic medical centers have long pushed back on the prospect of increased FDA involvement in these tests. It would be too onerous, they’ve argued, and it jeopardizes patient access to health services.

One of nearly 7,000 comments submitted in response to the draft rule came from the Association for Molecular Pathology, representing a wide-ranging group of professionals associated with laboratory testing. The FDA’s proposed changes “would result in laboratory professionals being treated as product manufacturers instead of board-certified healthcare providers,” the association’s president wrote, and it would “unequivocally hinder and harm patient care.”

The agency’s hands-off approach dates back to an era when these tests were a relatively small, low-risk sector of the health care system. Now, they are a much bigger player and include high-stakes tests made by commercial companies. While the Centers for Medicare and Medicaid Services reviews lab operations, it doesn’t check whether the tests themselves are clinically valid. The tests aren’t registered with the federal government, so nobody knows how many exist. In 2021, Pew Charitable Trusts estimated that 12,000 labs are likely to deploy them, many of which process thousands a day.

The ProPublica story on prenatal genetic screenings referenced by the FDA revealed how the agency didn’t check the tests before they reached patients or evaluate marketing claims made by the companies that sell them. Companies aren’t required to publicly report when a test gets it wrong, the investigation found, and no federal agency can recall faulty screenings. The story detailed how false positives, false negatives and indeterminate results can have painful consequences for expecting parents. (We also published a guide to the prenatal tests to help families with their questions.)

Our coronavirus investigation showed how a Chicago-based company with state and local contracts in Nevada sold testing services that were unreliable from the start. As it became clear that the lab was telling infected people that they had tested negative for the virus, company officials nonetheless expanded the reach of the lab’s testing. The company declined to comment for ProPublica’s previous stories on these problems.

The rule will go into effect over a four-year period. Within two years, test-makers will be expected to meet registration and listing requirements, among others, which is “a critical part of this rule,” according to Cara Tenenbaum, a former FDA policy adviser whose consultancy has advocated for more active oversight.

“At least knowing what is out there will be huge,” she said in an email.

High-risk tests will need to meet new FDA review requirements before reaching the marketplace starting in November 2027. Moderate-risk and low-risk tests will need to do the same starting in May 2028. It’s unclear how prenatal screening tests would be categorized.

The agency generally will not enforce some or all requirements for certain LDTs, including tests that were first marketed before the rule was issued and have not since been modified or have been modified in certain limited ways.

The agency will also generally not enforce some or all requirements for tests used within the Veterans Health Administration or the Department of Defense, as well as certain tests that meet other narrow conditions.

Nonetheless, the rule marks a massive shift in the FDA’s approach to a sector that touches millions. “The agency cannot stand by while Americans continue to rely on results of these tests without assurance that they work,” FDA commissioner Robert Califf said in an agency news release.

The final rule, he added, aims to “help ensure that important health care decisions are made based on test results that patients and health care providers can trust.”

The FDA tried to rein in the lab tests a decade ago, issuing a draft guidance in 2014. That prompted a two-year backlash from opponents. The agency ultimately dropped it.

Some critics have argued that regulation of LDTs should happen through legislation rather than rulemaking. But many also largely opposed a bipartisan bill in 2022 that came the closest to passing before ultimately being dropped at the end of the year. Later efforts to move a similar bill forward have not gained traction in Congress.

Laurie Menser, chief executive of the Association for Molecular Pathology, said in an emailed statement that the association is “very disappointed” in the new rule.

“It’s unfortunate the agency continues to overstep its authority and bypass the country’s legislative process,” Menser said. “AMP is currently reviewing the different aspects of the rule and assessing the many implications for our members and patient care.”

Lurie, who was closely involved with the FDA effort to address the tests a decade ago, said the rule has been a long time coming. “People had identified this problem a very long time ago, and wanted to take action, but found themselves stymied by opposition,” he said.

“I think that it shows real courage on the part of the agency, as well as commitment to the public health, to take this step,” he added.

by Debbie Cenziper, ProPublica; Michael D. Sallah, Pittsburgh Post-Gazette; and Julian Andreone, Medill Investigative Lab

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After years of legal battles, Philips has agreed to pay more than $1 billion to settle lawsuits waged by thousands of people who say they were injured by breathing machines capable of releasing toxic particles and fumes into their noses, mouths and lungs.

The proposed settlement unveiled Monday between the global manufacturer and plaintiffs’ lawyers will effectively end more than 700 lawsuits filed after the 2021 recall of millions of the company’s widely used sleep apnea devices and ventilators.

More than 50,000 people are involved in the litigation. It has yet to be determined how many will have claims that fall under the terms of the settlement, which will be filed in federal court in Pittsburgh.

Philips also agreed to provide $25 million to cover the cost of medical monitoring for users who are fearful that hazardous chemicals emitted from the machines could lead to long-term harm, including cancer. Since 2021, the Food and Drug Administration has received more than 500 reports of deaths reportedly associated with the machines since 2021.

Plaintiffs have said that Philips, which built the devices at two factories near Pittsburgh, should be held accountable for failing to pull the machines off the shelves years ago.

“I still don’t have my husband,” said Shawne Thomas of Louisiana, whose 51-year-old husband, Rodney, died from a rare form of nose and throat cancer in 2021 after using one of the recalled machines for months. “But it sounds like a good amount of money coming out of their pocket, so it makes me feel a little bit happier.”

An investigation by ProPublica and the Pittsburgh Post-Gazette last year revealed that Philips suppressed thousands of complaints about an industrial foam fitted inside the machines that could break down and send potentially dangerous material into the masks worn by users. Federal law requires medical device makers to turn over such reports to the FDA within 30 days.

Under the terms of the settlement, Philips did not admit fault or liability. In the company’s first quarter financial report on Monday, CEO Roy Jakobs said the settlement provides the company with a “clear path forward for sustainable value creation.”

He also cited what he called “reassuring test results” for the recalled machines.

In launching the recall, Philips said the degrading foam inside the machines could cause serious harm and carried cancer-causing materials. The company has since walked back those findings, saying further testing did not indicate using the devices could result in “appreciable harm to health.”

ProPublica and the Post-Gazette found that the FDA repeatedly questioned the safety claims by Philips, saying the tests were not adequate and further evaluation was needed. The news organizations obtained several reports detailing the results of tests on the foam. Those tests found that the material tested positive for genotoxicity, the ability of chemicals to cause cells to mutate, which can cause cancer.

This month, under the terms of a consent decree with the federal government, the company agreed to hire an independent safety monitor and submit to regular inspections for five years. Philips also agreed to stop selling its sleep apnea devices in the United States until the conditions in the agreement were met. The agreement does not restrict Philips from selling its breathing machines in other countries.

Last year, Philips also agreed to pay more than $479 million to compensate customers for the cost of the defective machines — an amount that plaintiffs’ lawyers say is now expected to top $600 million.

Several medical experts interviewed by ProPublica and the Post-Gazette say that it could take years to determine whether links exist between the machines and certain diseases, but that they believe the company should have warned the public about the health risks years earlier.

“I’m glad they’re taking responsibility for what they did because they knew,” said Louisiana Sheriff Brett Stassi, who was diagnosed with kidney cancer and rushed into surgery in 2021 after using one of the recalled devices for four years. “They put dollars over lives in my book.”

A criminal probe by the U.S. Department of Justice is ongoing, and the Government Accountability Office, the investigative arm of Congress, is launching an inquiry of the FDA’s oversight of medical device recalls for the first time in years.

Philips has said it is cooperating with authorities.

The FDA has defended its handling of the crisis, saying it acted as soon as it learned of the safety concerns in April 2021, just weeks before Philips launched the recall.

“The FDA welcomes the opportunity for GAO review of the agency’s oversight of medical device recalls,” the agency said in a statement early this year.

by Jake Pearson

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Across the country, states are reexamining their approaches to guardianship, overhauling decades-old laws to better protect vulnerable adults who, because of their age or ailment, can no longer care for themselves.

In Pennsylvania, legislators recently passed a sweeping bill requiring professional guardians to pass a certification exam in order to serve, among other changes. And in Illinois, lawmakers are seeking to make it harder for private guardians to profit off of vulnerable wards who have nobody else to look after them.

But in New York, where more than 28,000 people rely on guardians to ensure their personal and financial welfare, and where judges, lawyers and advocates have been warning of a growing crisis in the system, elected officials have taken little action.

The $237 billion state budget passed by the Legislature this month includes no new funding to support guardianship services, despite reporting by ProPublica that showed how the state’s system is in shambles, with authorities straining to ensure proper care of elderly and sick wards.

Guardianship Access New York, a coalition of nonprofit providers, had sought a modest sum from legislators: just $5 million to help them manage the finances and health care of poor adults who have nobody else to look after them and little to no money to pay for a private guardian — a group known in the industry as the “unbefriended.” That would have been a significant increase over the $1 million legislators had previously allotted to fund a statewide hotline that hundreds of people have consulted on behalf of friends or family.

But the budget passed April 20 only renewed the $1 million that funds the hotline.

“We’re disappointed that the Legislature is still unwilling to invest in this underfunded mandate that leaves so many people hurting,” said Brianna McKinney, who oversees advocacy for Project Guardianship, a nonprofit that serves as guardian to about 160 New York City wards.

As ProPublica reported last month, there aren’t enough guardians in New York for all of the people judges have found to be in need of one. The system relies on private attorneys, who experts say frequently refuse to take on people who do not have substantial assets, and a small network of nonprofits, two of which have shuttered in recent years because of financial constraints.

Oversight of guardians is also threadbare, ProPublica found. In New York City there are 17,411 people in guardianships but only 157 examiners to scrutinize the reports guardians must file documenting wards’ finances and care, according to state court data. With such thin ranks, reviews can take years to complete, during which time vulnerable wards have been defrauded and neglected.

In recent years, the guardianships of celebrities like Britney Spears and former NFL star Michael Oher have captured the public’s interest and prompted scrutiny of the legal arrangements.

In New York, a recent Lifetime documentary about the former talk show host Wendy Williams — and her guardian’s unsuccessful effort to prevent it from airing — has put an even brighter spotlight on the state’s guardianship system, raising questions of court oversight amid allegations of exploitation and improper care.

Spokespeople for Senate Majority Leader Andrea Stewart-Cousins, Assembly Speaker Carl Heastie and Gov. Kathy Hochul, the state’s most powerful Democrats who negotiated the spending bills, didn’t respond to questions about the lack of guardianship funding in the latest budget or the prospect of future funding.

That includes whether an additional $3 million earmarked for the state’s Office for the Aging’s budget to fund “various aging initiatives” would be used to finance guardianship providers.

Agency spokesperson Roger Noyes said a plan proposed by Hochul to confront the needs of the state’s aging population “presents an opportunity for additional policy focus on guardianship access, programmatic or structural changes, and alternatives to guardianship.” But the governor has provided few specifics on how her proposal will work, particularly with respect to combating elder abuse, a key pillar of the plan.

Many people in guardianship today are elderly and suffer from dementia, Alzheimer’s disease and other ailments that require assistance, according to judges. And advocates say the demand for services will only grow, with the state estimating a population of 5.6 million New Yorkers over 60 by 2030, one of the largest concentrations in the country.

In Illinois, the state’s aging population is driving the guardianship debate. Democratic Rep. Terra Costa Howard, a lawyer, said she was inspired to write legislation after her own representation of an elderly ward. She learned that a private guardianship company and a prominent law firm representing hospitals appeared to be working together, running up costly bills at the ward’s expense.

“What this little piece of legislation has uncovered is a huge problem — elder care is a big, big mess,” Costa Howard told ProPublica. “In our chamber, in our legislature, this is an issue people are willing to fight for. People weren’t paying attention to this until I raised it. I brought it up and now we’re going to go.”

But in New York there is neither a state legislator willing to champion reform nor are there powerful lobbying groups advocating on behalf of those in guardianship, many of whom live in assisted living facilities and nursing homes.

AARP New York said in a statement that it had dedicated its efforts elsewhere this legislative session, including securing funding to support older New Yorkers “who require home- and community-based services” as well as funding an oversight program for nursing homes and adult care facilities.

“If there are additional guardianship proposals introduced in the Legislature, AARP New York will certainly evaluate them in conjunction with our national policy and decide when or if to engage in the issue,” the statement said.

Such legislative action appears unlikely this session, which ends in June.

Sen. Kevin Thomas, a Long Island Democrat who first secured the $1 million to fund the statewide guardianship hotline and advocated for more funding this session, is leaving the Senate when his term ends next year. He didn’t respond to an interview request.

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by Patrick Rucker, The Capitol Forum, and David Armstrong, ProPublica

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In late 2020, Dr. Debby Day said her bosses at Cigna gave her a stark warning. Work faster, or the company might fire her.

That was a problem for Day because she felt her work was too important to be rushed. She was a medical director for the health insurer, a physician with sweeping power to approve or reject requests to pay for critical care like life-saving drugs or complex surgeries.

She had been working at Cigna for nearly 15 years, reviewing cases that nurses had flagged for denial or were unsure about. At Cigna and other insurers, nurses can greenlight payments, but denials have such serious repercussions for patients that many states require that doctors make the final call. In more recent years, though, Day said that the Cigna nurses’ work was getting sloppy. Patient files that nurses working in the Philippines sent to her, she said, increasingly had errors that could lead to wrongful denials if they were not corrected.

Day was, in her own words, persnickety. If a nurse recommended denying coverage for a cancer patient or a sick baby, she wanted to be certain it was the right thing to do. So Day said she researched guidelines, read medical studies and scrutinized patient medical records to come to the best decision. This took time. She was clearing fewer cases than many of her peers.

Some of her colleagues quickly denied requests to keep pace, she said. All a Cigna doctor had to do was cut and paste the denial language that the nurse had prepared and quickly move on to the next case, Day said. This was so common, she and another former medical director said, that people inside Cigna had a term for these kinds of speedy decisions: “click and close.”

“Deny, deny, deny. That’s how you hit your numbers,” said Day, who worked for Cigna until the late spring of 2022. “If you take a breath or think about any of these cases, you’re going to fall behind.”

In a written response to questions, Cigna said its medical directors are not allowed to “rubber stamp” a nurse’s recommendation for denial. In all cases, the company wrote, it expects its doctors to “perform thorough, objective, independent and accurate reviews in accordance with our coverage policies.” The company said it was unaware of the use of the term “click and close” and that “such behavior would not be tolerated.”

During Day’s final years at Cigna, the company meticulously tracked the output of its medical directors on a monthly dashboard. Cigna shared this spreadsheet with more than 70 of its doctors, allowing them to compare their tally of cases with those of their peers. Day and two other former medical directors said the dashboard sent a message loud and clear: Cigna valued speed. (ProPublica and The Capitol Forum found these other former Cigna doctors independently; Day did not refer them.) One of Day’s managers in a written performance evaluation called the spreadsheet the “productivity dashboard.”

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Measuring the speed and output of employees is common in many industries, from fast food to package delivery, but the use of these kinds of metrics in health care is controversial because the stakes are so high. It’s one thing if a rushed server forgets the fries with your burger. It’s another entirely if the pressure to act fast leads to wrongful denials of payment for vital care. Walgreens in 2022 dropped measurements of its pharmacists’ speed from their performance reviews after some alleged that practice could lead to dangerous mistakes.

ProPublica and The Capitol Forum examined Cigna’s productivity dashboards for medical directors from January and February 2022. These spreadsheets tallied the number of cases each medical director handled. Cigna gave each task a “handle time,” which the company said was the average amount of time it took its medical directors to issue a decision.

Day and others said the number was something different: the maximum amount of time they should spend on a case. Insurers often require approval in advance for expensive procedures or medicines, a process known as prior authorization. The early 2022 dashboards listed a handle time of four minutes for a prior authorization. The bulk of drug requests were to be decided in two to five minutes. Hospital discharge decisions were supposed to take four and a half minutes.

“Medical directors would message me and say, ‘We can’t do these cases in four minutes. Not if you want to do a good job,’” Day recalled.

Deny, deny, deny. That’s how you hit your numbers. If you take a breath or think about any of these cases, you’re going to fall behind.

—Dr. Debby Day, a former medical director at Cigna

As ProPublica and The Capitol Forum reported last year, Cigna built a computer program that allowed its medical directors to deny certain claims in bulk. The insurer’s doctors spent an average of just 1.2 seconds on each of those cases. Cigna at the time said the review system was created to speed up approval of claims for certain routine screenings; the company later posted a rebuttal to the story. A congressional committee and the Department of Labor launched inquiries into this Cigna program. A spokesperson for Rep. Cathy McMorris Rodgers, the chair of the congressional committee, said Rodgers continues to monitor the situation after Cigna shared some details about its process. The Labor Department is still examining such practices.

One figure on Cigna’s January and February 2022 dashboards was like a productivity score; the news organizations found that this number reflects the pace at which a medical director clears cases.

Cigna said it was incorrect to call that figure on its dashboard a productivity score and said its “view on productivity is defined by a range of factors beyond elements included in a single spreadsheet.” In addition, the company told the news organizations, “The copy of the dashboard that you have is inaccurate and secondary calculations made using its contents may also be inaccurate.” The news organizations asked what was inaccurate, but the company wouldn’t elaborate.

Nevertheless, Cigna said that because the dashboard created “inadvertent confusion” the company was “reassessing its use.”

Day was afraid to look at the dashboards. Anyone could see that by Cigna’s measures, she was a laggard. In January 2022, only a third of her peers had lower scores, and in February 2022, it was just a quarter.

In a recorded phone call and in emails with supervisors, Day complained that Cigna’s metrics failed to account for the quality of decisions. She said she and others asked higher-ups how often medical director decisions were overturned on appeal but nobody would say.

Day gave Cigna written permission to discuss her employment with ProPublica and The Capitol Forum.

The company described Day as a “disgruntled former employee” and said her “personal view is not an accurate representation of the work of the many medical directors and clinicians we employ.” Cigna added that prior authorization requests are often time-sensitive and the company’s “mission is to ensure our patients receive the right care as quickly as possible.”

Cigna rejected the assertions that denying cases was an effective way of working faster. “Even if medical directors were incentivized to review more claims — which they are not — it makes no sense to suggest that this incentivizes denials; it would be far quicker to approve all claims,” the company spokesperson wrote. The insurer said that denials take more time because they require a deeper review of clinical data, potentially requesting additional reviews by senior clinical directors, drafting denial letters and possibly phoning the treating physicians.

But another doctor who had worked at Cigna also said that denying a request for payment was far quicker than approving one since the nurses served up language that could be used to justify the denial. That former Cigna medical director said, “Sometimes you just have to accept the nurse and click and close if you had too much work.” (That doctor asked not to be named because they feared repercussions if they commented publicly.)

When Debby Day got her job at Cigna in November 2005, she thought it was a godsend.

She had been working for a health insurance startup in North Carolina. The charismatic founder of the company, Day said, had told her and a handful of principal executives to expect a windfall when the company went public. That never happened, and Day was eventually left with no job and no severance.

When a recruiter mentioned the medical director job at Cigna, it sounded like a perfect fit. The job was based in North Carolina, but Cigna didn’t mind that she was licensed in California, where she did her residency at Harbor-UCLA Medical Center. She was ready to leave the executive track, and the position allowed her to put her medical training to good use without the daily grind of working in a clinic.

The daughter of an ophthalmologist, Day had watched her father perform eye surgery when she was a child, and she found medicine fascinating. When Day started practicing, she learned quickly that while she enjoyed the intellectual challenges of medicine, the hands-on work of seeing patients drained her. As a medical director, she said, “I could really take care of patients without having to talk to them all day long.”

Cigna, like all health insurers, makes patients get approval in advance for certain treatments. Day became one of the people who reviewed these prior authorization requests, deciding what to cover and what to deny. Everyone Day worked with was under one roof in Raleigh, North Carolina. The office buzzed with conversations among colleagues, and she was able to consult with specialists on complex cases.

She never felt pressure to do anything but make the right decision for the patient. At the same time, she said, she didn’t hesitate to reject treatment she thought was improper.

Day describes herself as persnickety but feels that the time she spent reviewing case files was essential to reaching the right decision. (Andrea Bruce for ProPublica)

A couple years into her time at Cigna, Day noticed some doctors prescribing a costly treatment called intravenous immunoglobulin, or IVIG, that helps patients with weakened immune systems fight off infections. Only she found they were prescribing it in cases where it didn’t make any medical sense. That wasn’t good for patients or for Cigna. “Some of these guys were pouring it into every patient they could get their hands on and then making hundreds of thousands of dollars billing for it,” she recalled.

At the time, Cigna didn’t have a policy for when IVIG should be used, so Day developed one based on the scientific evidence available at the time. Day said this saved millions of dollars and that Cigna rewarded her with bonuses and stock options.

“In my head I truly believed that you could marry good health care with business,” she said.

As Day neared the end of her first decade at Cigna, the company closed regional offices in favor of a nationwide review system, she said. With medical directors working from home, Day could no longer pop down the hallway to consult with doctors in other specialities.

Cigna had used a productivity dashboard for years, but by 2019, these metrics began playing a more prominent role in the company’s evaluations of medical directors, Day said. Now, making a fast decision seemed more important than making the right decision, she said. In February 2019 emails to her managers, Day openly questioned this system.

Her boss responded: “We all understand that many cases are involved and take more time,” he wrote. “We have tried to account for that additional time in the allotment allowed for certain cases.”

Still, he made it clear that transaction volume — the metric on the dashboard that was similar to a productivity score — was one of the factors “we use to determine merit raises, bonus” and stock awards. When asked about this, Cigna said that “any assertion that our Medical Directors’ compensation (cash or stock) is tied to denials or their handle time for cases is false.”

In that same 2019 email, Day’s boss added, “We want to assist every medical director who wishes to improve his or her efficiency.”

Day shot back, “Some of our newer MDs are quite terrified of the ‘counting,’” she wrote. “All ask — ‘how is quality measured?’”

Soon, Day realized that her boss wasn’t talking in the abstract about improving efficiency; he was talking about her. She learned that managers were going to help her pick up the pace of her reviews.

When bosses reached out, they didn’t discuss whether she was making the right call, only how long it took her to decide, she said.

In my head I truly believed that you could marry good health care with business.

—Day

By then, Day said, Cigna had shifted much of the nursing work to the Philippines. She found mistakes in the case files that these nurses sent. In an email to Day, a fellow medical director lamented the amount of time it took to untangle one case and said the reports by “the overseas nurses” were “messes.”

Some of the more astonishing problems that Day spotted have stayed with her. In a case involving a newborn who needed an epilepsy evaluation, Day noticed that a Cigna nurse had listed the mother’s name as the patient, rather than the baby’s. Day fixed that mistake, avoiding what certainly would have been a denial. In another case, a nurse recommended denying payment for an ultrasound of the neck because the treatment wasn’t medically necessary. But the nurse had gotten the body part wrong. It was a hip that was injured, and the imaging was needed. An appeal that landed on Day’s desk involved Cigna’s decision to reject payment for a test because it wasn’t medically necessary for a patient with a sexually transmitted disease. But Day figured out that the patient had toenail fungus, not an STD.

Day said her bosses didn’t want to hear that she was catching errors. By October 2020, Cigna had placed Day on a performance improvement plan that required her to raise her “productivity level” — referring to the score on the dashboard — to at least 70%, which would be a significant jump for her but was slightly below the median for medical directors. The company made the consequences crystal clear: If she failed to successfully complete the plan, she could be terminated.

ProPublica and The Capitol Forum asked Cigna how it calculated that score, but the company wouldn’t say. “Transaction volume helps gauge productivity and efficiency — the amount of work done, not the speed at which it is done,” a Cigna spokesperson wrote. The company said this metric measured the time a medical director spent on tasks involving medical judgment versus other work, such as internal meetings or training.

On the early 2022 productivity dashboard, though, a different calculation could explain Day’s score, and this math reflects how fast medical directors reviewed cases. ProPublica and The Capitol Forum multiplied the number of cases Day handled by the time Cigna allotted for each type of case, then divided that total by the hours she worked that month. The resulting percentage equaled her score. Medical directors who spent every available minute of their workdays clearing cases within the time constraints Cigna set would score at least 100%. Indeed, some medical directors had scores greater than 100%, meaning they cleared cases in even less than the allotted time. The newsrooms’ formula accurately reproduced the scores of 87% of the Cigna doctors listed; the scores of all but one of the rest fell within 1 to 2 percentage points of the number generated by this formula. When asked about this formula, Cigna said it may be inaccurate but didn’t elaborate.

Day said her bosses told her that the way to boost her score was to review more cases during her normal work hours.

Responding to questions, Cigna said the productivity dashboard was “primarily used to ensure that we have enough medical directors to perform the amount and type of work that needs to be done.” It is not used, the company said, to evaluate the performance of medical directors or track the speed at which individual doctors do their work.

Cigna, however, later said of the dashboard that “in the unusual situation that a medical director is a significant outlier to peers performing similar types of reviews, managers might use this metric as one data point to understand and discuss the variance with the medical director.” It also said Day was placed on a performance improvement plan “to help her meet the most basic standards to support patient care.”

During the time Day spent on the performance improvement plan, she refused to change her approach, which she felt was necessary to make the right call.

In December 2020, she appealed to the human resources department, figuring that colleagues there would see that it was wrong to fire a medical director for taking care to decide critical medical questions.

She was wrong.

“You feel that the time constraints/metrics, which are in place to review these cases are unreasonable, for some cases are very complex consisting of multiple pages to review,” a Cigna human resources employee wrote, summing up Day’s feelings as the matter escalated.

And while Day’s supervisor “appreciates your attention to detail,” the human resources employee wrote, he “also realizes that there are metrics in place that he must hold everyone to.”

When asked about this, Cigna said, “Dr. Day raised questions about her performance improvement plan through appropriate internal ethics channels available to all employees, and there was no wrongdoing found.”

Eventually, the daily stress of being pushed to work faster coupled with the threat of being fired took a toll on Day. Sleepless and fighting depression, Day was at the breaking point.

“I actually sort of had a mental breakdown,” she recalled.

At the end of the day, we need to get your productivity up and we don’t have a lot of time to do that.

—Day’s supervisor

On a recorded call with her boss about her lagging productivity score, Day brought the subject back to the quality of the decisions she was making. Her boss made it sound like Day was a broken record.

“We have the same discussion every time we talk,” he said. While saying “nobody’s asking you not to do quality work,” her boss said, “you must know I just have to redirect our discussion.”

But Day continued: “When there is no measurement of quality, then the discussion will continue to have that element to it.”

The supervisor said he heard Day’s concerns “loud and clear” but warned that “at the end of the day, we need to get your productivity up and we don’t have a lot of time to do that.”

The focus on metrics was proof Cigna was losing its way, Day told her boss. When she started working at Cigna 15 years earlier, there was a “commitment to quality and taking care of our customers.” Day said that it was still important to her and other medical directors that “we go home at the end of the day and think we’ve done a good job for Cigna.”

In a response to questions, Cigna said the supervisor, who works in California, was unaware that he was being recorded and that under that state’s laws, it is illegal to record a private phone call without all parties’ consent. Day said that she was in North Carolina during the call and that North Carolina law allows a person on a call to record without getting the consent of others.

Day took a monthslong leave from the job in mid-2021 that allowed her to work part time, and she found a therapist who helped her manage the depression. When she returned, Day said, it was more of the same.

In the late spring of 2022 she decided to retire from Cigna.

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Maya Miller contributed reporting.