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These 5 Charts Show How Hotels Became New York’s Response to Homelessness

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This article was produced for ProPublica’s Local Reporting Network in partnership with New York Focus, an investigative news outlet reporting on New York. Sign up for Dispatches to get our stories in your inbox every week, and sign up for New York Focus’ newsletter here.

Hotels have long been considered a last resort for sheltering people who’ve lost their housing. But over the past few years, they’ve become New York’s predominant response to homelessness outside New York City, a recent investigation by New York Focus and ProPublica found.

Social services agencies across the state now place nearly half of all individuals and families seeking shelter in hotels. Yet those placed in hotels often go without services that they’re supposed to receive in shelters, such as meals, help finding housing and sometimes child care so they can look for work.

The growing reliance on hotels has been driven by soaring rent, shelter closures and a spike in evictions that followed a moratorium during the COVID-19 pandemic.

The state Office of Temporary and Disability Assistance has known about the problem for years and even put rules to address the issue on its regulatory agenda. But the agency has failed to formally propose the rules or come up with a way to ensure people receive services they need.

Here are five charts to explain our investigation.

Statewide Spending on Hotels More Than Tripled From 2018 to 2024 Data source: Analysis of Office of Temporary and Disability Assistance data on emergency shelter payments. Years are fiscal years. (Lucas Waldron/ProPublica)

The number of families and individuals placed in hotels doubled in the two years following the end of New York’s eviction moratorium in 2022. As the population in hotels shot up, so did the bill. Over that period, spending on hotels outside of New York City more than tripled to $110 million.

OTDA oversees the state’s county-run social services districts. The agency’s commissioner, Barbara Guinn, said that it prefers that counties use shelters, but that there aren’t enough beds for everyone who needs one. She said that the agency hadn’t studied the growth in hotel use.

Required Services in Shelters vs. Hotels Note: Requirements are for hotels outside of New York City. New York regulations state that hotels can be considered shelters, and thus mandated to provide services. But there aren’t any that are currently required to do so, Office of Temporary and Disability Assistance spokesperson Anthony Farmer said. Source: New York Codes, Rules and Regulations.

Despite the growth in spending, families placed in hotels aren’t promised the same services as people in shelters. New York requires family shelters to provide services like child care, assistance finding housing and three meals a day. But the regulations generally exempt hotels.

There’s an exception: A hotel is supposed to be considered a shelter if it “primarily” serves temporary housing recipients. OTDA spokesperson Anthony Farmer said that the agency interprets “primarily” to mean “exclusively, or almost exclusively,” and that no hotels currently meet that standard. An analysis of the agency’s data by New York Focus and ProPublica found that welfare recipients made up over half of the capacity for at least 16 hotels during fiscal year 2024.

Guinn said that social services offices have to work within the confines of what hotel owners will allow, and that counties try to provide services off-site.

The Number of Individuals and Families Housed in Hotels for More Than Six Months Nearly Tripled From 2022 to 2024 Data Source: Analysis of Office of Temporary and Disability Assistance data on emergency shelter payments. Years are fiscal years. Stays may not be continuous. (Lucas Waldron/ProPublica)

Not only are more people being placed in the hotels, but they are staying for much longer periods. The number of families and individuals spending at least six months out of the year in hotels nearly tripled from 2022 to 2024.

The lack of services leads to people getting stuck in the system, creating a snowball effect, said Steve Berg, chief policy officer for the National Alliance to End Homelessness.

“It’s this expanding problem,” he said. “A good shelter should be housing-focused. If they don’t have a pretty substantial effort to move people quickly back into housing and provide the services that are necessary to do that, the shelters quickly fill up, and then they just need more shelters.”

Farmer said via email that a lack of affordable housing contributes to the longer stays, and that counties can use other funding to help people move back into permanent housing.

New York Social Services Agencies Frequently Paid Hotels Over Fair Market Rent for a Two-Bedroom Apartment

Nearly half of all payments to hotels were for more than twice the counties’ FMR.

Data Source: Analysis of Office of Temporary and Disability Assistance data on emergency shelter payments; U.S. Department of Housing and Urban Development fair market rent data for two-bedroom apartments in each county for federal fiscal year 2024. (Lucas Waldron/ProPublica)

Many hotels are charging rates higher than rent for permanent housing.

The news organizations found that the overwhelming majority of hotel payments exceeded fair market rent for a two-bedroom apartment in the same county. (Fair market rent is defined by the U.S. Department of Housing and Urban Development as the 40th percentile of rent plus utilities in the local housing market.) The rates charged were often more than twice that.

“We’re forced to rent hotel rooms across the state, and the operators of these places understand that,” said state Sen. Roxanne Persaud, a Democrat and chair of the chamber’s Social Services Committee. “The municipalities’ backs are against the wall. And so they must place the unhoused person or persons somewhere. And so that’s why you see the cost is skyrocketing, because people understand that it’s an easy way to make money off the government.”

More Than a Third of Hotels Used to Shelter Homeless People Were Out of Date on Social Services Inspections as of October 2024 Data Source: Analysis of Office of Temporary and Disability Assistance data on inspections of hotels and motels used for emergency shelter. (Lucas Waldron/ProPublica)

New York Focus and ProPublica found numerous examples of families with children living in sordid and dangerous conditions. Roaches, mold, broken windows and filthy linens were common. Some hotels were subject to over a hundred emergency calls a year for assaults, robberies, mental health crises, overdoses and other incidents.

Hotels sheltering homeless families are supposed to be inspected every six months by their county’s social services office. Yet data obtained from OTDA shows that many wind up behind schedule. As of October, about 40% of hotels were either out of date on their inspection or didn’t have one listed.

Farmer, the OTDA spokesperson, said that nearly all hotels were inspected within a year, and that some had stopped accepting welfare recipients.

Guinn, the commissioner, said that OTDA will formally propose rules this year clarifying that people in hotels must receive the same services as they would receive in shelters. She also said her agency will increase oversight of how social services offices are delivering those services.

by Spencer Norris, New York Focus, and Joel Jacobs, ProPublica, graphics by Lucas Waldron, ProPublica

This Doctor Specializes in Diagnosing Child Abuse. Some of Her Conclusions Have Been Called Into Question.

1 day ago

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In court, Dr. Nancy Harper comes across as professional and authoritative. Often she begins her testimony by explaining her subspeciality: child abuse pediatrics, which focuses on the diagnosis and documentation of signs of child abuse. Her role, she often reminds judges and juries, is solely medical. Whether or not to remove a child from their home, terminate the parent’s rights or, in the most serious cases, charge a caregiver criminally is not up to her.

According to Harper’s testimony, she and her team at the Otto Bremer Trust Center for Safe and Healthy Children in Minneapolis handle about 700 cases of suspected abuse each year. She has testified that 10% to 20% of those wind up confirmed for physical abuse, although it is difficult to determine if these figures are accurate since child protection cases are not public.

When Harper, the center’s director, and her team diagnose abuse, parents and caregivers often struggle to challenge those opinions. By Harper’s own estimation, she’s never been wrong.

“I don’t think I’ve ever had a case where I thought it was abusive head trauma and the other specialist didn’t,” Harper testified in 2023, in the case of a day care provider charged with the death of a child in her care.

The defense attorney in the case pressed her: “Have you ever incorrectly diagnosed a child with abusive head trauma?”

“Not currently to my recollection,” she answered.

But in a handful of cases, judges and juries have found day care providers and parents not guilty of crimes after Harper has testified that abuse occurred, though a verdict cannot necessarily be interpreted as a repudiation of Harper or any other expert witness’ determinations or credibility.

Additionally, two federal lawsuits filed recently accuse Harper of ignoring or even concealing alternative explanations for children’s injuries. And, more broadly, medical and legal experts are increasingly questioning a leading child abuse diagnosis, shaken baby syndrome, which is also known as abusive head trauma.

Harper did not respond to requests for comment. She has yet to respond to either lawsuit. In past court testimony, Harper has said that both shaken baby syndrome and abusive head trauma are considered scientifically valid diagnoses by the mainstream medical community. Any controversy, she has said, exists primarily in the legal world rather than the medical one.

Kathleen Pakes, a former prosecutor who now specializes in the forensics of child abuse cases for the Office of the Wisconsin State Public Defender, said Harper’s claim of never making an incorrect diagnosis strains credulity.

“There is no other specialty in medicine that has zero error rate. None,” she said.

Below are four cases in which Harper concluded there was abuse but courts or juries determined otherwise.

On July 12, 2017, an 11-month-old boy named Gabriel Cooper collapsed in his high chair at the day care that Sylwia Pawlak-Reynolds operated in South Minneapolis. Paramedics took him to Hennepin County Medical Center, where he was declared brain dead a day later.

Harper reviewed Cooper’s medical records and wrote that “in the absence of a well-documented consistent severe accidental injury, non-accidental trauma or abusive head trauma remains the primary diagnostic consideration.” The child, she wrote, was essentially shaken to death. Before any criminal charges were filed, Pawlak-Reynolds boarded a plane for her native Poland to care for her ailing father, according to her attorney. In February 2018, prosecutors charged Pawlak-Reynolds with two counts of second-degree murder, citing Harper’s diagnosis.

According to her husband, Will Reynolds, they did not realize Pawlak-Reynolds was pregnant when she boarded her flight to Poland. She remained there to give birth to their third child, who is now 6, while Reynolds remained in Minnesota with their two older children, who are now 13 and 16. Reynolds said he and his wife have no confidence that she will get a fair trial, and that she fears she will lose custody of their youngest child if she reenters the country. The family has now been separated for eight years.

Sylwia Pawlak-Reynolds’ husband, Will Reynolds, remains in Minnesota with their two older children.

Early in the case, Pawlak-Reynolds’ attorneys obtained the same copy of Cooper’s hospital records that had been provided to Minneapolis police, which included the paramedics’ report. The document had been printed out at a significantly reduced scale, shrinking the text to the point that some fields were illegible. Two years later, they obtained a second copy, printed at normal size, which revealed a possible alternate explanation for the injuries: “Mom recalls [patient] did fall 2 days ago, striking the back of his head.”

“That was the sort of proverbial silver-bullet evidence that we’re always looking for in every case and usually never find,” said Brock Hunter, Pawlak-Reynolds’ lawyer.

Polish courts, including an appeals court, have denied extradition requests from the U.S. three times, and the country’s minister of justice has affirmed the rulings. The denials are particularly critical of Harper’s assessment. Polish forensic experts evaluated the case records and took note of a finding by a neurology expert hired by Pawlak-Reynolds, who wrote that Cooper carried a gene tied to a blood clotting disorder.

The ambulance report, the Polish judges wrote, “was concealed from the defense.”

“Then, after the fact was made public, it did not affect the actions of the American authorities in any way,” a Polish district court judge wrote in 2022.

Hennepin Country Medical Center

The Hennepin County Medical Examiner’s Office certified Cooper’s manner of death as “undetermined” and the date and place of injury “unknown,” a tacit disagreement with Harper’s opinion that Cooper would have collapsed “shortly after infliction of the trauma.”

The Hennepin County Medical Examiner’s Office declined to comment.

Then in 2023, Hennepin County Attorney Mary Moriarty wrote to Pawlak-Reynolds’ attorneys after meeting with them: “We agree that to resolve the current impasse regarding Ms. Pawlak-Reynolds, the best course for all involved is to dismiss the pending charges without prejudice, and for her to return to the United States.”

But months later, Moriarty changed her mind.

In a statement to ProPublica, a spokesperson for the Hennepin County Attorney’s Office wrote that the office is completing a “final, thorough review” of the case that will include an evaluation of “concerns regarding the medical conclusions and the overall strength of the case.”

Gabriel’s parents, Joseph and Samantha Cooper, did not respond to requests for comment. In a television interview in June, they denied that Cooper struck the back of his head two days before his collapse. They said that they want justice for their son.

Pawlak-Reynolds declined to comment through her attorney. In late February, her husband filed a federal lawsuit against Harper that claims she “knowingly and intentionally falsified, modified and erased exculpatory information” from her evaluation of Cooper, and she diagnosed abusive head trauma to “promote her own personal, academic, reputational and financial needs.”

Harper has yet to respond to the lawsuit. A spokesperson for Hennepin Healthcare, which operates Hennepin County Medical Center, declined to comment on the case or the lawsuit.

“There is no oversight,” Reynolds said. “It’s the thing they’re most resistant against and the thing that is most necessary to stop this legacy of brutality, that results in kids being taken away from innocent caregivers and innocent caregivers going to prison.”

An old photograph shows Pawlak-Reynolds and one of her children

In August 2017, Kathryn Campbell called 911 after a 4-month-old girl at her day care seemed lethargic and was “breathing wrong.” First responders did not take the baby to the hospital, but her mother eventually did. At the hospital, MRI scans showed fluid in the baby’s brain and doctors noted small bruises.

Dr. Barbara Knox, a child abuse pediatrician then with the University of Wisconsin, told police it was “obvious child abuse.” The Dane County district attorney charged Campbell with physical abuse of a child. Campbell pleaded not guilty.

But before the 2021 trial, Knox left the University of Wisconsin after she was placed on leave for “unprofessional acts that may constitute retaliation” and intimidation of her own staff. A Wisconsin Watch investigation cast doubt on Knox’s judgment in several cases of alleged abuse.

Knox did not respond to the Wisconsin Watch series or to ProPublica’s requests for comment. After two families in Alaska sued her in 2022, alleging she had wrongly concluded their children had been abused, Knox wrote in an affidavit that she has no control over whether police and child protection services workers take children away from parents, that she did not “conspire” with police or anyone else on custody issues, and that she did not personally evaluate one of the children. The lawsuit was dismissed in 2024 after the families agreed to drop the matter.

Knox moved on to a job at the University of Florida. According to a spokesperson for the university, Knox resigned as a pediatrician with the Child Protective Team in late June, effective Aug. 15. He declined to comment on the circumstances.

At Campbell’s trial, Knox’s name was never mentioned. Instead, Harper stepped in as an expert witness. When Campbell heard Knox had been replaced, she was initially hopeful.

“I’m like, oh, great, new eyes,” Campbell said. “They’re going to look at it and go, ‘This is nuts, I don’t agree with this.’ And I definitely was wrong.”

Harper’s assessment affirmed Knox’s diagnosis of abuse. She told the jury that the bruises were likely caused by squeezing by an adult’s hand. A medical expert hired by Campbell’s defense argued that the child’s bleeding could not be precisely dated and that a preexisting medical condition could have caused it.

After just two hours of deliberation, the jury returned a not guilty verdict. Campbell said she is grateful to have the case concluded, though she said she is still haunted by the accusations against her.

“That was the hardest thing too, going home after this case was done, and being like, ‘Am I allowed to be alone with my children now?’” she said. “It’s all because of the quote-unquote experts not doing their due diligence and looking further into underlying issues that these kids could have.”

In a statement to ProPublica, Dane County District Attorney Ismael Ozanne expressed confidence in both Harper and Knox, saying “their testimony had been consistent with many different medical professionals and experts in their own areas of practice.”

“It is important to note that a not guilty verdict by lay jurors hardly invalidates the widespread acceptance of abusive head trauma as a diagnosis in the medical community nor would it cause us to have concerns about Dr. Harper’s qualifications or knowledge in the field,” he added. “Jurors are not bound to accept any expert testimony as accurate.”

In the winter of 2022, a 4-month-old boy began breathing abnormally at his day care in Mineral Point, Wisconsin. His parents took him to a hospital, where he died days later. A police investigation determined that his day care provider, Joanna Ford, left him and several other children alone in her home for over an hour while she went to a tattoo and piercing parlor.

Prosecutors used Harper as an expert witness in the case. After evaluating the child’s medical records, she concluded that his injuries were “clinically diagnostic of abusive head trauma,” or, put another way, Ford shook the baby violently. She was charged with first-degree reckless homicide. Ford pleaded not guilty.

Ford’s defense lawyers successfully petitioned the judge in the case for a hearing to determine whether Harper’s expert witness testimony would be scientifically valid and admissible at trial. In response to questions, Harper explained why the child’s symptoms — brain swelling, blood under his skull, damage to his eyes — pointed to abuse, and why, despite the controversy surrounding it, the diagnosis of abusive head trauma was scientifically sound. She also explained that, because the baby was not walking or crawling, the fact that none of his caregivers could explain his injuries indicated abuse.

“People should know what happened,” she testified.

On cross examination by Ford’s lawyers, Harper said she couldn’t say for certain what time the abuse would have occurred, exactly how Ford had injured the baby and that there are no “great biomechanical models” for shaken baby syndrome.

A little over a month later, Judge Lisa McDougal delivered a highly critical ruling that barred Harper from telling the jury that the child died as the result of “abusive head trauma, non-accidental injury, child abuse or murder.” She also took issue with the idea that a lack of explanation for injuries is indicative of abuse, calling it a “leap in logic.”

“Offering a conclusive opinion as to how an injury may have occurred crosses a line and does not fit within the dictionary definition of what diagnosis is,” McDougal said. The judge also said that Harper views herself as an advocate, and that that casts doubt on her “fidelity to the scientific validation of abusive head trauma diagnoses, especially when it is a close call.”

The murder charge was dismissed. For leaving the children alone, Ford pleaded guilty to the lesser charge of neglect of a child where the consequence is death. She is serving a 10-year prison sentence. Ford, through her attorney, declined a request for an interview. The Iowa County district attorney also declined to comment.

On Feb. 4, 2022, Paul and Sarah Marshall hosted a dinner for her parents and a family friend at their home in Hudson, Wisconsin. Afterward, their 7-week-old son, Fox, became fussy. Paul Marshall carried him into the mother-in-law unit on the lower level of the house, which was cool and dark, to try to calm him. He emerged minutes later in a panic, yelling that the baby spit up and stopped breathing.

Paramedics rushed Fox to Children’s Minnesota, a hospital about 25 minutes across the state border in St. Paul. Doctors ran tests, and a scan showed Fox had a skull fracture with fluid pooling on both sides of his brain. He died days later.

Harper examined Fox, as well as his twin sister, Liana, and found “skull fractures, likely rib fractures, metaphyseal fractures.”

“This constellation of findings in a nonambulatory infant is clinically diagnostic of inflicted injury or child physical abuse likely occurring on more than one occasion,” she wrote.

But the Marshalls said that wasn’t true. They told Harper that Sarah Marshall had experienced a difficult pregnancy with gestational diabetes and severe anemia, and that Liana had a vacuum-assisted delivery. Both twins had been to their regular pediatrician over health concerns. While Liana’s health improved, Fox’s had not.

A spokesperson for Children’s Minnesota declined to comment on the case.

Because he was the last person alone with Fox before he stopped breathing, Paul Marshall was charged with first-degree reckless homicide. He was also charged with physical abuse of a child for hurting Liana. Sarah Marshall said there was no evidence that her soft-spoken husband had hurt their children.

“The state wanted to cast me as a naive idiot,” she said. “I chose not to believe it because of the logic and facts in my face. I had no reason to believe the accusation.”

At Paul Marshall’s 2023 trial, his defense lawyer, Aaron Nelson, cross-examined the other doctors who treated or evaluated Fox and Liana, and was able to highlight points of medical disagreement. A doctor who tested Liana for genetic disorders said she could not rule out rickets as a possible cause of her bone fractures. A neuropathologist did not agree with Harper that Fox had a trauma-induced blood clotting disorder. By Harper’s own admission on cross-examination, determining the age of the skull fractures in children Fox and Liana’s age was difficult. Nelson called six of his own medical experts to suggest that the difficult birth or a vitamin deficiency could explain the twins’ injuries.

“How many people have to be wrong for Dr. Harper to be right?” Nelson said in closing arguments.

After an 11-day trial, the jury found Marshall not guilty.

In a statement to ProPublica, St. Croix County District Attorney Karl Anderson pointed out that Harper was not the only treating physician who was concerned that Fox and Liana had been abused.

“A not guilty verdict does not mean that the jury concluded that the children were not abused,” Anderson said. “Rather, it means that they did not conclude that the State proved that Paul Marshall caused the death, beyond a reasonable doubt.”

Paul and Sarah Marshall with their children at home, which is decorated with memories of their son, Fox

Six weeks after the trial, the family moved three hours away into a century-old farmhouse that is far from the community that they felt wrongfully villainized by.

One of the cruelest impacts of the abuse diagnosis, they said, came after it was clear that Fox would die and the hospital staff began making preparations for his organs to be donated. Sarah Marshall said she had hoped to someday hear her son’s heart beating in another child’s chest. Instead, a court order put a halt to the procedure.

“They were already treating him as evidence,” she said.

The experience of going from a grieving parent to an accused murderer, her husband said, has given the couple post-traumatic stress. Paul Marshall said he is grateful to be with his wife and children, but what he calls a “broken system” has left them unsure whether or not to have another baby or even be left alone with one of their daughters.

“You get pregnant. You go to all of your appointments. You voice all of your concerns. You do everything you’re supposed to do as a parent and your child still dies. And the state tells you it’s your fault,” Sarah Marshall said. “I don’t understand why I live in a world like that.”

Mariam Elba contributed research.

by Jessica Lussenhop, and photography by Sarahbeth Maney

A “Striking” Trend: After Texas Banned Abortion, More Women Nearly Bled to Death During Miscarriage

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Before states banned abortion, one of the gravest outcomes of early miscarriage could easily be avoided: Doctors could offer a dilation and curettage procedure, which quickly empties the uterus and allows it to close, protecting against a life-threatening hemorrhage.

But because the procedures, known as D&Cs, are also used to end pregnancies, they have gotten tangled up in state legislation that restricts abortion. Reports now abound of doctors hesitating to provide them and women who are bleeding heavily being discharged from emergency rooms without care, only to return in such dire condition that they need blood transfusions to survive. As ProPublica reported last year, one woman died of hemorrhage after 10 hours in a Houston hospital that didn’t perform the procedure.

Now, a new ProPublica data analysis adds empirical weight to the mounting evidence that abortion bans have made the common experience of miscarriage — which occurs in up to 30% of pregnancies — far more dangerous. It is based on hospital discharge data from Texas, the largest state to ban abortion, and captures emergency department visits from 2017 to 2023, the most recent year available.

After Texas made performing abortions a felony in August 2022, ProPublica found, the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%.

The number of emergency room visits for early miscarriage also rose, by 25%, compared with the three years before the COVID-19 pandemic — a sign that women who didn’t receive D&Cs initially may be returning to hospitals in worse condition, more than a dozen experts told ProPublica.

While that phenomenon can’t be confirmed by the discharge data, which tracks visits rather than individuals, doctors and researchers who reviewed ProPublica’s findings say these spikes, along with the stories patients have shared, paint a troubling picture of the harm that results from unnecessary delays in care.

“This is striking,” said Dr. Elliott Main, a hemorrhage expert and former medical director for the California Maternal Quality Care Collaborative. “The trend is very clear.”

Blood Transfusions in First-trimester Pregnancy Loss ER Visits Spiked After Texas Banned Abortion

After the state’s first abortion ban went into effect in September 2021, blood transfusions increased. After abortion became a felony in August 2022, they increased more.

Note: For emergency department visits involving a pregnancy loss at less than 13 weeks gestation, or with an unknown gestational week.

The data mirrors a sharp rise in cases of sepsis — a life-threatening reaction to infection — ProPublica previously identified during second-trimester miscarriage in Texas.

Blood loss is expected during early miscarriage, which usually ends without complication. Some cases, however, can turn deadly very quickly. Main said ProPublica’s analysis suggested to him that “physicians are sitting on nonviable pregnancies longer and longer before they’re doing a D&C — until patients are really bleeding.”

That’s what happened to Sarah De Pablos Velez in Austin last summer. As she was miscarrying and bleeding profusely, she said physicians didn’t explain that she had options for care. Sent home from the emergency room without a D&C two times, she ultimately needed blood transfusions so that she wouldn’t die, according to medical records. “What happened to me was just so wrong,” she told ProPublica. "Doctors need to be providing care to pregnant women — that needs to be a baseline.”

Sarah De Pablos Velez was sent home from an emergency room while bleeding profusely during a miscarriage last year; she ultimately needed blood transfusions to save her life. (Ilana Panich-Linsman for ProPublica)

After ProPublica exposed preventable deaths following delays in care, the Texas Legislature passed a bill this year to clarify that doctors can provide abortions when a patient is facing a life-threatening emergency, even if it is not imminent.

But many Texas doctors say the reform does not address the difficulty of treating women experiencing early miscarriages, which almost always involve blood loss; they say it’s hard to know when the expected bleeding might evolve into a life-threatening emergency — one that could have been prevented with a D&C. Women can bleed and remain stable for a long time, until they crash.

Texas forbids abortion at all stages of pregnancy — even before there is cardiac activity or a visible embryo. And while the law allows doctors to “remove a dead, unborn child,” it can be difficult to determine what that means during early miscarriage, when an array of factors can signal that a pregnancy is not progressing.

An embryo might fail to develop. Cardiac activity may not emerge when it should. Hormone levels might dip or bleeding might increase. Even if a doctor strongly suspects a miscarriage is underway, it can take weeks to conclusively document that a pregnancy has ended, and all the while, a patient might be losing blood.

Some OB-GYNs and emergency room physicians have long been advising patients to complete their miscarriage at home, especially at Catholic hospitals, even if that is not the standard of care. But now, physicians across the state are faced with a law that threatens up to 99 years in prison, and more are making a new calculus around whether to intervene or even tell patients they are likely miscarrying, said Dr. Anitra Beasley, an OB-GYN in Houston. “What ends up happening is patients have to present multiple times before a diagnosis can be made,” she added, and some of those patients wind up needing blood transfusions.

While they can be lifesaving, transfusions do not stop the bleeding, experts told ProPublica, and they can introduce complications, such as severe allergic reactions, autoimmune disorders or, in rare events, blood cancer. The dangers of hemorrhage are far greater, from organ failure to kidney damage to loss of sensation in the fingers and toes. “There’s a finite amount of blood,” said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington. “And when it all comes out, you’re dead.”

ProPublica’s findings about the rise in blood transfusions make clear that women who experience early miscarriages in abortion ban states are living in a more dangerous medical climate than many believe, said Amanda Nagle, a doctoral student investigating the same blood transfusion data for a forthcoming paper in the American Journal of Public Health.

“If people are seeking care at an emergency department,” Nagle said, “there are serious health risks to delaying that care.”

Waiting for Certainty

In some clinics and hospitals across Texas, the pressure to definitively diagnose a miscarriage has led to delays in offering D&Cs.

Considering the chance of criminal prosecution, some doctors now default to what many pregnancy loss experts view as an overly cautious method for diagnosing miscarriage: ultrasound images alone, using criteria from the Society of Radiologists in Ultrasound. Relying only on images to diagnose — and discounting other factors, like lab results or clinical symptoms — can take days or even weeks.

Dr. Gabrielle Taper was a resident at a Catholic hospital in Austin when the ban was enacted, and a culture of fear took hold among her colleagues, she told ProPublica. “We started asking, ‘Are we certain that we can document that we’ve met the radiology guidelines?’ as opposed to just treating the patient in front of us,” she said.

If they couldn’t show that the likely miscarriage met the criteria, they often felt they had to discharge patients without offering a D&C. “People are already in distress, and you are giving them confusion, a false sense of hope,” she told ProPublica. “Having to send a patient home knowing they may bleed so much they would need a blood transfusion — when I know there are procedures I could do or medicine I could offer — is just excruciating.”

The hospital where she worked did not respond to ProPublica’s request for comment.

The American College of Obstetricians and Gynecologists does not recommend this approach, advising doctors instead to review the ultrasound as one piece of information among many and counsel patients on all their options.

The Society of Radiologists in Ultrasound said that the guidelines “are not meant to apply in the setting of a life-threatening situation, such as heavy bleeding,” but did not respond to a question about whether it agreed with ACOG that doctors should use a combination of ultrasound images and clinical judgment to assess a pregnancy loss.

Dr. Courtney A. Schreiber, an obstetrics and gynecology professor and expert in early pregnancy care, said that even if a patient wants to let a likely miscarriage complete at home, the medical team should still explain different management options, including medication to speed up the process or a D&C, should symptoms like bleeding get worse.

“It’s our obligation to share information, help manage expectations and keep women safe,” she said.

What happened to Porsha Ngumezi shows how dangerous it can be to delay care, according to more than a dozen doctors who previously reviewed a detailed summary of her case for ProPublica.

When the mother of two showed up bleeding at Houston Methodist Sugar Land in June 2023, at 11 weeks pregnant, her sonogram suggested an “ongoing miscarriage” was “likely,” her doctor noted. She had no previous ultrasounds to compare it with, and the radiologist did not locate an embryo or fetus — which Ngumezi said she thought she had passed in a toilet; her doctors did not make a definitive diagnosis, calling it a pregnancy of “unknown location.” After hours bleeding, passing “clots the size of grapefruit,” according to a nurse’s notes, she received two blood transfusions — a short-term remedy. But she did not get a procedure to empty her uterus, which medical experts agree is the most effective way to stop the bleeding. Hours later, she died of hemorrhage, leaving behind her husband and young sons.

Hope Ngumezi holds a photograph of him and his late wife, Porsha, who died in a Houston hospital during a miscarriage in June 2023. (Danielle Villasana for ProPublica)

Doctors and nurses involved in Ngumezi’s care did not respond to multiple requests for comment for ProPublica’s story last fall, and the hospital did not answer questions about her care when asked about it again for this story. A spokesperson from Methodist Hospital said its OB-GYNs follow ACOG’s miscarriage diagnosis guidelines, which recommend considering clinical factors in addition to ultrasounds.

Visit After Visit

Even in circumstances in which the abortion ban allows a doctor to intervene — to treat a life-threatening emergency, for example, or to “remove a dead, unborn baby” — there’s plenty of evidence, detailed in lawsuits and federal investigations, that doctors in Texas still aren’t offering procedures.

As soon as Sarah De Pablos Velez, a 30-year-old media director, learned she was pregnant last summer, she began attending regular checkups at St. David’s Women’s Care, in Austin. During her third appointment at about nine weeks, a resident, Dr. Carla Vilardo, and her supervisor, Dr. Cynthia Mingea, reviewed the ultrasound, according to medical records, which indicated her pregnancy wasn’t viable. Instead of being offered treatment for a miscarriage, De Pablos Velez says she was advised to hold out hope and come back for the next checkup.

Five maternal health experts and practicing OB-GYNs who reviewed the records for ProPublica said by that ultrasound visit, doctors would have had enough information to determine that the pregnancy wasn’t viable, even under the most conservative guidelines. If they wanted to be extra sure, they could have done blood work or one more ultrasound during that visit.

Instead, De Pablos Velez was told to come back in two weeks, according to medical records. During a visit when she should have been nearly 11 weeks pregnant, Mingea wrote in her chart she was “not optimistic” about the pregnancy's viability. Still, De Pablos Velez was advised to return in another week to be sure.

Within a few days, when the cramping got so bad she could barely walk, De Pablos Velez went to the emergency room at St. David’s Medical Center, unaware that a D&C could stop the pain and the bleeding. “I’ve never researched what it looks like for women who have a miscarriage,” she told ProPublica. “I always thought you go to the bathroom and have a little bit of blood.”

Over two visits to the emergency room, doctors told her that she could complete the miscarriage at home, even as she reported filling up three toilet bowls with blood and a nurse remarked that they needed a janitor to clean the floor, De Pablos Velez and her husband recalled. No obstetrician ever came to assess her condition, according to medical records, and while her hospital chart says “all management options have been discussed with the patient and her husband,” De Pablos Velez and her husband both told ProPublica no one offered her a D&C.

She was told to follow up with her OB at her next appointment in three days. Six hours after discharge, though, she was trying to ride out the pain at home when her husband heard her muttering “lightheaded” in the bathroom and ran to her in time to catch her as she collapsed. “She was pale as a ghost, sweating, convulsing,” said her husband, Sergio De Pablos Velez. “There was blood on the toilet, the trash can — like a scene out of a horror movie.”

An ambulance rushed her to the hospital, where doctors realized she no longer had enough blood flowing to her organs. She received two blood transfusions. Without them, several doctors who reviewed her records told ProPublica, she would have soon lost her life.

De Pablos Velez and her husband, Sergio, at home in Austin (Ilana Panich-Linsman for ProPublica)

Vilardo and the doctors who saw De Pablos Velez in the emergency room did not respond to requests to speak with ProPublica or declined to be interviewed. St. David’s Medical Center, which is owned by HCA, the largest for-profit hospital chain in America, said it could not discuss her case unless she signed privacy waivers. The hospital did not respond to ProPublica’s questions even after she submitted them. The De Pablos Velezes say that a hospital patient liaison told them after the ordeal that the hospital would conduct an internal investigation, educate the emergency department on best practices and share the results. It never shared anything. When ProPublica asked about the status of the investigation, neither the liaison nor the hospital responded.

Mingea, who supervised Vilardo’s care during checkups, reviewed the clinic’s records with ProPublica and agreed that De Pablos Velez should have been counseled about miscarriage management options at the clinic, weeks before she ended up in the ER. She said she did not know why she wasn’t but pointed ProPublica to the Society of Radiologists in Ultrasound criteria, which is hanging on the clinic’s wall and is used to teach residents.

She was adamant that her clinic, which she described as “very pro-choice — about as much as we can be in Texas,” regularly provides D&Cs for miscarrying patients. “I feel badly that Sarah had this experience, I really do,” she said. “Everybody deserves to be counseled about all their options.”

Doctors had five opportunities to counsel De Pablos Velez about her options and offer her a D&C, said Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, who reviewed case records. If they had, the life-or-death risks could have been avoided.

De Pablos Velez “basically received the same care Porsha Ngumezi did, only Porsha died and she survived,” said Abbott. “She was lucky.”

Sophie Chou contributed data reporting, and Mariam Elba contributed research.

by Kavitha Surana, Lizzie Presser and Andrea Suozzo

Miscarriage Is Increasingly Dangerous for Women in Texas, Our Analysis Shows. Here’s How We Did It.

1 day 1 hour ago

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Even though about a million women a year experience a miscarriage, there is little research on complications related to pregnancy loss in the first trimester, when most miscarriages happen. The need to explore this phase is urgent, experts told ProPublica, given the way state abortion bans have disrupted maternal health care.

Although most early miscarriages resolve without complications, patients with heavy bleeding can hemorrhage if they don’t get appropriate treatment — which includes a procedure called dilation and curettage, or D&C, that is now tangled up in legislation that bans abortion. As women recounted being left to lose dangerous amounts of blood, and ProPublica told the story of a mother who died in a Houston hospital while seeking miscarriage care, reporters searched for a way to gain a broader understanding of what was happening in the state.

We consulted dozens of researchers and clinicians to develop our methodology and understand how to look at early miscarriage outcomes in the emergency department.

Our latest analysis, of hospital discharge data from Texas, found that after the state made performing abortions a felony in August 2022, the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%.

The number of emergency room visits during first-trimester miscarriage also rose by 25%, a sign that women may be returning to hospitals in worse condition after being sent home, more than a dozen experts told ProPublica.

Experts say the spike is a troubling indicator of delays in care.

The most effective way to prevent severe blood loss during miscarriages, experts said, is a D&C, which uses suction to remove remaining tissue, allowing the uterus to close. The procedure is also used to terminate pregnancies.

Dr. Elliott Main, an expert on maternal hemorrhage and the former medical director for the California Maternal Quality Care Collaborative, said the increase in transfusions suggested to him that doctors working under abortion bans are now delaying those interventions for miscarrying patients for longer — “until they’re really bleeding.”

These findings add to ProPublica’s growing body of reporting revealing that maternal outcomes have gotten worse after the state’s abortion bans. In February, we published an analysis of second-trimester pregnancy loss hospitalizations, which found that the rate of sepsis climbed by more than 50% after the state banned abortion. That study focused only on inpatient stays in Texas hospitals. However, many of the clinicians and researchers we spoke with told us that that focus would limit what we could say about miscarriage care earlier in pregnancy; most people experiencing first-trimester pregnancy complications would likely be seen in a shorter emergency department visit, rather than an inpatient stay.

This methodology lays out the steps we took to examine early miscarriage outcomes in the emergency department, to help experts and interested readers understand our approach and its limitations.

Identifying First-Trimester Emergency Visits

We purchased seven years of discharge records for inpatient and outpatient encounters at hospitals and ambulatory surgery centers from the Texas Department of State Health Services. These records contain deidentified data for visits, with information about the encounter, including diagnoses recorded and procedures performed, as well as some patient demographic information and billing data.

We limited our analysis to visits with a diagnosed pregnancy loss across both the inpatient and outpatient datasets. We followed a methodology that maternal health researchers have used for many years to identify “abortive outcomes” — instances of pregnancy loss at less than 20 weeks, which includes diagnoses like ectopic pregnancy and miscarriage. Researchers have typically identified these cases in order to exclude them from metrics assessing complications in childbirth. In contrast, we focused our analysis only on those encounters with a pregnancy loss diagnosis. Medical experts suggested that it's possible more women are self-managing abortions at home; since a self-managed medication abortion would present like a spontaneous miscarriage, however, we can’t differentiate those patients in our data.

We also limited our analysis to either emergency department visits or inpatient stays that began in the emergency department. The state’s outpatient data also includes encounters for outpatient procedures and data for ambulatory surgery centers, which we excluded to focus on emergent hospital care. Ultimately, our analysis focused on 35,500 first-trimester visits per year that came into hospitals through the emergency department, excluding a small number (about 1,400 per year) of inpatient stays that did not begin in the emergency room.

To limit our analysis to pregnancy loss in the first trimester, we looked for a diagnosis code indicating gestational weeks. In cases where a long hospitalization had multiple gestational week codes recorded over the course of the stay, we took the latest one. We excluded any row that had a gestational week code of 13 weeks or more, which marks the start of the second trimester. The vast majority — 78% — of emergency department visits for pregnancy loss had a code indicating unknown gestational week or no gestational week diagnosis code at all. We included those visits in the first-trimester category. Clinicians told us that a pregnant patient coming to the emergency department in her first trimester is less likely to have had a doctor’s appointment establishing gestational age. Since pregnancy loss in the second or third trimester is more serious, and because it is easier to establish gestational age in a pregnancy that is further along, an emergency department doctor would likely be able to establish a gestational age over the course of treatment in those cases.

We then filtered our list of visits to ones where the patient was female and between the ages of 10 and 54, to exclude rows with potential errors. This removed 2,692 visits, or 1.1% of all visits we’d identified.

The number of emergency department first-trimester hospitalizations were relatively stable prior to COVID-19. In 2022, the first full year after the state passed its six-week abortion ban, the number of encounters jumped by 11%. And in 2023, the year after the state criminalized abortion, they rose again, increasing by 25% from pre-COVID levels.

While we could identify an increase in visits, we could not identify patients across visits, which means we can’t say how many of these visits represent the same person returning to the emergency department multiple times for the same pregnancy loss. Texas has seen an increase in live births since the state banned abortion — about 2.7% in 2022, compared with the pre-COVID average, and declining slightly in 2023. But this increase in births — and, by extension, pregnancies — does not explain the rate of change in emergency visits, which far surpasses it.

Clinicians also told us that the threshold for diagnosing pregnancy loss increased after the state banned abortion. To assess how many relevant visits our analysis might be leaving out, and whether we were missing more visits after hospital policy changes, we looked for visits without a pregnancy loss code but with a diagnosis of “threatened abortion” or “early pregnancy hemorrhage,” indicating uterine cramping or bleeding in early pregnancy. Since clinicians told us that these diagnoses might range from light spotting to significant bleeding, and since bleeding in pregnancy is common and does not always indicate a miscarriage in progress, we did not include these visits in our main analysis. However, we also identified a 23% increase in visits with those codes — from an annual average of 70,936 prior to COVID to 87,431 in 2023.

Identifying Transfusions

Next, we identified pregnancy loss visits with a transfusion, which typically indicates that there has been a dangerous loss of blood.

For our inpatient dataset, where procedures performed during a hospitalization were recorded as ICD-10-PCS codes, we identified visits with a blood transfusion using a list of codes defined by the Centers for Disease Control and Prevention. The outpatient dataset, which uses Current Procedural Terminology codes, has just one code — 36430 — for blood transfusions.

Prior to COVID-19, there were 840 first-trimester pregnancy loss emergency department visits each year, on average, with a blood transfusion. In 2022, the first full year after the state passed its first abortion ban, transfusions climbed to 1,076 — an increase of 28% from pre-COVID years. By 2023, the first full year after abortion was criminalized, that number climbed to 1,290 — an increase of 54% compared to pre-COVID. That’s 450 more visits with a blood transfusion in 2023 than the pre-COVID average.

Blood Transfusions in First-trimester Pregnancy Loss ER Visits Spiked After Texas Banned Abortion

After the state’s first abortion ban went into effect in September 2021, blood transfusions increased. After abortion became a felony in August 2022, they increased more.

Note: For emergency department visits involving a pregnancy loss at less than 13 weeks gestation, or with an unknown gestational week.

Even as the number of visits to the emergency department increased, the proportion of those visits with a transfusion also went up, from 2.5% in pre-COVID years to 2.8% in 2022 and 3% in 2023 — suggesting that the increase in transfusions may not be explained by an increase in encounters alone.

Experts who reviewed ProPublica’s data wondered if the increase in transfusions might be driven by more women experiencing complications of ectopic or molar pregnancies, rare nonviable pregnancies in which the likelihood of a blood transfusion is much higher than for a spontaneous miscarriage. The data did not bear this out. When we excluded visits with ectopic and molar pregnancy diagnoses, the increase in the number of pregnancy loss transfusions was even higher — it rose by 61% by 2023.

To understand whether there were increases in the numbers of transfusions in other maternal visits over the same time period, we also looked at blood transfusions in delivery events, using the federal methodology to identify birth complications. In hospital births, the number of transfusions increased by 6.7% in 2022 and 9.9% in 2023 compared with the pre-COVID average — an increase, but smaller in magnitude than the increase in first-trimester pregnancy loss hospitalizations.

Sophie Chou contributed data reporting.

by Andrea Suozzo, Kavitha Surana and Lizzie Presser

Connecticut’s New Towing Law Will Help Some, but Not All, Drivers. Here’s What They Told Us.

1 day 23 hours ago

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A Hartford woman never saw her car again after it was towed while she sat in housing court fighting an eviction.

A home care worker had her car towed while she hurried to assist a patient down the stairs.

A young man lost his car and slipped into financial instability after he mistakenly put his apartment’s parking sticker in the wrong spot.

Late last month, Connecticut lawmakers, following a series of stories by The Connecticut Mirror and ProPublica, passed sweeping reforms to the state’s towing laws that will address many of the issues drivers have complained about. The stories highlighted how towing companies can begin the process to sell people’s cars after 15 days, one of the shortest windows in the country.

Reporters heard from dozens of drivers across Connecticut who had to pay exorbitant fees or had their vehicles sold when they couldn’t afford the charges. Many told reporters about the severe consequences they experienced after their cars were towed or sold, including the loss of jobs, personal mementos and housing.

While some people’s cars might not have been towed under the new law, which takes effect Oct. 1, it doesn’t solve all the problems that vehicle owners raised.

Here are some of their stories, as well as whether the changes in the new law would have helped them.

Towing Home Health Aides

Not fixed: The bill does not address this issue.

Home care worker Maria Jiménez circled the Hartford apartment complex for low-income seniors, looking for a place to park. Jiménez drives patients to and from errands like doctor’s appointments and grocery shopping. Her patient that day last November used a cane, and Jiménez planned to park close so that her patient wouldn’t have to walk too far.

Unsuccessful, Jiménez stopped in front of the building’s entrance.

“I turned on the hazard lights and left the car on, just long enough to let her know I had arrived, since I didn’t have her phone number,” she said. Jiménez said she told a few bystanders she would be right back and asked them to keep an eye on her car.

She said she went inside only briefly, and when she returned, the car was gone. Bystanders told Jiménez the car had been towed and that they’d pleaded with the truck’s driver, to no avail.

Tracy Wodatch, president and CEO at Connecticut Association for Healthcare at Home, said many of her members complain about getting ticketed or towed when they’re doing their jobs helping people.

When it happens frequently enough at a particular complex, she said, an agency might speak with the landlord to ask for a designated spot. But there isn’t a statewide mandate.

New Jersey passed a law in 2018 allowing home health care workers, visiting nurses and others to apply for a placard similar to an accessible parking tag to place in their cars.

“Maybe we can talk to the legislators off session to see if there’s anything we can do,” Wodatch said.

The company that towed Jiménez, MyHoopty.com, was in Watertown, and Jiménez was stranded over 30 miles away in Hartford. “How will I get there if I don’t have a car?” she recalled thinking.

MyHoopty owner Michael Festa said the vehicle was parked in the fire lane without its hazard lights on for 17 minutes before it was towed and that the apartment complex had hired MyHoopty to prevent such parking violations.

“This is a critical safety issue, particularly at an elderly housing complex where the emergency access can be a matter of life and death,” Festa said. (MyHoopty has appeared in other stories in our series.)

Get in Touch

If you have information about health workers and caregivers being towed while on the job, email Dave Altimari at daltimari@ctmirror.org or Ginny Monk at gmonk@ctmirror.org, or call 203-626-4705.

The apartment complex owners didn’t respond to calls and emails for comment.

Jiménez said she makes about $290 a week. By the time she got to MyHoopty, the company told her the bill was more than $400.

Her husband footed the bill. But it wasn’t easy: “The only reason I could afford it is because I work mornings, I work nights,” he said.

Short Meters and Unpaid Tickets

Not fixed: The bill does not address this issue.

Marie Franklin paid the parking meter and dashed into Hartford housing court for a December 2023 hearing that would determine if she would get evicted from her apartment. She worried about the parking. People can wait for hours for the judge to call their cases, but the Hartford Parking Authority limits nearby meters to two hours.

So people facing eviction sometimes run the risk of getting a parking violation, getting their cars towed or missing their names being called for hearings, which can cause them to lose their housing in a default judgement for not showing up to court.

Joshua Michtom, a Hartford City Council member and an attorney who has represented children and parents in juvenile court, said although there’s a nearby parking garage, it’s more expensive and it fills up.

“You have to be there, but then you don’t know how long you’re going to have to wait,” Michtom said. “And the courts are not particularly forgiving if you’re not there the moment your case gets called.”

When Franklin’s name was finally called, a judge rejected her plea to stave off eviction. Dejected and stressed about losing her home, she walked out of court only to discover her 2015 Volvo was gone. Franklin had more than a dozen unpaid parking tickets, some of which were nearly 20 years old. She’d forgotten about some, and others were for vehicles she no longer owned. About half of the tickets were for exceeding the meter limit or parking over the line near the courthouse.

“I had paid for the parking meter and everything,” Franklin said. “They drive around, and they look for people’s cars.”

Marie Franklin’s car was towed during her eviction hearing. (Shahrzad Rasekh/CT Mirror)

Jill Turlo, CEO of the Hartford Parking Authority, said the agency’s officers use license plate scanners to find people with outstanding tickets. Turlo said “high-traffic metered areas,” like the street the courthouse is on, are “regularly patrolled by parking enforcement.” Turlo said that the parking authority has not received any requests to extend the time for metered parking near the courthouses.

While towing cars for unpaid parking tickets is a common practice for cities, Minnesota passed a law last year barring such tows, seeing them as an unfair burden on low-income families. Several cities, including Los Angeles, San Diego and San Francisco, have also stopped such tows after a California appeals court ruled that towing cars for unpaid parking tickets violated people’s rights against warrantless seizures, said Rebecca Miller, an attorney with the Western Center on Law & Poverty.

Hartford has one of the strictest policies in Connecticut. A city ordinance allows tows after two or more unpaid tickets that date back to September 2012. Other cities including Danbury and New Britain don’t tow for unpaid tickets. Norwalk and Waterbury will tow if there are four unpaid tickets; Stamford tows for three unpaid tickets or more than $250 owed, officials in those cities said. The limit in Bridgeport is $100, and New Haven’s is $200.

“We do have an ordinance where we can boot a car for unpaid tickets, but we haven’t used it in years,” said Deborah Pacific, director of the Danbury Parking Authority.

When Franklin went to eviction court, she had been trying to hold onto the place she and her daughter lived while she looked for a new job. Between unpaid fines, late fees, and towing and storage charges, it would have cost almost $3,000 to get her car back, she said.

Get in Touch

If you have information about towing near courthouses, email Dave Altimari at daltimari@ctmirror.org or Ginny Monk at gmonk@ctmirror.org, or call 203-626-4705.

“I would have chose to pay whatever I owed to my housing. So my car, there was nothing I could do,” Franklin said.

The vehicle was towed by Metro Auto Body & Towing, which did not return calls and emails for comment. It was later sold by the lender.

After losing her car and housing, Franklin moved to Florida to stay with her son.

Parking Sticker in the Wrong Place

Fixed: Apartment residents now have 72 hours if caught without a parking permit or with an expired one.

It’s often little discrepancies that lead to big consequences. When Tishawn Tillman moved into his Hartford apartment in September, he got a parking sticker that allowed him to park in the building’s private lot. He said he wasn’t sure where to put it, so he stuck it on the driver’s side window.

But less than a month later, his car was towed by Cross Country Automotive in Hartford.

“There is absolutely no legal documentation in my lease that says that this has to be strictly on the windshield,” Tillman said.

Minor rule violations such as parking crooked or not backing into a space have caused people’s cars to be towed and then sold when they couldn’t afford the fees. Stories like Tillman’s drove legislators to act. Under the new law, the towing company would have had to warn Tillman, giving him 72 hours to get a new sticker and place it in the right spot. The law also says towers have to get permission from the apartment complex to tow a vehicle unless it’s blocking traffic or parked in a fire lane.

Tillman said he assumed his car had been stolen. But the police told him it had been towed.

Tillman contacted Cross Country: “I asked them, ‘Did you see my sticker?’ And they said, ‘We didn’t see the sticker.’” He said he called the apartment manager, but he wouldn’t help.

“When I realized that neither of the parties were going to budge on the matter, I told them that I wasn’t going to pay the fine, even if I had the money, which I didn’t at the time,” Tillman said.

Tillman said his bill was “$200 but growing every day.”

He filed a complaint with the attorney general’s office, which said it unsuccessfully tried to resolve the issue through its voluntary mediation program and recommended he complain to the Department of Motor Vehicles.

Sal Sena, Cross Country’s owner, submitted a letter to the attorney general saying there are signs all over the parking lot explaining the rules. The apartment manager, Jack Matos, wrote to the attorney general that he talked with Sena about giving TIllman a discount on the towing fees.

“I reiterated Tishawn needs to make sure that it’s placed on the windshield,” Matos wrote.

Frustrated, Tillman eventually gave up trying to get his car back.

“I went from being a self-made young man with his own apartment and car to having to burn a hole in my pocket just to get to and from work on ride-share services like Uber and Lyft,” he said.

Unable to Reclaim Car Despite Having the Title

Fixed: The law allows vehicle owners to reclaim their cars with other documents besides DMV registration.

Shaleah Carr needed two more weeks until her DMV appointment in April to register the Chevrolet Malibu she had just bought from her mom. It was the earliest appointment she could get.

Her boyfriend had taken the car to his brother’s house to work on it when they decided to take it for a test drive. But the car broke down on U.S. Route 5 in South Windsor, and police called for a tow.

Her boyfriend told the tow truck driver that the car was registered to Carr’s mother and that Carr had the title and proof of insurance. But the towing company, Tolland Automotive, wouldn’t release the vehicle to Carr because she wasn’t the registered owner, said the company’s owner, George Fellows. The vehicle was towed on a Friday afternoon, and by the time Carr was able to get to the lot on Monday morning, she owed more than $300.

“I told them I’m on one income and I can’t afford it,” Carr said. “I just paid my rent for that month, and I even asked, ‘Do you guys do payments?’”

Since then, her Malibu has been sitting in the company’s lot.

Shaleah Carr couldn’t reclaim her car even though she has the title. (Shahrzad Rasekh/CT Mirror)

Carr’s dilemma has happened to people whose cars have been towed across Connecticut — they’ve been unable to quickly register their cars and then blocked from reclaiming them because they’re not registered in their names yet. By the time they can register their cars, so much time has passed that the tow bill is too expensive or the company has sold their car.

The new law gives consumers time to register their car before it can be towed and requires towers to release vehicles if presented with the title or a bill of sale as proof of ownership. The law also requires towers to accept other forms of payment besides cash and demands towers have business hours on weekends so fees don’t accrue while they’re closed.

Fellows said police called them to the scene. “Then we found out that this guy didn’t own the car at all,” Fellows said. Without the owner there, “it had to come back to our shop.”

Carr called her mother. “I was like, ‘You’re going to have to come up here,’ but even if she does, she can’t really do much,” Carr said. “She didn’t have the money to get it back either.”

Carr said the last time she called Tolland Automotive, the bill was $800. Given that she paid her mother only $500 for the car, she said, it almost wasn’t worth trying to get it back anymore.

Fellows said Carr’s mother did come into the office earlier this month with proof of registration, and he is willing to release the vehicle if she pays what is owed.

“It’s all on them,” he said. “I mean they knew what the issue was back then. Why haven’t they come back?”

Asia Fields contributed reporting.

by Dave Altimari, Ginny Monk and Shahrzad Rasekh, The Connecticut Mirror

A Doctor Challenged the Opinion of a Powerful Child Abuse Specialist. Then He Lost His Job.

2 days ago

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On a February afternoon in 2022, Dr. Bazak Sharon logged into a remote video meeting from his home office in Minneapolis. He propped up his cellphone next to his laptop and hit record on a video app.

There were several people in the meeting with Sharon, who at the time was a pediatrician with the University of Minnesota. Two hospital leaders, Sharon’s boss and a lawyer were there, too. But the person Sharon was most wary of was in the lower-right corner of the grid of faces: Dr. Nancy Harper, the director of the child abuse team at University of Minnesota Masonic Children’s Hospital in Minneapolis.

Sharon suspected that the discussion, about the care of a 3-month-old named Hank, was going to be contentious. He worried that someday, perhaps even in court, he might need evidence of his role caring for Hank. He was prepared to argue with Harper if she challenged his clinical judgment, but it was quickly apparent that the quality of the care he provided was not at issue.

Hank was born small and was not eating well or gaining enough weight; sometimes, according to his parents, he just seemed to be in pain. (ProPublica is using a nickname for the child at the parents’ request.) At an appointment in January, a doctor ordered an endoscopy, a procedure where a tiny camera is threaded through the body, and also suggested an MRI.

The scans of Hank’s brain showed fluid pooled under both sides of his skull. The blood was old, possibly months old, and Hank was admitted to the hospital. Sharon met him the next day.

A member of Harper’s team named Dr. Caroline George also evaluated Hank that day. In her opinion, according to court records, the bleeding was “consistent with abusive head trauma.” Sharon had suggested other possible causes, including an injury from birth, an infection or even spontaneous bleeding. Sharon wrote in the child’s medical record that it’s “likely we will never identify the exact mechanism that caused his injury.”

Three days after Hank was admitted, Sharon said he learned that a county child protection services worker was preparing to come to the hospital to take custody of the baby, as well as his 2-year-old brother, William.

Sharon said that he was stunned that no one had spoken to him since he was Hank’s primary doctor. So he did something that seemed to put him at odds with George, Harper and hospital leadership: He told Hank’s parents, CPS and police he didn’t think the bleeding alone was enough evidence to say this was abuse.

Sharon was also concerned that separating a sick infant from his parents based only on a suspicion of abuse would cause more harm to Hank. Working with the detective assigned to the case, he admitted William, though the older boy was not sick, so that the whole family could stay in the hospital under the supervision of a nursing assistant while doctors continued to treat and monitor Hank.

But four days later, according to Sharon, his supervisor told him that he was being removed from Hank’s care team, and that he should not communicate further with the parents. When Sharon asked why, he said he was told it was at Harper’s recommendation. “The care,” he said, “changed the second she got involved.”

In less than 48 hours, a judge determined that Hank and William were in need of child protection services and their parents were forced to leave the hospital without them. The same day, Sharon said, he was summoned to the first of two meetings with hospital leadership and Harper. When his supervisors scheduled the second meeting — titled “Review of CPS Patient” in the emailed invitation — less than a month later, Sharon came prepared to record it.

Before all this, Sharon had an appreciation for Harper’s formidability and for her influence in the world of child abuse pediatrics. She began her career as a pediatrician in the U.S. Navy before leading a child abuse team at a hospital in Texas. In 2014, she became the director of the University of Minnesota’s Center for Safe and Healthy Children.

A certified child abuse pediatrician for almost 16 years, the 56-year-old Harper consulted on suspected cases of abuse for several Twin Cities hospital systems, testified as an expert witness in child abuse trials across the U.S. and lectured on diagnosing signs of abuse. She was also the vice president of the Ray E. Helfer Society, a national nonprofit organization for physicians who work on the medical aspects of child abuse and neglect, and she became its president in 2023.

Harper testifies for the prosecution at a 2021 trial. (Coburn Dukehart/Wisconsin Watch)

Sharon, now 53 years old, was also well-respected. Originally from Israel, he came to the U.S. in 2003 to continue his medical studies. He began as a fellow at the University of Minnesota in 2006 and had been on faculty for 12 years. Specializing in infectious diseases, he became medical director of the university’s pediatric COVID-19 clinic and was a contributing member of the state Health Department’s Long COVID Guiding Council. Sharon was also a hospitalist, meaning he directed the care for admitted patients like Hank, coordinating with other doctors and specialists.

As the online February meeting progressed, it became clear to Sharon that, in a face-off with Harper, his medical expertise and the fact that he considered many of the people on the call to be friends counted for little. The lawyer noted that differing medical opinions could open the hospital or the doctors themselves up to a lawsuit. George added that the differences in opinions had also “made things difficult for particularly law enforcement.”

“I’m not a child abuse expert,” said Dr. Sameer Gupta, the chief medical officer of the hospital, on the call. “But, you know, my experience is this: Try to be completely aligned. That’s one story that’s coming from the medical team as much as possible, to avoid the potential for, one, litigation, two, to let the experts really drive the ship.”

Sharon became increasingly agitated during the call, shaking his head. He was angry that the conversation had revolved around protocols and the hospital’s legal liabilities, rather than Hank’s care.

“I think I did the best any doctor can do at that point in making sure that my patient is getting the best care while I’m not trying to hide any potential abuse,” he said during the meeting, the video of which he shared with ProPublica. “I felt very uncomfortable that CPS are showing up unannounced and taking two children away from the parents without having a discussion with the doctors who take care of this patient. I hope no one expects me not to say something when that happens in front of me.”

But Harper seemed to suggest that Hank might have been seen by too many doctors, and that Sharon had interfered with her team’s ability to “frame” the case to CPS and law enforcement. She said she did not consider it her role to be concerned about what could happen to a family after a diagnosis.

“Unfortunately,” she said, “if I spent all of my time worrying about … what’s going to happen with child protection and foster care or the cost for the legal stuff afterwards, I wouldn’t be able to do my job.”

Sharon began to protest. He said he had been reading the scientific literature on abusive head trauma and found it unconvincing, a conclusion more and more doctors were coming to. Harper cut him off. “If I spent two weeks reading the literature on COVID, would you consider me as qualified as you are?” she asked. “I’ve been doing this for decades.”

Gupta abruptly shut down the conversation. He said that Sharon’s plan to keep the family in the hospital was the “wrong decision and will never, ever happen again,” and then he ended the call.

As the screen went blank, Sharon let out a long, deep sigh. Though disturbed and frustrated, he did not yet realize his actions on behalf of Hank and his family would affect his career. Over time, Sharon came to see Harper as the main driver of a campaign to get him to fall in line with the child abuse team.

“She’s very black and white, right and wrong, no gray area,” he said, “which is not the way to do medicine or pediatrics.”

Harper did not respond to requests for comment. She and a spokesperson for University of Minnesota Physicians, which is the clinical practice for the university’s medical school faculty, also did not respond to a detailed list of questions. But the spokesperson wrote that the Otto Bremer Trust Center for Safe and Healthy Children, as it is now called and which is led by Harper, provides “trauma-informed medical care and psychosocial support while addressing research, prevention, advocacy, policy and education.”

“When healthcare providers and community organizations refer patients to CSCH, the team only makes decisions about diagnoses and subsequent medical care based on expert assessment of medical evidence (e.g., medical history, physical exam, lab and radiological findings, input from other medical specialists and information provided by caregivers),” the spokesperson added. “Further investigations and legal determinations are outside of our team’s scope.”

A spokesperson for Fairview Health Services, which owns Masonic Children’s Hospital, said in a statement that although Harper is an employee of University of Minnesota Physicians, “we obviously take these concerns seriously and are actively reviewing the matter.”

“Our highest priority is the safety, dignity, and wellbeing of our patients and families — especially in moments of crisis. We are aware of concerns being raised regarding the conduct of a University of Minnesota Physicians (UMP)-employed provider who practices in a UMP-led clinic within the M Health Fairview Masonic Children’s Hospital,” the spokesperson added. “We are in close communication with our academic partners and are evaluating any steps we may need to take to preserve the trust our patients and families place in us.”

Harper’s arrival in Minnesota coincided with the fallout of a high-profile tragedy: the 2013 death of 4-year-old Eric Dean.

Dean lived with his family in sparsely populated Pope County, in west-central Minnesota. According to an investigation by The Minnesota Star Tribune, teachers and caregivers reported signs that Dean was being abused to child protection workers at least 15 times before his stepmother threw him across a room, causing injuries that would kill him. She is in prison serving a life sentence.

In response, then-Gov. Mark Dayton signed an executive order in 2014 creating the Governor’s Task Force on the Protection of Children. The next year, along with a slew of other reforms, the state Legislature created a $23.35 million grant to give counties money based partially on the number of open child protection investigations.

She’s very black and white, right and wrong, no gray area, which is not the way to do medicine or pediatrics.

—Dr. Bazak Sharon

The number of child abuse cases soared. For instance, in Hennepin County, where Minneapolis is located, cases of physical abuse more than doubled from 2015 to 2016, before dropping over the next several years. Child abuse experts attributed the rise to what Joanna Woolman, a law professor who specializes in child abuse law, called “a moment of hyper-awareness around medical child abuse and child abuse in general.”

“We were convening a task force that was heavily made up of people with the view that we needed to do more, have more eyes on, be more aware,” added Woolman, who is also the executive director of the nonprofit Keeping Families Connected Minnesota, which provides free legal services to families going through child protection proceedings.

A subspecialty of pediatrics first recognized by the American Board of Pediatrics in 2006, child abuse pediatrics focuses on the diagnosis and documentation of signs of abuse. A diagnosis can help determine whether a parent loses custody of their child or faces criminal investigation. In cases where children die, it can mean murder charges. Harper was one of the first certified child abuse pediatricians in the country — the board counts over 350 subspeciality certifications nationwide — and is one of seven currently certified in Minnesota.

“Physicians with less training on child abuse and neglect both over- and under-identify injuries in children, whether they’re physical abuse injuries, sexual abuse injuries,” she testified in a 2019 trial. “A child with a missed injury could come back later with a more serious injury or even die. And so these are sort of issues where we realize that we needed expertise.”

Harper was hired as director of the Center for Safe and Healthy Children by the University of Minnesota the same year as Dayton’s executive order. According to testimony she gave in a 2019 criminal trial, the university recruited her to build up the center and create a regionwide child abuse consultation system.

“When I’m on call, I can be covering up to six different places where children can be seen,” Harper testified.

In 2016, the Otto Bremer Trust, a private charitable organization based in St. Paul, announced a $2.5 million grant to fund Harper’s ambitions to expand the center, which is based at Masonic. Harper is also program director for the university’s Child Abuse Pediatrics Fellowship, a three-year training program, giving her influence over the next generation of child abuse pediatricians. A spokesperson for the trust added that it does not have any “role in the day-to-day operations of the Center.”

Hennepin County has a contract with Harper’s employer, University of Minnesota Physicians, to provide medical consultation, expert witness testimony and case consultation with county attorneys. According to testimony Harper has given in the past, she and her team handle about 700 cases of suspected abuse each year. She has testified that 10% to 20% of those wind up confirmed for physical abuse, although it is difficult to determine if these figures are accurate since child protection case records are not public. She has given different answers on the witness stand when asked if she has ever testified for the defense; in 2021, she said she’d testified for the defense in a “half dozen or a dozen” cases. In 2023, she said she’d done so twice.

In 2018, Harper’s center began cohosting an annual Child Abuse Summit with the Hennepin County Attorney’s Office. In 2022, she received an introduction during a panel discussion from Dan Allard, senior assistant Hennepin County attorney, that illustrated the close relationship between Harper and her team and county prosecutors.

“If you haven’t heard Dr. Harper testify, she does a wonderful job. She knows her stuff,” Allard, who is also the head of the county attorney’s child abuse team, said at the summit. “We just barely try to keep up understanding what she’s talking about. So we just kind of let her go.”

In response to a detailed list of questions, Daniel Borgertpoepping, a spokesperson for the Hennepin County Attorney’s Office, wrote, “Since our office represents Hennepin County in CPS matters, we are unable to comment.”

Before Sharon’s encounter with Harper, he hadn’t given much thought to her team’s practices, which included evaluating and treating some of the worst cases of physical and sexual abuse of children. While he said he had referred a dozen or so cases of suspected neglect to her team, he viewed their work as a bleak side of pediatrics. He was happy to avoid it.

“I had a lot of respect for the child abuse doctors, like, ‘Thank you for doing that for us,’” he said.

But for roughly 15 years, the world of child abuse pediatrics has been roiled by criticism of the diagnosis once known as shaken baby syndrome and now categorized under the umbrella term abusive head trauma. A triad of symptoms — brain bleeding, brain swelling or injury, and blood in the retina — was once considered evidence that a child had been violently shaken, even if there were no other injuries or even bruising.

In court testimony, Harper has said that both shaken baby syndrome and abusive head trauma are considered scientifically valid diagnoses by “the mainstream medical community,” and that the controversy is more of a legal one than a medical one. She has acknowledged there are medical conditions that mimic possible signs of abuse, including bruises, bone fractures and head trauma symptoms, but she said that her assessments take all of that into account in concert with specialists like neurosurgeons and radiologists.

“We take a very detailed history from the family. We do a physical examination, look at past medical history, other medical conditions, the initial laboratory and X-ray reports,” she testified in 2023.

Sharon readily concedes that he wasn’t an expert in child abuse medicine. But as he and the other doctors tried to understand the bleeding in Hank’s brain as well as his lack of weight gain, he spent his evenings reading the scientific and legal literature about shaken baby syndrome and abusive head trauma, scribbling notes to himself. He read a key American Academy of Pediatrics statement reaffirming its belief in the diagnoses; he also read studies that challenged the science underlying them.

“It is wrong to fail to advise parents and courts when these are simply hypotheses, not proven medical or scientific facts,” Sharon wrote on a copy of one law review article.

He read about how the first neurosurgeon to posit the theory of shaken baby syndrome said in an interview years later that he was “disturbed that what I intended as a friendly suggestion for avoiding injury to children has become an excuse for imprisoning innocent parents.” According to the National Registry of Exonerations, over 40 people convicted in cases related to the diagnosis have been exonerated since the 1990s, often over increasing doubts that the three symptoms can be interpreted so definitively.

Sharon also learned that the subspecialty of child abuse pediatrics itself has also been under increasing scrutiny. Perhaps the most famous child abuse pediatrician case became the basis for the Netflix documentary “Take Care of Maya,” in which a 10-year-old girl’s pain syndrome was diagnosed by a child abuse pediatrician as Munchausen syndrome by proxy. A jury found the hospital liable for medical malpractice and awarded the family over $200 million; the hospital has appealed. Several families are suing a Pennsylvania hospital for what they say are false diagnoses of abuse by Dr. Debra Esernio-Jenssen, who led its child abuse team. A series of allegations of overzealous diagnoses of abuse have followed Dr. Barbara Knox from her job leading a child abuse team at the University of Wisconsin to similar positions in Alaska and at the University of Florida.

Sharon began to question the scientific nature of shaken baby syndrome and abusive head trauma after his dispute with Harper’s team. “It is wrong to fail to advise parents and courts when these are simply hypotheses, not proven medical or scientific facts,” he wrote on a copy of one law review article.

The child abuse pediatrician community is tightknit. After Knox left Wisconsin, Harper replaced her as an expert witness in some criminal cases. Esernio-Jenssen wrote Harper a nomination letter for a Ray E. Helfer Society award, calling her “an unstoppable force.”

Esernio-Jenssen and Knox, as well as the Helfer Society, did not respond to requests for comment. In a response to the lawsuit, attorneys for Esernio-Jenssen and her former hospital network wrote that they “are being attacked and demonized for protecting children from abuse and following the law,” and that the allegations of bad-faith abuse investigations are “obviously untrue.” The lawsuit is ongoing.

Knox was sued by two families in Alaska who accused her of leveling false accusations of abuse against them. In response, Knox said in an affidavit that she has no say over whether child protection takes children away from their parents, that she did not “conspire” with police or anyone else on custody issues or criminal prosecution, and that she did not personally evaluate one of the named children. The lawsuit was dismissed in 2024 after the families agreed to drop the matter.

According to a spokesperson for the University of Florida, Knox resigned her job there as a pediatrician with the Child Protective Team, effective Aug. 15. He declined to comment on the circumstances.

From the start, Sharon thought what was happening to Hank — a child struggling with eating and weight gain, with abnormal results on his endoscopy and weeks-old, unexplained cranial bleeding without any other symptoms of abuse — fit into his wheelhouse treating complex and even mysterious cases more than it fit into Harper’s. After poring through the literature on abusive head trauma, he was even more convinced.

Sharon followed his supervisor’s instruction not to speak to Hank’s parents. But after the couple’s attorney approached him, he provided a five-page account of Hank’s medical treatment. He included several potential alternative diagnoses.

“It is clear to me that missing child abuse is as serious as missing bacterial meningitis and should be considered as malpractice,” he wrote. “But also, as a hospitalist, who frequently manage children without clear definitions of their diagnosis, I’m used to ambiguity.”

Dr. Matthias Zinn, Hank’s neurologist, agreed with Sharon that the fluid in Hank’s brain, what he called “subdural collections,” could not be definitively tied to abuse. He provided a letter to the couple’s attorney as well. Zinn, who said he’s consulted on hundreds of cases of suspected abuse, said Harper’s child abuse team was by far the most aggressive he’s worked with.

“It was just crazy,” he said. “I remember speaking to them and saying, ‘What evidence do you have, other than the subdural collections?’ And they made it clear that they did not respect my opinion.”

Zinn has since left the University of Minnesota for a position in Florida.

Both a CPS investigator and a police detective spoke to Sharon repeatedly, and according to Hank’s parents, they also relayed Zinn’s opinion and begged CPS to talk to him as well. But the CPS petition alleging Hank was a victim of abuse only cited George’s assessment. There’s no mention of Sharon or Zinn.

George did not respond to requests for comment.

A spokesperson for Hennepin County declined to comment on individual cases or to respond to a detailed list of questions. But she provided a statement from Kwesi Booker, the director of Hennepin County Children and Family Services, which oversees child protection services. In that statement, Booker said “child protection social workers appropriately rely on the subject matter expertise of trained medical professionals in situations involving complex medical issues.”

Unable to let the matter go, Sharon wrote letters to the hospital’s leadership council about what he called “dangerous overreach” by Harper’s child abuse team. In response, Gupta said he referred the letter for review to the hospital’s Committee for Professional Enhancement. Citing privacy laws, hospital administrators would not tell Sharon the outcome of the committee’s review.

Separately, Gupta wrote Sharon a “peer review” letter informing him that, in several of his cases, there were concerns about his conduct, professionalism and a disregard for hospital protocol. Sharon said he was aware of his reputation for being strong-willed and, at times, dismissive or even rude to colleagues. The letter warned him against doing anything that could be seen as “retaliatory” toward other members of the staff. Gupta gave three examples related to Sharon’s purportedly improper procedures for prescribing medications for pediatric COVID-19 patients; he also referred to Sharon’s interaction with the child abuse team.

“Your documentation in the chart and communication with law enforcement was contrary to what was being stated by the child abuse team,” Gupta wrote in the peer review letter. “This created confusion with the community workers and with the family in a situation in which consistency is very important.”

Gupta did not respond to repeated requests for comment or to a list of questions.

Masonic Children’s Hospital

Hank’s family had a limited view of what was going on behind the scenes at Masonic Children’s Hospital, even though Hank’s mother, Kay, worked in the neonatal intensive care unit there. She recognized Sharon and knew of George, though she hadn’t worked closely with either. Because Hank’s parents both work in the pediatric field and for the privacy of their children, they asked that ProPublica not use their full names.

The day after Hank’s admission, Kay and her husband, Ross, explained to George about the baby’s difficulty with breastfeeding, his inexplicable pain and his inability to tolerate formula. When George asked her about possible accidents or injuries, the only thing Kay could think of was a time when she was driving and slammed on the brakes with Hank in his car seat.

After she read the CPS petition alleging her children were victims of physical abuse, Kay said that she came to suspect that George had been trying to collect information to use against her and her husband, not to treat Hank.

“I think she was sitting there hoping that I was just going to confess or tell her that I thought my husband might have done it,” Kay said. “And I was just hoping that she was going to help me.”

While Hank and William were in foster care, police confiscated the couple’s cellphones, laptops and baby monitors, and interviewed various family members and friends. In April 2022, Hennepin County decided not to pursue criminal charges.

CPS found no additional evidence of abuse, and after nearly four months, a judge ordered both boys returned to the couple, though it was on the condition that a grandparent live in the home full time as well. In June, just before a trial to determine if Hank had been abused, CPS agreed to begin the process of dismissing the matter, though the agency still made a “finding of maltreatment” by an “unknown offender.”

In late July, the Hennepin County Attorney’s Office signed off on the dismissal. It had been nearly seven months since Hank was first admitted to the hospital.

Around the same time, Kay and Ross took Hank for genetic testing, which showed he carried an abnormal gene duplication with unknown effects. He was also put on medication that resolved his stomach sensitivity issues and increased his appetite. One of Sharon’s theories was that the bleeding under his skull was due to poor feeding, dehydration or vitamin deficiency, though no one has been able to identify a definitive cause.

“He’s just been our little mystery baby, but he is a beautiful, healthy, thriving little 3-year-old,” Kay said.

William, she said, still has nightmares about being taken from his parents. At 5 years old, he insists on sleeping in their bed every night. Defending themselves, Kay said, plus the cost of additional caregivers amounted to roughly $100,000 for the family.

Kay never met Harper and only later came to understand the role she played. Because there was no trial, she never had the chance to confront Harper or George, or lay out any of the arguments that she and her husband had been falsely accused of abuse.

But just before the case closed, Kay saw an advertisement for the 2022 Child Abuse Summit, with Harper as a featured panelist. She bought a ticket to the event and sat right in front of Harper.

“They do these things and probably never have to see the people again, outside of places where they’re in charge,” she remembered thinking. “You’re going to have to see me.”

Sharon did not know it at the time, but he was far from the only person struggling in recent years to keep a family from losing their children after Harper’s involvement. In his job as an attorney for indigent parents at Hennepin County Adult Representation Services, Scotty Ducharme has dealt with horror stories and seen cases of extreme child abuse up close. But when allegations have arisen almost exclusively from a medical diagnosis from a child abuse pediatrician, which he calls a “CAP,” he has also seen signs that not all the doctors on the child’s treatment team are in lockstep.

“If you read the medical records written by the CAPs versus the regular doctors in the cases I’ve worked on, you can see the breadcrumbs by the regular doctors who don’t believe what the CAPs are saying,” he said. “I’ve only caught, on the record, doctors directly contradicting each other a few times.”

“I’ve only caught, on the record, doctors directly contradicting each other a few times,” said Scotty Ducharme, a former attorney for indigent parents at Hennepin County Adult Representation Services who is now in private practice.

In the spring of 2023, Ducharme met María Alejandra Ramírez Rodríguez and her husband, Cristian Andrés Guzmán de la Ossa, a couple in their 20s. Recent arrivals from Colombia who spoke no English, they brought their 4-week-old son to Hennepin County Medical Center in Minneapolis after noticing bruises on his thighs, back, forehead and face. They had taken photos of previous bruises as well, which they shared with doctors. (ProPublica is not naming the child to protect his privacy.) The couple also brought him to the hospital when he was 12 days old because his umbilical stump wouldn’t stop bleeding.

Harper examined the baby and reviewed X-rays of his skeleton. The results were alarming; he had 14 healing rib fractures, as well as fractures in his arms and legs in various states of healing. Harper wrote that the baby was “at grave risk for further injury, morbidity and mortality,” and the Hennepin County Attorney’s Office filed an expedited petition to permanently sever the parents’ rights. The baby was placed in foster care with a woman who worked as a nurse.

When Ducharme looked at the medical records, he saw that the baby had gone through a number of blood tests, including ones to check for clotting disorders. Several metrics were marked slightly outside of the normal range, including a reading for a protein tied to a genetic clotting disorder called von Willebrand disease. Ducharme zeroed in on a particular note, perhaps a “breadcrumb,” written by the pediatrician who saw the baby before Harper; he wrote that the baby would need more follow up from the hematology department “if more bruising develops.”

While in the care of the foster parent, the baby developed new bruises and Harper evaluated him again. A new abuse investigation was opened against the foster parent, and he was moved to a second foster family — in this case, a pediatrician and her husband. Once again, the baby developed new bruises, according to his visitation supervisor.

“This is medical, something weird is going on here,” Ducharme remembered thinking.

But according to notes from the CPS investigator, Harper declined to change her determination or to perform additional blood clotting disorder tests as the first doctor had advised: “Would not be any different now so they did not repeat those tests,” he wrote. He added that in Harper’s opinion, whoever bruised the baby in April was the most likely offender in subsequent incidents.

In her notes, Harper also questioned whether the marks noticed on the baby while he was living with his second foster family were true bruises. Instead, prosecutors posited a new theory in the case: that Ramírez and Guzmán were surreptitiously abusing their son during visits, even though the visits were supervised by a woman who works as an observer in CPS cases. To Ducharme, that strained credulity. He became concerned that Harper was too unwilling to change her diagnoses, and that prosecutors were reluctant to challenge her.

“She has this level of cachet with prosecutors, it’s like a trauma bond. I’m sure she’s right more than 90% of the time,” he said. “They’re unwilling to see her failures.”

But not everyone is. In several cases in recent years, judges and juries have found Harper’s diagnoses unconvincing. In 2024, a Wisconsin judge barred Harper from telling the jury that a child died as the result of “abusive head trauma, non-accidental injury, child abuse, or murder.”

“Dr. Harper sees herself as an advocate, at least in part, and this blurs her role as scientist and clinician with the role of advocate against child abuse, further calling into question her fidelity to the scientific validation of abusive head trauma diagnoses, especially when it is a close call,” the judge said.

In another Wisconsin case, Paul Marshall was found not guilty in 2023 of shaking his 7-week-old son, Fox, to death. Harper examined the boy at Children’s Minnesota, a hospital in St. Paul. A spokesperson for Children’s Minnesota declined to comment on the case.

“We were put through the grinder,” Marshall said. “We don’t get our son back, and we don’t get a lot of the closure that we should have had as a family. That was robbed from us.”

The Marshalls at home with their two daughters. “We don’t get our son back, and we don’t get a lot of the closure that we should have had as a family. That was robbed from us,” Paul Marshall said.

After Ducharme became convinced that there was a medical explanation for Ramírez’s baby’s injuries, he prepared a memo that pointed out a number of possible contributing factors, including that Ramírez had gone days without eating while she was pregnant and traveling across the U.S.-Mexico border from Colombia and had a difficult delivery in Minneapolis. Ramírez got her own medical records from Colombia which showed that, as a child, she’d also experienced unexplained bruising.

To challenge the prosecutors’ theory that the baby’s new bruises were from further abuse by the parents, Ducharme spoke to their visitation supervisor. She provided a sworn affidavit saying that she did not witness any abusive behavior from the parents, and that she’d become so stressed in part from the pressure to say she had witnessed abuse that she asked to be taken off the case. She also wrote that CPS workers were lying to and about the couple, claiming that the foster parents spoke Spanish, which they did not, and that Ramírez and Guzmán were unreliable about keeping visitation appointments.

“The parents attended every visit. They never cancelled,” the supervisor wrote. “Even when their tire popped on the way to their first supervised visitations, they got an Uber and were only about five minutes late.”

A judge ruled that there was “no evidence” that the parents were abusing their baby at visits and ordered a second medical opinion. But before that could happen, the county agreed to drop the termination of parental rights petition after Ramírez and Guzmán agreed to acknowledge that their son “sustained serious injury” while living with them, without admitting guilt. The case was converted to a regular child protection matter, which allowed the couple to have home visits. They eventually regained custody, and the case was closed in April 2024.

“There’s no accountability. There’s no finding of fact,” Ducharme said. “You think: ‘You get your baby back. None of the rest of it matters.’ But it matters.”

The couple found the entire experience bewildering and traumatic. Although they are now reunited, they missed six months of their newborn son’s life. Ramírez didn’t have the chance to breastfeed after the first foster parent began feeding her son formula instead of the breast milk she was pumping.

“We didn’t see him crawl. We didn’t see him turn over —” Guzmán said.

“We didn’t see him sit up,” Ramírez said.

María Alejandra Ramírez Rodríguez and her husband, Cristian Andrés Guzmán de la Ossa, brought their 4-week-old son to Hennepin County Medical Center in Minneapolis after noticing bruises on his body. After an evaluation by Harper, their son was sent into foster care for months before he was returned to them.

Although they worry about doing anything that might draw attention from immigration authorities, in late May they filed a federal civil lawsuit against Harper and the institutions she works for. Ducharme, who left his job at Hennepin County and is now in private practice, is representing the couple in the lawsuit, which alleges that Harper acted in “bad faith,” and that because of her actions there was no “genuine investigation” into the baby’s medical condition.

According to a spokesperson for Harper’s employer, University of Minnesota Physicians, they have not been served with the lawsuit yet and have not responded to the allegations.

“Why, after they didn’t find any physical abuse, did the hospital not keep doing exams to see if there was something medically wrong with him?” Guzmán asked. “They robbed us of our child without any real explanation.”

In late May 2023, a year and a half after Hank’s case, Sharon was on his way home from work when he got a phone call. A new case had come into the emergency room at Masonic Children’s Hospital that needed his consultation: a 3-month-old boy named Daniel. An MRI had shown fluid on his brain. CPS was already investigating whether this was abuse.

“Not again,” Sharon recalled thinking. He turned his car around.

At the hospital, he learned the unusual circumstances that had brought Daniel to the hospital: His mother, a pediatric nurse, had volunteered her son for an academic study that needed the MRIs of healthy children as a baseline. Someone on the research team noted fluid in Daniel’s brain, and a report was made to child protection services.

After meeting with the parents, examining Daniel and reviewing the MRI report, Sharon wrote up a one-page note. Among other things, he recommended that CPS continue assessing Daniel for possible abuse. But after what had happened with Hank’s case the year before, Sharon also put his views on the record.

“One should practice extreme caution attributing isolated intracranial fluid collection to abusive head trauma when no additional clinical signs or symptoms are found,” he wrote, “as the evidence to support this is controversial and has been questioned by many authorities (medical as well as legal).”

After a day in the hospital, Daniel and his parents, Grace and Paul, were allowed to go home together, although they said the CPS investigation remained open for a month. George, the same doctor involved in Hank’s case, asked Daniel’s parents to bring him back two weeks later, where Grace said he screamed as he was pinned down for additional X-rays and to check for bruises. According to medical records, George determined that Daniel had experienced an “accidental trauma” but did not attribute the cranial fluid to abuse.

Nevertheless, according to Sharon, his supervisor called to tell him that, once again, Harper was concerned about the legal liability created by his note, and that his opinion about the bleeding was “beyond the scope” of his practice. Struck by the similarities in Daniel’s and Hank’s cases, Sharon wrote another letter reiterating his concerns from the conference call in February 2022. He said that he’d spoken to many colleagues at the hospital who shared those concerns, and that he strongly believed “our organization must acknowledge and address these concerns in a transparent manner.”

In late June, University of Minnesota records show that three complaints were filed within days of one another against Sharon. Because the complaints were closed without discipline, they are protected personnel data under Minnesota law.

The first complaint was filed the same day he said he received an invite to a meeting with Dr. Joseph Neglia, head of the University of Minnesota Medical School’s Department of Pediatrics, physician-in-chief at Masonic Children’s Hospital and one of the people included on the February 2022 call. The second complaint was filed a few days later, while the third came the day before the meeting took place.

According to Sharon, an attorney for University of Minnesota Physicians at the meeting told him he was “weaponizing” his notes. A week and a half after that, Sharon said, Neglia brought him in again and gave him a choice: resign or be terminated on the spot. Sharon was shocked. He ultimately resigned.

Under an agreement with University of Minnesota Physicians, Sharon stayed on the job for several months with strict guidelines, including that he was prohibited from working with the infectious disease division. Neglia warned Sharon in a letter to “maintain a high level of professionalism and decorum” and not to engage in “any behavior that could be perceived as retaliation,” echoing the language in Gupta’s peer review letter to Sharon.

“You will refrain and remove yourself from involvement in any cases of suspected child abuse or potential non-accidental trauma,” Neglia wrote. “This includes any interactions with or communication with parents or guardians of a patient in such a case.”

Neglia did not respond to requests for comment.

At the time of his departure, Sharon was one of only a small number of doctors in the country who treated a complicated immune disease with behavioral symptoms in children known by the acronym PANDAS or PANS. Parents of Sharon’s patients were so upset by news of his resignation that they went to the local newspaper.

The coverage prompted an investigator from the Minnesota Attorney General’s Office to reach out to Sharon, and Sharon said he took the opportunity to share his concerns about the child abuse protocols at his former workplace. He said he has yet to hear back. A spokesperson at the attorney general’s office declined comment.

On a recent April afternoon, Sharon arrived at a restaurant in a suburb of Minneapolis. Tucked in a back corner table was Daniel, now a blond-headed 2-year-old, Grace, Paul and Grace’s mother. Sharon had not seen them since that day in the emergency room two years ago, and the family wanted to thank him for what he’d done. (Because Grace is a pediatric nurse and because she wants to protect her son’s privacy, ProPublica agreed to withhold the families’ full names.)

Grace still feels traumatized by the 24 hours she spent at Masonic Children’s Hospital, not sure if she’d be allowed to take her son home. She remembers that the one person who seemed to be in her corner was Sharon and how it felt to read that single line in her son’s medical report that may have cost Sharon his job.

“That was the light in the darkness at that point,” she said.

Daniel with parents, Grace and Paul. Grace still feels traumatized by the 24 hours she spent at Masonic Children’s Hospital, unsure if she’d be allowed to take her son home.

Since the incident, Grace said, she has had to work with George on cases of suspected child abuse and said she has become more understanding of how parents are treated.

For his part, Sharon characterizes the entire experience as “surreal.” He commutes from Minnesota to Colorado and Wyoming for temporary hospitalist and clinical work, but he is still looking for a full-time job. He wants to get back to treating infectious diseases and thinking about pediatric immunology, and he worries that he could be hurting his own reputation by speaking out about how hospitals deal with cases of suspected child abuse.

At the same time, he said he feels that he has to push back against the attempt to get him, and other physicians like him who may disagree with a child abuse pediatrician, to “fall in line.”

After leaving his job, Sharon got a tattoo on the inside of his left forearm, a quote attributed to Albert Einstein he said reflects his thinking and his actions at Masonic Children’s Hospital: “Unthinking respect for authority is the greatest enemy of truth.”

Mariam Elba contributed research. Melissa Sanchez and Agnel Philip contributed reporting.

by Jessica Lussenhop, and photography by Sarahbeth Maney

Kristi Noem Secretly Took a Cut of Political Donations

2 days 1 hour ago

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In 2023, while Kristi Noem was governor of South Dakota, she supplemented her income by secretly accepting a cut of the money she raised for a nonprofit that promotes her political career, tax records show.

In what experts described as a highly unusual arrangement, the nonprofit routed funds to a personal company of Noem’s that had recently been established in Delaware. The payment totaled $80,000 that year, a significant boost to her roughly $130,000 government salary. Since the nonprofit is a so-called dark money group — one that’s not required to disclose the names of its donors — the original source of the money remains unknown.

Noem then failed to disclose the $80,000 payment to the public. After President Donald Trump selected Noem to be his secretary of the Department of Homeland Security, she had to release a detailed accounting of her assets and sources of income from 2023 on. She did not include the income from the dark money group on her disclosure form, which experts called a likely violation of federal ethics requirements.

Experts told ProPublica it was troubling that Noem was personally taking money that came from political donors. In a filing, the group, a nonprofit called American Resolve Policy Fund, described the $80,000 as a payment for fundraising. The organization said Noem had brought in hundreds of thousands of dollars.

There is nothing remarkable about a politician raising money for nonprofits and other groups that promote their campaigns or agendas. What’s unusual, experts said, is for a politician to keep some of the money for themselves.

“If donors to these nonprofits are not just holding the keys to an elected official’s political future but also literally providing them with their income, that’s new and disturbing,” said Daniel Weiner, a former Federal Election Commission attorney who now leads the Brennan Center’s work on campaign finance.

ProPublica discovered details of the payment in the annual tax form of American Resolve Policy Fund, which is part of a network of political groups that promote Noem and her agenda. The nonprofit describes its mission as “fighting to preserve America for the next generation.” There’s little evidence in the public domain that the group has done much. In its first year, its main expenditures were paying Noem and covering the cost of some unspecified travel. It also maintains social media accounts devoted to promoting Noem. It has 100 followers on X.

In a statement, Noem’s lawyer, Trevor Stanley, said, “Then-Governor Noem fully complied with the letter and the spirit of the law” and that the Office of Government Ethics, which processes disclosure forms for federal officials, “analyzed and cleared her financial information in regards to this entity.” Stanley did not respond to follow-up questions about whether the ethics office was aware of the $80,000 payment.

Stanley also said that “Secretary Noem fully disclosed all of her income on public documents that are readily available.” Asked for evidence of that, given that Noem didn’t report the $80,000 payment on her federal financial disclosure form, Stanley did not respond.

Before being named Homeland Security secretary, overseeing immigration enforcement, Noem spent two decades in South Dakota’s government and the U.S. House of Representatives, drawing a public servant’s salary. Her husband, Bryon Noem, runs a small insurance brokerage with two offices in the state. Between his company and his real estate holdings, he has at least $2 million in assets, according to Noem’s filing.

While she is among the least wealthy members of Trump’s Cabinet, her personal spending habits have attracted notice. Noem was photographed wearing a gold Rolex Cosmograph Daytona watch that costs nearly $50,000 as she toured the Salvadoran prison where her agency is sending immigrants. In April, after her purse was stolen at a Washington, D.C., restaurant, it emerged she was carrying $3,000 in cash, which an official said was for “dinner, activities, and Easter gifts.” She was criticized for using taxpayer money as governor to pay for expenses related to trips to Paris, to Canada for bear hunting and to Houston to have dental work done. At the time, Noem denied misusing public funds.

Noem’s personal company, an LLC called Ashwood Strategies, shares a name with one of her horses. It was registered in Delaware early in her second term as South Dakota governor, around 1 p.m. on June 22, 2023. Four minutes later, the nonprofit American Resolve Policy Fund was incorporated in Delaware too.

American Resolve raised $1.1 million in 2023, according to its tax filing. The group reported that it had zero employees, and what it did with that money is largely unclear.

Noem’s Ashwood Strategies received an $80,000 fundraising fee in 2023 for raising $800,000 for the nonprofit, according to the group’s tax filing. (Internal Revenue Service. Screenshot and highlights by ProPublica.)

In 2023, the nonprofit spent only about $220,000 of its war chest — with more than a third of that going to Noem’s LLC. The rest mostly went toward administrative expenses and a roughly $84,000 travel budget. It’s not clear whose travel the group paid for.

The nonprofit reported that it sent the $80,000 fundraising fee to Noem’s LLC as payment for bringing in $800,000, a 10% cut. A professional fundraiser who also raised money for the group was paid a lower rate of 7%.

In the intervening years, American Resolve has maintained a low public profile. In March, it purchased Facebook ads attacking a local news outlet in South Dakota, which had been reporting on Noem’s use of government credit cards. Noem’s lawyer did not answer questions about whether the group paid her more money after 2023, the most recent year for which its tax filing is available.

The nonprofit has an affiliated political committee, American Resolve PAC, that’s been more active, at least in public. Touting Noem’s conservative leadership under a picture of her staring off into the sky, its website said the PAC was created to put “Kristi and her team on the ground in key races across America.” Noem traveled the country last year attending events the PAC sponsored in support of Republican candidates.

American Resolve’s treasurer referred questions to Noem’s lawyer. In his statement, Noem’s lawyer said she “did not establish, finance, maintain, or control American Resolve Fund. She was simply a vender for a non-profit entity.”

While Noem failed to report the fundraising income Ashwood Strategies received on her federal financial disclosure, she did provide some other details. She described the LLC as involving “personal activities outside my official gubernatorial capacity” and noted that it received the $140,000 advance for her book “No Going Back.” The LLC also had a bank account with between $100,001 and $250,000 in it and at least $50,000 of “livestock and equipment,” she reported.

The fact that Ashwood Strategies is Noem’s company only emerged through the confirmation process for her Trump Cabinet post. South Dakota has minimal disclosure rules for elected officials, and Noem had not previously divulged that she created a side business while she was governor.

Noem’s outside income may have run afoul of South Dakota law, according to Lee Schoenbeck, a veteran Republican politician and attorney who was until recently the head of the state Senate. The law requires top officials, including the governor, to devote their full time to their official roles.

“There’s no way the governor is supposed to have a private side business that the public doesn’t know about,” Schoenbeck told ProPublica. “It would clearly not be appropriate.”

Noem’s lawyer said South Dakota law allowed her to receive income from the nonprofit.

Do you have any information we should know about Kristi Noem or other administration officials? Justin Elliott can be reached by email at justin@propublica.org and by Signal or WhatsApp at 774-826-6240. Josh Kaplan can be reached by email at joshua.kaplan@propublica.org and by Signal or WhatsApp at 734-834-9383.

by Justin Elliott, Joshua Kaplan and Alex Mierjeski

States Fear Critical Funding From FEMA May Be Drying Up

5 days 1 hour ago

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Upheaval at the nation’s top disaster agency is raising anxiety among state and local emergency managers — and leaving major questions about the whereabouts of billions of federal dollars it pays out to them.

The Federal Emergency Management Agency still has not opened applications for an enormous suite of grants, including ones that many states rely on to pay for basic emergency management operations. Some states pass on much of that money to their most rural, low-income counties to ensure they have an emergency manager on the payroll.

FEMA has blown through the mid-May statutory deadline to start the grants’ application process, according to the National Emergency Management Association, with no word about why or what that might indicate. The delay appears to have little precedent.

“There’s no transparency on why it’s not happening,” said Michael A. Coen Jr., who served as FEMA’s chief of staff under former Presidents Barack Obama and Joe Biden.

FEMA’s system of grants is complex and multifaceted and helps communities prepare for and respond to everything from terrorist attacks to natural disasters.

In April, the agency abruptly rescinded a different grant program that county and local governments were expecting to help them reduce natural hazard risks moving forward. The clawback of money included hundreds of millions already pledged. FEMA also quietly withdrew a notice for states to apply for $600 million in flood mitigation grants.

On top of that, on June 11, U.S. Department of Homeland Security Secretary Kristi Noem began requiring that she review all FEMA grants above $100,000. That could slow its vast multibillion grants apparatus to a crawl, current and former FEMA employees said.

FEMA did not answer ProPublica’s questions about the missed application deadline or the impact of funding cuts and delays, instead responding with a statement from DHS Assistant Secretary Tricia McLaughlin that Noem is focused on bringing accountability to FEMA’s spending by “rooting out waste, fraud, abuse, and working to ensure only grants that really help Americans in time of need are approved.”

The memo announcing the change arrived the day after President Donald Trump said he wants to begin dismantling FEMA at the close of hurricane season this fall.

All of this has left states — some of which rely on the federal government for the vast majority of their emergency management funding — in a difficult position. While Trump has sharply criticized FEMA’s performance delivering aid after disasters strike, he has said almost nothing about the future of its grant programs.

“It’s a huge concern,” said Lynn Budd, president of the National Emergency Management Association and director of the Wyoming Office of Homeland Security, which houses emergency management. The state agency gets more than 90% of its operating budget from federal funds, especially FEMA grants. “The uncertainty makes it very difficult,” she said.

In North Carolina, a state hit hard by a recent natural disaster, federal grants make up 82% of its emergency management agency’s budget. North Carolina Emergency Management leaders are pressing state lawmakers to provide it with “funding that will sustain the agency and its core functions” and cut its reliance on federal grant funding, an agency spokesperson said.

A forced weaning off of federal dollars could have an outsize impact in North Carolina and the other states that pass on much of their FEMA grants to county and local agencies. Many rural counties have modest tax bases and are already stretched thin.

In May, ProPublica published a story detailing the horrors of Hurricane Helene’s impact on one of those counties, Yancey. Home to 19,000 people, it suffered the largest per capita loss of life and damage to property in the storm. Jeff Howell, its emergency manager, was operating with only a part-time employee and said that for years he had been asking the county commission for more help. It wasn’t until after the storm that county commissioners agreed with the need.

“They realized how big a job it is,” said Howell, who has since retired.

But even large metropolitan counties rely on the grants. The hold upin opening the grant applications concerns Robert Wike Graham, deputy director of Charlotte-Mecklenburg Emergency Management, which serves an area of 1.2 million people and is home to a nuclear power plant. The training and preparation FEMA grants help the agency pay for are critical to keeping the community safe in the face of a nuclear catastrophe.

Yet Graham said he has resorted to scouring social media posts and news reports for bits of clues about the grants — and the future of FEMA itself.

“We’re all having to be like, hey, what have you heard? What do you know? What’s going on? Nobody knows,” Graham said.

Trump is on his second acting FEMA administrator in five months, and the director who coordinates national disaster response turned in his resignation letter June 11. More than a dozen senior leaders, including the agency’s chief counsel, have left or been fired, along with an unknown mass of its full-time workers.

“Every emergency manager I know is screaming, ‘You’re screwing the system up.’ We’ve all been calling for reform,” Graham said. “But it’s too much, too fast.

Vulnerable to Political Shifts

Shortly after President Jimmy Carter created FEMA in 1979 to centralize federal disaster management, the agency began to dole out grants to help communities grappling with large-scale destruction. Over the years, its grants ballooned, especially after the terrorist attacks on Sept. 11, 2001, when huge new programs helped states harden security against this alarming new threat.

Today, FEMA operates roughly a dozen preparedness grant programs. Among other things, the money serves as a financial carrot to ensure that even spending-averse and tax-strapped states and counties employ emergency managers who help communities prepare for and respond to terrorist attacks and natural disasters.

Former FEMA leaders said states have been largely content to sit back and let the feds pay up. As a result, they said, the grants have created a system of dependence that leaves emergency managers vulnerable to ever-shifting national priorities and, at the moment, a president set on dismantling the agency.

Across the country, the percentage of state emergency management agencies’ budgets paid by federal funding ranges from zero to 99.4%, a 2024 National Emergency Management Association report says. A spokesperson declined to provide a state-by-state breakdown, so ProPublica canvassed a few.

Wyoming tops 90%. Texas’ agency gets about three-quarters of its operational budget from federal funding. Virginia gets roughly 70%. South Carolina comes in around 61% federal funding for day-to-day operations.

Most state emergency managers agree that their states need to depend less on the federal government for their funding, “but there’s got to be some glide path or timeline where we can all work toward the goal,” Budd said.

Some states would need upwards of a decade to prepare for such a seismic shift, especially those like Wyoming that budget every other year, she added. Its Legislature is in the middle of budget negotiations for fiscal year 2027-28.

Get in Touch

ProPublica is continuing to report on the aftermath of Hurricane Helene in North Carolina. If you are an emergency manager who would like to tell us about your needs or share your experience with recovery efforts, please email helenetips@propublica.org.

If emergency managers instead are scrambling, “the effects that we’re going to see down the line is a lack of preparedness, a lack of coordination, training and partnerships being built,” Budd said. “We’re not going to be able to respond as well.”

A key reason states have become so dependent on FEMA grants despite the risk of national political upheaval is that state legislatures and local elected leaders haven’t always prioritized paying for emergency management themselves despite its critical role. With FEMA’s grants, they haven’t had to.

W. Craig Fugate has seen reluctance to wean off FEMA grants from all levels of government. He served as FEMA administrator under Obama and, before that, as head of Florida’s emergency management division under then-Govs. Jeb Bush and Charlie Crist.

“My experience tells me locals will not step up unless they are dealing with a catastrophe,” Fugate said.

Because most of the preparedness grants require no match from state or local governments, he said, it strips away any motivation for them to do so — especially with other pressing needs vying for those dollars.

“The real question is how much of this is actually critical and should be the responsibility of local governments to fund?” Fugate said. “Neither local governments nor states have been very forward in funding beyond the minimums to match federal dollars.”

Small-Town North Carolina

After Hurricane Helene, North Carolina’s Emergency Management agency commissioned a report that pointedly criticized the state’s “over-reliance on federal grants to fund basic operations.” Only about 16.5% of the state agency’s budget comes from state appropriations.

The report noted that this reliance had led to an inadequate investment by the state in its emergency management staffing and infrastructure. A staff shortage at the agency “severely compromised the state’s response to Hurricane Helene.” Among other things, a lack of staff hampered the State Emergency Response Team’s ability to maintain a 24-hour operation that was supposed to support local and county officials who were overwhelmed by the massive storm.

North Carolina state Rep. Mark Pless, the Republican co-chair of the House Emergency Management and Disaster Recovery Committee, said the state’s conservative spending and $3.6 billion in reserves have “afforded us the ability to fund ourselves for preparedness” if FEMA suddenly yanks its grants.

But Democratic Rep. Robert Reives, the House minority leader, worried that any financial flexibility would dry up if planned and potential tax cuts in the years ahead create a budget shortfall, as some have predicted.

In mostly rural Washington County, along North Carolina’s hurricane-prone coast, Lance Swindell is a one-man emergency management office. His county, home to 11,000 people, lacks a big tax base.

Like other emergency managers across the state, Swindell said he supports cutting FEMA red tape and waste, but “grant funding is a major funding source just to keep the lights on.”

One of the grants in the FEMA program that blew past its deadline for opening applications pays half of his salary. That grant can fund core local operations such as staffing, training and equipment. It is critical to local emergency management offices: Almost 82% of counties across the country report tapping into it.

Cuts to this particular grant under the Biden administration already reduced what North Carolina gets — and therefore what gets passed down the governmental food chain to people like Swindell. North Carolina was allocated $8.5 million in fiscal year 2024, down from $10.6 million two years earlier.

Looking ahead, Swindell is still waiting for the applications to open while wondering if FEMA will more drastically slash the grants — and, if so, whether his county could find the money to continue paying his full-time salary.

Mollie Simon contributed research.

by Jennifer Berry Hawes

Senators Demand Investigation Into Canceled VA Contracts, Citing “Damning Reporting From ProPublica”

5 days 23 hours ago

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What Happened

Senators this week called for a federal investigation into the Trump administration’s killing of hundreds of contracts for the Department of Veterans Affairs. Democrat Richard Blumenthal of Connecticut and Angus King, a Maine independent, wrote to the agency’s inspector general on Monday asking for an investigation into the administration’s cancellation of the contracts and the consequences for veterans.

The senators highlighted “damning reporting from ProPublica” on the cancellations, including how the Department of Government Efficiency used an artificial intelligence tool that marked contracts as “MUNCHABLE.”

The senators wrote that DOGE’s use of AI to scrutinize contracts “adds an entire new level of unease connected to the decision-making, security, governance, and quality control of the entire process.”

VA officials have said they’ve killed nearly 600 contracts after DOGE’s review but have declined requests by lawmakers and ProPublica for details.

“Despite repeated requests in letters to the Secretary, questions at hearings, and dozens of emails to VA officials,” the senators wrote, “the Department has not provided a single briefing or a complete and accurate list of the contracts it has cancelled.”

Blumenthal and King wrote that the VA shared a list of contracts in May, but it was “riddled with errors and inaccuracies.”

What They Said

Amid the administration’s “stonewalling,” Blumenthal said in a statement, “ProPublica’s reporting revealed these cancelled contracts were delivering essential services to veterans and exposed the cruel and dumb AI formulas DOGE bros used to cancel contracts.”

Blumenthal added, “Veterans and all Americans deserve transparency around decisions being made at VA.”

Background

As ProPublica detailed, a DOGE staffer with no background in government or health care created the AI tool used to mark contracts as “munchable.” Among the contracts that were tagged and later killed was one to maintain a gene sequencing device for improving cancer treatment. Another was for blood sample analysis in support of a VA research project. And a third was to help measure and improve nursing care.

In another story, we reported how VA doctors and other staffers across the country have raised alarms about how the killing of contracts could threaten veterans’ care. In internal emails, hospital staffers warned about canceled contracts to maintain cancer registries, where information on the treatment of patients is collected and analyzed. DOGE had marked one such contract “for immediate termination.”

Why it Matters

The VA is one of the nation’s largest health care providers, charged with the care of more than 9 million veterans. President Donald Trump has long promised to prioritize former service members. “We love our veterans,” he said in February. “We are going to take good care of them.”

The administration has reiterated that stance even as the VA has been shedding employees and contracts. Amid the cutbacks, Trump’s pick to run the agency, Secretary Doug Collins, said earlier this year, “Veterans are going to notice a change for the better.”

Response

The VA has not responded to our request for comment about the senators’ letter. Previously, press secretary Pete Kasperowicz said that decisions to cancel or reduce the size of contracts are made after multiple reviews by VA employees, including agency contracting experts and senior staff.

He also said the VA has not canceled contracts that provide services to veterans or work that the agency cannot do itself without a contingency plan in place.

by Eric Umansky and Vernal Coleman

Congress Is Pushing for a Medicaid Work Requirement. Here’s What Happened When Georgia Tried It.

6 days ago

This article was produced for ProPublica’s Local Reporting Network in partnership with The Current. Sign up for Dispatches to get stories like this one as soon as they are published.

Congressional Republicans, looking for ways to offset their proposed tax cuts, are seeking to mandate that millions of Americans work in order to receive federally subsidized health insurance. The GOP tax and budget bill passed the House in May, and Senate Republicans are working feverishly to advance their draft of federal spending cuts in the coming days.

Georgia, the only state with a Medicaid work mandate, started experimenting with the requirement on July 1, 2023. As the Medicaid program’s two-year anniversary approaches, Georgia has enrolled just a fraction of those eligible, a result health policy researchers largely attribute to bureaucratic hurdles in the state’s work verification system. As of May 2025, approximately 7,500 of the nearly 250,000 eligible Georgians were enrolled, even though state statistics show 64% of that group is working.

Gov. Brian Kemp has long advocated for Medicaid reform, arguing that the country should move away from government-run health care. His spokesperson also told The Current and ProPublica that the program, known as Georgia Pathways to Coverage, was never designed to maximize enrollment.

Health care analysts and former state Medicaid officials say Georgia’s experience shows that the congressional bill, if it becomes law, would cost taxpayers hundreds of millions of dollars in administrative costs as it is implemented while threatening health care for nearly 16 million people.

Here’s how proposed federal work requirements compare to Georgia’s — and how they may impact your state:

How will states determine who is eligible?

What Congress proposes:

The House bill, H.R. 1, and draft Senate proposal require all states to verify that Americans ages 19 through 64 who are receiving Medicaid-funded health coverage are spending 80 hours a month working, training for a job, studying or volunteering. These new verification systems would need to be in place by Dec. 31, 2026, and would have to check on enrolled residents’ work status twice a year. That means people who already receive coverage based on their income level would need to routinely prove their eligibility — or lose their insurance.

The federal work requirements would apply to more than 10 million low-income adults with Medicaid coverage as well as approximately 5 million residents of the 40 states that have accepted federal subsidies for people to purchase private health coverage through what’s commonly known as Obamacare.

The House bill exempts parents with children under 18 from the new requirements, while the Senate version exempts parents with children under 15. Neither bill exempts people who look after elderly relatives.

Georgia’s experience:

Georgia’s mandate applies to fewer categories of people than the proposed federal legislation would. Even so, officials failed to meet the state’s tough monthly verification requirement for Pathways enrollees due to technical glitches and difficulty confirming the employment of those who work in the informal economy such as house cleaners and landscapers because they may not have pay stubs or tax records. The challenges were steep enough that Georgia has decided to loosen its work verification protocols from monthly to once a year.

What this means for your state:

The Congressional Budget Office estimates that H.R. 1 would result in at least 10 million low-income Americans losing health insurance. Health care advocates say that’s not because they aren’t working, but because of the bureaucratic hoops they would need to jump through to prove employment. Research from KFF, a health policy think tank, shows that the vast majority of people who would be subject to the new law already work, are enrolled in school or are unpaid stay-at-home caregivers, duties that restrict their ability to earn a salary elsewhere.

Arkansas is the only state other than Georgia to have implemented work requirements. Republican state lawmakers later changed their minds after data showed that red tape associated with verifying eligibility resulted in more than 18,000 people losing coverage within the first few months of the policy. A federal judge halted the program in 2019, ruling that it increased the state’s uninsured rate without any evidence of increased employment.

House Speaker Mike Johnson (Tom Williams/CQ Roll Call via AP)

House Speaker Mike Johnson, a Louisiana Republican, says Medicaid work requirements in H.R. 1 are “common sense.” He says the policy won’t result in health coverage losses for the Americans whom Medicaid was originally designed to help because the work requirements won’t apply to these groups: children, pregnant women and elderly people living in poverty. He points to the $344 billion in a decade’s worth of projected cost savings resulting from Medicaid work requirements as beneficial to the nation’s fiscal health. “You find dignity in work, and the people that are not doing that, we’re going to try to get their attention,” he said earlier this year.

Who will pay for the work verification system in each state?

What Congress proposes:

The House bill allocates $100 million to help states pay for verification systems that determine someone’s eligibility. The grants would be distributed in proportion to each state’s share of Medicaid enrollees subject to the new requirements — an amount health policy experts say will not be nearly enough. States, they say, will be on the hook for the difference.

Georgia’s experience:

In the two years since launching its experiment with work requirements, Georgia has spent nearly $100 million in mostly federal funds to implement Pathways. Of that, $55 million went toward building a digital system to verify participants’ eligibility — more than half the amount House Republicans allocated for the entire country to do the same thing.

Like other states, Georgia already had a work verification system in place for food stamp programs, but it contracted with Deloitte Consulting to handle its new Medicaid requirements. Georgia officials said the state has spent 30% more than they had expected to create its digital platform for Pathways due to rising consultant and IT costs. Deloitte previously declined to answer questions about its Pathways work.

What this means for your state:

All states already verify work requirements for food stamp recipients, but many existing systems would need upgrades to conform to proposed federal legislation, according to three former state Medicaid officials. In 2019, when states last considered work requirements, a survey by the nonpartisan Government Accountability Office showed that Kentucky expected administrative costs to top $200 million — double what H.R. 1 has allocated for the country.

Rep. Buddy Carter (Justin Taylor/The Current GA/CatchLight Local)

Rep. Buddy Carter, the Republican who represents coastal Georgia and chairs the health subcommittee of the House Energy and Commerce Committee, which had recommended Medicaid cuts in H.R. 1, said that upfront costs borne by states would be offset by longer-term savings promised in the House bill. Some congressional Republicans concede that the cost savings will come from fewer people enrolling in Medicaid due to the new requirements. Savings from work mandates amount to 43% of the $793 billion in proposed Medicaid cuts, according to the Congressional Budget Office.

How will states staff the program?

What Congress proposes:

Medicaid is a federal social safety net program that is administered differently in each state. Neither H.R. 1 nor the Senate legislative proposal provides a blueprint for how states should verify eligibility or how the costs of overseeing the new requirements will be paid.

Georgia’s experience:

Georgia’s experience shows that state caseworkers are key to managing applications and work requirement verifications for residents eligible for Medicaid. The agency that handles enrollment in federal benefits had a staff vacancy rate of approximately 20% when Georgia launched its work requirement policy in 2023. Georgia at the time had one of the longest wait times for approving federal benefits. As of March, the agency had a backlog of more than 5,000 Pathways applications. The agency has said it will need 300 more caseworkers and IT upgrades to better manage the backlog, according to a report submitted to state lawmakers in June.

What this means for your state:

Former state Medicaid officials and health policy experts say Georgia’s staffing struggles are not unique. In 2023, near the end of the COVID-19 public health emergency, KFF surveyed states about staffing levels for caseworkers who verify eligibility for federal benefits, including Medicaid. Worker vacancy rates exceeded 10% in 16 of the 26 states that responded; rates exceeded 20% in seven of those states.

Adding caseworkers will mean higher costs for states. Currently, 41 states require a balanced budget, meaning that those state legislators would either need to increase taxes and revenues to verify Medicaid enrollees are working or lower enrollment to reduce costs, said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

In about half a dozen large states where county governments administer federal safety net programs, the costs of training caseworkers on the new verification protocols could trickle from states to counties.

“There are provisions in there that are very, very, very challenging, if not impossible, for us to implement,” Sen. Lisa Murkowski, an Alaska Republican, told reporters in June of the costs facing her state to meet the House bill requirements.

by Margaret Coker, The Current

“You’re Already Approved”: How One Tennessee Company Sets a Debt Trap

6 days 1 hour ago

This article was produced for ProPublica’s Local Reporting Network in partnership with Tennessee Lookout . Sign up for Dispatches to get stories like this one as soon as they are published.

ProPublica and the Tennessee Lookout are continuing to investigate online sportsbook Action 247 and Harpeth Financial, which owns Flex Loan operator Advance Financial. To tell us about the experience you had with either or both companies, call or text reporter Adam Friedman at 615-249-8509.

Jeanette Thomas had just made her first payment on a loan from payday lender Advance Financial when she said the company emailed her with “good news.” She could borrow $206 more.

The solicitation was a relief to Thomas, a 62-year-old grandmother who had already exhausted the $783 disability check she receives each month since her health conditions render her unable to work.

Over the next few months, Thomas made the required minimum payments on what started in 2019 as a $400 loan to buy Christmas presents. But each time she did so, the company invited her to borrow almost all of the payment back, she said, with emails or letters like “Access Your Cash Today” or “You’re Already Approved.”

“They kept trying to rope me in,” Thomas said.

In the months that followed, the company continued to expand her credit, allowing Thomas to borrow close to $1,600 in total. In the emails and letters that Thomas kept, Advance never stated how much it would cost if she continued to reborrow.

Thomas had read her original loan documents warning that the loan carried a high 279.5% interest rate and would be challenging to pay off. But as the loan balance grew, Thomas came to realize she was trapped. By the spring of 2021, Thomas had paid Advance almost $4,000, yet she still owed more than $1,000 and was paying more than $200 a month to cover the interest, depleting the disability checks that were her only source of income.

Until the Flex Loan, reborrowing or rolling over payday loans was against the law. Tennessee lawmakers first banned reborrowing when they passed the state’s payday lending law in 1997. They reaffirmed that protection in 2011 when they updated that law.

When Tennessee lawmakers passed a 2014 law allowing Flex Loans, they included no such provision.

Instead, the bill’s sponsor, current House Speaker Cameron Sexton, said the loans could be better for borrowers because it required them to make a monthly minimum payment that covered all fees, interest and 3% of the principal. This key provision would ensure that borrowers would always be paying down the principal on the loan.

Thomas and more than a dozen borrowers told the Tennessee Lookout and ProPublica that Advance has encouraged them through emails and notifications to borrow back the value of almost all of the payments they made, tearing a hole in the safety net the law tried to put in place.

All but one of the 14 borrowers who spoke to the newsrooms for this story reported having reborrowed at least once as part of their Advance loan. As with Thomas, Advance made them eligible to borrow more shortly after paying, even though they were often making the minimum payments and almost immediately borrowing the money back to cover the cost of the payment they just made. Advance went on to sue 12 of these borrowers once they stopped being able to afford the loan.

Advance Financial sent ads to several borrowers telling them they were eligible to borrow more. (Obtained by Tennessee Lookout and ProPublica. Highlighted and redacted by ProPublica.)

Andrea Heady, 45, was sued by Advance in Knoxville for over $7,300, despite having paid the company nearly double what she ultimately borrowed. She initially took out $750 through a Flex Loan after the hours at her university job were slashed in June 2020.

“I’ve always sent money home to my mom,” who was taking care of Heady’s sister, she said. “It was COVID. My aunt and uncle were very sick, then they passed away and I just needed money.”

Heady said Advance would send her notifications letting her know she could borrow more. One email appeared as a financial statement, but included in bold and large text was the amount she had available to borrow. The statement did not provide a payment schedule, a new loan amount, the total cost of the loan or how long it would take to pay off making minimum payments, information a lender would have been required to provide if she'd been borrowing on a credit card.

Andrea Heady reborrowed on her Flex Loan over a dozen times after receiving notifications from Advance saying that she could borrow more. (Stacy Kranitz for ProPublica)

Heady reborrowed on her Flex Loan over a dozen times over the next 18 months as Advance increased her credit limit seven times. She stopped paying when her monthly payments of $650 equaled a quarter of her paycheck.

Heady hoped the company would forget about her, but it didn’t. In 2024 Advance sued and won a wage garnishment against her. Ultimately, Heady will end up paying Advance over $14,000 on the $3,850 she borrowed.

David Hill, a 36-year-old from Nashville, started by borrowing $175 from Advance in February 2020. Each month he would repay the full borrowed amount, including interest and fees, and reborrow the principal, often on the same or next day. Over 18 months, he reborrowed almost 80 times.

“COVID happened and I was going through financial trouble,” Hill said. “I would get a check and pay it off. But then I would have to borrow it back to have money.”

David Hill received emails from Advance encouraging him to borrow more money, which he ultimately did almost 80 times. (Stacy Kranitz for ProPublica)

Via email, Advance kept increasing his credit limit and encouraging him to borrow more. “Dear David,” started two of the emails, which contained notes like “good news — you have $645 available.” Hill eventually reached a point where he couldn’t afford the minimum payment, totaling over $400 a month.

He stopped paying and the company sued him in 2023 for over $4,700.

The Lookout and ProPublica sent detailed questions to Cullen Earnest, the senior vice president of public policy at Advance Financial. Earnest repeated what he said in a previous statement, that the company has an A+ rating from the Better Business Bureau. He added that the Tennessee Department of Financial Institutions has received just 91 complaints about flexible credit lenders since 2020, representing less than 0.001% of all new flex loan agreements, and that this data reflects the satisfaction of the vast majority of Advance’s customers.

The Tennessee Lookout and ProPublica previously reported that the company has sued over 110,000 Tennesseeans since it began offering the Flex Loan in 2015, making it one of the largest single plaintiffs in the state. One of the subjects in that story reborrowed on her Flex Loan over a dozen times, turning $4,400 in borrowed cash into more than $12,500 in payments to Advance. The company sued her and won a judgment that led to the garnishment of her wages.

Christopher Peterson, a senior official with the federal Consumer Financial Protection Bureau from 2012 to 2016 and a contributor to multiple reports about payday loans, said the agency sought to limit reborrowing on payday and title loans because the desire to borrow again often indicated that borrowers couldn’t afford the loans and would be paying them off forever. That is especially true of the Flex Loan in Tennessee, he said.

“It’s a nasty loan,” he said.

A Better Loan?

The CFPB began targeting high-interest lenders in 2013, releasing a report on the dangers of payday loans and how reborrowing often led to debt traps.

With the threat of federal regulation looming, Advance Financial Chairman Michael Hodges started working with Tennessee lawmakers to create a new type of high-interest loan that would avoid federal oversight, he told the Nashville Business Journal.

In Tennessee’s state House, Advance and other high-interest lenders turned to Sexton to sponsor the legislation.

Sexton was then the majority whip, a position typically reserved for ambitious state House members hoping to travel up the party’s ranks. Sexton also knew banking. He worked at a local bank as a business development executive, a position he still holds today, along with having a seat on its board.

Cameron Sexton, now the speaker of the Tennessee House, sponsored the Flex Loan legislation in 2014. (John Partipilo/Tennessee Lookout)

Starting in the spring of 2014, Sexton began guiding Flex Loan legislation through Tennessee’s state House committees. On the surface, the bill appeared to be a new type of loan with a 24% interest rate, which would be significantly cheaper than the triple-digit interest on payday and title loans. But the actual cost could be found in the bill’s details, which gave lenders the right to charge a 0.7% daily customary fee, which over a year adds another 255.5%.

Official video recordings from legislative committee hearings show that neither legislators nor Sexton discussed reborrowing or the loan’s interest rate.

When Sexton took to the Tennessee House floor in April 2014, his colleagues showed him deference because of his banking experience, said former Rep. Craig Fitzhugh, a rural West Tennessee Democrat and the minority leader at the time, who sponsored the original payday lending legislation in 1997.

During the hearing, Fitzhugh asked Sexton if he thought the soon-to-be-created Flex Loan was “a step up for consumers” compared to payday and title loans. Sexton said that was a “fair statement.”

When a lawmaker asked about the interest rate, Sexton said it was 190% to 210%, which is lower than the actual rate. But Sexton once again assured lawmakers that the minimum payment would reduce the cost of the loan for consumers.

“When you reduce the principal each and every month, obviously you’re decreasing the amount of interest,” Sexton said from the House floor.

The Flex Loan legislation passed the Tennessee House 83-6, with Fitzhugh abstaining from the vote. Fitzhugh said the high-interest lending landscape in Tennessee has only “gotten worse” over the past decade because of Flex Loans.

Rep. Gloria Johnson, a Knoxville Democrat, said she regrets voting for the Flex Loan legislation and feels like proponents of the legislation misled her.

“I definitely would not vote that way today, and would like to work to fix that massive mistake that’s hurt so many Tennesseans,” Johnson said.

A spokesperson for Sexton did not respond to questions from Tennessee Lookout and ProPublica.

Since passing the Flex Loans bill in 2014, Sexton has received over $105,000 in contributions to his campaign and political action committee from Advance Financial and its affiliated PACs, making them one of his largest contributors.

No Money for Food

Over five years after the law passed, Jeanette Thomas walked into an Advance Financial store three weeks before Christmas 2019 and filled out an application.

Thomas said she listed her income, gave them her debit card number and permission to directly charge her bank account the required monthly minimum payment. A borrower isn’t required to put up any assets, like a car or future paycheck, to get a Flex Loan.

Thomas wound up in a debt trap, borrowing again and again to keep herself afloat. The Consumer Financial Protection Bureau had tried to restrict reborrowing to protect consumers from falling into this kind of hole. (Stacy Kranitz for ProPublica)

Unlike some other borrowers, Advance allowed Thomas to pay monthly, instead of biweekly, because that’s how she received her federal disability benefits. Thomas said she suffered physical abuse for decades that left her with a traumatic brain injury.

The company deposited $400 into her account the same day she walked into the store.

At the time of the loan, Thomas had been trying to build a better relationship with her two sons and three grandchildren. She used the money to purchase gift cards, art supplies and toys. She was happy to be able to give her family something for the holidays.

Thomas’ first minimum payment to Advance was due Dec. 31 and was a manageable $51.78. That December had been cold, and when Thomas’ heat bill came in $50 higher than normal, she started to worry.

Then, just two days after her loan payment, Thomas said an unsolicited email arrived from Advance telling her she was eligible to borrow $206 more. Thomas thought she could afford it. Why would Advance loan her money she couldn’t pay back, she said she thought.

What Thomas did not realize was her first bill had only been for a 13-day payment period, meaning she’d been charged less than two weeks of interest. By taking the additional loan for an entire month, her monthly payment would almost triple to $130 per month.

Over the next two months, the company offered her a lifeline, extending her credit limit enough that she could make her payments with the money she’d just borrowed.

Eventually, Advance stopped increasing her credit limit and her monthly payment had increased to $230 a month, almost a third of her disability check.

Thomas cut her spending to the bone, hoping that a few months of payments would get her out of debt. She turned to friends to help pay for food, and to a local church to cover her utility bill.

Thomas said Advance sent her mailers and emails multiple times a month, offering to let her borrow any of the principal she had paid off. She tried to resist, but inevitably, she would have an unexpected expense, like medical bills from a series of mini strokes.

Thomas found herself in the position the CFPB had warned about when it sought to restrict reborrowing. Former CFPB official Peterson, who’s now a law professor at the University of Utah, helped work on the agency’s 2017 payday regulations. At the time, the agency wrote that consumers who reborrowed would inevitably be forced to choose between making an unaffordable payment on the loan or paying for necessities like food or rent.

By May 2021, Thomas could no longer afford to pay. The company kept her loan open and unpaid for 90 days, allowing the interest and fees to accumulate, nearly doubling the amount due to $1,700. Advance then charged Thomas two times in one week, withdrawing $430, or half of her monthly budget.

“I can remember just lying in my bed, stomach hurting and doubled over in pain because I couldn’t get something to eat,” Thomas said.

Not knowing where to turn for help, Thomas filed a complaint with the Tennessee attorney general’s Division of Consumer Affairs. In her complaint, she wrote that Advance “needs to stop abusing their power.”

“Now I cannot pay my rent,” she said.

The state investigated the case and took no action. By October 2022, Advance noted on one of Thomas’s monthly bills that it had “written off” her loan and closed her account. Unlike the other 110,000 Tennesseans who fell behind in their payments, Advance hasn’t sued Thomas, whose federal benefits are protected from garnishment.

The company also agreed in a letter to the state to “cease all communications” with Thomas, but Advance continues to send bills requesting a minimum payment of $226.49.

Thomas continues to receive bills requesting a minimum payment of $226.49 years after closing her account with Advance Financial. (Obtained by Tennessee Lookout and ProPublica. Highlighted by ProPublica.)

Mollie Simon contributed research.

Correction

June 27, 2025: A call for tips at the top of this story originally misstated the extent of the connection between two companies. It is not clear if Harpeth Financial owns Action 247. The nature of the ownership of Action 247, which shares executives and addresses with Advance Financial, is not made public in Tennessee public documents, and leadership in all three entities refused to answer questions about who in fact owns the sportsbook.

by Adam Friedman, Tennessee Lookout

A New Trump Plan Gives DHS and the White House Greater Influence in the Fight Against Organized Crime

1 week ago

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The Trump administration has launched a major reorganization of the U.S. fight against drug traffickers and other transnational criminal groups, setting out a strategy that would give new authority to the Department of Homeland Security and deepen the influence of the White House.

The administration’s plans, described in internal documents and by government officials, would reduce federal prosecutors’ control over investigations, shifting key decisions to a network of task forces jointly led by the FBI and Homeland Security Investigations, the primary investigative arm of DHS.

Officials said the plan to bring law enforcement agencies together in the new Homeland Security Task Forces has been driven primarily by President Donald Trump’s homeland security adviser, Stephen Miller, who is closely overseeing the project’s implementation.

Current and former officials said the proposed reorganization would make it easier for senior officials like Miller to disregard norms that have long walled off the White House from active criminal investigations.

“To the administration’s credit, they are trying to break down barriers that are hard to break down,” said Adam W. Cohen, a career Justice Department attorney who was fired in March as head of the office that coordinates organized crime investigations involving often-competing federal agencies. “But you won’t have neutral prosecutors weighing the facts and making decisions about who to investigate,” he added of the task force plan. “The White House will be able to decide.”

The proposed reorganization would elevate the stature and influence of Homeland Security Investigations and Immigration and Customs Enforcement among law enforcement agencies, while continuing to push other agencies to pursue immigration-related crimes.

The task forces would at least formally subordinate the Drug Enforcement Administration to HSI and the FBI after half a century in which the DEA has been the government’s lead agency for narcotics enforcement.

Trump’s directive to establish the new task forces was included in an Inauguration Day executive order, “Protecting the American People Against Invasion,” which focused on immigration.

The new task forces will seek “to end the presence of criminal cartels, foreign gangs and transnational criminal organizations throughout the United States,” the order states. They will also aim to “end the scourge of human smuggling and trafficking, with a particular focus on such offenses involving children.”

Since that order was issued, the administration has proceeded with considerable secrecy. Some Justice Department officials who work on organized crime have been excluded from planning meetings, as have leaders of the DEA, people familiar with the process said.

A White House spokesperson, Abigail Jackson, did not comment on Miller’s role in directing the task force project or the secrecy of the process. “While the Biden Administration opened the border and looked the other way while Americans were put at risk,” she said, “the Trump Administration is taking action to dismantle cross-border human smuggling and trafficking and ensure the use of all available law enforcement tools to faithfully execute immigration laws and to Make America Safe Again.”

The task force project was described in interviews with current and former officials who have been briefed on it. ProPublica also reviewed documents about the implementation of the task forces, including a briefing paper prepared for Cabinet-level officials on the president’s Homeland Security Council.

The Homeland Security Task Forces will take a “coordinated, whole-of-government approach” to combatting transnational criminal groups, the paper states. They will also draw support from state and local police forces and U.S. intelligence agencies.

Until now, the government has coordinated that same work through a Justice Department program established by President Ronald Reagan, the Organized Crime Drug Enforcement Task Forces — which the Trump administration is shutting down.

Known by the ungainly acronym OCDETF (pronounced “oh-suh-def”), the $550-million program is above all an incentive system: To receive funding, different agencies (including the DEA, the FBI and HSI) must come together to propose investigations, which are then vetted and approved by prosecutor-led OCDETF teams.

The agents are required to include a financial investigation of the criminal activity, typically with help from the Treasury Department, and they often recruit support from state and local police. The OCDETF intelligence center, located in the northern Virginia suburbs, manages the only federal database in which different law-enforcement agencies share their raw investigative files.

While officials describe OCDETF as an imperfect structure, they also say it has become a crucial means of law enforcement cooperation. Its mandate was expanded under the Biden and first Trump administrations to encompass all types of organized crime, not just drug trafficking.

As recently as a few months ago, the deputy attorney general, Todd Blanche, declared that OCDETF would play a central role in stopping illegal immigration, drug trafficking and street gangs. He even suggested that it investigate the governments of so-called sanctuary cities for obstructing immigration enforcement.

But just weeks after Blanche’s announcement, the administration informed OCDETF officials their operations would be shut down by the end of the fiscal year in September. In a letter to Democratic senators on June 23, the Justice Department confirmed that the Homeland Security Task Forces would absorb OCDETF’s “mission and resources” but did not explain how the new structure would take charge of the roughly 5,000 investigations OCDETF now oversees.

“These were not broken programs,” said a former Homeland Security official who, like others, would only discuss the administration’s plans on condition of anonymity. “If you wanted to build them out and make sure that the immigration side of things got more importance, you could have done that. You did not have to build a new wheel.”

Officials also cited other concerns about the administration’s plan, including whether the new task force system will incorporate some version of the elaborate safeguards OCDETF has used to persuade law enforcement agencies to share their case files in its intelligence database. Under those rules, OCDETF analysts must obtain permission from the agency that provided the records before sharing them with others.

Many officials said they worried that the new task forces seem to be abandoning OCDETF’s incentive structure. OCDETF funds are conditioned on multiple agencies working together on important cases; officials said the monies will now be distributed to law enforcement agencies directly and without the requirement that they collaborate.

“They are taking away a lot of the organization that the government uses to attack organized crime,” a Justice Department official said. “If you want to improve something, great, but they don’t even seem to have a vision for how this is going to work. There are no specifics.”

The Homeland Security Task Forces will try to enforce interagency cooperation by a “supremacy clause,” that gives task force leaders the right to pursue the cases they want and shut down others that might overlap.

An excerpt from a planning document drafted for the president’s Homeland Security Council describes how the new Homeland Security Task Forces would take charge of major organized crime investigations. (Text reproduced from a document obtained by ProPublica.)

The clause will require “that any new or existing investigative and/or intelligence initiatives” targeting transnational criminal organizations “must be presented to the HSTF with a right of first refusal,” according to the briefing paper reviewed by ProPublica.

“Further,” it adds, “the supremacy clause prohibits parallel or competitive activities by member agencies, effectively eliminating duplicative structures such as stand-alone task forces or specialized units, to include narcotics, financial, or others.”

Several senior law enforcement officials said that approach would curtail the independence that investigators need to follow good leads when they see them; newer and less-visible criminal organizations would be more likely to escape scrutiny.

In recent years, those officials noted, both Democratic and Republican administrations have tried at times to short-circuit competition for big cases among law enforcement agencies and judicial districts. But that has often led to as many problems as it has solved, they said.

One notable example, several officials said, was a move by the Biden administration’s DEA administrator, Anne Milgram, to limit her agency’s cooperation with FBI and HSI investigations into fentanyl smuggling by Los Chapitos, the mafia led by sons of the Mexican drug boss Joaquín Guzmán Loera, known as “El Chapo.”

Although the DEA eventually indicted the Chapitos’ leaders in New York, officials from other agencies complained that Milgram’s approach wasted months of work and delayed the indictments of some traffickers. Later, when the FBI secretly arranged the surrender of one of the sons, Joaquín Guzmán López, DEA officials were not told about the operation until it was underway, officials said. (Guzmán López initially pleaded not guilty but is believed to be negotiating with the government. Milgram did not respond to messages asking for comment.)

As to the benefits of competition, prosecutors and agents cite the case of El Chapo himself. Before he was extradited to the United States in January 2017, Guzmán Loera had been indicted by seven U.S. attorneys’ offices, reflecting yearslong investigations by the DEA, the FBI and HSI, among others. In the agreement that the Obama Justice Department brokered, three offices led the prosecution, which used the best evidence gathered by the others.

Under the new structure of the Homeland Security Task Forces, several officials said, federal prosecutors will still generally decide whether to bring charges against criminal groups, but they will have less of a role in determining which criminals to investigate.

Regional and national task forces will be overseen by “executive committees” that are expected to include political appointees, officials said. The committees will guide broader decisions about which criminal groups to target, they said.

“The HSTF model unleashes the full might of our federal law enforcement agencies and federal prosecutors to deliver justice for the American people, whose plight Biden and Garland ignored for four years,” a Justice Department spokesperson said, referring to former Attorney General Merrick Garland. “Any suggestion that the Department is abandoning its mission of cracking down on violent organized crime is unequivocally false.”

During Trump’s first term, veteran officials of the FBI, DEA and HSI all complained that the administration’s overarching focus on immigration diverted agents from more urgent national security threats, including the fentanyl epidemic. Now, as hundreds more agents have been dispatched to immigration enforcement, those officials worry that the new task forces will focus on rounding up undocumented immigrants who have any sort of criminal record at the cost of more significant organized crime investigations.

The first task forces to begin operating under the new model have not assuaged such concerns. In late May, Attorney General Pam Bondi and Virginia Gov. Glenn Youngkin announced that the Virginia Homeland Security Task Force had arrested more than 1,000 “criminal illegal aliens” in just two months, but the authorities have provided almost no details connecting those suspects to transnational criminal organizations.

Agents of Homeland Security Investigations and the FBI, part of the new Gulf of America Homeland Security Task Force, arrested dozens of undocumented immigrants in connection with a cockfighting ring in northern Alabama in mid-June. (Via HSI Atlanta’s X profile)

On June 16, the Gulf of America Homeland Security Task Force, a new unit based in Alabama and Georgia, announced the arrests of 60 people, nearly all of them undocumented immigrants, at a cockfighting event in northern Alabama. Although cockfighting is typically subject to a maximum fine of $50 in the state, a senior HSI official claimed the suspects were “tied to a broader network of serious crimes, including illegal gambling, drug trafficking and violent offenses.” Once again, however, no details were provided.

It is unclear how widely the new task force rules might be applied. While OCDETF funds the salaries of more than a thousand federal agents and hundreds of prosecutors, thousands more DEA, FBI and HSI agents work on other narcotics and organized crime cases.

In early June, five Democratic senators wrote to Bondi questioning the decision to dismantle OCDETF. That decision was first reported by Bloomberg News.

“As the Department’s website notes, OCDETF ‘is the centerpiece of the Attorney General’s strategy to combat transnational-organized crime and to reduce the availability of illicit narcotics in the nation,’” the senators wrote.

In a June 23 response, a Justice Department official, Daniel Boatright, wrote that OCDETF’s operations would be taken over by the new task forces and managed by the office of the Deputy Attorney General. But Boatright did not clarify what role federal prosecutors would play in the new system.

“A lot of good, smart people are trying to make this work,” said one former senior official. “But without having prosecutors drive the process, it is going to completely fracture how we do things.”

Veteran officials at the DEA — who appear to have had almost no say in the creation of the new task forces— are said to be even more concerned. Already the DEA has been fighting pressure to provide access to investigative files without assurances that the safeguards of the OCDETF intelligence center will remain in place, officials said.

“DEA has not even been invited to any of the task force meetings,” one former senior official said. “It is mind-boggling. They’re just getting orders saying, ‘This is what Stephen Miller wants and you’ve got to give it to us.’”

by Tim Golden

How Foreign Scammers Use U.S. Banks to Fleece Americans

1 week ago

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Brian Maloney Jr. was flummoxed when he was served with a lawsuit against his family’s business, Middlesex Truck and Coach, in January. Maloney and his father, also named Brian, run the operation, located in Boston, which boasts that it can repair anything “from two axles to ten.” A burly man in his mid-50s who wears short-sleeved polo shirts emblazoned with the company name, Maloney Jr. has been around his dad’s shop since he was 8. The garage briefly surfaced in the media in 2012 when then-presidential candidate Mitt Romney made a campaign stop there and the Boston Herald featured Maloney Sr. talking about how he had built the business from nothing in a neighborhood he described as having been a “war zone.”

Now Middlesex was being sued by a New Jersey man who claimed he had been defrauded of $133,565 in a cryptocurrency scheme. The suit claimed Middlesex “controlled and maintained” a bank account at Chase that had been used to collect the fraudulent payment. The purported victim wanted his money back.

None of this made any sense to Maloney Jr. His company did not have an account at Chase, and he barely knew what crypto was. “For God’s sake, we fix trucks and still have AOL,” he would later say.

It was only after Maloney went to Chase to investigate that he was able to piece together at least part of the explanation. It turned out that Chase had allowed an unknown individual, who applied online with no identification, to open an account under Middlesex’s name, according to information Chase provided to Maloney. The account was then used to solicit hundreds of thousands of dollars from fraud victims, including the $133,565 from the man who was now trying to reclaim his funds.

Middlesex’s experience, as bizarre as it seems, is part of a global problem that plagues the banking industry. The account falsely opened in Middlesex’s name, and many others like it, are way stations in a sophisticated multistep money laundering process that transports cash from U.S. scam victims to crime syndicate bosses in Asia.

There’s been an explosion in international online fraud in recent years. Particularly widespread are “pig-butchering” schemes, as ProPublica reported in 2022. The macabre name derives from the process of methodically “fattening” victims by getting them to contribute more and more money to an investment scheme that seems to be succeeding, before eventually “butchering” them by taking all their deposits. Often operated by Chinese gangs out of prison-like compounds in Cambodia, Laos and Myanmar, pig-butchering in that region has reached a staggering $44 billion per year, according to a report by the United States Institute of Peace, and it likely involves millions of victims worldwide. The report called the Southeast Asian scam syndicates the “most powerful criminal network of the modern era.”

A huge portion of such fraud is transacted in cryptocurrency. But given that the typical consumer doesn’t own crypto, many scams unfold with a victim tapping a traditional bank account to wire dollars to swindlers, who receive the funds in their own accounts, then convert them into crypto to move across borders. Later in the process, the scammers will typically transfer their crypto back into standard currency.

Bank accounts are so crucial to this process that a thriving international black market has developed to rent accounts for fraud. That, it seems, is how a Chase account in the name of Middlesex ended up as a repository for the proceeds of pig-butchering.

The huge demand for accounts used for misbehavior gives banks a crucial, and not always welcome, role as gatekeepers — a responsibility required by U.S. law — to prevent criminals from opening accounts or engaging in money laundering. Yet from the U.S. to Singapore, Australia and Hong Kong, banks have consistently failed at that responsibility, according to experts who have investigated money laundering, as well as reviews of fraudulent account details shared by victims and court cases reviewed by ProPublica. The list of financial institutions whose accounts pig-butchering scammers have made use of includes global behemoths like Bank of America, Chase, Citibank, HSBC and Wells Fargo and many other U.S. and foreign lenders.

The banks said in statements to ProPublica that they make extensive efforts to fight fraud by investing in systems to detect suspicious activity and to report it to authorities (read the banks’ statements here). The American Bankers Association, which represents the industry, acknowledged that “with more than 140 million bank accounts opened every year bad actors can sometimes get through despite determined and ongoing efforts to stop them.” But the group said other industries like telecommunications providers and social media platforms need to do more to fight fraud because there’s only so much that financial institutions can do.

Pig-butchering scams present some unique challenges for banks. Among other things, a customer in thrall to a fraudster will sometimes foil their own bank’s attempts to prevent them from sending money to a criminal. And foreign-based scammers have become adept at finding middlemen in the U.S. to exploit the banking system. “Cyber-enabled fraud operations in Southeast Asia have taken on industrial proportions,” according to an October report by the United Nations Office on Drugs and Crime. John Wojcik, one of the authors of the report, told ProPublica, “Banks have never been targeted at this scale, in these ways.”

It doesn’t help that there are “no real standards as to what a bank has to do for detecting fraud or money laundering,” said Lester Joseph, a financial compliance consultant who used to oversee money laundering cases at the Department of Justice and later worked at Wells Fargo. The main law governing U.S. compliance regimes, the Bank Secrecy Act, requires financial institutions to maintain programs to know their customers and to detect and report suspicious activity to the government. That might mean noticing, say, that a newly opened account is suddenly receiving and sending hundreds of thousands of dollars of wire payments each month.

But it is up to banks to design those programs. The regulations don’t even require that the programs be effective. That gives banks wide flexibility on how much due diligence and monitoring to do — or not do. More scrutiny upfront means slowing down business and adding costs. Many banks don’t ask questions until it’s too late.

If you’re a criminal looking to obtain a bank account with no pesky formalities, it’ll take you only minutes to find one on the messaging app Telegram. Chinese forums there feature ads for “cars” or “fleets” — bank accounts or other online payment platforms that can be used to collect stolen funds. (The vehicle metaphor stems from the fact that in Chinese slang, money laundering operations are known as “motorcades.”) One Telegram ad offered accounts at PNC, Chase, Citi and Bank of America and boasted of “firsthand” control of the accounts: “People can go to the bank to transfer money,” the ad said.

An ad on Telegram, since taken down, offered bank accounts for “precision chat” — slang for pig-butchering — at Bank of America, Chase, Citibank and PNC. Under “advantages,” the ad listed “firsthand [control], people can go to the bank to transfer money … not a virtual account.” (Screenshot by Cezary Podkul)

Another Telegram channel listed various flavors of pig-butchering scams for which it provided bank accounts. The group, named KG Pay, boasted of accepting wire transfers, making withdrawals from U.S. banks and converting deposits into crypto to transfer them to scammers. KG offered to handle deposits of up to $1 million in accounts that imitate “normal business transactions.” To avoid suspicion, KG said, it sliced big amounts into smaller batches. If banks grew suspicious and froze one of its accounts, KG said, it had agents ready to call customer service to persuade them to lift the freeze. For smaller transfers, a video tutorial inside the channel showed how easy it was to send cash using the Chase app. (Telegram deleted the KG Pay channel after ProPublica asked about it. In a statement, Telegram said it “expressly forbids money laundering, scams and fraud and such content is immediately removed whenever discovered. Every month, over 10 million accounts, groups and channels are removed for breaching Telegram’s terms of service — including rules that prohibit money laundering and fraud.”)

Demand for money laundering is huge in Sihanoukville, a seedy gambling hub in Cambodia notorious for hosting massive scam operations. In some hotels above casinos there, blocks of guest rooms have been converted into offices where workers help fraudsters find motorcades to move illicit funds, according to a 2024 report by a doctoral anthropology student.

A walled complex in Sihanoukville, Cambodia, known to have housed scamming operations (Cindy Liu for ProPublica)

Inside those offices, the tap of keyboards and buzz of Telegram notifications suggested a trading floor at a stock exchange. But the work of the people interviewed by Yanyu Chen, the doctoral student, was very different. The workers, all Chinese and speaking on the condition of anonymity, were candid. They said they were tasked with matching cyberscam gangs with providers who could supply them with bank accounts to collect and move proceeds from fraud victims. In Telegram chat groups, the workers could see bank account suppliers and swindlers in need of accounts and would match the two and keep track of trades and commissions.

The business has become so mainstream that even one of Cambodia’s most prominent financial services firms, Huione Group, runs an online marketplace that allegedly facilitates such transactions. Its Telegram channels, including the one that included the aforementioned ad offering “firsthand” control of U.S. bank accounts, have helped launder funds for pig-butchering scams as well as heists linked to North Korea, according to the U.S. Treasury’s Financial Crimes Enforcement Network. (Huione said in a statement that it is working to prevent abuse of its services and is “fully committed to collaborating with the U.S. Treasury Department to address expeditiously any and all concerns.”)

The workers interviewed by Chen were unperturbed about enabling fraud. One described the work as boring, little more than copying and pasting bank account info between scammers and motorcades. Another worker told her that he viewed himself as “solving a very old problem of getting into the banking system people who have long been shut out of it.”

The fraud that ensnared Middlesex Truck and Coach as a tangential victim covered thousands of miles via electronic byways. By all appearances, it emanated from Cambodia, then reached New Jersey, where a mark was persuaded to wire a total of $716,000 to accounts tied to purported businesses in Boston, New York, California, Hong Kong and elsewhere. All but a few appeared to have been incorporated by Chinese individuals, sometimes just days before their accounts started accepting large sums.

The fleecing of Kevin, who ProPublica agreed to identify by first name only, was a textbook example of pig butchering. Kevin had reached the stage in life when he wanted to ease his workload after a varied career as a financial planner, small-business owner and fitness instructor. Just before Christmas 2022, someone purporting to be a San Diego woman named Viktoria Zara friended Kevin on Facebook. She soon introduced him to a sleek crypto trading website called 3A on which she claimed to have made $700,000 on bitcoin futures. (Facebook deactivated Zara’s profile after ProPublica inquired about it, and a spokesperson said the social media company has “detected and disrupted over seven million accounts associated with scam centers” in Asia and the Middle East since the start of 2024.)

Kevin acknowledges he was seduced by the thrall of easy money. “Something came over me,” he said. Kevin accepted Zara’s offer to teach him how to trade and, within a few weeks, he was routinely wiring tens of thousands of dollars to various bank accounts to fund his trading.

The accounts were not registered to 3A. They were listed under a variety of companies he’d never heard of, such as Guangda Logistics and Danco Global.

Kevin found this odd. But Zara, his supposed friend, told him that was just how 3A operated, and Kevin felt safe wiring funds to accounts at Chase because of its size and reputation. Every time he did so, the sum showed up in his online 3A portal, making him think the transactions were real. Better yet, his investments had apparently soared; his account balance now read $1.4 million.

An excerpt from Kevin’s chat log with the purported 3A trading site shows how the scammers, claiming to be customer service reps, directed him to wire funds to companies other than 3A with accounts at Chase. (Courtesy of Kevin. Redacted by ProPublica.)

Like many a pig-butchering victim, Kevin realized something was off only when he went to withdraw his profits and 3A demanded that he first pay a “tax” of almost $134,000. Kevin knew from his financial planning days that wasn’t how things worked. But he set aside his doubts and went to his bank late one afternoon in April 2023 to wire the tax payment. He’d been given a fresh Chase account to send funds to and pressured to wire money within two hours.

This time, his money was addressed to Middlesex Truck and Coach. Kevin was so under the sway of his scammers at that point that he did not question the money’s destination. Nor did the teller at the TD Bank branch he went to. (TD declined to comment on Kevin’s case but said it trains employees to challenge customers when transactions seem suspicious and to warn them never to wire funds to people they do not know.)

As soon as Kevin got home, panic set in: 3A told him the Chase account to which he’d just wired $134,000 was frozen and that his tax payment would not go through. He would need to send another $134,000 to a different account. Confused, Kevin went back to TD first thing the next day and asked the teller to reverse the wire. Over the next two weeks, Kevin said, his bankers at TD called Chase three times but never got a response. (Chase did not answer ProPublica’s questions about Kevin’s efforts to recall his wire but said the wire recall process is challenging and rarely succeeds.)

It is possible to reverse a wire transfer if customers inform their banks quickly, before the transaction has been completed, according to lawyers and experts. But banks have no obligation to reverse a transfer even when a customer reports potential fraud. “It’s really up to the receiving institution if they release the funds and how they go after the customer on their end,” said Saskia Parnell, a banking industry veteran who now volunteers for an anti-scam group called Operation Shamrock.

As Kevin agonized, the 3A customer service reps dangled a solution: Just wire the funds again and unlock your $1.4 million. He feared TD wouldn’t let him send the wire again, so he switched to PNC Bank and sent a fresh $134,000 wire to another recipient at Cathay Bank in California. That yielded yet another tale about a purported government roadblock and the demand for yet another payment.

Kevin wasn’t thinking clearly. His son, who had struggled with substance abuse, had suddenly died of a fentanyl overdose. Kevin was overwhelmed with grief. He agreed to make another payment.

By June 2023, even a call from PNC’s fraud department declining his outgoing wire could not dissuade him. It was the only instance, out of the 11 times he attempted to wire money to scammers, that a bank stopped the transaction, according to Kevin, who did not have a history of making wire payments before. (PNC said in a statement that “we believe we took appropriate action.”)

It made no difference. Kevin’s mind was so clouded that he instead opened a new account at Wells Fargo. The switch illustrated another challenge: Even if one bank succeeds in preventing fraud, criminals can still win if another bank isn’t as diligent. (Wells Fargo said it invests hundreds of millions of dollars a year to fight scams).

After wiring $150,000 from Wells Fargo to two Chinese entities listed at a Singaporean bank, Kevin waited to receive his trading proceeds. But when all that resulted was another request that he wire money — $40,000 this time — Kevin finally grasped reality. He was now without a son, and his finances lay in ruins. “The whole world was coming to an end,” he recalled.

Kevin had preserved enough savings to hire a private investigator, John Powers of Hudson Intelligence, to follow the financial trail. Powers found a litany of red flags among the entities that had gotten bank accounts and received Kevin’s funds. Some of the businesses gave phony addresses, such as a vacant home. Another was registered to a one-bedroom apartment in Los Angeles that was also listed as the headquarters of a dozen other businesses set up since 2022 by different Chinese individuals. Contact info was scarce; official emails for two companies included the temporary email domain “netsmail.us,” which doesn’t connect to a functioning website. All of these ersatz businesses had accounts at Chase, Cathay or Singapore’s DBS Bank.

Chase said that it has policies to identify and verify the identities of its customers, and that it continually evaluates and enhances them. Cathay said it also reviews its systems and policies to detect and prevent fraudulent activity. DBS did not respond to requests for comment.

Another clue indicated that the banks had been doing business with a larger criminal enterprise. Two of the companies Kevin sent funds to, Guangda Logistics (which lists no contact information) and Danco Global (which did not respond to ProPublica’s request for comment), showed up on a list of more than six dozen shell entities that had been used to defraud Americans of nearly $60 million. The information was uncovered in an investigation by the U.S. Secret Service into KG Pay, one of the money laundering groups that was on Telegram.

Kevin acknowledges he was seduced by the thrall of easy money. “Something came over me,” he said. Kevin ultimately wired a total of $716,000 to scammers’ accounts at Chase and other banks. (Christopher López for ProPublica)

The case of the man behind KG Pay sheds further light on how motorcades use U.S. banks. Daren Li, a Chinese national in his early 40s, went by the alias KG Perfect. Based in Cambodia, he directed the movement of large sums of pig-butchering proceeds from the U.S. to overseas. Li, who was arrested in April 2024 at the airport in Atlanta, pleaded guilty in November to conspiracy to commit money laundering. He admitted that at least $73.6 million of victim funds were deposited into bank accounts he and his co-conspirators controlled. Li, who is in federal detention awaiting sentencing, could not be reached for comment through his lawyer. Seven other people have pleaded guilty to conspiring with Li.

KG exploited a weakness in the U.S. banking system: Banks are reluctant to share account information, even after they’ve identified suspicious activity. A law enacted in the wake of the Sept. 11, 2001, attacks gave banks a reprieve from secrecy rules if they alert one another to potential terrorism or money laundering activities. But the information sharing is voluntary and “banks are not communicating with each other,” according to Matt O’Neill, who led many money laundering investigations for the U.S. Secret Service during his 25 years there. “Fraudsters know it and fraudsters are clearly making hundreds of millions or billions of dollars off of this glaring gap in the system,” said O’Neill, who now runs 5OH Consulting.

One of the most prolific cogs in Li’s motorcade, according to civil and criminal cases, was a Chinese national named Hailong Zhu. He entered the U.S. on a tourist visa around 2019 and then stayed, working odd jobs in construction and at a restaurant. In 2022, Zhu was recruited to help Li’s other operatives set up businesses and bank accounts near Los Angeles in exchange for $70,000.

Zhu turned the assignment into a full-time job, eventually juggling seven accounts at Bank of America, Chase, East West Bank and Wells Fargo tied to two entities set up in his name: Sea Dragon Trading and Sea Dragon Remodel. When Bank of America restricted Zhu’s Sea Dragon Trading account due to suspected fraud on Oct. 19, 2022, Zhu got another account at Bank of America the next day using Sea Dragon Remodel. By Nov. 1, 2022, he had secured four more accounts at Chase, Wells Fargo and East West Bank. Except for varying his address and email, investigators found that Zhu provided largely the same info when opening accounts for the two shell entities.

Zhu’s account opening spree happened just a few months after federal prosecutors blamed “the corruption of BofA bankers” for a scheme in which a handful of employees opened 754 accounts at Bank of America registered to 13 false addresses in the Los Angeles suburbs. In that case, shadowy middlemen dispensed bribes of $200 to $250 per account to Bank of America employees who overrode internal compliance systems to open accounts for overseas Chinese citizens who weren’t physically present at the branch to open the accounts, in violation of the bank’s rules. Even when the bankers registered 176 customers to one small home, the accounts were still opened. (Two of the bankers later pleaded guilty to making false entries in bank records; Bank of America said in a statement that it “uncovered illegal activity using its monitoring systems, terminated the employees, and cooperated with law enforcement, who successfully prosecuted those involved. This is how our anti-money laundering program is designed to work.”)

With banks always one step behind, Zhu’s accounts kept receiving hundreds of thousands of dollars from victims across the U.S. Zhu would bundle the proceeds and transfer them abroad. During one week in November 2022, for example, he received six wires totaling almost $52,000 into one of his accounts and wired out one lump sum of $53,000. The destination was a bank account in the Bahamas controlled by Li and others, who converted the funds into cryptocurrency for their journey to scam centers located overseas, including in Sihanoukville. Investigators discovered a crypto wallet address they believed Li controlled. Data from cryptocurrency analytics firm Crystal Intelligence shows the wallet address sent and received about $341 million of crypto across 16,800 transactions between April 2021 and April 2024.

Zhu was arrested in March 2023 and charged with bank fraud. His lawyers acknowledged at trial that their client opened bank accounts and moved funds but said that Zhu did not know his bosses were using them for criminal purposes. Zhu was acquitted after the attorneys persuaded the trial judge that using false information to obtain a bank account does not constitute a scheme to defraud a bank. Only months after the acquittal, Zhu was charged again, this time with money laundering offenses, in an indictment filed in December 2023. Zhu, who couldn’t be reached for comment, did not enter a plea and was listed as a fugitive as of March 2025.

In January 2024, Kevin, desperate to get his money back, sued the 10 companies to which he had wired money at the scammers’ behest, including Middlesex Truck and Coach. None replied to his lawsuit — most were shell entities, after all — until January 2025, when Kevin’s lawyer got an email from Brian Maloney Jr.

Maloney confessed that his staff had ignored the lawsuit when it was initially served because it looked like a scam. He said he’d never banked with Chase and had no idea about any account that had been used to defraud Kevin. Maloney agreed to go to the local Chase branch to investigate and try to help Kevin get his money back.

“I went to the bank and said, ‘What the hell is going on?’” Maloney told ProPublica. After spending nearly two hours with the local Chase branch manager, Maloney realized that he, too, was a victim of the bank’s lax procedures: He said the branch manager told him that Chase had allowed someone to obtain an account online in his company’s name in March 2023 with nothing more than a digital signature and an employer identification number, but no personal identification. That account had then accepted hundreds of thousands of dollars of wire transfers. And now Maloney’s family business — not Chase — was the defendant in a lawsuit. “How is this legal?” he wondered. (Colin Schmitt, a retired FBI agent, said Chase could have mitigated the fraud by at least pausing incoming wire transfers to the fake Middlesex account and asking its owner to justify the transactions. “If you’re just using an account just for wires, that’s a big red flag,” Schmitt said.)

Still, there was a silver lining: The funds remained in the account. Not only Kevin’s $134,000, but almost $100,000 more from several other victims sat frozen inside since spring 2023.

Kevin was glad the money was still there, but he wondered why it took a lawsuit to unearth the info. “It does not seem like the system is tailored to give any deference to the victim,” he said. “That’s what frustrates me.” His lawyers advised him to seek an order from a federal judge to get his funds back and filed such a petition in March. After ProPublica asked Chase about Kevin’s funds in April, the bank agreed to return the money to him without a court order.

The $134,000 landed back in Kevin’s bank account in mid-May. Finally, he felt a sense of relief. (He has now dropped the suit against Middlesex.) But Kevin also wondered what would happen to the other people whose money got siphoned up by the fake Middlesex account. Would Chase wait for them to file lawsuits too?

Banks are starting to face lawsuits by pig-butchering victims who allege laxness in opening accounts. In December, a California man who was defrauded of nearly $1 million sued DBS and two other banks for alleged failures to comply with know-your-customer and anti-money-laundering laws. A college professor from Iowa who lost $700,000 filed a lawsuit in January against Hang Seng Bank in Hong Kong for failing to do proper due diligence on the people who opened accounts used to defraud him. Hang Seng reached an agreement with the Iowa professor to dismiss the suit and declined to comment further. DBS did not reply to requests for comment on the California case, but the bank asserted that the lawsuit contains “fatal flaws,” according to a filing in the suit.

Such cases are long shots, according to Carla Sanchez-Adams, senior attorney at the National Consumer Law Center. The suits typically fail because it’s hard to show that financial institutions knew or should have known about potential fraud.

Still, banks are well aware that fraud is on the rise. Nearly 1 in 3 Americans say they have been the victim of online fraud or cybercrime, according to a 2023 poll commissioned by Wells Fargo. “The scale of fraud taking place every day is a massive burden for our country and for the millions of hard-working women and men whose lives are affected by it,” Rob Nichols, president of the American Bankers Association, said in an October speech.

Nichols contends that “consumers credit the banking industry with doing more than other industries to protect them from fraud and keep their information safe.” He cited an initiative by the ABA to create a database of fraud contacts to help banks figure out who to call when there’s a problem. And he urged the Trump administration to develop a national fraud prevention strategy.

Other countries are taking more aggressive steps. In October, the U.K. began requiring banks to reimburse scam victims up to £85,000, or about $116,000, per claim when they make a fraudulent payment on behalf of their customers, even if the customers authorized the transfer. Australia recently enacted a law that will require banks to share suspect account info with one another. Thailand has gone even further, creating a Central Fraud Register intended to compel banks to identify and close accounts used for money laundering.

The U.S. lacks such rules. O’Neill, the former Secret Service agent, thinks that updating the Patriot Act, the post-9/11 law meant to encourage banks to share intel, would be a good place to start. But Congress has not moved in that direction and the Trump administration has shown no sign that it plans to prioritize this issue. (Asked what steps the administration is taking, a spokesperson told ProPublica to Google the administration’s sanctions related to pig-butchering scams.)

For now, bank accounts remain easy for fraudsters to obtain. A sleek-looking brokerage akin to 3A has been online for months, soliciting deposits for what a researcher at the Global Anti-Scam Organization identified as a pig-butchering scheme. Anyone wishing to “invest,” the brokerage said, can wire money to a shifting array of banks, including Chase.

Update, June 26, 2025: After this article was published, East West Bank replied to ProPublica’s prepublication requests for comment, saying the bank is “committed to maintaining the highest standards of regulatory compliance and customer protection” and that it has been “continuously enhancing our risk management and oversight processes, integrating fraud risk mitigation strategies, updating technologies, engaging external expertise, and improving educational resources on fraud prevention.”

Doris Burke contributed research.

by Cezary Podkul

Her Family Needed Housing. They Spent Months in New York Hotels, Left to Fend for Themselves.

1 week 1 day ago

This article was produced for ProPublica’s Local Reporting Network in partnership with New York Focus, an investigative news outlet reporting on New York. Sign up for Dispatches to get our stories in your inbox every week, and sign up for New York Focus’ newsletter here.

Jasmine Stradford sat on her porch near Binghamton, New York, with toys, furniture, garbage bags full of clothing and other possessions piled up around her. She and her partner were being evicted after falling behind on rent.

So last June, they and their children — then ages 3, 12 and 15 — turned to New York’s emergency shelter system for help. It was built to provide homeless residents not only beds, but also food, help finding permanent housing and sometimes child care so parents can find work, attend school or look for apartments.

Stradford and her family received almost none of that. Instead of placing them in a shelter, the Broome County Department of Social Services cycled them through four roadside hotels over three months, where they mostly had to fend for themselves.

“I remember staring at my kids, thinking that I’d failed them,” Stradford said. “Then I remember going to DSS and being completely dehumanized.”

Stradford’s family was part of a growing trend: In the past few years, hotels have quietly become the state’s predominant response to homelessness outside New York City. New York Focus and ProPublica found that the state’s social services agencies placed just under half the 34,000 individuals and families receiving emergency shelter outside the city in fiscal year 2024 in hotels — up from 29% in 2018. The change was most pronounced in Broome County, where hotel cases more than quintupled.

Statewide spending on hotels more than tripled over that period to $110 million, according to an analysis of state temporary housing data by the news organizations. In total, hotels outside New York City were paid about $420 million to shelter unhoused people from April 2017 to September 2024.

Statewide Spending on Hotels More Than Tripled From 2018 to 2024 Data source: Analysis of Office of Temporary and Disability Assistance data on emergency shelter payments. Years are fiscal years. (Lucas Waldron/ProPublica)

It’s a makeshift arrangement that provides people a roof over their head but little else. State regulations exempt hotels from providing the same services that families are supposed to receive in the shelter system.

The hotels are “less supportive, less conducive for good health outcomes, good education outcomes,” said Adam Bosch, CEO of Hudson Valley Pattern for Progress, a policy research nonprofit. “If our ultimate goal is to get people moving back toward independence, sticking them in a hotel on a hillside away from services, away from schools, away from transportation networks is not a great strategy.”

Homelessness in New York City received intense media coverage as the migrant crisis became fodder in the presidential election. But far less attention has been paid to the homeless population throughout the rest of New York, which far surpasses most other states on its own.

Few of the migrants were relocated to hotels outside the city. Instead, the spike in hotel housing stems from a combination of soaring rent, dozens of shelter closures and what housing advocates and industry representatives said was a botched response to the end of the state’s pandemic-related eviction moratorium in 2022. After the moratorium ended, landlords began evicting tenants at rates exceeding previous years. With fewer shelters and more people in need, the number of individuals and families placed in hotels shot up.

An unhoused family living at the Knights Inn in Endwell, New York. It was one of the hotels where the Broome County Department of Social Services placed the Stradford-Moses family. (Michelle Gabel for ProPublica)

Barbara Guinn, the commissioner of the state Office of Temporary and Disability Assistance, said in an interview that her agency hadn’t studied the growth in hotel use for emergency shelter. The trend has been scarcely mentioned at legislative hearings in Albany.

But OTDA, which supervises the county social services offices, has long known about the problems the hotels present. In early 2020, state auditors warned the agency that it wasn’t adequately overseeing shelters, including hotels used as temporary housing. OTDA acknowledged that hotels present challenges because they don’t have on-site support services or the same level of supervision as shelters.

Samir, Moses and Stradford’s 3-year-old son, tries to pass the time in one of the hotel rooms the family stayed in after its eviction. (Courtesy of Jasmine Stradford)

Watch video ➜

Rules clarifying the requirement that temporary housing recipients in hotels receive shelter-like services have been on OTDA’s regulatory agenda for at least four years. But the agency, and lawmakers who oversee it, stood by as hotel housing increased. Guinn said she couldn’t “provide insight” on why the agency never formally proposed the rules, but she committed to advancing them this year. The Broome County Department of Social Services did not make its commissioner, Nancy Williams, available for an interview and did not respond to a detailed list of questions.

Reporting across the state, the news organizations found people living for months and sometimes years in hotels, doing what they can to get by. Families share beds while their belongings fill the corners of their rooms. Without kitchens and barred from using most appliances, they trek down shoulderless highways to grocery stores or scour food pantries for anything they can cook in a microwave. They squish cockroaches skittering in dressers. And hotels often force them to move out every few weeks, keeping stability out of reach.

The four hotels that Stradford’s family was placed in last summer collectively made about $10,000 sheltering it over three months — more than what the family owed in back rent. That works out to more than twice the monthly fair market rent for a four-bedroom apartment in Binghamton at the time.

New York Social Services Agencies Frequently Paid Hotels Over Fair Market Rent for a Two-Bedroom Apartment

Nearly half of all payments to hotels were for more than twice the counties’ FMR.

Data Source: Analysis of Office of Temporary and Disability Assistance data on emergency shelter payments; U.S. Department of Housing and Urban Development fair market rent data for two-bedroom apartments in each county for federal fiscal year 2024. (Lucas Waldron/ProPublica)

This isn’t unusual. County social services offices regularly pay the hotels rates that are worth many times fair market rent for permanent housing in their areas, according to the analysis of OTDA’s housing payment data. One motel in Rome, outside Utica, that was the scene of a shooting last fall charged the county $250 a night for a room at times, according to invoices submitted to the county’s Department of Social Services.

Over three months, Stradford’s family struggled to maintain some semblance of its old life while bouncing from hotel to hotel. The family would lose countless possessions. The kids’ educations would be disrupted, as the school bus failed to keep up with their moves. Their experiences would show the importance of the services they weren’t receiving and what happens to New York’s homeless families when they can’t access them.

“It’s Like Malpractice”

Stradford and her partner, Tiberious Moses, had been evicted after she missed work at a children’s group home while recovering from surgery and Moses struggled to support the family with temporary jobs. At first, Stradford was relieved when the Department of Social Services informed her that it would place them in a hotel instead of a shelter.

“Going to the hotel, I originally thought, ‘OK, this gives a little bit more leeway, a little bit more comfort, hospitality, all of that,’ only to find out that it’s not that at all,” she said. “If you are a DSS recipient, you’re nothing. You are the bottom of the pit.”

Stradford’s family — two adults, three children and four dogs — was packed into a room with two beds at an Econo Lodge sandwiched between a gas station and another budget hotel. Stradford said she found cockroaches and had trouble getting the hotel to clean their room. She said she often saw drug use at the hotel and felt unsafe. Law enforcement and emergency services were called to the hotel 116 times in the first half of that year, dispatch logs show.

Despite those conditions, the Econo Lodge received more money to house temporary assistance recipients than any other known hotel outside New York City, according to the OTDA payments data for the 2024 fiscal year. The hotel, now called Hillside Inn & Suites, served more than 900 individuals and families placed by the Department of Social Services for at least 30,000 total nights, earning over $2.3 million.

The Hillside Inn & Suites, formerly an Econo Lodge, in Binghamton, New York. The Stradford-Moses family spent 26 nights here. (Michelle Gabel for ProPublica)

“We’re forced to rent hotel rooms across the state, and the operators of these places understand that,” said state Sen. Roxanne Persaud, chair of the chamber’s Social Services Committee. “The municipalities’ backs are against the wall. And so they must place the unhoused person or persons somewhere. And so that’s why you see the cost is skyrocketing, because people understand that it’s an easy way to make money off the government.”

OTDA’s regulations say hotels should be considered shelters and provide services if they are used “primarily” as temporary housing for homeless welfare recipients. At least 16 hotels appear to house mostly welfare recipients, the analysis showed.

OTDA spokesperson Anthony Farmer said the agency interprets “primarily” to mean hotels that “house recipients exclusively, or almost exclusively, throughout the year.” He said that hotels aren’t required to deliver services but that county social services agencies “are responsible for some level of service provision.” The state, however, doesn’t regularly collect information on how counties provide services. Guinn said OTDA plans to create a formal process for counties to submit it under new regulations.

(Illustration by ProPublica)

The Econo Lodge’s contract with Broome County doesn’t call for the services offered by shelters, like food and assistance finding housing. It requires the hotel to provide little more than a room with housekeeping, linens and toiletries. The hotel’s CEO, Paresh Patel, declined to comment.

In contrast, traditional shelters often put a significant amount of their funding toward social services. Shelter budgets obtained from OTDA show that they frequently retain at least part-time employees to prepare food and help people find jobs and housing. Local social services offices try to offset the lack of on-site services by hiring caseworkers but have struggled to retain them.

Instead, hotel residents like Stradford’s family are caught in a web of conflicts between the way those services are provided, the strings attached to benefits and the rules and limitations of living in hotels. Social services departments might provide them food stamps to buy groceries, but hotel residents usually don’t have kitchens and are often not allowed to have appliances like hot plates. To keep their lodging, they’re generally required to seek housing and to work or look for jobs, but they often don’t receive child care. They have to regularly meet with caseworkers at social services offices but must rely on spotty public transportation.

“To me, it’s like malpractice as a homeless services provider to place people without support services” in hotels, said Deborah Padgett, a professor of social work at New York University. “It’s good in the sense that they get more privacy, but for them to get a life and not be dependent on the government, they need to be close to services and not be punished for making mistakes.”

Guinn said that her agency would prefer counties use regulated shelters in housing emergencies but that there aren’t enough beds to accommodate everyone. Social services offices must rely on hotels when shelters don’t have space or don’t exist in a particular county, Farmer said in an email.

After 26 nights, Broome County relocated Stradford’s family to the Quality Inn & Suites in Vestal, a Binghamton suburb down the Susquehanna River that’s home to Binghamton University. Stradford’s car had been repossessed, so they stuffed a suitcase and the kids’ book bags with as many clothes as they could and hopped on the bus.

(Illustration by ProPublica)

At the Quality Inn, the family struggled to eat. They had applied for food stamps, but Stradford said she couldn’t get wage records from her former employer proving she was eligible. Instead, the county provided them a restaurant allowance worth about $15 a day to cover all five of them. To get by, they took the bus to food pantries like Catholic Charities, which had started creating “hotel bags” stuffed with canned food, oatmeal, crackers, macaroni and cheese and snacks for the kids — anything that could be eaten cold or prepared with a microwave.

While many shelters provide food on site, contracts between the hotels and Broome County forbid emergency housing recipients from eating the hotels’ food. Stradford said her family was threatened with removal from the Quality Inn after her 12-year-old daughter, Taylor, tried to eat the continental breakfast.

“When we first started taking families on, we did allow breakfast, and unfortunately there was too much being carried away, so we chose to change that,” the hotel’s general manager, Bernadine Morris, said. The Quality Inn has since closed and could not be reached for follow-up questions.

People can get kicked out of hotels and lose their housing assistance for repeatedly violating hotels’ policies, including by using their own cooking appliances. One woman who previously lived at the Motel 6 in Binghamton said she avoided sanctions by throwing an extension cord from the window of her second-story room to use a pressure cooker on the sidewalk.

Stradford’s nonstop juggling act left her on edge. She was grieving her mother’s death, feeding five people and four dogs, apartment-hunting and hustling to culinary classes and social services appointments. She said her children started feeling the stress too: Her 3-year-old, Samir, was wetting the bed frequently, and the older kids missed classes for their summer courses.

The family began butting heads with Quality Inn managers, who accused them of being disruptive and terminated their stay, according to Stradford’s social services case file.

“I’m not totally surprised that they run into problems with the hotel supervisors and the staff just because they’re trying to find some way to get their needs attended to, and it’s not really fair to expect the hotel to do what those people are not trained to do,” Padgett said.

During the three months her family lived in hotels, Stradford’s nonstop juggling act left her on edge. (Michelle Gabel for ProPublica)

Shelters are required to have enough qualified staff to meet residents’ needs. The staff members generally have at least some training in how to handle populations with complex needs, said Elizabeth Bowen, an associate professor at the University at Buffalo School of Social Work.

After Stradford and her family lost their room at the Quality Inn, the county sanctioned them and declined to find them a new place to stay. Moses, who had just gotten a job at Dave & Buster’s, paid out of his own pocket for a room at the Red Roof Inn in Johnson City. When they arrived, the woman at the front desk saw their belongings and dogs and told them the motel wouldn’t honor the reservation. They had used what little money was left on Ubers and the room deposit. The motel did not return requests for comment.

As it rained, Stradford got ahold of the Department of Social Services and pleaded their case. The county decided to continue housing her family until her sanction could be appealed. It booked them at the Knights Inn, another 10 minutes down the road in a town called Endwell.

“I Got Into Protection Mode”

Stradford’s family became skilled at sleeping on a single bed at the Knights Inn. Stradford, Moses, Samir and 15-year-old De’Vante would sleep side by side while Taylor slept horizontally at their feet.

The rest of the facility was in chaos, Stradford said. She saw hypodermic needles and other drug paraphernalia lying in the grass and underneath the stairwell and people slumped over while standing beside the dumpster. Over about six years that the county used it for temporary housing, law enforcement and emergency services were summoned to the motel for 789 incidents, including assaults, overdoses, robberies, domestic disputes and mental health crises.

Note: Knights Inn charged $109.09 per day for two rooms for at least part of their stay. (Illustration by ProPublica)

The Knights Inn had a litany of issues that prevented it from passing Broome County Social Services’ inspections from 2018 to 2021. According to inspection reports, the rooms were dimly lit due to missing light bulbs and broken lamps. The walls were stained and punched through, and the wallpaper peeled off. Some rooms’ doors didn’t lock. Windows didn’t either or were broken. Carpets were torn, and inspectors found cockroaches in dressers.

Health and safety issues plague hotels used as emergency shelters across the state. A 2020 state comptroller audit found that 60% of the hotels they reviewed outside New York City were in “unsatisfactory” condition — about the same as the percentage of shelters.

One woman, who was living with her children in a motel south of Albany, showed paint flaking off their walls and mattresses covered in black mold. Two other parents placed in the motel said they felt that if the Department of Social Services caught them in private housing that resembled their living conditions, their kid could be taken away by Child Protective Services.

OTDA requires social services agencies to inspect hotels housing families every six months. But an analysis of OTDA compliance data showed that social services districts often fail to keep up with hotel inspections: About 40% of the 351 hotels used to house homeless people outside New York City were out of date on their social services inspections as of mid-October or didn’t have an inspection date listed.

Farmer, the OTDA spokesperson, said that most hotels had been inspected within a year and that some others had stopped housing people.

Even when social services agencies do inspections, records show they sometimes fail to take action. Hotels have to correct problems within 30 days, unless it’s a safety problem. If they don’t, counties are supposed to stop placing people there, according to a directive from OTDA.

Records show that the Knights Inn fixed some of the issues as it went but continued to get written up in every inspection for two and a half years. Despite this, Broome County placed hundreds of social services cases there, earning the motel over $750,000.

A Knights Inn manager, Aizaz Siddiqui, said that the motel moved people out of rooms that needed the most work until they were renovated.

In January 2021, the county said it would stop placing people at the Knights Inn until the violations were corrected. The motel received a clean inspection in July 2022. But Stradford said the Knights Inn wouldn’t give them toilet paper or fresh sheets, which are required in shelters. A bedsheet was used as a curtain for their rear window.

Taylor and Samir watch TV in the Knights Inn room. (Courtesy of Jasmine Stradford)

The family stayed for three weeks, but tensions with management boiled over when the family failed to get rid of their dogs by the deadline set by the motel. Eventually, the Knights Inn told them to leave. After giving them a few extra days to find other accommodations, Siddiqui called the police to remove them.

Siddiqui said the families placed at the inn by the Department of Social Services deserve sympathy, but he still has to maintain order. “It’s a tough situation to be in, and we try to work with them as much as we can,” he said. “But again, we do have to fulfill our policies, and we have to stand by them.” The motel declined to respond to additional questions about the conditions.

Stradford’s family didn’t have anywhere else to go. As the State Police arrived, she planted herself on a red cooler in front of their room and refused to leave until the county found them somewhere to stay.

Some community activists she met through local charity work showed up to support her and livestreamed the incident on Facebook.

Note: Motel 6 charged $190 per day for two rooms. (Illustration by ProPublica)

After a three-hour standoff, management relented and allowed the family to stay two more nights. One of the activists arrived with a U-Haul and drove their stuff to the Motel 6, a 15-minute drive back up the river, past the Econo Lodge on the outskirts of Binghamton.

Things were initially calm at the Motel 6. But about three weeks into their stay, the Motel 6 complained to the county that Stradford had left the children alone, which they were told violated the motel’s guest policy. Stradford said she was doing charity work at the time but complained that she couldn’t attend school or meet the state’s requirements to look for housing if she had to constantly supervise her children.

The motel gave the family the weekend to leave. When they missed their checkout time, the Sheriff’s Office came to remove them.

Moses called Stradford, who was at school, to tell her what was happening. She headed to the Department of Social Services to plead their case.

“I got into protection mode,” Stradford said. “I wasn’t going to leave there and just put myself in a seriously homeless situation. So I told them I wasn’t leaving until I knew that we had a secure spot to go to.”

But her attempts failed. The agency said it would no longer help her family due to the complaints. The clerk used a special tool to unlock the room for the deputies.

Community members once again showed up to livestream the encounter and pressure the county. The Sheriff’s Office helped the family find a motel, where it stayed for two more nights.

In the end, it wasn’t New York’s social services system that found stable housing for Stradford’s family; it was a local landlord who heard about the case and offered an apartment at a rate the family could afford on Moses’ wages and temporary assistance from the county.

Moses holds Samir in the family’s new apartment. (Michelle Gabel for ProPublica)

Stradford’s family was placed in hotels for 89 days, about the average for a social services case. Many stay far longer. More than 1,500 individuals and families spent six months or more in hotels, according to payment data from the 2024 fiscal year.

“Some of us really get into a hard time and we really do need the help. We don’t just rely on the system,” Stradford said. “I pay my hard-earned tax dollars. I worked multiple jobs. I’m the one that tried to keep afloat and stuff like that. But things happen in life.”

Between their six moves, the family lost most of its possessions: furniture, Social Security cards, birth certificates, tax documents, family photos, laptops, coats, a painting from someone Jasmine was taking care of, Samir’s toy box, Taylor’s art projects and a blanket covered in motivational quotes that Stradford’s mom had given her before she passed. They had to give up two of their dogs.

When they arrived at their new home, they had only a couple of suitcases and garbage bags full of clothes.

(Illustration by ProPublica) How We Measured Hotel Stays

To track temporary housing recipients placed in hotels, New York Focus and ProPublica used data obtained from the New York Office of Temporary and Disability Assistance through an open records request. The data contains 1.1 million payments issued from April 2017 to September 2024 for emergency shelter stays outside New York City. OTDA repeatedly delayed releasing the data for 10 months but finally did so after ProPublica’s attorneys got involved in the appeals process.

The data classified payments by type of shelter, including family shelters, transitional housing and hotels. It also included an “emergency shelter” category for temporary housing assistance provided before a case is fully approved, which can flow to both hotels and shelters.

Our analysis includes only payments explicitly classified as hotel payments. We excluded some payments that were classified as hotel payments but where the recipients appeared to be nonprofits that operated homeless shelters.

The data also included unique IDs for each assistance case that received shelter, allowing us to determine how many people stayed in hotels and for about how long. Each case represents either an individual or a family.

To find hotels that housed mostly welfare recipients, New York Focus and ProPublica relied on each hotel’s total number of rooms reported to the New York State Department of Health and checked whether shelter payments covered at least half of the hotel’s total capacity from April 1, 2023, to March 31, 2024.

The data listed the start and end date for each payment, but it was not always clear whether the stay was inclusive or exclusive of the final date. As a result, we chose to exclude the final night whenever counting up dates to create the most conservative estimates possible, unless the payment covered a single night. When comparing the payments against fair market rent, we included the final night, which would decrease the daily rate.

Hotels used to house homeless families outside New York City must be inspected by counties once every six months. After that, the district has 30 days to submit the report to OTDA for review.

OTDA provided a database of inspections for hotels as of Oct. 15, 2024. To determine whether a hotel was past due on inspection, we checked whether the most recent inspection was completed and submitted to OTDA in the seven months leading up to that date. In some cases, the inspection may have been conducted but was not submitted to the state on time.

This story was supported by the journalism nonprofit the Economic Hardship Reporting Project.

If you have been placed in a hotel or have information about the use of hotels as emergency housing in New York, contact New York Focus reporter Spencer Norris at 570-690-3469 or spencer@nysfocus.com.

Joel Jacobs contributed data reporting.

by Spencer Norris, New York Focus

Seven Things to Know About ProPublica’s Investigation of the FDA’s Secret Gamble on Generic Drugs

1 week 2 days ago

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In 2022, three Food and Drug Administration inspectors headed to India to investigate a massive Sun Pharma plant that produces dozens of generic drugs for Americans. Over two weeks, they found dangerous breakdowns in the way critical medications were made, and the FDA ultimately placed the factory on an import ban — prohibiting the company from shipping drugs to the United States.

The agency, however, quietly gave the global manufacturer a special pass to continue sending more than a dozen drugs to Americans even though they were made at the same substandard factory that was officially banned from the U.S. market.

It wasn’t the first time. Here are the key takeaways from ProPublica’s 14-month investigation into the FDA’s oversight of foreign drugmakers:

  • Over a dozen years, the agency entrusted to protect America’s drug supply gave similar exemptions to some of the most troubled foreign drugmakers in India, allowing factories banned from the U.S. market to continue shipping medications to an unsuspecting American public.

  • A secretive group inside the FDA exempted the medications from import bans, ostensibly to prevent drug shortages. With each pass, the agency dismissed warnings from its own inspectors about dangerous breaches in drug quality on factory floors. All told, the FDA allowed into the United States at least 150 drugs or their ingredients from banned factories found to have mold, foul water, dirty labs or fraudulent testing protocols. Nearly all came from factories in India.

  • The FDA did not regularly test the drugs exempted from import bans to see if they were safe or actively monitor reports about potential harm among patients. And as the drugs circulated in the United States, the agency kept the practice largely hidden from the public. The FDA said it put protective measures in place, such as requiring third-party oversight of factories to ensure the exempted drugs were safe.

  • Some of the exempted drugs were recalled — just before or just after they were exempted — because of contaminants or other defects that could cause health problems. And a ProPublica analysis identified more than 600 complaints in the FDA’s files about the exempted drugs at three factories alone, each flagging concerns in the months or years after the medications were excluded from import bans. The reports cite about 70 hospitalizations and nine deaths.

  • Janet Woodcock, who for more than two decades led the FDA’s Center for Drug Evaluation and Research, said she didn’t see a need to inform the public about the drugs from banned factories because the agency believed they were safe and that such information would create “some kind of frenzy” among consumers who might seek to change their prescriptions. “We had to kind of deal with the hand we were dealt,” she said, noting she supported the exemptions to deal with chronic drug shortages.

  • Decisions made by the FDA decades ago gave rise to the use of exemptions. In the 2000s, as the cost of brand-name drugs soared, the FDA approved hundreds of generic drug applications for foreign manufacturers that had been in trouble before, companies well-known to the inspectors working to stamp out safety and quality breakdowns.

  • The exempted drugs that have come to the United States include antibiotics, chemotherapy treatment, antidepressants, sedatives and epilepsy medication.

Sun Pharma did not respond to multiple requests for comment. When the FDA imposed the ban, the company said it would “undertake all necessary steps to resolve these issues and to ensure that the regulator is completely satisfied with the company’s remedial action. Sun Pharma remains committed to being … compliant and in supplying high-quality products to its customers and patients globally.”

Patricia Callahan and Vidya Krishnan contributed reporting. Alice Crites contributed research.

by Debbie Cenziper, Megan Rose, Brandon Roberts and Irena Hwang

His Kidney Failed. He’ll Never Know if a Transplant Drug From a Banned Factory Was to Blame.

1 week 2 days ago

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Joe DeMayo always knew his healthy years could end abruptly, bound to the lifespan of a transplanted kidney about the size of a small fist. But as the father of a toddler, he had hoped to have more time.

When he was 33, his wife had donated her kidney to him, a milestone that changed the course of DeMayo’s life. The relentless fatigue, nose bleeds and itchy skin brought on by his own poorly functioning kidneys vanished, and he felt good enough to leave home in Philadelphia for a new beginning in the foothills of northern California.

Over long afternoons, DeMayo would hike in the mountains with his wife and their black-and-white mutt, Fausto. When his son was born, he’d imagined himself coaching baseball games, clad in Phillies gear.

But his donated kidney started to fail in early 2023, much earlier than expected. The decline came as a surprise to DeMayo, who had been faithfully taking his medications, including tacrolimus, an essential immunosuppression drug that helps stave off organ rejection.

Joe DeMayo, his wife and son at Christmas in 2022. About a year later he would have a second kidney transplant. (Courtesy of Joe DeMayo)

DeMayo didn’t know at the time that the capsules he swallowed twice a day precisely 12 hours apart could have left him vulnerable — or that one of the most formidable drug regulators in the world may have failed to protect him.

As he grew weaker, his kidney unable to cleanse his body of excess fluid and waste, investigators from the Food and Drug Administration headed to western India to inspect the factory that manufactured DeMayo’s tacrolimus and other generic drugs for American consumers.

It was at least the eighth time since 2015 that the FDA had been there, and each of those visits had uncovered problems in the way the drugs were made, government records show.

During the inspection in the spring of 2023, investigators discovered the Intas Pharmaceuticals factory had, among other things, manipulated drug-testing records to cover up the presence of particulate matter — which could include glass, fiber or other contaminants — in the company’s drugs.

Unaware of the inspection, DeMayo continued taking his tacrolimus capsules. He fought exhaustion and struggled to hold onto his job behind a deli counter.

“Daddy needs a new kidney,” he recalled telling his 5-year-old son at the time.

DeMayo’s tacrolimus medication (George Etheredge, special to ProPublica)

That November, the FDA barred the Intas factory from exporting drugs to the United States. But under a long-standing practice uncovered by ProPublica, the agency excluded certain medications from the factory-wide ban, including tacrolimus, allowing the drugs to continue flowing to the U.S.

In a statement to ProPublica, Intas, whose U.S. subsidiary is Accord Healthcare, said that the company could not comment on the cases of individual patients but that its tacrolimus is safe and effective. The company said it immediately responded to the FDA’s inspection findings, launching a program focused on quality and investing millions of dollars in upgrades and new hires. Intas also said that some exempted drugs were never shipped to the United States but would not provide details.

“Intas is well on its way towards full remediation of all manufacturing sites,” the company said.

ProPublica’s investigation found the FDA has allowed more than 150 drugs or their ingredients from banned factories into the country over the past dozen years, ostensibly to prevent drug shortages.

The agency did not routinely test the drugs or actively look for signs of sudden or unexplained reactions among patients. And the exemptions were largely kept hidden from Congress and the public, including patients like DeMayo, who counted on his medication to keep him alive.

DeMayo filled another prescription for tacrolimus only days before the FDA exempted it from the Intas import ban and continued taking the capsules until just before his second transplant surgery at Temple University Hospital in January 2024.

“I’m trying to do the right thing, take all my medicine,” said DeMayo, 45, who took Intas tacrolimus for two years. “If I’m doing all that, shouldn’t somebody be doing their due diligence?”

In a statement, the FDA said drugmakers that receive a pass from import bans are required to conduct additional safety and quality testing and hire third-party experts to assess the results before shipping medication to the United States. Current and former FDA officials said those measures are faulty. Many of the companies have been cited before for testing protocols that were ineffective or prone to fraud.

DeMayo, now recovered from his second transplant surgery, gave ProPublica two bottles of his unused Intas tacrolimus capsules. ProPublica had them tested at Valisure, an independent, accredited lab in Connecticut.

The Testing Process

I. Preparation Valisure conducted three separate tests on DeMayo’s medication. For two of the analyses, technicians emptied the material inside the capsules onto a scale so precise that it protects samples from the movement of air. The material was then put into a solution for testing.

II. Assessment for Dosage For the first assessment, technicians used a machine to separate, identify and quantify compounds in the solution.

The liquid was poured into tiny vials and then assessed for physical and chemical properties. The analysis revealed how much of the medication’s key ingredient was present and whether it matched the dosage levels described on the label.

III. Testing for Contaminants Valisure also tested the drug for the presence of toxic elements, including lead, arsenic and mercury. The liquid was put into a machine that breaks down chemicals into atoms using plasma that is 18,000 degrees — hotter than the surface of the sun.

IV. Testing for Dissolution In the third assessment, a technician prepared a liquid that simulates stomach acid.

Then, the technician placed the pills into small metal cages and dropped them into the liquid.

The testing machine measured how fast the drug dissolved and whether the capsules provided the right amount of medication at the right time.

(Photography by George Etheredge, special to ProPublica)

In their first test, the scientists at Valisure found that some of DeMayo’s pills contained an adequate amount of the key ingredient but others contained a lower amount than the minimum level set by U.S. regulation. Pharmacists, doctors and other experts said underdosing can leave patients vulnerable to organ rejection.

Valisure did not find any substantive contamination in DeMayo’s medication.

But the scientists found another potential problem. The capsules dissolved quickly — up to three times faster than the name brand. Rapid dissolution can introduce too much of the drug too quickly, experts said, potentially causing tremors, headaches and kidney failure.

Note: Data was modeled by Valisure using the Weibull model. The chart depicts modeled data for 1 mg capsules. (Lucas Waldron/ProPublica)

ProPublica did not test tacrolimus made by any other manufacturer. In its statement, Intas said that the findings are “unrelated to the [FDA’s] inspections” and that the FDA had determined the drug was equivalent to the brand-name version when it was first approved for the U.S. market.

Valisure previously tested Intas’ tacrolimus for the Department of Defense, which is conducting safety and quality testing on more than three dozen drugs commonly used by U.S. service members and their families. Those tests, too, showed the capsules dissolved too quickly.

“This is an alarming signal of other quality issues that can be affecting patient care,” said retired Army Col. Vic Suarez, who helped launch the Defense Department effort and is assisting on the project.

The FDA conducted its own studies of Intas’ tacrolimus in recent years and reported a similar result on its website. The agency noted there was no apparent risk of organ rejection but said the Intas generic could create toxins in the body, which can cause kidney damage. The FDA said the capsules may not provide the same therapeutic effect as the brand-name version.

The findings were made public in September 2023. Weeks later, the agency went on to excuse the drug from the Intas import ban, allowing the company to continue shipping tacrolimus to the United States.

Janet Woodcock, who for years led the FDA’s Center for Drug Evaluation and Research, said in an interview that the results of the testing are concerning and that the agency should quickly “try to sort them out.”

“This obviously was a quality problem,” she said.

Woodcock did not say why the FDA exempted the drug from the import ban imposed on the Intas factory. Though Woodcock approved exemptions for years, she had left the center and was serving as the FDA’s principal deputy commissioner when the exemptions for tacrolimus and other Intas drugs were made.

DeMayo said he’ll never know whether the medication contributed to the loss of his donated kidney. Organ rejection, which can happen quickly or over years, is among the most common causes of kidney failure in transplant patients, but kidneys can fail for other reasons, too, said Joseph Vassalotti, chief medical officer at the National Kidney Foundation.

In DeMayo’s case, he was hospitalized with a stomach virus and dehydration the same year his kidney function started to decline. Still, he questions the drug that was supposed to protect him and worries that other transplant patients who have taken Intas tacrolimus could be at risk.

One and a half years after the FDA banned the factory from shipping drugs to the United States, tacrolimus is still excluded. A customer service agent for the company said Intas recently stopped distributing the drug, but the company did not respond to a request for comment.

“The people who oversee the pills are failing and the people who are making the pills are failing,” DeMayo said. “How did it get so bad?”

In January, one year after his second kidney transplant, DeMayo went to Temple University Hospital for a follow-up appointment. (First and third photos: Hannah Yoon for ProPublica. Second photo: George Etheredge, special to ProPublica.)

Lucas Waldron contributed graphics and development.

by Debbie Cenziper and Megan Rose

New York Bans Anonymous Child Welfare Reports

1 week 4 days ago

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The New York State Legislature this week passed a bill banning anonymous complaints to the state child abuse hotline. If Gov. Kathy Hochul signs the legislation, New Yorkers will now have to provide their name and contact information if they want to make an allegation that someone might be neglecting a child.

This dramatic change in the law comes a year and a half after a ProPublica investigation showed how the hotline had been weaponized by jealous exes, spiteful landlords and others who endlessly called in baseless allegations. Even if a caller didn’t leave their name or any details, and even if the same allegation had repeatedly been investigated and found to be unsubstantiated, it automatically triggered an invasive search of the accused’s home and often a strip search of the children.

We detailed the case of one Brooklyn mother whose apartment was searched dozens of times — by police officers and child protective services caseworkers who never had a warrant and often showed up at her door after midnight — all because an angry former acquaintance kept anonymously calling the hotline about her. She was never found to have mistreated her children in any way.

According to federal statistics, 96% of anonymous calls to child abuse hotlines are deemed baseless after an investigation. Among all allegations of child abuse or neglect, including non-anonymous calls, 83% are ultimately deemed unfounded.

In New York, more than 4,000 children every year had experienced child protective services investigations as a result of anonymous calls — until now.

The legislation passing is “a win-win for everybody,” said Democratic state Sen. Jabari Brisport, the bill’s sponsor. Not only will it protect victims of domestic violence who may have an abusive current or former partner who has used the anonymous reporting system to harass them or to influence a custody dispute, it will also help caseworkers themselves, Brisport said. “They are stretched so thin already,” he said. “By reducing the number of these false complaints, we can let them do their jobs better.”

“But the fact that false reports make such an effective method of harassment is a symptom of deeper issues in how CPS operates,” Brisport added, referring to how the home searches and investigations that result from these calls often turn families’ lives upside-down. Black parents especially are affected, he said, and they can feel helplessly unable to comfort their children through a terrifying and opaque process that can lead to their separation from their mom and dad.

A committee of the U.S. Commission on Civil Rights last year published a report that cited ProPublica’s journalism on these issues and called on New York to abolish anonymous reporting. ProPublica’s articles were also circulated among lawmakers and legislative staff in Albany both last year and this spring.

California and Texas, too, have passed legislation to curtail anonymous reporting. Several other states are considering similar bills.

New York’s new law will maintain the confidentiality of callers to the child abuse hotline, just not their anonymity. That means that if someone thinks that a family member, neighbor or colleague is harming a child, and they call it in, they can still be assured that the state will not reveal their identity to the alleged abuser or publicly in any way. The caller will just have to provide their name and contact information so that caseworkers can follow up, in part to make sure that they don’t have an ulterior motive for making a malicious accusation and so that caseworkers can gather more details from the caller to conduct a more informed investigation.

If they refuse to identify themselves, hotline staff will decline to pass along the tip to child protective services. But an amendment was added to the bill stating that if a caller doesn’t want to leave their name, they can still speak to a supervisor, who will then explain to them that if they provide their name it will remain confidential; that intentionally making a false report is illegal; and that issues involving children in need can also be addressed through housing, food and other services. Contact information for such services will be provided.

The new law will not affect mandated reporters of child abuse, such as teachers and police officers, who already were not anonymous.

Chris Gottlieb, director of the NYU School of Law Family Defense Clinic, helped to shepherd the legislation to its passage. She said that when she used to bring up this issue in Albany — and talk about how child protective services agents searching families’ homes without a warrant can be deeply traumatizing for both parents and children — she was often met with blank stares. But then ProPublica’s reporting “helped to change the conversation,” she said, and more importantly, parents themselves, many of them Black and Latino and led by the community organizer Joyce McMillan, started holding regular rallies on the steps of the Legislature and testifying at hearings.

In fact, parents have filed a first-of-its-kind class-action lawsuit challenging warrantless child protective services searches of their homes as unconstitutional. New York City is contesting the suit, but the city’s Administration for Children’s Services has said that it is committed to addressing child safety concerns while also respecting families’ rights.

In past statements to ProPublica, ACS has said that it is required by state law to investigate fully and to seek to conduct a home assessment whenever it receives a report of child maltreatment from the state, no matter the original source of that report. But a spokesperson said that the agency supports anonymous reporting reform with the perspective that protections for children who are in danger should also be preserved.

One of the plaintiffs in the class-action suit, Shavona Warmington, praised New York state lawmakers for abolishing anonymous reporting once and for all.

The Queens mother of six alleges that someone called in complaints about her every several months for a decade, knowing that the mere fact of a call would cause caseworkers to pound on her door; threaten that they would call the police if she didn’t let them in; search her refrigerator, cabinets, closets and bed while her kids watched; and then strip search and interrogate them. She said that the content of the reports to the hotline always sounded familiar, clearly from the same person, but that this never mattered.

In the suit, she contended that the person who made the complaints was likely the man who abused her. He could call every day and they would still send somebody out.

Her children have been traumatized by the sound of a knock on the door, she said.

“I have no contact with him otherwise, just through ACS,” Warmington said, referring to her abuser.

by Eli Hager

ProPublica Sued the FDA for Withholding Records About the Safety of Generic Drugs

2 weeks ago

We are still reporting. If you are a current or former FDA employee or someone in the industry with information about the agency, the safety of generic drugs, or the manufacturers that make them, our team wants to hear from you. Megan Rose can be reached on Signal or WhatsApp at 202-805-4865. Debbie Cenziper can be reached on Signal or WhatsApp at 301-222-3133. You can also email us at FDA@propublica.org.

ProPublica has sued the U.S. Food and Drug Administration in federal court in New York, accusing the agency of withholding information about the safety and availability of generic drugs critical to millions of Americans.

For years, Congress, watchdog groups, doctors and others have questioned the quality of generic drugs made in factories overseas. To better understand how the FDA regulates the industry and protects consumers, ProPublica submitted four records requests last year under the Freedom of Information Act.

The FDA declined to quickly release the documents, including records that would identify drugs made at some of the most troubled factories in India. Inspection reports that describe unsafe manufacturing conditions are public, but the FDA redacts the names of the medications made in those factories.

“Americans (including pharmacists, doctors, hospital systems, policy makers) cannot see for themselves which drugs may have been made in unsafe facilities,” the lawsuit said.

ProPublica requested the records as part of an ongoing investigation into the safety of America’s generic drug supply. ProPublica has reported that the FDA allowed some manufacturers to continue shipping their drugs to Americans even after the factories that made them were found in violation of quality standards and banned from the U.S. market. More than 150 drugs or their ingredients were given these little-known exemptions over the past dozen years.

In its response to ProPublica’s initial records request, the FDA said the news organization had not demonstrated “a compelling need” to expedite the release of documents. Since the lawsuit was filed in November, the agency has begun to turn over some of the requested records. The case is still active in federal court in New York.

ProPublica has argued the records will help inform American consumers, who increasingly rely on generic drugs made overseas. Quality concerns have dogged the industry for years: In 2023, four people died after using tainted eye drops made in India, and others had to have their eyeballs surgically removed.

“Every single one of us relies on the FDA to ensure that the medicines we take and give our loved ones are safe,” said ProPublica’s outside counsel, Jack Browning, a partner at Davis Wright Tremaine. “With the increasing prevalence of offshore manufacturing, it is imperative for organizations like ProPublica to ensure that safety violations are not being swept under the rug.”

The Department of Health and Human Services, which oversees the FDA, declined to comment on the case, citing the ongoing litigation.

This is the second time ProPublica has sued the FDA in recent years.

In 2023, the news outlet and the Pittsburgh Post-Gazette filed a lawsuit against the agency for withholding records related to the massive recall of breathing machines made by Philips Respironics. The agency ultimately provided the documents.

Dailey and Nguyen are with Northwestern University’s Medill Investigative Lab in Washington, D.C.

by Katherine Dailey and Jessie Nguyen, Medill Investigative Lab

Federal Judge Deems Trump Administration’s Termination of NIH Grants Illegal

2 weeks ago

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What Happened: A federal judge ruled on Monday that the Trump administration’s termination of hundreds of grants by the National Institutes of Health was “void and illegal,” ordering some of them to be reinstated, including many profiled by ProPublica in recent months.

District Judge William G. Young made the ruling in two lawsuits challenging the Trump administration’s directives and cancellations: One case was brought by more than a dozen states’ attorneys general, and the other was led by the American Public Health Association alongside several other organizations and researchers.

In Monday’s ruling, the judge determined that the directives that led to the grant terminations were “arbitrary and capricious” and said they had “no force and effect.” The judge’s ruling ordered the funding of the grants to be restored. It only covers grants that have been identified by the plaintiffs in the cases.

What the Judge Said: After Young ruled that the agency directives and terminations were illegal, he noted that the government’s practices were discriminatory.

“This represents racial discrimination, and discrimination against America’s LGBTQ community,” he said. “That’s what this is. I would be blind not to call it out. My duty is to call it out, and I do so.”

This year, the Trump administration banned the NIH from funding grants that had a connection to “diversity, equity and inclusion,” alleging that such research may be discriminatory. ProPublica previously found that caught up in mass terminations was research focused on why some populations — including women and sexual, racial or ethnic minorities — may be more at risk of certain disorders or diseases.

“I have never seen a record where racial discrimination was so palpable,” Young said during Monday’s hearing. “I’ve sat on this bench now for 40 years, and I’ve never seen government racial discrimination like this, and I confine my remarks to this record, to health care.”

He also noted the administration’s targeting of LGBTQ+ research. “It is palpably clear these directives and the set of terminated grants here also are designed to frustrate, to stop research that may bear on the health — we are talking about health here — the health of Americans, of our LGBTQ community,” he said. “That’s appalling.”

Background: In recent months, ProPublica has been covering the toll of the grant cancellations by the NIH. More than 150 researchers, scientists and investigators have reached out to ProPublica and shared their experiences, revealing how the terminations are dramatically reshaping the biomedical and scientific enterprise of the nation at large.

They described how years of federally funded research may never be published, how critical treatments may never be developed and how millions of patients could be harmed.

“Two and a half years into a three-year grant, and to all of a sudden stop and not fully be able to answer the original questions, it’s just a waste,” said Brown University associate professor Ethan Moitra, whose grant studying mental health treatment for LGBTQ+ people was terminated.

Response: White House spokesperson Kush Desai said it was “appalling that a federal judge would use court proceedings to express his political views and preferences,” adding that “justice ceases to be administered when a judge clearly rules on the basis of his political ideologies.”

Desai also defended the administration’s policies targeting “diversity, equity and inclusion,” calling it a “flawed and racist logic.” He also said that the administration was committed to “restoring the Gold Standard of Science,” which he claimed involves a recognition of the “biological reality of the male and female sexes.” The NIH, he said, is shifting “research spending to address our chronic disease crisis instead, not to validate ideological activism.”

Andrew G. Nixon, the director of communications for the Department of Health and Human Services, told ProPublica that the agency “stands by its decision to end funding for research that prioritized ideological agendas over scientific rigor and meaningful outcomes for the American people,” and that it was “exploring all legal options, including filing an appeal and moving to stay the order.”

Why It Matters: The mass cancellation of grants in response to political policy shifts has no historical precedent, experts told ProPublica, and marks an extraordinary departure from the agency’s established practices. ProPublica previously revealed that the Department of Government Efficiency — the administration’s cost-cutting initiative —— gave the agency direction on what to cut and why, raising questions about the provenance of the terminations.

The judge's ruling adds to a growing number of legal decisions halting or scaling back the administration’s actions. As of Monday, according to The New York Times, there have been more than 180 rulings that have “at least temporarily paused” the administration’s practices.

Whether the administration follows Monday’s ruling, however, remains an open question. As ProPublica reported, the NIH has previously terminated research grants even after a federal judge blocked such cuts, and the administration has disregarded several other rulings.

“If the vacation of these particular grant terminations, the vacation of these directives, taken as a whole, does not result in forthwith disbursement of funds,” Young said in Monday’s hearing, “the court has ample jurisdiction.”

Were you involved in a clinical trial, participating in research or receiving services that have ended, been paused or been delayed because of canceled federal funding? Our reporters want to hear from you. To share your experience, contact our reporting team at healthfunding@propublica.org.

Asia Fields contributed reporting.

by Annie Waldman

Threat in Your Medicine Cabinet: The FDA’s Gamble on America’s Drugs

2 weeks 1 day ago

We are still reporting. If you are a current or former FDA employee or someone in the industry with information about the agency, the safety of generic drugs, or the manufacturers that make them, our team wants to hear from you. Megan Rose can be reached on Signal or WhatsApp at 202-805-4865. Debbie Cenziper can be reached on Signal or WhatsApp at 301-222-3133. You can also email us at FDA@propublica.org.

On a sweltering morning in western India in 2022, three U.S. inspectors showed up unannounced at a massive pharmaceutical plant surrounded by barricades and barbed wire and demanded to be let inside.

For two weeks, they scrutinized humming production lines and laboratories spread across the dense industrial campus, peering over the shoulders of workers at the tablet presses, mixers and filling machines that produce dozens of generic drugs for Americans.

Much of the factory was supposed to be as sterile as an operating room. But the inspectors discovered what appeared to be metal shavings on drugmaking equipment, and records showing vials of medication that were “blackish” from contamination had been sent to the United States. Quality testing in some cases had been put off for more than six months, according to their report, and raw materials tainted with unknown “extraneous matter” were used anyway, mixed into batches of drugs.

Sun Pharma’s transgressions were so egregious that the Food and Drug Administration imposed one of the government’s harshest penalties: banning the factory from exporting drugs to the United States.

But the agency, worried about medication shortages, immediately undercut its mission to ensure the safety of America’s drug supply.

A secretive group inside the FDA gave the global manufacturer a special pass to continue shipping more than a dozen drugs to the United States even though they were made at the same substandard factory that the agency had officially sanctioned. Pills and injectable medications that otherwise would have been banned went to unsuspecting patients across the country, including those with cancer and epilepsy.

The FDA didn’t routinely test the medications for quality problems or use its vast repository of drug-related complaints to proactively track whether they were harming the people who relied on them.

And the agency kept the exemptions largely hidden from the public and from Congress. Even others inside the FDA were unaware of the details.

In the hands of consumers, according to the FDA’s longtime head of drug safety, the information would have caused “some kind of frenzy.”

“We felt we didn’t have to make it a public thing,” said Janet Woodcock, who spent nearly four decades at the agency.

The exemptions for Sun weren’t a one-time concession. A ProPublica investigation found that over a dozen years, the same small cadre at the FDA granted similar exemptions to more than 20 other factories that had violated critical standards in drugmaking, nearly all in India. All told, the group allowed into the United States at least 150 medications or their ingredients from factories with mold, foul water, dirty labs or fraudulent testing protocols.

The FDA inspection report of the Sun Pharma factory in India warned of leaks that could allow dirty water into a sterile area where drugs were made. (Obtained by ProPublica. Highlighted by ProPublica.)

Some of the drugs were recalled — just before or just after they were exempted — because of contaminants or other defects that could cause health problems, government records show. And a ProPublica analysis identified more than 600 complaints in the FDA’s files about exempted drugs at three of those factories alone, each flagging concerns in the months or years after they were excluded from import bans in 2022 and 2023.

The “adverse event” reports about drugs from the Sun plant and two others run by Indian drugmaker Intas Pharmaceuticals described medication with an abnormal taste, odor or residue or patients who had experienced sudden or unexplained health problems.

The reports cite about 70 hospitalizations and nine deaths. And those numbers are conservative. ProPublica limited its count to reports that linked problems to a single drug. However, the total number of complaints to the FDA that mention exempted drugs is in the thousands.

“Abdominal pain … stomach was acting very crazy,” one report said about a woman using a seizure drug from Sun Pharma. The FDA received the complaint in 2023, nine months after it excluded the medication from the import ban.

“Feeling really hot, breaking out with hives, hard to breathe, had confusion, glucose level was high, heart rate went up and head, arms and hands got numb,” noted another report about a patient taking a sedative from Intas. The complaint was sent to the FDA in June 2023, the same month the agency exempted the medication.

The outcomes described in the complaints may have no connection to the drug or could be unexpected side effects. In some cases, the FDA received complaints about the same drugs made by other manufacturers.

Still, the seriousness of the reports involving exempted drugs did not galvanize the agency to investigate, leaving the public and the government with no way of knowing whether people were being harmed and, if so, how many.

Those unknowns have done little to slow the exemptions. In 2022, FDA inspectors described a “cascade of failure” at one of the Intas plants, finding workers had destroyed testing records, in one case pouring acid on some that had been stuffed in a trash bag. At the second Intas factory, inspectors said in their report that records were “routinely manipulated” to cover up the presence of particulate matter — which could include glass, fiber or other contaminants — in the company’s drugs.

A 2022 FDA inspection report described “a cascade of failure” at one of the Intas plants, noting that employees were observed destroying records “by tearing it into pieces.” (Obtained by ProPublica. Highlighted by ProPublica.)

The FDA barred both plants in 2023 from shipping drugs to the U.S. Then the agency simultaneously granted more than 50 exemptions to those banned factories — the broadest use of exclusions in ProPublica’s analysis.

Intas, whose U.S. subsidiary is Accord Healthcare, said in a statement that the company has invested millions of dollars in upgrades and new hires and launched a companywide program focused on quality. Exempted drugs were sent to the United States in a “phased manner,” the company said, with third-party oversight and safety testing. Intas also said that some exempted drugs were never shipped to the United States because the FDA found other suppliers. The company would not provide details.

“Intas is well on its way towards full remediation of all manufacturing sites,” the company said.

Sun did not respond to multiple requests for comment. When the FDA imposed the ban, the company said it would “undertake all necessary steps to resolve these issues and to ensure that the regulator is completely satisfied with the company’s remedial action. Sun Pharma remains committed to being … compliant and in supplying high-quality products to its customers and patients globally.”

Both companies’ factories are still under import bans.

“We’re supposed to have the best medicine in the world,” said Joe DeMayo, a kidney transplant patient in Philadelphia who took an immunosuppression medication made by Intas until December 2023, unaware that a month earlier the FDA had excused the drug from an import ban. “Why are we buying from people who aren’t making it right?”

Joe DeMayo, a father and grocery store worker, had no idea the capsules he took every day to protect his transplanted kidney were coming from a factory in India that the FDA had banned from the U.S. market. (Hannah Yoon for ProPublica) An excerpt from an FDA inspection of an Intas factory about its manufacturing of sterile drugs (Animation by Lisa Larson-Walker/ProPublica)

Watch video ➜

Game of Chance

How the United States wound up here — playing a game of chance with risky drugs made thousands of miles away — is the story of an agency that has relentlessly pressed to keep the supply of low-cost generics flowing even as its own inspectors warned that some of those drugs posed a potentially lethal threat to the American public.

The vast majority of the prescriptions filled in the country are for generic drugs, from penicillin to blood thinners to emergency contraception, and many of those come from overseas, including India and China. For years, the FDA has vouched for the quality of generics, assuring the public in press releases, speeches and social media campaigns that they are just as safe and effective as brand-name drugs.

That guarantee came under serious question in 2019 when journalist Katherine Eban published a breakthrough book, “Bottle of Lies,” that exposed rampant fraud and manufacturing violations in Indian factories and the FDA’s reluctance to aggressively investigate.

ProPublica identified another alarming level of entrenched failure: Even when the agency did investigate and single out factories that were among the worst in India, it still gave them access to American consumers. All the while, patients took their medicine without question, trusting an agency that has long been considered the gold standard in drug regulation.

While specialized business publications have sometimes reported on exemptions when they happen, they’ve offered little context and few specifics.

The FDA in many ways put itself in this untenable position, forced to decide between not having enough drugs or accepting potentially dangerous ones, interviews and government records show.

For years, the agency gave companies with a history of manufacturing breakdowns approval to produce an increasingly larger share of generic drugs, allowing them to become a dominant force in American medicine with the power to disrupt lives if production lines were shuttered.

“It’s our own fault,” said former FDA inspector Peter Baker, who reported a litany of failures during inspections in India and China from 2012 to 2018. “We allowed all these players into the market who never should have been there in the first place. They grew to be monsters and now we can’t go back.”

The decisions to weaken penalties and allow banned factories to continue sending drugs to the United States were approved by Woodcock, one of the agency’s most powerful administrators. For more than two decades, she led the Center for Drug Evaluation and Research, the arm of the FDA that serves as the country’s gatekeeper for new and generic drugs.

In a series of interviews with ProPublica, Woodcock said she supported the use of exemptions “as a practical approach.”

“We had to kind of deal with the hand we were dealt,” she said.

Janet Woodcock, who served for years as the country’s top drug regulator, said she believed the drugs coming into the United States from banned factories were safe. The FDA did not routinely test the drugs for quality problems. (Jason Andrew for ProPublica)

Woodcock said she didn’t see a need to inform the public because the agency believed the drugs were safe. She said she mentioned the practice periodically in closed-door meetings with congressional staffers, but she did not provide specifics about those conversations.

After Woodcock left her post in 2020 to help lead the agency’s response to the COVID-19 pandemic, the exemptions — including those for Sun and Intas — continued under her successor, Patrizia Cavazzoni. Cavazzoni, who left the agency earlier this year and rejoined Pfizer, declined to comment.

Former FDA Commissioner Robert Califf, who led the agency when Sun and Intas received exemptions, told ProPublica that tough calls had to be made and the practice did not worry him.

The FDA did not respond to questions about who made those decisions or how the drugs were evaluated, and it declined requests for interviews with officials who currently oversee drug regulation. In an email, the agency said the exemptions are “thoroughly evaluated through a multi-disciplinary approach.”

Years after the FDA started granting exemptions, some current and former officials say they wrestle with a lingering fear that bad drugs are circulating in the United States.

“It’s not even a hypothetical,” said one senior FDA employee familiar with the exemptions, who, like others, spoke on the condition of anonymity because they were not authorized to speak publicly. “It’s not a question of if — it’s a question of how much.”

“It Was Rotten Eggs”

Although the FDA has been giving companies a way around import bans since at least 2013, the internal process was so secretive that many current and former FDA officials said they have no idea how many exemptions have been granted or for what drugs. In an email, the agency said it did not maintain a comprehensive list.

Even two high-level FDA staff members who worked on drug shortage challenges for the agency said in interviews they had never heard of the exemptions.

Congress required the FDA in 2012 to provide specific information every year about how and when the agency relaxed its rules for errant drugmakers to prevent shortages. But the FDA did not mention exemptions to import bans until 2024 — and only then in a single footnote of its 25-page report to Congress.

ProPublica uncovered the frequent use of exemptions by searching for the “import alert” list published on the FDA’s website that names factories banned from the U.S. marketplace. Because the agency publishes only a current list and doesn’t make the old ones public, the news organization used internet archives and FDA documents maintained by the data analytics company Redica Systems, ultimately compiling import alerts dating back more than a decade. The lists identify the drugs exempted from bans but provide few other details.

ProPublica reviewed scores of inspection reports and corporate documents for overseas factories and interviewed more than 200 people, including current and former officials of the FDA, to understand the little-known practice and the ongoing threat posed by the agency’s decisions.

The investigation revealed not only how many drugs received exemptions from import bans, but also how long the FDA allowed those exemptions to stay in place — in some cases for years.

The agency has removed exemptions when there is no longer a shortage concern. In those cases, the drugs are then banned along with the others at the factory. Both Sun and Intas have had drugs that lost their exemptions.

Two and a half years after the Sun factory was banned, five drugs are still exempted. Intas, whose factories were banned in 2023, currently has 24 drugs on the list. The bans themselves are removed only after companies fix the problems.

Earlier this month, the FDA went back to the Sun Pharma factory for a surprise inspection and found ongoing problems, according to a Sun filing with the Indian stock exchange and Indian media reports. The concerns focused on the way sterile drugs were made, including some of the exempted drugs still being sent to the United States, according to a person familiar with the situation who did not want to be named because they were not authorized to speak publicly.

The FDA said it put protections in place for exempted drugs: Manufacturers are required to conduct additional quality checks before they are sent to the United States. That has included extra drug-safety testing, in some cases at an independent lab, and bringing on third-party consultants to verify the results.

The agency did not provide ProPublica with the names of the third-party consultants hired by Sun and Intas. Intas declined to name its consultants.

“The odds of these drugs actually not being safe or effective is tiny because of the safeguards,” said one former FDA official involved in the exemptions who declined to be named because he still works in the industry and fears professional retribution. “Even though the facility sucks, it’s getting tested more often and it’s having independent eyes on it.”

But current and former FDA inspectors said those safety measures require trusting the vigilance of companies that were banned, at least in part, for providing unreliable or deceptive test results to the government or failing to investigate reports about drugs with contaminants or other quality concerns.

The FDA has granted exemptions from import bans to more than 20 foreign factories despite serious quality issues. In this 2019 inspection of a factory in south-central India, inspectors found cross-contamination on drugmaking equipment. (Obtained by ProPublica. Highlighted by ProPublica.)

The FDA could have done its own routine testing of the exempted drugs but chose not to. The agency said in an email that it tests the drugs using a “risk-based approach” but would not provide ProPublica with any information about which drugs have been tested and what the results were.

Woodcock said testing was expensive and budgets were tight. She acknowledged that regularly assessing the exempted drugs for quality or safety concerns “would have enhanced our confidence … and made everyone more comfortable.”

The European Union, by contrast, requires drugs made in India and China to be checked for quality on EU soil. And the U.S. Department of Defense is conducting its own testing of more than three dozen generic medications and has already identified potency and other quality issues.

“If you don’t know about the quality of the product, why are you letting it in?” said Murray Lumpkin, the FDA’s former deputy commissioner for international programs, who left the agency in 2014 before most of the exemptions were granted.

Beyond the lack of testing, the FDA didn’t actively look for patterns of harm among the exempted drugs in its adverse event database, Woodcock and others said.

ProPublica’s analysis of that data found thousands of reports both before and after the factories were given a pass to sidestep import bans. The reports described unexpected cases of cardiac arrest, blurred vision, choking, vertigo and kidney injuries, among other issues — and in some instances identified specific concerns about how the drugs were made.

Photos from an FDA inspection show discarded and shredded records. Drugmakers are supposed to retain records like these for inspectors to review to prove that drugs going to American consumers are safe and effective. (Obtained by ProPublica)

One person who took Intas’ clonazepam, a sedative and epilepsy drug, reported getting “brain zaps” and bright blue teeth from the coating of dye on the drug. The FDA received the complaint the same month the agency exempted the drug from the import ban.

Even before the FDA exempted Intas’ antidepressant bupropion, consumers reported that it made them sick, wasn’t always effective and had an abnormal odor, which pharmacists and others say can happen when an inactive ingredient breaks down.

“It was rotten eggs,” Nari Miller, a geologist in California who took the pills in 2022 and had severe stomach pain, told ProPublica. “I opened it and smelled it when I got home and it was awful.”

Intas said it could not respond to specific complaints and that all drugs have side effects. “Intas and Accord pay attention to each and every adverse event report,” the company said, adding, “Accord and Intas are committed to continuing to bring safe and effective medicines to patients.”

In its statement, the FDA said the database is monitored weekly for new reports in general. Woodcock, however, acknowledged the reports about exempted drugs, ideally, “would be under much more scrutiny.”

Excerpt from an FDA inspection of the Sun Pharma factory that led to an import ban (Animation by Lisa Larson-Walker/ProPublica)

Watch video ➜

Too Big to Fail

Decisions made by the FDA decades ago gave rise to the use of exemptions and the risks that now confront the American public.

When new brand-name drugs come to market, they are protected by patents and exclusive sales rights that make them generally expensive. When patents expire, generic drug companies rush in to make their own versions, which are supposed to be equivalent to the brand. Generics are often far cheaper, and insurance companies typically insist that patients use them.

In the 2000s, as the cost of brand-name drugs soared, the FDA began to approve large numbers of generics. The agency, however, gave hundreds of those approvals to foreign manufacturers that had been in trouble before, companies well known to the inspectors working to stamp out safety and quality breakdowns at overseas factories, ProPublica found.

The FDA granted Sun Pharma alone more than 250 approvals for generic drugs since the late 2000s, when the company started amassing violations, records show. The agency’s decisions helped to transform the company from a local provider in India to one of the leading exporters of medications to the United States, with nearly $2 billion in annual U.S. sales.

The approvals kept coming as inspectors continued to raise concerns about manufacturing practices at the company’s factories in India, government records show.

More problems were found at a factory that Sun had acquired in Detroit, where the diabetes drug metformin was contaminated with metal scrapings. The violations were so significant that federal marshals in 2009 raided the plant and seized drugs. The company eventually shuttered the factory.

The rapid expansion of Sun and other foreign drugmakers set off new alarms among inspectors, their supervisors and advisers to Woodcock.

“In a rational system, you would have said, ‘This company is not producing properly, so let’s not approve any more of their drugs,” said William Hubbard, former FDA deputy commissioner for policy, planning and legislation. “The agency in a sense kind of let this happen.”

Ajaz Hussain, the former deputy director of an FDA office that oversaw pharmaceutical science, said that after leaving the agency and becoming a consultant, he made his concerns known in meetings with Woodcock and others.

“They can’t manufacture it. Why do you keep approving it?” Hussain recalled in an interview with ProPublica. “I said, ‘Wake up.’ … But they didn’t listen.”

Hussain in 2012 went to work for Wockhardt, one of the largest pharmaceutical companies in India, but quit eight months later after he said he told his superiors about manufacturing failures in the company’s factories.

Although FDA inspectors had reported lapses after multiple visits to Wockhardt plants between 2004 and 2012, the agency cleared the way for the company to export sedatives, antibiotics, beta blockers, painkillers and other generics to the United States, records show. Wockhardt received exemptions from import bans in 2013. The company did not respond to repeated requests for comment, but at the time, the company said it was going to quickly address the FDA’s concerns.

The FDA could have denied generic drug applications — nothing in the law prohibits the agency from saying no to companies with spotty track records. In an email, the FDA said it considers a company’s history and conducts inspections in some cases before issuing approvals.

Woodcock said the agency knew which factories were poor performers but feared being sued by companies blocked from introducing new drugs based on past behavior. Instead, she said that she tried to convince drugmakers to invest in equipment and practices that would turn out higher-quality drugs.

“We had many meetings about this, and we agonized about all these problems,” she said.

But little changed.

Shortages vs. Quality

In 2008, dozens of Americans were killed by contaminated blood thinner from China. So when Margaret Hamburg was appointed commissioner of the FDA in the aftermath of the crisis, she pressed the agency to crack down on overseas drugmakers.

Her efforts ran headlong into what would become the worst drug shortage in modern history. By 2010, cancer drugs were scarce. So were the drugs on hospital crash carts. In all, more than 200 critical medications were in short supply.

Razor-thin profit margins had limited the number of companies that were willing to make generic drugs. And the FDA’s enforcement overseas had forced some manufacturing lines to temporarily shut down, which exacerbated the problem.

LeRoy Hubley, whose wife and son died after taking a tainted generic blood thinner from China, testified before Congress in 2008. The crisis helped prompt the FDA, under Commissioner Margaret Hamburg, to ramp up inspections of overseas drugmakers. (Brendan Smialowski/Bloomberg News)

Congress lambasted the FDA for the shortages and started requiring the agency to prove every year how it was combatting the problem.

At the time, the FDA had a small team focused on shortages that operated on the edges of Woodcock’s 4,000-person Center for Drug Evaluation and Research. With the pressure on, Woodcock elevated the team in 2010 to report directly to her deputy, a move that gave those staff members a commanding voice at the highest levels of the agency, several former staffers told ProPublica.

After 16 years in top leadership roles, Woodcock was formidable enough to force a culture change. Standing 5’2” in FDA conference rooms where she had often been disregarded as the lone woman, Woodcock had fought for her status — sometimes, she said, pushed nearly to tears with frustration. The board-certified internist asserted her authority by wielding data, what she called “brute force” and the soft persuasion of an occasional gift of an orchid, picked from her garden in suburban Maryland.

Woodcock, an avid gardener, retired from the FDA last year. (Jason Andrew for ProPublica)

By 2010, Woodcock had marshalled the center into a powerhouse with great independence — in many ways, outside the reach of the political whims of the commissioners who came and went. Those who worked with her over the years said despite her approachable manner, she fiercely guarded her territory.

In the conference room next to Woodcock’s office, the drug shortage staff began to weigh in whenever the FDA’s compliance team moved to penalize wayward drugmakers because of bad inspections, according to several former FDA officials involved in the deliberations.

Sometimes the small group would decide that a factory could no longer ship drugs to the United States and would try to get other manufacturers to make more. And other times, the group determined that exemptions from import bans were the only course.

Discussions could be tense and often lasted for weeks. A former employee on the compliance team told ProPublica that they repeatedly argued to impose a total import ban on a foreign factory because they feared the drugs couldn’t be trusted. They were left feeling uncomfortable about an exemption granted anyway — for a product that they would not use themselves.

Without exemptions, Woodcock told ProPublica, the FDA might have been forced to source the drugs from a “totally unknown manufacturer, say, from China or somewhere.”

Current and former FDA officials said the concessions became a yearslong practice rather than a stopgap measure and that the protections put in place by the agency were not sufficient. They question why Woodcock and her successor didn’t do more to raise alarms with Congress or the public about the decision to rely on inadequate factories for critical drugs.

Woodcock said she thought the exemptions were a symptom of larger issues involving the drug supply that the FDA had no control over — the agency, for example, can’t force companies concerned about slim profit margins to produce generic drugs.

Two former FDA commissioners told ProPublica they knew about the practice but were not included in the decision-making.

Hamburg, who spent six years at the agency under the Obama administration, said the extent of the practice surprised her. “Had I known that it was sort of an open-ended policy, I would have been disturbed,” she said.

One of her successors, Stephen Hahn, appointed during President Donald Trump’s first term, said more people should have been involved in the decisions.

“You’re talking about a drug of questionable quality being brought into the country,” he said.

Woodcock said she did not believe she needed their input. “I didn’t think in the individual circumstances it was necessary to elevate,” she said, “because what could they do?”

Excerpt from an FDA inspection of the Sun Pharma factory that led to an import ban (Animation by Lisa Larson-Walker/ProPublica)

Watch video ➜

“We Know What Was Found”

In 2020, the billionaire founder of Sun Pharma joined a pivotal conference call with FDA compliance and investigative staff.

Dilip Shanghvi, whose father had run a wholesale drug business in Kolkata, India, started the company in the 1980s and ultimately turned Sun Pharma into one of the largest suppliers of generic drugs in the United States. On the call, Shanghvi spoke about improvements at Sun’s enormous plant in the Indian city of Halol, according to an FDA official who attended the meeting.

Among other drugs, the plant produced at least 16 sterile injectables for the U.S. market, according to a Sun email to the FDA obtained by ProPublica. Injectables are particularly dangerous if contaminated because the medication is injected directly into the body, unlike a pill that goes through the filtering of the digestive tract.

In 2018 and 2019, inspectors had reported a series of violations at the factory, and Sun had received more than 700 complaints about what appeared to be crystals or spider webs forming in one of its injectable medications, records show.

The company also had to recall more than 135,000 vials of vecuronium bromide, a muscle relaxer used during surgery, after reports that the medication contained glass particles. Sun said the defect could cause life-threatening blood clots.

On the call with the FDA, according to the agency official, Shanghvi assured the government that the Halol plant was turning out high-quality products.

Yet, when the three investigators went back to the factory that scorching morning in 2022 for the surprise inspection, it was clear within days that the FDA would have to take swift action.

Splitting up to check different parts of the plant, the inspectors quizzed workers about cleaning procedures and looked at disassembled equipment to see if it was contaminated with residue from old drugs. At one point, they spotted water leaking near areas where sterile drugs were made, an alarming observation because water can introduce contaminants capable of causing infections or even death.

Digging through company records and test results, they found more evidence of quality problems, including how managers hadn’t properly investigated a series of complaints about foreign material, specks, spots and stains in tablets.

The 2022 FDA inspection report of Sun’s Halol plant described metal particles in vials of injectable medication. (Obtained by ProPublica. Highlighted by ProPublica.)

Several FDA employees familiar with the inspection report — 23 pages of detailed violations — said they had no idea why the agency went on to exclude so many of Sun’s drugs from the subsequent import ban.

“We know what was found,” said the FDA official who attended the meeting with Shanghvi. “How could you trust [those] drugs?”

Sun did not respond to questions about the recalls or its regulatory history with the FDA. In its 2023-24 annual report, the company said, “We have a relentless focus on 24x7 compliance to ensure continuity of supplies to our customers and patients worldwide.”

The specific findings of the FDA’s latest inspection of the Sun plant conducted this month have not yet been made public, and the company did not respond to a request for comment.

To some current and former FDA officials and other experts, plugging a supply shortage with drugs that may be contaminated or ineffective is no solution at all.

“That might be helping a shortage but might be creating a new problem,” said Lumpkin, the former deputy commissioner.

Last summer, a pair of FDA investigators arrived at another manufacturing plant in India that had a bustling production line. After more than a week at the Viatris factory, they left with a familiar list of safety and quality violations.

The inspectors found that equipment wasn’t clean and managers failed to thoroughly investigate unexplained discrepancies in test results.

In a statement to ProPublica, Viatris said it immediately worked to resolve the FDA’s concerns. “Patient safety remains our primary and unwavering focus,” the company said.

Just before Christmas, the FDA banned the facility from exporting drugs.

Then the agency gave the factory a pass, and four of its drugs are still bound for the United States.

Patricia Callahan and Vidya Krishnan contributed reporting, and Alice Crites contributed research.

Medill Investigative Lab students Haajrah Gilani, Emma McNamee, Julian Andreone, Isabela Lisco, Aidan Johnstone, Megija Medne, Yiqing Wang, Phillip Powell, Gideon Pardo, Casey He, Lindsey Byman, Josh Sukoff, Kunjal Bastola, Shae Lake, Alyce Brown, Zhiyu Solstice Luo, Jessie Nguyen, Sinyi Au, Kate McQuarrie and Katherine Dailey contributed reporting.

by Debbie Cenziper, Megan Rose, Brandon Roberts and Irena Hwang