ProPublica

by Mark Olalde, illustrations by Peter Arkle, special to ProPublica

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In December 1990, officials in the federal agency tasked with regulating offshore oil and gas drilling received a memo with a dire warning: America faced a ticking time bomb of environmental liability from unplugged oil and gas wells, wrote the agency’s chief of staff. Those wells and their costly cleanup obligations were being concentrated in the hands of cash-strapped drillers at the same time as production was shrinking. (The document, unearthed by public interest watchdog organization Documented, was shared with ProPublica and Capital & Main.)

More than three decades later, little action has been taken to heed that warning, and the time bomb is threatening to explode.

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More than 2 million oil and gas wells sit unplugged across the country. Many leak contaminants like brine, methane and benzene into waterways, farmland and neighborhoods. The industry has already left hundreds of thousands of old wells as orphans, meaning companies walked away, leaving taxpayers, government agencies or other drillers on the hook for cleanup.

America’s oil fields are increasingly split between a small number of wells producing record profits and everything else. Researchers estimate roughly 90% of wells are already dead or barely producing.

Consider the Permian Basin, the world’s most productive oil field, stretching from West Texas across southeastern New Mexico.

“The Permian is the oil patch’s Alamo — that’s where it’s retreating to,” Regan Boychuk, a Canadian oil cleanup researcher, said of the oil industry. “That’s their last stand.”

Even here, many wells sit idle and in disrepair. It’s time to plug them, according to a growing chorus of researchers, environmentalists and industry representatives.

The question of who pays for cleanup remains unanswered. Time and again, oil companies have offloaded their oldest wells. Their tactics are not written down in one place or peddled by a single law firm — but companies follow an unmistakable pattern. The strategy, which is legal if followed properly, has become such a tried-and-true endeavor that researchers and environmentalists dubbed it “the playbook.”

Clark Williams-Derry, an analyst with clean-energy-focused think tank the Institute for Energy Economics and Financial Analysis, studies fossil fuel companies’ cleanup costs. “There’s almost a cheerleading squad for shedding your liabilities, like a snake sheds its skin and just slithers away,” he said.

Should you want to become an oil executive and try this strategy yourself, here’s how it works …

As you launch your business, begin by collecting subsidies, tax breaks and other incentives from the government to guarantee you can pump oil and gas profitably. Globally, fossil fuel subsidies total in the trillions each year, according to organizations such as the International Monetary Fund.

Next, start pumping and profiting.

As you set up your business, create layers of shell companies. Down the road, they’ll provide a firewall between you and your liabilities — key among them, cleanup costs.

Once oil and gas production slows, sell low-producing wells. Smaller drillers operating on thinner margins, known in the business as “scavenger companies,” will be happy to take them off your hands.

Rinse and repeat by selling wells as their profits slow to a trickle. They’ll be sold again to ever-smaller companies that teeter on the edge of insolvency. Maintenance and environmental stewardship will usually fall by the wayside as companies eke out a profit. Studies show that the number of environmental violations rises as wells pass to less-capitalized drillers. But these wells aren’t your problem any longer.

Pull any remaining profits before regulators hit you with violations and fines for your remaining wells that aren’t pumping and may be leaking.

Then, idle the wells — pausing production, but not plugging them or cleaning up — and walk away. Regulators are typically tasked with ensuring that as much oil as possible is pumped out of the ground, so rules allow wells to sit idle, instead of being plugged, in case prices surge and it becomes profitable to restart them. However, a study in California found that, after wells are inactive for only 10 months, there’s a 50-50 chance they will never produce again.

Regulators will likely grow tired of asking you to clean up your wells, but you can make the case for leaving them unplugged for now. Pitch grand plans, as other drillers have — maybe repurposing the wells for bitcoin mining, carbon sequestration or the synthesis of hydrogen fuel — that require the wells to remain open.

When regulators’ patience has reached its limit, remind them what will happen if they come down hard on you. Fines or other extra costs could force your business into bankruptcy, leaving your unplugged wells as orphans and taxpayers on the hook. Ask them if they want to be responsible for that catastrophe.

“The root of the problem is there’s no regulator of the oil industry across North America,” Boychuk said, adding that “the rule of law has never applied to oil and gas.”

When regulators finally act, declare bankruptcy. The Bankruptcy Code is meant to protect businesspeople like you who took risks. More than 250 oil and gas operators in the U.S. filed for bankruptcy protection between 2015 and 2021, according to law firm Haynes Boone. (Industry groups estimate there are several thousand oil companies in the country.)

Regulators only require oil and gas companies to set aside tiny bonds that act like a security deposit on an apartment. Because you didn’t clean up your wells, you’ll lose that money, but it’s a fraction of the profits you’ve banked or the cost of the cleanup work. ProPublica and Capital & Main found that bonds typically equal less than 2% of actual cleanup costs.

And as you finalize your exit, the labyrinth of shell corporations you set up should act as corporate law intends, protecting you from future responsibility. Such companies, little more than stacks of paper, will be responsible for your liabilities, not you. Even if regulators know who is behind a company, it becomes increasingly difficult to penetrate each layer of a business to go after individual executives.

“It’s the essence of corporate law,” Williams-Derry said.

Now that you’ve offloaded your wells, you’re free to start fresh — launch a new oil company and buy some of your old wells for pennies on the dollar, a proven option. Maybe you leave oil entirely — that’s also tried-and-true. Or become a vintner and open a winery just down the road from the wells you left as orphans — you wouldn’t be the first.

For its part, the oil industry downplays the so-called playbook and the country’s orphan well epidemic. “There’s a general trend, which is there are very few orphan wells,” said Kathleen Sgamma, who has been among oil companies’ most vocal proponents as president of the Western Energy Alliance, an industry trade group. Plus, she said, companies’ bonds and states’ orphan well funds help pay for plugging.

But those tasked with addressing the reality of the country’s orphan wells disagree. “We have a welfare system for oil and gas. I hope you understand that,” said New Mexico Commissioner of Public Lands Stephanie Garcia Richard, who oversees the state’s public lands. New Mexico has already documented more than 1,700 orphan wells across the state. “We have oil and gas welfare queens.”

In New Mexico, Garcia Richard is trying to hold accountable one of the myriad drillers that have followed key steps in the playbook, the oil company known as Siana.

Siana is made up of two related entities — Siana Oil and Gas Co. LLC and Siana Operating LLC — based in Midland and Conroe, Texas. The company operated 11 wells in southeastern New Mexico in the heart of the Permian Basin.

In reality, Siana is the corporate shield for a man named Tom Ragsdale. After he aggregated his few wells, he generated cash through a trickle of oil and gas production and set up a business injecting other companies’ wastewater into his wells to dispose of it. But the state worried that Ragsdale’s operations were polluting the environment and that he was refusing to pay royalties and rental fees he owed the state, according to State Land Office staff.

Ragsdale did not respond to repeated requests for comment from ProPublica and Capital & Main. He also did not appear for a pretrial conference after the state brought legal action against Siana, court records show, and a state court judge ruled against his companies.

Siana was responsible for at least 16 spills, according to New Mexico Oil Conservation Division data, mainly spilling what’s called produced water, a briny wastewater that comes to the surface alongside oil and gas. “Corrosion” and “Equipment Failure” were among the causes.

The State Land Office hired an engineering firm to study the damage. The firm produced a damning 201-page report in 2018, finding oil and salt contamination exceeding state limits at Siana’s most polluted site. At high enough levels, these substances can kill plants, harm wildlife and impact human health.

The State Land Office estimated that cleaning up that site alone would cost about $1 million.

In 2020, New Mexico won a judgment against Ragsdale’s companies that, with interest, is now worth more than $3.5 million. But it won’t cover the cleanup cost. Between a small bond and the judgment, the state has been able to recover a mere $50,000 or so from Siana and related entities.

When the state tried to collect the rest, Ragsdale placed Siana Oil and Gas in bankruptcy protection in June 2023. Although he listed the company as having millions in assets at the time of the bankruptcy, the company had only $20,500 in a bank account. Court records show Siana is responsible for between $1 million and $10 million in liabilities, including money owed to the state of New Mexico, other oil companies, various counties and others.

Stickers plastered around Siana’s drill sites — on which the company’s name is misspelled — provide phone numbers to call in case of leaks or other emergencies. None went to Ragsdale or Siana employees. A man named William Dean answered one number. He owned a local oil field services company called Dean’s Pumping that was contracted to work on Siana’s wells, but Ragsdale stopped paying its bills, ultimately owing his company tens of thousands of dollars, Dean said.

“He was trying to half-ass things,” Dean said of Ragsdale. “I don’t know what happened to Tom.”

Siana’s bankruptcy case is ongoing, but Ragsdale has been largely unresponsive even in those proceedings.

Siana is, Garcia Richard said, “an exemplar of how our system has failed.” Although he was very nearly free of his old wells, Ragsdale flouted the playbook and ignored the bankruptcy judge’s demands that he participate in the case. In an unusual move, the judge in late September issued a warrant for Ragsdale’s arrest to compel him to hand over certain data. The U.S. Marshals Service was investigating Ragsdale’s whereabouts but had not taken him into custody as of mid-December, according to an agency representative.

The day after the judge issued the arrest warrant, the bankruptcy trustee filed a complaint alleging Ragsdale had committed fraud, siphoning about $2.4 million from Siana to purchase real estate in Houston.

That money could have gone toward cleaning up the mess left to New Mexico taxpayers.

ProPublica and Capital & Main visited Siana’s 11 wells in late 2023. At one drill site, methane leaked from a wellhead that had also stained the surrounding land black from spilled oil. The air was sour with the smell of toxic hydrogen sulfide. A nearby tank that held oil for processing was rusted through. Another had leaked an unidentified liquid. There appeared to be hoofprints where cattle had tracked through the polluted mud.

ProPublica and Capital & Main found oil spills at multiple Siana wells. At others, the idle pump jacks stood silent — corroded skeletons at the end of the line, the detritus of another run through the playbook.

Efforts to reform the system that has shielded oil companies from liability have been haphazard. When the federal government rewrote its rule setting bond levels on federal public land earlier this year, a simple math error meant the government would ask oil companies to set aside around $400 million less in bonds than it would’ve otherwise. And when states have tried to pass reforms, they’ve been stymied by state legislators’ and regulators’ chummy relationships with the industry.

As an ever-greater share of wells go offline and the economy transitions to cleaner forms of energy, policymakers face a choice: Do they focus attention on propping up or cleaning up the industry?

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Sgamma of the Western Energy Alliance gives voice to one path forward. “Any time a well goes into an orphan status, it’s not a good thing,” Sgamma said, yet her group has been instrumental in killing efforts to address the orphan well epidemic and the oil industry’s contributions to climate change. Her organization is suing to halt the federal rule that sought to bring bonding levels closer to true plugging costs.

Sgamma co-authored the energy section of Project 2025, the conservative policy paper with deep ties to the first Trump administration that lays out policy priorities for a conservative White House. The plan would “Stop the war on oil and natural gas,” reopen undeveloped habitat from Alaska to Colorado for drilling, increase the number of sales for oil leases on public lands and shrink federal environmental agencies. President-elect Donald Trump has repeatedly indicated this closely aligns with his vision for pumping America’s “liquid gold.” He has begun staffing his administration with pro-oil and gas figures.

The future for which Sgamma is fighting sees a resilient American oil and gas industry, able to “take a lot of punches” while continuing to grow unabated.

Or there’s the future Garcia Richard, who oversees New Mexico’s public land, envisions. She has paused the leasing of public land to drillers until the Legislature forces oil companies to pay state taxpayers higher royalties that reflect fair market rates. She directed her staff to aggressively pursue companies like Siana. And her office is preparing to raise required bonding levels. As she talked about this work, she held up the literal rubber stamp that imparts the State Land Office’s seal on documents, suggesting that’s not how business is done anymore. She also held up a small notebook where she tracks the numerous companies her office is pursuing for polluting the state’s land and water.

In her future, Garcia Richard said, oil drillers wouldn’t behave like Siana and Ragsdale. “A good-acting company is a company that understands there’s a cost of doing business that shouldn’t be borne by the landowner, shouldn’t be borne by the taxpayers,” she said. But in the modern American oil industry, she added, the playbook and the still-burning fuse of the cleanup time bomb represent little more than “Wild West behavior.”

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by Pamela Colloff

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On the 911 call, Nick Flannery’s voice was frantic as he tried to revive his infant son. “Come on, buddy,” he pleaded with the 2-month-old, who had gone limp. “Come on, buddy. Breathe.”

Nick, who was on paternity leave from his IT job, had been caring for his two boys while his wife, Felecia, was at a doctor’s appointment. Not long before he called 911, on Sept. 7, 2023, his baby, Arlo, vomited while being given a bottle. Nick, who was cradling him, turned him over to ensure that he did not choke, then changed him into fresh clothes and put him in his bouncy seat. Suddenly, Arlo’s eyes rolled back and his body stiffened. Then he went still.

Paramedics rushed to the Flannerys’ house in Blue Ash, Ohio, a suburb of Cincinnati. They revived the infant, but his breathing remained shallow. Felecia, who returned home to find emergency medical workers swarming her driveway, staggered across the front yard toward her family, uncomprehending.

In the emergency room at Cincinnati Children’s Hospital Medical Center, the Flannerys looked on as doctors worked to save their son. Soon, a social worker took them aside. She explained that a CT scan revealed the presence of subdural hematomas, or bleeding between the brain and the skull: a symptom, she said, commonly seen in abuse cases. Nick and Felecia were dumbfounded.

More tests still needed to be run, she told the Flannerys, but mandatory reporting laws required that the police and child welfare officials be alerted. Nick and Felecia, upset but certain that any concerns would be allayed once doctors gathered more information, said they understood.

Detectives arrived, and the attending physician told them that subdural hematomas could indicate an underlying medical condition — or that the baby had been shaken. It was the latter scenario that Felecia remembers the doctor mentioning to her that evening. “I’ll never forget him telling me, ‘You would probably know this as shaken baby syndrome,’” she says. Felecia, having once listened to a podcast that characterized the diagnosis as controversial, grew alarmed.

No outward signs suggested Arlo had endured harm. (Arlo is a nickname his parents asked that I use to protect his privacy.) He had no bruises, scratches or cuts. No external evidence of head trauma, like a scalp injury or a skull fracture. No broken bones. No symptoms of neglect or malnutrition. Nick and Felecia were his sole caregivers, and neither of them had any prior interaction with child protective services or a criminal history.

The next day, as they sat at their son’s bedside in the pediatric ICU, they were visited by two doctors with the hospital’s child abuse team. Dr. Steven Pham, who was halfway through a three-year fellowship in child abuse pediatrics, and Dr. Pratima Shanbhag, a child abuse pediatrician, each examined Arlo. Child abuse pediatrics is a relatively new subspecialty whose practitioners work closely with police officers and social workers to investigate potential cases of intentional harm. These physicians are entrusted with a profound responsibility: deciding whether a child’s symptoms indicate abuse or are due to an unrelated medical issue. Their findings often determine whether parents face criminal charges and whether children are separated from their families.

Pham asked the Flannerys whether anything had happened to their son — a fall? a car accident? — that might account for the bleeding on his brain. More tests still needed to be performed, he said, but the absence of any reasonable explanation for Arlo’s symptoms suggested that the infant had suffered abusive head trauma.

Pham was using the term that the American Academy of Pediatrics has recommended physicians employ since 2009 instead of “shaken baby syndrome.” That year, the AAP endorsed the use of the more comprehensive term “abusive head trauma” to describe not only brain, skull and spinal injuries that result from shaking but also those resulting from blunt impact or a combination of the two.

The name change came amid controversy over whether shaken baby syndrome’s signature symptoms — brain swelling and bleeding around the brain and from the retina — were always evidence of abuse. Once believed to be proof of shaking, the symptoms had by then been shown to have other causes, including accidental falls, illness, infection and congenital disorders. The courts took notice, and in 2008, a Wisconsin appeals court held that “a shift in mainstream medical opinion” raised questions about the diagnosis’s core assumptions.

It was in the wake of the Wisconsin decision that the AAP’s Committee on Child Abuse and Neglect, a small group of child abuse specialists, spearheaded the name change. The committee’s work came at a time when confidence was eroding in a diagnosis that the child protection community saw as vital to safeguarding children. The new name, abusive head trauma, was not only more precise, according to its 2009 consensus statement on the matter, it would also shore up credibility in the courts. “Legal challenges to the term ‘shaken baby syndrome’ can distract from the more important questions of accountability of the perpetrator and the safety of the victim,” the statement read.

Fifteen years later, the diagnosis is still shaping criminal prosecutions and child welfare investigations. Child abuse pediatricians say they do rigorous workups to rule out the possibilities of both natural and accidental causes before they settle on the diagnosis. But doctors — and the police, prosecutors and judges who look to them for guidance — don’t always get it right. Thirty-five people whose convictions rested on the diagnosis are currently listed on the National Registry of Exonerations. Not yet counted is Joshua Burns, whose wrongful conviction was vacated by a Michigan court in November.

This year, convictions that hinged on the diagnosis were overturned in California, Minnesota and Kentucky. In Texas, doubts about the guilt of a death row inmate, Robert Roberson, galvanized a bipartisan group of lawmakers to call for a wholesale reappraisal of the evidence; the legal battle that followed succeeded in postponing his scheduled execution in October. In a similar case in Arkansas, another father, Cody Webb, was acquitted of capital murder. Some judges, meanwhile, have started looking at the diagnosis with more skepticism. Last year, a New Jersey appellate court backed a lower-court judge who pronounced the diagnosis “akin to junk science.”

That tension — between child abuse pediatricians who stand by their ability to identify abuse from telltale symptoms and a mounting number of criminal cases that point to the fallability of the diagnosis — leaves families like the Flannerys vulnerable. “The rebranding of shaken baby syndrome preserved the diagnosis and allowed it to live on with less scrutiny,” says Randy Papetti, an Arizona trial attorney and author of the 2018 book “The Forensic Unreliability of the Shaken Baby Syndrome.” “Shaken baby syndrome is alive and well but mostly operates under an alias.”

Felecia and Nick (Anne Vetter)

Nick and Felecia had been together ever since they were juniors in high school in Troy, Ohio — he, earnest and mild-mannered, with chunky black glasses that channeled Buddy Holly; she, warm and unguarded, with a mane of red hair. They were strivers, intent on muscling their way out of what Nick called “the bottom end of the lower middle class.” He enlisted in the Army to pay for college, serving a combat deployment to Afghanistan, and Felecia worked her way into management at a national retail chain. They were intentional about starting a family, waiting until they were financially secure enough, in their late 20s, for Felecia to stay at home when they had their first child, Arlo’s older brother, in 2021. They built a house in a good school district, with room for a big family, and painted it a cheerful lavender.

The Flannerys did not hire a lawyer when the specter of abuse was first raised by doctors. They remained singularly focused on their infant son, who lay intubated in the pediatric ICU, his tiny body dwarfed by medical machinery. Before his hospitalization, they had told his pediatrician how he slept so much that Felecia often had to wake him for feedings, but their pediatrician had not been overly concerned; Arlo was meeting all his milestones and appeared to be thriving. Three days after he arrived at the hospital, he underwent surgery to relieve the excess fluid that had been building up inside his head. Nick and Felecia were relieved to see that he gradually improved with each day that followed.

In a report that Pham forwarded to the Blue Ash Police Department a week after the operation, he wrote that Arlo’s symptoms — which a recent exam had shown included retinal hemorrhages — raised a “concern” for abusive head trauma. Further testing, he noted, had not turned up any evidence of a genetic condition or a bleeding disorder that could explain his symptoms. Though it was not a definitive diagnosis, it was enough to set in motion a chain of events that would upend the Flannerys’ lives.

Two days later, on Sept. 20, 2023, a social worker came to their home to inform them that Hamilton County Job and Family Services, which oversees child protective services for the area, was filing for temporary custody of their children. Moments later, Blue Ash police detectives served a search warrant, demanding that the Flannerys allow them entry and turn over their phones.

Police body cameras captured the Flannerys’ anguish: Nick buckled, nearly falling to his knees. Felecia, wide-eyed, stared back at the officers’ hardened expressions.

What followed was a grinding bureaucratic journey that stripped them of everything they had worked so hard to build. They were forbidden from bringing Arlo home when he was released after a two-week stay at the hospital; a court order mandated that he and his brother live with Felecia’s aunt. Limited to supervised interactions with their children, Nick and Felecia did everything they could to maintain a sense of normalcy, arriving at the aunt’s house each morning before dawn, so they could be there when the boys awoke, and caring for them throughout the day, until Felecia nursed Arlo to sleep. Barred from spending the night, they returned home each evening to an empty house.

Desperate to be a family again, and hoping that voluntarily submitting to an extra degree of scrutiny might convince the authorities they had nothing to hide, the Flannerys had cameras installed in every room of their house. At a hearing in Hamilton County Juvenile Court that October, Magistrate Nicholas Varney offered a tentative path forward: The children could return home, but under strict conditions. Nick and Felecia were barred from being alone with them, and the boys’ grandmothers, who had come to court and volunteered to help, agreed to take turns and maintain a constant presence.

The threat of losing their children never went away. A caseworker would appear unannounced, entering their home and probing whether the Flannerys had deviated in any way from the court order. Their original caseworker, and then her replacement, often sought to get Felecia alone, pressing her to accept that her husband was an abuser. “I was not seen as protective of my children because I did not believe that Nick hurt our son,” she told me. In a November hearing, a prosecuting attorney put the county’s objectives plainly: “We maintain that the Flannery children would be at imminent risk of harm were they to continue to reside in their parents’ home today and were custody not to be granted to Job and Family Services.”

Then, on Jan. 3, Blue Ash police detectives made an unannounced visit, arresting Nick on assault and child endangerment charges. Nick, who was handcuffed in front of his older son, was careful not to react. “I knew they wanted to see me as this horrible, violent person with a hairpin trigger,” he says. From that moment onward, the Flannerys found themselves in parallel legal battles: one in juvenile court over custody of their children, and another in criminal court, where Nick faced prosecution.

Two days after his arrest, when he was set to be released on bond, the Flannerys’ caseworker arrived at the house without warning. Though Nick was within his rights to return home — the court had not imposed a no-contact order — the caseworker removed the infant and toddler that afternoon.

Felecia hurriedly nursed Arlo before he was taken away. “I was sitting on the stairs, just crying and crying,” Felecia told me. “My toddler started wiping my tears away, and I remember thinking, ‘I have to get it together, because this might be the last time I ever see them.’”

The boys were not placed in foster care, as she had been told was a possibility — they went to her aunt — and they were returned home the following week at the direction of the juvenile court. But the knowledge that her children could be taken from her at any moment left her unmoored. Stalked by the fear of what might happen if one of the boys fell or hurt themselves, she rarely left home, trusting the cameras she had installed to document her every interaction with her children. She and Nick scrupulously followed the court’s order to have an approved family member present around the clock, but she began losing sleep over any possible breach — even imagined — that could cost them custody. “I started having nightmares,” she says, “where the nightmare was that I was found alone with my children.”

The Flannerys felt certain there was a logical explanation for Arlo’s symptoms, and they began to piece together what they knew, starting with his difficult delivery, which had ended in an emergency cesarean section. More than 24 hours of labor — augmented with Pitocin, to make contractions stronger — had left a deep hollow above his forehead. The Flannerys had been assured that this was a normal consequence of a challenging delivery, and the indentation, though conspicuous, had eventually gone away. In retrospect, they wondered if this had anything to do with the bleeding on his brain.

Also notable, looking back, was the dramatic increase in Arlo’s head circumference in the weeks after his birth. By one month, his medical records showed, he had leapt from the 81st percentile for head size to the 99th, which was a possible cause for concern. The Flannerys had been told that his head growth would have to be monitored, and that if it continued to expand at the same rate, that he would be referred to a specialist for evaluation. (His next head measurement was scheduled to be taken the day after Nick called 911.)

Nick holds Arlo the day he was born. A difficult delivery left a deep hollow above his forehead. (Courtesy of Flannery Family)

As their questions multiplied, the Flannerys consulted three doctors: a pediatrician who was qualified to testify in court as a child abuse expert, a pediatric neurologist and a radiologist. After studying Arlo’s medical records and imaging, they each concluded that he had not suffered a sudden trauma just before he was rushed to the ER. In written reports, and later testimony given in juvenile court by two of the experts, they laid out their findings. Arlo, they determined, had a preexisting health condition: the bleeding on his brain was chronic, likely originating at birth. Fluid had then collected between his brain and skull, and pressure built, eventually triggering seizures. This explained Arlo’s rapid head growth and the excessive sleepiness that the Flannerys had reported to their pediatrician.

In his report, Pham dismissed the idea that Arlo’s birth was to blame, pointing to the baby’s sudden collapse a full two months after he was born. Pham made no mention of the details in Arlo’s medical records that noted the baby’s head circumference at one month or the unusual rate of growth that his pediatrician had flagged for further monitoring.

But several facts in the medical record suggested an ongoing condition: In addition to his quickly expanding head circumference, there was his pronounced sleepiness — possibly a symptom of seizures related to fluid around the brain. There were also the post-operative notes of Arlo’s neurosurgeon, which described the subdural hematomas as “chronic,” suggesting they had been present for an indeterminate period of time. The blood on the infant’s brain was straw-colored, the surgeon had observed, not the pink or red typically associated with acute trauma. During a 2023 juvenile court hearing, Pham acknowledged speaking with the neurosurgeon and reviewing the surgical notes, but he said he did not include them in his report because he focused on other indicators, such as Arlo’s rapid decline. “The thing that I focused on is his acute presentation,” Pham said.

I wanted to better understand Pham’s perspective and that of the pediatrician who had examined Arlo with him, Shanbhag. The Flannerys agreed to provide a letter authorizing the doctors to talk to me about their son’s protected health information, but a spokesperson for Cincinnati Children’s declined to make them available for an interview. The hospital also did not respond to a detailed list of questions.

The Flannerys believed the new expert opinions provided by the three doctors would exonerate Nick. “I thought investigators would consult the doctors we were talking to, and this whole misunderstanding would be swept away,” Felecia says.

But the suspicion of abusive head trauma, once raised, is hard to undo. Kristina Kerlus, a Las Vegas mother I spoke with, whose 2-month-old, Jocai Davis, was rushed to the hospital in 2018 in cardiac arrest, told me that doctors developed “tunnel vision” after finding that her son had the diagnosis’s signature symptoms. Jocai died three days later, and she was charged with murder. It took years of legal wrangling — during which her three other children were removed from her custody — for Kerlus to be vindicated. Prosecutors dropped charges in 2022 after the defense’s medical experts determined that Jocai had died from complications of sickle cell trait, an inherited blood disorder.

Even if accused parents challenge an abusive head trauma diagnosis with medical experts of their own, prosecutors tend to view these witnesses cynically. Their distrust stems from a core belief among some child advocates that physicians who question the diagnosis — whom some dismiss as “denialists” — are bad actors. “Denialists persist in generating false controversy against the diagnosis of AHT and unwarranted skepticism about shaking being an important mechanism of AHT,” states an opinion piece co-authored by three prominent child abuse experts that appeared last year in JAMA Pediatrics, a journal of the American Medical Association. “Misinformation generated by science denialists may harm children.”

Dr. Cindy Christian, a lead author of the American Academy of Pediatrics’s 2009 statement, called it “cynical” to suggest that the shift to abusive head trauma was made to evade scrutiny of the diagnosis. Rather, she wrote in an email, the name change ensured “that physicians were using correct terminology in medical records and in courts.” The controversy around shaken baby syndrome, she added, is largely contained to the legal arena. “The diagnosis is not controversial in children’s hospitals around the world,” she wrote. “The courtroom is not designed to be the arbiter of scientific truth.”

In its most recent policy statement about the diagnosis, the AAP said in 2020 that the name change to abusive head trauma “was misinterpreted by some in the legal and medical communities as an indication of some doubt in or invalidation of the diagnosis and the mechanism of shaking as a cause of injury.” The AAP “continues to embrace the ‘shaken baby syndrome’ diagnosis as a valid subset of the AHT diagnosis.”

The antipathy for physicians who challenge the diagnosis was hard to miss at the International Conference on Shaken Baby Syndrome/Abusive Head Trauma, held in Salt Lake City this September. The conference — which draws child abuse pediatricians, social workers, police and prosecutors — featured multiple presentations that cast doctors who testify for the defense as both ill-informed and mercenary. During a keynote presentation, a Milwaukee prosecutor, Deputy District Attorney Matthew Torbenson, questioned whether doctors operate in good faith when they rebut an abusive head trauma diagnosis. “Is that practicing medicine,” he asked a sympathetic crowd, “or is that providing reasonable doubt for sale?”

The expert opinions of doctors from outside the field of child abuse pediatrics who weigh in on these cases — including radiologists, neurologists and pathologists — are rarely given the same deference by the courts, one reason most legal efforts to counter the diagnosis fail. In July, I chronicled the efforts of prosecutors at the Nashville DA’s office to overturn the 2004 shaken-baby conviction of Russell Maze; though seven medical experts concluded that his son’s death was the result of natural causes, the presiding judge refused to grant a new trial.

For the Flannerys, having three physicians who provided an alternate explanation for Arlo’s symptoms did not prove to be enough. During a hearing in juvenile court in March, Shanbhag took the stand to dismiss the notion that a birth injury could explain the infant’s presentation at the ER, emphasizing that abusive head trauma was the only possible cause. “There was no other medical condition that could account for those injuries,” she said.

After hearing from both sides, Varney, the magistrate, handed down a ruling late this summer in which he leaned heavily on Shanbhag’s testimony, finding that the infant had been abused. Still, the magistrate was careful to state that due to doctors’ differing opinions, both “the origin and cause of the injuries” remained “unknown.” The attorneys whom the Flannerys retained to represent them in juvenile court, James Whitfield and Aaron Rapier, criticized this conclusion as logically inconsistent with a finding of abuse and the equivalent of claiming there “may be ‘abuse’ without any ‘abuser.’” The guardian ad litem — the attorney appointed by the court to represent Arlo’s interests — opposed the magistrate’s ruling that abuse had occurred, noting that such a conclusion was “not supported by the manifest weight of the evidence.”

Protective orders remain in place, requiring the Flannerys to keep living under the watchful eyes of family members, cameras and caseworkers. They have done everything the court has asked — taking parenting classes, submitting to mental health evaluations, complying with the safety plan — but more than a year after their boys were returned home, they are still living in limbo. “We’ve asked our caseworker, ‘So what comes next?’” Felecia says. “And the answer is that they are still pursuing custody. They offer us no plan — just that we need to say that Nick harmed Arlo.” (A spokesperson for Hamilton County Job and Family Services declined to comment on pending litigation.)

Felecia longs for their old life, unencumbered by the quiet terror of an abuse investigation. She looks at other mothers at the grocery store — mothers who are unaware that their lives can be turned upside down in an instant — and she feels “like a different species, like an alien,” she told me. Nick speaks of what feels like a primal wound: “the shame and stigma of being called an unfit parent.”

Still, the Flannerys know they are lucky. Unlike other parents who have faced the same kinds of accusations, they had the means to post bond and get Nick out of jail. They had family members who were able to serve as caregivers, which prevented Arlo and his brother from being put in foster care. Their friends stuck by them. Nick did not lose his job. And they did not suffer the worst possible outcome: Their baby lived. Arlo, now a healthy 1 1/2-year-old, has enjoyed a full recovery; ever since the surgery that relieved the excess fluid on his brain, he has not needed any medical interventions.

Yet the future is filled with uncertainty. Nick, who is expected to stand trial next year, faces up to 12 years in prison if convicted. Felecia once wanted to fill their lavender house with children, but she no longer thinks beyond the present. “We used to have plans and dreams,” she told me. “And now our future is a huge question mark.”

Arlo (Anne Vetter) Correction

Dec. 29, 2024: This story originally misstated the name of Dr. Steven Pham’s fellowship. It is child abuse pediatrics, not childhood pediatrics.

by Nicole Santa Cruz

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On a May afternoon, Teresa Stratton sat on her walker near a freeway in Portland, Oregon, talking about how much she wanted to live inside. She missed sleeping uninterrupted in a bed and having running water.

When you live outside, “the dirt embeds in your skin,” the 61-year-old said. “You have to pick it out, because it just doesn’t come out anymore.”

Living inside would also mean no longer having her belongings repeatedly confiscated by crews the city hires to clear encampments. These encounters, commonly known as “sweeps,” are the “biggest letdown in the world,” she said, noting that she lost the ashes of her late husband to a sweep.

Over the past year, my colleagues Ruth Talbot, Asia Fields, Maya Miller and I have investigated how cities have sometimes ignored their own policies and court orders, which has resulted in them taking homeless people’s belongings during encampment clearings. We also found that some cities have failed to store the property so it could be returned. People told us about local governments taking everything from tents and sleeping bags to journals, pictures and mementos. Even when cities are ordered to stop seizing belongings and to provide storage for the property they take, we found that people are rarely reunited with their possessions.

The losses are traumatizing, can worsen health outcomes, and can make it harder for people like Stratton to find stability and get back inside.

Our reporting is particularly relevant because cities have recently passed new camping bans or started enforcing ones already on the books following a Supreme Court decision in June that allows local officials to punish people for sleeping outside, even if shelter isn’t available.

President-elect Donald Trump has vowed to ban urban camping and “get the homeless off our streets,” by creating “tent cities” and by making it easier to institutionalize people with severe mental illness. “Our once-great cities have become unlivable, unsanitary nightmares, surrendered to the homeless, the drug addicted, and the violent and dangerously deranged. We are making many suffer for the whims of a deeply unwell few, and they are unwell indeed,” he said in a campaign video.

But our reporting shows there are more effective and compassionate ways for cities to deal with these issues.

The U.S. Interagency Council on Homelessness earlier this year released updated strategies for addressing encampments “humanely and effectively,” advising communities to treat encampment responses with the same urgency they would any other crises — such as tornadoes or wildfires. The council recommends providing 30 days’ notice before a removal and giving people two days to pack, unless there’s an urgent public health and safety issue. (Most cities don’t give any notice if encampments are deemed hazardous or a threat to public safety.)

The council also recommends that cities store belongings for as long as it typically takes for someone to get permanent housing. We found that the longest any city stores property is 90 days. But the wait for permanent housing can be much longer.

If officials, alongside case managers and health care professionals, worked with unhoused people over weeks, rather than days, before sweeping an encampment to help them get inside, they wouldn’t be separated from their belongings and their possessions wouldn’t need to be stored in warehouses, said Marc Dones, the policy director for the Benioff Homelessness and Housing initiative, a homelessness research group that developed recommendations for addressing encampments.

This approach would place case workers and service providers on the front lines of encampment removals. Instead, sanitation workers usually handle these traumatic displacements, research shows. And in America’s 100 largest cities, police are usually working alongside sanitation workers to not only conduct encampment closures, but also run warrant checks and cite people for camping or trespassing.

People are usually forced to move without any — or minimal — connections to housing or support. We heard from people that offers of shelter sometimes were just a piece of paper with phone numbers for congregate shelters on it or city workers mentioning a shelter.

In many American cities, this perpetuates a cycle by pushing people into surrounding neighborhoods, which causes housed residents to complain more, which leads to more sweeps.

“We have gone all in on sweeps, and we have not really explored other options,” said Megan Welsh Carroll, co-founder and director of the Project for Sanitation Justice at San Diego State University, who has advocated for spaces where people experiencing homelessness can shower and use the restroom. “And I wonder if we could bring back some compassion and some empathy if our sidewalks felt cleaner and safer to walk down.”

Punitive policies, whether they originate with Trump or local governments, make homeless people more invisible, which will continue to erode public compassion, said Sara Rankin, a law professor at Seattle University who studies the criminalization of homelessness. “All of those approaches are designed to create the illusion that the problems are getting better, when really it’s just sweeping human beings under the rug without regard to their humanity, without regard to what really happens to them,” she said.

Those experiencing homelessness told us they already feel like they’re seen as problems to be solved, not people to be helped. In reporting on the issue, we wanted to help ProPublica’s readers recognize the humanity of the people we had met and talked to, so we gave them notecards and asked them to describe their experiences with sweeps in their own words.

We wanted our readers to better understand people like Kyra Gonzales, a woman I met in Albuquerque, New Mexico. She told me that city officials had recently taken the only pictures she had of her daughter. While talking, we discovered her daughter and my 4-year-old share the same birthday. Making that connection helped me understand how emotionally devastating sweeps can be.

She told me she knows that her belongings are an “eyesore,” so she tries to keep them out of the way. She also told me that her tent had been taken by the city. Temperatures that month dropped as low as 14 degrees. “I cried because it was cold,” she said.

I asked her what the public doesn’t understand about homelessness.

“I was just like you once,” she said, looking me in the eye. “I’m not any different now, I’m just without housing, without a house.”

by Asia Fields, Nicole Santa Cruz, Ruth Talbot and Maya Miller, design by Ruth Talbot

A record number of Americans are living outside. Cities have responded by removing encampments from public spaces, a practice commonly referred to as “sweeps.” In the process, workers often take people’s belongings — including important documents, survival gear and irreplaceable mementos.

Over and over, people across the country told ProPublica they were devastated by such losses. We gave them notecards so they could explain in their own words how the sweeps have affected them.

Here are some of their stories.

by ProPublica

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Over the past year, as the 2024 election dominated headlines, ProPublica’s reporters and editors dove deeply into the issues atop many voters’ minds.

Kavitha Surana, Cassandra Jaramillo and Lizzie Presser uncovered the deaths of at least five women who weren’t able to access timely reproductive and medical care under abortion bans in Texas and Georgia. As part of our series examining new patterns of immigration, Melissa Sanchez and Maryam Jameel reported on what was happening in Whitewater, Wisconsin, as the city became a Republican talking point. Eli Hager and Lucas Waldron dug into why low-income families in Arizona weren’t using school vouchers as voucher supporters were pitching similar programs across the country.

That’s not all. Our reporters also spent months investigating other issues that touch readers’ lives, from the challenges of finding a mental health care provider who takes insurance to the human toll of the fentanyl crisis.

ProPublica reporters will continue this work in the new year as Donald Trump’s second administration takes shape. In the meantime, revisit ProPublica’s 25 most-read stories published in 2024, as measured by the total amount of time spent reading them across several of our publishing platforms.

1. The Year After a Denied Abortion By Stacy Kranitz, special to ProPublica, and Kavitha Surana

Tennessee law prohibits women from having abortions in nearly all circumstances. But once the babies are here, the state provides little help. ProPublica followed Mayron Michelle Hollis and her family for a year as they struggled to make it.

2. “Eat What You Kill” By J. David McSwane; co-published with Montana Free Press

Hailed as a savior upon his arrival at St. Peter’s Hospital in downtown Helena, Montana, Dr. Thomas C. Weiner became a favorite of patients and the hospital’s highest earner. As the myth surrounding the high-profile oncologist grew, so did the trail of patient harm and suspicious deaths.

3. Armed and Underground: Inside the Turbulent, Secret World of an American Militia By Joshua Kaplan

Internal messages reveal how AP3, one of the largest U.S. militias, rose even as prosecutors pursued other paramilitary groups after the Jan. 6, 2021, assault on the Capitol.

4. How 3M Executives Convinced a Scientist the Forever Chemicals She Found in Human Blood Were Safe By Sharon Lerner, photography by Haruka Sakaguchi, special to ProPublica; co-published with The New Yorker

Decades ago, Kris Hansen showed 3M that its PFAS chemicals were in people’s bodies. Her bosses halted her work. As the EPA took steps to force the removal of the chemicals from drinking water, she wrestled with the secrets that 3M kept from her and the world.

Candace Fails holds a photograph of her daughter Nevaeh Crain, who died last year after seeking help from two hospitals for pregnancy complications. (Danielle Villasana for ProPublica)

5. A Pregnant Teenager Died After Trying to Get Care in Three Visits to Texas Emergency Rooms By Lizzie Presser and Kavitha Surana

It took three ER visits and 20 hours before a hospital admitted 18-year-old Nevaeh Crain as her condition worsened. Doctors insisted on two ultrasounds to confirm “fetal demise.” She’s one of at least three Texas women who died under the state’s abortion ban.

6. Multiple Trump Witnesses Have Received Significant Financial Benefits From His Businesses, Campaign By Robert Faturechi, Justin Elliott and Alex Mierjeski

Witnesses in the various criminal cases against Donald Trump have gotten pay raises, new jobs and more. If any benefits were intended to influence testimony, that could be a crime.

7. “Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care By T. Christian Miller, ProPublica; Patrick Rucker, The Capitol Forum; and David Armstrong, ProPublica

When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to EviCore, whose business model depends on turning down payments for care recommended by doctors for their patients.

8. IRS Audit of Trump Could Cost Former President More Than $100 Million By Paul Kiel, ProPublica, and Russ Buettner, The New York Times

The tax agency concluded in its long-running investigation that Donald Trump effectively claimed the same massive write-off twice on his failed Chicago tower.

9. A Woman Died After Being Told It Would Be a “Crime” to Intervene in Her Miscarriage at a Texas Hospital By Cassandra Jaramillo and Kavitha Surana

Josseli Barnica is one of at least three pregnant Texas women who died after doctors delayed emergency care. She’d told her husband that the medical team said it couldn’t act until the fetal heartbeat stopped.

10. Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable. By Kavitha Surana

At least two women in Georgia died after they couldn’t access legal abortions and timely medical care in their state, ProPublica has found. This is one of their stories.

11. How Walmart’s Financial Services Became a Fraud Magnet By Craig Silverman and Peter Elkind

Scammers have duped consumers out of more than $1 billion by exploiting Walmart’s lax security. The company has resisted taking responsibility while breaking promises to regulators and skimping on training.

12. He Was Convicted of Killing His Baby. The DA’s Office Says He’s Innocent, but That Might Not Be Enough. By Pamela Colloff, photography by Stacy Kranitz; co-published with The New York Times Magazine

When new scientific evidence casts doubt on convictions, the justice system has no easy path to freedom — even when it’s the prosecutors doing the asking.

13. Trump’s Lawyers Told the Court That No One Would Give Him a Bond. Then He Got a Lifeline, but They Didn’t Tell the Judges. By Robert Faturechi, Justin Elliott and Alex Mierjeski

An appeals court reduced Donald Trump’s bond by more than 60% after his attorneys claimed it was a “practical impossibility” to pay the full amount. Their failure to disclose a proposal from a billionaire financier may have violated ethics rules.

14. For the Women Who Accused the Trump Campaign of Harassment, It’s Been More Harassment By Marilyn W. Thompson

Donald Trump is well known for publicly bullying his political rivals, but the president-elect’s campaign has also used similar tactics to launch private, relentless attacks against some of its own workers.

15. Inside the Historic Suit That the Gun Industry and Republicans Are on the Verge of Killing By Vernal Coleman, photography by Sarahbeth Maney

For 25 years, gunmakers have repeatedly tried to end one city’s lawsuit over illegal gun sales. Meanwhile, illicit purchases of firearms continued at an unrelenting and hazardous pace.

16. Inside Ziklag, the Secret Organization of Wealthy Christians Trying to Sway the Election and Change the Country By Andy Kroll, ProPublica, and Nick Surgey, Documented

The little-known charity is backed by famous conservative donors, including the families behind Hobby Lobby and Uline. It spent millions to make a big political push for the 2024 election — but it may have violated the law.

(Collage by Han Cao for ProPublica. Source images: Brown County, Wisconsin, court document and photographs courtesy of Maylia Sotelo and Carrie Harrison.)

17. Maylia and Jack: A Story of Teens and Fentanyl By Lizzie Presser; co-published with Teen Vogue

Police knew she was selling fake Percocet but did not stop her. His mother sought the right treatment for his addiction but could not find it. Two teens got caught up in a system unprepared to handle kids on either side of the drug trade.

18. Inside Project 2025’s Secret Training Videos By Andy Kroll, ProPublica, and Nick Surgey, Documented

“Eradicate climate change references”; only talk to conservative media; don’t leave a paper trail for watchdogs to discover. In a series of never-before-published videos, Project 2025 detailed how a second Trump administration would operate.

19. What Happened in Whitewater By Melissa Sanchez and Maryam Jameel, photography by Sofia Aldinio, special to ProPublica

Before Springfield, Ohio, became a flashpoint in the immigration debate, Trump and right-wing pundits exploited a police chief’s plea for resources to claim Whitewater was being subjected to an “invasion.” The truth turned out to be much more complicated.

Anna DiNoto in her office in Monroe, Washington. (Tony Luong, special to ProPublica)

20. Why I Left the Network By Annie Waldman, Maya Miller, Duaa Eldeib and Max Blau, photography by Tony Luong, special to ProPublica, design by Zisiga Mukulu; co-published with NPR

Those who need therapy often have to pay out of pocket or go without care, even if they have health insurance. Hundreds of mental health providers told us they fled networks because insurers made their jobs impossible and their lives miserable.

21. An 11-Year-Old Denied Making a Threat and Was Allowed to Return to School. Tennessee Police Arrested Him Anyway. By Aliyya Swaby, ProPublica, and Paige Pfleger, WPLN/Nashville Public Radio

A state law makes threats of mass violence at school a felony, even if they’re not credible. Judges and school officials say the law unnecessarily traumatizes kids.

22. Skipping School: America’s Hidden Education Crisis By Alec MacGillis; co-published with The New Yorker

Absenteeism has nearly doubled since the pandemic. With state and federal governments largely abdicating any role in getting kids back into classrooms, some schools have turned to private companies for a reimagined version of the truant officer.

Fabiola Velasquez walks her youngest child to school. (Ash Ponders, special to ProPublica)

23. In a State With School Vouchers for All, Low-Income Families Aren’t Choosing to Use Them By Eli Hager and Lucas Waldron

Working-class parents often express interest in vouchers. But in Arizona, the nation’s school choice capital, these families aren’t using them due to the inaccessibility of private schools and the costs of transportation, meals and uniforms.

24. Judge Aileen Cannon Failed to Disclose a Right-Wing Junket By Marilyn W. Thompson and Alex Mierjeski

Aileen Cannon, whose oversight of the Donald Trump classified documents case garnered widespread criticism, has repeatedly violated a rule requiring that federal judges disclose their attendance at private seminars.

25. A Third Woman Died Under Texas’ Abortion Ban. Doctors Are Avoiding D&Cs and Reaching for Riskier Miscarriage Treatments. By Lizzie Presser and Kavitha Surana

Thirty-five-year-old Porsha Ngumezi’s case raises questions about how abortion bans are pressuring doctors to avoid standard care even in straightforward miscarriages.

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by Renee Dudley

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The Federal Trade Commission is investigating Microsoft in a wide-ranging probe that will examine whether the company’s business practices have run afoul of antitrust laws, according to people familiar with the matter. In recent weeks, FTC attorneys have been conducting interviews and setting up meetings with Microsoft competitors.

One key area of interest is how the world’s largest software provider packages popular Office products together with cybersecurity and cloud computing services, said one of the people, who asked not to be named discussing a confidential matter.

This so-called bundling was the subject of a recent ProPublica investigation, which detailed how, beginning in 2021, Microsoft used the practice to vastly expand its business with the U.S. government while boxing competitors out of lucrative federal contracts.

At the time, many federal employees used a software license that included the Windows operating system and products like Word, Outlook and Excel. In the wake of several devastating cyberattacks, Microsoft offered to upgrade those license bundles for free for a limited time, giving the government access to its more advanced cybersecurity products. The company also provided consultants to install the upgrades.

Vast swaths of the federal bureaucracy accepted, including all of the military services in the Defense Department — and then began paying for those enhanced services when the free trial ended. Former sales leaders involved in the effort likened it to a drug dealer hooking a user with free samples, as they knew federal customers would be effectively locked into the upgrades once they were installed. Microsoft’s offer not only displaced some existing cybersecurity vendors but also took market share from cloud providers like Amazon Web Services, as the government began using products that ran on Azure, Microsoft’s own cloud platform.

Some experts told ProPublica that the company’s tactics might have violated laws regulating contracting and competition, and the news organization reported that even some of Microsoft’s own attorneys had antitrust worries about the deals.

Microsoft has said its offer was “structured to avoid antitrust concerns.” The company’s “sole goal during this period was to support an urgent request by the Administration to enhance the security posture of federal agencies who were continuously being targeted by sophisticated nation-state threat actors,” Steve Faehl, the security leader for Microsoft’s federal business, told ProPublica.

Some of those incursions were the result of Microsoft’s own security lapses. As ProPublica reported in June, Russian state-sponsored hackers in the so-called SolarWinds attack exploited a weakness in a Microsoft product to steal sensitive data from the National Nuclear Security Administration and the National Institutes of Health, among other victims. Years before the attack was discovered, a Microsoft engineer warned product leaders about the flaw, but they refused to address it for fear of alienating the federal government and losing ground to competitors, ProPublica reported.

While the engineer’s proposed fix would have kept customers safe, it also would have created a “speed bump” for users logging on to their devices. Adding such “friction” was unacceptable to the managers of the product group, which at the time was in a fierce rivalry with competitors in the market for so-called identity tools, the news organization reported. These tools, which ensure that users have permission to log on to cloud-based programs, are important to Microsoft’s business strategy because they often lead to demand for the company’s other cloud services.

According to a person familiar with the FTC’s probe, one such identity product, Entra ID, formerly known as Azure Active Directory, is another focus of the agency’s investigation.

Microsoft has defended its decision against addressing the SolarWinds-related flaw, telling ProPublica in June that the company’s assessment included “multiple reviews” at the time and that its response to security issues is based on “potential customer disruption, exploitability, and available mitigations.” It has pledged to put security “above all else.”

The FTC views the fact that Microsoft has won more federal business even as it left the government vulnerable to hacks as an example of the company’s problematic power over the market, a person familiar with the probe told the news organization.

The commission is not alone in that view. “These guys are sort of a version of ‘too big to fail,’” said Sen. Ron Wyden, an Oregon Democrat who chairs the Senate Finance Committee and a longtime critic of Microsoft. “I think it’s time to amp up the antitrust side of the house, dealing with antitrust abuses.”

The FTC’s investigation of Microsoft, which was first reported by the Financial Times and Bloomberg, is far from the company’s first brush with federal regulators over antitrust issues. More than two decades ago, the Department of Justice sued the company in a landmark antitrust case that nearly resulted in its breakup. Federal prosecutors alleged that Microsoft maintained an illegal monopoly in the operating system market through anticompetitive behaviors that prevented rivals from getting a foothold. Ultimately, the Justice Department settled with Microsoft, and a federal judge approved a consent decree that imposed restrictions on how the company could develop and license software.

John Lopatka, a former consultant to the FTC who now teaches antitrust law at Penn State, told ProPublica that the Microsoft actions detailed in the news organization’s recent reporting followed “a very familiar pattern” of behavior.

“It does echo the Microsoft case” from decades ago, said Lopatka, who co-authored a book on that case.

In the new investigation, the FTC has sent Microsoft a civil investigative demand, the agency’s version of a subpoena, compelling the company to turn over information, people familiar with the probe said. Microsoft confirmed that it received the document.

Company spokesperson David Cuddy did not comment on the specifics of the investigation but said the FTC’s demand is “broad, wide ranging, and requests things that are out of the realm of possibility to even be logical.” He declined to provide on-the-record examples. The FTC declined to comment.

The agency’s investigation follows a public comment period in 2023 during which it sought information on the business practices of cloud computing providers. When that concluded, the FTC said it had ongoing interest in whether “certain business practices are inhibiting competition.”

The recent demand to Microsoft represents one of FTC Commissioner Lina Khan’s final moves as chair, and the probe appears to be picking up steam as the Biden administration winds down. The commission’s new leadership, however, will decide the future of the investigation.

President-elect Donald Trump said this month that he will elevate Commissioner Andrew Ferguson, a Republican attorney, to lead the agency. Following the announcement, Ferguson said in a post on X, “At the FTC, we will end Big Tech’s vendetta against competition and free speech. We will make sure that America is the world’s technological leader and the best place for innovators to bring new ideas to life.”

Trump also said he would nominate Republican lawyer Mark Meador as a commissioner, describing him as an “antitrust enforcer” who previously worked at the FTC and the Justice Department. Meador is also a former aide to Sen. Mike Lee, a Utah Republican who introduced legislation to break up Google.

Doris Burke contributed research.

by Heather Vogell

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New regulations in Thailand will force baby formula companies to stop advertising, giveaways and discounts for so-called toddler milk, which experts say can contribute to growing obesity and other health problems among the nation’s children.

The action follows a ProPublica investigation that revealed how the U.S. worked to weaken Thailand’s last major attempt to ban formula advertising, in 2017.

Thai health authorities at the time had hoped to end marketing for all formula products as part of their efforts to increase the country’s breastfeeding rate, which was among the lowest in the world. Of particular concern was toddler milk, a type of formula made especially for young children, often pitched with bold and, experts say, unsupported health claims. But formula makers like Mead Johnson asked U.S. trade officials to intervene, setting off a 15-month diplomatic and political pressure campaign that resulted in an exemption for toddler milk ads.

By last year, toddler milk — a processed drink that typically includes powdered milk, vegetable oil and sweeteners — accounted for more than half of all formula sales in Thailand, according to Euromonitor, which tracks sales data.

The U.S. intervention in Thailand was one of roughly two dozen such efforts documented by ProPublica this year as it investigated the federal government’s long-running support for the multibillion-dollar formula industry. In recent years, that advocacy has often centered on opposing local efforts to regulate formula marketing around the globe.

Health officials and activists say such advertising can mislead parents and even prompt mothers to abandon breastfeeding too soon, depriving children of a range of health protections. Mead Johnson did not respond to a request for comment. But the industry has defended its promotion of toddler milk, saying it “can contribute to nutritional intake and potentially fill nutrition gaps for children 12 months and older.”

In Thailand in 2023, ProPublica observed towering displays of powdered toddler milk boxes lining grocery store shelves beside boxes of baby formula. Companies offered steep discounts for toddler drinks and gave away items such as toys, musical instruments or even small swing sets in exchange for purchases.

“The marketing is quite aggressive,” said Dr. Titiporn Tuangratananon, who worked on the Thai health ministry’s effort to enact the new restrictions.

In 2016 and 2017, U.S. trade officials lambasted Thailand on the floor of the World Trade Organization for proposing restrictions on toddler milk advertising. Officials then said the rules raised questions about whether they were “more trade restrictive than necessary.”

This year, however, the U.S. took a different approach. In a letter to Thai authorities, officials said the U.S. “supports Thailand’s objective to prevent deceptive marketing practices thereby protecting the health and wellbeing of both infants and young children.”

While trade officials asked questions such as which products would be covered and why the new rules would restrict marketing that was not deceptive or inaccurate, they did not echo concerns industry representatives raised about whether the rules were inconsistent with trade treaties, documents obtained by ProPublica show.

In response to questions, a spokesperson for the Office of the U.S. Trade Representative said the agency and others involved in trade policy support regulatory decisions “based on science.”

“Since the start of the Biden Harris Administration, USTR has made no secret our commitment to making sure our trade policy works for people,” spokesperson Angela Perez said in a statement. USTR does not “blindly” advance the will of corporations, the statement said, and has been moving “away from the formerly standard view that too often deemed legitimate regulatory initiatives as trade barriers.”

Before adopting the new rules on toddler formula, the Thai health ministry had a hearing and met with representatives of formula companies, which strongly opposed the changes.

A letter from the industry group the Infant Nutrition Council of America said restrictions on trademarked brands of toddler milk — also known as growing-up milk — could “violate Thailand’s obligations” under a WTO agreement on intellectual property.

“The Ministry’s focus on restricting information about formula and growing up milk products up to 36 months of age overlooks other public health and public policy concerns,” the letter said, citing the challenges faced by working women, the impact of local dietary practices on malnutrition and the importance of milk products for child development.

Another group, the US-ASEAN Business Council, said the changes could violate trade treaties and “deny Thai consumers important information to identify reputable, scientifically-formulated products that are safe and effective.”

The business council declined to comment further. The nutrition council did not respond to questions from ProPublica.

With the new rules, Thailand joins roughly three dozen countries to adopt restrictions on the marketing of formula drinks for children through age 3 or even older — measures the World Health Organization has supported because of concerns about the drinks’ nutrition and potential to disrupt breastfeeding.

The regulations will go into effect in July.

by Doug Bock Clark

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Months before voters went to the polls in November, a group of election skeptics based in North Carolina gathered on a call and discussed what actions to take if they doubted any of the results.

One of the ideas they floated: try to get the courts or state election board to throw out hundreds of thousands of ballots cast by voters whose registrations are missing a driver’s license number and the last four digits of a Social Security number.

But that idea was resisted by two activists on the call, including the leader of the North Carolina chapter of the Election Integrity Network. The data was missing not because voters had done something wrong but largely as a result of an administrative error by the state. The leader said the idea was “voter suppression” and “100%” certain to fail in the courts, according to a recording of the July call obtained by ProPublica.

This novel theory is now at the center of a legal challenge by North Carolina appeals court Judge Jefferson Griffin, a Republican who lost a race for a state Supreme Court seat to the Democratic incumbent, Allison Riggs, by just 734 votes and is seeking to have the result overturned.

The state election board dismissed a previous version of the challenge, which is now being considered in federal court. Before the election, a Trump-appointed judge denied an attempt by the Republican National Committee to remove 225,000 voters from the rolls based on the same theory.

The latest case is getting attention statewide and across the country. But it has not yet been reported that members of the group that had helped publicize the idea had cast doubt on its legality.

“I don’t comment on pending litigation,” Griffin wrote to ProPublica in response to a detailed list of questions. “It would be a violation of our code of judicial conduct.”

Embry Owen, Riggs’ campaign manager, disputed the challenge and called on Griffin to concede. “It’s not appropriate for this election to be decided in court, period. NC voters have already made the decision to send Justice Riggs back to the Supreme Court,” she said.

The theory Griffin is citing originated with a right-wing activist, Carol Snow, who described herself to ProPublica in an email as “a Bona Fide Grade-A Election Denier.” Snow promoted it with the help of the state chapter of the Election Integrity Network, a national group whose leader worked with President Donald Trump in his failed effort to overturn the 2020 election. The network also was behind extensive efforts to prepare to contest a Trump loss this year in other states, as ProPublica has reported, as well as in North Carolina, according to previously unreported recordings and transcripts of meetings of the state chapter.

State election officials have found that missing information on a voter’s registration is not disqualifying because there are numerous valid reasons for the state’s database to lack that those details.

Those reasons include voters registering before state paperwork was updated about a year ago to require that information or using alternate approved documents, such as a utility bill, to verify their identities. What’s more, voters must still prove their identity when casting a ballot — most often with a driver’s license. “There is virtually no chance of voter fraud resulting from a voter not providing her driver’s license or social security number on her voter registration,” attorneys for the state election board wrote in response to the RNC lawsuit.

Bob Orr, a former GOP state Supreme Court justice who left the Republican Party in 2021, said he too doubts the theory. “I appreciate fighting for every vote: If you honestly think illegal votes have been cast, it’s legitimate to try to prove that,” he said. “But the bottom line is: Did anyone vote illegally? Have you been able to prove one person voted illegally? At this point, no. And we’re weeks past the election and multiple recounts, and there’s no evidence of that.”

In modern history, the state board’s decision on who wins elections has been final, said Chris Cooper, a professor specializing in North Carolina politics at Western Carolina University. That includes an even tighter race in 2020, when a Democratic justice conceded to a Republican after protesting her 401-vote loss to the board.

“We’re used to close elections, we’re used to protests, we’re used to candidates pushing every legal action up to the point the state election board rules,” Cooper said. But, he added, there is an important difference with Griffin’s petition, which goes beyond the state election board to the courts.

“This is basically saying the state elections system is wrong, and we’re going to court to try to change the rules of the game after the game has been played — which is unprecedented.”

In July 2024, the North Carolina chapter of the Election Integrity Network convened online to plan its efforts ahead of the presidential election. Worried about a surge of voter registrations from nonwhite voters who they believed would back Democrats, the activists discussed how to assemble a “suspicious voters list” of people whose ballots they could challenge.

Then, one of the group’s board members, Jay DeLancy, said he had another idea “that’s a lot slicker.”

DeLancy said that if a candidate lost a close election, the loss could be overturned by questioning the validity of voters whose registrations are missing their driver’s license and Social Security information. “Those are illegal votes,” he claimed. “I would file a protest.”

Jim Womack, the leader of the chapter, immediately pushed back: “That’s a records keeping problem on the part of the state board. That’s not illegal.”

Later in the call Womack said, “I’m 100% sure you’re not going to get a successful prosecution.” And he told the group, “That’s considered to be voter suppression, and there’s no way a court is going to find that way.”

But DeLancy asked for backup from the originator of that theory: Carol Snow. She argued that her theory could in fact overturn the outcome of an election.

“I guess we’re gonna find that out,” Snow said.

Snow is a leader of the conservative activist group North Carolina Audit Force and lives in the state’s rural mountains. After Trump’s loss in 2020, she threw herself into questioning the election’s results. In 2022, she accompanied a pair of far-right activists to a North Carolina election office where the two men unsuccessfully tried to forcefully access voting machines, and she participated in a failed pressure campaign to oust the election director who resisted them, ProPublica previously reported.

She also began filing overwhelming numbers of records requests and complaints to state election officials, an effort that Womack praised on the July call: “I think Carol has shown a way of really harassing — not that we want to do it for harassment purposes — but really needling the Board of Elections to do their jobs by just constantly deluging them.”

Since late 2021, the state elections board had spent far more time on her requests and complaints than those of any other individual, spokesperson Patrick Gannon said in a statement. “Ms. Snow’s constant barrage of requests and complaints causes other priorities and responsibilities to suffer,” Gannon said.

Snow described her work to ProPublica as “simply taking the time to learn about my state’s electoral process” and acting for the public good. “The records I’ve requested are owned by the public. In other words, I’m asking for what belongs to me,” Snow wrote to ProPublica. “If government agencies are understaffed and unable to comply with this state’s Public Records law, they should address the issue with the entities that fund them.”

In the fall of 2023, Snow filed a complaint alleging that North Carolina’s voter registration form did not clearly require voters to provide their driver’s license number and the last four digits of their Social Security number, as required by federal law — instead that information was coded as optional. Snow later described the missing information as a “line of attack” through which bad actors could cast fraudulent votes using fake identities. (A right-wing conspiracy theory holds that this was how Biden won the 2020 election.)

But she was not able to demonstrate that the missing information had led to anyone improperly voting. After obtaining public records for hundreds of thousands of voter registrations, Snow provided the state board with only seven examples of what she called potential double voting. The state board found all seven to be innocuous things like data entry errors.

The state board quickly updated the form to require the information. But from late 2023 through the fall of 2024, six complaints, some of which were partly based on Snow’s theory, were filed with the state election board. Aside from the updates to the form, the state board dismissed the complaints.

By the time of the July call, some of Snow’s peers seemed dismissive as well.

“I’m not suggesting that we can’t arm a candidate that loses a short, a close race with the information they need to file a protest using this,” Womack said on the call. “But I would just suggest to you that that’s not the way to win on this thing.”

Yet the information did end up in the Republican National Committee’s lawsuit trying to disqualify 225,000 voters, a challenge DeLancy filed against Riggs’ victory in North Carolina’s most populous county, and, the day after that was dismissed, Griffin’s challenge to over 60,000 voters.

DeLancy wrote to ProPublica that he filed the challenge on his own and did not coordinate with Griffin. He also said he disagreed with Womack’s description of such challenges as “voter suppression.” Instead, he said, he saw it as “a proper response” to the state election board’s “violation of federal law.” “Carol Snow deserves an Order of the Long Leaf Pine for exposing this treasonous behavior on the part of the election officials,” he wrote, referring to an award bestowed by North Carolina’s governor.

Womack wrote to ProPublica that the group he leads “is a non-partisan, neutral organization” that does “not favor one party over another.”

He also said that recordings of the group’s calls are “prohibited and violate our internal policies” and “whatever bootleg recording you may have is unauthorized and may well be altered.” ProPublica has seen a video recording of the call and verified portions of it with some participants.

Though Griffin’s challenge of Riggs’ victory is now being considered in federal court, legal experts say it could still end up back where he intended: in front of the state Supreme Court.

Griffin’s petition is making what experts describe as extreme asks to the Supreme Court: to allow him to bypass the lower courts, to allow ballots to be thrown out without proving that voters did anything knowingly wrong and to essentially decide whether to change its composition to six Republicans and one Democrat.

“Even if they do their best to be open-minded and independent, the facts of the potential conflicts of interest are just too obvious to the public,” said Orr, the former Republican justice.

Griffin has described Republican Supreme Court Chief Justice Paul Newby as a “good friend and mentor,” and Newby promoted Griffin’s 2020 run for the court of appeals. What’s more, a ProPublica review of campaign finance reports show that the spouses of three justices, including Newby’s wife, donated over $12,000 to Griffin’s most recent or previous campaigns. (The husband of the Supreme Court’s other Democratic justice donated to Riggs.)

Newby and other justices did not respond to a detailed list of questions sent to spokespeople for the Supreme Court.

When announcing his candidacy for the Supreme Court, Griffin declared, “We are a team that knows how to win — the same team that helped elect Chief Justice Paul Newby and three other members of the current Republican majority.”

A cartoon illustration that hangs in the Supreme Court depicts all the Republican appellate jurists as superheroes from the Justice League, with Newby caricatured as Superman and Griffin as the Flash.

by Andrea Suozzo

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

During the year’s busiest season of charitable giving, donors may wonder whether the nonprofits they are considering donating to are going to be good stewards of their money.

ProPublica’s Nonprofit Explorer already allows users to thoroughly research charities, and now we’re adding more features to help you understand the financial health of organizations. Starting Monday, you can search for organizations that have reported a significant theft, as well as those that have had auditors flag serious financial issues.

Although tax forms are the primary documents we make available on Nonprofit Explorer, we have also added audits available since 2017. Federal and state regulators use them to get a more nuanced look at the financial management and governance of an organization, including information about financial controls and compliance with government grant programs.

With this update, you can search for all 33,400 organizations that filed audits with the federal government because they spent more than $750,000 in federal funds in a given fiscal year.

We’ve also made it possible to easily scan findings where auditors raised a variety of concerns, the most serious being a “going concern” flag; that is, the possibility that the organization won’t be able to meet its financial obligations in the near future. This may signal that the organization’s expenses have outstripped its revenue, or it may indicate other issues, like risky investments or financial mismanagement.

There are other findings you can search for as well, like “material noncompliance,” “material weakness in internal controls” and “significant deficiency in internal controls” — all of which are findings that donors or researchers may want to investigate further. Findings from the organization’s most recent audit will also appear as flags on an organization’s page to make them easy to find.

Our search also now includes the option to see organizations that reported a significant diversion of assets on their most recent tax filing. This is a rare but serious issue, in which the organization has discovered an unauthorized diversion of either 5% of an organization’s assets or $250,000, whichever is smaller.

To search for any organization that matches these criteria without knowing their name, just click the search button without filling in any text and you can view the entire set of nonprofits. You can use the tools on the right of the screen and hit the “apply” button to filter.

We have lots of ideas for future improvements and additions to Nonprofit Explorer. If you have feedback on these improvements or features you’d like to see added to the site, please get in touch! We’d love to hear from you.

And as always, if you use Nonprofit Explorer and value the information it provides, please consider donating. It’s support from people like you that lets us keep updating and improving this app!

by Jesse Coburn and Andy Kroll

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

As Donald Trump’s nominee to run the U.S. Department of Housing and Urban Development, Scott Turner may soon oversee the nation’s efforts to build affordable apartments, protect poor tenants and aid the homeless. As a lawmaker in the Texas House of Representatives, Turner voted against those very initiatives.

Turner supported a bill ensuring landlords could refuse apartments to applicants because they received federal housing assistance. He opposed a bill to expand affordable rental housing. He voted against funding public-private partnerships to support the homeless and against two bills that called merely to study homelessness among young people and veterans.

Behind those votes lay a deep-seated skepticism about the value of government efforts to alleviate poverty, a skepticism that Turner has voiced again and again. He has called welfare “dangerous, harmful” and “one of the most destructive things for the family.” When one interviewer said receiving government assistance was keeping recipients in “bondage” of “a worse form to find oneself in than slavery,” Turner agreed.

Such views would seemingly place Turner at odds with the core work of HUD, a sprawling federal agency that serves as a backstop against homelessness for millions of the nation’s poor, elderly and disabled. With an annual discretionary budget of $72 billion, the department provides rental assistance to 2 million families, oversees the country’s 800,000 public housing units, fights housing discrimination and segregation and provides support to the nation’s 650,000 homeless. If Turner’s record indicates how he will direct the agency’s agenda, it is those clinging to the bottom of the housing market who have the most to lose, researchers and advocates said.

“It just doesn’t seem to me like this is someone who is at all aligned with what the values of that agency should be,” said Cea Weaver, director of the advocacy group Housing Justice for All. “It’s a deregulatory agenda, and it’s an anti-poor people agenda.”

Shamus Roller, executive director of the National Housing Law Project, said Turner’s views, if translated into policy, could increase homelessness. “If, at a fundamental level, you believe that people getting assistance with their rent when they’re very poor and struggling, if you think that’s actually dependence and a bad thing, you’re going to try to undermine those programs,” he said.

One former colleague offered a more optimistic view of Turner’s stewardship of HUD. “My sense of him is he will try to help people,” said Richard Peña Raymond, a Democratic Texas House member who served on a committee with Turner. “I do think he’ll do a good job.”

Turner did not respond to detailed questions. A spokesperson for the nominee said: “Of course ProPublica would try and paint a negative picture of Mr. Turner before he is even given the opportunity to testify. We would expect nothing less from a publication that solely serves as a liberal mouthpiece.”

The Trump transition team and HUD did not respond to requests for comment. Trump’s announcement of Turner’s nomination praised him for “helping lead an Unprecedented Effort that Transformed our Country’s most distressed communities” as head of a White House council that promoted opportunity zones, a plan to spur investment in low-income neighborhoods by offering generous tax breaks, during Trump’s first administration. “Under Scott’s leadership,” the announcement went on, “Opportunity Zones received over $50 Billion Dollars in Private Investment!”

Turner is hardly the only Trump cabinet nominee to display skepticism or outright hostility toward the work of agencies they may lead. But, while other nominees have faced intense scrutiny in recent weeks, Turner has attracted little public attention and said even less about his intentions, beyond vowing to “bring much-needed change” to HUD, as he wrote on Facebook last month. ProPublica pieced together his views on housing through a review of legislative records and of Turner’s public speeches, podcast appearances and sermons at the Plano, Texas, megachurch where he is a pastor.

A possible HUD agenda for Turner can be found in Project 2025, the Heritage Foundation’s recommendations for a conservative presidential administration. The report calls for cutting funding for affordable housing, repealing regulations that fight housing discrimination, increasing work requirements and adding time limits for rental assistance and eliminating anti-homelessness policies, among other changes. The Project 2025 chapter on HUD lists Ben Carson, the department secretary during the first Trump administration and a mentor to Turner, as its author. Carson, as secretary, was involved in efforts to end an anti-segregation rule, add work requirements for housing assistance and make it harder to prove housing discrimination.

Turner’s views appear to be deeply rooted in his upbringing outside Dallas, where he was, as he later put it, “a young kid from a broken home, from a poor family.” His parents’ relationship was “filled with violence, domestic violence, abuse, a lot of anger [and] alcohol.” Years later, as a legislator, Turner said that his sister had been “on state assistance and wasn’t feeding [Turner’s] nephew while she was on drugs.” (ProPublica was unable to locate Turner’s sister for comment.)

Football proved an escape. Turner received a scholarship to play for the University of Illinois Urbana-Champaign, and then he went on to a nearly decadelong career in the National Football League. He began transitioning into politics while still in the league, interning for California Rep. Duncan L. Hunter. After an unsuccessful run for a California congressional seat in 2006, Turner moved back to Texas and was elected in 2012 to the state House of Representatives, where he served for four years.

There, Turner solidified his position as a deeply conservative member opposed to many government interventions into the housing market, legislative records show. He voted against supporting foreclosure prevention programs. He opposed legislation to help public housing authorities replace or rehabilitate their property (although he voted for a minor expansion of that bill two years later). He also sought to require drug testing for poor families applying for government assistance, the Houston Chronicle reported at the time. Turner did support some modest housing assistance measures, such as bills helping housing developments for seniors and in rural areas seek low-income housing tax credits.

During his time in office, Turner was the lead author of 17 substantive bills. None were related to housing, and none of them became law.

“He’s a very nice guy,” but “he didn’t really make much of a legislative impression,” said a former high-ranking Republican Texas lawmaker, who requested anonymity to speak candidly about a former colleague. “He didn’t leave a deep footprint.”

That did not stop Turner, however, from mounting an audacious bid for the House speakership, a move reportedly backed by Tim Dunn, a West Texas pastor and oil billionaire who has used his fortune to push the state Legislature far to the right. Turner’s speaker campaign failed, but it helped solidify his position within Texas’ deep-red Christian political milieu, where he has remained ever since.

Turner is an associate pastor at Prestonwood Baptist Church, a political force in Texas that has counted numerous statewide elected officials as congregants. Jack Graham, the church’s senior pastor, prayed over Trump at an event in October and praised his electoral victory from the pulpit in November. Turner’s skepticism about government assistance has found its way into his sermons there, where he has derided the “perverse incentives created by the government and the welfare system, which in turn creates an epidemic of fatherlessness in our country.”

Turner or his political staffers also used campaign money to attend three conferences held by WallBuilders, an organization that seeks “to reveal the historical truths” about the “Christian foundation of our nation,” campaign finance records show. In 2016, Turner gave a $10,000 gift to WallBuilders from his campaign account.

Turner’s allies on the Christian far right also include Ziklag, a secretive network of ultrawealthy Christian families and religious influencers that support Trump. As ProPublica reported, Ziklag has raised millions of dollars as part of a larger mission to help Christian leaders “take dominion” over key areas of American society, from education and business to media and government. This year, Ziklag spent millions of dollars to mobilize Republican-leaning voters in swing states despite being a tax-exempt charity that isn’t allowed to intervene in politics. (A lawyer for Ziklag previously told ProPublica that the organization does not endorse candidates for political office.)

In June 2019, Turner and his wife, Robin, attended a private Ziklag conference at the Broadmoor luxury resort in Colorado Springs, Colorado, according to photos of the event posted by an attendee. At the time, Turner was working in the first Trump administration as executive director of the White House Opportunity and Revitalization Council, where he served as a public salesman for the opportunity zones initiative. Turner has praised the program as a way to improve neighborhoods with high poverty and unemployment rates. Previous reporting by ProPublica found that the program was exploited by wealthy, politically connected investors, which drew scrutiny from members of Congress.

Internal documents obtained by ProPublica and Documented show that Ziklag members sought to take advantage of the program; in May 2019, Ziklag said in one of its newsletters that members of the group had met with three administration officials about opportunity zones. “The administration informed the group they are in a state of listening and learning about the program,” the document reads. “Ziklaggers are exploring additional avenues to make an impact on the program moving forward.”

After leaving the Trump administration, Turner started a nonprofit that promotes “Christ-centered reading enhancement programs” for children and helps people get driver’s licenses. He also became “chief visionary officer” at the multifamily housing developer JPI.

Now, if confirmed, Turner will be in charge of an agency with some 10,000 employees at a critical time. “We’re dealing with a pretty terrible housing crisis all across the country,” said Roller, of the National Housing Law Project. HUD will be “essential to any effort” to solve it.

Jesse Coburn covers cities, housing and transportation for ProPublica. He’s interested in how the second Trump administration will reshape federal policy in those areas, particularly at the Department of Housing and Urban Development and the Department of Transportation. If you work for one of those agencies or are affected by their work, he’d like to hear from you. You can email him at jesse.coburn@propublica.org, or reach him via phone, Signal or WhatsApp at 917-239-6642. His mailing address is: Jesse Coburn, ProPublica, 155 6th Avenue, 13th Floor, New York, NY 10013.

Correction

Dec. 24, 2024: This story originally misidentified the member of Congress for whom Scott Turner interned. It was Rep. Duncan L. Hunter, not his son, Rep. Duncan D. Hunter.

by Joel Jacobs and Megan O’Matz

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

More than a decade ago, loan financier Matt Martorello was worried that the golden days for his high-interest lending venture were over.

In an email to his accountants, he detailed how attorneys general in multiple states were sending cease-and-desist letters to the online enterprise he operated with a Native American tribe based in Michigan. Major banks wanted nothing to do with the business, which offered small-dollar loans at exorbitant interest rates far above limits set by many states. Federal regulators were suing his competitors.

The pressure was getting to be too much. Martorello feared the federal government seeking “every $ I have” in restitution, he wrote in the December 2012 email.

He was expecting his firm, then based in the Virgin Islands, to be audited by the U.S. Consumer Financial Protection Bureau and worried about the agency’s ability to put the tribal lending industry out of business. The federal agency was leaning hard on loan operations that formed alliances with tribes to claim sovereign immunity and bypass state laws that protect consumers.

“Bottom line is, this business will simply not exist in 2 to 3 years anything like it does right now,” Martorello wrote.

But none of that came to pass. In the 12 years since, the tribal loans kept flowing, fueling a multibillion-dollar industry built on punishing loan terms aimed at people who can least afford them.

How did the industry survive?

ProPublica found that tribal lending benefited from more than just sovereign immunity.

Powerful allies in the financial sector and payday loan industry, which encompasses all forms of short-term lending, have served as protectors at key junctures. Even as many states kicked out storefront payday and auto title lenders, online tribal lending flourished. Industry lobbyists helped beat back congressional plans for consumer protections, while payday industry lawyers dragged the CFPB to court and hindered the agency.

At the same time, differing approaches over three presidential administrations saw crackdowns on tribal lending excesses rise, then falter. Coming off a successful case that devastated one major tribal-affiliated operator, the Federal Trade Commission’s consumer protection bureau has been sidetracked by competing demands and a 2021 Supreme Court decision that constrained the agency’s ability to recover money from companies.

An FTC staff attorney who handled lending cases across a variety of industries told ProPublica that the agency monitors complaints but “can’t sue every bad actor.”

“We’re a small agency of limited resources. We have to pick and choose where we think we can make the greatest impact,” said Gregory Ashe, the attorney.

A wavering commitment at the federal level provided just enough leeway for the tribes to adapt and thrive. The consequences for consumers have been catastrophic.

Using a sample of personal bankruptcies nationwide over a three-year period, ProPublica found nearly 5% included unpaid high-interest loans linked to tribes. That translates to an estimated 19,000 cases on average per year.

“They gave me the money quick, but they also empty your pockets just as fast,” said Bobbie J. Williams, a sheet-metal worker from Rhode Island and father of four who needed an infusion of cash when he was sick with COVID-19. His 2022 bankruptcy petition included two tribal loans.

Since 2019, ProPublica found, on average more than 1,800 consumer complaints per year are routed to the FTC about these types of loans, which can carry annual percentage rates of over 600%. Complaints came from people in dire need, including single parents, people crushed under medical debt and others trying to stave off homelessness.

Consumer advocates do not expect that the second Trump administration will do anything to crack down on abusive lending practices linked to tribes or any other form of predatory lending. The billionaire Elon Musk, Donald Trump’s close adviser, posted “Delete CFPB” on X in November, signaling that the nation’s primary consumer watchdog could be on the chopping block in the new administration.

“We would like to see more enforcement action by both federal and state authorities,” said Lauren Saunders, associate director of the National Consumer Law Center, which has advocated for tougher measures on payday lenders.

Martorello, who lives in Texas, declined through an attorney to comment for this story, citing “ongoing and pending litigation.” In the email to his accountants, which was later revealed as part of a civil suit, Martorello stressed he was operating legally and acting on the advice of major law firms. “I don’t want you to think that we are doing anything wrong, we certainly are NOT,” he wrote.

With Martorello’s fears about regulation unrealized, the website affiliated with his tribal partners — Big Picture Loans — is still online offering short-term installment loans. The tribe, which split with Martorello, charges APRs between 160% and 699%, it told ProPublica.

“We’ve helped more than 400,000 people experience a smarter way to borrow!” the website boasts.

A Powerful Industry

For more than a decade, U.S. Sen. Jeff Merkley has tried to protect consumers from outrageous lending rates.

Over and over again — seven times in 12 years — the Oregon Democrat has proposed a bill to force internet lenders, including Native American companies, to comply with state interest rate caps and to register with the CFPB. Year after year the effort fails.

On the Senate floor in 2016, he pressed his colleagues for their support, explaining the reality of high-interest online loans. “These payday loans pull families into a vortex of debt from which they cannot escape, and this vortex destroys them financially,” he said.

U.S. Sen. Jeff Merkley argues for his SAFE Lending Act in this 2016 video posted to Facebook. (Sen. Jeff Merkley/Facebook)

Merkley got only 13 co-sponsors that year: all Democrats and one independent, Vermont’s Bernie Sanders. The current version before the Senate has even fewer: 10.

His legislation has never even made it out of committee, a fate he attributes to the considerable influence of “the payday loan industry and big banks,” he told ProPublica in a prepared statement.

Payday lenders spent $4.9 million lobbying Congress in 2023, according to OpenSecrets, an organization that tracks money in politics. That includes $1.3 million laid out by the Online Lenders Alliance, a trade group that includes tribal lenders. “For Tribes involved in consumer lending, these enterprises have become a critical part of their economic development efforts as Tribes rely on business enterprises to provide essential government services to their members,” the Online Lenders Alliance told ProPublica in an email.

“This is a very entrenched industry with a lot of dollars at stake,” said University of New Mexico law professor Nathalie Martin, who has studied tribal lending.

Ellen Harnick, executive vice president of the Center for Responsible Lending, a nonprofit that works to end abusive financial practices, said the payday industry hires high-priced, experienced lobbyists who ingratiate themselves with state and federal lawmakers through campaign contributions, dinner invitations and casual meetings while roaming the halls of power. The access gives them opportunities to argue that high-cost loans are beneficial for people who find it hard to obtain credit.

The result, she said, is that even legislators who would never counsel anyone they love to take on such burdensome debt nonetheless decide, “I’m not going to shut it down.”

Reform measures have been opposed by the Native American Financial Services Association, which represents tribal lenders, and a larger industry group: the American Financial Services Association, which advocates for the consumer credit industry and does not include tribal lenders.

Congressional action is a direct threat to tribal lending because while tribes claim immunity from state laws, they must comply with federal lending laws. Merkley’s bill would have given the federal government a means to force tribes to abide by state interest rate caps. The Online Lenders Alliance is against such caps, arguing they block some consumers from getting smaller loans necessary to make ends meet.

Currently, there is no federal interest rate cap, with one notable exception: Payday lenders cannot charge active-duty service members and their families more than 36% annually.

In every congressional session since 2008, separate from Merkley’s efforts, lawmakers have unsuccessfully sought to extend that cap to all Americans.

Although banks and credit unions generally don’t charge over 36% for credit cards or other products, the larger financial industry has strongly opposed a cap. The U.S. Chamber of Commerce in 2021 also formally opposed the legislation, arguing that it would harm consumers by limiting access to credit. Proponents of the cap say that 36% is high enough to facilitate lending and that unconscionable rates lead to major debt traps.

At times the role of Native Americans in the industry has been used to beat back the 36% cap. At a 2021 hearing, U.S. Sen. Jon Tester, a Montana Democrat, acknowledged the need to protect consumers from “bad actors and unscrupulous practices.” But he said the Senate also had to consider “the sovereignty issue” of Native Americans and the “good-paying jobs” the tribal lending industry provided in his state.

He suggested that the committee “massage this bill” to make it better, fearing that the bill as written could have negative impacts on tribes. The legislation never passed.

Federal Regulators Lose Their Way

The Scott Tucker case, with its tales of lavish spending and colorful deception, temporarily brought attention to some of the questionable practices and partnerships associated with tribal lending.

Tucker controlled AMG Services Inc., an online payday lender that grew into a billion-dollar business. Inside the call center in Overland Park, Kansas, employees were instructed to pretend they were on tribal lands somewhere else in the country. They were given out-of-state weather reports to help play up the ruse in their small talk with customers.

AMG’s success helped fuel Tucker’s splashy lifestyle that included a side venture: Level 5 Motorsports, a professional auto racing team.

But Tucker’s life in the fast lane — complete with luxury homes, a Lear jet, and a fleet of Ferraris and Porsches — came to a screeching halt. In early 2016, a federal grand jury indicted him on charges related to collecting unlawful debts and failing to truthfully disclose loan terms. It claimed he entered into “sham business relationships” with three tribes and “systematically exploited” more than 4.5 million borrowers.

Tucker and his lawyer were convicted of participating in a racketeering enterprise, wire fraud and other charges. A judge sentenced Tucker to 200 months in prison and his lawyer to 84 months.

Tucker’s spectacular downfall, the subject of an episode of TV’s “American Greed,” sent waves of fear around the industry. Federal prosecutors also indicted a Philadelphia-area tribal lender and his lawyer around the same time as Tucker, but then brought no major criminal cases against others in the industry in the years that followed.

“I’m not aware of additional cases, and wouldn’t be able to comment on any ongoing investigations that may or may not exist,” U.S. Department of Justice spokesperson Wyn Hornbuckle told ProPublica.

Scott Tucker, who faced wire fraud and other charges as result of his loan operations, exits a federal court in Manhattan in 2016. No other major criminal cases were brought in later years involving the tribal lending industry. (Brendan McDermid/Reuters)

Earlier in the Obama administration, in an initiative dubbed Operation Choke Point, regulators sought to “choke off” fraud by pressuring bank executives and payment processors to scrutinize their relationships with industries deemed “high risk,” particularly payday lenders.

The effort briefly stalled tribal lending as the companies disabled lenders’ access to customers’ bank accounts, effectively incapacitating their operations.

But Republican lawmakers cried foul, seeing it as an attempt to stifle legal businesses. They hauled regulators into congressional hearings and chastised them. Faced with an uproar, regulators began to back off.

“I view it as tragic that it kind of blew up politically,” said Dru Stevenson, a professor at South Texas College of Law Houston who studied the firestorm around Operation Choke Point.

He believes that although the program’s image suffered from a few overly aggressive officials, if it had run its course, “tribal lending would be in a different place, where it would be less abusive and less exploitative.”

The fallout likely had a long-term effect on enforcement, he said. “There’s too many people at these agencies who lived through the backlash of Operation Choke Point and it’s not worth the risk of having that come up again.”

The Trump administration officially ended Operation Choke Point and set a new, friendlier tone across agencies.

Trump’s appointee to head the CFPB, Mick Mulvaney, wrote in the CFPB’s five-year strategic plan in 2018 that the bureau would refrain from “pushing the envelope,” so as not to trample on the liberties of citizens or interfere with the sovereignty or autonomy of Native American tribes. That year he killed a case against Golden Valley Lending, a tribal lender based in California.

The CFPB, under Trump, also repealed a rule requiring payday lenders to determine whether borrowers had the ability to repay.

Another tribal lending operation in California continued for about a decade before being shut down by the FTC in May 2020 for deceptive practices. By then it had issued 285,700 consumer loans, totaling nearly $60 million. With fees and interest, borrowers had repaid a whopping $175 million. By the time the FTC acted, most of the profits had been spent or transferred overseas by nontribal business partners. The government ultimately returned less than $1 million to borrowers.

Regulation never ramped up again under President Joe Biden. In part that’s because the CFPB was hamstrung by an unfavorable appellate court ruling in a case brought by the payday lending industry that challenged the agency’s constitutionality. In May, the U.S. Supreme Court handed CFPB a major victory, upholding its funding mechanism and, therefore, its existence.

Empowered once again, the CFPB vowed to pursue predatory lenders and restart a dozen or so cases that stalled during the court fight. No tribal lender, however, appeared on that list. The CFPB, via a spokesperson, declined to comment for this story.

Defeated But Defiant

Matt Martorello, the Texas man who in 2012 feared the U.S. government stomping out tribal lending, ended up in court, but not because of any federal action.

A Virginia law firm, Kelly Guzzo PLC, filed a class-action lawsuit on behalf of borrowers in 2017 against Martorello and council members of Michigan’s Lac Vieux Desert Band of Lake Superior Chippewa Indians. Also named in the suit was Big Picture Loans LLC, which is owned by the tribe. The suit challenged the legality of the loans, given Virginia’s longstanding policies capping interest rates, and was followed by additional civil suits across the country.

Big Picture Loans settled in 2020 for $8.7 million in restitution for customers and $100 million in debt relief. Martorello, however, refused to give in.

His company, Eventide Credit Acquisitions LLC, unsuccessfully sued Big Picture Loans and its parent company to prevent it from settling. “It was a massive waste of everyone’s time and money,” the tribe told ProPublica in an email.

The tribe said it has no current relationship with Martorello following the 2016 purchase of a Martorello company that had been servicing its loans.

A judge ruled against Martorello in 2023 and ordered him to pay tens of millions to Virginia borrowers. That same judge also found that Martorello had been the “de facto head” of the tribe’s lending business, a finding he has vigorously disputed.

Earlier this year, Martorello agreed to a $65 million settlement with borrowers across the nation. But he later filed for bankruptcy and couldn’t raise enough money to fund the settlement by an agreed-upon deadline, voiding the deal. His legal battle challenging the 2023 judgment now will continue in a federal appeals court.

Eventide, the company he founded, also has filed for bankruptcy.

As part of that case, it has argued that if online tribal lending was not appropriate and violated state lending laws, then “Congress, the CFPB, and other federal agencies would have shut it down a long time ago.”

To do the best, most comprehensive reporting on this opaque industry, we want to hear from more of the people who know it best. Do you work for a tribal lending operation, either on a reservation or for an outside business partner? Do you belong to a tribe that participates in this lending or one that has rejected the industry? Are you a regulator or lawyer dealing with these issues? Have you borrowed from a tribal lender? All perspectives matter to us. Please get in touch with Megan O’Matz at megan.omatz@propublica.org or 954-873-7576, or Joel Jacobs at joel.jacobs@propublica.org or 917-512-0297. Visit propublica.org/tips for information on secure communication channels.

Mariam Elba contributed research.

by Jeremy Kohler and Alex Mierjeski

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Former U.S. Rep. Billy Long of Missouri, whom President-elect Donald Trump has named his nominee to head the IRS, touts his expertise in tax matters.

He advertises his credential as a certified tax and business advisor, and he adds CTBA to his name on his X profile. That profile encourages people to message him to “save 40% on your taxes.”

Long identifies himself as a certified tax and business advisor, a designation created by a small firm that only requires attendance at a three-day seminar. (X)

But tax experts told ProPublica that they have never heard of CTBA as a credential in the tax profession. The designation is offered by a small Florida firm, Excel Empire, which was established just two years ago and only requires attendance at a three-day seminar. That is in stark contrast to the 150 credit hours and the rigorous exams required to become a certified public accountant, a standard certification for tax accountants.

In most tax cases, only lawyers, CPAs and enrolled agents — federally authorized tax practitioners — can represent taxpayers at the IRS.

“The cost of relying on tax advice from somebody that is solely focused on minimizing the tax liabilities that you have — as opposed to somebody that’s focused on both minimizing the tax liabilities and complying with the tax law — can be extraordinarily high if you are found to be in violation of the standards,” said Nathan Goldman, an associate professor of accounting at North Carolina State University.

Excel Empire’s three-day certification course has been advertised for as much as $30,000; its upcoming session is advertised at $4,997. Matthew Pearson, one of its founders, said this summer in a podcast that about 135 people have earned the CTBA designation, which the firm designed to help people without tax backgrounds to become advisors.

Nina Olson, a prominent taxpayer advocate, said that the modern tax industry has seen “a proliferation of different groups and entities that are providing tax advice” and that consumers have no way of knowing who is competent.

“It could just be that you’ve taken a very short course, and paid a large fee for that course, and that gives you the ability to put some initials after your name,” said Olson, who served as the IRS’ national taxpayer advocate from 2001 to 2019. She is now executive director of the Center for Taxpayer Rights, a Washington-based nonprofit that promotes fairness and access to justice in tax systems.

Tax experts said that Long’s years of experience as a real estate agent and as an auctioneer — before spending a dozen years in Congress — pales next to the deep experience in tax policy or management of the people who have held the job. For instance, the current IRS commissioner, Danny Werfel, previously served as acting IRS commissioner and held leadership roles at the Office of Management and Budget. He also worked in the private sector as a managing director at Boston Consulting Group.

Long’s experience in the tax world has been more narrowly focused. In the two years since he left Congress, he worked to bring in customers for at least two firms that marketed the employee retention credit — a pandemic-era benefit designed to support businesses that kept workers despite revenue losses or disruptions caused by COVID-19.

The credit also attracted fraud, eventually landing on the IRS’ “worst of the worst” list for tax scams. Two Democrats on the Senate Finance Committee on Wednesday announced an investigation into the firms, noting Long had neither a “background in tax preparation nor any credential as a licensed accountant, attorney or enrolled agent.”

Worth up to $28,000 per employee, the credit was available for the 2020 and 2021 tax years and has been widely used by both for-profit companies and nonprofit organizations across the country. However, the IRS raised significant concerns about aggressive promoters pushing ineligible businesses to file questionable claims. Red flags included inflated payroll numbers, claims for all quarters without proper eligibility or citing minor government orders that did not directly impact business operations.

The IRS says it has recovered over $1 billion from businesses that voluntarily reported improper claims. And it has launched hundreds of criminal investigations to try to recoup what it says could be billions of dollars more.

In a prepared statement in November, Werfel said businesses should review their claims and see if they were misled by firms marketing the tax credit.

“They should listen to trusted tax professionals, not promoters,” he said.

In a 2023 podcast discussing his work for the two firms, Long joked that he had a hat bearing the name of the credit glued to his head. He said his work marketing the tax credit had caused some clients to question their CPAs’ advice.

“Hey, this auctioneer, real estate broker, former congressman told me I’m going to get $1.2 million back,” he said. “Uh, you’re my CPA. Why didn’t you tell me that?” And he said the response of CPAs would be: “That’s a joke. That’s a fake deal. That’s not true. You’re going to have to pay all that money back. You’ll get audited.”

But he said the firms he worked for had never seen the IRS turn down one of their claims.

There is no evidence that either Excel Empire, Long or the firms that he worked for — Lifetime Advisors of Hudson, Wisconsin, and Commerce Terrace Consulting of Springfield, Missouri — engaged in wrongdoing. In the same 2023 podcast, Long emphasized he and his colleagues had helped only taxpayers who were entitled to the benefit.

Neither Long, Lifetime Advisors nor Commerce Terrace Consulting responded to requests for comment.

If Long is confirmed and succeeds Werfel, he’ll have the power to influence how Americans pay their taxes and how the federal government collects revenue. Trump has promised to end IRS “overstepping,” while Republicans have said that they would slash billions of dollars in funding passed under the Biden administration to modernize the IRS and enhance tax enforcement.

The IRS and the Trump transition team did not respond to requests for comment.

During his time representing Southwest Missouri in Congress, Long pursued legislation to abolish the IRS and establish a national sales tax. Billionaire Elon Musk, a Trump advisor, recently asked on X if the agency’s budget should be “deleted.”

Like Long, members of Excel Empire suggest that accountants don’t feel it is their role to save their clients money because they prioritize compliance over planning and are too busy during tax season to discuss strategies. The company’s website claims the firm has saved taxpayers hundreds of millions of dollars.

Edward Lyon, who is listed on Excel Empire’s website as chief tax planner and tax attorney, writes on his personal website that the seven most expensive words in the English language are “My CPA takes care of my taxes.”

Lyon elaborated on a podcast last year, noting that accountants “generally are rule followers,” but when it comes to lawyers, “we are trained to understand the rules but we’re trained to stretch the rules and bend the rules and poke at the rules and do an end run around the rules. It's a much more proactive focus.” Still, he has consistently emphasized that his company acts “legally, ethically and morally.”

On its website, Excel Empire claims that certified public accountants are not focused on saving their clients money and says their advisers are better equipped to identify tax breaks. (Excel Empire)

The company’s co-founder, Pearson, once described Lyon on a podcast as the “preeminent proactive tax attorney in the country.” Lyon and Pearson declined to comment.

The Ohio Supreme Court suspended Lyon’s law license in 2005 for failing to meet registration and fee requirements on time, and he hasn’t regained it. He also does not appear to be registered with the Securities and Exchange Commission as an investment advisor.

Despite this, Lyon says he has trained tens of thousands of tax and finance professionals. As the author of several books and a column, he claims to be one of the country’s most widely read tax strategists and commands speaking fees of $15,000 and first-class travel arrangements.

Lyon has also developed several tax certification programs. On the Excel Empire website, some officers, including Pearson, use a title created by Lyon: tax master.

Appearing on another podcast, Lyon discussed how small businesses can be used as tax shelters. As an example, he asked the host, Heather Wagenhals — who also carries the CTBA title — if she had a swimming pool at her home, where she records her show.

“I do,” Wagenhals said. “That’s why I picked this one.”

Lyon responded: “All right, so I’m gonna rock your world in five words, ready? On-premises employee athletic facility.”

“Oh my God!” Wagenhals said.

Lyon added: “It’s really there in the tax code, and nobody’s told you that.”

In another podcast, Pearson brags about firing an accountant who balked at his request for advice about how to use a new Corvette “to keep from paying taxes.”

Olson said that attitude was disturbing and that simplistic answers can create problems for taxpayers in IRS audits and in the courts. “A swimming pool in someone’s home, even if employees are working in the home and using it, still would require the court to look at the percentage of employee use versus personal use — and they would look really closely at that,” she said.

by J. David McSwane

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Anthony Olson wanted a career, children, a partner with whom he could hike Montana’s trails. Despite the diabetes diagnosis at age 4, the anemia, the kidney transplant that failed at age 29, the dialysis, he clung to those dreams. He attended community college and later moved from his parents’ house in Helena to study accounting at Montana Tech in Butte. He thought he might live a nearly normal life.

All of that was taken away in early 2011 when an oncologist at St. Peter’s, Helena’s only hospital, diagnosed him with myelodysplastic syndrome, a blood disorder that’s often described as pre-leukemia. The life expectancy of MDS patients is short. “He told me that without treatment, I’d be dead before the end of the year,” Olson said. He was 33.

“That diagnosis changed the direction of my life,” Olson, now 47, told me.

Olson couldn’t have known that he was one of many patients who, according to court records, may have received inappropriate, harmful or unnecessary treatments from Dr. Thomas C. Weiner. As I reported earlier this month, administrators at St. Peter’s suspected Weiner, who directed the hospital’s cancer center, was hurting patients for years. Yet hospital administrators allowed him to keep treating people until late 2020, when they suspended and then fired him. Weiner has denied all the allegations.

“I trusted that he was doing what was best for me,” Olson said of Weiner. “I never really questioned that until someone else told me that there was reason to.”

I discovered Olson’s story in a cache of records related to an ongoing legal dispute between Weiner and St. Peter’s. I was struck by how similar his case was to that of another Weiner patient, Scot Warwick. Weiner had diagnosed Warwick with Stage 4 lung cancer and treated him with chemo and other therapies for 11 years, court records show; after Warwick died in 2020, his family learned, from both a biopsy and an autopsy, that he never had cancer. Weiner insisted that Warwick had cancer all those years and that other doctors “missed” the disease.

Olson’s diagnosis was similarly flimsy, and he had been treated over nearly the same period of time. But there was a key difference between the two men: Olson lived to tell his story.

After he was diagnosed, Olson dropped out of college, moved back in with his parents and began Weiner’s prescribed regimen: four straight days on chemo, four weeks off. Repeat until he died. Olson endured this for nine years.

“I stopped moving towards a career and a future and was trying to figure out, ‘What can I do now? What’s most important to me?’” Olson said. “I spent a lot of time thinking about that, but I didn’t really have the money, especially with the cost of treatments, to do anything. I was kind of just stuck.”

In our conversations, Olson downplayed what happened to him next. As chemo goes, he said he had it easier than most. He kept most of his hair, for example. But exhaustion from the chemo anchored him to his parents’ basement. He sank into himself, tinkering with computers and dabbling in photography, “reaching for anything that I could do in my relatively short amount of time.” He told loved ones he’d soon be gone. He asked his parents to take his car. His father refused.

Early in his treatment, tests showed the chemo had worsened Olson’s anemia. Weiner placed him on weekly iron-rich blood transfusions. Over months and then years of chemotherapy and other treatments, Olson bonded with Weiner and St. Peter’s staff. He thought of them as friends. As the iron levels in his blood continued to rise, the cancer center nurses began calling him “The Iron Man.”

“I thought he was helping me,” Olson said of Weiner. “I actually felt pretty fortunate that we had such a gifted doctor in such a small community.”

His parents, too, believed they’d found “a miracle” in Weiner. Olson appreciated that Weiner had taken over as his primary care physician. Like dozens of Weiner’s patients, Olson told me he thought he had found a sort of concierge alternative to the broken maze that is the American health care system. Weiner often fast-tracked patients for hospital stays, which made him popular with patients. It also increased his patient load — as many as 70 patient contacts a day, records show. The more treatments and visits Weiner billed, the more money he made.

“He always made the process fairly easy,” Anthony’s mother, Patti Olson, said of Weiner. “So, if we needed medications or anything like that, he would bridge that gap for us. That went a long way in helping us through a lot of pretty difficult situations.”

Dr. Thomas C. Weiner (Louise Johns, special to ProPublica)

In 2016, Dr. Robert LaClair, the kidney specialist who was managing Olson’s dialysis, became concerned. After hundreds of blood transfusions, Olson’s body was suffering from “iron overload” (a ferritin level of over 10,000), which can destroy internal organs. It could have killed him.

LaClair tweaked Olson’s treatments, which improved his anemia and iron overload. He told him that he could now be a candidate for a new kidney, which would supplant the need for dialysis and maybe allow him to regain his life. The only problem? His chemo treatment disqualified him from the transplant waitlist.

Olson told me there were moments of real anger at his situation, “but most of the time, I think I was pretty level, and just did it because it had to be done, and this was the treatment. For a lot of it, I was amazed that I was still around and that it was working as well as it was.”

By 2019, LaClair suspected that Weiner may have misdiagnosed Olson and urged his patient to get a second opinion. But LaClair kept quiet about his misgivings for years, according to records and interviews. Weiner was a powerful figure within St. Peter’s and in Helena. He was earning $2 million a year and had threatened to sue the hospital several times, court records show. While his nurses adored him, others inside St. Peter’s feared him. Many on staff credited him with forcing out two hospital CEOs who had challenged his pay, court records show.

“If any one of us came up against him, we would have been crushed,” LaClair told me. “He had too much power and too much money.”

LaClair finally took his concerns to the hospital’s peer review committee, an internal group of doctors charged with examining questions about patient care. In early 2020, he became the committee chair and would lead the effort to remove Weiner. He acknowledged that he and the hospital waited too long to act.

In December 2020, St. Peter’s fired Weiner, accusing him of “harm that was caused to patients by receiving treatments, including chemotherapy, that were not clinically indicated or necessary,” among other allegations.

Weiner responded by suing the hospital for wrongful termination and defamation. Former patients created a Facebook group called “We stand with Dr. Tom Weiner” and held the first of hundreds of small protests outside the hospital. A Montana judge dismissed Weiner’s suit. He filed an appeal, which is pending with the state Supreme Court.

When Olson learned that Weiner had been removed, he was outraged, convinced that he’d lost a brilliant medical mind, who had been kind and given him years he otherwise would never have seen. He and his parents cheered on the protestors. “I would have been probably one of those people, on his side, up until all this blew up and we found out what was really going on,” he told me.

Olson didn’t know that his case was among dozens that St. Peter’s sent to outside medical reviewers at the University of Utah and The Greeley Company, a health care consultancy. The reviewers discovered that Weiner had ordered two bone marrow biopsies in 2011. The first showed signs of MDS, which researchers in recent years have found is commonly misdiagnosed. However, the second, taken 10 months later, indicated no disease.

Weiner shared the negative biopsy result with Olson but told him to ignore it; all it proved was that the regimen was working. Weiner continued Olson’s chemotherapy.

That second biopsy, at the very least, should have prompted more testing to confirm or eliminate MDS, the reviewers wrote. It was unclear “why this second bone marrow biopsy result was ignored, and why another bone marrow biopsy was not done,” the report said. “The patient may have been exposed to the toxicities of these treatments unnecessarily.”

When I questioned Weiner about Olson’s case, he dismissed the reviewers’ conclusion that he should have stopped chemotherapy when the follow-up biopsy was negative. “That doesn’t say you didn’t have the disease,” he said. “It just means that the treatment worked, and it knocked it away. It doesn’t mean you didn’t have it at the beginning.”

I pressed Weiner. If the chemo had “knocked it away,” wouldn’t that call for adjusting the treatment? He said he continued chemo for another nine years on the advice of experts at the Mayo Clinic. Olson scoured his medical file and found no evidence to support this claim.

After Weiner was gone, Olson received another biopsy, which came back negative. St. Peter’s also retested the sample from the first biopsy. It, too, showed that he never had MDS. Despite the overwhelming evidence that Weiner had misdiagnosed and improperly treated Olson, LaClair felt he couldn’t just say, “Dr. Weiner did this to you.” Records show many Weiner patients bristled when told to get a second opinion or became hostile at the suggestion that Weiner had mistreated them.

“The worst part of the harm is that they believed in him,” LaClair told me. “The harm that he’s done to these people — they’re broken both physically and mentally because of what he did.”

For years, LaClair could not comprehend why so many in Helena continue to support Weiner, but in watching the change in one of his favorite patients, he came to understand something: Olson didn’t just feel betrayed; he was heartbroken. “You want to hear something that really makes you sick?” LaClair asked. “He said to me, ‘I just wanted him to say he’s sorry.’”

After receiving chemo through his 30s and into his 40s, Olson’s cancer treatments were stopped in early 2021.

In a court filing that year, the hospital alleged that Weiner “misdiagnosed and/or failed to properly diagnose numerous other patients whose subsequent chemotherapy treatments may not have been warranted … .” St. Peter’s, however, did not provide a full accounting. The hospital reported that it had suspended Weiner to the state medical board, which declined to comment. But it’s unclear whether St. Peter’s relayed Olson’s case or any of the other misdiagnoses to the board. Hospital administrators declined to comment on the case, even though Olson signed a medical privacy waiver granting them permission to talk to me. A spokesperson said in a statement that “St. Peter’s is focused on moving forward, and we remain fully committed to providing the great care and experience our community deserves.”

When I presented Weiner with examples of alleged patient harm, he denied that he mistreated anyone and remained unapologetic. He does acknowledge, however, that Olson suffered for no reason.

“I felt that he had MDS,” Weiner said. “I was continuing this medicine to suppress it and control it for as long as possible, because he had no other option. Obviously, if I knew that he never had MDS, I wouldn’t have done it, but I was under the belief from the reports and everything that he should continue it. Now, again, hindsight says that he got it needlessly, and that part of it, I’m sorry about. I am.”

For Olson, the acknowledgement that he didn’t have cancer is 13 years too late. In 2022, he sued St. Peter’s for malpractice. The hospital settled and paid an undisclosed amount. Because Weiner was an employee of St. Peter’s, he was not held liable.

No longer overloaded with iron or receiving chemo, Olson became eligible for a donor kidney. In the summer of 2023, he got one. He continues to struggle with an array of health issues, but he knows there’s a chance he can live into old age.

Olson tries not to think about what happened to him. It takes him to a dark place. He still wants to see the best in people, even Weiner. But he sometimes can’t help but wonder what motivated his former oncologist. “Did he just do this for money?” he asked. “Was he betting on me to die and just thought he could make more money?”

by Kavitha Surana, Robin Fields and Ziva Branstetter

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After the Supreme Court overturned the constitutional right to abortion in 2022, President Joe Biden issued an executive order tasking the federal government with assessing the “devastating implications for women’s health“ of new state abortion bans.

Experts were warning that these bans would interfere with critical medical care and lead to preventable deaths. And the states that passed the laws had little incentive to track their consequences.

Biden directed the secretary of Health and Human Services to make sure federal agencies were “​​accurately measuring the effect of access to reproductive healthcare on maternal health outcomes.” He called on the National Institutes of Health and the Centers for Disease Control and Prevention to drive targeted research and data-collection efforts.

But the Biden administration has missed a critical opportunity to illuminate how abortion bans are interfering with maternal health care, leading to deaths and irreversible injuries: The CDC has not pushed state committees that review maternal deaths to examine the role these new laws have played.

The CDC leads the nation’s work to track and reduce maternal mortality, spending nearly $90 million over the last five years to fund state panels made up of health experts who analyze fatalities to spot trends and recommend reforms. While it cannot require states to collect or report certain data, the CDC gives committees detailed guidance for assessing whether deaths were preventable and which factors contributed to them.

Following this guidance, committees consider factors including obesity, mental health issues, substance use, homicide and suicide. In 2020, the CDC added a checkbox to its model case review form for committees to indicate whether discrimination played a role.

Yet the agency has issued no guidance to address the recent rollback of reproductive rights or to direct committees to consider how abortion bans factor into deaths. Some state officials point to this silence as a reason their committees haven’t made any changes to their process. “The committee must follow national guidelines in maternal mortality review committee death investigations,” said a spokesperson for Oklahoma’s health department, which oversees the committee in the state.

Researchers say that this can obscure the impact of abortion bans.

“It’s pushing it under the rug in a way — like we don’t want to count it, we don’t want to know what’s happening,” said Maeve Wallace, an epidemiologist at the University of Arizona who has published studies on the intersection of intimate partner violence and maternal deaths, including one that found a rise in maternal homicides in places with increased abortion restrictions.

When asked about this, the CDC said the information submitted by states is sufficient to understand any effects from abortion bans.

“Maternal mortality review committees already comprehensively review all deaths that occur during pregnancy and through the year after the end of pregnancy, including abortion-related deaths,” said David Goodman, lead health scientist with the CDC’s Maternal Mortality Prevention Team. “The current process includes documenting and understanding contributing factors.”

But experts said that the CDC’s current guidance gives committees no standard way to consider the role abortion bans played in maternal deaths, which makes it harder to study deaths related to the restrictions and create an evidence base to inform recommendations.

Georgia’s maternal mortality review committee blamed the state’s abortion ban as a factor in one of the deaths examined by ProPublica, that of Candi Miller. The 41-year-old mother of three ordered abortion medication online and suffered complications, but did not visit a doctor “due to the current legislation,” her family told the coroner, who documented the statement. Committee members told ProPublica that the explicit mention in the records indicated the law created a barrier to care.

Candi Miller and her family (Courtesy of Turiya Tomlin-Randall)

The case of Amber Thurman wasn’t as clear-cut; she had taken abortion medication at home and she sought care in a Georgia hospital for complications similar to Miller’s. Records showed doctors discussed, but did not provide, a dilation and curettage procedure to clear her uterus of infected tissue as she suffered for 20 hours with sepsis. Any impact the law may have had on the doctors’ decisionmaking was not noted in records the committee reviewed.

The committee concluded that one of the factors in her preventable death was the delay in care. And while members were able to check a “discrimination” box for Thurman’s case, they did not have any method to flag that she experienced a delay in receiving a procedure that is commonly used in both abortions and miscarriages and that had recently been criminalized.

If such a category were created by the CDC, it would allow researchers to see if there have been increased delays in care after abortion was banned, maternal health researchers said.

Experts told ProPublica this categorization would likely have covered the three other deaths ProPublica reported on, of Texas women who had not considered ending their pregnancies but who needed the same kind of procedure to manage their miscarriages. In those cases and that of Thurman, doctors diverged from the standard of care in ways that raise serious questions about how criminal abortion bans are affecting care for pregnancy loss, ProPublica’s reporting found.

“CDC public data shows an alarming increase in maternal mortality in states that ban abortion,” said Nancy L. Cohen, president of Gender Equity Policy Institute, a nonpartisan research organization. “Our analysis of the evidence and other factors strongly indicates that the bans are driving this increase, but there is no way currently to determine from publicly available data if abortion restrictions contributed to a particular death.”

The CDC “has the power to correct this,” she said, by asking states to collect information about whether abortion restrictions contributed to a death.

Amber Thurman with her son (Via Facebook)

Inas Mahdi, a maternal health researcher who previously worked at the CDC for 15 years, said officials at her former agency know the power that investigating the impacts of policy can have. “The CDC is well aware that without data, there’s no action,” she said. But she added that officials likely experienced “trepidation” over wading into a “polarizing” topic without more direct support from the administration.

In Republican-led states, there’s little appetite to study the harmful effects of laws that their leaders avidly support, and any backlash could hamper efforts to improve maternal health that are seen as bipartisan, she said.

Her fellow CDC alum, Dr. Zsakeba Henderson, agrees. “If CDC were to request that of maternal mortality review committees, I know there would be pushback at the state level,” said Henderson, who previously worked in the agency’s reproductive health division supporting state-based perinatal quality collaboratives. The maternal mortality program is voluntary, and states could simply opt out. In the past year, for example, Texas decided to forgo federal funding and not share maternal death data with the CDC. Officials at the CDC declined to comment on the reason for the change. A spokesperson for the Texas Department of State Health Services said the Legislature directed the agency to do this.

A spokesperson for the Biden administration responded to ProPublica’s questions about whether his order had been fulfilled with a list of efforts to gather and make available data on contraception access and maternal health care outcomes. They said the administration had also “amplified” data from other sources on the impact of abortion bans in a memo.

When asked why the CDC has not created a checkbox to track deaths related to abortion access, a spokesperson for HHS, the CDC’s parent agency, said that the CDC “receives feedback from states on data fields.” The spokesperson noted that the discrimination checkbox was “added based on state requests” after a work group went through a multiyear process.

The spokesperson also said the lack of a checkbox does not mean HHS failed to meet the goals of Biden’s order. The spokesperson forwarded a 73-page update on the maternal mortality crisis that had been sent to Congress this past July. The report is packed with information on progress combating major maternal health risks: task forces to support mental health, initiatives to respond to the opioid crisis, research on intimate partner violence.

It doesn’t include a single reference to abortion access.

Ushma Upadhyay, a public health scientist at the University of California, San Francisco, said collecting data is crucial for understanding how the new abortion bans are impacting maternal health. Her research through WeCount, a project from the Society of Family Planning, has helped establish that the number of abortions has increased nationally since Roe v. Wade was overturned.

Though she has participated in roundtables with HHS officials about how it could better support reproductive health research related to abortion access, she never saw the agency take action based on these talks, she said. (When asked about what these conversations had led to, the agency shared a readout on an expert roundtable about contraception and said its work on studying how abortion restrictions impact maternal health care is ongoing.)

Upadhyay said sending a congressional update on maternal mortality with no mention of abortion access as evidence of fulfilling the order “kind of says it all.” When it comes to measuring the impact of abortion restrictions, “HHS is not doing much.”

The federal government’s largest contribution to this effort comes in the form of millions of dollars of NIH funding to research projects by academics looking into the impact of abortion restrictions, Upadhyay said. But more than two years after the Dobbs v. Jackson Women’s Health Organization decision allowed abortion bans to go into effect, none of those studies have been published and it’s unclear whether the incoming administration will continue funding them.

Researchers who track reproductive health lament the failure to think creatively and act urgently to monitor the fallout of abortion bans while the department had a chance.

“The Biden administration’s lost opportunity is that it viewed Dobbs as a political moment to gain advances for the Democratic Party,” said Tracy Weitz, the director of the Center on Health, Risk, and Society at American University. “It did not take this seriously as a public health crisis.”

The window is closing as President-elect Donald Trump prepares to take office. There is little chance a Republican administration will try to collect data that helps shed light on the impact of abortion bans, which were uniformly passed by Republican-majority state houses.

Last week, Trump named Ed Martin, a prominent anti-abortion activist, to be the chief of staff for his Office of Management and Budget, which oversees how the federal budget is administered. Martin has opposed abortion exceptions, supported a national ban and discussed the idea that women and doctors should be prosecuted for abortions.

If Project 2025 is any guide to how the Trump administration will approach abortion, the CDC may soon start a very different project: launching a mandatory, nationwide surveillance program aimed at portraying abortion care as dangerous.

The conservative blueprint for reshaping the federal government recommends that the agency require all states to report detailed data on abortions, miscarriages and stillbirths or risk losing federal funding.

It states that the CDC “should ensure that it is not promoting abortion as health care.” Instead, “It should fund studies into the risks and complications of abortion.”

Mariam Elba contributed research.

by Kavitha Surana

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

As doctors navigate risks of criminal prosecution in states with abortion bans, hospital leaders and lawyers have left them to fend for themselves with minimal guidance and, at times, have remained “conspicuously and deliberately silent,” according to a 29-page report released Thursday by Senate Finance Committee Chair Ron Wyden. The poor direction is leading to delays in emergency care for patients facing pregnancy complications, the report concluded.

The Oregon Democrat launched a probe in September in response to ProPublica’s reporting on preventable maternal deaths in states with abortion bans. Wyden requested documentation from eight hospitals to see whether they were complying with a federal law that requires them to stabilize or transfer emergency patients; his committee has authority over the regulatory agency that enforces the law. The report also draws on roundtable discussions with doctors from states with abortion restrictions.

The resulting committee staff report provides a new layer of insight into the chaotic and dysfunctional hospital landscape in states with abortion bans, as well as a fresh opportunity for hospitals to consider reforms and provide proactive and transparent guidance to patients and doctors.

Physicians, whose accounts were anonymized, described hospital lawyers who “refused to meet” with them for months, were "pretty much impossible" to reach during "life or death" scenarios and offered little help beyond “regurgitating” the law, according to the report. Doctors described how other doctors gave out wrong and potentially harmful information, saying that patients could not legally choose their own course of treatment and that doctors could not legally treat ectopic pregnancies, potentially fatal complications in which an embryo develops outside the uterine cavity.

“Doctors are playing lawyer, and lawyers are playing doctor,” Wyden said in an interview. As a result, “women are getting hurt, they’re suffering, they can die, and we want to deliver this wake-up call so that they’re better protected and they understand what their rights are.”

The Biden administration has told hospital officials that they have a responsibility under the federal Emergency Medical Treatment and Labor Act, known as EMTALA, to stabilize any patients who show up to their emergency rooms, even if that means doing so with an abortion procedure that conflicts with state abortion law. If they can’t, according to the administration’s guidance, they must transfer the patient to a hospital that can. Some states have fought this. In Texas, a court ruled that the administration’s guidance can’t supersede the state abortion ban and the Supreme Court turned down an appeal.

Information on how to handle the legal conflicts between the bans and federal law is usually not written down at hospitals and, in some cases, is only provided on a “need-to-know” basis, the investigation found. Nurses not included on the same emails as doctors did not trust that they could treat patients, according to an Idaho physician, who added that doctors are left on their own to “figure out the second or third best option.” An emergency medicine doctor who once worked in Texas said they’d encountered OB-GYNs who were too afraid to help deliver care. Another said that colleagues “just want to get these patients out of the hospital” because they worried about the professional and personal risks of treating them.

The report described each of the five preventable deaths ProPublica reported as examples of the fatal consequences of abortion bans. It also added to the mounting accounts of patients in crisis being denied care. Physicians shared examples such as:

• A patient in Idaho whose placenta had “sheared off” the side of the uterus, leading to a massive hemorrhage; the bleeding patient was sent home from the emergency room four or five times. Only at the moment they were “going to bleed out” did the hospital believe they were legally allowed to stabilize the patient, the doctor said.
• Another Idaho patient who was 19 weeks pregnant and cramping and spotting but was sent home at the direction of maternal-fetal medicine specialists until she could “be brought into an emergency situation.”
• A patient whose water broke at 21 weeks and whose fetus wasn’t viable. Doctors refused to remove the fetus until the heartbeat stopped, first sending her home and then, upon her return, requiring her to wait over six hours before they agreed to induce labor. ProPublica wrote about a similar case in Texas in which a woman died of a fatal infection after being made to wait for 40 hours for the fetal heartbeat to stop.

Wyden was able to obtain documentation and answers from hospitals that are rarely provided to the public. In December, ProPublica requested miscarriage treatment protocols from the 50 hospitals in Texas that account for roughly half of the births in the state, according to state hospital discharge data. Almost all declined to provide them. Researchers who attempted a similar survey in Oklahoma last year were met with comparable resistance after they tried to get hospitals to share their policies for treating pregnancy complications under the state’s ban, according to a study by Physicians for Human Rights.

The senator requested documentation from eight hospitals across the country that had been the subject of reports of delayed or denied emergency care for pregnancy complications. He asked for their “policies, processes and procedures related to state abortion laws and emergency reproductive health care.” All eight responded, sharing hundreds of pages of documentation and answers, which the committee published along with the report. The documents provide a rare, detailed view into the operations of private medical systems that may give doctors and ethics committees at hospitals new insight into what others are doing to respond to the laws.

The response revealed that many of the hospitals were relying on guidance created before the existence of abortion bans, the report said. In most cases, physicians were given basic EMTALA guidance that didn’t discuss how to handle new abortion restrictions and were told to contact legal or ethics counsel for questions. Only a few hospitals had created proactive guidance to help their providers navigate the new landscape, and only two of those explicitly discussed conflicts that exist between abortion bans and EMTALA and how to handle them. It was not always clear if these directives were created before media reports of denied care.

Freeman Health System in Missouri was found by federal investigators to have violated EMTALA after doctors told a patient whose water broke nearly 18 weeks into her pregnancy that they could not induce labor because of the state’s new abortion law. It submitted robust protocols to the committee that include a flowchart of its intake for pregnant patients and informed consent paperwork advising patients of high-risk pregnancy complications that constitute an “emergency medical condition” under EMTALA. The Missouri hospital system was the only one out of the eight that said it offered full civil and criminal defense of any providers sued under state abortion laws, according to the report.

Also surveyed was the Georgia hospital system that treated Amber Thurman, a 28-year-old single mother who faced a deadly infection from a rare complication after taking abortion medication. Doctors at Piedmont Henry Hospital discussed, but did not provide, a procedure to clear her uterus in time, according to a report by the state maternal mortality review committee, which concluded that her death was preventable.

Piedmont told Wyden it had assembled a task force after the state’s abortion ban went into effect. The hospital said it gave providers educational material on conflicts the abortion ban could create, including a “decision tree,” a statement from the American College of Obstetricians and Gynecologists on navigating exceptions to abortion bans and guidance for complying with the law’s documentation requirements. (ProPublica reported in September that the task force provided education in the months after Thurman’s death.)

Piedmont, Freeman and five of the other hospitals mentioned in the report did not respond to requests for comment. Dr. R. Cliff Moore, the chief medical officer and maternal-fetal medicine physician for Woman’s Hospital in Louisiana, said that when an early pregnancy-loss diagnosis is unclear, physicians “wait for additional information as long as the patient is stable.”

“The policies, evaluation, treatment and care for early pregnancy loss at Woman’s Hospital have not changed,” he said.

To safeguard emergency reproductive care, the report called for abortion access to be reestablished across America and for the federal government to enforce EMTALA “to the fullest extent of the law.”

But with Republicans in control of all branches of government next session, Wyden recognizes this is an unlikely scenario.

“It is all the more important that hospitals and provider groups step up and do all that they can to make sure patients get the health care they need,” he said. “That means making it crystal clear that patients have a federal legal right to emergency care, no matter where they live, and shouldn’t have to be on the brink of death to get it.”

The report issued four recommendations:

• It called on hospitals and hospital associations to work together to provide training, guidance and resources to doctors to ensure they provide emergency pregnancy care in abortion ban states.
• It said professional medical organizations “should issue guidance and publish standards that clearly define appropriate clinical care in obstetric emergencies.”
• It encouraged hospitals to support the full spectrum of doctors, from OB-GYNs to family medicine physicians, in becoming certified to prescribe mifepristone, part of the two-pill abortion medication regimen.
• It said doctors should counsel patients about their rights under EMTALA and how to report violations.

Mariam Elba, Cassandra Jaramillo, Lizzie Presser and Ziva Branstetter contributed reporting.

by Jennifer Berry Hawes, data analysis by Nat Lash, with additional reporting by Mollie Simon

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The scoreboard glowed with the promise of another Friday night football game in Liberty, Mississippi, a small town near the Louisiana border. The Trojans, in black and gold, sprinted onto the field to hollers from friends and families who filled barely half the bleachers.

The fans were almost all Black, as is the student body at the county’s lone public high school. Scanning the field and the stands would give you little indication that more than half the county’s residents are white.

In some swaths of the South, a big event like high school football unites people. But not in Amite County.

Just beyond the Trojans’ scoreboard, past a stand of trees, another scoreboard lit up. At Amite School Center, a small Christian private school, cars and pickup trucks crammed every inch of space on the front lawn and in its parking lots. A charter bus for the visiting team, another private school, rumbled near the entrance to the field.

A good 500 people, nearly all of them white, filled the bleachers and flowed across the hill overlooking the field. They cheered from lawn chairs and waggled cowbells as cheerleaders in red-and-white uniforms performed a daring pyramid routine.

A child waved a handmade white poster that read, “Go Rebels.”

Amite School Center, like many private schools across the Deep South, opened during desegregation to serve families fleeing the arrival of Black children at the once all-white public schools. ProPublica has been examining how these schools, called “segregation academies,” often continue to act as divisive forces in their communities even now, five decades later.

In Amite County, about 900 children attend the local public schools — which, as of 2021, were 16% white. More than 600 children attend two private schools — which were 96% white. Other, mostly white students go to a larger segregation academy in a neighboring county.

“It’s staggering,” said Warren Eyster, principal of Amite County High until this school year. “It does create a divide.”

The difference between those figures, 80 percentage points, is one way to understand the segregating effect of private schools — it shows how much more racially isolated students are when they attend these schools.

Considerable research has examined public school segregation. Academics have found that everything from school attendance zones to the presence of charter schools can worsen segregation in local public schools.

But the ways in which private schools exacerbate segregation are tough to measure. Unlike their public brethren, they don’t have to release much information about themselves. That means few people on the outside know many details about these schools, including the racial makeup of their student bodies — at a time when legislatures across the South are rapidly expanding voucher-style programs that will send private schools hundreds of millions more taxpayer dollars.

Very White Private Schools in Majority-Black Districts

ProPublica looked at majority-Black public school districts where private schools also operated. A wide swath of districts across the South exhibited the same pattern: Student populations in private schools are far whiter than in the surrounding public schools.

Includes only districts that had within their boundaries at least one private school that reported to the National Center for Education Statistics’ Private School Universe Survey at least once since 2015. Source: Private School Universe Survey. (Nat Lash, ProPublica)

But a new ProPublica analysis shows the extent to which private schools segregate students. We dug into decades of private and public school data kept by the U.S. Department of Education, including a survey of the nation’s private schools conducted every other year by its National Center for Education Statistics. Outside of academia, few people know about this data.

The surveys are imperfect measures. Schools self-report their information, and about 1 in 4 didn’t respond to the most recent round in 2021. But the surveys are the only national measure of this kind. ProPublica used them to determine how often students attended schools with peers of the same race in tens of thousands of private schools nationwide and compared that to public schools.

A stark pattern emerged across states in the Deep South — Louisiana, Mississippi, Alabama, Georgia, South Carolina and North Carolina — where about 200 majority-Black school districts educate 1.3 million students. Alongside those districts, a separate web of schools operates: private academies filled almost entirely with white students. Across the majority-Black districts in those states, private schools are 72% white and public schools are 19% white.

Many of those districts are home to segregation academies, which siphon off large numbers of white students. In many areas, particularly rural ones, these academies are the reason that public school districts scarcely resemble their communities — and the reason that public schools are more Black than the population of children in the surrounding county.

Which county has the largest chasm? Amite.

Amite School Center’s football team, the Rebels, and fans during a home game in September 2024. (Edmund D. Fountain, special to ProPublica)

Along the two-lane country roads through Amite County, fear still mingles with the red clay. Civil rights violence scarred the place just a few generations ago. At least 14 lynchings and other terrifying acts of racist violence took place here, including one of the nation’s most infamous unsolved civil rights murders. In neighboring Pike County, the town of McComb became known as the “bombing capital of the world” for its violent resistance to civil rights.

“You can’t forget things like that,” said Jackie Robinson, chair of the Amite County Democratic Committee. A Black woman, she remembers going to the neighborhood store with her grandmother and being called a racial slur. Her mother told stories of crosses burning.

Robinson said she encounters Black residents who won’t put campaign signs for Black candidates in their yards. They fear that white residents, who own most of the local businesses, might shut them out if they do.

Liberty, Mississippi, is the county seat of Amite County, which has a long history of racial segregation and civil rights violence. (Edmund D. Fountain, special to ProPublica)

White adults outnumber Black ones, and white elected officials control the school district that educates mostly Black children.

Only one school trustee is Black. She sent her children to the local public schools, but few, if any, of the white trustees did. One longtime white board member, whose children attended Amite School Center, has as his Facebook profile picture a photo of the private school’s football team. ProPublica reached out to all of the school board members multiple times, but none responded.

That school board hired a superintendent who is white. It selected high school and middle school principals who are white. And all of the people collecting $7 cash from each spectator at the football game appeared to be white.

Janice Jackson-Lyons, a Black woman, ran for a school board seat in 2020 against the white incumbent with the private school Facebook photo. She described her campaign message as: “I’m reaching for all children. I’d love to see all the kids go to school together because all the kids in Amite County are going to compete for jobs with people from all over the world.” She lost by 60 votes.

Woran Griffin lost a race for an Amite County School Board seat in November. (Edmund D. Fountain, special to ProPublica)

Woran Griffin, who volunteers with Amite County High School’s football team, ran for a board seat in November. He and another Black resident, an educator in a neighboring school district, both lost to white candidates. “There are too many whites running kids they don’t know nothing about,” he said.

They are among the Black residents who wonder: Why do white people who never sent their kids to the public schools keep challenging Black candidates who have? Many Black residents figure it comes down to control — over property tax rates, district spending contracts and hiring.

“I call that a plantation-style school,” said local resident Bettie Patterson, a Black woman who served on the school board years ago.

Amite County has one of the lowest property tax rates for funding schools in Mississippi. And when the board consolidated schools in 2010, it shuttered the elementary school in Gloster, a mostly Black town in the county, and moved all students to Liberty, a mostly white one. The only school left in Gloster is a Head Start for preschoolers.

The grounds of the abandoned Gloster Community Center, which also served as an elementary school. The school closed_ _in 2010, after budget reductions and decreases in state funding. (Edmund D. Fountain, special to ProPublica)

Superintendent Don Cuevas wouldn’t comment on the racial dynamic of the board. “We have a good school system,” he said. “We have a safe school system. Everybody’s treated equal.”

Several Amite public school teachers and parents described watching the PTA, the booster club and a parent liaison position disappear. They said they don’t feel their input is welcome. But Cuevas said the district wants to be selective about when it asks for money from its families, many of whom have very low incomes, when the district doesn’t need it.

“Financially, we’re set,” Cuevas said. “We handle money very well.” He pointed to renovations at the elementary school, including improvements to the parking lot and plumbing, a new iron fence around the entire property and a guard shack. The superintendent said it was to ensure safety and order, but Griffin said the fence felt “like a prison wall.”

Multiple Black educators told ProPublica that the district had passed over qualified Black teachers with local roots for jobs and promotions.

Jeffery Gibson, who grew up in Gloster, was a PE teacher and Amite County High School’s head football and a track coach last year when, he said, he applied for two open administrative positions. Given he had coached multiple state championship teams, received his administrator license and worked as a lead teacher, he figured he’d be a strong candidate.

“I know the kids,” Gibson said. “I can motivate them. I can get them to do what I ask. I can get them to reach their full potential. I’m from there.” But he said the district didn’t respond to his applications, so he took a job as the athletic director of a larger district.

Former Amite County High School head football coach Jeffery Gibson greets players at halftime in September 2024. (Edmund D. Fountain, special to ProPublica)

ProPublica identified 155 counties across the Deep South with private schools that likely opened as segregation academies. Roughly three dozen of those schools are in Mississippi. One in Amite County has never — over nearly 30 years of responding to a federal survey — reported enrolling more than one Black student at a time.

The other, Amite School Center, began reporting enrollment of Black students in the past decade, but not enough to come close to reflecting the population of children in Amite County, where almost half of school-age kids are Black. In the 2021 federal survey, Amite School Center reported student enrollment was 3.5% Black. It employs no Black teachers.

When asked if his school still creates divisions in the community, ASC’s Head of School Jay Watts said no: “I haven’t seen it here.” The school has a policy that says it doesn’t discriminate based on race.

The nonprofit Christian academy, home of the Rebels, opened hastily in 1970 “in the wake of court ordered all-out racial desegregation of the Amite County Schools,” a local Enterprise-Journal story said a few months beforehand.

Back then, A.R. Lee Jr., a doctor and congressional candidate from Liberty, was president of the nonprofit Amite School Corp. As violence erupted in other Southern towns, Lee told a Mississippi newspaper reporter, “The fact that we have a private school here is the reason everything is calm. If we didn’t have it, it wouldn’t be calm in Amite County.”

In the front office of the modest one-story school, which educates just over 300 students across all grade levels, a Confederate flag with “ASC” emblazoned in the center is tacked to a cabinet. Down a hallway, Watts sat at a desk beneath an impressive deer mount, a wooden paddle perched against the office’s doorframe. He welcomed questions from a reporter who showed up without an appointment.

Watts seemed eager to share what his school offers: a Christian-based education that eschews government interference.

“We are charged with educating academically, physically, spiritually, emotionally,” Watts said. “I’m not sure that that’s the mission of the public schools. They’re there to educate academically. I think our mission is broader.”

Because ASC is private, it can operate without the government dictating whether teachers can lead prayer, what tests they administer — and whether or not that paddle gets used. Watts said many of its families think the broader culture is changing in ways they don’t agree with.

“We don’t have to let a girl go to the boys’ bathroom or a boy go to the girls’ bathroom,” he said.

Josh Bass, the school’s athletic director and basketball coach, worked at public schools earlier in his career, then came to ASC from a larger academy in neighboring Pike County. He said he and his wife enrolled their three children at ASC primarily due to their Christian faith: “If it’s not biblical leadership, then I don’t want it for my child.”

He insisted that racial segregation isn’t the school’s goal today. “That might have been at one time, 100 years ago, and some people hang on to that,” Bass said. “We want all to have an opportunity to go to these schools and be a part of what we’re trying to lead them to be.”

Amite School Center’s athletic director Josh Bass watches the football team. Bass said he enrolled his children in the private school because of its focus on Christian education. (Edmund D. Fountain, special to ProPublica)

The men also recognized that even though ASC’s tuition is relatively low compared to many other private schools — under $6,000 a year per child — disparities in resources still create barriers. The median white household income in Amite County is $54,688, compared to $21,680 for a Black household, the U.S. Census Bureau estimates.

ASC has received $459,000 in donations over the past three years through a state tax credit program for certain educational charities, including private schools. But Watts said the school still lacks the money to offer financial aid.

Across the tree line at the public school’s district office, Cuevas said in terse tones that he had no comment about anything related to the private schools or the parents who choose them. He knew nothing about what ASC offers and therefore could not — and would not — compare the public schools to it.

“I don’t even know those answers,” Cuevas said. “I don’t know anything about the private schools. I don’t ask.”

He said he didn’t go out into the community to promote the schools he leads. Instead, he opened the schools’ doors and tried to educate whoever walked in. He’s unclear why so many white students don’t come.

“We don’t know why. We offer a good education,” Cuevas said.

Gibson, the public school’s former football coach, turned his pickup truck onto ASC’s jam-packed campus and found a slip of empty grass on the front lawn where he could park amid the football crowd. He had never set foot on this property even though he had worked and attended the nearby public schools.

Halftime approached as he headed toward the football field. A peal of parents’ yells — “Way to go!” and “Keep pushing!” — burst from the entrance. Once inside, Gibson scanned a sea of white people who filled the bleachers and packed together in lawn chairs, most of them strangers to him except for a few who worked at the public school district. The public schools pay more and offer better benefits.

Gibson had come to see one of his favorite players, a gifted senior who was on his team last year — and who was now the only Black player he saw on ASC’s team. It wasn’t hard to find the teen’s father. Nobody said anything unfriendly to him, but Gibson felt hundreds of eyes watching as he strolled over to the man, who stood front and center against the fence.

The player he came to see had transferred to ASC after Gibson left the public high school. Gibson had barely said hello to the teen’s father before the player scored a touchdown. Cheers cascaded from the crowd, and Gibson joined them.

But it felt strange standing there with so many white people at the “white school.” Back when he was growing up, he couldn’t have imagined such a thing. In college and after, while coaching in Oklahoma, Gibson made good friends who are white. As he cheered with the crowd at ASC, he wondered how many white friends he might have made here in Amite had the local kids all gone to school together.

He found an empty seat in the front row of the metal bleachers and took in the manicured field before him. It was so close to the one where he’d been a student and coach. Yet it felt like stepping into another world.

by Kavitha Surana and Lizzie Presser

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We heard the same story again and again this year:

The women were having miscarriages. They were bleeding and in pain.

They needed a medical procedure to clear their uterus, but their doctors delayed it or didn’t even counsel them about it. Our yearlong investigation found that abortion laws are affecting how physicians treat pregnancy loss and other complications because the procedures used in these cases are also used for abortions.

We spoke to women who survived terrifying experiences, and we interviewed family members of those who died without care. They all felt unprepared as they entered emergency rooms, unaware of how abortion laws were reaching into pregnancy care.

They wished they had known what to expect and how to advocate for themselves and their loved ones.

We created this guide for them and anyone who finds themselves in the same position.

We wrote it in consultation with dozens of doctors, including those who hold positions at leading medical organizations and those who regularly treat patients who are miscarrying.

This guide does not provide medical or legal advice. We encourage you to seek out other reliable resources and consult with experts you trust.

What Is a Miscarriage?

When a pregnancy has stopped developing before 20 weeks, that is considered a miscarriage.

This is common — it happens in up to 1 out of every 4 known pregnancies. The medical term for miscarriage is “spontaneous abortion.”

During a pregnancy loss, someone might experience symptoms like bleeding and cramping and pass pregnancy tissue. Or an ultrasound might show that there’s no fetal cardiac activity even if the patient had no miscarriage symptoms.

While most miscarriages resolve on their own, some lead to dangerous complications, including hemorrhage and infection.

Eight in 10 miscarriages occur in the first trimester. A pregnancy that ends after 20 weeks is considered a stillbirth, but sometimes it is still referred to as a miscarriage.

Other rare complications, like premature rupture of membranes (when the water breaks too early) or preeclampsia (life-threatening high blood pressure), can develop in the second trimester of pregnancy and endanger both the pregnant patient and the fetus. Choosing not to intervene may mean there is some chance the fetus could survive, but it also may put the patient at risk of developing life-threatening complications.

Each situation is unique. In these circumstances, doctors should talk to patients about the risks and benefits of continuing the pregnancy and the option of ending it to protect their health, experts said. Sometimes these cases are referred to as a miscarriage.

What Are the Treatment Options?

When a patient is having a miscarriage or is at high risk for one, they should be offered three choices, according to major medical organizations like the American College of Obstetricians and Gynecologists:

1. Expectant management: Waiting to see if the body will pass the pregnancy on its own.
2. Medication: Taking medicine to help the body clear the tissue. This can include misoprostol or mifepristone with misoprostol, which causes the uterus to contract and can speed up the process
3. Procedure: Getting a dilation and curettage (D&C) in the first trimester or a dilation and evacuation (D&E) in the second trimester to empty the uterus.

All of these can be safe choices for an uncomplicated miscarriage, and a first trimester-miscarriage is rarely an emergency. The standard of care is for doctors to explain all options along with their risks and benefits, and then let their patients choose what they prefer. All major medical societies say that patients should be given that choice.

If a patient is bleeding heavily or showing signs of infection, doctors should recommend a procedure (D&C or D&E) to protect their health, medical experts say.

What Is a D&C?

A D&C is a procedure to empty the uterus and is one of several safe ways to navigate pregnancy loss.

The term D&C stands for dilation and curettage and the procedure is often called “surgical” — but that’s a bit of a misnomer. It is more accurately called “uterine aspiration.” Doctors don’t need to make incisions or use sharp tools. They insert a straw-like tube into the uterus and use suction to gently draw out pregnancy tissue. The patient can be awake, sedated or asleep. It only takes a few minutes and typically ends the bleeding quickly.

When this suction procedure was popularized in the 1970s, after abortion became legal nationwide, “it was a real awakening” in maternal health care, said Dr. Philip Darney, a reproductive health care expert at the University of California, San Francisco. It made emptying the uterus faster, safer and more accessible, he said, saving countless lives.

Today, the simple procedure is usually used for pregnancies up to 12 weeks. Some prefer it as a quick and thorough way to complete a miscarriage and minimize ongoing pain and bleeding, as well as infection risks. For patients with heavy bleeding or infections in the first trimester, a D&C could be lifesaving, doctors told us.

What Is a D&E?

A D&E, or dilation and evacuation, is a procedure used in the second trimester to empty the uterus. The doctor uses suction and tools like forceps. The patient is sedated or asleep in an operating room. It takes less time than an induction, allows the patient to avoid a labor experience and generally is associated with less blood loss and infection risk than other options. For patients with heavy bleeding or infections in the second trimester, a D&E could be lifesaving, doctors told us.

How Have D&Cs and D&Es Been Affected by Abortion Bans?

The same procedures are used for both abortions and miscarriages; whether they’re used to remove pregnancy tissue because of a complication or because the patient has decided to end the pregnancy for another reason, there’s no difference in how the procedures are carried out, and most state abortion bans aren’t clear about when physicians are legally allowed to perform them. The American College of Obstetricians and Gynecologists, the leading organization representing OB-GYNs, calls the language these laws use to describe exceptions “unclear” and “inherently vague.”

This can create confusion and fear around the procedures. For example, a patient can be in the process of miscarrying, but there might still be fetal cardiac activity. Some doctors consider intervening to be a risk because managing the miscarriage in that situation could be defined as an abortion.

The laws attach criminal penalties to a violation — in Texas, for example, doctors can face up to 99 years in prison for performing an abortion. State laws usually include exceptions for “medical emergencies.” (Patients can check their state law and discuss it with their doctors.)

Many physicians have told us, however, that the exceptions do not account for how quickly emergencies can develop or how medical decisions are made. While many miscarriages resolve on their own, infections and other complications like heavy bleeding can rapidly become life-threatening, leaving doctors little time to intervene.

While some OB-GYNs who work in abortion-ban states interpret these laws as allowing them to offer all options for a miscarriage, sticking to longstanding medical best practices, our reporting has found that confusion around the grey areas in the laws and the need for extra documentation have caused some doctors to change their approach to counseling and treating miscarriages, even in cases where there is no fetal cardiac activity.

We have found that sometimes doctors didn’t talk about any procedures or medication management options with patients and only told them about the “watch and wait” approach. We’ve heard from doctors who say that it can be difficult to get these procedures approved by their hospitals and that sometimes other medical staff such as OB-GYNs, anesthesiologists or nurses don’t feel comfortable participating. In still other cases, we have reported on doctors delaying care while they take extra steps to document that there is no fetal heartbeat.

At least five women — Amber Thurman, Candi Miller, Josseli Barnica, Nevaeh Crain and Porsha Ngumezi — died after they didn’t receive these procedures in time, we found.

How to Find Doctors Who Will Offer All Options

Talk to people and organizations you trust for recommendations. This can include local doulas, midwives, nurses who work on labor and delivery wards, and reproductive health organizations.

Medical experts suggested asking physicians direct questions like: I’ve seen stories about patients who were unable to get care for miscarriage or pregnancy complications because of state abortion laws. Can you explain to me how the law in our state could affect my care?

They suggested following up with questions like:

• Considering the law in our state, are there options you would not be able to offer?
• If I were having a miscarriage, would you do a D&C if I wanted one? Would you do a D&C if I needed one for medical safety?
• If I were having a miscarriage in the second trimester, would you perform a D&E?
• Are you allowed to tell me my options or give me information in the event of a miscarriage?
• If you can’t provide these services, where should I go?

How to Prepare for Emergencies

Experts told us patients can talk to their doctors early about what to do if something goes wrong.

Here are some questions they recommend asking:

• If I think I’m miscarrying, can I receive care at your office, or do I need to go to the ER?
• Do you do D&Cs and D&Es? How often and where?
• If my water breaks in the second trimester, do you offer the option of abortion care or do you wait until there are signs of infection?
• Which hospital do you recommend if I need emergency care?

How to Choose a Hospital

Here are some things doctors and patients told us you can do:

• Ask to see the hospital’s miscarriage management guidelines.
• Ask whether doctors are expected to counsel patients on all three treatment options and provide whichever the patient chooses.
• Ask if the hospital has any physicians who have expertise in D&Es. One sign that a doctor may be well-qualified to perform this procedure is if they have done a Complex Family Planning fellowship.
• Check what organizations a hospital is affiliated with. Hospitals with religious affiliations sometimes don’t perform procedures to empty the uterus. Hospitals affiliated with universities tend to provide more comprehensive care and are more likely to have doctors with extra training in D&Es.
• Don’t delay seeking emergency care, even if it’s difficult to find an ideal hospital.

What to Do if You’re Experiencing Signs of a Miscarriage

Cramping and bleeding can be signs of miscarriage, but not always. Call your doctor or midwife to discuss symptoms first.

• You may be advised to wait and monitor your symptoms. Most miscarriages resolve without intervention within two weeks.
• If a doctor says to go to a hospital or a clinic, experts suggest asking for:
  • An ultrasound to guide your care
  • An OB-GYN to be involved in your care
  • Information about all three treatment options
  • The treatment option you prefer to get
• Be on the lookout for symptoms like high pulse and feeling faint, which could mean you have a serious complication. Bleeding heavily, such as soaking a pad in 30 minutes or less, is a reason to ask doctors if it’s necessary to empty the uterus, experts told us.

What to Do if You Aren’t Getting Care You Need

Medical experts recommend the following:

• Documenting the care.
• Asking directly for the desired treatment.
• Asking why care is being denied.
• Asking to see another doctor if the one assigned to the case is not providing the desired care.
• Requesting a transfer to another hospital if the one you’re at will not provide the care. Patients can cite EMTALA, the Emergency Medical Treatment and Labor Act, and remind physicians that federal law requires hospitals to stabilize anyone experiencing an emergency. If they can’t, they must transfer the patient to another hospital that will.
• Showing doctors evidence-based standards of care from professional medical organizations to explain that you should be offered these options. Here are guidelines from the American College of Obstetricians and Gynecologists.
• Asking to speak with patient advocates, who work at hospitals to help patients understand their rights and answer questions about their care. Or asking to speak to the hospital’s legal team. Hospitals have processes for escalating concerns.
• Asking for an ethics consult if you still aren’t getting straight answers or are being denied a procedure. Another option is an interdisciplinary meeting with your doctors and nurses, nursing leaders and hospital administrators.
• Reminding doctors that you are being denied the standard of care, which could mean the providers are committing malpractice.
• Filing complaints with the state survey agency, if you think EMTALA was violated, and with the state medical board.
• Calling your state representatives or contacting legal advocacy groups that can advocate for patients’ rights, including the Repro Legal Helpline at If/When/How (844-868-2812), the Center for Reproductive Rights (917-637-3600), the American Civil Liberties Union or the National Women’s Law Center.
• You can also reach out to journalists at ProPublica at reproductivehealth@propublica.org. We are continuing to investigate cases of denied care.

by Sharon Lerner

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

Citing a recent ProPublica investigation, Sen. Richard Blumenthal, D-Conn., urged the Environmental Protection Agency in a letter this week to issue a final report on the health risks of formaldehyde that is “science-based” and “as strong as possible,” adding that “the agency has an obligation to protect the public from the chemical.”

Formaldehyde, used for everything from preserving dead bodies to binding wood products and producing plastic, is extremely widespread and causes far more cancer than any toxic air pollutant. ProPublica’s analysis of EPA air pollution data showed that, in every census block in the U.S., the risk of getting cancer from a lifetime of exposure to formaldehyde in outdoor air is higher than the goal the agency has set for public exposure to air pollutants.

The EPA issued a draft of the formaldehyde risk evaluation in March and, after receiving feedback from the public and a committee of experts, is expected to release the final version by the end of the year. The forthcoming evaluation will be used to inform future restrictions the agency puts on the chemical. But the ProPublica investigation found that the draft version of the report used unusual techniques to underestimate the risk posed by formaldehyde.

In one case, the agency determined whether concentrations of formaldehyde in outdoor air posed an “unreasonable risk” — a level that requires the agency to address it — not by measuring them against a health-based standard, but rather by comparing them to the highest level of the chemical measured outdoors in a five-year period. The measurement the agency chose as a reference point was a fluke, ProPublica found, and had not met the quality control standards of the local air monitoring body.

The EPA did not immediately respond to questions from ProPublica about Sen. Blumenthal’s letter and when the agency plans to release its final report.

The EPA is evaluating the health risks of formaldehyde under the Toxic Substances Control Act, the main federal law that governs chemicals. That process typically relies on toxicity estimates calculated by a separate division of the agency. In the case of formaldehyde, the EPA released the final toxicity values in August of this year, decades after it began the process of calculating them. Throughout that time, companies that make and use the chemical — and could lose money if it is restricted — criticised the agency’s numbers and worked to delay their release.

Some industry-affiliated members of the expert committee that reviewed the draft evaluation of formaldehyde this year have continued to find fault with the EPA’s toxicity estimates and have suggested that the agency weaken them in its final report.

In his letter, Blumenthal advised EPA Administrator Michael Regan against taking this route. “Throughout your tenure, EPA has been steadfast in upholding its vital mission of protecting human health and the environment,” he wrote. “I urge you to continue this commitment and issue a final risk evaluation for formaldehyde that is rooted in the best available science.”

by Charles Ornstein

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

In my early years living in New Jersey, I keenly remember The Star-Ledger in Newark reporting on how hundreds of police officers and firefighters got anabolic steroids, human growth hormone and other forms of testosterone at taxpayer expense for medically unnecessary reasons. It was a tour de force of local journalism; something that deepened my understanding of the state where I lived.

Sadly, this kind of journalism has been harder to find as the papers that cover Jersey have struggled financially. Because the state is sandwiched between two big TV media markets — New York City and Philly — the issues facing our towns and cities get far less attention.

Indeed, in February, The Star Ledger is ceasing its print publication entirely and moving to an online-only format. Over the years leading up to this decision, the paper imposed multiple rounds of job cuts and its offerings thinned, even as the staffers who remained continued to produce vital journalism. The company’s leaders say they will reinvest funds from ending the print publication into the core newsroom.

I hope so. Because with each passing year, the reminders of the local news industry’s decline become more pronounced. Layoffs. Newspapers closing. Fewer investigative stories.

That’s why I’m so proud to share how ProPublica is stepping in to help fill this void through a number of new initiatives that we’ve launched and will continue to roll out in the new year.

In early 2024, we announced our 50 State Initiative, through which we pledged to tell accountability stories with partners in all 50 states over the next five years. We’re currently working with our first 10 local newsrooms, including a project in North Dakota (the first time we’re collaborating with an outlet in the state), and we will be selecting another 10 in 2025.

As part of this effort, we pay for a reporter’s salary and benefits for one year so they can dive deep into a project that matters for their communities or regions. We also pair those reporters with editors here and members of ProPublica’s data, research, crowdsourcing and news applications teams so they apply new and innovative techniques to their reporting. One of the consequences of newsroom layoffs has been drastic reductions or the elimination of research and data teams. Giving partners access to those resources greatly expands a story’s possibilities.

The 50 State Initiative is an outgrowth of our Local Reporting Network, which began in 2018 and has generated about 100 projects to date. Those stories have changed laws and changed lives. They’ve led to a national emergency being declared in Alaska, debt being forgiven in Memphis, Tennessee, and vast sums of money being allocated to fix long-standing problems in Idaho and Hawaii. Almost weekly, we see the impact of journalism from reporters in the network. We have seen changes in both blue and red states; so many issues transcend partisanship. People want to fix problems where they live when they become aware of them.

Reporter Jennifer Smith Richards looks through archived newspapers at the Mount Vernon Public Library in Ohio. (Sarahbeth Maney/ProPublica)

This success is possible because we work with a huge range of publications: legacy newspapers, radio and TV stations, and a new cadre of nonprofit newsrooms that have sprung up seeking to increase the sources of news to local residents. We’ve learned over and over again that people in different communities get their news in different ways, but the appetite for fact-based reporting transcends location.

Next year, we will build on this track record of success. In January, we will launch what we are calling our Sustainability Desk, which will work with previous partners to produce stories even after a reporter’s one-year fellowship has ended. We are hiring an editor and several other members of our staff to keep these relationships going and to identify opportunities to match the local knowledge of our partners with ProPublica’s investigative expertise. Be on the lookout for stories from these partnerships early in the year.

We are also launching a new initiative with our partners at The Texas Tribune. In addition to continuing the work of our shared investigative unit, we will be identifying major issues facing the state and collaborating with five local newsrooms each year to cover one of those issues from different perspectives.

Texas is helping to set the national dialogue on issues from education to health care to immigration. Gov. Greg Abbott focused the national spotlight on the border by busing more than 100,000 newly arriving immigrants to New York, Chicago and other big cities. The state is poised to adopt private school vouchers in its upcoming legislative session. And it also has the highest share of residents without health insurance in the nation. We will provide financial, editorial and audience support to five newsrooms around the state, and we are hoping that our investment in journalism meets the moment. As Texas lawmakers consolidate power in Austin — and newsrooms pare back their presence in the capital — this new approach will help to ensure newsrooms from El Paso to Tyler, Lubbock to Laredo, can learn about how people in various parts of the state are dealing with similar issues.

Reporter Mark Olalde uses a hand-held gas monitor to test for explosive methane and toxic hydrogen sulfide as part of his writing on oil well cleanup in New Mexico. (Nick Bowlin/Capital & Main)

Lastly, we will be hiring a reporter based in Florida. This will be our first dedicated reporting effort in the state, although we have done memorable work there, including Local Reporting Network partnerships with The Palm Beach Post on the harm caused by sugar cane burning and with the Miami Herald about a Florida program that was doing a poor job taking care of children born with brain damage.

The changes promised by Donald Trump as he prepares for his second administration are sure to create effects that will be felt locally. We are prepared to document the consequences for communities in an unprecedented way. When Trump took the oath of office for the first time, we had no regional offices and we hadn’t yet started our Local Reporting Network.

Now we have ProPublica journalists on the ground in 17 states: Alabama, Arizona, Colorado, Georgia, Idaho, Illinois, Michigan, Minnesota, Missouri, Nevada, New Mexico, North Carolina, Oregon, South Carolina, Texas, Washington and Wisconsin. Florida will make 18.

And we have 21 active Local Reporting Network partnerships across the country. All told, ProPublica has nearly 50 reporters in different communities covering local news through an investigative lens.

We may never fully replace the hyperlocal coverage of high school sports, the police blotter and the town council. But we do believe that every American should have the benefits of accountability journalism, regardless of where they live.

by Paul Kiel

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

Fourteen years ago, Congress set out to remedy a basic unfairness in the tax code. The tax that funds Medicare, because it’s aimed mainly at wages, hits even the poorest American workers. But the wealthy could easily avoid paying their share. So lawmakers created a new type of Medicare tax to capture the kinds of income the rich often enjoy: interest, dividends and capital gains from investments.

A host of billionaires — sports team owners, oil barons, Wall Street traders and others — have managed to avoid paying it, ProPublica found.

To study who was actually paying the new tax, ProPublica analyzed its trove of IRS data containing information on thousands of the wealthiest Americans. We identified 17 people who, in the first six years of the law, 2013 through 2018, each shielded at least $1 billion in capital gains from the tax. Together, this small group, by collectively exempting more than $35 billion, saved about $1.3 billion in taxes.

Most members of the group were able to sidestep the tax because of a huge gap written into the law, which allows owners to exempt gains from the sale of their businesses. They include Donald Sterling, the disgraced former NBA team owner who avoided the tax when he sold the Los Angeles Clippers to Steve Ballmer for $2 billion in 2014.

But others eluded the tax in ways that raise questions about how the law is being enforced.

One clear target of the new tax was investment professionals who rack up capital gains. Yet ProPublica found examples in the IRS data of financiers who claimed outsize profits but did not pay the tax. Tax experts contacted by ProPublica said they couldn’t think of a legitimate reason why those individuals were exempt.

Lynn Tilton, a hard-charging private equity manager, who has been dubbed the “diva” of distressed asset investing, is one example. The biggest avoider of the new tax in the data was Jeff Yass, the Republican megadonor who sits atop one of the most profitable trading firms in the world.

Both Medicare tax and its twin, the Net Investment Income Tax, as the new levy was called, are easily avoided by business owners. Last week, ProPublica revealed how some of Wall Street’s most powerful people use a loophole to avoid paying Medicare tax on their share of their firms’ profits. Eliminating these ways around the taxes, as House Democrats proposed to do in a 2021 bill, would raise an estimated $250 billion over 10 years. Medicare, the federal program that provides health care for some 68 million seniors, is projected to run short of money in 2036.

“It becomes a pretty glaring problem when you have ultra-rich individuals layering loopholes on top of loopholes to dodge both the NIIT and Medicare taxes,” said Sen. Ron Wyden, chair of the Senate Finance Committee, in a statement. “To the nurse or the janitor whose taxes come straight out of their paychecks, it’s ridiculous to see these examples of fabulously wealthy individuals enjoying huge windfalls and continuing to avoid paying a fair share.”

The NIIT, together with its holes, entered the tax code as part of the Obama administration’s push to pass the Affordable Care Act. In need of ways to help pay for a major expansion of government health care subsidies, Democratic lawmakers embraced the idea of this new tax on investments.

The aim was to level the playing field. All workers pay at least 2.9% in Medicare taxes on their wages, an amount usually deducted automatically from their paychecks. The NIIT, for high-income taxpayers (defined as $250,000 and up for a married couple), subjected investment income to a 3.8% rate. That mirrored the Medicare tax rate that workers earning over the same threshold paid under the new law.

But while the tax was a bold step, the ACA’s lead negotiators had navigated various interest groups to piece the bill together and were afraid of whom their new tax might provoke. Behind closed doors, Democratic leaders hashed out a compromise that carved active business owners out of the tax.

The small-business owner is a hallowed figure on Capitol Hill, and an army of lobbyists and trade groups stand ready to mobilize against any bill that arguably disadvantages small businesses. The Democrats crafting the NIIT were wary of such a campaign.

Democrats wanted to avoid “a swing state Dem being attacked for punishing an entrepreneurial hard-working person” with the tax, said Robert Andrews, a former Democratic U.S. representative from New Jersey who was among the negotiators.

The phrase “small business” conjures images of Main Street grocers, plumbers or garage-based startups, but the types of business that benefit from the carve-out range from small to enormous. There are millions of passthrough businesses, so called because the income earned and taxes owed pass through to the owner. Only a small number of such businesses are worth $100 million or more, yet the owners of the largest businesses are likely the prime beneficiaries of the exemption.

Owners of passthrough businesses with significant revenue already enjoy plenty of tax perks, as ProPublica showed in previous stories. The NIIT carve-out added to that list. The carve-out meant that when they sold their businesses, or portions of them, they’d be spared any extra charge beyond income tax on their capital gains. They’d pay a lower tax rate on those gains than on virtually any other form of investment.

“What we’re left with in terms of these gaps are nonsensical results,” said Steve Rosenthal of the left-leaning Tax Policy Center.

When Sterling sold the LA Clippers, virtually the entire $2 billion sale price was taxable capital gain, because he’d bought the team for $12.5 million in 1981. Sterling, who made his money in LA real estate, did not give the impression of someone who enjoyed owning an NBA franchise. He was notorious for deriding his own players and underinvesting in the team. But it was only a scandal, a leaked private recording in 2014 of him urging his girlfriend not to be seen “associating with Black people,” that forced him to sell after the NBA banned him.

It was the biggest payday of Sterling’s life by far. He paid substantial income tax on the capital gain from the sale, but the exemption from the NIIT saved him around $70 million. Neither Sterling, who is 90, nor his tax preparer responded to requests for comment.

In ProPublica’s database, most of the biggest winners from the NIIT carve-out were owners, like Sterling, selling their privately held businesses. Among those exempting gains of $1 billion or more were four moguls from the fossil fuel industry spared the extra tax when they sold off portions of their oil, natural gas or coal empires. The carve-out saved each of the four between $45 million and $87 million in taxes.

The NIIT carve-out was huge and costly, but it didn’t apply to all business owners. Owners who are merely passive investors in a business, for instance, must pay the NIIT on that income. And Congress singled out securities traders as clearly subject to the tax.

The NIIT was targeted at “high-income people who lived off investments,” remembered Andrews. It was designed to hit “someone who is day-trading, someone who is arbitraging the market,” he said, referring to the practice of exploiting mismatched prices of securities, like stocks or bonds.

That could serve as a loose description of what Yass’ firm, Susquehanna International Group, is renowned for. Yass, a former professional poker player who thrives on taking well-calculated risks, amassed an army of traders at Susquehanna to outwit the market. They are hired to execute computer-driven strategies that seize on advantages at the microsecond level and search for situations that, through a cleverly executed arbitrage, they can exploit. The firm deals extensively in options as well as other securities. Susquehanna has been immensely profitable; Forbes estimates Yass’ fortune at $50 billion.

From 2013 through 2018, Yass reported a total of $9 billion in capital gains on his taxes, according to ProPublica’s IRS trove, but excluded $8.5 billion of those gains from the NIIT. That saved him more than $300 million in taxes during those years. Two of Yass’ Susquehanna partners, Arthur Dantchik and Joel Greenberg, also excluded billions in gains from the NIIT during that time: $2.1 billion and $1.2 billion, respectively. Together, they saved about $120 million.

In 2013 and 2014, Yass managed to wipe out not only his gains for the purpose of the NIIT but also hundreds of millions in interest and dividend income. In each of those years, his tab for a tax crafted to target traders like him amounted to $0.

Tax experts contacted by ProPublica struggled to explain how Yass and his Susquehanna partners could justify excluding their firm’s gains from the NIIT.

“Although the principal here is active in the business, the business is trading in financial instruments,” said Andrew Needham, a former attorney with Cravath, Swaine & Moore who has written extensively on how tax laws apply to hedge funds and other financial firms and now teaches at New York University School of Law. That means Yass’ gains should be subject to the NIIT, he said. “I don’t know what his theory is.”

A Susquehanna spokesperson, speaking on behalf of Yass and his partners, declined to respond to a list of questions.

Yass, a longtime libertarian, gave $95 million last election cycle to conservative groups, especially the antitax Club for Growth, putting him among the largest political donors in the country.

Yass has a history of taking bold positions on his tax returns. The IRS recovered more than $75 million from Yass after one protracted audit fight that spilled into court, and Susquehanna is currently in court fighting another audit. In an earlier story, ProPublica detailed how Yass and Susquehanna engineered the firm’s investments to transform income normally taxed at the high, ordinary rate into income taxed at the 20% long-term capital gains rate. Those maneuvers saved Yass over $1 billion in taxes.

ProPublica analyzed the tax data of hundreds of the wealthiest hedge fund and private equity managers to understand how they were complying with the NIIT. Huge, blanket exemptions among finance moguls like Yass were rare, we found, but when they did occur, the cost to the Treasury was considerable.

Tilton won fame on Wall Street as the brash, stiletto-wearing head of her own investment firm. She specialized in distressed investing: Her funds purchased both the debt and equity of over 40 struggling companies, then blended those investments together and sold them to investors. Tilton sought out publicity — with mixed success. The Sundance Channel developed a reality show starring Tilton titled “Diva of Distressed,” but it never made it past the pilot. In 2011, she tried to convince Forbes that she was a billionaire, but the magazine disagreed, estimating her wealth at around $830 million.

Tilton has left a trail of unhappy investors. She’s been sued for fraud and racketeering, for misleading investors and pillaging the portfolio companies for her own profit. Tilton, for her part, maintained that she’d fully briefed investors and denied taking any improper compensation. She successfully fought off three major lawsuits, including one from the Securities and Exchange Commission.

Tilton’s investment funds were passthrough businesses set up so that she, not her investors, would bear the tax burden. In most years, there wasn’t much of a burden to bear. But in 2016, the funds posted a $1.4 billion capital gain. While a huge gain sounds like a good thing, for Tilton it meant a big tax bill.

The income tax hit was significant for her, about $162 million after deductions. She complained about having to pay the bill in one of the lawsuits against her firm, calling it a tax on “phantom income.” As she put it later at the trial, “But let’s be clear, I was paying taxes for money received by the noteholders.”

While Tilton did pay income tax on that big gain, she claimed that the entirety of the $1.4 billion was exempt from the NIIT. That saved her about $50 million in tax.

An attorney for Tilton declined to comment for the record but said that Tilton had correctly exempted her gains because she had actively managed the funds’ investments in the portfolio companies.

Tax experts contacted by ProPublica disagreed. Brian Galle, a professor at Georgetown Law and former federal prosecutor of tax crimes, said Tilton appeared to have invented a category of financier who is not subject to the tax. The tax clearly applies to passive investors and traders, he said. Tilton appeared to be claiming to be somewhere in between, an “active” investor but not a trader. While there is some ambiguity in the regulations surrounding the law, he said, it was a “ridiculous argument.”

Tilton, like Yass, has had her battles with the IRS. From 1996 through 2013, all but two of her tax returns drew audits, the largest change leading to $1.5 million in additional tax on one year’s return. But ProPublica’s IRS data shows no active audits of Tilton’s later returns as of mid-2020.

One reason might be the devastating budget cuts to the IRS that started in 2011 and reduced enforcement staff by a third. The agency did glance at Tilton’s 2016 return, according to the data, but concluded that, although the return had “audit potential,” no agents were available to examine the return.

Similarly, there’s no indication the agency has scrutinized Yass’ NIIT obligations. As of mid-2020, the agency did not have an open audit of his tax returns for 2013 through 2017. An audit of his 2018 return was in the early stages. The IRS declined to comment.

In just the last year, the IRS began to regain some of its lost enforcement muscle, hiring thousands of new revenue agents with funds from the 2022 Inflation Reduction Act. However, it’s unclear how long that resurgence will last. Congressional Republicans have continually vowed to clawback the extra enforcement money. The incoming Trump administration has supported that goal while touting a new round of tax cuts, in particular for business owners.