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Body Cameras Were Sold as a Tool of Police Reform. Ten Years Later, Most of the Footage Is Kept From Public View.

11 months ago

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In the last 10 years, taxpayers have spent millions to outfit police officers across the country with body-worn cameras in what was sold as a new era of transparency and accountability. But a survey by ProPublica shows that when civilians die at the hands of police, the public usually never sees the footage.

At least 1,201 people were killed in 2022 by law enforcement officers, about 100 deaths a month, according to Mapping Police Violence, a nonprofit research group that tracks police killings. ProPublica examined the 101 deaths that occurred in June 2022, a time frame chosen because enough time had elapsed that investigations could reasonably be expected to have concluded. The cases involved 131 law enforcement agencies in 34 states.

In 79 of those deaths, ProPublica confirmed that body-worn camera video exists. But more than a year later, authorities or victims’ families had released the footage of only 33 incidents.

In 101 police killings in June 2022, body-camera footage … Jason Kao/ProPublica

We filed public records requests for the video in the remaining 46 cases and in 26 were told it could not be publicly released or did not receive any response. In 14 cases, law enforcement agencies offered the video for a fee, ranging from $19 in Lowndes County, Georgia, to nearly $16,000 in Hillsborough County, Florida. Six departments eventually gave ProPublica the footage for free.

The lack of disclosure undermines the promise that equipping police with body cameras would increase transparency around fatal police encounters and hold officers to account for bad or criminal behavior.

President Barack Obama made body-worn cameras a centerpiece of his police reform efforts after Michael Brown, an 18-year-old Black man, was shot and killed by police in Ferguson, Missouri, in 2014. Police claimed they were acting in self-defense, while witnesses said that was not true. Weeks of protests ensued. It was one in a series of police killings in which the officers’ stories differed from witness accounts or videos taken by civilians nearby. Brown’s family, advocates and even some law enforcement leaders called for the widespread use of body-worn cameras in hopes they would help restore trust between police and a public that had lost faith.

The Justice Department allocated millions to help departments across the country outfit officers with the technology.

“They were wholly sold as an accountability tool to reassure people that police would be held accountable for their actions or for what they are doing while operating under the powers of the state,” said Hans Menos, who advises police departments with the Center for Policing Equity and formerly headed the Police Advisory Commission in Philadelphia, an early adopter of body cameras. “If we don’t provide that level of transparency, what we’ve really done is made people pay for something that they don’t get any tangible benefit out of.”

Philadelphia signed a $12.5 million contract in 2017 to equip its entire police force with cameras. Since then, at least 27 people have been killed by Philadelphia police, according to Mapping Police Violence, but in only two cases has body-camera video been released to the public.

ProPublica’s review shows that withholding body-worn camera footage from the public has become so entrenched in some cities that even pleas from victims’ families don’t serve to shake the video loose.

In Savannah, Georgia, for instance, neither Saudi Arai Lee’s family nor the public has been allowed to see the footage of the fatal shooting of the 31-year-old Black man.

Savannah police and Georgia state investigators say Lee was walking down a street June 24, 2022, when an officer stopped to question him. Lee told the officer he had a permit to carry a gun and pulled out his wallet. He lifted his shirt to show the gun. Then, for an undisclosed reason, the officer began chasing Lee, and shot and killed him. It was the fifth killing by Savannah police in a year. The agencies won’t release the footage, they said, because the killing is still under investigation.

Lee’s uncle, Timothy Lee, arrived on the scene minutes after the shooting and spoke to witnesses. “He was reaching for his wallet and that’s when the man shot him,” Timothy Lee said people told him. “We want justice. We think he should go to jail for the rest of his life for what he did.”

On the same day, halfway across the country, Christopher D. Kelley was killed by police in Topeka, Kansas. His family also wants the footage of his killing to be made public, according to their attorney, LaRonna Lassiter Saunders. The family and lawyer have seen the video and believe that if it were made public it could serve to prevent similar tragedies in the future.

Kelley, a 38-year-old Black Marine veteran, was in the midst of a mental health crisis, Saunders said, when police found him behind an Amtrak station, standing on a pile of rocks and holding a knife. More than a dozen officers surrounded him with guns drawn and spent almost an hour trying to convince Kelley to drop the knife, even firing nonlethal bean bags at him, according to a report by state investigators. Then, according to the district attorney, who cleared police of wrongdoing, Kelley “raised the knife and charged” toward police, prompting three officers to open fire. If the public saw exactly what happened, Kelley’s family has said, maybe the next time Topeka police are called to help someone in a mental health crisis, they won’t end up killing them.

“If you want to create transparency and accountability and to restore the trust that this community has lost … release the doggone tapes,” Kelley’s sister Christian said at a press conference in February.

The Promise of Body-Worn Cameras

After Brown’s killing, the Department of Justice stepped up funding for police to buy body-worn cameras, providing more than $184 million over the next decade. By 2016, nearly half of 15,328 law enforcement agencies across the country, and 80% of police departments with more than 500 officers, had begun using the cameras, according to the Department of Justice. For many police officers in America today, body cameras are standard-issue equipment that they are supposed to turn on during most law enforcement activities.

The videos, advocates say, can help civilians fact-check the official account of what happened in a contentious incident, such as when police use force or take someone’s life.

“Law enforcement has the power of credibility on their side,” said Dawn Blagrove, an attorney with Emancipate North Carolina, a group that helps families get access to body-worn camera video. “Even though time and time again they are proved to be uncredible or unreliable, people still are disposed to believing whatever narrative law enforcement puts out.”

Sometimes the release of those videos can spur change. In the last two years, Raleigh, North Carolina, police banned no-knock warrants and adopted a deescalation policy for encounters with people in a mental health crisis. The reforms were made, Blagrove said, because body-camera video helped document what police were doing wrong in such encounters so they could try to fix it.

Varying Disclosure Policies

Police departments involved in 14 of the June 2022 deaths that ProPublica reviewed released the body-camera footage because a department policy or a state or local law demanded it. The requirements vary. Seattle, for example, has a department policy calling for video to be released within 72 hours of a “critical incident,” while in California, a state law requires all departments make the footage public within 45 days.

The videos often begin with a brief introduction by an officer, followed by edited and redacted footage. Sometimes, they are accompanied by 911 recordings and video from dash cameras or drones. Other times they include stills of a weapon the victim allegedly carried. When Akron, Ohio, city leaders held a news conference to release video from the June 27 shooting of Jayland Walker, they included footage from eight officers,

When Akron, Ohio, city leaders held a news conference to release video from the June 27 shooting of Jayland Walker, they included footage from eight officers, in accordance with a city law mandating such disclosure within a week of an incident.

“It is clear what our community wants is to be able to review the information for themselves,” said Mayor Dan Horrigan at the news conference. “It is our commitment to be as open and transparent as we can be.”

The videos showed that officers shot 25-year-old Walker 46 times in under 10 seconds, sparking protests. In April, a grand jury decided the officers should not be indicted on criminal charges. Walker’s family has filed a civil suit against the city.

But Akron isn’t the norm.

Some departments that have disclosure policies don’t always follow them. The New York Police Department, the largest in the country, is supposed to release video within 30 days of a critical incident. But a ProPublica review of the department’s data found that of 380 such incidents since the policy was enacted, the department released videos only 64 times, and only twice within its own 30-day time frame. A spokesperson for the NYPD said that privacy concerns, local laws or unspecified department policies kept it from releasing more of the videos. “The NYPD remains wholly committed to its policy of releasing such recordings as quickly and responsibly as circumstances and the law dictate,” the spokesperson wrote.

Many other departments — including 11 from ProPublica’s June 2022 review — said they cannot disclose body-camera footage while incidents are under investigation.

That’s the reason Savannah police cited when they denied requests from ProPublica to see the video of Lee’s killing.

Advocates for more transparency, though, say making video available to the family and the public should happen regardless of how an investigation is proceeding.

“The point of the tape being released is expediency in getting it to the public,” said Juandalynn Givan, a state lawmaker in Alabama who has pushed for more transparency there. “You might not have convened a grand jury for six or eight months."

State Law Blocks the Way

In many states, the roadblocks to disclosure are encoded into the law.

In Pennsylvania, for example, a law passed in 2017 — after the state supreme court ruled body-worn camera footage is a public record — requires requests for video to be made in person or via certified mail within 60 days of an incident. And police and prosecutors are given broad discretion to withhold video if they see it as evidence in an investigation. “It actually serves more as a block to accountability and transparency than it does to foster release of information,” said Terry Mutchler, an attorney who has helped clients obtain video through court orders.

That’s what allows Philadelphia, one of the largest departments in the country, to routinely withhold video.

A spokesperson said the department is “committed to transparency and accountability” and added that “the legal framework governing the release of BWC footage is designed to balance the public’s right to information with the need to protect ongoing investigations and sensitive details.”

In Alabama, Kansas and South Carolina, the law makes footage confidential by default, often classifying it as an investigative record akin to a police interrogation, which can be released at the discretion of police or a judge.

Alabama’s Law Enforcement Agency cited state law when it refused ProPublica’s request for video of the June 9, 2022, fatal shooting of Robert Tyler White by an off-duty Rainbow City police officer. Police say White tried to enter the officer’s vehicle and an elementary school. White’s family has said he suffered from depression and may have been suicidal but does not think he was trying to harm others.

Kansas law allows families of victims to view footage within 20 days of a request, but there is no requirement for police to release it to the public.

ProPublica’s request for footage of Kelley’s killing was denied under that law. Releasing the video, the city of Topeka said, “is not in the public’s interest.”

But Kelley’s family members, who have seen the video, want it to be made public because they say it highlights how police mishandled a mental health emergency. Saunders, the family’s attorney, says the video shows police surrounded Kelley and unnecessarily escalated a situation. “After 50-plus minutes of him asking them to leave him alone, him trying to run away … you can see he just got to a point where he was already broke,” Saunders said.

She said he did not charge at police with a knife, as the department has claimed. “He tried to make a run for this little path that they had made, but as soon as he headed down that path they shot him several times,” she said

State investigators and Topeka police declined to comment on what the video showed and directed questions to the district attorney’s office, which did not respond to interview requests. In September 2022, the district attorney cleared the officers of wrongdoing.

Four months after Kelley’s death, Topeka police killed another man whose family had called 911 because he was having a mental breakdown. Saunders, who has seen body camera video from that incident as well, said it showed police chased Taylor Lowery and surrounded him as he held a wrench and stood next to a knife. Five officers then shot and killed him. The district attorney found the killing was justified, saying Lowery had tried to carjack someone and was a threat to police officers. Lowery’s family disagrees and wants video of that killing to be released to the public.

Having the public see what transpired, Saunders said, could spark reforms like redirecting 911 calls to mental health crisis teams rather than police. But, she said, that first requires the public to see the video that contradicts the official narrative. “They’re making it look like these two men were violent or attacking, and that was not the case,” Saunders said. “If anything, they were under attack, they were retreating, they were running, they were trying to get away. And so they [the families] just want the public to see the real truth.”

North Carolina law requires a court order for footage to be released to the public. ProPublica found three killings in June 2022 for which video exists but has not been released, and in each case police denied our request, citing that law.

Even families must petition a judge to get a copy of video. Without a court order, they have to ask police to let them view the footage at police stations. Police chiefs, district attorneys and a host of other law enforcement personnel, possibly even the same officers involved in the killing, can legally be in the room and have the power to choose which parts of a video a relative can see based on their interpretation of the statute.

“There is no way for you to watch the video without essentially going into the belly of the beast,” said Dawn Blagrove, who crisscrosses the state to accompany relatives to police stations to view footage. Their goal, she said, is “making sure that when people are having to relive, or see for the first time, a loved one taking their last breath, that they don’t do that without some support, that they don’t do that alone.”

In the wake of the May 2020 murder of George Floyd, advocates in North Carolina attempted to reform its body-camera law as part of a broad criminal justice reform bill that included provisions for releasing video to the public, said Blagrove, who served on the governor’s Task Force on Racial Equity in Criminal Justice, which drafted the bill. “Once they got it into the General Assembly, the real substantive parts of those recommendations that would have created real change were gutted,” said Blagrove.

Instead, changes to the law made accessing video even more difficult, requiring a court order. The fallout from the law, Blagrove said, has been devastating. “It is just a system that is designed around protecting law enforcement and, simultaneously, creating a chilling effect on friends and family who want to get some answers as to how and why their loved one has died.”

In many of these states, lobbying groups representing law enforcement officers and prosecutors have played a decisive role in keeping video out of public reach. The North Carolina Sheriffs’ Association, for instance, successfully blocked the reforms Blagrove and other advocates were hoping to enact into law after 2020. In Alabama, lobbying on behalf of police chiefs, sheriffs and district attorneys helped block two proposed laws that would have allowed the public to request video. Law enforcement lobbying groups have also thwarted efforts at reforms in Kansas since 2015.

Selective Release

Without uniform state policies in place for when video must be released to the public, Blagrove and other advocates say police departments have been able to selectively release footage to support their narrative, while often hiding images that might be embarrassing or worse.

This January, police in Raleigh said they killed Daniel Turcios, a Hispanic man they encountered on the interstate after a traffic accident, because he was high on drugs and threatening them with a knife. Police released an edited video supporting that narrative. But after public pressure, they released the full video along with a toxicology report, which showed something very different, Blagrove said. “They chased him and they shot him and killed him in front of his family,” Blagrove said. “They had him written off as this knife-wielding, drug-induced man, and by the time we were finished with it, it was like a family man was shot in front of his children.”

Alabama lawmakers adopted North Carolina’s law, almost word for word, this June.

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by Umar Farooq

Utah Women Tried to Report Sexual Assaults to Police. They Say They Faced Delays and Language Barriers.

11 months ago

Leer en español.

This story details allegations of sexual assault.

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

In June 2022, Yanett Bernal walked into the police station in Provo, Utah, to report that her OB-GYN had sexually assaulted her. She said after making a written statement she told a detective over the phone how David Broadbent conducted painful vaginal and rectal exams during her last pregnancy.

A month later, Bernal went back to the station to ask for a copy of her report. A worker at the reception desk told her that a report didn’t exist, she recalled.

“They said they had nothing,” she said, “and didn’t tell me I should do it again or anything.” What they did tell her, she said, is that she should call a number to speak with someone in Spanish and to wait for a detective to call her back.

Another month went by, and still Bernal hadn’t heard from the detective.

So Bernal turned to an independent victim advocate named Gloria Arredondo. She had been fielding similar questions from women who, like Bernal, were having difficulties making reports about Broadbent to Provo’s Police Department or accessing their records. All were native Spanish speakers from Mexico. Some told her it was hard to get someone at the department to take their cases seriously or even to call them back.

Arredondo suggested that Bernal and others visit the Mexican Consulate, an hour away in Salt Lake City, for help.

Arredondo, who has worked with Latino victims of crimes since 2012, said this was the first time she’s involved a consulate in order to get a callback from the police.

“It’s been very frustrating to see them not be able to make a report,” she added. “For me, it was common sense that you went to the police, they took your report and started to work on it.”

The consulate confirmed that at least two women did go to its offices “looking for support” and that it called the detective in charge in August to ask for an update on the case. The goal, said Maria Fernanda Gomez Contreras, head of the consulate’s office of protection, was “to ensure that the women are being heard and that they deserve the same treatment as anyone else.”

Bernal, who did go to the consulate, is one of 49 women who went to Provo police over the last nearly two years to report that Broadbent sexually abused them. Utah County prosecutors are considering charges in some of the cases but have not decided whether to criminally charge the doctor. He has agreed to stop practicing medicine while this police investigation is ongoing. As part of a separate civil case, Broadbent’s attorneys have said sexual assault allegations against him were “without merit”; the doctor did not respond to a request for comment, sent through his lawyer, about this case.

In March, 20 Mexican immigrants filed a civil lawsuit against two hospitals where Broadbent worked, saying that they knew of his alleged misconduct and failed to act. (Attorneys for the two hospital systems have asked a judge to dismiss the suit, arguing that Broadbent’s alleged actions against these women didn’t take place on their premises. One of the hospitals, MountainStar, also said in a statement it was not aware of complaints being made to the hospital itself, that Broadbent is not and was not a hospital employee, and that he doesn’t have privileges there now.)

The Salt Lake Tribune and ProPublica interviewed 14 of those women who, between March 2022 and April 2023, went to the police station to allege that he inappropriately touched their breasts, vaginas and rectums during exams — often without warning or explanation, and in ways that hurt them and made them feel violated.

Valencia, first image, and Alvarez, second image, went with a group of women to the Provo police station in March 2022 to report Broadbent for sexual assault. Valencia told them the doctor touched her in ways that felt inappropriate as she was seeking care in 2006 for a high-risk pregnancy. Alvarez said Broadbent conducted painful exams and made comments about her appearance that felt inappropriate during her visits in 2011. (Francisco Kjolseth/The Salt Lake Tribune)

The interviews by the two news organizations also reveal that many of these women faced delays, language issues and insensitive interviews when they went to the police. Of the 14, five said police turned them away at least once.

Getting the Mexican Consulate involved appeared to have worked for Bernal: She said soon after, she heard back from a detective regarding her case.

“That was when they changed here,” Bernal said. “They changed and they listened to us.”

Provo police Capt. Brian Taylor did not address the women's complaints, saying he couldn’t publicly discuss case specifics. He said the department “systematically collected interviews and presented reports to the Utah County Attorney’s Office.”

“Reporting sexual abuse is a deeply personal decision,” he added. “We honor victims who come forward and encourage people to do so.”

Over the last year, The Tribune and ProPublica have investigated obstacles that Utahns face when seeking justice against medical providers who they say sexually assaulted them. A February article detailed how a different group of women similarly accused Broadbent of sexual misconduct and sought justice in civil court — just to have a judge dismiss their case, ruling that it fell under medical malpractice law instead of a civil sexual assault claim. The women have appealed the ruling to the Utah Supreme Court, which is considering the case.

An August investigation by the news organizations showed how patients of a Utah County therapist had reported alleged inappropriate touching to both state licensers and local leaders within The Church of Jesus Christ of Latter-day Saints; neither group reported the therapist to law enforcement. Both said they take allegations of sexual assault seriously and indicated that they had addressed the complaints through their own processes.

But Bernal and these other women did go to the police. And they’re still waiting to see if anything comes of their efforts.

“He Said the Doctor Was Doing His Job”

From the beginning, some of the 14 women we interviewed said their efforts to give statements about Broadbent to the police were stymied. Body-camera footage shows that in at least two cases, police officers took initial information in a hallway — sitting on a bench under the station’s public “Wall of Honor” in the police lobby, where photos of fallen officers are displayed — rather than a private interview room.

In this screenshot of police bodycam video, one woman who went to report Broadbent — who was obscured by police behind the rectangle to protect her privacy — was interviewed under the station’s “Wall of Honor.” On her left, Wilma Castro, a Spanish-speaking victim advocate with Provo police, sits with the alleged victim as an officer conducts a preliminary interview. In at least two cases, police officers interviewed alleged victims of sexual assault in the lobby instead of a private room. (Obtained by The Salt Lake Tribune and ProPublica)

A staff victim advocate accompanied the officer as each case was discussed out in the open. Taylor said officers taking initial reports will move an alleged victim to a more private area, he said, if there are people in the police lobby. It is not clear from body-camera footage whether there were others in the hall during the interviews, but in one instance, audio on the video picks up others passing by and talking within earshot of the woman sharing her complaint with the officer. Arredondo, who accompanied one of the women, said the hallway felt like an unusual place to ask the women to share.

“I worried about their privacy,” she said.

The first detective on the case was Kevin Fernandez, who joined the Provo Police Department in 2018 after becoming a sworn officer. Fernandez’s family comes from Mexico City, according to a 2020 Daily Herald article, and he grew up in Southern California. The detective speaks Spanish, and the Police Department said he has conducted more than 300 investigations as a Special Victims Unit detective in his six years with the force. The Tribune and ProPublica did not speak to Fernandez directly, but Taylor said the detective was consulted in response to questions sent to the department.

In the first six months of the investigation, Fernandez was the assigned officer in 30 reports involving Broadbent.

Maria Eduviges Bernal, who is Yanett’s aunt and also reported Broadbent to the police, remembers that she struggled to detail to Fernandez how Broadbent touched her vagina in ways that felt inappropriate during 2018 appointments. After providing her statement, Eduviges Bernal said Fernandez concluded that her doctor hadn’t done anything criminal.

“He didn’t see it as a crime,” she said he told her. “He said the doctor was doing his job.”

In his summary notes, Fernandez expanded on this assessment:

“I advised that there is no way to prove there was any sexual intent or gratification on behalf of the doctor. The doctor had a legitimate reason for having his hands on and in the patients [redacted]. The doctor did not do any inappropriate movements that would show any sexual intent. I advised [redacted] of how the interaction does not meet the elements of a crime and that this case would be closed. [redacted] advised she understood and is glad this is being documented.”

This immediate conclusion stunned and broke her morale, Eduviges Bernal said. Not usually an outspoken person, she said she was intent on filing the report — if only for her records and so that other women in her family, including her daughter, might avoid future harm.

“You go [to the police] because you think they’re going to help you or they’re going to give you attention,” Eduviges Bernal said. “I wasn’t expecting for him to have an opinion.”

Provo police station, located within the community’s City Hall (Francisco Kjolseth/The Salt Lake Tribune)

Deciding before an investigation whether a crime took place is discouraged by The International Association of Chiefs of Police sex assault investigation guidelines. So is including an opinion in a written police report.

“Every effort should be made to exclude officer opinion in the written report and to avoid asking leading questions,” the IACP guidelines recommend.

Taylor did not respond to a question asking if Fernandez should have offered his conclusion that there was no way to prove sexual intent in Eduviges Bernal’s case.

In January, civil attorneys representing some of the women became concerned about the detective’s investigative methods. A year had gone by since some of their clients reported Broadbent to police, and Fernandez had still not gotten their clients’ medical records.

Attorneys Eric Nielson and Marianne Card sent a request to prosecutors asking that the police assign a new detective. That did happen, though Taylor said the new detective was assigned in order to balance the workload as she transitioned into the Special Victims Unit.

Card said that once the new detective was assigned, most of her clients were interviewed again.

According to RAINN, a national anti-sexual-violence organization, trained law enforcement teams should work together to “reduce repetition of questions and interviews.” These re-interviews also seem to go against Provo’s own best practices; Taylor said detectives “work to minimize the number of times a victim has to make a disclosure." Any re-interviews in this case, Taylor said, were done at the request of the civil attorneys. Nielson, however, said he believed the re-interviews were a “tacit admission” from police that the investigation wasn’t done properly the first time.

Santacruz (Francisco Kjolseth/The Salt Lake Tribune)

Martha Santacruz, one of the 14 who spoke to The Tribune and ProPublica, said she had a positive experience making a report with Fernandez but found being re-interviewed and reviewing her evidence this past April difficult.

“I felt very bad because it is a very hard thing to relive. ... I kept thinking what happened with the other report that we already had?” Santacruz said. “I don’t know what he did. I don’t know what happened.”

“Highly Deficient” Language Services

As low-wage immigrant workers and mothers, going to law enforcement to accuse an American doctor of sexual assault was an unprecedented experience for all. And one of the major issues they encountered was finding an officer who could understand Spanish.

Some of the women told The Tribune and ProPublica they were turned away because no one was available at the department who could speak Spanish. Others were met with delays: In one police report, it was noted that a woman called the department because she had been told a Spanish-speaking detective would contact her, but she had been waiting for four days and hadn’t heard back.

The American Civil Liberties Union of Utah this summer labeled the Provo Police Department’s policies for language access as among the worst in the state, calling its language services policies to non-English speakers “highly deficient.”

The nonprofit examined police policy manuals throughout Utah and noted that Provo does not have a formal written policy addressing access to language services. The city was one of four Utah municipalities to receive a “highly deficient” rating.

Utah led the nation in population growth over the previous decade, according to the 2020 census, becoming less white and homogenous. A quarter of Provo’s population of nearly 115,000 people speak a language other than English in their homes, according to the Census Bureau’s most recent American Community Survey. Latinos now make up almost 18% of the population, and Spanish is the most common language after English.

“Language access isn’t a privilege, it’s a right,” said Andrea Daniela Jimenez Flores, immigrants’ rights policy analyst for the ACLU of Utah. “Utah’s laws and policies have to reflect that reality and ensure that no one’s denied justice, dignity or well-being because of the languages they do or don’t speak.”

Some of the women who reported Broadbent told The Tribune and ProPublica that they relied on a volunteer interpreter or a family member when they spoke to police. One woman said on at least one occasion she relied on a cousin to translate for her — an issue of general concern to the ACLU of Utah.

The nonprofit noted in its report that the Provo Police Department doesn’t use authorized interpreters and instead relies on Spanish-speaking officers or on other community resources, such as The Church of Jesus Christ of Latter-day Saints’ Missionary Training Center.

When asked how often this happens in Provo police investigations, Taylor said that using family members to interpret for alleged victims is “a problem.”

“If a family member is used or, even worse, a child, they are also victimized,” he said. “Also, validity of statements is called into question when impartiality of translators cannot be assured.”

Taylor said the police have a “patchwork” of language services and are not staffed 24 hours a day with Spanish-speaking personnel. While there are 21 officers who speak Spanish to some degree, Taylor said, the department doesn’t know how many of its officers would test as proficient in the language.

Taylor said the department agrees with the findings in the ACLU report, adding that limited English proficiency shouldn’t be a barrier.

“We are reviewing our practices,” he said, “comparing them to the recommendations of the ACLU report and reviewing possible policy improvements.”

Left Waiting

First image: Bernal told Provo police in July 2022 that Broadbent had grabbed her breast and conducted genital exams that felt inappropriate to her. She said at the time she deferred to his authority: “We come from a ranch,” she said. “We are not educated, so we thought he was doing the right thing because he was schooled and knew what he was doing.” Second image: Jacobo went to Provo police in April 2023 to report that Broadbent had touched her inappropriately during exams when she was pregnant in 2014; she said she didn’t feel supported or believed by police officers when she reported, calling it “one of the worst days of my life.” (Francisco Kjolseth/The Salt Lake Tribune)

Even after interventions by lawyers, an advocate and the consulate, the language barriers and delays have continued. In April, when Bereniz Robles walked into the Police Department, it took her three attempts before anyone would take her report about Broadbent.

Each time Robles went to the police station, she said, she was told there was no one working who spoke Spanish. Robles said she was told she could come back later or call at a different time.

She was eventually able to make an early morning appointment in April. Accompanied by Arredondo, the victim advocate, she arrived at the scheduled time — but the doors were locked and they had to wait a half hour before someone let them in.

Robles, who saw Broadbent as a patient more than a decade and a half ago, said she was motivated to make a report in order to keep the doctor from practicing again. But she said there were many moments, including that morning, when she considered giving up.

“There is no point in talking if they are not going to pay attention to you,” she said. “It was one of the moments that I was very discouraged.” She said that while the report she gave accurately captured her experience with Broadbent, the process to get it done left her feeling “worthless.”

Utah County Attorney Jeff Gray said in a November interview that his office is reviewing the cases as a whole and hoped to make a decision on charges by the end of the year. However, on Friday, he said that after consulting with a medical expert, prosecutors determined more follow-up interviews were needed.

But Nielson, one of the civil attorneys, is frustrated and has twice sent letters urging Gray to prosecute the case — drawing parallels to other cases like former Columbia University OB-GYN Robert Hadden and former USA Gymnastics Coach Larry Nassar, both serving prison time for sexually assaulting their patients during exams.

Gray pushed back. “We will file charges, or make a determination on filing charges, when our investigation is complete — no sooner and no later,” the county attorney said.

Gaspar (Francisco Kjolseth/The Salt Lake Tribune)

Almost two years after she reported to the police, Maria Gaspar, one of the 14 interviewed, said she still fears not being believed as an immigrant woman who is publicly calling out an alleged sex assault.

And she said her four daughters are her motivation to get through the denials and delays.

“I’m still afraid,” she said, “but at the same time it gives me strength because I say I have to teach them something good, not to keep quiet here or in Mexico.”

by Adriana Gallardo, ProPublica, and Jessica Miller, The Salt Lake Tribune

When Railroad Workers Get Hurt on the Job, Some Supervisors Go to Extremes to Keep It Quiet

11 months 1 week ago

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When questioned by federal officials or faced with an accident, the nation’s powerful freight railroad companies say they are among the safest employers in America and tout their injury records to prove it.

But those statistics belie a troubling dynamic within the companies, ProPublica found: a culture that blames workers when they get hurt and motivates supervisors to go to extreme, and sometimes dangerous, lengths to keep injuries off the books.

The playbook is scattered across the pages of sworn court testimonies and complaints to workplace regulators. One supervisor said in a deposition that he drove a track repairman, who had been vomiting and stumbling from heat stroke, to a job briefing site an hour away instead of a hospital. Another admitted he paid a carman to hide his head injury. A third accompanied a hurt worker into an emergency room, according to a recent complaint to regulators, and demanded, successfully, that a doctor change his discharge record so that the railroad would not have to report the injury to the government.

Other railroad workers told ProPublica they had gotten hurt on the job but chose to keep it quiet, saying they were aware of what happened to those who talked.

The allegations of harassment and retaliation came alive in hundreds of interviews conducted by reporters and thousands of records they reviewed, including federal lawsuits stretching back 15 years, complaints to the Occupational Safety and Health Administration as recent as this summer and hours of audio recordings captured by workers.

The reporting showed how railroad officials pushed arguments that workers faked their accidents or were at fault for them, at times hiding evidence to the contrary. The officials then punished and fired workers, including those who lost fingers and limbs, for reasons that fell apart when tested in court.

Judges, juries and regulators found several of these firings unjust and illegal; documents of their official findings burned with outrage:

“Reprehensible.”

“A culture of retaliation.”

“Pattern and practice of willful misconduct.”

“There is no justice for employees injured on the job.”

Though the companies won at least 10 of the cases, every one of America’s six largest freight rail operators, the so-called Class 1s, settled lawsuits with workers who alleged they were retaliated against, harassed or fired after injuries; of 185 suits, at least 111 were resolved this way. Several more are ongoing, and at least a couple resulted in jury verdicts for the injured workers.

In addition, in the past five years, OSHA regulators found merit to at least six complaints alleging retaliation, and administrative law judges working for the Department of Labor sided with workers in at least six more cases within that time period. Regulators acknowledge these cases are likely an undercount, because not all workers will go through the arduous process of filing a complaint or lawsuit.

Several officials who investigate worker injuries told ProPublica that the rails are unique in how aggressively they deal with hurt workers. The antagonism is baked into railroad culture, ProPublica found.

In other industries, employees can draw workers’ compensation, no matter who is at fault for their injuries; in return, they are prevented from suing their companies. The railroads, however, are governed by the Federal Employers’ Liability Act, which allows hurt workers to sue and get bigger payouts but requires them to prove their company was at fault.

Layer on top of that company performance metrics and bonus systems that punish managers for reporting injuries. “We’re constantly going up against that, and it’s very frustrating,” said Michael Wissman, who audits railroad companies for the Federal Railroad Administration, which oversees rail safety. He said he recently set out to investigate an injury an employee’s colleague reported, but then, when he asked the worker about it, the man denied he was hurt enough to need government attention and seemed hesitant to say more.

“I feel for the employee if he was fearful for his job,” Wissman said. “My hands are kind of tied. I have nothing to go on.”

Congress has known for decades of the railroad industry’s propensity for hiding and lying about worker injuries. It held a landmark hearing in 2007 to examine the practice. Congressional staffers found government reports that identified “a long history” of railroads underreporting injuries, deaths and near misses. They had identified more than 200 cases in which workers said they were harassed following injuries and lined up a number of them to speak. “We are going to hear some very startling and dismaying testimony,” House Transportation and Infrastructure Committee Chairman James Oberstar said at the beginning of the hearing, “but it has to be laid out in the public.”

In the wake of those hearings, Congress passed an update of the Federal Railroad Safety Act in 2008, which toughened safety rules, oversight and whistleblower protections and specified that railroad companies had to ensure their injured workers got prompt medical care.

But 15 years later, ProPublica found, many of the problems persist, in large part because many of their drivers persist. “I believe it’s linked to their bonus structure,” Wissman said of the rail companies. “There’s no ands, ifs or buts about it.”

The Association of American Railroads, the industry’s lobbying arm, did not comment on those incentives but said employee safety has improved because of the companies’ concerted efforts.

“Railroads patently reject the unsubstantiated allegation that there is a systemic safety culture lapse or widespread underreporting of injuries,” association officials said in a statement. “Isolated incidents or behaviors do not reflect an industry-wide problem or account for the thousands of professional railroaders who work safely and responsibly every day. Let us be clear: there is no distinction between railroad culture and safety culture. Railroad culture is safety culture.”

The railroad companies mentioned in this story echoed those points, saying their rules require them to promptly report injuries and forbid retaliation against hurt workers. “Allegations that managers are incentivized to hide or ignore injured employees are false,” a Union Pacific spokesperson said in a statement. Read the companies’ and AAR statements.

Karl Alexy, chief safety officer for the FRA, said there is a “yawning gap” between what he hears from top leaders and the management culture on the ground level. “These guys up at the headquarters certainly have the perspective that it’s unacceptable and they don’t want it to happen,” he said. In fact, according to the FRA, Union Pacific disciplined one or more managers this summer for misclassifying injuries so that they didn’t have to report them to regulators.

“But then they’ll turn around and put these unrealistic expectations on these managers out in the field,” Alexy said, “and [the managers] are like, ‘I got to do whatever I can do, because otherwise, I’m going to lose my job.’”

ProPublica previously reported about how, in a quest to maximize profits, railroad companies are pushing managers to keep trains moving at all costs by using performance metrics that penalize them for delays, even those caused by fixing safety hazards. Those scorecards, which can dictate five-figure bonuses, also tally worker injuries. But it’s not just about money.

ProPublica spoke with seven railroad workers who were managers at CSX, Norfolk Southern, Union Pacific and Canadian National between 2011 and 2021. Most are still employed by those companies. All described an industry philosophy that deems every injury preventable — and the fault of the employee and their manager.

Having a spate of injuries can kill a career, they all said. “It decides who is on the fast track for promotion … and it decides who fizzles out,” one manager said. Another said that when he was first promoted, he slammed his finger in a train door and broke it. “There was no way in hell I was going to report that to anybody,” he said. Today, his finger is still bent.

None of the former managers believed that employees should escape discipline for injuries due to sloppiness, poor oversight or failure to follow procedures. But they said the railroad’s prosecutorial approach to handling injuries includes those no one could have avoided.

As supervisors, they all said, the injuries they dreaded most were those serious enough to report to the FRA, because they invite time-consuming government intervention and ire from higher-ups who brag about their safety record to customers, shareholders and the public. Federal regulations require companies to report any injuries that result in a worker being prescribed certain medications, missing time from work or being assigned to light-duty work.

That context helps explain some of the behavior ProPublica discovered.

This August in Minnesota, Canadian Pacific Kansas City bridge specialist Robert Johnston smashed his knee after his leg fell between railroad ties. He said his manager called him repeatedly while he was getting an X-ray at the hospital. “He’s like, I will get you whatever you need, over the counter,” Johnston said. “Anything that you need if you don’t take prescription drugs.”

Johnston had no fractures but was still in pain, his knee swelled to double its normal size, so an emergency room doctor told him to take medicine and a day off from work. But when his bosses later read his discharge papers, they deemed them unacceptable, Johnston told ProPublica and said in a complaint he filed with OSHA.

Robert Johnston said he injured his knee while on the job for Canadian Pacific Kansas City. (Jenn Ackerman for ProPublica)

In the complaint and interview, he said Nate Lund, one of his supervisors, told him they needed to go back to the emergency room and get the papers changed. Johnston said he refused, but Lund insisted. “We sat there and sat there and he hounded me and hounded me,” Johnston said. Desperate to go home, Johnston said, he relented. (When reached for comment, Lund hung up on a ProPublica reporter and later did not respond to questions sent by text.)

At the hospital in Wabasha, Johnston said Lund took over, telling medical staff he needed the paperwork to change. The doctor, Johnston recalled, was beside himself, shaking his head in disgust. “Fucking railroad,” he recalled the doctor saying, and then mouthing to him, “Get a lawyer.” Johnston recalled Lund asking the doctor if he could retype the discharge papers. The doctor refused; the most he would do is cross out the instructions in pen, leaving the original instructions plainly visible.

The original papers given to Johnston by a doctor (Redacted by ProPublica. Courtesy of Robert Johnston.)

Despite the discomfort in his knee, Johnston said, he went to work the next day and his managers were happy to see him and very accommodating. “I mean, they literally would have given me a La-Z-Boy and fed me grapes,” he said. “They did not want me to do anything, but they didn’t want me to have a day off. It was really weird.”

Johnston resigned from the railroad about three weeks after his accident. In a statement, Canadian Pacific Kansas City said Johnston’s story “does not align with the information [the company] has regarding this situation” and declined to comment further. An OSHA investigation is pending.

A stretch of railroad along the Mississippi River near Minnesota City, Minnesota, about 10 miles from where Johnston was injured (Jenn Ackerman for ProPublica)

An earlier case peels back the pressures managers face when their workers get injured.

In 2015, Pierre Hunter, a general supervisor at Illinois Central Railroad, a subsidiary of Canadian National, got a call from a higher-up after one of his employees, carman Cameron Davis, hit a pothole while driving an ATV in a Memphis rail yard and damaged it. Word had gotten around that Davis had gotten hurt in the accident.

Hunter’s supervisor Darrell Hoyt wanted Hunter to make sure the injury didn’t have to be reported, Hunter said in a recorded statement with Davis’ lawyers. “You need to get that fixed. Handle it. Do what you got to do,” Hunter said Hoyt advised him. “Don’t put your job on the line for another employee.”

Hunter said he was certain his job hung in the balance as he repeatedly called Davis and pressured him not to tell anyone he’d had doctors look at his head, which was throbbing and swollen. Davis recorded some of the calls, which later became part of a lawsuit against the company. “Just stick to your story if anybody asks. You never went to a damn hospital. You ain’t injure yourself at all,” Hunter said. “Don’t say shit else to … no goddamn body, not a fucking soul on CN property.”

“You Ain’t Injure Yourself at All”

Pierre Hunter, a general supervisor at Illinois Central Railroad, asks carman Cameron Davis not to tell anyone about an injury.

(Obtained by ProPublica)

“What’d the doctor say?” Hunter continued. “They give you something or they say you’ll be all right? … No medication, none of that shit, right?”

In the recorded call, he advised Davis to cover the big bump on his head with a knit hat so that he wouldn’t arouse talk among his co-workers.

Hunter later told Davis the best way out of trouble for the accident was to sign a statement admitting it was his fault, not tell anyone about his injury and take a 15-day suspension without pay. “Take my word, they want to get rid of you,” Hunter recalled telling Davis. Davis said he couldn’t afford to be off for two weeks, but Hunter had a way around that, too: “Bribe him to not report it,” he said in his statement to Davis’ lawyers. While Davis served out his suspension, Hunter gave him $1,500.

Davis ultimately reported the injury anyway. About six months later, he was fired, accused of violating safety rules like not maintaining the proper distance away from moving equipment and working without protective eyewear. "I was targeted because of what happened,” Davis told ProPublica. “It was retaliation for the injury.”

Once the railroad heard the taped phone call, it also fired Hunter.

Emails, calls and social media messages to Hunter went unanswered. Hoyt told ProPublica in a message that he didn’t remember the affair and that it wasn’t “consistent with company policy or my application of safety commitments.” Canadian National settled the case with Davis for an undisclosed amount. A spokesperson told ProPublica the railroad doesn’t comment on “individual personnel cases.”

During the 2007 hearings on Capitol Hill, workers testified about being left to die by the tracks while railroad managers ignored pleas for care. The 2008 update to the Federal Railroad Safety Act required the companies to provide “prompt medical attention” and mandated that railroads bring injured workers to the hospital as soon as they ask.

About five years after the harrowing congressional testimony, outside Chicago, a supervisor was driving a Union Pacific machine operator, Jared Whitt, to the hospital. Whitt’s lips felt as if they were about to burst and his arms and legs tingled, he testified as part of a lawsuit he later filed. He closed his eyes and thought about his five kids. Was he dying? “Please,” he recalled telling his manager: “Get me there. Please hurry.”

Whitt had suffered a heat stroke as June temperatures climbed to about 100 degrees, and his manager, work equipment supervisor Dave Birt, believed Whitt was going into cardiac arrest, Birt said in his deposition. They had just started toward the hospital when Birt’s cellphone rang. “Well,” Whitt heard Birt say, “what do you want me to do?” A pause. “I’m no doctor, but when a man’s arms are numb and tingling, I’d say he needs to go see one.” Pause. “I’m pulling over.”

Birt held the phone to Whitt’s ear. Whitt couldn’t hold it himself because his numb arms had retracted, his fists clenched at the top of his chest, Whitt said in his pretrial deposition. The man on the other end was Birt’s boss, manager of track programs Talmage Dalebout. “Why don’t we just bring you back here to the job site and get you cooled down,” Whitt recalled Dalebout saying. “If you get cooled down, you’ll probably be OK.” Birt declined to comment when reached by ProPublica. Dalebout didn’t respond to calls, texts and social media messages.

Union Pacific claims in the lawsuit that Whitt never requested to be taken to the hospital and, when Birt says he asked, Whitt chose the job site. But experts say workers suffering from heat stroke —a potentially life-threatening condition marked by confusion in which body temperatures can rise to 106 degrees — lack the faculties to make any decision for themselves; someone should always take them to the hospital regardless of what a worker requests. In hindsight, Birt said later in deposition, he wished they had continued to the hospital.

Back at the job site, Whitt testified that he remained in Birt’s truck for some time. A co-worker brought him Gatorade and bottles of water. Then he recalled ending up in a trailer, where people were pouring cold water over him and his co-workers were rubbing his arms to restore circulation, according to Whitt. He didn’t get to the hospital until some four and a half hours after his body started tingling and his consciousness began slipping, according to court records. His roommate drove him.

The heat stroke partially disabled Whitt, he said in his court deposition. He no longer had the strength to work at the railroad and for years struggled with his left arm and hand, which went numb whenever he raised it above his shoulders. Two years later, Whitt had surgery to restore movement to his left arm. The surgeon cut away part of his left pectoral muscle and removed his left upper rib. Whitt sued Union Pacific, and the railroad settled with him for an undisclosed sum.

Whitt, who now works as a home inspector, said he still can’t believe that a manager intervened to redirect him away from the hospital. “It’s unfathomable,” Whitt told ProPublica. “I can’t imagine treating a human that way.” Today, he says, his arm remains tight, with a limited range of motion and numb at the armpit.

The cautionary incident didn’t appear to influence what happened three years later, when another Union Pacific worker fell ill on a blistering hot day in Kansas, according to records from a lawsuit he later filed.

Guillermo Herrera worked in the same road crew as Whitt, which roves throughout the company’s western region repairing tracks. On July 26, 2015, Herrera’s worried co-workers called higher-ups. The track repairman had vomited and was out of it, according to the court records. When the bosses came to get Herrera, he needed assistance getting into a pickup truck. He whispered a plea for help into his foreman’s ear; “Ayudame,” he said, according to a court deposition.

Considering the shape he was in, Herrera’s co-workers assumed he was being taken to a hospital, they testified. And indeed, there was one 21 minutes away. But instead, track supervisor Charley Diaz drove him to a job site to cool down, according to his deposition. The job site was about an hour away.

Once again, Union Pacific defended its actions, saying that Herrera would have been taken to a hospital if he had asked, and that Herrera at one point said he wanted to go back to his motel room. (Herrera contends that he was in and out of consciousness but kept saying the word “hospital.”) Either way, Diaz himself suggested he was concerned about Herrera’s mental state. “I told him to stay awake,” Diaz testified. “I didn’t want him going to sleep or anything like that, so I just watched him and asked him how he was feeling mostly.” (Diaz did not respond to calls and text messages.)

Diaz drove Herrera to the job briefing site, a boxcar office on wheels. Safety captain Bobby Steely testified that he checked on Herrera in the truck several times, each time asking him if he wanted to go to a hospital. (Steely declined to comment when reached by ProPublica.) After about 20 minutes, he said, Herrera finally said yes.

Herrera was ultimately diagnosed with heat stroke, which profoundly altered his life.

In the year that followed, he later testified, he could no longer drive safely or get a decent night of sleep. His morning walk around the block was so difficult, he had to sit down for a half hour or so until the tingling in his legs dissipated. His days were all about rest and heat avoidance, and he did physical therapy six hours a week. His family barred him from the kitchen because his memory issues had caused him to start two small fires.

He sued Union Pacific in 2015, a case that settled for an undisclosed amount. Union Pacific did not comment on either of the cases, but a company spokesperson said in a statement that nothing is more important than safety. “Employees complete annual training on how to respond to and handle injuries,” the spokesperson said.

An injury can paint a target on a worker’s back, ProPublica found.

It happened to Montana conductor Zachary Wooten, who damaged his right wrist so severely in 2015 after falling from a BNSF train that he needed surgery. The culprit, he said, was a defective latch on the train; he struggled to open it and felt a stab of pain as his wrist popped. When he tried to climb back up onto the engine after inspecting the train, his wrist gave way and he fell to the ground.

From that moment forward, court and company records show, his supervisors and BNSF lawyers searched for ways he could have come to work already hurt. “They always tried to blame it on something else that happened at home and say you dragged it into work,” said Wooten’s union representative, retired switch foreman Mark Voelker.

Mark Voelker, a retired switch foreman, was the union representative for an injured Montana conductor. “They always tried to blame it on something else that happened at home and say you dragged it into work,” he said. (Tailyr Irvine, special to ProPublica)

According to records from an internal company hearing, a superintendent of operations had visited 27-year-old Wooten when he was in the emergency room and asked him how he got a scrape on his other arm. Wooten, who was on pain medication, told the manager he got the rug burn during sex a day before the injury — an episode that also involved his bed breaking. The company took that morsel of information and used it to insinuate that’s also how he damaged his hand, records show. “I am not comfortable answering questions about my sex life,” Wooten told railroad officials during the internal hearing.

ProPublica learned of other unusual arguments used to blame workers, and not safety hazards, for their injuries. Machinist Bobby Moran was wearing his company-issued safety gloves in 2019 when one got caught in a lathe, snapping bones from his forearm down and severing a finger; another damaged finger later had to be surgically amputated. Union Pacific fired him after accusing him of using the equipment in the Arkansas yard for personal reasons, perhaps to manufacture a firearm silencer. “I was fearful,” Moran said. “Me and my wife were thinking, ‘When is the FBI going to show up?’”

Moran said he had been creating a piece of equipment that would improve the functionality of a hydraulic pump he and his fellow machinists worked with in the repair shop; his legal team showed the railroad’s attorneys the device’s schematics and a video of it working just as he said it would. According to Moran’s lawyer, Union Pacific never provided evidence to support its weapon theory before it settled the case. Union Pacific did not comment on it.

Moran at home in Rose Bud, Arkansas. He lost fingers in a lathe accident. (Rachel Boillot for ProPublica)

As for Wooten, BNSF pulled several angles of videos to show how, in the hours before the accident, he appeared to be favoring his right wrist by using his left hand. What the company didn’t know is that, according to Wooten, he is ambidextrous, as adept with one hand as with the other. Two months after his accident, the company fired him, accusing him of lying about his injury. Then, when Voelker gave information to Wooten’s attorney about the unrepaired loose handle on the locomotive, he, too, was fired. His dismissal letter cited his “misconduct and failure to comply with instructions when you disclosed confidential BNSF business information.”

A jury believed Wooten’s story, finding he was wrongfully terminated in retaliation for his on-the-job injury; he was awarded $3.1 million. U.S. District Judge Dana L. Christensen denied the company’s appeal, calling BNSF officials’ testimony biased, unreliable, inconsistent and lacking in credibility. “They latched on to an early formed presumption that Wooten was being dishonest that jaded their treatment of Wooten throughout,” the judge said. The company settled with Voelker over his wrongful firing claim.

BNSF has lost at least three cases in recent years in which it tried to allege a worker faked or exaggerated their injuries. In one, the company fired a worker in 2020 who suffered neck and back injuries in a crash because a private investigator surveilled him exercising at the gym — part of a physical therapy and a workout regimen ordered by his doctor. OSHA described the behavior as a “knowing and callous” disregard for his rights and found merit to his argument that he was retaliated against for getting hurt. The company settled his case in court in May.

BNSF did not comment on any cases but said it prohibits retaliation against employees for reporting injuries or safety concerns. “We take any alleged violation of those policies very seriously,” the company said in a statement.

Former managers interviewed by ProPublica said their companies foster a culture in which every injury claim is treated with skepticism. The presumption, one said, is: “How is the person trying to [screw] me? How can we prove he’s lying?”

ProPublica obtained about 10 hours of recorded railroad manager phone meetings that give a window into how supervisors discuss injuries and their efforts to catch employees violating rules. They took place among Norfolk Southern managers in its Tennessee region between January and April of 2016 and were led by Division Superintendent Carl Wilson and Assistant Division Superintendent Shannon Mason. Wilson, whose LinkedIn page describes him as retired, did not respond to calls, text messages, social media messages and a letter sent to his home. Mason, who is still with the company, declined to comment. Norfolk Southern wouldn’t answer ProPublica’s questions about the calls, only saying that they were “routine and focus on safety.”

While the meetings were indeed largely devoted to business like company performance, productivity and safety, the tenor changed nearly every time an injury was brought up, as Wilson and the other supervisors expressed incredulity that it was legitimate and discussed ways the injury could be proven to have been the employee’s fault.

In one call, they discussed an employee who also owned a motorcycle repossession business and questioned whether the injury could have happened there. Wilson told the managers he asked for surveillance of the engineer. “Hopefully he messes up,” Wilson can be heard saying in the call.

On another call, Wilson described one 67-year-old employee with a shoulder injury as a “piece of work” and insisted he was trying to get out of a training session. The managers cast doubt on another employee who said he was attacked by bees: “If there was anything, it looked more like a shaving bump.” Wilson, in another call, lamented losing the chance to fire an employee before he injured himself by slipping and hitting his head: “Quite honestly, he got us before we could get him.” And when they brought up a female conductor who felt her knee pop when she stepped onto a train, the conversation turned to her weight.

“She’s a big gal,” said Wilson, who also referred to her as “cheerful.” “Her joints, her knees are gonna wear out eventually sooner than most of us simply because we don’t carry the amount of weight that she carries.” He joked that if another manager had run her out of the company earlier, they “wouldn’t have this problem.”

The comments disgusted the worker, Amy Simmons, who called the discussion “embarrassing” and “unprofessional” when ProPublica shared the recording with her. She said that railroaders’ knees wear out because they are asked to walk mile after mile along rocky ballast and the company has cut staffing to the bone, demanding moreand more from each employee. “They’re wearing us out because they won’t give help,” she said. “It’s not my weight. If anything, it’s the fact that they overwork us.”

Former conductor Amy Simmons once felt her knee pop when she stepped onto a train. During a phone meeting among Norfolk Southern managers in its Tennessee region, the conversation turned to her weight. She said that railroaders’ knees wear out because they are asked to walk mile after mile along rocky ballast. (Jessica Tezak for ProPublica)

She has since left the industry and said she regretted the amount of time she wasted and all that she sacrificed trying to be a good employee. To her, the calls illuminate the way railroad companies truly see their workers.

“They hire you to fire you,” she said. “They don’t care.”

Jeff Kao, Carolyn Edds, Mollie Simon, Mariam Elba, Miriam Pensack and Ruth Baron contributed research.

by Topher Sanders, Dan Schwartz, Danelle Morton, Gabriel Sandoval and Jessica Lussenhop

Doctors With Histories of Big Malpractice Settlements Work for Insurers, Deciding If They’ll Pay for Care

11 months 1 week ago

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When Shawn Murphy’s wife died in 2009 after a botched gallbladder surgery, he presumed the doctor who performed the operation would be forced out of medicine for good.

Dr. Pachavit Kasemsap, a former Air Force surgeon, had cut Loretta Murphy’s aorta during that common procedure, according to a database of malpractice payments kept by Florida insurance regulators. She never left the hospital and died just shy of her 40th birthday. Shawn Murphy was left to raise their two daughters, then 13 and 17, on his own.

During the weeks that Murphy prayed for his wife to recover and the months that he fought Kasemsap in circuit court in Brevard County, Florida, he didn’t know that other families had complained that their loved ones had suffered under the same doctor’s care.

Kasemsap has settled five malpractice cases for a total of $3 million, according to the Florida malpractice payment database. That includes $1 million paid to the Murphy family. In one of the cases Kasemsap settled, a patient said the doctor negligently stapled and stitched her rectum to her vagina. Kasemsap denied doing that, and in legal filings in all five cases, the doctor denied that he was negligent.

The doctor’s LinkedIn profile says his last job as a surgeon ended in December 2012, months before he settled the last of those five cases. But there was one industry ready to welcome him regardless: health insurance.

Kasemsap got a job as an insurance company medical director, where suddenly he had the power to impact the lives of far more patients than he would ever have seen in the operating room.

For most policyholders, the inner workings of their health insurer are a black box: Requests to cover treatment or pay claims go in, and approvals or rejections are spit out.

The pivotal gatekeepers inside the box are medical directors like Kasemsap. They can, without ever seeing a patient, overrule the judgment of the doctor who did and deny payment for a recommended procedure, test or medicine.

Insurers say medical directors steer patients away from unnecessary or risky care and expensive treatments for which there are less costly, equally effective alternatives. Patients and their physicians complain that insurance company doctors routinely, and wrongly, deny payment for critical lifesaving treatments because they are expensive.

The stakes are high: A refusal to pay for treatment can drive families into bankruptcy. Some patients, facing the cost, forgo care altogether. And a single medical director can rule on 10,000 cases a year, according to court testimony in a case involving Aetna. Some Cigna doctors have ruled on more than 10,000 cases in a month without opening the patient file, as ProPublica and The Capitol Forum have reported.

Despite the key role insurers’ medical directors play in the lives of patients, their identities and backgrounds, and their qualifications for making such life-altering assessments, remain largely hidden.

Many states require medical directors to be licensed physicians, but beyond that it is generally up to insurers to determine which medical professionals are fit for the job.

Patients and the doctors who treat them don’t get to pick which medical director reviews their case. An anesthesiologist working for an insurer can overrule a patient’s oncologist. In other cases, the medical director might be a doctor like Kasemsap who has left clinical practice after multiple accusations of negligence.

As part of a yearlong series about how health plans refuse to pay for care, ProPublica and The Capitol Forum set out to examine who insurers picked for such important jobs.

Reporters could not find any comprehensive database of doctors working for insurance companies or any public listings by the insurers who employ them. Many health plans also farm out medical reviews to other companies that employ their own doctors. ProPublica and The Capitol Forum identified medical directors through regulatory filings, LinkedIn profiles, lawsuits and interviews with insurance industry insiders. Reporters then checked those names against malpractice databases, state licensing board actions and court filings in 17 states.

Among the findings: The Capitol Forum and ProPublica identified 12 insurance company doctors with either a history of multiple malpractice payments, a single payment in excess of $1 million or a disciplinary action by a state medical board.

One medical director settled malpractice cases with 11 patients, some of whom alleged he bungled their urology surgeries and left them incontinent. Another was reprimanded by a state medical board for behavior that it found to be deceptive and dishonest. A third settled a malpractice case for $1.8 million after failing to identify cancerous cells on a pathology slide, which delayed a diagnosis for a 27-year-old mother of two, who died less than a year after her cancer was finally discovered.

None of this would have been easily visible to patients seeking approvals for care or payment from insurers who relied on these medical directors.

When patients look for doctors, they can first check the physicians’ education, experience and qualifications. Most states allow consumers to see if doctors have been sanctioned by a medical board for providing substandard care, and many also provide some information about malpractice payments. But that kind of up-front scrutiny isn’t possible with medical directors because patients typically don’t learn their identity until a denial arrives.

Kasemsap’s history of malpractice payments was no secret before Cigna hired him in 2019. Two years earlier, he was the subject of a front-page story in the South Florida Sun Sentinel headlined “Dangerous Doctors.” In addition to handling appeals for the insurer, Kasemsap obtained a certification through a Cigna physician leadership program and oversees the work of 13 other medical directors there, according to his LinkedIn profile. Cigna CEO David Cordani posed with him and others in a photo at a recent company leadership event.

When told Kasemsap was working in this critical role, Murphy was shocked. “This guy should not be deciding medical questions,” he said. “I don’t care if it’s an earache.”

Kasemsap wrote in an email to ProPublica and The Capitol Forum: “Please know that I carry every patient outcome with me, and those experiences reinforced my commitment to being a compassionate, detail-oriented, dedicated colleague who puts our members at the center of everything I do.” Kasemsap said he was responding on his own behalf, not Cigna’s. He did not answer other questions about his malpractice cases or his role at the insurer.

Cigna, in a statement, said all of its medical directors are board-certified, credentialed physicians and the company holds its medical directors to the same standard as doctors who participate in its network. “We use a comprehensive suite of materials and discussions to assess how our medical directors support patients efficiently and effectively,” a company spokesperson wrote.

In another statement, the spokesperson wrote, “As I’m sure you’re aware, malpractice claims against physicians are common, particularly in high-risk specialties such as surgery, and the settlement of malpractice claims does not necessarily mean that malpractice occurred.”

Between 2005 and 2014, during the time when Kasemsap settled his malpractice cases, only 6% of doctors nationwide had any paid malpractice claims and only 1% had two or more paid claims, according to a study in the New England Journal of Medicine. A study in the same journal found that while surgeons were more likely to face a claim than physicians overall, less than 5% of general surgeons paid a malpractice claim each year between 1991 and 2005.

“I can say in my 35-plus years doing this that this is the most unskilled surgeon I have ever seen in a case,” said Mac McLeod, a malpractice attorney who represented two plaintiffs who sued Kasemsap, including the woman who said Kasemsap connected her rectum to her vagina.

When asked about McLeod’s assertion, Kasemsap wrote, “This is a mischaracterization of a highly complex medical case that occurred more than 15 years ago.” Kasemsap did not say what was mischaracterized.

A Doctor Goes Sleuthing

A few days before Christmas in 2021, Terrold Dance was loaded down with electrical tools when he slipped on some ice at a worksite and went to a Colorado hospital for help. An MRI later showed that Dance had torn his rotator cuff, the muscles and tendons that surround the shoulder joint and keep the upper arm bone in the socket.

Workers’ compensation paid for the scan and some physical therapy, but that didn’t fix the problem. By the next Christmas, Dance was still in pain and couldn’t fully raise his arm over his head. A Colorado orthopedic surgeon, Dr. Braden Jones, examined Dance and concluded that he needed surgery.

“The guy had not gotten better for a year,” Jones recalled. “It was a pretty clear-cut case for surgery.”

Pinnacol Assurance, the workers’ compensation company that handled Dance’s policy, required that the surgery be authorized in advance, and the company hired a medical reviewer named Dr. Jon Erickson to scrutinize Dance’s request and medical records. Like a medical director, a contract medical reviewer for Pinnacol evaluates whether a surgery is medically necessary. In a letter to a case manager, Erickson concluded that steroid injections and some physical therapy would likely be enough to fix Dance’s problem. Pinnacol denied the request for surgery.

“I believe the mechanism of injury is somewhat questionable,” Erickson wrote, “and we would be best served by considering a program of nonoperative care which involves injections.”

The letter baffled Jones. It downplayed Dance’s shoulder injury and brushed aside the MRI report, Jones said. Erickson didn’t cite any published research or medical society guidelines to explain why an operation was not needed. Jones said that the letter was such a break from accepted orthopedic practice that he wondered if Erickson had ever been a surgeon.

So Jones decided to check. The Colorado medical board had a copy of Erickson’s medical license and an explanation for why he hadn’t set foot in an operating room in many years.

A disciplinary report from the medical board said Erickson had performed a “substandard” hip replacement surgery in 2013 that led to irreparable harm to a patient. Erickson tried in three additional operations to fix it, the disciplinary report said, but the patient had to undergo a fifth surgery elsewhere and will always walk with a limp.

That wasn’t all. The report criticized Erickson for another faulty hip replacement six months after the first. The surgery had taken place on a Friday, and by Monday the same patient was back on the operating table with a broken hip. Erickson performed a second surgery but something was wrong. An X-ray showed the problem.

Erickson had put the hip in backwards.

In a 2017 settlement with the Colorado medical board, Erickson was allowed to keep his license as long as he never performed any kind of orthopedic surgery again. As a doctor reviewing cases for an insurer, though, Erickson has the power to decide that orthopedic operations are not medically necessary, when he himself is not allowed to perform them.

In an interview, Erickson defended his decision to deny Dance’s surgery and his work overall. “This was a relatively clear-cut case,” Erickson said. He added, “What we do at Pinnacol when we review these cases is prevent a lot of inappropriate care, and we save a lot of money for our clients.”

In a statement, Pinnacol said Erickson was contracted as an independent reviewer and that he did not work directly for Pinnacol. “He is not and has never been an employee,” a spokesperson wrote, adding that Pinnacol no longer uses Erickson to review cases. “Our mission as a not-for-profit, state-chartered carrier is to serve the workers and employers of Colorado, and we would never, nor do we support denying necessary medical care ‘to save our clients money.’”

The company said its claim denial rates are “roughly half the state average.” While Pinnacol is a nonprofit insurer, it does typically return money to its customers in the form of an annual dividend.

For Jones, the experience confirmed all of his worst suspicions about medical directors.

“If you have ever seen a Lego, you know which way the hip goes,” Jones said. “I always considered these medical directors to be sellouts, but I thought an insurance company would have more dignity than to hire someone like this.”

After Jones complained to Pinnacol about Erickson’s history and the wrongheaded nature of the denial, the insurer approved Dance’s rotator cuff surgery, which he underwent earlier this year. Dance has since regained full strength and motion.

Jones was so disturbed by what he discovered that he complained to the medical board. Chief among Jones’ beefs: If Erickson is not allowed to perform orthopedic surgery due to the board action, why is he allowed to rule on insurance cases that affect what orthopedic surgeons in good standing can do? The medical board acknowledged to Jones in a September letter that his complaint remained open but declined to comment to ProPublica and The Capitol Forum. Erickson said he thought Jones’ decision to file a complaint with the medical board “was a little bit overkill.”

Trouble With Medical Boards

Doctors turn to health insurance company work for many reasons. Some do it after burning out on clinical care or a change in circumstance, such as starting a family or retiring from a practice. Many find the work rewarding, saying they can help patients by flagging care that is unnecessary or even dangerous.

The job offers good pay with potential bonuses and a set schedule without weekend work or night shifts. The median pay for medical directors at insurers like UnitedHealthcare, Cigna and Elevance is around $300,000 a year, with the high end of the salary range over $400,000, according to the job site Glassdoor.

Despite this, ProPublica and The Capitol Forum found, insurance companies still wind up employing doctors who state medical regulators have rebuked for providing shoddy care or being dishonest.

A unit of Cigna called eviCore has employed Dr. Lorraine Driscoll as an associate medical director from 2006 through at least March 2022, according to records filed with the Maryland Insurance Administration. The New Jersey medical board in 2013 found grounds for disciplining Driscoll for “dishonesty, deception, and misrepresentation and/or … for engaging in professional misconduct.”

The board reprimanded Driscoll, an obstetrician-gynecologist, for altering patient records in ways that could help her fight a 2004 malpractice case involving a child born with Down syndrome. That case, which wound up settling for $700,000, was one of six that Driscoll settled, according to her application to be certified as a medical director by the Maryland Insurance Administration. (Maryland officials approved her application.) She did not respond to calls, emails or a letter with detailed questions sent via FedEx.

Other insurers, including Aetna and UnitedHealthcare, hire eviCore to determine whether certain treatments are medically necessary.

When asked if Driscoll still works for eviCore, a company spokesperson declined to answer. In a written statement, eviCore said its medical directors are all board-certified physicians “who are dedicated to ensuring that patients receive safe, effective care guided by the latest clinical evidence.” The company added that its doctors “are held to the same legal, licensing and education requirements that physicians treating patients are held to.”

Aetna has on its in-house team Dr. Beth Ann Binkowski, an internal medicine physician who was censured and reprimanded by the New York state medical board in 2015 for failing to appropriately prescribe medications for five patients at Syracuse University with mental health conditions. Binkowski referred a reporter to Aetna for comment. A company spokesperson said all Aetna medical directors are licensed and board certified and that the company follows accreditation requirements and state and federal regulations.

UnitedHealthcare hired Dr. Dolores Rhymer-Anderson as a medical director in 2015 despite the fact that the Georgia medical board had previously reprimanded her for care related to the delivery of a baby born with severe neurological damage in 2000. She settled a related malpractice lawsuit for $2 million. In a legal filing in that malpractice case, Rhymer-Anderson denied that she was negligent and said she exercised the appropriate degree of care and skill ordinarily employed by doctors in the same circumstance.

A peer reviewer appointed by the medical board faulted Rhymer-Anderson for failing to conform to the minimum standard of acceptable and prevailing medical practice. As part of an agreement with the board in 2006, she was required to complete 20 hours of continuing medical education and pay a fine of $1,500. The board order stated Rhymer-Anderson did not acknowledge any impropriety and agreed not to contest the allegations to avoid protracted litigation.

Rhymer-Anderson excluded obstetrics from her practice before the board order, blaming the move on her experience with the lawsuit, according to a regulatory filing. She said she hoped to avoid another legal action.

But in 2008 she was sued again and settled the case for $1 million. That lawsuit faulted her work during a diagnostic procedure to evaluate a patient’s uterus. The patient went into respiratory distress and suffered a brain injury from lack of oxygen. The patient spent a month in the hospital before being transferred to a long-term care facility. The lawsuit accused Rhymer-Anderson of incorrectly administering anesthesia, failing to properly supervise a nurse assisting and failing to secure an airway by endotracheal tube.

In her application to be certified as a medical director in Maryland, Rhymer-Anderson said she settled because the plaintiff was estimating the cost of future care at $16 million, which exceeded her malpractice insurance, and she was concerned a jury award could put her personal assets at risk. She said in the Maryland filing that three expert witnesses concluded that she met the standard of care in the case. In a court filing in that case, Rhymer-Anderson said she acted within the standard of care in treating the patient and did not commit any act of negligence that resulted in injuries. (Maryland officials approved her application.)

Settlements of $1 million or more, referred to as catastrophic claims, are rare. Only 7.6% of claims saw settlements that large in a study of malpractice cases filed nationwide from 1992 through 2014. The same study found the average malpractice payment by doctors in Rhymer-Anderson’s specialty was $432,959.

Rhymer-Anderson did not respond to phone calls, emails and a letter with detailed questions sent via FedEx.

A UnitedHealth Group spokesperson said Rhymer-Anderson left the company last year. The spokesperson also wrote, “Medical directors go through a rigorous hiring process, to ensure they are qualified for the roles for which they are being considered.” He added, “We review individual performances regularly and provide ongoing training to help them with their various responsibilities.”

“Cranking Out Denials”

When an insurer shoots down a request to pay for care, the patient’s doctor can call the insurance company’s doctor to make the case for why it should be approved. This is known as a peer-to-peer review.

But doctors often complain they’re not actually speaking with peers when they call an insurer. They get exasperated when an orthopedic surgeon weighs in on a procedure to treat an irregular heartbeat or a pediatrician questions an oncologist’s plan for an adult with lung cancer.

In a survey conducted by the American Medical Association, only 2% of the doctors who responded said that health insurance medical directors were “always” appropriately qualified to assess the requested treatment. More than a third said health plan doctors were “rarely” or “never” qualified.

When Orrana Cunningham’s doctor at the MD Anderson Cancer Center in Houston asked her insurer to approve the use of expensive proton beam therapy to attack her cancer, the decision on whether to pay for the care fell to an Aetna doctor who had not treated patients in more than 20 years, according to records from a lawsuit the Cunningham family brought against Aetna.

Dr. David Massman, a medical director at Aetna, denied coverage of the treatment, ruling that it was “experimental or investigational.”

Cunningham’s radiation oncologist, Dr. Clifton Fuller, then requested a peer-to-peer call so that he could explain why proton beam therapy was the best method for treating Cunningham’s stage IV nasopharyngeal squamous carcinoma, a rare cancer located at the base of her skull. Proton beam therapy was needed, he said, because it could precisely deliver radiation to the cancer site while avoiding devastating side effects, such as loss of sight and memory, that could occur with other radiation treatments.

It was a complex procedure. Fuller wanted someone with a background in treating cancer to be on the call. Instead, he was paired with Massman, a family medicine physician who had never worked in radiation oncology and had never seen a proton beam machine.

Massman went to work for health insurers two decades ago after his Illinois medical license was placed on a four-year probation for issues related to a drug addiction, according to state licensing records. His license is in good standing now.

In their peer-to-peer call, Fuller testified in a sworn deposition, Massman acknowledged Fuller may be right that proton beam therapy was a safe treatment for Cunningham but said he “can’t do anything about it” because the therapy did not comply with an Aetna clinical policy guideline.

Appeals of the decision failed. In all, three Aetna medical directors reviewed the treatment request and subsequent appeals. None of them were radiation oncologists.

As the appeals dragged on, Cunningham grew sicker. Out of options, her husband decided to mortgage the family home and sell other assets to pay for the $92,000 treatment.

Cunningham underwent the procedure in April 2015, four months after her doctors first asked Aetna to approve it. When she returned home in May, she started to behave strangely. She didn’t recognize her husband or son. She was diagnosed with herpetic encephalitis, a disease that her family’s attorney contended was unrelated to the cancer treatment and triggered by stress. She died later that month.

Cunningham’s husband sued Aetna in Oklahoma state court, alleging that the insurer breached its contract with his wife, acted in bad faith and inflicted emotional distress.

At the trial, Massman testified that he could not recall details of his peer-to-peer call with Cunningham’s radiation oncologist, but he said that he would never tell a treating physician that they were right about a treatment Aetna was denying.

In his closing arguments at the trial, Cunningham’s lawyer, Doug Terry, condemned Aetna’s medical directors: “These doctors were not properly qualified to know the first thing about the medical issues involved here. None of them had any experience with radiation oncology or proton therapy. They were cranking out denials as fast as they could.”

Aetna’s lawyer countered that the company was proud of the medical directors who denied Cunningham’s care for “standing up for what is right.” Massman and other Aetna medical directors involved in denying Cunningham’s care sat in the front row as the company’s lawyer made his closing argument, said Terry.

The jury in 2018 awarded Cunningham’s estate and her husband $25.6 million. After Aetna appealed the jury verdict, the parties settled the case under confidential terms in 2021.

Massman did not respond to calls, emails and a letter with detailed questions sent via FedEx.

In a statement, Aetna said its “sympathies continue to be with the Cunningham family.” It said that today any clinical reviews or peer-to-peer conversations related to proton beam therapy are conducted by board-certified radiation oncologists. The company did not answer a question about efforts more generally to match specialists to the treatment requested.

“Frequent Flyers”

A small group of doctors — about 2%, termed “frequent flyers” by one study author — are responsible for 40% of medical malpractice claims in the country.

It’s unusual for doctors to make payments in multiple malpractice cases, and that can signal that a physician is providing low-quality care. In Florida, the state health department is mandated to investigate any doctor who has had three or more claims in excess of $50,000 within a five-year period.

In 2013 Dr. John Stripling stopped working as a urologist, according to a deposition he gave in a product liability case. Around that time he faced medical malpractice lawsuits from patients in two states who alleged he botched enlarged prostate procedures.

In total, Stripling settled cases with 11 former patients between 2014 and 2017 with a combined payout of $3.6 million, according to Florida Department of Health records. After receiving “malpractice information,” the Arkansas State Medical Board told Stripling in 2015 that he would have to appear before the board if he wanted to renew his license, which was expiring. He never did.

Stripling was able to maintain his license in Florida, state records show, and he began working for health insurers in 2016, according to his LinkedIn profile. His most recent job, his profile said, was as a medical director for naviHealth, a unit of UnitedHealth Group’s Optum business, where he weighed in on placements of patients released from the hospital. A UnitedHealth Group spokesperson said Stripling left naviHealth in March.

A 2014 lawsuit filed in Arkansas state court by Larry Stanley, a patient of Stripling’s, alleges that dozens of the doctor’s patients in that state and Mississippi experienced severe and unacceptable complications when the doctor performed a procedure known as transurethral laser ablation of the prostate, or TULAP. The procedure uses a laser to treat an enlarged prostate, which can otherwise cause problems with urinating.

The lawsuit alleged that a nurse who worked with Stripling reported to another urologist that 40 of Stripling’s patients who underwent the TULAP procedure experienced “unprecedented complications.” The office manager and head nurse in Stripling’s practice were so alarmed by the high rate of complications that they went directly to the chief executive officer of the company Stripling worked for, according to Stanley’s lawsuit.

After Stanley’s TULAP procedure with Stripling in 2010, he was left incontinent, had to use catheters to drain his bladder and underwent additional surgeries, according to Stanley’s suit. In a court filing in that case, Stripling denied that he was negligent or at fault. The lawsuit was dismissed after both sides said they had resolved the matter, but the court records don’t provide any additional detail. Stanley died in 2019. His son Greg recalled his father received about $300,000 in a settlement.

A steelworker in his younger years, Larry Stanley had later owned and operated a sawmill for 40 years. Greg Stanley said his father was a changed man after the surgery. He rarely left home, worried he would have wet spots on his clothes.

“This doctor butchered him,” Greg Stanley said.

In a 2012 deposition in a malpractice case in Mississippi, Stripling said he stopped doing the laser prostate operation on Dec. 7, 2010, when he had a “coming-to-Jesus meeting” with himself and concluded “this is it.” At least eight of the settlement payments made in his malpractice cases involved incidents that occurred in 2010, according to the licensing records.

Stripling said in the deposition that too many of his patients “were doing poorly” after their operations. “There was something flawed in what was being done; and I didn’t have a clear answer, but it was time to make a decision,” he said. He testified that he went back to performing an older procedure that didn’t involve a laser.

That Mississippi case later settled for $305,000, according to Florida state medical licensing records. In a court filing, Stripling said he complied with the standard of care and was not negligent in his treatment of the patient.

Stripling did not respond to phone messages, emails and letters with detailed questions sent via FedEx. The UnitedHealth Group spokesperson reiterated that the company’s medical directors go through a rigorous hiring process, that their performance is regularly reviewed and that the company provides ongoing training.

Another “frequent flyer” was Cigna’s Kasemsap, who settled five malpractice suits after denying in court filings that he was negligent.

It was in November 2006, during a colostomy reversal surgery, that Kasemsap allegedly connected a 42-year-old woman’s vagina to her rectum, according to a malpractice complaint filed in state court in St. Augustine, Florida. The mistake caused air and feces to pass through the vagina, and the patient had to undergo three more surgeries, according to the complaint.

A month later, according to allegations in another lawsuit, Kasemsap mistakenly cut a patient’s common bile duct and an artery during a gallbladder surgery. A jury found him negligent in that case and awarded the patient $600,000. Kasemsap and the patient subsequently agreed to settle the case.

Kasemsap’s malpractice insurer made another payment to a patient who said in a lawsuit that he had suffered from a mild case of hemorrhoids that Kasemsap wrongly diagnosed as a far more serious case. The doctor then negligently performed a 2007 surgical procedure that left the patient with “constant, severe physical pain and suffering, incontinence and irritation,” the complaint said.

Kasemsap settled two more malpractice cases for incidents in 2009, including one filed by Loretta Murphy’s family after her death, court records show.

Kasemsap started working for insurers in 2013, according to his LinkedIn profile, which boasts about his contributions to companies’ financial health.

As a senior medical director at Highmark, a Blue Cross Blue Shield plan, he claimed credit for saving $3 million a year by removing high-cost specialty drugs from automatic authorization, his profile said. He also said he saved the company $15 million by initiating step therapy in the treatment of macular degeneration. Step therapy generally requires patients to try less expensive treatments before more expensive ones. (When asked about Kasemsap’s profile, a spokesperson for Highmark wrote, “We can’t speak to how Dr. Kasemsap categorizes his work. Medical directors use evidenced-based guidelines and the unique clinical picture of each member’s case to render medical necessity decisions only, which is agnostic of cost.”)

Since late 2019, Kasemsap has worked at Cigna, where he not only has reviewed treatment requests but has also managed other medical directors who handle Medicare Advantage requests for care, according to his LinkedIn profile. Kasemsap has thrived in his role at Cigna, and the company made him part of its Physician Leadership Development Program, which provides business and leadership skills.

Kasemsap’s success at Cigna came as a bitter surprise to the Murphy family.

When Loretta Murphy’s daughter Amanda Cain was young, her mother would play beauty parlor with her. Murphy would do Amanda’s hair like she learned in cosmetology school, and Amanda would paint her mother’s nails — purple with pink and white flowers.

“Her favorite flower was hibiscus, so I would always try that on the toes,” said Cain, who ended up pursuing her own career in cosmetology.

A photo in a family album shows Loretta Murphy kissing her daughter Amanda Cain when Cain was a little girl. Murphy died when Cain was 17. (Greg Kahn, special to ProPublica)

Cain was a junior in high school when her mother went to Kasemsap to get her gallbladder removed. The procedure was only supposed to take about an hour. When more than an hour passed, Cain started to get nervous. Her grandparents were in the waiting room and eventually took her home to look after her younger sister.

The next time Cain saw her mother, she was lying in a hospital bed with a machine helping her breathe.

Murphy died a year before Cain graduated from high school. It was just one of many life events her mother never got to witness, including the birth of Cain’s two children.

That Kasemsap has any say in the well-being and health of vulnerable people is maddening, Cain said.

“What do you say about anyone that would hire this guy knowing what they know?” she asked. “How, how would they still hire him?”

Do You Have Insights Into Dental and Health Insurance Denials? Help Us Report on the System.

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

Idaho Hasn’t Assessed School Buildings for 30 Years. Students and Educators Helped Us Do It Ourselves.

11 months 1 week ago

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

It’s no secret that Idaho’s school buildings have problems. The state’s superintendents, maintenance directors, teachers and students see the leaks, pack into crowded hallways and feel the extreme cold and heat throughout the year. But state officials don’t know the extent of the issues because the last full review of school buildings was completed in 1993.

The Idaho Statesman and ProPublica joined forces to explore the deteriorating conditions and the consequences for students and teachers. To identify patterns, we worked with communities to bring together data, documentation and visual evidence from across the state. We spoke to as many people as we could, and visited dozens of schools, to see what conditions were like on the ground.

Here’s what we did.

We surveyed all 115 superintendents in the state and heard from 91% of them. Our data team helped design a survey inviting them to identify significant challenges in their districts. We first showed it to a small group of district leaders, who helped us anticipate and address potential concerns. In May, the state’s association of school administrators shared the link with its members, and regional leaders encouraged them to fill out the survey. We followed up with our own introductions and sent reminders throughout the year.

Our goal was to hear from every public school district so we could analyze how widespread facilities issues were and identify which respondents faced the most serious problems. All but nine responded: Arbon Elementary, Bliss, Council, Culdesac, Mullan, Pleasant Valley, Teton County, Troy and Whitepine. (Prairie Elementary did not complete the survey but provided information in an email.)

The responses came in from May 26 through Dec. 8. Most were filled out by current superintendents or facilities directors, but 14 have since left their positions or changed districts. At least a dozen superintendents shared assessments performed for them by firms or contractors.

Every district said it had at least one problem that posed a significant challenge or required major repairs, and 78% said they had five or more. Twenty percent said they had 10 or more problems. These are the problems, along with the percentage of superintendents who said they had them:

  • Heating – 68%
  • Cooling – 67%
  • Roof – 61%
  • Accessibility for people with disabilities – 58%
  • Security (locks on classroom doors, secure entrances, etc.) – 58%
  • Bathrooms – 58%
  • Windows – 55%
  • Leaky plumbing, walls, windows or roof – 50%
  • Structural issues like cracks in the walls or foundation – 41%
  • Traffic safety (at street crossings, in parking lots or in drop-off areas) – 38%
  • Electrical (lighting problems, power going out, tripping breakers, etc.) – 35%
  • Asbestos – 31%
  • Overcrowding or use of portable buildings for extra space – 28%
  • Fire and emergency preparedness – 26%
  • Outdated technology or equipment – 16%
  • Inadequate Wi-Fi – 10%
  • Drinking water – 10%
  • Other – 9%

Only 4% of superintendents thought they would be able to address the issues in the next year, while 20% said they may be able to.

When asked what was preventing them from addressing facilities problems, 88% mentioned funding.

We also asked superintendents about how they would rate the physical conditions of their schools. Not all respondents rated every school in their district, but together they rated 677 schools and said 21% were in poor condition, 41% were in fair condition and 38% were in good condition. Thirty-five percent said at least one-fourth of their schools were in poor condition.

We heard from 233 students, parents, teachers and others. In April, we published a callout. We wanted to talk to those most likely to be affected by facilities issues, such as people with disabilities or those in the most rural and remote corners of the state — where communities may not come across our online publications.

Dozens of Facebook and Reddit moderators supported our efforts to reach groups of educators, parents or residents in certain parts of Idaho. We spoke about our efforts at a meeting of the state’s special education advisory panel and handed out flyers at a conference for school administrators. The Idaho Education Association shared our callout with 10,000 members and asked for 200 flyers to put up in schools. Students and recent graduates told their friends about the callout while the Idaho Business for Education and the American Institute of Architects Idaho sent it to their members. Some local media outlets also helped spread the word, including Ben Reed with 99.1 La Perrona, who shared the Spanish translation of our callout.

Teachers helped us hear from students. Moscow High School English teacher Rachel Lyon shared essays from her students. Ninth grade student Natasha Gartstein wrote, “The Moscow High School has been in use for nearly 90 years. That’s before the Kardashians, Michael Jackson, and even the Beatles.”

We also worked with artist Pia Guerra to draw illustrations of five students, two educators and a parent to help bring their stories to life.

Diego Hernandez, a 10th grade student at Canyon Springs High School, told us, “The look of the school is kind of deteriorating. … Just walking in and seeing something that looks like this is almost depressing.” (Pia Guerra for ProPublica)

We were given tours of 39 schools from maintenance directors, superintendents or principals. Maintenance staff were able to show us the problems going on behind the walls, which students and educators sometimes couldn’t see, along with the patches they’d used because they couldn’t afford a permanent fix.

During our school visits, we met with students and educators. At six of these schools, we spoke to classes and met with the student government or student media groups. We explained our project and passed out notecards for students to write what they liked about their buildings, what they would change and the impact issues had on them. They often said they appreciated their teachers, who made do with the state of their buildings, and were proud to go to the same schools as their parents and grandparents. But we overwhelmingly heard about facilities problems. It was clear that students were aware of how school funding worked, with some explaining recent bond elections in their community.

ProPublica and Idaho Statesman reporters asked students to write what they liked about their buildings, what they would change and the impact issues had on them. These responses came from Leila Guffey, a senior at Kamiah High School, and Diego Hernandez, a 10th grader at Canyon Springs High School. (Asia Fields/ProPublica)

In some districts, we brought a camera that produces instant prints so students could show us the issues in their school buildings from their own perspectives. We received dozens of photographs back.

Idaho Statesman and ProPublica reporters brought a camera that makes instant prints to school visits so students could show the problems in their schools. Students documented a deteriorating locker at Kamiah High School, leaky ceilings at Moscow High School, and bathroom drains bulging up from the floor at Canyon Springs High School. (Courtesy of Kamiah, Moscow, and Canyon Springs students)

We verified the information. Before publishing, we reached out to the people who shared information with us to collect more details. We checked those accounts with the district to hear their responses and any updates on the conditions.

Nearly every example that made it into our story was something that the districts agreed was an issue. In a few cases where the district disagreed with parts of a student or community member’s account, we noted that in the story.

If you’d like to get in touch with our team, you can email idahoschools@propublica.org. If you’re an educator who might be interested in using our project in your classroom, we’re happy to assist however we can. If you’re interested in classroom materials or updates about this project, send us an email.

If you want to talk to us about schools in another location, you can use our general tip line at propublica.org/tips. We can’t guarantee that we’ll be able to follow up on everything, but we review everything we receive.

by Asia Fields, ProPublica, and Becca Savransky, Idaho Statesman

Falling Apart

11 months 1 week ago

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

No other state spends less on school infrastructure per student than Idaho. As a result, many students, especially those in rural districts, deal with leaking ceilings, freezing classrooms and discolored drinking water. Some students have to miss school when the power or heat goes out.

School districts often can’t build or repair buildings because Idaho is one of only two states that require two-thirds of voters to approve a bond. Some districts have held bond elections several times only to see them fail despite having support from a majority of voters. But the Legislature has been reluctant to make significant investments in facilities. Administrators say they don’t know how they’ll keep their schools running and worry that public officials don’t understand how bad the problems are.

Idaho hasn’t done an official assessment of school building conditions in 30 years. The Idaho Statesman and ProPublica tried to fill this gap with the help of people who know the system best. We surveyed all 115 public school district superintendents, and 91% responded. Every superintendent who responded said they have at least one facilities problem that poses a significant challenge, and 78% told us they have five or more. Then, we went to communities across the state. Thirty-nine schools took us on tours, often led by district maintenance directors. We also collected stories and photographs from 233 students, parents, educators and others, who described how the conditions affect their lives.

Read more about our survey and outreach efforts.

“Communities show what is valuable by what we build,” said David Reinhart, West Ada School District’s chief operations officer. “When our students are in old and run-down buildings, it signals to them that what they do in school is of little value.”

“It makes school less enjoyable, harder to focus,” said Luke Sharon, a senior at Lake City High School in Coeur d’Alene.

“The kids see it,” said Amy Eslinger, who graduated from Emmett High School in 2009. “I grew up knowing how bonds and levies worked but never saw them pass and watched myself and my peers suffer from it.”

Here’s what students and educators across the state told us about the floods and leaks, overcrowding and inaccessibility, safety and security flaws, structural deficiencies and heating and cooling problems that impact every part of their day.

Discolored Water, Falling Ceiling Tiles, Ruined Projects

50% of Idaho superintendents we heard from said leaks pose a significant challenge or require major repairs, while 61% said they had problems with their roofs and 58% said the same about bathrooms.

“The leak made us feel like there was yet another way our school is falling apart. We were also sad because something like this could damage our precious instruments that we most certainly could not replace for a long time due to cost.”

—Laura Woras, music teacher, Idaho City Middle/High School, Basin School District

Laura Woras’ music classroom has flooded two years in a row.

Woras went to drop off supplies in her Idaho City classroom during spring break in 2022 and found the area around her desk flooded and hot water shooting out of a wall. It destroyed the floor pillows she had bought for students to sit on while playing their instruments. The next year, it happened again. The superintendent told us the old pipes spring leaks once a month and need replacement.

Separately, the school struggles with leaks from its fire sprinkler system. A levy that would have fixed this failed to pass in November.

Video of Woras’ classroom flooding (Courtesy of Laura Woras)

Watch video ➜

Evidence of water damage on the wall months after the second leak (Asia Fields/ProPublica)

“Something is always falling apart in our school district.” —Natalie Kulick, science teacher, Idaho City Middle/High School, Basin School District

In Kulick’s class, multiple leaks have sent water pouring down the walls, destroying cards from former students, workbooks, papers and posters.

“The previously leaking roof hadn’t been addressed due to budgetary constraints. Due to the heavy snow and already bad roof, it caused the ceiling to collapse. We’re hoping the repairs will hold until we can figure something else out about replacing the whole roof.” —Jason Moss, superintendent, Grace Joint School District

“In one area, after a particularly hard snow was melting, the custodians rigged up a tarp across the ceiling to catch all the leaks and funnel them into garbage cans and plastic totes that they could dump,” Moscow School District middle school teacher Cyndi Faircloth said.

(Courtesy of Rachel Aiello)

“At Post Falls Middle School, class would be moved to a different room temporarily because a tile from the ceiling had collapsed due to water damage. Sometimes we would carry on anyway and ignore it.” —Grey Goodwin, 2023 Post Falls High School graduate, Post Falls School District

The district said it has since repaired sections of the roof.

Water damage to the ceiling in the Caldwell School District, first and second image, and the Basin School District, third image. Ceiling tiles are falling in the Plummer-Worley School District’s high school gym, fourth image, which we also saw in two other districts. (First image: Courtesy of Bernie Carreira. Second image: Asia Fields/ProPublica. Third image: Asia Fields/ProPublica. Fourth image: Asia Fields/ProPublica.)

The land that the Basin School District’s schools sit on used to be a pond that had been dredged by miners. During spring runoff, the elementary school floods.

Superintendent Brian Hunicke shows how high the water goes when it floods. (Asia Fields/ProPublica)

Spring runoff goes under the building, creating a musty smell. “My first year here I thought it was a dead mouse.” —Jill Diamond, principal, Potlatch Elementary School, Potlatch School District

“There’s a room that you can’t even go in on a rainy day, because it just smells terrible.” —Michelle Tripp, principal, Ross Elementary School, Kuna School District

“The water is loaded with iron and tastes terrible.” —Scott Davis, Kootenai superintendent. (The district scraped together grants and donations to add a filtered bottle fill station to each building.)

“Old buildings with lead in pipes.” —Mark Kress, Snake River superintendent. (The district said it has mitigated lead levels in drinking water and tests the water monthly.)

“Concerns with drinking water have caused us to get water delivered. … Some of the water is colored in some of the classroom sinks.” —Allen Mayo, Shoshone-Bannock administrator

“We have had to bring in port-a-potty restrooms when plumbing systems have failed.” —Matt Diel, facilities director, Lake Pend Oreille School District

Bathroom drains at Canyon Springs High School, an alternative school in the Caldwell School District, are “popping up out of the ground” because of old rusty piping that has shifted, said Bernie Carreira, the district’s maintenance director.

Bathrooms at Canyon Springs High School. Idaho Statesman and ProPublica reporters brought a camera that makes instant prints to school visits so students could show the problems in their schools. (Courtesy of Canyon Springs students)

Classes in Stairwells and Closets

28% of superintendents we heard from said overcrowding or use of portable buildings is a significant challenge. 58% said accessibility for people with disabilities poses a significant challenge or requires major repairs.

“The first two or three minutes of passing, it’s sardines.”

—Tracy Donaldson, vice principal, Kuna High School, Kuna School District.

Donaldson described the crowded hallways. The high school was designed for about 1,400 students, but it serves about 1,900, according to the district.

“Our biggest concern is lack of space. We are using 18 modular classrooms at Rigby High School.” —Chad Martin, superintendent, Jefferson County School District

The district has been relying on portable buildings because there is a shortage of space.

“Underclassmen without cars are forced to eat on the floor in the halls due to the lack of space in the cafeteria.” —Claire Yoo, 2023 alum, Idaho Falls High School, Idaho Falls School District

The school was built for 900 students but serves about 1,250, according to the district. The cafeteria accommodates about 200 students.

Moscow High School has 814 students but room for only about 100 in the cafeteria.

The cafeteria at Moscow High School doesn’t even fit all students who get free and reduced lunch through the school. (Asia Fields/ProPublica)

At Heyburn Elementary in the St. Maries School District, a stairwell at the front entrance was turned into the music classroom.

(Asia Fields/ProPublica)

Photo class is held in a former storage room in the Plummer-Worley School District.

(Asia Fields/ProPublica)

“Most high school PE classes are not able to use the gym most of the time since it’s too small. … Not enough fields were built on campus for the number of students we have now.” —Natasha Gartstein, ninth grade student, Moscow High School, Moscow School District

As a result, the district has to transport students to nearby parks and the University of Idaho for physical education, cutting into class time. On one busy week in the fall, the district had 28 bus trips from the school.

At Heyburn, a teacher’s lounge is in an old locker room, where showerheads are still attached to the wall.

(Asia Fields/ProPublica)

About half of superintendents said they have buildings that aren’t compliant with the Americans with Disabilities Act.

Schools built before the act have some flexibility in meeting the requirements.

“He can’t ever really just be free to explore because he could tip over the edge. … I think there’s a lot of learning that kids get when they can freely explore their world. My little guy doesn’t get that.”

—Marisa Smith, mother of a second grade student, Discovery Elementary School, West Ada School District

Marisa Smith’s son, Tug, uses a wheelchair and is legally blind. He can’t access the playground unless teachers carry him because it has wood chips and a steep drop from the curb. After reporters reached out, the district said it would make some improvements. But the playground would still have wood chips, which are difficult to navigate in a wheelchair.

“We typically have to move students with physical disabilities out of their neighborhood school to a newer school that can better accommodate their physical needs.” —Wendy Johnson, superintendent, Kuna School District

“It’s kind of just really embarrassing. … I oftentimes would fall out of my wheelchair and hurt my knees again.” —Ammon Tingey, 2023 alum, Highland High School, Pocatello-Chubbuck School District

Ammon Tingey described climbing up and down stairs every day to get to honors classes while he was supposed to be using a wheelchair after an injury. He said he was discouraged from taking the classes because they were on the bottom floor and the school didn’t have an elevator. The district did not list accessibility as an issue in its survey. It said it offers more than one section of honors courses, and there would have been another option for students to access on the main floor. The school also has a wheelchair lift in one section of the building.

Fire Risks, Power Outages, Security Flaws

58% of Idaho superintendents we heard from said security poses a significant challenge. 31% said asbestos does and 26% said fire and emergency preparedness do.

“My heart was racing because I’ve heard in the news of things like this happening. … It’s just hard to think what if this would have been real and there actually was someone there and they made a mistake like this. We were like sitting ducks.”

—Bryn Bowersox, 10th grade student, Moscow High School, Moscow School District

Bryn Bowersox was in PE class earlier this year when the school went into lockdown because of a shooting threat. The announcement couldn’t be heard in the gym, and the door didn’t lock securely, according to the district. Bowersox said the class learned of the threat late when a teacher received a message on his phone. The district has since installed new announcement systems and purchased new locks.

Superintendents across the state were able to make some security upgrades with a state grant created this year that provided each school with up to $20,000, but many said it wasn’t enough to fully secure their older schools.

“Not all students can hear the public announcements, and not all classroom teachers can easily communicate with the office.” —Superintendent *

“We have no secure entries and high concerns for many ‘what if’ security scenarios.” —Superintendent, referring to the main entrances*

*We are not naming the superintendents or their districts to avoid exposing security concerns.

A fire broke out at Highland High School in the Pocatello-Chubbuck School District earlier this year and destroyed the cafeteria, gym and band rooms.

The building had previously failed a fire inspection, but the district said that the alarm system was still operational. During the fire, the school’s sprinklers went off, but the alarm didn’t activate. The district said it has since serviced alarms at all of its schools. The damage will be covered by insurance, but the district ran a bond election in November hoping to expand and upgrade the school while rebuilding. The bond measure failed, despite garnering 56% of votes.

The Highland High School gym was ravaged by a fire. (Pocatello Fire Department, obtained by ProPublica and Idaho Statesman)

“The elementary has no fire suppression system.” —Brian Hunicke, Basin superintendent

“Don’t have a sprinkler system for fires.” —Scott Davis, Kootenai superintendent, about two of the district’s three schools

“Does not have a functioning fire control system.” —David Sotutu, superintendent of New Plymouth School District until June, about the sprinklers in the district’s career technical education building

The boiler at Canyon Springs High School is covered in a material that contains asbestos fibers. (Sarah A. Miller/Idaho Statesman)

“The middle school is loaded with asbestos.” —Scott Davis, superintendent, Kootenai School District

The asbestos is not exposed but makes what would otherwise be simple repairs and upgrades challenging and expensive, Davis said.

“A student plugged their laptop into one of these outlets. There was a pop, a spark.” —Jennie Withers, teacher, Meridian Middle School, West Ada School District

An electrical outlet at Meridian Middle School (Courtesy of Jennie Withers)

“The kids know it will flicker once, and then they’re waiting. They’re like, ‘OK,’ and it’ll flicker twice, and then they’re like, ‘OK, three times.’ … If it hits the third time, then it’s going to be out for a while — and they know that.” —Brian Hunicke, superintendent, Basin School District

Hunicke said the district had eight power outages last year, and its generator only covers refrigeration, the computer server and emergency lights.

Some districts have also had challenges making Wi-Fi work in their older buildings.

“Some days the Wi-Fi will just stop working. This means that some teachers who rely on PowerPoints or internet access can’t continue with what they had planned for that day.”

—Reesa Loewen, senior, Kamiah High School, Kamiah School District

Jill Patton, principal of Pioneer Elementary School in the Salmon School District, said students have been kicked off the internet in the middle of state exams because of the building’s poor Wi-Fi.

At Caldwell’s Syringa Middle School, the breaker trips if a heater and the microwave are turned on at the same time.

(Sarah A. Miller/Idaho Statesman)

Deteriorating Foundations and Falling Bricks

41% of Idaho superintendents we heard from said structural issues like cracks in the walls or foundation pose a significant challenge or require major repairs.

“The look of the school is kind of deteriorating. … Just walking in and seeing something that looks like this is almost depressing.”

—Diego Hernandez, 10th grade student, Canyon Springs High School, Caldwell School District

Caldwell Superintendent N. Shalene French said all 10 of her district’s schools are in poor condition. At Canyon Springs, an alternative school that students describe as deteriorating, about 80% of students are people of color, and more than 96% come from low-income households.

“The foundation is crumbling. … You keep up with what you can; you can’t fix a crumbling foundation.” —Troy Easterday, superintendent at Salmon School District

“Foundation and wall cracks are worrisome.” —Joe Steele, superintendent at Butte County School District

“We know there is probably a crack in the foundation; however, with no money to fix it, we are left to just simply prepare for heavy rains as much as possible and to devote extra time to clean up efforts.” —Megan Sindt, superintendent at Avery School District

First image: Peeling paint and water-damaged ceiling tiles at Canyon Springs High School in the Caldwell School District. Second image: A classroom in the nearly 90-year-old section of Lakeside High School in the Plummer-Worley School District. (First image: Sarah A. Miller/Idaho Statesman. Second image: Asia Fields/ProPublica.)

“The state of our buildings, particularly the outer buildings, is embarrassing. … School should be a place of security and a place to be proud of.” —Jennie Withers, teacher, Meridian Middle School, West Ada School District

“Holes in the walls, leaks, exposed wires — they are distracting.” —Leila Guffey, senior, Kamiah High School, Kamiah School District

At Kamiah High School in the Kamiah School District and other schools we visited, students told us that their schools’ appearance affected how they viewed their schools and themselves.

Wires hanging from the ceiling and a deteriorating locker at Kamiah High School in the Kamiah School District. Kamiah Superintendent Paul Anselmo said exposed wires and pipes make the school look “like a warehouse.” (Courtesy of Kamiah High School students)

Bricks have cracked and pieces have fallen out at Jefferson Middle School in the Caldwell School District.

They haven’t hit anyone, but it’s a potential hazard, said Bernie Carreira, the Caldwell maintenance director. (Sarah A. Miller/Idaho Statesman) A cracked and settled sidewalk caused by poor water drainage and corrosion at the base of a steel entry column at Stephensen Elementary in the Mountain Home School District. (Obtained by ProPublica and Idaho Statesman from a 2020 assessment by a structural engineering firm)

Schools also have structural issues with windows, which were listed as a problem by 55% of superintendents we heard from.

In three districts, teachers or superintendents reported that windows have fallen out. In another, the deteriorated windows allow bats to make their way into the high school two to three times each fall.

“Bats come in through the window casings. … We keep the ‘bat net’ handy at all times.” —Janet Williamson, superintendent, Camas County School District

Blankets, Coal Boilers and Poor Ventilation

68% of Idaho superintendents we heard from said heating poses a significant challenge or requires major repairs. 67% said the same for cooling.

“It’s extremely hard to focus on schoolwork while shivering.”

—Kendall Edwards, ninth grade student, Moscow High School, Moscow School District

Edwards said some rooms are freezing in the winter. Frank Petrie, Moscow’s maintenance director, said heating is a challenge because of antiquated systems.

“Even as a kid in elementary school, I knew that it probably wasn’t normal to have to wear coats inside occasionally.” —Ali Johnson, 2021 alum, Capital High School, Boise School District

“I know one teacher who keeps a stack of blankets in his room so kids can cover up while he teaches.” —Cyndi Faircloth, teacher, Moscow Middle School, Moscow School District

Brian Hunicke, superintendent at Basin School District, told us that at Idaho City Middle/High School, the heat didn’t work about 10 times last year, not including during power outages. When it happens, students “suffer for about a day” before the district can get someone in to fix it.

“The district is still using coal to heat buildings. The coal creates dirty air outside the buildings, and depending on wind direction it can unintentionally compromise indoor air quality. As we have looked for ways to improve air quality, we recognize that dirty air can impact those with compromised immunity and asthma.” —Shane Williams, superintendent, West Jefferson School District

Coal boilers have become increasingly rare in schools and homes across the country over the past few decades.

Coal used to heat the Swan Valley School District elementary school (Courtesy of Michael Jacobson)

Russell Elementary School in the Moscow School District has a boiler from when the school opened in 1926. If it were to break down, it would be hard to find replacement parts, the district said.

(Asia Fields/ProPublica)

Heat is also a problem when school starts in the late summer, educators say.

It’s “sweltering.” —Janet Avery, Potlatch superintendent

“Over 100 degrees in the fall and late spring” inside. —Robyn Bonner, head teacher at Peck Elementary in the Orofino School District

“Melting in the hot conditions.” —Erin Heileman, teacher at Morningside Elementary School in the Twin Falls School District

“It gets so hot in the afternoon that students start to put their head down. … It makes it difficult to teach kids.” —Gerald Dalebout, social studies teacher at Moscow High School in the Moscow School District

“There is no ventilation in that school, and it does not meet any EPA standards for fresh air intake or carbon dioxide levels, which were tested by the district.” —Ken Eldore, facilities director until June, Priest River Junior High School, West Bonner School District

Another administrator also told us about the levels, but interim superintendent Joseph Kren, who was hired in October, said he couldn’t find a record of a test.

“Emmett Middle School lacks adequate ventilation, which I believe is a contributing factor to high levels of flu and illness.” —Craig Woods, superintendent, Emmett School District

Emmett High School’s air quality is better than the middle school’s after upgrades, but is still “not up to today’s required air circulation standards,” according to its superintendent.

Emmett High School (Sarah A. Miller/Idaho Statesman) 88% of superintendents we heard from mentioned that funding is preventing them from addressing facilities problems.

Districts have cobbled together funds to make some improvements over the years. Administrators said federal COVID-19 relief dollars allowed them to replace expensive HVAC systems and roofs. But that money is nearly gone.

Many superintendents said they felt hopeless about ever passing a bond to renovate or replace schools, especially since funding other educational needs is already a challenge. Districts also regularly ask voters to approve supplemental levies to cover some salaries and operating costs that go beyond state funding.

“Rural school districts can’t pass bonds to build new facilities,” said Todd Shumway, superintendent of the North Gem School District. “It only takes a few to defeat a bond.”

Not passing a bond means districts not only worry about maintaining their buildings, but also about what would happen if a gas line shuts down, the boiler stops working or the sewage system fails. And it means that as Idaho faces a teacher shortage, qualified educators can look across state borders at modern schools in better-funded districts — and decide to leave the state behind.

Kuna School District is building a second high school to relieve overcrowding, but it needs more funding to complete it. A bond measure to do this failed in March despite 56% of voters supporting it. District officials say they may have to consider going to school year-round or in split shifts if the student body continues to grow. (Asia Fields/ProPublica)

Design and development by Anna Donlan.

Opener image sources: Asia Fields/ProPublica; Sarah Miller/Idaho Statesman; courtesy of Kamiah High School students; courtesy of Moscow High School students; courtesy of Bernie Carreira; Pocatello Fire Department, obtained by ProPublica and Idaho Statesman

by Asia Fields, ProPublica, and Becca Savransky, Idaho Statesman, illustrations by Pia Guerra for ProPublica

Idaho Lawmakers Are Discussing a Proposal That Would Make It Easier to Repair Schools

11 months 1 week ago

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

Idaho lawmakers are discussing a proposal that would make it easier for school districts across the state to repair and replace their aging buildings.

Idaho is one of two states that require two-thirds of voters to approve a bond, which is one of the few ways a district can secure funding to build new school facilities. The Idaho Statesman and ProPublica have reported this year how this threshold has stymied districts from fixing or replacing antiquated boilers, leaking roofs, failing plumbing, overcrowding and inadequate building security.

As lawmakers head into the legislative session in January, prominent Republicans say they’re now considering ways to change the Idaho Constitution and the two-thirds supermajority requirement.

Drafts of a potential resolution are still in the early stages, and the effort is being headed by Rep. Rod Furniss, a Rigby Republican who represents the legislative district encompassing Salmon, where the school district tried and failed to pass a bond six times in seven years.

Lowering the threshold would require support from two-thirds of legislators, and a ​majority of voters would need to approve the constitutional amendment on the ballot.

Hundreds of students, educators and school administrators have told the Statesman and ProPublica about the ways school building conditions impact their daily lives. Some have argued it’s nearly impossible for school districts to reach two-thirds support in communities that are low-income or have older households with no kids in school, and it’s creating inequity among districts.

James Gilbert, superintendent of the Mountain Home School District, told the Statesman and ProPublica that school repairs “just continue to add up, and there is no real funding solution to address the issues unless bonds or levies are passed.”

Since 2006, fewer than half of all school bonds have passed. Had a simple majority been required, as is the case in most other states, around 80% of them would have been approved, an analysis by the Statesman and ProPublica found.

Legislators have done little to address the problem despite an Idaho Supreme Court ruling in 2005 that declared the state’s funding system for school infrastructure unconstitutional and tasked lawmakers with making sure facilities were properly funded.

“People are generally getting more and more dissatisfied with the fact that we’re not able to address our aging facilities in public education,” Sen. Dave Lent told the Statesman.

Lent and Rep. Wendy Horman, both Republicans, discussed the proposal during a town hall meeting in Idaho Falls last week. Lent, who chairs the Senate Education Committee and determines the bills introduced by the panel, told the Statesman he plans to co-sponsor the resolution. Horman co-chairs the influential Joint Finance-Appropriations Committee, which sets the budgets for all state agencies every year.

In the past, proposals to lower the supermajority have failed to gain traction.

In 2017, a resolution that would have started the process to lower the threshold to 60% never made it out of a legislative committee. Lawmakers who oppose changing the supermajority have said there should be a high threshold to impose taxes on a community.

“Unless an existing school actually falls to the ground and becomes unusable, I don’t perceive them ever passing a bond,” Josh Tolman, a former Salmon school board member, previously told the news organizations in an interview.

Furniss said in an interview that ​lawmakers are discussing ways to reduce the vote threshold in elections when turnout is high. That way, ​bond measures wouldn’t fail with 65% support in high-turnout years — what would be a blowout election in any other race.

On the whole, Furniss expects that “quite a few more bonds might pass,” but only in situations where the election adequately gauges the “will of the people.”

Furniss said lawmakers have looked at systems used in other states, including Montana and Alaska. Montana requires a smaller majority in high-turnout elections and a larger majority in low-turnout elections. But if turnout is low enough, a bond automatically fails, which is one reason Furniss said some lawmakers in favor of reform are leaning against the idea.

Furniss said a different option he favors is to lower the threshold districts would need to meet in years that have historically high turnout. For example, bond measures on the ballot during presidential election years might require a simple majority while those in midterm years could require 60%.

Lent and Furniss acknowledged that lowering the threshold for bonds would be a heavy lift, given that it would need support from two-thirds of lawmakers in Idaho’s conservative Legislature. But Lent said lawmakers are committed to finding ways to help school districts upgrade aging facilities and address maintenance problems.

Lawmakers plan to “take the temperature” once the session starts to determine the proposals that will get the most traction, Lent said. Legislators are also looking at other options to help school districts with their aging facilities, including offering more state funding.

“Our first priority is to figure out a way to have greater state participation and relieve the pressure on local property taxes for facilities,” he said. “We definitely want to have lots of options to see what we can get done.”

Update, Dec. 14, 2023: This story was updated to include comment from James Gilbert, superintendent of the Mountain Home School District.

by Becca Savransky and Bryan Clark, Idaho Statesman

Mayors Are Presiding Over Their Town Courts Despite Guidance Saying They Shouldn’t. A Lawmaker Calls for Reform.

11 months 1 week ago

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

Update, Dec. 15, 2023: This story has been updated to reflect the fact that after this story was published, another town — Tullos, Louisiana — said that it had appointed a magistrate following WVUE and ProPublica’s inquiries.

Amid questions about how he ran his court, the mayor of the tiny village of Fenton, Louisiana, recently decided he would no longer serve as the town judge.

He had been recorded saying police officers must write more tickets and now found himself defending his impartiality. Some court records included notations by officers and village employees saying not to “fix” certain tickets; other notations said tickets were dropped after someone, often a law enforcement officer, had intervened.

The U.S. Supreme Court has ruled that having a mayor serve as judge is unfair to defendants if a town brings in a substantial part of its revenue through the court and if the mayor is responsible for the town’s finances. The court in Fenton brought in 92.5% of the town’s revenue in one recent year, but the mayor still sat on the bench.

After WVUE-TV and ProPublica reported on what was going on, the mayor last month appointed an attorney to preside over the court instead.

Mayor’s courts, where the authority to enforce local ordinances by default rests with the mayor, exist in small towns throughout Louisiana, which commission annual audits that show how much money each town takes in. The state auditor’s office holds those reports, but it doesn’t track which towns take in enough money from their court to create a potential conflict of interest.

WVUE and ProPublica decided that we would. Looking at recent audits for all municipalities in Louisiana that file them, we could see which towns took in the greatest share of their revenue through fines and related costs. Starting with the towns other than Fenton that collected the highest percentage, we began calling around to confirm that all that money came through their mayor’s court.

Of the 15 towns we reached in the last several weeks, 13 had mayors on the bench even though their courts brought in anywhere from 14% to 82% of their total governmental revenue in the fiscal year ending in 2022. The Louisiana Judicial College, the educational arm of the state Supreme Court, recommends that mayors appoint someone else to serve as judge if their town takes in at least 10% of its overall revenue from court.

Told of our findings so far, a state lawmaker is calling for reform of a court system that exists only in Louisiana and Ohio.

“If 48 states can live without mayor’s court, why can’t we?” said state Rep. Edmond Jordan, a Democrat from Baton Rouge. “You got the town attorney acting as the prosecutor. So everybody is in on the game, except the person being charged with the offense.”

You got the town attorney acting as the prosecutor. So everybody is in on the game, except the person being charged with the offense.”

—State Rep. Edmond Jordan

Jordan said he wants to create a task force to study mayor’s courts. Unlike other courts in Louisiana, they don’t have to follow rules of procedure designed to ensure that they’re run fairly and properly. And unlike municipal judges, who handle the same types of offenses, mayors do not need a law degree to adjudicate cases. Until this year, they weren’t required to undergo any training.

Last year, Jordan filed a bill to abolish mayor’s courts, but it was opposed by the Louisiana Municipal Association, which advocates for the interests of villages, cities and towns. Jordan then tried to require towns with mayor’s courts to appoint attorneys to preside over their courts, but lawmakers resoundingly voted the bill down.

Seven of the mayors in those 13 towns said they’re not convinced they’re doing anything wrong, including four who said they believe they treat defendants fairly despite their reliance on the court for a large portion of the town’s budget. Two of those who defended their practices also said they can’t afford to pay someone else to preside. One said if he finds out that he needs to appoint someone, he will.

However, two towns — Albany, east of Baton Rouge, and Tullos, in north Louisiana — responded by appointing magistrates.

Mayors Step Down From the Bench After WVUE, ProPublica Ask About Court Revenue

Most of the 13 towns identified by the news organizations are home to just a few hundred people. They include Turkey Creek, in south-central Louisiana, where the police department is funded entirely by citations.

The village of Dodson, located in north-central Louisiana, collected half a million dollars — 73% of its total revenue — from its mayor’s court in the year ending in June 2022.

Henderson, a town of about 1,600 just east of Lafayette on Interstate 10, had revenues of about $3.5 million in the year ending in June 2022, according to an audit. About $2 million of that came through its court.

Of the 301 municipalities and two combined city-parish governments required to file audits, we found 91 with mayor’s courts that collected 10% or more of the municipality’s revenue through fines and forfeitures in a single year. (Although the state provides no official definition of “fines and forfeitures,” it generally refers to penalties for breaking the law and associated fees.) We called those courts to see who presided — in some courts, the mayor has appointed a magistrate instead — and to confirm how much of that money came through court.

Small Towns Where Mayors Run Courts That Bring in Substantial Revenue

The Louisiana Judicial College advises towns with a mayor’s court to appoint someone other than the mayor to act as judge if court collections account for at least 10% of their overall revenue.

Courts in these towns took in at least 10% of the budget in one year, but town employees confirmed that the mayor still presided there. Two of the 13 changed course after we contacted the towns.

  • Georgetown, population 277: 82% of revenue
  • Tullos,* population 304: 79%
  • Robeline, population 117: 74%
  • Dodson, population 294: 73%
  • Baskin, population 210: 70%
  • Turkey Creek, population 394: 67%
  • Henderson, population 1,617: 56%
  • Woodworth, population 1,762: 41%
  • North Hodge, population 296: 39%
  • Urania, population 698: 24%
  • Estherwood, population 694: 22%
  • Brusly, population 2,578: 17%
  • Albany,* population 1,235: 14%

*Appointed a magistrate after WVUE and ProPublica inquired.

Sources: Municipal audits on file with the Louisiana legislative auditor for fiscal year 2022; 2020 U.S. Census; town employees.

Competing Advice for Small Town Mayors

Starting this year, anyone who presides over a mayor’s court in Louisiana must complete three hours of video training provided by the state Judicial College, in which the trainer says he “would highly recommend” appointing a magistrate if a town’s court generates at least 10% of its revenue.

Mayors in all 13 towns we identified have taken that training. Two of them pointed out that the guidance about appointing someone else was phrased as a recommendation. Two others said they had followed different advice, including one who said he talked to the Louisiana Municipal Association. About 250 of the association’s 300 or so members have mayor’s courts, and the association publishes a lengthy guide on how to run them.

The Judicial College’s advice is based on a federal court ruling in Ohio, which held that 10% would be considered a “substantial” share of town revenue under the 1972 Supreme Court opinion that addressed the fairness of mayor’s courts. The Ohio town in the Supreme Court case generated between 37% and 51% of its annual revenue through its court.

Bobby King, the prosecutor for a mayor’s court outside Baton Rouge, led much of the Judicial College training. Mayors whose courts take in a substantial amount of money “can be in a bind” if they sit on the bench, he said in the training. If a mayor presides, he said, “you can be held that you’re violating people’s constitutional rights to due process.”

After watching the videos, the mayor of Brusly, whose court accounts for 17% of its revenue, said he asked the Municipal Association if he needed to appoint a magistrate. Mayor Scot Rhodes said he was told by someone in the association’s legal department that the threshold doesn’t apply to the many cases in which defendants simply pay their fines. Instead, he said he was told, it applies only to revenue from the few cases in which defendants appear in court before him to fight their tickets or ask for a break. “I’ve been advised that we’re doing everything on the up-and-up,” he said.

Henderson Mayor Sherbin Collette said he came to the same conclusion after a training session at the Municipal Association’s convention in 2022. “If we find out that it is better that we have a magistrate,” Collette said, “we are going to see that it happens.”

Karen White, executive counsel for the association, told WVUE and ProPublica in an email that the association “does not provide legal guidance, opinions, or advice to municipal members”; that’s up to each municipality’s attorney. When the association participates in events with other entities such as the Judicial College, the state Supreme Court or the legislative auditor, “there are times in which a remark is attributed, innocently but erroneously, to a particular entity.”

White wrote that it is problematic to “adopt a singular guideline for all municipal governments in the state” because there are wide variations in how towns are chartered and operated. “There has been no rule from the U.S. Supreme Court to support any definite threshold as triggering the mandatory appointment of a magistrate.”

The association’s 210-page guide to mayor’s courts says that “it seems prudent that, when possible,” a magistrate be appointed to oversee the court. If a town can’t afford it, the guide says, the mayor should try as much as possible to “separate their duties” as presiding officer of the court from their duties as the town’s chief executive.

The Municipal Association’s guide also offers an alternative: a “hybrid” arrangement in which the mayor handles guilty pleas but an appointed magistrate oversees proceedings in which someone pleads not guilty, as well as any trials or hearings that may be required.

In northeast Louisiana, the mayor for the village of Baskin, which took in 70% of its revenue from mayor’s court in one year, told WVUE and ProPublica that he is considering a hybrid approach when we asked why he presides over court. “I get everyone’s frustration,” Mayor Layton Curtis said. “We really need to be respectful of everybody.”

Mayor’s courts play an integral role in ensuring public health and safety, as their jurisdiction encompasses the enforcement of all municipal ordinances.”

—Karen White, executive counsel for the Louisiana Municipal Association

Woodworth, near the central Louisiana city of Alexandria, is one of two towns among the 13 that now use that approach. Mayor David Butler said he does this because he doesn’t “want to show any partiality,” although he believes he treats defendants fairly. He said he’s been on the bench long enough that he can read people —  “whether they are honest or not honest.”

However, King said he doesn’t believe the hybrid approach addresses a potential conflict of interest for any town where the court takes in at least 10% of revenue. In his training, he tells people that what matters is total collections.

White wrote that questions about conflicts of interest are not unique to mayor’s courts because all types of courts in Louisiana receive some funding from the fines and fees they impose.

“Mayor’s courts play an integral role in ensuring public health and safety, as their jurisdiction encompasses the enforcement of all municipal ordinances,” she wrote. “Neither mayors nor council members have any control over how many persons violate traffic and other ordinances, nor how often.”

“As Long as They Don’t Have a Bad Attitude, I Try to Help Them”

Proponents of mayor’s courts say they’re an efficient, informal way to administer justice in small towns. Several mayors said they run their courts simply and fairly, usually without holding trials.

Dodson Mayor Richie Broomfield, who also does maintenance for the town, wears jeans and work boots to court. “I don’t want to intimidate anybody. I don’t want anybody to think bad of me,” he said. “They don’t even stand up, we just sit there and talk.”

But as court records in Fenton suggest, not all drivers are treated the same. There, some records included notations from officers and village employees not to “fix” tickets or “help” drivers who had a “bad attitude.” Fenton village attorney Mike Holmes said cases are adjudicated based on provable violations of law, not those notations.

In Fenton, Louisiana, WVUE and ProPublica found a dozen court records with notations saying not to “help” people or “fix” someone’s ticket because of their behavior. Fenton village attorney Mike Holmes said such notes do not affect how cases are decided. (Obtained by WVUE and ProPublica. Redacted and highlighted by ProPublica.)

Broomfield also takes into account drivers’ behavior. When people come to court, he said, they’re usually polite. But that doesn’t mean they were nice when they were stopped, so he reads officers’ notations about drivers’ behavior. “I think I’m very fair,” Broomfield said, noting that speeding cases are often clear-cut. “As long as they don’t have a bad attitude, I try to help them.”

Albany had court revenue of $200,000 in the year ending in June 2022 — about 14% of its overall revenue.

John Boudreaux, a former reserve police officer who lives near Albany, was ticketed there in August for speeding and having an expired license plate. What he found when he went to court to fight the ticket was “very odd,” he said: The mayor was presiding.

“I didn’t even know that existed until that night,” he said. “Either you need to be a mayor or you need to be a magistrate; you can’t be both.”

He said the prosecutor told defendants that if they pleaded not guilty, they would end up being found guilty in a trial and they would end up paying more money.

Keith Rowe, the prosecutor at the time, told WVUE and ProPublica he didn’t say that to defendants and told them instead that they’re presumed innocent. But he said he did tell defendants that they “more than likely” would be found guilty if an officer testified against them. “I just try to tell them the real facts,” Rowe said.

Boudreaux is appealing his case to the local district court.

In an email, Mayor Eileen Bates-McCarroll told WVUE and ProPublica that she knows about “the suggestion” that towns appoint a magistrate and she was considering it. Monday night, the town’s board of aldermen took that step. Rowe will no longer prosecute cases; now he will preside over court.

Joel Jacobs of ProPublica reviewed the data analysis.

by Samantha Sunne, Dannah Sauer and Lee Zurik, WVUE-TV

Knoxville’s Juvenile Detention Center Says Hundreds of Seclusions Were “Voluntary.” Some Kids Don’t See It That Way.

11 months 1 week ago

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

To hear the state of Tennessee tell it, Knoxville’s Richard L. Bean Juvenile Service Center has shown “significant and consistent improvement.” It no longer illegally locks kids up alone in cells, as an investigation by ProPublica and WPLN exposed last month.

But a closer look at the facility’s most recent inspection by the state Department of Children’s Services tells a different story. Instead of secluding children against their will, the facility claims that kids are voluntarily agreeing to be locked up alone. In the first three months of 2023, the facility used this “voluntary” seclusion more than 1,000 times — even though there were usually only about 30 kids staying there. That’s three times as many incidents as a similar period the year before.

Tennessee law closely regulates the conditions under which kids can be locked up alone, against their will in juvenile detention centers. But a 2021 state law permits facilities to isolate children if the child requests a cooling-down period. To be considered truly voluntary under the law, kids have to be able to leave whenever they want.

Zoe Jamail, policy coordinator of Disability Rights Tennessee, says it looks like the facility is classifying the lockups as voluntary to get around the law. Her organization acts as a monitoring agency for juvenile detention facilities in the state.

“One of the effects of calling this voluntary is that you then no longer have to comply with any of the parameters that the state has put around seclusion,” she says.

Both inspections by DCS and reports from detained youth also suggest the seclusions are not truly voluntary.

In 2021, after the new law took effect, a DCS inspector visited the center. She documented that the facility’s reliance on these voluntary seclusions was on the rise, and that it was “unclear” if the youth knew they could leave their cell by choice.

“You can’t come in and out — like, the door’s locked,” says one teenager that we’re referring to by his middle name, Tyler, to protect his privacy as a minor.

A cell at the Bean Center where kids are sometimes kept in isolation (William DeShazer for ProPublica)

Tyler spent months at the Bean Center this year. He says a “voluntary lockup” meant at minimum two hours in his own cell before a guard would let him out. And if he asked to get out sooner?

“They’d get mad. They’d be like, ‘You can’t do that.’”

Tyler says he and other kids would request a voluntary lockup to sleep more or get out of class.

But this summer, he says Bean started cracking down on that by sending them to another cellblock called brown pod for even longer than they wanted.

“Bean made it where they move you to brown and you’re in there for like the whole day,” Tyler says. “People who would ask to go on lock up would still be locked up for like two or three days before they’d come back.”

Another teen who we’re calling by his middle name, Francisco, says he was locked up for a day after asking for a brief voluntary lockup.

The way he remembers it: “Mr. Bean decided that he was mad that everybody was taking voluntaries because school wasn’t happening. He just was like: ‘All right, then everybody’s going to brown for a day. And if you don’t go to school no more, you go to brown for the whole day, to the next day.’”

Bean admitted to that policy during our interview in September.

“So what I started doing is put them in seclusion until the next morning, and then they want to go to school,” Bean said then. “And so that’s working pretty good.”

Superintendent Richard L. Bean has been running a juvenile detention center in Knoxville, Tennessee, since 1972. (William DeShazer for ProPublica)

Bean and the county board that oversees the center didn’t respond to requests for comment. They haven’t responded since we ran our story last month, which found that the center was locking kids up in seclusion more than other facilities in the state — often as punishment and for longer than the law allowed.

In a statement, DCS said it wants to “ensure that this facility, and any juvenile detention center, has an appropriate policy in place that requires the facility to notify a youth choosing to enter voluntary seclusion that the youth may terminate the voluntary seclusion at will.”

The department says if a kid can’t end the lockup at will, then it no longer qualifies as voluntary. And if it doesn’t, then Bean’s reliance on illegally locking kids up alone has only increased.

by Paige Pfleger, WPLN/Nashville Public Radio

How Police Have Undermined the Promise of Body Cameras

11 months 1 week ago

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When Barbara and Belvett Richards learned that the police had killed their son, they couldn’t understand it. How, on that September day in 2017, did their youngest child come to be shot in his own apartment by officers from the New York Police Department?

Miguel Richards, who was 31, grew up in Jamaica and had moved to New York about a year earlier after coming to the United States through a work-study program. His father’s friend gave him a job doing office work, and he rented a room in the Bronx. But he started to struggle, becoming reclusive and skipping days of work. His mother, with whom he was particularly close, pleaded with him to return to Jamaica. “It’s as if I sensed something was going to happen,” she says. “I was calling him, calling him, calling him: ‘Miguel, come home. Come home.’”

His parents knew he had never been violent, had never been arrested and had never had any issues with the police. What details they managed to gather came from the Bronx district attorney: Richards’ landlord, who hadn’t seen him for weeks, asked the police to check on him. The officers who responded found Richards standing still in his own bedroom, holding a small folding knife. And 15 minutes later, they shot him.

Richards’ death marked a historic turning point. It was the first time a killing by officers was recorded by a body camera in New York. The new program was announced just months before as heralding a new era of accountability. Now, a week after the shooting, the department posted on its website a compilation of footage from four of the responding officers. The video, the department said in an introduction to the presentation, was produced “for clear viewing of the event as a totality.” And as far as the department was concerned, the narrative was clear. Sometimes “the use of deadly force is unavoidable,” the police commissioner at the time, James O’Neill, wrote in an internal message. The level of restraint shown by all officers, he said, is “nothing short of exceptional.” And, he added, “releasing footage from critical incidents like this will help firmly establish your restraint in the use of force.”

Richards’ parents were not convinced. Belvett watched footage at the district attorney’s office. What he saw, and what was released, did not, in fact, show that the use of deadly force was unavoidable. He later learned that the department had not released all the footage. What else didn’t they know about their son’s death?

Belvett and Barbara Richards’ 31-year-old son, Miguel, was killed by New York City police officers in 2017. (Naila Ruechel for The New York Times)

When body-worn cameras were introduced a decade ago, they seemed to hold the promise of a revolution. Once police officers knew they were being filmed, surely they would think twice about engaging in misconduct. And if they crossed the line, they would be held accountable: The public, no longer having to rely on official accounts, would know about wrongdoing. Police and civilian oversight agencies would be able to use footage to punish officers and improve training. In an outlay that would ultimately cost hundreds of millions of dollars, the technology represented the largest new investment in policing in a generation.

Yet without deeper changes, it was a fix bound to fall far short of those hopes. In every city, the police ostensibly report to mayors and other elected officials. But in practice, they have been given wide latitude to run their departments as they wish and to police — and protect — themselves. And so as policymakers rushed to equip the police with cameras, they often failed to grapple with a fundamental question: Who would control the footage? Instead, they defaulted to leaving police departments, including New York’s, with the power to decide what is recorded, who can see it and when. In turn, departments across the country have routinely delayed releasing footage, released only partial or redacted video or refused to release it at all. They have frequently failed to discipline or fire officers when body cameras document abuse and have kept footage from the agencies charged with investigating police misconduct.

Even when departments have stated policies of transparency, they don’t always follow them. Three years ago, after George Floyd’s killing by Minneapolis police officers and amid a wave of protests against police violence, the New York Police Department said it would publish footage of so-called critical incidents “within 30 days.” There have been 380 such incidents since then. The department has released footage within a month just twice.

And the department often does not release video at all. There have been 28 shootings of civilians this year by New York officers (through the first week of December). The department has released footage in just seven of these cases (also through the first week of December) and has not done so in any of the last 16.

Asked about the department’s limited release of footage, a spokesperson pointed to a caveat, contained in an internal order, that footage can be withheld because of laws or department policy. “The NYPD remains wholly committed to its policy of releasing such recordings as quickly and responsibly as circumstances and the law dictate,” the spokesperson wrote. “Though transparency is of the utmost importance, so too is the Police Department’s commitment to preserving privacy rights.” The department did not say which policies require the withholding of footage and did not address other questions about its record on the cameras. (Mayor Eric Adams’ spokesperson did not make him available for comment.)

For a snapshot of disclosure practices across the country, we conducted a review of civilians killed by police officers in June 2022, roughly a decade after the first body cameras were rolled out. We counted 79 killings in which there was body-worn-camera footage. A year and a half later, the police have released footage in just 33 cases — or about 42%.

This article is the product of more than six months spent investigating how the police have undermined the promise of transparency and accountability that accompanied the body-camera movement. We interviewed dozens of department insiders, government lawyers, policing experts and advocates and reviewed hundreds of pages of internal reports, obtained through Freedom of Information requests, and dozens of hours of surveillance-camera and body-camera footage, including some that the New York Police Department fought against disclosing. The reporting reveals that without further intervention from city, state and federal officials and lawmakers, body cameras may do more to serve police interests than those of the public they are sworn to protect.

To Seth Stoughton, a former police officer who is now a professor at the Joseph F. Rice School of Law at the University of South Carolina, body cameras represent the latest chapter in America’s quest for a technological fix to the deeply rooted problem of unchecked state power. “Dash cams were supposed to solve racial profiling,” he says. “Tasers and pepper spray were supposed to solve undue force. We have this real, almost pathological draw to ‘silver bullet’ syndrome. And I say that as a supporter of body-worn cameras.” He later added, “We just said to police departments: ‘Here’s this tool. Figure out how you would like to use it.’ It shouldn’t be a surprise that they’re going to use it in a way that most benefits them.”

Jeff Schlanger, a former New York deputy commissioner who had an oversight role during the implementation of body-worn cameras and left the department in 2021, believes that the police have often failed to use the cameras for accountability and that political leaders need to do more. “Mayors, City Council members, all locally elected officials,” he says, “should be losing sleep over the lack of meaningful independent oversight of the police.”

Jeff Schlanger is a former deputy commissioner who left the New York Police Department in 2021. “Mayors, City Council members, all locally elected officials,” he says, “should be losing sleep over the lack of meaningful independent oversight of the police.” (Naila Ruechel for The New York Times)

When full footage has been released, often by prosecutors or after public pressure, it often contradicts initial police accounts. In 2015, a white officer in Cincinnati killed a Black man during a traffic stop. The officer said his life was in danger. But his body-camera video showed that was a lie, and he was prosecuted for murder. (Charges were dropped after two mistrials.) And in Philadelphia this August, an officer shot and killed a man after, the police said, he lunged at officers with “a weapon.” In fact, footage released by the district attorney — who charged the officer with murder — shows that the man was sitting in his own car.

In New York, Miguel Richards’ parents weren’t the only ones who had doubts about the department’s claims that the shooting was unavoidable. The footage the department released stopped right when the officers fired at Richards. It didn’t include the minutes after the shooting, and it didn’t include footage from other police units that responded.

Ruth Lowenkron, a disability rights lawyer who specializes in mental health issues, wanted to see it all. Working for New York Lawyers for the Public Interest, a legal-advocacy nonprofit, she and her colleagues, along with activists, had begun pushing the city to find an alternative to using the police as first responders to people in crisis. On her second day on the job, a sergeant shot and killed a 66-year-old woman who had schizophrenia and was holding a baseball bat in her Bronx apartment. The department’s own investigators concluded that the sergeant escalated the situation and caused the shooting.

Now, watching the video the department released of Richards’ shooting, Lowenkron feared that the same thing happened to him. The department’s edited footage showed the officers making a few attempts to connect with Richards early in the encounter. “What’s your name, man?” one officer asked. But they were also barking increasingly terse commands. “You are seconds away from getting shot,” one officer said. “Do you want to die?” A few minutes later, as one of them warned that Richards might have a gun, the officers fired.

Lowenkron filed a records request, certain that there was more to the story. In releasing the partial footage, the police commissioner had vowed that the “NYPD is committed to being as transparent as possible.” But nearly three weeks after her request, Lowenkron received a different message from one of the department’s records officers: “I must deny access to these records.”

Ruth Lowenkron has fought the New York Police Department for years for access to body-camera footage in various cases. Of one video she received, she says, “It was a horror movie.” (Naila Ruechel for The New York Times)

Body-worn cameras were adopted by police departments across the country in the wake of widespread Black Lives Matter protests in 2014, sparked when Michael Brown was killed by the police in Ferguson, Missouri. The officer who shot Brown was not equipped with a camera, and there was a dispute about what happened in the last moments of Brown’s life. Amid deep schisms over race, justice and policing, there was at least agreement that police interactions should be recorded. Brown’s mother pressed for the technology to become standard equipment. “Please,” she begged Missouri legislators, “let police-worn body cameras be a voice of truth and transparency.”

President Barack Obama put the cameras at the center of his plans to restore trust in policing. Cities quickly began spending millions on the devices, expenditures that continue today for storage and software. Los Angeles has spent nearly $60 million since getting cameras in 2016. In Philadelphia, where footage is rarely released, the cameras have cost taxpayers about $20 million. New York City has spent more than $50 million. But whether citizens benefit from the cameras they’re paying for is often up to the police, who have often been able to keep footage hidden from the public in even the most extreme cases. In 2018 in Montgomery, Alabama, an officer unleashed his police dog on a burglary suspect without warning, severing the Black man’s femoral artery and killing him. The police and the city have refused to release footage for five years, arguing that it could cause “civil unrest” and that the officers could face “embarrassment.” But a lawyer for the man’s family, which is suing the city, got a copy of the transcript in the discovery process and entered it into the court record. “Did you get a bite?” an officer asked the one who had the dog, according to the document. “Sure did, heh, heh,” the K-9 officer responded.

The secrecy undercuts the deterrent effect on officer behavior that many had presumed body cameras would produce. Three years before the Minneapolis police officer Derek Chauvin murdered George Floyd by kneeling on his neck, body-camera video caught him kneeling on the necks of others. In 2017, Chauvin dragged a handcuffed Black woman out of her house, slammed her to the ground and then pressed his knee into her neck for nearly five minutes. Three months later, Chauvin hit a 14-year-old Black boy at least twice in the head with a heavy flashlight, choked him and pushed him against a wall. The boy cried out in pain and passed out. Chauvin pushed a knee into his neck for 15 minutes as the boy’s mother, reaching to help him, begged, “Please, please do not kill my son!”

The footage was left in the control of a department where impunity reigned. Supervisors had access to the recordings yet cleared Chauvin’s conduct in both cases. Minneapolis fought against releasing the videos, even after Chauvin pleaded guilty in December 2021 to federal civil rights violations in one of the cases. A judge finally ordered the city and the police to release the tapes this April, six years after Chauvin abused the boy. “Chauvin should have been fired in 2017,” says Robert Bennett, a lawyer who represented both of the victims. If the police had done that, “the city never burns. We’d have a downtown still. It’s a parade of horribles. All to keep something secret.”

A Department of Justice report from this summer found that the secrecy and impunity was all part of a larger pattern in the Minneapolis Police Department. Shootings, beatings and other abuse had routinely been captured on video. But the department didn’t make the footage public or mete out punishment.

There was a similar dynamic in Memphis, Tennessee, where officers in a street-crimes unit regularly abused residents. They wore body cameras but faced no consequences until the case of Tyre Nichols, who was beaten to death this January by officers in the unit, attracted national attention. The footage showed that some of the officers took their cameras off. Others knew they were being recorded and pummeled Nichols anyway. It was only after public outcry that the department took the rare step of releasing footage, which contradicted initial police accounts and led to state and federal charges for five officers.

Some politicians have often quietly enabled obstacles to this kind of accountability. When South Carolina became the first state in the nation to require the use of cameras in 2015, Nikki Haley, the governor at the time, made the announcement with the family of Walter Scott standing behind her. Scott was a Black man who, two months earlier, was stopped by the police for a broken taillight and was shot in the back and killed when he tried to run away. A witness filmed the shooting, and that video contradicted official police accounts.

The way to true reform is through using body cams as an early-warning system, as a way to correct small mistakes before they become big mistakes.

—Jeff Schlanger, former New York deputy commissioner

“This is going to make sure Walter Scott did not die without us realizing that we have a problem,” Haley said as she signed the legislation. What the governor didn’t say was that the same law stipulated that footage from cameras is “not a public record subject to disclosure,” thus relieving police departments from any obligation to release it. And indeed, little footage has ever become public in South Carolina.

In 2021, York County sheriff’s deputies responding to a call for a wellness check found a young man sitting in his pickup truck with his mother standing next to him. They fired at him nearly 50 times. The sheriff, who refused to release body-camera footage, said the man pointed a shotgun at deputies. When the man, who survived, obtained the footage after suing, it showed no such thing. So far this year, the police in South Carolina have killed at least 19 people. The police have released footage in only three of those cases. When we asked one department, the Spartanburg County Sheriff’s Office, why it had not, a spokesperson pointed to the law, writing, “We never release that footage.”

The pattern has become so common across the country — public talk of transparency followed by a deliberate undermining of the stated goal — that the policing-oversight expert Hans Menos, who led Philadelphia’s civilian police-oversight board until 2020, coined a term for it: the “body-cam head fake.” And there is no place that illustrates this as well as New York City, the home of the world’s largest municipal police force, some 36,000 officers strong.

New York’s adoption of body-worn cameras started with a moment of unintentional inspiration. In 2013, Judge Shira Scheindlin was hearing testimony in a federal lawsuit in which multiple advocacy groups claimed that the Police Department’s aggressive “stop and frisk” policy was racially biased and unconstitutional. One day during the trial, an expert witness for the city mentioned a new tool for accountability — body-worn cameras — in passing.

“My head snapped when I heard the words,” Scheindlin recalled this year. “I thought, ‘That could be a useful remedy!’”

Two months later, Scheindlin issued a historic ruling that New York’s stop-and-frisk practices were unconstitutional. She ordered the Police Department to begin piloting body-worn cameras, writing that they were “uniquely suited to addressing the constitutional harms at issue in this case.” Scheindlin laid out three ways the cameras would help: “First, they will provide a contemporaneous, objective record of stops and frisks.” She continued, “Second, the knowledge that an exchange is being recorded will encourage lawful and respectful interactions on the part of both parties. Third, the recordings will diminish the sense on the part of those who file complaints that it is their word against the police.”

But in a preview of obstacles that would follow, the department was slow to roll out the devices, even as they were becoming common in other cities. More than two years after Scheindlin’s ruling, the department hired researchers at New York University to conduct a survey about what residents wanted from a body-camera project. The community’s answers were overwhelming and clear: transparency and disclosure.

Officers, however, wanted the opposite. They were concerned that the recordings would “show a different side of the story than what would otherwise be told,” according to a separate NYU survey. To Scheindlin and the plaintiffs in the stop-and-frisk case, that was exactly the point.

When the department released its policy in April 2017, it was clear whose opinions held more sway. No video would automatically become public. Anyone that requested it would have to go through an opaque, often slow-moving Freedom of Information process — in which the department itself would be the arbiter of what would be released (though the courts could review that decision).

The policy blunted the technology’s potential for accountability in other ways. Officers could decide when to start filming, instead of at the beginning of all interactions as the public wanted. And while the public had little access to footage, the police had privileged access: Officers who were the subjects of complaints would be allowed to watch the footage before having to give any statements — something that could allow them to tailor their accounts to the video.

The policy was “so flawed that the pilot program may do little to protect New Yorkers’ civil rights,” Ian Head and Darius Charney of the Center for Constitutional Rights wrote in a guest essay in The New York Times. “Instead, it might shield police officers from accountability when they engage in misconduct.”

Still, on April 27, 2017, Commissioner James O’Neill and Mayor Bill de Blasio held a news conference at a precinct in Washington Heights to celebrate the rollout of body-worn cameras. Stepping up to the lectern, O’Neill said he was initially skeptical of the cameras but had become a believer. “I’m totally convinced now that this is the way forward,” he said. “These cameras have a great potential to de-escalate.”

Then the mayor went to the lectern. Officers had long felt that de Blasio, a self-proclaimed progressive, was too supportive of Black Lives Matter protests and not sufficiently supportive of the police. That sentiment turned into rage when a man espousing hatred of the police murdered two officers in late 2014. Hundreds of police officers turned their backs on the mayor at the funerals. Ever since, de Blasio had been working to repair the relationship.

“This is an historic day for New York City,” de Blasio said, with O’Neill by his side. “This is the first day of the era of body-worn cameras, and that means we are going on a pathway of transparency and accountability that will benefit everyone.”

Five months later, officers killed Miguel Richards, making his case the first in which the potential of body-camera video would be tested. But Ruth Lowenkron, the public-interest attorney who filed a request for the footage, was getting little from the Police Department. After it rejected her initial request, she appealed the decision. The department sent her some redacted footage but again rejected her request for all of it.

Disclosing the full footage would be an “unwarranted invasion of personal privacy,” the department wrote. Whose privacy — the dead man’s or the officers’ — was not explained. Releasing the full footage, the department insisted, could “endanger the life or safety of any person.”

The letter came from the department’s legal unit, led by its deputy commissioner, Larry Byrne, who was known for his fierce advocacy for the department. From the outset of the body-worn-camera program, Byrne made it clear that he was resistant to widespread release of footage. “They are not public records in the sense that, because the officer turns the camera on, they are now in the public domain,” Byrne told NY1 in 2015. In fact, he insisted, “most of this footage” would never be made public.

Lowenkron kept requesting the Richards footage and kept getting rejected or sent redacted video. In July 2018, she and her colleagues decided to file a lawsuit in state court demanding the full footage. They even got a former Police Department lawyer, Stuart Parker, to help litigate the suit pro bono. The department’s various explanations for its denials “pissed me off,” Parker recalls. He retired from the department as an assistant commissioner in 2016, the year before cameras were widely rolled out. But he had been excited by their potential and was frustrated by the department’s kneejerk secrecy. “There’s a good side to the department,” he says, “but there’s always been a self-serving dark side to it too.”

In response to the suit, the department argued in legal filings that it had blurred the footage “in order to protect the privacy of both Richards and his family.” But Lowenkron and her team had obtained affidavits from Richards’ parents saying that the department never asked them whether they wanted the footage released or redacted. And what the Richardses wanted, they said, was for the full footage to be released to the public.

Public disclosure of footage isn’t the only path to hold officers in New York accountable for misconduct. For 70 years, the city’s Civilian Complaint Review Board had been vested with the responsibility to investigate New Yorkers’ allegations against the police. From the start, though, its powers were weak. The agency was actually part of the Police Department, and its board consisted of three deputy police commissioners. The department fought efforts over the years to make the agency independent. In the face of a plan in the mid-1960s to include civilians on the Civilian Complaint Review Board, the head of the largest police union, then called the Patrolmen’s Benevolent Association, said, “I’m sick and tired of giving in to minority groups with their whims and their gripes and shouting.”

The agency eventually became independent in 1993 after stiff opposition months before from off-duty officers. Thousands of them — along with Rudy Giuliani, then a mayoral aspirant after losing the previous election — staged a huge protest outside City Hall, with many of them going on to block the Brooklyn Bridge. After the changes, the review board still relied on an often noncooperative Police Department for records, and its investigations frequently petered out amid competing accounts. And like many civilian oversight boards across the country, in the rare cases when it substantiated misconduct, it could only recommend discipline to the police commissioner, who could and often did ignore it.

Many civilians, whom the board relied on to initiate complaints, had long grown skeptical of the agency’s ability to ensure that officer misconduct had consequences. But the advent of body-camera video promised to fundamentally change how the agency worked. For the first time, staff members would have an objective record of the incidents they investigated. That was Nicole Napolitano’s hope when she joined the review board as its new director of policy and advocacy in September 2017 — the same year body cameras were rolled out in New York and one week after officers killed Richards. “We talked about it in detail” at the agency, she says of the initial footage of the Richards shooting. “We thought, ‘Look at what body-worn cameras can show us.’”

Napolitano, who is married to a retired detective, knew it would be a challenge. As a senior policy manager in the Office of the Inspector General for the New York Police Department, she had seen how the department could simply ignore the recommendations in her reports. Napolitano hoped she would have more direct impact in her new, more senior position at the review board. But what she hadn’t appreciated was how much the police controlled the literal tools of their own oversight.

Nicole Napolitano, as director of policy and advocacy at the Civilian Complaint Review Board, argued for a law that would take away the New York Police Department’s sole control over camera footage. She was let go in November 2020. (Naila Ruechel for The New York Times)

As with most civilian boards across the country, the agency did not have its own access to footage. Like the public, it, too, had to rely on the cooperation of the department. To try to obtain footage, the board had to navigate a baroque multistep process. Written requests were submitted to a department “liaison” unit, which in turn forwarded them to the legal unit for review. Then the department had to locate the footage, which was a significant undertaking because it wasn’t cataloging the footage in any systematic way. Unlike in many other cities, the department’s cameras had no GPS location data. If a civilian making a complaint didn’t know an officer’s name or badge number, investigators and even the department could have a hard time finding footage.

Perhaps most problematic for Napolitano, though, was the fact that the review board’s investigators had to agree to a strict set of conditions before watching videos of incidents. If they spotted other, unrelated misconduct, they were not allowed to investigate it. “If you were setting up a system to be shitty,” one agency insider says, “this is the system you’d create.”

At times, the department’s animosity toward the board was palpable. Napolitano remembers one meeting in 2017 between board officials and Kerry Sweet, then a top official at the department’s legal bureau who helped oversee the body-camera rollout. As other police brass shuffled in, Sweet said they had missed a chance to “bomb the room” when only board officials were there, which would have “solved everything.” (Sweet, who has since retired, says he doesn’t recall saying that, but added, “On reflection, it should have been an airstrike.”)

Napolitano and her colleagues noticed an even more troubling trend: The department would often tell the review board that the footage it requested didn’t exist — only for the civilian agency to later discover that wasn’t true. According to an analysis the agency put out in early 2020, this happened in nearly 1 of every 5 cases.

Napolitano thought there was a straightforward solution to the department’s stonewalling: The review board should be able to directly log in to the department’s system where footage is stored. That’s how it worked with civilian oversight boards in a few other major American cities, including Chicago, which revamped civilian oversight after Laquan McDonald was killed in 2014 and the city tried to withhold footage that contradicted officers’ accounts. Chicago’s oversight board now not only has direct access to videos but also regularly releases footage publicly, and its investigators have used it to successfully push for officers to be fired for misconduct. Napolitano didn’t see a reason for it to be otherwise in New York. So in her first semiannual report, at the end of 2017, she noted the challenges of getting footage — and called on the city to give the review board direct access. Both the department and City Hall, Napolitano says, “freaked” out.

“It was a rough time for de Blasio when it came to public safety,” Napolitano added, referring to the mayor’s tenuous relationship with the police. “In a dispute between CCRB and NYPD, City Hall always chose the NYPD. Always.”

“I don’t agree,” de Blasio says. “The tension between the CCRB and the NYPD is natural and built-in. I decided each issue on the merits and according to my values.” He went on, “The blunter truth is when a progressive challenges the police culture and the police unions and the status quo of American policing, the left is not going to have their back. You’re not getting that thank-you card. And the right will viciously attack.”

While the department fought Lowenkron and Napolitano on the release of body-camera footage, there was one group that had access to all of it and could use it to check for misconduct: the department’s own investigators. After every police shooting, detectives with the Force Investigation Division review the incident to see whether officers complied with department policy. The Richards case was the first time body-worn-camera footage could let them see what actually happened in a killing by officers. As investigators dug through the video and interviewed officers in the weeks and months after the shooting, they saw a far more complicated picture than the one the police commissioner painted.

As the tape began, one officer, Mark Fleming, beamed his flashlight into the far side of Richards’ nearly bare, unlit bedroom. Richards was standing perfectly still in the dark, seemingly catatonic, wearing a blue polo shirt and sunglasses and holding a knife in his left hand.

Department guidelines for dealing with people in crisis who do not pose an immediate threat say officers should try to “isolate and contain” the person. “The primary duty of all members of the service is to preserve human life,” department policy states. Officers are also instructed to wait for a supervisor’s permission before trying to subdue someone in crisis.

At first, it appeared that the officers who encountered Richards were following their training. “Look, we could shut the door,” Officer Redmond Murphy suggested to his partner. But Fleming, who had served more years in the department, quickly rejected the idea. He kept telling Richards to drop the knife, and he radioed for an officer with a Taser.

Two officers from the specially trained Emergency Services Unit, which deals with people experiencing mental health crises, arrived. Then Murphy said he thought he saw something, perhaps a gun, in Richards’ right hand, which was obscured behind a backpack on the bed. “Hold up,” one of the ESU officers told Fleming and Murphy before heading back downstairs to grab protective gear. “I don’t know if it’s a toy or a gun,” Murphy quickly added.

As the specialists went downstairs, the officer with the Taser, Jesus Ramos, went upstairs and joined Fleming and Murphy outside Richards’ room. “Do you want to take him down now?” Ramos asked them. “Yeah,” they both answered.

At nearly the same moment, a radio command came from headquarters, emphasizing department guidelines. “Isolate and contain,” the dispatcher told the officers. “Use nonlethal force whenever possible.” As Ramos lifted his Taser and stepped into the room, Fleming — who later said Richards was raising his arm — fired his gun. Murphy fired, too. It’s impossible to see that moment in the grainy, shaky footage. The clearest angle would most likely have been Fleming’s camera, but it was covered by his arm as he held his flashlight.

The shooting of Miguel Richards was the first to be recorded by NYPD body cameras. Police Commissioner James O’Neill wrote in an internal message that releasing footage would show officers’ “restraint in the use of force.” Below are clips from the videos the police initially released. They contain graphic content.

Officers answered a call for a wellness check and found Richards standing still in the far corner of his bedroom, holding a small folding knife. “Look, we could shut the door,” Officer Redmond Murphy said at one point. Instead, police shouted at Richards for the next 15 minutes.

Watch video ➜

Murphy says he thinks he sees something in Richards’ hand: “I don't know if it's a toy or a gun.” Officer Mark Fleming says: “I don’t want to shoot you if you’ve got a fake gun in your hand. You hear me? But I will shoot you if that’s a real gun.”

Watch video ➜

A radio command from headquarters reminded the officers of NYPD guidelines to “isolate and contain” a person in a mental health crisis and to “use nonlethal force whenever possible.” Fifteen minutes after arriving, they opened fire. An internal investigation later found that Richards “was contained and posed no immediate threat of danger.”

Watch video ➜

Fleming and Murphy fired 16 times, hitting Richards seven times, including twice in the chest, rupturing his aorta. As gunshots rang out, the supervisor they were supposed to wait for arrived. (None of the officers responded to requests for comment.)

The internal investigators asked the officers to explain. “We kind of handle everything on our own,” Murphy offered. An internal investigator pressed Fleming about what had “situationally changed” and prompted the decision to “take him at that point.” Fleming said everything changed once his partner said Richards might have a gun. “I perceived that his intentions were lethal,” Fleming said. But his answers suggested that he hadn’t fully grasped Richards’ mental state. “Why would any sane person hide a fake gun?” Fleming asked.

When the investigators asked why the two officers did not broadcast that Richards was an “EDP” — or an emotionally disturbed person — with a knife, as protocol dictates, Murphy told them he and Fleming had handled people in crisis before. Asked why they made the decision to use force, Murphy simply said, “We wanted to, like, end it.”

While the Force Investigation Division ultimately concluded that the officers had been “justified” in shooting — because they were facing an “individual armed with a knife and an imitation firearm” — the investigators also said that Fleming and Murphy should still be punished. Richards, their September 2018 internal report noted, “was contained and posed no immediate threat of danger.” And the officers violated policy by not asking permission from their supervisor before they acted. The department’s full investigative record was first reported by the independent journalist Michael Hayes in his 2023 book, “The Secret Files.” The review recommended that the officers face disciplinary charges that could ultimately result in their firing.

But in New York, as in almost all cities in the United States, the police commissioner has absolute power over punishment. In March 2019, O’Neill, who had extolled the promise of body cameras just two years earlier, overruled his own investigators. He decided that neither Fleming nor Murphy would be punished for killing Richards. Instead, the commissioner docked them three vacation days for something else they did: stopping for pizza before responding to the call for the wellness check. (O’Neill did not respond to questions or requests for comment.)

It would be another three months before anyone outside the department would see the full footage. That June, a New York judge ruled that the “public is vested with an inherent right to know” and ordered the department to turn over the recordings to Lowenkron’s organization.

She received a package with a DVD a month later from the department. Bracing herself, she sat down to view it on her computer. The footage that the department publicly released cut off when the officers fired. Lowenkron now saw the aftermath: Richards collapsed to the floor, crumpled and bleeding in the same spot where he had been standing rigidly seconds before.

“He’s still alive,” Fleming said.

“Holy shit,” Murphy replied. “Just fucking cuff him.”

The officers then flipped over Richards, severely injured, so roughly that his head could be heard bouncing off the floor.

They searched around the room for the firearm they thought Richards had. Eventually, Fleming found a palm-size, silver-colored plastic toy gun. “It’s some fucking little thing,” he said. (The video does not show Richards holding the toy gun.) More than three minutes passed before anyone administered any type of aid to the dying man. It was an Emergency Services Unit specialist who retrieved medical equipment after hearing the shots.

Outside the apartment building, more video recorded other officers milling about. One told a colleague, “They were just hurling fucking shots.”

The NYPD initially withheld the footage of the aftermath of the Richards shooting. Below are clips from the videos that a state judge later ordered released. They contain graphic content.

As the officers move into Richards’ room moments after shooting him, Fleming observes, “He’s still alive.” Murphy is breathing heavily. “Holy shit,” he says.

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The officers ask one another if they are all right as they mill around Richards’ injured body. He is handcuffed and flipped over so roughly his head can be heard bouncing heavily on the floor.

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As more officers arrive outside Richards’ apartment building, one tells a colleague, “They were just hurling fucking shots.”

Watch video ➜

Lowenkron was shocked. Officers had shot a young man and roughly handled him as he bled to death. “The utter disrespect,” Lowenkron says. “It was a horror movie.”

New York Lawyers for the Public Interest would go on to share the footage with journalists. It would also use the footage in a webinar for mental health advocates in November 2020. “The point,” Lowenkron told me, “was to get more people engaged on this issue: transforming New York and this country’s response to people in crisis.”

But by then, for another man in distress, it was too late.

In April 2019, one month after O’Neill decided against punishing the officers for the Richards shooting, another officer shot and killed a man named Kawaski Trawick.

The circumstances were remarkably similar to those in the Richards case. Trawick was also a young Black man who lived in the Bronx and was experiencing a mental health crisis in his own apartment. He was also holding a knife when the police arrived. And he was also shot soon afterward. At the Civilian Complaint Review Board, Napolitano was immediately struck by the parallels: “I remember reading the headline on Trawick and thinking, ‘Didn’t I read this already?’”

This time, though, the victim’s family filed a complaint with the review board, providing an opening for civilian investigators to use body-worn-camera footage to make a case that the department and others couldn’t ignore.

But despite repeated requests over many months, the department wouldn’t share the footage — or any other records — with the review board, leaving the oversight agency effectively unable to begin its own investigation of the case. The refusal was in line with the department’s longstanding practice to withhold footage from the board until the department’s internal investigation was over, a process that often takes more than a year. Such delays can effectively torpedo the review board’s investigations: Under New York civil-service law, any disciplinary cases against police officers must be brought within 18 months of the incident.

In the Trawick case, the review board obtained the full body-camera video in January 2021 — more than a year and a half after the killing — and only after a state judge ordered the department to hand it over to Lowenkron’s organization, New York Lawyers for the Public Interest, which had sued for it. The judge determined that the department had been withholding the footage “in bad faith.”

What it showed was even more damning than what was captured in the Richards shooting. As the police entered his apartment, Trawick demanded to know, “Why are you in my home?” One officer, Herbert Davis, who was Black and more experienced, then tried to stop his white junior counterpart, Brendan Thompson, from using force. “We ain’t gonna tase him,” Davis said in the video.

Thompson didn’t listen. Instead, he fired his Taser at Trawick, sending roughly 50,000 volts pulsing through him. As Trawick started rushing toward the officers, Thompson lifted his gun and prepared to fire. “No, no — don’t, don’t, don’t, don’t, don’t,” Davis said, pushing his partner’s arm down. But Thompson fired four shots, hitting Trawick twice and killing him almost instantly, 112 seconds after they arrived at the apartment. (Davis and Thompson did not reply to requests for comment.)

There was also troubling footage of the aftermath of the shooting. Officers swarmed outside Trawick’s apartment. “Who’s injured?” a sergeant asked. Two officers replied in near unison: “Nobody. Just a perp.”

With all that in hand, the review board completed its investigation in June 2021. The agency, through one of the few powers it had gained over the years, can file and prosecute disciplinary cases against officers — which triggers a Police Department trial, after which a departmental judge sends a provisional decision to the police commissioner, who makes the final call.

This September, the police judge overseeing the Trawick case recommended that there should be no discipline. Her reason had nothing to do with the shooting itself; in fact, the judge wrote that she had “serious doubts” about the decisions of the officer who killed Trawick. But the review board, she said, had failed to file charges within the 18-month statute of limitations, as outlined under state law. In the end, the department’s refusal to give the footage to the review board had effectively run out the clock on any chance the officers would be punished.

“That should not be tolerated,” says Jeff Schlanger, the former deputy commissioner. “Both CCRB and NYPD are city agencies. This is something the mayor needs to resolve.”

In the wake of George Floyd’s murder in 2020, huge demonstrations for racial justice and against police brutality rolled across the country and the world. It was a global reckoning brought on by footage — the video, recorded by a teenager on her smartphone for more than eight minutes, showing Derek Chauvin ending Floyd’s life.

Napolitano and her team at the review board had collected data showing how footage could make a difference in New York too. Access to body-camera footage roughly doubled the likelihood that agency investigators would be able to decide a case on its merits rather than dismiss it as inconclusive. But the backlog was growing. That May, the board filed 212 requests with the Police Department for body-worn-camera footage — and the department sent only 33 responses. (While the pandemic slowed the work of all city agencies, the backlog predated it.)

“The withholding of footage stops investigations and prevents the CCRB from providing adequate and meaningful oversight of the NYPD,” an internal agency memo warned. “The situation for New York City oversight of the police has steadily grown worse during the duration of a BWC program intended primarily to aid oversight.”

We just said to police departments: ‘Here’s this tool. Figure out how you would like to use it’ It shouldn’t be a surprise that they’re going to use it in a way that most benefits them.

—Seth Stoughton, a former police officer who is now a law professor at the University of South Carolina

Napolitano campaigned internally for a law that would take away the department’s absolute control over footage and give the review board its own access. That November, she was let go, along with three other staff members who had sent pointed emails and memos about the department’s withholding of footage. The four filed a lawsuit claiming that their firing violated their First Amendment rights and received an undisclosed settlement. A review-board spokesperson wrote in an email that the agency has “publicly and repeatedly called on legislators to support the fight for direct access. No employee has ever been fired for supporting direct access to BWC footage.”

This spring, the City Council speaker, Adrienne Adams, and the New York City public advocate, Jumaane Williams, sponsored a bill that would give the review board direct access to footage so that it wouldn’t be beholden to the department for cooperation during investigations. “There are difficult split-second decisions that have to happen” in policing, Williams told me. “But if we’re not able to look at the same thing, if we have to take the word of the NYPD, that doesn’t make this conversation any easier.”

The Police Department has opposed the bill. A department official insisted at a City Council hearing in March that the department “does not fear transparency.” But the official argued that it would be an “insurmountable obstacle” to give the review board direct access while following state confidentiality laws. The bill has been stalled for months.

The city, meanwhile, paid out at least $121 million in settlements last year for lawsuits alleging misconduct by police officers — the highest total in five years.

With footage remaining in the control of the Police Department, body-worn cameras have made little difference to the public. This year, a federal court monitor wrote a scathing report about persistent problems with stop-and-frisk, the unconstitutional policing tactic that prompted Scheindlin to order the department to adopt body cameras a decade ago. The monitor found that contrary to Scheindlin’s expectations, police supervisors weren’t using footage to flag misconduct. In a sample of cases the monitor looked at, supervisors reviewing footage of stop-and-frisk encounters concluded that 100% of the cases they looked at were proper stops. The court monitor reviewed the same footage and found that 37% of the stops were unconstitutional.

“It was an experiment,” Scheindlin says, one that didn’t anticipate issues like control over footage. Scheindlin, who stepped down from the bench in 2016, says she now believes that the Police Department should no longer be the sole custodian of its own video. “That troubles me,” she says. “It should always be somebody independent.”

In interviews with a half-dozen former commanders and high-level officials, most of whom were involved in the body-camera program itself, they said that despite its public pronouncements, the department hasn’t committed to using footage for accountability. “Body cams are essential, if done right,” says a high-ranking commander who just retired and who spoke on the condition of anonymity because he still works in law enforcement. “They are a game changer.” He added, “If there’s a problem, you flag — and potentially there’s discipline. But that’s not happening in most cases.” Instead, he says, body cameras have become “an exercise in just work they have to do. It’s a culture thing.”

Rudy Hall has a particularly useful vantage point. He was part of the team that rolled out the body cameras, visiting police departments around the country to see how they were using the technology, and has gone on to work for the federal monitor overseeing the department’s compliance with Scheindlin’s now-decade-old order on stop-and-frisk. “I watch a lot of body-cam videos,” Hall told me. “I have absolutely seen supervisors approve problematic conduct.”

“Body-worn cameras have not been exploited the way they should be,” says Jeff Schlanger, the former deputy commissioner. “The way to true reform is through using body cams as an early-warning system, as a way to correct small mistakes before they become big mistakes. But there weren’t a lot of discussions about it. The NYPD needs to do a lot better.”

One of the most comprehensive studies of the use of body cameras, a 2019 meta-analysis led by researchers at George Mason University, recommended that police departments consider using footage the way sports teams use game tape, to regularly review and improve performance. That’s essentially what the New Orleans Police Department did after the U.S. Department of Justice put it under federal oversight about a decade ago in response to the police killings of several Black men and persistent police violence. Body cameras were a “critical engine for us to continuously evaluate performance,” says Danny Murphy, who ran a unit at the department overseeing compliance with the federal mandate.

Four auditors were hired to join the police force and comb through footage. They looked to make sure that officers were using their cameras and that supervisors were flagging any problematic behavior. “If officers know they’re being viewed, if supervisors know they’re being reviewed, it creates a pressure for accountability,” says Murphy, who left the department four years ago. A 2020 report from the city’s civilian oversight agency — which has direct access to footage — noted a reduction in both the use of force and citizen complaints, which the department attributed to “the use of the body-worn cameras and the increased scrutiny and oversight these cameras provide leadership.” The police in New Orleans also regularly and quickly release video from shootings and other major incidents. But in the end, it’s the police chief who has the final say on discipline.

During his tenure at the New York Police Department, Schlanger had, in fact, started a kind of internal oversight system similar to the one in New Orleans. Schlanger and other senior officials would meet with each of the department’s 77 precincts every six months and look at body-camera footage to identify problematic trends and officers. “It was CompStat for constitutional policing,” Schlanger says, referring to the department’s data-heavy program for tracking crime. “If we saw a precinct doing poorly, we’d work to help them. It made a difference.”

The department quietly ended the review program last year.

A civil suit on behalf of Miguel Richards’ estate was filed against the city in 2018. New York is seeking the dismissal of the case. A judge has been considering the request for two and a half years. “I want answers,” his mother told me, “and haven’t been able to get them.”

The three officers involved in the Richards shooting were honored in 2018 by the largest New York police union, the Police Benevolent Association, which gave them its Finest of the Finest award for “extremely brave and tactically sound action” in the Richards shooting, noting that “the officers had no choice but to open fire.”

The officers were later deposed in the lawsuit. One of them, Mark Fleming, said in his testimony in September 2020 that he had learned a lesson: that the Emergency Services Unit — whose help he told department investigators he didn’t need — is in fact better equipped and trained to deal with situations that involve people having a mental health crisis.

It’s not clear what, if any, lessons the department itself has taken in. Since Richards’ death in 2017, when cameras were widely rolled out, officers have killed at least 11 people in crisis. There is no evidence that officers have been punished in any of the cases.

Photographs of Miguel at the Richards home in Jamaica. “I want answers,” his mother says, “and haven’t been able to get them.” (Naila Ruechel for The New York Times)

On a Sunday morning in the Bronx this spring, there was another shooting. Santo de la Cruz called a city emergency line. His son, 42-year-old Raul de la Cruz, was in the middle of a schizophrenic episode and had posted a disturbing video on Facebook that morning. Wearing camouflage clothing and a hat with a patch of an Israeli flag, Raul complained about racist police officers. His father called 311, avoiding 911 because he was afraid of what would happen if the police showed up. “I thought they would send someone capable of dealing with a situation like that,” he says in Spanish. “Because I was calling for a sick person, not to send the police to shoot him up.” But it was the police who arrived, with body cameras rolling. And Raul was holding a knife.

The officers shot him 28 seconds after arriving. He was hospitalized for more than a month before being released, having lost a kidney and part of his liver. A department commander cited the body-camera footage when he gave a brief news conference the day of the shooting to describe what happened. “This situation was fast, volatile and dangerous,” he said. The officers’ “quick response saved at least one civilian and protected themselves.”

But the department has not released the footage or commented in the eight months since.

Lowenkron’s colleagues at New York Lawyers for the Public Interest have once again requested the video, so far to no avail. The department has also withheld the footage from the Civilian Complaint Review Board, per the practice of sharing records with the agency only after its own investigation is done.

On Dec. 5, weeks after we sent questions to the department about that practice, the department signed a memorandum of understanding with the board to send footage to it within 90 days of a request.

But for now, nobody outside the department knows exactly what happened in the de la Cruz shooting, including the family. They have not heard anything from the department. They want to see the footage.

Do you have a tip about policing or another subject? Eric Umansky can be reached by email at eric.umansky@propublica.org and on Signal and WhatsApp at 917-687-8406.

by Eric Umansky, with additional reporting by Umar Farooq

Michigan Enacts Laws to Reform Its Juvenile Justice System

11 months 1 week ago

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In 2020, the detention of a Michigan teenager for failing to do her homework drew widespread outrage: protests outside the facility where she was held and petitions calling for her release. More broadly, the case of the girl identified as Grace put scrutiny on a troubled system that allowed a 15-year-old to be locked up for months for a noncriminal offense.

The following year, Gov. Gretchen Whitmer appointed a task force to study the state’s juvenile justice system. It recommended changes to state law, policy and funding, many of which advocates had been calling for.

On Tuesday, more than three years after ProPublica highlighted Grace’s case, Michigan’s lieutenant governor signed bipartisan legislation intended to transform how the state handles young offenders.

The package of 19 bills signed by Lt. Gov. Garlin Gilchrist II aims to keep young people out of the court system and detention when they get in trouble and instead provide more funding for community-based help, such as family counseling and mental health treatment. Other reforms include eliminating most fines and fees for juvenile defendants and their families and providing state funding for attorneys to represent young people who want to appeal their cases but can’t afford legal help. (Gilchrist signed the bills because Whitmer was unavailable and criminal justice reform has been a key interest for the lieutenant governor.)

Grace’s mother attended the bill signing.

“It was emotional because I’m like, This is happening, it really is happening, and it is going to benefit so many youth,” she said.

Grace was 15 and the pandemic was just starting when she failed to do her online homework, a requirement of her probation the year before for fighting with her mother and stealing a cellphone, which was returned hours later. A judge sentenced her to a juvenile detention center in a Detroit suburb because of the violation.

A Michigan appeals court ordered her release about a month after ProPublica published its investigation. She has since graduated from high school and is in college.

Grace, who ProPublica has identified by her middle name to protect her identity, called the reforms “a victory for youth and a step toward breaking the pipelines and cycles.”

“I hope we can continue to learn from the youth of yesterday to better support, guide and understand the youth of the future,” she wrote in a text message.

Grace and her mother hug outside their home in suburban Detroit in 2020. (Cydni Elledge, special to ProPublica)

Jason Smith, executive director of the Michigan Center for Youth Justice, an advocacy group, said that Grace’s case spurred necessary change. Until then, Michigan leaders had been focused on reforming the adult criminal justice and child welfare systems, but juvenile justice had been less of a priority.

“It definitely was a catalyst for getting folks, especially at the state level, to take juvenile justice reform seriously,” Smith said. “This was an opportunity to really act and address some long-standing issues within the system.”

Many of the changes were recommended last year by the Michigan Task Force on Juvenile Justice Reform, chaired by Gilchrist, with members including judges, lawmakers, court officials and families that had experience in the system. The group spent a year digging into why Michigan incarcerates so many young people for noncriminal offenses and then suggested ways to reduce the number. The task force found that decisions about whether to detain a juvenile as well as access to services, such as mental health treatment, often depend on where you live.

Data obtained by the task force from 32 counties, representing about 55% of the juvenile population, determined that roughly 23% of cases referred to courts by prosecutors were for noncriminal offenses such as truancy, running away and incorrigibility. These “status offenses” are only punishable because the person is a minor. An additional 26% of cases were for low-level misdemeanor offenses. Nearly 12% involved children 12 and under.

The legislative changes will not eliminate the detention of children for technical violations of probation or for status offenses, even though that was recommended by the task force. Some states have outlawed that practice. According to 2017 federal data, Michigan held more young people for status offenses than 46 other states, a ProPublica investigation found. Nearly half of those juveniles were Black, and the majority were female.

Still, through changes in policy and funding, the bills aim to keep low-level offenses out of the courts altogether and, when young people are in court, to steer them toward community services rather than detention.

“Every system that does something other than prepare a young person to be successful is a system that desperately needs to be reformed,” Gilchrist, a Democrat, said at the bill signing in Detroit. “There are a lot of things that you can do to help a person besides lock them up. And so we need to have more options, we need to have more choices, and those choices need to be better supported. And this provides a pipeline and a pathway for more of those services to be available for more people in Michigan.”

One reform signed into law Tuesday requires that courts and law enforcement use screening tools to assess a young person’s risks and needs before deciding whether detention is the right option. The standardized assessments are designed to match youth with the most appropriate level of supervision; only some counties in Michigan currently use these tools.

The legislation also prioritizes state funding for community-based services — such as family counseling, mental health support and substance abuse treatment — over detention and residential placements.

Under the current system, the state’s Child Care Fund Unit reimburses counties 50% for juveniles diverted to community programs. The state will now instead pay 75% of those costs, but still cover only 50% of the cost of detention and longer-term residential placement. The change could encourage county courts to rely more on community service programs because they would get more of the cost reimbursed by the state.

State funding also could be used for what is known as “pre-arrest diversion,” which would allow law enforcement to connect children to services without them being arrested or ordered to court.

Another reform establishes an Office of the Child Advocate, which will be responsible for investigating complaints about juvenile justice facilities, including detention facilities. Until now, a similar office only was responsible for investigating complaints related to children in the welfare system.

Most of the laws take effect Oct. 1 to allow time for the state to provide the increased reimbursements to the counties for community services and for courts to adjust to the changes. The legislation establishing the Office of the Child Advocate is expected to take effect soon.

One bill that did not pass before the end of the legislative session would have mandated legal representation for young people in the criminal justice system who can’t afford it, and it would have required the state to pay for it. The law also would have provided training for attorneys and oversight to help ensure quality representation.

While a separate new law will provide access to attorneys for youth appealing their cases, there is currently no state funding for juvenile defense at the earlier stages, something that Grace’s mother said is crucial for a more just system.

“While there has been progress,” she said, “there is more progress to be done.”

by Jodi S. Cohen

Idaho Keeps Some Psychiatric Patients in Prison, Ignoring Decades of Warnings About the Practice

11 months 1 week ago

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One night in March 1976, a young advocate for people with mental illness arrived at the Idaho statehouse with a warning.

Marilyn Sword urged lawmakers not to ratify a system that would ultimately lock away some of Idaho’s most debilitated psychiatric patients in the tiny, concrete cells of a maximum security prison — a kind of solitary confinement with no trial, no conviction and often no charges.

Idaho didn’t have any psychiatric hospitals secure enough for patients whose break with reality made them lash out in fear, anger or confusion. What it did have was a maximum security prison.

Sword said putting prison officials in charge, as lawmakers were contemplating, could violate the civil rights of patients committed by the court for hospitalization. She said it would burden them with “the double stigma of being mentally ill and then being placed in a maximum security unit at the penitentiary,” minutes of the meeting show.

Idaho leaders plunged forward with the legislation anyway.

In the five decades since, Idaho has continued to ignore warnings over and over that its law fails mental health patients by sending them to a cell block, ProPublica found in a review of legislative records and news clips.

“I think it’s really tragic that it has been this many years, and we’re still at this point,” Sword, now 77, said in an interview this summer.

Marilyn Sword was among the first mental health advocates to warn Idaho lawmakers in the 1970s that Idaho’s plan to house “dangerously mentally ill” patients in prison may violate their civil rights. Sword testified in 1976 as president of the Idaho Mental Health Association. (Sarah A. Miller for ProPublica)

Governors, lawmakers and state officials have been put on notice at least 14 times since 1954 that Idaho needs a secure mental health unit that is not in a prison.

They also have been told publicly at least eight times since 1974 that Idaho may be violating people’s civil rights by locking them away without a conviction, and that the state could be sued for it.

The most recent warning came this year, when Idaho’s corrections and health and welfare directors wrote that the practice was a problem “not only because of our lack of appropriate levels of care for this population but because the treatment violates the patients’ civil rights.”

Idaho will soon be the last state to legally sanction the practice of imprisoning patients who are “dangerously mentally ill,” to use Idaho’s parlance, but who are not criminals. New Hampshire is phasing it out.

State leaders repeatedly have defended Idaho’s approach — in 1977, 2007 and 2017 — as a temporary measure while the state worked on a stand-alone clinical unit or a permanent secure wing in a hospital. Those facilities never materialized.

At the start of this year, the Legislature refused to use any of Idaho’s $1.4 billion surplus to build a $24 million mental health facility for patients, opting to continue holding them without charges at the state’s maximum security prison south of Boise.

In placing patients who have not been charged with crimes in prison instead of in a treatment facility, Idaho is at odds with the U.S. Substance Abuse and Mental Health Services Administration. Holding prisoners with mental illness in prolonged seclusion also goes against recommendations of the American Psychiatric Association, the American College of Correctional Physicians, federal courts and the United Nations.

ProPublica and Mississippi Today have reported on a related issue recently: how Mississippi keeps hundreds of people with mental illness in county jails as they await appropriate hospital beds.

Idaho’s practice touches far fewer people and typically addresses more extreme behaviors. But it also stands apart because the Idaho patients are locked up longer — an average of 110 to 160 days in recent years — and in solitary confinement, in a maximum security facility, under a program fully endorsed in Idaho statute.

C Block holds the acute behavioral health unit of the Idaho Maximum Security Institution. The prison block is divided into three sections, one of which has nine cells for men considered “dangerously mentally ill.” They include patients who haven’t been charged or convicted of a crime. (Sarah A. Miller for ProPublica)

Joe Stegner, a former Republican leader, helped bring Idaho closer than ever toward building a hospital to replace the cell block in 2007 and 2008. Yet the project he championed was no match for Idaho’s inertia and austerity.

The defeat helped seal his retirement from politics.

“I started thinking, ‘You know, if you can’t have some wins in the Legislature, why are you kicking yourself around?’” Stegner, who served as a senator, said in an interview this summer.

“I set out to make a difference,” he said.

“The Damned and the Forgotten”

Two men sat in the Idaho Maximum Security Institution’s C Block near Boise on a recent day, neither of them convicted or charged in a crime.

The cell block was silent. An occasional face peered through a cell-door window the size of a computer keyboard. Inside each cell, another tiny window offered a view of razor wire, floodlights and rocks on the prison grounds.

First image: Patients admitted to the Idaho Security Medical Program spend months, on average, in cells like this one in a state prison near Boise. Second image: A view of the prison yard and desert surroundings from a cell in C Block. (Sarah A. Miller for ProPublica)

About a half-dozen civilly committed psychiatric patients a year are housed here and at a women’s prison in eastern Idaho under the Idaho Security Medical Program, state data shows.

The men share a block of nine cells with patients facing criminal charges and needing treatment before they can stand trial. Occasionally, a convicted felon with mental illness joins the mix. The women’s prison has one isolated cell.

Patients who end up here have conditions that can trick them into believing strangers are aliens who must be destroyed, or that the phlebotomist drawing their blood is implanting something in their arm, or that a nurse intends to infect them with a lethal virus. They react with violence.

A part-time psychiatrist, a part-time nurse practitioner and a dozen full-time staff members are expected to bring the patients back from shattered realities.

Certified nursing assistant Emma Wilson makes rounds inside the Idaho Security Medical Program’s section of C Block. (Sarah A. Miller for ProPublica. Patient document blurred by ProPublica.)

Civilly committed patients with the most severe symptoms spend as much as 23 to 24 hours a day confined to cells the size of a parking space.

Confinement can become necessary because it takes time to find effective medications that stabilize a patient before cognitive and behavioral therapies can begin, corrections spokesperson Jeff Ray said in an email. Until then, he said, “it is in the patient’s best interest they be kept safely in their cell, so they do not hurt themselves or others.”

Every patient gets checked on at least twice an hour, according to the corrections department. They can leave to shower, handcuffed, shackled and accompanied by guards.

Patients who take their medications, follow the rules and remain calm are allowed to spend time in the common area. There, they can watch television, use a microwave or sit in caged-in phone booths to make calls and send email on a terminal designed for prisoners. There are metal “restraint desks,” designed for shackling a person ’s ankles, bolted to the floor.

“There’s no color. There’s no nice pictures. There’s no couches,” said Kasey Abercrombie, a statewide coordinator for the Idaho Department of Health and Welfare, whose job includes regular in-person visits to these patients at the prison.

“It is prison,” Abercrombie told a roomful of attorneys and judges at a July Idaho State Bar meeting. “And when you think about this population in that setting, it is probably dawning on you how wild this is.”

The men spend hours peeling paint from the walls of their cells, a habit so universal that prison workers debate whether it makes sense to repaint between patients.

First image: Members of the prison staff try to keep patients occupied with worksheets, word searches, sudoku puzzles, radios and, in some cases, activities outside their cells. But the men often spend time in isolation peeling paint off the walls. Second image: A phone for the men in this section of C Block is inside a metal cage. (Sarah A. Miller for ProPublica)

“We try to do what we can with what we’re given,” said Mallory Logan, a prison social worker who works with civilly committed patients. But she said her unit can’t match the resources of a true forensic hospital.

Prison employees keep an imaginary barrier between convicted inmates who are in C Block for mental health care and the other patients with no convictions or charges.

There’s a “C” taped to the door of “civil” patients, a reminder that the person inside is not there as punishment. Signs around C Block remind staff members not to let the “civils” commingle with the inmates when they’re out of their cells.

Signs throughout C Block remind staff members not to let the “civils” commingle with criminally convicted inmates when they’re out of their cells. (Sarah A. Miller for ProPublica)

Little else separates patients. They are guarded, medicated and fed by the same prison employees. They have the same rules and reward systems that can allow them to have a radio or buy candy from the commissary.

Like many other states, Idaho can hospitalize people against their will under a court-ordered involuntary mental health commitment. At least two professionals must agree that such patients are likely to injure themselves or others or are “gravely disabled” due to mental illness.

If patients lash out — maybe punching or threatening to kill hospital workers — Idaho’s law says the state can ask the court to declare them “dangerously mentally ill” so they can be moved to a maximum security facility.

The typical patient isn’t a character who “really tugs on your heartstrings,” says Walter Campbell, chief psychologist for the Idaho Department of Correction.

“These are the damned and the forgotten,” he says.

Idaho is one of two states known to put people with mental illness in a prison without a criminal charge. The other, New Hampshire, just broke ground on a 24-bed secure mental health facility that will allow the state to end the practice — but not before a patient died last spring.

Psychiatrists and legal scholars commissioned by SAMHSA, the federal government’s main mental health agency, say it shouldn’t happen, period. In a 2019 report prepared for the agency that describes “principles for law and practice” in treating mental illness, the authors wrote, “Unless already incarcerated for a criminal offense, or facing criminal charges … no person who has been committed should be placed in a correctional facility for treatment services.”

One former patient’s mother provided ProPublica with copies of her son’s medical records and documentation of 15 uses of force on him during his stays in the Idaho Security Medical Program while under civil commitment. ProPublica is not naming the 38-year-old man to protect his privacy.

The records show that he was alone in his cell for days on end, aside from showers and short check-ins from staff. He didn’t always take his medications as required under his court-ordered commitment, so officers were called to hold him down for the drugs to be injected. Once, they fired pepper spray through a hatch in the cell door before entering.

His mother said she believes his confinement in a prison cell made it harder for him to recover. It was months before he was released last June to a state psychiatric hospital, where he remains.

The number of times force was used on the patient is unusually high, according to Ray, the prisons spokesperson.

“This is an extreme case which is not representative of the typical patient’s experience,” Ray said, adding that the use of pepper spray “is rare but on some occasions necessary.”

While acknowledging that prison is not the most therapeutic environment for people with severe mental illness, Ray described corrections officers assigned to the unit as “carefully selected, specially trained, and expected to consistently meet high performance standards.”

“They are some of the best correctional professionals in our department,” he said.

The prison psychiatrist who treated this patient wrote, in another medical record, that he told Idaho health and corrections leadership that prison was an inappropriate setting for this patient, who had been placed under involuntary civil commitment and had a history of injuring staff members at hospitals. Idaho’s health and corrections directors later asked legislators to fund a new secure mental health facility. (Obtained by ProPublica)

According to psychiatrists and researchers, forced solitude can exacerbate conditions for people with profound mental illness, making them lash out more.

“Solitary confinement is recognized as difficult to withstand; indeed, psychological stressors such as isolation can be as clinically distressing as physical torture,” Jeffrey L. Metzner and Jamie Fellner wrote in 2010 in The Journal of the American Academy of Psychiatry and the Law.

It is “the mental equivalent of putting an asthmatic in a place with little air,” according to a ruling by the 9th U.S. Circuit Court of Appeals, which covers Idaho.

Legal experts said Idaho is on shaky legal footing with its practice.

When told about Idaho’s system by ProPublica, David Fathi, director of the American Civil Liberties Union National Prison Project, called it “shocking beyond belief” and a likely violation of patients’ constitutional rights.

“I think the state has considerable exposure here,” Fathi said, “and I would urge them to discontinue this practice before they get sued over it.”

Megan Schuller, legal director for the Judge David L. Bazelon Center for Mental Health Law, said Idaho may also be violating the Americans with Disabilities Act and should invest in community-based care that keeps people from needing a secure facility.

“The bottom line is, you’re imprisoning people for having a mental health condition — for the manifestations of that condition,” Schuller said. “And that is just absolutely not equal treatment to how we treat any other type of health condition or even mental disability.”

Decades of Warnings

The idea of locking Idahoans with mental illness in a penitentiary was around as far back as 1954, when the Idaho Statesman reported that a county prosecutor had pressed for a place to incarcerate the “criminally insane.” At the same meeting where the prosecutor spoke, an influential Republican suggested putting the ward in the state prison. But Idaho’s health director argued a prison ward wasn’t appropriate; people with illnesses belonged in a hospital.

In the 1970s, a new generation of Idaho health and law enforcement officials offered an alternative. They would jointly operate a secure mental health facility, on the grounds of the new Idaho state corrections complex that was going up south of Boise.

The state health agency would provide psychiatric care, furniture, medical equipment and first aid; the state corrections agency would take care of security and room and board. The unit would house up to 17 patients including “persons considered mentally ill and dangerous” but who committed no crime.

Health and corrections leaders called it “a historical first” and “a new era” for Idaho. The Legislature approved, and the joint unit was open by 1972.

The collaboration quickly unraveled. In 1976, citing “numerous problems with management and operation,” the state prisons director pushed legislation that would give him full control over the unit.

Corrections officials were poised to start running the show, and critics were stunned.

Sword and other mental health advocates quoted in legislative records that year urged the state to keep a separation between civil patients and prisoners.

Marilyn Dorman, a regional behavioral health board chair, argued that mental health care decisions should not be made by corrections officials but by someone “who has the training in mental health and mental hygiene needed to best represent the patients.”

A supervisor at the psychiatric unit, Jeffrey Toothaker, was so outraged that he spoke out publicly against his boss, Idaho health director Milton Klein. In a letter to the editor of the Idaho Statesman, Toothaker said he found it “difficult to work with a good conscience for a department that has at its head a director that supports such a bill.”

Klein acknowledged to lawmakers that the arrangement wasn’t ideal. Without money to build a new secure psychiatric facility, he said, placing patients in the state pen was the best compromise available.

And that approach was designed to be temporary, authorized for only one year. In 1977, legislative minutes show, lawmakers said a secure unit for civilly committed patients would open in 1978 at Idaho’s State Hospital South, replacing the prison ward.

One senator said that while the U.S. Supreme Court might not look kindly upon placing civilly committed patients in prison, it would probably give Idaho a pass if a better solution was in the works.

It’s unclear what happened to construction at the hospital. But in 1979, a year after the ward was supposed to have opened, the Legislature made the civil commitment unit at the state penitentiary permanent.

It’s drawn criticism ever since.

The prison unit where civilly committed patients are housed has the trappings of a place designed for incarceration, such as these metal “restraint desks.” (Sarah A. Miller for ProPublica)

A national mental health advocate in 1990 called the unit a “dumping ground” for those with severe mental illness. "Death Row is just down the hall,” said psychiatrist and mental health advocate E. Fuller Torrey, according to an Idaho Statesman article. “Their major crime is schizophrenia.”

The same year, a complaint from a disability rights organization drew a U.S. Department of Health and Human Services civil rights investigation, according to an Idaho Statesman report. The federal agency could find no documentation of the outcome when asked recently by ProPublica.

The state’s behavioral health administrator told lawmakers in 2006 that “Idaho desperately needs a secure psychiatric facility or facilities for these people” instead of prison.

None of the criticism seemed to make an impression. Only once since 1976 have Idaho’s political leaders been united in their desire to give patients the right treatment in the right place.

Stegner, the state senator, was among those leading the charge.

The Hospital Takes Shape

Stegner ran his family’s grain-elevator business in north-central Idaho before jumping into politics. He ascended the Republican ranks to become the Senate assistant majority leader by the mid-2000s.

It struck Stegner as wrong when he learned Idaho was locking people with mental illness in prison without a conviction. In 2007, three decades after his predecessors assured people a new hospital wing for civilly committed patients was on its way, Stegner saw an opportunity to make it finally happen.

Sen. Joe Stegner, left, at the Capitol in Boise in 2005. Stegner has since retired from the Legislature. (Dianne Humble/Idaho Press Tribune via AP)

State mental health administrators who’d been making a renewed push to build a secure facility had fully scoped it out.

The building would house 300 beds for patients committed to the state as a result of their mental illness, as well as convicted criminals with severe mental illness and violent behaviors. The two groups would be kept in separate areas.

Stegner persuaded fellow lawmakers to set aside $3 million to design the facility. Construction was estimated at $70 million — roughly $101 million in today’s dollars.

Stegner still remembers driving out to the dusty sagebrush-covered land south of Boise to choose the site where the building would go: “a little low draw” behind a hill that would keep the prison out of view from the new psych unit.

State officials toured high-security psychiatric facilities in California, Kansas and Missouri.

Gov. Butch Otter put the project in his budget for the following year and highlighted it in his January 2008 State of the State address.

The House and Senate voted to allow bonds for the project, noting the demonstrated need for a standalone treatment facility.

Several legislators signed a resolution saying people placed in civil commitment and not serving a criminal sentence “should not be housed in correctional facilities.”

Stegner could see a future where Idahoans whose psychiatric diseases made them lash out would have a place to be safely treated. There was political support for it. There was money. There was even an architectural rendering.

And then nothing.

The governor’s office dropped its support, Stegner said.

Otter told ProPublica the plan stalled because of bureaucratic disputes over where to build the facility and, later, because of the 2008 financial crisis. “We all agreed we needed it,” he said of the new mental health facility, but there wasn’t enough money to go around. “And we all agreed we didn’t want to raise taxes,” he said.

Stegner believes one factor made it easier to kill the project. A year before, acting on a proposal from the Otter administration, legislators had tweaked wording in Idaho’s law governing the mental health unit to put corrections officials on firmer ground in the event of a lawsuit. It may have lessened the urgency to build a hospital.

“That was really a crushing defeat for me — one that changed my attitude about remaining in the Legislature, and one that is one of my biggest regrets in my legislative career,” Stegner told ProPublica.

Idaho officials went on to back away from or block the development of a mental health facility two more times.

Most recently, legislators this year failed to take up Gov. Brad Little’s proposal to use a fraction of Idaho’s record-breaking budget surplus to build a 26-bed facility on state land near the state prison.

One additional expense lawmakers did tack on to the budget: $750,000 to enable the execution of death row inmates by firing squad.

The Next Opening

Stegner and Sword, the activist who testified against imprisoning civilly committed patients in the 1970s, are looking to Little again in 2024. The governor made mental health care a focus of his administration when he took office in 2019. After getting nowhere on his proposal for a new secure facility this year, Little has signaled he plans to try again.

Based on a request from his administration, the state’s building advisory council gave its blessing Nov. 14 to a $25 million facility. That could bolster Little’s chances of legislative approval. Little’s press secretary told ProPublica the governor sees the building as “a critical part of our state’s behavioral health infrastructure.”

The Department of Health and Welfare would provide the mental health care for patients there. The Department of Correction would provide security. They would operate the facility together, and patients would no longer be held in prison cells.

It would be, by and large, just as state lawmakers envisioned more than 50 years ago.

Correction

Dec. 13, 2023: This story originally misspelled the first name of a coordinator for the Idaho Department of Health and Welfare. She is Kasey Abercrombie, not Kacey.

by Audrey Dutton

“Unacceptable”: Senators Call on GAO to Probe FDA’s Oversight of Medical Devices, Citing Series on Philips CPAP Recall

11 months 1 week ago

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Two prominent U.S. senators are calling for a government investigation into the Food and Drug Administration’s oversight of medical devices following revelations that the agency failed to protect the public from defective breathing machines capable of sending particles and fumes into the masks of patients.

Sens. Dick Durbin, D-Ill., and Richard Blumenthal, D-Conn., asked the Government Accountability Office — the investigative arm of Congress — to probe how the FDA tracks warnings about dangerous devices, oversees recalls and takes action against companies that put patients at risk.

Durbin chairs the Senate Judiciary Committee and Blumenthal, who also sits on the panel, heads an investigations subcommittee that reviews violations of laws and regulations impacting national health and safety.

The letter signed by the two lawmakers on Wednesday follows a yearlong investigation by ProPublica and the Pittsburgh Post-Gazette that detailed breakdowns by device maker Philips Respironics as well as the FDA in the years leading up to one of the largest and most disruptive recalls of its kind.

The news organizations found that the FDA had received hundreds of complaints about contamination inside Philips’ popular continuous positive airway pressure, or CPAP, machines and ventilators long before the June 2021 recall but took no action to alert doctors or patients. The complaints included at least 30 that described degradation of an industrial foam inside the machines that was found to break down and release potentially hazardous material.

“It now appears that FDA missed several opportunities to mitigate the harm done to the millions of patients who have used these recalled medical devices,” the senators wrote. “It is not clear whether or not FDA took action to inform hospitals, health care providers, and patients about the potential risks.”

The news organizations also found that Philips, with two sprawling factories outside Pittsburgh, held back thousands of additional foam complaints from the government, some dating back to 2010.

ProPublica and the Post-Gazette reported that Philips carried out multiple internal tests on the devices before the recall, including health hazard evaluations that found the foam could emit volatile organic compounds at dangerous levels.

“Even when Philips Respironics conducted an internal health hazard evaluation, which confirmed that inhaling the chemicals from the sound abatement foam could cause ‘permanent impairment,’ it did nothing, while patients suffered,” the senators wrote. “That is unacceptable.”

The senators asked the GAO to look at how the FDA ensures that medical device companies initiate recalls, what the agency does when manufacturers fail to comply and what resources or legislation would be needed to improve the agency’s oversight.

Durbin and Blumenthal said the inquiry would be a follow-up to a similar GAO study more than a decade ago that found the FDA often failed to review medical device recalls to determine if they protected the public.

“Given recent reporting and the dramatic increase in recalls since then, it is clear that GAO and Congress must examine FDA’s oversight of medical device recalls once again,” the senators wrote.

In the Philips case, the FDA said it acted as soon as it learned of the safety concerns in April 2021, just weeks before the recall.

The agency acknowledged that it received earlier reports from Philips, including complaints that detailed “general contamination issues,” but said the contamination could have been caused by external sources and not the problem foam. The FDA said it received 30 reports about the foam itself in the years before the recall but that those complaints did not indicate that any patients had been harmed.

Philips said it evaluated complaints about the foam on a case-by-case basis and launched the recall shortly after the company became aware of the potential significance of the problem. The company has also said that more recent testing shows that its machines are unlikely to cause “appreciable harm.”

Philips and its parent company “share the same objectives as the FDA,” the firm said.

In the aftermath of the news organizations’ first story in September, Blumenthal asked the Justice Department to take immediate enforcement action against Philips. He later expanded his call for aggressive enforcement in a letter to FDA Commissioner Robert M. Califf and Attorney General Merrick Garland.

Calling the findings by ProPublica and the Post-Gazette “explosive,” Blumenthal urged both leaders to “urgently use all of their authorities to protect current and future patients by investigating these allegations thoroughly, taking the strongest enforcement action possible, including criminal charges, if the allegations are substantiated.”

Michael Korsh of the Pittsburgh Post-Gazette contributed reporting.

by Jonathan D. Salant, Pittsburgh Post-Gazette; Debbie Cenziper, ProPublica; and Michael D. Sallah, Pittsburgh Post-Gazette

The Judiciary Has Policed Itself for Decades. It Doesn’t Work.

11 months 1 week ago

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For decades, judges have relied on a select group to make sure the judiciary adheres to the highest ethical standards: themselves.

The Judicial Conference, a secretive, century-old council of federal judges led by the chief justice of the Supreme Court, oversees the ethics and financial disclosures for more than 1,700 federal judges, including the nine justices of the high court. Those financial disclosures, submitted yearly as a list of assets and gifts, are often the only window into whether judges with lifetime appointments have conflicts of interest as they rule on the country’s most consequential legal cases.

The judiciary's leaders argue that the conference has been an effective watchdog over America's third branch of government. The conference’s authority plays an important role in judicial controversies and has been at the center of some defenses of the court following ProPublica’s reporting on possible ethical breaches. With its “sound structure of self-governance,” Chief Justice John Roberts wrote in 2021, “the Judicial Conference has been an enduring success.”

In reality, the Judicial Conference has instead often protected, not policed, the judiciary, according to interviews and previously undisclosed internal documents. For decades, conference officials have repeatedly worked to preserve judges’ most coveted perks while thwarting congressional oversight and targeting “disloyal” figures in the judiciary who argued for reforms.

In the mid-1990s, two judges — a member of the Supreme Court and a judge on the conference — arranged to obscure a legal publisher’s role in underwriting meetings for an awards ceremony attended by judges at lavish resorts in locales like the Virgin Islands and Hawaii.

Years later, amid a Senate-ordered audit of judges’ travel records, one of the conference’s top officials in Washington told the chief justice that he had ordered his staff “to present the data in a way to mitigate the damage.” Congress did not ultimately pass any of the bills being floated around the time to restrict gifts and travel.

And when the judiciary clarified its rules on federal judges’ disclosures earlier this year, the final version was watered down, according to internal documents obtained by ProPublica. The goal behind some of the proposed edits, a staff attorney explained in an email to a subordinate, was to avoid “drawing bright lines.”

The conference, which sets procedures and rules for all federal courtrooms, coordinates an array of committees run by judges appointed by the chief justice. One of these, the Financial Disclosure Committee, is responsible for enforcing Watergate-era transparency laws and handling the rare allegation that a judge may have knowingly filed a false disclosure report.

Across the federal government, financial disclosures and potential conflicts of interest are self-reported. But experts say the judiciary has the least oversight of all three branches.

Members of the House and Senate face bipartisan ethics committees. Top officials at the White House and agencies like the Department of Defense need to have their disclosures cleared by an independent ethics office. Inspectors general can investigate and refer cases to the Department of Justice.

The enforcement capability of the judiciary’s Financial Disclosure Committee was tested in 2011, when Justice Clarence Thomas was accused of failing to disclose the source of his wife’s income, as well as potential free flights on real estate developer Harlan Crow’s private jet. The conference promised to look into it.

Instead, ProPublica found, two successive Financial Disclosure Committee chairs decided behind closed doors to end the inquiry at the outset and chose not to seek any evidence before the committee announced that it hadn’t seen any to support the allegations.

Even one of the Financial Disclosure Committee’s main functions — making sure judges’ self-reported income, assets and gifts comply with the law — is designed to help judges, not hold them accountable, according to nine federal judges and current and former staffers. Most of that daily work is farmed out to an obscure government agency known as the Administrative Office.

The Administrative Office, which answers to the Judicial Conference, had only about 12 full-time staffers in its financial disclosure division in 2022 and a rotating crew of temps. They review more than 4,000 disclosure reports each year. Instead of closely scrutinizing those disclosures, staff relies on the “honor system,” several of the people said.

Former officials at the Administrative Office say the unit is so mismanaged that a program assistant who orders office supplies and furniture has been tasked with helping review disclosures; staffers without law degrees have routinely given legal advice to judges; and some employees, including temps, have opted to simply fill out judges’ disclosures for them before signing off on those very same reports.

Wendy Smith, a former top attorney at the Administrative Office’s financial disclosure division, said the agency was structured to give the judiciary the appearance of complying with transparency laws, when it actually doesn’t. “They do not have a functioning financial disclosure and ethics program,” Smith said, “and I don’t believe they want one.”

In response to interview requests and a detailed list of questions, the agency said in a statement that it’s not a regulator and “the Judiciary has in place a robust and sound set of policies and procedures for facilitating compliance” with transparency laws, “designed to promote confidence in government.” The office declined to answer any of the specific questions “because many of them seem to be predicated on false or distorted premises.” The agency did not elaborate.

Roberts and Thomas did not respond to a list of ProPublica’s extensive questions.

Last month, the Supreme Court adopted its first-ever code of conduct but stopped short of defining an enforcement mechanism. That, coupled with the Judicial Conference’s record, has led some observers to assert that the new rules will ultimately change little.

That’s the way some judges like it.

“The vast majority of judges willingly comply with the rules,” Robert Loesche, who was the top lawyer at the Administrative Office for years, told ProPublica. “But there’s a minority of judges out there who push the envelope of judicial independence and don’t want their behavior monitored.”

“I’m Telling You: Nothing”

In 2011, lawmakers and advocacy groups filed a series of complaints against Thomas. The Heritage Foundation, a prominent conservative think tank, had paid his wife, Ginni Thomas, nearly $700,000 over multiple years.

Common Cause, a nonpartisan watchdog group, revealed that Thomas didn’t report that source of income on his financial disclosures, despite a legal requirement to do so. The New York Times also raised the possibility that Thomas may have flown on Crow’s jet at least three times. If Thomas had, in fact, taken those flights and Crow footed the bill, the justice failed to disclose that, too.

The conference told the lawmakers and Common Cause that the Financial Disclosure Committee would look into both issues.

Clarence and Ginni Thomas in 2010. Thomas had failed to disclose the source of Ginni’s income for years and later amended his reports. (Francisco Kjolseth/AP Photo)

Early in 2012, the committee held a meeting. Some of the judges in attendance expected a serious conversation about how to handle the matter. If there is “reasonable cause” to believe a judge might have intentionally falsified a disclosure or omitted information, the conference, through the Financial Disclosure Committee, is supposed to refer the case to the attorney general.

Instead, the committee’s chair, a Kentucky district judge and President Bill Clinton appointee named Joseph H. McKinley Jr., said immediately that he had decided to end the inquiry, explaining that Thomas already amended his filings to include Ginni’s source of income, according to one of the judges in the room.

McKinley asked the committee to bless his decision. The attendee interpreted that request as political cover for what was already a foregone conclusion. McKinley did not mention the plane travel, this judge said.

McKinley noted that the previous committee chair, senior federal appellate Judge Bobby R. Baldock, a President Ronald Reagan appointee, had also concluded months earlier that there was no reason to look more closely. But two judges who sat on Baldock’s committee at the time told ProPublica that Baldock had never discussed any of the allegations with the full committee.

Now, during the 2012 meeting, two other members of McKinley’s committee said they wanted more information on the circumstances of Thomas’ alleged lapses. At a minimum, the pair of judges said, the committee should ask the justice directly about how he came to omit something as basic as the source of his wife’s income, which Thomas had previously reported.

The matter went to a vote. McKinley prevailed. That April, he told the Administrative Office he was dropping the inquiry. The potential undisclosed travel never came up at all, according to one of the attendees. There’s no evidence that any judiciary officials ever investigated whether Thomas was on board the flights and, if so, whether he broke the law by not disclosing it.

Asked about the lack of an investigation into Thomas’ possible trips on Crow’s jet, one former Administrative Office official shrugged. “How would you address it otherwise?” the official said. “‘Hey justice, did you ever take a flight?’”

McKinley did not respond to requests for comment. Baldock declined to comment. The Administrative Office has said that both judges followed protocol and also referred the matter to a smaller group of judges, known as the subcommittee on compliance. The agency did not provide ProPublica with evidence of those conversations.

The handling of the Thomas issue doesn’t surprise lawyers and judges familiar with the disclosure committee’s role. Four former committee members said that although they were responsible for enforcing transparency laws, they understood that they had no actual power or personnel to conduct investigations. In the decades since the ethics law passed, the conference has never referred a single case of a potentially falsified report to the Justice Department for further review.

The judges at the appellate and district levels have long been governed by an ethics code and subject to misconduct investigations by local panels of colleagues. Experts have noted that there is no similar procedure for the Supreme Court justices.

McKinley appears to have violated judiciary policy by not mentioning the Thomas matter or its resolution in the committee’s biannual reports to the conference, according to congressional testimony from Judge Mark Wolf, who was a member of the conference at the time and fought to get more information about the committee’s closed-door proceedings. Instead, Wolf testified, the situation was improperly kept from judges like him, and the entire affair was “shrouded in secrecy.”

(According to the conference’s written policy, the committee’s reports are supposed to be public, but the Administrative Office has declined to provide the 2011 and 2012 documents to ProPublica. The policy itself is not public; ProPublica obtained a copy.)

Thomas did not respond to detailed questions about the episode. On Monday, his friend Mark Paoletta, who has attended vacations with Thomas and once represented Ginni as her attorney, wrote in a piece that ran in The Federalist that he “obtained” those questions. He wrote that Thomas acted consistently with transparency laws and that the conference did not need to investigate because Thomas was not required to disclose private jet travel.

The Ethics in Government Act explicitly requires justices to file accurate financial disclosures annually. “The more reasonable interpretation was that the law does and did cover those types of gifts,” said Jeremy Fogel, a former federal judge who served on the Financial Disclosure Committee for seven years. “The overarching purpose of the legislation was to cover situations like this.”

Other judges and court observers have offered a more institutional explanation for the committee’s apparent unwillingness to investigate Thomas: The Judicial Conference may have no authority over Supreme Court justices to begin with.

“You have to go a long way before you get lower-court judges to call a Supreme Court Justice onto the carpet,” said Russell Wheeler, a senior fellow at the Brookings Institute and one of the country’s preeminent experts on the federal courts.

Few publicly raised questions at the time about whether the committee lacked jurisdiction. Instead, the conference told Congress that “nothing had been presented to support a determination” that the justice had improperly failed to report gifts of travel. That statement has since been repeatedly cited as an exoneration.

“The Judicial Conference issued a letter confirming that Justice Thomas had not improperly failed to disclose information concerning his travel,” Thomas’ attorney, Elliot Berke, wrote in August.

“That couldn’t be further from the truth,” one of the judges on the 2012 committee told ProPublica, noting there was only brief discussion of the committee’s limited remit and no effort to actually investigate the allegations against Thomas. “I’m telling you: nothing.”

Now the Supreme Court is embroiled in the worst ethics scandal in a generation. ProPublica and other outlets have detailed lavish gifts and trips that ultrawealthy conservatives have given to Thomas and, and in one instance, to Justice Samuel Alito. They failed to disclose the largesse, including private plane rides — the same alleged lapse that the Judicial Conference balked at 11 years ago. (Thomas has since acknowledged he should have reported a real estate transaction with Crow and amended a past disclosure to reflect the sale.)

In recent months, some Democratic lawmakers have once again called for the Judicial Conference to investigate Thomas and refer the case to the attorney general. And again, the conference referred their complaints to the Financial Disclosure Committee.

The Administrative Office has declined to explain where the process stands or how the Judicial Conference has squared its duty to enforce the financial disclosure law while possibly lacking the ability — or authority — to investigate the circumstances surrounding justices’ omissions or inaccuracies.

Judges and Kings

The conference’s 2012 handling of the Thomas affair was emblematic of its deferential treatment of judges, according to documents and officials. For years, judicial leaders insisted on preserving perks like free travel and deflected calls for congressional reform when the gifts came to light.

In 1995, the Minneapolis Star Tribune revealed that multiple Supreme Court justices, including liberals and conservatives, had gone on opulent trips funded by West Publishing ahead of a prestigious judicial honor known as the Devitt Awards.

West then enjoyed a near-monopoly on publishing federal court records, an indispensable legal research tool used by lawyers and judges across the country. The Star Tribune reported that the company had hosted the justices and other federal judges on the awards’ selection committee at luxury resorts, trips worth as much as $7,700 per judge. One former justice, Lewis Powell Jr., had written letters asking the company to choose the U.S. Virgin Islands or Palm Beach, Florida, “on the water, superior facilities, and affording many interesting things to do and places to see — particularly for our ladies.”

Justices who attended later decided favorably for West by declining to hear multiple cases that its legal opponents had appealed to the Supreme Court. (Denying such appeals is routine. The justices agree to hear only a small fraction of cases brought to them.)

Sen. Arlen Specter, R-Pa., requested hearings to launch an investigation. Responsibility for containing the damage fell to a pugnacious official who served as then-Chief Justice William Rehnquist’s eyes and ears in Washington: L. Ralph Mecham.

Mecham, a former oil and mining executive and lobbyist, had become the director of the Administrative Office in 1985 and would serve until 2006. The director is also the secretary of the Judicial Conference. Congress created the Administrative Office in 1939 as an alternative to the Justice Department, which had been in charge of running the courts’ day-to-day operations.

Mecham never saw himself as a judicial watchdog. In letters to friends and colleagues, he described his role variously as a “servant,” “ally” or “fireplug” for judges under constant assault by reporters and Congress for, among other things, undisclosed junkets. For this story, ProPublica reviewed hundreds of contemporaneous notes, letters and other memos archived at multiple universities.

L. Ralph Mecham was director of the Administrative Office and secretary of the Judicial Conference for more than 20 years. He spent much of that time working to protect judges. (Screenshot by ProPublica via C-Span)

The legal community began to realize the Administrative Office had effectively become the judiciary’s lobbying and public relations arm. In the 1990s, when critics said the agency was behaving too much like an advocate for judges, officials with the agency responded that they were proud to be “guilty” of the charge.

During his tenure, Mecham’s primary allegiance was to his boss, Rehnquist. The two had regular written correspondence and meetings. (Both men are now dead.)

At the height of the questions about the Devitt Awards, Mecham left a message with Rehnquist’s assistant saying that “he wonders if someone shouldn’t call Senator [Orrin] Hatch to have him call Senator Specter to persuade him to withdraw his request to investigate the Devitt Award,” according to the assistant’s notes of the conversation.

It’s unclear if Rehnquist made such a call. But 10 days later, Mecham reported in a confidential letter that he’d learned Hatch considered Specter’s proposed investigation “ridiculous” and said there would never be hearings on the matter.

After news stories broke about judges going on lavish trips paid for by a publishing company, Mecham worked behind the scenes to head off a congressional inquiry. On the left is a message he left for then-Chief Justice William Rehnquist, with a follow-up memo he sent days later. (Stanford University archives)

Meanwhile, Ralph Nader, the consumer activist, wrote to Rehnquist about the scandal to ask for a prohibition on such trips. As pressure mounted, Justice Anthony Kennedy, who was on the Devitt Awards committee, discussed an alternate plan with the CEO of West Publishing: The company could give a grant to an organization like the American Judicature Society, which would then administer the awards and host the committee meetings.

Kennedy relayed his efforts to Richard S. Arnold, a judicial conference judge and fellow member of the awards committee, and asked him to call West to voice his support for the plan. Arnold wrote in a memo afterwards, “Even though the money will come from a grant by West, this would apparently purge whatever taint exists in the eyes of Mr. Nader or others, and the issue of the propriety of my participation in the administrative decisions affecting legal publishers would disappear.”

Two months later, the society announced it was taking over the Devitt Awards, with funding from West. (A spokesperson for the company said at the time that the move had been years in the making.) Congress did not hold hearings on the matter.

Kennedy, who retired in 2018, did not respond to requests for comment. Arnold died in 2004. At the time, several judges said there was nothing inappropriate about the trips because they were disclosed and it hadn’t impacted their rulings.

Following the Devitt stories, there was more press coverage about federal judges taking extended travel to seminars hosted by private interests and sometimes failing to disclose the trips. Critics noted that the sponsoring corporations and foundations often promoted a free-market, pro-industry ideology while educating judges on issues like regulation.

Iowa Republican Sen. Charles Grassley launched an audit of judges’ travel in 1997. The Government Accountability Office collected individual judges’ travel records. (The GAO has no authority over the Supreme Court, one of the only institutions outside Congress with that immunity.)

Mecham had long feared that Grassley was “going after judges” and tried multiple times to gather intelligence by finding out who was speaking to the senator’s staff and what they provided to the GAO. “I think the judiciary is facing serious problems with respect to the travel issue,” Mecham told one of the conference committees as the data started coming in. But he added a reassurance the next day: “I have asked my staff to do everything they can to present the data in a way to mitigate the damage.”

In summer 1997, Mecham sent a series of letters to the Judicial Conference’s executive committee to warn them about Sen. Charles Grassley’s GAO probes into judicial travel. (University of Utah archives)

It’s unclear how they carried out that plan. Grassley’s probe eventually resulted in lengthy reports detailing thousands of judges’ trips, from Jackson Hole, Wyoming, to Panama, funded by taxpayers or private interests.

In the end, though, Congress imposed no new travel restrictions on judges.

In an interview with ProPublica, Mecham’s former associate director, Clarence Lee, defended his boss, saying the Administrative Office can successfully help enforce transparency laws and hold the judiciary accountable. He said the agency often drew the ire of judges because it disciplined their clerks for infractions like misusing office computers. Lee dismissed congressional probes as political stunts.

“Any mechanism put in place that allows a secondary group to second guess their [judges’] behavior can have draconian results,” he said. “You don’t have an inspector general for kings or judges because then you’d no longer have a king or a judge."

Thomas’ financial disclosure report for 1997. Thomas disclosed private air travel on Harlan Crow’s jet. He later stopped reporting similar trips and has since argued that he believed that such gifts were exempt from disclosure. (Thomas financial disclosure, provided by Documented)

In the early 2000s, public concern and political pressure continued. One study conducted by a public-interest law firm found that nearly a quarter of the judiciary had traveled to at least one seminar put on by conservative groups between 1992 and 1998. These events were often at resorts while some of the judges in attendance were trying cases those groups had a stake in. And almost 1 out of every 9 federal judges — appointed by both Democratic and Republican presidents — had failed to report a privately funded trip during that same stretch, according to the study, which made national headlines.

Some judges on the conference broke ranks and advocated internally for reform. Mecham urged Rehnquist to fire the outspoken apostates from their committee posts, “not only because they have been repeatedly disloyal to you but also because they have been disloyal to the Judicial Conference.”

Abner Mikva, then a retired federal appellate judge, leading liberal congressman and personal mentor to Barack Obama, went public. He submitted an article to a law review journal titled “Judges, Junkets and Seminars.”

“It grieves me that so many judges feel threatened by proposals to change the present system,” wrote Mikva, who died in 2016. “If that large a portion of the public — legislators, the media, lawyers, litigants — sees a problem, then it is a problem that needs redressing.”

“Looking in the mirror,” he added, “is not enough to guarantee the perception of honesty and integrity that has to be the touchstone of a successful judicial system.”

In the aftermath, the Judicial Conference made some concessions on travel rules, including a requirement for seminars to report their funders before judges can attend and better public access to financial disclosures. But the judiciary has largely managed to prevent substantive reform from Congress, including at least two failed Senate bills that would have restricted travel and gifts or created an independent ethics monitor.

Twenty-Something Temps

The Administrative Office does not consider itself a regulator. But staff inside its tiny financial disclosure division are responsible for screening judges’ financial disclosures. Employees there describe a flawed process.

Those who examine the disclosure forms are often temps. Two former examiners told ProPublica they did not recall any training on how to review the gift portion of the reports. And since 2019, they no longer compare judges’ assets on their current disclosure with the previous year’s, which many staffers had considered the bare minimum of due diligence. The committee decided it “could rely on the filer’s certification that the report is accurate,” according to a recent Judicial Conference report. If someone does happen to catch something that may be wrong with a report, it is typically handled with a letter asking the judge to fix it.

One former temp, who was hired straight out of college, said most of the supervision she received was about using proper grammar in her emails. “Guys have been on the bench for 20 years and the last thing they want to do is talk to a 20-year-old who’s telling them they’re not doing their job right,” said another examiner.

Filing instructions for judges inform them that there is no longer a side-by-side comparison of financial disclosures. In the past, examiners had used that process to look for discrepancies in judges’ assets. (Judicial Filing Instructions obtained by Fix the Court)

Staffers without law degrees have routinely given ad hoc legal guidance to judges about their financial disclosures because of staffing shortages, one former Administrative Office official told ProPublica. Contemporaneous notes also show that’s been an internal practice.

“That’s awful,” said Peter McCabe, who was a top official at the agency for decades. “I can’t believe that.”

After senior staff sign off on the work, the disclosures are sent to the Financial Disclosure Committee for final approval, which is largely ceremonial, said three former committee judges. “It’s an assurance that a report has been filed,” one told ProPublica. “Is it truthful? I have no idea.” Two said they didn’t receive any ethics training for how to interpret and apply the Ethics in Government Act and instead relied on the same standards they applied on their own disclosures.

What Is the Solution?

Public trust in the judiciary is the lowest it’s been in 50 years. Now that the Supreme Court has adopted its own ethics code, questions remain about how that code will be enforced.

There’s no simple fix. Critics caution some proposed solutions could breach the separation of powers.

Some expert proposals:

APPOINT a panel of respected retired judges to advise Supreme Court justices on recusal questions, or a council of lower-court federal judges — similar to some state supreme court systems — to investigate ethical complaints against the justices above them.

INSTALL an inspector general with authority over the entire judiciary, including justices.

CREATE an independent ethics office inside the judiciary, modeled after the Office of Government Ethics in the executive branch.

REWRITE gift rules to prohibit judges from accepting expensive gifts without approval — similar to rules for the legislative branch — and close gaps in the financial disclosure instructions.

REQUIRE those who file briefs in Supreme Court cases to disclose their funders so that lawyers and the public can identify any potential conflicts with the justices.

FIX procedures inside the Administrative Office with more legal staffers, faster turnaround on releasing public records, and better quality controls for screening judges’ self-reported financial disclosures.

The process amounts to the “honor system,” six former staffers and judges on the Financial Disclosure Committee said.

Federal law requires the disclosures to be made available 30 days after being filed. In June, ProPublica asked the Administrative Office for dozens of disclosures. But the agency still hasn’t released them, citing a backlog of requests.

The judiciary has “redaction authority” to remove parts of judges’ disclosures from public view. It’s meant to be invoked if revealing something, like a home address, would pose a security threat for judges or their family. The Administrative Office told ProPublica the authority “is strictly interpreted and applied.”

However, a 2018 GAO report found nearly one in four requested redactions was for something other than an obvious security risk. Some judges redacted gifts they had received or the value of their stocks. On top of that, the GAO found, the Administrative Office has at times ignored its legal requirement to submit annual reports to Congress on how judges are using their redaction authority.

Staff inside the office also play a crucial role in shaping the judiciary’s rules for what gifts judges can accept and what they need to disclose. That, too, has at times been used as an opportunity to help judges preserve their perks, records and interviews show.

In late 2022, after decades of criticism, the judicial conference began work to refine the language about financial disclosure requirements in the judiciary’s rules.

When the new wording came out in March, it did not substantively change its rules about what fell under the controversial personal hospitality exception. Instead, the conference merely made explicit that judges must disclose gifts of transportation, like private jet rides. In a recent report to the conference, the committee itself characterized the update as “clarifying.”

An initial proposal for the March update had gone further, according to internal documents. Lawyers at the Administrative Office provided an analysis for the Financial Disclosure Committee laying out how the Senate defined personal hospitality more strictly and gave a proposal for some new, more prescriptive language.

The update would have imposed tighter disclosure requirements for when a judge gets a free stay at someone’s house. That language was softened before the final cut.

The draft language required stays to be disclosed if that property gets “rented out to others other than on an occasional basis.” The final guidance, however, lowered that threshold and instead requires judges to disclose the gift only when they’ve stayed at a property that’s “regularly rented out to others for a business purpose.”

The goal for some of the other proposed edits, deputy general counsel Laurina Spolidoro explained in an email obtained by ProPublica, was to present “a consideration of factors” to judges “rather than drawing bright lines.”

To Smith, Spolidoro’s subordinate at the time, the message was clear: judges wanted the ability to continue accepting certain gifts without having to disclose them. Spolidoro did not respond to requests for comment, but an Administrative Office spokesperson refuted Smith’s characterizations and said those in the office take their job seriously.

Smith said she quit the Administrative Office because she wasn’t allowed to do her job as an ethics attorney, and when she tried to make changes to the financial disclosure program, she was stripped of her duties.

Smith said she was told by Spolidoro and others that “the judiciary is outside the Ethics in Government Act.”

Kathleen Quinn and Marissa Muller from Berkeley Journalism’s Investigative Reporting Program contributed research.

Do you have any tips about justices or judges? Contact Brett at brett.murphy@propublica.org or on Signal at 508-523-5195.

by Brett Murphy and Kirsten Berg

Representatives Propose Ban on Insurers Charging Doctors a Fee to Be Paid Electronically

11 months 1 week ago

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A bipartisan group of six U.S. representatives has introduced a bill that would prohibit insurers and their intermediaries from levying fees on doctors for paying them electronically. The legislation comes in the wake of a ProPublica investigation that detailed the toll of such fees, which add up to billions of dollars that could be spent on care but are instead funneled to insurers and payment processors.

The charges are akin to having an employer deduct 1.5% to 5% to provide a paycheck electronically if an employee prefers to receive a payment directly into their bank account rather than via a paper check. Yet that’s the choice many insurers are increasingly forcing on doctors.

“We don’t tolerate paying fees to receive direct deposit of a paycheck, likewise, doctors and patients should not be forced to pay predatory fees on electronic payments on essential health services,” the bill’s lead sponsor, Republican Rep. Greg Murphy of North Carolina, said in a statement announcing the legislation. Murphy’s bill would effectively force the Centers for Medicare & Medicaid Services, the federal government’s chief regulator on health care payments, to prohibit the fees.

As it happens, that would bring the giant agency back to its original position. CMS prohibited fees for electronic funds transfers until it was lobbied by a payment processor called Zelis. The agency changed its position in 2018, then went even further in 2022, explicitly stating that such fees are not prohibited. A spokesperson for CMS said the agency does not comment on proposed legislation. Zelis did not reply to a request for comment on Murphy’s bill, but the company previously told ProPublica that its services remove “many of the obstacles that keep providers from efficiently initiating, receiving, and benefitting from electronic payments.”

CMS’s about-face was detailed in copious internal records meticulously collected by a New York City urologist, Dr. Alex Shteynshlyuger, who has made it his mission to fight the costly fees. His crusade now appears to have found a sympathetic ear in Congress: Like Shteynshlyuger, Murphy is a urologist, and he co-chairs the House GOP Doctors Caucus. Three Democrats and two Republicans thus far have signed on as co-sponsors of his bill.

The proposed legislation has the backing of the American Medical Association, whose policymaking body voted last month to adopt a new resolution opposing “growing and excessive” fees on electronic funds transfer payments. Shteynshlyuger, who has spent six years trying to convince CMS to ban the fees, introduced a proposal at New York state’s medical society that then made its way to the AMA. He said of the new federal bill: “I’m happy that the legislators got involved.”

Administrators at small medical clinics are hoping the bill will bring them relief from the fees, which are “doing nothing for us but costing us money,” said Rebecca Hamilton, who manages an arthritis and rheumatology clinic in Wichita, Kansas.

Often, it’s independent clinics like Hamilton’s that suffer the most from such fees, since medical practices collect the vast majority of their revenues through EFT payments, according to the Medical Group Management Association. The winners are the recipients of the fees: large insurers and payment processors like Zelis.

One form of electronic fee is not addressed by Murphy’s bill: charges for use of so-called virtual credit cards, which Shteynshlyuger has also been campaigning against. Virtual credit cards are temporary card numbers that are typically used for one payment. Fees for VCC use run as high as 5% versus a typical 2.5% for other kinds of electronic payments.

ProPublica’s investigation showed how Matthew Albright, a lobbyist for Zelis, used a combination of cajoling, argument and the threat of litigation to get CMS to withdraw a 2017 notice prohibiting fees for electronic payment. CMS had posted the notice, which was based on a federal rule from 2000, on its website after hearing complaints from doctors. Internal CMS emails detailed how Albright repeatedly demanded that CMS withdraw and revise the notice, and when CMS ultimately refused, a law firm representing Zelis threatened to sue the agency. Within days, CMS removed the notice. It later stated that fees are allowed.

CMS previously told ProPublica that it reversed its position because it concluded that it had no legal authority to “flat-out prohibit fees.”

Albright, like CMS, has changed his public position on the fees. Before he joined Zelis, Albright worked for the federal agency, where he wrote the rules implementing electronic health care payments. Shortly after his time at CMS, at a 2015 conference for health care business managers in Las Vegas, Albright expressed unequivocal opposition to fees for electronic payments. When Albright outlined the agency’s rules, audio of the event shows, the mere mention of virtual credit cards prompted some members of the audience to cry, “Evil!” Albright asked if that sentiment was unanimous, prompting a wave of yeses.

Doctors Shouldn’t Have to Pay to Get Paid

Before he became an industry lobbyist, Matthew Albright expressed opposition to electronic payment fees at a conference in Las Vegas in 2015.

Laughter ensued, and Albright, who has a master’s degree in divinity, joked that he was preaching to the choir. His sermon? “What other industry does not get paid for the services they’re doing, and when they do get paid, they have to pay for getting paid? What other industry, right? It’s ridiculous!”

Reached by telephone for comment, Albright said, “I can’t speak to you.”

by Cezary Podkul

This Researcher Warned of Unnecessary, Risky Vascular Procedures. She Was Called a “Nazi” and Accused of “Fratricide.”

11 months 1 week ago

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Vascular surgeon Dr. Caitlin Hicks recalls the first time, about a decade ago, that a patient came to her with a lower leg mottled with purple and starting to decay. She searched for a pulse in the damaged limb, but blood had stopped flowing into it.

The patient had previously undergone an invasive vascular procedure, using devices designed to clear out clogged arteries. But when Hicks questioned the patient about the symptoms that had led them to initially seek treatment, they seemed mild or nonexistent.

Then Hicks saw another similar patient, and then another. In some cases, the only solution was amputation.

Over time, she began to worry if the patients landing on her operating table were a harbinger of something more ominous: doctors performing lucrative procedures on patients who might not have needed them.

In clinic offices and outpatient surgical centers, doctors were inserting into leg arteries catheters affixed with lasers or blades to pulverize fatty deposits from vessel walls. The procedures, called atherectomies, carried risks — of infection or the errant nick from a blade — that were perhaps worth the gamble for patients who could lose their legs from poor circulation. But some of the patients Hicks was treating had not initially been that sick.

“A lot of them would tell you, ‘Well, the doctor said I had a blockage in my artery,’” she said, “but if you asked them about symptoms, they didn’t actually have any.”

So Hicks, an associate professor of surgery at Johns Hopkins University School of Medicine, and a team of academic physicians decided to do what regulators and insurers had not. They began years of groundbreaking, peer-reviewed research that revealed that some doctors appeared to be overusing atherectomy procedures, performing them on high numbers of patients who may not have needed them.

They built on studies that showed aggressive, invasive treatments made far less sense for patients with milder symptoms, like leg pain while walking, which is often caused by clogged arteries obstructed with plaque. The majority of these patients are unlikely to develop severe vascular disease, and they can often be treated with less invasive therapies like medication and exercise. While most doctors follow best practices, many have continued to use aggressive interventions, ProPublica found, often warning patients that without them, they could lose their limbs. Instead, research has shown, the procedures may be associated with a higher risk of amputation.

Hicks and her fellow researchers didn’t publicly reveal the outlier doctors, but four years ago, they disclosed their names to the Centers for Medicare and Medicaid Services, encouraging the government insurers to examine their own data and crack down on abuse. They also sent a list to the Society for Vascular Surgery, where senior medical society members and leaders in the field believed the time had come for tighter standards.

And then Hicks and her colleagues waited. Surely their careful, methodical and confidential evidence would prompt change. Instead, what they got was an at-times scalding wave of blowback.

Today, atherectomies remain unchecked, not only because regulators and insurers haven’t done enough to rein them in, ProPublica’s reporting has found, but because doing them remains easy and profitable. Since 2013, the number of atherectomies has doubled and payments to doctors have nearly tripled, totaling about half a billion dollars annually as of 2021, according the most recent year of Medicare data. Physicians can charge Medicare tens of thousands of dollars for multiple procedures conducted in a single office visit.

And the government’s own data shows it continues to pay individual providers millions of dollars a year to perform the procedures, including on patients with only milder symptoms, with little pushback and few rules.

In response to questions, CMS told ProPublica that it examines its billing data for outliers, taking action when it identifies problems by denying claims, suspending payments or referring questionable providers to law enforcement.

But the story of Hicks and her colleagues illustrates the challenges of highlighting potentially dangerous practices and effecting change, especially when physicians’ livelihoods are at stake.

What the researchers hadn’t bargained on was a vocal contingent of doctors willing to fight for their freedom to perform the vascular procedures as they saw fit in their private practices. While not all were outliers, many spent years attacking the overuse studies and the researchers behind them and wielding influence to mute reforms.

Nowhere was this opposition more palpable than this past May, at the annual meeting for the Outpatient Endovascular and Interventional Society, a group of doctors who treat vascular disease outside of hospitals and often in their own private practices. Among glass cases in which atherectomy catheters gleamed like luxury jewelry, hundreds of doctors convened at Walt Disney World’s Coronado Springs resort to learn how to bolster their businesses.

In one presentation, Dr. Sandeep Rao, an interventional radiologist from El Paso, Texas, flicked through a presentation on vascular procedure metrics. “That clinic patient, how well are you in getting to them on the table? And eventually, once you get them on the table, how well you’re converting them into the codes that you can bill for them?” Rao asked the room. “All of a sudden, if that patient doesn’t show up, now again, and that patient just goes, ‘I don’t want any more procedures,’ now that’s maybe something that you may not be able to bill for. So when I have a patient captured and captive on my table, I try to maximize how much I’m able to get.”

(Rao later told ProPublica his comments were focused on patient safety: He wanted to do every procedure necessary at once so that a patient didn’t have to return for a second set of procedures, risking complications.)

Protecting their practices — both from regulators and critics — was a persistent theme. No physician was perhaps as bold as interventional radiologist Dr. Alex Dabrowiecki of Oregon, who provocatively brandished a slide listing the recent academic articles from Hicks on atherectomy overuse. Stamped at the top in bold letters was the word “Fratricide.”

“There are some academic institutions who find [office-based laboratories] a threat or find big issues with how we are practicing,” he said. (Dabrowiecki later shared with ProPublica that his slide was meant as “tongue-in-cheek.”)

One of Dr. Alex Dabrowiecki’s slides at the annual meeting for the Outpatient Endovascular and Interventional Society. He later said that his slide was meant as “tongue-in-cheek.” (Obtained by ProPublica)

Vascular surgeon Dr. Robert Tahara, who leads the society for outpatient physicians, told ProPublica in an email that his members feel attacked by the research on procedure overuse. “I and many others simply but vociferously take issue with the portrayal that [office-based laboratory] docs are only using atherectomy as a revenue tool,” he said, noting that the Medicare data, used by Hicks and others, has many limitations that “precludes the ability to draw any meaningful conclusions.” Tahara added that terminology used by Rao at the conference was “ill crafted, not well conveyed and does not reflect the OEIS thinking.”

Other private practice doctors have accused Hicks of weaponizing ivory tower research and have vilified her as an “atherectomy nazi.” Some physicians have critiqued the focus on more milder vascular disease, which can have a range of symptoms. Last August, after she published an opinion piece in MedPage Today, which showed that many of her critics are performing atherectomies in the majority of their cases, doctors called on the Society for Vascular Surgery to end her “reign of terror,” threatening a mass exodus if the group did not somehow stop her from continuing her research.

“She will destroy the Society if she is not reined in,” wrote vascular surgeon Dr. Patrick Ryan, founder of the Nashville Vascular and Vein Institute, in a private society discussion board post that was shared with ProPublica, adding that her “abuse of claims data” made private practice doctors a target for regulators. The society later took the post down, citing “personal attacks that were clear violations,” society officials told ProPublica.

“The only result of her work that I have seen is promoting disunion within the [society],” Ryan later told ProPublica in an email, “making me and perhaps others angry that the life and limb-saving work we do every day is being cast as a money grab.”

Ryan, Tahara, Rao and Dabrowiecki did not stand out in a ProPublica analysis of possible atherectomy overuse.

Hicks bristled at the hostility but said her critics misunderstand her motivations.

“I’m just trying to talk about doing the best care possible for patients,” she said. “I’m not trying to suggest that a technology or a practice pattern is evil.”

Outpatient clinics can be an effective place to treat patients and atherectomy procedures are useful in some cases, Hicks said, but she reiterated that some doctors “are doing way too many of these interventions and hastening the worsening of disease in many patients.”

Hicks during a surgery. “I’m just trying to talk about doing the best care possible for patients,” she said. “I’m not trying to suggest that a technology or a practice pattern is evil.” (Rosem Morton for ProPublica)

Taking researchers’ mounting concerns of possible patient harm into account, the Society for Vascular Surgery tasked a group in 2018 to develop “appropriate use criteria” to guide doctors on how to treat their patients; these standards are also often used by insurers and regulators to decide which procedures should be covered and which deserve greater scrutiny.

The group determined that patients with milder disease should first be treated with exercise therapy and that invasive procedures should be reserved for those with severe lifestyle-limiting symptoms. In some circumstances, the group concluded, invasive procedures were flat-out “inappropriate.”

But before the standards could be published, the group faced familiar pushback. Some society members attacked the use of the word “inappropriate” to describe some procedures conducted on patients, urging the society to soften the language of the criteria.

“I have no doubt that the publication of this document will result in a huge backlash,” an unnamed society member reportedly said during an internal feedback process. “It will reinforce the perception that the society is trying to rein in the poorly informed, unwashed masses in the community, and protect patients from profit driven surgeons doing unnecessary procedures on their unwitting victims.”

Nearly all 23 authors of the criteria — many of them veteran, highly respected surgeons — wrote to society leadership in February 2022 to defend their process and its terminology, according to an internal letter that was leaked to ProPublica.

“The primary reason to retain the terminology was that the panelists, in fact, felt very strongly that there were certain scenarios that should be deemed as inappropriate,” they wrote. “Simply changing the terms at this point from ‘inappropriate’ to ‘rarely appropriate’ would not only violate the scientific integrity of the project, but [would] also be disrespectful to the extensive work invested by the panelists.”

But two months later, when the society published the criteria, it removed the terms “appropriate” and “inappropriate,” saying that the words have “different and often highly charged social connotations in the 21st century.” They replaced them with the more convoluted jargon “benefit outweighs risk (B>R)” and “risk outweighs benefit (R>B).”

Dr. Joseph Mills, the current president of the Society for Vascular Surgery, insisted that the terminology change didn’t undermine the project’s integrity. “We didn’t change the methodology, we didn’t change the message, we still published it,” he said. Mills, who was one of the authors of the criteria, said he recognizes that overuse is an issue, and that the society would not stop Hicks from doing her research. “We don’t want her to stop doing her work,” he said. “Our true north is always patients first and always try to stick with the science when there is science. I think we’ve been pretty consistent with that.”

But several physicians, including some authors of the criteria, told ProPublica that they felt leadership had caved to the complaints of a vocal minority and made the criteria more vague.

Dr. Rita Redberg, the former chief editor of JAMA Internal Medicine and a cardiologist who has studied vascular disease standards, said such terminology changes can have implications for patient care. “It just leaves a lot more wiggle room and room for interpretation and confusion,” she said. “It’s important to be accurate and scientifically correct. Certainly those kinds of changes for non-evidence based reasons raise a lot of concern.”

Just last month, the European Society for Vascular Surgery published its own practice guidelines, recommending conservative care for most patients with milder symptoms. In contrast to guidance in the United States, it explicitly discouraged routine atherectomy use for patients with milder symptoms, citing the procedure’s “lack of superiority” compared with other treatments, in terms of efficacy and safety.

Some American medical leaders have begun to doubt whether their societies have the capacity to truly address the outliers in their ranks. After former Society for Vascular Surgery president Dr. Kim Hodgson used his platform to call out procedure overuse two years ago, he said in response he was removed from the leadership of a society quality improvement program and projects he had lobbied for to improve care, including an initiative to educate physicians on whether they are outliers, were modified or thwarted.

“I think they have kowtowed to the outliers,” he told ProPublica. “People don’t like to get screamed, hollered and yelled at so they often will appease that group.”

Mills, the current society president, said that Hodgson was not removed from the quality improvement program because of his stance on atherectomies, but because he had retired from practicing surgery and officials wanted a leader who could work more collaboratively with all perspectives. “It wasn’t done to cave in to certain subgroups,” Mills said.

The outlier education initiative that Hodgson lobbied for may still be implemented, said Ken Slaw, the society’s executive director, but so far the society has implemented more voluntary improvement programs. “We could try to make up something like a report card and send it to surgeons and say this is where you lie on the curve of use,” Mills said. “The problem with that is that it makes us a police force.”

Despite the pushback, Hodgson, like Hicks, has not backed down. Standing before dozens of physicians at a conference last month, Hodgson once again appealed to his colleagues that, in the absence of bold society and regulatory action, the onus of protecting patients fell on them all individually.

“We all know who these people are,” he told the doctors. “If you don’t want to be part of the problem, you need to also recognize that part of the problem is the silence.”

Do You Have Experience With Peripheral Artery Disease? Have You Had a Procedure on Your Leg? Tell Us About It.

by Annie Waldman

How ProPublica and CareSet Investigated the Overuse of Vascular Procedures

11 months 1 week ago

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 6.5 million Americans have peripheral artery disease, a condition in which arteries are obstructed, restricting blood flow, most often in the legs. The first sign is often leg pain during activity, also known as claudication. While most treatments are safe, in recent years, experts have warned that some doctors may be subjecting patients to invasive procedures too early in their disease progression, needlessly exposing them to risks of complications, including amputation and even death.

Over the past year, ProPublica has investigated these vascular treatments, and we found some doctors are earning millions of dollars conducting a questionable number of procedures. For treatments in outpatient clinics, federal insurers, like Medicare, pay generous reimbursements to doctors, who can charge tens of thousands of dollars for procedures done in a single office visit.

Treatments include widening the arteries with stents and balloons and clearing plaque from vessel walls with a laser or bladed catheter, also known as an atherectomy. Despite minimal evidence to support the treatment’s benefits compared with less expensive alternatives, atherectomies have surged in recent years, researchers have found, with hundreds of outlier doctors performing the procedure in a majority of their patient cases.

ProPublica found that, from 2017 through 2021, about 200 doctors accounted for more than half of atherectomy procedures and Medicare payments, totaling nearly $1.5 billion, according to public federal data. Many of these physicians work in outpatient clinics.

To better understand how doctors are using the procedure, ProPublica sought to analyze Medicare data for patients who underwent atherectomy treatments, working with the data journalism team at CareSet, a health analytics group that exists to transform Medicare data into insights for better patient care.

For our analysis, we set out to understand how often doctors were performing atherectomy procedures for patients in the early stages of disease. We relied on Medicare fee-for-service claims data and examined atherectomy procedures conducted over the past four years, from 2019 through 2022, limiting our analysis to the first-time atherectomy procedures that patients underwent during this time. We focused on initial atherectomy procedures to better understand whether interventions were occuring in the early stages of vascular disease, before possible progression of the illness. For each doctor, we calculated what percentage of their patients receiving a first-time atherectomy appeared to have had only more mild vascular disease, based on a diagnosis of claudication.

What Data Was Used for the Analysis?

When a patient is treated by a physician, medical details on their diagnoses and procedures are submitted to insurers for reimbursement payments. The Centers for Medicare and Medicaid Services collect this data for patients covered by its federal insurance and share it with the public and researchers, removing names and other private information to protect patient privacy.

To examine doctor reimbursement for atherectomy procedures, ProPublica relied on Medicare’s provider use and payment dataset, which contains details on the services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. This public data let us calculate how much Medicare paid each provider in reimbursement per type of procedure. We looked at five years of data, from 2017 through 2021, the most recent year available.

But the public reimbursement data does not include detailed information on provider behavior or patient diagnosis, so ProPublica partnered with CareSet, which has special access to Medicare claims data. The data included carrier, institutional inpatient and institutional outpatient claims. We used codes from the Current Procedural Terminology system, devised by the American Medical Association and used by Medicare, and we identified patients who underwent a first-time atherectomy procedure. We limited our analysis to patients who had procedures from Jan. 1, 2019, through Dec. 31, 2022.

We classified patients into two categories: those with more severe chronic disease, who had a diagnosis of chronic limb-threatening ischemia; and those who appeared to have milder vascular disease, based on a diagnosis of claudication. Patients with claudication were defined by the International Classification of Diseases code families I70.20, I70.21 and I73.9, a set of diagnosis codes used by other researchers in peer-reviewed studies. We omitted patients who underwent an atherectomy procedure before their first treatment in our study period. To do this, we looked back at the data 12 months before the start of our study period. We also excluded patients with a diagnosis of acute limb ischemia, which is often linked to an emergency event. We included patients who initially had a claudication diagnosis at the time of their first atherectomy procedure but whose disease may have advanced to a more severe stage during our study period, because of concerns that the interventions may have contributed to disease progression.

We pooled the patient-level data by doctor to calculate what percentage of each physician’s patients underwent a first-time atherectomy for claudication versus chronic limb-threatening ischemia.

Why Did We Focus on Patients With Claudication?

We wanted to know whether doctors who conduct atherectomies are using the procedure excessively on patients who appear to have milder vascular disease.

For many patients with peripheral artery disease, an initial symptom is pain when walking or exercising, which is also known as intermittent claudication. The discomfort often arises from limited oxygen in the leg muscles due to the narrowing of arteries, which can progressively become obstructed with plaque. According to experts, the majority of patients who experience claudication will not develop severe vascular disease, like chronic limb-threatening ischemia. While endovascular interventions are recognized by experts as appropriate for severe disease, best practices recommend that milder symptoms initially be managed by noninvasive care, which can slow or even reverse symptoms. These treatments may include exercise, diet changes, quitting smoking and medication.

The medical guidelines of several professional societies encourage starting with these noninvasive approaches. Last year, the Society for Vascular Surgery published appropriate use criteria for patients with claudication and recommended first-line treatments of exercise before resorting to interventions. It also advised against conducting procedures on arteries below the knee, emphasizing that interventions in these vessels for patients with claudication are of “unclear benefit and could be harmful.”

Just last month, the European Society for Vascular Surgery published its clinical practice guidelines on treating patients with asymptomatic peripheral artery disease and intermittent claudication, recommending conservative care for most of these patients. It also explicitly discouraged the routine use of atherectomy for patients with disabling claudication “due to the lack of superiority of atherectomy over conventional endovascular therapies in terms of efficacy and safety endpoints.”

Numerous studies have questioned the efficacy of atherectomy over the years, including from Cochrane, a widely respected network of experts that conducts systematic reviews of research. A Cochrane review found atherectomies are not necessarily more effective than alternative procedures. The studies on the effectiveness of atherectomy, it found, were small and had inconsistent results, and their methodologies had a “high risk of bias.”

While most doctors follow best practices, ProPublica has found that some opt for overly aggressive invasive treatments in early stages of vascular disease, which research has found may be associated with an increased risk of complications. In response to recent research, interviews with doctors and patients, and the recent medical guidelines and criteria, we sought to better understand doctor behavior in treating patients with claudication.

How Did We Develop Our Methodology?

Over the past year, our reporting has relied on numerous interviews with researchers, doctors and medical experts from various specialties, including but not limited to vascular surgery, interventional radiology and interventional cardiology. These conversations with experts have helped inform our analysis process. We also used several studies as a starting point for our own methodology, including some from Dr. Caitlin Hicks, an associate professor of surgery at Johns Hopkins University School of Medicine and a leading researcher on procedure overuse.

One of the principal studies we relied on was “Use of Atherectomy during Index Peripheral Vascular Interventions,” which examined first-time vascular procedures, comparing atherectomies with other endovascular interventions, such as angioplasty and stenting. The researchers found substantial variation in how doctors use atherectomies as first-time procedures, with some using the treatment sparingly and others deploying it in a majority of their cases. High rates of atherectomy were more strongly associated with patients who had claudication and for procedures conducted in outpatient settings.

Another study that informed our process was “Overuse of early peripheral vascular interventions for claudication,” which sought to understand whether physicians were adhering to best practices for treating claudication, which recommend noninvasive approaches for patients in the early stages of the disease. Most doctors follow the practice guidelines, but researchers found a group of outlier physicians with high rates of intervention in patients newly diagnosed with claudication. Doctors who worked in high-volume outpatient settings also tended to have a higher rate of early intervention, which “supports the concern that some procedures for claudication may be overused for financial gain,” the authors concluded.

We also were informed by “Practice Patterns of Vascular Surgery’s ‘1%,’” which examined the use of procedures by vascular surgeons who accounted for the top 1% of all Medicare payments. The analysis found that of the $589 million in Medicare payments that went to vascular surgeons in 2016, the top 1% of that workforce — 31 doctors — received $91 million, or 15% of all payments. These outliers also accounted for 49% of the atherectomy payments to vascular surgeons. “The dramatic differences in practice patterns raise concern for potential overuse of specific, highly reimbursed services,” the researchers wrote.

While these studies, and several others, helped inform our process, our analysis with CareSet was independently conducted and did not rely on data of other researchers. Compared with the other studies, our analysis looked at a longer time frame, four years of data, and examined a different metric, percentage of a physician’s patients with claudication at the point of their initial atherectomy procedure.

What Are Our Top-Line Findings?

Relying on public Medicare data, we found that a small fraction of physicians conducting atherectomies account for a majority of the nation’s procedures and Medicare reimbursement payments. About 200 doctors were responsible for conducting nearly 200,000 atherectomies over five years.

Even though these providers only make up about a tenth of all doctors conducting the procedure, they accounted for 53% of all atherectomies in the country. Over five years, they received nearly $1.5 billion in reimbursements for them, representing almost two-thirds of all Medicare payments for the procedures. These physicians may be conducting more procedures and receiving more payments from commercial insurance and Medicaid, as our analysis only looked at Medicare data.

At the top of the list are three physicians from the greater Los Angeles area: Dr. Amiel Moshfegh with $45.8 million in Medicare reimbursement, Dr. Harold Tabaie with $24.8 million and Dr. Malwinder Singha with $23.8 million.

Doctors With Highest Medicare Reimbursement for Atherectomies From 2017 to 2021 Note: We defined an atherectomy procedure with Current Procedural Terminology codes 37225, 37227, 37229, 37231, 37233 and 37235. For each year of data, if a provider had fewer than 11 patients, they were not included in the dataset.

Relying on more detailed Medicare fee-for-service claims data analysis provided by CareSet, we calculated the number of patients who underwent a first-time atherectomy procedure during our study period when they appeared to have only had milder vascular disease based on a diagnosis of claudication.

Between 2019 through 2022, our analysis found that there were at least 121,000 patients who had first-time atherectomy procedures. Nearly 30,000 of these patients appeared to have more mild vascular disease, based on a diagnosis of claudication, according to the data, amounting to about 24.5%, or nearly 1 in 4 patients.

For about 170 doctors, half or more of their first-time atherectomy patients had only claudication as a diagnosis. And for nearly 780 doctors, a quarter or more of their first-time atherectomy patients had only claudication as a diagnosis. For more than 5,000 doctors, the number of claudication patients that had an atherectomy was too low to be reported, with fewer than 11 patients over four years.

Among high users of atherectomy, who conducted 200 or more procedures over four years, on average, about 15% of their patients appeared to have had more mild vascular disease based on a diagnosis of claudication.

Doctors Who Treated Most First-Time Atherectomy Patients With Milder Vascular Disease From 2019 to 2022 Note: We defined milder vascular disease based on a diagnosis of claudication at the time of the initial atherectomy procedure within our study period. Doctors Who Treated Largest Percentage of First-Time Atherectomy Patients With Milder Vascular Disease From 2019 to 2022 Note: We excluded physicians who conducted first-time atherectomies on fewer than 50 patients on average per year to focus on practitioners who have a higher use of the procedure over time. We defined milder vascular disease based on a diagnosis of claudication at the time of the initial atherectomy procedure within our study period.

While the data enables us to identify doctors that appear to have outlier treatment patterns, it does not allow us to determine the precise clinical reason why the doctors differ from peers or their motivation for conducting more procedures than other physicians. But researchers and experts told ProPublica that given the financial incentives to conduct atherectomy procedures in outpatient facilities, these patterns should raise alarms.

What Are the Limitations of Our Analysis?

Our analysis has some limitations. It relied on Medicare fee-for-service claims data, which is submitted by providers for financial purposes. While the data is supposed to be accurate, we cannot account for errors or inaccuracies — in particular, related to procedure or diagnosis codes — in what providers submit to Medicare. Despite the fact that electronic health record data is a richer resource, we did not use it as it’s not available at the scale required to conduct this study.

Medicare claims data only covers beneficiaries of the federal insurance program, and therefore we cannot make direct conclusions about beneficiaries with other insurance coverage. For patients with other insurance coverage, treatment patterns may look different. That said, it is estimated that more than 98% of American adults over the age of 65 are enrolled in Medicare, and about half of them appear in the fee-for-service data, which makes it one of the largest pools of health care information in the world.

Because Medicare claims data was submitted for billing purposes, it does not have complete clinical information on patient symptoms or disease severity. We do not have detailed information about arterial lesions, such as their exact locations, size or degree of occlusion, or clinical imaging, both of which might factor into a patient’s treatment plan. We also do not always know whether medication, exercise therapy or other less-invasive treatments were attempted before an invasive procedure, and if so, for how long. These kinds of programs are often not covered or tracked as part of the financial transaction.

Dr. Robert Tahara, president of the Outpatient Endovascular and Interventional Society, which represents doctors who treat vascular disease outside of hospitals and often in their own private practices, said Medicare’s claims data is not detailed enough to draw conclusions about doctor behavior. Tahara, who was not an outlier in our data, said that the data does not provide information on the stage of patients' disease, their disease progression or whether medical therapy didn’t work for them — details that could provide a greater understanding of why a treatment was chosen. “For example, the patient’s claudication could be worsening and coming close to critical limb ischemia, but the claim could still include a code for intermittent claudication,” he wrote in an email.

We relied on a 12-month lookback to determine whether the atherectomy was a first-time procedure. If a patient received an atherectomy before 2018, it is possible that we have identified a follow-up procedure rather than their first-time intervention. However, this should not impact our findings of whether they received an atherectomy when their recent diagnosis was for claudication.

As part of the data use agreement, we are unable to display data for doctors with fewer than 11 patients because of privacy concerns.

How Did Doctors React to Our Data Analysis?

Several experts and doctors called our findings concerning. Dr. Marty Makary, a professor of surgery and health care quality researcher at Johns Hopkins University School of Medicine, has used similar Medicare claims data to research outlier practice patterns and said that our analysis reinforces his own findings. “It is validating concerns on the grounds that some physicians are responding to a perverse financial incentive,” he said. “The data suggest they may be doing procedures on people who don’t need them.”

Makary leads Global Appropriateness Measures, a consortium of physicians who use clinical wisdom and health care data to detect outlier patterns and discourage overuse. Outlier analyses are critical for improving health care, he said, as most physicians change the way they practice when they learn that they stand out. “Our general principle is that 83% of outliers reduce their pattern of overuse after they see where they stand on the bell curve,” he said.

But several private practice doctors, including some of the outlier physicians we identified in our analysis, rebuffed our analysis or took issue with the use of Medicare claims data.

ProPublica reached out to every doctor named in our story through multiple emails and phone calls, providing questions to the physicians, their clinics, hospitals or lawyers. The following doctors, their offices or lawyers did not respond to ProPublica’s questions for this story at the time of publication: David Burkart, Ian Cawich, Thomas P. Davis, Pablo Guala, Omar Haqqani, Syed Hussain, Juan Kurdi, Moinakhtar Lala, James McGuckin, Jim Melton, Rajiv Nagesetty, Daniel Simon, Pushpinder Sivia and Harold Tabaie. Dr. Bhaskar Purushottam and Monument Health, where he works, both declined to comment. Riverside Healthcare in Illinois, where Hussain has worked since September 2022, declined to comment on the doctor’s practice. Kurdi’s lawyer declined to comment.

Florida vascular surgeon Dr. Joseph Ricotta, the national medical director of vascular surgery and endovascular therapy at Tenet Healthcare, said he rarely intervenes on patients with claudication, unless they have severe lesions. “The overwhelming majority of claudicants obviously we don’t intervene on,” he said. “The majority are managed with medical therapy.” Medicare claims data does not provide detail on the severity of arterial lesions, he said.

Maryland vascular surgeon Dr. Samer Saiedy, who was an outlier in the data, echoed these concerns and said the data doesn’t include enough details to provide a full picture of why he may have treated a patient with an invasive procedure. At his practice, patients are only given the option of invasive procedures, he said, if they have severe pain and have already tried less aggressive approaches first.

“If you look at atherectomy only, and you narrow down, yes, I’ll be an outlier because I do a lot of claudicants for severe symptoms after we do the medical treatment,” he said. “They cannot walk through the pain, they’re already on blood thinners, they’re already on this and already on this. We’re going to do something.”

Tennessee physician Dr. Prateek Gupta also took issue with our analysis, which he called “incomplete,” stating in an email that he is not “an outlier when you analyze all of the necessary factors.” Our analysis, he said, attempts “to allege medically unnecessary treatment based upon one factor” and that “a professional medical opinion about medical necessity is based upon multiple factors, indicia of disease, prognosis, anticipated patient outcome, alternative treatment options, patient preference and others.” Claudication can sometimes be debilitating for patients, he said. “As a practice with protocols, we manage most claudicants conservatively with medical therapy,” he said. “Patients with severe claudication get offered endovascular or open surgical procedures based on their comorbidities and preference if medical therapy fails.”

Jessica Johnson, the chief operating officer of South Dakota’s Vascular & Interventional Specialists, where Dr. Chad Laurich works, did not respond to specific questions regarding ProPublica’s analysis but said that the vascular surgeon had an “unwavering dedication to advancing vascular surgery while prioritizing patient well-being.” The community has “experienced improved wound healing, saved limbs, improved quality of life and many lives saved,” she said. Laurich did not directly respond to ProPublica’s questions.

Cherlynn Hecker, the clinical director at Dr. Christopher LeCroy’s practice, said that he doesn’t conduct procedures on patients with mild disease unless they have lifestyle limiting pain and have already tried exercise and medication therapy first. “This endovascular work is preventing patients having bypasses or amputation,” she said. LeCroy did not directly respond to ProPublica’s emailed questions.

Some doctors said billing errors explained their high rates of intervention on claudication patients. Dr. Colbert Perez said that his practice, Caprock Cardiovascular Center & Cath Lab in Lubbock, Texas, had been marking their patients with incorrect diagnosis codes in Medicare billing claims for several years, which made its patient population appear to have milder disease. Perez said that he rarely intervenes on patients with mild disease and that his practice, which outsources its coding and billing to another company, was looking into the billing issue and was in contact with CMS for corrections and changes. Billing errors can occur, but CMS mandates that physicians “are responsible for ensuring that claims submitted” under their name are “true and correct.”

Some physicians said that Medicare reimbursement data is misleading. Saiedy, who has made about $23.5 million from Medicare in reimbursements for atherectomy procedures over five years, according to federal data, said the payments cover all clinic expenses and are not going to him directly. “You have to look at the overhead of the practice,” he said. “That includes nurses, anesthesia, leases for the equipment, rent.”

California interventional radiologist, Dr. Malwinder Singha, who received $23.8 million in Medicare reimbursements for atherectomy procedures over five years according to federal data, echoed Saiedy’s concerns. “It is devoted to running of the [office-based laboratory] and only a tiny fraction is earned by the operator,” he wrote in an email to ProPublica. “I have to pay my employees and expenses for all the supplies (wires, balloons, stents, atherectomy catheters, etc.), imaging equipment, [electronic medical records], facilities rent, etc.”

Singha also took issue with the use of claims data to identify clinical outliers. “It does not take into account the patient population I see and the severity of their disease,” he said. He added that outpatient facilities are safe, and their patients are satisfied with their care. “What I and my colleagues do is safe and effective,” he said. “There are hundreds of office-based labs who treat thousands and thousands of patients. The adverse event rate is minuscule.”

Dr. Amiel Moshfegh, who received over $45 million in Medicare reimbursements for atherectomy procedures over five years according to Medicare data — more than any other doctor in the country — said his atherectomy statistics reflect “the quality outcomes generated for patients and the confidence of referral sources in directing patients” to his practice. He did not answer ProPublica’s questions on his treatment of patients with claudication.

Interventional radiologist Dr. James McGuckin, who received $17.2 million in Medicare reimbursements for atherectomy procedures over five years according to Medicare data, treats “a significantly high-risk patient base” who are at-risk for amputation, said his attorney, David Heim in an email this past August.

Do You Have Experience With Peripheral Artery Disease? Have You Had a Procedure on Your Leg? Tell Us About It.

by Annie Waldman, ProPublica, with data analysis by Alma Trotter and Fred Trotter, CareSet

Thousands of Patients May Be Undergoing Vascular Procedures Too Soon or Unnecessarily

11 months 1 week ago

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

Four years ago, researchers warned the Centers for Medicare and Medicaid Services that some doctors were overusing — potentially even abusing — invasive vascular procedures, increasing patients’ chances of complications, which include amputation or even death.

They handed the federal agency a list of outlier physicians they found in the government insurer’s own data. But the agency has done little to stop the practice and instead continues to pay doctors who exhibit this behavior millions of dollars a year.

The names of the doctors were never publicly revealed.

ProPublica is shedding new light on the problem.

Working with data journalists from the health analytics group CareSet, and in consultation with experts, ProPublica sought to better understand how often physicians were using one particularly controversial procedure, the atherectomy, on patients with questionable need for it. Over the past year, ProPublica has chronicled the rise of these procedures along with horror stories of patients who lost their legs from complications.

Their cases and many others, plus dozens of interviews with patients, health care providers and medical device representatives, have laid bare a thriving industry of strip-mall clinics and outpatient vascular centers where elderly patients are being exploited for multimillion-dollar Medicare payouts.

As part of the procedure, doctors use a laser or bladed catheter to remove plaque from the patients’ vessel walls. For treatments conducted in outpatient clinics, Medicare pays generous reimbursements to doctors, who can charge tens of thousands of dollars for procedures done in a single visit. Experts recognize atherectomies are appropriate for severe vascular disease, but they told ProPublica that the majority of patients with milder symptoms like leg pain while walking, a condition known as claudication, should start with treatments like medication and exercise.

We analyzed Medicare claims records for people who had first-time atherectomies between 2019 and 2022 and found that nearly 1 in 4 patients underwent the invasive procedure after only a diagnosis for claudication, indicating an early stage of vascular disease.

This amounts to nearly 30,000 patients who may have undergone procedures too soon or possibly even unnecessarily. (Read more about our findings and methodology.)

Some doctors stood out because of the money they made. Dr. Amiel Moshfegh, a Beverly Hills radiologist, received $45 million from Medicare over five years for performing thousands of atherectomies, according to public Medicare records. Most of his Medicare patients were older Latinos, according to federal data, who were warned in Spanish-language advertisements that poor circulation could lead to amputation. About 15% of his patients who underwent a first-time atherectomy, 170 of them, appeared to have milder disease based on their diagnosis for claudication, according to the data.

Other doctors stood out because a large portion of their patients who underwent atherectomies had just claudication, raising questions about the necessity of the procedures. That was the case for Dr. Christopher LeCroy, who works for a chain of vascular clinics across the Florida panhandle; about half of his first-time atherectomy patients appeared to have milder disease based on their diagnosis, according to the data.

And while over 5,000 physicians who provide vascular care rarely intervened on patients who appeared to have milder vascular disease based on their diagnoses, ProPublica and CareSet found that about 170 other doctors performed half or more of their first-time atherectomies on these kinds of patients.

“It’s concerning that we may be doing unnecessary procedures and spending unnecessary health care dollars,” said Dr. Caitlin Hicks, an associate professor of surgery at Johns Hopkins University School of Medicine and a leading researcher on procedure overuse. “We know that aggressive interventions for claudication may give short-term relief, but in the long term, patients are the same as they started or even worse.”

Doctors named in our data objected to being portrayed as part of the problem.

Moshfegh, for example, noted he had no malpractice claims or blemishes on his license. “Atherectomies ultimately can save the government and taxpayers millions of dollars by avoiding amputations,” he said. He did not respond to ProPublica’s questions on his clinic’s use of advertisements, the treatment of patients with milder vascular disease or why he had received more Medicare reimbursements for atherectomy than any other physician in the country. (Read his full statement here.)

LeCroy did not directly respond to ProPublica’s questions sent by email, but the clinical director at his practice said he doesn’t conduct procedures on patients with mild disease unless they have lifestyle-limiting pain and have already tried exercise and medication therapy. “This endovascular work is preventing patients having bypasses or amputation,” said Cherlynn Hecker. Others echoed these points.

Several portrayed the mounting concerns about overuse as part of a debate, not settled science, and said they should be trusted to decide whether their patients can benefit from atherectomies. Private practice doctors also explained that their high reimbursement payments are meant to cover their total business expenses and do not lead to excessive personal profit. Some rebuffed ProPublica’s analysis, taking issue with the use of claims data, which they said does not provide key details on patient symptoms and critiquing the focus on claudication, which they said can have a range of severity. While Medicare claims data has limitations, academics across the country and even government fraud detectives use it to examine trends and identify outliers.

Johns Hopkins surgeon and researcher Dr. Marty Makary said these kinds of outlier analyses are crucial to protecting patients. “Most of the public is flying blind,” said Makary, who also leads the organization Global Appropriateness Measures, which uses similar medical data to address outliers and curb overuse. “The moral dilemma that the medical community is now facing is that we can see practice patterns in big data that are inappropriate. Do we have a duty to act? I think we do.”

Using the research of Hicks, Makary and their colleagues as a springboard, ProPublica has spent the past year examining Medicare data for vascular care to answer some basic questions: Which doctors are making the most money off a single procedure? Who are they treating? And what is happening to their patients?

Relying on public Medicare data, we found that about 200 doctors are responsible for a majority of atherectomies conducted across the country. Over five years, from 2017 through 2021, this small cadre of mostly vascular surgeons, interventional radiologists and cardiologists has earned nearly $1.5 billion dollars, conducting almost 200,000 procedures. At the top of the list sits Moshfegh, the Beverly Hills radiologist who raked in almost double the reimbursements of any other doctor in America, for over 7,000 atherectomy procedures.

Doctors With Highest Medicare Reimbursement for Atherectomies From 2017 to 2021 Note: We defined an atherectomy procedure with Current Procedural Terminology codes 37225, 37227, 37229, 37231, 37233 and 37235. For each year of data, if a provider had fewer than 11 patients, they were not included in the dataset.

While some vascular specialists making millions have developed national empires of clinics, been profiled on local television or garnered dozens of online patient reviews, Moshfegh has kept a remarkably low profile.

After completing his medical training in 2014, Moshfegh went into outpatient vascular care. For a couple years, he led endovascular services for the Los Angeles office of Vascular Access Centers, a national chain of clinics founded by Dr. James McGuckin.

Moshfegh later began working with FIT Vascular, a smaller vascular clinic chain with offices in central Los Angeles and Bakersfield, California. He appears to have worked closely with several podiatrists, sharing hundreds of patients primarily with two podiatry clinics, according to recent Medicare referral claims data from CareSet. One of the podiatry groups, Stockdale Podiatry in Bakersfield, also shares office space with FIT Vascular — the vascular suite sits behind a beige, unmarked door off of the podiatry clinic’s waiting room.

When a ProPublica reporter visited the clinic, Victoria Arredondo, a medical assistant for FIT Vascular, told ProPublica that Moshfegh travels to Bakersfield from Los Angeles several times a week to conduct artery procedures, treating half a dozen patients a day. Nearly all of their patient referrals came from Stockdale Podiatry, she said. While Moshfegh’s name is not listed on FIT Vascular’s website, he is featured in its marketing videos and his face appears in its advertisements.

The federal government generally forbids doctors from making payments to induce referrals or making referrals to entities they have a financial interest in. While it’s not prohibited for physicians to pay another doctor to lease office space, such real estate transactions must be consistent with fair market value to abide by federal law. Neither Stockdale Podiatry or FIT Vascular responded to ProPublica’s emailed questions, including those related to their real estate arrangement. Moshfegh did not respond to ProPublica’s questions about his relationship with the podiatry clinic, though he did say that he adheres “the highest standards of medical ethics” and that his atherectomy statistics reflect “the confidence of referral sources in directing patients” to his practice.

While the raw numbers can highlight doctors like Moshfegh who stand out for how many atherectomies they do, they don’t provide much detail on how individual patients are being treated. So ProPublica worked with CareSet to look at the types of patients that doctors treat, examining whether doctors were frequently conducting procedures on patients who appeared to have more mild disease based on their diagnoses. Using Medicare claims data, we identified patients who underwent a first-time atherectomy procedure between 2019 and 2022, and for each doctor, we calculated the percentage of these patients who only had claudication.

Doctors Who Treated Largest Percentage of First-Time Atherectomy Patients With Milder Vascular Disease From 2019 to 2022 Note: We excluded physicians who conducted first-time atherectomies on fewer than 50 patients on average per year to focus on practitioners who have a higher use of the procedure over time. We defined milder vascular disease based on a diagnosis of claudication at the time of the initial atherectomy procedure within our study period.

This highlighted doctors like Dr. Juan Kurdi of Lubbock, Texas; nearly half of his first-time atherectomy patients appeared to have milder disease based on their diagnosis, according to the data. Kurdi did not directly respond to ProPublica’s emailed questions or phone messages, and his lawyer declined to comment. Kurdi’s currently the target of a criminal investigation by the Department of Justice, according to court filings; he has not been charged. The government and his lawyers are discussing a potential pre-indictment resolution, according to case filings.

His colleague Dr. Colbert Perez, who was also high on this list with 37% of his first-time atherectomy patients having only claudication according to the data, said that their practice, Caprock Cardiovascular Center & Cath Lab, had been marking their patients with incorrect diagnosis codes in Medicare billing claims for several years, which made their patient population appear to have milder disease. While billing errors can occur, CMS mandates that physicians “are responsible for ensuring that claims submitted” under their name are “true and correct.”

Perez said that he rarely intervenes on patients with mild disease, following best practices, and said the center, which outsources its coding and billing to another company, was looking into the billing issue and was in contact with CMS for corrections and changes. He did not provide details on the federal investigation into Kurdi but told ProPublica that his colleague was “going through a separation” with the practice.

In all, experts who reviewed ProPublica’s analysis called the findings alarming and validating. They called on government insurers to do something about the fact that a quarter of all patients who got first-time atherectomies — enough to fit in a sports arena — may not have needed them. CMS told ProPublica that it monitors claims data for outliers and can act when it identifies problems, by denying claims, suspending payment or referring questionable providers to law enforcement.

“When we see patterns that are beyond the boundaries of reasonable according to respected peers in the field,” Makary said, “that is a signal that there should be a closer review.”

Editor’s Note

ProPublica reached out to every doctor named in our story through multiple emails and phone calls, providing questions to the physicians, clinics, hospitals or lawyers. The following doctors, their offices or lawyers did not respond to ProPublica’s questions for this story at the time of publication: David Burkart, Ian Cawich, Thomas P. Davis, Pablo Guala, Omar Haqqani, Syed Hussain, Juan Kurdi, Moinakhtar Lala, James McGuckin, Jim Melton, Rajiv Nagesetty, Daniel Simon, Pushpinder Sivia and Harold Tabaie. Dr. Bhaskar Purushottam and Monument Health, where he works, both declined to comment. Riverside Healthcare in Illinois, where Hussain has worked since September 2022, also declined to comment on the doctor’s practice.

In addition to the doctors quoted in the story, the following doctors responded to ProPublica’s findings.

Maryland vascular surgeon Dr. Samer Saiedy told ProPublica that Medicare claims data doesn’t include enough details to provide a full picture of why he may have treated a patient with an invasive procedure. At his practice, patients are only given the option of invasive procedures, he said, if they have severe pain and have already tried less aggressive approaches first. “If you look at atherectomy only, and you narrow down, yes, I’ll be an outlier because I do a lot of claudicants for severe symptoms after we do the medical treatment,” he said. “They cannot walk through the pain, they’re already on blood thinners, they’re already on this and already on this. We’re going to do something.”

Saiedy also said the Medicare reimbursement data is misleading. Saiedy, who has made about $23.5 million from Medicare in reimbursements for atherectomy procedures over five years, according to federal data, said the payments cover all clinic expenses and are not going to him directly. “You have to look at the overhead of the practice,” he said. “That includes nurses, anesthesia, leases for the equipment, rent.”

California interventional radiologist Dr. Malwinder Singha, who received $23.8 million in Medicare reimbursements for atherectomy procedures over five years according to federal data, echoed Saiedy’s concerns. “It is devoted to running of the [office-based laboratory] and only a tiny fraction is earned by the operator,” he wrote in an email to ProPublica. “I have to pay my employees and expenses for all the supplies (wires, balloons, stents, atherectomy catheters, etc.), imaging equipment, [electronic medical records], facilities rent, etc.”

Singha also took issue with the use of claims data to identify clinical outliers. "It does not take into account the patient population I see and the severity of their disease," he said. He added that outpatient facilities are safe, and their patients are satisfied with their care. "What I and my colleagues do is safe and effective," he said. "There are hundreds of office based labs who treat thousands and thousands of patients. The adverse event rate is miniscule."

Interventional radiologist Dr. James McGuckin, who received $17.2 million in Medicare reimbursements for atherectomy procedures over five years, treats “a significantly high-risk patient base” who are at-risk for amputation, said his attorney, David Heim, in an email this past August. Earlier this year, the Department of Justice sued McGuckin for submitting false claims to the federal health care programs for “medically unnecessary invasive peripheral artery procedures,” allegations that Heim had called “provably wrong.” His lawyers have moved to dismiss the case.

Do You Have Experience With Peripheral Artery Disease? Have You Had a Procedure on Your Leg? Tell Us About It.

by Annie Waldman, ProPublica, with data analysis by Alma Trotter and Fred Trotter, CareSet

5 Takeaways From ProPublica’s Investigation of Coast Guard Detentions at Sea

11 months 1 week ago

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In late February, a smuggling boat carrying dozens of Haitians bound for the U.S. was intercepted so close to Florida’s shore that those aboard could see the lights of hotels and passing cars. But although they were in U.S. waters, they have few rights compared to people who arrive at land borders. That’s even true of the three young children traveling alone on that boat, a 10-year-old boy and two sisters, 8 and 4.

I spent months reporting on this group of people, the children in particular, and on the hidden world of immigration enforcement at sea, a border where different rules apply. These are five key findings of the investigation, published last week in partnership with The New York Times Magazine.

Coast Guard detentions in the Caribbean and straits of Florida have reached their highest level in nearly three decades.

Since the summer of 2021, the Coast Guard has detained more than 27,000 people aboard its fleet of cutters in the Caribbean and straits of Florida, more than in any similar period in nearly three decades.

“We are in extremis,” a senior Coast Guard official wrote to colleagues in an email, part of a trove of internal records and data that I obtained. Most of the 27,000 are Haitian and Cuban, people who in recent years have faced extraordinary levels of violence and political unrest. But even people fleeing violence, rape, the threat of death — who on land would be likely to pass an initial asylum screening, according to legal experts — are routinely sent back to the countries they’ve fled when they try to arrive by sea.

The U.S. government has a separate system for people detained at sea to ask for protection. But it is nearly impossible to get through. Of the 27,000 people detained since July 2021, the Coast Guard logged 1,900 such claims, according to an internal Coast Guard database I obtained. Only about 60 of them had those claims approved by the U.S. Citizenship and Immigration Services officials.

Yet even the people whose “fear” claims are approved are not allowed into the U.S. Instead they can agree to be sent to an immigration detention facility on the U.S. naval base at Guantánamo Bay, Cuba, where they’re told they should be prepared to wait for two years or more, until another country agrees to take them as refugees. Only 36 of the people with approved claims since July 2021 agreed to be sent to Guantánamo.

Unlike on land, even unaccompanied children traveling by sea are almost always denied protection in the U.S.

Since July of 2021, the Coast Guard has detained about 500 unaccompanied minors, mostly Haitians. Nearly every one of them was sent back.

On land, unaccompanied minors from countries other than Mexico and Canada cannot simply be turned back. But at sea, children are treated much like adults. Of the 500, only about 1% were allowed into the U.S. because officials determined they would likely be persecuted or tortured if sent back to the countries they fled.

The Coast Guard says that its crew members screen children to identify “human-trafficking indicators and protection concerns including fear of return.” A spokesperson told me that “migrants who indicate a fear of return receive further screening” by Homeland Security officials.

Once children are sent back to Haiti, some face uncertain fates.

No U.S. agency would explain what, if any, precautions the U.S. government takes to protect children, beyond an initial screening conducted aboard cutters.

Our reporting centered on the experience of a 10-year-old boy named Tcherry who, after he was delivered to Haiti by the Coast Guard, left the port with a man he’d met only weeks before at a smuggler’s house. No U.S. or Haitian officials spoke with Tcherry’s mother, who is in Canada, before the man was allowed to leave with the boy. The man himself was surprised how easy it had been.

“When we have custodial protection of those children, we want to make sure that the necessary steps are taken,” a Coast Guard spokesperson said, “to ensure that when we repatriate those migrants, they don’t end up in some nefarious actor’s custody or something.”

But one official from an agency involved in processing people delivered by the U.S. Coast Guard to Haiti told me, “Children leave the port, and what happens to them after they leave, no one knows.”

People are harming themselves in the hopes of making successful asylum claims.

As more and more people have taken to the sea, and their desperation has grown, an increasing number of migrants and refugees have harmed themselves in hopes that they will be rushed to hospitals on land, where they believe they can make asylum claims.

People detained on cutters have swallowed jagged metal cotter pins pulled from the rigging and stabbed themselves with smuggled blades, apparently trying to cause such severe injury that they’d be taken to a hospital. In January, a man plunged a five-inch buck-style knife that he’d carried onto a cutter into the side of his torso and slashed it down his rib cage. Crewmembers now start every leg at sea by scouring the decks for anything that people might use to harm themselves. According to a Department of Homeland Security spokesperson, “medical evacuations do not mean that migrants have a greater chance of remaining in the United States.” But without the ability to claim asylum on cutters, more people are trying anyway.

The rigid immigration restrictions at sea, combined with the nearly 30-year spike in people detained, has created a moral crisis for Coast Guard members, too.

Coast Guard crew members described to me their distress at having to reject desperate person after desperate person. Several people I talked to said that the worst part of the job was turning away the children who were traveling alone. “The hardest ones for me are the unaccompanied minors,” one crew member told me. “They’re put on this boat to try to come to America, and they have no one.”

Crew members were seeing so much suffering, including encountering the bodies of people whose boats had capsized in the sea, that it was not uncommon for them to find each other sobbing. Some were struggling with what one former crew member called a “moral dilemma” because they had begun to understand that the job required them to inflict suffering on others. “We hear their stories, people who say they’d rather we shoot them right here than send them back to what they’re running from,” another Coast Guard member told me. “And then we send them all back.”

The Coast Guard leadership was getting worried: “I don’t see how the current level of operations is sustainable,” the commander of U.S. Coast Guard Sector Miami wrote to colleagues, “without the breaking of several of our people.”

Jason Kao contributed data reporting.

by Seth Freed Wessler

Help ProPublica Investigate the World of Subprime Car Loans

11 months 1 week ago

U.S. consumers are falling behind on their auto loans at historic rates. Experts blame inflation, soaring interest rates and high retail car prices. Our journalists want to learn more about this industry and understand the causes and consequences of the surge in delinquencies.

Many struggling car owners have “subprime” loans, in which people with poor credit scores agree to pay higher-than-normal interest rates to qualify. Lenders say the arrangement is meant to protect them in case the borrower can’t pay.

For investors, subprime loans can also represent an opportunity: High interest rates on the consumers’ end can yield great returns when loans are bundled together and sold as securities on Wall Street.

In recent years, regulators have sued lenders, accusing them of issuing loans they knew consumers would fail to pay back. State attorneys general and the Consumer Financial Protection Bureau have also called out lenders, saying they are inflating the prices of cars and failing to clearly explain how much interest is due over the life of loans.

We think there are lots of stories to tell about this industry. To do the best possible journalism, we need to hear from people who know it well. Do you work for a subprime lender — in customer service, collections, loan funding, training or risk management? Are you paying off a subprime car loan? Are you a lawyer dealing with these issues in court? A regulator? An investor? Please use the form below to get in touch with us. We look forward to speaking with you.

by Byard Duncan and Ryan Gabrielson