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by Duaa Eldeib

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Inside the medical examiner’s office, two pathologists removed a baby’s lungs from his chest, clamped them together and placed them in a container of water. Then they watched.

They were examining the suspicious death of the baby whose body was found in a Maryland home; his mother said he was stillborn.

If the lungs floated, the theory behind the test holds, the baby likely was born alive. If they sank, the baby likely was stillborn.

“A very simple premise,” the assistant medical examiner later testified.

The lungs floated — and the mother was charged with murder.

In investigations across the country, the lung float test has emerged as a barometer of sorts to help determine if a mother suffered the devastating loss of a stillbirth or if she murdered her baby who was born alive. The test has been used in at least 11 cases where women were charged criminally since 2013 and has helped put nine of them behind bars, a ProPublica review of court records and news reports found. Some of those women remain in prison. Some had their charges dropped and were released.

But the test is so deeply flawed that many medical examiners say it cannot be trusted. They put it in the same company as the discredited analysis of bite marks and bloodstain patterns, 911 calls and hair comparisons, all of which lack solid scientific foundations and have contributed to wrongful convictions.

It is pseudoscience masquerading as sound forensics, they say. Some even liken the test to witch trials, where courts decided if a woman was a witch based on whether she floated or sank.

“Basing something so enormous on a test that should not be used, that has been completely discredited, is absolutely wrong,” said Dr. Ranit Mishori, the senior medical adviser for the nonprofit Physicians for Human Rights, which has been studying the test, and a professor of family medicine at Georgetown University School of Medicine. “You can send a person who is innocent to prison for many years.”

Medical examiners who rely on the lung float test typically do so in cases where someone gives birth outside of a hospital, often at home and far from the watchful eyes of medical professionals. Absent those witnesses, doubt can overshadow the insistence that the baby was stillborn.

Since the Supreme Court struck down the constitutional right to abortion, legal experts and reproductive justice advocates have voiced fears that an increased reliance on the lung float test will lead to more prosecutions in a landscape where any pregnancy that doesn’t end with a living, breathing baby can be viewed with suspicion. In several cases, the fact that a woman had considered abortion was used against her. Black, brown and poor women, research shows, already disproportionately face pregnancy-related prosecutions. Black women also are more than two times as likely to have a stillbirth as white women.

Even medical examiners who perform the test as part of an autopsy acknowledge its shortcomings. They concede that there are several ways to perform it, undermining the standardization that many forensic disciplines demand. Yet judges have allowed prosecutors to use it as evidence in court.

“Basing something so enormous on a test that should not be used, that has been completely discredited, is absolutely wrong.”

—Dr. Ranit Mishori, senior medical adviser for Physicians for Human Rights

ProPublica contacted the nation’s largest medical examiners’ offices to ask if they use the lung float test and discovered a patchwork of practices. Many offices said they just don’t trust it. The County of Los Angeles Department of Medical Examiner called its results “inaccurate.” The Harris County Institute of Forensic Sciences in Houston said it found the test to be “very unreliable” and “not supported by empirical evidence.”

In Cook County, home to Chicago, pathologists use it, but give more weight to “more reliable methods” including X-rays, microscopic examinations and autopsy findings to determine whether a birth was live or still. Others, like the Virginia Office of the Chief Medical Examiner, said the test may be useful only if a baby was not born into a toilet, CPR was not performed and decomposition was not present. None of the 12 largest offices by jurisdiction expressed full-throated support for the test.

And while the national organization that represents medical examiners said that it doesn’t have an official stance on the lung float test, it said it “strongly advocates using scientifically validated and evidence-based practices in forensic pathology.” The National Association of Medical Examiners called the lung float test “a single, dated test” that has not been subjected to the organization’s rigorous evaluation process.

Dr. Gregory Davis, a forensic pathologist at the University of Kentucky College of Medicine and a consultant to the office of the medical examiner in Kentucky, called the test “an outrageous breach of science.” He said he has personally observed the lungs of stillborn babies float and those of live-born babies sink.

The fundamental problem with the test, he said, is that there are many ways that air can enter the lungs of a stillborn child.

“There’s no way,” Davis said, “you can determine live birth versus stillbirth with this test.”

Moira Akers, the Maryland woman whose baby died, didn’t intend to get pregnant. She and her husband, Ian, already had two young children and the couple worried they wouldn’t be able to handle another child.

They struggled financially — she was a stay-at-home mom and he worked only a few days a week as a first mate on a dinner cruise. Her previous pregnancies — both ending in cesarean sections — were difficult, and challenges with her youngest child demanded much of her attention.

Due to Akers’ age, 37, and weight, her pregnancy was considered high risk. The couple decided to terminate, but they didn’t tell her family, who are Catholic and who she worried may not have approved. When Akers was a little girl, her mother said, she dreamed of being a mother, and as an adult she doted on her children.

After her appointment with a gynecologist around 15 weeks into her pregnancy, court records show that Akers thought that it was too late for her to have an abortion in Maryland. She decided she would carry the baby to term without letting anyone know she was still pregnant and give it up at a firehouse.

“I wanted the baby to have a good life,” Akers later told police. “I just knew we weren’t going to be able to provide that.”

Moira Akers (Courtesy of Debra Saltz)

She didn’t gain much weight and she told her husband early on that the pregnancy had been terminated. She also didn’t divulge the fact that she was pregnant to other family members, who were going through their own hardships, court records and interviews show. Her sister was being treated for cancer and feared she’d never be able to have children of her own. Her brother was recovering from an accident that had left him temporarily using a wheelchair. And the family had recently buried her grandmother and aunt.

Akers declined comment through her attorney. But the description of the case is based on police and court records, including a trial transcript, as well as interviews with her family and her lawyer.

On Nov. 1, 2018, in the family’s three-bedroom duplex in suburban Baltimore, Akers had been having contractions when she felt a strong urge to use the bathroom. She delivered her son into the toilet. She said he was not breathing. She grabbed her older son’s Star Wars towel to wrap the baby in, then carried him into the bedroom to get scissors and cut the umbilical cord.

“I didn’t hear anything,” Akers later told a detective. The baby, she said, didn’t move.

She didn’t know what to do next. Akers scanned the room and spotted a large Ziploc bag meant to store her daughter’s clothes. She placed her baby in the blue bag, and she put the bag in the closet.

Akers was bleeding heavily from the delivery. Blood soaked the carpet and smeared the bathroom floor. It stained the bathtub, closet door and hallway.

Her husband came upstairs. Alarmed by all the blood, he called the paramedics. When they arrived, they asked Akers questions as she sat on the couch with her husband and two children. She denied being pregnant.

It wasn’t until later, after Akers arrived at the hospital, that she told a nurse that she had “delivered a stillborn child” at home, police records show.

The doctors, who came in next, saw a protruding umbilical cord still attached and asked if the baby was alive. Akers said she had delivered a stillborn baby and told them about the bag and the closet.

Police launched an investigation. Akers described being in denial about the pregnancy and sad about the baby’s death.

The two Maryland doctors conducted an autopsy. The baby, they wrote in their report, appeared to be “well-developed” and “well-nourished” and had been delivered after about 41-42 weeks of pregnancy. He had blue eyes and straight brown hair.

Neither the external exam of the baby nor his bloodwork nor an X-ray revealed signs of foul play. But the narrative from police described a woman who hid her pregnancy from her family and paramedics, considered an abortion and placed the baby’s body in a closet. A microscopic view of the lungs, which were soft and pink in some areas, also appeared to show that some parts had air in them and others did not.

They also had the results of the lung float test.

“A flotation test and microscopic examination of the lungs was consistent with a live birth,” the autopsy read. The baby, the medical examiners concluded, died of asphyxia and exposure from being left in the closet.

Prosecutors charged Akers with child abuse and murder.

The lung float test’s simplicity — essentially unchanged over centuries — is both a feature and a flaw.

Some medical examiners take out one lung at a time. Some cut the lungs up and test pieces, and may even go so far as to squeeze them. Others clamp them together or put the heart and lungs in a jar. Some drop in the liver as a control. Others submerge the lungs in liquid formaldehyde instead of water.

As the assistant medical examiner in Akers’ case testified, “there’s a million ways” to conduct the test.

In theory, the test is meant to determine whether air has reached the microscopic air sacs inside the lungs. If it has, the sacs open and spread out. If it hasn’t, the sacs remain collapsed.

“It is not always possible to reach a definitive conclusion, but that may be preferable to [a case] that is based on a problematic test.”

—Capt. Kyle Kennedy, Oregon State Police

But the problem with using aeration as a proxy for proof of life, many medical experts argue, is that babies don’t have to take a breath for air to enter their lungs. Air can be introduced when the baby’s chest is compressed as it squeezes through the birth canal. If there is an attempt to resuscitate a stillborn baby, that pressure can inflate the lungs. And if a body has started to decompose, gases from that process can cause the lungs to float in water. Even the ordinary handling of a stillborn baby can allow air to enter the lungs.

Doctors have long struggled with the best way to determine whether a baby was born alive in unattended births. Many experts agree that it’s nearly impossible without incontrovertible evidence such as milk in the baby’s stomach or signs of the umbilical cord stump beginning to heal where it was cut.

The uncertainty can be difficult for juries to accept, especially when prosecutors present what appears to be a scientific test that proves a baby was born alive and, as a result, was murdered.

“It is not always possible to reach a definitive conclusion, but that may be preferable to one that is based on a problematic test,” said Capt. Kyle Kennedy of the Oregon State Police department, of which the Oregon State Medical Examiner is a part.

The Oregon State Medical Examiner, he said, does not use the lung float test.

The test can produce correct results, said Dr. Christopher Milroy, a forensic pathologist with the Eastern Ontario Regional Forensic Pathology Unit and a professor at the University of Ottawa in Canada. But given that it also produces inaccurate results, he said it should not be used in criminal cases.

“It’s not like some of the things we do,” he said, “where we are going, ‘Well, did they die of diabetes or did they die of something else natural?’”

Milroy has studied the test and its history and has found references to its use in the 17th century, when witch trials were still occurring. But by the late 1700s, its reliability was questioned by doctors and lawyers. More than 200 years later, in 2016, the authors of a forensic medicine textbook wrote that there were too many recorded instances of stillborn lungs floating and live-born lungs sinking for the test to be used in a criminal trial.

No agency currently tracks how often the lung float test is used in criminal cases. But the 11 cases ProPublica identified are likely an undercount because some cases weren’t covered in news reports, and plea deals and acquittals often create less of a public record.

Still, the test has been cited in medical textbooks and is often included in forensic pathology training. Its defenders say that there aren’t any better alternatives, and they may be criticized for not doing their job if they don’t use it. Some also say they don’t rely solely on the test; they acknowledge its weaknesses but say it complements other exams. In addition, some people do, in fact, kill their babies.

Prosecutors have often turned to a 2013 academic study from Germany to support admitting the lung float test as evidence. “The study proves that for contemporary medicine, the lung floating test is still a reliable indicator of a newborn’s breathing,” the authors wrote.

But some experts have questioned that study, saying its results have not been reproduced, its 98% accuracy rate is misleading and it didn’t actually answer whether a baby was born alive because the births in the study had been attended by medical professionals, so there was never any real question about what happened.

The hospital affiliated with the study’s authors declined to comment.

The dearth of research around the test raises critical questions about whether it should be allowed as evidence, said Marvin Schechter, a New York criminal defense lawyer who served on the committee that wrote a groundbreaking National Academy of Sciences report in 2009 on strengthening forensic science in the United States. Schechter said the lung float test wasn’t included because the commission reviewed only the most frequently cited forensic tests.

His concerns with the test mirror many of the ones flagged in the report. For example, he said, the lack of standardization is evident in the fact that some medical examiners squeeze the lungs as part of the test.

“What is that? Your squeeze is different than my squeeze,” he said. “That’s not science.”

Schechter called for a national conference to evaluate the test and its admissibility in court.

“If you apply the rules and regulations that follow science to the lung float test, how does it pass muster?” Schechter said. “The research doesn’t exist, and if the research doesn’t exist, then you shouldn’t be doing it.”

Every so often, after the lung float test has been used to help put a woman behind bars, the questions around it set her free.

In 2006, Bridget Lee had hid her pregnancy after having an affair. She didn’t want anyone in the small Alabama community where she played piano at her church to know.

Bridget Lee at her home in Carrollton, Alabama, in 2009 (Jay Reeves/AP)

When she went into labor at home, she said her son was stillborn. She placed his body in a plastic container and put it in her SUV, where it sat for days.

The medical examiner used the lung float test and concluded that Lee’s son had been born alive. Lee was charged with murder, which in Alabama carried the possibility of the death penalty.

Lee’s lawyer called on Davis to review the autopsy report, which was the first time he saw the lung float test being used to support criminal charges against a mother. He concluded that the autopsy was filled with errors. It missed an infection in the umbilical cord and erroneously described decomposition as signs of injury.

Davis’ review led to the Alabama Department of Forensic Sciences to examine the case, and the agency ruled that not only had the medical examiner botched the autopsy, but the baby was stillborn. Neither the medical examiner nor the prosecutors responded to requests for comment.

Lee spent nine months in jail before prosecutors dropped the charges against her.

She later told reporters that she knows it’s hard for people to understand how she could put her baby’s body in a container and leave it in her car. But, she said, the best way to describe it was like having “an out-of-body experience.”

While individual reactions are hard to comprehend, mental health specialists say the shock and pain of delivering a stillborn baby at home can be so traumatic that people may detach or disassociate from reality, said Dr. Miriam Schultz, an associate clinical professor of psychiatry who specializes in reproductive psychiatry at Stanford Medicine Children’s Health.

“Sometimes a survival instinct will kick in to try to normalize what’s an absolutely incomprehensibly shocking and devastating reality,” Schultz said. “One could imagine possibly trying to make evidence of what just happened less visible and wanting to completely compartmentalize this traumatic event that just has occurred.”

Late one April night in 2017, Latice Fisher said she felt the urge to defecate. About three hours later, she delivered her son into the toilet at her home.

The medical examiner in Fisher’s case performed the lung float test, which revealed that parts of the lungs floated and parts didn’t. He ruled that the baby was born alive and died from asphyxiation. Police also found that Fisher had searched for abortion pills on her phone.

Yveka Pierre, senior litigation counsel with the reproductive justice nonprofit If/When/How, said the people who are prosecuted for their pregnancy outcomes are typically from marginalized communities. They’re Black, like Fisher; or they’re brown, like Purvi Patel, an Indiana woman who was sent to prison for feticide after self-inducing an abortion, a charge that was later vacated; or they face financial hurdles, like Akers.

“Some losses are tragedies, depending on your identity, and some losses are crimes, depending on your identity.” Pierre said. “That is not how we say the law should work.”

Pierre, who also worked on Akers’ case, said Fisher and her husband did what prosecutors say to do by calling 911, but Fisher was still arrested. Once the medical examiner’s investigation starts, she said, the office typically works in tandem with the police.

A grand jury indicted Fisher on second-degree murder charges in January 2018. But a few months later, a local group raised money to get her released on bond. The group also contacted a national nonprofit, now known as Pregnancy Justice, which helped connect Fisher with longtime criminal defense attorney Dan Arshack. He began researching the lung float test and came to an unmistakable conclusion.

“It should be permitted to the same extent that dunking a woman in water is permitted to determine if she’s a witch,” he said in an interview.

“Some losses are tragedies, depending on your identity, and some losses are crimes, depending on your identity. That is not how we say the law should work.”

—Yveka Pierre, senior litigation counsel with If/When/How

Arshack asked Davis to review the autopsy, which he found troubling. Arshack also asked Aziza Ahmed, then a professor at Northeastern University School of Law, to focus specifically on the forensics of the lung float test.

By not requiring rigorous testing or proof of its accuracy, Ahmed wrote, the “courts themselves have played a key role in sustaining the inaccurate belief” that the test could reliably determine whether a child was born alive.

Arshack wrote letters to District Attorney Scott Colom explaining Davis and Ahmed’s findings, saying there was no “reasonable legal or scientific basis” to conclude that a crime occurred. He also explained that it wasn’t “good public policy to prosecute women for bad pregnancy outcomes, especially Black women in Mississippi,” who suffer higher rates of maternal mortality and stillbirth.

In May 2019, Colom announced that he had learned of concerns surrounding the reliability of the lung float test. Once the question of whether the child was born alive was scientifically in dispute, he said, he dismissed the charges against Fisher and sent the case to another grand jury armed with the details about the test.

“When you’re talking about a murder charge for a mother,” Colom said in an interview, “I felt that was crucial information because I certainly didn’t want to be prosecuting somebody for a stillborn death that could not be her fault.”

This time, the grand jury chose not to indict Fisher.

As Akers’ case made its way through court, Davis was asked to review the autopsy. He noted that Akers had classic risk factors for stillbirth: hypertension during pregnancy, obesity, advanced maternal age and previous pregnancies. She also was past her due date and reported not feeling the baby kick in the days leading up to the birth.

Dr. Gregory Davis at University of Kentucky College of Medicine (Natosha Via for ProPublica)

Davis agreed with the medical examiner, Dr. Nikki Mourtzinos, and the associate pathologist who conducted parts of the autopsy, that there were infections in the pancreas, placenta — the vital organ that provides the fetus with nutrients and oxygen — and the umbilical cord, which serves as the baby’s lifeline in the womb.

But what he found “perplexing,” he wrote, is that they did “not seem to take these critical findings into account regarding such findings being associated with stillbirth.” When it was his time to take the witness stand at trial, he said the infections in the placenta, umbilical cord and membranes were “a smoking gun association” with stillbirth.

An OB-GYN also testified that he believed Akers suffered from a placental abruption — a complication where the placenta separates from the wall of the uterus — which also can lead to a stillbirth and cause heavy bleeding.

Prosecutors said the case hinged on whether the baby was born alive. Among the evidence they pointed to were the results of the lung float test, the pinkish appearance of the lungs and lack of decomposition, malformation of the baby’s head or slippage of the skin.

“These lungs floated,” the prosecutor said during closing. “They floated because this child had breathed and was alive after he was delivered at home that day.”

The prosecution homed in on the fact that Akers had wanted an abortion, which was underscored by her cellphone search history. They said she never intended to have her baby live and breathe. When she didn’t get an abortion, they said, she chose to give birth at home and kill her son. They pointed out that she hadn’t received prenatal care and that she didn’t attempt to resuscitate the baby.

Akers told police she thought it was too late.

During closing arguments, prosecutors displayed an oversized photo of the baby on the screen and repeated that Akers put his body in a bag, using the word “bag” 26 times.

In April 2022, the jury found Akers guilty of second-degree murder and first-degree child abuse.

In response to questions from ProPublica, the state’s attorney declined to comment. Mourtzinos, the assistant medical examiner who testified in Akers’ case, did not respond to requests for comment. She’s no longer with the Maryland medical examiner’s office. The agency’s interim chief medical examiner said the office is accredited by the National Association of Medical Examiners and follows the organization’s autopsy performance standards. Any and all ancillary tests, she said, “are done on a case by case basis, at the discretion of the attending medical examiner” and interpreted in the context of the entire case.

When the verdict was read, Akers collapsed in her chair, dropped her head to the table and sobbed. Her family, who was seated behind her, filled the courtroom with their own cries.

Last summer, as much of the country awaited the aftermath of the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, which eliminated a constitutional right to abortion, the New York-based nonprofit Pregnancy Justice released a guide for medical, legal and child welfare professionals on confronting pregnancy criminalization.

The organization advised defense attorneys and medical examiners to challenge the lung float test. In many cases, the authors wrote, criminal charges are based on “the erroneous assumption that a woman engaged in acts or omissions that harmed the fetus.”

The backdrop to the lung float test is the deeper issue of criminalizing pregnancy loss. That was already on the rise before the Dobbs decision, with data from Pregnancy Justice showing that nearly 1,400 pregnant women were arrested, prosecuted or sentenced between 2006 and the 2022 Dobbs decision, more than three times the total for the previous 33 years. Many of the charges were connected to drug use while pregnant.

Society often wants to hold someone responsible, said Dana Sussman, deputy executive director of Pregnancy Justice. Mothers are usually the easiest to blame.

One of the first things Pregnancy Justice lawyers now ask in a pregnancy loss case is whether the prosecutor is attempting to use the lung float test.

“It’s almost like an intake question,” Sussman said. “We will fight every attempt that we learn of to use that test because that is a life sentence based on unreliable information and unreliable science.”

The lack of understanding, research and education around stillbirth also contributes to the urge to assign blame. Every year in the U.S., more than 20,000 pregnancies end in stillbirth, defined as the death of an expected child at 20 weeks or more. But the public is often shocked to hear that number or learn that only a fraction of stillbirths are attributed to congenital abnormalities. Some babies died just minutes before they were born and were placed in their parents’ arms while they were warm to the touch and their cheeks were still rosy.

Davis, an affable man with a snow-white beard, has started to spread the word about the lung float test. At a post-Dobbs legal seminar in Tennessee over the summer, he told a room of lawyers about the test, one that many of them had not heard of but may soon encounter.

A lawyer sitting in the back told the crowd that the lung float test seemed to have the same validity as bite mark analysis, which for decades was accepted as evidence and now is considered junk science.

“What do you do when they say this test has been accepted in the past?” she asked.

Davis pointed her to a letter where he gathered signatures from more than two dozen forensic pathologists and medical examiners from around the world who declared that the lung float test is not a scientifically reliable test or indicator of live birth and “is not generally accepted within the forensic pathology community.”

He had submitted the letter in Akers’ case.

In July of last year, three months after the Akers verdict, prosecutors asked the judge to sentence her to 40 years. They said it was the “the most heinous of crimes that can be committed” and it was carried out by a woman who hid her pregnancy and took her baby’s life in a “detached and calculated manner.”

Akers’ family came to her defense. Her husband said that in their nearly 20 years together, Akers’ “devotion to her family defies description.” One of his greatest joys in life, he said, was seeing the way their kids light up anytime she enters a room.

Her lawyer, Debra Saltz, said Akers made “lapses in judgment” by not telling anyone she was pregnant, having the baby alone and then putting his body in the closet. But, she said, “There is in this life no way anybody will get me to believe that Moira Akers killed her baby. I believe Moira, and I believe the science, that this baby was stillborn.”

Before the judge imposed his sentence, Akers addressed him.

“My children are my entire world,” she said, “and I fell in love with my son as soon as I saw him.”

The judge, who acknowledged what an “extraordinarily difficult case” it was, said the charges against Akers were “particularly egregious because they were perpetrated against an innocent, helpless, newborn child.”

He sentenced her to 30 years in prison.

Akers’ appeal, now pending, focuses on the shortcomings of the lung float test.

As she waits for a ruling, she stays connected to her family from prison. Her mom, Mary Linehan, said most of their conversations revolve around the ordinary details of her children’s lives, their first day of school and their favorite new toys.

Akers’ mom, who retired from her job as an accountant at a Catholic church and school, helps watch her grandchildren. When they ask about their mom, she said, their dad tells them that she “got blamed for something she didn’t do, and we’re fighting to get her out.”

Mariam Elba contributed research.

by Jonathan D. Salant and Michael D. Sallah, Pittsburgh Post-Gazette; Haajrah Gilani, Medill Investigative Lab; and Debbie Cenziper, ProPublica

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Update, Oct. 6, 2023: This story was updated to note a fall in Royal Philips’ stock prices.

A powerful U.S. senator is calling on federal prosecutors to take immediate action against Philips Respironics after revelations the global company withheld thousands of warnings about popular breathing machines capable of spewing hazardous particles and fumes into the masks of patients.

“Philips brazenly turned a blind eye to its dangerous defective machines all in the name of profit,” Sen. Richard Blumenthal, D-Conn., said in a statement about the device maker, which has long dominated the market for ventilators and sleep apnea machines.

The call for enforcement from the Department of Justice comes just days after an investigation by ProPublica and the Pittsburgh Post-Gazette revealed the company kept secret more than 3,700 complaints about the faulty devices over the course of 11 years before launching a massive recall in 2021.

At the time, Philips acknowledged that an industrial foam placed inside the devices to reduce noise could break down in heat and humidity and release material into the air paths of the machines. By then, the company’s two factories in Pittsburgh had turned out millions of the tainted devices, which were delivered to infants, the elderly, COVID-19 patients and at least 700,000 veterans.

As the complaints mounted, stock prices for the device maker’s parent company, Royal Philips, soared to the highest levels in at least 40 years. In a statement, Philips said it regrets any “distress and concern” caused by the recall and it is cooperating with prosecutors and regulators.

“Philips’ priority is patient safety and quality,” the company said.

Safety tests on the foam by Philips in the wake of the recall were called into question by the FDA on Thursday, which said in a statement that the tests were not adequate and did not “fully evaluate the risks posed to users.” Philips agreed to conduct additional tests, the agency said.

Stock prices for Royal Philips, which fell in the wake of the ProPublica and Post-Gazette investigation, dropped by more than 9% on Friday morning after the FDA announcement.

The Justice Department, which has been examining the company’s testing practices and safety claims, can impose a range of penalties against medical device companies in violation of federal safety laws, including civil sanctions and criminal charges.

“Philips knew about the serious risks of its breathing machines for years, but inexcusably, withheld critical information,” said Blumenthal, a member of the Senate Judiciary Committee and chair of an investigations subcommittee that probes violations of laws and regulations impacting national health and safety. “The DOJ must take immediate, aggressive action against Philips for its years-long wrongdoing.”

Senate Majority Whip Dick Durbin, D-Ill., also lambasted Philips for “allowing consumers to breathe in harmful particles from their CPAP machines.”

“It’s deeply disturbing that Phillips would sit on this information as Americans became sicker and sicker,” Durbin said in response to the news organizations’ investigation.

To keep the public safe, federal law requires device makers to submit reports of device malfunctions, patient injuries and deaths within 30 days. In the years before the recall, ProPublica and the Post-Gazette found, Philips withheld the vast majority of complaints about the foam from the Food and Drug Administration, which oversees the medical device industry.

News of the recall stunned patients and their doctors, who scrambled to find information about the potential health risks. The FDA has since classified the recall as the most serious, for device defects that can cause severe injury or death.

“All I could do is tell them the truth, what their options were and be sympathetic,” said Dr. Byron Cooper, a Philips CPAP user and newly retired pulmonologist who treated sleep apnea patients in Washington, D.C. “It would have helped to have more transparency.”

Durbin and Rep. Jan Schakowsky, D-Ill., recently proposed legislation to streamline the recall process so that patients quickly learn about potential health risks.

“When these recalls, like the one Phillips finally issued after more than a decade, come to light, consumers have a right to be informed,” Durbin said.

Philips has said that complaints about the foam were limited before the recall and evaluated on a case-by-case basis, and that when it became aware of the potential significance of the problem in early 2021, the company launched the recall shortly after that.

Philips acknowledged the foam could release chemicals or break into particles capable of causing life-threatening injuries.

Since the recall, the company has changed course, saying recent testing on the DreamStation continuous positive airway pressure, or CPAP, machine and similar devices shows that chemical emissions fall within safety thresholds.

ProPublica and the Post-Gazette obtained copies of the results of four tests carried out in 2021 that were solicited by Philips. Three experts who reviewed the results for the news organizations disputed the company’s claim that emissions fall within safety thresholds. The experts also pointed out that the foam tested positive for genotoxicity, the ability of a chemical to cause cells to mutate, which can lead to cancer.

As doctors struggle to assess the long-term health risks, Connecticut Attorney General William Tong said third-party experts should conduct safety tests on the devices.

“There are still people with defective devices who are rightfully scared and frustrated and they deserve better from both Philips and FDA,” said Tong, who last year joined Blumenthal in a letter to federal regulators urging them to take action against the company.

Kushal Kadakia, a public health researcher at Harvard Medical School who has written about the recall, said the FDA should launch an advisory panel to determine whether the devices are safe and should also require Philips to carry out a study tracking the long-term health consequences.

The FDA, which said it does not comment on compliance matters, said that it is “unsatisfied” with the status of the recall and that the agency would continue to ensure that patients receive accurate information.

Last month, Philips reached a settlement in one of several lawsuits against the company, agreeing to pay at least $479 million to reimburse customers and others for the costs of the defective machines.

After ProPublica and the Post-Gazette published their investigation, which drew on previously undisclosed company records, interviews with Philips insiders and leaked test reports, Philips released a statement saying the stories “do not present new facts and we do not agree with the characterizations made in these articles.”

Help ProPublica and the Pittsburgh Post-Gazette Investigate the Recall of Philips Respironics Breathing Machines

Evan Robinson-Johnson and Michael Korsh of the Pittsburgh Post-Gazette contributed reporting.

by Justin Elliott, Joshua Kaplan and Alex Mierjeski

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For months, Supreme Court Justice Clarence Thomas and his allies have defended Thomas’ practice of not disclosing free luxury travel by saying the trips fell under a carve-out to the federal disclosure law for government officials.

But by not publicly reporting his trips to the Bohemian Grove and to a 2018 Koch network event, Thomas appears to have violated the disclosure law, even by his own permissive interpretation of it, ethics law experts said. The details of the trips, which ProPublica first reported last month, could prove important evidence in any formal investigation of Thomas’ conduct.

Thomas’ defense has centered on what’s known as the personal hospitality exemption, part of a federal law passed after Watergate that requires Supreme Court justices and many other officials to publicly report most gifts.

Under the exemption, gifts of “food, lodging, or entertainment received as personal hospitality” don’t have to be disclosed. The law provides a technical definition of “personal hospitality.” It only applies to gifts received from someone at that person’s home or “on property or facilities” that they or their family own. A judge would generally not need to disclose a weekend at a friend’s house; they would need to report if someone paid for them to stay at the Ritz-Carlton.

Numerous ethics law experts have said that gifts of transportation, such as private jet flights, must be disclosed under the law because they are not “food, lodging, or entertainment.”

Thomas has laid out a different view of the disclosure requirements. In his financial disclosure released in late August, Thomas asserted that the personal hospitality exemption extended to transportation. Justice Samuel Alito has made the same argument in an op-ed where he elaborated on his reasoning: private jets would count as “facilities” under the law’s definition of personal hospitality. In this view of the disclosure requirements, a key question would be whether the person providing a private jet flight actually owned the jet. So, for example, Thomas would not need to report flights on his friend Harlan Crow’s private plane because Crow owns it.

Thomas and Alito’s position is incorrect, many experts said, because it simply ignores the statute’s language: that the personal hospitality exemption only applies to food, lodging, or entertainment.

But there’s an additional reason the newly revealed trips should have been disclosed.

ProPublica recently reported that in 2018, Thomas traveled on a Gulfstream G200 private jet to Palm Springs, California, to attend a dinner at the Koch political network’s donor summit. He didn’t hitch a ride on a jet owned by a friend. Instead, he flew there on a chartered plane: a jet available through an Uber-like service that lets wealthy individuals rent other people’s planes. The owner of the jet at the time, Connecticut real estate developer John Fareri, confirmed to ProPublica that he didn’t provide the plane to Thomas and that the Palm Springs flight was a charter flight. That means someone else — not the owner — paid.

A Koch network spokesperson said the network didn’t pay for the flights. Because Thomas didn’t disclose the trip, it’s still not clear who chartered the plane. Jet charter companies told ProPublica the flights could have cost more than $75,000.

Experts told ProPublica they couldn’t think of an argument that would justify not disclosing the Palm Springs trip. “Even using Thomas’ flawed logic about the personal hospitality exception, there’s no way this chartered flight fits into that exception,” said Kedric Payne, a former deputy chief counsel at Congress’ ethics office.

Thomas and his attorney did not respond to questions about why he didn’t disclose the flight or if he paid for it himself. After the Palm Springs donor event, the plane flew to an airport outside Denver, where Thomas appeared at a ceremony honoring his former clerk, then back to northern Virginia, where Thomas lives.

Thomas’ undisclosed trips to the Bohemian Grove present a similar issue. As ProPublica reported last month, Thomas has for 25 years been a regular at the Grove, an all-men’s retreat held on a 2,700-acre property in California. Thomas has been hosted by Crow, who is a member of the secretive club, and stayed at a lodge there called Midway. Members typically must pay thousands of dollars to bring a guest, according to a Grove guest application form obtained by ProPublica and interviews with members.

Crow does not own the Grove nor does he own the lodge where Thomas has stayed. Experts said in these instances again, even by Thomas’ own characterization of the rules, he appears to have violated the law by not disclosing the trips.

“It makes a mockery of the statute,” said Richard Painter, who served as the chief ethics lawyer for the George W. Bush White House. Painter said that if charter flights and trips to Grove don’t need to be disclosed, “you could call everything personal hospitality. Broadway show tickets. A first-class ticket on Delta Air Lines. A trip on the Queen Mary.”

Following ProPublica’s reporting on Thomas’ failure to disclose gifts earlier this year, members of Congress sent a complaint to the Judicial Conference, the arm of the judiciary responsible for implementing the disclosure law. In April, the Judicial Conference said it had referred the matter to a committee of judges responsible for reviewing such allegations.

The law says that if there is “reasonable cause” to believe a judge “willfully” failed to disclose information they were required to, the conference should refer the matter to the U.S. attorney general, who can pursue penalties. But that would be unprecedented. As of May, the Judicial Conference said it had never made such a referral. The committee’s process appears to be ongoing.

In his filing in August, Thomas said that his view of the disclosure rules was based in part on conversations he had with staff at the Judicial Conference. Thomas did not respond to questions about the advice he received. A judiciary spokesperson declined to comment on whether it was ever the Judicial Conference’s position that gifts of private jet flights didn’t need to be reported.

This March, the judiciary revised its regulations to make explicit that private jet travel must be disclosed because transportation is not covered by the personal hospitality exemption. Experts said the update merely clarified what was always the case. (ProPublica reviewed other federal judges’ financial disclosure filings and found at least six recent examples of judges disclosing gifts of private jet travel before the regulations were updated.)

More than a decade ago, Thomas’ disclosure practices came under scrutiny following research by a watchdog group and a story in The New York Times about his relationship with Crow. Democratic lawmakers wrote to the Judicial Conference in 2011, saying that Thomas had failed to report the sources of his wife’s income and that he “may” have also received free private jet trips without reporting them.

What happened after that remains opaque.

In a four-sentence letter the following year, the secretary to the Judicial Conference said that the complaint had been reviewed. “Nothing has been presented,” he wrote, “to support a determination” that Thomas improperly failed to report gifts of travel. The letter did not detail what steps the conference took, the reasoning behind its decision or what information it had been presented with.

At the time, nothing in the public record had established that Thomas had ever accepted undisclosed private jet flights. But Thomas’ attorney Elliot Berke has cited the 2012 letter as vindication of Thomas’ practices. “The Judicial Conference issued a letter confirming that Justice Thomas had not improperly failed to disclose information concerning his travel,” Berke wrote.

ProPublica asked the Judicial Conference for details on the 2012 episode, including whether the committee conducted an investigation and an explanation of its ultimate conclusion: Did it determine that private jet flights need not be reported? Or did it determine that it wasn’t clear if Thomas had actually accepted such a gift?

A Judicial Conference spokesperson declined to comment.

by Cezary Podkul

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

Mr. Big had a problem. He needed to move what he called “fraud funds” back to China, but a crackdown was making that difficult. So in August, Mr. Big, who, needless to say, did not list his real name, posted an ad on a Telegram channel. He sought a “group of smuggling teams” to, as he put it, “complete the final conversion” of the stolen money by smuggling gold and precious stones from Myanmar into southern China, in exchange for a 10% cut.

It’s unclear whether Mr. Big ultimately succeeded; his ad has since been deleted, and ProPublica was unable to reach him. But the online forum where he posted his ad says a lot about why Americans and people around the world have found themselves targeted by an unprecedented wave of fraud originating out of Southeast Asia, whose vast scale is now becoming apparent. In a single recent criminal investigation, Singapore police seized more than $2 billion in money laundered from a syndicate with alleged ties to organized crime, including “scams and online gambling.”

The Telegram channel that featured Mr. Big’s plea for assistance was a Chinese-language forum offering access to “white capital” — money that has been laundered — “guaranteed” by a casino operator in Myanmar, Fully Light Group, that purports to ensure that deals struck on the forum go through. Fully Light also operates its own Telegram channels that advertise similar services. One such channel, with 117,000 participants, featured offers to swap cryptocurrency for “pure white” Chinese renminbi or “white capital” Singaporean dollars. (Telegram took down that channel after ProPublica inquired about it. Fully Light did not respond to requests for comment.)

The presence of a casino in facilitating such deals is no coincidence. A growing number of gambling operations across Southeast Asia have become key pillars in a vast underground banking system serving organized criminal groups, according to new research by the United Nations Office on Drugs and Crime. The research has not been published, but the agency shared its findings with ProPublica.

There are now over 340 physical casinos across Southeast Asia (as well as countless online ones), and many of them show accelerating levels of infiltration by organized crime, according to the UNODC. The casinos function as “a shadow banking system that allows people to move money quickly, seamlessly, jurisdiction-to-jurisdiction, with almost no restriction,” Jeremy Douglas, UNODC’s top official in Southeast Asia, told ProPublica in September. That has made money laundering “easier than ever before,” he said, and it’s been “fundamental to the expansion of the transnational criminal economy” in the region — especially cybercrime.

As ProPublica reported in detail last year, Southeast Asia has become a major hub for cryptocurrency investment scams that often start as innocent-sounding “wrong number”-type text messages. The messages frequently originate from seedy casino towns in Cambodia, Laos and Myanmar, where criminal syndicates lure workers with the promise of lucrative jobs, only to force them to work as online scammers. UNODC’s map of known or suspected scam compounds shows a clear overlap with gambling hubs in Laos, Myanmar and Cambodia, where allegations of forced online scam labor have become so widespread that they recently prompted Interpol to issue a global warning about the problem, which the international police agency said was occurring on “an industrial scale.”

Gambling has long attracted organized crime, but never more than in Myanmar, Cambodia, Laos and the Philippines, where loose regulations and endemic corruption allow casinos to operate with little oversight or responsibility to report suspicious transactions. Before the COVID-19 pandemic began, officials in those countries wooed Chinese casino operators in an effort to attract foreign direct investment. Criminal bosses, facing a crackdown in China and sanctions imposed by the U.S., began investing in casinos and cutting deals to run their own special economic zones in Myanmar and elsewhere where they could operate unfettered.

When the pandemic struck in 2020, travel restrictions emptied newly built casinos, hotels and offices of workers and visitors across the region. Criminal syndicates repurposed the facilities to house online fraud operations and turned to human smugglers to staff them up. (For example, when Philippine authorities raided several online gambling operators between May and August, they discovered more than 4,400 laborers, most of them human trafficking victims forced to perpetrate online fraud.)

Online casinos can be easily used for money laundering: They often accept cryptocurrency deposits that can be converted to virtual chips and placed in bets or cashed out in currency, making them seem like proceeds of legitimate gambling. That method of money laundering is becoming increasingly common in Southeast Asia.

Physical casinos have their own attractions for money laundering. They have become a draw for a parallel industry of junket operators, who organize gambling trips for high-rollers. Those junkets also attract organized criminal groups that need to move money across borders and do so using junkets’ gambling accounts, according to recent prosecutions by Chinese authorities. Last year, 36 individuals connected to Suncity Group, once one of the biggest junket operators in the world, were convicted in China of facilitating about $160 million in illegal cross-border payments and transactions. The company’s ex-CEO, Alvin Chau, is in jail for running a criminal syndicate and other charges.

In northeast Myanmar, Fully Light Group has emerged as a “multi-billion-dollar business conglomerate and a key player” in casinos and illegal online gambling, according to research by Jason Tower, Myanmar country director for the United States Institute of Peace. “These are not normal casinos in any way,” Tower said, because they’re located in what he calls “criminal enclaves” that are more under the control of organized crime than any government authority. For instance, Tower found hundreds of criminal convictions by Chinese courts related to illegal casinos, fraud, kidnapping, drugs and weapons charges in the Kokang Special Administrative Zone, near Myanmar’s border with China, where Fully Light is based. In its review, UNODC found Kokang casinos — both those owned by Fully Light and by others — also played a major role in money laundering. They operate Telegram channels that openly advertise money laundering services, including some that link back to official Fully Light channels and offer the company’s guarantee to cross-border exchanges of cryptocurrencies. Some Fully Light-affiliated Telegram channels include solicitations to participate in what are known as money mule “motorcades” that move funds through multiple cryptocurrency wallets or bank accounts.

Billions of dollars more are likely flowing into the region, thanks to online scams that show no signs of abating. Nick Smart of the cryptocurrency analytics firm Crystal Blockchain has been tracing the flows of crypto funds deposited into online platforms that are set up to look like investing sites in order to fleece victims. Following the money trail from just one such website, which he suspects to be linked to criminal organizations in Myanmar, led him to a wallet that also pooled funds from 14 other known crypto scams. The wallet received about $44 million in various cryptocurrencies between December and July, when it ceased activity. With thousands of such websites popping up every day, victims’ losses are easily “in the billions,” said Smart, the director of blockchain intelligence at Crystal.

The global cybercrime spree has prompted countries across the region to take a bolder tack. In June, Thailand cut off electricity to two cyberfraud hot spots across its border with Myanmar (with disappointing results). More recently, Thai officials shut down six illegal cellular towers suspected of providing internet service to scam compounds in Myanmar. Chinese authorities have also arrested thousands of their own citizens in dramatic operations that included a humiliating perp walk of hundreds of suspected cybercriminals across a border crossing from Myanmar to China’s southern Yunnan Province on Sept. 6.

On Sept. 26, UNODC unveiled an agreement with China and the 10-member Association of Southeast Asian Nations to jointly combat organized crime and human trafficking linked with casinos and scams. An action plan accompanying the agreement calls on the countries to “make anti-money laundering and wider anti-corruption efforts a higher priority.”

But the challenge is steep. Even as multiple countries crack down, Laos, one of the poorest nations in the region, is getting ready to allow online gambling operators to set up shop within its borders and target foreigners.

And governments need to broaden their focus. Anti-money-laundering regulations often zero in on bank cash transfers of $10,000 or more. The UNODC’s Douglas said governments will need to turn their attention to casinos and other nontraditional financial players. “Everyone’s been focusing on transactions of $10,000 going through banks and flagging suspicious transactions,” Douglas said, “and these guys are moving millions around the corner through the casino, laughing at the system.”

by Richard A. Webster, Verite News

This article was produced for Verite News by Richard A. Webster, who covered Jefferson Parish as part of ProPublica’s Local Reporting Network in 2021-22. Sign up for Dispatches to get stories like this one as soon as they are published.

In September, the Louisiana Supreme Court issued a ruling that appeared to be a major blow to criminal justice reformers seeking to shrink the state’s bloated prison population.

The 4-3 ruling struck down a law that empowered prosecutors to revisit and reduce excessive sentences through post-conviction plea agreements with defense attorneys. The law, which passed the state Legislature unanimously in 2021 and had the backing of the Louisiana District Attorneys Association, was meant to create a formal process to release prisoners serving decadeslong sentences, in many cases for relatively minor crimes, handed down under the state’s habitual offender, or “three strikes,” law.

Verite News and ProPublica recently featured the story of Markus Lanieux, who might have been helped by that law. Lanieux was convicted in 2009 of aggravated flight from an officer, a crime that typically carried a two-year sentence. But two previous drug felonies allowed the Jefferson Parish district attorney to try Lanieux as a habitual offender, which resulted in a sentence of life without parole. If Lanieux had been originally convicted under current habitual offender sentencing laws, the most he could have gotten was four years.

The Supreme Court’s ruling came as the result of a legal challenge filed last year by Louisiana’s conservative attorney general, Jeff Landry, who claimed the law encroached on and usurped the exclusive power of the governor to grant clemency or pardons. Landry intervened in the case of William Lee, whose life sentence had been reduced using the now-overturned law.

His legal challenge was seen as part of a growing backlash across the country against prosecutors who have pushed to end mass incarceration, and it caused many district attorneys in Louisiana to temporarily drop negotiations to reduce excessive sentences while the case was pending.

Immediately after the court announced its decision, Landry, who is running for governor on a tough-on-crime platform, hailed it as a victory for public safety.

“This unconstitutional legislation resulted in some rapists and murderers receiving ‘get out of jail free’ cards,” Landry said. “That recklessness ends now.”

Louisiana Attorney General Jeff Landry (Valerie Plesch/Bloomberg via Getty Images)

In a dissenting opinion, state Supreme Court Chief Justice John Weimer criticized Landry’s challenge and warned that the majority’s decision could “have the disastrous effect of undermining, and further limiting, the post-conviction relief procedure that has operated to correct the evils of the past.”

“The post-conviction legislation at issue here was unanimously enacted by the legislature, the people’s representatives, and signed into law by the governor,” Weimer wrote. “Its obvious purpose is to insure justice is done and to act as a counter balance or check on the renegade practices and prejudices of the past.”

News of the ruling quickly spread throughout the state’s prisons, said attorney Nick Trenticosta, who argued on behalf of the law before the Supreme Court and visited several inmates at the Elayn Hunt Correctional Center in St. Gabriel the following week.

“It’s on every prisoner’s mind,” he said. “My clients are now in distress.”

“It’s Not Fine, but It Will Be OK”

Trenticosta, however, was in the prison to tell them not to worry, that far from dealing a death blow to post-conviction resentencing efforts, the attorney general might have inadvertently given them new life.

In their decision, the justices said the new law was unconstitutional because it didn’t require prosecutors or judges to identify a specific legal problem with a prisoner’s sentence before granting relief. The ability to adjust a sentence without a specific legal basis, they said, amounted to an “act of grace,” like a pardon, which is considered the domain of the governor.

If the decision had stopped there, it could have been extremely damaging, Trenticosta said. But the justices went on to uphold the “absolute discretion” of prosecutors to provide such post-conviction relief, emphasizing it was the duty of prosecutors to “see that no innocent man suffers.”

According to Trenticosta, the decision affirmed, for the first time explicitly, the right of prosecutors and defense attorneys to cooperatively reach post-conviction deals. Three other defense attorneys with extensive experience in post-conviction deals generally agreed with Trenticosta’s analysis of the ruling’s language, though one of them was concerned about its real-world consequences.

Before the passage of the 2021 reform law, it was common practice for defense attorneys and prosecutors to meet informally to discuss the reduction of someone’s sentence. If both sides came to an agreement, they would take the plea deal to a judge to authorize, which avoided costly and timely litigation. There wasn’t, however, a court- or Legislature-approved structure to this process, which caused concern among some judges, Colin Reingold with a New Orleans-based criminal justice reform group called the Promise of Justice Initiative and three other defense attorneys told Verite News.

While one court where these deals happened frequently might have been comfortable authorizing them, others in places where such deals were rare might have balked. This resulted in an unequal administration of justice across the state, said the defense attorneys.

In its ruling, the court spelled out the eight grounds on which district attorneys could reduce someone’s sentence through post-conviction plea agreements. Some of those are fairly narrow, including whether the sentence amounted to double jeopardy or the requirement that DNA testing provides “clear and convincing evidence” of innocence. Others are more general and create a wider lane through which an attorney could argue for someone’s freedom, such as proof that “the conviction was obtained in violation of the constitution of the United States or the state of Louisiana.”

Importantly, the justices added, when defense attorneys assert one of those grounds in seeking a sentence reduction, prosecutors have no obligation to demand evidence.

“If a defendant seeks post-conviction relief pursuant to one of these grounds, a district attorney is not required by this decision to oppose the application.”

Jee Park, executive director of the Innocence Project New Orleans, said she worries that the ruling could create obstacles to negotiating lesser terms, possibly driving judges to demand more evidence than previously required to prove a reduction in sentence is legally necessary.

But she agreed that it wasn’t the end of post-conviction relief. “It’s not fine, but it will be OK,” Park said. “There are definitely still claims available to attack unjust and excessive sentences.”

For people like Lanieux, this comes as welcome news. Lanieux’s attorney, Amy Myers, was in negotiations with the Jefferson Parish district attorney to reduce his sentence under the now-overturned law when Landry filed his challenge. The district attorney, like many prosecutors across the state, temporarily halted those negotiations pending a decision.

Amy Myers (Kathleen Flynn, special to ProPublic and Verite News)

Myers said the ruling reaffirmed arguments she had previously been making: that Lanieux’s sentence is unconstitutional because he had an ineffective lawyer, and that his sentence is cruel and unusual. Both are included in the eight grounds listed by the court.

“Markus has always had good legal issues,” Myers said. “If we have a district attorney who is willing to consider the merits of those legal issues, we can resolve Markus’ case.”

In an emailed statement, the Jefferson Parish District Attorney’s Office, which prosecuted Lanieux, said it was “not inclined to further comment as to Mr. Lanieux’s case at this time.”

During his 14 years of incarceration, the Iberville Parish native lost his mother in 2020 to COVID-19 and his sister last year to unknown causes. And on Sept. 7, the day before the news organizations published a story on his life sentence, Lanieux’s son was found dead in his cell at the Raymond Laborde Correctional Center in Cottonport. Evidence relating to his death was inadvertently given to a funeral home, Verite News reported.

Markus Lanieux mourns with family members at the viewing of Markus Lanieux Jr., who died in prison. (Kathleen Flynn, special to ProPublic and Verite News)

Lee, the prisoner whose case was the subject of Landry’s challenge, also maintains hope following the court’s decision, said his attorney, Trenticosta. When the Supreme Court ruled in the attorney general’s favor, St. Tammany Parish prosecutors reinstated Lee’s life sentence. Warren Montgomery, the district attorney for St. Tammany and Washington parishes, was not available to comment because of medical reasons, according to his office.

Despite the setback, Trenticosta expects to restart negotiations with the district attorney under the parameters established by the court. He said Lee’s case could fit under a number of them, including ineffective counsel, the unconstitutional withholding of evidence or a claim of innocence based on new evidence.

“Warren Montgomery believed that the new evidence shook the integrity of the conviction, and I don’t think anything has changed,” he said. “I fully predict that Mr. Lee will come home in the near future.”

by Anna Maria Barry-Jester

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Ever since he was a medical student, Dr. Neil Martinson has confronted the horrors of tuberculosis, the world’s oldest and deadliest pandemic. For more than 30 years, patients have streamed into the South African clinics where he has worked — migrant workers, malnourished children and pregnant women with HIV — coughing up blood. Some were so emaciated, he could see their ribs. They’d breathed in the contagious bacteria from a cough on a crowded bus or in the homes of loved ones who didn’t know they had TB. Once infected, their best option was to spend months swallowing pills that often carried terrible side effects. Many died.

So, when Martinson joined a call in April 2018, he was anxious for the verdict about a tuberculosis vaccine he’d helped test on hundreds of people.

The results blew him away: The shot prevented over half of those infected from getting sick; it was the biggest TB vaccine breakthrough in a century. He hung up, excited, and waited for the next step, a trial that would determine whether the shot was safe and effective enough to sell.

Weeks passed. Then months.

More than five years after the call, he’s still waiting, because the company that owns the vaccine decided to prioritize far more lucrative business.

Pharmaceutical giant GSK pulled back on its global public health work and leaned into serving the world’s most-profitable market, the United States, which CEO Emma Walmsley recently called its “top priority.” As the London-based company turned away from its vaccine for TB, a disease that kills 1.6 million mostly poor people each year, it went all in on a vaccine against shingles, a viral infection that comes with a painful rash. It afflicts mostly older people who, in the U.S., are largely covered by government insurance.

Importantly, the shingles vaccine shared a key ingredient with the TB shot, a component that enhanced the effectiveness of both but was in limited supply.

From a business standpoint, GSK’s decision made sense. Shingrix would become what the company calls a “crown jewel,” raking in more than $14 billion since 2018.

But the ability of a corporation to allow a potentially lifesaving vaccine to languish lays bare the distressing reality of public health vaccine creation. With limited resources, governments have long seen no other option but to team with Big Pharma to develop vaccines for global scourges. But after the governments pump taxpayer money and resources into the efforts, the companies get control of the products, locking up ownership and prioritizing their own gain.

That’s what GSK did with the TB vaccine. Decades ago, the U.S. Army brought in GSK to work on a malaria vaccine and helped develop the ingredient that would prove game-changing for the company. It was an adjuvant, a substance that primed the body’s immune system to successfully respond to a vaccine for malaria — and, the company would come to learn, a variety of other ailments.

GSK patented the adjuvant and took control of the supply of the ingredients in it. It accepted government and nonprofit funding to develop a TB vaccine using the adjuvant. But even though it isn’t carrying the vaccine to the finish line, it isn’t letting go of it entirely either, keeping a tight grip on that valuable ingredient.

As TB continued to rage around the globe, it took nearly two years for GSK to finalize an agreement with the nonprofit Bill & Melinda Gates Medical Research Institute, or Gates MRI, to continue to develop the vaccine. While the Gates organization agreed to pay to keep up the research, GSK reserved the right to sell the shot in wealthy countries.

The trial that will determine whether the vaccine is approved won’t begin until 2024, and isn’t expected to end until at least 2028. “We just can’t operate like that for a disease that is this urgent,” said Thomas Scriba, a South African scientist and TB expert who also worked on the study.

GSK pushes back against the premise that the company delayed the development of the TB vaccine and says it remains dedicated to researching diseases that plague underserved communities. “Any suggestion that our commitment to continued investment in global health has reduced, is fundamentally untrue,” Dr. Thomas Breuer, the company’s chief global health officer, wrote in a statement.

The company told ProPublica that it cannot do everything, and it now sees its role in global health as doing early development of products and then handing off the final clinical trials and manufacturing to others. It also said that a vaccine for TB is radically different from the company’s other vaccines because it can’t be sold at scale in wealthy countries.

We don’t ask for a fair deal from our pharma partners. We let them set the terms, but we don’t ask them to pick up the check. And I just find it frankly a little humiliating.”

—Mike Frick, a director of the tuberculosis program at Treatment Action Group

Though a good TB vaccine would be used by tens of millions of people, it has, in the parlance of industry, “no market,” because those who buy it are mostly nonprofits and countries that can’t afford to spend much. It’s not that a TB vaccine couldn’t be profitable. It’s that it would never be as profitable as a product like the shingles vaccine that can be sold in the U.S. or Western Europe.

Experts say the story of GSK’s TB vaccine, and its roller coaster of hope and disappointment, highlights a broken system, which has for too long prioritized the needs of corporations over those of the sick and poor.

“We don’t ask for a fair deal from our pharma partners,” said Mike Frick, a director of the tuberculosis program at Treatment Action Group and a global expert on the TB vaccine pipeline. “We let them set the terms, but we don’t ask them to pick up the check. And I just find it frankly a little humiliating.”

Steven Reed, a co-inventor of the TB vaccine, brought his idea to GSK decades ago, believing that working with a pharmaceutical giant was essential to getting the shots to people who desperately needed them. He’s disillusioned that this hasn’t happened and now says that Big Pharma is not the path to saving lives with vaccines in much of the world. “You get a big company to take it forward? Bullshit,” he said. “That model is gone. It’s failed. It’s dead. We have to create a new one.”

Gaining Control

In the early 1980s, the U.S. Army was desperate for a way to keep troops safe from the parasite that causes malaria. Military scientists had some promising ideas but wanted to find a company that could help them develop and manufacture the antigen, the piece of a vaccine that triggers an immune response. They called on SmithKline Beckman, now part of GSK, which had a plant outside of Philadelphia committed to the exact type of antigen technology they were researching.

For the company’s part, working with the Army gave it access to new science and, importantly, the ability to conduct specialized research. The Army had laboratories for animal testing and ran clinical trial sites around the world. It’s also generally easier to get experimental products through regulatory approval when working with the government, and Army scientists were willing to be infected with malaria and run the first tests of the vaccine on themselves.

Col. Carl Alving, then an investigator at the Walter Reed Army Institute of Research, said he was the first person known to be injected with an ingredient called MPL, an adjuvant added to the vaccine. Today, we know that adjuvants are key to many modern vaccines. But at the time, only one adjuvant, alum, had ever been approved for use. Alving published promising results, showing that MPL boosted the shot’s success in the body.

Company scientists took note and began adding MPL to other ingredients. If one adjuvant was good, maybe two adjuvants together, stimulating different parts of the immune system, might be even better.

It was an exciting development, bringing the multiple adjuvants together, Alving said in an interview. But then he learned that the company scientists had filed a patent for the combinations in Europe, which put limits on what he and his colleagues could do with MPL. “The Army felt perhaps a little frustrated by that because we had introduced Glaxo to the field.”

Still, the Army wanted the malaria vaccine. Military personnel started comparing the adjuvant combinations on rhesus monkeys at an Army facility in Thailand and ran clinical trials that tested the most promising pairs in humans and devised dosing strategies.

The Army found that one of the combinations came out on top: MPL and an extract from the bark of a tree that grows in Chile. The bark extract was already used in veterinary vaccines, but a scientist at one of the world’s first biotech companies had recently discovered you could purify it into a material that makes it safe enough for use in humans.

Alving said that at the time, he didn’t patent the work he and his colleagues were doing or demand an exclusive license for MPL. “It’s a question of the Army being the Army, which is not a company,” Alving said. (This was actually the second time the government failed to secure its rights over MPL. Decades earlier, the ingredient was discovered and formulated by scientists working for the Department of Veterans Affairs and a National Institutes of Health lab in Montana. One of the scientists, frustrated that his bosses in Bethesda, Maryland, wouldn’t let him test the product in humans, quit and formed a company, taking the research with him. Though his company initially said it thought MPL was in the public domain and couldn’t be patented, he did manage to patent it.)

Of those of you who think this is just philanthropy, it is not.”

—Luc Debruyne, former president of vaccines at GSK

Experts say drug development in the U.S. is littered with such missed opportunities, which allow private companies to seize control of and profit off work done by publicly funded researchers. Governments, they say, need to be more aggressive about keeping such work in the public domain. Alving has since done just that, recently receiving his 30th patent owned by the military.

It’s an open secret in the pharmaceutical world that companies participate in global health research because it’s where they get to try out new technologies that can be applied to other, more lucrative diseases.

At an investor presentation in 2016, a GSK executive used the malaria vaccine example to explain the benefit of such work. “Of those of you who think this is just philanthropy, it is not,” Luc Debruyne, then president of vaccines at GSK, told the group. He explained that it was through the malaria work that the company invented the adjuvant that is now in its blockbuster shingles vaccine. And, he explained, vaccines are high-volume products that make a steady stream of money over time. “So doing good business, innovating and doing well for the world absolutely can get married.”

As the Army’s research on the combination of MPL and the bark extract evolved — and its market potential became clear — GSK moved to vacuum up the companies that owned the building blocks to the adjuvant.

In 2005, it bought the company that owned the rights to MPL for $300 million. In 2012, it struck a deal for the rights to a lion’s share of the supply of the Chilean tree bark extract.

The company was now in full control of the adjuvant.

Picking a Winner

GSK eagerly began to test its new adjuvant on a number of diseases — hepatitis, Lyme, HIV, influenza.

Steven Reed, a microbiologist and immunologist, had come to the company in 1994 with an idea for a tuberculosis vaccine. An estimated 2 billion people are infected with TB globally, but it’s mainly those with weakened immune systems who fall ill. A century-old vaccine called BCG protects young children, but immunity wanes over time, and that vaccine does little to shield people from the most common type of infection in the lungs.

Reed had just the background and resources to attempt a breakthrough: An adjunct professor at Cornell University’s medical school, he also ran a nonprofit research organization that worked on infectious diseases and had co-founded a biotech company to create and market products.

He and his colleagues were building a library of the proteins that make up the mycobacterium that causes TB. He also had access to a blood bank in Brazil, where TB was more prevalent, that he could screen the proteins against to determine which generated an immune response that prevented people from getting sick.

At the time Reed pitched the vaccine, the company’s decision over whether to take him up was made by researchers, said Michel De Wilde, a former vice president of research and development at the company that partnered with Reed and later became part of GSK. Today, across the industry, finance units play a much stronger role in deciding what a company works on, he said.

GSK signed on, asking Reed to add the company’s promising new adjuvant to his idea for a TB vaccine.

Reed and his colleagues used more than $2 million in federal money to conduct trials from 1995 to 2005. GSK also invested, but NIH money and resources were the key, Reed said. As the vaccine progressed into testing, the Bill & Melinda Gates Foundation pitched in, as did the governments of the United Kingdom, the Netherlands and Australia, among others.

Amid all that, in 2003, GSK started testing the adjuvant in its shingles vaccine, according to annual reports, but at a much faster speed. With TB, it performed a small proof-of-concept study to justify moving to a larger one. There’s no evidence it did so with shingles. By 2010, GSK’s shingles vaccine was in final trials; in 2017, the FDA approved it for use.

To employees and industry insiders, GSK was making its priorities clear. The company built a vaccine research facility in Rockville, Maryland, to be closer to the NIH and the Food and Drug Administration; at the same time, it was retreating from TB and other global public health projects, according to former employees of the vaccine division.

All the while, the adjuvant was limited. GSK struggled to ramp up production of MPL, according to former employees there; it relies on a cumbersome manufacturing process. And it wasn’t clear whether there was sufficient supply of the Chilean tree that is essential to both vaccines.

After researchers learned of the TB vaccine’s successful proof-of-concept results in 2018, GSK said nothing about what was next.

“You would have thought people would have said: ‘Oh shit, this is doable. Let’s double down, let’s quadruple down,’” said Dr. Tom Evans, former president and CEO of Aeras, a nonprofit that led and paid for half of the proof-of-concept study. “But that didn’t happen.”

Scriba, who was involved in the study in South Africa, said he never imagined that GSK wouldn’t continue the research. “To be honest it never occurred to us that they wouldn’t. The people we worked with at GSK were the TB team. They were passionate about TB,” Scriba said. “It’s extremely frustrating.”

But Reed said that when the shingles vaccine was approved, he had a gut feeling that GSK would abandon the tuberculosis work.

“The company that dropped it used similar technology to make billions of dollars on shingles, which doesn’t kill anyone,” Reed said.

Those in the field grew so concerned about the fate of the TB vaccine that the World Health Organization convened a series of meetings in 2019.

Breuer, then chief medical officer for GSK’s vaccine division, explained that the pharmaceutical giant was willing to hand off the vaccine to an organization or company that would cover the cost of future development, licensing, manufacturing and liability. If the next trial went well, they could sell the vaccine in the “developing world,” with GSK retaining the sales rights in wealthier countries.

GSK would, however, retain control of the adjuvant, Breuer said. And the company only had enough for its other vaccines, so whoever took over the TB vaccine’s development would need to pay GSK to ramp up production, which Breuer estimated would cost around $200 million.

To be honest it never occurred to us that they wouldn’t [continue the research]. The people we worked with at GSK were the TB team. They were passionate about TB.”

—Thomas Scriba, a South African scientist and TB expert

Dr. Julio Croda was director of communicable diseases for Brazil at the time and attended the meeting. He said he was authorized to spend significant government funds on a tuberculosis vaccine trial but needed assurances that GSK would transfer technology and intellectual property if governments paid for its development. “But in the end of the meeting, we didn’t have an agreement,” he said.

Dr. Glenda Gray, a leading HIV vaccine expert who attended the meeting on behalf of South Africa, said she wasn’t able to get a straight answer about the availability of the adjuvant.

The year after the WHO meeting, after what a Gates representative described as “a lot of negotiation,” GSK licensed the vaccine to Gates MRI, a nonprofit created by the Gates Foundation to develop drugs and vaccines for global health issues that for-profit companies won’t tackle.

GSK told ProPublica that it did not receive upfront fees or royalties as part of the arrangement, but that Gates MRI paid it a small incentive to invest in the company’s global health endeavors. GSK and Gates MRI declined to comment on the amount.

Gates MRI tax documents show a payment designated as “royalties, license fees, and similar amounts that allow the organization to use intellectual property such as patents and copyrights” the year the agreement was finalized. Among available tax documents, that is the only year the organization has made a payment in that category.

The amount: $10 million.

An Uncertain Future

In June of this year, the Gates Foundation and the Wellcome Trust announced they were pledging $550 million to fund the phase 3 trial that will finally show whether the vaccine works. They’ve selected trial locations and are currently testing it on a smaller subset of patients, those with HIV.

Jeremy Farrar, chief scientist at the WHO, said he’s more optimistic than he’s ever been in his career that we’ll have a new TB vaccine this decade.

Gates MRI and GSK declined to say who had the rights to sell the vaccine in which countries, but Gates MRI said it will “work with partners to ensure the vaccine is accessible for people living in high TB-burden lower- and middle-income countries,” and GSK acknowledged that its rights extend to South America and Eastern Europe, two regions with significant pockets of TB.

As expected, Gates MRI will be reliant on GSK to supply the adjuvant, which concerns vaccine hopefuls because of the lack of transparency surrounding its availability. One of the key ingredients, the bark extract, comes from a tree whose harvest and export has been controlled by the Chilean government since the 1970s because of overexploitation. A megadrought and forest fires continue to threaten native forests today. The main exporter of the bark says it has resolved previous bottlenecks, and GSK said it is working on a synthetic version as part of its long-term plan.

In response to questions about why it retained control of the adjuvant, GSK said it was complicated to make, would not be economical to produce in more than one place, and was a very important component in many of the company’s vaccines, so it wasn’t willing to share the know-how.

The adjuvant is only growing in value to the company, as it adds yet another lucrative vaccine to its portfolio that requires it. In May, the FDA approved a GSK vaccine for the respiratory virus known as RSV. Analysts project that the shot will bring in $4 billion annually at its peak. GSK continues to study the adjuvant in additional vaccines.

GSK strongly insists that it has enough of the adjuvant to fulfill its forecasted needs for the RSV, shingles, malaria and TB vaccines through 2035.

The company and Gates MRI said their agreement includes enough adjuvant for research and the initial supply of the TB vaccine, if it is approved. The organizations declined, however, to specify how many people could be vaccinated. GSK also said it was willing to supply more adjuvant after that, but further negotiations would be necessary and Gates MRI would likely need to pay to increase adjuvant manufacturing capacity. For its part, Gates MRI said it is evaluating several strategies to ensure longer term supply.

Several experts said that Gates MRI should test other adjuvants with the vaccine’s antigen. That includes Farrar, who said it would be “very wise” to start looking for a new adjuvant. He is one of the few people who has seen the agreement between Gates MRI and GSK as a result of his previous role as director of the Wellcome Trust. Farrar is now helping to lead a new TB Vaccine Accelerator Council at the WHO and said he believes one of the group’s roles would be to find solutions to any future problems with the adjuvant.

Gates MRI declined to answer when asked if it was considering testing other adjuvants with the vaccine’s antigen. GSK, along with several other scientists and regulators that ProPublica spoke with, expressed that using a new adjuvant would require redoing all of the long and expensive clinical trials.

U.S. government officials, meanwhile, are working to identify adjuvants that aren’t already tied up by major pharmaceutical companies.

For a corporation, the primary concern is “what is this adjuvant doing for my bottom line,” said Wolfgang Leitner, who began his career working at Walter Reed Army Institute of Research on the malaria vaccine as a consultant for GSK. Now the chief of the innate immunity section at the National Institute of Allergy and Infectious Diseases, his job is to encourage the development of new adjuvants and to make sure that researchers have access to ones that aren’t tightly controlled by individual companies.

The WHO has also been helping to build a global network of vaccine manufacturers who can develop and supply vaccines to less wealthy countries outside of the shadow of Big Pharma; it is using a technology debuted during the COVID-19 pandemic called mRNA, which deploys snippets of genetic code to trigger an immune response. Reed, an inventor of GSK’s TB vaccine, co-founded the company at the center of that effort, Afrigen, after growing concerned about the fate of the vaccine he made for GSK.

Reed helped create a second TB vaccine, which Afrigen has the rights to manufacture for sale in Africa. But that vaccine has yet to start a proof-of-concept trial.

Over the past five years, an average of just $120 million a year has been spent on all TB vaccine research globally, including money from governments, pharmaceutical companies and philanthropic organizations, according to annual surveys conducted by the Treatment Action Group. For perspective, the U.S. alone spent more than $2 billion developing COVID-19 vaccines from 2020 to 2022. At a special UN meeting on tuberculosis in 2018, the nations of the world pledged to ensure $3 billion was spent on TB vaccine research and development over the next five years. Just 20% of that was handed out.

While that mRNA hub holds promise, it will be years before an mRNA TB vaccine enters a proof-of-concept trial, according to people involved. The pharmaceutical companies that made successful COVID-19 vaccines have refused to share the technology and manufacturing techniques that make mRNA vaccines work. One company, Moderna, has said it won’t enforce its patents on mRNA vaccines Afrigen creates for COVID-19, but it’s not clear what it’ll do if Afrigen applies those techniques to a disease like TB. (Paul Sagan, board chairman of ProPublica, is a member of Moderna’s board.)

To date, the GSK tuberculosis vaccine — which does not use mRNA technology — is the only one that meets a set of characteristics the WHO believes are necessary for a viable TB vaccine.

The phase 3 trial is set to begin early next year. In the time between the two trials, approximately 9 million people will have died from TB.

Mollie Simon contributed research.

by Audrey Dutton

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

When the U.S. Supreme Court last year overturned Roe v. Wade, it greenlighted the kind of near-universal abortion restrictions that Idaho lawmakers had spent the previous two years crafting. Gov. Brad Little said the state should turn to helping women who might otherwise have terminated pregnancies.

“We absolutely must come together like never before to support women and teens facing unexpected or unwanted pregnancies,” said Little, a Republican who supports the abortion ban. About 1,700 to 2,000 people a year in Idaho had abortions before the court ruling. “Families, churches, charities, and local and state government must stand ready to lift them up and help them and their families with access to adoption services, health care, financial and food assistance, counseling and treatment, and family planning.”

But since the June 2022 decision, Idaho has failed to deliver — even as other conservative states with abortion bans took steps to enhance their safety nets for families during pregnancy and after birth.

Idaho legislators disbanded a state committee that investigated the root causes of maternal deaths, making it the only state in the nation with no such mortality review.

They allowed two bills to die that would have put Idaho on the same track as nearly every other state with abortion restrictions — including Florida, Kentucky and Texas — by extending postpartum Medicaid coverage to 12 months. Idaho’s Medicaid coverage ends two months after birth, the minimum under federal law.

They turned down $36 million in federal grants to support child care this summer, while other states with new abortion restrictions — Alabama, Louisiana and Missouri among them — made investments in early childhood education and day care. Idaho lawmakers at the time attributed the decision to a pending audit of a different batch of grants.

Democrats generally support these kinds of measures, but Idaho Republicans dominate the state capitol and therefore control which bills move forward.

Rep. Brent Crane, a longtime Republican leader who chairs the House State Affairs Committee, said GOP lawmakers last year had hoped to put forward bills to improve health care and support for kids and families after the Supreme Court struck down federal protections for abortion rights. They instead got bogged down in debate over exceptions to the abortion ban.

“Idaho has some work to do,” Crane said. “Be patient with us.”

The need is urgent, according to Emily Allen, policy associate for the nonprofit Idaho Voices for Children. The state, she said, needs health care funding and other support in place to adjust to life after the abortion ban.

“Things have changed,” Allen said. “We can either bury our head in the sand, or we can respond with good policy that is very family-centric.”

But Blaine Conzatti, president of the Idaho Family Policy Center and a leading anti-abortion lobbyist, is not bothered by the lack of government support. Pregnancies, births and child care are not the purview of the government, he said, but of families, communities, charities and, most of all, churches.

“The Bible is clear, and the history of Christendom broadly is clear, that it’s the church’s responsibility to meet the needs of the poor and to ensure that people have the services that they need to live flourishing lives,” Conzatti said.

No action set Idaho apart from other abortion-ban states more than when the Idaho Legislature allowed its Maternal Mortality Review Committee to die this year. The committee had been granted unique powers to review private health care and other records of women who died during or within a year after pregnancy and draw conclusions about the root causes of those deaths.

Its budget of $10,000 a year came only from federal funds, so keeping the committee going seemed pro forma. Every single state, New York and Texas alike, had put one in place. But in Idaho, a lobbyist for an ultraconservative political nonprofit stood up and spoke against it at a hearing.

Fred Birnbaum, legislative affairs director of Idaho Freedom Foundation, said studying the causes of Idaho’s roughly 10 to 15 preventable maternal deaths each year risked inviting a push for more government support to help keep people from dying. And government support was anathema to his group.

“You know the old saying, ‘All roads lead to Rome,’” said Birnbaum, who testified against the committee’s creation on similar grounds in 2019. “Well, all government-created committees lead to the call for more government spending.”

Birnbaum’s assessment was partly correct. Idaho’s maternal mortality committee had made recommendations that could increase public spending, such as extending Medicaid coverage postpartum, expanding access to naloxone to prevent death from opioid overdose and providing better housing and child care support. But of the 52 recommendations in the committee’s final report, most called for no new government spending.

The role of such committees has not been so controversial in other Republican-led states.

The Texas Maternal Mortality and Morbidity Review Committee, for example, has been around for about a decade and is now “part of the entire effort” to reduce tragic outcomes from pregnancy and birth, said Chris Van Deusen, director of media relations for the Texas Department of State Health Services.

The Texas committee’s findings in 2018 that patients had bled to death in childbirth helped push the state to adopt recommendations and protocols for hospitals to train their employees to measure blood loss and to educate people on what is abnormal bleeding. Birth-related hemorrhage deaths started to fall the following year, Van Deusen said.

He said the committee has generally had the support of Texas lawmakers, who voted last year to adopt one of its recommendations and extend postpartum Medicaid coverage to 12 months.

Advocates for the creation of Idaho’s committee in 2019 pointed out how other states had helped reduce maternal death rates: seat belt laws in Nevada; substance use disorder treatment in Michigan; urgent messages to doctors and hospitals in Florida.

Lucky Bourn, the longtime Republican coroner of Minidoka County and a member of the maternal mortality committee, said its demise means Idaho will have no window into maternal deaths in the wake of its abortion ban, because the committee’s final report used data from 2021.

“I was very disappointed in the Legislature when they did not continue the funding of it,” Bourn said. “The thought that comes to my mind is, ‘With the change in the abortion laws in the state of Idaho, do you think that might have a correlation in the rise of the mortality rate of the women who don’t want to be pregnant?’”

The number of maternal deaths since the abortion ban took effect has not yet been reported. The committee believed it would have had 10 maternal deaths to evaluate from 2022 if it had continued.

ProPublica identified at least two deaths during pregnancy and childbirth that the maternal mortality committee could have evaluated. One death was from complications during childbirth in 2022, according to the woman’s obituary. The other was a murder-suicide this year that claimed the life of the pregnant mother and her toddler, according to the sheriff in the rural North Idaho county where she lived.

Little’s staff told ProPublica that he will bring forward a proposal in 2024 “to continue the work of this important committee.”

Lawmakers are also poised to consider other proposals that have previously gone nowhere. Idaho House Majority Leader Megan Blanksma, a Republican from Elmore County, said she is working on bills that would improve prenatal and postpartum health care, resume the study of maternal deaths and “support young families.”

Blanksma also said she will revive legislation to extend Medicaid coverage for postpartum care to a full year, a concept she said she dropped last session because of the ballooning cost of Medicaid.

Idaho state Rep. Megan Blanksma asks Rep. Dori Healey about the rationale for continuing the state’s Maternal Mortality Review Committee, which studied the root causes of preventable deaths during and within a year of pregnancy. Both lawmakers are Republicans. (Video screen capture from Idaho In Session)

“We are working on a full package to introduce come January,” Blanksma told ProPublica.

Conzatti, the anti-abortion lobbyist, advocates a more hands-off approach from the state.

Idaho has at least 16 “pregnancy resource centers” spread across every region of the state. Many in Idaho are Christian-oriented organizations that offer counseling, referrals and some material support like diapers. According to the American College of Obstetricians and Gynecologists, the centers’ goal back when Roe v. Wade was in effect was to persuade women to carry their pregnancies to term rather than have abortions.

Few Idaho centers offer medical care beyond pregnancy tests and “heartbeat” ultrasounds.

But those centers are where Conzatti said people who have unplanned pregnancies should now look to for help. They embody his vision of a world before legalized abortion and before Medicaid got involved in the lives of poor families.

Crane, the Republican House leader, wouldn’t rule out state-funded support for pregnancy centers if there’s political will for it among lawmakers.

“Every option is on the table,” he said.

by Brandi Kellam, Virginia Center for Investigative Journalism at WHRO, and Gabriel Sandoval, ProPublica

This article was produced for ProPublica’s Local Reporting Network in partnership with the Virginia Center for Investigative Journalism. Sign up for Dispatches to get stories like this one as soon as they are published. This story was co-published with Virginia Center for Investigative Journalism at WHRO and The Chronicle of Higher Education.

This past May, we were working on a story about how the establishment and expansion of Virginia’s Christopher Newport University dismantled a vibrant Black neighborhood. When we asked university officials for archival material, we encountered something we hadn’t heard about before. We learned that in Virginia, the papers of state university presidents are largely exempt from public records laws.

We asked for several boxes containing some of the papers of Paul Trible, the university’s president from 1996 to 2022, which pertained to real estate acquisitions, board meetings and development projects. Since the city of Newport News seized the core of the Black community for a new campus in the early 1960s, Christopher Newport has bought almost all of the remaining homes there.

We hoped the records would show how Trible’s administration obtained properties in the Shoe Lane area abutting the campus and reveal any internal debates about its actions. We wanted to know whether the university encouraged or pressured homeowners to sell and whether it used or threatened to use eminent domain, the government’s right to forcibly purchase private property for public use.

As a public institution, Christopher Newport is subject to the state public records law. But the university would not let us see the vast majority of Trible’s documents. It cited a 49-year-old amendment, section 2.2-3705.7 of the Virginia code, exempting the “working papers and correspondence” of “the president or other chief executive officer of any public institution of higher education in the Commonwealth” from disclosure. Since Trible, now a Christopher Newport distinguished professor, was unavailable for an interview, the lack of access to his communications left unanswered questions, such as why the university’s governing board approved taking properties by eminent domain in 2005 after he publicly said there was no need to do so.

Virginia may have the broadest and most explicit exemption for college presidents’ papers in the country, based on a guide from the Reporters Committee for Freedom of the Press. While university presidents have said that public scrutiny would hamper frank dialogue and “reflective” decision making, the exemption renders their perspectives — and the schools’ inner workings — less visible to the media and Virginia taxpayers. Legislative proposals to repeal or narrow it have failed in the face of opposition from the higher education lobby.

Virginia universities aren’t required to invoke the exemption — they can provide the information if they choose. But we were far from the first journalists to be thwarted by this provision. It came into play in 2006 when Old Dominion University rejected a request from a Virginia newspaper for an evaluation prepared for its president of a mandatory course that students had criticized. William & Mary cited the exemption in 2007 in denying requests from news outlets and alumni related to a donor’s decision to revoke $12 million in pledges, though it later reversed itself and released a sought-after email. Also, in 2022, William & Mary withheld 17 pages from a public radio reporter seeking information about “lab school design concepts.” And the University of Virginia wielded the exemption during a firestorm in 2014 over a Rolling Stone article, which was subsequently retracted, about an alleged rape on campus.

Moreover, as Christopher Newport’s denial of our request for some of Trible’s papers highlights, the amendment doesn’t say how far back the exemption goes or whether it applies to former presidents. Open records advocates said that, based on their reading of the statute, the exemption should only apply to ongoing deliberations. Nearly 30 states protect such deliberations by university officials from disclosure.

“The intention of this exemption was to provide decision-makers with some breathing room to make decisions,” said Megan Rhyne, executive director of the Virginia Coalition for Open Government, a nonprofit that presses for access to public records. “It was never intended to be a black box in which all their papers and correspondence get put into and locked away forever.”

But the Virginia Freedom of Information Advisory Council, a state agency that helps resolve public records disputes, has taken the position that the statute’s silence makes it impossible to set a time limit. “FOIA doesn’t address everything,” senior attorney Joseph Underwood said. “There are dark corners.”

In a 2004 opinion, the council’s executive director wrote that any cutoff date “would require clear language of intent from the General Assembly that the exemption no longer applies after a certain number of years after the creation of a record.”

Asked about Christopher Newport’s use of the exemption, university spokesperson Jim Hanchett said in a statement that the university “is committed to meeting its open government obligations and at all times acting in accordance with the Commonwealth of Virginia’s open record laws.”

In a Sept. 18 message to faculty and staff, Christopher Newport president Bill Kelly acknowledged that the university’s progress “has come at a human cost, and we must continue to learn about and understand our complicated history.” The city chose a site for Christopher Newport, which was then a branch of the Colleges of William and Mary system, on land “that was home to a valuable and well-established neighborhood,” Kelly wrote. “The residents of that neighborhood, most of them African Americans, lost their homes, many due to the use of eminent domain.” This “important chapter … is appropriately receiving renewed attention,” he added in an apparent reference to our Sept. 5 article.

Like Christopher Newport, Old Dominion and UVA have grown by displacing Black residents. An Old Dominion spokesperson said that it has focused on improving relations with the surrounding neighborhood and that students of color now make up the majority of its enrollment. UVA has established presidential commissions to examine its role in slavery and segregation, and has set a goal of developing 1,500 affordable units in university properties. Those schools also said that they abide by state public records law, giving similar explanations to Christopher Newport’s. William & Mary said it follows guidance from the Virginia Freedom of Information Advisory Council and gives “careful consideration” to “the documents requested and the context in which they were created and have been used.”

To be sure, several states including Pennsylvania and Delaware go even further in shielding universities, though they don’t single out presidential papers. In Pennsylvania law, four universities — Penn State, the University of Pittsburgh, Temple University and Lincoln University — are categorized as “state-related” rather than “state-affiliated,” a distinction that exempts them from disclosing most information. The University of Delaware and Delaware State University are not considered “public bodies” under Delaware law, though they receive taxpayer funding.

Enacted in 1968, Virginia public records law exempts officials such as the governor, the lieutenant governor, the attorney general, state legislators and mayors. It added university presidents to the list in 1974, even as the Watergate scandal was prompting calls for increased transparency. James T. Edmunds, a Democratic state senator and a graduate of the University of Richmond’s law school, introduced the change. It was a turnaround from a stance Edmunds had taken the previous year, when he had supported a bill to make public the actions taken by university governing boards, saying that news reporters deserved more access.

After leaving the state Senate, Edmunds served on the board of the Virginia community college system and practiced law. His career came to an abrupt halt in 1987 when he admitted to stealing more than $170,000 from clients. He served 10 months in prison and surrendered his law license, which was reinstated in 1995. Edmunds died in 2008.

It’s unclear why Edmunds proposed the presidential exemption. His widow, Harriett Edmunds, who worked as a legislative aide before they were married, said she didn’t recall. “I do know that he was interested in the community college system,” she said. “That was one of his major, major interests.”

A November 2014 Rolling Stone article indirectly fueled a debate over Virginia’s presidential exemption. The article, which concerned an alleged rape at a University of Virginia fraternity, was discredited and retracted. But news outlets, hoping to sift fact from fiction and learn how the university handled sexual misconduct cases, barraged UVA with requests for its president’s correspondence. UVA deflected them, citing the exemption. A spokesperson said the university no longer has copies of those requests.

Amid the fallout, two legislators filed proposals in 2015 to eliminate the presidential exemption. Then-delegate David Ramadan, a former member of George Mason University’s governing board, who sponsored one of the bills, told us that he “thought there were a lot of good things” university presidents “were doing that should be out in the public and shouldn’t be hidden.”

The bills died in committee, but the Virginia Freedom of Information Advisory Council took up the issue. College presidents fought back, arguing that secrecy was needed to foster candid discussions. “The removal of this exemption would hinder our ability to embrace reflective decision-making,” the Council of Presidents wrote in July 2015. “As the law currently allows, neither university presidents nor those that advise us are inhibited in communication due to fear of our preliminary discussions becoming public and thus inaccurately reported, taken out of context, viewed as final when far from it, and quite possibly politicized.” The letter did not address the exemption’s use to shield the papers of former presidents.

Among the signatories to the letter was Trible, Christopher Newport’s then-president. A former Republican politician and U.S. senator, he was Christopher Newport’s longest-serving president; its library is named for him and his wife. Ultimately, the advisory council called for tightening the exemption by limiting it to “working papers” and making available the correspondence of presidents and other officials, but the legislature didn’t adopt the recommendation.

Despite Christopher Newport’s denial of our request for Trible’s papers, our reporting continued to raise questions about his role in uprooting Black families. For example, we learned that, although university officials had vowed not to pressure residents to sell, Trible wrote to at least one homeowner, encouraging sales talks.

In July, we sent another request to Christopher Newport. We were interested in a house on Prince Drew Road, long owned by a Black family, that the university’s board had approved taking by eminent domain for a parking lot during Trible’s administration. A university spokesperson told us that its real estate foundation bought the building without resorting to eminent domain, but we wanted to learn more.

In response, the university said it had two pages of presidential correspondence about the property. It refused to give us those pages, citing the exemption. Trible again could not be reached for comment, and a university spokesperson did not respond to our request to contact him.

Louis Hansen of the Virginia Center for Investigative Journalism at WHRO contributed reporting.

by Robin Urevich, Capital & Main, with additional reporting by Gabriel Sandoval, ProPublica

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

The Los Angeles Housing Department is proposing to significantly increase staff and double the frequency of inspections of residential hotels in an effort to stop some landlords from renting the low-cost housing to tourists in violation of city law.

The recommendations, detailed in a report to the mayor’s office last month, follow an investigation by Capital & Main and ProPublica that found some residential hotel owners had turned their buildings into boutique hotels and were advertising nightly rentals on travel websites.

Since taking office in December, Mayor Karen Bass has made a major push to tackle the city’s housing and homelessness crisis by providing shelter for people living on the streets and speeding up construction of new affordable housing.

The city has paid less attention to preserving some of its already existing low-cost housing in residential hotels. Some 300 such buildings — which typically consist of basic single rooms, sometimes with shared bathrooms — were protected under a 2008 city ordinance. The law requires landlords to keep the buildings for long-term tenants or replace the units by building new ones or paying into a city housing fund.

But until recently, the law has gone largely unenforced. In response to the news organizations’ findings that 21 residential hotels were marketing rooms to tourists, Bass’ office requested that the Housing Department investigate the hotels. The department has since sent warning letters to 17 of the hotels and fined 13 of them. Nearly all the hotels have appealed the city’s enforcement efforts, and some have sued the city in federal court.

The mayor’s office also asked the Housing Department to report on how the lack of enforcement occurred and to make recommendations to prevent it from happening in the future. In the report, Ann Sewill, the Housing Department’s general manager, and Anna Ortega, an assistant general manager, blamed short staffing. They said that the department has only one inspector to oversee all 300 residential hotels across the city’s 487 square miles, and that his priority had been the conditions of the buildings.

“With additional resources and support, LAHD can dramatically and successfully elevate its ability to stop rogue property owners from violating the Residential Hotel Ordinance and undermining the availability of the housing stock,” they wrote to Mercedes Márquez, the mayor’s chief of housing and homelessness solutions.

In addition to more frequent inspections, Housing Department managers said they’ve requested funding for five residential hotel inspectors and two support staff in next year’s budget. They plan to continuously monitor online advertising and use “stakeouts” to collect evidence of tourist activity at hotels. They also want the city attorney’s office to have more resources to investigate cases and defend against lawsuits.

LA Deputy Mayor of Housing Jenna Hornstock said the Housing Department has taken “comprehensive” and “meaningful steps” toward residential hotel enforcement. More funding for enforcement, she said, will involve “hard conversations about the resources that we have and how we can best allocate them.”

The department said it would soon complete an audit of all of the city’s residential hotels to determine whether they are placing tourist ads. If it finds such ads, the department said it can use the city attorney’s administrative citation enforcement system to quickly sanction violators. However, the $527 fines — designed to keep minor offenders out of court — are relatively light. Maximum penalties for noise complaints or drinking in public are nearly double that amount.

Deepika Sharma, a University of Southern California law professor who directs the school’s housing law and policy clinic, said the Housing Department’s proposed approach won’t have teeth unless the city uses its legal authority to sue hotel owners who routinely ignore citations.

“It takes important impact cases to make a difference,” Sharma said, because taking a repeat violator to court sends a message that deters others. But she said the city attorney’s office hasn’t routinely done that.

Past attempts to enforce the residential hotel law from 2016 to 2018 fizzled when housing inspectors issued citations but failed to follow up on them. Afterward, the hotels continued to offer their rooms for short-term rentals in violation of the department’s orders.

The 17 hotels that were recently cited are also appealing to the Housing Department to reconsider their residential hotel status altogether. Sewill and Ortega said the department will hear all appeals by Nov. 30.

Barbara Schultz, director of housing justice at the Legal Aid Foundation of Los Angeles, questioned whether such appeals are permitted. She pointed out that the ordinance specifies that owners have 60 days after they’re notified of their residential hotel status to challenge the designation. The Housing Department made those notifications between 2008 and 2014.

“I’m curious as to why they’re allowing appeals at this point,” she said. “That’s a lot of units that could potentially be lost.”

Meanwhile, the owners of 12 of the residential hotels have sued the city in federal court in Los Angeles, alleging the Housing Department has infringed on their constitutional protections against unreasonable searches and seizures and government taking of private property.

Frank Weiser, the attorney who represents the owners, said in a text message he would not comment on the cases, “given the pending litigation with the city.” Weiser has unsuccessfully challenged LA’s residential hotel law at least twice in the past.

Ivor Pine, a spokesperson for the city attorney’s office, said the lawsuits won’t have an effect on the city’s current enforcement of the residential hotel law. He declined to comment on the lawsuit’s allegations.

Hornstock said the mayor’s office is currently working on setting Housing Department priorities for the coming year, including whether it can meet the department’s request for a beefed-up enforcement budget.

by Mark Olalde

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Update, Oct. 10, 2023: Gov. Gavin Newsom on Saturday signed AB1167 into law. “I share the author’s desire to minimize the risk that the state will be liable for costs of plugging and abandonment of orphaned and abandoned oil and gas wells,” he wrote to the Legislature. However, he added, future amendments to the legislation might be needed to ensure it does not inadvertently push existing oil companies to walk away from their wells.

The California Legislature recently passed a bill that would provide the state’s taxpayers some of the strongest protections in the nation against having to pay for the cleanup of orphaned oil and gas wells. But Gov. Gavin Newsom has not indicated if he will sign it.

AB1167 would require companies that purchase idle or low-producing wells — those at high risk of being left to the state — to set aside enough money to cover the entire cost of cleanup. Assemblymember Wendy Carrillo, a Los Angeles Democrat who authored the bill with the support of the Natural Resources Defense Council and Environment California, said it’s needed to “stem the tide” of orphaned wells.

Newsom has until Oct. 14 to make a decision. A spokesperson declined to comment, saying the governor would evaluate the bill “on its merits.” The state’s Department of Finance released a two-page analysis opposing it.

It costs more than $180,000 to clean up an average orphan well in California, the state told the U.S. Department of the Interior in 2021, according to documents ProPublica obtained via a public records request. This includes plugging the well with cement, removing aboveground infrastructure like pumpjacks and decontaminating the site. But bonds, which are financial instruments guaranteeing to pay for cleanup, cover only a tiny fraction of that cost. A ProPublica analysis of state data found that oil and gas companies have set aside only about $2,400 per well. (State oil regulators are currently reevaluating companies’ bonds to increase them within existing law, which does not mandate that they cover the entire cleanup cost.)

Left unplugged, many wells leak climate-warming methane, brine and toxins that were used in the drilling process.

“It’s a setup for disaster,” said Ann Alexander, a Natural Resources Defense Council senior attorney.

The bill follows ProPublica’s reporting on the exodus of oil majors from the state’s declining industry — one sale last year saw more than 23,000 wells move from Shell and ExxonMobil to a little-known German asset management group called IKAV — and on the multibillion-dollar cost to clean up the industry. ProPublica’s work was repeatedly cited by the Legislature and the bill’s supporters.

Despite its green reputation, California has a long history of weak oversight of its oil and gas industry, which has left behind an estimated 5,300 orphaned wells. Many are scattered across Los Angeles, complicating redevelopment. Others spew methane in Kern County’s huge oilfields.

Companies have little incentive to plug wells; it’s cheaper to sell or to walk away and forfeit the small bonds currently required by the state.

“It’s too easy for them right now to offload those unproductive oil wells to newer or less-resourced companies that may turn around and go bankrupt and that don’t have the adequate financial capacity to do the job of cleaning up,” said Laura Deehan, director of Environment California.

The Western States Petroleum Association and California Independent Petroleum Association industry trade groups warned state lawmakers that “this misguided bill will increase the number of orphan oil wells in California.” The organizations argued that requiring bonds that cover the full cleanup cost would dissuade sales to companies hoping to enter the market. This, in turn, could lead to well owners getting stuck with the expensive cleanup, causing insolvency and ultimately leaving the wells with the state.

Dwayne Purvis is a petroleum reservoir engineer who authored a study that estimated it would cost as much as $21.5 billion to clean up California’s oil industry. He pointed out that the most common type of bond — a surety policy — is similar to insurance guaranteeing a well will be plugged, so oil companies wouldn’t have to set aside the full cleanup cost in cash to comply with AB1167. Federal regulators recently found these bonds are relatively cheap.

If that stops companies from buying wells in California, Purvis said, then there’s a bigger problem: “This admits — implicitly but almost inescapably — that the cost of plugging exceeds the value of remaining production,” he told ProPublica via email.

A Western States Petroleum Association spokesperson did not address questions about its claims. The California Independent Petroleum Association did not respond to requests for comment.

In negotiations over the bill, according to people present, the trade associations pointed to one example in particular to highlight why the legislation would create more orphan wells — the sales of some of the more than 750 wells orphaned following bankruptcy filings by multiple entities in the Greka group of companies. The sales, the industry argued, presented an opportunity for the wells to be plugged by an oil company, not the state.

However, hundreds of the wells remain on the orphaned list to this day, only they’re now associated with a new company: Team Operating.

Greka’s CEO and Team Operating didn’t respond to emails requesting comment.

The bill does carry a potential loophole, experts cautioned: whether the increased bond requirements in the bill would apply to wells transferred through shell companies, as is often the case.

The state Department of Finance’s opposition to the bill relied on three arguments.

The agency’s report claimed that large companies with enough resources to plug wells are coming into the California market. But research shows these producers are exiting the state and handing off their aging, unprofitable wells to smaller companies that are less likely to be able to afford cleanup.

Its analysis also suggested that bond underwriting companies are “becoming hesitant” to do business in California. Purvis said that if these companies believe the situation is too risky to guarantee cleanup costs will be paid, “then the taxpayers of California probably should not extend producers the same credit.”

Finally, the report argued the bill is unnecessary because California regulators already have the authority to recoup plugging costs from wells’ previous owners.

While existing law gives the state this authority, it only applies to wells transferred after Jan. 1, 1996. Oil drilling in California dates back to the 1860s, and many thousands of wells were sold prior to the law’s cutoff, meaning the state can’t go after the wells’ former operators.

ProPublica reviewed the state’s list of orphaned wells and found numerous examples of well cleanups being left to taxpayers despite the wells being sold after 1996. In those cases, the state either hasn’t used its authority or has otherwise failed to secure plugging funds.

Department of Finance analysts referred questions to the state’s oil regulators, who were the source for much of the report. A spokesperson for the California Geologic Energy Management Division said state regulators have obtained money from previous owners on occasion.

But going after older operators is difficult, said Rob Schuwerk, a former New York assistant attorney general and the North American executive director of the energy finance think tank Carbon Tracker Initiative, and bonds are guaranteed money.

“There’s no better substitute for having the cash,” he said.

by John Harwood for ProPublica

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President Joe Biden said Friday that he was not fully confident that the current U.S. Supreme Court, which he described as extreme, could be relied on to uphold the rule of law.

When asked the question directly, Biden paused for a few seconds. Then he sighed and said, “I worry.”

“Because,” he said, “I know that if the other team, the MAGA Republicans, win, they don’t want to uphold the rule of law.”

But he said, “I do think at the end of the day, this court, which has been one of the most extreme courts, I still think in the basic fundamentals of rule of law, that they would sustain the rule of law.”

Still, Biden said the court itself should recognize it needs ethics rules after stories by ProPublica revealed that billionaires had given undisclosed gifts to Supreme Court justices and that Justice Clarence Thomas has made appearances at events for donors to the Koch political network. The code of conduct that applies to other federal judges doesn’t apply to the Supreme Court. “The idea that the Constitution would in any way prohibit or not encourage the court to have basic rules of ethics that are just on their face reasonable,” Biden said, “is just not the case.”

The discussion was part of a rare formal interview on a topic the president has laid out as a priority: How America’s democracy is under siege. Seated in the Roosevelt Room of the White House on Friday afternoon, Biden seemed relaxed and confident, batting back a question about why he thinks he’s the only Democrat who can protect democracy next year, especially given voter concerns with his age: “I’m not the only Democrat that can protect it. I just happen to be the Democrat who I think is best positioned to see to it that the guy I was worried about taking on democracy is not president.”

Biden cast the threat to democracy posed by Donald Trump’s 2024 candidacy as a resistance movement animated by fear of change. “I think Trump has concluded that he has to win,” Biden said, noting the rising vitriol in the embattled former president’s rhetoric. “And they’ll pull out all the stops.”

Biden linked the attempt by House Republicans to bring Washington to “a screeching halt” through a government shutdown to Trump’s effort to regain the presidency. He warned against the desire of “MAGA Republicans” — which he called a minority of the GOP, much less the nation as a whole — to weaken institutions such as the federal civil service to shift power over the U.S. government toward the president alone. Trump has promised his supporters to “be your retribution” in a second term.

The drama over a government shutdown resulted from the “terrible bargain” Republican Speaker Kevin McCarthy made with extremist colleagues to secure his job, Biden said. “He’s willing to do things that he, I think, he knows are inconsistent with constitutional processes.” He added: “There is a group of MAGA Republicans who genuinely want to have a fundamental change in the way that the system works. And that’s what worries me the most.”

Biden faulted his Democratic Party for failing at some points to respond effectively to one of the wellsprings of the anti-democratic threat: the anxieties of Americans, most conspicuously blue-collar white men, unsettled by economic, cultural and demographic change.

What’s needed isn’t so much economic benefits as “treating them with respect,” said Biden, who has emphasized his middle-class Scranton, Pennsylvania, upbringing throughout his political career. “The fact is, we’re going to be very shortly a minority-white-European country. Sometimes my colleagues don’t speak enough to make it clear that that is not going to change how we operate.”

Biden expressed confidence that the majority of the Republican Party and the nation itself would ultimately safeguard the American experiment. But he exhorted them to “speak up” in opposition to the increasingly menacing rhetoric Trump has deployed in response to his legal peril.

“[Do] not legitimize it,” he said. He added, in what seemed a reference to the vitriol aimed at jurors and potential jurors in trials for the Jan. 6 insurrection and Trump-related cases, “I never thought I’d see a time when someone was worried about being on a jury because there may be physical violence against them if they voted the wrong way.”

He encouraged Americans concerned about democracy to be “engaging” more with family, friends and acquaintances who have embraced extremism. Even more urgent, he added, is voting in next year’s presidential election. “Get in a two-way conversation,” he said. “I really do believe that the vast majority of the American people are decent, honorable, straightforward. … We have to, though, understand what the danger is if they don’t participate.”

ProPublica also asked Biden whether his former Senate colleague Joe Lieberman is upholding democracy by working with an organization called No Labels to pursue a potential third-party candidacy. “Well, he has a democratic right to do it. There’s no reason not to do that. Now, it’s going to help the other guy. And he knows [that]. … That’s a political decision he’s making that I obviously think is a mistake. But he has a right to do that.”

Biden was asked whether Fox News and other outlets that spread falsehoods about the 2020 election drive the threat that he’s concerned about or simply reflect sentiment that already exists. Both, Biden said: “Look, there are no editors any more. That’s one of the big problems.” Without providing detail, he suggested that reporters on outlets such as Fox are just doing what they’re told.

In response to a question about whether the decision by Elon Musk, the billionaire owner of X (formerly Twitter), to lower guardrails against misinformation contributes to the problem, Biden said, “Yeah, it does.” Biden noted that the invention of the printing press had effects that are still felt today. He suggested something similar was happening with the internet. “Where do people get their news?” he continued. “They go on the internet. They go online … and you have no notion whether it’s true or not.”

by Paul Kiel

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The Justice Department announced criminal charges on Friday against a former IRS contractor for leaking confidential tax information to two unnamed news organizations.

The DOJ’s description of one of those leaks appears to refer to the trove of IRS data that ProPublica used to report its “Secret IRS Files” series. The vast dataset contained details on thousands of wealthy Americans, and ProPublica reported dozens of stories based on an analysis of it.

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“As we have said from the beginning, we do not know the identity of the source, so we have nothing further to say about the charges filed today,” Stephen Engelberg, ProPublica’s editor in chief, said.

The DOJ’s description of the second leak, information regarding “a high-ranking government official,” appears to match The New York Times’ reporting on the taxes of Donald Trump. A spokesperson for the Times did not immediately respond to a request for comment.

The former IRS contractor, Charles Littlejohn, 38, of Washington, D.C., was charged with a count of disclosing tax return information, a felony that carries a maximum sentence of five years. Littlejohn’s attorney declined to comment.

For an overview of the main findings from ProPublica’s “Secret IRS Files” series, see “Ten Ways Billionaires Avoid Taxes on an Epic Scale.”

by John Harwood for ProPublica

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President Joe Biden said in an interview on Friday that House Speaker Kevin McCarthy had made a “terrible bargain” and that “in order to keep the speakership, he’s willing to do things that he, I think, he knows are inconsistent with the constitutional processes.”

Asked about the looming government shutdown, and the impeachment inquiry that McCarthy agreed to authorize in the hopes of keeping right-wing Republicans from ousting him from his post as speaker, Biden criticized the role of a “group of MAGA Republicans who genuinely want to have a fundamental change in the way that the system works. And that’s what worries me the most.” He marveled that former President Donald Trump had described himself in a recent speech as “retribution” on behalf of his supporters, and that Republicans “seem to be encouraging it.”

The comments came as part of a wide-ranging interview with ProPublica contributor John Harwood that will be published Sunday morning. In it, Biden discussed everything from what he portrayed as looming threats to democracy, including his views of the roles played by Fox News and Elon Musk, to his concerns about the need for ethics reform on the Supreme Court.

by Heather Vogell

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After months in which indictments in four successive criminal cases against Donald Trump raised the stunning, if distant, prospect that a former U.S. president could be put behind bars, it was the seemingly less momentous civil case in New York that this week generated the most tangible consequences so far: A dramatic fraud ruling that, if it survives appeal, could strip Trump of a chunk of the business empire that not only made his fortune but provided him with his very identity.

New York State Supreme Court Justice Arthur Engoron, having previously made a preliminary finding that Trump, his sons and some Trump Organization executives “had a propensity to engage in persistent fraud by submitting false and misleading Statements of Financial Condition,” granted a partial summary judgment in favor of the state of New York. “Even with a preliminary injunction in place,” his lacerating opinion noted, “and with an independent monitor overseeing their compliance, defendants have continued to disseminate false and misleading information while conducting business.”

Engoron canceled certificates for Trump entities controlling some of the former president’s properties, which they need to operate legally in New York. Trump could also be required to give up a portion of profits linked to the properties, depending on the outcome of a civil trial that is scheduled to start next week. An appeals court on Thursday said the trial can proceed without delay.

The seeds of the state’s case date back to 2019. In February of that year, former Trump lawyer Michael Cohen claimed in a congressional hearing that Trump had manipulated the values of his assets. “It was my experience that Mr. Trump inflated his total assets when it served his purposes, such as trying to be listed amongst the wealthiest people in Forbes,” Cohen testified, “and deflated his assets to reduce his real estate taxes.”

On Oct. 16, 2019, ProPublica published a story that revealed a series of “stark” inconsistencies between what the Trump Organization had reported to property tax authorities about the financial health of his landmark skyscraper at 40 Wall St. and what the company told lenders. The discrepancies made the building appear more profitable to the lenders, and less so to city tax officials. A real estate and finance professor told ProPublica at the time that the discrepancies were “versions of fraud.” Former New Jersey Attorney General Anne Milgram said, “Certainly, if I were sitting in a prosecutor’s office, I would want to ask a lot more questions.”

On Dec. 7, 2019, according to Engoron’s ruling, New York Attorney General Letitia James subpoenaed the Trump Organization. Three years later, the state sued, claiming that Trump, his company and his associates grossly misstated the value of some of his properties on statements of financial condition shared with lenders and insurers. They included 40 Wall Street, Trump Tower, Trump Park Avenue, his Seven Springs Estate in Westchester, Mar-a-Lago and property near his Scottish golf course in Aberdeen.

In this week’s ruling, Engoron called James’ evidence “conclusive.” Between 2014 and 2021, he wrote, Trump and others overvalued his assets by $812 million to $2.2 billion.

In a social media post, Trump called the accusation that he committed fraud “ridiculous and untrue” and called Engoron “DERANGED.” James is a Democrat, and Trump has maintained her investigation is politically motivated. He has denied wrongdoing.

At 40 Wall Street, Engoron’s decision said that in 2015, Trump Organization statements of financial condition overstated the property’s value by nearly $200 million. Though the company had received an appraisal in 2015 saying the building was worth $540 million, which James contended itself might have been an inflated amount, Trump statements of financial condition put the value at $735.4 million that same year.

In a November 2019 story, ProPublica also found discrepancies in the amount of commercial space the Trump Organization claimed was occupied in Trump Tower — differences that made it appear in statements to a lender that the building was financially healthier than it seemed in documents provided to tax authorities.

Engoron’s decision said Trump also submitted statements of financial condition that described the roughly 11,000-square-foot triplex apartment where he has lived in Trump Tower as nearly three times the size it is, the judge said. “A discrepancy of this order of magnitude, by a real estate developer sizing up his own living space of decades, can only be considered fraud,” he wrote.

In response to the ruling, an attorney for Trump, Christopher Kise, said in a statement emailed Wednesday that the decision was “outrageous” and “completely disconnected from the facts and governing law.” He said that the judge disregarded the views of those involved in the loan transactions, who he said testified that there was no fraud and that the transactions were highly profitable. He said the decision “seeks to nationalize one of the most successful corporate empires in the United States.” Trump’s legal team has said it will appeal the ruling.

Through a spokesperson, James said after the ruling that “we look forward to presenting the rest of our case at trial.”

Andrea Bernstein contributed reporting.

by Molly Burke, Medill Investigative Lab

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ProPublica and the Pittsburgh Post-Gazette have filed suit against the U.S. Food and Drug Administration in federal court in New York, accusing the agency of holding back records related to the sweeping recall of breathing machines that were sold around the world.

In June 2021, Philips Respironics acknowledged that an industrial foam fitted inside its popular DreamStation continuous positive airway pressure, or CPAP, machines and other devices could break down and send particles and fumes into the masks worn by patients. Health risks include headaches, respiratory conditions, nausea and “possible toxic and carcinogenic effects,” the company said.

The FDA, which regulates the medical device industry, categorized the recall as Class 1, reserved for defects that can cause serious harm or death.

But the agency denied multiple requests by the news organizations to quickly release documents under the Freedom of Information Act, including the company’s prior test reports on the degrading foam and monthly updates by Philips about the status of a recall that has impacted millions of people in the United States and other countries.

In its denial, the FDA estimated it would take as long as two years to produce the records.

After the lawsuit was filed in April, the FDA agreed to begin producing documents. The agency, however, fully redacted the company’s test results and assessments on the degrading foam — more than 1,000 pages — even though the FDA has previously summarized those results in publicly available records.

The agency cited an exemption in FOIA law that protects trade secrets and commercial or financial information that could impact a company’s business interests.

“The company’s interests should not supersede the public’s need to be fully informed about a product that the FDA itself has said has defects that can cause serious harm or death,” Post-Gazette Executive Editor Stan Wischnowski said.

Representatives for the news organizations said they plan to continue challenging the FDA’s response.

“Transparency in this case is a matter of significant and urgent public concern,” Sarah Matthews, ProPublica’s deputy general counsel, said in a statement. “These records will shed light on the recall of Philips ventilators and other breathing devices that have put the health of millions of Americans in jeopardy.”

Lawyers for the FDA have previously argued the news organizations are not entitled to an expedited delivery of records.

“Exceptional circumstances exist that necessitate additional time,” the government said in its response.

A spokesperson for the FDA said the agency does not comment on ongoing litigation.

Mediahuis NRC, an Amsterdam-based newspaper collaborating with ProPublica and the Post-Gazette on stories about the recall, has also faced obstacles in getting documents from government agencies.

Jet Schouten, a reporter at NRC, filed requests with the national health agencies in the Netherlands, Germany, Sweden and Finland for records related to the recall. Schouten said that the countries have no publicly available data about patient complaints related to the machines.

Schouten received documents from most of the countries, but the Dutch agency did not turn over the requested records. She turned to a Dutch court, which imposed deadlines for the agency to produce the records and then fined it 23,000 euros for missing the deadlines.

Schouten received the money but has not yet received the records.

“I don’t want any money,” Schouten said. “I want the documents.”

Michael Korsh of the Pittsburgh Post-Gazette contributed reporting.

by Kyle Hopkins, Anchorage Daily News

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

An Anchorage city commissioner and her husband have been charged with fraudulently obtaining $1.6 million in COVID-19 recovery money for their charity. Charges filed in federal court in Anchorage accuse the couple of buying cryptocurrency and making personal use of money intended to help people find homes and addiction treatment.

A federal grand jury on Sept. 19 indicted Rosalina Mavaega, 41, and Esau Fualema Jr., 44, on five felony charges including major fraud, wire fraud and money laundering. The charges come after the Anchorage Daily News and ProPublica first reported in May that the Anchorage Assembly gave the couple one of the city’s largest awards under the American Rescue Plan Act despite prior fraud allegations.

Mavaega was arrested Wednesday, court records show. The U.S. Attorney’s Office publicly announced the charges that afternoon.

As of Thursday morning, the city website still listed Mavaega as a member of the Anchorage Equal Rights Commission, which is tasked with investigating allegations of discrimination, as well as the city housing and homelessness committee.

Anchorage Mayor Dave Bronson appointed Mavaega to the commissions in 2022. The executive director of the Equal Rights Commission said Thursday morning that Mavaega remains a commissioner. The chairperson of the homelessness commission said she remains a “member of good standing” on that commission, representing nonprofits, and attended its most recent meeting earlier this month.

Bronson spokesperson Veronica Hoxie said Thursday that the mayor asked for Mavaega’s resignation when she was being investigated in May. Mavaega declined, Hoxie said.

“The Mayor cannot unilaterally remove a member of boards and commissions per municipal code,” Hoxie wrote in an email. “However, Ms. Mavaega’s service is under official review by the Board of Ethics. The Board is addressing the issue and took initial public testimony in an executive session during its meeting on September 22. The matter is still under consideration by the Board.”

Mavaega and Fualema were in custody as of Thursday morning and could not immediately be reached for comment. When a reporter visited Mavaega’s office on May 18, an employee said she was not available but was scheduled to talk with investigators that afternoon. She did not respond to subsequent emails and phone calls seeking comment.

Fualema also did not respond to emails, phone messages or an interview request delivered to his home at the time.

First image: Rosalina Mavaega. Second image: Esau Fualema Jr. (LinkedIn)

The Anchorage Assembly in May 2021 awarded Mavaega and Fualema’s charity, House of Transformations, $1.6 million even though the state permanently barred the couple from serving as Medicaid providers in 2015.

The state Division of Senior and Disability Services gave four reasons for the ban: violating background check requirements, submitting billing claims without adequate documentation, offering a rebate for Medicaid referrals and submitting claims without supporting documentation.

As a result, Maveaga’s business can no longer bill any federal health care program, including Medicare, Medicaid and Denali KidCare, for its services. Mavaega appealed the ban in 2016, arguing the penalty was too severe and relied on hearsay evidence, but a state Superior Court judge upheld the punishment.

The charges relate to how they obtained the 2021 grant, how they used the money and alleged efforts to subsequently acquire additional grants from the city.

They are accused of lying to federal, state and city officials in order to claim they met legal requirements to receive an ARPA grant from the city. The charges say the couple directed a grant writer to submit proposals that “falsely described the operating expenses and officers and directors” of their various charities.

The charges say the couple transferred $297,250 of the grant to their personal checking account, using the money as collateral to obtain a personal loan. The loan money was used, in turn, to buy $191,000 in cryptocurrency and to pay taxes owed by one of their businesses.

An additional $402,000 in grant money was used to finance a for-profit beauty salon, according to the charges. The charges say that as part of their grant agreement, they promised to use about $500,000 to make down payment on two Anchorage properties that could be used for housing services. They did not do so, the charges say, and failed to disclose that Fualema already owned 50% of one of the properties.

House of Transformations and various limited liability companies that use the same office address and same name, or similar names, are among a constellation of nonprofits and businesses the couple created in recent years.

House of Transformations was one of the biggest recipients in the first round of ARPA grant awards from the city. It received more than city agencies such as the fire and police departments, and it received the 13th overall largest grant out of the 64 awarded.

Update, Sept. 29, 2023: This story has been updated to add additional comments from Anchorage officials.

Correction

Sept. 30, 2023: This story originally misstated the first name of Anchorage Mayor Dave Bronson’s spokesperson. It is Veronica, not Victoria.

by Debbie Cenziper, ProPublica, and Michael D. Sallah, Pittsburgh Post-Gazette

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Millions of people in the United States and around the world were affected by the June 2021 recall of Philips Respironics ventilators and CPAP and BiPAP machines. ProPublica and the Pittsburgh Post-Gazette reported on how the company kept complaints about the devices secret for years. As part of that reporting, the news organizations found answers for consumers trying to navigate the crisis.

We are not providing medical advice and encourage patients and their family members to seek guidance from trusted health care providers.

Why Did Philips Respironics Recall These Breathing Machines?

Foam that the company embedded in millions of ventilators and sleep apnea machines to reduce noise was found to break down, in some cases because of heat and humidity.

The material is polyester-based polyurethane, which is used to stuff mattresses, seat cushions and sofas. Tests for the company have found that when the foam degrades, it can release chemicals at dangerous levels.

After receiving thousands of complaints, Philips announced a recall of about 20 models of ventilators and CPAP (continuous positive airway pressure) and BiPAP (bi-level positive airway pressure) machines. The Food and Drug Administration said that as many as 15 million devices with the sound-abatement foam had been sold since 2009.

The FDA, which oversees the medical device industry, declared the recall a Class 1 — the most severe type, reserved for device defects that can cause serious injury or death.

Was My Ventilator, CPAP or BiPAP Machine Recalled?

The recalled machines were sold not only in the United States but around the world, including in Canada, Australia and Brazil. Most of the affected devices were DreamStations, the company’s signature CPAP machine.

Continuous Ventilator, Minimum Ventilatory Support, Facility Use

• E30

Continuous Ventilator, Non-Life Supporting (BiPAP)

• DreamStation ST, AVAPS
• SystemOne ASV4
• C Series ST, AVAPS, also known as System One BiPAP AVAPS (C-Series), System One BiPAP S/T (C-Series)
• OmniLab Advanced Plus (sleep lab) CPAP
• OmniLab Advanced Plus

Noncontinuous Ventilator (CPAP)

• System One 50 series
• System One 60 series
• DreamStation CPAP
• DreamStation Go
• Dorma 400, 500

Mechanical Ventilators

• Trilogy 100
• Trilogy 200
• Garbin Plus, Aeris, LifeVent Ventilator
• A-Series BiPAP Hybrid A30
• A-Series BiPAP V30 Auto Ventilator
• A-Series BiPAP A40
• A-Series BiPAP A30

What Does the Government Say About the Health Risks?

The FDA has reported that when the foam breaks down, the material can move through the device and be inhaled or ingested. The agency said users can experience headaches, asthma, inflammatory conditions, respiratory tract problems and “toxic or cancer-causing effects to organs,” among other health complications.

The FDA has advised consumers with recalled machines to consult their doctors about the best course of action, noting that some users may face greater health risks if they stop using their machines altogether.

The agency is providing safety updates and has continued to categorize the recall as Class 1.

What Does Philips Say About the Health Risks?

When the recall was announced, Philips reported that the defect had the potential to cause both short- and long-term health risks, including life-threatening conditions. Previously, two internal health hazard evaluations launched by Philips had concluded that the risk to people who used the machines was “unacceptable.”

In recent months, Philips has reported that initial testing was limited and based on a “worst-case scenario,” and that new tests on the DreamStation and similar devices have found the foam breakdown is “unlikely to result in an appreciable harm to health in patients.”

Medical experts who reviewed the findings on behalf of ProPublica and the Post-Gazette raised concerns about the company’s safety claims. The experts said that far more devices need to be tested to capture clear-cut patterns and that human studies examining exposure levels over time are critical to assessing long-term harm.

The experts also pointed out that the machines tested positive for genotoxicity, the ability of a chemical to cause cells to mutate, a process that can lead to cancer. Philips has said that a third-party assessment still concluded the DreamStations and similar machines are unlikely to cause harm. Testing on ventilators is ongoing.

Are Ozone Cleaners to Blame?

Philips has said that unapproved ozone cleaners customers use to clean their devices can accelerate foam degradation.

The FDA has advised consumers to avoid ozone or ultraviolet light cleaners on CPAP and BiPAP machines. But in a letter to the company last year, the agency said the blame for the crisis ultimately lies with Philips.

“There are reasonable grounds to believe that the risk associated with the devices was not caused by the failure of a person other than Philips to exercise due care in the installation, maintenance, repair, or use of the devices at issue,” the FDA wrote.

How Can I Register for a Replacement CPAP Machine or Other Device?

Customers whose machines were recalled are supposed to be able to get replacements from Philips, which has a patient registration site.

Though Philips has said millions of replacement devices have been sent out, customers have reported the process is riddled with delays.

To register, Philips requires the name of the recalled device and its serial number. The company also requires a current doctor’s prescription.

Philips is offering new machines, refurbished machines or financial payments in lieu of a new device, depending on the situation. The company advises customers who have retained lawyers to consult with them before making a decision.

Patients in the United States can register their recalled devices online or by calling the company at 877-907-7508.

Once you register, you should receive a confirmation number, which you can use to track the status of your request.

How Can I Tell the Government About a Problem With My Breathing Device?

The FDA maintains a database known as the Manufacturer and User Facility Device Experience that tracks reports about malfunctions, patient injuries and deaths linked to medical devices.

Under the law, manufacturers, importers and certain facilities are required to report such events. But patients can report them too, as can their relatives, doctors and other health care professionals, either through the FDA’s online MedWatch portal or by submitting FDA Form 3500B.

Is the Information on Social Media Trustworthy?

Many patients whose devices were recalled have taken to social media to gather information, including tips about safe ways to continue using the devices and where to find replacements.

Videos by YouTube personalities purport to show customers how to tear the foam out themselves, but safety regulators have warned against doing that because it can dislodge potentially toxic material.

The recall also helped fuel an online market for secondhand devices. Experts say that customers should seek proof that any recalled machine being sold online has been properly repaired.

While online forums can be helpful, public health experts say sleep and respiratory care doctors are in the best position to give you good advice.

Help ProPublica and the Pittsburgh Post-Gazette Investigate the Recall of Philips Respironics Breathing Machines

Michael Korsh of the Pittsburgh Post-Gazette contributed reporting.

by Patrick Lohmann, Source New Mexico, and Byard Duncan, ProPublica

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

On a recent sunny morning in the high pastures of northern New Mexico, Tito Naranjo greeted a pair of federal surveyors on a patch of gravel where his traditional adobe home once stood.

Naranjo used his walking stick to show them the outline of where his sunroom had been before it burned up in a wildfire accidentally set by the U.S. Forest Service last year. They walked slowly to the edge of the property, past a blackened willow tree that once held a tire swing, and stepped over a creek now empty of trout.

The tour confirmed what satellite imagery hinted at: This 97-acre property was a total loss. The home Naranjo and his wife had shared for 50 years, a stand of aspen trees, a small apple orchard, miles of fencing and a bridge he had built himself, all gone.

Naranjo, 86, hasn’t laid the first adobe brick of a replacement home, hammered a fence post or planted a single tree. And with congestive heart failure raising the risk of a stroke, he worries he won’t live long enough to do so.

First image: Tito Naranjo, left, points to the edge of his property during a visit with Cody Townsend, a conservationist with the U.S. Department of Agriculture. Second image: Naranjo slowly walks up what used to be a road on his property before post-fire flooding washed it away. (Patrick Lohmann/Source NM)

Seventeen months after losing their homes and livelihoods in the Hermits Peak-Calf Canyon Fire, Naranjo and thousands of others in the aging, rural communities in New Mexico’s Sangre de Cristo Mountains are still waiting for money to rebuild.

As the fire swept across the mountains for five months in mid-2022, the Federal Emergency Management Agency responded as it would to any disaster. It provided roughly $6.2 million to about 1,100 households for short-term expenses like housing and evacuation and, in some cases, for limited damage to housing and possessions.

But even for people who lost everything, those payments were capped at about $38,000. Most people got far less, and some got nothing. Few people were given temporary housing. Farmers and ranchers are struggling to earn a living.

The money for the far more difficult and expensive task of rebuilding is supposed to come from a $4 billion fund set up by Congress just for this fire — an acknowledgment of the Forest Service’s culpability in triggering the blaze. But the FEMA office handling those payments didn’t start sending checks as quickly as expected, and it has yet to spend 98% of the money.

FEMA has defended its rollout of the claims office, saying it is moving as fast as a federal agency can. Normally, FEMA offers only short-term disaster aid. This is only the second time it has been tasked with paying survivors so they could rebuild after a federal agency lost control of a prescribed burn meant to prevent a wildfire. FEMA established policies, hired staff and opened offices in eight months.

Faced with delays in getting paid and questions about what FEMA will ultimately cover, a local attorney representing Naranjo and several hundred other survivors recently convinced a federal judge to allow some of her aging, infirm clients to testify under oath about what they have lost — an unusual move intended to preserve knowledge that their relatives don’t have.

Antonia Roybal-Mack, the lawyer, said she wants to make sure these victims are made whole if they die before they get a check from the federal government. If they end up filing suit to get what they believe they deserve, “these clients will likely expire before they get their day in court,” she said.

Her clients include farmers and ranchers who lived off land that was burned in the fire or that was washed out in the floods that followed. According to sworn court filings, they include a Vietnam veteran who said he was “blown to hell” in the war, a salon owner who said her doctors told her that her recent lung disease came from “chemicals and smoke,” and a former police chief who recently was treated for cancer for the fourth time.

In an excerpt from a court filing, an elderly fire victim seeks permission to testify under oath about his losses in case he dies before FEMA pays him. (Obtained by Source NM. Redacted by ProPublica.)

Many survivors have lived in these tight-knit communities for decades, some their whole lives. Their way of life — captured by the Spanish word querencia, which people here use to express their love of the land and their obligation to it — was under threat even before the megafire. Naranjo is one of the last fluent speakers of Tewa, the language spoken in the Indigenous pueblo he grew up in. The population of Mora County, where he now lives and one of two counties that were badly burned, declined 15% from 2010 to 2020, to about 4,200, according to census figures.

Now living at his son’s home two hours away, Naranjo is trying to figure out what, if anything, he can do for his land. His wife, Bernice, said the instability of life since the fire and their sudden reliance on the government has made his final chapter distressing and chaotic.

“He doesn’t show his emotions very clearly, but he does feel the loss tremendously,” she said. “And he knows that he may never be able to rebuild.”

Naranjo at his sister’s home in Santa Clara Pueblo, New Mexico (Adria Malcolm for ProPublica) Before a Check, the Fine Print

The $4 billion Congress set aside is supposed to compensate survivors, businesses, local governments and nonprofits for damages in the 534-square-mile burn scar. But the claims process is long and complicated, and the vast majority of victims haven’t gotten anything yet.

FEMA wrote its first check to a survivor in June, according to the claims office. That’s a year after the fire raced through the mountains. As of Sept. 15, it had paid $67 million, just under 2%, most of which went to individuals. The pace has picked up in recent weeks, however. (New figures are expected next week.)

Though the Forest Service said 430 homes burned in the fire, a maximum of $2 million has gone to housing as of Sept. 15, according to FEMA’s figures. FEMA said it is processing “a fairly small number” of claims for housing, though officials have declined to say exactly how many.

The problem is twofold: Some people held off on filing claims as they waited months for FEMA to finalize its rules on exactly what it would pay for. And for those who did file, the checks have not come quickly.

Source New Mexico and ProPublica spoke to about 30 survivors about the claims process. A little under half said they had not yet filed a claim. They said they were desperate to start rebuilding but needed clarity on the claims process.

Until late August, the claims office operated under interim rules largely copied from the Cerro Grande Fire in 2000 — the only other time FEMA has paid for damages for a wildfire accidentally started by the federal government. FEMA officials acknowledged differences between the fires but said they started with those rules because they were in a rush to get moving.

Some of those residents told us they didn’t want to file claims under those rules, believing they would miss out on additional money if the final rules were more generous. FEMA officials told survivors that would not happen, but lawyers and residents told Source and ProPublica they feared that the formulas in the interim rules would determine their payments regardless.

A big sticking point was the value of the trees that once covered these mountainsides. Residents and lawyers said the interim rules undervalued those trees, which are harvested for timber, Christmas trees, and latillas and vigas — ceiling rafters commonly used in Southwestern homes. While the claims office issued partial payments for other damages, it held off on paying for trees until it could figure out how to value them.

The final rules released on Aug. 28 offered far more for trees than the interim rules, which finally assuaged those concerns. Based on that formula, Angela Gladwell, the head of the claims office, said she expected tree losses to top $1 billion.

Scorched trees cover Holman Hill in New Mexico. The Hermits Peak-Calf Canyon Fire ravaged 534 square miles, about the size of Los Angeles, in the Sangre de Cristo Mountains of northern New Mexico. (Adria Malcolm for ProPublica)

Residents who didn’t wait for the rules to be finalized faced different obstacles. After a claim is filed, FEMA must formally “acknowledge” it. But FEMA has no deadline by which that must happen. The agency started encouraging people to file claims in November, but none were acknowledged until April. The delays continued through the summer.

FEMA told Source and ProPublica that it tries to acknowledge claims within 30 days, but that it took time to create a new office and train staff. The agency also said its office had at times received a lot of notices at once, which delayed the process.

The claims office is catching up: As of Sept. 14, it had acknowledged about 80% of the 2,214 claims filed. But those survivors face a new round of waiting. Once FEMA acknowledges a claim, it has 180 days to make an offer to pay for those damages. People can decide to take the money or to fight for more through arbitration or in federal court.

The pace of payouts is slower than it was for the Cerro Grande Fire. After a similar amount of time since a law went into effect to compensate those victims near Los Alamos, FEMA had paid about $162 million out of $545 million allocated — about 30%. That included about $84 million to individuals.

FEMA says payments are taking longer this time because this fire was bigger, the communities are poorer and have less insurance, and the claims are more complex, with agricultural and ranching losses to consider along with burned homes.

The agency plans to distribute $1 billion — a quarter of the total allocated — by January 2025. It did meet a recently set internal target of spending $50 million by Oct. 1, a spokesperson pointed out.

Regardless of whether they have filed a claim yet, survivors face uncertainty over whether all their costs will be covered. People who accept a payment must sign a form saying they won’t seek additional compensation or sue the government for “past and present and future claims” for the category of loss they’re being paid for. But more than a year after the fire was extinguished, people don’t know if they’ve seen the last of the damage.

The fire burned root systems and topsoil, creating a landscape where dirt and debris sloughs off the mountainside when it rains, particularly after spring snowmelt and during the summer monsoon season. That’s expected to continue for several years.

Since the fire, “I’m constantly doing flood control and mitigation,” said Felicia Ortiz, whose hillside property is eaten away during rainstorms. FEMA acknowledged her claim on Aug. 18 and has yet to pay her.

She estimates she’s spent roughly $8,000 on recovery, much of it to divert floodwaters. “Cleaning up messes from the flooding — it happens, you clean up, it happens again, you clean up again.”

Mud and debris pushed over fences on Felicia Ortiz’s property in Rociada, New Mexico, after a rainstorm in July 2022. Since the fire, she said, “I’m constantly doing flood control and mitigation.” (Courtesy of Felicia Ortiz)

Despite the form that survivors must sign, FEMA says victims like Ortiz need not worry about ongoing damage after they’ve accepted a check. Any loss that occurs afterward could be eligible for reconsideration, the agency says; Gladwell, the claims office head, has sole discretion on whether to reopen a particular claim.

All these obstacles leave some fire victims wondering whether they can trust the federal government that burned their property, denied short-term aid to many of them and then promised to make them whole.

“I do believe that Angie Gladwell is really trying to serve the people,” said Kayt Peck, who waited until the final rules were released to file a claim for her destroyed home. “But she’s just one cog in the FEMA wheel. And when you’re working with someone that you know from the past that you couldn’t trust, and they’re telling you to trust them, don’t trust them.”

FEMA has stressed that the claims office is separate from the program that provided limited assistance when people were fleeing their homes. Staffers with the claims office regularly show up at community events, handing out brochures encouraging people to file claims. The claims office advocate holds meetings to combat “half-truths and misinformation” about what FEMA will and won’t pay for.

“We know that trust is earned by doing what we say we are going to do, and delivering results,” FEMA spokesperson Deborah Martinez said.

A Year of Waiting

Most of the people who spoke with Source and ProPublica said they can’t rebuild before FEMA pays their claim. Few of those displaced by the fire had insurance. Some said they’ve already spent their temporary aid; others never got any.

A state agency said in February that people are leaving for urban areas such as Albuquerque and won’t be able to return without financial help. Calls from fire victims to a mental health hotline shot up this spring. And in August, U.S. Sen. Ben Ray Luján greeted President Joe Biden on a visit to New Mexico by handing him a letter criticizing delays in payments.

New Mexico Gov. Michelle Lujan Grisham said on a recent visit to the burn scar that the message from FEMA is to wait, just as it was last summer: “That’s what you’re hearing from everyone: ‘I don’t know what I’m supposed to do. I’m waiting.’”

Martinez, the FEMA spokesperson, said the claims office recognizes that the recovery “has been a uniquely challenging and often frustrating experience for many,” and it is providing “unwavering support” to survivors.

FEMA has partnered with other federal agencies to help survivors. A Department of Agriculture program provides free estimates for some types of losses. FEMA will pay up to five years of flood insurance premiums for those expecting post-fire flooding. And the claims office recently announced it would pay survivors’ Small Business Administration disaster loans, including interest.

Brian and Nell Rodgers lost not just their home on a hilltop 5 miles east of Hermits Peak, but their carefully planned life of self-sufficiency. They raised trout in an indoor pond. Brian had converted a few vehicles to run on biodiesel; when the waste vegetable oil he was processing into fuel exploded during the fire, he said, it could be seen for miles.

They put their disaster aid toward an RV and moved to Santa Rosa, 80 miles away in the desert. For six months, the couple “itemized every detail of our life” in anticipation of a larger payout, said Nell Rodgers, a 70-year-old retired schoolteacher. They filed their claim in July. The claims office acknowledged it quickly, but the money has yet to arrive.

When Nell experienced chest pains after a surgery in July, she wanted to go to an emergency room in Santa Fe, more than an hour away. Because they were short on cash, Brian Rodgers had to ask his ex-wife, who lives nearby, for $20 in gas money.

The government “took away our retirement — and took away our possibilities,” Nell Rodgers said. “And so now, the only thing we can count on is compensation. And that doesn’t seem to be coming anytime soon.”

Brian Rodgers, center, interrupts a U.S. Forest Service district ranger during a town hall meeting in Las Vegas, New Mexico, in March, where the agency discussed how it was managing the removal of burned trees that could fall down. (Adria Malcolm for ProPublica)

Sam Arthur, the owner of a clothing boutique in Las Vegas, New Mexico, lost the home he shared with his wife, Tamara Fraser, in April 2022 — the day the fire suddenly surged across the mountains. Dozens of homes were destroyed in one day.

He said he promptly received the maximum amount of emergency assistance, but it was nowhere near enough to repair his home or restore his acres of scorched property. He submitted a notice of loss to FEMA on Jan. 6, seeking to be paid for the destruction of his home, relocation costs, debris removal, cleanup and other expenses. The agency didn’t acknowledge his claim until Sept. 1. Under the rules, it has until the beginning of March to make a payment offer.

In the meantime, he and his wife are living in a “tiny home” on wheels in the parking lot behind his store. “At least it’s ours, and we don’t have to pack up and leave again,” he said. “Those things were starting to take a toll.”

First image: A pickup truck and trailer on the site of Sam Arthur and Tamara Fraser’s former home in Rociada, New Mexico. Second image: Arthur in front of the burned land on his property. (Adria Malcolm for ProPublica) Neighbors Step Up

While victims wait, they’re getting help from a local volunteer group that has raised funds to pay for essentials like refrigerators, generators and wheelchair ramps.

Neighbors Helping Neighbors got its start when Janna Lopez, a retired state worker, began bringing hot food to a shelter at a former school gym as the fire raged in April 2022. After the fire was contained and survivors’ needs grew more complex — unpaid rent, flooded driveways, contaminated wells — she and fellow volunteers kept at it.

By July, the organization had handed out about $300,000 to about 65 households — about as much as FEMA had provided to households by then, said Bob DeVries, a volunteer and track coach at the local university. (Since then, FEMA has increased its payments.) Now, payments from the volunteer group are approaching $500,000.

Every Thursday, the group’s two case managers gather at a local church with representatives of four local religious and philanthropic organizations. They decide how much to give each victim, no strings attached, typically capped at $12,000.

Janna Lopez, Hap Escue and Chip Meston, from left, during a Neighbors Helping Neighbors meeting at First United Methodist Church in Las Vegas in August. Lopez, founder of the volunteer aid group, helped with two applications for assistance that Escue and Meston reviewed. (Adria Malcolm for ProPublica)

One day in early August, they handled “Case 260,” a man in his 60s. His refrigerator was damaged when the power had been shut off, and the ojito, the natural spring he used for farm animals, was destroyed by flooding.

He didn’t have insurance, and his claim hadn’t been paid yet. He had gotten just $800 in disaster aid. “He’s, in essence, exhausted what he can get from the federal government,” said Chip Meston, who runs a local beef processing plant and represents one of the churches.

The committee quickly agreed to pay the entire request: $3,068.55.

Though the immediate crisis has passed, the number of people seeking help hasn’t dropped. There are about 45 active cases, with a backlog of more than 270. About 20% of households in the area were below the poverty line before the fire, and if they got any short-term aid from FEMA, it’s long spent, DeVries said.

If you or someone you know needs help, here are a few resources:

• Call the National Suicide Prevention Lifeline: 988
• Text the Crisis Text Line from anywhere in the U.S. to reach a crisis counselor: 741741

Rosie Serna, 75, said Neighbors Helping Neighbors pulled her out of despair. She’d gotten by on Social Security since her husband died. The fire took the home where she hosted big outdoor gatherings for kids and grandkids.

For a while, FEMA helped her with rent as part of its disaster aid, but it stopped after she accepted temporary help from an aid group. By April, the $700 rent came due. She had no way to pay. She felt overwhelmed.

“I was just thinking of so many things: ‘Why me?’ ‘What am I going to do?’” she recounted, moved to tears. “And I said, ‘Maybe it’s better if I just don’t exist anymore.’ I thought, ‘Nobody cares about me.’ I felt so alone.”

Rosie Serna at the house she is renting in Mora, New Mexico. When Serna evacuated her home, the only item she took with her was her statue of the Virgin Mary. (Adria Malcolm for ProPublica)

One day in early April, Serna got a call from Gloria Pacheco, a retired schoolteacher and volunteer who was checking on her FEMA case. Serna seemed to have lost hope.

Worried, Pacheco drove 45 minutes to see her, the first time they had met in person.

After a long conversation, Pacheco connected Serna to a therapy service for fire victims, which Serna said has been helpful. Neighbors Helping Neighbors gave her a few hundred dollars for propane.

FEMA recently denied Serna’s appeal for rental assistance, but Pacheco said she’ll keep trying. Serna calls Pacheco “my angel.”

“I Really Have to Prepare”

As Naranjo waited to be sworn in for his deposition in a hotel conference room on July 20, he glanced at his watch. “We’re running 21 minutes behind,” he said to the lawyers gathered to question him.

Over the next two hours, he testified about the life he and his wife had built near their childhood pueblos, the monstrous fire that made ash of his journals, FEMA’s denial of any short-term aid, the future of his land.

“Is it your goal to restore the property as best you can to the way it was before the fire started?” asked Roberto Ortega, an assistant U.S. attorney.

“That can never happen,” Naranjo answered. “I would like to see it, but I saw it in its glory. It was a paradise. That paradise can never be rebuilt.”

The site of Tito and Bernice Naranjo’s former home (Adria Malcolm for ProPublica)

As he prepares to leave his land and any compensation he ultimately receives to his wife and children, he’s made his priority the 3-mile fence that once encircled his property. He’s tired of his neighbor’s cows eating his grass for free. Most of all, he wants a permanent demarcation of what he will leave behind.

A few days after the deposition, he walked his property with Department of Agriculture employees to assess the damage. “I really have to prepare. You need to have permanent markers on it, so people know where your boundaries are,” Naranjo told them. “That’s why I want the fence. That’s my priority. Because my children don’t know the boundaries of our property.”

During a tour of the damage to Naranjo’s property with the USDA employees, he points to a mountainside the fire descended. (Patrick Lohmann/Source NM)

But rebuilding the fence, as with everything else FEMA has been involved with, isn’t as simple as he hoped. If he wants the full replacement cost, he’ll have to prove the fence was his by submitting affidavits from his neighbors or receipts — for a fence he built himself, 50 years ago, with timber from his property.

Back then, he felt energized by the land, waking early to run a 7-mile loop around the property and occasionally discovering prayer shrines left by early Pueblo peoples. Now everything is exhausting — walking up the washed-out road, dealing with the fence, hearing his kids’ ambivalence about whether they want to rebuild.

“I just haven’t got the strength, or the energy, or the outlook, or the dreams that I had at the time,” he said.

He no longer plans to have his remains spread on the property. He once envisioned his ashes scattered among the aspens and ponderosa pines. Instead, blowing through those blackened trees will be ashes of the paradise he lost.

A blackened willow tree on Tito and Bernice Naranjo’s property in Chacon, New Mexico (Adria Malcolm for ProPublica)

Were You Affected by the Massive Wildfire in Northern New Mexico? We Want to Hear From You.

by Anna Clark, ProPublica, and David Jesse, The Chronicle of Higher Education

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

Among the people streaming onto Baker College campuses early this fall were some new faces: federal investigators conducting an unusual review of the marketing and recruitment practices of the Michigan private college.

The investigators looked at records and asked questions about admission interactions, including what prospective students were told about cost, financial aid and post-graduation salaries, according to multiple sources with direct knowledge who spoke anonymously because they said they could lose their jobs if they talked to the news media. Questions from the investigators focused on student experiences at Baker and whether the school lived up to promises made in the recruiting process.

The investigators’ presence is the latest sign of precarious times at the nonprofit college. The U.S. Department of Education, whose investigation into Baker was made public in June, could penalize the college by jeopardizing its accreditation or access to federal student aid. At the same time, Baker’s finances are spiraling down: Revenue and enrollment have declined precipitously in the past decade. Its Michigan footprint has shrunk from nine traditional campuses to five.

In a 2022 investigative report, ProPublica and the Detroit Free Press detailed the college’s low graduation rates and the heavy debt that many students shoulder. The college regularly spent more on marketing than on financial aid, and experts identified conflicts of interest in the college’s governance structure.

As the 2023-24 school year gets underway, not all students are aware of the peril their college could be in. Over several days in August, at Baker’s new Royal Oak campus, outside Detroit, only one of more than two dozen students interviewed knew about the federal investigation.

Over in southwest Michigan, Meayah Haselhuhn learned about it from news reports — and she’s concerned. The 25-year-old mom has been taking online classes at Baker while working full time, with hopes of graduating in a business program and landing a better-paying job by the time both her kids are old enough for school.

But now, she plans to find a different college.

“I cannot risk it,” she said.

Six weeks after Haselhuhn expressed those worries, federal investigators showed up.

Baker’s public relations manager confirmed that federal investigators were on site last week at two campuses, Owosso and Royal Oak. “We knew they were coming,” she wrote in an email, adding that “we are and will remain fully cooperative with any requests made from the Department of Education.”

Baker declined to answer additional questions about the inquiry. The federal government would not comment on the visits or the investigation. In a public disclosure notice in late August, Baker’s accreditor, the Higher Learning Commission, said the college must file a report on the status of the investigation every 90 to 120 days, but those reports are considered private and not available to students, faculty or staff.

Nonprofit schools like Baker aren’t typically subjected to such scrutiny.

Michigan, unlike most states, has no mechanism to oversee private colleges. But even states with such a system rarely use it, unless the school is close to shutting down. Accreditation agencies, meanwhile, generally have small staffs and rely on volunteers from other colleges who conduct site visits and read reports.

That leaves the federal government. But it has largely refrained from direct oversight of nonprofit colleges, except in extreme cases.

When it launches investigations, the focus has been on for-profit institutions. The unit investigating Baker was gutted under the Trump administration but reconstituted under President Joe Biden.

While high-profile investigations of schools like ITT Technical Institute and Corinthian Colleges led to their closure and loan cancellation for former students, there are no known completed investigations of nonprofit private institutions for marketing and recruitment practices in undergraduate programs.

Baker College is undergoing one of the most extraordinary periods of change in its 112-year history. Founded as a for-profit business college in Flint, and serving as a training ground for many auto industry employees, it converted to nonprofit status in 1977 and grew fast, propelled by federal Pell Grants and federally subsidized student loans. It became a pioneer in online learning, opened multiple campuses and grew to be the largest private nonprofit school in Michigan.

Money flowed into Baker’s accounts as the college grew. At the end of the 2013-14 academic year, Baker was bringing in $219 million in revenue and had $226 million in expenses. By the end of the 2022-23 school year, revenue was $58 million and expenses had shrunk as well, to $93 million.

From a high of about 45,000 students in 2011-12, enrollment is now about 4,000.

Baker’s officials have attempted a turnaround by orchestrating a radical shift in its target market, closing campuses in historically industrial places like Flint and Allen Park and building a new one in the more well-off suburb of Royal Oak. The rebranding from an open-enrollment college to a more traditional school includes being more selective in which students are admitted and devising a new mascot — the Baker College Bees.

For the 2018-19 school year, 2,107 prospective students applied to Baker. According to federal records, the college offered admission to about 80% of applicants and 745 of them enrolled.

By contrast, in the 2022-23 school year, about the same number of prospective students applied to Baker. The college offered admission to just over 35%, and 323 enrolled.

But the reality of its finances has meant steep cuts in spending. It chopped $10 million in spending on educational and instructional expenses between 2021 and 2022, audited financial statements show.

Baker has a large endowment, yet the proceeds remain largely untouched. Organized as the Jewell Educational Fund, it grew even as the college’s finances declined, rising 127% between 2011 and 2021.

Baker had about $350 million in its endowment in August 2022, the most recent numbers available. But its earnings have been lightly used, even as Baker closed campuses, and students took on sizable debt.

Records show that the extent of the endowment’s spending was $7.4 million on scholarships, or about 1.9% of the total on hand at the beginning of the 2021-22 fiscal year. Nationally, the average spend rate for endowments the size of Baker’s was 4.6%, according to a study by the National Association of College and University Business Officers.

With lower-income students lacking sufficient access to scholarship money, ProPublica and the Free Press reported in 2022, they often turned to federal loans. Former students described how they had left Baker without the skills necessary to succeed in a well-paying career but burdened by crushing sums of debt.

Some former Baker students have filed what are known as borrower-defense claims with the Department of Education, asserting that deception had led them to take out loans and that the loans should be forgiven. Data from 2020 showed that the number of claims about Baker was unusual for nonprofits. For-profits usually are the subject of such complaints. The Department of Education wouldn’t comment on how it is handling those claims.

Another place disgruntled former students have turned to is the U.S. Federal Trade Commission.

Between 2016 and mid-2023, about 60 complaints were received by the FTC involving accusations of misleading claims by Baker, ProPublica and The Chronicle of Higher Education found.

Among the complaints from 2022 was one from a student who wrote: “Baker College is a supposed non-profit institution, but they have made false claims about their employability of graduates, finances, and programs.”

Another wrote: “I was lured into a sense that I would be attending a college that valued their students only to learn that they valued my financial asset to the college and not my education. I feel that I have been deceived and used for their financial gain.”

The FTC declined to comment. It does not confirm or deny the existence of any investigations because the agency’s investigations are not public.

While Baker did not respond to detailed questions for this story, it said in previous statements to reporters that the college is not allowed to restrict student borrowing. It also emphasized a commitment to improving student outcomes and reducing their loan debt. It has defended its governance structure and marketing practices.

Haselhuhn, the mom who plans to leave Baker, also is concerned about departing with too much debt. She earned an associate degree from a community college at no cost, in part, she said, because she came out of Michigan’s foster care system.

For a year in Baker’s online program, she has about $13,000 in student loans, she said. “It’s hard to imagine paying it.”

Kevin, a Baker graduate who asked that his full name not be used, said he’s conflicted about the investigation.

He has a good job and remembers many excellent teachers at the Flint campus, he said. But he also saw problems, including students who, believing Baker’s marketing, took on debt for programs that wouldn’t lead to successful careers.

It’s “shameful,” he said, and he thinks Baker should be held accountable.

At the same time, he’s concerned that the investigation — and its possible consequences, including accreditation loss — will hurt Baker graduates.

Even as he pays down $55,000 in student-loan debt, he has one question: “Is my degree going to be worth nothing?”

by Debbie Cenziper, ProPublica; Michael D. Sallah, Michael Korsh and Evan Robinson-Johnson, Pittsburgh Post-Gazette

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. This story was co-published with the Pittsburgh Post-Gazette.

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To understand the breakdowns that led to one of the most tumultuous medical device recalls in generations, ProPublica and the Pittsburgh Post-Gazette spent a year probing what happened inside Philips Respironics after the company first learned that contaminants were turning up in breathing machines designed to save lives.

The news organizations also tracked what has happened since the recall as the company claimed that its devices were safe despite multiple test reports showing that foam embedded inside them to reduce noise could break down and send dangerous particles and chemicals into the masks of patients. Millions of ventilators, continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) machines were impacted by the recall.

Reporters for the two news outlets collaborated with Mediahuis NRC in Amsterdam, where Philips’ parent company, Royal Philips, is headquartered, as well as with student journalists from Northwestern University’s Medill Investigative Lab.

Reporters obtained newly unsealed court records, internal documents, text messages and public records in the United States and other countries to track Philips’ and its parent company’s response to the problem. Those documents included records from four tests conducted by independent labs brought on by Philips that describe the chemicals released by the foam.

The reporting team also drew on thousands of complaint reports spanning 13 years that were submitted to a national repository known as the Manufacturer and User Facility Device Experience database. The records are maintained by the Food and Drug Administration and describe reports of patient deaths and injuries as well as device malfunctions.

To better sort and examine the reports from MAUDE, the team used a proprietary system called Device Events, a search engine developed by former FDA analyst Madris Kinard.

Over the course of months, reporters pulled every report about the recalled machines. More than 100,000 had been filed with Philips or the government since 2010 by patients, doctors and others. (It is possible that some patients or events were referenced in more than one report.)

Because the records include the date the company received each complaint, reporters were able to determine how long it took Philips to submit them to the FDA.

Federal law requires device makers to turn over to the government within 30 days all reports of patient injuries, deaths and malfunctions that have the potential to cause harm.

The reports described thousands of cases of cancer, liver and kidney conditions, respiratory infections and other illnesses among device users. Some users or their family members directly tied those illnesses to the use of recalled machines. Others simply reported illnesses without elaborating.

The methodology used by ProPublica and the Post-Gazette was reviewed by Kinard and by Ross Meisner, the chief commercial officer of Basil Systems, a research platform for quality, safety and regulatory analysis.

Philips has said new tests on its DreamStation CPAP machine show that the machines are “unlikely to result in an appreciable harm to health in patients” and that testing on ventilators is ongoing. The company has also said that it properly responded to complaints about the foam and launched a recall when the problem became clear.

Testing to determine the level of health risk posed by the foam could take years. The FDA has declared the recall as a Class 1, which is for device defects capable of causing severe injury or death.

The reporting team interviewed more than 200 people in the United States and a dozen other countries, including former Philips employees who described lapses inside the company that allowed problems to go unaddressed for years.

Reporters traveled the country to interview doctors, researchers, patients and the family members of those who died, and consulted public health researchers and physicians on risks posed by the devices. Dr. Ronald Chervin, director of the University of Michigan Sleep Disorders Centers, and Dr. Radhika Breaden, a sleep medicine specialist in Oregon, provided guidance on the science behind sleep apnea and CPAP machines.

The news organizations have requested dozens of additional documents from the FDA. In April, ProPublica and the Post-Gazette sued the FDA in federal court in New York over the agency’s refusal to expeditiously release the records. The case is ongoing.

Reporting was contributed by Monica Sager, Molly Burke, Margaret Fleming, Susanti Sarkar, Nicole Tan, Claire Gardner, Bridgette Adu-Wadier, Aidan Johnstone, Kelly Adkins, Haajrah Gilani, Juliann Ventura and Grant Schwab of Northwestern University’s Medill Investigative Lab, and Ryann Grochowski Jones of ProPublica contributed data analysis.