ProPublica

by Brett Murphy and Alex Mierjeski

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

During his three decades on the Supreme Court, Clarence Thomas has enjoyed steady access to a lifestyle most Americans can only imagine. A cadre of industry titans and ultrawealthy executives have treated him to far-flung vacations aboard their yachts, ushered him into the premium suites at sporting events and sent their private jets to fetch him — including, on more than one occasion, an entire 737. It’s a stream of luxury that is both more extensive and from a wider circle than has been previously understood.

Like clockwork, Thomas’ leisure activities have been underwritten by benefactors who share the ideology that drives his jurisprudence. Their gifts include:

At least 38 destination vacations, including a previously unreported voyage on a yacht around the Bahamas; 26 private jet flights, plus an additional eight by helicopter; a dozen VIP passes to professional and college sporting events, typically perched in the skybox; two stays at luxury resorts in Florida and Jamaica; and one standing invitation to an uber-exclusive golf club overlooking the Atlantic coast.

This accounting of Thomas’ travel, revealed for the first time here from an array of previously unavailable information, is the fullest to date of the generosity that has regularly afforded Thomas a lifestyle far beyond what his income could provide. And it is almost certainly an undercount.

While some of the hospitality, such as stays in personal homes, may not have required disclosure, Thomas appears to have violated the law by failing to disclose flights, yacht cruises and expensive sports tickets, according to ethics experts.

Perhaps even more significant, the pattern exposes consistent violations of judicial norms, experts, including seven current and former federal judges appointed by both parties, told ProPublica. “In my career I don’t remember ever seeing this degree of largesse given to anybody,” said Jeremy Fogel, a former federal judge who served for years on the judicial committee that reviews judges’ financial disclosures. “I think it’s unprecedented.”

This year, ProPublica revealed Texas real estate billionaire Harlan Crow’s generosity toward Thomas, including vacations, private jet flights, gifts, the purchase of his mother’s house in Georgia and tuition payments. In an April statement, the justice defended his relationship with Crow. The Crows “are among our dearest friends,” Thomas said. “As friends do, we have joined them on a number of family trips.”

The New York Times recently surfaced VIP treatment from wealthy businessmen he met through the Horatio Alger Association, an exclusive nonprofit. Among them were David Sokol, a former top executive at Berkshire Hathaway, and H. Wayne Huizenga, a billionaire who turned Blockbuster and Waste Management into national goliaths. (The Times noted Thomas gives access to the Supreme Court building for Horatio Alger events; ProPublica confirmed that the access has cost $1,500 or more in donations per person.)

Records and interviews show Thomas had another benefactor, oil baron Paul “Tony” Novelly, whose gifts to the justice have not previously been reported. ProPublica’s totals in this article include trips from Crow.

Each of these men — Novelly, Huizenga, Sokol and Crow — appears to have first met Thomas after he ascended to the Supreme Court. With the exception of Crow, their names are nowhere in Thomas’ financial disclosures, where justices are required by law to publicly report most gifts.

From left to right, H. Wayne Huizenga, David Sokol and Paul “Tony” Novelly. These business magnates apparently came into Clarence Thomas’ life after he was appointed to one of the most sacrosanct positions of power in American government. (Joel Auerbach/Getty Images, Bloomberg/Getty Images and the Horatio Alger Association Website)

The total value of the undisclosed trips they’ve given Thomas since 1991, the year he was appointed to the Supreme Court, is difficult to measure. But it’s likely in the millions.

Huizenga sent his personal 737 to pick Thomas up and bring him to South Florida at least twice, according to John Wener, a former flight attendant and chef on board the plane. If he were picked up in D.C., the five-hour round trip would have cost at least $130,000 each time had Thomas chartered the jet himself, according to estimates from jet charter companies. In February 2016, Thomas flew on Crow’s private jet from Washington to New Haven, Connecticut, before heading back on the jet just three hours later. ProPublica previously reported the flight, but newly obtained U.S. Marshals Service records reveal its purpose: Thomas met with several Yale Law School deans for a tour of the room where they planned to display a portrait of the justice. (Crow’s foundation also gave the school $105,000, earmarked for the “Justice Thomas Portrait Fund,” tax filings show.)

Don Fox, the former general counsel of the U.S. Office of Government Ethics and the senior ethics official in the executive branch, said, “It’s just the height of hypocrisy to wear the robes and live the lifestyle of a billionaire.” Taxpayers, he added, have the right to expect that Supreme Court justices are not living on the dime of others.

Fox, who worked under both Democratic and Republican administrations, said he advised every new political appointee the same thing: Your wealthy friends are the ones you had before you were appointed. “You don’t get to acquire any new ones,” he told them.

Thomas and Novelly did not respond to a detailed list of questions for this story. Huizenga died in 2018 and his son, who is the president of the family’s holding company, also did not respond to multiple requests for comment.

In a statement to ProPublica, Sokol said he’s been close friends with the Thomases for 21 years and acknowledged traveling with and occasionally hosting them. He defended the justice as upright and ethical. “We have never once discussed any pending court matter,” Sokol said. “Our conversations have always revolved around helping young people, sports, and family matters.”

“As to the use of private aviation,” he added, “I believe that given security concerns all of the Supreme Court justices should either fly privately or on governmental aircraft.”

The justices have said they follow court rules prohibiting them from accepting gifts from a group of people so frequently that “a reasonable person would believe that the public office is being used for private gain.” But what actually constitutes a gift under those rules is ambiguous and, in practice, justices have few restrictions on what they can accept. Other members of the court have accepted travel underwritten by wealthy businessmen and speaking invitations at universities. Stephen Breyer accepted a flight to a Nantucket wedding from a Democratic megadonor. Ruth Bader Ginsburg took a tour of Israel and Jordan paid for by an Israeli billionaire. Those gifts are public because Breyer and Ginsburg disclosed them.

Thomas, however, is apparently an extreme outlier for the volume and frequency of all the undisclosed vacations he’s received. He once complained that he sacrificed wealth to sit on the court, though he depicted the choice as a matter of conscience. “The job is not worth doing for what they pay,” he told the bar association in Savannah, Georgia, in 2001, “but it is worth doing for the principle.”

To track Thomas’ relationships and travel, ProPublica examined flight data, emails from airport and university officials, security detail records, tax court filings, meeting minutes and a trove of photographs from personal albums, including cards that Thomas’ wife, Ginni, sent to friends. In addition, reporters interviewed more than 100 eyewitnesses and other sources: jet and helicopter pilots, flight attendants, airport workers, yacht crew members, security guards, photographers, waitresses, caterers, chefs, drivers, river rafting guides and C-suite executives.

ProPublica has not identified any legal cases that Huizenga, Sokol or Novelly had at the Supreme Court during their documented relationships with Thomas, although they all work in industries significantly impacted by the court’s decisions.

In a small-circulation biography given to Huizenga’s friends and family, Thomas acknowledged that he and Huizenga discussed some of the billionaire’s companies but said their relationship was never transactional. “It wasn’t that kind of friendship,” he told the interviewer. The justice said they’d prefer to go to a small restaurant in a strip mall or sit on the billionaire’s lawn and drink tea or diet soda.

“We are in a society where everything is quid pro quo,” Thomas said, but not with the Huizengas. “I don’t do anything for them and they can’t do anything for me.”

“Four Lucky Couples”

On Labor Day weekend 2019, Thomas boarded a private plane in Washington, D.C., for the first leg of a sojourn out West. The vacation had been months in the making and, thanks to Sokol, it was all taken care of. He’s hosted the Thomases virtually every summer for a decade.

The first stop was the Great Plains. It was the home opener at the University of Nebraska-Lincoln, which Ginni Thomas had attended before transferring. The Thomases were joined there by other couples, including one of the justice’s most vocal advocates, Mark Paoletta, who then worked for the federal government, and his wife.

Sokol, a major university donor who graduated from the Omaha campus, arranged for the group to attend the football and volleyball games with all-access passes. Clarence Thomas met with the football team the day before the game. The group walked out of the tunnel before kickoff. During halftime, they stood on the sidelines to watch the marching band perform, at one point posing for a picture in the end zone: “The Sokols took four lucky couples to the first Nebraska footbal game of the season,” Ginni Thomas wrote in one of the card captions.

Sokol, back left, has arranged for Thomas and others to attend several sporting events at the University of Nebraska-Lincoln. The invitations come with all-access passes and seats in a luxury suite. The justice’s wife, Ginni, has memorialized some of these trips in cards to friends. (Obtained by ProPublica)

Sokol runs a private equity firm and now also chairs a holding company that owns large international shipping and power utility corporations. He resigned from Berkshire Hathaway in 2011 amid an internal investigation by the company that found he had violated its insider trading policy. (At the time, Sokol denied wrongdoing and said his resignation was unrelated to the episode; he was never indicted.)

That Saturday, the group watched both the football and volleyball games from luxury suites. The football skybox, which typically costs $40,000 annually, belonged to Tom Osborne, a former Republican congressman who was also the head coach of the team for 25 years. Hosting the Thomases had ripple effects. A local priest requested a ticket for his 87-year-old mother, but the volleyball coach had to tell him none was available. “All of our tickets have been taken for Clarence Thomas and his group,” the coach wrote.

The Thomases have been treated to at least seven University of Nebraska-Lincoln games — five arranged by Sokol — in recent years. The Times first reported on Thomas’ appearances at some of them.

Thomas has never reported any of those tickets on his yearly financial forms. Judiciary disclosure rules require that most gifts worth more than $415 be disclosed. “It’s so obvious,” said Richard Painter, former chief White House ethics lawyer for President George W. Bush. “It all has to be reported.” ProPublica identified more than 60 federal judges who disclosed tickets to sporting events between 2003 and 2019. In 1999, Thomas disclosed private flight and accommodations for the Daytona 500 but hasn’t reported any other sporting events before or since.

In a statement, Osborne confirmed Thomas has “watched a couple of football games” in his suite, which the university had given to him. He said he is “taxed” for the use of the suite but did not answer whether Thomas has ever reimbursed him. The University of Nebraska-Lincoln did not respond to requests for comment.

On Labor Day weekend, 2019, the group sat in former football coach and ex-congressman Tom Osborne’s suite. Osborne told ProPublica he and the justice became friends years ago, when he was in office. (Obtained by ProPublica) The day before the football game, Thomas met with the team. Sokol arranged these visits in emails with the athletic department. (Twitter)

On Sunday, the morning after the football game in Nebraska, Sokol flew with Thomas by private jet to Sokol’s Paintbrush Ranch just outside Jackson Hole, Wyoming. The property, valued in the low eight figures, sits in the foothills of Shadow Mountain. A local radio personality said of the estate: “This is the ultimate home and it has the most iconic view of the Tetons I’ve seen. Ever.”

Sokol also owns a waterfront mansion in Fort Lauderdale, Florida, currently worth $20.1 million, where he’s hosted the Thomases as well, according to photos of the visits. The 12,800-square-foot property includes a home theater, elevator, walk-in wine cellar and yacht docking. (In addition, Sokol and Thomas have shared an opulent lodge together while vacationing at Crow’s private lakeside resort, Camp Topridge, in the Adirondacks.)

Sokol’s ranch outside Jackson Hole, Wyoming, which he sold in 2020, is a sprawling, 9,000-square foot estate in the foothills of Shadow Mountain, designed like a lodge. (Realtor Website. Personal information redacted by ProPublica.) The Thomases and others spent several days at the ranch in late summer 2019. (Realtor Website. Personal information redacted by ProPublica.)

In Wyoming, the Thomases fished, rafted on the Snake River and sat by a campfire overlooking the Teton Range with the other couples. At one point, the Paolettas serenaded the justice with a song they wrote about him.

Like Thomas, Paoletta did not disclose the trip on his yearly financial filings. At the time, Paoletta was general counsel and the designated ethics official at the Office of Management and Budget. In a statement, Paoletta said he wasn’t required to disclose the trip because he had reimbursed Sokol, but he did not say how much or provide documentation of those payments. “I complied with all ethics laws and regulations,” Paoletta said.

After the football game in Nebraska, Sokol flew the group, including the Thomases, to his opulent ranch overlooking the Teton Range. They rafted, fished and sat by a campfire. At one point, Mark Paoletta and his wife serenaded the justice. (Obtained by ProPublica)

Details of the vacation to Nebraska and Wyoming were drawn from photographs, trip planning emails and social media posts, as well as interviews with airport workers, local residents and others familiar with the travel, including river raft guides.

Since 1990, Sokol and his wife have donated more than $1 million to Republican politicians and groups, along with smaller amounts to Democrats. Last October, in New Orleans, Sokol made a direct reference to a pending Supreme Court case while addressing a group of former Horatio Alger scholarship recipients. (Thomas was not in attendance.)

The speech veered into territory that made many of those in attendance uncomfortable and left others appalled, emails and others messages show. Sokol, who has written extensively about American exceptionalism and the virtues of free enterprise, minimized slavery and systemic racism, some felt. He then criticized President Joe Biden’s student loan forgiveness plan, arguing Biden had overstepped the government’s authority, according to a recording of the speech obtained by ProPublica.

“It’s going to get overturned by the Supreme Court,” Sokol predicted, echoing a common legal commentary.

He was right. This summer, the court struck down Biden’s student loan forgiveness plan. Thomas voted in the majority.

Sokol has also hosted the Thomases and others at his mansion in Fort Lauderdale, Florida. The waterfront property, which comes with yacht docking, has a private movie theater, among other luxuries. (Obtained by ProPublica) Deep Sea Fishing in the Caribbean

Nearly every spring, Novelly, a billionaire who made his fortune storing and transporting petroleum, takes his two yachts on a fishing expedition to the Bahamas’ Exuma Islands. Photographs from the trips show porcelain beaches, cerulean waters and fresh mahi-mahi. Friends and family come and go for days at a time.

Three of Novelly’s former yacht workers, including a captain, told ProPublica they recall Thomas coming on board the vessels multiple times in recent years. Novelly’s local chauffeur in the Bahamas said his company once picked Thomas up from the billionaire’s private jet and drove him to the marina where one of the yachts, Le Montrachet, frequently docks.

Le Montrachet, named after the premium French wine, is a 126-foot luxury vessel complete with a full bar, multiple dining areas, a baby grand piano, accommodations for 10 guests and a handful of smaller fishing boats and jet skis. Novelly charges about $60,000 a week to outsiders who want to charter it.

Novelly often takes his luxury yacht, Le Montrachet, on fishing expeditions around the Bahamas’ Exuma Islands. The billionaire’s former yacht workers said Thomas was one of his guests. (CharterWorld Website)

Another past guest on Novelly’s yacht is “Alligator” Ron Bergeron, one of the biggest land and roadway developers in Florida. Around 2018, Novelly and Thomas went to Bergeron’s private ranch on the edge of the Everglades — a sprawling, gated estate with centuries-old cypress trees and an 1800s-style saloon on site. He described Novelly as a man who likes to share his success with others. “He’s very generous with all his friends,” Bergeron told ProPublica.

Bergeron said his conversations with Thomas at the ranch were strictly about charity work and not business. “You’re talking about a great man,” Bergeron said, “who gives his time to make a difference for America.”

Since 1999, Novelly’s family and companies have publicly disclosed at least $500,000 to conservative causes and Republican candidates in federal elections. (Before then, he had given to both parties.)

Novelly, who recently stepped down from his CEO roles, ran his business affairs aggressively, ending up on the wrong side of the government in at least two cases. He spends much of his time between St. Louis and Boca Raton, Florida, where he has a 23,000 square-foot palatial estate appraised at $22.2 million. In 2002, Novelly established residency and a holding company in the Virgin Islands. During a hearing with local officials, Novelly described the arrangement there as a “quid pro quo,” meaning the U.S. territory received a boost to the local economy in return for offering substantial tax breaks. The IRS would later call it an “abusive tax avoidance scheme” and pursued Novelly for millions in back taxes and penalties. Novelly denied the characterization and eventually settled with the government for a negotiated amount.

There’s no evidence his friendship with Thomas helped Novelly in one of his most significant disputes. In 2005, the Justice Department sued Novelly’s company, Apex Oil, because its corporate predecessor had contributed to a massive groundwater contamination beneath an Illinois village and then Apex refused to help with the cleanup. Apex argued the spill had occurred before the company went through a bankruptcy years earlier. Several judges ruled against Apex, which eventually appealed to the Supreme Court in 2010. The justices declined to hear the case, and the company had to pay about $150 million to help remove oil from the soil.

It’s not clear how Thomas voted in the case because such votes are not typically public. The vacations ProPublica identified appear to have occurred after the case was resolved.

In 2020, Apex Oil, Sokol and Crow helped fund a documentary defending Thomas as a response to an HBO film that was critical of the justice. Sokol called the HBO movie a “Molotov cocktail into our homes” and a prime example of America’s eroding civility.

The “Most Coveted” Invitation in the World

Thomas’ first billionaire benefactor is likely H. Wayne Huizenga, believed to be the only person in American history to build three separate Fortune 500 companies. One of the three was AutoNation, which Huizenga founded in 1996 before building it into the largest car dealer in the country. Between 1998 and 1999, Huizenga’s holding company spent $500,000 lobbying federal agencies that regulate the automotive industry, according to OpenSecrets data. Over the years, the Huizenga family and companies gave millions to state and federal Republican candidates and once threw a fundraiser for the Florida GOP that helped keep the party afloat for months.

The billionaire was known to regularly lavish gifts and perks on those in his orbit. He routinely took friends on opulent vacations. He paid his employees handsomely and sometimes covered their bills and personal expenses. On a whim, Huizenga once handed box tickets for the opera, which were worth thousands, to his caterer, Bob Leonardi.

“I led the life of a multimillionaire without being one,” Leonardi said.

Huizenga’s employees frequently saw Thomas around the billionaire’s mansion in Fort Lauderdale. Bob Leonardi, middle, was Huizenga’s caterer for years and said his boss liked to share his wealth with friends and employees. (Obtained by ProPublica)

For 20 years, Thomas benefited from Huizenga’s attention as well, availing himself of the billionaire’s fleet of aircraft and other luxuries. Huizenga took Thomas to see the Miami Dolphins and Florida Panthers several times between the mid-’90s and mid-2000s, according to interviews and photographs. Huizenga owned both teams at the time.

Executives saw Thomas around Huizenga’s office often. Richard Rochon, the former president of Huizenga Holdings, said Thomas once shadowed the billionaire during meetings. “He just wants to see what I do every day,” Rochon recalled Huizenga saying.

On at least two occasions, Thomas attended Huizenga’s birthday and Christmas parties, which the billionaire held inside his private hangar at the Fort Lauderdale airport. Van Poole, a lobbyist and former chairman of the Florida GOP, recalled riding down the elevator at the nearby Hyatt Pier 66 hotel — which Huizenga also controlled — when the Thomases stepped in with a security detail. The group discussed college sports and then traveled to the party together, Poole said.

Thomas occasionally flew on Huizenga’s helicopters, sometimes taking off from the roof of the corporate headquarters, and at least one of his Gulfstream jets around Florida, according to his former pilots. But the billionaire’s most luxurious planes were a pair of 737 jets he had retrofitted like a lounge, complete with recliners, love seats, mahogany dining and card tables and gourmet food.

At least two times in the mid 2000s, Huizenga sent one of them to pick up Thomas and deliver him to Fort Lauderdale, said John Wener, the flight attendant on board.

Huizenga owned a fleet of aircraft that he kept in a private hangar at the Fort Lauderdale airport. Two of the planes were 737 jets he had retrofitted to look like lounges. He sent those planes to pick up Thomas at least twice and deliver him to South Florida, according to a flight attendant on board. (Lynne Sladky/AP Photo)

Wener recalled chatting with the justice about his nomination to the Supreme Court and the tumultuous Senate confirmation hearings after Thomas’ former aide, Anita Hill, accused him of sexual harassment. “He said, ‘Just imagine a job interview and you’re in front of 100 people that hate you,’” Wener recalled Thomas remarking. “‘How would that interview go?’”

In the early 2000s, Huizenga gave Thomas something that was priceless at the time: a standing invitation to his exclusive, members-only golf club, the Floridian. Designed by golf legend Gary Player, the course was lined with cottages for Huizenga’s friends, a yacht marina for them to dock and a helipad if they wanted to fly in. One family friend told the Huizenga family biographer that the Floridian was “the most coveted private golf invitation in the world.” Those who worked and played there said the membership rolls were a Rolodex of the rich, famous and powerful: From Michael Douglas and Rush Limbaugh to Michael Bloomberg and former Vice President Dan Quayle. Donald Trump once asked to be a member but Huizenga spurned him, according to three of Huizenga’s former employees.

All 200-plus members were “honorary” and didn’t pay dues — Huizenga covered everything. “It was a little slice of heaven, a magical place,” former media personality Matt Lauer told the biographer. “You drove through the gates and it was this fairytale land that he had created.”

One of the crown jewels of Huizenga’s business empire was the Floridian golf and yacht club. When Huizenga owned the property, he gave honorary invitations to some 200 close friends without charging them an initiation fee or dues. Thomas was seen by several employees at the club over the years. (Floridian Website)

It’s unclear if Thomas was a member or Huizenga’s frequent guest with similar privileges. The billionaire’s former personal photographer and two former golf pros at the club recalled seeing Thomas there multiple times over the years. One of Huizenga’s helicopter pilots said he had picked the justice up from the property. And a fifth employee, a former waitress and concierge, said she once served Thomas and Huizenga, who were wearing golf attire, as they dined alone in the enormous waterfront clubhouse for lunch. “Have you met a Supreme Court justice?” Huizenga asked the waitress before she took their order. “This is Clarence Thomas.”

Today, the Floridian, which the Huizenga family sold in 2010 before it underwent renovations, has a $150,000 initiation fee.

Paying for Access to the Supreme Court Chambers

Thomas first met Huizenga at a formal gala in Washington, D.C., in 1992, when they were both inducted into the Horatio Alger Association. Henry Kissinger and Maya Angelou were among the other honorees that year. The organization, named after the 19th-century novelist who popularized rags-to-riches folklore, gives millions in college scholarships each year and also brings together some of the country’s wealthiest, self-made business tycoons for opulent events. (In real life, Alger was a minister on Cape Cod who resigned from his parish after he was credibly accused of molesting boys.)

“We were proud to honor Justice Thomas more than 30 years ago,” an association spokesperson said in a statement, “and remain grateful for his continued involvement in our organization.” She said Thomas spends countless hours mentoring scholarship recipients.

Thomas met Huizenga in 1992 at their induction ceremony in Washington, D.C. They became close friends for decades afterward and the billionaire, who died in 2018, regularly hosted Thomas in Florida. Thomas acknowledged the pair occasionally talked about business but said their relationship was never transactional. (Obtained by ProPublica)

Thomas appears to have met Huizenga, Sokol, Novelly and Bergeron through the organization. Several of Thomas’ trips to Florida in the 2000s appear to have been connected with the association. In that time period, he joined Huizenga at Horatio Alger scholarship ceremonies in South Florida, travel that the justice disclosed in several of his yearly financial filings.

However, he never identified Huizenga in any of his disclosures. The association spokesperson confirmed to ProPublica that the billionaire hosted those events “and covered all costs involved.”

Experts said that means Thomas’ disclosures would be, at a minimum, incomplete and misleading because the rules require federal judges to identify the source of the gifts they receive. “Source means the person or entity that paid for it,” said Kathleen Clark, a legal ethics authority at Washington University in St. Louis.

Belonging to the association has had its privileges. As part of a board meeting, the Thomases once went on a lavish trip to Jamaica, where they were hosted by a wealthy donor who owned a luxury hotel atop a former sugar plantation. Johnny Cash performed. Horatio Alger Association membership itself is worth at least $200,000, according to the organization’s meeting minutes in 2007, a sum that those who nominate a new member are responsible for raising in that person’s honor. The association spokesperson said there was no requirement to raise money for new members back when Thomas was inducted.

Thomas has likely helped the group earn many times that figure since then. Every year, the justice hosts an event for members inside the Supreme Court’s Great Hall. The Times previously reported that the event afforded the Horatio Alger Association unusual access to the court.

Membership into the Horatio Alger Association itself comes with a price tag. The association requires members to donate at least $200,000 on behalf of new inductees. A spokesperson said that when Thomas was inducted there wasn’t a donation requirement. (Obtained by ProPublica. Highlights by ProPublica)

ProPublica examined boxes of the association’s historical archives, including financial records that show the group has required donations of at least $1,500 — $7,500 for nonmembers — to attend the Supreme Court event. In 2004, those who donated $100,000 for a table at the main ceremony got 10 seats inside the Supreme Court. In the judiciary’s code of conduct — which is general guidance that does not apply to Supreme Court justices, though they say they consult it — there is explicit language advising federal judges against using their position to fundraise for outside organizations.

Financial records from the Horatio Alger Association archives show the group has been fundraising off of an event hosted by Thomas inside the Supreme Court building. (Obtained by ProPublica. Highlights by ProPublica.)

But that’s what Thomas has done, said Virginia Canter, a former government ethics lawyer who served in administrations of both parties and reviewed the association’s financial records at ProPublica’s request.

“To use the Supreme Court to fundraise for somebody’s charity is, to me, an abuse of office,” she said. Canter acknowledged the organization may do good work, but that’s besides the point, she said, because wealthy donors aren’t supposed to be able to pay thousands of dollars to visit a justice inside the courthouse walls.

“It’s pay to play,” Canter added, “isn’t it?”

Do you have any tips on the Supreme Court? Brett Murphy can be reached by email at brett.murphy@propublica.org and by Signal or WhatsApp at 508-523-5195. Justin Elliott can be reached by email at justin@propublica.org or by Signal or WhatsApp at 774-826-6240. Josh Kaplan can be reached by email at joshua.kaplan@propublica.org and by Signal or WhatsApp at 734-834-9383.

Josh Kaplan and Justin Elliott contributed reporting.

by Mary Hudetz

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

We had reached the top of a sandstone mesa when Theresa Pasqual set down her hiking pole and scanned the storied canyon before us.

We could see the centuries-old buildings of Chaco Canyon, a site in northwest New Mexico that her tribe’s ancestors, the Ancestral Puebloans, had occupied before eventually establishing other communities in the region. Pueblo Bonito, the canyon’s largest structure, sprawled from near the base of the bluff where we stood, its walls arcing around hundreds of hollowed rooms.

Two colleagues and I had traveled to the canyon with Pasqual as part of our reporting on how the nation’s most prestigious museums and universities had excavated Native American cultural sites like this and how they continued to keep what they took.

Pasqual, who is from the Pueblo of Acoma, roughly 100 miles to the south, has visited this remote canyon countless times, starting some four decades ago as a child on trips with her father. Now, she is the director of the Acoma Historic Preservation Office.

She describes Chaco Canyon as a place to which Acoma people make pilgrimages. It is a sacred site, and multiple tribes trace their ancestry to it. It is also incomplete, void of the thousands of items and hundreds of ancestral remains that museums took during excavations that began in the late 1800s, she said.

“It’s like a looted palace somewhere in some other country,” said Pasqual. “What we see in Chaco now is really only the shell of what was once here.”

Theresa Pasqual, director of Acoma Historic Preservation Office, says Pueblo Bonito will be incomplete as long as items and human remains that came from the site are held in the collections of museums and educational institutions. (Russel Albert Daniels for ProPublica)

I first met Pasqual several months earlier as my colleagues and I began investigating why many museums have been slow to return human remains, burial items and sacred objects to tribes.

I had struggled to decide whether to report on the topic. As an Apsáalooke, or member of the Crow Tribe in Montana, I know how sensitive discussions of museum holdings and matters of repatriation can be for a tribal community. Where I grew up, museums had collected ancestors and precious objects, sometimes through exploitative purchases and sometimes through outright grave robbing. Contemplating this history as an Indigenous person can feel disturbing and dehumanizing.

How could I write about this issue, I often asked myself. But how could I not, given that it has lingered far longer than Congress intended when it passed the Native American Graves Protection and Repatriation Act in 1990.

NAGPRA called for institutions to inventory their collections and publicly report the human remains and items that had come from Native American graves and then return them to Indigenous communities. But Pasqual notes that tribal communities have shouldered the burden of this work — both the financial cost and the emotional distress. Her tribe, like others, had to draw on existing ceremonies to establish a new process for reburials that did not exist before the looting.

“We as a community have to carry that burden,” she told me. “Part of the cost is that emotional toll, the cultural, spiritual cost that is carried by the community.”

Leigh Kuwanwisiwma, former director of the Hopi Cultural Preservation Office in Arizona, shared a similar sentiment when I interviewed him. During his 30-year career, he reburied more than 8,000 ancestors for the Hopi Tribe. The number of belongings he buried with the deceased surpassed 15,000. Now retired, he has a sense of fulfillment, knowing he helped his tribe. But he also has had to cope with trauma, even anger, from confronting how institutions and government agencies have mistreated ancestral remains, he said.

“It’s not well documented what people like me have to go through,” said Kuwanwisiwma, who speaks with a soft and measured voice. “But it’s now part of our current historical trauma.”

Even after ProPublica has published multiple stories on repatriation over the past eight months, it is still unsettling to ponder the sheer scale at which museums stored away the bodies of so many Indigenous ancestors. Six thousand at Harvard University. Nine thousand at the University of California, Berkeley. (Both institutions have pledged to prioritize repatriation.)

In total, museums across the country hold the remains of 104,539 Native Americans, according to the most recent figures we have reported from the National Park Service, which administers NAGPRA.

Historical accounts show that tribal leaders from California to Maine opposed the plundering by outsiders and many tried to block archaeologists from desecrating burials on their lands.

On my reservation, Chief Medicine Crow, one of my ancestors, was so troubled by the looting that he donated some of his land so tribal members could have a cemetery in Lodge Grass, Montana, said Timothy McCleary, an anthropology professor at Little Big Horn College. Until then, the final resting place for many had been in the open, unpopulated countryside of our tribe’s homelands.

I think a lot about how this issue has persisted from Medicine Crow’s lifetime to mine.

Chief Medicine Crow (Edward S. Curtis/Library of Congress)

In the Southwest, where I live now, there was such an intense interest in the ancient dwellings of Ancestral Puebloans that major museums competed with each other to be the first to seize sites.

Richard Wetherill, a rancher-turned-amateur-archaeologist from Colorado, helped steer the American Museum of Natural History to Chaco Canyon. From the canyon, the museum collected the remains of some 150 Native American ancestors during a methodical yet aggressive expedition around the turn of the 20th century that was funded by two heirs to a soap fortune.

The museum’s archaeologists directed the excavations while Wetherill served as their guide. He established a homestead in the canyon during the expedition and managed to keep it after Chaco Canyon became a national park.

Ever since, researchers have been fixated on Pueblo Bonito. Called a “great house,” it once stood four stories tall, according to the National Park Service, and has 40 kivas, ceremonial and social spaces with brick-lined walls.

Our reporting at ProPublica has focused, in part, on how museums have kept many ancestors by saying that, based on their records, they cannot determine which tribe these human remains belong to. Sometimes institutions make these decisions even when tribes have documented ancestral ties to the place that was excavated and have presented that information to the museum or made it publicly known.

The American Museum of Natural History holds the largest collection from Chaco Canyon that has been publicly reported under NAGPRA rules. In a statement, the museum said it recognizes Pueblo peoples’ ties to the canyon. However, the museum said there are gaps in the archaeological record after the Ancestral Puebloans migrated from the canyon eight centuries ago, which makes it difficult to affiliate human remains and items to specific tribes.

For Pasqual, Chaco Canyon, known in her tribal language as Wa’asrp’ashak’a, emerges often in the telling of her ancestors’ migration, she said. She had heard the term often enough in her youth that by the time her father first took her to the site around age 9, she already felt profoundly familiar with and connected to the place, she said.

Others from Zuni Pueblo in New Mexico and the Hopi Tribe in Arizona also shared with me how they see evidence of their cultural ties to Chaco Canyon all around them.

Pueblo Bonito contains dozens of kivas, or underground ceremonial spaces. (Russel Albert Daniels for ProPublica)

Clark Tenakhongva, a former vice president of the Hopi Tribe, understands his cultural link to Chaco Canyon through his tribe’s oral histories, he said. The Hopi believe they had great engineers, astronomers and doctors among their ancestors. At Chaco Canyon, where a southern wall of Pueblo Bonito aligns with the sunrise on the equinox, his tribe refined that knowledge and maintained it after migrating to the mesas in Arizona where many live now, he said.

“All the education and knowledge that we have — we have within our homes, within our kivas, within our plazas — came from here,” said Tenakhongva, who once helped lead efforts to protect cultural landscapes like Chaco Canyon and Bears Ears National Monument in Utah.

Edward Wemytewa, a councilman from the Pueblo of Zuni, simply calls Chaco Canyon a home.

“We’re descendants of Chaco. That’s very clear,” he said. “We are still a living culture. We still practice our ceremonies.”

This year, the Interior Department is considering changes to regulations under NAGPRA that would speed up the repatriation process. But even if change comes, repatriation will take time, likely years.

Yet even though much time has passed, repatriation work that’s just beginning now should not be rushed, Pasqual said. When museums work with tribes to return ancestral remains and items, tribal representatives meet with museum staff in person to discuss what was taken and stored for decades, and the tribes have seen the institutions become better as a result of these consultations, she said.

Pasqual descends a mesa along Chaco Canyon. (Russel Albert Daniels for ProPublica)

One expert we interviewed said that if the institutions continue repatriating at their current pace they would need another seven decades to consult with tribes and return what they have.

As we stood on the mesa, I asked Pasqual what she hoped would come of the repatriation work she and others have done. I was considering a similar question as our reporting team thought about the potential impact of our investigation.

“I would hope that for future generations, like my family’s grandchildren, that there will come a time when they will know that this place is complete,” Pasqual responded.

It was late afternoon as we descended onto a trail that threads between massive boulders and cliff ledges before reaching the canyon floor. Soon, we were walking down a wide dirt path past a cemetery named for Wetherill, the rancher. Wetherill is buried just off the trail; his grave lies undisturbed not far from the burial sites and rooms he helped excavate.

But Pasqual hardly acknowledged this point on the trail. Instead, we made a final stop near a sign on the north side of Pueblo Bonito that details the ways tribes remember their ancestors’ time at Chaco Canyon: “songs, stories, languages, ceremonies, pottery, art, corn, shells, architecture and sun-watching.”

She had read the sign countless times on her visits. People may have moved away, but they did not forget Chaco Canyon, it says.

She climbed into her truck and began her drive back to Acoma Pueblo.

Fajada Butte juts up from the plain near Chaco Canyon in New Mexico. (Russel Albert Daniels for ProPublica)

by Annie Waldman

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

Cheryl Lee Carr clutched her phone, willing it to ring. The last time she’d answered it, a hospital surgeon told her he didn’t know if he could save her mother’s leg, let alone her life. But he would try to stop the hemorrhaging from her major leg artery, punctured by a doctor at a nearby clinic.

Carr had spent that morning in February 2020 at the Lehigh Valley Vascular Institute in Bethlehem, Pennsylvania, waiting as her 82-year-old mother underwent what was supposed to be a simple procedure to clear plaque from her arteries. More than four hours in, Carr knew something was wrong. She pushed past the front desk to find her dazed mother in a recovery room, two clinic employees holding a bloody compress over a leg that had turned deep purple.

“Where’s the doctor?” Carr recalled yelling. “Call 911 right now!”

Now, as Carr braced for news about her mother’s fate, her thoughts turned to the clinic’s doctor who, she recalled, was nowhere to be seen as his patient bled. Carr pulled up a search engine and typed in his name: James McGuckin.

A deluge of results poured in.

What the hell? she seethed as she scrolled. Why is he still practicing?

For more than a decade, the Pennsylvania doctor and his national empire of vascular clinics had been scrutinized by agencies at every level — state medical boards, the Food and Drug Administration, the Department of Justice — for conducting experimental or unnecessary procedures on patients, putting their lives and limbs at risk.

He’d been disciplined by medical boards in over a dozen states, lost privileges in multiple hospitals and settled federal allegations of fraud, admitting that his company had performed procedures without any documented need. Pennsylvania had tried to shut his clinics down. Just a few months ago, federal attorneys announced a case against him, claiming he put “profits over the health and safety of his patients” when performing invasive artery procedures, regardless of symptoms or need.

And yet, after all of that, McGuckin is still seeing patients today, still adding to the nearly $50 million he has earned in the past decade in federal insurance reimbursements.

Dr. James McGuckin

Medical boards are supposed to ensure doctors are not endangering their patients. State health inspectors are supposed to make sure facilities are meeting minimum standards of care. And the federal government is supposed to make sure that doctors are not swindling the nation’s largest insurance program, Medicare, by exploiting vulnerable elderly patients.

But the ability of McGuckin to continue practicing, despite scrutiny from each of these regulators, highlights troubling gaps in the public safety net, ProPublica found. Those charged with identifying and stopping problem physicians are often slow-moving, blind to holes in their oversight and frequently unable — and at times unwilling — to stop doctors from practicing, even in cases of egregious harm or brazen fraud. Punishments are often nominal or easy to avoid, especially for well-resourced doctors like McGuckin.

One area that has become perilous for patients is vascular medicine. ProPublica recently uncovered a pattern of excessive and unnecessary vascular treatments in outpatient facilities. Medicare reimburses generously for these invasive treatments, which include using stents and balloons to widen arteries, and spiraling blades or lasers to clear plaque from blocked vessels, in a procedure called an atherectomy. Though they can be done safely outside of hospitals, they carry risks of complications that include clots, bleeding, limb loss and even death.

Over the past decade, federal investigators have accused more than a dozen physicians or companies in the vascular space of performing unnecessary procedures or making false claims. Some have continued to treat patients and profit from government insurance even after settling misconduct claims, only to be accused of committing similar behavior a few years — and millions of dollars — later.

At 61, with eyes that matched his bluish scrubs, McGuckin earned the trust of his patients, many of whom came to him for help with leg pain or circulation problems; several told ProPublica he appeared knowledgeable, caring and charming. One of the perks of going to see him was a limousine service that ferried them to and from appointments, they said.

Several of his patients faced complications after invasive vascular procedures — two lost their legs and several nearly lost their lives, according to interviews and medical and legal records. “The things that have happened to me have been a disaster,” Maria Rohena, 69, said in Spanish as she wept. Her leg was amputated five days after a procedure in McGuckin’s clinic in July 2021, according to medical records.

Maria Rohena’s grandson cares for her in a nursing home. Her leg had to be amputated five days after a 2021 procedure in McGuckin’s clinic, according to medical records. (Kriston Jae Bethel for ProPublica)

McGuckin’s attorney David Heim described him as a “very good, skilled surgeon who has helped thousands of patients,” many of them at higher risk. “Any effort to portray Dr. McGuckin as some ‘greedy’ or ‘bad’ doctor would be completely false and defamatory,” he said. Heim did not respond to ProPublica’s questions about specific patients, citing privacy. McGuckin’s attorneys said that he has never been found personally liable for fraud and that the government’s most recent allegations are “provably wrong.”

Carr could not anticipate, as she waited for the call that winter day, just how bleak it would get. “My mother would never have gone under the knife with that guy if I had known anything about him,” she said.

“A Question of Accountability”

From an early point in his career, McGuckin wanted to be calling the shots.

After completing his medical degree in 1987 from Philadelphia’s Hahnemann University School of Medicine, now Drexel University College of Medicine, he earned his board certification in radiology, eventually publishing articles in academic journals and participating in several professional societies, including the American Board of Radiology, the Society of Interventional Radiology and the Pennsylvania Medical Society.

While working in hospitals, he felt he was just “a small cog” in the system, he said in an interview. So, in 2002, a few years after completing his medical training in Philadelphia, he opened his first private practice office.

Before long, he would open a chain of facilities, Vascular Access Centers, that would reach a dozen states under his leadership, and thousands of patients.

“Here, the physician gets to be the pitcher or quarterback,” he said in the interview, of running an office. “We call the plays, set the schedule, drive the tempo. … There is never a question of accountability or the primacy of the customer.”

But there were soon questions of accountability and appropriate care.

Around 2010, McGuckin started offering a controversial procedure: an invasive, experimental treatment for multiple sclerosis, which involved deploying balloons and stents in veins across the body to improve blood flow. The treatment, which lacked substantial evidence that it improved patient symptoms, was rejected by the medical establishment, and the use of devices for the treatment was unapproved by the FDA. Only about 30 doctors performed it, often charging thousands of dollars to do so.

Angioplasty: A compact balloon is inserted into a blood vessel and inflated to flatten plaque against its walls.

Stent: A metal mesh tube is implanted into a narrowed blood vessel to hold open its walls.

Atherectomy: A catheter, often capped with a blade or laser, is inserted into a blood vessel and removes plaque off its walls.

(Illustrations by Now Medical Studios, special to ProPublica)

McGuckin became a leading evangelist for the treatment, conducting hundreds of the risky procedures on patients, including a South Carolina woman who, in May 2012, nearly died after a stent dislodged and traveled to her heart. The Milwaukee Journal Sentinel, which wrote about the case, reported that the patient sued McGuckin in 2015 and the case was confidentially resolved two years later.

In July 2012, FDA inspectors showed up at one of his facilities and cited him for multiple violations, which are spelled out in an April 2013 letter. They included enrolling patients in unapproved clinical research; failing to screen for abnormal kidney function, which could have subjected patients to renal failure; and not reporting serious adverse events.

Despite evidence that such treatments put patients in grave danger, none of the medical boards in the more than a dozen states in which he was licensed to practice took action for more than a year. Some boards took four years.

State medical boards serve as the first line of defense against unscrupulous physicians. Typically composed of doctors and laypeople working part time, boards regulate who can practice medicine and investigate complaints of poor care.

But they are not set up for aggressive or speedy detective work. Take the board in McGuckin’s home state of Pennsylvania, which oversaw more than 75,000 health care workers as of 2021; it had a budget of roughly $1.2 million to investigate misconduct that year, or about $290 per case opened.

For this reason, boards don’t typically seek out investigations; they wait for patients, staff or other doctors to formally complain. They are slow to act and notoriously lax with their sanctions, aware that bold actions may provoke a costly and time-consuming appeals process.

Washington was the first state to sanction McGuckin, in November 2015, after a lengthy investigation that began four years earlier. It charged him with “unprofessional conduct” for performing more than 200 procedures, fined him $17,500, made him return the money patients paid out of pocket and ordered him to stop the treatments.

It also required him to pass an ethics course by writing an essay, which evaluators found unacceptable, saying McGuckin didn’t “demonstrate a capacity to think ethically about why he is being held to account.” McGuckin filed a second draft, which was also unsatisfactory. He only passed the course with help from a one-on-one tutor.

The Washington Medical Quality Assurance Commission, which oversees doctors in the state, also made him sign a consent decree, admitting that the invasive procedures were inappropriate. Years later, during a lengthy bankruptcy lawsuit involving his chain, he would testify that he signed it because he felt he had to but didn’t feel he was guilty of the misconduct.

“It is clear to the Court that McGuckin is willing to sign documents, like the Consent Decree, even if he does not believe that his statements are true,” U.S. Bankruptcy Judge Ashely M. Chan, in Philadelphia, would say in 2020. “The Court finds that McGuckin is not truthful and cannot be relied upon for anything that he says.”

By 2017, 15 other state medical boards had followed Washington in citing McGuckin for the MS treatments. Most of the sanctions, however, constituted minimal fines, often less than what McGuckin could bill for a single two-hour vascular procedure.

Pennsylvania, for instance, charged him $10,000 in 2016. That year, he took in almost $4 million in federal reimbursements alone.

In a letter shared with ProPublica, McGuckin’s attorney George Bochetto said the doctor “was not disciplined because he performed a so-called ‘unproven and risky procedure,’ but rather was ensnared in a complicated administrative bureaucracy.”

While he lost hospital privileges across four facilities in Pennsylvania and New Jersey, no medical board limited his ability to practice.

“Bang ’Em All”

All the while, federal agents were investigating McGuckin for an entirely different set of allegations.

While states regulate medical facilities and doctors, the Department of Justice attempts to protect the nation’s largest insurance systems, like Medicare, from fraud. Its investigations are often instigated by whistleblowers, whose inside testimony is crucial to uncovering details of wrongdoing.

Dr. Michael Levine, a seasoned nephrologist with an expertise in hemodialysis vascular access, started working for McGuckin in 2009 at multiple New Jersey clinics that were part of Vascular Access Centers.

“At first, there was no red flag,” Levine told ProPublica. The clinics mostly treated patients with renal disease whose vessels occasionally needed treatment related to their dialysis lines. But Levine said he quickly learned that patients were being put into treatment loops where they were regularly booked for unneeded tests and procedures. “They were having the patients come back every three months, which to me is corruption,” he said.

While the procedures were relatively low risk, each time a doctor puts a foreign device in a patient’s body, it carries a chance of complication. Levine said he was therefore shocked when McGuckin pushed him to do more procedures without a clear clinical need.

McGuckin ordered each dialysis patient to be “squirted with dye,” Levine said in court records, implying that all patients should be subjected to an X-ray test to fish for blood clots or narrowed vessels to treat, regardless of whether their primary doctor ordered it.

McGuckin also allegedly told Levine to treat patients’ vessels with inflatable balloons and implant stents without a medical need. “Bang ’em all,” McGuckin allegedly told him, according to legal filings.

When Levine refused to go along with this practice, he said he was fired. Shortly after, in 2012, he filed a whistleblower lawsuit, which spurred a federal investigation.

“It’s not an issue of competency,” he told ProPublica. “It’s the issue of using his skills for his own self benefit and seeing his patients not as human beings, but as sources of income.”

David Stebbins, who was the administrator director of the centers from 2006 through 2018, said he also witnessed McGuckin’s drive to increase profits with unnecessary procedures. “McGuckin exerted pressure on all of the MDs working for him to increase procedural ‘acuity,’” he told ProPublica in an email. After more than a decade of working for McGuckin, when Stebbins questioned whether the clinics were possibly violating state regulations, he said he, too, was let go.

“McGuckin is an arrogant Charlatan who expects his senior staff to do whatever they’re told, or they may find themselves looking for work,” said Stebbins, who filed a separate whistleblower complaint in 2020, which is ongoing. “Under incredible pressure, they comply.” Attorneys for McGuckin did not respond to Stebbins' allegations.

Despite allegations that patients might be at risk of unnecessary, invasive procedures, it still took six years for the Justice Department to settle the claims initiated by Levine.

In October 2018, Vascular Access Centers signed a settlement with the federal government, agreeing to a $3.8 million fine. As part of the agreement, the company had to admit that it regularly scheduled, performed and billed for procedures without any evidence of need.

But as is the case with many federal settlements involving doctors, they are rarely held personally liable, or they can just pay steep fines to get out of trouble.

While McGuckin signed the company’s agreement with the federal government, as the company’s general partner and manager of each of its clinics, he was not held personally responsible for its misconduct. No physicians were specifically called out in the federal settlement; McGuckin’s attorney said the government chose not to pursue a case against him because there was no evidence implicating his physician services.

But McGuckin’s business partner claimed in the bankruptcy case that McGuckin had negotiated with the government and agreed to the terms of the burdensome settlement in exchange for securing his own personal release.

McGuckin’s signatures on a settlement (United States Court for the Eastern District of Pennsylvania)

At his clinics across Pennsylvania that were not affiliated with the embattled chain, McGuckin could still continue to treat patients unchecked.

Other doctors have gotten a similar deal.

Take Dr. Feng Qin, a vascular surgeon in New York.

In 2015, he settled allegations of fraud, admitting that he had routinely performed unnecessary procedures on end-stage renal disease patients. He paid a $150,000 fine but was able to continue practicing.

Even after the settlement, Qin performed unnecessary procedures, according to federal legal filings. “The monitoring by the feds, I know how to play Medicare’s asses now,” he told his billing assistant in 2015, according to a later whistleblower complaint.

Three years later, the Justice Department indicted and arrested Qin for fraud, after which he agreed to another settlement, paying $800,000. Lawyers for Qin, who left the country after the settlement, did not respond to ProPublica’s emailed questions.

Though Qin was temporarily excluded from federal health care programs, other doctors have continued to receive government payments even after multiple settlements.

Consider Dr. Mubashar Choudry, a cardiologist in Maryland. He was never found guilty of patient harm, but his medical practices have twice been scrutinized by the Justice Department for alleged misconduct.

In 2014, his medical group agreed to pay about $1.9 million to settle allegations that it was involved in an overbilling scheme. Then in 2020, Choudry and his practices settled allegations of kickbacks with the federal government, paying $750,000. In both cases, neither Choudry nor the companies were required to admit liability.

Kirk Ogrosky, Choudry’s attorney, said such arrangements are typical, and his client settled to “avoid the cost and uncertainty of litigation.” His attorney emphasized that Choudry’s settlement was not about the quality of patient care.

Choudry has not been limited from practicing or accessing federal payment programs. In 2021, the most recent year of public Medicare data, Choudry earned $1.5 million in federal reimbursements.

The settlement against McGuckin’s clinics also didn’t prevent him from continuing to bill Medicare.

Between 2019 and 2021, the most recent years of federal payment data available, McGuckin made more than $17 million.

Putting “Profits Over the Health and Safety of His Patients”

While medical boards oversee doctors, state health departments regulate medical facilities, which can include clinics like McGuckin’s. Their investigations, too, are largely driven by complaints and rarely result in major consequences.

So it was remarkable that, in 2019, Pennsylvania’s Health Department decided to take on McGuckin after officials read about his company’s federal settlement in The Philadelphia Inquirer.

At the time, he owned four clinics in the state that weren’t affiliated with the chain.

The department reviewed their license applications and found that the clinics had “failed to fully, completely, and accurately” disclose pertinent details about the federal scrutiny involving McGuckin and his other company. In January 2019, the department issued rare orders for four of his private clinics, revoking their licenses and cutting off their ability to operate.

McGuckin appealed the orders and his lawyer argued that a shutdown would expose his clinics’ patients to “irreparable harm” without their care. His lawyer also noted that the department had based the order on the assessment that McGuckin was “not a responsible person,” instead of relying on claims of patient harm or complaints. His lawyer also said that because McGuckin was not held personally liable in the settlement, he had been exonerated from its “salacious” allegations.

Garrison Gladfelter, who oversees surgical centers for the state, told McGuckin’s attorney in letters that, pending the appeal, McGuckin’s facilities could continue to operate on one condition: that he not personally perform procedures or provide training to the medical staff.

In response, McGuckin sued Gladfelter as well as the state’s health secretary, Dr. Rachel Levine, alleging that his clinics’ licenses were unlawfully revoked and their attempt to ban him from working at his own practices infringed on his “constitutional right to practice medicine.”

The lawsuit continued for eight months, and in October 2019, it was dismissed with an acknowledgment that the issues between McGuckin and the state had “been settled.”

The details of this settlement were kept secret. There’s no public evidence of why McGuckin’s facilities were allowed to continue to operate, with him performing procedures. The Health Department told ProPublica that, after the confidential settlement, it increased oversight at two of McGuckin’s facilities.

But against the tide of litigation, the Health Department largely backed off, and like the state medical boards and the Justice Department before it, it allowed McGuckin to continue to practice.

And so he did, for almost four years.

All the while, federal authorities had more information indicating his patients were at risk.

Two months after the federal settlement, in December 2018, yet another whistleblower filed a complaint: Dr. Aaron Shiloh, who was employed by McGuckin in his private practice in Pennsylvania. In a letter, McGuckin’s attorney Bochetto called him “disgruntled.” Shiloh’s attorney pushed back, requesting further details, but McGuckin’s attorneys did not respond to ProPublica’s request for more information.

His claims would lead attorneys from the Justice Department to conclude that from 2016 through 2019, McGuckin performed more than 500 medically unnecessary or insufficiently documented procedures, which allowed him to earn at least $6.5 million in Medicare reimbursement. They also found that McGuckin performed several invasive procedures on many patients, regardless of their symptoms, putting “profits over the health and safety of his patients.”

The procedures are intended for patients with peripheral artery disease, a condition that afflicts 6.5 million Americans over the age of 40. According to the federal government, McGuckin not only performed procedures on patients with only “moderate” leg pain, against the widely accepted standards of care, he also performed procedures on patients who were disabled and and unlikely candidates for such interventions.

He performed procedures for leg pain in a patient who was paralyzed on one side of her body and did not walk at all, according to the complaint. On another patient, the government said, he conducted “unnecessary below-the-knee procedures in the small portion of what remained of a patient’s already amputated leg.” One patient told the federal government, according to legal filings, that he felt like McGuckin “was just experimenting on him.”

Earl Toler of Long Pond, Pennsylvania, told ProPublica he also felt part of an experiment. He sought treatment at 74 after experiencing weakness in his leg when walking. Over about a year, Toler underwent 10 vascular procedures, according to later legal filings. His condition progressively worsened until his left leg grew swollen and mottled and one of his toes turned dark blue.

To save his life, in November 2018, doctors at a local hospital needed to amputate his leg above the knee. During a malpractice lawsuit against McGuckin and other doctors at his clinic, medical experts who testified on Toler’s behalf claimed the doctors had deviated from the accepted standards of care, particularly in not referring Toler to a vascular surgeon for more advanced treatment, which they alleged eventually led to his limb loss. In legal filings, McGuckin denied the allegations. The lawsuit went to trial last year, and the jury sided with McGuckin and his doctors, clearing them of any wrongdoing.

Despite the verdict, Toler, an excavation contractor by trade who can largely no longer work after his amputation, still holds them responsible for his condition. And when he read over the allegations of the current Justice Department lawsuit, he was floored. “It’s a pattern,” he said. “I knew I wasn’t the only one.”

Earl Toler had his leg amputated after several procedures in McGuckin’s clinic. (Michelle Gustafson for ProPublica)

Two and half years after Toler’s amputation, Rohena, a churchgoing grandmother from the Allentown area, blacked out and had a heart attack in McGuckin’s recovery room, according to medical records. The clinic called an ambulance to take her to the nearest hospital, where medical staff found a main artery had been nicked, causing extensive blood loss. Rohena was treated for five days before her leg was amputated.

A lawsuit has been initiated, according to her attorney Frank Mangiaracina. “Maria is stuck living in a nursing home, and she doesn’t have her leg or life anymore,” he said.

According to clinic medical records, Rohena had undergone four treatments with McGuckin in two months.

A ProPublica analysis of federal payment data from 2017 through 2021 found that McGuckin ranks among the 5% of doctors who perform the most atherectomy procedures like the one Carr’s mother, Toler and Rohena underwent before facing complications.

Recent research has shown that a substantial number of doctors who treat peripheral arterial disease are quickly resorting to device interventions in the earliest stages against best practices. Doctors have used scare tactics to convince patients to get these painful and risky procedures; McGuckin, for instance, allegedly told patients the interventions were necessary to “save their leg” or “stop the chop.” But patients in early stages of vascular disease have less than a 2% risk of amputation after five years, researchers have found. That risk could surge up to 5% or even 10% with aggressive interventions.

McGuckin’s attorneys argued the federal allegations are “baseless” and “irreparably tarnish” his reputation. “McGuckin did not violate any medical standards of care in treating his patients,” his attorneys wrote in legal filings. “The Government’s medical necessity claims amount to nothing more than a ‘scientific disagreement.’”

Justice Department investigations into whistleblower claims are kept secret until prosecutors are ready to file a lawsuit. They did so in May 2023. Despite McGuckin’s arguments that it should be dismissed, it is ongoing.

According to the Health Department, McGuckin has closed or relinquished ownership of his clinics across Pennsylvania in the past few years. When ProPublica called the Lehigh Valley Vascular Institute in July to inquire whether he was still practicing, the receptionist said he was taking appointments.

“Penniless and Paralyzed”

Cheryl Lee Carr (Michelle Gustafson for ProPublica)

A few weeks ago, Carr pored over the details of the new federal case. It brought her to tears.

Though that phone call back in 2020 brought good news — the hospital surgeon managed to save her mother’s life and leg — the aftershocks took a lasting toll.

While recovering at the hospital, her mother, Elaine Micelli, struggled to use her left arm, and one side of her face drooped. Carr suspected her mother had developed a neurological issue. “She asked me to go down the hall and get her a box of tissues from her closet — she thought she was at home,” she said.

An assessment at the hospital revealed she had suffered strokes, medical records show, likely due to the low blood pressure, which she had when she was admitted.

Before her visit to McGuckin, the 82-year-old still mowed her 2 1/2 acre lawn in the summer and cleared snow with her blower in the winter. She volunteered for the crime watch at the local fire department and, every week, called bingo numbers at the senior center.

Elaine Micelli, a former patient of McGuckin’s (Courtesy of Cheryl Lee Carr)

Now, she lives in a nursing home and requires 24-hour care. She no longer walks, requires assistance to eat and wears diapers. She cannot speak fluidly or remember key moments of her past. “He destroyed my mom’s life,” Carr said of McGuckin. “She’s penniless and paralyzed … just waiting to die.”

Shortly after her mother’s injury, Carr said she filed a formal complaint about McGuckin with both the state’s Medicare office and its medical board.

Three years on, she said, she has not received a response.

Do You Have Experience With Peripheral Artery Disease? Have You Had a Procedure on Your Leg? Tell Us About It.

by Alec MacGillis

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 is exempt from our Creative Commons license until Dec. 2, 2023.

One fall evening in 2020, Jarell Jackson and Shahjahan McCaskill were chatting in Jackson’s Hyundai Sonata, still on a post­-vacation high, when 24 bullets ripped through the car. The two men, both 26, had been close friends since preschool. They’d just returned to West Philadelphia after a few days hang gliding, zip lining and hiking in Puerto Rico. Jackson was parked outside his mom’s house when a black SUV pulled up and the people inside started shooting. Both he and McCaskill were pronounced dead at the hospital.

In the aftermath, McCaskill’s mother, Najila Zainab Ali McCaskill, couldn’t fathom why anyone would want to kill her son and his friend. Both had beaten the odds for young Black men in their neighborhood and graduated from college. Jackson had been a mental health technician in an adolescent psych ward while her son had run a small cleaning business and tended bar. She wondered if they’d been targeted by a disgruntled former employee of the cleaning business. But then the police explained: Her son and his friend had been killed because of a clash on social media among some teenagers they’d never even met.

Shahjahan McCaskill, left, and Jarell Jackson were close friends since preschool. (Courtesy of Monique Jackson)

For months, a battle had been raging on Instagram between crews based on either side of Market Street. Theirs was a long-running rivalry, but a barrage of online taunts and threats had raised tensions in the neighborhood. Police had assigned an officer to monitor the social media activity of various crews in the city, and the department suspected that the Northsiders in the SUV had mistaken one of the two friends for a rival Southsider and opened fire. An hour after the shooting, a Northsider posted a photo on Instagram with a caption that appeared to mock the victims and encourage the rival crew to collect their bodies: “AHH HAAAA Pussy Pick Em Up!!”

Jackson and McCaskill died in the first year of a nationwide resurgence in violence that has erased more than two decades of gains in public safety. In 2020, homicides spiked by 30% and fluctuated around that level for the next two years. There are early signs that the 2023 rate could show a decrease of more than 10% from last year, but that would still leave it well above pre-pandemic levels.

Najila Zainab Ali McCaskill in front of a portrait of her son Shahjahan (Hannah Price, special to ProPublica)

Criminologists point to a confluence of factors, including the social disruptions caused by COVID‑19, the rise in gun sales early in the pandemic and the uproar following the murder of George Floyd, which, in many cities, led to diminished police activity and further erosion of trust in the police. But in my reporting on the surge, I kept hearing about another accelerant: social media.

Violence prevention workers described feuds that started on Instagram, Snapchat and other platforms and erupted into real life with terrifying speed. “When I was young and I would get into an argument with somebody at school, the only people who knew about it were me and the people at school,” said James Timpson, a violence prevention worker in Baltimore. “Not right now. Five hundred people know about it before you even leave school. And then you got this big war going on.”

Never miss the most important reporting from ProPublica’s newsroom. Subscribe to the Big Story newsletter.

Smartphones and social platforms existed long before the homicide spike; they are obviously not its singular cause. But considering the recent past, it’s not hard to see why social media might be a newly potent driver of violence. When the pandemic led officials to close civic hubs such as schools, libraries and rec centers for more than a year, people — especially young people — ­were pushed even further into virtual space. Much has been said about the possible links between heavy social media use and mental health problems and suicide among teenagers. Now Timpson and other violence prevention workers are carrying that concern to the logical next step. If social media plays a role in the rising tendency of young people to harm themselves, could it also be playing a role when they harm others?

The current spike in violence isn’t a return to ’90s-era murder rates — ­it’s something else entirely. In many cities, the violence has been especially concentrated among the young. The nationwide homicide rate for 15- to 19-year-olds increased by an astonishing 91% from 2014 to 2021. Last year in Washington, D.C., 105 people under 18 were shot —nearly twice as many as in the previous year. In Philadelphia in the first nine months of 2022, the tally of youth shooting victims — 181 ­­­— equaled the tally for all of 2015 and 2016 combined. And in Baltimore, more than 60 children ages 13 to 18 were shot in the first half of this year. That’s double the totals for the first half of each year from 2015 to 2021 — and it has occurred while overall homicides in the city declined. Nationwide, this trend has been racially disproportionate to an extreme degree: In 2021, Black people ages 10 to 24 were almost 14 times more likely to be the victims of a homicide than young white people.

Those confronting this scourge — ­police, prosecutors, intervention workers — ­are adamant that social media instigation helps explain why today’s young people are making up a larger share of the victims. But they’re at a loss as to how to combat this phenomenon. They understand that this new wave of killing demands new solutions — ­but what are they?

To the extent that online incitement has drawn attention, it’s been focused on rap videos, particularly those featuring drill music, which started in Chicago in the early 2010s and is dominated by explicit baiting of “opps,” or rivals. These videos have been linked to numerous shootings. Often, though, conflict is sparked by more mundane online activity. Teens bait rivals in Instagram posts or are goaded by allies in private chats. On Instagram and Facebook, they livestream incursions into enemy territory and are met by challenges to “drop a pin” — ­to reveal their location or be deemed a coward. They brandish guns in Snapchat photos or YouTube and TikTok videos, which might provoke an opp to respond — ­and pressure the person with the gun to actually use it.

In December, I met 21-year-old Brandon Olivieri at the state prison in Houtzdale, Pennsylvania, where he is serving time for murder. In 2017, Olivieri said, he had a run-in with other teens in South Philadelphia after he tried to sell marijuana on their turf. Later, in a private Instagram chat for Olivieri and his friends, someone posted a picture of a silver .45-caliber pistol. Then another member, Nicholas Torelli, posted a picture of cat feces on the sidewalk, with the caption “Brandon took a shit on opp territory.” It was a joke, but the conversation quickly turned aggressive. Later that day, Olivieri asked Torelli to drop an image of their opponents into the chat, so everyone could see what they looked like. Torelli complied, and, according to court records, Olivieri replied that he would “pop all of them.”

When Olivieri, Torelli and two friends encountered four of their opponents later that month, there were heated words, a struggle and three gunshots from the silver pistol. One bullet struck Caleer Miller, a member of Olivieri’s group. Another hit Salvatore DiNubile, in the other crew. Both died; they were 16. Olivieri was convicted of first-degree murder in DiNubile’s death and third-degree murder in Miller’s. (Torelli testified against Olivieri and was not charged.) Olivieri was sentenced to 37 years to life.

DiNubile’s father, also named Salvatore, believes the ability to share threats online encouraged Olivieri and his friends to make them; having made them, they felt compelled to follow through. “You said you were gonna do this guy. Here’s your chance,” he told me. “You try to live up to this gangster mentality that he’s self-created.” Olivieri maintains his innocence and says that he wasn’t the one who fired the fatal shots, but he agreed that he and his friends often hyped one another up by making boasts online. “It’s what we call pump-faking,” he explained.

Last year, as the number of juvenile shooting victims in Washington, D.C., climbed toward triple digits, the city’s Peace Academy, which trains community members in violence prevention, held a Zoom session dedicated to social media. Ameen Beale of the D.C. Attorney General’s Office shared his screen to display a sequence typical of online flare-ups culminating in a fatality.

The presentation started with a photo, posted to In­stagram in 2019, showing the local rapper AhkDaClicka on the Metro; the caption mocked him for being caught there, without a gun, by adver­saries. Then came a screenshot of private messages between AhkDaClicka and a rival rapper named Walkdown Will that the latter posted derisively on Instagram Live. Next, an Instagram Story from AhkDaClicka insulting another rapper who had allegedly been present at the Metro run-in and a YouTube video of AhkDaClicka rapping about the incident, including the line, “Just give me a Glock and point me to the opps.” Soon afterward, in January 2020, AhkDaClicka was fatally shot. He was 18; his real name was Malick Cisse. That May, police arrested Walkdown Will — ­William Whitaker, also 18. He pleaded guilty to second-degree murder last October.

Beale’s presentation left some participants dumbfounded. “I cannot believe the level of immaturity and stupidity that’s become the norm,” one wrote in the chat. Another asked the question looming over the session: Had anyone in the city’s violence prevention realm asked the social media companies to limit inflammatory content?

“I don’t think we’ve made much progress,” Beale admitted. When the city had sought to have posts removed, he said, the companies had rebuffed its pleas with vague arguments about free speech. Even if social media platforms did remove a post, 20 people could already have shared it with hundreds or thousands more. And given the pace of online life, you might spend five years trying to block harmful content on one platform, only for all the activity to migrate to another.

I asked a spokesperson for Google, which owns YouTube, about the AhkDaClicka video with the line about the Glock, as well as another video posted last summer, titled “Pull Da Plug.”

It showed a Louisville, Kentucky, rapper and about a dozen other young men apparently celebrating a shooting that had left a man on life support (he later died). The head of the Louisville violence ­prevention agency had told me that the victim’s family asked Google to remove the video, but it stayed up, collecting more than 15,000 views. The spokesperson, Jack Malon, told me the company generally had a “pretty high threshold” for removing music videos, in part because company policy allows exceptions for artistic content.

My conversations with Malon and his counterparts at Snap and Meta (which owns Facebook and Instagram) left me with the impression that social media platforms have given relatively little thought to their role in fueling routine gun violence, compared with the higher-profile debate over censoring incendiary political speech. Meta pointed me to its “community standards,” which are full of gray-area statements such as “We also try to consider the language and context in order to distinguish casual statements from content that constitutes a credible threat to public or personal safety.” Snap argued that its platform was more benign than others, because posts are designed to disappear and are viewed primarily by one’s friends. I also reached out to TikTok, but the company didn’t respond.

Communities, meanwhile, have been left to fend for themselves. But violence ­prevention groups are dominated by middle-­aged men who grew up in the pre-­smartphone era; they’re more comfortable intervening in person than deciphering threats on TikTok. Before the pandemic, an intern at Pittsburgh’s main anti-­violence organization scanned social media posts by young people considered at risk of becoming involved in conflicts. The Rev. Cornell Jones, the city government’s liaison to violence prevention groups, told me that the intern had once detected a feud brewing online among teenagers, some of whom had acquired firearms. Jones brought in the participants and their mothers and defused the situation. Then the intern left town for law school and the organization reverted to the ad hoc methods that are more typical for such groups. “If you’re not monitoring social media, you’re wondering why 1,000 people are suddenly downtown fighting,” Jones said ruefully. In early July, a shooting at a block party in Baltimore validated his concern: Though the event had been discussed widely on social media, no police officers were on hand; later, a video circulated of a teenager showing off what appeared to be a gun at the party. The shooting left two dead and 28 others wounded.

A decade ago, Desmond Upton Patton, a professor of social policy, communications and psychiatry at the University of Pennsylvania, got the first of several grants to study what he called “internet banging.” His research team co-designed algorithms with a team at Columbia University to analyze language, images and even emoji on Twitter and identify users at risk of harming themselves or others. The algorithms showed promise in identifying escalating online disputes. But he never allowed their use, worried about their resemblance to police surveillance efforts that had enabled profiling more than prevention. “Perhaps there is a smarter person who can figure out how to do it ethically,” he said to me.

For now, the system is failing to anticipate violence — and even, quite often, to convict people whose social media feeds incriminate them. In May, three teens were tried for the murders of Jarell Jackson and Shahjahan McCaskill in Philadelphia. At the time of the shooting, two were 17 and the third was 16. Social media activity formed a key part of the prosecutors’ evidence: Instagram posts and video feeds showed the three defendants driving around in a black SUV seemingly identical to the one that had pulled up alongside Jackson’s car. Other posts showed two of them holding a gun that matched the description of one used in the shooting. After a day of deliberations, the jury acquitted them of murder, finding two of the defendants guilty only of weapons charges. The verdict left the victims’ families reeling. “For me and my family, [the trial] was like a seven-day funeral,” Monique Jackson, Jarell’s mother, told me. Afterward, the detective who had investigated the murders speculated to her that jurors on such cases often struggle to grasp the basic mechanics of social media and how essential it is to the interactions of young people. As Patton put it to me: “What we under­estimate time and time again is that social media isn’t virtual versus real life. This is life.”

First image: Monique Jackson. Second image: Jackson holding a photo of her son Jarell. (Hannah Yoon, special to ProPublica)

Update, Aug. 9, 2023: This article has been updated to clarify YouTube’s policy for removing music videos.

by Irena Hwang and Al Shaw

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

[For more technical details, view this story on our website.]

This year at ProPublica, we’ve paired computer modeling with traditional reporting to explore questions around viral outbreaks: What causes them and what can be done to prevent the next big one?

One of the most feared diseases is Ebola, which kills about half the people it infects and has shown that it can pop up in unexpected countries such as Guinea. The virus jumped from a wild animal to a human there in 2013, leading to an epidemic that ultimately left 11,000 dead around the globe.

Researchers studying how outbreaks begin have learned that deforestation can increase the chances for pathogens to leap from wildlife to humans. Jesús Olivero, a professor in the department of animal biology at the University of Malaga, Spain, found that seven Ebola outbreaks, including the one that started in Meliandou, Guinea, were significantly linked to forest loss. We found that, around five of those outbreak locations, forests had been cleared in a telltale pattern, increasing the chances that humans could share space with animals that might harbor the disease.

We wondered: Could we use what we learned about these locations to find places that had not yet experienced outbreaks but could be at risk for one? Were there places where Ebola could emerge that look a lot like Meliandou did in 2013?

With the help of epidemiologists and forest-loss experts, along with one of ProPublica’s data science advisers, Heather Lynch, professor of ecology and evolution at Stony Brook University, we developed a machine-learning model designed to detect locations that bore striking similarity to places that had experienced outbreaks.

The result? Out of a random sample of nearly 1,000 locations across 17 countries, ProPublica’s model identified 51 areas that, in 2021 (the most recent year that satellite image data on forest loss was available at the time of our analysis), looked a lot like places that had experienced outbreaks driven by forest changes.

These locations fell within forested zones in Africa that have wildlife believed to be carrying Ebola; that had recently experienced extensive forest fragmentation (that is, clearing of forests in many small, disconnected patches); and that have a population baseline that could sustain an outbreak if one emerged. To our surprise, 27 of the locations were in Nigeria, where an Ebola outbreak has never started.

After reviewing our findings, one of the researchers we consulted, Christina Faust, a research fellow at the University of Glasgow, Scotland, called the analysis a “best estimate of risk,” in light of the many outstanding questions about how Ebola arises.

“You’ve clearly identified ecological features that are consistent across the spillover locations,” Faust said. “And these ecological conditions and human conditions are cropping up in other places. And given that we don’t know so much about the reservoirs, I think this is our kind of best ability to do a risk analysis.”

Why Random Forests

This model was developed out of an earlier analysis we published in February. We used satellite imagery and epidemiological modeling to show that villages where five previous Ebola outbreaks occurred are at a greater risk of spillover happening today, including Meliandou, Guinea, the site of the worst Ebola outbreak in history.

In five locations where outbreaks had occurred, we found a distinctive pattern in how forests erode over time. At the highest level of fragmentation, the areas where humans and virus-carrying animals might interact, or “mixing zones,” are largest, and risk is at its peak. But after the forest becomes so eroded by human activity that it can’t sustain wildlife anymore, risk decreases.

That analysis focused on the research led by Olivero and an epidemiological model created by Faust and her colleagues that tracked how spillover risk changes as forests become increasingly fragmented. But there was also other intriguing research on the link between land use and Ebola spillover that caught our attention.

One paper, by a team led by Maria Rulli at the Politecnico di Milano, Italy, found a relationship between increased forest fragmentation over time and Ebola outbreaks. We came across a couple other papers that mapped out where Ebola is likely to exist in wild animals, including one by Olivero himself.

As part of the first project, we created a data set of ecological characteristics from satellite imagery. We were curious if some of the factors, like the number of forest patches or proportion of mixing zones around those patches, could shed additional light on how susceptible a location could be to disease spillover.

Months in, we asked ourselves, could we combine the 23 environmental and population characteristics and what we learned from work by Olivero, Faust and Rulli into a single model? Could such a model reveal new insights into the conditions related to forest change that make it possible for Ebola to jump from animals to humans?

On the advice of Lynch, our science adviser, we started by looking for any clear patterns or clusters among the characteristics.

But after squinting at lots of tiny scatter plots, nothing jumped out. This wasn’t entirely unexpected, because we had only seven outbreaks to compare. When the number of characteristics far outnumbers the events you’re interested in, it can be hard to tease out clear relationships. So Lynch suggested something straight from her own research playbook: decision trees and random forests.

Decision trees, Lynch explained, are machine learning algorithms that create chains of binary decisions to help distinguish groups from one another. We hoped they could help us find places that looked a lot like locations where Ebola outbreaks had occurred. These trees — not to be confused with the leafy trees in our forest data — are useful because they can sort and cluster data based on combinations of characteristics that might not be obvious when considering each individually, and flag potential matches.

Decision trees helped us figure out which population and forest characteristics best explain the differences between locations we’re interested in, and all others.

Here’s an example of one decision tree generated by our model.

Most importantly, they’re easy to understand. Unlike many machine learning models, it’s easy to pop the hood on a decision tree and examine the choices made at each step. But easy doesn’t mean unsophisticated. Many decision trees, each with random, slight differences, can be combined into something called a random forest, which aggregates the results of multiple decision trees. Random forests are a popular and versatile technique that has been used widely in academia and journalism.

Computers can generate many decision trees, each with slight differences. Together, they make up a random forest.

Any single location that is flagged by a majority of trees in a random forest is considered a location of interest.

We created a random forest made up of 1,000 trees. If a location was flagged by the random forest, then it was classified as similar to locations where Ebola outbreaks had been linked to forest loss, and reviewed by us.

Choosing Data

Our ultimate goal was a model that could figure out which characteristics were distinctive in places that had experienced Ebola outbreaks. So we created three buckets of data: outbreaks linked to forest loss, outbreaks that had other origins and random places where outbreaks never happened.

Collecting the first two buckets was easy: the seven Ebola outbreaks previously linked to forest loss by Olivero and his collaborators went into one. The rest of the outbreaks since 2000 (the earliest year for which forest loss data from Hansen/Global Forest Watch is available) went into the other.

For the third bucket, we had lots of options. We started with a database of villages and hamlets in 28 countries. Then, we found which of them overlapped with Olivero’s data that maps where conditions are favorable for wild animals to harbor Ebola. In all, we had 11 million locations to examine.

It was unfeasible to query all 11 million, so we collected a random sample of 50,000 and collected population statistics for each. We then determined which of the 50,000 locations were at least 100 kilometers, about 62 miles, away from the outbreaks already in our two buckets. Finally, we narrowed the sample to villages and hamlets where the human population was within the range of populations in our outbreak buckets, because they might interact with the forest in similar ways; for example, for firewood or hunting. The populations couldn’t be too small, either — spillover events require, by definition, human hosts to jump into.

Our last step was to filter for locations similar to those in our second bucket. In other words, these locations had characteristics that could sustain an Ebola outbreak, maybe even due to a spillover event, but for reasons unrelated to forest loss. We selected 21 of those random locations for our third bucket of data.

For all 35 locations, which we refer to as our training data, we calculated 23 different characteristics about forest change and population using a variety of data sources.

Seven locations used as training data were outbreaks tied to forest loss.

The other locations fell into two buckets: outbreaks not tied to forest loss, or locations where outbreaks were never recorded.

Training and Validating the Model

With training data in hand, we set about trying to get the model to find insightful patterns. It’s a real possibility, especially when the input data is limited, that machine learning models will find patterns where there actually are none. This is called overfitting; think of it as a computer interpreting polka dots as a connect-the-dots game.

To avoid overfitting, we trained multiple random forest models, each time withholding some of the data. This is a common strategy in ecology, where data can be scarce and it’s important to make sure that a model is not overly influenced by the idiosyncrasies of any one data point. In our case, Ebola is such a rare disease that excluding one of seven outbreaks in each training round allowed us to see if any of them were disproportionately affecting the models.

The results from each training round also gave us a better idea about which of the 23 characteristics were most important. Only four characteristics were ranked as important across all training rounds: the number of patches the forest is divided into, the forest area at two points in time and changes in forest fragmentation.

This set of characteristics was exciting, because it confirmed that key concepts from the work by Olivero, Faust and Rulli could be combined into a single model.

Before we ran with these results, though, we wanted to gut-check one last possibility: that whatever pattern our model had found was too general. Sure, maybe we’d built something that identified a handful of shared traits among seven outbreaks, but perhaps our approach would always find key characteristics among a small number of data points.

To test this hypothesis, Lynch proposed something called, intriguingly, a “garbage model.”

Think of an English-Spanish dictionary, except the word pairs are all shuffled — “cat” is linked with “perro,” instead of “gato.” Using the dictionary to translate an English sentence would result in a totally nonsensical Spanish sentence.

Shuffling our data, Lynch said, should result in similarly nonsensical classifications of the data withheld from training. If not, then our approach was likely too general. But if the garbage model generated garbage classifications for the withheld data, then we could have some reassurance that whatever patterns our actual model found were genuine.

We tried it and — out came basura, as expected. It was time to create the final model.

Testing the Model

Our final model only used the four most important characteristics of the nearly two dozen we’d started out with: how much patchier the forest had become in the two years leading up to an outbreak, how much bigger the mixing zones had gotten in that time, the amount of total forest in the year the outbreak happened and the amount of forest two years before that.

Finally, it was time to test the model by showing it completely new places and then asking which of them look like the set of outbreaks in the first bucket.

We took another random sample of approximately 1,000 places from the 50,000 previously sampled random set of settlements. Calculating fragmentation statistics in Google Earth Engine is time consuming — it took us about a week to process 1,000 locations. Collecting data for more locations would not have been feasible.

Out of nearly 1,000 test locations, we found that 51 were consistently flagged. About half of the locations were in southwest Nigeria. Sixteen were in the Democratic Republic of Congo, and the remaining handful were in Ghana, Burundi and Benin.

Given that a spillover-induced outbreak of Ebola has never been recorded in Nigeria, we were surprised by the results. But a literature review revealed other papers that warned of the potential for Ebola spillover events in Nigeria. These papers, plus the locations flagged in the Democratic Republic of Congo — the site of the most recent Ebola outbreak with confirmed links to a spillover event — gave us the confidence to hit pause on all the coding and modeling to do some reporting.

You can read about it in our story.

Caroline Chen contributed reporting.

by Caroline Chen, Al Shaw and Irena Hwang

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

We’re investigating the cause of viruses spilling over from animals to humans — and what can be done to stop it. Read more in the series.

The bright spots on the map struck us like a lightning bolt.

We had spent months teaching a computer about the Ebola virus –– feeding it information about the landscapes and populations in places where the disease had previously emerged, showing it how to analyze those outbreaks for patterns, and then instructing it to flag other areas that looked similarly perilous.

Some of the highlighted spots were predictable; the virus had repeatedly ravaged one of those countries.

But we didn’t expect our model to light up Nigeria, the most populous country in Africa. The West African nation and international travel hub has never seeded an Ebola outbreak, but just a year ago, it served as the springboard for another virus to travel into Europe and the Americas and spread across the globe. However that virus, mpox, originally known as monkeypox, is rarely fatal.

What if it had been Ebola, which kills about half of the people it infects?

We asked Nigerian public health officials whether they were concerned.

“Ebola is not part of our top concerns any more,” said Oyeladun Okunromade, the director of surveillance and epidemiology at the Nigeria Centre for Disease Control.

In the aftermath of the 2014 West African Ebola epidemic, the worst on record, Nigerian officials were on high alert. But last year, they took the virus off the list of the top infectious diseases the country needed to prepare for, downgrading Ebola in relation to threats like mpox, which Nigeria was actively fighting.

The disjoint between how our model sees Nigeria’s risk and how the nation’s health officials view it reveals a weakness in the way that governments and public health experts are preparing for future pandemics. The methods many countries use to rank threats focus mainly on factors that occur after an outbreak has already begun, such as the potential economic impact of an epidemic. Or they rely on past cases, looking at where a pathogen has previously struck.

Neither approach considers the root causes.

We’ve spent more than a year digging into the question of what causes outbreaks and what the world can do to prevent them. And we’ve learned that while science has advanced so we’re starting to understand the complex factors that trigger an outbreak, the world is not doing nearly enough to try to head off the next big one.

Most emerging infectious diseases come from wildlife. Those outbreaks require two essential elements: animals that carry a virus and opportunities for those animals to infect people.

Many of these fateful jumps, known as spillovers, have happened in forested, but populated, areas where trees have been cut down. Researchers have found that when people cut trees in patches, leaving the landscape dotted with holes like Swiss cheese, that creates more pockets and edges where humans and infected animals can collide. That world-shaking Ebola outbreak in 2014, for example, started in a Guinean village surrounded by a ring of forest.

Models that incorporate these environmental drivers could help countries look forward instead of backward as they determine how to allocate resources. Solomon Chieloka Okoli, an epidemiologist who works for Nigeria’s field epidemiology and laboratory training network, said his country, like many others, tends to react to outbreaks after they’ve started instead of trying to prevent them. That isn’t enough, Okoli said. “Being proactive is the best line of defense — if you wait, a lot of people will have died before you can get yourself together.”

Our model, created in consultation with scientists, was able to identify ecological factors that were common to past Ebola spillovers. The resulting risk map should be enough to prompt action, according to Christina Faust, a fellow at the University of Glasgow, Scotland, whose research focuses on how human activities like deforestation affect disease transmission.

Ebola often starts with a fever, so governments should invest in surveillance systems that help health authorities track patients with fevers, she said. “We should be watching these areas.”

Training Computers to Learn How Outbreaks Work

Models are not crystal balls; they can’t say exactly when or even whether a place will be hit with an outbreak. But they are great for understanding risk — where it is growing and where it may be shifting to.

“I love these as advocacy tools, because they’re meant for action,” said Dr. Maria Van Kerkhove, an infectious disease epidemiologist at the World Health Organization. “We just want these types of maps to inform and say: Make sure you’ve considered what might be circulating that you haven’t yet detected.”

We were curious to see where risky deforestation patterns are happening today. So we turned to a machine learning technique called “random forests” (no relation to actual tree-filled forests!) that can be used to spot patterns that might explain how some previous Ebola outbreaks happened. We limited our analysis to the geographic area where wildlife that can transmit Ebola is most likely to be found. This area covers 27 African countries from Guinea to Uganda.

We started with seven locations of past Ebola outbreaks that researchers have linked to forest loss. Then we selected 23 parameters, including demographic characteristics like the change in population from 2019 to 2021 (the most recent available data), as well as forest characteristics like the amount of tree loss and the patchiness of the surrounding forests.

We pulled data from satellite imagery and online population databases, fed it to the model and asked the computer to examine these factors across the seven known Ebola outbreaks. The model digested all this information and determined the relative importance of each parameter.

We also asked it to compare the outbreak sites to a set of places that were in the area where Ebola-carrying animals could live but had not seen an Ebola spillover.

Then we gave it a list of 1,000 candidate villages that had at least the same population size as previous Ebola spillover sites. (The 1,000 candidates were a random sample of all the villages that met our criteria; we weren’t able to run our model on the full set because of the amount of time and computing power that would have been required.) We asked the computer: Are there places that look very similar to past outbreak sites?

The model identified 51 locations with patterns of tree loss very similar to the seven previous Ebola outbreaks. The Democratic Republic of Congo had 16, which made sense; the country has recorded more than 10 Ebola outbreaks since the 1970s. The model highlighted additional spots in Ghana, Burundi and Benin.

More than half of the locations of concern, 27, were concentrated in Nigeria.

(Source: Hansen/UMD/Google/USGS/NASA, OpenStreetMap)

(If you — like us — are a nerd and want to read about our model in more detail, here is a comprehensive methodology.)

Why Nigeria’s Deforestation May Increase Its Risk

We were initially surprised to see the cluster of flagged locations in the southwest region of Nigeria, since the nation has never been the starting point for an Ebola outbreak. (The country has dealt with Ebola patients before, after an infected traveler flew to Lagos from Liberia during the West Africa outbreak in 2014.)

But we came to learn that Nigeria has experienced rapid deforestation over the past two decades. According to Global Forest Watch, the country has lost over 3,800 square miles of forest since 2001, and the rate of that loss has been accelerating. Nigeria has cleared the equivalent of nearly 170,000 football fields every year since 2017.

This is in part because energy prices have risen, making conventional fuel sources like kerosene unaffordable for many families, said NwaJesus Anthony Onyekuru, a professor of resource and environmental economics at the University of Nigeria. “They don’t want to use kerosene to cook, so they use wood,” he said.

Our model showed that this rapid forest clearing has happened in the dangerous, patchy pattern that researchers say leads to more interactions between humans and wildlife, and therefore increases the chances of spillover.

Scientists have found that bats can shed more virus when they’re stressed, such as by losing their habitats. That means that hunters may now encounter wildlife that is more likely to transmit a pathogen. Some Nigerians eat bats. Hunger has driven other residents to hunt for monkeys and rats in the forests, according to the epidemiologist Okoli. He said that consumption of large rats in the country’s southern region may have spurred the recent mpox outbreak.

Local deforestation has contributed to an increase in Lassa fever cases, said Dr. Charles Akataobi Michael, a senior technical officer at the Africa Centres for Disease Control and Prevention. Lassa fever can cause bleeding from the mouth, nose and gastrointestinal tract in severe cases, as well as neurological symptoms like hearing loss. The virus is carried by rodents, and people can be infected when food or household items are contaminated with the rodents’ urine or droppings.

The virus has been circulating in areas where people burn trees to create farmland, said Michael, destroying the rodents’ habitat. “They go to human habitats as a result of bush burning and deforestation to find food,” he said. “As we continue to alter the environment, the risk of disease outbreaks are increasing significantly.”

As the country’s population continues to grow rapidly, residents are chipping away at the forests to make room for farms. This land-use change is another way that risk may be increasing: Many outbreaks around the world have started when a virus jumped first from wildlife to a farm animal and then made another leap to humans. That includes deadly forms of bird flu and the brain-inflaming Nipah virus, which was immortalized in the movie “Contagion.”

Though we were initially surprised, we’ve since learned that Nigeria has appeared in other academic models as a potential Ebola hot spot. A 2019 analysis, published in the journal Nature Communications, identified Nigeria as a country at risk for an Ebola outbreak based on both current conditions and future climate and socioeconomic drivers.

In 2014, a different group of scientists used human and animal data to map locations most at risk of an Ebola outbreak. Among countries that had never reported an Ebola spillover before, Nigeria was at the top of their list. We know that Ebola isn’t constrained to country borders — after all, the worst Ebola outbreak to date started in Guinea, where the virus hadn’t previously been thought to be a threat. And this year, Marburg, Ebola’s cousin, has spread in two countries that had never before recorded an outbreak.

David Pigott, who led the 2014 analysis, said looking at prior cases isn’t the best way to evaluate risk: “The conversation of preparedness should not just be a function of what happened in the past.”

But that, we learned, is exactly what Nigeria is doing.

The Gap Between Knowledge and Action

The Nigerian experts we interviewed all acknowledged the importance of environmental factors in increasing outbreak risk. But many said that not much has been done to try and mitigate dangerous deforestation.

Okunromade, from the Nigeria CDC, helped create its One Health Strategic Plan — a national action plan based on the “one health” principle that the well-being of the environment, animals and humans are deeply interconnected. She said the government has brought together experts on human and animal diseases so that they can share information about pathogens such as mpox, Lassa fever and bird flu.

Yet when we asked what the country was doing to address environmental risks, she wasn’t aware of any initiatives, though she said it may be possible that other agencies were telling the public about the dangers of deforestation.

Okunromade said that experts used a tool developed by the U.S. Centers for Disease Control and Prevention to assess the risks of dozens of diseases that come from animals. The process has local experts select five criteria, commonly including epidemic potential or a country’s diagnostic capacity, and answer questions about different diseases for each criteria. Based on the answers, the diseases get scored as having a higher or lower priority.

When Nigerian officials ran this exercise in 2017, the devastating Ebola epidemic was fresh in their memories, and Ebola made the top five. “Looking at West Africa, at the countries surrounding us, looking at Sierra Leone, looking at Liberia, they were the worst hit. So that was why it made the list,” she said.

Ebola is a disease that would typically rank highly using the U.S. CDC’s tool because it gives more points to pathogens with a higher fatality rate. In 2022, Nigerian officials re-did the ranking exercise and initially, Ebola was still in the top five, but the officials felt it was more important to look at recent cases. Since there hasn’t been an Ebola outbreak in neighboring countries in recent years, the disease fell off their priority list, according to Michael, from the Africa CDC, who participated in the ranking process.

The CDC’s tool, which has been used by more than two dozen countries, does not require consideration of environmental causes like deforestation when ranking threats. Dr. Casey Barton Behravesh, the director of the U.S. CDC’s One Health Office, said that the process does not mandate which criteria should be considered and “it’s up to the country or region to decide on the criteria of greatest importance to them.” In examples she provided, two workshops, conducted in Alaska and the Economic Community of West African States, included a question about whether climate change would impact a disease. Some other countries considered the environmental impact of a potential outbreak, but they did not look at environmental factors that could increase the chance of a spillover. None of the examples included a question about deforestation.

There’s hope that new tools will evolve. The WHO is currently working with Pigott, who is an assistant professor of health metric sciences at the University of Washington, and other academics to develop risk maps for 16 different pathogens. Their model will incorporate data on environmental drivers of outbreaks. They aim to publish their work in a journal in future months, according to Pigott.

Pigott acknowledged that it can be hard for governments to prioritize a rare event like an Ebola outbreak. Still, he said, preparing for a disease like Ebola can be incorporated into plans for other pathogens. A malaria test may be the most logical place to start in a patient with a fever; if that is negative, health workers should be ready to test for Ebola, he said. But that only works if they are aware of the potential threat.

Ultimately, putting a disease on a priority list is only the first step. True prevention will need to address people’s lives, said Okoli, the Nigerian field epidemiologist: “If you say, ‘Don’t cut the bush to make charcoal,’ then you need to provide gas. If people are saying, ‘When I’m hungry, I get wild game,’ then you need to make it easier to get meat from the shops. You need to provide an alternative.”

Preventing the next outbreak from starting, Okoli said, should not be that hard. “It’s just about the political will and the willingness of the government to do something.”

by Megan O’Matz and Mariam Elba

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.

Margaret Rose Bostelmann’s ideals are clear from one glance at her well-kept ranch-style house in central Wisconsin.

A large American flag is mounted near the front door, and a “We Back the Badge” sign on her front lawn announces her support for law enforcement. Bostelmann, a Wisconsin elections commissioner, said she voted for Donald Trump in 2020 and added: “I will always vote Republican. I always have.”

But her fellow Republicans have exiled her and disparaged her, sought to upend her career and, on this day in July, brought the 70-year-old to tears as she discussed what she’s been through over the last several years because she refuses to support false claims that Trump won the state in the 2020 presidential election.

Bostelmann, who goes by Marge, previously served for more than two decades as the county clerk in Green Lake County, overseeing elections without controversy. But two years into her term in a Republican slot on the Wisconsin Elections Commission she became a target, denounced and disowned by the Republican Party of Green Lake County, which claimed she had failed to protect election integrity in the state.

Now a suit filed in June by a Wisconsin man who promotes conspiracy theories about election fraud seeks her removal from the commission. Citing her estrangement from the county party, the suit claims she’s not qualified to fill a position intended for a Republican.

The elections commission, which has an equal number of Republican and Democratic members, has faced an onslaught of discredited claims about election fraud in Wisconsin. The most recent drama involves the commission’s nonpartisan administrator, Meagan Wolfe, whose term is expiring and whose future in the role is in doubt. After the three Republican members of the commission supported Wolfe in a June vote, Republicans in the state legislature made it clear they wanted to find a way to get rid of her.

The Republican clashes in Wisconsin exemplify ongoing discord seen across the country, with elections officials shunned, berated and even driven away by members of their own party over their defense of the integrity of the 2020 election.

In Hood County, Texas — a solid red block in a red state — hard-line Republicans successfully pushed for the resignation of the elections administrator, even though Trump won 81% of the vote in the county. In Surry County, North Carolina, where Trump also won overwhelmingly, the Republican elections administrator was threatened with firing or a pay cut for refusing to give a GOP party leader access to voting equipment to conduct a forensic audit. And in Clare County, Michigan, officials are considering possible charges against a GOP activist accused of kicking the party chair in the groin.

The Wisconsin Elections Commission has been sued by numerous parties, verbally attacked by voters and earmarked for elimination by GOP lawmakers. It has survived only because a Democrat still occupies the governor’s office and wields veto power.

In an April survey of local election officials nationwide, the Brennan Center for Justice, an independent, nonpartisan law and policy organization, found that nearly one in three reported being abused, harassed, or threatened because of their job.

In a rare interview, Bostelmann wept at one point. For the most part, though, she was defiant, insisting the 2020 election was not stolen by Joe Biden.

“I’m a Republican who stands up for the truth and not for a lie,” Bostelmann said. And she predicted the latest legal gambit, which seeks her removal, would fail.

Don Millis, the Republican who chairs the Wisconsin Elections Commission, also has expressed frustration with the election conspiracy theorists. At the commission’s June meeting, he said he considered some of the agitators to be “grifters” who are conning people of goodwill into thinking there is something wrong with the election system.

“It’s not about winning or preventing fraud,” he said of the conspiracy theorists’ motives. “It’s about getting publicity or attention. It’s about grifting, convincing others to donate to their cause.”

In a recent interview with ProPublica, Millis said he was referring to a small set of people he believes are trying to raise money by spreading lies through social media or newsletters. “There are many people who believe them, who don’t know any better,” he said.

From Fraudster to Fraud Investigator

The man who brought the suit against Bostelmann is Peter Bernegger, grandson of the founders of Hillshire Farm, the Wisconsin deli meat and sausage company. Now 60, Bernegger has described himself as a “data analyst” and an “independent journalist.”

He has engaged in relentless — and so far futile — legal efforts to prove fraud in the 2020 election. This mirrors a different kind of legal fight from earlier in his life: trying to overturn his own fraud conviction.

A 2008 indictment accused Bernegger and a business partner in Mississippi of deceiving investors, bilking them of $790,000 in various ventures — including the development of a gelatin, intended for pharmaceutical or cosmetic companies, made from the carcasses of catfish. A federal jury acquitted the partner, who has since died, but convicted Bernegger of mail and bank fraud. He was sentenced to 70 months in prison and ordered to pay nearly $2.2 million in restitution.

Bernegger overwhelmed the courts with claims to clear his name, alleging procedural errors, insufficient evidence, judicial bias, ineffective counsel, violations of his constitutional rights and other misconduct.

“Mr. Bernegger, you file an awful lot,” said U.S. District Court Judge William Griesbach of Wisconsin. “Just let me say that. You file so many things. And in all honesty, I don’t have time to keep up on it all.”

Though most of his claims failed, Bernegger did succeed on one front: He got his restitution reduced to roughly $1.7 million. Ordered in 2019 to get a steady job to make payments on the debt, Bernegger testified that he had limited options.

He said his health was too poor for him to be able to lift heavy objects, drive a truck or operate heavy equipment. “I work odd jobs, a wide variety of them. And it is cash, but it's legal,” he explained.

When ProPublica reached Bernegger by phone for this story, he immediately hung up. He did not respond to letters and emails seeking comment.

Much of his energy, it appears, is now devoted to stoking doubt about election integrity. In his social media posts and podcast appearances, he has railed against Wolfe, the Wisconsin elections commission administrator, while repeating sweeping, unsubstantiated claims about problems in voting systems across the country. Along the way, he has made alliances with like-minded individuals beyond his home state.

Bernegger has ties to Omega4America, a website promoting a super-fast computing method to identify fraud by matching voter data with property tax records and other large databases. The site solicits donations to a nonprofit called Election Watch Inc.; Bernegger founded a tax-exempt organization with that same name in 2022.

The Texas Tribune has reported that the Omega4America project was initially funded by MyPillow CEO Mike Lindell, a conspiracy theorist close to Trump. Omega4America makes glowing claims about programming marketed by Texan Jay Valentine as a powerful tool that could replace the Electronic Registration Information Center, or ERIC, a multistate consortium that ferrets out duplicate voter registrations across states. ERIC has been the subject of heavy criticism from conservatives who believe its work identifying unregistered voters for states bolsters the rolls for Democrats.

In a podcast, Bernegger mentioned that he has access to the “Valentine fractal programming system” as he seeks to uncover voter fraud. Valentine, who is listed on the Omega4America website as the site contact, declined to discuss his work or Bernegger, telling a ProPublica reporter: “I have nothing to say to you.”

In an April episode of a podcast called The AlphaWarrior Show, Bernegger said he’s now part of a team of 10 scouring federal campaign data for oddities. He named James O’Keefe as a member of that team. O’Keefeis the former head of Project Veritas, a conservative group known for secretly recording liberal organizations, and has a new media company that encourages “citizen journalists” to investigate election fraud. ProPublica’s attempts to reach O’Keefe for comment were unsuccessful.

Toward the end of the AlphaWarrior podcast, the host urged viewers to “smash” the blue donate button on an Election Watch website to show support for Bernegger and his team.

“It means we sacrifice a movie or a fancy dinner and we throw a couple dollars their way,” he said.

Peter Bernegger, right, on The AlphaWarrior Show (via Rumble) “I Don’t Know That I’d Be Welcome”

Marge Bostelmann still doesn’t fully understand how it got to this point, how she became such a target of Bernegger and others, including people she once thought held similar values.

But she does know that things in Green Lake began to change in 2020, during Trump’s reelection bid. Bostelmann said she stopped paying membership dues to the county party after the party chair became critical of her and of the way the 2020 election had been run in Green Lake County by her successor.

By November 2021, as conservatives carried out investigations into voting accommodations made in Wisconsin during the pandemic — including the use of drop boxes and allowing unsupervised absentee voting in nursing homes — Bostelmann and others on the elections commission came under attack for their votes shaping those procedures.

Kent McKelvey, the Green Lake County GOP chair at the time, issued a press release saying Bostelmann’s actions on the Wisconsin Elections Commission “do not reflect the principles, values and beliefs of the Green Lake County Republicans, in this case, supporting the proper enforcement of the law and of election integrity.”

The press release said flat-out that “Ms. Bostelmann is no longer a member of the Republican Party of Green Lake County.” McKelvey did not respond to requests for comment.

The snub hurt. Bostelmann, a former foster parent who knows many local Republicans through her activities with her church and the Rotary Club, said she stopped attending many local GOP events. “I don’t know that I’d be welcome,” she said.

Even as efforts to prove fraud in Wisconsin fizzled, the pressure on the commission remained intense. Powerful Republicans in the state Senate called for Wolfe’s ouster, blaming her for what they saw as regulatory overreach by the commission, though in her role she carries out the orders of the six voting members.

Prior to the commission’s key June vote on Wolfe, Bostelmann said, she received a disturbing phone call from an acquaintance who had been critical of Wolfe. “The patriots would not be happy” with her, she was told, if she backed Wolfe. Bostelmann took that as a threat.

Still, she and the panel’s two other Republicans voted to reappoint Wolfe. Bostelmann defended Wolfe publicly at the June meeting, saying the administrator had been unfairly targeted “as the scapegoat” by people dissatisfied with the commission and the outcome of the 2020 election.

In a tactical move, Democrats abstained from voting, leading to a final tally of three yes votes. That appeared to mean that the panel did not have the requisite four votes to send the matter to the state Senate for final consideration, and it was widely thought Wolfe would continue in her post because of the impasse.

But the Senate, surprisingly, decided the three affirmative votes were enough for it to take up her nomination. Wolfe’s reappointment is now pending before the Senate elections committee. No public hearing or vote has been scheduled.

Lawsuits are expected, though for now she remains on the job.

“Some judge will tell us who our administrator is. That’s my guess,” said the commission chair, Millis, a tax attorney who favored retaining Wolfe.

Like Bostelmann, Millis has been the target of Bernegger, who on Twitter has ranted about Millis ignoring election system problems, referring to him as “Blind Don.”

Robert Spindell, the third Republican member of the commission, said he hasn’t been chastised for his renomination of Wolfe. He said he thought it best that the Senate take up the matter. “I haven’t had anybody call or criticize me,” he said, noting: “Most of the people I know on this election stuff are not shy.”

Through a spokesperson, Wolfe declined a request for an interview.

Bernegger’s suit against Bostelmann demands that the circuit court remove her from her seat on the commission, citing the disavowal from Green Lake County Republican Party. “She cannot prove she is a member of the Green Lake County Republican Party and is otherwise qualified to hold the designated Republican seat,” he wrote.

The statute that governs commission appointees does not specifically require them to be dues-paying party members.

Records show Bernegger has bombarded the Wisconsin Elections Commission with official complaints and demands for data, often accompanied by threats of legal action and accusations of criminal conduct. In one email he referred to a commission staffer as a “prick.”

“Please note that I am becoming increasingly uncomfortable with this individual’s erratic behavior that is directed at myself, our staff and local election officials,” Wolfe wrote to the commission in October 2022. In May of this year, Wolfe told the commission Bernegger made her feel “incredibly unsafe” when he noted her home address in bold in an email to the commission and called her a “pathological liar.”

The commission fined Bernegger $2,403 in March 2022 for filing frivolous complaints. Records show commission staff have, at times, forwarded his correspondence to the Wisconsin Department of Justice.

On July 7, the Wisconsin Department of Justice’s Criminal Investigation Division served Bernegger with a letter at his home in New London, stating that his actions could reasonably have made Wolfe and others at the commission feel “harassed, tormented or intimidated.” It warned that he could be arrested for stalking if he continued his behavior.

Excerpt of a Wisconsin Department of Justice’s Criminal Investigation Division letter served to Peter Bernegger on July 7 (Obtained by ProPublica)

One of Bernegger’s lawsuits over records against the commission is still ongoing.

He has also sued officials in Dane, Door, Grant, Marathon, Milwaukee and Ozaukee counties, the town of Hudson, the city of Hudson, the city of Milwaukee and the town of Richmond in Walworth County. The suits are related to broad public record requests he made for absentee ballot applications, images of ballots, router logs and other materials and involve disputes over costs and access. While many of those have been dismissed, four are still pending.

“We’re all trying to do our jobs to the very best of our abilities. It makes it difficult when we are constantly being undermined and questioned,” said Marathon County Clerk Kim Trueblood. Her office provided Bernegger with some information when he inquired but denied him certain documentation that Trueblood said was exempt from release. He sued, but a judge dismissed the case.

Another clerk, Vickie Shaw of the town of Hudson, said she had to go to court three times to deal with a Bernegger suit over records. A judge threw out the case, Bernegger appealed, and it was tossed again.

Before Bernegger’s suit, Shaw had quit in 2021, finding the job too burdensome and confrontational. But she returned the following year because, she said, the town “didn't have anybody to run the April election.”

Bostelmann expressed dismay with Bernegger’s tactics against her and the other election clerks.

“It’s bullying is what it is. It’s truly bullying,” she said. “It’s almost like they are trying to get people who are knowledgeable, and do a good job, to quit to have people who don't know how to do the job to come in.”

by Logan Jaffe

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

Illinois Gov. J.B. Pritzker signed into law Friday sweeping reforms that for the first time will give tribal nations — not state agencies, universities or museums — final say over how and when the remains of their ancestors and sacred items are returned to them.

“With the Governor signing these bills into law, Illinois is proving that a government is capable of reflecting on its past injustices and planning for a future that respects and celebrates our interconnectedness,” Prairie Band Potawatomi Nation Chairperson Joseph “Zeke” Rupnick said.

The newly signed Human Remains Protection Act was shaped by tribal nations over more than two years of consultations with the Illinois State Museum and the state Department of Natural Resources. The legislation unanimously passed the state House and Senate this spring and follows publication of ProPublica’s “The Repatriation Project,” an ongoing investigation into the delayed return of Native American ancestral remains by universities, museums and government agencies.

“Here in Illinois we believe in justice, and we won’t hide from the truth,” Pritzker said. “It’s up to us to right the wrongs of the past and to chart a new course.”

The law makes it the state’s responsibility to help return ancestral remains, funerary objects and other important cultural items to tribal nations, and it compels the state to follow the lead of tribal nations throughout the repatriation process. It also establishes a state Repatriation and Reinterment Fund to help with the costs of reburial, tribal consultation and the repair of any damage to burial sites, remains or sacred items.

Existing law to protect unmarked cemeteries in Illinois failed to create a pathway for tribal nations to rebury ancestral remains that had been disinterred. That law, passed in 1989, deemed most Native American remains to be property of the state.

The new law increases criminal penalties for the looting and desecration of gravesites, while adding a ban on profiteering from human remains and funerary objects through their sale, purchase or exhibition. Moreover, it mandates tribal nations be consulted as soon as possible when Indigenous gravesites are unintentionally disturbed or unearthed — such as during construction projects.

The measure follows decades of Indigenous activism, new leadership within the Illinois State Museum and IDNR, and ProPublica reporting that revealed widespread delays in institutions’ compliance with a 1990 federal repatriation law. ProPublica found that more than 30 years after passage of the Native American Graves Protection and Repatriation Act, museums and other institutions nationwide still hold more than 100,000 Native American human remains.

The failure to repatriate expeditiously, as required by NAGPRA, is rife in Illinois, where more than 15,461 Native Americans have been excavated — more than from any other state, the ProPublica investigation found. The vast majority of those ancestors are still held by Illinois institutions. Previous policies at the Illinois State Museum, which holds the remains of at least 7,000 ancestors, favored the scientific study of remains over their return to tribes for reburial.

Sunshine Thomas-Bear, the cultural preservation director for the Winnebago Tribe of Nebraska, said, “It has been a rough road in trying to get the protection and rights that non-Natives have in protecting our ancestral burial sites and homelands.” She added that many Illinois gravesites have been desecrated and destroyed.

“This bill cannot remedy the damage that has been caused thus far, but perhaps it will protect the sites that remain in our homelands,” Thomas-Bear said, though she emphasized that the law is “a step in the right direction” for rebuilding relationships.

Significantly, the law empowers IDNR to set aside and maintain land solely for the reburial of repatriated Native American ancestors and their belongings. Tribal nations have pointed to the lack of protected places for reburial in Illinois as among the highest barriers to repatriation.

For example, in 1999 the Sac & Fox Tribe of the Mississippi in Iowa, the Sac and Fox Nation of Missouri in Kansas and Nebraska and the Sac and Fox Nation, Oklahoma, repatriated the remains of 34 of their ancestors held by the University of Illinois Urbana-Champaign, records show. The tribes wanted to rebury their ancestors at or near the site where they were originally interred: a former Sauk and Meskwaki village in Rock Island County along the Mississippi River. But the state wouldn’t allow the tribes to use the land, said Johnathan Buffalo, the tribal historic preservation director of the Sac & Fox Tribe of the Mississippi in Iowa. They had to rebury the ancestors in Iowa — west of the Mississippi River, the same borderline used by the U.S. government when it expelled all Native American tribes from the state during the 1830s.

“That old wound opened when Illinois did that to us,” Buffalo said.

More than 30 tribal nations are recognized by the state museum as having cultural and historic ties to Illinois. The consultations, which are ongoing, began with discussing the repatriation of more than 230 ancestors unearthed from what today is known as Dickson Mounds.

“The need to rebury and to think about a different way of being in relationship with land from the state side was reiterated to us from just about every tribal nation,” said Heather Miller, the director of tribal relations and historic preservation for the Illinois State Museum. Miller is also an enrolled citizen of the Wyandotte Nation.

The new law is part of a broader effort to recenter Native voices in Illinois and within state institutions, a commitment brought to the Illinois State Museum in part by its former director, Cinnamon Catlin-Legutko, before her death this year. It was signed in tandem with two other laws; one requires the history of Native Americans in the Midwest be taught in Illinois public schools and another that bans school boards from prohibiting students from wearing cultural or tribal clothing and regalia in schools and at graduation ceremonies.

Interim Director Jennifer Edginton said the museum and IDNR, which oversees the institution, have “been looking very inward” to address the previous absence of Indigenous worldviews in their programs, collections and exhibits.

“We don’t want to continue that erasure, or stereotypes, or things that the museum field in general, unfortunately, has done since the inception of museums,” Edginton said.

The Legacy of Forced Removal

Today, no federally recognized tribes reside in Illinois, though Chicago is home to one of the largest urban communities of Indigenous people in the country. The absence of an organized political presence and tribal government has in part led to the state having among the worst repatriation track records in the nation.

“Forced removal affects everything,” said Miller, referring to the expulsion of Native American tribes from Illinois throughout the 1800s. “There was the physical removal, but that also removed [tribal nations] from being able to have a say in law, to have a say in voting, and from participating in all the ways the state operates and functions.”

That legacy has also contributed to Illinois museums designating many of the ancestral remains in their collections as “culturally unidentifiable” under the federal repatriation law. That designation has been misused by some institutions to avoid repatriating remains under NAGPRA, giving museums outsize power in consultations with tribal nations.

With passage of the new Illinois law, that balance of power will for the first time tip toward tribal nations whose ancestral lands became the state of Illinois.

“We have the ability to now bring those communities that were forcibly removed in violent ways back here,” Miller said. “Rather than being a ‘removal state,’ Illinois could be known as a ‘new relations’ state instead.”

The Future of Funerary Items

Another significant aspect of the new law is that it prohibits institutions from charging admission to view human remains that are Native American and any items that were originally buried with those individuals. Although the public display of Native American ancestral remains by museums fell out of practice after the passage of NAGPRA in the early 1990s, the public display of their funerary items has not.

After Dickson Mounds Museum in the early 1990s closed a burial exhibit that displayed the remains of more than 230 Native Americans, the institution still maintained a permanent exhibit that featured items taken from Indigenous gravesites across the state. As ProPublica reported this year, in September 2021, curators dismantled much of the exhibit at the request of tribal partners, who wished to see the items reunited with the ancestors they were buried with before their repatriation. Those funerary items made up about 40% of the exhibit.

State museum officials told ProPublica they’re not sure how many museums in Illinois still display funerary items. The law applies to every museum, university and historical society in the state — far more than the 15 institutions in Illinois that have reported their Native American holdings under the NAGPRA.

When asked about what he would say to museums that may push back against the law, Illinois State Rep. Mark L. Walker said: “Too bad.”

Walker, a Democrat who represents part of Chicago’s northwest suburbs, sponsored the legislation. He said he’s already received interest from other states looking to adopt similar laws.

“I think we can be a model for other states,” Walker said. “Whether we can change [Illinois’] image to such an extent that these communities actually trust us? I don’t know. That may take 30 years.”

by Sharon Lerner

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

The Environmental Protection Agency approved a component of boat fuel made from discarded plastic that the agency’s own risk formula determined was so hazardous, everyone exposed to the substance continually over a lifetime would be expected to develop cancer. Current and former EPA scientists said that threat level is unheard of. It is a million times higher than what the agency usually considers acceptable for new chemicals and six times worse than the risk of lung cancer from a lifetime of smoking.

Federal law requires the EPA to conduct safety reviews before allowing new chemical products onto the market. If the agency finds that a substance causes unreasonable risk to health or the environment, the EPA is not allowed to approve it without first finding ways to reduce that risk.

But the agency did not do that in this case. Instead, the EPA decided its scientists were overstating the risks and gave Chevron the go-ahead to make the new boat fuel ingredient at its refinery in Pascagoula, Mississippi. Though the substance can poison air and contaminate water, EPA officials mandated no remedies other than requiring workers to wear gloves, records show.

ProPublica and the Guardian in February reported on the risks of other new plastic-based Chevron fuels that were also approved under an EPA program that the agency had touted as a “climate-friendly” way to boost alternatives to petroleum-based fuels. That story was based on an EPA consent order, a legally binding document the agency issues to address risks to health or the environment. In the Chevron consent order, the highest noted risk came from a jet fuel that was expected to create air pollution so toxic that 1 out of 4 people exposed to it over a lifetime could get cancer.

In February, ProPublica and the Guardian asked the EPA for its scientists’ risk assessment, which underpinned the consent order. The agency declined to provide it, so ProPublica requested it under the Freedom of Information Act. The 203-page risk assessment revealed that, for the boat fuel ingredient, there was a far higher risk that was not in the consent order. EPA scientists included figures that made it possible for ProPublica to calculate the lifetime cancer risk from breathing air pollution that comes from a boat engine burning the fuel. That calculation, which was confirmed by the EPA, came out to 1.3 in 1, meaning every person exposed to it over the course of a full lifetime would be expected to get cancer.

Such risks are exceedingly unusual, according to Maria Doa, a scientist who worked at EPA for 30 years and once directed the division that managed the risks posed by chemicals. The EPA division that approves new chemicals usually limits lifetime cancer risk from an air pollutant to 1 additional case of cancer in a million people. That means that if a million people are continuously exposed over a presumed lifetime of 70 years, there would likely be at least one case of cancer on top of those from other risks people already face.

When Doa first saw the 1-in-4 cancer risk for the jet fuel, she thought it must have been a typo. The even higher cancer risk for the boat fuel component left her struggling for words. “I had never seen a 1-in-4 risk before this, let alone a 1.3-in-1,” said Doa. “This is ridiculously high.”

Another serious cancer risk associated with the boat fuel ingredient that was documented in the risk assessment was also missing from the consent order. For every 100 people who ate fish raised in water contaminated with that same product over a lifetime, seven would be expected to develop cancer — a risk that’s 70,000 times what the agency usually considers acceptable.

When asked why it didn’t include those sky-high risks in the consent order, the EPA acknowledged having made a mistake. This information “was inadvertently not included in the consent order,” an agency spokesperson said in an email.

Nevertheless, in response to questions, the agency wrote, “EPA considered the full range of values described in the risk assessment to develop its risk management approach for these” fuels. The statement said that the cancer risk estimates were “extremely unlikely and reported with high uncertainty.” Because it used conservative assumptions when modeling, the EPA said, it had significantly overestimated the cancer risks posed by both the jet fuel and the component of marine fuel. The agency assumed, for instance, that every plane at an airport would be idling on a runway burning an entire tank of fuel, that the cancer-causing components would be present in the exhaust and that residents nearby would breathe that exhaust every day over their lifetime.

In addition, the EPA also said that it determined the risks from the new chemicals were similar to those from fuels that have been made for years, so the agency relied on existing laws rather than calling for additional protections. But the Toxic Substances Control Act requires the EPA to review every new chemical — no matter how similar to existing ones. Most petroleum-based fuels were never assessed under the law because existing chemicals were exempted from review when it passed in 1976. Studies show people living near refineries have elevated cancer rates.

“EPA recognizes that the model it used in its risk assessments was not designed in a way that led to realistic risk estimates for some of the transportation fuel uses,” an agency spokesperson wrote. For weeks, ProPublica asked what a realistic cancer risk estimate for the fuels would be, but the agency did not provide one by the time of publication.

New chemicals are treated differently under federal law than ones that are already being sold. If the agency is unsure of the dangers posed by a new chemical, the law allows the EPA to order tests to clarify the potential health and environmental harms. The agency can also require that companies monitor the air for emissions or reduce the release of pollutants. It can also restrict the use of new products or bar their production altogether. But in this case, the agency didn’t do any of those things.

Six environmental organizations concerned about the risks from the fuels — the Sierra Club, Natural Resources Defense Council, Moms Clean Air Force, Toxic-Free Future, Environmental Defense Fund and Beyond Plastics — are challenging the agency’s characterization of the cancer risks. “EPA’s assertion that the assumptions in the risk assessment are overly conservative is not supported,” the groups wrote in a letter sent Wednesday to EPA administrator Michael Regan. The groups accused the agency of failing to protect people from dangers posed by the fuels and urged the EPA to withdraw the consent order approving them.

Chevron has not started making the new fuels, the EPA said.

Separately, the EPA acknowledged that it had mislabeled critical information about the harmful emissions. The consent order said the 1-in-4 lifetime cancer risk referred to “stack air” — a term for pollution released through a smokestack. The cancer burden from smokestack pollution would fall on residents who live near the refinery. And indeed a community group in Pascagoula sued the EPA, asking the U.S. Court of Appeals in Washington, D.C., to invalidate the agency’s approval of the chemicals.

But the agency now says that those numbers in the consent order do not reflect the cancer risk posed by air from refinery smokestacks. When the consent order said stack emissions, the EPA says, it really meant pollution released from the exhaust of the jets and boats powered by these fuels.

“We understand that this may have caused a misunderstanding,” the EPA wrote in its response to ProPublica.

Based on that explanation, the extraordinary cancer burden would fall on people near boats or idling airplanes that use the fuels — not those living near the Chevron refinery in Pascagoula.

Each of the two cancer-causing products is expected to be used at 100 sites, the EPA confirmed. ProPublica asked for the exact locations where the public might encounter them, but Chevron declined to say. The EPA said it didn’t know the locations and didn’t even know whether the marine fuel would be used for a Navy vessel, a cruise ship or a motorboat.

In an email, a Chevron spokesperson referred questions to the EPA and added: “The safety of our employees, contractors and communities are our first priority. We place the highest priority on the health and safety of our workforce and protection of our assets, communities and the environment.”

Doa, the former EPA scientist who worked at the agency for three decades, said she had never known the EPA to misidentify a source of pollution in a consent order. “When I was there, if we said something was stack emissions, we meant that they were stack emissions,” she said.

During multiple email exchanges with ProPublica and the Guardian leading up to the February story, the EPA never said that cancer risks listed as coming from stack emissions were actually from boat and airplane exhaust. The agency did not explain why it initially chose not to tell ProPublica and the Guardian that the EPA had mislabeled the emissions.

The agency faced scrutiny after the February story in ProPublica and the Guardian. In an April letter to EPA administrator Michael Regan, Sen. Jeff Merkley, the Oregon Democrat who chairs the Senate’s subcommittee on environmental justice and chemical safety, said he was troubled by the high cancer risks and the fact that the EPA approved the new chemicals using a program meant to address the climate crisis.

Sen. Jeff Merkley (Graeme Sloan/Sipa via AP Images)

EPA assistant administrator Michal Freedhoff told Merkley in a letter earlier this year that the 1-in-4 cancer risk stemmed from exposure to the exhaust of idling airplanes and the real risk to the residents who live near the Pascagoula refinery was “on the order of one in a hundred thousand,” meaning it would cause one case of cancer in 100,000 people exposed over a lifetime.

Told about the even higher cancer risk from the boat fuel ingredient, Merkley said in an email, “It remains deeply concerning that fossil fuel companies are spinning what is a complicated method of burning plastics, that is actually poisoning communities, as beneficial to the climate. We don’t understand the cancer risks associated with creating or using fuels derived from plastics.”

Merkley said he is “leaving no stone unturned while digging into the full scope of the problem, including looking into EPA’s program.”

He added, “Thanks to the dogged reporting from ProPublica we are getting a better sense of the scale and magnitude of this program that has raised so many concerns.”

The risk assessment makes it clear that cancer is not the only problem. Some of the new fuels pose additional risks to infants, the document said, but the EPA didn’t quantify the effects or do anything to limit those harms, and the agency wouldn’t answer questions about them.

Some of these newly approved toxic chemicals are expected to persist in nature and accumulate in living things, the risk assessment said. That combination is supposed to trigger additional restrictions under EPA policy, including prohibitions on releasing the chemicals into water. Yet the agency lists the risk from eating fish contaminated with several of the compounds, suggesting they are expected to get into water. When asked about this, an EPA spokesperson wrote that the agency’s testing protocols for persistence, bioaccumulation and toxicity are “unsuitable for complex mixtures” and contended that these substances are similar to existing petroleum-based fuels.

The EPA has taken one major step in response to concerns about the plastic-based chemicals. In June, it proposed a rule that would require companies to contact the agency before making any of 18 fuels and related compounds listed in the Chevron consent order. The EPA would then have the option of requiring tests to ensure that the oil used to create the new fuels doesn’t contain unsafe contaminants often found in plastic, including certain flame retardants, heavy metals, dioxins and PFAS. If approved, the rule will require Chevron to undergo such a review before producing the fuels, according to the EPA.

But environmental advocates say that the new information about the plastic-based chemicals has left them convinced that, even without additional contamination, the fuels will pose a grave risk.

“This new information just raises more questions about why they didn’t do this the right way,” said Daniel Rosenberg, director of federal toxics policy at NRDC. “The more that comes out about this, the worse it looks.”

by Jessica Miller, The Salt Lake Tribune

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

This story discusses sexual assault.

Andrew was feeling crushed by the cultural expectation to get married.

Twenty-two years old, he had just returned from a mission for The Church of Jesus Christ of Latter-day Saints and was attending a singles’ ward in Provo, Utah — a local congregation of unmarried college students.

But Andrew is gay. And marriage between a man and a woman is a central tenet of the Latter-day Saint faith, which teaches that the highest level of heaven is reserved only for married, heterosexual couples. Same-sex marriage is not an option in the church.

So in the fall of 2015, he did as many Latter-day Saints do when they are having a crisis: He went to his bishop.

The lay leader suggested trying therapy, Andrew remembered. In fact, the bishop said he had just gotten a referral that same day for a local therapist named Scott Owen who worked well with gay men who were members of their faith. Owen co-owned a Provo therapy business called Canyon Counseling and, at that time, was also a regional leader in a Provo-area stake, a cluster of congregations that is similar to a Catholic diocese.

The coincidental timing — that his bishop learned of Owen on the same day Andrew disclosed his internal struggles — felt miraculous.

“It was like, God has a plan,” Andrew said. “This is going to work out. Everything seems dark and depressing. But this therapist is going to fix everything.”

But that’s not what happened. For five months beginning in October 2015, Andrew said, the clinical mental health counselor groped him, encouraged him to undress and kissed him during sessions. Andrew said Owen told him that the touching was a therapeutic way to learn how to accept love and intimacy.

Andrew, now 30, is being identified by a pseudonym to protect his privacy.

Sexual touching in a therapy session is considered unethical by all major mental health professional organizations, and it is defined in Utah rules as “unprofessional conduct” that could lead to a mental health worker losing their license or other discipline. It’s also illegal in Utah.

By March 2016, Andrew had reported Owen to both his bishop and to state licensing officials. A new investigation from The Salt Lake Tribune and ProPublica shows how Utah licensers allowed Owen to continue practicing and church leaders repeatedly heard concerns but took several years to take official action. For nearly two years after Andrew’s report, Owen provided therapy to clients, some of whom were men referred for “same-sex attraction” counseling. During that time, at least three more patients allege they were sexually abused by Owen, including two who reported him to the state licensing body in 2018. Those reports ultimately led Owen to agree to surrender his license.

Owen’s case is indicative of a flawed and misleading system: Officials within Utah’s Division of Professional Licensing encourage the public to look to the agency’s disciplinary records to vet a professional, yet those records rarely offer a full picture of misconduct. Despite Owen’s pattern of alleged inappropriate behavior, his publicly available disciplinary records reference touching but never disclose that the accusations against him were sexual in nature. This is one of a number of shortcomings identified by The Tribune and ProPublica while reporting on how Utah officials fail to supervise medical professionals and to adequately address patient reports of sexual assault.

Scott Owen (Obtained by The Salt Lake Tribune)

Owen, a large-framed bald man with dark blue eyes who speaks with a drawl, built a reputation over his 20-year career as a therapist with Christian values who could help Latter-day Saint men with same-gender attraction. He gave public lectures so often about pornography and masturbation, Owen told a crowd of LGBTQ+ church members in 2016, that he had earned the nickname “The Porn King.”

Although Owen, now 64, responded to an initial email from a reporter, he did not answer detailed questions sent to him via certified mail.

Officials with DOPL say that, given the evidence they had from Andrew’s complaint, they believe they responded appropriately. But, communications between Andrew and an investigator suggest that the agency’s actions rested largely on Owen’s denial that anything improper had happened and a failed polygraph test officials asked Andrew to take — a tool that experts say is known to be specifically unreliable with victims of sexual abuse, and that some states ban for that reason.

Church spokesperson Sam Penrod said the faith made an annotation on Owen’s personal church record in spring of 2019 — three years after Andrew’s initial report to his bishop. An annotation is a confidential marking intended to alert a bishop to someone whose conduct has threatened the well-being of other people or the church. It can affect what roles members are asked to fill within their congregation.

Penrod said in an email: “The Church takes all matters of sexual misconduct very seriously. This case was no exception.”

Both the church and the licensing division declined to comment on whether they reported the therapist to the police. Provo police officials said they had no record of ever receiving any report of sexual abuse against Owen.

Owen co-founded Canyon Counseling in Provo, Utah, in 1998. (Leah Hogsten/The Salt Lake Tribune) Touching in Therapy

Owen pushed physical boundaries from the very start, Andrew said. After their first session, Owen ended their meeting with a quick hug. At his second appointment, Andrew said, Owen held him in a longer embrace.

“I’m doing this because I know you’re uncomfortable with love,” Andrew remembered Owen telling him as they hugged. “I want you to get used to it.” Such touching, he recalled Owen saying, would be “a key step in my therapy.”

Andrew did feel uncomfortable. But he remembered Owen seemed genuine and truthful in their therapy sessions — even “Christ-like” in his caring.

Growing up in the Latter-day Saint faith, Andrew was taught to trust men in positions of authority. There was also the expectation to talk with his bishop about deeply personal sexual details during one-on-one interviews. These annual closed-door discussions generally start when members become teenagers and typically explore whether they are following the faith’s rules; they have been criticized by some parents and therapists as being “inappropriate” and “intrusive.”

These interviews, Andrew said, left him with a skewed view of what was appropriate in a mentoring relationship.

“I felt like a lot of the times I didn’t understand what normal boundaries to have around sexuality,” he said, in part because of how he was instructed to relate to religious leaders. “You have to air it all to these particular people in your life — and then you hide it desperately from everyone else.”

In the late 1960s, church leaders took a hard stance against even identifying as gay, including “homosexuality” in a list of behaviors that could result in excommunication. Bishops and church leaders in subsequent years were taught that being gay was a reversible condition, and church leaders would send gay men to conversion therapy or advise they could be fixed by marrying a woman.

By the time Andrew began seeing Owen in 2015, the church had publicly acknowledged that its members do not have a choice in being attracted to the same sex; today, church policy says a gay member can remain in good standing if they remain celibate and never marry someone of their same gender.

“At the time, I knew it might not be possible for me to get married, and that would still be OK in the church framework,” Andrew recalled. But, he added, “so much of the LDS dream is based on marriage that that was crushing and really depressing to me.”

So Andrew kept going to therapy, even as he said Owen began touching him more, at times rubbing his back or his bottom during hugs. Owen encouraged him to undress during some therapy sessions, Andrew said, which evolved into what he describes as “makeout sessions.” Looking back now, it’s clear to Andrew that this was inappropriate — but in the moment, he felt desperate and confused.

Andrew reasoned with himself that he was not physically attracted to Owen when they touched, which would be similar if he married a woman. Maybe it was a way for him to learn how to express romantic feelings he didn’t have or to fake it until those feelings came.

“I couldn’t accept that I was being taken advantage of,” Andrew said. “That’s a hard thing to be like, ‘Oh, I’ve been sexually abused this whole time.’”

“This was supposed to be my miracle,” he added.

Decorations in Andrew’s room (Leah Hogsten/The Salt Lake Tribune) A Reprimand

Andrew decided to stop therapy in February 2016, as he wrestled with whether what had happened had been abusive. He confided in a friend during late-night study sessions on Brigham Young University’s campus a few days later. In an interview corroborating Andrew’s account, she recalled urging him to tell someone.

Within a week of stopping therapy, Andrew again found himself confiding in his bishop.

Andrew recalled feeling like his church leader, who works as a livestock and pasture insurance agent, seemed confused about how to help a gay member of the church — and whether this type of touching in therapy was supposed to be helpful. He referred Andrew to another therapist who, Andrew said, told him Owen’s alleged conduct was a “gross violation” of patient boundaries.

Andrew went back to his bishop with this information, but the lay leader never reported that information to church authorities. The church’s general handbook for members makes it clear that if a bishop or stake president “learns of abuse of a spouse or another adult,” they are supposed to call a confidential hotline for guidance from lawyers and clinical professionals.

The bishop, whom The Tribune and ProPublica are not identifying to protect Andrew’s identity, said that he struggled to process what Andrew told him, and that he felt it was sufficient that he had encouraged Andrew to report Owen to state licensing officials at DOPL. The division is responsible for licensing Utah professionals, from medical doctors to armed security guards to massage therapists. It is also charged with investigating misconduct and can revoke a license or put someone on administrative probation.

By then, Andrew had stopped seeing Owen. Andrew’s bishop questions now whether he should have said something to a higher church leader, but he said he felt the faith’s guidance for when bishops should report alleged abuse to church authorities pertained more to “something happening that needs to be stopped, like when there’s abuse in the home.” The bishop added that he didn’t feel he knew how he should help members who were struggling with their sexual identity and their faith.

“A bishop is supposed to be a spiritual guide. Not a psychologist, not a family therapist. So I felt equipped to listen and love them, absolutely,” he said. “But as far as to help them process what it means and how to be a part of this religion and be gay — I never figured that out.”

Andrew followed his bishop’s guidance and went to licensers in early March 2016. In a statement Andrew wrote for investigators — which he shared with The Tribune and ProPublica — Andrew described the escalating touching and accused Owen of touching parts of his genital area at their last appointment.

“I left feeling disgusted in what had happened,” Andrew wrote about their last appointment, “and vowed to never return.”

To conduct their investigation, licensing officials offered the therapist a polygraph test. He refused, according to DOPL. They also asked Andrew if he would wear a recording device, he said, and go to Owen’s office to ask him about the touching. Andrew said he didn’t feel like he could go through with that.

That’s when the investigator asked Andrew if he would take a lie detector test.

Andrew said the investigator reasoned to him that if he could pass one, it could bolster what essentially was a case of one person’s word against the other.

The polygraph did not go well, Andrew said — the results suggested he was being deceptive.

“I had so much trauma,” Andrew said. “And so, certainly, when they asked me questions about the particular things that happened in therapy, it’s going to elicit a very strong emotional response.”

Researchers say this is a common response for trauma victims, and many recommend that sexual abuse victims not undergo polygraph exams. Half of states have laws explicitly prohibiting law enforcement from conducting a polygraph test with someone reporting a sexual assault, with some barring any government employee from requiring an alleged sexual assault victim to take one. There is no law in Utah that puts limits on the use of polygraph tests on victims.

Melanie Hall, the spokesperson for DOPL, acknowledged that an investigator did “offer the option” of a polygraph test to both Owen and Andrew. She said that it is “extremely rare” for a polygraph to be used as part of an investigation, but that the agency doesn’t track how often.

Andrew’s failed polygraph sent his own mental health spiraling. He wrote in an email in October 2016 that he no longer wanted to participate in the investigation unless someone else came forward.

A month later, Owen was given a public reprimand from licensers for the one inappropriate action he admitted to: that he gave Andrew hugs. Owen admitted in licensing documents that he “inappropriately touched a client in a non-sexual manner.”

Hall said the “overwhelming majority” of DOPL’s disciplinary actions are negotiated settlements — where a licensed professional admits to lesser conduct than what is alleged by those who say they’ve been harmed.

Owen later told the Clinical Mental Health Counselor Licensing Board, in a hearing in Salt Lake City at which he received an official reprimand, that his client had been struggling with a family issue, and that it was “not uncommon” for him to hug his patients.

But he denied Andrew’s allegations to the board, calling it “quite a story he concocted.”

“I readily agreed and admitted to giving him hugs at the end of the session and that sort of stuff,” Owen said during the meeting, adding that someone at DOPL told him that he should “know better” than to hug someone who was seeking therapy for same-sex attraction.

Owen said that he had changed his practices.

“I don’t do that anymore,” he said. “I have just been a little bit stunned and burned by this. I’ll shake hands, and I don’t even like to shake hands until my office door’s open and completely out in the reception area with my receptionist there.”

Owen left the meeting that day with a reprimand but no other limitations on his license — and no need to tell his other patients.

“I Felt Betrayed”

At precisely the time DOPL was investigating Owen, and then publicly reprimanded him, another man living in Provo and attending the same religious university as Andrew was questioning whether the way the therapist touched him during sessions had crossed the line.

Jonathan Scott had been seeing Owen for three years — and he would continue to see him for nine months more after the reprimand. His allegations bear a striking resemblance to Andrew’s, but he was not aware of the licensing reprimand — and it would be years before he realized that his experience was not unique.

Jonathan Scott began therapy sessions with Scott Owen in 2013 as an effort to heal from childhood sexual abuse. Scott said that the therapist touched him inappropriately but that he did not initially recognize Owen’s alleged actions as abuse. (Leah Hogsten/The Salt Lake Tribune)

Jonathan Scott, a reserved 32-year-old with curly ash brown hair, first started seeing Owen in 2013 as a lanky BYU student struggling to deal with childhood trauma from being sexually abused by his Boy Scout leader in Illinois. His parents found Owen online and met with him first; Jonathan Scott’s father recalls Owen saying that he could help their son have safe relationships with adult men.

Jonathan Scott said his new therapist reminded him of the man who sexually abused him when he was a kid. They had similar nervous tics, and the way each man had looked at him felt the same. They were both middle aged and had the large frame and roundness of a teddy bear.

“That was kind of the point,” Jonathan Scott remembers. Unlike his abuser, Owen was supposed to be “a safe, good man who is supposed to help me reestablish trust with men.”

But Jonathan Scott said Owen frequently touched him under his clothing while hugging him during sessions.

Like Andrew, he said this touching gradually escalated. Eventually, he said, his sessions felt like nothing more than 40 minutes of cuddling. Also like Andrew, he told himself that to heal he needed to learn to accept touch. And because he was raised in the church, he added, he wasn’t going to question a religious leader.

“You justify things. You let things slide. But did it feel comfortable? No, it didn’t feel comfortable. It didn’t feel safe,” he said. “But I was told I needed to work through that.”

Jonathan Scott ended therapy in 2017 when he moved. He never contacted DOPL, or the police, himself. It was only two years later that his partner — upset with the thought that Owen had never faced consequences — was searching online and found the reprimand. She corroborated details of his account in an interview with The Tribune.

It felt like a betrayal, Jonathan Scott said, to learn that Owen had denied touching Andrew around the same time he says the therapist had been groping him.

“When I found out that there were others, I felt not alone,” he said. “I felt justified in my anger of what I thought had happened to me. I felt even less trust in authority.”

Hall said that DOPL may, in some cases, require a disciplined licensee to inform their patients of unprofessional conduct, though that didn’t happen in Owen’s case. Utah has no law requiring this type of disclosure, and there are only three states that do require medical professionals disciplined for sexual misconduct to disclose that to their patients.

“DOPL and/or the licensing board may decide to implement this requirement,” Hall said, “if there is strong concern about an individual treating others without first informing them and receiving consent from the patient.”

But a search of more than 3,200 filings obtained from DOPL’s website, some from as early as 2010, shows the state has rarely required disclosure of unprofessional conduct to individual patients.

A Surrendered License

Owen continued to practice for nearly two years after the reprimand. It would take two more people coming forward before the licensing process was able to take meaningful action.

One of those was Sam, a 43-year-old man who now lives in Arizona. As a Latter-day Saint who was attracted to other men, Sam struggled to feel accepted, his brother Jason recalled. One fall day in 2017, Sam called Jason sobbing to tell him about a therapist he had been going to: how Owen had made him feel loved; how the therapist told him that he could help him learn to accept intimacy; how the sessions had become sexual.

Sam later detailed his experiences in a written timeline, an account that a friend later also shared in a letter to the church: It started in January 2017 with a hug and by August had escalated to mutual masturbation.

He declined an interview request relayed through his brother. Sam and his brother are identified by pseudonyms for this article, and information about Sam’s experience was gleaned from interviews and records provided by his brother and Troy Flake, a friend Sam confided in at the time.

In February 2018, DOPL received another report alleging Owen engaged in sexual misconduct. Details of the complaint were redacted in response to a public records request. And in April, Sam himself spoke to a DOPL investigator.

“Just got off the phone with the investigator,” Sam wrote in a text message to his brother. “It was pretty rough to explain to him all of what happened, but I’m glad I got through it and started this process.”

He wrote that the investigator had “accumulated accounts from several of Scott’s clients.”

Within weeks of Sam speaking to the investigator, Owen surrendered his license as part of an agreement with Utah’s licensing division. According to the DOPL order, investigators believed that Owen inappropriately touched “a number” of clients in a five-year period beginning in 2013. There was no reference to the sexual nature of those contacts. And when Owen surrendered his license, he was able to give it up while neither agreeing with nor denying licensers’ findings.

Reports to Church Leaders

Utah’s licensing division wasn’t the only entity that had knowledge of Owen’s activities for years before he was censured. There was also the church.

Andrew had gone to his bishop back in 2016, but church officials say their legal department did not learn of any alleged inappropriate conduct involving Owen until two years later, after DOPL had already begun to investigate.

As with Andrew, Sam first relayed his concerns to a trusted church leader. In the timeline Sam created, which he had shared with Flake, he wrote that Owen at times had told him that he “didn’t need to run off and talk to my bishop about” their counseling sessions.

If he wanted help processing what was happening, Sam wrote in that document, Owen suggested he talk with Alan Hansen, a psychologist who was also Owen’s business partner at Canyon Counseling. Hansen’s role as Sam’s stake president at that time meant he was also in charge of overseeing thousands of church members who make up local congregations in their area.

A patient of Owen’s twice raised concerns with Alan Hansen, co-owner of Canyon Counseling, about inappropriate touching during therapy. (Leah Hogsten/The Salt Lake Tribune)

In August 2017, Sam went to Hansen’s church office on BYU’s campus, where he disclosed that Owen had been “physical” with him during sessions.

He wrote in his timeline that Hansen encouraged him to keep attending therapy and gave him a priesthood blessing — a prayer of healing and encouragement given by adult men in their church. The blessing made Sam feel better, he wrote, and he continued seeing Owen for therapy for two months. But then, he added, he became too uncomfortable with the sexual touching he said happened inside the Canyon Counseling office.

In December, according to the timeline, he told Hansen again about Owen’s touching. This time, though, he was more explicit — telling the church leader that Owen had kissed him and had engaged in heavy petting and other types of sexual touching.

“Alan acknowledged that some of Scott’s actions clearly crossed some boundaries and that was likely due to Scott’s own weaknesses,” Sam wrote. “He also stated that Scott had done something like this before — and that there were others. I don’t remember his exact language, but that was the effect of what he said.”

Hansen did not respond to a list of questions sent to him, and he referred a reporter to the church’s legal department. A church spokesperson did not address questions about Hansen.

Sam continued to tell other church leaders about Owen’s behavior — and Hansen’s dismissal of it. He also went to his previous bishop in Provo. Sam wrote in text messages to his brother that this church leader confronted Hansen about “essentially doing nothing about my situation with my previous therapist.”

“He thinks it’s possible that it’s a releasable offense for the stake president,” Sam wrote to his brother about the chance that church authorities would strip Hansen of his official role in their faith. But that didn’t happen.

Penrod, the church spokesperson, did not respond to a question asking whether Hansen ever received disciplinary action for not reporting his business partner to church authorities.

He added that “local leaders who are themselves professional therapists should not refer members to affiliated therapists or practices in which they have a financial interest.”

But concerns over Owen’s behavior didn’t end when he surrendered his license. Flake, Sam’s friend, was worried that Owen could still be teaching in a church setting and was frustrated that he believed Hansen had known what was going on and took no action. More than a year later, in December 2019, he sent an email to church lawyers urging them to investigate.

A church attorney responded to his email later that same day, according to correspondence shared with The Tribune and ProPublica, telling Flake the firm would provide the information “to Owen’s current leaders and let you know if we need additional information.” The attorney made no mention of Hansen. Flake says he never heard from the church lawyers again.

The Tribune asked church officials in an email whether Hansen had ever been disciplined in connection to his business partner’s actions, but the church did not respond to that question. Hansen’s psychologist license is in good standing with the state, and no disciplinary action has been taken against him.

“There’s Been Zero Justice”

Years after they say they were sexually assaulted, several of Owen’s former patients are connected now through one more person who says the ex-therapist sexually abused him nearly 40 years ago: Owen’s own cousin, a Boise, Idaho, man named James Cooper.

Cooper wrote to his family in June 2020, telling them that Owen molested him in a shared bed during a trip to Colorado in the 1980s. The email describes how Cooper had learned that past winter that Owen had surrendered his license.

He also sent a separate email to Owen, who denied the allegation and replied: “I don’t see this the same, but I am so sorry for your pain and hurt.”

Cooper wrote in the email to his family that up until then “my strategy has been to forget and avoid Scott [Owen] as much as possible, and admittedly that means I was content to keep my head in the sand in this regard.”

But after he read about Owen surrendering his license, Cooper wrote, it forced him to think about those who allege his cousin later hurt them. The 48-year-old man scoured the internet, searching for any potential victims and posting anonymously on Google reviews asking others to reach out to him.

Owen’s cousin, James Cooper, alleged Owen molested him in the 1980s. More recently, Cooper sought out and connected former patients of Owen’s who allege they were abused in therapy. (Sarah A. Miller for ProPublica)

That’s how he connected with Andrew, Jonathan Scott and Sam’s friend Flake; together, the men grappled with what to do next. All of them described long-term effects of Owen’s alleged conduct and also a sense that there had been no meaningful consequences for him.

Both Andrew and Jonathan Scott have left the church, in part because of the alleged abuse. Sam has been devastated after realizing he had been taken advantage of, according to Flake, which has destroyed his ability to trust his own perception. And Jonathan Scott has thought about reporting Owen to the police, but he continues to struggle to trust authority figures.

“There’s been zero justice, as far as I can see,” Jonathan Scott said.

Owen today is listed as the registered agent for Canyon Counseling in public business records. It’s not clear what his role in the business is, but in 2019, Flake called the police to report seeing Owen’s truck in the Canyon Counseling parking lot, though he did not have a license to practice therapy.

An officer contacted Owen, who said he owns the business — but is not a therapist any more.

The Mental Health Profession Violations

Scott Owen is one of at least 197 mental health professionals who have been disciplined by Utah licensers since 2012, according to a data analysis by The Salt Lake Tribune and ProPublica of available disciplinary documents on the state Division of Professional Licensing’s website as of April 20, 2023. This database is not exhaustive, as older filings may no longer appear on the website.

Of those, 73 — or 37% — had been disciplined for sexual misconduct. Searches of DOPL’s disciplinary records suggest that mental health professionals are more often disciplined for sexual-related misconduct than doctors or nurses. The Tribune and ProPublica also identified 28 other misconduct cases where a therapist had an inappropriate “dual relationship” with a client — such as a client sleeping over at a therapist’s home or cleaning horse stalls together — that did not appear on paper to be explicitly sexual in nature.

Owen is one of five Utah mental health professionals identified by The Tribune and ProPublica who have been disciplined more than once for sexual conduct. Several of them continue to work in the therapy business in some capacity. Two others among the five were put on probation and allowed to continue working as therapists, according to disciplinary filings, while a third opened a life coaching business marketing himself as a “one of the few Ph.D.-level coaches” in southern Utah.

Utah licensers consider any sexual contact with a current patient to be misconduct, and sexual relationships with a former patient are not allowed within two years after they stop seeing a therapist.

When asked if the licensing division knew whether therapists were at higher risk for sexual misconduct, spokesperson Melanie Hall said DOPL is aware that certain license types “have a tendency towards certain types of violations.” She didn’t specifically address mental health professionals, but she gave certified public accountants as an example of professionals who have increased access to bank accounts and are more likely to commit financial fraud than other professionals who do not have that access.

The agency, she said, “takes these factors into account when investigating complaints, and takes appropriate disciplinary action when necessary.”

The news organizations also asked Hall about whether DOPL reports cases to law enforcement. Under Utah law, it is illegal for a health professional to engage in sexual contact with their patient under the guise of providing treatment.

The licensing division, Hall said, is not legally required to forward information to law enforcement — just as the police are also not mandated to share information about a licensed professional they are investigating. The only exception to this, she said, is a requirement that drug thefts be reported to police.

Hall said that licensers do collaborate and report crimes to police agencies “often,” though she did not explain under what circumstances they would do so. She said that licensers may encourage a patient to reach out to the police or decide that the case does not require a criminal investigation. She would not say whether anyone at DOPL ever reported Owen to the police.

Help ProPublica and The Salt Lake Tribune Investigate Sexual Assault in Utah

Editor’s Note: Three sources for this story — Andrew, Sam and Jason — are identified only by pseudonyms because they requested anonymity. Two are alleged victims of sexual assault, and the third is the brother of one of those men. We have granted this request because of the risk to their standing in their communities if they were publicly identified. The Salt Lake Tribune and ProPublica typically use sources’ full names in stories. But sometimes that isn’t possible, and we consider other approaches. That often takes the form of initials or middle names. In this case, we felt that we couldn’t fully protect our sources by those means. Their full names are known to a reporter and editors, and their accounts have been corroborated by documents and interviews with others.

This story was supported in part by a grant from the Fund for Investigative Journalism.

Jeff Kao and Haru Coryne, ProPublica, and Will Craft, special to The Salt Lake Tribune, contributed data reporting. Mollie Simon, ProPublica, contributed research.

by Melissa Sanchez and Maryam Jameel

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.

Leer en español.

Central Wisconsin’s Clark County is home to more dairy farms than any other county in the state, which bills itself as America’s Dairyland. Its identity is so tied to the dairy industry that a 16-foot-tall, black-and-white talking Holstein stands outside downtown Neillsville, the county seat.

To corral the cows, milk them and clear their manure at these dairy farms — the dirty, dangerous work that makes this multibillion-dollar industry go — farm owners here and across Wisconsin rely on a labor force that they know is largely undocumented.

But the state makes it almost impossible for workers to have lives outside the farm without breaking the law. In Wisconsin, undocumented immigrants can own and register their cars and trucks, but they aren’t allowed to drive them. Those who drive anyway are pulled over again and again and again, and issued tickets that eat away at their wages.

The law banning undocumented immigrants from obtaining driver’s licenses has cascading effects across the state. Law enforcement officials say the roads are less safe because undocumented immigrants aren’t trained and tested on basic driving rules but they drive anyway — and often without insurance. Court officials say tickets for driving without a license overwhelm their dockets and drain their limited resources. Farmers say they have to build or find employee housing to help their workers avoid getting ticketed.

The workers, many from remote, impoverished communities in Latin America, are grateful for the jobs. And yet they feel trapped.

They are people like a 33-year-old Nicaraguan who came to Wisconsin two years ago after hearing from friends that it was easy to find work on “los ranchos,” as dairy farms here are known by Spanish-speaking workers. He lives with three other Central American men in a small, white house owned by their boss that sits a few miles down a county road from the farm.

One afternoon in March, as the worker drove a roommate’s Jeep to the grocery store, a Neillsville police officer ran a random check of the license plates. The officer learned that the Jeep’s registered owner didn’t have a driver’s license and pulled him over.

The worker told the officer he didn’t have a license, records show, and the officer issued him a $200.50 citation.

“A day’s worth of work, lost. It hurts,” said the man, who routinely works 14-hour days.

Over the past year, ProPublica has interviewed more than 100 undocumented current and former dairy workers — in farm breakrooms, in the trailers and apartments where they live, in the shops where they wire money home, and at courthouse cashier’s windows where they pay their tickets. They said they are isolated and stuck on the farms where they work and often live. They struggle to get to grocery stores, to their children’s schools and to immigration court hearings. They delay medical care.

So they either rely on others who, for a price, drive them where they need to go, or they break the law and take their chances.

“You can’t call Uber because there isn’t any. You can’t take the bus because there aren’t any,” said John Rosenow, a dairy farmer in western Wisconsin who has become one of the most prominent advocates for immigrant workers in the state. “The closest barber shop is 15 miles away. The closest grocery store is 25 miles away.”

Making matters worse, the punishments for repeat offenses can escalate in severity, exposing workers to stiffer financial penalties, criminal cases and jail time. In counties that have formal agreements with federal immigration authorities, the threat of deportation hangs over every police stop.

What’s happening in Clark County and across Wisconsin is the result of Congress’ failure to figure out what to do about the millions of undocumented immigrants who live here and work in industries that, like dairy, unabashedly depend on them. That leaves state lawmakers to craft legislation to try to address the consequences — or to ignore what’s happening, punishing immigrants in the process.

Wisconsin is home to about 70,000 undocumented immigrants, mostly from Latin America, according to estimates from the nonprofit Migration Policy Institute. These are the people who hang drywall, clean hotel rooms, wash dishes in restaurant kitchens and package the nation’s cheese.

Determining how many of Wisconsin’s dairy workers are undocumented is almost impossible. Workers use fake papers to get jobs, farmers accept those papers without question, and the state and federal governments make little effort to get an accurate count. But a conservative estimate from a recent University of Wisconsin at Madison study puts the number of undocumented Hispanic workers on medium-to-large farms at roughly 6,200. That figure excludes the many immigrant workers on smaller farms, those with fewer than 500 cows.

Advocates for immigrants have worked for years to persuade lawmakers to give undocumented immigrants driving privileges, as 19 states — most of them blue — have done. But those efforts have been unsuccessful in Wisconsin, where legislative districts have been drawn to favor Republicans. Few GOP lawmakers have been willing to support any such efforts; political observers say the lawmakers don’t want to look soft on immigration.

So local communities are left to look for their own solutions.

In one county, officials have been quietly conducting a pilot driver’s education program aimed largely at undocumented immigrants who were caught driving without a license. They are reluctant to speak publicly about it out of fear that any attention will lead to conservative backlash.

Elected district attorneys in several counties have stopped bringing criminal charges against people caught driving without a license; both Democrat and Republican prosecutors say they want to dedicate their limited resources to crimes with victims.

And in four counties in southwestern Wisconsin, community advocates worked with local law enforcement agencies and dairy farmers a few years ago to create identification cards that workers could show officers during traffic stops to prove that they worked in the area and, potentially, keep those encounters from escalating.

“It did not prevent them from getting a ticket, but it prevented them from being handcuffed and hauled off to jail,” said Shirley Barnes, the recently retired co-director of the MultiCultural Outreach Program in Dodgeville. “The fact is, all the police officers in all of these counties know exactly where these people work. They know it is local farmers who are employing these people.”

A dairy farm in south-central Wisconsin (Caleb Santiago Alvarado for ProPublica)

One morning in May, a former dairy worker from Honduras slid into a courtroom bench in the Clark County Circuit Court in downtown Neillsville and waited for his name to be called. His 16-year-old son sat next to him, missing school to serve as his father’s interpreter. ProPublica is identifying the man only by his first name, José. Like other workers in this story, he asked not to be fully identified because he is undocumented and fears being deported.

A month earlier, a state trooper had pulled José over for driving 15 mph over the speed limit on U.S. Highway 10. In addition to issuing a speeding ticket, the trooper had cited him for driving without a valid license.

“We just enforce the law,” Sgt. Brandon Gray, a spokesperson for the Eau Claire post of the Wisconsin State Patrol, said in an interview. “If they don’t have a valid license, then obviously they receive a citation.”

José said he regrets speeding. But he said it’s impossible for him to comply with the license requirement.

“It makes me so damn sad I could cry,” said José, who said he came to the U.S. two years ago to better provide for his son. “I have to drive. Nobody else is going to come to support my son. Nobody else is going to pay my rent.”

José left court with his son after paying $200.50 for driving without a license and another $175.30 for speeding. José drove home, still licenseless.

Of the 35,000 people who live in Clark County, just 6% are Hispanic, according to census estimates.

Yet last year, 187 of the 245 cases that were brought in this court for operating a vehicle without a valid license — or more than 75% — involved Hispanic drivers, according to data compiled for ProPublica by Court Data Technologies, a Madison company.

A similar trend is playing out in circuit and municipal courts across the state, ProPublica found. (Citations for this charge can go to either type of court if it’s a first-time offense; circuit courts also handle repeat offenses, which can become criminal cases.)

Roughly half of the 16,000 circuit court convictions for driving without a valid license involved Hispanic drivers, according to the information provided by Court Data Technologies from cases filed in 2022.

The actual percentage is likely higher, since Latin American immigrants are often marked as “Caucasian” in court records; José, for example, is listed this way.

Hispanic residents make up less than 8% of the population.

“Those numbers are alarming,” said Primitivo Torres Martinez, deputy director for statewide civic engagement for Voces de la Frontera, the state’s largest immigrant rights advocacy group, who learned of the statistics from ProPublica. “The thing is, farmers need [immigrant workers] to drive, so it’s a Catch-22 for a lot of folks.”

Police and the courts don’t track the immigration status of drivers. But across the state, people involved in nearly every step of the traffic enforcement process — police, judges, prosecutors, defense attorneys, interpreters and other circuit and municipal court officials — agreed that most Hispanic drivers who get ticketed for not having a license are undocumented immigrants.

Records from these cases routinely describe drivers who show Mexican or Nicaraguan identification cards to police, don’t speak English and need an interpreter, or tell officers they can’t get a license because of their immigration status. You can see them in courthouse lobbies, glancing hopefully around for an interpreter when the clerk offers to use Google Translate on her phone, or sitting anxiously on courtroom benches, wondering whether they will end up being deported.

Thousands more tickets for driving without a valid license were processed last year in the state’s roughly 230 municipal courts. These courts operate independently from each other and, as a result, there is no one single place to get case information that would allow a statewide analysis of those courts.

But ProPublica obtained data from about a dozen municipal courts and found that, over and over, Hispanic drivers received a substantial share of these citations.

In Milwaukee, the state’s largest city, they accounted for nearly 40% of the tickets. In Waukesha, a Milwaukee suburb, 49%. In Manitowoc, along Lake Michigan, 58%. In each of these places, Hispanics account for 20% or less of the population.

The numbers appear to be starker in municipal courts farther from metropolitan areas. At the Marshfield Area Municipal Court in central Wisconsin, for example, 69% of these tickets issued by the Marshfield Police Department went to Hispanic drivers, records show. Less than 3% of Marshfield residents are Hispanic.

It’s a similar story in Sparta, a small town surrounded by dairy farms in western Wisconsin. Sparta’s municipal court does not track defendants’ race or ethnicity, but ProPublica found that 91 of the 131 tickets issued last year for driving without a valid license — or about 70% — involved defendants with common Hispanic surnames like Cruz, Cortez and Gonzalez. (The U.S. Census Bureau says that more than 85% of people with those last names are Hispanic.) Fewer than 6% of residents in Sparta are Hispanic.

Immigrant dairy workers from around Sparta, Wisconsin, regularly visit Supermercado Guerrero to buy groceries and painkillers, cash their checks and wire money to relatives in Mexico and Central America. (Caleb Santiago Alvarado for ProPublica)

Mention the subject of tickets in a tiny Mexican grocery store there and the tired dairy workers in line will nod their heads with familiarity and indignation.

“I’ve been pulled over probably 15 times,” said one man, a longtime dairy worker from Mexico. Sometimes, he said, it’s the same police officer who pulls him over. “They recognize me immediately and call me by name, saying, ‘I told you not to drive,’” the worker added. “But I have to drive to get to work.”

Most Hispanic immigrant drivers don’t bother to contest the tickets, they simply pay in cash, said Andrea Ziegler, Sparta’s municipal court clerk. Altogether, Hispanic drivers in Sparta paid more than $8,400 in tickets issued last year for not having a license, records show.

“I don’t think it’s right. If you’re going to ticket them, then you need to provide a path for them to get a license so they can work, so they can continue to contribute to our society,” Ziegler said.

“Our farms would not be able to survive without them.”

When we asked farmers about their employees’ immigration status, they told us they merely accept the paperwork that applicants hand them.

“I don’t think it’s right. If you’re going to ticket them, then you need to provide a path for them to get a license so they can work, so they can continue to contribute to our society.”

—Andrea Ziegler, Sparta, Wisconsin’s municipal court clerk

But over the years, the dairy industry has tacitly acknowledged its reliance on an undocumented workforce. At the federal level, it has tried unsuccessfully to gain access to an immigrant guest worker program. Closer to home, dairy farmers have become powerful allies of Voces de la Frontera in its campaign to allow undocumented immigrants to get driver’s licenses.

Almost a dozen dairy farmers across Wisconsin told ProPublica they wish their workers could get licenses.

In one sense, their motivation is economic. Many farmers say they would like to ensure their employees can get to and from work without police stopping and ticketing them. Several described the calls they’ve received in the middle of the night from workers who needed a ride after they got locked up. “If they throw them in jail, they’re no good to us,” said one farmer in western Wisconsin.

Farmers said they are also motivated by empathy.

“It’s basically a human need issue,” said Randy Roecker, a third-generation dairy farmer who runs a 275-cow operation in Sauk County, in central Wisconsin. “They need to be able to drive to go get groceries, the bank, the doctor, but yet they feel they can’t because they’re afraid they’re gonna get picked up all the time.”

Randy Roecker watches as his dairy cows are taken to the milking parlor. (Caleb Santiago Alvarado for ProPublica)

Like many other farmers, Roecker and his family decided to build employee housing when they expanded their operation and hired their first immigrant workers in 2006.

That was the year Wisconsin lawmakers banned access to driver’s licenses for undocumented immigrants. Some dairy workers who were in the state at the time still keep their expired licenses in their wallets in the hope that the old documents may help them avoid tickets in traffic stops.

The change in the law was a response to the federal REAL ID Act — a post-9/11 law sponsored by then-U.S. Rep. James Sensenbrenner, a Wisconsin Republican — which standardized the type of identification that could be used to board planes and enter federal buildings. To comply, Wisconsin and other states began to require proof of U.S. citizenship or other legal status to obtain licenses.

From the beginning it was clear the law would hurt undocumented immigrants living in states that let them drive. For some lawmakers, like Sensenbrenner, this was a good thing; he told reporters at the time that Wisconsin had become a “mecca for illegal aliens” seeking driver’s licenses.

Latino lawmakers and advocates said banning these immigrants from driving would cause more problems than it would solve. Bernard Trujillo, then a law professor at the University of Wisconsin at Madison, told The Capital Times that if Wisconsin denied immigrants driver’s licenses, “they will just drive without it.”

“This is the ‘If I close my eyes, I’ll make them go away’ approach to treating the undocumented, which is ineffective as a policy matter,” he added.

(Caleb Santiago Alvarado for ProPublica)

On a frigid evening in February 2021, John Rosenow stood outside his dairy farm in Cochrane, in western Wisconsin, and watched as a longtime employee got pulled over on his way into work.

A Buffalo County sheriff’s deputy had been parked in front of the farm observing traffic on a stretch of county road where the speed limit is 35 mph. The deputy noted later that he saw a car moving at a “slow rate of speed,” then ran the license plate. The records check showed that the car’s owner didn’t have a license, so the deputy pulled it over.

Despite a language barrier, the worker was able to tell the deputy he didn’t have a driver’s license but showed his Mexican identification card. The deputy told him that he’d be getting a ticket in the mail and warned him not to drive without a license.

Because it was the worker’s second citation in three years, he was charged with a misdemeanor in Buffalo County Circuit Court.

To Rosenow, the traffic stop looked like racial profiling. He wrote a letter to the judge in the case.

“Certainly, the court can understand how important Juan and other Mexicans are to the agricultural and food processing industries in our area,” Rosenow wrote. “Harassment by the Sheriff’s department does not help make our community any safer.”

That argument didn’t sway the judge. The worker, who has since returned to Mexico to be with his family, pleaded guilty and paid $443 for the ticket and mandatory court costs — including a DNA test, a requirement in criminal cases. The total amount was equivalent to about five days’ take-home pay.

In a statement, Buffalo County Sheriff Mike Osmond declined to comment on the traffic stop but said he understood the concerns about potential racial profiling. But he said that his deputies “enforce traffic laws impartially, without discrimination based on race or ethnicity” and that his office is “committed to upholding the constitutional rights of all individuals, regardless of their immigration status.”

Across Wisconsin, dozens of undocumented immigrants who have been stopped and ticketed solely for not having a license told ProPublica they believed they were the victims of racial profiling.

Among them: the 33-year-old Nicaraguan man who was pulled over after a random plate check as he drove to the grocery store in Neillsville this spring. “How did he know I didn’t have a license?” he wondered. “I hadn’t committed any infraction but got pulled over.”

In an interview, Neillsville Police Chief Jim Mankowski said he would support letting undocumented immigrants get licenses as a way to make the roads safer and to help officers more quickly and accurately identify people they encounter.

“How did he know I didn’t have a license? I hadn’t committed any infraction but got pulled over.”

—A Nicaraguan man who was pulled over after a random plate check

But he said random plate checks can help officers discover violations that are tied to the registered owner of a vehicle, from suspended or revoked licenses to outstanding arrest warrants. He said officers should have a reasonable suspicion that the person driving a vehicle is its owner; for example, if a plate check determines the owner is a man who doesn’t have a license, it wouldn’t make sense to pull the vehicle over if a woman is driving.

He added, “If it’s a tool that can help my cops do their job better, that’s something that we have to embrace.”

Records from law enforcement and court cases across the state show that, in many communities, sheriff’s deputies and police officers routinely run the license plates of passing vehicles — regardless of the racial or ethnic background of the driver — and pull people over if they discover a violation. But the issue of not having a license hits Hispanic drivers the most.

One of the underlying factors is the contradiction in state policy that allows undocumented immigrants to register their cars but not drive them.

“They put a bullseye on them,” said Tony Gonzalez, an immigration rights advocate in north-central Wisconsin. “The state collects the money on registration and there is no benefit for that registrant. It’s like taxation without representation.”

A spokesperson for the state transportation department said the agency “implements the laws as written.” The spokesperson could not say how many vehicles are registered to people who do not have driver’s licenses.

Getting pulled over after a random license plate check by police is so common that many undocumented immigrants have turned to a black market for protection: Several people who spoke with ProPublica described paying someone with a license to register a vehicle under their name to help avoid getting pulled over. One man, a home construction contractor in a Milwaukee suburb, said that once he started registering his car under his company’s name instead of his own, he stopped getting pulled over and ticketed for not having a license.

Similarly, a dairy worker in Jefferson County, in southern Wisconsin, said he felt “like an ATM” for police after paying thousands of dollars over the past few years in fines and court costs resulting from not having a license. Then, he said, he heard of someone in another community who, for a price, would register his car under their name.

It has been worth the money, the worker said. He hasn’t been pulled over since.

Help ProPublica Journalists Investigate the Dairy Industry

Alex Mierjeski and Jeff Frankl contributed research.

by Anjeanette Damon and Byard Duncan

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

As soon as Lisa Casteel learned her 78-year-old mother had agreed to sell her Kansas City home to a “We Buy Ugly Houses” franchise for far below its market value, she contacted the buyer to halt the deal.

In her letter to the company, she invoked a Kansas state law that grants three days to cancel certain sales agreements. She believed it would protect her mother and any other vulnerable homeowners entangled by questionable real estate deals. Her mother had no other place to live and had recently been showing signs of dementia, she said.

But the representative of the franchise, Red Rock REI, refused.

The experience more than three years ago revealed a glaring hole in regulations meant to protect people from unfair and deceptive practices. Even though HomeVestors franchises are in the business of buying properties, they use many of the same methods found in high pressure sales. In Kansas and many other states, laws that require a grace period for getting out of such sales contracts don’t apply to real estate transactions. Neither does a federal law aimed at protecting people from predatory sales practices.

Only after the Kansas Attorney General’s Office intervened at Casteel’s request was her mom able to keep her home. The attorney general ultimately demanded that Red Rock REI release Casteel’s mother from the contract by relying on state laws that protect the elderly from deceptive practices. And while Casteel succeeded in saving her mother’s house, no other action was taken against the franchise.

“I feel bad for others out there who are getting taken advantage of,” Casteel said. “They’ve got no help. And they feel like there’s no place to turn but to go ahead and sell to Red Rock and Ugly Houses and people like that.”

Adam Hays, who owned Red Rock before selling the franchise in 2021, said his sales representative did not observe that Casteel’s mother had any cognitive issues. He said HomeVestors demanded its franchises maintain a “strict standard of integrity and honesty.”

He said his company did not easily release homeowners from contracts because that would make it difficult to stay in business. His practice was to conduct “due diligence” into a homeowner’s reason for backing out of a deal to ensure another party wasn’t interfering with the homeowner’s decision. He said when he received the letters from the attorney general’s office about Casteel’s mother, he realized she had a legitimate reason for canceling the contract.

A corporate spokesperson for HomeVestors said the company was unaware of Red Rock’s dealing with Casteel’s mother and that it is no longer a franchise. HomeVestors recently prohibited some of the tactics Red Rock used to tie homeowners to contracts.

An investigation this year by ProPublica found some HomeVestors of America franchises used deception and aggressive sales tactics to persuade homeowners in vulnerable situations to sell their homes for far below market prices. The investigation also found few jurisdictions have laws or regulations to protect homeowners from aggressive tactics that fall short of outright fraud or elder abuse.

There have, however, been a few attempts by policymakers to protect vulnerable homeowners. A first-of-its-kind law in Philadelphia regulates real estate investors that participate in wholesaling properties — meaning they buy houses and resell them without making improvements or sell purchase contracts signed by the homeowner to another investor.

“A high pressure sales technique isn’t new, and we’ve been trying to protect people against it in all sorts of areas for years,” said Kate Dugan, staff attorney at Community Legal Services in Philadelphia, which worked on the law.

The law attempts to address a flaw in most consumer protection laws: Because homeowners are being pressured to sell rather than to buy something, the laws don’t cover them as consumers.

“The harm is the same, though: Parties with unequal bargaining power are engaging in a transaction, and the less sophisticated party loses,” Dugan said.

Oklahoma recently became one of a few jurisdictions to require licenses for residential real estate wholesalers. Unethical behavior can put wholesalers’ licenses at risk.

“When you don’t have reasonable guidelines, or restrictions or regulations in place to protect very minimum standards of abuse, then you’re going to open up the door for rampant abuse, like we’re seeing right now,” said Grant Cody, executive director of the Oklahoma Real Estate Commission.

ProPublica spoke to experts, including advocates for homeowners, real estate lawyers, a regulator and an individual in the business of flipping houses, about policies that could better protect homeowners. Here are their suggestions for regulations policymakers could consider.

A Cooling-Off Period

Casteel was quick to answer when asked what policymakers could do to help people like her mother.

“There should be at least a cooling-off period,” she said. “And I don’t think three days is enough. Because for seniors who fall victim to this, they may not mention it to a family member within the first couple of days.”

Advocates for stronger homeowner protections agree the law should provide an efficient way to cancel a signed real estate contract within a set period under certain circumstances. Or, as an alternative, policymakers could adopt something similar to Philadelphia’s requirement that wholesalers give a homeowner three days to consider a contract before it’s signed.

Cooling-off periods are common in other transactions that involve high pressure sales or large assets. Many states, for example, have a right of rescission in timeshare sales, and a cooling-off period is built into many annuity purchases.

In particular, homeowners who have never publicly listed their houses for sale should be allowed a quick way out of a contract, said Sarah Bolling Mancini, co-director of advocacy at the National Consumer Law Center. Public listings attract competing offers and can better determine fair market value. Such a regulation would also protect homeowners from cash buyers who solicit sales.

Casteel said she’d also require that cash house buyers leave a copy of the contract with the homeowner along with the paperwork necessary to cancel it.

Asked by ProPublica whether HomeVestors would support such a regulation, a corporate spokesperson said the company is implementing a 72-hour cooling-off period requirement for its franchises.

“We require our franchisees to comply with our Systems and Standards, which generally go above and beyond state regulations, and we regularly update our standards to ensure our franchisees do the right thing and act to protect consumers,” she said.

Penalties for Persistent Solicitation

HomeVestors and its franchises spend heavily on advertising — peppering neighborhoods with billboards and sending postcards to thousands of addresses at a time, promising quick cash and a painless sale process. Other homebuyers call and text endlessly.

Many homeowners view these aggressive, ground-level marketing strategies as a nuisance. And in some cities, policymakers have taken steps to curb them.

In Houston, residents can report illegally placed “bandit signs” to the city’s Department of Neighborhoods. Violators there can face up to $500 in fines, lawsuits and even arrest. Following reporting from WABE, the Atlanta City Council in 2020 prohibited real estate investors from “repeated and unsolicited attempts” to contact a homeowner after being asked to stop. Such overtures now amount to a form of “commercial harassment.” Violators can face fines or up to six months in jail.

And Philadelphia’s “do-not-solicit” list, launched last year, allows residents to opt out of in-person sales pitches, emails, phone calls and mailers. Offenders face up to $2,000 in fines. The city can ask a judge to assess larger fines on repeat offenders.

Restrictions on Recording Claims on a Property Title

ProPublica’s investigation found some HomeVestors franchises routinely recorded documents against a homeowner’s title to trap them in a deal — a predatory practice known as “title clouding.” In response to ProPublica’s reporting, HomeVestors prohibited its franchises from clouding titles. But other cash homebuyers still do it.

Dugan said policymakers should consider restrictions on title clouding, including a waiting period between signing a contract and recording it and an easy way for a homeowner to contest the recording.

Many jurisdictions, including Philadelphia, allow homeowners to sign up to be notified when any document has been recorded against their title.

In many cases, months pass before homeowners learn that a contract had been recorded against the title. Sometimes the homeowner has died and their family must pay the house flipper to release the claim.

For example, six months passed before Casteel learned that Red Rock REI had recorded the sales contract against her mother’s title. When the Kansas Attorney General’s Office pressed Red Rock to remove the recording, the franchise owner tried to justify the action.

In an email to the attorney general’s office, the franchise owner said he recorded the contract to protect his interest in the property in the event Casteel’s mother “was being dishonest” and tried to sell the house to someone else.

Red Rock didn’t remove the recording until the attorney general’s office issued multiple warnings.

“It might discourage this predatory behavior if the bad actor knows that the homeowner will get notice immediately,” Dugan said.

Requiring a License

A professional license, such as those required for real estate agents, isn’t a guarantee against unethical behavior. But experts said licensing could require a basic education so that wholesalers know such things as real estate laws, what should be included in a contract and what disclosures homeowners are entitled to. A licensing board could investigate homeowner complaints.

Philadelphia’s licensing of residential real estate wholesalers has provided transparency into who is wholesaling, Dugan said. The law also allows homeowners to cancel contracts at any time before closing if they’ve sold to an unlicensed wholesaler, which is a strong incentive for wholesalers to become licensed.

Kevin Link, a former Financial Industry Regulatory Authority investigator who co-owns a house-flipping business in Maryland, said he would welcome more regulation of the industry to weed out bad actors and ensure that those in the business have a minimum level of real estate education.

“Right now, the only regulations in place are those that govern white-collar crime,” he said.

HomeVestors’ corporate spokesperson said the company isn’t opposed to requiring wholesaler licenses.

“We look forward to exploring this, as well as other constructive ideas, on how we can best protect consumers within our industry,” she said.

A Need for Federal Regulations?

Real estate regulation is largely the domain of cities, counties and states, creating a patchwork of policies and varying degrees of oversight and transparency. Because many regulatory bodies can only investigate licensed real estate activity, wholesalers often operate without the same guardrails as real estate agents.

Federal regulations to standardize local oversight, similar to the Secure and Fair Enforcement for Mortgage Licensing Act passed 15 years ago in the wake of the financial crisis, could help. The SAFE Act, which passed in 2008 after the explosion in predatory mortgage practices helped inflate a housing bubble and spark that year’s financial crisis, requires minimum local licensing standards for mortgage originators.

“I think a federal statute could be very helpful and meaningful,” Mancini said.

Rather than leaving it to states to enact a regulatory model, however, Mancini said federal rules could be applied to “we buy houses” transactions, such as by allowing a homeowner to cancel a sale if they have never publicly listed the home or obtained an appraisal, didn’t have a real estate agent or were directly solicited to sell the house.

She said states could also follow Maryland’s lead and ensure their unfair and deceptive acts and practices laws explicitly apply to real estate purchases in which high pressure sales tactics are used or a homeowner has been misled about the value or marketability of their house.

Mollie Simon contributed research.

by Cassandra Jaramillo

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

Update, Aug. 9, 2023: Ohio voters rejected Issue 1 in a special election on Aug. 8, according to The Associated Press. The proposal would have raised the threshold to pass constitutional amendments in Ohio, including the upcoming abortion rights measure on the ballot in November.

In her eight years as a pediatrician, Dr. Lauren Beene had always stayed out of politics. What happened at the Statehouse had little to do with the children she treated in her Cleveland practice. But after the Supreme Court struck down abortion protections, that all changed.

The first Monday after the Dobbs v. Jackson Women’s Health Organization ruling was emotional. Beene fielded a call from the mother of a 13-year-old patient. The mother was worried her child might need birth control in case she was the victim of a sexual assault. Beene also talked to a 16-year-old patient unsure about whether to continue her pregnancy. Time wasn’t on her side, Beene told the girl.

“What if it were too late to get her an abortion? What would they do? And I just, I felt sick to my stomach,” Beene said. “Nobody had ever asked me a question like that before.”

Beene felt she had to do something. She drafted a letter to a state lawmaker about the dangers of abortion bans, then another doctor reached out with an idea to get dozens of doctors to sign on. The effort took off. About 1,000 doctors signed that letter, and they later published it as a full-page ad in The Columbus Dispatch.

Beene felt momentum building within the medical community and decided to help use that energy to form the Ohio Physicians for Reproductive Rights coalition. Now, Beene and the coalition are working to pass a citizen-led amendment to enshrine reproductive rights into the state constitution. The state’s six-week ban on abortion was blocked by a judge in October 2022.

The group is a part of an emerging political force: doctors on the front lines of the reproductive rights debate. In many states, the fight to protect reproductive rights is heating up as 14 states have outlawed abortion. Doctors who previously never mixed work with politics are jumping into the abortion debate by lobbying state lawmakers, campaigning, forming political action committees and trying to get reproductive rights protected by state law.

In Texas, at a two-day court hearing earlier this month , women who were denied abortion care testified they were harmed by the state’s abortion ban. Two Texas doctors, who are plaintiffs, took the stand to testify about the chilling effect they say the laws have had on them. Dr. Damla Karsan, a Houston obstetrician, said she had never testified in a court case before but felt compelled to participate in this one to advocate for her patients and colleagues.

“I feel like I’m being handicapped,” Karsan said, referring to the Texas abortion law. “I’m looking for clarity, a promise that I will not be persecuted for providing care with informed consent from patients that someone interprets is not worthy of the medical exception” that would permit a legal abortion.

Although doctors’ groups have formed on both sides of the issue, most of these groups oppose abortion bans, largely because doctors worry that abortion bans could put their patients’ health at risk. Doctors now find themselves risking criminal and civil penalties in some states if they act to help patients who are suffering.

The Ohio coalition, along with its partners, gathered signatures for months in order to put the proposed constitutional amendment on the November ballot. The group filed more than 700,000 signatures on its petition, nearly twice the minimum number needed. The amendment’s language would protect several aspects of reproductive medical care, not just abortion: misscarriage care, contraception and in vitro fertilization.

“We see all those areas being negatively impacted by the Dobbs decision,” Beene said. “So we felt that by establishing that fundamental right to reproductive freedom, we would be able to protect all of those issues.”

In Nebraska, doctors formed the Campaign for a Healthy Nebraska PAC, which raised money to target key races, according to the Flatwater Free Press. The group also worked to get the Nebraska Medical Association to publicly oppose abortion restrictions, the news organization reported.

The Good Trouble Coalition in Indiana also mobilized medical professionals to work with legislators on abortion laws.

States including Michigan and Vermont have also used citizen-led ballot initiatives to get reproductive protections included in their constitutions, efforts that were supported by voters. In Michigan, doctors created a committee to help campaign for the proposal. Beene said the Ohio coalition modeled its strategy on Michigan’s approach.

In at least one state, doctors have rallied for a measure that would have limited abortion access.

In Kansas, a coalition of 200 physicians, nurses and pharmacists publicly supported an amendment to remove the right to an abortion from the state constitution, according to the Kansas Reflector. Voters ultimately rejected the amendment, with 59% voting against the initiative.

Mary Ziegler, an abortion historian and a law professor at the University of California, Davis, said medical associations have been involved in the abortion debate before, but the organizing efforts are broader this time, with several doctors’ groups throwing their support behind ballot initiatives that protect reproductive rights and draw widespread public support.

“It’s not a trivial thing that it’s a ballot initiative, because one of the other things we’ve seen is that voters are with them,” Ziegler said. “Doctors who are afraid of alienating potential patients or colleagues are realizing that bans are not popular with most people. So the risk may be lower than people thought of taking a stand.”

Beene prepared for backlash when she and other Ohio physicians came out against abortion bans. But she didn’t expect that lawmakers would try to change the rules needed to pass a citizen-led amendment just months after the coalition started to collect signatures.

Lawmakers in May passed a controversial resolution to raise the threshold needed for an amendment to pass from a simple majority to 60%. Voters will decide whether to adopt the proposal, known as Issue 1, in an Aug. 8 special election.

The Republican-controlled Ohio legislature passed a law last year banning special elections, citing their low turnout and high costs, but state lawmakers scheduled this August’s election despite the ban. Republicans have signaled that this vote on Issue 1 was aimed at blocking the reproductive rights amendment.

Jen Miller, executive director of the League of Women Voters of Ohio, a nonpartisan voting rights organization, said the group is against Issue 1 because it would overturn more than 100 years of precedent in the state for how citizen-initiated amendments are passed.

“What they’re trying to do is to trick voters into voting our own rights away in a low-turnout August election,” Miller said. “Even voters who never miss an election are unaware that there is an August special election.”

It’s possible that only a single-digit sliver of the population will vote —  records from the Ohio secretary of state’s office show the 2022 August primary election had 8% voter turnout.

If Issue 1 is adopted, the reproductive-rights amendment would require approval from 60% of voters to pass in November, which Beene said she believes is what lawmakers want.

“They’ve sunk to tremendous lows and they’re doing everything they can to try to stop us,” Beene said.

Are You in a State That Banned Abortion? Tell Us How Changes in Medical Care Impact You.

by Jennifer Berry Hawes, photography by Gavin McIntyre for ProPublica

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

In his younger days as a carriage driver, Tony Youmans would strike a rapport with customers, nearly all of them white, as he prepared to show them around downtown Charleston, South Carolina. Youmans knew that long-whitewashed racial history lurked everywhere — beneath every cobblestone, every courtyard garden, the hooves of every draft horse he steered past the finely preserved antebellum structures.

Sign up for Dispatches, a ProPublica newsletter about wrongdoing in America.

But if he mentioned slavery or pointed out enslaved people’s quarters, “a couple would cringe and roll their eyes, so you quickly went back to the moonlight and magnolias.”

Today, he is part of a movement to tell a more complete story of the city. After 40 years in its booming tourism industry, he is seeing a huge shift in visitors’ reactions, from denialism to curiosity.

“African American tourism right now is red hot, especially in the South,” Youmans said. He sees this up close as manager of the Old Slave Mart Museum and director of the Old Exchange and Provost Dungeon, two key historic sites. “People are hungry for this information,” he said, “and they come to Charleston specifically looking for it.”

Elijah Green, a formerly enslaved man, sits in front of the Old Slave Mart in Charleston, South Carolina. Green once told an interviewer that the mart’s owner was “very cruel” and that “seldom one of his slaves survive a whipping.” (The Photography Collections, University of Maryland, Baltimore County)

For generations, Charleston has been better known for its wartime history and physical beauty than the horrific institution that built it. But new interest from visitors, historians and armchair detectives alike is helping to unearth details of the painful past of this coastal city where about 40% of captive Africans arrived into American chattel slavery. Just last month, ProPublica reported how a graduate student discovered an 1835 newspaper advertisement for an auction of 600 people at the Exchange — marking the largest known slave sale in U.S. history. It had gone unrecognized as such for nearly two centuries.

Multiple companies now offer tours of Charleston emphasizing Black history and culture. Plantations that once described enslaved laborers as “servants” and “workers” hold Juneteenth commemorations. The City Council apologized for the city’s role in slavery. And an expansive new museum opened in June to tell the African American story at a wharf where thousands of captives once arrived to be sold.

Yet, as that redress gains potency, tensions are flaring. Republicans increasingly frame demands for a frank accounting of slave history as the exploitation of a bygone past to push “woke” agendas.

South Carolina’s GOP-controlled legislature enacted a measure similar to hundreds nationwide, concentrated in former slave states, that restrict teaching related to race. Since 2021, a budget provision has forbidden state education funds from being used to teach that any student “bears responsibility for actions committed in the past by other members of the same race” or that someone should feel “discomfort, guilt or anguish” due to race.

As a result, one school district near the state capital faced a lawsuit, and a student in a nearby district challenged a lesson about systemic racism. But it remains to be seen how the restrictions will impact racial reckoning in Charleston, an old city where buildings stand atop slave burial grounds and countless stories remain hidden.

The Concrete Story

Tonya Matthews is ushering this once-ignored history out onto an enormous stage.

After 23 years of plowing through the indifference and denial that once permeated Charleston, the International African American Museum opened in late June. It stands at a downtown wharf where ships delivered an estimated 30,000 captives to sell.

It is hard to overstate the mammoth feat of raising $125 million to build a museum to share the African American experience in a city that a generation ago scarcely acknowledged the realities of slavery at all. Matthews, the museum’s president and CEO, often hears: “I never thought this would happen.”

The International African American Museum opened in late June. It sits on the former site of Gadsden’s Wharf, where all Charleston-bound slave ships were received during the final 22 months of the legal transatlantic slave trade in the United States. (Sean Rayford/Getty Images)

Fresh off huge buzz around the museum’s opening, Matthews said she was more focused on telling that story than tracking the state’s political headwinds, which she called “a lot of noise at the top.” She doesn’t expect it to affect what the private museum teaches, nor does she hear much about it from people on the ground — the teachers and other visitors she called the “curious folks.”

But it’s impossible to ignore for both white and Black Americans trying to grapple with the country’s original sin, whether they are descendants of enslaved people or those who enslaved them.

“It’s all a very, very personal journey, which is why the noise is so threatening and striking and discouraging to everyone,” she said. “Because when we hear it, we take it in personally.”

Along with nine galleries and various traveling exhibitions, the museum also offers the Center for Family History to bridge gulfs in African American genealogy. That requires help from white families whose records often are the only ones that exist about Black people’s enslaved ancestors. The museum aims to provide a safe space for that exchange.

“One side is simply asking for the authentic story,” Matthews said. “And the other side is asking not to be judged.”

Old Story, New Audience

Christine King Mitchell is pushing Charleston’s slave history from obscurity to prominence at a small, city-owned museum tucked off a cobblestone road.

On a recent morning, she stood with her back to a row of windows that look out over what once was a four-story brick fortress, a barracoon called the “jail” where enslaved people for sale were housed. The complex included a “dead house,” a morgue. Today, the site is a private parking lot.

Mitchell works at the Old Slave Mart Museum, where many auctions moved after the city banned them at the Exchange and surrounding streets in 1856. From the dimly lit second floor, she tells an unvarnished story of slavery here and across Charleston. Record numbers of people are coming to hear it.

Christine King Mitchell shares the history of South Carolina’s slave trade with students and other visitors at the Old Slave Mart Museum in Charleston.

She began working at the Slave Mart a decade ago — and annual visitors have skyrocketed since, from about 30,000 to more than 80,000 last year. They now narrowly surpass visitors to the Exchange, one of the most historic colonial public buildings in the country.

Mitchell’s first audience of the day was a class from a private school in Greenville, a city three hours away in upper South Carolina. They listened with quiet intensity as she explained how slavery infused every vein of the city’s economy.

“You’re talking insurance companies making money, the shipbuilding industry making money…”

A big screen beside her projected an 1856 document titled: SLAVE POLICY. In it, Aetna Life Insurance Co. had insured a 24-year-old enslaved woman named Sebina for $600. “This city was built on the backs of Black people,” Mitchell said. “You can start to understand the tentacles.”

Mitchell informs visitors about the business of slavery during a presentation at the Old Slave Mart Museum. First image: Visitors stop to examine panels containing historical information on slavery at the Old Slave Mart Museum. Second image: Shackles used to bind enslaved people during transport are on display at the museum.

When she first read the policy about five years ago, she cried. For white people, slavery might seem distant. But to her, it feels very near. She remembers her first freeborn grandfather, “and I’m not 100 years old yet.” Now 67, she grew up in the 1960s picking cotton with her mother.

This history plays forward today. Mitchell, who wrote a new book, “The Business of Slavery,” noted the generational wealth gap that persists between Black and white people. The education disparities. The Black women paid 52 cents for every $1 a white man is paid in South Carolina.

After the class left, while waiting for the next one to file in, she explained the importance of her work. “If you understand the past, you understand the present.” She pointed an index finger and moved it in a circular motion toward the museum’s display panels, the chains under glass, the bricks in the walls with enslaved people’s fingerprints still pressed into them.

“It’s all of this.”

Unearthing Buried Stories

Lauren Davila is using archival research to unearth lost stories in what once was the heart of the local slave-trading district — although you’d hardly know it traversing the streetscape today.

Davila was a College of Charleston graduate history student when she began compiling a digital map of businesses connected to the slave trade around Broad Street, one of the city’s most iconic stretches. Rows of mostly two- and three-story buildings, many of them predating the Civil War, line the street. Wrought iron and columns adorn the structures, which today house law firms, restaurants and banks — with little indication of what they were once used for.

Lauren Davila, photographed behind the Old Exchange and Provost Dungeon, discovered a newspaper ad that promoted the sale of 600 people while conducting research as a graduate student at the College of Charleston.

Only two buildings overtly acknowledge their histories despite the concentration of horrors that happened in the vicinity. “Charleston is really doing a disservice to locals, tourists and Black people as a whole by not acknowledging it,” said Davila, now an adjunct at the College of Charleston.

While searching Charleson newspaper archives last year for an especially prolific slave-trading firm, Davila paused at one of its advertisements. Published in 1835, the ad informed readers of the upcoming sale of 600 enslaved people. She had discovered the largest known slave auction in American history, a finding first reported by ProPublica in June.

The sale was held at the Exchange, a grand 1771 structure at the head of Broad Street. One of the two historical markers on the street that mention slavery stands outside the building, where city leaders once entertained George Washington. Installed in 2016, the marker describes how public auctions of enslaved people were held there.

The other marker, added in 2021, hangs on a bank building a block down that once housed a slave trader’s office. Margaret Seidler was researching her family tree when she discovered a notorious slave trader among her ancestors and then hired a deeds researcher who pinpointed the building as his former office.

Seidler, a white Charlestonian who funded some of Davila’s research training, has since been tracking down descendents of slave traders. Many she approached have cried when she presented evidence of their ancestors’ actions. Some privately thanked her.

Fewer are willing to publicly acknowledge it. Others won’t at all. They don’t see the point. One white descendant told her that slavery was unfortunate but is getting too much emphasis today. All the discussion did, he added, was give people ideas about reparations.

But another recently agreed to publicly acknowledge a prominent trader among her ancestors as a way to “recognize the importance of this truth being known and told as part of the history of Charleston.”

And soon, there could be a third marker a few doors down from the office of Seidler’s ancestor. Davila traced the building that once housed the firm that organized the sale of 600 people to 24 Broad St.

Since 1989, Stephen Schmutz has owned the building, an elegant salmon-colored structure where he has spent a long career practicing law. A large framed portrait of Martin Luther King Jr. hangs near his desk, a gift from the Racial Justice Network for his work. He also represented three families whose loved ones were among nine Black people murdered by a white supremacist in 2015 inside Emanuel AME Church, just a mile away.

Schmutz’s building stands close enough to the Exchange that someone standing outside might have heard wailing from enslaved families torn apart. When ProPublica told him that his building once housed a notorious slave-trading firm, he was stunned.

“It has been a lot of things,” he said. “But I didn’t know it had been one of those things.”

Davila has asked him to meet and discuss putting a marker outside his building; he told ProPublica he wouldn’t object.

Changing the Narrative

Harold Singletary joined thousands of others celebrating the International African American Museum’s opening last month. Shortly after, he read ProPublica’s story about the sale of 600 people — and learned that several of his ancestors were among those sold.

They included the mother and grandparents of a woman Singletary so reveres that he named his business, BrightMa Farms, after her. It operates in part on the same 10-acre plot she farmed after the Civil War freed her.

He quickly realized that the farm’s corporate office sits barely a four-minute stroll from the Exchange, where his ancestors stood before potential buyers. He used to work for a developer on Broad Street near the building that housed the firm that sold them. It all felt very surreal.

Harold Singletary recently discovered that some of his ancestors were sold as part of the 600-person sale in Charleston, which took place not far from the corporate office of his business, BrightMa Farms.

He supports efforts by Davila and Seidler to put a marker outside so that others who walk by learn the story. “It’s connecting dots. It’s these conversations that never were had,” he said. “We are still in a position of changing the narrative.”

For him, teaching history isn’t an esoteric examination of dates and events. Everywhere he goes in Charleston, the past feels very near. As white lawmakers work to protect students from feeling discomfort while learning about their state’s racial legacy, Singletary wants them to consider how he experiences it. He wants them to know the pain he, and his children, feel walking past the place where their ancestors were sold or the building where the white men who orchestrated it grew rich.

Correction

July 31, 2023: This story originally misstated a street number. Several residents want to put an historical marker at 24 Broad St. There already is one at 34 Broad St.

by Jeremy Schwartz

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

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

Two months after Texas lawmakers stripped millions of dollars from a company that supplies child identification kits, a bill to fund a similar program in Pennsylvania is facing key opposition.

In March, two Pennsylvania senators filed legislation that called for purchasing and distributing child identification kits for all of the state’s first graders. The kits, which would cost the state about $350,000, needed to use “inkless” fingerprinting technology, according to the bill.

Such a provision would provide an advantage to one vendor: the National Child Identification Program, a Waco, Texas, company run by former NFL player Kenny Hansmire, who has a track record of failed businesses and has been disciplined by Connecticut banking regulators.

On May 2, the bill sailed through the Senate Education Committee on a unanimous vote, a key step that was celebrated by the company’s representatives and the legislation’s authors. During a press conference that day, Hansmire turned to a common phrase he uses to promote the kits, calling the bill a “gift of safety” and urging the lawmakers to support the measure.

“We’re asking the state of Pennsylvania to step up, the Senate and the House to step up,” he said.

A week later, ProPublica and The Texas Tribune published an investigation that found no evidence that the kits had ever been used to find a missing child and that the company had used exaggerated statistics as it sought to secure government dollars across the country.

After the investigation was published, Texas lawmakers — who had approved legislation in 2021 that delivered nearly $6 million to the company — zeroed out future funding for the effort.

Pennsylvania lawmakers also began taking a closer look at the company. The bill’s authors removed the requirement that kits be “inkless,” and the measure passed the full Senate last month with a 34-15 vote. Now the bill is awaiting a hearing in the House Education Committee. But the chair of that committee told the news organizations that he has no plans to bring the legislation forward for a vote.

Jason Thompson, a spokesperson for bill sponsors Sens. Scott Martin and Camera Bartolotta, both Republicans, said the removal of the provision that required the kits to be “inkless” would allow a wider pool of potential vendors to seek a state contract. Hansmire has claimed that his company’s inkless technology makes its kits superior.

“Understanding the clear value of providing these kits to young people, Senator Bartolotta and Senator Martin amended their bill to provide additional flexibility to ensure whatever kits are distributed to students meet the needs of Pennsylvania families, law enforcement and taxpayers,” Thompson said.

But that change was not enough to persuade multiple state lawmakers who questioned the use of taxpayer funding to pay for the kits, including Rep. Peter Schweyer, chair of the House Education Committee.

“This just never seemed like it was all that well thought out,” Schweyer, a Democrat, said, adding that addressing school violence and mental health are more urgent priorities. “I’d rather hire a couple more cops or spend money on a couple more psychologists in our most at-risk schools.”

Two Democratic senators offered similar concerns.

Sen. Maria Collett said she was worried that the legislation, as originally proposed, appeared to benefit a single vendor. She noted that several nonprofits in the state already provide child ID kits for free to parents who want them.

“To ask the taxpayers of Pennsylvania to invest hundreds of thousands of dollars, year over year, to a private vendor for a product that we have no data showing the efficacy of is unconscionable, in my opinion,” she said.

Sen. Nikil Saval said the news organizations’ investigation raised concerns among lawmakers.

“A number of us, initially, were supportive of the effort,” Saval said. “Frankly, the reporting gave a number of us pause.”

Beyond questions of the kits’ effectiveness, the news outlets’ investigation found Hansmire had a string of failed businesses, had millions of dollars in outstanding federal tax liens and had previously been barred from some finance-related business in Connecticut by banking regulators because of his role in an alleged scheme to defraud or mislead investors.

Hansmire, who did not respond to emailed questions for this article, has said the kits help law enforcement find missing children and save time during the early stages of a search. But none of the law enforcement agencies contacted by the news outlets could recall the kits having assisted in finding a missing child.

Hansmire also previously said that his legal disputes, including his sanction in Connecticut, had been “properly resolved, closed and are completely unrelated to the National Child ID Program.” He claimed to have “paid debts entirely” but did not provide details.

The Pennsylvania House Education Committee is scheduled to reconvene in late September, following the Legislature’s summer break.

If the committee takes no action, another legislative avenue called a “code bill” could potentially provide funding for the kits, but Schweyer said he isn’t aware of a push for such a move.

“It doesn’t feel like there’s a lot of momentum for it here,” he said. Schweyer added: “For now, it’s a dead issue in Pennsylvania.”

by Duaa Eldeib

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

Members of Congress on Thursday introduced sweeping legislation that aims to reduce the country’s stillbirth rate, tackling gaps in research, data and awareness as well as authorizing tens of millions of dollars in new funding.

If passed, the Stillbirth Health Improvement and Education (SHINE) for Autumn Act of 2023 would be the most comprehensive federal stillbirth law on record. Rep. Young Kim, R-Calif., who introduced the bill in the House, called it “the first step in the right direction” to help prevent stillbirths and ensure healthy pregnancies.

As a mother, grandmother and co-chair of the Maternity Care Caucus, Kim said she understands the challenges firsthand. She said that when one of her daughters lost a baby a few years ago, the doctor’s response was, “It happens.”

“These experiences have made me want to be a part of the solution,” she said. “I want us to have more information and make sure things are better for my grandkids. We should be able to prevent the preventable.”

Every year in the U.S., more than 20,000 pregnancies end in stillbirth, the death of an expected child at 20 weeks or more. Research shows as many as 1 in 4 stillbirths may be preventable, a figure that jumps to nearly half as the due date nears. But for years, the U.S. stillbirth crisis has been overlooked.

ProPublica has reported extensively on the devastating effects of stillbirth on families and the country’s failure to prevent, prioritize and raise awareness around stillbirth. Stark racial disparities underscore the crisis, as Black women are more than twice as likely to have a stillbirth as white women. But government officials, doctors and researchers often cite the dearth of research, data and autopsies as barriers to change.

Kim and other lawmakers lauded ProPublica’s reporting for bringing the stillbirth crisis to the forefront and revealing shortcomings in how the nation’s health care system was combating stillbirths.

“ProPublica’s work has been so important for shedding light on the challenges related to stillbirth, amplifying the stories of mothers and women whose voices have not been heard, and highlighting the gaps in our stillbirth-related data and where the United States stands compared to other countries,” said Kim, who was not involved in last session’s legislation.

Sen. Cory Booker, D-N.J., introduced legislation in the Senate last year with Sen. Marco Rubio, R-Fla., but it did not pass. They joined forces again to reintroduce a measure on Thursday. Booker said the growing list of bipartisan cosponsors and the relentless work of advocates makes him optimistic that it will pass this session.

“Sadly, despite staggering statistics, stillbirth remains one of the most underfunded and understudied public health issues in the United States. This legislation would provide long-overdue resources towards research and data collection,” said Booker, adding that he was “incredibly grateful” to ProPublica for raising awareness and giving a human face to the ongoing crisis, which has been “critical” to garnering support for the legislation.

The SHINE for Autumn Act is named after the daughter of New Jersey maternal health advocate Debbie Haine Vijayvergiya. Autumn Joy was stillborn 12 years ago this month.

The SHINE for Autumn Act is named for the stillborn daughter of Debbie Haine Vijayvergiya, a maternal health advocate. Her daughter, Autumn Joy, was stillborn in 2011. (Liz Moughon/ProPublica)

“This is life-saving, historic, monumental legislation,” Haine Vijayvergiya said. “I’ve been waiting and working so hard all these years, knocking on doors and screaming from rooftops trying to get someone’s attention, trying to find anyone who can help to elevate the sense of urgency around this issue.”

She teared up as she expressed gratitude to the lawmakers who listened and signed on to the legislation. She’s now turning her attention to getting the bill passed, which means a steady stream of meetings and calls.

“ProPublica has helped to shine the very brightest light,” she said. “I don't think we’d be where we are today without the help of ProPublica.”

The bill marks the second time this month that federal lawmakers have introduced stillbirth legislation. The Maternal and Child Health Stillbirth Prevention Act specifically adds stillbirth prevention to the list of federal funding programs earmarked for mothers and children.

The SHINE for Autumn Act would authorize a total of $45 million in federal funding over the next five years for the various programs. That includes building a partnership between federal and state agencies to focus on collecting better data on stillbirths and risk factors, as well as building capacity at the local level to assess and standardize that data. It also seeks to develop and make educational awareness materials publicly available. Many women interviewed by ProPublica said they didn’t know they were at risk until they delivered their stillborn baby.

In addition, the bill paves the way for a perinatal pathology fellowship program to help provide additional training for fetal autopsies. In 2020, autopsies were conducted or planned in less than 20% of stillbirths, according to data from Centers for Disease Control and Prevention, which also shows that the cause of death is not determined in about one-third of stillbirths.

Rep. Dave Joyce, R-Ohio, Rep. Kathy Castor, D-Fla., and Rep. Robin Kelly, D-Ill., are all cosponsors in the House. Kelly, who co-chairs the Maternity Care Caucus with Kim, said the federal government has a major responsibility when it comes to ensuring maternal and newborn care, and part of that includes addressing the alarming racial disparities in maternal mortality and stillbirth.

“Stillbirth is a deeply painful experience for many mothers, and another area (of) health care where Black women feel a disproportionate burden,” she said. “By shedding light on this issue and directing more resources and more awareness to supporting moms and babies, we can improve outcomes across the board.”

Key medical organizations, including the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, have also backed the legislation. Dr. Tony Sciscione, president of the Society for Maternal-Fetal Medicine, said preventing stillbirths is crucial.

“One of the most difficult things that maternal-fetal medicine subspecialists do is comfort families as they try to understand why their baby was stillborn,” he said. “For patients and clinicians, there are far too many questions and far too few answers.”

by Isabelle Taft, Mississippi Today, and Mollie Simon, ProPublica

This article contains descriptions of threats of violence and mental illness.

This article was produced for ProPublica’s Local Reporting Network in partnership with Mississippi Today. It was also co-published with Sun Herald and Northeast Mississippi Daily Journal. Sign up for Dispatches to get stories like this one as soon as they are published.

If you or someone you know needs help:

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

Nearly 40 years ago, a federal appeals court ruled that Alabama officials could not jail people in mental health crisis who were sent to the state for help. Jailing people going through the state’s civil commitment process, the court decided, amounted to punishment. And about 30 years ago, after Kentucky was labeled the worst state in the nation for jailing mentally ill people without charges, legislators there banned it.

But a new survey of counties and an analysis of jail dockets in Mississippi, which has no such law, has found that people going through the civil commitment process for mental illness are regularly jailed as they await evaluation and treatment, even when they haven’t been charged with a crime. Some counties routinely hold such people in jail — people awaiting treatment for mental illness or substance abuse were held in jail without charges at least 2,000 times from 2019 to 2022 in 19 counties alone, sometimes for days or weeks.

Nationally, Mississippi is a stark outlier. Mississippi Today and ProPublica conducted a nationwide survey of disability advocacy organizations and state agencies that oversee behavioral health. None described anything close to the scale of what’s happening in Mississippi.

Civil commitment laws are meant to ensure people get treatment even when they don’t recognize that they need it, said James Tucker, an attorney and the director of the Alabama Disabilities Advocacy Program. Locking them up as they wait for a treatment bed doesn’t fulfill that goal.

“The bargain for your lack of freedom is that the state has decided you need treatment,” he said. “The minute that order is entered, the state has a constitutional duty to deliver treatment.”

At least 12 states plus the District of Columbia prohibit jailing people undergoing commitment proceedings for mental illness unless they have been charged with a crime.

Mississippi law, however, allows people going through the civil commitment process to be sent to jail if there is “no reasonable alternative.” If there are no publicly funded beds in appropriate facilities, local officials sometimes decide they have no other option.

“We Forbid the Use of Jails”

In the 1970s, a federal class-action lawsuit against Alabama officials alleged that it was unconstitutional to jail people going through the commitment process for mental illness while they awaited hearings. It was common at the time: Probate judges in three-quarters of the state’s counties had jailed people, according to discovery findings cited in a court ruling.

Lawyers for the plaintiffs — everyone in the state who had been committed or would be in the future — cited previous lawsuits that had uncovered fire hazards, overcrowding and a dearth of mental health and routine medical care in Alabama’s county jails.

The district court ruled against the plaintiffs’ constitutional claims, reasoning that if the local jail was the only option in a county, it was the least restrictive facility that would also protect society.

"The bargain for your lack of freedom is that the state has decided you need treatment. The minute that order is entered, the state has a constitutional duty to deliver treatment." – James Tucker, director of the Alabama Disabilities Advocacy Program

But in 1984, a panel of judges on the 11th U.S. Circuit Court of Appeals rejected that reasoning. Circuit Judge Thomas Alonzo Clark wrote in his opinion that nothing prevented counties from placing people in a public facility in another county or in a local private facility that was equipped to handle mentally ill patients.

Clark cited a doctor’s testimony that jail often worsened psychosis, made it harder to treat people and increased suicidal tendencies.

“We forbid the use of jails for the purpose of detaining persons awaiting involuntary civil commitment proceedings, finding that to do so violates those persons’ substantive and procedural due process rights,” the judge wrote.

The reasons that Alabama officials provided for placing people in jail were similar to Mississippi officials’ arguments today. But Mississippi is in a different federal circuit, and the practice there has not been tested with a class-action lawsuit.

A sister of one woman who had died in a Mississippi jail in 1987 tried and failed to convince a federal judge that the woman’s rights had been violated when she was incarcerated without treatment.

Colett Boston, left, and Everlean Boston hold a photograph of their mother, Mae Evelyn Boston, in Oxford, Mississippi. When the sisters were young, their mother died in jail as she went through the civil commitment process. (Eric J. Shelton/Mississippi Today)

Mae Evelyn Boston, an Oxford woman who had dealt with paranoid schizophrenia for most of her adult life, had a psychotic episode shortly after giving birth. Her older daughter, Everlean, was 12 years old; she remembers her mother saying she was going to kill the baby because the girl “had a demon in her.”

One of Boston’s sisters initiated commitment proceedings — making Boston one of more than 100 people jailed for that reason from 1984 to 1988 in Lafayette County, according to a deposition cited in a 1990 ruling by U.S. District Judge Neal Biggers. When deputies arrived to take her mother into custody for evaluation, Everlean recalled, it took six of them to get her onto the ground before handcuffing her and placing her in the back of a cop car.

Once Boston was in jail, guards did not complete a medical screening required by department policy and didn’t know Boston had given birth via cesarean section 12 days before, Biggers wrote. She died two days later from heart failure caused by blood clots.

Everlean Boston remembers her mother smoking cigarettes and listening to the blues on quiet Sundays at home. The day deputies took her mother away was the last time she saw her. “I never got to say goodbye,” she recalled. “I never got to say I loved her. It hurts.”

“I never got to say goodbye. I never got to say I loved her. It hurts.” – Everlean Boston, whose mother, Mae Evelyn Boston, died in jail as she went through the civil commitment process

Biggers concluded that the “medical care customarily provided by the county for mentally ill detainees does not fall below constitutional standards” and that what happened with Boston represented a “scheduling error” and an “isolated instance.” The county, which argued it had provided adequate care for Boston, had the right to detain people like her “in the interest of societal safety,” he found, and those people were not entitled to placement in the “least restrictive alternative” such as a hospital. Biggers considered the Alabama appeals court ruling from a few years earlier, but concluded it didn’t apply because it was based on specific facts about that state’s jails.

“The court declines to hold that use of jails for temporary detention of persons awaiting civil commitment proceedings is unconstitutional per se,” Biggers ruled.

Since then, at least nine lawsuits have been filed over the deaths of Mississippians incarcerated during civil commitment proceedings. None of those lawsuits directly challenged the constitutionality of being jailed during the commitment process. The U.S. Supreme Court has not ruled on the matter, academics and attorneys with expertise in civil commitment said.

In the years after Boston’s death, Mississippi continued to stand out.

The chancery courthouse in Lafayette County, at the site that previously housed the county jail where Mae Evelyn Boston died (Eric J. Shelton/Mississippi Today)

In 1992, the National Alliance for the Mentally Ill and Public Citizen’s Health Research Group conducted a national survey about the practice of jailing mentally ill people.

Almost a third of city and county jails in Mississippi responded. About 76% of respondents said they detained people who had not been charged with a crime and were awaiting an evaluation, treatment or hospitalization for mental illness. That was the second-highest percentage of any state in the country and far higher than the national average of 29%.

An unnamed Mississippi jail official said in the organizations’ report that jails were a “dumping ground for what nobody else wants.”

The report gave its “Worst State Award” to Kentucky, where 81% of responding jails reported holding people without criminal charges for mental evaluations.

Two years later, Kentucky’s legislature voted unanimously to ban the practice. The state health agency and its federally designated disability rights organization told Mississippi Today and ProPublica that Kentucky jails today are not used to hold people without charges awaiting mental health evaluations.

Few States Compare to Mississippi

Officials with the Mississippi Department of Mental Health emphasize that they do not support the practice of jailing people during the commitment process. But a spokesperson said they “have heard anecdotally from other states regarding challenges of individuals waiting in jail.”

Nationally, even basic data like the number of people committed each year is elusive. After reviewing some of Mississippi Today and ProPublica’s findings, the Treatment Advocacy Center, a national nonprofit that advocates making it easier for people with mental illness to get treatment, started planning a project to understand how often people are jailed without charges during the commitment process across the U.S.

Sign up for Dispatches, a ProPublica newsletter about wrongdoing in America.

Mississippi Today and ProPublica contacted agencies overseeing mental health and disability advocacy organizations in every state to find out whether Mississippi is an outlier. It is.

Respondents in 42 states and the District of Columbia said they were not aware of people being regularly held in jail without charges during the psychiatric civil commitment process. In a handful of those states, respondents said they had seen it once or twice over the years.

In two states, people can be sent from state psychiatric hospitals to mental health units inside prisons. In a few others, respondents said they had seen people jailed for noncompliance with court-ordered treatment for mental illness or substance abuse.

Respondents in three other states — Alaska, South Dakota and Wyoming — reported that people sometimes are sent to jail to await psychiatric evaluations, but the information they provided suggested that it happens to fewer people, and for a shorter period, than in Mississippi.

In 2018, staffing shortages at the Alaska Psychiatric Institute caused people to be held at the Anchorage Correctional Complex until they could be evaluated. The next year, an Anchorage judge ordered an end to the practice except in the “rarest circumstances,” finding that it had caused “irreparable harm.”

A subsequent settlement declared that jails shouldn’t be used unless no other option was available and that such detentions should be as short as possible.

But detentions do still occasionally happen in the state when people in rural areas await transportation to an evaluation center, said Mark Regan, legal director at the Disability Law Center of Alaska. According to the Alaska Department of Family and Community Services, people awaiting evaluation were held in jail 555 times from mid-2018 through late February 2023.

Across South Dakota, people without charges sometimes have been held in jail during the commitment process, according to law enforcement agencies and Disability Rights South Dakota, but such holds are limited by law to 24 hours; in Mississippi, the vast majority of cases analyzed were for more than 24 hours. The South Dakota Department of Social Services said it doesn’t track how often it happens and declined to answer questions.

And in Wyoming, a person can be held in jail for up to 72 hours on an emergency basis before a hearing, but they must have a mental examination within 24 hours. Such holds in jail have occurred “in very rare circumstances,” according to the state.

Attempts to constrain the use of jails date back at least to 1950, when the federal government sent governors model legislation that limited the incarceration of people for mental illness to “extreme emergency” situations. The National Institute of Mental Health called incarcerating such people “among the worst of current practices.”

Some states adopted the legislation. Mississippi did not.

Agnel Philip contributed reporting.

by Isabelle Taft, Mississippi Today, with data analysis by Agnel Philip, ProPublica, reporting by Mollie Simon, ProPublica

This article contains detailed descriptions of mental illness and suicide.

This article was produced for ProPublica’s Local Reporting Network in partnership with Mississippi Today. It was also co-published with Sun Herald, Northeast Mississippi Daily Journal and The Guardian. Sign up for Dispatches to get stories like this one as soon as they are published.

*** If you or someone you know needs help:

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

When sheriff’s department staff in Mississippi’s Benton County took Jimmy Sons into custody several years ago, they followed their standard protocol for people charged with a crime: They took his mug shot, fingerprinted him, had him change into an orange jumpsuit and locked him up.

But Sons, who was then 20 years old, had not been charged with a crime. Earlier that day, his father, James Sons, had gone to a county office to ask that his youngest son be taken in for a mental evaluation and treatment. Jimmy Sons had threatened to hurt family members and himself, and his father had come across him sitting on his bed with a loaded shotgun.

On Sons’ booking form, in the spot where jailers usually record criminal charges, was a single word: “LUNACY.”

The booking form for Jimmy Sons, identifying his “offense” as “lunacy” (Obtained by Mississippi Today)

In every state, people who present a threat to themselves or others can be ordered to receive mental health treatment. Most states allow people with substance abuse problems to be ordered into treatment, too. The process is called civil commitment.

But Mississippi Today and ProPublica could not find any state other than Mississippi where people are routinely jailed without charges for days or weeks during that process.

What happened to Sons has occurred hundreds of times a year in the state.

The news organizations examined jail dockets from 19 Mississippi counties — about a quarter of the state’s 82 — that clearly marked bookings related to civil commitments. All told, people in those counties were jailed at least 2,000 times for civil commitments alone from 2019 to 2022. None had been charged with a crime.

Most were deemed to need psychiatric treatment; others were sent to substance abuse programs, according to county officials.

Since 2006, at least 13 people have died in Mississippi county jails as they awaited treatment for mental illness or substance abuse, Mississippi Today and ProPublica found. Nine of the 13 killed themselves. At least 10 hadn’t been charged with a crime.

A woman going through the civil commitment process, wearing a shirt labeling her a “convict,” is transported from her commitment hearing back to a county jail to await transportation to a state hospital in north Mississippi this spring. (Eric J. Shelton/Mississippi Today)

We shared our findings with disability rights advocates, mental health officials in other states and 10 national experts on civil commitment or mental health care in jails. They used words such as “horrifying,” “breaks my heart” and “speechless” when they learned how many people are jailed in Mississippi as they go through the civil commitment process.

Some said they didn’t see how it could be constitutional.

“If an ER is full, you don’t send people to jail,” said Megan Schuller, legal director of the Bazelon Center for Mental Health Law, a Washington, D.C.-based organization. “This is just outright discriminatory treatment in my view.”

Mississippi Today and ProPublica also interviewed 10 individuals who had been committed and jailed, as well as 20 family members.

Many of those people said they or their family members had been housed alongside criminal defendants. Nobody knew how long they would be there. They were often shackled when they left their cells. Some of them said they couldn’t access prescribed psychiatric medications or had minimal medical care as they experienced withdrawal from illegal drugs.

“It felt more criminal than, like, they were trying to help me,” said Richard Millwood, who was booked into the DeSoto County jail in 2020 following an attempted suicide. “I got the exact same treatment in there as I did when I was in jail facing charges. In fact worse, in my opinion, because at least when I was facing charges I could bond out.”

"I got the exact same treatment in there as I did when I was in jail facing charges. In fact worse, in my opinion, because at least when I was facing charges I could bond out." — Richard Millwood, who was booked into jail following an attempted suicide

DeSoto County leadership, informed of Millwood’s statement, did not respond.

Millwood spent 35 days in jail before being admitted to a publicly funded rehab program 90 miles away.

Jimmy Sons didn’t receive a mental evaluation when he was booked into the Benton County jail in September 2015, according to documents in a lawsuit his father later filed. Less than 24 hours later, he was dead. Left alone in a cell without regular visits by jail staff, he had hanged himself.

He had been back in Mississippi for just a few days, planning to join his dad in electrical work, said his mother, Juli Murray. He had set out from her home in Bradenton, Florida, so early in the morning that he didn’t say goodbye.

Murray remembers the phone call from Jimmy’s half-brother in which she learned her son was in jail. She didn’t understand why.

“If you do something wrong, that’s why you’re in jail,” she said. “Not if you’re not mentally well. Why would they put them in there?”

The Lesser Sin

When James Sons went to the clerk’s office in the tiny town of Ashland to file commitment paperwork for his son, he took the first step in Mississippi’s peculiar, antiquated system for mandating treatment for people with serious mental health problems.

Jimmy Sons at age 18 at his father’s home in Mississippi (Courtesy of John Sons)

It starts when someone — usually a family member, but it could be almost anyone — signs a form alleging that the person in question is “in need of treatment because the person is mentally ill under law and poses a likelihood of physical harm to themselves or others.”

James Sons filled out that form, listing why he was concerned: Jimmy’s guns, his threats, his talk of suicide.

Then a special master — an attorney appointed by a chancery judge to make commitment decisions — issued a “Writ to Take Custody.” It instructed sheriff’s deputies in Benton County, just south of the Tennessee border, to hold Jimmy Sons at the jail until he could be evaluated.

The sheriff’s office asked Sons to come in on an unrelated matter. When he showed up, Chief Deputy Joe Batts told him he needed a mental health evaluation. Batts tried to reassure Sons that the process would be as quick as possible and would end with him back home, according to Batts’ testimony in the lawsuit Sons’ father filed over his death.

Then Batts told Sons, “What we’re going to have to do now is take you back and book you.”

Sign up for Dispatches, a ProPublica newsletter about wrongdoing in America.

What he never told Sons, he later acknowledged in a deposition, was that the young man would have to wait in jail for days before he would see a mental health provider. The first screening required by law was four days away. If it concluded he needed further examination, he would be evaluated by two more medical professionals. Then the special master would decide whether to order him into treatment at a state psychiatric hospital.

The whole process should take seven to 10 days, according to the state Department of Mental Health. But sometimes it takes longer, the news organizations found. And if someone is ordered into treatment at their hearing, they generally have to wait for a bed, though the department says average wait times for state hospital beds after hearings have dropped dramatically in the last year.

While waiting for their hearing, people like Sons are supposed to receive treatment at a hospital or a short-term public mental health facility called a crisis stabilization unit. But state law does allow people to be jailed before their commitment hearing if there is “no reasonable alternative.” (The law is less clear about what’s allowed following a hearing.)

The Benton County Sheriff’s Department formerly housed the county jail where Jimmy Sons died, in Ashland, Mississippi. (Eric J. Shelton/Mississippi Today)

Mississippi Today and ProPublica spoke to dozens of officials across Mississippi involved in the commitment process: clerks who handle the paperwork, chancery judges and special masters who sign commitment orders, sheriffs who run the jails, deputies who drive people from jails to state hospitals, and the head of the state Department of Mental Health.

None of them thinks jail is the right place for people awaiting treatment for mental illness.

“We’re not a mental health hospital,” said Greg Pollan, president of the Mississippi Sheriffs’ Association and the sheriff of rural Calhoun County in the north of the state. “We’re not even a mental health Band-Aid station. That’s not what we do. So they should never, ever see the inside of my jail.”

Batts himself, who took Sons into custody in Benton County, said law enforcement officers across Mississippi “hate to detain people like that. But we’re told we have to do it.” He acknowledged that the facility “was substandard to begin with, not having the space and the adequate facilities to hold and monitor someone in that mental state — it just puts everybody in a bad situation.” And he said he thought the state could provide alternatives to jail.

Some counties jail most people going through the commitment process for mental illness, Mississippi Today and ProPublica found. Other counties reserve jail for people who are deemed violent or likely to hurt themselves. And at least a handful sometimes jail people committed for substance abuse — even though a 2021 opinion by the state’s attorney general says that isn’t allowed under state law.

This happens because until people are admitted to a state hospital, counties are responsible for covering the costs of the commitment process unless the state provides funding. If a crisis stabilization unit is full or turns someone away, the county must find an alternative, and it must foot the bill.

Counties can place patients in an ER or contract with a psychiatric hospital — and some do — but many officials balk at the cost. Many officials, particularly those in poor, rural counties, see jail as the only option.

“You have to put them somewhere to monitor them,” said Cindy Austin, chancery clerk in rural Smith County, located in central Mississippi. Chancery clerks are responsible for finding beds for people going through the commitment process. “It’s not that anybody wants to hold them in jail, it’s just we have no hospital here to hold them in.”

Timothy Gowan, an attorney who adjudicated commitments in Noxubee County from 1999 to late 2020, said people going through the commitment process there generally were jailed if they were determined to be violent and their family didn’t want them at home.

According to the Noxubee County jail docket, people going through the civil commitment process with no criminal charges were booked into the jail about 50 times from 2019 to 2022. Ten stays lasted at least 30 days. The longest was 82 days.

“Putting a sick person in a jail is a sin,” Gowan said. “But it’s the lesser of somebody getting killed.”

Some counties rarely hold people in jail — sometimes because a sheriff, chancery judge or other official has taken a stand against it. Rural Neshoba County in central Mississippi pays Alliance, a psychiatric hospital in Meridian, to house patients.

"We’re not a mental health hospital. We’re not even a mental health Band-Aid station. That’s not what we do. So they should never, ever see the inside of my jail." — Greg Pollan, president of the Mississippi Sheriffs’ Association and sheriff of Calhoun County

The practice isn’t confined to poor, rural counties. DeSoto County, a populous, relatively wealthy county near Memphis, jailed people without charges about 500 times over four years, the most of any of the counties analyzed by Mississippi Today and ProPublica. The median jail stay there was about nine days; the longest was 106.

The state and county recently set aside money to build a crisis stabilization unit — currently, the nearest one is about 40 miles away — but the county and the local community mental health center haven’t decided on a location, said County Supervisor Mark Gardner.

Some county officials say that keeping people out of jail during the process requires the state to step up. State Rep. Jansen Owen, a Republican from Pearl River County in southern Mississippi who represents people during the commitment process, said he believes counties that spend “millions of dollars on fairgrounds and ballparks” could find alternatives to jail. But he also sees a need for more state-funded facilities.

“You can’t just throw it on the counties,” he said. “It’s a state prerogative. And them being held in the jail, I think, is a result of the state kicking the can down the road to the counties.”

Wendy Bailey, head of the state Department of Mental Health, said it’s “unacceptable” to jail people simply because they may need behavioral health treatment. Department staff have met with chancery clerks around the state to urge them to steer families away from commitment proceedings and toward outpatient services offered by community mental health centers whenever possible.

The Department of Mental Health says it prioritizes people waiting in jail when making admissions to state hospitals. The state has expanded the number of crisis unit beds from 128 in 2018 to 180 today, with plans to add more. And it has increased funding for local services in recent years in an effort to reduce commitments.

But Bailey said the department has no authority to force counties to change course, nor legal responsibility for people going through the commitment process until a judge orders them into treatment at a state psychiatric hospital.

Locked in the “Lunacy Zone”

Willie McNeese’s problems started after he came home to Shuqualak, Mississippi, a town of about 400 people and a lumber mill, in 2007. He had spent a decade in prison starting at age 17.

He found the changes that had taken place — bigger highways, cellphones — overwhelming, said his sister, Cassandra McNeese. He was eventually diagnosed with bipolar disorder.

“It’s like a switch — highs and lows,” said Willie McNeese, now 43. “I might have a whole lot of laughter going on, trying to make the next person laugh. Then my day going down, I be depressed and worried about situations that nobody can change but God.”

McNeese has been involuntarily committed in Noxubee County 10 times since 2008 and has been jailed during at least eight of them, one for more than a month in 2019 according to court records and the jail docket. During his most recent commitment starting in March 2022, McNeese was held in jail for a total of 58 days in two stints before eventually going to a state psychiatric hospital.

Cassandra McNeese, left, and her mother, Yvonne A. McNeese, in Shuqualak, Mississippi. Cassandra’s brother, Willie McNeese, has been held in jail during civil commitment proceedings at least eight times since 2008. Cassandra McNeese said Noxubee County officials told her jail was the only place they had for him to wait. ”This is who you trust to take care of things,” she said. ”That’s all you have to rely on.” (Eric J. Shelton/Mississippi Today)

From 2019 to 2022, about 1,200 civil commitment jail stays in the 19 counties analyzed by Mississippi Today and ProPublica lasted longer than three days. That’s about how long it can take for people to start to experience withdrawal from a lack of psychiatric medications, which jails don’t always provide. About 130 stays lasted more than 30 days.

McNeese said he spent much of his time in jail last year standing near the door of his cell, what jail staff called the “Lunacy Zone,” screaming to be allowed to take a shower. A jailer tased him to quiet him down, and his clothes were taken from him. For a period, his mattress was taken, too.

“It’s a way of punishment,” he said. “They don’t handle it like the hospital. If you have a problem in the hospital they’ll come with a shot or something, but they don’t take your clothes or take your mattress or lock your door on you or nothing like that.”

McNeese said he had inconsistent access to medication and received none during his first stay in 2022, which lasted 25 days.

The Noxubee County Sheriff’s Department did not respond to questions about McNeese’s allegations.

Staff from Community Counseling, the community mental health center where McNeese had regular appointments, could have provided him with medication, but McNeese said no one from the center came to visit him in jail. A therapist at Community Counseling said staff go to the jail only when they’re called, usually when there’s a problem jail staff can’t handle. Rayfield Evins Jr., the organization’s executive director, said when he recently worked in Noxubee, deputies brought people from the jail to his facility for medication and treatment.

"If you have a problem in the hospital they’ll come with a shot or something, but they don’t take your clothes or take your mattress or lock your door on you or nothing like that." — Willie B. McNeese, jailed multiple times following a diagnosis for bipolar disorder

Mental health advocates in Mississippi and other people who have been jailed during the commitment process said the limited mental health treatment McNeese received is common.

Mental health care varies widely from jail to jail, and no state agency sets requirements for what care must be provided. Jails can refuse to distribute medications that are controlled substances, which includes anti-anxiety medications like Xanax. The state Department of Mental Health says counties should work with community mental health centers to provide treatment to people waiting in jail as they go through the commitment process.

But those facilities generally don't have the resources to provide services in jails, said Greta Martin, litigation director for Disability Rights Mississippi.

Martin’s organization, one of those charged by Congress with advocating for people with disabilities in each state, investigates county jails when it receives complaints. “We are not seeing any indication that these individuals are getting any mental health treatment while they are being held in these county facilities,” she said.

Willie McNeese was incarcerated at the old jail in Noxubee County multiple times during civil commitment processes, including his first commitment in 2008. (Eric J. Shelton/Mississippi Today)

McNeese said those jail stays added physical discomfort and pain to the delusions that got him committed in the first place. “Then you get to the mental hospital — they have to straighten you all the way back over again,” he said.

Since being released from the state hospital last year, McNeese said, he has been doing well. He is now living in Cincinnati with his wife.

Scott Willoughby, the program director at South Mississippi State Hospital in Purvis, said it can be hard to earn patients’ trust when they arrive at the psychiatric hospital from jail.

At his facility, patients sleep two to a room in a hall decorated with photographs of nature scenes. Group counseling sessions are often held outside under a gazebo. In between, patients draw and paint during recreational therapy.

Willoughby has spoken with patients who had attempted suicide and were shocked to find themselves in jail as a result.

“People tend to associate jail with punishment, which is exactly the opposite of what a person needs when they’re in a mental health crisis,” he said. “Jail can be traumatic and stigmatizing.”

“I’m More Scared of Myself”

When Sons learned that he was going to be booked, he became anxious about being locked in a cell, Batts testified. So he was assigned to an area of the jail reserved for trusties — inmates who are allowed to work, sometimes outside the jail, while they serve their sentences.

On the afternoon of his first day in jail, Sons was sitting on his bed when a trusty named Donnie Richmond returned from work. Richmond said in a deposition that he asked a deputy who the new guy was.

“You better watch him,” Richmond recalled the deputy telling him. “He kind of off a little bit.”

Richmond offered Sons a cigarette and cookies and asked him why he was there. Sons took a cigarette and told Richmond the deputies had said he would hurt someone.

“He was like, ‘Man, I’m going to be honest with you,’” Richmond testified. “‘I ain’t going to hurt no one. I’m more scared of myself, of hurting myself.’”

Sons was not placed on suicide watch. The jail’s suicide prevention policy applied only to those who had attempted suicide in the jail, although attorneys for the jail officials in the lawsuit over his death said there was an unwritten policy to closely monitor people going through the commitment process.

An excerpt of the Benton County Sheriff’s Department’s suicide prevention policy at the time of Sons’ death (Obtained by Mississippi Today)

That evening, Sons told a jailer he was feeling anxious around the other men. He asked to be moved to a cell by himself.

A guard took him to a cinder block cell with no windows. There was no television and nothing to read. He was given a blanket.

A security camera in Sons’ cell was supposed to allow jail staff to watch him at all times. But jail officials said in depositions that no one noticed anything unusual the next morning.

At 11:28 a.m., Sons rose from his bunk bed, walked to the door and placed his ear near it. He went back to his bunk, fashioned a noose and tied it around his neck. He sat there for three minutes before hanging himself, according to a narrative of the video in court records.

He stopped moving just before 11:38 a.m. A trusty serving lunch peeked through a tray opening in the door 48 minutes later and saw his body.

The door of the Benton County Jail cell where Sons was held (Obtained by Mississippi Today)

Sons’ father sued Benton County, the sheriff and several of his employees over his death. The defendants denied in court filings that they were responsible, but the county’s insurance company eventually settled the case for an undisclosed sum. (All that’s publicly known is that the county paid a $25,000 policy deductible toward defense costs.)

Sheriff’s department staff said in depositions they had kept an eye on Sons, but they couldn’t watch the video feed constantly. Lawyers for the defendants said there was no evidence sheriff’s department employees knew someone could kill himself in the way Sons did.

Sheriff A. A. McMullen, who is no longer in office, acknowledged in a deposition that “any mental commitment is a suicide risk,” but he said he wasn’t sure it would have made a difference if Sons had been placed on suicide watch.

“You could write up the biggest policy in the world and you couldn’t prevent it. There’s no way. God knows, you know, it hurts us,” he said. “If they’re going to do it, they’re going to do it.”

McMullen couldn’t be reached for comment for this story.

In an interview, jail administrator Kristy O’Dell, who joined the department after Sons died, said the jail still holds two or three people going through the commitment process each month.

John S. Farese, an attorney for Benton County, told Mississippi Today and ProPublica that the county, like others, “does the best they can do with the resources they have to abide by the laws” regarding commitments. He said the sheriff and the county will try to adapt to any changes in the law “while still being mindful of our limited personnel and financial resources.” He declined to comment on the specifics of the Sons case, which he didn’t work on.

Murray, Sons’ mother, was at a grocery store around noon the day her son died. As she picked out a watermelon, she thought about him, a fitness buff who loved fruits and vegetables. A strange thought crossed her mind: “Jimmy’s never going to eat watermelon again.”

When she got home, she got the call that he was gone.

John Sons, Jimmy’s half-brother, wrote in a text to Mississippi Today and ProPublica that the family is left with “complete and total guilt for putting him in the prison and always the wonder if we would not have done that move, if he would be with us today.”

But Richmond, the trusty who briefly shared a cell with Sons, testified that it was jail staff who “messed up.”

“He hung himself,” Richmond said. “I say this. God forgive me if I’m wrong. We couldn’t have saved that man from killing himself, but we could have saved that man from hanging himself in that jail.”

How We Reported This Story

No one in Mississippi has ever comprehensively tracked the number of people jailed at any point during the civil commitment process, according to interviews with dozens of state and county officials.

Last year, the state Department of Mental Health released, for the first time, a tally of people who were admitted to a state hospital directly from jail following civil commitment proceedings. The department tracked 734 placements in fiscal year 2022. (Under a law that takes effect this year, every county must regularly report to the department data regarding how often people are held in jail both before and after their commitment hearings.)

But that figure understates the scope of commitments. It doesn’t include people who were sent places other than a state hospital for treatment or who were released without being treated, and it counts only the time people spent in jail after their hearings. People can be jailed for 12 days before a commitment hearing, or longer if a county doesn’t follow the law.

County jail dockets can provide a more comprehensive picture, so Mississippi Today and ProPublica requested them from 80 of Mississippi’s 82 counties. Seventeen counties provided dockets that clearly marked bookings related to civil commitments — with notes including “writ to take custody,” “mental writ” and “lunacy.” In two more counties, we reviewed dockets in person.

Many counties didn’t respond, said their records were available only on paper or declined to provide records. Some cited a 2007 opinion by the state attorney general that sheriffs may choose not to enter the names of people detained during civil commitment proceedings onto their jail dockets.

After cleaning and standardizing the data from the dockets, we counted the number of jail stays involving civil commitments in which the person was not booked for a criminal charge on the same day. (We ended up excluding about 750 civil commitments for that reason.) If the dockets provided booking and release dates, we calculated the duration of jail stays.

Our count of commitments includes those for both mental illness and substance abuse. None of the jail dockets specified which commitment process people were going through, although some county officials said they don’t jail people committed for substance abuse and haven’t for years.

State laws regarding commitment for mental illness and substance abuse are different, but in many counties they were handled similarly until late 2021. That’s when the Mississippi attorney general’s office said state law didn’t allow people going through the drug and alcohol commitment process to be jailed.

To identify deaths of individuals held in jail during the civil commitment process, we reviewed news articles and federal court records. We also reviewed nearly 90 investigations of jail deaths from the Mississippi Bureau of Investigation. Most of the deaths had not previously been publicly reported.

For our survey of practices in other states, we contacted agencies overseeing mental health and disability advocacy organizations in every state and Washington, D.C. We received responses from one or the other in every location, and we received responses from both in 33. We also searched for news reports of similar cases in other states.

Do you have a story to share about someone who went through the civil commitment process in Mississippi? Contact Isabelle Taft at itaft@mississippitoday.org or call her at 601-691-4756.

by Kavitha Surana

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

Since the Supreme Court overturned Roe v. Wade last year, doctors have warned that limiting abortion care will make pregnancy more dangerous in a country that already has the highest maternal mortality rate among industrialized nations.

The case of Mylissa Farmer, a Missouri woman, is one example. Last August, her water broke less than 18 weeks into her pregnancy, when her fetus was not viable. She was at risk for developing a life-threatening infection if she continued the pregnancy. Yet during three separate visits to emergency rooms, she was denied abortion care because her fetus still had a heartbeat. Doctors specifically cited the state’s new abortion law in her medical records and said they could not intervene until her condition worsened. She eventually traveled to Illinois for care.

Even for people who don’t develop sudden life-threatening complications, doctors note that carrying a pregnancy to term is inherently risky because rapid physical and hormonal changes can exacerbate chronic health conditions and trigger new complications. If more people are forced to continue unwanted pregnancies, there are bound to be more pregnancy-related deaths: A study by the University of Colorado estimates a 24% increase in maternal deaths if the United States bans abortion federally. They predicted the increase would be even higher for Black patients, at 39%. Currently, 14 states have total abortion bans.

Additionally, when abortion is illegal, it makes the procedure more dangerous for those who still try to terminate their pregnancies. The World Health Organization found that unsafe or illegal abortions account for up to 10% of maternal deaths worldwide.

As the United States enters its second post-Roe year, advocates say it’s important to gather data on the impact abortion bans are having on the health of pregnant people to help both policy makers and voters understand the life-or-death consequences of the restrictions. Without such accounting, they say, the public may remain ignorant of the toll. Maternal mortality rates would be a crucial gauge of impact.

Despite the stakes, experts say, at least in the short term, it may be difficult or impossible to track the number of lives lost due to limits on abortion access.

ProPublica spoke to four members of state maternal mortality review committees. Here are some of the challenges they see to drawing any clear conclusions from maternal mortality data in the near future.

The Data Can Be Inconsistent

Each state has its own system for compiling the data maternal mortality researchers work with. The quality of the data varies vastly by state. It can involve comparing birth and fetal death records, scanning through obituaries, and sometimes begging coroner’s offices to send death records. Many states are still working toward a complete system.

“It really depends on the rigor of the contributing entities,” said Dr. Michelle Owens, a maternal-fetal medicine specialist and the clinical chair for Mississippi’s maternal mortality review committee. “We rely so heavily upon the information we glean from these sources, and if that information is not as reliable … it will definitely have a negative impact on our work and understanding of what the contributing things may have been and what the gaps are.”

All the maternal mortality experts that ProPublica spoke with noted issues with the “pregnancy check box” used in death certificates to denote whether a patient was pregnant at the time of death or within the previous year. In Florida, Dr. Karen Harris, an OB-GYN and a member of Florida’s maternal mortality review committee, has observed the check box “overselect some patients who were never pregnant, or not pregnant in the last year, and it underselects patients who were pregnant.”

Sometimes the check box is wrong because of clerical errors, the researchers said. Other times, it’s simply not filled out because no autopsy was performed to verify whether the person was pregnant. That information could be important in measuring deaths that happen early in pregnancy — including murders. Homicide is a leading cause of death for pregnant or recently pregnant Americans, and researchers also would like to measure how abortion bans, which could force people in abusive relationships to carry unwanted pregnancies, affect those numbers.

Studying pregnancy-associated deaths within a year of pregnancy helps researchers account for any additional factors like substance abuse, unstable housing, suicide or mental health problems. These could be important in identifying deaths connected to continuing an undesired pregnancy.

The data can also be slow — some states, like Florida, provide data to the committee for the past year right away. But others are years behind. Currently, many states have only released data through 2019.

Records May Not Address Abortion Access

One of the thorniest questions facing maternal mortality experts: How can they determine if abortion access was a factor?

Dr. Lynlee Wolfe, an assistant professor at the University of Tennessee Medical Center and a member of the state’s maternal mortality review committee, wishes maternal mortality review reports could include a check box for the question, “Did inability to get an abortion play a role?”

“But you often can’t dig that out of notes,” she said. “I think what we’re asking is kind of an untrackable number.”

The experts said they could look into causes of death that may be linked to a patient’s inability to get an abortion when they’re having an emergency pregnancy complication: Sepsis, hemorrhage and heart issues, for example, are all worth studying to see if medical records might indicate if doctors delayed ending the pregnancy because the fetus still had a heartbeat.

But beyond that, when the pregnancy was unwanted or exacerbated broader health concerns, it could prove very difficult to determine if abortion access was a factor in the patient’s decision-making.

For example, if a patient had a heart condition that carried a 50% chance of death in pregnancy, researchers would like to see whether the patient was counseled about the risk and offered a termination.

But in a state that had criminalized abortion, “no one’s going to write that down,” said Harris, the Florida doctor. “So we won’t be able to know in the in-depth review if this was a patient choice — or if it was something that was forced upon her.”

Researchers might be able to learn more about the patient’s state of mind and whether the pregnancy was desired or not from interviews with family members and social service records, Owens, the Mississippi doctor, said. But there’s no guarantee they would have discussed their feelings about the pregnancy with family members either.

“With stigma and controversy surrounding conversations and considerations around abortions, people are hesitant to share those thoughts and feelings outside a very small circle of trust,” she said.

Risk of Political Interference

Maternal mortality review committees are funded by their states, and some are overseen by state legislatures.

The maternal mortality review members ProPublica spoke with said they did not anticipate interference with their report findings, even if they found examples where abortion access was a factor in a maternal death.

But some maternal care advocates worry such committees are vulnerable to political interference and manipulation. Last year, the Texas Department of State Health Services announced it was delaying its 2019 maternal mortality review report, originally scheduled for September 2022, until mid 2023.

Some saw the delay as a way to keep negative numbers out of the public eye during election season and postpone their release until after the 2023 legislative session had ended. A member of the review committee said she believed there was no legitimate need for the delay and that it was “dishonorably burying these women.” ProPublica reached out to the committee and the Texas health agency to ask about these concerns, but did not receive any response.

After pushback, the report was partially released in December 2022. It found persistent disparities affecting Black mothers and showed that the childbirth complication rate had risen 28% since 2018.

In July, Idaho disbanded its maternal mortality review committee, making it the only state without one. Lawmakers cited the costs of operating the committee — though members said operating costs were about $15,000 a year and covered by a federal grant. The decision came after a lobbying group argued that the committee was a “vehicle to promote more government intervention in health care” and opposed its recommendation to extend Medicaid coverage to mothers for 12 months postpartum.

The Sample Size Is Small

Maternal mortality rates in the U.S. are higher than in other wealthy countries and have been rising in recent years, so many resources are devoted to studying root causes of the trend and possible strategies for reversing it. But the actual number of deaths is statistically small: In 2021, the U.S. saw an estimated 32.9 deaths per 100,000 births, or 1,205 total pregnancy-related deaths, according to the Centers for Disease Control and Prevention.

This makes it difficult to draw conclusions that are rigorous by epidemiological standards, said Dr. Elliot Main, a Stanford professor and the former medical director for the California Maternal Quality Care Collaborative.

While researchers may learn of individual cases where it’s clear that abortion access was an issue in the patient’s outcome, it could take years to have a data set large enough to reveal a clear picture.

Main also pointed out that many other factors influence maternal mortality rates, which muddles the picture. “Maternal deaths are so rare and often complicated in their underlying causes,” he said. “If you see a trend over time, we have to break it down to see what’s really causing that.”

Before the Supreme Court’s decision in Dobbs v. Jackson Women's Health Organization struck down federal protections for abortion rights, U.S. maternal mortality rates were already rising. Influences include COVID-19, the opioid crisis and people having children at older ages, when they are at higher risk for complications. The U.S. also has long-standing racial and socioeconomic health care disparities affecting quality prenatal care — more than half of Georgia’s counties have no OB-GYN, for example. That can mean more patients go into pregnancy with undiagnosed health conditions and may be at higher risk for life-threatening complications.

Main and other researchers suggested that studying data on childbirth complications may provide more avenues for understanding the effects of abortion bans, because those are more common and would provide a larger data set to study.

Bans Don’t Prevent All Abortions

One reason the impact of Dobbs on maternal mortality rates could remain limited even in states that have banned abortion is that some people who want to terminate their pregnancy are still able to do so, either by traveling or by ordering abortion medication in the mail.

It’s impossible to know the full picture of how many are able to jump through the hoops and obtain abortions even when there are no legal options nearby. But WeCount, a research project led by the Society of Family Planning that has been collecting data from abortion providers, estimates that in the six months following Dobbs, about 35,000 people in abortion-ban states were able to get abortions in other states — just over half of the people estimated to have sought abortions in those states, based on numbers from the same time period the previous year. It’s unclear what happened to the other half. Some may have continued their pregnancies, others may have ordered abortion pills in the mail, which could be sent by organizations based in Europe and Mexico and not be recorded in any database.

Still, having to travel out of state to a limited number of abortion providers meant more patients were forced to wait until their second trimester, researchers said, when an abortion can be more complicated.

And while abortion pills are considered an exceedingly safe method of terminating a pregnancy through the first 10 weeks, according to the Food and Drug Administration and leading medical organizations, patients should still have the option to take them with the instruction and care of a medical provider, advocates say.

by James Bandler

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

Reflecting rising concerns that Big Tech’s infatuation with artificial intelligence threatens privacy and economic competition, Sen. Elizabeth Warren has begun investigating Google’s efforts to swoop up medical information derived from biopsy specimens of millions of military service members.

Warren, a Massachusetts Democrat and the chair of the Senate Armed Services Subcommittee on Personnel, wrote on Tuesday to Google and the Department of Defense, seeking information and records related to the company’s pursuit of a vast trove of medical data overseen by the military’s Joint Pathology Center. The archive represents a largely untapped gold mine for AI and health care companies, because computers can use the data to develop algorithms that detect patterns, like telltale signs of tumors, faster and often better than humans can.

In her letters, Warren accused Google of “aggressive attempts” to gain service members’ medical information and Defense Department officials of “favoritism” toward the tech giant. “I am alarmed by reports that Google tried to privately broker a deal to secure exclusive access to JPC data,” Warren wrote to Sundar Pichai, CEO of both Google and its parent company, Alphabet.

Warren was referring to a ProPublica report published last December, which revealed that at least a dozen Defense Department staff members pushed back against Google’s campaign for the medical data. ProPublica found that Google began in late 2015 to gather medical information at military installations and hospitals around the country, which it planned to use to build AI tools. Such software, the company hoped, would give it an edge in the race to develop algorithms that could help pathologists diagnose illnesses more quickly and accurately, predict prognoses and, eventually, Google scientists hoped, find new treatments for diseases, including cancers.

Google’s allies in the Defense Department and on the staff of the House Armed Services Committee tried to help the company, ProPublica reported. In exchange for exclusive access to the archive, the company offered to digitize the collection of pathology slides that are stored at a sprawling warehouse in Silver Spring, Maryland. But staff at the JPC and elsewhere expressed dismay about risks to the privacy of service members’ tissue specimens and about the use of a sensitive government resource by a corporation to develop unproven AI tools. In 2021, Google was not selected for a pilot project to begin digitizing the collection.

“The public deserves a full accounting of DoD’s secretive interactions with Google regarding private health data contained at the JPC and complete transparency surrounding DoD’s blatant favoritism towards Google,” Warren wrote to Defense Secretary Lloyd Austin III. She has asked both Google and the Defense Department to respond by Aug. 8.

A Warren spokesperson characterized the letters as a “prelude to inform a potential Senate investigation and potential future legislation.” The senator said in a statement on Tuesday that the JPC “has millions of tissue samples from servicemembers and veterans that are meant to support the public good — but Google came dangerously close to landing an exclusive monopoly on these samples and the right to charge DoD for access to this data.”

A Google spokesperson declined to comment but referred ProPublica to statements and a blog post that the company published in response to the December story. “We had hoped to enable the JPC to digitize its data and, with its permission, develop computer models that would enable researchers and clinicians to improve diagnosis for cancers and other illnesses,” the company said then. “Despite efforts from Google and many at the Department of Defense, our work with JPC unfortunately never got off the ground, and the physical repository of pathology slides continues to deteriorate.”

A Defense Department spokesperson declined to comment, saying the agency doesn’t discuss communications with members of Congress. The JPC has said that its highest priority is to ensure that any medical information shared with outside parties is “used ethically and in a manner that protects patient privacy and military security.”

Since the Civil War, the U.S. military has been collecting and studying human tissue of armed service members in an effort to reduce the toll of injuries, diseases and fatalities suffered in wartime and peace. The collection has spurred numerous advances in medicine and science, including the first genetic sequencing of the 1918 flu virus. Today, the repository holds more than 31 million matchbook-sized blocks of human tissue and 55 million pathology slides.

Pathology is ripe for the AI revolution. A single pathology slide, which can be scanned and digitized, holds vast amounts of visual information. In 2021, Google told the military that the JPC collection of veterans’ skin samples, tumor biopsies and slices of organs holds the “raw materials” for the most significant biotechnology breakthroughs of this decade — “on par with the Human Genome Project in its potential for strategic, clinical, and economic impact.”

But lawmakers, regulators and ethicists have struggled to keep pace with developments in AI. Some models can process information now at a scale that’s beyond human comprehension.

The corporate use of the JPC collection is particularly delicate. Most of the specimens come from military service members who did not consent to the use of their tissue for research. In addition, there are national security ramifications. China has already collected huge health care data sets from the U.S., both legally and illegally, as it seeks to develop its own AI capabilities, according to the National Counterintelligence and Security Center.

Warren has emerged as one of Google and Big Tech’s most vocal critics on Capitol Hill. In 2019, she assailed the company’s efforts to amass millions of patient records in a partnership with the Catholic health care system Ascension, dubbed “Project Nightingale.”

Doris Burke contributed research.