ProPublica

by Shannon Dooling and Christine Willmsen, WBUR

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When the mayor of Revere, a working-class city north of Boston, began looking for a new police chief in 2017, he wanted a leader to clean up what he described as the “toxic culture” within the department.

Mayor Brian Arrigo brought in a consultant to help pick the city’s top cop, who oversees more than 100 officers and civilian employees. The consultant, a former police chief in another Boston suburb, tested four candidates — all internal — for attributes such as decisiveness, initiative, leadership and communication skills. None of the candidates scored high enough to persuade the consultant that they would do the job well.

“No city should settle for a Police Chief who cannot deliver an ‘Excellent’ performance when competing for the Police Chief’s position,” he reported to the mayor.

Nevertheless, Arrigo chose one of those four candidates for a three-year interim chief role and appointed another, then-Lt. David Callahan, as chief in 2020. An investigation by WBUR and ProPublica found Callahan not only fell short on the assessment but was also steeped in the toxic culture the mayor deplored.

In 2017, the same year that Arrigo started searching for a chief, Callahan was accused of bullying and sexually harassing a patrolman and “creating an atmosphere of fear.” In the fallout, the 40-year-old patrolman has been on paid leave for more than a year and is seeking an “injured on duty” retirement status, which would cost the city at least $750,000 before the typical retirement age of 55. Callahan disputes those allegations. He did acknowledge in an interview with WBUR and ProPublica that, before becoming chief, he sent a sexually explicit image to another officer.

“It was a mistake,” he said. “It shouldn’t have happened. And I owned up to it and it’ll never happen again.”

Callahan’s selection from an underwhelming pool of candidates illustrates the predicament of Revere and other municipalities that are constrained by regulations from hiring outsiders for the key position of police chief.

“If you restrict the search process to somebody who is already inside the department, you’re making it a lot more difficult for any sort of substantive change to take place,” said Carl Takei, a senior staff attorney at the ACLU focused on police practices.

In a wide-ranging 90-minute conversation in a conference room at Revere police headquarters, Callahan defended his record. He said that he is revising the department’s policies so it can obtain state accreditation, and that he is trying to make it more diverse and welcoming. “It’s not like the kind of good old boys’ network anymore,” he said.

He added that he’s willing to take unpopular steps when necessary, citing an investigation a decade ago of a Revere colleague in a public corruption case, for which he received a commendation from the FBI. “I’ve gone against the grain, and I’ve taken a lot of heat for it,” he said.

In a separate interview with WBUR, Arrigo said he would give Callahan an “A” for his performance as chief. While some critics say Callahan has applied discipline unevenly, Arrigo said the chief has stood up to the department’s culture as if he were an outsider rather than a veteran of three decades on Revere’s force. Still, the mayor emphasized that his options were limited by a decades-old requirement that the chief of police in Revere be chosen from within the department.

In fact, after Arrigo received the candidates’ assessment scores in 2017, the mayor urged the City Council to amend the hiring rule so he could look outside the Police Department. “The fact of the matter is we are currently constraining ourselves to a limited pool of candidates when selecting someone for one of the most important jobs in the city of Revere,” he told the council. His goal, he said, was to choose from the best candidates anywhere “in the name of public safety.” The council didn’t budge.

Restrictions on hiring police chiefs from outside department ranks are common in Massachusetts. In Waltham, which has an ordinance similar to Revere’s, two chiefs who were promoted internally became embroiled in scandal. More than 60 other Massachusetts municipalities abide by state Civil Service Commission rules for how to appoint a chief. This means that the chief is selected from within the department, based on the highest scores on the civil service exam, unless the city specifically requests a statewide search, which hardly ever happens. According to Massachusetts officials, there have been 32 civil service appointments for police chiefs within the last five years. All have been internal promotions, and none of the municipalities considered outside candidates.

The colonel who heads the Massachusetts State Police also had to be hired from within its ranks until 2020. The legislature dropped the requirement in the wake of a sweeping overtime pay scam in which more than 45 troopers were implicated and at least eight pleaded guilty.

Police departments in at least two other states face similar constraints. New Jersey law prevents most municipalities from looking outside their departments for chiefs, and California authorities linked internal hiring mandates in one city to alleged civil rights abuses by police.

Police unions and local elected officials often support hiring from within. It’s seen as a way to reward veterans of the force for their service and to keep political allies close. Having a chief who grew up in the area and knows the community may also be an advantage.

Revere Mayor Brian Arrigo. He said he would give Callahan an “A” for his performance as chief. (Jesse Costa/WBUR)

Callahan pointed to these homegrown benefits when asked about internal hiring mandates for police chiefs. He said while it depends on what an individual department needs, it can be difficult to bring in someone from the outside.

“There’s a lot of animosity because you’re going to have people in the department that are upset that they weren’t chosen for the position,” he said. “They’re not necessarily going to cooperate with the new person who’s hired, and there’s going to be some friction.”

But with police departments facing demands for reform nationwide, some experts say one way to address problems such as toxic cultures, racial discrimination, poor training or use of excessive force is to bring in an outsider.

Chuck Wexler, executive director of the Police Executive Research Forum, a Washington, D.C.-based think tank, said internal hiring mandates are outdated and can be counterproductive for troubled departments.

“To simply limit your department and say, ‘We’re not going to look at anyone outside,’ I don’t think that’s good management, period,” Wexler said.

For more than four decades, the Revere Police Department has struggled with corruption and ineffective leadership by chiefs hired from within. A Revere lieutenant was promoted to chief in 1980 after attaining the highest score on the civil service exam. He had purchased a stolen copy of the test from an exam theft ring and was sentenced to four years in prison in 1987.

In that era, Revere typically chose the internal candidate for chief of police who scored highest on the state civil service exam. That changed in 2001, when then-Mayor Thomas Ambrosino wanted the freedom to hire someone regardless of exam results and to have more control over the terms and length of the appointment.

“My recollection is that I was anxious to remove the police chief position in Revere from civil service because I didn’t think that was the most effective way of choosing a police chief,” Ambrosino, who is now city manager in Chelsea, said in an interview.

First, he needed the support of the City Council. They reached a compromise. The council agreed to take the chief’s position out of civil service, and the state approved the move. From now on, the chief would be chosen from within the ranks of the Police Department and no civil service exam was required.

Ambrosino recalled that the council wanted to please the police unions by making sure that the chief continued to be hired from inside. Ambrosino said he considered it the cost of getting the deal done. But he now says the ordinance hamstrings the mayor’s ability to choose the best candidate for the job.

“As a chief executive, you want to have maximum flexibility. You would want to have the ability to go outside the department if you felt you didn’t have a really strong qualified candidate within the department,” he said. “So for that reason, it’s, in my opinion, not a great policy.”

More recent mayors have sought the power to choose someone from outside the department, but they couldn’t persuade the City Council. In 2012, under pressure from then-Mayor Dan Rizzo, the chief resigned and stayed on as a captain, according to the Revere Journal. Rizzo said the Police Department lacked leadership and clear direction, and he wanted the option to pick an outside candidate.

None of the four candidates for Revere police chief scored “excellent” or “very good” on an assessment. (Jesse Costa/WBUR)

Two consultants to the city would later express similar concerns. In 2015, the year that Arrigo was elected mayor, the Collins Center consulting group said in a draft report that the department’s culture was “very militaristic” and the “lack of unity between the command staff members is most alarming.” Deploring the “fair amount of distrust” among Revere police at all levels, the consultant concluded the city’s internal hiring requirement for its police chief “limits the ability of the department to get the best candidate for the job.”

The other consultant, Ryan Strategies Group, evaluated Callahan and the other three internal candidates in 2017 for police chief. Headed by a former Arlington, Massachusetts, police chief, it administered a series of exercises and tests over multiple days. Each candidate role-played a counseling session with a disgruntled subordinate, led a mock community meeting and completed a written take-home essay.

No candidate scored in either of the two highest ranges, “excellent” and “very good.” The highest of the four scored a low “good,” and the others were “satisfactory,” according to Ryan group’s report. Callahan was one of the top two scorers, according to a person who requested anonymity to discuss individual results. Callahan said that he didn’t know his score or receive any feedback on his performance. He, like the other three candidates, said that the testing was fair and thorough.

The Ryan group did not review personnel records. Besides Callahan’s issues, the city had settled a sexual harassment complaint in 2008 against 13 defendants, including one of the other candidates, Steven Ford. He did not admit any wrongdoing. Another candidate, James Guido, whom Arrigo named as interim chief in 2017, would be sued in 2019, along with the Revere police department, by a female officer who accused him of unfair discipline and retaliation because of her gender. In a deposition, Guido disputed the allegations. The case is pending.

During a heated 2017 meeting with the council, Arrigo said that both the Collins report and the candidates’ scores on the Ryan group’s assessment showed why the city needed to look outside the department for the next police chief. “We owe it to ourselves, we owe it to our city, to have an expanded pool of candidates,” he said.

Ryan Strategies Group also performed an organizational review of the department at Arrigo’s request. It revealed concerns about morale. It also found the department was shirking best practices by not conducting regular audits of property and evidence, and had failed to report to the Suffolk County District Attorney’s Office that an audit found discrepancies in drugs and guns.

The Ryan group’s report strongly opposed a requirement to hire an internal candidate as chief. “There are times when the culture of a community and/or Department become so politicized or polarized that it is necessary to be able to consider a candidate who is not overly involved with local politics or enmeshed in long standing conflicts,” it said.

The council sent Arrigo’s request to change the ordinance to its public safety committee, where it was never brought to a vote. Revere City Councilor Patrick Keefe, who opposed the mayor’s proposal at the time, said that he’s confident in Callahan’s leadership, but he would be open to expanding the pool of candidates for chief in the future.

“I would probably prefer to have the chief of police be an internal candidate, but if you don’t have the best candidate, sometimes you have to think of other options,” he said.

WBUR reached out to multiple city councilors to ask their opinion on the ordinance. Only Keefe responded.

At Callahan’s swearing-in ceremony in July 2020 on the steps of City Hall, the new chief told a crowd thinned by the pandemic that he would honor the same values he’d practiced for almost 30 years at the department. “Since my first day, I have always treated everyone fairly and with the respect they were due,” he said. “I’m committed to serving the community this way, and I will instill these values in the men and women that will be following my lead in the Revere Police Department in the future.”

His appointment capped a steady rise through the ranks. After joining the department in 1991, the Revere native became a lieutenant in 2003. He served as the commander of the Drug Control Unit and was assigned to the Criminal Investigation Unit. In 2012, the FBI recognized Callahan for his “exceptional assistance” in the bureau’s investigation into a public corruption case involving a Revere police officer. As a lieutenant, he was among the highest paid Revere employees. In 2019, he made $213,500, including $72,700 for working details or overtime. Callahan has a five-year contract as chief, and his current salary is $192,000.

But Callahan’s behavior hasn’t always been exemplary. This past May, Callahan testified at an arbitration hearing in City Hall over his role in the firing of an officer. Under cross-examination by union attorney Patrick Bryant, and again in an interview with WBUR and ProPublica, Callahan admitted that, while he was a lieutenant, he texted a sexually explicit image to a patrolman. The patrolman passed the image, which depicted the Virgin Mary superimposed on a vagina, to others in the department, according to screenshots seen by WBUR and ProPublica. According to notes of the testimony taken by Bryant’s law clerk, Callahan said he was never disciplined for his actions.

The most serious allegation against Callahan emerged in March 2017, when Revere police officer Marc Birritteri filed a formal complaint to then-police Chief Joseph Cafarelli. It outlined “harassment and bullying concerns that I have had with Lt. David Callahan over the past several years,” according to documents obtained by WBUR and ProPublica.

“I feel like I have become a target of Lt. Callahan’s disrespectful torment and jokes that have had a negative impact on my job and personal life,” Birritteri wrote. “I have actually had to seek therapy on more than one occasion which is still ongoing due to this continuing harassment in the work place.”

In his complaint, Birritteri alleged that Callahan repeatedly called him a “rapist” in front of fellow employees, apparently alluding to a sexual assault allegation against him. Birritteri wrote that a three-month investigation determined that he had not committed any wrongdoing, and he was never disciplined.

Callahan also told Birritteri that he needed “to drop a load in another whore so she can take the rest of your paycheck,” according to Birritteri’s complaint. The comment referred to a child custody dispute that Birritteri was going through at the time, the complaint stated.

At least three officers told WBUR they witnessed Callahan’s taunting of Birritteri and described it as relentless, including Revere Police Patrol Officers Association President Joseph Duca and two others who declined to be named for fear of retaliation.

Callahan disputed these allegations. He said no one told him about the complaint for 11 months after it was filed. “I never knew there was a problem,” he said.

A review of Revere police records shows that Birritteri’s complaints were never investigated by internal affairs, and Callahan was not disciplined. Department policy prohibits “harassing conduct” that “creates an intimidating, hostile, or offensive work environment.”

“I have actually had to seek therapy on more than one occasion which is still ongoing due to this continuing harassment in the work place,” Marc Birritteri wrote in a formal complaint about Callahan, then a lieutenant. (Jesse Costa/WBUR)

In a letter sent to Arrigo on April 12, 2017, then-chief Cafarelli informed the mayor that he had been made aware of an “ongoing pattern of psychological abuse directed at Officer Birritteri at the hand of Lieutenant Callahan.” The verbal abuse, Cafarelli wrote, was “occasionally sexual in nature in the presence of other officers.” Describing Callahan as a “domineering supervisor who leads by creating an atmosphere of fear,” Cafarelli recommended that the mayor place Callahan on administrative leave pending a full investigation by an outside body. The recommendation wasn’t followed.

Two months later, Birritteri reported to the department that the bullying was continuing. “I am being further harassed and intimidated by employees and supervisors,” he stated. He was referring to friends of Callahan’s in the department, according to two officers, who declined to be identified for fear of retribution.

That October, the city reached a settlement with Birritteri, acknowledging that he presented “credible complaints of harassment” while on duty. The city paid for his legal fees and insurance co-pays for mental health therapy, and it reinstated 38 sick days.

In 2018, when he was no longer chief, Cafarelli sued the city and the mayor. He alleged that Arrigo failed to restore him to his former position as lieutenant because Cafarelli had advocated for Birritteri and had recommended putting Callahan on leave, according to court documents. Cafarelli said in the lawsuit that Arrigo and Callahan were “very good friends” and that the mayor had already decided to name Callahan as police chief. The city and the mayor responded in court documents that Cafarelli had not given timely notice of his intent to return to his old rank. This past April, a superior court judge dismissed the retaliation claim but allowed a breach of contract claim to go forward. Cafarelli said he now works as a private contractor for the U.S. government.

Arrigo acknowledged that the city substantiated Birritteri’s complaints and said that he had spoken with Callahan about the allegations. Still, the mayor said the harassment did not give him pause when he appointed Callahan as chief.

Birritteri continued to receive counseling, according to his correspondence with the city. In 2021, he and the mayor reached another agreement that would pay him $65,000. The patrolman promised not to disparage the city, the mayor or Police Department. The mayor also agreed to not fight Birritteri’s request with the city Retirement Board for a special type of retirement for officers injured on duty. That claim is pending. If granted, he would likely collect pay of more than $50,000 a year, or almost three-fourths of his highest salary.

Allegations about Birritteri’s own conduct as a police officer have also cost the city. In 2012, he was sued by a man who said he was assaulted at a parade and alleged that Birritteri failed to intervene. The city settled the case for $15,000, according to the city solicitor, and all claims were dismissed. And in a September 2021 lawsuit, a woman alleged that Birritteri violated her civil rights by wrongfully arresting her and unlawfully searching her car. A $36,000 settlement was reached in April, according to the solicitor. Duca, in his capacity as union president, said that Birritteri denies wrongdoing.

Like many internally hired police chiefs, Callahan is a political ally of the mayor’s. Callahan has donated close to $5,000 to Arrigo’s campaigns over the last six years and has knocked on doors on Arrigo’s behalf. He said he was “very active” in supporting Arrigo’s election because he agreed with the mayor’s vision for the city. Both Callahan and Arrigo said that his political support for the mayor had nothing to do with his hiring as chief. Arrigo interviewed the top two candidates, according to people familiar with the process. The mayor said he also sought feedback from other police officers and community members.

As chief, Callahan has feuded vehemently with the patrolman’s union — for example, over his decision to restore a shift schedule that the union criticized for contributing to burnout. Callahan, who has the shift rotations posted on the wall of his spacious office, said the schedule he has implemented is better for public safety. Duca is so dismayed with Callahan that he’s now open to hiring an outsider as chief. Duca said the police force would benefit from looking elsewhere for future chiefs instead of having to “choose from the best of the worst” candidates.

Arrigo said he has seen Callahan “hold the department to a higher standard than prior chiefs.” The mayor cited the firing of a patrolman, Rick Griffin, the son of a retired sergeant. The mayor determined that Griffin, while in his probationary period, was allegedly untruthful when questioned by the police’s internal affairs department, according to court documents. Griffin was asked about an evening in which he argued with his girlfriend and then was in a car accident, according to Griffin and Duca. Griffin denied the allegations and said he was not formally interviewed before he was let go. He filed a complaint in superior court against the Civil Service Commission, the city and the mayor, alleging that his termination was politically motivated, because his family backed an opponent of Arrigo’s, and that he was denied due process. The case against the city and the mayor is pending, while the complaint against the Civil Service Commission is on appeal.

Also fired was another patrolman, Youness Elalam, who had sexual contact with a custodian in a private room at the police station while off duty, according to a state police investigation. Elalam and the custodian told investigators that, while she was uncomfortable with having sex at work, they were in a consensual relationship, documents show. Elalam told WBUR that he was treated harsher than other officers facing discipline because he is Muslim and Moroccan. Elalam’s firing was the subject of the arbitration hearing that Callahan testified at in May.

During that hearing, Callahan said that, as a lieutenant, he had become aware of allegations that another senior officer had sex with a 911 dispatcher throughout the police station and in department vehicles while on duty. Callahan acknowledged at the hearing that he had an obligation to investigate the information he received but didn’t do it thoroughly, according to notes of the testimony. The senior officer, who denied the allegations, wasn’t reprimanded.

“If you’re friendly with the chief and supportive of his interests, you again have your own kind of private internal affairs process,” said Bryant, the union attorney representing Elalam.

Callahan declined to comment on the case, saying it’s still pending. According to Elalam, a tentative settlement was reached last month, in which the city will pay him $25,000 and reinstate him on the force. He will be placed on unpaid administrative leave and will be allowed to resign in good standing, with favorable letters of recommendation from the chief and the mayor.

“It’s a huge win and relief. I fought so hard so I could continue to be a police officer,” he said. “I don’t have to deal with Revere anymore, and I can move on to another chapter of my life doing the job I love.”

Youness Elalam. He says he was disciplined more harshly than other officers because he is Muslim. (Jesse Costa/WBUR)

In 1999, two years before Revere adopted its ordinance requiring police chiefs be hired from within, Waltham instituted a similar policy. Promoted under the new rule, Edward Drew became chief in 2000 after 26 years in the Waltham department. In 2008, Drew paid a $1,000 fine to the State Ethics Commission for interfering with the hiring process to help his daughter gain a position on the force. Drew, who waived his right to contest the commission’s findings, did not respond to emails or phone messages.

While Drew was being criticized for favoritism, Waltham Mayor Jeannette McCarthy tried to broaden the selection process to external candidates. The measure was tabled by the City Council and hasn’t been brought up again. McCarthy, who has been mayor since 2004, did not respond to requests for comment.

After Drew retired from Waltham’s force, he was replaced by Thomas LaCroix, who resigned after being found guilty in 2013 on two counts of assaulting his wife. LaCroix died the following year.

Waltham City Councilor Kathleen McMenimen said she voted in favor of the internal hiring mandate in 1999 after hearing several potential candidates for chief voice their support during a council meeting. McMenimen, still a councilor, said she remains supportive of the ordinance, despite the tarnished chiefs, because she believes internal candidates are the most knowledgeable about the city.

“They understand their rank and file, they understand their superior police officers, they understand the city, its neighborhoods and its population, and its demographics,” she said. “And they understand the laws that they are required to adhere to.”

Scandals involving chiefs hired from within have also cropped up in New Jersey. As a result of a century-old state law and Civil Service Commission rules, most smaller New Jersey municipalities must hire chiefs internally.

In Caldwell, a few miles northwest of Newark, Chief James Bongiorno, who joined the force in 1996, was accused of creating a hostile work environment and violating the civil rights of two female officers.The town settled the cases in 2019 for a total of $240,000. Two years later, the town reached a $375,000 settlement with a former lieutenant who alleged Bongiorno created a hostile work environment. Bongiorno did not acknowledge wrongdoing either time. He remains at the helm of the department.

South of Trenton, in Bordentown, then-police Chief Frank Nucera allegedly assaulted a Black teenager while the young man was handcuffed. Nucera, who then retired after 34 years on the force, was convicted in 2019 of lying to the FBI in connection with the investigation. Federal hate crime charges were dropped after two juries failed to reach a verdict.

Police unions in New Jersey have pushed to keep the internal hiring requirements.

“Many times police unions are in support of not bringing an outsider because even though they’re not the chief, everybody below has this hope that they might be chief,” said Brian Higgins, retired chief of the Bergen County police and a lecturer at the John Jay College of Criminal Justice.

In 2021, the Atlantic City Police Department’s largest union sued the state, which is in charge of staffing decisions for the department, when officials signaled a move to expand the search for chief to external candidates. Union President Jules Schwenger said that a new chief will soon be named. “He is from our department and very qualified for the position,” Schwenger said, adding the lawsuit is “on standby.”

Bakersfield, California, reached a settlement in 2021 with the state’s Department of Justice, which had been investigating alleged civil rights abuses by city police officers. As part of that settlement, and to avoid further litigation with the state DOJ, the city will have a ballot referendum on whether to remove a requirement to select the police chief from within the department. This November, voters will have the final say on how the chief is hired.

Arrigo, Revere’s mayor, is up for reelection next year. He said that he would still like to see the ordinance amended to allow the hiring of an outsider as chief, but he doesn’t expect it to happen soon. “That may be for the next mayor,” he said.

Alex Mierjeski of ProPublica contributed research. Yasmin Amer of WBUR contributed reporting.

by Catherine Rentz

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

Baltimore County police are starting to get back test results from a long-delayed project to process the oldest known collection of DNA evidence from rape cases.

Last year, ProPublica wrote about the trove of evidence and the prescient doctor who began assembling it in the 1970s, long before preserving forensic evidence was common police practice. Police have processed DNA from 49 of about 1,800 remaining cases as of the first quarter of this year, according to a department memo obtained through a public information request and follow-up communications with a sergeant in charge of the cold case unit. Ten of the 49 cases yielded actionable DNA profiles, according to the sergeant. The results, even from such a small batch, are at once promising and alarming:

• The DNA profiles of unidentified suspects in three “stranger rape” cases have been uploaded into a federal DNA database. Sgt. Moe Greenberg wrote in an email that there are no results in those cases yet.
• Police identified a suspect in a 1979 case. The prosecutor’s office initially decided not to move forward with charges, but Baltimore County Deputy State’s Attorney John Cox said his office is now reevaluating and looking at what options are available.
• A suspect was identified in a 1978 case, but the answers came too late: The suspect died in October, and the victim died years ago.
• Police connected a fourth victim to a serial rapist whose identity has eluded them since 1978; they have his DNA profile, but it doesn’t match anyone in the FBI database. That could mean the person was never arrested for a crime that would result in his DNA profile being uploaded into the database or that his profile remains in a backlog somewhere. According to the memo, police have sent the case to a private lab, Bode Technology, for forensic genealogy testing, which will try to identify a suspect by looking for possible relatives in publicly accessible DNA databases.

“It’s frightening but also heartening to think there are more serial rapists who may be caught with this testing,” said Wendell Carter, whose sister Alicia was killed in 1983 on the Goucher College campus by a serial predator who terrorized women across the Baltimore region between 1978 and 2000.

Police developed DNA profiles from testing 100 cases between 2005 and 2014, which eventually exposed Alicia’s killer, Alphonso W. Hill, as the worst known serial rapist in the state. Those cases placed him in the same spot on Goucher College campus where two other students were raped in the years before Alicia was killed. He has admitted to those rapes. He has since been linked to 25 rapes around the region, mostly thanks to forensic clues provided by this database. Hill confessed to killing Alicia last year after our investigation.

Though the evidence has delivered some promising results so far, ProPublica’s investigation exposed how much more must have been lost when some hospitals and police departments destroyed evidence and when police delayed testing.

Dr. Rudiger Breitenecker saved glass microscope slides and tubes containing samples from 2,252 sexual assault examinations conducted in his hospital between 1975 and 1997. He was the founder and director of the Rape Care Center at the Greater Baltimore Medical Center, and he started saving the samples years before rape kits were standardized and DNA testing technology was invented. His forensic pathologist background led him to believe it was better to save than to destroy, as others were doing at the time.

The doctor’s evidence collection went largely ignored until retired Sgt. Rose Brady heard about it in 2004 and began the first systematic effort to process and test Breitenecker’s savings. Investigators focused on stranger rape cases that had a high probability of being solved, and they ultimately arrested nearly 20 suspected serial rapists. The project stopped in 2014 due to lack of funds. Before Brady got involved, the hospital had destroyed some of the oldest slides in the collection in accordance with its retention policy. Today, about 1,800 cases’ worth of evidence remains untested.

Following scandals over police using questionable investigative practices and destroying evidence from sexual assault cases more recently, Baltimore County Executive Johnny Olszewski Jr. announced reforms and a new testing effort in 2019 thanks to a grant from the private Hackerman Foundation. Shelly Hettleman, a state senator from Baltimore County, requested funding from the foundation after sponsoring a law that mandated the testing of newer rape kits. The law does not cover the older evidence.

Hettleman said it is too soon to conclude much from the early results, but she expressed frustration that the testing has been so delayed. She and other officials say the pandemic and restricted lab capacities have slowed the new effort down. At the current rate, processing the rest of the evidence could take another half a century.

Advocates say such a delay is unacceptable, especially considering that many sex offenders assault more than one person. Recent research also documents how these predators can become one-man crime waves who also wind up charged with burglaries and murders. “How can we value women so little that we allow this to continue?” asked Jane Manning, a former prosecutor who now leads the Women’s Equal Justice Project, which helps survivors navigate the criminal justice system.

Special victims units typically work with relatively anemic resources given their daunting case loads. Baltimore County’s SVU team added 19 new cases in a recent stretch of 11 days.

Cold case squads frequently have even fewer resources. Police leadership had not devoted a single full-time detective to investigating the doctor’s evidence before the 2019 effort began, despite earlier pleas from the SVU team after they began to discover how many serial criminals were hidden in the untested slides. The dynamic is exacerbated when the media focus on newer cases, putting the pressure on officials with limited funds to deprioritize cold cases.

Now, Baltimore County’s SVU squad actually has a cold case group with one sergeant, two full-time detectives and three assistants. Despite this boost in resources, the workload is nevertheless tremendous considering the 1,800 cases from Breitenecker’s collection that are still waiting to be gone through, in addition to other cold cases. When investigating decades-old crimes, it’s often a challenge just to locate victims and witnesses. But the effort can be worth it.

Martha Southworth said it was very difficult not knowing who had attacked her at the edge of Goucher College campus in 1979. She thought her case would never be solved. But after police began testing the hospital slides in the mid-2000s, the slides from her case exposed Hill as a serial predator and provided a major clue that was vital to solving two other cases on the campus: Julie Wood’s rape in 1980 and Alicia Carter’s murder in 1983. Southworth said that going to court and seeing Hill sentenced to 30 years “was such a freeing experience for me. I didn't have to be afraid anymore.”

That is one reason, Manning said, that it is so important to pursue these cold cases. The ex-prosecutor also said that those frustrated with investigations have other avenues they can use to pursue justice. They can reach out to elected officials to push for new city and state laws that would enable survivors to file lawsuits against law enforcement for failure to protect, as people can do in New York City. They can also reach out to the Department of Justice, which investigates police departments, and ask it to look into the way local law enforcement is handling sex crimes. The federal government investigated the Baltimore city police in 2016 and found indications of gender bias and a general failure to sufficiently process sexual assault evidence and pursue what looked to be suspected serial offenders. The city police have since undergone reform efforts. The Justice Department is also investigating the University of Maryland, Baltimore County for its response to sexual misconduct, according to The Baltimore Sun.

Most importantly, Manning said, survivors can organize politically around the issue to “let public officials know that there will be a price to pay if you continue to allow impunity for rape.”

Baltimore County police wrote in the memo that the pace of testing should pick up now that they have expanded staffing and added another private DNA lab to help process the evidence. Greenberg said in an email that in addition to this first batch of test results, 75 more slide cases have been outsourced for testing. Testing has been completed on 17 of those cases so far, and the results are still under review.

by Vianna Davila, Lexi Churchill and Ren Larson

This story includes descriptions of sexual assault and physical violence.

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If you or someone you know has been sexually assaulted, you can receive confidential help by calling the Rape, Abuse & Incest National Network’s 24/7 toll-free support line at 800-656-4673 or visiting its website. You can be connected to a hotline staff member in your area or to the Department of Defense’s Safe Helpline.

Christian Alvarado began to type as he sat alone in an interrogation room at Fort Bliss, a sprawling Army post in El Paso, Texas. He’d spent most of the previous seven hours hooked up to a polygraph, answering a military investigator’s questions about an allegation that he’d sexually assaulted a fellow soldier.

His story had changed several times during the interview in late July 2020. The investigator told Alvarado he’d already failed two polygraph tests, then left the room so that the young soldier could type up his account in a sworn statement. With his fingers on the keyboard, Alvarado began describing the night in December 2019 that he spent in the barracks with a female soldier he’d met that day.

“She was drunk and so was I,” Alvarado, an Army private first class, typed on the investigator’s computer. “We had sex, but she passed out.”

A portion of Christian Alvarado’s statement to investigators, highlighted and redacted by ProPublica and The Texas Tribune. Although Alvarado is identified here as a specialist, military court documents and an Army spokesperson identify his rank as a private first class. (Obtained by ProPublica and The Texas Tribune)

He wrote that he’d lied about the encounter being consensual in previous interviews with investigators because he wanted to protect his Army career.

When Alvarado was done with his written admission, the military investigator walked back in the room. He asked Alvarado why he continued to have sex with the woman after she passed out. “I was in the moment,” the 20-year-old soldier replied.

The investigator then asked Alvarado about another allegation against him. An Army chaplain’s assistant had accused him of sexually assaulting her in May 2020 after a house party. Sex with her was “wrong due to how intoxicated she was,” Alvarado said, but he would not agree to a sworn statement about the second allegation because it would just be “icing on the cake.”

Alvarado told the investigator that he’d had sex with 42 women in the past four years, about a quarter of whom were intoxicated at the time. His sexual experiences had become boring and they blurred together, he said, to the point that he struggled to remember specific details about his partners.

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At the end of the daylong interrogation, Alvarado’s commanders didn’t place him in detention or under any restrictions beyond the orders he had already received to stay at least 100 feet away from the two women who had accused him of assault, according to records. He was free to leave.

A month later, he sexually assaulted another woman.

Had Alvarado’s case been handled by civilians and not the military, his written admission could have been enough evidence to quickly issue an arrest warrant, according to two lawyers who previously worked for the El Paso County district attorney’s office.

“I would have felt comfortable charging at that point,” said Penny Hamilton, who led the Rape and Child Abuse Unit at the district attorney’s office and later served as an El Paso County magistrate judge. “When you have the offender admitting the sexual act took place and you have the offender admitting that the alleged victim couldn’t have consented because she was passed out, then you have the elements” of a criminal charge.

In Texas’ civilian system, a person charged with sexual assault goes before a magistrate judge, who’d set a bail amount that experts said could easily be in the tens of thousands of dollars. Civilian magistrates and judges use bail to ensure suspects show up at trial. Suspects are released only if they can pay the bond.

The military justice system has no bail. Many decisions about who should be detained for serious crimes before trial are made not by judges but by commanders, who are not required to be trained lawyers.

Recent congressional reforms changed the system, which has long drawn criticism for the extensive discretion commanders wield. While the revisions stripped some of their authority, commanders continue to control various aspects of the judicial process, including deciding whether service members accused of crimes should be detained while awaiting trial, a process called pretrial confinement.

A ProPublica and Texas Tribune investigation into how commanders in the Army, the nation’s largest military branch, use pretrial confinement revealed a system that treats soldiers unevenly and draws little outside scrutiny. Over the coming months, ProPublica and the Tribune will explore how military justice operates, often in vastly different ways than the civilian system.

The news organizations obtained data from the Army on nearly 8,400 courts-martial over the past decade under the Freedom of Information Act. The resulting analysis, the first-of-its-kind, showed that soldiers accused of sexual assault are less than half as likely to be placed in pretrial confinement than those accused of offenses like drug use and distribution, disobeying an officer or burglary.

Soldiers accused of sexual assault are less than half as likely to be placed in pretrial confinement than those accused of offenses like drug use and distribution, disobeying an officer or burglary.

The analysis showed that, on average, soldiers had to face at least eight counts of sexual offenses before they were placed in pretrial confinement as often as soldiers charged with drug or burglary crimes.

That disparity has grown in the past five years. The rate of pretrial confinement more than doubled in cases involving drug offenses, larceny and disobeying a superior commissioned officer, but it remained roughly the same for sexual assault cases like Alvarado’s, the analysis found.

For instance, the Army opted against pretrial confinement for a staff sergeant who was accused of raping the wife of a soldier in his command at Fort Bliss, while at another post a 19-year-old Texas woman was placed in detention for more than three months for using drugs and mouthing off to commanders.

“Justice that’s arbitrary is not justice,” Col. Don Christensen, a former chief prosecutor for the Air Force, said. “It shouldn’t come down to the whims of a particular commander.”

Army officials defended the system. They said that soldiers accused of violent offenses aren’t necessarily more likely to get pretrial confinement. “The nature of the offense is one factor to consider in a decision to put someone in pretrial confinement, but it is not the sole factor,” said Lt. Col. Brian K. Carr, chief of the operations branch at the Office of the Judge Advocate General’s Criminal Law Division, in an email. Characteristics of individual soldiers and their willingness to follow orders are also important factors, Carr said.

He said that, under military regulations, commanders must first decide whether there’s good reason to believe that a soldier committed a crime and is either likely to flee before trial or engage in serious criminal misconduct. Commanders have to consider if other restrictions, such as directing soldiers to remain in military housing or requiring regular check-ins with superiors, are sufficient to keep them out of trouble. They should also weigh a soldier’s military service record, character, mental condition and any previous misconduct.

In March 2020, months before Alvarado was interviewed about the sexual assault allegations, commanders reprimanded him after El Paso police arrested him for firing an AR-15 outside of his girlfriend’s apartment. Alvarado told police at the time that he was attempting to scare off a pack of coyotes. An El Paso County warrant in the case remains outstanding.

Despite the reprimand and the initial sexual assault allegations, former Fort Bliss spokesperson Lt. Col. Allie Scott said that the conditions to justify placing Alvarado in pretrial confinement were not met. Scott, who recently transferred to another post, declined to clarify. She said Fort Bliss would not comment on internal deliberations.

Nearly a month after Alvarado walked out of the interrogation room at Fort Bliss, an Army captain determined there was probable cause that he committed sexual assault, according to records obtained by ProPublica and the Tribune. In a letter to the news organizations, Alvarado would later say he was innocent but declined to answer specific questions.

If something had been done sooner, he would have never gotten the chance to hurt me.

—Lee, who was assaulted by Alvarado

The Army’s decision, and the failure to quickly act on it, came too late for Lee, a civilian and the third woman whom he would later be charged with sexually assaulting.

Lee, who agreed to go by her middle name for this story, still relives the moment in late August when Alvarado assaulted her in her living room. He pinned her down on her couch and wrapped his hand around her throat while her two children slept across the house.

She recalls calling a friend and crying weeks later when she learned from military investigators that Alvarado had previously been accused of sexual assault.

“If something had been done sooner, he would have never gotten the chance to hurt me,” Lee said.

A Justice System Led by Military Commanders

The U.S. military justice system dates back to the American Revolution. Yet the way in which the system works and how it diverges from the civilian legal process is unknown to many Americans. (About 8% of adults in the U.S. currently serve or have served in the active-duty and reserve military forces.)

The system was created to help commanders keep their fighting forces in line. So, at the start, courts handled only military-specific offenses like desertion or dereliction of duty.

“George Washington needed a means to discipline his troops,” said Rachel E. VanLandingham, a professor at Southwestern Law School in Los Angeles and a former Air Force judge advocate, which is a military attorney. “It was very much a commander’s tool.”

Bail was never part of the military system because service members were often stationed in fortresses or remote, frontier garrisons, where commanders controlled their movements, said Joshua Kastenberg, a professor at the University of New Mexico School of Law and former Air Force judge advocate.

Civilian crimes were not tried at court-martial until the American Civil War, and then only as a way to prosecute Union soldiers who were accused of crimes in Confederate states, Kastenberg said.

For decades after, the military could tackle civilian offenses only during times of war.

Then the first and second world wars exposed a greater number of enlisted men and women to a justice system that was dramatically different from the civilian one. For example, the people representing them at trial were not required to be trained lawyers.

In an effort to bring the military more in line with civilian court practices, Congress developed the Uniform Code of Military Justice in 1950. This was a major turning point, giving the military — and, in turn, commanders — jurisdiction over civilian offenses like murder and sexual assault, not just during wars but in times of peace, Kastenberg said.

In the years since, the military pushed back against limiting commanders’ control. Some military legal experts interviewed by ProPublica and the Tribune maintain pretrial confinement is superior to the civilian bail system because a suspect’s freedom has nothing to do with their ability to pay. Criminal justice experts who oppose bail argue that it criminalizes poverty and penalizes people of color.

Critics of the military justice system say giving commanders authority over who gets detained reinforces an ongoing problem in the military. Commanders are an accused person’s supervisor and have little experience or training to make consequential legal decisions.

Commanders “have convinced themselves that they have some special insight shared by no others that makes them solely qualified to make prosecution decisions and control the justice system,” said Christensen, now president of the nonprofit Protect Our Defenders, an organization that promotes military justice reform.

The most recent congressional push to shield the courts-martial process from commanders’ influence followed the 2020 murder of Vanessa Guillén, an Army specialist who was sexually harassed by a supervisor and then allegedly killed by another soldier at Fort Hood, Texas.

A mural and growing memorial honor Spc. Vanessa Guillén at Houston’s Taqueria del Sol in July 2020. (Briana Vargas for The Texas Tribune)

Guillén’s death helped build momentum for a long-standing effort by some lawmakers to dramatically reduce commanders’ role in the military justice system. A bill introduced by U.S. Sen. Kirsten Gillibrand, a New York Democrat, proposed stripping commanders of the power to decide whether to prosecute serious offenses and giving that authority to military lawyers.

The military brass pushed back. To remove commanders “from prosecution decisions, process, and accountability may have an adverse effect on readiness, mission accomplishment, good order and discipline, unit cohesion, trust, and loyalty between commanders and those they lead,” Gen. Mark A. Milley, the chair of the Joint Chiefs of Staff, wrote in a May 2021 letter to Oklahoma Sen. James Inhofe, the top Republican on the Armed Services Committee.

In the end, Congress approved a compromise last year that created a new office of military attorneys with the power to prosecute cases related to some serious crimes such as sexual assault, domestic violence, murder and kidnapping.

Commanders retained prosecutorial control over other offenses, like robbery, assault and distribution of controlled substances.

Under the new law, commanders also held on to authority over other parts of the judicial process, including pretrial confinement. They can consult military attorneys with legal questions, but they are not required to follow that advice. And while a magistrate judge reviews cases in which a person is placed in pretrial confinement, there is no such review when commanders opt against detaining soldiers accused of crimes.

“A Dangerous Person” Staff Sgt. Randall S. Hughes (U.S. Army)

To understand the way that commanders’ discretion works in practice, consider the case of Randall S. Hughes, a Fort Bliss Army staff sergeant who was accused of raping the wife of one of his soldiers at a Super Bowl party in 2017.

The woman told ProPublica and the Tribune she repeatedly asked that the Army place Hughes in pretrial confinement after it began an investigation. Hughes’ commanders did not. They eventually decided against pursuing the case, citing evidence and advice from military counsel.

Hughes later moved to Joint Base McGuire-Dix-Lakehurst in New Jersey where, in May 2020, his 16-year-old daughter told military investigators that he had sexually assaulted her two months earlier.

Again, he was not detained.

Hughes’ commanders in New Jersey instead directed him to live on post and required him to check in by phone three times a day.

During the investigation into his daughter’s accusation, military law enforcement discovered allegations that years earlier Hughes sexually assaulted one ex-wife and raped another. The latter incident occurred while he was already under investigation for the rape at Fort Bliss. They learned a third ex-wife accused him of strangling her in 2015.

Hughes was again not put into pretrial confinement.

Matt Leonard, an Army spokesperson, said in an email that Hughes’ commanders “took appropriate action” to ensure the staff sergeant showed up at trial and did “not engage in further serious misconduct.” They also issued protective orders for the victims.

In a March 2021 plea deal, Hughes admitted to a number of charges, including raping the woman at the Super Bowl party and one of his ex-wives. He also was convicted of “squeezing” another ex-wife’s neck with his hands. A judge sentenced him to almost 14 years in prison and dishonorably discharged him. He did not plead guilty to sexually assaulting his daughter but admitted to using indecent language with her and pulling her by the hair.

Hughes’ attorney did not respond to an email requesting comment.

Chayla Madsen, Hughes’ first ex-wife and the mother of the daughter who accused him of sexual assault, said she agreed to the plea deal only because military attorneys said it would speed up the judicial process and be better for the victims.

Madsen used to believe the safest place her daughter could be was on a military base. Now she has no faith in a system that failed to take serious legal action against Hughes in 2017 when he was first accused of sexual assault.

“They had every reason to believe he is a dangerous person,” Madsen said.

Serial Offenses

Fort Bliss, where Hughes was first accused of sexual assault, uses pretrial confinement significantly less often than the vast majority of Army posts, applying it at a rate of roughly 6% for cases without sexual offenses and 5% for sexual assault cases, according to the news organizations’ analysis.

Pretrial Confinement Is Used Less Frequently in Sexual Assault Cases

The percentage of sexual assault cases that included pretrial confinement was lower than other types of cases at most Army posts. Shown are domestic posts that tried or arraigned at least 20 sexual assault and 20 other types of cases in the past decade.

Note: Numbers include Army general court-martial and special court-martial cases. “Other cases” exclude those with murder charges. Among these 29 posts, the number of cases tried or arraigned varied, ranging from just over 40 to more than 800. The median installation had 66 sexual assault cases and 83 other cases. Source: U.S. Army Court-Martial Information System. (Ren Larson/ProPublica and The Texas Tribune)

Just as they had done with Hughes, Fort Bliss commanders similarly decided at various junctures not to detain Alvarado.

They had another opportunity two weeks after he assaulted Lee.

Military investigators guided the 30-year-old mother, who had a brief relationship with Alvarado before the assault, to contact him and see if he would acknowledge what happened on the night of Aug. 26, 2020, when he asked to come over to her house to talk.

While sitting in a room with investigators, Lee texted Alvarado and asked him to explain why he didn’t stop when she told him to.

He apologized.

“Do you even know what you’re apologizing for?”

“My aggressive behavior.”

“Alvarado, it was more than aggressive. You choked me until I almost passed out and left bruises around my neck. Even when I told you to stop, you still shoved your hand down my pants. Why didn’t you stop when I told you to?”

The two texted for more than an hour. Lee kept pressing even after Alvarado attempted to end the conversation. Then he finally answered.

“I choked you and fingered [you]. I don’t want to talk about it.”

After the admission, the Army ordered that Alvarado stay 100 feet away from Lee. He also had other restrictions, including a requirement that he check in with commanders seven times a day in person or by phone, text or video call.

Scott, the Fort Bliss spokesperson, said commanders determined Alvarado’s restrictions “based on the information available to them at the time.”

But six attorneys and military law experts expressed surprise that commanders still did not order him into pretrial confinement.

“He’s under investigation for two sexual assaults, he’s been told to leave these people alone and then we have credible evidence that he’s committed another sexual assault,” said Geoffrey S. Corn, a former Army officer and law professor. “That’s enough to prove to me two things: No. 1, he’s dangerous and, No. 2, he might be a flight risk because he’s not getting the message he has to behave.”

One night, almost a month after the text exchange, Lee called 911 when her 10-year-old son told her that Alvarado had tapped on his bedroom window and said hello, according to a police report and an interview with Lee. Military police arrived quickly but could not locate anyone. Had Alvarado been there, he would have been in violation of the protective order that required him to stay away from Lee.

Scott said neither Fort Bliss investigators nor Alvarado’s commanders knew of the claim because military police files did not mention his name. Records obtained by ProPublica and the Tribune show that Lee shared Alvarado’s name and the fact that she had a protective order against him with a 911 dispatcher.

In late October, two months after Lee was assaulted, the Army formally charged Alvarado with three counts of sexual assault, as well as with strangling Lee and lying to investigators. Still, he was not detained.

By the end of December, Alvarado was in trouble again.

How long do we need to let a serial predator continue to violate orders and harm people?

—Franklin Rosenblatt, a law professor who previously served as a Fort Bliss judge advocate from 2010 to 2012

He was arrested for driving drunk during a trip to Arizona, where his family lives. Fort Bliss officials said they were not aware of the arrest because neither Alvarado nor the Scottsdale Police Department notified the post.

Alvarado then missed several required check-ins with commanders. Such failures could trigger pretrial confinement. They didn’t. After a month of missed check-ins, Alvarado’s company commander increased how often he had to contact his superiors and required him to write a 1,000-word essay on “the importance of Army leaders ensuring the safety and well-being of their Soldiers.”

“How long do we need to let a serial predator continue to violate orders and harm people?” said Franklin Rosenblatt, a law professor who previously served as a Fort Bliss judge advocate from 2010 to 2012.

Different Treatment A photo of Olivia Ochoa displayed in her parents’ home. Her experience shows how aggressive Army commanders can be even in cases with more minor infractions. (Ilana Panich-Linsman for ProPublica and The Texas Tribune)

Army officials say that pretrial confinement should be a last resort because it detains soldiers before they’ve been convicted of a crime. But Pvt. Olivia Ochoa’s experience shows how aggressive Army commanders can be even in cases with more minor infractions.

A San Antonio native, Ochoa became interested in military intelligence jobs after meeting a recruiter her senior year of high school. She joined the Army as a promising soldier in August 2020 shortly after graduating and was promoted in rank, according to her recruiter.

The 19-year-old soldier soon began to get in trouble. Months into her Army career, Ochoa was reprimanded for sexual harassment and creating a hostile work environment after she and another soldier were accused of slapping each other’s butts, inner thighs and frequently flirting during formation in Fort Huachuca, Arizona.

The incident, which Ochoa denies, was the first in a series of run-ins with her drill sergeants, ranging from not carrying “the appropriate amount of water” in her water bottle to more serious issues like underage drinking and eating a THC edible.

“Once I knew I was gonna get in trouble no matter how much I tried, I completely stopped trying,” Ochoa said.

By May 2021, one of Ochoa’s drill sergeants recommended that she be released from the Army.

While waiting to be discharged, Ochoa said, she was sexually assaulted by another soldier at an off-post hotel. She initially worried that if she filed a report, the military would delay her release, but after her mental health began deteriorating, she decided to report the assault.

In July, Ochoa was caught with psychedelic mushrooms and what investigators believed to be a vape pen with THC. The Army charged her with drug possession and use.

Her commander placed her under restrictions that, among other things, allowed her to visit only the few buildings on post where she slept, ate and worked out.

Two days later, Ochoa got in trouble for refusing her superiors’ order to go back to bed after she left her room to check on a friend who was being placed in confinement. That was enough for commanders to place her in pretrial confinement the next day.

A military magistrate ordered Ochoa’s release about a week later, determining confinement was “not warranted” because she had not broken her restrictions.

Her freedom was short-lived.

In the week following her release, Ochoa’s commander again placed her in pretrial confinement after she was caught two days in a row at stores she had been barred from visiting, once trying to buy cough medicine she said she planned to take to get high.

Although the Army’s case centered on drug use and possession, Ochoa was ultimately put in pretrial confinement both times for violating superior officers’ orders.

Although the Army’s case centered on drug use and possession, Ochoa was ultimately put in pretrial confinement both times for violating superior officers’ orders. Her commanders added seven new counts of disobeying and disrespecting superiors onto her drug case for reasons that included refusing to return to her room and visiting the on-post stores.

Ochoa’s actions showed that she should not be in the Army, but her punishment was excessive, said Rosenblatt, the law professor and former Army judge advocate. He said her case is an example of how pretrial confinement is used in “arbitrary” ways that can often be fueled by a commander’s relationship with the soldier.

Commanders often interpret drug use as jeopardizing the morale or safety of the unit, whereas they tend to view sexual assaults as a conflict between two people, said Aniela Szymanski, a private attorney and Marine Corps Reserve judge advocate.

“I think that’s going to take some time for commanders to grow into having the same knee-jerk reaction to sexual assault offenses as they do to drug offenses,” she said.

Ochoa spent 103 days in pretrial confinement. She stopped eating, barely slept and was losing her hair and eyelashes.

“Once I knew I was gonna get in trouble no matter how much I tried, I completely stopped trying,” Ochoa said. (Ilana Panich-Linsman for ProPublica and The Texas Tribune)

In November, after her initial trial date was pushed back by two months, Ochoa accepted a plea deal. She was sentenced to time served. During the hearing, Ochoa learned Army officials had decided not to pursue her sexual assault case, determining that they could not establish probable cause.

The decision was a surprise to Ochoa and her civilian lawyer, Sean Timmons, who said investigators did not interview key witnesses about the assault. Army officials later agreed to speak with additional people, but they came to the same conclusion and closed the case this year.

“I believe if she was a soldier who they actually liked and wanted to see have a productive career, they probably would have already taken steps to do this investigation properly,” Timmons, a former military attorney, said in an interview. “But because they don’t like her, they’re going to maltreat her and they’re going to do a half-assed job prosecuting him.”

A Fort Huachuca spokesperson said the Army takes sexual assault allegations seriously and conducted a thorough and independent investigation into Ochoa’s case.

“Broken”

In March 2021, more than seven months after Alvarado confessed during his interrogation, he was placed in pretrial confinement.

By then, the allegations of sexual assault against him had drawn national attention. Asia Graham, the soldier who Alvarado acknowledged he sexually assaulted while she was unconscious, died at age 19 after accidentally overdosing on drugs. Before her death, Graham had written a letter to her mother, Nicole Graham, about the pain she felt because the Army had failed to take action against Alvarado.

Nicole Graham’s daughter, Asia, was the soldier whom Alvarado acknowledged sexually assaulting while she was unconscious. She died at age 19 after accidentally overdosing on drugs. (Ilana Panich-Linsman for ProPublica and The Texas Tribune)

The publicity around Graham’s case caused two more women to come forward in an interview with the cable news network NewsNation and accuse Alvarado of assaulting them years earlier in Arizona. The women had not previously reported the incidents.

Commanders’ repeated decisions against pretrial confinement, which gave Alvarado the opportunity to assault Lee, did not draw public attention. But Alvarado’s civilian defense attorney last year, Sherry Bunn, told ProPublica and the Tribune that she believed Army leaders were simply reacting to “the press and publicity and the political nature” of Graham’s and Guillén’s deaths when they decided to confine him. Army officials say he was put in pretrial confinement because of the additional allegations.

Nicole Graham said her daughter might still be alive had commanders placed Alvarado in detention earlier.

Nicole Graham said her daughter might still be alive had commanders placed Alvarado in detention earlier. That might have convinced her daughter, who was haunted by the assault, that the Army was taking the case seriously, the mother said.

“I think she would have felt maybe stronger in her recovery and not self-medicated,” she said.

Nicole Graham got the chance to face Alvarado on June 18, 2021, when a military judge found him guilty of sexually assaulting her daughter and Lee, of strangling Lee and of lying to investigators. The judge acquitted him of all other charges, including the sexual assault of the chaplain’s assistant. After the judge’s ruling, Nicole Graham read a statement from the stand about Asia: “The military has let her down.”

The judge sentenced Alvarado to 18 years and three months in a military prison and a dishonorable discharge from the Army. He got credit for the time he spent in pretrial confinement ahead of his trial: 108 days, five days more than Ochoa.

Because of the dishonorable discharge and the length of his sentence, Alvarado’s case is under automatic appeal. A decision is still pending. He remains in custody.

The fact that Alvarado is behind bars gives Lee little comfort. The attack changed her.

She still has nightmares about the presence of someone in her home, walking up the steps to her bedroom and beating on the door.

Life was not perfect before the assault. She’d lost a pregnancy before having her two children. Two marriages to Army soldiers ended. But she still had a life. She used to enjoy socializing, inviting friends over for game nights or going out around town.

Now, she stays home most of the time.

She’s thought about cutting her long hair, because attackers can grab you by the hair.

She no longer likes to be touched, especially on her face. Even her young daughter loving on her can sometimes cause her to panic.

“I’m a little more broken than I used to be.”

Help ProPublica and The Texas Tribune Report on the Military Justice System

by Ren Larson

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.

Each year, hundreds of Army soldiers face trial in military courts for offenses that range from murder to failure to report for duty.

The military justice system largely operates separately from the civilian legal process and is unknown to many Americans. Under the system, commanders, who are not required to be trained lawyers, wield significant influence and can detain soldiers while they are awaiting trial through a process known as pretrial confinement.

Soldiers Accused of Sexual Assault Are Less Likely to Be Placed in Pretrial Confinement Than Those Accused of Drug Offenses

The decision to detain a soldier before trial is made by Army commanders. Here is the pretrial confinement rate for:

Note: Data includes Army general court-martial and special court-martial cases tried or arraigned in the past decade. Cases with concurrent murder charges are excluded. Drug cases exclude those with a concurrent sexual assault charge. Source: U.S. Army Court-Martial Information System. (Ren Larson/ProPublica and The Texas Tribune)

An investigation by ProPublica and The Texas Tribune found that soldiers accused of sexual assault are less than half as likely to be placed in pretrial confinement than those accused of offenses like drug use and distribution. Soldiers accused of other more minor offenses such as disobeying an officer or damaging nonmilitary property also have higher rates of pretrial confinement than those accused of sexual assault.

That gap held up even when narrowing in on certain types of sexual assault cases that we suspected might be more likely to result in pretrial confinement.

When we limited the analysis to charges involving the most violent sexual offenses, the pretrial confinement rate remained well below that of drug offenses. (Sexual assault charges include a range of offenses, from rape to nonconsensual contact of body parts like the inner thigh.)

Our analysis also focused on charges, not the outcome of the trial, since the decision to put a soldier in pretrial confinement is made before a case is adjudicated and because guilt is not a requirement for pretrial confinement. But even for soldiers who were eventually found guilty of at least one sexual assault offense, the rate of pretrial confinement remained well below the rate for drug cases, with or without a drug offense conviction.

Here’s How We Did This

ProPublica and the Tribune examined nearly 8,400 cases over a decade that went to the Army’s general court-martial and special court-martial, which are sometimes likened to felony and misdemeanor courts, respectively, in the civilian system.

A case was considered to have pretrial confinement if the soldier was held or given credit for at least one day in confinement.

We analyzed the rate of pretrial confinement for the 25 offenses most frequently referred to courts-martial, including sexual assault, drug crimes, physical assault, larceny and being AWOL.

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

ProPublica and the Tribune spoke with military law experts and individuals familiar with the way Army records are maintained to inform our analysis and review our findings. Experts provided guidance on the accuracy of data fields, informed our approach to standardize charges and helped to vet our findings.

Over time, the military has changed how it charges some offenses. For our analysis, older charges were standardized to the most recent edition of the Manual for Courts-Martial, which guides trial proceedings. We did this by looking at the description of the offense and articles the case was charged under in the Uniform Code of Military Justice at the time an alleged offense took place. (Our analysis focuses on cases that went to courts-martial in the past decade, but a handful of those cases used charges from older editions of the manual.)

For example, the military’s criminal laws used to group certain consensual and nonconsensual sexual acts under the same article when charging soldiers. We aligned these rape and sexual assault charges with the recent edition of the manual and did not count charges related to consensual acts as assault.

We analyzed sexual assault offenses by looking at cases with charges of either sexual assault of an adult or of a child.

Cases with a murder or sexual assault charge were grouped only with their most serious offense. Put another way, if a soldier’s case included both murder and sexual assault charges, our analysis of pretrial confinement grouped it with murder charges, not with sexual assault offenses. And cases that included sexual assault offenses and more minor charges were grouped only with sexual assault.

If a case did not include one of those more serious offenses but had multiple charges, we analyzed pretrial confinement for each charge. For example, if a case included larceny and drug use, it was grouped with the larceny offense and the drug offense cases. This was necessary because beyond murder, homicide and sexual assault, there is not a clear way to rank the roughly 600 offenses by severity.

We also looked at pretrial confinement by trial location. For about 1% of cases, we corrected the trial location because it was entered imprecisely.

We found that the rate of pretrial confinement varied greatly by location. For sexual assault cases, it ranged from just under 4% at Fort Sill in Oklahoma to about 19% at Fort Leonard Wood in Missouri. We looked at U.S. installations that tried or arraigned at least 20 sexual assault cases and 20 cases of other types, excluding murder.

At 20 of the 29 installations, sexual assault cases had a lower rate of pretrial confinement than other cases that were tried or arraigned.

Pretrial Confinement Is Used Less Frequently in Sexual Assault Cases

The percentage of sexual assault cases that included pretrial confinement was lower than other types of cases at most Army posts. Shown are domestic posts that tried or arraigned at least 20 sexual assault and 20 other types of cases in the past decade.

Note: Numbers include Army general court-martial and special court-martial cases. “Other cases” exclude those with murder charges. Among these 29 posts, the number of cases tried or arraigned varied, ranging from just over 40 to more than 800. The median installation had 66 sexual assault cases and 83 other cases. Source: U.S. Army Court-Martial Information System. (Ren Larson/ProPublica and The Texas Tribune) We Will Continue to Investigate Military Justice

The database is expansive, with trial records from five continents and cases going back to the 1980s. But it has noteworthy limitations.

Military regulations require commanders to consider if lesser restrictions (like requiring regular check-ins) are insufficient before placing a soldier in pretrial confinement. For this story, we could not assess whether individuals received or followed restrictions before confinement because this information was not reliably recorded in the database. Of cases that had pretrial confinement, only 7% noted pretrial restrictions. Our review of case documents revealed instances where soldiers were subject to pretrial restrictions that were not recorded in the database.

We also know that some types of cases are not captured in the database, including cases where a soldier withdrew from military service ahead of arraignment or was punished outside of court. According to the most recent report to Congress on military justice, the Army used nonjudicial punishment in more than 25,000 cases in the past fiscal year. During that time, only about 700 people were arraigned in the branch’s highest trial courts.

We know other offenses are never reported at all. A 2020 Department of Defense report on sexual assault in the military estimates that for every service member who reports a sexual assault, at least two more do not.

ProPublica and the Tribune will continue to investigate the military justice system, which regulates the conduct of more than 1.3 million active-duty service members.

Evidence from trials, nonjudicial punishment and administrative actions are essential to our investigations. Your story is important to us.

Help ProPublica and The Texas Tribune Report on the Military Justice System

Texas Tribune data editor Chris Essig reviewed the analysis.

by Vianna Davila, Ren Larson, Lexi Churchill and Jessica Priest, ProPublica and The Texas Tribune, and Adriana Gallardo, ProPublica

Military investigations can be opaque. The people involved may be the only witnesses to how cases move or stall. An investigation by ProPublica and The Texas Tribune into pretrial confinement, an aspect of the military justice system that allows commanders to detain service members ahead of trial, showed that Army soldiers accused of sexual assault are less than half as likely to be placed in pretrial confinement as those accused of offenses like drug use and distribution, disobeying an officer or damaging nonmilitary property.

Our news organizations plan to continue examining the military justice system, which handles more than 1,000 cases across all branches annually. Charges in those cases range from disobeying an officer to murder. We also want to learn more about how the military handles cases that do not make it to courts-martial and how commanders assign nonjudicial punishments.

To do this, we’d like to hear from service members, former service members and families about how the military justice system operates, including how it investigates allegations of sexual assault, domestic violence, drug use as well as noncombat deaths. We are also interested in how military justice intersects with the civilian justice system.

As we embark on this effort, we want to make sure we’re asking the right questions. We hope our work can prevent future harm. To that end, we hope to learn from and speak with military support staff and current and former service members, along with the families of both groups. In particular, we would like to hear from people who have experience at military bases in Texas.

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Some of Our Organizations’ Previous Reporting on the Military: Disaster in the Pacific

An investigation into what went wrong in America’s 7th Fleet after a series of deadly naval accidents in the Pacific.

Deplorable conditions, unclear mission: Texas National Guard Troops call rushed border operation a disaster

Some Guard members say a massive mobilization, which would normally take months to plan, set back their income, education and well-being.

Reliving Agent Orange

For decades, Vietnam veterans suspected that the chemical mixture harmed their health and that of their children. But the Veterans Affairs agency hadn’t studied its own data for clues. ProPublica and The Virginian-Pilot investigated the mixture’s effects and military families’ fight for benefits.

by Mark Olalde and Maya Miller, video by Mauricio Rodríguez Pons and Ed Ou, photography by Ed Ou

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Join us Aug. 16 for a live virtual event, “New Mexico’s ‘Death Map’: Uranium and Nuclear Energy in the U.S.”

The “death map” tells the story of decades of sickness in the small northwest New Mexico communities of Murray Acres and Broadview Acres. Turquoise arrows point to homes where residents had thyroid disease, dark blue arrows mark cases of breast cancer, and yellow arrows mean cancer claimed a life.

Neighbors built the map a decade ago after watching relatives and friends fall ill and die. Dominating the top right corner of the map, less than half a mile from the cluster of colorful arrows, sits what residents believe is the cause of their sickness: 22.2 million tons of uranium waste left over from milling ore to supply power plants and nuclear bombs.

Neighbors created the “death map” to highlight cancer cases in New Mexico’s Murray Acres and Broadview Acres communities. (Image courtesy of Candace Head-Dylla. Graphic composition by Mauricio Rodriguez Pons/ProPublica)

“We were sacrificed a long time ago,” said Candace Head-Dylla, who created the death map with her mother after Head-Dylla had her thyroid removed and her mother developed breast cancer. Research has linked both types of illnesses to uranium exposure.

Beginning in 1958, a uranium mill owned by Homestake Mining Company of California processed and refined ore mined nearby. The waste it left behind leaked uranium and selenium into groundwater and released the cancer-causing gas radon into the air. State and federal regulators knew the mill was polluting groundwater almost immediately after it started operating, but years passed before they informed residents and demanded fixes.

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Candace Head-Dylla was one of the first neighbors to leave Murray Acres because of the contamination.

The contamination continued to spread even after the mill closed in 1990.

The failures at Homestake are emblematic of the toxic legacy of the American uranium industry, one that has been well-documented from its boom during the Cold War until falling uranium prices and concerns over the dangers of nuclear power decimated the industry in the 1980s. Uranium mining and milling left a trail of contamination and suffering, from miners who died of lung cancer while the federal government kept the risks secret to the largest radioactive spill in the country’s history.

But for four decades, the management of more than 250 million tons of radioactive uranium mill waste has been largely overlooked, continuing to pose a public health threat.

ProPublica found that regulators have failed to hold companies to account when they missed cleanup targets and accepted incorrect forecasts that pollution wouldn’t spread. The federal government will eventually assume responsibility for the more than 50 defunct mills that generated this waste.

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At Homestake, which was among the largest mills, the company is bulldozing a community in order to walk away. Interviews with dozens of residents, along with radon testing and thousands of pages of company and government records, reveal a community sacrificed to build the nation's nuclear arsenal and atomic energy industry.

Time and again, Homestake and government agencies promised to clean up the area. Time and again, they missed their deadlines while further spreading pollution in the communities. In the 1980s, Homestake promised residents groundwater would be cleaned within a decade, locals told the Environmental Protection Agency and ProPublica. After missing that target, the company told regulators it would complete the job around 2006, then by 2013.

In 2014, an EPA report confirmed the site posed an unacceptable cancer risk and identified radon as the greatest threat to residents’ health. Still, the cleanup target date continued shifting, to 2017, then 2022.

Rather than finish the cleanup, Homestake’s current owner, the Toronto-based mining giant Barrick Gold, is now preparing to ask the Nuclear Regulatory Commission, the independent federal agency that oversees the cleanup of uranium mills, for permission to demolish its groundwater treatment systems and hand the site and remaining waste over to the U.S. Department of Energy to monitor and maintain forever.

Uranium waste piles are the main source of contamination at the Homestake facility. (Video by Mauricio Rodríguez Pons/ProPublica)

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Uranium waste piles are the main source of contamination at the Homestake facility. (Video by Mauricio Rodríguez Pons/ProPublica)

Watch video ➜

Before it can transfer the site to the Department of Energy, Homestake must prove that the contamination, which exceeds federal safety levels, won’t pose a risk to nearby residents or taint the drinking water of communities downstream.

Part of Homestake’s strategy: buy out nearby residents and demolish their homes. Local real estate agents and residents say the company’s offers do not account for the region’s skyrocketing housing costs, pushing some who accept them back into debt in order to buy a new home. Those who do sell are required to sign agreements to refrain from disparaging Homestake and absolve the company of liability, even though illnesses caused by exposure to radioactive waste can take decades to manifest.

Watch video

As a nurse, Elaine Borchert saw many uranium miners suffer serious illnesses.

Property records reveal the company had, by the end of 2021, purchased 574 parcels covering 14,425 acres around the mill site. This April, Homestake staff indicated they had 123 properties left to buy. One resident said the area was quickly becoming a “ghost town.”

Even after the community is gone, more than 15,000 people who live nearby, many of them Indigenous, will continue to rely on water threatened by Homestake’s pollution.

The company said it has produced models showing that its waste won't imperil the region's water if it walks away. The NRC says it will only grant a groundwater cleanup exemption if that’s the case.

But while Homestake and other mining companies have polluted the region, it’s been the NRC and various other agencies that stood by as it happened. ProPublica found the NRC has issued exemptions from groundwater cleanup standards to uranium mills around the country, only to see pollution continue to spread. This has occurred as climate change hammers the West, making water ever scarcer.

“Groundwater moves. Groundwater doesn’t care about regulations,” said Earle Dixon, a hydrogeologist who reviewed the government’s oversight of uranium cleanup and pollution around Homestake for the New Mexico Environment Department and the EPA. Dixon and other researchers predict contamination at Homestake will likely spread if cleanup ends.

The company has denied that its waste caused residents’ illnesses, and judges ruled in Homestake’s favor in a case residents filed in 2004 alleging the site caused cancer. Doctors testified that the pollution was a substantial factor contributing to residents’ cancers, but tying particular cases to a single source requires communitywide blood, urine and other testing, which hadn’t been done.

“We are proud of our work done in remediating the Homestake Uranium Mill site,” Patrick Malone, Homestake's president, said in a letter responding to questions from ProPublica. He said Homestake was entering the final stages of cleanup because “the site is at a point where it is not technically feasible to provide additional, sustainable improvements to water quality.”

David McIntyre, an NRC spokesperson, attributed cleanup delays to the area’s complex groundwater system. “We understand and share the concern that remediation is taking so long,” McIntyre said, adding that the agency’s priority is to protect public and environmental health rather than meet particular deadlines.

The EPA has oversight of the former mill’s cleanup under its Superfund program that aims to clean the country’s most toxic land. The EPA regional office did not respond to questions.

Larry Carver has lived in Murray Acres for the majority of his life. He has no plans to move. (Ed Ou for ProPublica)

Larry Carver has implored an endless stream of regulators to take action since his family moved to Murray Acres in 1964, and neighbors defer to him to tell the community’s story. The 83-year-old leaned against his Chevrolet pickup on a blustery spring morning, peering from beneath a baseball cap at Homestake’s 10-story pile of waste. He lamented that the community would be sacrificed so uranium waste could remain.

For Carver, arrows on a map don’t tell the full story of uranium’s impact. His wife’s aunt and uncle owned the home closest to the waste piles. Her aunt died of liver cancer when she was 66 years old, and her son, who grew up playing in unfenced waste ponds, died of colon cancer when he was 55 years old. Now, Carver and his wife both have spots on their lungs, with hers recently requiring radiation treatment.

“All the houses are going to be gone. The wells are being plugged. The septic systems are being torn up,” Carver said. “There will be nothing.”

Homestake Has Bought More Than 14,000 Acres Surrounding the Mill

Larry Carver, who has lived in his home since 1970, has refused to sell his property to the company.

Graphic by Lucas Waldron/ProPublica. Source: Satellite imagery from NAIP; parcel data obtained from the Cibola County assessor.

Watch video ➜

“A Long Time to Keep the Secret”

Saturday, April 26, 1958, was a momentous day in the towns of Grants and Milan, New Mexico.

(Images courtesy of the Cibola County History Museum. Graphic composition by Mauricio Rodríguez Pons/ProPublica)

Full-page newspaper ads announced the opening of Homestake’s new uranium mill. A military flyover kicked off the festivities, a high school band played, and the New Mexico secretary of state unveiled a plaque commemorating the occasion. An estimated 6,000 people, nearly three times Grants’ population at the beginning of that decade, toured the mill, the local newspaper, the Grants Beacon, reported. Grants would be the Carrot Capital of America no more. It was running headlong into the Atomic Age.

But the celebration was short-lived: Less than a year and a half after operations began, state and federal regulators, with the company’s help, began investigating whether contaminants were leaking from Homestake’s waste.

Homestake opened in 1958, drawing workers from across the country to the towns of Grants and Milan. Image ​​courtesy of the New Mexico Bureau of Geology and Mineral Resources. (Graphic composition by Mauricio Rodríguez/ProPublica)

ProPublica found that, as with most uranium mills in the U.S., Homestake built no liner between the earth and the sandy waste left over from milling, known as tailings. This happened even though an engineer with the New Mexico Department of Health warned the company only weeks after the mill opened that it needed to at least compact the soil underneath its waste to prevent leaks. Without a liner, pollution seeped into aquifers that supplied drinking water. In 1961, the same engineer wrote that groundwater samples showed radium 226, a radioactive and cancer-causing element, at levels as much as 31 times higher than naturally occur in the area, indicating “definite pollution of the shallow ground water table by the uranium mill tailings’ ponds.”

A federal report a year later identified even higher levels of radium 226 in groundwater.

Residents drank that water, fed it to livestock and applied it to crops. They weren’t told of the issue or supplied with bottled water until the mid-1970s, neighbors said. “A long time to keep the secret,” Carver said.

The EPA in the 1970s found elevated levels of selenium, which can damage the nervous system at high doses. Homestake disputes what levels of contaminants are attributable to the mill versus other sources, a question regulators are currently studying. The company confirmed in 1976 that its waste had created a plume of contamination in the groundwater but waited another decade to connect residents to an uncontaminated water system, only doing so after pressure from the EPA.

Seventeen years after pollution was first detected, Homestake began a series of ultimately unsuccessful attempts to clean the groundwater. The company pumped contaminated water out of aquifers and evaporated it aboveground, treated it in filtration systems and dumped hundreds of millions of gallons of clean water on the waste to flush uranium out of the pile, collecting the newly contaminated water for disposal.

Homestake was still left with more polluted water than it could process, so the company irrigated crops, applying more than 3.1 billion gallons to farmland in the subdivisions. As a result, the topsoil contained elevated levels of uranium and selenium. The state and the NRC halted the practice, which the NRC said the company had done without its approval.

(Video by Mauricio Rodríguez Pons/ProPublica)

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Much of the now-fallow farmland has turned to dust that’s an incessant headache for residents. Windstorms whip it up, piling it on roadways and pushing it through the slightest cracks in homes. Regulators have issued dozens of violation notices to the company, including for failing to fence off contaminated land and for exposing workers to high uranium levels without alerting them.

At the state level, New Mexico regulators waited until 2009, 49 years after first finding water pollution, to issue a formal warning that groundwater included substances that cause cancer and birth defects. They waited another nine years before barring people from drilling new or replacement wells in aquifers near the cleanup effort, but the order did not require existing wells to be plugged. A spokesperson for the New Mexico Office of the State Engineer said authorities had issued a “relatively small” number of domestic or livestock well permits in the contaminated area. That number, the spokesperson said, is 122.

Uranium exposure is pervasive in this part of the world.

Miners who worked before 1971, when the government was the sole purchaser of uranium, are eligible for compensation under the Radiation Exposure Compensation Act. In June, President Joe Biden signed a bill postponing its expiration for two years. But miners who worked in the industry after other uranium buyers entered the market, as well as residents of communities that were impacted by uranium extraction and processing, like those next to Homestake, still receive no benefits. Spearheaded by the New Mexican delegation, bills pending before Congress would expand the legislation to include more miners and appropriate funds to study the health impacts of living near these sites.

Linda Evers is waiting on those reforms. She worked in the area’s mines and mills, including Homestake, after the 1971 cutoff. She stayed on the job through two pregnancies, removing trash from the ore until hours before she gave birth to her son. Both her children have birth defects, and she now lives with kidney failure, cysts on her organs and a degenerative bone disease.

(Video by Ed Ou for ProPublica)

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“You worked in a never-ending dirt storm,” Evers remembered. “You were supplied a paper mask that was worthless in about 20 minutes.”

She also dealt with contamination at home. For more than 15 years, Evers lived across the street from Homestake. Her well water was so foul it stunted the plants in her garden, she said. Evers eventually accepted the company’s buyout offer and moved to a new home farther from the waste. A half-built greenhouse sits in her former backyard, her once-lively home stripped of its porch and part of the roof.

“I’m Just Left on the Ground to Seep”

Down the road, John Boomer doesn’t know where he’ll go if he sells to Homestake. An artist who paints with a Southwestern palette of sand and soil, he lives in an art studio and home he shares with his partner, Maggie Billiman, a member of the Navajo Nation and fellow artist.

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The music of artist John Boomer, who lives near the waste, tells the story of the decline of the uranium industry in Grants, New Mexico.

The consequences of uranium production are constantly on the couple’s minds. More than 500 abandoned uranium mines pockmark the Navajo Nation, and Billiman’s father, a Navajo Code Talker in World War II, died of stomach cancer, an illness associated with downwind exposure to nuclear tests. Boomer has written the story of uranium into lyrics, singing about the harm caused by the waste that was left behind.

Those corporate little creeps

Will cause many a widow to cry and weep

While I’m just left on the ground to seep

Homestake is working on requests to both the NRC and the EPA for groundwater cleanup waivers, arguing it’s done all it can to clean up the area.

The company excavated soil from more than 3,500 acres where wind had carried contaminants off-site. Homestake also collected about 1.3 million pounds of uranium and 75,000 pounds of selenium by treating or evaporating more than 10 billion gallons of groundwater, according to company data.

Other uranium mines and mills polluted the area’s main drinking water aquifer upstream of Homestake. Residents worry what will happen to contamination from those sites and from Homestake when the company halts its water treatment.

Homestake says it has built a hydrological model that shows the former mill’s contamination will stay close to the site. (The model won’t be released until the company files its formal application for cleanup exemptions, likely in August.)

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Despite Homestake's remediation, residents of surrounding communities continue to be exposed to radiation from the piles. (Video by Mauricio Rodríguez Pons/ProPublica)

Watch video ➜

But researchers who have studied the hydrology around Homestake said the contamination will head downstream. “Would it keep on moving? Yes, that’s nature,” said Dixon, the hydrogeologist. The real question, he said, one that modeling can’t answer, is how quickly the pollution will migrate.

ProPublica identified sites across the West where regulators approved waivers based on modeling, only to later discover the predictions were flawed.

At a site in Wyoming called Bear Creek, the NRC found concentrations of uranium in groundwater more than 10 times higher than a model had predicted. At a site along the banks of the Colorado River, in Rifle, Colorado, the NRC approved a cleanup plan based on groundwater modeling that predicted uranium would fall to safe levels within 10 years. Monitoring showed concentrations remained dangerously high about a decade later, and new modeling predicted uranium levels wouldn't reach safe levels for more than a century.

There’s also the cleanup of another Wyoming mill named Split Rock, which Homestake has compared its site to as it seeks a cleanup exemption. Regulators granted a waiver in 2006 after the responsible company presented a model showing contamination wouldn’t reach downstream wells for 1,000 years. “The recent data, however, have shown results that are not consistent with the model predictions,” the NRC wrote seven years later. Nitrates, which are sometimes used in the uranium refining process, were measured in a downstream monitoring well at more than four times approved limits.

McIntyre, the NRC spokesperson, said that in those cases, “NRC staff reviewed groundwater monitoring results and verified that the levels were and remain protective of public health and safety,” adding that the agency requires models used in waiver requests be conservative in their predictions.

Leaders of communities downstream from Homestake, including the Pueblo of Acoma, fear that wishful thinking could allow pollution from the waste to taint their water. The Acoma reservation, about 20 miles from Homestake’s tailings, has been continuously inhabited since before 1200. Its residents use groundwater for drinking and surface water for irrigating alfalfa and corn, but Donna Martinez, program coordinator for the pueblo’s Environment Department, said the pueblo government can’t afford to do as much air and water monitoring as staff would like.

“There are always going to be concerns with the plumes,” Martinez said.

Most days, Billiman contemplates this “poison” and whether she and Boomer might move away from it as she prays to Mother Earth and Father Sky toward Mount Taylor, one of the four sacred Diné peaks, which rises just east of the subdivisions.

“I tell her, gosh, we did this to you. I’m sorry,” Billiman said. “Then, we just say ‘hózho náhásdlii, hózho náhásdlii’ four times.”

“All will be beautiful again,” Boomer roughly translated.

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John Boomer and Maggie Billiman pray to the sacred mountain of Mount Taylor. Day after day, they apologize to nature for the damage caused by the uranium industry.

As they prayed one recent morning, the dawn light tumbled over the mountain, illuminating the nearby Haystack Mountain, where a Diné man named Paddy Martinez discovered economically recoverable uranium in 1950 and ignited the region’s mining boom. The light cascaded over Homestake’s tailings piles, across the valley and onto the five subdivisions.

“Doing It Right… …Right to the End”

The smell of pizza wafted through a Village of Milan government building down the road from the mill site, as about 20 locals trickled in to meet with Homestake one April evening. They caught up while JoAnne Martinez, a community liaison for Homestake, beseeched them to tuck into the food she had set out. A map taped to the wall showed the location of groundwater contamination, and a stack of glossy booklets celebrated the company’s reclamation project with the slogan: “Doing it right… …Right to the end.”

Tensions rose when residents spoke about the company’s offers to buy their properties. Homestake, whose parent company Barrick had nearly $12 billion in revenue last year, pays market value based on past sales prices of comparable properties, rather than the cost to replace what residents have, which is ballooning rapidly amid the housing crunch. Over the past five years, prices for residential properties around New Mexico have increased about 59%, while they’ve spent about half as long on the market, according to data from real estate companies Zillow and Redfin, respectively.

Neighbors are concerned by what they deem to be low offers from Homestake to buy their properties. (Mark Olalde/ProPublica)

In the meeting, residents explained what that trend, coupled with Homestake’s offers, has meant for their own housing searches. “It’s like you spit on me,” one resident said of the company’s proposal to buy the property where she has lived for 61 years. Another neighbor told ProPublica she had asked a builder to assess the cost of constructing a nearly identical home and got an estimate $60,000 higher than what Homestake offered. But Homestake didn’t budge.

Neighbors have worried about Homestake’s impact on their property value for decades. They filed a class-action lawsuit against the company in 1983 for alleged property damages, later settling the case for what they deemed to be small payouts. In exchange, those residents agreed to release the company from further liability.

More recently, the company has rejected residents’ requests to move the waste to a lined disposal cell, which could prevent additional groundwater contamination and radon exposure and possibly allow them to stay in their homes. So far, cleanup has cost more than $230 million, including about $103 million that came from taxpayers through the Department of Energy. Homestake estimates it could cost as much as $2 billion more to move the entire pile. Buying out five subdivisions is the cheaper option.

(Mauricio Rodríguez Pons/ProPublica)

Homestake argues capping the site and walking away is safer, citing reports that conclude moving the pile would lead to at least one workplace traffic-related death and a high likelihood of workers and residents developing cancer. The reports used calculations from the Department of Energy, which is moving 16 million tons of uranium waste off of a site in Moab, Utah. The department’s report found it posed far less risk to workers than later estimates for Homestake. Department of Energy staff said they could not comment on why there are such different risks for the Homestake and Moab sites.

As more neighbors at the meeting demurred about the company’s offers, Orson Tingey, a land manager for Homestake and Barrick, explained that the company has continued to offer the same rates for properties as it did before the COVID-19 pandemic to remain consistent. “We know that doesn’t necessarily work for everybody,” he said.

“I Don’t Even Know How You Fight It”

Jackie Langford set a radon detector on her kitchen table and shooed away her inquisitive 12-year-old, who was more interested in talking uranium policy than finishing his homework. She recalled when her family moved in a decade ago for her husband’s job. No one mentioned the risks posed by Homestake’s tailings pile, which looms less than a mile away.

Jackie Langford in her house near the mill. No one alerted her about the radon risks in the area before she moved in. (Ed Ou for ProPublica)

Now, as a registered nurse tending to former uranium miners, Langford knows too much about the dangers. When it’s inhaled, radon breaks down in the lungs, releasing bursts of radiation that can damage tissue and cause cancer. Her patients have respiratory issues as well as lung cancer. They lose their breath simply lifting themselves out of a chair.

Radon, the radioactive gas formed as uranium decays, poses Homestake’s main cancer threat to residents, according to the EPA’s 2014 study. It is more concentrated in outdoor air near Homestake than in a nearby community with a former uranium mill that has fully covered its waste.

It hasn’t helped that the company has struggled to control radon emanating from its larger waste pile, exceeding federal safety standards each of the last six years, according to company readings reported to the NRC. This year, Homestake requested permission to add a new cover to the pile to reduce radon emissions, which the NRC is now reviewing.

A radon test kit in a resident’s home. (Ed Ou for ProPublica)

During the pandemic Langford and her family began thinking more about Homestake’s possible impact on their respiratory health, driving them to buy a radon detector. The gas can seep into buildings through cracks in foundations. Indoor radon exposure is the second-leading cause of lung cancer in the United States, behind smoking.

When Langford measured levels in her home, the radon detector registered 4 picocuries per liter and rose as high as 7 pCi/L, she said — levels high enough that the EPA recommends remediation.

She brought her concerns to Homestake, but “for the longest time, they wouldn’t talk to me,” she said. The company eventually connected her with one of their consultants, who told her not to worry because his own home tested above 4 pCi/L and the results did not concern him. He also told Langford, as well as ProPublica, that he is not a radon expert and suggested she complete a longer-term radon test and contact people better versed on the topic.

In 2010, before Langford moved in, EPA contractors placed radon detectors in homes near Homestake and found unsafe radon levels in a dozen homes.

While independent researchers suggested the uranium waste could be a source of indoor radon, the EPA has not determined that is the case, instead identifying naturally occurring gas seeping from the soil. The agency required Homestake to fund radon mitigation in homes but has not done any more radon testing or mitigation since.

“Best practice would be retesting at least every other year to assure things have not gotten worse,” said Michael Murphy, who is retired from the EPA’s indoor air quality team.

ProPublica spoke with eight households the EPA monitored, and all said they were never retested or advised to retest on their own. An EPA staffer told one resident the agency had no plans to conduct follow-up studies.

John Boomer and Elaine Borchert measured radon levels in their homes. (Ed Ou for ProPublica)

Because the EPA did not return to test, ProPublica did, placing certified indoor radon kits in nine area households. Three returned readings that exceeded the EPA’s threshold for mitigation, while a fourth registered above the World Health Organization’s lower suggested mitigation level. Langford’s tests averaged 6.95 pCi/L.

She immediately thought about her son. Children are more vulnerable to radon.

Jackie Langford’s test results (Photo by Ed Ou for ProPublica. Graphic composition by Mauricio Rodríguez Pons/ProPublica.)

Early this spring, Homestake approached Langford and her husband with an offer to purchase their home. They wavered. The family loved the area and knew neighbors who had sold, only to find it impossible to buy a similar property elsewhere.

“I don’t think that’s fair,” Langford said, “but at this point I don’t even know how you fight it.”

With the results from their radon testing front of mind, Langford’s husband signed Homestake’s buyout deal. The family had made a decision. Their health was too important to remain in their home.

How We Reported the Story

Methodology: To report on the Homestake uranium mill’s impact on the area, ProPublica worked with residents to crowdsource indoor radon levels, home purchasing contracts and health-related documents.

Radon Testing: Indoor radon levels were collected using Air Chek 3- to 7-day radon test kits placed in nine houses in Milan and Grants, New Mexico. Air Chek’s devices and laboratories are included on the National Radon Proficiency Program’s approved device and analysis provider list.

Radon levels vary day to day and season to season, so ProPublica followed EPA recommendations to conduct two sequential short-term tests. A ProPublica reporter helped install the first test at each house to ensure the testing locations adhered to EPA testing protocols. After about five days, residents took down each test and sent the kits to Air Chek’s laboratory. Residents immediately placed the second Air Chek 3- to 7-day test in the same location. About five days later, residents shipped the second test to the lab. We averaged the results of the two tests to obtain an estimated indoor radon level for each house.

Three households were only able to obtain one result. In one case, this was because a test was not properly sealed and could not be analyzed; in another, a test had a manufacturing defect; due to a shipping delay the third arrived at the laboratory beyond the necessary time frame for testing. For these three households, we relied on the readings from one test. Each of the households that received only one test showed levels below the EPA and World Health Organization thresholds for radon mitigation.

Before placing the tests, we interviewed seven professionals with radon testing expertise and reviewed the EPA and American Association of Radon Scientists and Technologists’ testing guidelines. These independent experts reviewed ProPublica’s methodology and provided feedback. After testing, ProPublica presented the results to the same experts.

We also discussed the results with residents of each household that hosted tests.

Outreach Methodology: To interview as many households living near the mill site as possible, we mirrored community engagement efforts conducted by federal and state authorities during previous environmental health studies. This included:

• publishing advertisements in the Cibola Citizen and Gallup Independent
• sending letters to every household in the area
• following up with phone calls and text messages to numbers associated with every area household
• door-knocking at households that did not respond to the ads, letters and phone calls

Help Us Report on Uranium Mining, Milling and Enrichment

Alex Mierjeski and Mollie Simon contributed research.

by Maya Miller, Graphics by Mauricio Rodríguez Pons and Ed Ou

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.

About five billion years ago, stars merged and exploded, creating uranium that eventually became embedded in the Earth. As uranium decays as part of a natural process, it emits radon, a radioactive gas. This gas can seep into homes and other buildings through pipes and cracks in foundations. If present in high enough concentrations, the gas and its byproducts can damage lung tissue and cause lung cancer.

This guide will explore:

• Why is radon a public health threat?
• How do I know if I’m at risk from radon?
• What is radon testing?
• How can I get a radon test?
• What level of radon is unsafe?
• How do I get rid of radon?
• Where can I get more information on radon?
• How do I share tips, questions and experiences with reporters?

Radon is prevalent across the country, but particularly in areas with large uranium deposits. The Environmental Protection Agency and U.S. Geological Survey identified areas where it is a greater concern. (See if you live in one of these areas by checking your state map.)

We learned about radon risks while reporting on the lingering health threats from the three-decade uranium mining boom in the United States that peaked during the Cold War. It quickly became apparent that many people are unaware of risks from radon and struggle to find accurate information on the radioactive gas.

(Mauricio Rodríguez / ProPublica)

Watch video ➜

Take Jackie Langford. When she moved into a home near a former uranium processing site, no one alerted her to the dangers of radon. Many of her neighbors had also been surprised to learn of the risks. That’s partly because there are no federal laws requiring developers and property owners to disclose information about the presence of the cancer-causing gas, regularly test for radon or construct buildings in ways that prevent the gas from seeping into homes.

A radon test kit hangs in Jackie Langford’s home in Milan, New Mexico. (Ed Ou for ProPublica)

Langford took steps to protect herself that others can take, too. To understand these steps, we spoke with state radon officials, environmental scientists and health specialists, as well as residents who live with varying radon levels in their homes. We also dug into global health reports and federal data.

Why is radon a public health threat?

Breathing in radon can be dangerous. Its radioactive particles decay in the lungs, releasing small bursts of radiation. Research shows this can damage lung tissue and cause lung cancer.

In the U.S., exposure to indoor radon accounts for 7,000 to 21,000 lung cancer deaths each year, according to estimates by the EPA. Only cigarettes cause more annual lung cancer deaths.

In Utah, which recently passed a law to assess prevention opportunities, researchers estimated the state had 5,826 radon-related lung cancer fatalities over a 50-year span — or more than 100 deaths each year.

How do I know if I’m at risk from radon?

The most effective way to learn the risk is to test for the gas (more on that below). You may also be entitled to information from the property’s current or previous owners.

In 36 states, property owners have a legal obligation to disclose radon testing results or sources of radon emissions to homebuyers. The situation is murkier for renters: Only four states require landlords to disclose past radon levels to tenants, according to a database assembled by Temple University’s Center for Public Health Law Research.

You can learn about your state’s radon laws by contacting your state radon office.

What is radon testing?

You can measure radon levels indoors using small devices and test kits, similar to smoke detectors. There are two main approaches: long-term and short-term.

Since indoor radon levels are tied to airflow, levels can fluctuate day to day and by season. This makes long-term testing, which takes between 90 and 365 days, the most accurate method. If you are interested in long-term testing, you can check out this list of long-term and continuous radon devices approved by the National Radon Proficiency Program. Your state radon office should also have information and equipment for long-term testing.

Short-term tests are a sound alternative, especially if you need results quickly. These tests take anywhere between two and 90 days. Here are best practices for short-term tests:

• Two tests are better than one. Experts recommend using two short-term tests before deciding whether to install a radon reduction system. Possible approaches are:
  • Two tests, back-to-back. Put up one test and then, when it’s time to send it to the lab, put up a second test in the same spot. Make sure you are using the same test model. Average the two results to get a better sense of the radon levels in the home or building.
  • Two tests, side-by-side at the same time. You can put up two test kits (again, make sure they are the same model) four inches apart. This method helps determine the accuracy of the tests and is often used in real estate transactions since it takes the least amount of time.
• Radon experts told us they consistently use tests from Air Chek and Alpha Energy Laboratories and find they’re easy to use and accurate. Experts said to avoid tests that are not calibrated since these are far less accurate. Follow the instructions on the test kit as closely as possible.

Each state has a radon program and many offer free radon testing kits. You can find the contact information for your state radon office here. Your state radon expert should also be able to answer any questions you have. The National Radon Program Services at Kansas State University has partnered with the EPA to offer discounted short-term radon test kits.

How can I get a radon test?

Each state has a radon program, and many offer free radon testing kits. You can find the contact information for your state radon office here. Your state radon expert should also be able to answer questions about setting up a test.

You can also visit the website of the National Radon Program Services at Kansas State University, which has partnered with the EPA to offer discounted short-term radon test kits.

How much radon is considered unsafe?

The more radon someone breathes in over their lifetime, the more likely they are to develop lung cancer, according to the EPA. Radon amounts are determined by calculating the rate of radioactive decay in the air, measured in picocuries per liter of air (abbreviated pCi/L).

Eleanor Divver, a radon coordinator with the Utah Department of Environmental Quality, likens the cumulative risk of radon to the risk of smoking cigarettes. If a house has an average of 4 pCi/L of radon, breathing that air every day would be the equivalent of smoking between six and eight cigarettes daily, she said.

Radon risk if you’ve never smoked (Mauricio Rodriguez Pons/ProPublica. Source: EPA)

The EPA estimates that if 1,000 people who do not smoke are exposed to 4 pCi/L of radon over a lifetime of 70 years, about seven could develop lung cancer as a result. Children are generally more vulnerable because they breathe more frequently and are closer to the ground, where radon concentrations are higher. The risk also increases for smokers — at the 4 pCi/L radon level, about 62 additional people out of 1,000 could develop lung cancer. These estimates exceed the EPA’s threshold for acceptable cancer risk.

The federal agency recommends households with an average of 4 pci/L of radon install mitigation systems to reduce radon levels.

The World Health Organization suggests mitigation systems starting at 2.7 pCi/L of radon in the air. WHO’s recommendations are based on a review of research by 100 scientists from 30 countries.

How do I get rid of radon?

The strategy for lowering radon levels depends on how the radon is getting into the house and why the gas is becoming trapped there.

To find the strategy that’s best for your residence, speak with a certified radon specialist. Here are some ways to find one:

1. The National Radon Proficiency Program has a searchable database of certified radon mitigators.
2. The National Radon Safety Board has its own searchable database of certified radon mitigators.
3. Ask your state radon office for recommendations for certified radon mitigators.

The cost to reduce radon levels often exceeds $1,500, according to experts. Few states assist with the cost. Your state radon office might have suggestions if you need to remediate your home but need financial assistance.

Where can I get more information on radon?

The EPA publishes a Citizen’s Guide to Radon and a website with information and resources.

How do I share tips, questions and experiences with reporters?

We want to hear from you if you have had experience with radon, and are especially interested in connecting if:

• You have done radon testing and want to report the results.
• You are concerned about the indoor radon levels in your space and want to test.
• You have worked with a government agency, nonprofit or private company dedicated to radon and have insights or experiences to share.

To get in touch, email maya.miller@propublica.org or fill out the form below. We look forward to learning from you.

by Maya Miller and Mark Olalde

The American uranium industry boomed in the 1950s, pockmarking the West with mines and mills and leaving behind contamination that disproportionately impacted Native American land.

Four decades ago, the industry collapsed, hit by high-profile nuclear accidents, changes in global markets and the advent of new uranium extraction methods.

Now, ProPublica is working to better understand the process and impacts of transferring responsibility for long-term monitoring and maintenance of uranium mills to the federal government. We’re interested in learning about different agencies’ approaches to regulating as these handoffs take place and what it’s like to work at companies involved in these transitions.

Hearing about your experiences will help us focus our coverage and hold the relevant institutions accountable. Please fill out this questionnaire if you have worked with any public agencies, consulting firms, tribes or companies involved in the uranium industry, or have been impacted by uranium because of where you live.

The more people we hear from, the better we’ll be able to report on uranium.

by Jesse Eisinger

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

Law professor Lev Menand has a new book out on that strange institution, the Federal Reserve, what it does and how its power and responsibility have grown over time.

Menand is an associate professor at Columbia Law School specializing in finance and regulation. Before he joined the law school, he held various roles at the Treasury Department during the Obama administration and was an economist at the Federal Reserve Bank of New York, helping to oversee large lenders.

I recently sat down with him to discuss the Fed, the economy, the capital markets, whether we are facing another financial crisis and why he thinks over-reliance on the Fed is bad for our economy and our democracy.

This conversation has been edited for length and clarity.

Thanks very much for joining me. Can you summarize the thesis of your book, “The Fed Unbound: Central Banking in a Time of Crisis”?

The Federal Reserve is an organization created by Congress for a limited, very important purpose to do a difficult job, which is to manage the U.S. money supply.

When you log on to a Bank of America or Citigroup account and you see a balance there, that’s the money that the Fed is managing. Those are not the same thing as green pieces of paper. And the Fed’s job is to ensure that you treat them the same, that you think of them the same. And that the amount of those Bank of America bucks is growing at a rate that is appropriate for the economy to put all of its resources to work, including all of its people.

The thesis of the book is that monetary liberalization, deregulation of the banking system and a lot of choices made during the second half of the 20th century caused the Fed to become “unbound.” Basically, what you have is the rise of a “shadow banking” system. All these financial companies that aren’t under the Fed’s purview, they start creating money. The Fed doesn’t have the tools to manage them, and then they run into problems during economic downturns, and the Fed pulls out all the stops and tries to backstop them — bail them out.

That’s the 2008 financial crisis. And that fundamental dynamic is still with us.

Essentially what you’re saying is that this institution, which is about 100 years old, the Federal Reserve, was created to manage money so that when there was a financial crisis, the Fed would come in and lend to them and cushion that blow. But over time, the Fed’s mandate had grown and its power had grown and we’re trying to figure out why that happened and whether that’s a good thing or a bad thing. Is that fair enough?

Fair enough.

Following the Great Depression, the Fed was very successful. We didn’t have intermittent banking panics. Every time there was a recession, people didn’t run on banks. We thought that we had solved monetary instability and financial crises until 2008. And what was 2008? It was a run on shadow banks. A whole group of financial institutions had come along and started to do what banks do. They started to create deposits of their own called different things. And they were exposed to the same run dynamics that you saw in the 19th century before the Fed was created. And the Fed decided if we don’t come in and backstop this system, it will collapse. But it was never expected that this would be how the Fed [acted]. The Fed was not designed to stabilize the shadow banking system.

Let’s just back up. You’ve given a preliminary definition of shadow banking, but walk us through it. These are not bank deposits that are backstopped by the federal government, by the Federal Deposit Insurance Corp. Give us a really simple example. A money market fund is part of the shadow banking system, right? So it’s not like it’s an obscure financial system for the elite. Most middle-class Americans touch the shadow banking system.

Yeah. So there are three major types of shadow banking that I talk about in the book. You mentioned one, that’s the one that ordinary Americans are most likely to have encountered. The other types are primarily wholesalers for businesses, not ordinary individuals, but basically what they all have in common is they are non-bank firms that do not have a bank charter that are trying to reproduce the bank business model. The Fed doesn’t have the same set of tools to ensure that the money market fund [and other shadow bank institutions aren’t] taking too many risks.

The shadow banking system is huge, right?

In 2007, which was the peak of the shadow banking system, a peak we will eventually return to if further reforms are not made, it’s estimated that there were about $15 trillion of shadow bank-issued money instruments against $7 or $8 trillion of bank deposits and less than $1 trillion of government-issued cash.

In the aftermath, the shadow banking system got a lot smaller because we had a lot of major shadow banks fail like Lehman Brothers. And then over the last 10 to 15 years, it has grown again.

So now we’re back where the banking system is much bigger. There’s $18 trillion of deposits. And the shadow banking system is probably around the same size, maybe slightly smaller. It’s very hard to estimate the size, well, because it’s in the shadows.

You say that this is in the shadows, which is another way of saying it’s not fully regulated. So we had a financial crisis in 2008. You write that they essentially have two failures coming out of this. One is to not recognize the true nature of the crisis. They think of it as a 100-year flood rather than a fundamental aspect of structural fragility. And then the second thing is that we pass a sweeping financial reform, the Dodd-Frank act, that touches every corner of the financial system and yet is, I think your view would be, woefully inadequate. What does the Fed do right? What does the Fed do wrong?

So a stable and, in fact, growing money supply is an absolutely critical precondition for the sorts of economies that we live in today. If the money supply shrinks rapidly, our entire economic structure falls apart. People owe each other money. And if the amount of money in circulation starts to shrink rapidly, because the entities that have issued it are failing, then debtors can’t pay back their debts and they start defaulting. That turns into a vicious cycle.

You can think of the failure of banks a bit like the failure of power plants. If the Long Island Power Authority just shut down and stopped working, it would be very hard for any business on Long Island to continue to produce goods and services. The Fed and Congress ultimately stepped in to bail out and prevent the further collapse of this grid. Now that was necessary, otherwise we would have ended up in a great depression of the same scale or probably a larger, worse depression than in the ’30s.

So the Fed’s hand in 2008 was more or less forced. If we wanted to continue to operate this economy, we were held hostage by the players that were providing the infrastructure upon which the economy was operating. Where things went wrong was a failure to grapple with the deep problems with continuing to have an economy in which the public and households and businesses are at the mercy of unregulated power plants that are able to basically profit off economic activity during good times, and then hold the entire society as it were hostage for public support during bad times. We ended up making some changes but not addressing that fundamental problem.

Today we continue to have a dynamic where a very large financial sector is profiting off implicit and explicit public backstops and is fundamentally fragile in its design.

The pandemic was exactly such a shock. The lesson that the Fed learned from 2008 was to offer even more public support for the financial sector, even faster. And in one respect that was successful. But the dynamics of that, the implications for all of the rest of us of having this government agency making $3 trillion available for a bunch of financial firms that aren’t operating in the public interest, this is deeply troubling. It’s a dynamic that will eventually lead to either the failure of our democracy or the failure of our economy.

A dynamic leading to a failure of our democracy seems pretty dire and significant. I want to obviously explore that in a second and explore the implications of this, the quiet crash, the silent crash of March 2020. In some ways the Fed never stops bailing out the economy throughout that period from late 2008 through to March of 2020.

I do think in critical respects, we are still living in a 2008 financial crisis world. The acute phase of that crisis ended in early 2009, but we have not recovered from the damage.

The last 15 years are characterized by anemic growth, worsening inequality that is in part a byproduct of the Fed’s effort to juice economic growth, which disproportionately enriches asset owners. [We have] a financial sector that is not investing in expanding the productivity of the American economy.

We didn’t actually use this period to invest in expanding capacity. And we continue to have a financial system that is fragile.

By the time 2009 comes around, you have a financial system that is very weakened. Fed officials launch a program called quantitative easing. That’s initially targeted at the housing market. And so they go and buy hundreds of billions of dollars of mortgage-backed securities.

“Quantitative easing” is this wonky phrase, but there are two things about it. One is the Fed is buying securities and it didn’t used to do that; it used to just move short-term interest rates up and down. And then the second thing is it’s buying assets to help certain sectors of the economy. It’s a dramatic change that’s happening here with the Fed, right?

Yeah. Look, the Fed is operationally a bank. It’s supposed to be a bank just for banks. And it’s generally the way that it operated from the Second World War up to the 2008 crisis was to adjust the constraints on bank balance sheets.

Then there are subsequent rounds of QE where the Fed buys Treasury securities, the federal government’s debt, in an effort to bring down longer-term interest rates in the economy and further juice economic activity. So there’s not sufficient fiscal stimulus and the economy is coming back very slowly. And the Fed has moved its interest rates down to zero so that the banks can expand their balance sheets, but they’re not expanding their balance sheets at a rate sufficient to allow the economy to rebound.

The mechanism by which QE works is to increase asset prices. So you have a booming stock market, a booming government debt market, a booming housing market, even though you have an economy, an underlying economy that is still weaker than it was before the 2008 crisis.

It’s a troubling way in my view to do economic policy. It might be the ninth-best approach. It’s making one group of people who are already very well off even more well off. It is a very unhealthy place for society to be.

My friend, Chris Leonard, has written a book called “The Lords of Easy Money” about how the Federal Reserve “broke the economy.” Here in this interregnum between crises, what you’re saying is that the Fed was flooding the markets with purchasing power that was stimulating the asset markets and it was flowing to the wealthiest people, asset holders already. And we got something that looked like bubbles too, right? We get the crypto markets, we get NFTs, we get SPACs. The Fed in some ways is trapped into this because governments around the world are not spending wisely. They’re not helping the Fed out. They’re not helping the economy. In fact, they’re counterproductive. They’re embracing austerity.

Yeah. The failure of the fiscal authorities of legislatures in the United States and also in Europe to address economic weakness is a source of the pressure and the motivation on the Fed to experiment with massive asset purchases as an alternative approach to avoiding an even weaker economy.

We need to recognize this was a very bad policy mix that we ended up in, to inject huge amounts of liquidity into the financial system as opposed to, say, writing people checks or helping keep people in their homes or investing in infrastructure the way that Chinese government does.

There’s so many other ways to manage economic weakness. But if your approach is not to do any of those things and actually to restrict the amount of money available to governments and state and local governments to spend, and to cause layoffs of public-sector employment, if you’re not going to do any of those things and you just want to flush the financial system full of liquidity, one of the problems you’re going to have is that you’re going to get bubbles in financial markets.

So let’s go back to March of 2020. It’s poorly understood. Because in some ways the government and the Fed have learned from this critique that you’re leveling. The Fed does a bunch of things it had never done before, even in the financial crisis of 2008.

Yeah. In part the lesson they took from 2008 was never let things get so bad that we have a failure of a major firm like Lehman Brothers, because that’s a disaster. And so when things started to deteriorate in March of 2020, when there was just a run on the shadow banking system, just like there was in 2008, the Fed stepped in quickly.

It expanded its own balance sheet enormously, very rapidly. It didn’t do anything like this in 2008. This was a shock-and-awe approach to suggest to anybody running on a shadow bank that there was no need to run, that the Fed could take all the assets onto its own balance sheet, that there wasn’t going to be a repeat of Lehman Brothers.

With some encouragement from Congress, it also sets up facilities to lend to ordinary businesses and to state and local governments. But the actual dynamic, when you look at it carefully, is they’re getting breadcrumbs and these additional programs are helping to legitimize the much, much larger and fundamentally problematic lending programs for the financial sector.

Our politics are calcified. Our political system is subject to numerous veto points. The Fed in contrast is a committee run by one guy, Jerome Powell. A defender of the Fed would say: “Look, they can act very quickly. Yes, it goes through the financial system, which helps financiers and asset holders and the wealthy disproportionately, but eventually it trickles down and saves the economy. Your criticism really is with the political system, not the Federal Reserve.”

There is this dynamic in which the more the Federal Reserve tries to use its financial system-based tools to respond to economic problems, the more pressure it takes off the political system to produce legislative solutions that are more egalitarian and more effective at solving these same problems. A key predicate of this is our democracy doesn’t work, that our politics don’t work, that fundamentally legislators can’t make good policy, that we need to rely on a couple of unelected technocratic experts to make policy that most Americans don’t understand that benefits the financial sector disproportionately, and that’s the best we can do as a society and a polity.

I reject the idea that’s the best we can do.

We are dooming ourselves to very bad dynamics over time, a declining economy really, and potentially a declining society. To reinvigorate our economy and our society, we have to move beyond our reliance on central bank medicine and to revive a meaningful economic, legislative agenda and politics. And one thing that’s encouraging in this regard is that the last couple of years you’ve seen some of that. You’ve seen the legislature act in ways that it did not act between 2008 and 2020, reflecting some sense that mistakes were made during that period.

Now we have a very interesting and troubling period because we have the Fed confronting something much more traditional. We have an overheated economy. What do you think about the Fed’s job right now? Is the Fed doing the right thing? Is this a product of the shadow banking systems frailty or is this completely separate?

I think it’s important to recognize that the current inflationary dynamic is primarily a supply-side shock. The pandemic just scrambled the normal patterns of demand for goods and services, and we ended up with shortages in certain important goods and services, which caused prices to rise.

Then we have spiking commodity and energy prices due to geopolitical conflict and also due to the pandemic in various ways. The driving factors of this inflationary dynamic are not loose financial conditions.

Here again, we stand the risk of over-relying on the Fed to solve a set of problems that require action by the government through a variety of other tools. So it’s certainly the case that some amount of interest rate hiking is necessary. Interest rates were too low and should be hiked. But the big question is should they continue to be hiked to the point where they choke off the whole overall economy, to shrink the overall economy so that it can match up in size with the amount of oil and natural gas that’s currently being produced and the amount of key goods and services that are coming through our supply chains?

We don’t need the Fed to tighten to such an extent that it induces a recession. Instead, we need other government policies targeted at supplying more of the goods and services that are experiencing this shock. It would be very unfortunate if because of the high price of oil and gas, we cause people to lose jobs all across the economy.

I am cautiously optimistic that policymakers understand this now better than they have. We will be better off tolerating some amount of inflation for some period of time while the economy adjusts to an enormous shock rather than overreacting and trying to eliminate that inflation by creating a certainty of high unemployment and a bad investment outlook and climate for the economy going forward.

It’s so frustrating. The Fed functions through the financial system disproportionately helping the wealthy. It creates asset bubbles all throughout the economy. It then starts to tighten. And in doing so, it disincentivizes companies from investing and growing while courting a recession that will throw millions of average people out of work after those millions of average people have only barely begun to benefit from a decade of loose financial conditions by having their wages grow.

Let me just add one more piece that will really make your head explode. There’s a very good chance that to the extent the Fed follows through on aggressive tightening in the coming months, that it leads to financial instability. And so at the same time, as you have the Fed pursuing policies that push up unemployment, weaken the labor market and reduce business investment, the Fed may well find itself standing up all of its emergency facilities again to support the shadow banking system.

Essentially because they created bubbles and now…

The shock of removing them, yes, is going to cause a run dynamic in the shadow banking system. It could happen at any point really.

Well, that was where I was going to end this conversation, which is: Do you think we’re headed for another financial crisis? Because the fundamental fragility of the economy — the shadow banking system — has not been dealt with, and you have a Fed that is using these very blunt tools.

I think it’s entirely possible. Part of the problem we have is it’s very hard for officials or academic observers and even market participants to have a handle on the balance sheet strength of financial institutions that fund themselves in the [shadow banking system]. And so it’s difficult to anticipate when a run might happen.

The Fed needs to be very cautious. It’s not actually dealing with a financial system that can necessarily go to that speed and absorb that shock. We’re in a very uncertain and risky time from an economic and financial perspective right now. Everybody should be on high alert and people should demand that their Congress try to tackle these issues and think about these problems, because it’ll be much better to start moderating now than to wait for another big crash, to put in place safeguards and structures that are necessary for a healthy economy and flourishing society going forward.

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by Ken Ward Jr. and Alexa Beyer, Mountain State Spotlight

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

From his Summers County, West Virginia, farmhouse, Mark Jarrell can see the Greenbrier River and, beyond it, the ridge that marks the Virginia border. Jarrell moved here nearly 20 years ago for peace and quiet. But the last few years have been anything but serene, as he and his neighbors have fought against the construction of a huge natural gas pipeline.

Jarrell and many others along the path of the partially finished Mountain Valley Pipeline through West Virginia and Virginia fear that it may contaminate rural streams and cause erosion or even landslides. By filing lawsuits over the potential impacts on water, endangered species and public forests, they have exposed flaws in the project’s permit applications and pushed its completion well beyond the original target of 2018. The delays have helped balloon the pipeline’s cost from the original estimate of $3.5 billion to $6.6 billion.

But now, in the name of combating climate change, the administration of President Joe Biden and the Democratic leadership in Congress are poised to vanquish Jarrell and other pipeline opponents. For months, the nation has wondered what price Democratic West Virginia Sen. Joe Manchin would extract to allow a major climate change bill. Part of that price turns out to be clearing the way for the Mountain Valley Pipeline.

“It’s a hard pill to swallow,” said Jarrell, a former golf course manager who has devoted much of his retirement to writing protest letters, filing complaints with regulatory agencies and attending public hearings about the pipeline. “We’re once again a sacrifice zone.”

The White House and congressional leaders have agreed to step in and ensure final approval of all permits that the Mountain Valley Pipeline needs, according to a summary released by Manchin’s office Monday evening. The agreement, which would require separate legislation, would also strip jurisdiction over any further legal challenges to those permits from a federal appeals court that has repeatedly ruled that the project violated the law.

The provisions, according to the summary, will “require the relevant agencies to take all necessary actions to permit the construction and operation of the Mountain Valley Pipeline” and would shift jurisdiction “over any further litigation” to a different court, the D.C. Circuit Court of Appeals.

In essence, the Democratic leadership accepted a 303-mile, two-state pipeline fostering continued use of fossil fuels in exchange for cleaner energy and reduced greenhouse emissions nationwide. Manchin has been pushing publicly for the pipeline to be completed, arguing it would move much needed energy supplies to market, promote the growth of West Virginia’s natural gas industry and create well-paid construction jobs.

“This is something the United States should be able to do without getting bogged down in litigation after litigation after litigation,” Manchin told reporters last week. He did not respond to questions from Mountain State Spotlight and ProPublica, including about the reaction of residents along the pipeline route.

ProPublica and Mountain State Spotlight have been reporting for years on how a federal appeals court has repeatedly halted the pipeline’s construction because of permitting flaws and how government agencies have responded by easing rules to aid the developer.

The climate change legislation, for which Manchin’s vote is considered vital, includes hundreds of millions of dollars for everything from ramping up wind and solar power to encouraging consumers to buy clean vehicles or cleaner heat pumps. Leading climate scientists call it transformative. The Sierra Club called on Congress to pass it immediately. Even the West Virginia Environmental Council urged its members to contact Manchin to thank him.

“Senator Manchin needs to know his constituents support his vote!” the council said in an email blast. “Call today to let him know what climate investments for West Virginia means to you!”

But even some residents along the pipeline route who are avidly in favor of action against climate change say they feel like poker chips in a negotiation they weren’t at the table for. And they are anything but happy with Manchin. “He could do so much more for Appalachia, a lot more than he is, but he’s chosen to only listen to industries,” farmer Maury Johnson said.

It’s not clear exactly when the Mountain Valley Pipeline became a focal point of the efforts to win Manchin’s vote on the climate change legislation. Reports circulated in mid-July that the White House was considering giving in to some Manchin demands focused on fossil fuel industries. That prompted some environmental groups to urge Biden to take the opposite route, blocking the pipeline and other pro-industry measures.

Pipeline spokesperson Natalie Cox said in an email that it “is being recognized as a critical infrastructure project” and that developers remain “committed to working diligently with federal and state regulators to secure the necessary permits to finish construction.” Mountain Valley Pipeline LLC, the developer, is a joint venture of Equitrans Midstream Corp. and several other energy companies.

The company “has been, and remains, committed to full adherence” with state and federal regulations,” Cox added. “We take our responsibilities very seriously and have agreed to unprecedented levels of scrutiny and oversight.”

The White House and Senate Democratic Leader Chuck Schumer’s office did not respond to requests for comment.

Mountain Valley Pipeline is one of numerous pipelines proposed across the region, reflecting an effort to exploit advances in natural gas drilling technologies. Many West Virginia business and political leaders, including Manchin, hope that natural gas will create jobs and revenue, offsetting the decline of the coal industry.

To protect the environment, massive pipeline projects must obtain a variety of permits before being built. Developers and regulators are supposed to study alternatives, articulate a clear need for the project and outline steps to minimize damage to the environment.

In Mountain Valley Pipeline’s case, citizen groups have successfully challenged several of these approvals before the 4th U.S. Circuit Court of Appeals. In one widely publicized ruling involving a different pipeline, the panel alluded to Dr. Seuss’ “The Lorax,” saying that the U.S. Forest Service had failed to “speak for the trees” in approving the project. The decision was overturned by the U.S. Supreme Court, but not before the project was canceled.

The 4th Circuit has ruled against the Mountain Valley Pipeline time and again, saying developers and permitting agencies skirted regulations aimed at protecting water quality, public lands and endangered species. In the past four years, the court has found that three federal agencies — the U.S. Forest Service, the U.S. Army Corps of Engineers and the Interior Department’s Bureau of Land Management — illegally approved various aspects of the project.

While those agencies tweaked the rules, what Manchin’s new deal would do is change the referee. In March, Manchin told the Bluefield Daily Telegraph that the 4th Circuit “has been unmerciful on allowing any progress” by Mountain Valley Pipeline.

Then, in May, lawyers for the pipeline petitioned the 4th Circuit to assign a lawsuit by environmental advocates to a new three-judge panel, instead of having it heard by judges who had previously considered related pipeline cases. Among other things, the attorneys cited a Wall Street Journal editorial, published a week earlier, declaring that the pipeline had “come under a relentless siege by green groups and activists in judicial robes.”

Lawyers for the environmental groups responded in a court filing that Mountain Valley Pipeline LLC was just “dissatisfied that it has not prevailed” more often and was unfairly lobbing a charge that the legal process was rigged. The 4th Circuit rejected the company’s request.

It is unclear whether this pending case, which challenges a water pollution permit issued by West Virginia regulators, would be transferred if the Manchin legislation becomes law.

Congress has intervened in jurisdiction over pipeline cases before. In 2005, it diverted legal challenges to decisions on pipeline permits from federal district courts to the appeals court circuit where the projects are located. The move was part of a plan encouraged by then-Vice President Dick Cheney’s secretive energy task force to speed up project approvals. (Under the Constitution, Congress can determine the jurisdiction of all federal courts except the U.S. Supreme Court.)

Besides the pipeline, Manchin has cited other reasons for his change of heart on the climate change bill. He has emphasized that the bill would reduce inflation and pay down the national debt.

Approval for the pipeline may not be a done deal. Both senators from Virginia, where the pipeline is also a hot political issue, are signaling that they don’t feel bound by Manchin’s agreement with the leadership. Manchin’s own announcement said that Democratic leaders have “committed to advancing” the pipeline legislation — not that the bill would pass. Regional and national environmental groups are walking a fine line. They support the climate change legislation while opposing weakening the permit process.

The pipeline’s neighbors say they’ll keep fighting, but they recognize that the odds are against them. “You just feel like you’re not an equal citizen when you’re dealing with Mountain Valley Pipeline,” Jarrell said.

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ProPublica will once again organize and host the Diversity Mentorship Breakfast at the Online News Association conference in Los Angeles this September. This is the eighth year of the program, which is designed to connect people from backgrounds that are historically underrepresented in journalism with people at the top of the field. After two years of virtual events, we’re back to gathering in-person. The breakfast will take place at 8 a.m. PDT on Friday, Sept. 23.

Professional networks are crucial to advancing a journalist’s career. The goal of this event is to help promising journalists build these networks in order to make the industry more inclusive.

Past mentors have included newsroom leaders, startup founders, highly accomplished reporters, producers, designers, editors and more.

We pair mentees with mentors based on their backgrounds, challenges and interests in journalism. Mentees also have an opportunity to network with one another.

We aim to pair mentors with at most two mentees for this event, and are planning to accept about 20 mentees. Our event will kick off with a short group discussion and then will transition to guided networking between mentors and mentees.

Anyone is welcome to apply to be a mentee, and people from underrepresented groups — including people of color, women, LGBTQ people and people with disabilities — are especially encouraged. Applicants must be attending ONA22 and must be available Friday, Sept. 23, from 8 to 9:30 a.m. PDT.

If you’re interested in participating as either a mentor or mentee, apply via this form. The deadline to apply is Monday, Sept. 5. We’ll let you know in mid-September if you’ve been matched with a mentor. We’ll do our best to match each applicant with a mentor, but space is limited.

Past mentors have found the experience easy and rewarding, and they have let us know they appreciate meeting with ambitious journalists in the early and middle stages of their careers and sharing their knowledge with them. We will provide some guidance for beginning and maintaining a relationship with your mentee.

Questions? Email diversity@propublica.org. For more about ProPublica’s commitment to helping make our newsroom and journalism at large more inclusive, see some of the steps we’re taking.

by Kiah Collier and Maya Miller

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.

The U.S. Environmental Protection Agency on Wednesday announced plans to “engage and inform” nearly two dozen communities across the country where air pollution from commercial sterilizer plants has significantly increased lifetime cancer risks for nearby residents. The facilities use a toxic gas called ethylene oxide to sanitize medical and dental equipment and fumigate certain food products. The announcement comes after the EPA’s inspector general and news publications including ProPublica and The Texas Tribune highlighted the agency’s yearslong failure to inform communities of their risks.

The EPA said that its analysis of the industry’s self-reported emissions data showed that about a quarter of the nearly 100 commercial sterilizers the agency regulates are exposing nearby residents to unacceptable cancer risks from ethylene oxide. It posted risk maps and other information online for each of the high-risk facilities and announced dates for national and community-specific webinars and in-person meetings in the coming weeks.

“Today EPA is taking action to ensure communities are informed and engaged in our efforts to address ethylene oxide, a potent air toxic posing serious health risks with long-term exposure,” EPA administrator Michael S. Regan said in a statement. “Under my watch, EPA will do everything we can to share critical information on exposure risk to the people who need and deserve this information, and to take action to protect communities from pollution.”

The EPA is also putting the finishing touches on a proposal to place stricter limits on how much ethylene oxide commercial sterilizers can release into the outside air; it plans to unveil the plan later this year. The agency said Wednesday that it is planning to propose limits on ethylene oxide usage inside such facilities to better protect workers who handle the chemical, as well as people who work or attend school nearby.

Existing regulations on commercial sterilizers, as well as other facilities that manufacture or use ethylene oxide, do not account for the EPA’s latest research on the chemical that shows it is far more toxic than the agency knew.

In 2016, the agency concluded that ethylene oxide was 30 times more carcinogenic than previously thought for people who continuously inhale it as adults and 50 times more carcinogenic for those who are exposed since birth. The conclusion fueled a backlash from the chemical and sterilizer industries, which say that the EPA’s findings are deeply flawed. They have made it clear they plan to fight the EPA’s forthcoming regulatory proposals.

The EPA has known since at least 2018 that some of the communities it identified on Wednesday are at risk from ethylene oxide pollution and has even directed regional offices to hold public meetings. Those occurred in many places; in some more affluent and white communities, residents used the information to pressure elected officials to sue and even shutter sterilizer plants and enact stricter regulations of the chemical at the state level.

The EPA played catch-up last year, holding meetings in several additional communities, though it left out others. One of those communities was Laredo, a city of 260,000 on the Texas-Mexico border.

Last year, an unprecedented analysis of five years of industry data by ProPublica and The Texas Tribune found that a 38-year-old commercial sterilizer located in close proximity to an elementary school in Laredo was the most toxic facility of its kind in the country. Yet none of the more than 100 residents contacted by reporters, including local officials, were aware of the risk; all but one said they didn’t even know the plant existed.

The EPA told ProPublica and the Tribune last year that it was holding off on public engagement in certain communities while it gathered more recent emissions data from each of the nearly 100 commercial sterilizers that it regulates. This data collection is a key step in the agency’s work to craft updated regulations of the facilities.

The agency’s analysis of that data served as the basis of Wednesday’s announcement. It found that ethylene oxide emissions from 23 sterilizers across the country created an excess cancer risk for nearby residents of at least 1 in 10,000. That means that if 10,000 people are exposed to that amount of ethylene oxide over their lifetimes, at least one of them would likely develop cancer as a result of the exposure. (That’s in addition to any cancer risk caused by factors like lifestyle and genetics.) The EPA stressed that the amount of ethylene oxide the facilities are emitting is not high enough to pose short-term health risks.

The Laredo facility, owned by Midwest Sterilization Corporation, was one of those 23. So was the company’s other sterilizer plant in Missouri, which the ProPublica/Tribune analysis found to be the second-most toxic sterilizer plant in the country. Midwest, the country’s largest privately owned contract ethylene oxide sterilizer, didn’t respond to a request for comment.

Its Missouri facility moved to reduce ethylene oxide emissions after the EPA identified it as high-risk in 2018, triggering the agency’s regional office to contact the facility and meet with local leaders. Yet its ethylene oxide emissions remained high enough for it to make the EPA’s list of high-risk facilities.

In a news release Wednesday, the EPA noted that “medical sterilization is a critical function that ensures a safe supply of medical devices for patients and hospitals” and that it is “committed to addressing the pollution concerns associated with EtO in a comprehensive way that ensures facilities can operate safely in communities while also providing sterilized medical supplies.”

According to the EPA’s webpage detailing cancer risk at the Laredo facility, the agency will hold a community meeting in that city on Sept. 15.

Last year, Laredo’s lone environmental group, which first learned about the Midwest facility from ProPublica and the Tribune, spearheaded the formation of a clean air coalition that has pushed for emissions reductions and worked to inform residents of the risks associated with ethylene oxide exposure.

The group, the Rio Grande International Study Center, urged the EPA on Wednesday “to go beyond informing the public, and require immediate third-party fence-line air monitoring in neighborhoods and schools that are most impacted by Midwest.”

“Laredo has been a sacrifice zone for long enough,” said Sheila Serna, the group’s new climate science and policy director, who previously investigated a serious complaint against the Midwest facility while working as an inspector for Texas’ environmental agency. “We demand that our voices be heard and that any and all actions be taken to protect the most vulnerable in our community, which means phasing out the emissions of this highly dangerous and carcinogenic air toxin.”

Yaneli Ortiz, who grew up 5 miles from the Midwest sterilization plant in Laredo, gets ready for her quinceañera. In 2019, she was diagnosed with acute lymphocytic leukemia, a cancer that’s been linked to ethylene oxide exposure. Her hip bone has deteriorated due to steroids that diminished the blood supply through her leg and joints, leaving her in constant pain. (Kathleen Flynn, special to ProPublica/Texas Tribune) State Study Finds High Cancer Rates in Laredo

On July 19, the Texas Department of State Health Services published the results of a cancer cluster study requested earlier this year by the Laredo health department. (The state health department only conducts cluster studies by request.)

The study examined rates of four different types of cancer that have been linked to ethylene oxide exposure in three different census tracts nearest the Midwest plant, focusing on diagnoses from 2006 to 2019.

It found that rates of one type of cancer associated with ethylene oxide exposure, extranodal non-Hodgkin lymphoma, were “significantly greater than expected” given the population. It also noted higher-than-expected numbers of cases of breast cancer and nodal non-Hodgkin lymphoma, which have also been linked with the chemical, though not at rates that are statistically significant. None of the rates were high enough to trigger an investigation into possible causes, a state health department spokesperson said.

The head of the Texas Cancer Registry told ProPublica and the Tribune last year that cancer rates may be higher in certain areas due to chance alone and that “cluster investigations in a community setting have rarely led to the identification of associations between cancers and environmental exposures” including air pollution.

However, the state study was limited to the areas closest to the Midwest plant, and the ProPublica/Tribune analysis showed the potential risk extends beyond that. It also didn’t examine rates of other types of cancer linked to ethylene oxide exposure, such as acute lymphocytic leukemia, citing the need to protect patient privacy because there were so few cases in the three census tracts examined.

It’s likely that the incidence rates the state examined in its Laredo study were an undercount, as many residents are low-income or uninsured and travel across the border to Mexico to seek more affordable care. (Doctors in Mexico are not obligated to report cancer diagnoses to the Texas registry.) The city, where nearly every resident is Latino, also has limited health care options, with few oncologists and no children’s hospital.

Last year, ProPublica and the Tribune told the stories of two children in Laredo battling acute lymphocytic leukemia: 9-year-old Juan “JJ” Nevares and 15-year-old Yaneli Ortiz.

Ortiz, who lives just outside the census tracts covered in the state’s cluster study, has been in remission since January. However, the steroids she took during treatment led to the deterioration of her hip bone, and she recently had hip replacement surgery.

JJ, who attended the elementary school close to the Midwest facility and lives nearby, was diagnosed four years ago and continues to undergo treatment in San Antonio.

Sara Montalvo Saldaña, JJ’s aunt and one of his primary caregivers, said she hopes officials take a closer look at rates of acute lymphocytic leukemia. She wonders why it has taken so long for federal and state regulators to inform residents of the risk posed by Midwest.

“They don’t have a sense of urgency. They have not seen it firsthand,” Saldaña said.

The results of the state health department study stand in stark contrast to what a toxicologist hired by Midwest told the local environmental group last year during a one-on-one meeting: Rates of all types of cancer in Laredo were below state averages. She assessed data from the entire county, which state officials and health experts have said is too large of an area to draw firm conclusions about the impact of a single industrial plant’s emissions.

On Wednesday, the EPA said it was working with the 23 high-risk sterilizers, as well as state and local agencies and stakeholders, to reduce ethylene oxide pollution. The agency didn’t say whether those conversations had already resulted in any emissions reductions, but information it provided on the individual facilities indicated that some have plans to install controls that will significantly reduce emissions. The Laredo facility is not one of them.

It’s unclear if Texas’ environmental regulatory agency is cooperating with that effort.

While only two of the commercial sterilizers the EPA identified are in Texas, the state is the largest ethylene oxide polluter in the country thanks to the numerous petrochemical manufacturing facilities clustered on the Gulf Coast. The EPA plans to propose updates to the regulations that limit air pollution at those facilities in coming years.

The historically industry-friendly Texas Commission on Environmental Quality has openly challenged the EPA’s latest ethylene oxide science, even launching its own review, which ruled that the chemical was significantly less toxic than the federal agency had found. That resulted in Texas enacting a new standard in 2020 that could allow plants to emit more of the chemical; the EPA in January formally rejected that standard.

“TCEQ fundamentally disagrees with EPA’s exposure estimates and risk characterization associated with sterilization facilities,” the commission said in a statement to ProPublica and the Tribune. “EPA overestimates both the exposure concentration at which ethylene oxide may cause cancer (cancer potency) and the predicted ambient concentrations of ethylene oxide near sterilization facilities.”

The commission did not respond to questions about whether it would cooperate with the EPA’s effort to reduce ethylene oxide emissions at facilities in Texas.

Even so, Saldaña is grateful about this next set of steps. “It gives me hope,” she said. “Instead of being mad or thinking maybe this would have never happened to JJ, I’m hoping that this will make sure others don’t have to go through it.”

Update, Aug. 6, 2022: This story was updated to add more information about some facilities’ plans to reduce ethylene oxide pollution after conversations with the EPA.

Correction

Aug. 6, 2022: This story originally misstated whether a plant was identified by the EPA as being high-risk. Midwest Sterilization Corporation’s Missouri plant was among the facilities given that designation.

by Tony Schick, Oregon Public Broadcasting

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

Crystal Conant was camped for the night on a bluff overlooking the upper Columbia River in northeast Washington, beading necklaces by the glow of a lantern.

The next morning, hundreds would gather at Kettle Falls for the annual salmon ceremony, held since time immemorial to celebrate the year’s first fish returning from the ocean. Conant and fellow organizers needed necklaces for everyone who would come. Honoring the gift of salmon, she said, requires giving gifts in turn.

Behind them, friends and family had formed a drum circle inside the wooden husk of an old Catholic mission. Back when the salmon were still running up Kettle Falls, the sound of dozens of drum circles would have thundered across the plateau.

But there is only one circle now. And there are no salmon.

Although tribes from throughout the Northwest no longer fish for salmon at Kettle Falls, they honored the spirit of the annual salmon ceremony by passing out canned and smoked salmon at the First Salmon Ceremony on June 20. (Kristyna Wentz-Graff/OPB)

The fish cannot get past two federal dams, masses of concrete each hundreds of feet tall. The construction of those dams, which began more than 80 years ago, rendered salmon extinct in hundreds of miles of rivers and destroyed the area’s most important fishing grounds.

“The salmon still keep trying to come, and they come and they hit their little noses on the dam, over and over, ’cause they hear us calling,” said Conant, a member of the Arrow Lakes and Sanpoil tribes. “So we’re going to keep having our ceremonies and we're going to keep calling the salmon home until they get here.”

After nearly a century without salmon, Conant and other members of upper Columbia River tribes want to reintroduce the fish into waters long blocked by the dams.

But there’s been something blocking those efforts, too: the Bonneville Power Administration.

The U.S. government promised to preserve tribes’ access to salmon in a series of treaties signed in the 1850s. Upholding those treaties now rests in no small part with Bonneville, a federal agency little known outside the Northwest that takes hydropower generated at Grand Coulee and other dams and sells it wholesale to electric utilities, primarily in Oregon, Washington and Idaho. Decades ago, Congress placed the agency at the center of salmon recovery, giving it conflicting mandates: protect fish and fund their recovery, all while running a business off the dams that have reduced fish populations by the millions.

Grand Coulee Dam, with the Lake Roosevelt reservoir behind it, was built between 1933 and 1941. (U.S. Bureau of Reclamation)

For decades, judges have admonished the federal government over its failure to do more to protect Columbia River salmon. Most recently, the Biden administration in March took the unprecedented step of acknowledging the harm dams have caused to Native American tribes and calling for an overhaul of Columbia River Basin management. Bonneville, the government’s money-making arm on the Columbia, is the federal agency involved in every measure the Biden team is discussing to save salmon.

But an investigation by Oregon Public Broadcasting and ProPublica has found that Bonneville has, time and again, prioritized its business interests over salmon recovery and actively pushed back on changes that tribes, environmental advocates and scientists say would offer the best chance to help salmon populations recover without dismantling the entire dam system.

The agency said it has invested heavily in supporting salmon and sacrificed revenue to make dams safer for fish. It said any limitations on its fish and wildlife measures are the result of financial pressures.

In response to the news organizations’ findings, Bonneville spokesperson Doug Johnson said in a statement that the agency and its federal partners “will continue to participate in regional discussions on long-term strategies to address the protection and enhancement of salmon and steelhead,” including the White House efforts.

“Ultimately, the region as a whole must continue to advance collaborative solutions to meet the needs of the Pacific Northwest,” Johnson said. Two other federal agencies that work with Bonneville to manage the region’s dams, the U.S. Army Corps of Engineers and the Bureau of Reclamation, issued statements identical to Bonneville’s.

In an interview, Johnson said the agency has had to contain its fish and wildlife spending at levels it could sustain. “The statutes direct Bonneville to operate in a business-like manner,” he said. “Like any other business, we monitor projects in our budgets and make appropriate adjustments as needed.”

Columbia River salmon recovery is one of the most expensive endangered species efforts in the country, costing Bonneville more than $20 billion since it started in 1980. But while Bonneville’s net revenues have surpassed targets in the last few years, it flatlined or reduced budgets for fish recovery at a time when, according to salmon advocates, more money is needed than ever to prevent extinctions of more Northwest salmon populations.

Crystal Conant hands out frozen salmon to attendees at last year’s First Salmon Ceremony. Conant said because the salmon no longer swim at Kettle Falls, “There’s bits and pieces of all of our hearts that are missing.” (Kristyna Wentz-Graff/OPB)

Proposals on the table, according to the White House and other participants in the talks, include breaching dams on the lower Snake River in southeastern Washington, funding the reintroduction of salmon into blocked areas and removing Bonneville from salmon management.

“We cannot continue business as usual,” the White House memo said.

But on each of those three issues, interviews and documents show, business as usual is what Bonneville has tried to preserve.

Building to a Crisis

The Bonneville Power Administration began as a federal agency designed to run as a business. And, in many ways, that has never changed.

The agency was created in 1937, when Pacific Northwest hydroelectric dam-building had just begun and federal officials spoke openly about sacrificing salmon runs for the sake of developing cities and farmland. Bonneville was the government’s way to market the dams’ hydropower and electrify the rural West.

A World War II-era poster for the Bonneville Power Administration promoting Columbia River power’s contribution to the war effort (Bonneville Power Administration)

The successful harnessing of the Columbia for electricity became synonymous with American pride over settling the West and winning World War II. Massive flows of water rushed down through tunnels, spinning turbines and generating electricity that in turn powered homes and factories, most notably aluminum plants that manufactured bomber planes. Bonneville even hired Woody Guthrie to write folk songs about Uncle Sam putting the river to work for factories and farmers.

Although the dams are owned and operated by different agencies, Bonneville co-manages them, covering construction debts and operating costs with the proceeds from the electricity that the dams generate. Bonneville sells electricity to public utilities, which in turn sell it to homes and businesses. Today, Bonneville’s operating revenues are more than $3.8 billion per year. It manages power from 31 dams and owns about 75% of the Pacific Northwest’s power lines.

But what was good for generating power was devastating for fish. In the mid-1950s, when wild Chinook salmon on the Snake River had to pass just one dam on their journey to the ocean, they numbered about 90,000. By 1980, seven additional dams later, the Snake River population had fallen to around 10,000.

In some places, like the Grand Coulee and Chief Joseph dams in northeast Washington, there is no way for fish to pass through at all, and the salmon are entirely gone upriver from the dams. While the rest of the federal dams on the Columbia and Snake Rivers include ways for salmon to migrate past them, these passages still take a toll. Fish can get thrashed by turbines if they pass through the dam’s powerhouse. They suffer in the warm and stagnant reservoirs that replaced free-flowing water when the rivers were dammed. And they fall prey to predators like sea lions, which have thrived in the conditions the dams created. Scientists say many fish that pass through multiple reservoirs and dams end up dying later on from the stress of the journey.

Multiple Dams on the Columbia and Snake Rivers Have Led to Massive Declines in Salmon

Some dams, including the Chief Joseph and Grand Coulee Dams, completely block the fish, long depended on by Pacific Northwest Tribes, from swimming to the sea.

(Lucas Waldron, ProPublica. © OpenStreetMap contributors.)

Faced with the possibility of federal agencies labeling salmon as endangered, Congress took action in 1980: It passed the Northwest Power Act, tethering the fate of salmon to that of the Bonneville Power Administration. The act required Bonneville to fund a comprehensive fish and wildlife program, and to “protect, mitigate, and enhance fish and wildlife to the extent affected by the development and operation of any hydroelectric project of the Columbia River and its tributaries.”

The new law established conflicting mandates for Bonneville: making money from hydropower while helping save salmon from extinction. And by the 1990s, it was clear the measures were failing to rescue salmon. Several populations became listed as threatened or endangered and salmon advocates filed lawsuits over federal dam operations.

As part of an ongoing court case that has lasted decades, judges have ordered federal agencies, including Bonneville, to improve special passageways that allow fish to bypass dams’ turbines. Judges also ordered the agencies to increase their “spill,” meaning the amount of water they allow to flow past a dam instead of into its powerhouse; young salmon on their way to the ocean benefit from that spill, traveling faster past the dam with less likelihood of getting caught in a turbine.

But for Bonneville, every drop that didn’t go through turbines was also wasted fuel and lost revenue — revenue it claimed it could hardly afford to miss out on.

In 2008, Bonneville tried to halt ballooning fish and wildlife costs and lawsuits with a series of funding agreements. The agency doled out $900 million over 10 years to states and tribes for fish and wildlife restoration. But that money came with a catch: Signing the accords required a promise not to sue over management of the Columbia River power system. The accords also required signatories to affirm the adequacy of the federal government’s fish and wildlife mitigation.

Only the Nez Perce Tribe and the state of Oregon declined the money. Along with a dozen fishing and environmental groups, they continued the longstanding challenge of federal dam operations in court.

As the case dragged on, Bonneville faced multiple pressures. It needed to raise its rates to pay for mounting fish and wildlife requirements ordered by the courts, but the Public Power Council, a coalition of consumer-owned public utilities that buy the bulk of its electricity, pushed back. The power council warned Bonneville that it would lose customers if it didn’t curb its rising power costs, a third of which stemmed directly from fish and wildlife measures.

Then, while Bonneville was struggling to improve its finances, salmon fell further into crisis. By 2018, declines in salmon populations triggered an official warning from federal scientists. Scientists had set a threshold that, once crossed, was meant to put the government in urgent action mode to help the fish.

But at the same time, Bonneville was desperate to help itself.

Two salmon swim in a corner of the salmon run at Chief Joseph Dam. (Chona Kasinger for ProPublica) Shortchanging the Fish

In 2018, the same year salmon declines were triggering federal alarm bells, Bonneville adopted a new strategic plan meant to fix its finances. It aimed to keep the agency’s fish and wildlife spending from exceeding the rate of inflation; in some years, this spending didn’t end up growing at all. Electricity markets also improved; the agency sold surplus power during times of peak demand like summer heat waves. And it kept expenses low.

Since then, Bonneville’s net revenues have soared past agency targets. Last year, the agency’s net revenues were $360 million above its target. Halfway through 2022, it was on pace for an even better year.

“For the past four years, we’ve done fairly well financially,” Johnson, the Bonneville spokesperson, said. “Five, six, seven years ago, our detractors were talking about the potential for us to go bankrupt because we had so much debt and we were doing so poorly financially. This found solid footing that we have financially is a recent development for us.”

The agency used the unexpected revenues to shore up its cash reserves and lower rates for customers. It didn’t put any of the windfall toward fish and wildlife programs.

In fact, after adjusting for inflation, Bonneville’s current two-year budget for fish and wildlife is down more than $78 million from what it was in 2016-2017, before the agency adopted its new strategic plan. That came at a time when scientists said significantly more investment has been needed to give salmon a chance as the climate warms.

“Simply put,” Andrew Missel, attorney for the Idaho Conservation League, wrote in a 2021 brief to Bonneville about its budget process, “in the face of declining salmon and steelhead runs, BPA has decided to starve mitigation projects of needed funds, and has failed to even consider using an expected boon in revenue to help shore up those projects.”

After fish and wildlife agencies told Bonneville its budgets were compromising their efforts, Bonneville announced in June it would increase fish and wildlife spending by about 8% in 2024 based on its assessments of what the program needed to remain viable. That increase would still put it below inflation-adjusted spending levels prior to 2018.

Jeremy Takala, a biologist and member of the Yakama Nation Tribal Council, said the tribe has shovel-ready salmon habitat restoration projects waiting for funding.

“It’s really frustrating,” Takala said in a July speech at a save-the-salmon rally in Portland, Oregon. “BPA basically managing our funding source, it just does not make sense. It’s a really, really huge conflict that frustrates the tribes.”

Bonneville and its spending have factored heavily into negotiations between salmon advocates and the Biden administration.

Jim McKenna, an adviser to Oregon Gov. Kate Brown who is involved in the negotiations, said Oregon, tribes and salmon advocates are asking the administration to greatly increase funding for fish hatcheries and habitat restoration, and to put tribes and other local fish and wildlife biologists directly in charge of how to spend the money.

“The bucket of money is woefully inadequate,” McKenna said. “And, Bonneville is not the agency that should be managing those funds.”

Ultimately, that funding is paramount to whether the government will honor the treaty, signed over 150 years ago, that assured the Yakama tribe of its right to take fish where they always had “at all usual and accustomed places.”

Bill Bosch, who has spent decades working for the Yakama Nation’s fisheries program, said the federal government must fully fund tribes’ hatcheries and habitat efforts, unless it intends to spend the money itself on removing dams and restoring the natural river.

“If you’re not willing to fund one or the other of those,” Bosch said, “then are you basically saying you’re going to abrogate the treaty?”

David Washington of Harrah, Washington, snips adipose fins off of salmon, identifying them as hatchery fish, at the Cle Elum Supplementation and Research Facility in Cle Elum. (Kristyna Wentz-Graff/OPB)

Two years ago, Bonneville and its partner agencies faced a major turning point. The agencies had been scolded by U.S. District Judge Michael Simon for running a dam system that “cries out” for a new approach. He ordered them to conduct a comprehensive environmental impact statement for the Columbia and Snake River dams that included “all reasonable alternatives” to their current actions. The judge hoped the process could “break through any logjam that simply maintains the precarious status quo.”

By 2020, Bonneville and its dam co-managers, the Army Corps of Engineers and the Bureau of Reclamation, released their long-awaited new master plan for the river. Despite Judge Simon’s hopes, the plan mostly preserved the status quo.

The plan hinged on a proposal the federal bodies called “flexible spill.” For years, the courts had been ordering them to spill water past their dams to aid fish migration. Under the flexible spill plan, they’d spill as much water as they could when it wasn’t needed to make electricity. The plan was an experimental concept, but modeling showed it could increase the number of salmon that survive their migration to return as adults by as much as 35%, and the agencies hoped it could become their long-term solution.

For many salmon biologists, the plan wasn’t the solution it purported to be. They argued such measures hadn’t seen enough real-world use to establish how fish actually responded, and said even the predicted 35% increase wouldn’t be enough to halt the decline of salmon populations. And, they said, other aspects of the federal plan gave dam operators leeway to slow or even stop the flow of water behind dams at times, making it harder for salmon to migrate out to sea.

In many regards, the agencies’ plan was a step backward for salmon compared to what courts had already rejected, said Michele DeHart, manager of the Fish Passage Center, a small federal research body funded by Bonneville.

Records show that DeHart provided Bonneville and its co-managers with analyses demonstrating that they were overstating the benefits of their preferred course of action for the Columbia River, and that it would likely lead to a further decline of the river’s fish.

Still, all three federal bodies proceeded with their preferred option, which they said struck a balance between clean energy, economics and fish and wildlife needs.

At the same time, Bonneville and its partners have rejected an increasingly popular suggestion for saving several of the Columbia basin’s salmon populations from extinction: taking four dams on the lower Snake River in southeastern Washington out of operation and restoring the natural flow of water.

The Removal of Four Dams on the Snake River Could Help Salmon Recover

The Biden administration is exploring proposals for the removal of the dams, called “breaching,” which would allow more fish to reach the ocean and to make the return trip to spawn.

(© OpenStreetMap contributors)

The Fish Passage Center, the Nez Perce Tribe, and more than 60 scientists have all concluded that breaching the four dams is the only scenario that has a likelihood of allowing Snake River salmon populations to recover. In July, the National Oceanic and Atmospheric Administration called breaching the dams “essential” for healthy salmon runs.

The dams generate just 4% of all the power sold by Bonneville, but breaching them is opposed by the public utilities that make up Bonneville’s customer base and by farmers, who rely on the dam-impounded reservoirs to irrigate their crops and barge them downriver. Two separate reports released this year, one by Washington elected officials and the other by the Department of Energy, concluded the services of the four dams could be replaced, with a total cost between $10 billion and $30 billion.

Public utilities have spent millions on public relations campaigns in support of keeping the lower Snake River dams. They have pushed Bonneville to be more aggressive in opposition to breaching any dams. They say the dams are crucial to the region’s goals of reducing carbon emissions and fighting climate change, which presents another major threat to salmon.

Though Bonneville has not vocally opposed dam removal, behind the scenes it worked to sway public opinion in favor of keeping the dams fully operational. The agency drafted talking points in 2019 and distributed them to public utilities for use in conversations about the dams, instructing them that “BPA would prefer to NOT have these statements attributed to the agency.”

Hundreds of supporters took to the water at Portland’s Willamette Park in June, calling for the removal of the lower Snake River dams in support of salmon. (Kristyna Wentz-Graff/OPB)

In 2020, the agency sent emails to a dozen news organizations “correcting the record” with facts about the importance of the dams, and tried to pitch reporters on an angle about the questionable benefit to salmon of breaching the Snake River dams when compared to the importance of the clean energy the dams produce.

“How many more fish would it actually bring back? Would it be worth it?” an agency communications staffer, Dave Wilson, said in one email to an NPR reporter.

Both Bonneville and its public utility customers have pointed to a handful of studies, funded by Bonneville, that cast doubt on the effectiveness of dam removal.

Asked about the emails, Johnson said Bonneville wanted the public to understand the importance of the dams to public power, and for the region to understand what it would be giving up if the dams are breached.

DeHart, of the Fish Passage Center, said it should come as no surprise when Bonneville protects dam operations.

“It is BPA’s job to protect their interests, and they’re doing a good job,” DeHart said. “They’re protecting their own interests, and their interests are not fish.”

Nowhere are those interests more significant than on the upper Columbia River, where two massive dams produce roughly half of all the power Bonneville sells.

Bonneville and its partners have operated those dams without any way for fish to pass them for more than half a century.

That, the Spokane Tribe argued in court documents, “has been nothing short of an attempt to permanently destroy a culture.”

“The Government’s Been Fighting Us”

Colville tribal member Shelly Boyd looks over the waters covering the historical fishing grounds of Kettle Falls. The falls, where tribes from the Northwest gathered for thousands of years to fish for salmon, were submerged with the creation of Grand Coulee Dam. (Kristyna Wentz-Graff/OPB)

A year ago, Michael Marchand sat on the banks above the Columbia, his long white hair blowing in the wind as he watched members of his tribe perform a salmon ceremony without any salmon. The former chair of the Colville Tribes grew up hearing stories from his grandparents about sharing the fish from Kettle Falls with tribes across the region. He said they worried, after the falls were inundated, that the tribe’s connection to the salmon would disappear.

In the water below him, Conantand other ceremony organizers and tribal leaders were ankle deep in the current. They stood with a stone in each hand, lifted them into the air and rapped them against each other. The crowd on the banks echoed them, and soon the rhythmic clacking of their salmon call drowned out even the speedboaters in the distance. Before the dam drove them extinct on this part of the Columbia River, the salmon passing Kettle Falls were legendary, growing to the size of an 8-year-old child and capable of hurdling waterfalls and navigating by smell for more than 1,000 miles to reach their home streams.

Upper Columbia tribes have a multiphase plan to restore salmon in those waters: transplanting fish above the dams to establish populations, then creating new systems of fish passage, like trapping fish and trucking them around the dams, a technique already used on other rivers.

It’s not just about restoring the tribes’ own fisheries. The rivers and streams above Grand Coulee Dam offer some of the best remaining coldwater habitat for salmon, and could be a bastion for the fish amid climate change. Reintroduction has been endorsed by the Northwest Power and Conservation Council, which oversees the fish and wildlife program funded by Bonneville, and more recently by NOAA. It’s part of the ongoing negotiations between salmon advocates and the Biden administration, which have also discussed dam breaching and shifting Bonneville’s fish and wildlife responsibilities to states and tribes.

But, so far, tribes in the upper Columbia say they haven’t been able to get the help they need from the federal government, which by treaty and federal doctrine is the trustee of their rights.

Salmon is prepared immediately after the early morning salmon ceremony by Rick Desautel, fisheries technician for Colville Tribes' Fish & Wildlife. The salmon is skewered and then placed over a fire, to be eaten for lunch just a few hours later. (Chona Kasinger for ProPublica)

“The government’s been fighting us about putting these fish here,” said Marchand, who served on the Colville tribal council when upper Columbia tribes released their plan for reintroduction. “Part of it is energy costs. And part of it’s just, to me, it’s just raw power politics.”

Because salmon are extinct above Grand Coulee Dam, Bonneville doesn’t currently have to worry about how well fish pass the dam and all the costs associated with that. But upper Columbia tribes say they’ve designed their reintroduction plan to work within existing dam operations and have no intention of jeopardizing power production.

Bonneville and its partners have refused to evaluate the idea of bringing salmon back to the upper Columbia. Collectively, Bonneville, the Army Corps and the Bureau of Reclamation told the tribe that fish passage was too complicated and too time-consuming to include in their plan for the river.

“You’re talking about roughly half of the production of the entire system with those two very large dams on the upper Columbia,” Johnson said. “That could introduce fairly high costs and a lot of upward rate pressure for Bonneville's power customers.”

Johnson called it a very complex issue, and one that “warrants a lot of discussion.”

Bonneville has created other obstacles to the reintroduction of fish. The Spokane Tribe told the agency in 2019 that its “lack of funding and stonewalling” put their efforts three years behind schedule. The Colville Tribes say it has been more difficult to get funding for the fish reintroduction than for any other fish and wildlife project. And in 2018, when the Colville Tribes and Bonneville were due to renew their funding accord, the agency included provisions in the new agreement that forbid the use of any accord funding in the tribe’s reintroduction efforts. It also forbade the tribe from using any fish from their Chief Joseph Hatchery for relocation. Two tribes partnering with the Colville on reintroduction efforts asked Bonneville to remove the language: One called it “meddling” and the other said it “directly undermines” its efforts “in seeking cultural restitution for lost resources.” But Bonneville kept the language, and with roughly $68 million in funding — and the many jobs that this money would sustain — riding on the accord, the Colville Tribes signed.

Bonneville said reintroduction above Grand Coulee Dam isn’t what Congress authorized the hatchery for, but that it is working with tribes to find a path forward.

Meanwhile, tribes have worked around the restrictions to try to reintroduce fish.

A bucket of juvenile salmon is transferred from a tank delivered by the Coeur D’Alene Tribe for release near the Chief Joseph Dam (first image), handed to Conor Giorgi, anadromous program manager for the Spokane Tribe (second image), and released into the Columbia River by Casey Baldwin, a research scientist for the Confederated Colville Tribes (third image). (Chona Kasinger for ProPublica)

In 2019, they began to capture adult salmon that were returning from the ocean and relocated them above the dams. Conant, who organizes the salmon ceremony, was among the tribal members who released those captive fish into the water. To her delight, biologists later found salmon from the tribes’ releases spawning in the Sanpoil River, a tributary of the upper Columbia.

“It’s not necessarily like, oh, ‘salmon’s the magic food that saves the Indian!’” Conant said. “But it brings back fishing. It brings back taking care of the fish, cutting and drying it, processing, spending that time with your uncle, spending that time with your grandma. It brings it all back.

“There’s bits and pieces of all of our hearts that are missing,” Conant said. “We’re filling our hearts back up and fighting our way back to our culture.”

Members of the Spokane Tribe were amazed to discover in 2019 that some of the juvenile Chinook salmon they tagged with trackers and released above Grand Coulee Dam somehow not only made it downriver through Grand Coulee and Chief Joseph dams despite their lack of dedicated fish passageways, but made it more than 600 miles to the ocean.

One of those salmon returned as an adult, swimming all the way back to the Chief Joseph Hatchery at the base of its namesake dam.

But its journey ended there. The federal agencies’ protocols prohibited tribes from relocating the captured salmon above Grand Coulee Dam.

Instead of returning to its home waters, it died below the dam.

Lake Roosevelt now covers the historical tribal fishing grounds of Kettle Falls. (Kristyna Wentz-Graff/OPB)

Help Us Understand Pacific Northwest Salmon and Treaty Rights

Alex Mierjeski contributed research.

by Duaa Eldeib

This story contains descriptions of stillbirths.

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.

Late one afternoon last October, Dr. Shelley Odronic sat in her office and, just as she had thousands of times before, slid a rectangular glass slide onto her microscope.

A pathologist who works in rural Ohio, Odronic leaned forward to examine tissue from the placenta of a woman who had recently given birth. She increased the magnification on the microscope. Never had she seen so many tiny, congealed reservoirs of blood or such severe inflammation of the tissue, a sign the placenta had been fighting an infection.

“Right away, I knew it wasn’t compatible with life,” Odronic said.

She asked her secretary to print out the patient’s chart. In dark letters were the words “fetal demise.” A stillbirth, the death of a fetus at 20 weeks or more of pregnancy. But that didn’t solve the mystery. Odronic had examined many placentas from pregnancies that ended in stillbirth. None looked like this — withered and scarred.

Dr. Shelley Odronic works in her office in Lima, Ohio. Odronic, a pathologist, noticed severe damage in the placentas of pregnant people who had COVID-19. (Maddie McGarvey for ProPublica)

Odronic kept reading. No chronic medical conditions. Good prenatal care. Then, buried in the middle of the report, she spotted something. Seven days before the stillbirth, the mother had tested positive for COVID-19. Odronic wondered if the virus could explain the damage to the placenta. In the world of placenta pathology, a new affliction is unusual, especially one so dramatic in presentation and so devastating in effect.

Her mind traveled to Dr. Amy Heerema-McKenney, a pathologist at Cleveland Clinic and an expert on the placenta, who had trained Odronic during residency. Odronic went to sleep that night with a pit in her stomach and a plan to call her former teacher in the morning.

Heerema-McKenney was in her office when the phone rang. As she listened, she knew that what Odronic was describing was what she and her colleagues had observed repeatedly over the past several months: a patient positive for the coronavirus, a placenta destroyed by COVID-19, a baby stillborn.

Their next discovery was equally stunning. None of the stillbirths they studied involved a pregnant person who had been fully vaccinated. The doctors checked with colleagues across the country and around the world. The fatal pattern held.

Placenta slides (first image) in Dr. Amy Heerema-McKenney’s office at the Cleveland Clinic. Heerema-McKenney (second image), a placenta pathologist, works in the lab. She noticed the impact COVID-19 was having on placentas and stillbirths. (Maddie McGarvey for ProPublica)

Unvaccinated women who contracted COVID-19 during pregnancy were at a higher risk of stillbirths. They also were more likely to be admitted to the intensive care unit, give birth prematurely or die. Yet their greatest protection — the COVID-19 vaccine — sat largely untouched, buried under doubt, polluted by disinformation.

Pharmaceutical companies and government officials failed to ensure that pregnant people were included in the early development of the COVID-19 vaccine, a calamitous decision made amid the urgency of a rapidly spreading pandemic. That decision left pregnant people with little research to rely on when making a critical decision on how best to keep the babies growing inside of them safe.

At the same time that research was excluding pregnant people from vaccine trials, a full-scale assault on vaccination was unfolding online. Taking advantage of the lack of data, conspiracy theorists, anti-vaxxers and even some medical professionals spread false claims about the vaccine’s safety in pregnancy, leading many pregnant people to delay or refuse the vaccine. Even now, with numerous studies unequivocally announcing the safety of the vaccine for pregnant people, some doctors have failed to communicate the dangers of COVID-19 to pregnant people or the vaccine’s role in mitigating it.

The Centers for Disease Control and Prevention contributed to the confusion with vague early messaging about whether pregnant people should get vaccinated. While Americans lined up at pharmacies and stalked vaccine websites in hopes of securing a shot last year, pregnant people had some of the lowest vaccination rates among adults, with only 35% fully vaccinated by last November. Meanwhile, many Americans were already moving on to their boosters after federal officials that month expanded eligibility for the additional shots to anyone 18 or older. And much of the country was beginning to return to pre-pandemic life. The Sunday after Thanksgiving, for instance, set the record for the busiest day of air travel since March 2020.

November also marked a key moment in the understanding of COVID-19’s impact on stillbirths. A CDC study looking at 1.2 million births in the first 18 months of the pandemic found that more than 8,000 pregnancies ended in stillbirths, including more than 270 of them in patients with a documented COVID-19 diagnosis at the time of delivery.

Although stillbirths were rare overall, babies were dying. The risk of a stillbirth nearly doubled for those who had COVID-19 during pregnancy compared with those who didn’t. And during the spread of the delta variant, that risk was four times higher.

Odronic inspects a placenta. The placenta is vital to keeping a growing fetus alive, delivering oxygen and nutrients as their organs develop. (Maddie McGarvey for ProPublica)

Indeed, doctors discovered that some stillbirths resulted from COVID-19 directly infiltrating the placenta, a condition they named SARS-CoV-2 placentitis. Cases were found even in people whose COVID-19 symptoms were mild or nonexistent. In some cases, however, placentas were discarded with medical waste without being tested for COVID-19, and parents never learned what led to their baby’s stillbirth.

COVID-19 also led to stillbirths among pregnant people who became exceedingly ill after contracting the virus. It damaged their lungs and clotted their blood, putting their babies in such severe distress that they were born before they could take their first breath.

“These are pregnancies that should not have ended,” Heerema-McKenney said.

She and others had tried to alert the CDC as well as maternal and state health organizations to their findings, but she said they either didn’t get a response or were told they needed to collect more data and publish studies. Pathologists are experts in disease diagnosis, dealing with death and illness from the safe distance of their labs. Convincing obstetricians who met with patients daily or doctors who were making policy recommendations was a challenge.

“I tried to sound the alarm. We tried so hard to get people to listen,” Heerema-McKenney said. “It was a really frustrating place to be as pathologists doing these autopsies, looking at these placentas and saying, ‘God, no, not another case.’”

Around the same time Heerema-McKenney was examining the damaged placentas, Ginger Munro was on life support in a hospital 250 miles away in another part of Ohio.

She and her husband, Kendal, had been trying to have a child for five years. They hadn’t expected that she’d get pregnant in the middle of a pandemic. But when her pregnancy test came back positive in the spring of 2021, she rushed to post a picture of it in an online pregnancy group. “Is it just me or can you see the 2 lines??” she asked.

The pandemic had already brought much change to their lives. Ginger, who lives in the small town of Washington Court House in southwest Ohio, quit her job as assistant nutrition director with the county’s Commission on Aging. She stationed hand sanitizer throughout her house and in her car, and she only went grocery shopping early in the morning. If she noticed someone in an aisle, she skipped it.

“I knew the virus was real,” she said, “but I was terrified to take the vaccine.”

Ginger Munro sits in her home in Washington Court House, Ohio. (Maddie McGarvey for ProPublica)

Ginger worried that the vaccine’s development had been rushed, and she hadn’t seen any data showing it was safe for pregnant people. At this point, the CDC had not explicitly recommended the vaccine during pregnancy. Ginger already worried she was tempting fate by getting pregnant at 40; she said she didn’t want to risk endangering her baby by taking the vaccine.

Besides, if it was really important, her doctor would have mentioned it, and, she said, she would have followed his advice. But, she said, he never did. Her family hadn’t gotten vaccinated either. In a mostly rural county where less than half of the residents were vaccinated, they were hardly alone.

Her doctor declined to comment through a spokesperson at the hospital system where he works; the spokesperson said the hospital couldn’t disseminate information about the vaccine to pregnant patients before it was recommended.

Ginger’s pregnancy progressed without complications. She and Kendal shared the news of a new baby with Ginger’s two daughters from a previous marriage. At their kitchen table, near a sign that read “eat cake for breakfast,” Sophia, then 14, covered her mouth with both hands while Hailee, then 18, simply beamed.

At a backyard gender reveal three months later, Ginger’s growing belly resembled a basketball against her tiny frame. She leaned in to kiss her husband, her long, dark hair falling onto her shoulders. Red confetti rained down on the deck.

Kendal, an aircraft maintenance and avionics manager at an airport two counties away, worked through the pandemic. In the summer, when they realized his cough was actually COVID-19, it was too late. Ginger was sick.

What the Placenta Does

The placenta’s job is as critical as it is clear: keep the baby alive.

For the most part, it does that well. The placenta is the first organ to develop after conception, and it connects to the fetus through the umbilical cord, which delivers oxygen. The placenta provides nourishment, expels waste and does much of the work of the fetus’s lungs, kidneys and liver as they develop. The dark-red organ typically is solid, with a sponge-like texture and blood vessels that spread out like the branches of a tree.

The placenta also acts as a shield against most viruses, but when it’s attacked by COVID-19, the branches can collapse, killing the cells, cutting off oxygen to the fetus, leaving holes to be filled by pools of blood. In response to the infected and dying cells, inflammation and scarring spread throughout the placenta.

Unable to survive the damage to the placenta, many babies were stillborn.

Having trouble reaching her doctor, she went to two different emergency rooms. One, she said, declined to treat her with monoclonal antibodies, which research had shown can be an effective treatment for pregnant people with COVID-19. The other, which described her in medical records as “an exceedingly pleasant individual admitted with symptomatic COVID-19 pneumonia,” transferred her about an hour away to the University of Cincinnati Medical Center. There, records show, she was admitted with acute respiratory distress syndrome due to COVID-19.

The University of Cincinnati doctor asked Ginger and Kendal — who was on FaceTime because of the hospital’s COVID-19 protocols — about “fetal priority.” Ginger made her wishes clear: Save the baby, their baby, the baby they had tried so hard to have. Kendal, who was worried about both his wife and their unborn child, said he went along with Ginger in that moment.

“You were so scared,” Kendal wrote in a notebook that night. “We told each other over and over how much we loved each other.”

They hung up so the doctors could insert a breathing tube. Before they could begin, Kendal called back three more times just to hear her voice.

Doctors put Ginger on ECMO, a form of life support reserved for the sickest patients. Kendal, Hailee, Sophia and Ginger’s mother and sister were later allowed in the hospital two at a time, and they prayed at her bedside nearly every night. Ginger was sedated, her face swollen and obscured by tubing, her cheeks flattened by the crush of the ventilator straps, her wrists tied down so she wouldn’t accidentally pull out her breathing tube.

Her family took solace in knowing the baby’s heartbeat was steady and her ultrasounds were normal. The doctors gave Ginger medication to help the baby’s lungs mature in case she was born early. After more than 30 days on ECMO, doctors took Ginger off the machine only to put her back on the next morning. She was the first patient in the hospital’s history to be placed on ECMO twice.

The plan, records show, was to deliver at 28 weeks. But the day after Ginger was put back on life support, Kendal got the call telling him the baby was on her way. As doctors prepared for the delivery in Ginger’s intensive care room, the family camped out in the waiting room, jittery from excitement and vending machine snacks. They talked about baby names and future family outings. They pulled the waiting room chairs together to form makeshift beds and covered themselves with blankets they brought from home.

They don’t know if they actually fell asleep before a nurse burst through the doors screaming at them to follow. “She’s coming! She’s coming!” They didn’t make it far before they were blocked by doctors and nurses, some huddled over an incubator in the middle of the hall and the rest crowded around Ginger.

Hailee tried to peer over the sea of blue scrubs to catch the first glimpse of her little sister. She smiled beneath her black mask. She’ll be OK, she said to herself.

But after a few minutes of trying to revive the baby, a doctor told Kendal it was time. Kendal nodded, asked for a chair and collapsed as he tried to process his daughter’s death.

Then another wave of grief washed over him. Someone would have to tell Ginger.

A baby bonnet and memorial card for Elliotte, who was stillborn on Sept. 14, 2021. Her mother, Ginger, was hospitalized with COVID-19, placed on life support and eventually went into early labor. (Maddie McGarvey for ProPublica)

Ginger’s medical records describe a baby born at 27 weeks “without signs of life” after an “uncomplicated delivery.” Her placenta had separated from the wall of the uterus, the risk of which studies have shown increases with COVID-19.

When Ginger woke up, she looked down at her sunken belly and realized she had given birth. She assumed her daughter was in the newborn intensive care unit. Ginger was barely able to speak around the tube in her trachea, but after a few days in which no one brought the baby to her, she couldn’t wait any longer. Ginger turned to her mother and sister and mouthed the words, “Where’s the baby?”

The room fell silent. They called Kendal, who rushed to the hospital. He told her what had happened. He described their daughter’s dark hair and her long fingers and toes, just like her mother’s.

Ginger, who had always loved the sweet smell of a newborn’s breath, whispered to her husband.

“Did you smell her breath?”

“She wasn’t breathing,” he said.

Ginger and Kendal Munro visit their daughter Elliotte’s grave. She was stillborn at 27 weeks. (Maddie McGarvey for ProPublica)

In the hurried quest for a safe and effective COVID-19 vaccine, pharmaceutical companies and government officials did not include pregnant people in their initial plans. It’s a failure that continues to reverberate.

“They absolutely should have been included in COVID vaccine trials from the beginning,” said Kathryn Schubert, president and CEO of the Society for Women’s Health Research, a Washington, D.C.-based nonprofit that advocates for the inclusion of women in research and clinical trials.

Researchers and advocates have spent more than four decades trying to dismantle the belief that it’s unsafe or unethical for pregnant women to participate in clinical trials. A couple years ago, it seemed like they had finally prevailed.

Shortly before leaving office, President Barack Obama signed into law the 21st Century Cures Act, which established the Task Force on Research Specific to Pregnant Women and Lactating Women. The group found longstanding obstacles, including liability concerns, to including pregnant and lactating people in clinical research. It concluded that recommending halting medication or forgoing treatment while pregnant may actually endanger the health of the mother and her fetus more than the treatment itself.

The need for everything from asthma to depression medication doesn’t stop when a person gets pregnant, and when a catastrophic event such as a pandemic hits, experts said, pregnancy should not preclude someone from receiving life-saving treatment.

Around the same time, researchers discovered that the Zika virus, which was mainly transmitted through mosquitoes, could pass from a pregnant person to their fetus and cause severe birth deformities. A second group of experts joined together to develop separate guidance on including pregnant people in the research, development and deployment of pandemic vaccines.

Both groups pushed to remove pregnant women from a list of vulnerable populations that required additional review before being allowed to participate in research. Instead of proving that pregnant women should be included, manufacturers would need to provide compelling evidence for why they shouldn’t.

In 2018, the federal task force issued recommendations calling for including pregnant and breastfeeding people in biomedical research, and the Department of Health and Human Services adopted some of the guidance. But a gap remained between what the task force and others insisted was needed and what was actually happening.

“We were frustrated because COVID-19 provided an opportunity to implement the recommendations of the task force,” said Dr. Diana Bianchi, the director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the chair of the task force.

In February 2021, Bianchi and her colleagues published an article lamenting the exclusion of those who were pregnant or breastfeeding from the initial COVID-19 vaccine clinical trials. “Pregnant and lactating persons should not be protected from participating in research, but rather should be protected through research,” they wrote.

Ruth Faden, the founder of the Johns Hopkins Berman Institute of Bioethics, helped lead the group that issued the guidance after Zika. She and others urged manufacturers to include pregnant people in the development of the COVID-19 vaccine as part of Operation Warp Speed, the federal program that provided billions of taxpayer dollars to pharmaceutical companies to speed up vaccine production.

“There is a playbook in place so that when the U.S. launches Operation Warp Speed, it should be pretty obvious what should be done,” she said. “It’s not like no one knows how to do this, either ethically or technically.

“Nevertheless, it doesn’t happen,” Faden added. “Once again, pregnant people are left behind.”

A spokesperson for Pfizer said the company followed guidance from the Food and Drug Administration. Although pregnant people were not included in the initial vaccine clinical trials, Pfizer tested its vaccine on pregnant rats and did not identify any safety concerns. The company subsequently launched a clinical trial with pregnant women but halted it because at that point the vaccine had already been recommended for pregnant people.

Similarly, Moderna also studied its vaccine on pregnant animals, but the company said it made the decision “to prioritize the study of the safety and efficacy” of the vaccine in adults who weren’t pregnant. It called that approach “consistent with the precedent to study new vaccines in pregnant women only after demonstration of favorable benefit and risk in healthy adults.”

In response to questions from ProPublica, Johnson & Johnson referred a reporter to its website, which didn’t address the relevant issues.

Some government officials, including several from the Food and Drug Administration, said they support having pregnant women take part in clinical studies of vaccines for emerging infectious disease, including COVID-19. A spokesperson for the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health, said the agency did not “dictate the protocol development” for the trials and said that responsibility lies with the companies.

The failure to include pregnant people early on in COVID-19 vaccine trials was, at least in part, a casualty of the tremendous urgency to respond to an intense public threat and develop the vaccine as quickly as possible, Faden said. But multiple groups had published road maps on how to ethically include pregnant people without slowing down that process.

“I can’t tell you how many pregnant people might not have died or how many stillbirths might not have occurred if the playbook had been followed,” she said, “but I’m willing to bet it was a significant chunk that would have been prevented if there had been a full-throated, evidence-based recommendation for COVID-19 vaccines in pregnancy almost simultaneous to when it was available for the rest of the adult population.”

By the time the CDC specifically recommended the vaccine for pregnant people, in August 2021, the damage had been done.

A dizzying and vague series of advisories led to confusion and delayed vaccinations. When the COVID-19 vaccines were first made available in December 2020, the CDC said health care workers and residents of long-term care facilities should be prioritized, but the shots were not explicitly recommended for pregnant people. Instead, the agency said on its webpage for vaccines and pregnancy that pregnant health care workers “may choose to be vaccinated.” In explaining that decision, the CDC said that experts had considered how mRNA vaccines, which do not contain the live virus, work. They concluded that the vaccines “are unlikely to pose a risk for people who are pregnant.”

“However,” the CDC added, “the potential risks of mRNA vaccines to the pregnant person and her fetus are unknown because these vaccines have not been studied in pregnant women.”

In January, the World Health Organization recommended against pregnant people getting the vaccine unless they faced increased risk, such as complicating comorbidities or exposure to the virus due to a job in health care, but the agency later reversed course.

A few months later, in March 2021, the CDC continued its lukewarm messaging that pregnant people “may choose” to be vaccinated. The agency listed some points for pregnant people to consider discussing with their health care providers, starting with how likely they are to be exposed to COVID-19.

After a promising study showed that the vaccine was safe for pregnant people, CDC Director Dr. Rochelle Walensky said at a White House briefing in late April that the CDC was recommending the vaccine for them. But the CDC did not update its website to reflect her comments and said the agency’s guidance had not changed: Pregnant people “may choose to be vaccinated.”

Once again, pregnant people were put in the precarious position of receiving ambiguous and inconsistent recommendations. In May 2021, the CDC reiterated that pregnant people faced an increased risk of getting severely ill from COVID-19, but the language surrounding the vaccine — “If you are pregnant, you can receive a COVID-19 vaccine” — was noncommittal.

A CDC spokesperson, responding to questions from ProPublica, said in an email that pregnant people were part of the first recommendations in December 2020 that encouraged people 16 and older to get vaccinated. At that time, data about the safety and efficacy of the vaccine during pregnancy was limited “because pregnant people had been excluded from pre-authorization clinical trials,” so the CDC included additional supporting language for pregnant people, saying they were eligible and could choose to receive the vaccine. The agency said its recommendations were based on available evidence and evolved throughout the pandemic.

Before making changes to its guidance, the CDC had its team of scientists review available data to ensure that there was “an abundance of evidence.”

“For each update to the statement of risks during pregnancy, multiple types of studies and the strength of evidence for each were reviewed,” another CDC spokesperson said. “These reviews of the evidence were accompanied with discussions among subject matter experts both internally and externally with clinical partners for an ultimate determination of risk.”

Dr. Cynthia Gyamfi-Bannerman, a perinatologist and chair of the department of obstetrics, gynecology and reproductive sciences at the University of California, San Diego School of Medicine, shared the daunting task of making vaccine recommendations for pregnant people as part of COVID-19 task forces for two leading organizations, The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.

In the beginning, she said, the only pregnancy-specific data they had came from a few dozen participants who were inadvertently included after becoming pregnant during the clinical trials and from some pregnant animal data.

“It played out in real time in the COVID pandemic because we see the effects of not including pregnant people in these trials,” Gyamfi-Bannerman said. “We couldn’t make a strong recommendation, so pregnant people were hesitant. I think that directly led to fewer people using the vaccine than we would have wanted.”

At the end of June 2021, the CDC added a general update to its website to reflect the dangers of the delta variant tearing across much of the country. “Getting vaccinated prevents severe illness, hospitalizations, and death,” it wrote. “Unvaccinated people should get vaccinated and continue masking until they are fully vaccinated.”

But it wasn’t until Aug. 11, eight months after the first vaccine was administered, that the CDC issued its formal recommendation that pregnant and breastfeeding people get vaccinated.

“The vaccines are safe and effective,” Walensky said in a statement at the time, “and it has never been more urgent to increase vaccinations as we face the highly transmissible Delta variant and see severe outcomes from COVID-19 among unvaccinated pregnant people.”

August would prove to be the deadliest month for COVID-19-related deaths of pregnant people. The CDC issued an emergency call the next month strongly recommending the vaccine to pregnant people, noting that approximately 97% of pregnant people hospitalized with COVID-19 were unvaccinated. The dangers to symptomatic pregnant people included a 70% increased risk of death, and their developing babies could face a host of perils, including stillbirths.

Researchers have yet to determine exactly why some pregnant people with COVID-19, vaccinated and unvaccinated alike, deliver stillborn babies, while others do not. Attempts to answer that question have been hindered, in part, by incomplete data. The CDC’s statistics on COVID-19-related fetal and maternal deaths are undercounts. The CDC has data on less than 73,000 birth outcomes following a mother’s confirmed COVID-19 diagnosis in 2020 and 2021, of which 579 were pregnancy losses.

That information was sent in by fewer than three dozen health departments, and those estimates don’t include states like Mississippi, which in September reported 72 COVID-19-related stillbirths since the start of the pandemic, nearly double what the state would have expected, according to data from the Mississippi State Department of Health. Preliminary state data shows total stillbirths increased there in 2020 then dipped in 2021, but were still higher than pre-pandemic numbers.

A separate CDC database shows more than 220,000 COVID-19 cases and at least 305 deaths among pregnant people.

“CDC recognizes that pregnant people faced challenging decisions about how to best protect themselves in the setting of uncertainty related to both the infection and the COVID-19 vaccine,” a CDC spokesperson said, adding, “COVID-19 vaccination remains one of the best ways to protect yourself and your family from serious illness from COVID-19.”

Heartbroken and determined, Jaime Butcher has emerged as an unofficial ambassador for the vaccine, posting in online pregnancy and stillbirth forums about the risks of being pregnant and unvaccinated.

No one, she said, told her of the risks. Doctors, the CDC and health officials, she continued, aren’t doing enough to inform people. Even now, well into the pandemic’s third year, the message still isn’t getting through.

“I kept seeing it happening more and more to women and it wasn’t talked about,” she said. “They just say, ‘Oh, get the vaccine,’ which is great, but they don’t talk about what getting the virus can do to pregnant women.”

As a wedding planner, Butcher was surrounded by love. She found it with her husband, then in the daughter growing in her belly, who they named Emily after Butcher’s grandmother.

Butcher suffered five miscarriages before, she said, she opened an email from an in-vitro fertilization clinic confirming her pregnancy in the summer of 2020. She screamed, and her husband rushed to wrap her in a hug.

They waited until she was five months along to announce her pregnancy at Thanksgiving. The next day, Black Friday, they bought a high chair, a tummy time mat and pink onesies.

They were taking precautions, Butcher said, especially since the vaccine wasn’t yet available to her or her husband. But a week later, she woke up with a runny nose, though she didn’t think much of it. Still, she went to the hospital to make sure everything was OK. An ultrasound came back normal.

When her daughter’s kicking slowed the next morning, she called her doctor’s office again. They told her to eat something sweet to get the baby moving. She tried everything she could find: orange juice, Cheerios, Twix, graham crackers, peanut butter and jelly. Nothing worked.

A few hours later, Butcher drove herself to the hospital, where she followed her daughter’s heartbeat on the screen. Steady. Then slow. Then still.

She delivered at 23 weeks. Butcher didn’t know she had COVID-19 until they tested her at the hospital. A lab report later revealed extensive damage to the placenta.

“I was in shock. I was in shock that I lost my daughter, in shock that I had COVID,” Butcher said. “She should be alive, but it’s because of COVID that I lost her.”

A week later, she parked in front of Kohl’s to return the high chair, the clothes still on tiny hangers and the stroller her mom gave her. As she made her way to the register, she saw a baby in an identical stroller. The tears stung all the way down her cheeks.

“You see what you want right in front of you,” she said, “and it’s like, ‘My baby should be here. This shouldn’t have happened.’”

Even before the pandemic, almost a quarter of all stillbirths may have been preventable. The stillbirth crisis has simmered silently in the U.S., claiming the lives of more than 20,000 babies annually. But parents often suffer alone, overwhelmed by grief and guilt.

Butcher, now 45, scheduled her vaccine as soon as she could. Her second dose fell on what was supposed to be Emily’s due date. After getting the shot, she and her husband drove up to Cleveland to visit their daughter’s grave and tell her that her mother got the vaccine in her honor. They let her know how much she was loved and how desperately they wished she was still safe inside her mother’s womb.

They didn’t linger long that spring day. It was a quiet visit. Butcher brought Emily pink flowers, always pink, and said goodbye.

They didn’t know it at the time, but they’d be back in a year to introduce her to her little brother.

Amid the devastation of the pandemic, Heerema-McKenney sees a glimmer of hope. The antibodies from the vaccine have been shown to transfer through the placenta. That immunity in the womb, research shows, reduces the risk of the youngest infants being hospitalized with COVID-19. She continues to encourage pregnant patients to get vaccinated and boosted. If not for them, for their baby.

Heerema-McKenney stands outside the hospital in Cleveland. (Maddie McGarvey for ProPublica)

While 71% of pregnant people were fully vaccinated as of mid-July, a figure not much lower than national vaccination rates for people 18 or older, only around 2% received at least one of their shots while they were pregnant — suggesting that persuading people who are already pregnant to get vaccinated remains a challenge. Research points to a substantial waning in immunity five to eight months after getting the first vaccine, yet only 58% of pregnant people were boosted. Like with booster rates among those who aren’t pregnant, Black and Hispanic people trail behind.

Heerema-McKenney said obesity, high blood pressure, age and diabetes may also increase the risk of stillbirth, but, she said, it appears the strongest risk factor is not being vaccinated.

“We have a set of data saying that the vaccination is safe, and we have a set of data saying that COVID causes an increase in stillbirth. When you’re seeing those two,” she said, “to me it says, ‘Get the vaccine.’”

Another reason for optimism is that the height of SARS-CoV-2 placentitis appears to have coincided with the dominance of the delta variant; Heerema-McKenney said she has not seen a case of COVID-19 directly infiltrating the placenta for months.

Neither has Odronic, who is relieved to get back to her routine work of cancer biopsies after the punishing period last fall when she saw one to two stillbirths a week. Her hospital honored her in November as Physician of the Year for the “tireless leadership she demonstrated during the COVID response,” the first time the award was given to a pathologist.

Odronic saw one to two stillbirths a week last fall. (Maddie McGarvey for ProPublica)

But, doctors warn, the virus continues to mutate and the risk of stillbirth remains.

“Maybe we’re out of the woods with this, but we just don’t know,” Heerema-McKenney said. “There’s nothing more tragic than seeing a healthy pregnancy end because of something that’s potentially preventable.”

Back in southwest Ohio, doctors released Ginger from the hospital at the end of October, two and a half months after she was admitted. Her oldest daughter, Hailee, who is now 19, got vaccinated shortly after her mother was hospitalized. Ginger said she wanted to get vaccinated when she awoke in the hospital, but she said her doctors told her to wait a bit.

Since then, she said, her fear of the vaccine came flooding back.

At a recent appointment, Ginger listened carefully as her doctor urged her to get vaccinated, which, the doctor said, would be even more important if she were to get pregnant again. Ginger trusted her. “There’s no agenda behind it,” Ginger said. “I will get the vaccine.”

Ginger continues to wrestle with feelings of gratitude and guilt for surviving when her baby did not. In December, the family held a memorial service for the daughter they named Elliotte Jo and called Ellie. Ginger and Kendal were still too grief-stricken to speak, so Hailee and her uncle prepared remarks.

“You have the best dad that I know would have given you everything under the sun and protected you with every ounce of his being,” Hailee said. “And you also have the best mom to guide you through life. Having two older sisters, you would have had the best wardrobe and many visits to Starbucks.”

She breathed laughter into the room, if only briefly.

In June, the family traveled to Florida. As the waves lapped against the shore and the sunrise turned the sky pink, they etched Elliotte’s name in the sand.

A photo of Kendal with Hailee and Sophia, who are holding their stillborn baby sister, Elliotte. (Maddie McGarvey for ProPublica) Help Us Continue Our Reporting

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Mariam Elba and Gabriel Sandoval contributed research.

by Duaa Eldeib

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Even before the COVID-19 vaccine was authorized, there was a plan to discredit it.

Leaders in the anti-vaccination movement attended an online conference in October 2020 — two months before the first shot was administered — where one speaker presented on “The 5 Reasons You Might Want to Avoid a COVID-19 Vaccine” and another referred to the “untested, unproven, very toxic vaccines.”

But that was only the beginning. Misinformation seeped into every corner of social media, onto Facebook feeds and into Instagram images, pregnancy apps and Twitter posts. Pregnant people emerged as a target. A disinformation campaign preyed on their vulnerability, exploiting a deep psychological need to protect their unborn children at a moment when so much of the country was already gripped by fear.

“It’s just so powerful,” said Imran Ahmed, the founder and chief executive officer of the U.S. nonprofit Center for Countering Digital Hate, which tracks online disinformation.

A majority of the disinformation came from a group of highly organized, economically motivated actors, many of them selling supplements, books or even miracle cures, he said. They told people the vaccine may harm their unborn child or deprive them of the opportunity to become parents. Some even infiltrated online pregnancy groups and asked seemingly harmless questions, such as whether people had heard the vaccine could potentially lead to infertility.

The Center for Countering Digital Hate found that nearly 70% of anti-vaccination content could be traced to 12 people, whom they dubbed The Disinformation Dozen. They reached millions of people and tested their messaging online, Ahmed said, to see what was most effective — what was most frequently shared or liked — in real time.

“The unregulated and unmoderated effects of social media where people are allowed to spread disinformation at scale without consequences meant that this took hold very fast,” Ahmed said. “That’s had a huge effect on women deciding not to take the vaccine.”

Some people, such as Robert F. Kennedy Jr., seized on the initial dearth of research into vaccines in pregnant people. “With no data showing COVID vaccines are safe for pregnant women, and despite reports of miscarriages among women who have received the experimental Pfizer and Moderna vaccines, Fauci and other health officials advise pregnant women to get the vaccine,” Kennedy posted in February 2021 on Facebook. Kennedy did not respond to requests for comment.

Disinformation flourished, in part, because pregnant people were not included in the vaccine’s initial clinical trials. Excluding pregnant people also omitted them from the data on the vaccine’s safety, which created a vacuum where disinformation spread. Unsure about how getting the shots might affect their pregnancy — and without clear guidance at the time from the Centers for Disease Control and Prevention — pregnant people last year had some of the lowest vaccination rates among adults.

The decision to delay or avoid vaccination, often made out of an abundance of caution and love for the baby growing inside of them, had dire consequences: Unvaccinated women who contracted COVID-19 while pregnant were at a higher risk of stillbirths — the death of a fetus at 20 weeks or more of pregnancy — and several other complications, including maternal death.

Although initial clinical trials did not include pregnant people, the Food and Drug Administration ensured that vaccines met a host of regulatory safety standards before authorizing them. Citing numerous studies that have since come out showing the vaccine is safe, the CDC now strongly recommends that people who are pregnant, breastfeeding or planning to become pregnant get vaccinated. The major obstetric organizations, including The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, also urge pregnant people to get vaccinated.

But two and a half years into the pandemic, misinformation is proving resilient.

A May 2022 Kaiser Family Foundation poll found more than 70% of pregnant people or those planning to become pregnant believed or were unsure whether to believe at least one of the following popular examples of misinformation about the COVID-19 vaccine: that pregnant people should not get vaccinated; that it’s unsafe to get vaccinated while breastfeeding; or that the vaccine has been shown to cause infertility. None of which are true.

Dr. Laura Morris, a University of Missouri, Columbia family physician who delivers babies, has heard all those falsehoods and more from her patients. She has long relied on science to help encourage them to make well-informed decisions.

But when officials rolled out the vaccine, she found herself without her most powerful tool, data. The disinformation didn’t have to completely convince people that the vaccine was dangerous; creating doubt often was sufficient.

“That level of uncertainty is enough to knock them off the path to accepting vaccination,” Morris said. “Instead of seeing vaccines as something that will make them healthier and improve their pregnancy outcomes, they haven’t received the right information to make them feel confident that this is actually healthy.”

Before COVID-19, Morris typically saw one stillbirth every couple of years. Since the pandemic started, she said she has been seeing them more often. All followed a COVID-19 diagnosis in an unvaccinated patient just weeks before they were due. Not only did Morris have to deliver the painful news that their baby had died, she also told them that the outcome might have been different had they been vaccinated. Some, she said, felt betrayed at having believed the lies surrounding the vaccine.

“You have to have that conversation very carefully,” Morris said, “because this is a time where the people are feeling awful and grieving and there’s a lot of guilt associated with these situations that’s not deserved.”

In December 2021, the Federation of State Medical Boards found a proliferation of misinformation about COVID-19 among health care workers. Two-thirds of state medical boards reported an increase in complaints about misinformation, but fewer than 1 in 4 of them reported disciplining the doctors or other health care workers.

Dr. Sherri Tenpenny, an osteopath, was the speaker at the October 2020 conference who called the COVID-19 vaccine “toxic.” She later testified at an Ohio state House Health Committee hearing on the Enact Vaccine Choice and Anti-Discrimination Act. She falsely claimed that the vaccine could magnetize people. “They can put a key on their forehead, it sticks,” she said. “They can put spoons and forks all over them, and they could stick.” She also questioned the connection between the vaccine and 5G towers.

Despite her statements, the State Medical Board of Ohio has not taken any disciplinary action against her. Her medical license remains active. Tenpenny did not respond to requests for comment.

It’s difficult to know exactly how many doctors were disciplined, a term that can mean anything from sending them letters of guidance to revoking their license. State medical boards in some cases refused to disclose even the number of complaints received.

Some records were made public if formal disciplinary action was taken, as in the case of Dr. Mark Brody. The Rhode Island physician sent a letter to his patients that the state medical board determined contained several falsehoods, including claims that “there exists the possibility of sterilizing all females in the population who receive the vaccination.” The Rhode Island Board of Medical Licensure and Discipline reprimanded him for the letter, then suspended his medical license after other professional conduct issues were uncovered. He surrendered his license in December.

Brody said in an interview that he stands by the letter. He said the word “misinformation” has been politicized and used to discredit statements with which people disagree.

“This term doesn’t really apply to science,” he said, “because science is an ever-evolving field where today’s misinformation is tomorrow’s information.”

The Washington Medical Commission has received more than 50 complaints about COVID-19 misinformation since the start of the pandemic, a spokesperson there said. California does not track misinformation complaints specifically, but a Medical Board of California spokesperson said that, in that same time period, the group received more than 1,300 COVID-19-related complaints. They included everything from fraudulent promotion of unproven medications to the spreading of misinformation.

“We were certainly surprised that more than half of boards said they had seen an increase in complaints about false or misleading information,” said Joe Knickrehm, vice president of communications for the Federation of State Medical Boards, which in April adopted a policy stating that “false information is harmful and dangerous to patients, and to the public trust in the medical profession.”

Other groups, including The American College of Obstetricians and Gynecologists, warned doctors about spreading misinformation. In October, the organization asked its members to sign a letter endorsing the COVID-19 vaccine, writing that “the spread of misinformation and mistrust in doctors and science is contributing to staggeringly low vaccination rates among pregnant people.” But the letter was never published. “We didn’t achieve the numbers we had hoped,” a spokesperson for the organization said, “and did not want to release it if it was not going to be compelling to patients.”

The fact that some medical professionals have been spreading disinformation or failing to engage with their patients about the vaccine is profoundly disappointing, said Dr. Rachel Villanueva, a clinical assistant professor of obstetrics and gynecology at New York University’s Grossman School of Medicine and president of the National Medical Association, which represents Black doctors.

Research has shown that hearing directly from a health care provider can increase the likelihood that patients get vaccinated. And doctors, Villanueva said, have a responsibility to tell their patients the benefits of getting vaccinated and the risks of choosing not to. She has explained to her patients that although the vaccine development program was named Operation Warp Speed, for example, manufacturers followed proper safety protocols.

“Before COVID, there already existed a baseline distrust of the health care system, especially for women of color, feeling marginalized and feeling dismissed in the health care system,” she said. “I think that just compounded the already lack of confidence that existed in the system.”

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by Chris Morran and Daniel Petty

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Private equity is seemingly inescapable. From housing to hospitals and fisheries to fast food, equity investors have acquired a host of businesses in recent decades. Private equity firms control more than $6 trillion in assets in the U.S. But what makes them different from any other type of investor putting their money into a business?

Private equity investors — typified by firms like Bain Capital, Apollo Global Management, TPG, KKR and Blackstone — are different from venture capitalists, who provide a cash infusion to small startups and hope they blossom into the next Facebook. Nor are they stock traders making split-second decisions to buy or sell shares in public companies. Rather, private equity funds aim to take control of a business for a relatively short time, restructure it and resell the company at a profit.

But as ProPublica and many others have shown, the ways in which private equity goes about this restructuring can raise a number of concerns, over such things as layoffs and furloughs for employees and degraded services for customers. Critics also worry that private equity firms weigh down acquired companies with substantial debt from the money borrowed to finance the purchase.

What Is Private Equity?

Private equity funds are pooled investments that are generally not open to small investors. Private equity firms invest the money they collect on behalf of the fund’s investors, usually by taking controlling stakes in companies. The private equity firm then works with company executives to make the businesses — called portfolio companies — more valuable so they can sell them later at a profit.

This is different from, say, an individual investor buying a share of Amazon stock for $135. Purchasing that share gives you an infinitesimal stake in the company and entitles you to any dividend the company may pay out, but your ownership stake isn’t large enough to affect the company’s decision-making and operations. Private equity funds, by contrast, are not publicly traded securities, and the amount they invest usually involves trying to take a controlling stake in companies.

Private equity funds are generally backed by investments from large institutional investors: pension funds, sovereign wealth funds, endowments and very wealthy individuals. Private equity firms manage these funds, using both investors’ contributions and borrowed money.

Like any business, private equity firms want to make money, generating returns for their investors. Fund managers typically spend time conducting extensive research on both companies and industries — called due diligence — before making an investment. They consider multiple factors when deciding to invest. Among them are whether a company operates in an industry that’s difficult for other competitors to enter, generates consistent profits (or can become profitable), provides a reliable cash flow so it can pay off debt, has a strong position or brand within its market, has an effective management team, isn’t likely to face disruptive change through technologies or regulation and may be underperforming relative to other companies in its industry.

As of September 2020, about one-third of North American private equity firms’ $6.5 trillion in assets were so-called “dry powder”: cash or highly liquid securities that could be quickly invested at the right opportunity. The growth of private equity and other forms of private investment has, experts say, resulted in fewer companies going public and many more staying private for longer.

What Do Private Equity Firms Do?

Once private equity firms acquire a company, they encourage executives to make the company operate more efficiently before selling — or “exiting” — several years later, either through a sale to another investor or through an initial public offering.

“The number one factor private equity firms focus on now is the ability to grow the revenue of the company,” Steven Kaplan, a professor of entrepreneurship and finance at the University of Chicago Booth School of Business, said in an email. Other considerations, Kaplan said, include reducing costs, refinancing existing debt and multiple arbitrage — the latter a term describing how private equity funds try to acquire firms trading below their intrinsic value.

Critics of private equity, notably U.S. Sen. Elizabeth Warren, a Massachusetts Democrat, argue that private equity firms’ focus on turning a quick profit destroys long-term value and harms workers. But not everyone agrees. In some cases, particularly with distressed companies that can’t pay their debts, private equity firms are often willing to lend money to businesses when traditional lenders such as banks won’t. Defenders of private equity also note that their need for returns serves retirees — public pensions are responsible for about a third of investment into private equity funds. The median North American pension fund invests about 6% of its assets into private equity funds.

“To make money, you have to sell the company to someone,” Kaplan said. “If you have destroyed long-term value, you are going to have a hard time exiting. The critics essentially assume that buyers are stupid on a grand scale. That’s not a plausible assumption.”

In response to the criticism, some private equity firms have begun offering equity to workers of the companies they acquire under the belief that if the company does well, everyone — and not just management and the fund managers — should share in a company’s success.

“The problem is not private equity in general,” said Eileen Appelbaum, a critic of private equity and co-director of the Center for Economic Policy and Research, a progressive think tank. “The problem is private equity leveraged buyouts.”

Large private equity firms, she said, don’t ultimately create wealth, but tend to extract it from companies through the use of leverage and other means. When selling companies, private equity firms frequently sell them to other private equity firms, often without full transparency. “They maintain a myth of doing really well,” she said.

By contrast, smaller private equity firms that acquire a handful of smaller companies tend to do better at adding value because they tend to buy businesses that are more likely to need improvements. The acquiring firms can’t as easily use the same kinds of financial engineering, she said.

What Returns Do Private Equity Firms Generate?

Even though private equity firms generally invest little of their own money into acquisitions, they typically receive both a small percentage of a company’s total assets (usually 2%) as a management fee and a 20% cut of resulting profit from a sale of the company, all of which the U.S. government taxes at a significant discount to the firm under a tax advantage called “carried interest.” Under this compensation scheme — called “two-and-twenty” — the private equity firm makes some money regardless of whether its portfolio companies are profitable.

Both Republicans and Democrats have called for the “carried interest” loophole to be closed. A bill backed by U.S. Sens. Joe Manchin and Chuck Schumer had aimed to partially close the loophole by only allowing firms to take advantage of carried interest once they’ve owned a company for five years — two years longer than current law. However, after opposition from Sen. Kyrsten Sinema — a critical vote for the legislation — this component of the bill was removed. Private equity firms argue that allowing fund managers to take pay as carried interest occurs only when the fund (and thus the companies) are profitable.

Private equity firms also market their funds as high-yield vehicles for institutional and wealthy investors, claiming the potential for returns higher than public stock indices like the S&P 500 and the Russell 2000 index of small-cap stocks. Additionally, private equity funds have a reputation for being less volatile than individual stocks, which can spike or crater based on something as minor as a tweet. The comparison isn’t perfectly fair, however: Investors in private equity funds must lock their money into a fund for many years and don’t start receiving distributions until later in the cycle, whereas retail investors with an S&P 500 mutual fund can buy and sell much more easily.

There are certainly private equity success stories in which distressed businesses are turned around and then eventually sold at a profit. But private equity has a reputation for aggressive cost management and saddling companies with heavy debt loads, which can result in neglect of vital but non-revenue-generating aspects of an investment and overconsolidation — acquiring multiple similar businesses, which reduces competition and can have far-reaching impacts on costs and labor.

How Do Private Equity Firms Use Debt?

The current version of private equity was born out of the leveraged buyout boom of the 1980s, in which cutthroat investors borrowed heavily to purchase companies and squeeze as much money as possible out of their purchases, usually by liquidating assets and looting pension funds.

The percentages of deals that have been financed with borrowed money have declined markedly over time. In the 1980s, according to Kaplan, deals were frequently consummated at 90% debt-to-enterprise value ratios, meaning nearly all of the money used for the acquisition was borrowed. If a company cost $100 million to acquire, the private equity fund would borrow $90 million and use $10 million of its own investors’ money — equity — to finance the purchase. In the 1990s, the typical ratio declined to closer to 70%. Nowadays, typical leverage ratios are in the 50% to 60% range.

Buying a company using debt is called a leveraged buyout. It’s similar to taking out a loan to buy a house and then renting it out to a tenant, with the cash flow from rent meant to pay down the landlord’s mortgage.

Why does private equity use so much debt? Generally, it amplifies a private equity fund’s expected returns on its investments, in part because the federal government allows interest payments on debt to be tax-deductible. Because it enhances returns, it also enhances the firm’s expected profit. The trade-off is that heavy leverage increases the risk that the firm will be unable to make its debt payments.

One of the more criticized aspects of leveraged buyouts is that the debt used to finance the acquisition doesn’t belong to the equity firm or fund. Rather, it belongs to the newly acquired company — and it can become an anchor that drags that business down.

The collapse of Toys R Us is a good example. Private equity giants including Bain Capital and KKR joined together in 2005 to purchase the flagging kids’ retail giant for $7.5 billion, even as the retail toy industry was contracting amid increased competition from Amazon and other online sellers. Though the once-popular chain’s revenues did not sink notably in the years that followed, the billions in debt related to the purchase continued to grow relative to the company’s revenue as its owners reinvested excess cash into the business to make it competitive with online retailers. Eventually, debt holders lost patience and decided that they could get more of their money back if Toys R Us closed up entirely than if it continued operations.

In 2020, ProPublica spotlighted a hospital chain run by a private equity firm that had repeatedly tried and failed to unload its health care business on new buyers. Employees at hospitals under this umbrella told us they were sometimes unable to purchase basic supplies like sponges and IV fluids, elevators broke down regularly, and ambulance drivers’ fuel cards were rejected at the pump. Yet the equity firm had already managed to squeeze out $400 million in dividends and fees for itself and investors.

By the time a potential buyer was found for that hospital chain in early 2021, its equity owners had saddled it with $1.3 billion in debt, while the firm and investors were set to walk away debt-free and having reaped a total of $645 million.

How Has Private Equity Expanded Into Health Care?

Between 2009 and 2016, the number of private equity deals involving health care businesses tripled, according to a PWC report. These investments weren’t just in hospital groups, but also in staffing companies, particularly for specialties like emergency room physicians and anesthesiologists.

TeamHealth is a major medical staffing company and the country’s top employer of emergency room doctors. It’s also owned by private equity giant Blackstone and has been the subject of multiple ProPublica investigations.

In 2019, ProPublica joined with MLK50 to report on numerous low-income patients at Memphis hospitals who had been sued by a TeamHealth subsidiary over unexpected medical debt from ER visits. Such large-scale lawsuits had not been normal practice before Blackstone acquired TeamHealth in 2017. TeamHealth at first defended the lawsuits, arguing that it only went after patients who had not attempted to pay. But after the news organizations asked more questions about the lawsuits, TeamHealth announced it would no longer pursue them.

A subsequent review of tax returns, lawsuit depositions and court documents exposed how TeamHealth, after the Blackstone acquisition, had been marking up patients’ bills to maximize its profit. Tax records for two of the company’s Texas affiliates showed that they inflated their bills by nearly eight times the actual cost of the services provided. While much of that markup was billed but never collected, all of the additional profit from the amount eventually paid went not to the doctors but to TeamHealth. The firm said in a statement that it was fighting for doctors against underpaying insurance companies: “We work hard to negotiate with insurance companies on behalf of patients even as they unilaterally cancel contracts and attempt to drive physician compensation downward.”

“These companies put a white coat on and cloak themselves in the goodwill we rightly have toward medical professionals, but in practice, they behave like almost any other private equity-backed firm: Their desire is to make profit,” said Zack Cooper, a Yale professor of health policy and economics, about this practice.

In April 2020, we reported on TeamHealth cutting back on ER doctors’ hours at a time when some hospitals were being overwhelmed with COVID-19 patients. Staffers employed by other equity-owned firms also told us their hours were being reduced or asked to take voluntary furloughs. At the time, the firms said these changes were needed to make up for the revenue shortfalls as a result of non-COVID patients canceling elective procedures and avoiding the ER. The firms also noted that they had not cut hourly rates.

How Has Private Equity Entered the Housing Market?

As the U.S. crawled out from the Great Recession, private equity firms took advantage of very low interest rates and the appetite of investors looking for seemingly stable places to stash their cash to venture into new fields like residential real estate. Amid a nationwide affordable housing crisis, private equity has quickly become a dominant player in the apartment rental business.

Some have likened the private equity cycle of acquire, restructure, resell, repeat to the practice known as house flipping, in which a buyer purchases a home, makes improvements, then quickly sells it at a profit. But as ProPublica reporting has demonstrated, the way private equity firms restructure the homes they purchase differs significantly from the changes a house flipper would make.

A house flipper’s target buyer is someone looking to purchase a home, and so the upgrades the investor makes are intended to make the property more appealing to the people who will be living in it: Getting rid of popcorn ceilings and plywood paneling, replacing the kitchen appliances, slapping on new coats of paint and improving the curb appeal. Conversely, equity firms are eventually hoping to sell their housing assets to property management firms or other investors. These buyers are much less interested in whether the flooring is real wood or laminate, so long as the units are filled and tenants are paying their bills.

And that’s what ProPublica heard when speaking to tenants at apartment buildings purchased in recent years by private equity investors. Renters at one San Francisco apartment building told us that after their management company was purchased by a large private equity fund in 2017, rents soared, trash collected in the hallways and on the rooftop deck, and the building’s dedicated security guard was forced to cover a second property as well, resulting in nonresidents entering the apartment complex without permission. One tenant described having to heat her bathwater on the stove because she couldn’t get anything but cold water from the tap.

Private equity is now the dominant form of financial backing among the 35 largest owners of multifamily buildings, our analysis of National Multifamily Housing Council data showed. In 2011, about a third of the apartment units held by the top owners were backed by private equity. A decade later, half of them were.

What Role Is Private Equity Playing in the Fishing Industry?

One way private equity firms try to generate greater returns is to acquire similar assets and operate them under the same umbrella, allowing firms to take advantage of economies of scale by sharing costs. That often means putting a greater burden on workers, whether it’s nurses having to make due with fewer vital supplies, apartment employees having to work at multiple buildings or fishing vessels seeing their earnings chiseled away by equity owners who have shifted the costs of doing business onto individual operators.

“Tell me how I can catch 50,000 pounds of fish yet I don’t know what my kids are going to have for dinner,” asked fisherman Jerry Leeman in a recent ProPublica-New Bedford Light investigation into how private equity has taken over the New Bedford, Massachusetts, fishing industry.

While Leeman and his crew are not struggling to catch fish, their deal with equity-owned Blue Harvest leaves them responsible for much of their working expenses. They’re charged for fuel, gear, leasing of fishing rights and maintenance on company-owned vessels. While some of the fish they catch typically sell for $2.28 per pound at auction, Leeman has netted only about 14 cents per pound. Each of his crew members earns about half that amount.

Their situation is a result of a race in recent years by investors to snatch up as much of the regional fishing industry as possible.

Backed by $600 million in funding from a private equity firm, which proclaimed an initial goal of “dominance” over the scallop industry, Blue Harvest has been acquiring vessels, fishing permits and processing facilities up and down the East Coast since 2015. It subsequently expanded into tuna, swordfish and groundfish — Leeman’s specialty.

“What we’re seeing is a fundamental transformation of the fishing industry,” said Seth Macinko, a former fisherman who’s now an associate professor of marine affairs at the University of Rhode Island. “Labor is getting squeezed and coastal communities are paying the price.”

Blue Harvest did not respond to questions from ProPublica, but said in an email that the firm’s focus was to advance its company strategy so employees “can be confident about their future.”

“I cannot tell you how many times I have listened to employees scared to the core for themselves and their families due to unsubstantiated rumors about our company,” Blue Harvest President Chip Wilson wrote in an email.

What’s the Future of Private Equity?

Private equity has gone through multiple eras. In the 1980s, private equity firms focused on breaking up companies through highly leveraged buyouts. Starting in the 2010s, they began to focus on making large operational improvements to their portfolio companies, and the 2020s are expected to largely be the same. Some critics argue that the largest private equity firms have become so large themselves that they have become the very thing that they aimed to disrupt in the 1980s: large corporate behemoths that were slow, inefficient and had disparate business units. The size of private equity funds themselves continues to grow.

Absent massive regulatory changes that would make it too costly to finance buyouts or would entirely remove the carried interest tax savings, private equity firms will continue to acquire companies, restructure their operations, improve efficiency and seek to generate market-beating returns for their investors. “Most deals are competitive these days,” said Kaplan, the University of Chicago professor. “As a result, you cannot earn a good return without improving the business.”

Update, August 5, 2022: This article has been updated to reflect the removal of the carried interest provisions of the legislation supported by Sens. Manchin and Schumer.

by Josh Peck and Imani White

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We also welcome your suggestions for stories. Our coverage focuses on patterns of misconduct and systemic harm. We look for untold stories about abuses of the criminal justice system, such as prosecutorial or judicial misconduct, wrongful convictions and inequities. We typically do not publish articles about individual incidents, but your collective observations will help us identify bigger issues and themes.

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by Andrea Suozzo

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Forty members of Congress on Monday asked the IRS and the Treasury to investigate what the lawmakers termed an “alarming pattern” of right-wing advocacy groups registering with the tax agency as churches, a move that allows the organizations to shield themselves from some financial reporting requirements and makes it easier to avoid audits.

Reps. Jared Huffman, D-Calif., and Suzan DelBene, D-Wash., raised transparency concerns in a letter to the heads of both agencies following a ProPublica story about the Family Research Council, a right-wing Christian think tank based in Washington, D.C., getting reclassified as a church. Thirty-eight other lawmakers, including Reps. Adam Schiff, D-Calif., Debbie Wasserman Schultz, D-Fla., Rashida Tlaib, D-Mich., and Jamie Raskin, D-Md., signed onto the letter.

“FRC is one example of an alarming pattern in the last decade — right-wing advocacy groups self-identifying as ‘churches’ and applying for and receiving church status,” the representatives wrote, noting the organization’s policy work supporting the overturning of Roe v. Wade and its advocacy for legislation seeking to ban gender-affirming surgery.

“Tax-exempt organizations should not be exploiting tax laws applicable to churches to avoid public accountability and the IRS’s examination of their activities,” they wrote.

The Family Research Council did not respond to requests for comment. The IRS told ProPublica that it does not comment on congressional correspondence.

The FRC’s website describes the organization as “a nonprofit research and educational organization dedicated to articulating and advancing a family-centered philosophy of public life,” noting that it provides “policy research and analysis for the legislative, executive, and judicial branches of the federal government.”

The FRC sought and received reclassification from a standard tax-exempt charity to an “association of churches” in 2020.

In its application for church status, the organization said it met 11 of the 14 characteristics that the IRS uses to determine whether an organization is a church, including an established place of worship — a chapel in the organization’s Washington office building, at which it said it holds services attended by more than 65 people. (Someone who answered the phone at the office said the group doesn’t offer church services.) The organization said its association comprises nearly 40,000 “partner churches” that must affirm a statement of faith to join; it did not offer the names of those partners on its form to the IRS or provide them to ProPublica.

The representatives’ letter asks the IRS to review the FRC’s status change and to examine its review process for organizations similarly seeking to switch their status to become a church or association of churches.

“It’s disturbing that a letter like this is even necessary,” Huffman said. “Unfortunately our IRS has been so worn down and beaten up by the right wing that they have essentially ceased all scrutiny of organizations that self-report as churches.”

The IRS classifies churches and associations of churches as tax-exempt charitable organizations, meaning that they do not have to pay federal taxes and that donors can deduct contributions from their own taxes. However, churches are exempt from submitting Form 990, the annual financial disclosure that nonprofit organizations use to list board members, key staffer salaries, large payments to independent contractors and grants given by the organization.

And unlike for other tax-exempt organizations, a high-level Treasury official must sign off on any audit of a church.

“We understand the importance of religious institutions to their congregants and believe that religious freedom is a cherished American value and constitutional right. We also believe that our tax code must be applied fairly and judiciously,” Huffman and DelBene wrote.

In their letter, the representatives asked for feedback from the IRS on whether it needs additional direction from Congress to enforce rules surrounding tax-exempt organizations and churches. Huffman said that he hopes to pursue legislative action if the IRS isn’t able to address these concerns, but that the letter is a first step.

“You need to start here — give the agency a chance to clean up its mess,” he said.

Tell Us How Religious Organizations Intersect With Elections Near You

Please help us understand if religious organizations are becoming involved in elections and weighing in on politics in your community.

by Zach Despart, The Texas Tribune

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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.

More than a dozen news organizations filed a lawsuit against the Texas Department of Public Safety on Monday, accusing the agency of unlawfully withholding public records related to the May school shooting in Uvalde.

The organizations, which include ProPublica and The Texas Tribune, have each filed requests for information detailing the response to the massacre by various authorities under the Texas Public Information Act. ProPublica and the Tribune filed about 70 records requests with multiple agencies.

DPS has refused to release records sought in the requests, even as the agency has selectively disclosed some information through public testimony, third-party analyses and news conferences.

“In the immediate aftermath of the tragedy, and continuing throughout the ensuing two months, DPS has declined to provide any meaningful information in response to the Requests regarding the events of that day — despite the awful reality that some 376 members of law enforcement responded to the tragedy, and hundreds of those were in the school or on school property not going into the unlocked classroom where the gunman continued killing helpless youth,” the lawsuit states.

A comprehensive report released in July by a Texas House of Representatives committee found that numerous law enforcement agencies, including the state police, failed to quickly confront the gunman, who killed 19 students and two teachers over the course of about 77 minutes. DPS has provided little information about the actions of its 91 officers who responded to the scene.

Under Texas law, records are presumed public unless a government body cites a specific exemption that allows information to be withheld under the state’s public information act.

DPS has said that releasing records could interfere with an ongoing investigation. The news organizations argue that there is no such investigation, given that the guilt of the gunman is not in dispute and authorities say the 18-year-old acted alone. The local prosecutor, Uvalde County District Attorney Christina Mitchell Busbee, has acknowledged that she is not conducting a criminal investigation.

The records requested by the news organizations include emails, body camera and other video footage, call logs, 911 and other emergency communications, interview notes, forensic and ballistic records, and lists of DPS personnel who responded to the shooting.

“The Texas Department of Public Safety has offered inconsistent accounts of how law enforcement responded to the Uvalde tragedy, and its lack of transparency has stirred suspicion and frustration in a community that is still struggling with grief and shock,” said Laura Lee Prather, a First Amendment lawyer at Haynes Boone who represents the news organizations. “DPS has refused numerous requests by these news organizations even though it’s clear under Texas law that the public is entitled to have access to these important public records. We ask that the court grant our petition so that the people of Texas can understand the truth about what happened.”

In addition to ProPublica and the Tribune, the plaintiffs include The New York Times Company, The Washington Post, NBC News, CNN, ABC News, CBS News, Scripps Media and Gannett.

The suit was brought in state district court in Travis County.

by Charles Ornstein

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A dozen years ago, a Santa Monica, California, pain doctor named Gerald M. Sacks emerged as one of the pharmaceutical industry’s top paid speakers — anointed to extol the virtues of a variety of drugs, even though several experts in pain medicine said they’d never heard of him.

His drug company haul had occurred largely under the radar until 2010, when ProPublica started digging into what the firms were paying physicians to deliver talks and consult on their pills. That’s when we consolidated the payments from seven companies, most of which had been forced by government settlements to make them public, in a database we called Dollars for Docs.

Sacks turned out to be a big winner, and we wrote about how little in his resume explained why. He was even a focus of an op-ed we wrote in the Los Angeles Times about how patients are often unaware of the relationships their doctors have with drug companies.

Nevertheless, companies continued to pay Sacks large sums. From 2015 to 2021, he received more than $2 million from companies to speak and consult on their behalf, including spending on travel and meals, federal data shows.

But last month — 12 years since we first wrote about him — Sacks’ puzzling role as one of the drugmakers’ chosen pain doctors took a different turn: Federal prosecutors allege he’d been paid to prescribe.

Sacks agreed to pay more than $270,000 to resolve allegations by the U.S. Department of Justice that he’d accepted kickbacks from drug companies Purdue Pharma and Depomed to prescribe their products. Purdue is the maker of OxyContin and pleaded guilty in 2020 to, among other things, conspiring to provide kickbacks to doctors. The Anti-Kickback Statute prohibits doctors from prescribing drugs in exchange for speaking or consulting payments from drug manufacturers.

From 2015 to 2018, Purdue paid Sacks more than $70,000 for speaking and consulting. Depomed, which changed its name to Assertio Therapeutics in 2018, paid him more than $285,000 for speaking and consulting from 2015 to 2018, according to the federal government’s Open Payments database. Neither Assertio nor its predecessor, Depomed, has been accused by the government of wrongdoing.

Sacks writes a few thousand prescriptions a year, including refills, to patients in the federal Medicare program. Among the tally in years past were hundreds of prescriptions for the drugs for which the government accused him of taking kickbacks.

Sacks denied wrongdoing in the settlement and did not return phone calls seeking comment. Neither Purdue Pharma nor Assertio returned emails seeking comment.

“Physicians are prohibited from accepting kickbacks designed to influence their decision making,” Deputy Assistant Attorney General Michael D. Granston said in a news release. “Adherence to this prohibition is especially crucial with regard to dangerous drugs like opioids.”

The allegations against Sacks relate to his prescribing of the drugs Butrans, Hysingla and OxyContin, made by Purdue, to patients on Medicare between December 2010 and October 2021. They also cite his prescribing of the drugs Gralise, Lazanda and Nucynta, made by Depomed, to Medicare beneficiaries in 2016.

Experts say the evidence is now overwhelming that there is a strong association between drug company payments and doctor prescribing. This link is worrisome, they say, because doctors should prescribe medications solely based on what’s best for the patient, not because they receive money from the company that makes a drug. Some prescription drugs may be more expensive or have greater side effects than cheaper or generic alternatives.

Today, the federal government collects information on payments from all drug and device makers in its Open Payments database. Researchers say such payments show that patients and regulators need to be on guard.

In a research article last month in the Journal of Health Politics, Policy and Law, the authors note it’s not just one study that found a troubling link between drug company cash and what doctors prescribe. “Every published, peer-reviewed study that has evaluated the association between payments and prescribing using a causal inference framework has found evidence that receipt of industry payments increases physicians’ prescribing,” they wrote. They call on a variety of parties, including doctors, the drug industry and regulators, to take action to reduce these conflicts.

Dr. Aaron Mitchell, one of the authors and an oncologist at Memorial Sloan Kettering Cancer Center, said the ever-growing list of research findings upends the presumption that payments to physicians, particularly small ones like meals, don’t influence doctors’ prescribing.

“The legal interpretation of a kickback has long been that industry payments and other transfers of value to physicians are OK as long as they don’t influence prescribing,” he said. “We now have overwhelming data that such payments do influence prescribing. In light of that we need to seriously reexamine the status quo.”

Mitchell suggested that regulators, like the Office of Inspector General of the U.S. Department of Health and Human Services, review their guidance related to industry payments and “be clear to everyone that these are going to be under increased scrutiny and increased risk of prosecution than they have in the past.”

The OIG’s Office of Counsel said in a statement that it “has long expressed concerns over the practice of pharmaceutical manufacturers providing anything of value to physicians in a position to make or influence referrals to manufacturers’ products.” The office issued a special fraud alert in 2020 that discussed the risks of speaker program payments to physicians and other practitioners by drug and medical device companies.

“OIG has pursued, and will continue to pursue, abusive financial relationships between pharmaceutical manufacturers and physicians,” the statement said.

In 2021, the most recent year for which there is publicly available data on payments to doctors, drug companies paid Sacks more than $84,000.