a Better Bubble™

ProPublica

The Fed Keeps Getting More Powerful. Is It Bad for America?

2 years 8 months ago

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.

Do You Have a Tip for ProPublica? Help Us Do Journalism.

by Jesse Eisinger

Joe Manchin’s Price for Supporting the Climate Change Bill: A Natural Gas Pipeline in His Home State

2 years 8 months ago

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.

Do You Have a Tip for ProPublica? Help Us Do Journalism.

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

Hand-Picked Mentors and Networking: Apply for ProPublica’s 2022 Diversity Mentorship Breakfast at ONA

2 years 8 months ago

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to be notified when there’s an opening for a job, internship or fellowship.

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 ProPublica

The EPA Has Identified 23 U.S. Facilities Whose Toxic Air Pollution Puts People at Risk

2 years 8 months ago

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 Kiah Collier and Maya Miller

How a Federal Agency Is Contributing to Salmon’s Decline in the Northwest

2 years 8 months ago

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 Tony Schick, Oregon Public Broadcasting

“God, No, Not Another Case.” COVID-Related Stillbirths Didn’t Have to Happen.

2 years 8 months ago

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

We plan to continue reporting on stillbirths. If you’re interested in sharing a story about your experience, please sign up here and we may follow up.

Mariam Elba and Gabriel Sandoval contributed research.

by Duaa Eldeib

How Misinformation About COVID Vaccines and Pregnancy Took Root Early On and Why It Won’t Go Away

2 years 8 months ago

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.

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.”

Help Us Continue Our Reporting

We plan to continue reporting on stillbirths. If you’re interested in sharing a story about your experience, please sign up here and we may follow up.

by Duaa Eldeib

What Private Equity Firms Are and How They Operate

2 years 8 months ago

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

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 Chris Morran and Daniel Petty

Public Defenders and Defense Attorneys: Help ProPublica Report on Criminal Justice

2 years 8 months ago

ProPublica’s journalism is propelled by the people who share their observations, advice, expertise and inside knowledge with us. Public defenders and defense attorneys have long been important to our work.

As our staff grows, we are experimenting with better ways to stay in touch. This is one of them: If you are a current or former public defender or criminal defense attorney, we invite you to add your name to our list of volunteer sources. We may contact you with questions about your expertise and the intricacies of the criminal justice system. We will also share occasional updates about stories in the works.

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.

By filling out the form below and sharing it with others, you will help us tell stories that can make a difference in how the U.S. criminal justice system works.

by Josh Peck and Imani White

A Right-Wing Think Tank Claimed to Be a Church. Now, Members of Congress Want to Investigate.

2 years 8 months ago

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

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 Andrea Suozzo

News Organizations Sue Texas Department of Public Safety Over Withheld Uvalde Shooting Records

2 years 8 months ago

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.

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 Zach Despart, The Texas Tribune

After Receiving Millions in Drug Company Payments, Pain Doctor Settles Federal Kickback Allegations

2 years 8 months ago

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

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.

by Charles Ornstein

New York Polio Case Now Connected to Traces of Virus Found in UK and Israel

2 years 8 months ago

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

Public health officials’ international hunt for clues in the case of polio that paralyzed a New York man has turned up a big one: The virus that infected him matches the genetic fingerprint of poliovirus found in sewage samples taken in London and in the Jerusalem area, officials at the Centers for Disease Control and Prevention and the World Health Organization told ProPublica on Friday.

It is not yet clear how the virus moved from one place to another or where it was first.

“That is still being investigated,” Oliver Rosenbauer, communications officer for WHO’s Global Polio Eradication Initiative, said in an email.

The hunt for answers in countries thousands of miles apart shows how viruses can hopscotch across the globe. Polio is highly contagious and, because the majority of infections cause no symptoms, it can circulate silently through communities where there is no routine monitoring.

ProPublica reported on Tuesday that U.S. public health agencies generally haven’t tested sewage for evidence of polio, relying on high vaccination rates to protect Americans from the disease, but there are signs of cracks in that shield, both here and abroad.

Waiting for patients to show up with symptoms can be perilous: By the time there’s a case of paralysis, 100 to 1,000 infections may have occurred, public health experts say. New York health officials began screening wastewater only after the case there was identified.

The New York case was the first in the U.S. in nearly a decade. It was discovered after a young man in Rockland County, a suburban area northwest of New York City, sought medical treatment in June for weakness and paralysis. He had not been vaccinated against polio. It was well into July when tests confirmed he had polio.

Genetic sequencing confirmed that he had what’s called vaccine-derived polio. This kind of polio is linked to an oral polio vaccine that hasn’t been used in the U.S. since 2000. The oral vaccine, still used in other parts of the world, relies on weakened polio viruses to trigger the immune system and create protective antibodies. In rare instances, when the weakened viruses circulate in people who have not had the vaccine or are under-immunized, they can revert to a form that can sicken unvaccinated people.

Public health officials said the traces of poliovirus found in sewage samples from early June in Rockland County and greater Jerusalem were still too weak to cause paralytic polio. It’s not clear where the virus evolved, becoming powerful enough to cause the Rockland County patient’s illness.

A spokesperson for Rockland County’s Health Department said she could not confirm whether the man had traveled to London or Jerusalem this year.

Another mystery in the case is that like the U.S., the U.K. hasn’t used the oral polio vaccine in years. Instead, both use only an injectable vaccine that contains inactivated viruses and cannot cause vaccine-derived polio. Though Israel does use oral polio vaccine, the version it uses does not contain the strain of polio, known as Type 2, that’s turned up in the sewage samples or that infected the New York man.

New York officials say they are now testing both stored sewage samples, which were collected as part of the effort to track COVID-19, and more recent ones for signs of polio.

While high vaccination rates in the U.S. have made the risk of polio remote, some communities have far lower vaccination rates than the country overall. Rockland County in 2018 and 2019 struggled with an extended outbreak of measles — also preventable with vaccination — that was concentrated in its Orthodox Jewish community. Some news organizations have reported that the man paralyzed with polio is a member of that community.

Most Americans aren’t old enough to remember, but in the first half of the 20th century, polio ranked among the nation’s most feared diseases. It victimized mostly young children, attacking their spinal cords, brain stems or both, and left thousands with irreversible paralysis. After the first vaccine was approved in 1955, U.S. cases dropped precipitously within a couple of years.

by Robin Fields

U.S. Lawmakers Demand Federal Scrutiny of Turkey’s Drones

2 years 8 months ago

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

As countries around the globe add armed drones to their arsenals, federal lawmakers are pressing the Biden administration to investigate how U.S. parts and technology ended up in what has fast become one of the most popular models on the world market: Turkey’s TB2.

Manufactured by the Turkish firm Baykar Technology, the TB2 can hover high above a battlefield and strike targets with laser-guided missiles. Baykar has maintained that the TB2s are domestically produced, with nearly all of the parts coming from within Turkey. But, as ProPublica reported this month, wreckage from downed drones in multiple conflicts has shown otherwise. A range of components were made by manufacturers in the U.S., Canada and Europe.

To learn more, Rep. Tony Cárdenas, D-Calif., recently introduced an amendment to the House version of the National Defense Authorization Act. The annual budgeting bill is often an opportunity for lawmakers to require reports from the administration on pressing issues, and Cárdenas focused on the TB2, highlighting Azerbaijan’s deployment of the weapon in its 2020 war against neighboring Armenia over the disputed territory of Nagorno-Karabakh. Images of drone wreckage published by local media outlets and the Armenian military at the time showed parts that matched those made by several U.S.-based companies. Some of those firms told ProPublica they had taken steps to stop direct sales to Turkey, but others continue to sell key parts.

Turkey has ramped up TB2 exports in recent years. At least 14 countries now own the drones, and 16 others are seeking to purchase them.

“We’ve been paying close attention to Turkey’s drone sales and how these weapons have been deployed around the world,” Cárdenas told ProPublica in a statement. “I’m troubled about the destabilizing effects we’re seeing and the human rights concerns that follow, especially in places like Nagorno Karabakh. We need a full accounting of the role U.S manufactured parts are playing so that Congress can conduct proper oversight.”

If enacted, the legislation would require the Defense Department, in consultation with the State Department, to produce a report on U.S. parts in the TB2s used in the Nagorno-Karabakh conflict and any potential violations of export laws, sanctions or other regulations. Neither the Turkish Embassy in Washington nor Baykar Technology returned requests for comment for this story. Previously, when asked about the source of key components in its drones, Baykar did not respond to specific questions and would only say those queries were based on unspecified “false accusations.”

At issue are U.S. export laws. Typically, military parts are strictly controlled, requiring licenses from the State Department detailing their buyers and end uses. But many of the key components in the TB2 are commercial-grade technologies, which are found in a variety of consumer products and not subject to arms laws. And as a member of key global anti-arms compacts, Turkey can easily import the off-the-shelf parts, avoiding a web of sanctions and restrictions intended to curb the efforts of countries like Iran and China, which also operate drone programs.

Some critics have called on the Biden administration to crack down on Turkey. Other countries, including Canada, have previously instituted export bans to keep key parts from flowing. But for the U.S., experts say, there are a number of diplomatic considerations. Turkey is a long-standing NATO ally. And, more recently, the TB2 has emerged as a critical tool in places like Ukraine, where the country’s military has used it to battle Russian forces — a fact that the drone maker, Baykar, has repeatedly emphasized in media coverage of the conflict. “I think it is one of the symbols of resistance,” Selçuk Bayraktar, the firm’s chief technology officer, told CNN. “It gives them hope.”

Elsewhere, however, the TB2 is far less revered. In fact, it has been used to kill not just soldiers but civilians, drawing the ire of various governments and human rights groups.

In 2019, for example, Turkey sent the drones to the Tripoli-based Government of National Accord in Libya, despite a United Nations arms embargo. The U.N. said the weapon then helped transform a “low-intensity, low-technology” fight there into a bloody conflict. In Ethiopia, amid a war with rebels, the government used TB2s in airstrikes that have killed dozens of civilians, including those living in a camp for displaced people.

Biden administration officials raised concerns about drone use in the Ethiopia conflict with their Turkish counterparts but stopped short of taking action, despite an executive order authorizing them to impose sanctions against any party involved in the fighting.

This year’s National Defense Authorization Act reflects America’s tense relationship with Turkey. If signed into law, it would restrict the administration’s efforts to sell F-16 fighter jets to the country. Lawmakers cited a number of recent moves by Turkey, including its opposition to Finland and Sweden joining NATO. “How do you reward a nation that does all of those things,” Foreign Relations Committee Chair Sen. Robert Menendez, D-N.J., told Politico.

The House amendment on TB2s, introduced by Cárdenas and co-sponsored by 19 others, represents the second attempt in the past year to put the Turkish drone program on the White House’s radar.

Last year, lawmakers sought a similar mandate for a report on U.S. parts and technology used in the Nagorno-Karabakh conflict. One version of the 2021 amendment, introduced by Menendez, called for a broad assessment of the TB2s, their sales since 2018 and U.S. parts used in them. The final version, however, was watered down. It did not name the Turkish drone or Turkey specifically, and it asked the Biden administration to look generally into American “weapon systems or controlled technology” used in the 2020 Azerbaijan-Armenia conflict. ProPublica found that the Turkish government had hired lobbyists to discuss the drones issue with lawmakers at the time.

Under the law, that report was due in June, but the Defense Department has yet to release it. A spokesperson told ProPublica this month that it was “out for final review with pertinent stakeholders.” The department did not respond to subsequent requests for an update on when that review would be complete.

To some administration critics, the delay is another indication of Turkey’s clout in Washington.

“Taking something off the shelf and using it to patch together a weapon might not technically cross a legal line, but it should be of concern,” said Aram Hamparian, executive director of the Armenian National Committee of America, a pro-Armenia lobbying group that has called for a range of measures against Turkey. “It should be addressed as part of our general U.S.-Turkey relationship, and I’m not sure it is. I think they get a free pass on it.”

The Senate is expected to finalize its version of the National Defense Authorization Act in the coming months.

by Umar Farooq

Help Us Investigate Termination of Parental Rights in the Child Welfare System

2 years 8 months ago

Journalists at ProPublica and NBC News would like to connect with people whose parental rights have been terminated in the past decade.

We have received an outpouring of responses, and at this time we are only looking for people with cases in Alaska, Arkansas, Arizona, Michigan, Minnesota, New Mexico, Oklahoma, Texas, Utah, Vermont, Virginia and West Virginia.

We want to understand how your case was handled by your state’s child welfare agency and courts, and what types of services you were provided to help reunite your family.

We know this can be difficult to talk about, and we appreciate you sharing your experience. Filling out our short questionnaire will help us do more reporting that matters to your community.

We take your privacy seriously. We are gathering these stories for the purposes of our reporting, and we will contact you if we wish to publish any part of your response.

We won’t be able to respond to everyone who reaches out, and we cannot provide legal advice or assistance with your case. But we promise to read everything you submit, which will help guide our work.

Asia Fields contributed reporting.

by Agnel Philip, ProPublica; Hannah Rappleye, NBC News; Eli Hager, ProPublica; Suzy Khimm, NBC News; and Nirma Hasty, NBC News

At Liberty University, Veterans’ Complaints Keep Coming

2 years 8 months ago

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

When an Army veteran was looking for somewhere to get an online aviation degree a couple of years ago in hopes of becoming a pilot, Liberty University advertised having the speed and flexibility she needed: accelerated eight-week courses with start times throughout the year and 52 affiliated flight schools around the country where she could get the required flight training. She signed up for the program, paying with the GI Bill benefits that have made military veterans such a reliable source of revenue for Liberty and other universities with large online programs.

But when her husband, who was still on active duty, learned he would be transferred from Georgia to Hawaii, she discovered that the lone Liberty flight affiliate on Oahu, George’s Aviation Services in Honolulu, did not offer the accelerated courses Liberty had touted. This meant that it would take her double the time to complete her program, two years rather than one, and would cost U.S. taxpayers more along the way, she stated in a complaint she filed with the Department of Veterans Affairs.

“There was not one time where it was clearly stated that some flight affiliates do not accept students in the accelerated program,” she wrote in her complaint. “I would not have enrolled knowing that I didn’t have the option at every flight affiliate and now I am stuck with having very few courses remaining and an inability to continue in the program.”

The complaint was one of more than a dozen provided in response to a public records request about Liberty that was filed with the Veterans Affairs department’s GI Bill Feedback Tool and shared with ProPublica. In 2018, ProPublica published an investigation of the highly lucrative online operation at Liberty, the evangelical college in Lynchburg, Virginia, founded in 1971 by the Rev. Jerry Falwell. The investigation showed how under the leadership of Falwell’s son, Jerry Falwell Jr., who took over after his father’s death in 2007, Liberty turned its online division into the financial engine of its burgeoning campus and political network, helping drive the university’s net assets from $150 million in 2007 to more than $2.5 billion in 2018.

The article revealed how much Liberty — the second-largest provider of online education after the University of Phoenix — relied on taxpayer funding for tuition revenue: Its students received more than $772 million in total aid from the Department of Education by 2017, plus more than $40 million from the Department of Veterans Affairs. Military veterans are such a big market for Liberty University Online that it has a whole division assigned to them.

And the article described a “steep drop-off in quality from the traditional college to the online courses” that was “openly acknowledged among Liberty faculty.” It showed how the university managed to keep its costs in delivering online courses exceedingly low by relying on low-paid instructors and course designers. This helped explain how Liberty, which is a nonprofit organization, managed to pocket $215 million of net income on nearly $1 billion in revenue in 2016, but it also helped explain why students were filing complaints with Virginia’s higher education oversight agency. It was a couple dozen such complaints, obtained via a public records request, that gave rise to the ProPublica investigation, revealing a much deeper iceberg of concerns about Liberty’s online operation. (In the 2018 article, Falwell Jr. described the university’s financial management as shrewd and defended the quality of its instruction.)

There have been dramatic changes at Liberty since then: In the summer of 2020, Falwell Jr. resigned as president after news reports of extramarital activities involving him and his wife. (He said that his wife had had an affair but that he had not.) Meanwhile, the university community has witnessed the realization of the goal that Falwell cited in championing Donald Trump for president in 2016: the Supreme Court’s overturning of Roe v. Wade.

Throughout all the upheaval, though, complaints about online education have kept coming, as shown by the VA’s records, which were provided to Dahn Shaulis, a higher education blogger who filed a records request for complaints and then shared the agency’s response with ProPublica. Those records do not indicate whether the VA took any action in response to the complaints.

A spokesperson for Liberty said in a statement that the university is “not presently aware of any negative findings” by the VA for any such complaints. “In several circumstances,” the statement continued, “including one referenced, the VA independently determined the student’s complaint to be unfounded and did not request Liberty’s review.” (The spokesperson said the university is legally barred “from disclosing certain specific details about individual students.”) He added that Liberty “has trained hundreds-of-thousands of students and naturally not every student was fully satisfied with their experience, but we are ranked much lower with regard to VA complaints per capita compared to our online competitors.”

Asked about the complaints against Liberty, a VA spokesperson replied with a statement that noted: “VA continues to review and monitor all GI Bill schools’ compliance with applicable statutes and regulations, and when necessary, will take appropriate action and provide GI Bill students, the public, and state or federal partners with timely information and options.” The statement added, “Actions taken in response to a reported issue are not shared on the GI Bill Feedback Tool.”

The woman moving to Hawaii was not the only aggrieved aviation student. Another complaint, filed early this year, alleged a “bait and switch tactic” by Liberty to gain a student’s enrollment. The university offered a course meant to allow a helicopter pilot to transition their skills into an airplane certification, combining that training with prerequisite courses that would together result in a full-tuition load. The transition course required special approval, and the applicant applied for and received it, and then went through the requisite “financial check-in” portal to confirm his payment via the GI Bill.

Only after he’d done all that did it emerge that, according to the complaint, the transition course was in fact nonexistent. But he was signed up for the prerequisite courses, which he would never have bothered to take on his own. After he protested, the university unenrolled him completely from the university, which he took as “retribution.” He asked that the VA “place [Liberty] in a review status where they are forced to administer the program in a more circumspect manner.”

For another veteran, the problems started later in his time at Liberty, when he was just a few credits shy of getting his degree. In May 2021, he suddenly got notice that his financial aid had been suspended because he had supposedly fallen short of Satisfactory Academic Progress standards, even though his GPA was well above the 2.0 given as the minimum necessary on the financial aid website. The university then demanded he pay $2,934 to make up the difference, which he said made it impossible to complete his degree. He was unable to reach anyone to resolve the matter. “I have made several calls to the school and no one has been willing or able to help in getting the information needed to ensure that this issue gets resolved,” he wrote. “I have filed several appeals to this and all have been denied but they have refused to say why or ask for any additional information from me in any way.”

Lack of communication was a recurring theme in the complaints. Another student, entering her last semester in the school of education, had reached out to Liberty early this year to let the school know that due to health problems, she would be unable to act as a student teacher and would need to transfer into a nonlicensure track as a result. But she said she received incorrect information and was placed into the wrong class and from there fell into a morass of delays and unreturned emails, as emails are the only way that the school lets students communicate with the “gate coordinators” who oversee advancement through the education degree program.

“Advising has told me that they are required to answer in 48 hours, but that has never been the case for me,” she wrote. “At this point, I feel like they have taken my money and the money of the VA and are now leaving me high and dry. They do not seem to care that I am going to be unable to graduate and finish my degree after years of work. I have invested countless hours trying to meet their requirements and have faced nothing but misinformation, incorrect information [and] people passing the buck to someone else.” She concluded, “I feel like I have wasted my time and money as well as the money the VA has invested in my education.”

Yet another veteran offered a more systematic criticism this spring. Liberty, his complaint asserted, was failing GI Bill recipients on three levels: The university fails to certify their GI Bill benefits properly, which often creates a welter of unnecessary debts and offsets; it fails to provide proper academic advising, with the consequence that “veterans can get over their heads and fail classes or not be adequately informed about course loads”; and it fails to provide adequate academic support for the online programs, with communications limited mostly to emails. “They do not answer their phones besides the call centers that cannot provide detailed support no matter what,” he wrote.

For another veteran who was seeking a Ph.D. in health science and ended up in a billing dispute with the university, the most confounding part was his sense that Liberty was indifferent to the troubles he was experiencing. “Little do they know this causes undue stress in our lives,” he wrote in his complaint, “but I’m sure they do not care because they are only in it for the money.”

by Alec MacGillis

Barbados Resists Climate Colonialism in an Effort to Survive the Costs of Global Warming

2 years 8 months ago

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 a partnership between ProPublica and The New York Times Magazine, and it is exempt from our Creative Commons license until Aug. 26.

Late on May 31, 2018, five days after she was sworn in as prime minister of Barbados, Mia Mottley and her top advisers gathered in the windowless anteroom of her administrative office in Bridgetown, the capital, for a call that could determine the fate of her island nation. The group settled into uncomfortable straight-backed chairs around a small mahogany table, staring at framed posters of Barbados’ windmills and sugar cane fields. Mottley, who was then 52, can appear mischievous in the moments before her bluntest declarations, but on this evening her steely side showed. She placed her personal cellphone on speaker and dialed a number in Washington for the International Monetary Fund. As arranged, Christine Lagarde, the managing director, answered.

Mottley got to the point: Barbados was out of money. It was so broke that it was taking out new loans just to pay the interest on the old ones, even as its infrastructure was coming undone. Soon the nation would have no choice but to declare itself insolvent, instigating a battle with the dozens of banks and creditors that held its $8 billion in debt and triggering austerity measures that would spiral the island into further poverty. There was another way, Mottley said, but she needed Lagarde’s help.

Mottley, the first woman to lead Barbados, had been working toward this conversation for nearly two years, consulting expert financial and legal advisers to develop a plan that would restructure the country’s soaring debts in a way that would free up money to invest in Barbados’ economy. Then, nine months before voting day, that plan took on new urgency as two powerful hurricanes ripped through the Caribbean 12 days apart; they missed Barbados, but one of them obliterated nearby Dominica.

Sargassum seaweed, which thrives in warming oceans, is overtaking a beach in Barbados. (Erika Larsen/Redux, for The New York Times)

In Mottley’s view, that obliteration was “like a nuclear event.” It was increasingly clear that climate change would make all the projects that Barbados already could not afford more necessary — and more expensive. The storms revealed that even the most heroic economic planning could be laid to waste in a moment. It was already obvious that every climate crisis was an economic crisis; but going forward, she realized, every economic crisis would effectively be a climate crisis. For Mottley, this meant the money she needed the IMF to help her recoup wasn’t just for her people’s prosperity but for their survival.

Mottley’s insistence on speaking directly with Lagarde — she had been pushing for the meeting for nearly a week while Lagarde’s office demurred — was an unorthodox way to approach the leader of one of the world’s dominant economic institutions. Having descended from two generations of elite politicians, Mottley had learned, though, that important decisions at large organizations are made at the top. Her grandfather was the mayor of Bridgetown; her father served as the country’s consul general to the United States. She was groomed at the island’s elite girls’ academy, Queen’s College, and at the private United Nations International School in New York. Beside her in the anteroom was her adviser Avinash Persaud, a close friend since the days when they each studied at the London School of Economics, where she received her law degree in 1986. Persaud, who went on to lead research departments at J.P. Morgan and State Street Bank, was deeply knowledgeable about development finance. The two friends were joined by the principals of a little-known but influential London financial firm called White Oak Advisory — Sebastian Espinosa and David Nagoski — debt experts who had developed a novel contractual clause to protect countries from at least some of the economic consequences of climate-driven catastrophes.

Mottley (Erika Larsen/Redux, for The New York Times)

With Lagarde on the phone, Mottley made her pitch. Barbados, she said, was going to default on the debt it owed to private banks and investors. She wanted Lagarde’s support in persuading them to renegotiate its terms. The IMF is both the assessor and the enforcer of global economic policy, the de facto gatekeeper to the world’s capital markets. Mottley knew that banks and investors would work with her only if Barbados were participating in a formal IMF program for economic reform — and it had to start immediately.

Mottley told Lagarde that Barbados was prepared to do voluntarily what most countries have to be coerced to do: cut its budget and raise taxes. But she needed something in return. With the effects of climate change bearing down on the region, the kind of austerity the IMF demanded from developing nations — slashing the size of government agencies and firing thousands of public employees while auctioning off real estate and other national assets — would no longer work. Mottley wanted Lagarde to endorse an economic program that would still allow her to raise salaries of civil servants, build schools and improve piping and wiring for water and power. “Before you carry people on a long journey,” she told Lagarde, “you have to give them a little breakfast.”

Barbados, while considered relatively wealthy by World Bank standards, hadn’t been able to borrow on the international market since 2013, and it had no capacity to pay for essential programs and projects. The concern was immediate, Mottley explained: Hurricane season was about to begin. The room fell quiet. No one was sure how Lagarde would respond. Would she trust Mottley to spend on Barbados first? Or demand — as the IMF usually did — deference to debtors? Then, as Mottley’s advisers recall, came the director’s surprising reply: She was extremely supportive of what Mottley was proposing.

The next day, Mottley declared that Barbados would stop making its payments on the nation’s debts. “Today, my friends, we pry off the hands that have been strangling us,” she said. Some of the business leaders she had gathered to stand behind her at the lectern winced. The value of Barbados’ bonds on the global markets crashed. S&P Global downgraded the island’s credit. The country teetered on the edge of financial chaos. With that, Mottley’s adventure onto the global stage of financial and climate activism began.

What Mottley sought would not be easy. She would have to untangle the relationships connecting the IMF with the financial institutions that invest in countries like Barbados — a global financial system that simultaneously helps and preys upon countries at their moments of greatest need. She would have to challenge the rules of that system and its powerful figures, who often struggle to recognize how climate change is altering the traditional dynamics of debt and development. Mottley would come to see the traps of that system as fundamentally unjust, born from generations of colonial rule. Just as outsiders once pillaged the Caribbean for wealth created by the hands of slaves, investors in those former imperial powers now squeezed former territories for their assets, for access to markets, for interest on loans. And she would have to contend with all of that waiting for the next storm, knowing she governed a dot of land isolated in one of the most vulnerable places on Earth.

Jehroum Wood of the Walkers Institute for Regenerative Research, Education and Design is working on a coral regeneration project to help mitigate erosion. (Erika Larsen/Redux, for The New York Times)

Few parts of the planet are as imperiled by the changing climate as the Caribbean’s crescent-shaped string of islands. Every summer, the warm waters off the northwest coast of Africa spin off cyclonic systems that hurtle across the Atlantic, reaching the easternmost stretch of these islands — where Barbados stands sentinel. Quick successions like that of Hurricane Irma and Hurricane Maria, the two storms that narrowly missed the island, were supposed to be rare. Now, though, experts believe that global warming could drive a fivefold increase in strong hurricanes, suggesting that hits from Category 4 and 5 storms will become an annual near-certainty.

Droughts, meanwhile, are growing longer and drier, threatening drinking-water supplies and making it difficult to grow food. Barbados, a teardrop-shaped island of 290,000 people, is among the half of Caribbean islands the United Nations already describes as water-scarce, with seawater seeping into its aquifers and rainfall that might drop by as much as 40% by the end of the century. The droughts will lead to wildfires, killing more vegetation and crops. When it does rain, it is projected to rain heavily and all at once, causing precipitous landslides, which will wipe out roads, rip up electrical grids and cut off energy supplies. At the same time, rising and warming seas are eroding shorelines and killing off reefs and fisheries. According to the IMF, roughly two-thirds of the 511 disasters to hit small countries since 1950 have occurred in the Caribbean, taking more than 250,000 lives.

These islands have another dubious distinction: They carry more debt, relative to the size of their economies, than almost anywhere else on the planet, a fiscal burden that makes it virtually impossible for them to pay for the infrastructure necessary to protect them from the climate disruptions to come. Barbados, which in 2017 had the third-highest debt per capita of any country in the world, was spending 55% of its gross domestic product each year just to pay back debts, much of it to foreign banks and investors, while spending less than 5% on environmental programs and health care.

This is true beyond the Caribbean too. In poor nations around the world — from the deserts of North Africa to the low-lying islands of the Pacific and the Caribbean — rising sovereign debt is becoming a hidden but decisive aspect of the climate crisis. According to the United Nations Conference on Trade and Development, external debt for what are called Small Island Developing States, or SIDS, more than doubled between 2008 and 2021. The IMF projected that three-quarters of emerging-market economies would pay a third or more of their tax revenue just on debt service in 2021. In the zero-sum game of budgets, that means less money for shoring up infrastructure that is already in shambles. A recent analysis by Eurodad, the European debt-and-finance advocacy organization, found that over the last six years, Latin American and Caribbean countries have slashed what they pay on anything non-debt-related by 22%. As Mottley explained to me, “We always have to put aside debt money first.”

The warming planet has turned this into a self-perpetuating cycle: Were it not for the disasters worsened by climate change, much of the region’s debt might not exist in the first place. Jamaica’s debt, for example, can be tied to the response to Hurricane Gilbert more than three decades ago. Grenada’s is in part because of Hurricane Ivan in 2004. Dominica’s 2017 loss, relative to its GDP, was the equivalent of a $44 trillion hit to the U.S. economy.

Avinash Persaud (Erika Larsen/Redux, for The New York Times)

According to the World Bank, these climate-driven damages have made it difficult for the Caribbean economies to achieve anything resembling healthy growth. Since 1980, the cumulative cost of disasters has amounted to more than half of a year’s worth of total economic product for 14 Caribbean nations. The costs have eclipsed average annual GDP growth in five of them. There are poor countries with more debt, and there are island countries in the Pacific facing more imminent climate threats, but nowhere in the world do the debt and climate vulnerabilities overlap to the extent they do in the Caribbean. Fixing the debt crisis, as Persaud told me, “isn’t about countries mopping up their fiscal discipline. It is that countries on the front line face a different kind of risk. They face wipeout risk.”

The IMF could buffer this crisis. Indeed, doing so is arguably its mission. The IMF was formed in 1944 when the soon-to-be victors of World War II met at a hotel in Bretton Woods, New Hampshire, to build a new economic system for a world devastated by years of war and depression. Its mandate: to stabilize global markets and keep currencies — and debts — predictable. Today 190 member countries pay dues into a pool from which they can borrow in a crisis.

On balance, the IMF and the World Bank have served their primary function well, steadying economies and offering the reassurance of economic leadership to global markets over many decades. But the fund also became a conduit by which global capital, and the mixed blessings that come with it, flow to the world’s poorer nations. Its advisers are the people who dictate the often-painful recalibrations a troubled country must take to crawl back toward economic recovery and regain market trust. It has become one of the most influential, if underappreciated, determiners of climate policy in the world.

The IMF doesn’t lend much money directly — that’s the job of the World Bank and other development banks — and it doesn’t negotiate between a country and its creditors. But it does draw the boundaries of possibility and policy, and its stamp of approval is an essential prerequisite for other investors, banks and ratings agencies to encourage new projects or lend more money. Should those private contracts fail, the bankers and other buyers know that to some degree, the great international finance institutions stand by ready to help make them whole. An indebted developing country is paralyzed and ostracized without the IMF’s stamp of approval, which gains it access to the world’s capital markets. And that approval is conditioned on fiscal changes that can carve deeply into the bone of civil society.

For her entire life, Mottley had watched Barbados painstakingly build itself up as a postcolonial democracy. Now climate change was prying away the nation’s — and the whole region’s — grip on its destiny. The big institutions capable of aiding Caribbean countries, Mottley could see, leaned too heavily on outdated assumptions and equations. The IMF requires countries to perform within its framework but has been slow to allow that global warming might require the framework to change, only recently beginning to fold some nominal climate risk into its calculations. It continues to hold countries to metrics for success — primarily the ability to keep the ratio of total debt to annual GDP quite low — that many economists say are unrealistic and arbitrary. The IMF has held steadfastly to its doctrine for years, based on its studies of how larger economies, not small ones, function. But a doctrine that demands austerity often only increases a country’s vulnerability to climate threats. “There’s an orthodoxy as to what is acceptable, and what can be sustained,” Mottley said.

By declaring nations like Barbados too rich to qualify for development aid, the World Bank — which effectively puts IMF policy into practice — has relegated them to economic purgatory. The bank has folded climate risk into a range of climate-related aid and disaster-finance programs, but it still does not formally consider a country’s specific climate risk when it evaluates eligibility for its discounted development loans.

Then, by failing to fully account for how the exceptional costs of climate change affect national wealth, the IMF and the World Bank have wound up driving countries in need toward profit-reaping hedge funds and banks, to borrow billions of dollars, often at credit-card-like interest rates.

Throughout, the debts have been collected. They were collected as the shadow of the 2008 financial crisis lingered and as a pandemic decimated tenuous health care systems and tourist-reliant economies. They continue to be collected despite a climate crisis that is caused almost entirely by the copious fossil fuels that those same powerful creditor nations burned to industrialize and achieve their own wealth, the very wealth that undergirds the IMF. Caribbean nations are being asked, in a sense, to pay not only their own debts but the rest of the world’s debts, too, for all the progress it made while leaving the Caribbean behind.

Oistins Fish Market and community are a tourist attraction in the parish of Christ Church. (Erika Larsen/Redux, for The New York Times)

Mottley’s ascent seemed inevitable to some Barbadians — one childhood friend said that at 12, she promised she would be prime minister — but not to all. Even after she earned her law degree at 21, her father urged her toward private practice. Why would Mia, the oldest of four siblings, a girl who loved music and for a while even managed a reggae band, want to wade into the island’s internecine politics? “Horses for courses,” Mottley told me recently, using the British phrase suggesting that everyone has a purpose in life. Her mother was the real politician. “Mommy would tell us all along that you all and your father are lawyers, but I am the law,” she said. It was her mother who “sees people, she hears people, she feels people.” That became Mottley’s creed. As prime minister, she is often seen at food trucks and is known as Mia to cabdrivers and reporters.

Mottley was first elected to Barbados’ Parliament in 1994. She was the youngest Barbadian ever appointed to a ministerial position and has served as both the country’s attorney general and its minister of economic affairs. Since 2008, she has twice headed the Barbados Labour Party. Her 2018 election was a landslide, with the party taking all 30 seats in the country’s lower Parliament.

She told me once that one of her great regrets was not being around to fight for Barbados’ independence in 1966. The country’s first prime minister, Errol Barrow, was a family friend, and Mottley grew up steeped in his belief that it was the responsibility of the island’s government to use its resources to lift up, educate and house its citizens. She also shared Barrow’s indignation about Barbados’ past. The island, first claimed by King James I of England, was importing slaves from Africa as early as 1625, receiving thousands of people from Guyana and the Gold Coast and using them up — their life expectancy once on Barbados was less than 10 years — to produce sugar. When the British Parliament passed the act that abolished slavery in its territories in 1833, it paid white slave owners 20 million pounds to compensate them for the loss of their property, even as it required the kidnapped Africans to provide four additional years of free labor as “apprentices.”

“It goes further,” Mottley told me. The British rulers then told its freed slaves that if they didn’t continue to work, they couldn’t live on the plantations that made up most of the 166-square-mile island, “the master and servant land.” That arrangement continued for many decades, extending the system of sugar and exploitation that powered the modernization of Britain and its boom in banking, shipping and insurance. Along the way some 250,000 Black Barbadians died.

As it turns out, Mottley says, she didn’t miss the rebellion after all. “My belly full but me hungry,” she intoned one afternoon, recalling Bob Marley. “A hungry mob is an angry mob.” Her point was that the stakes for Barbados and the Caribbean are still high and the dynamics the same: The region’s 45 million people still have little voice and are easy to forget, and as the Caribbean becomes increasingly unlivable, it could become a source of potential destabilization — and mass migration — right at America’s door.

For at least a decade before Mottley was elected, a mixture of poor management and corruption had eroded the country’s economy. As Barbados’ former central bank governor DeLisle Worrell described it to me, the country had developed a “dysfunctional” fiscal culture in which government agencies and departments took loans and negotiated deals without consulting the central bank, accumulating sprawling debt and a backlog of need. On the touristed southern end of the island, sewage erupted from neglected pipes as funding to fix them lagged. The country’s response was to print more money and borrow more from abroad, to stanch the economic bleeding. In 2013, during Worrell’s term, Barbados took one of the largest commercial loans in its history — $150 million — from Credit Suisse at 7% interest; within a year, it had grown to $225 million, and by 2018, the interest on the balance was 12%. The money didn’t last, and the sewer lines weren’t fixed. It would be the last commercial loan Barbados could get. Running a consistent deficit, the country began drawing down its foreign reserves to service the loans. By the time of the 2018 election, the government was nearly broke, its reserves having dwindled to enough for just 28 days.

The people of Barbados did not choose Mottley — or her Barbados Labour Party — over its rival by a margin of 3-to-1 because their political philosophies were substantively different. They were not; both are center left. Nor was the vote driven by people thinking Mottley would challenge the global finance system or solve climate change. The vote was for fiscal competence.

Climate change was only a small part of the fiscal morass, but it was a big part of what could keep Barbados from ever clawing out. As Mottley plotted how to escape the fiscal spiral, she met repeatedly with European climate scientists who helped bring into focus how everything from the island’s housing stock to its coral reefs would determine how habitable Barbados would be in the future. Along with restructuring the country’s debt, Mottley laid out a plan, called Roofs to Reefs, to restore the island’s physical and ecological infrastructure. But it was going to take money — a lot of it. Mottley thought she could work her way to the heights of global finance to gather that money. She wasn’t the first to try it, and she didn’t know how hard a climb that would soon prove to be.

The development site for HOPE, a government project that builds hurricane-resilient houses for first-time home buyers (Erika Larsen/Redux, for The New York Times)

The IMF’s education in the economic threat of climate change began with Hurricane Ivan in 2004. It was heading straight for Barbados but veered south and instead hit Grenada, another former British colony, as a Category 3 storm; it damaged most of the structures on the island, including 73 of the country’s 75 schools. Four-fifths of Grenada’s power grid was knocked out, along with most of its nutmeg trees, virtually eliminating a key export for years. The total damages topped $800 million. Aid did come; the World Bank disbursed $20 million almost immediately. Grenada, already heavily indebted before the storm, still plunged into a deep recession. In December 2004, it missed its first payment, entering what Standard & Poor’s termed “selective default.” Then, seven months later, another hurricane struck.

In the IMF’s view, Grenada could not sustain its debts, and that judgment gave cover for the country to renegotiate with the banks and foreign governments that it owed. The IMF’s assessment came at the usual price, though. Grenada agreed to slash its federal payroll — the government was the largest employer on the island — as well as sell off assets and privatize agencies, all toward the goal of reducing its debt.

As the IMF sees it, reducing debt is the recipe for financial stability. But in the climate era, stability also requires enormous spending. Grenada needed sea walls to protect its towns against ocean surges and retaining walls to keep its mountainous roads from collapsing. It needed to harden the country for worse storms and droughts to come. And immediately after Ivan, it needed a place to send its children and its sick. So the government spent a part of its budget on new schools and hospitals and roads. But when Grenada missed its fiscal targets, the IMF instead blamed the country’s “capital expenditure overruns” for its “fiscal slippages.” From then on, according to a 2007 staff report, the IMF wanted Grenada to pay off its debts to outside investors first.

“The IMF always blames the countries,” says Timothy Antoine, director of the Eastern Caribbean Central Bank and Grenada’s permanent secretary in the Ministry of Finance during the hurricanes. Focusing on debt alone was “absolutely ludicrous,” a sign that the fund was still unprepared to acknowledge the extreme effect that a catastrophic event had on a country’s finances. Grenada had cut its budget and increased its revenues but watched its economy crumble and its poverty explode anyway. Lack of fiscal discipline alone could not account for the country’s troubles, and it wanted the support of the most powerful global institutions in finding a solution.

Over time, the IMF did begin to recognize the importance of preparing for the economic shock that climatic changes could bring — by 2014, several of its Grenada reports mentioned it. Still, connecting the risk to the consequence of default appears to have been too great a leap. Climate change was not even identified as a cause or risk factor when the IMF released its post-mortem on Grenada’s restructuring in 2017, suggesting that it had few methods for quantifying how environmental pressures might affect debt or the pace of its repayment. What was discussed was political instability and rising interest rates, not faltering agricultural exports or rising heat. “They only have a hammer,” says Daniel Munevar, a former senior analyst for Eurodad now with the U.N. Conference on Trade and Development.

In June 2014, as Grenada again approached insolvency, Antoine gathered civic and religious leaders in the second-story meeting room of a Catholic church overlooking Grand Anse Beach to plot a different approach. Grenada’s leaders wanted a mechanism that could protect them against repeating the same fate when another climate catastrophe hit. But the IMF staff weren’t sure how to put a value on the chance of a catastrophe and how to measure something that hadn’t even happened yet. A breakthrough came from White Oak Advisory — the consultants Grenada had hired.

David Nagoski, left, and Sebastian Espinosa of White Oak Advisory (Erika Larsen/Redux, for The New York Times)

Espinosa, the firm’s co-founder, had long seen how wealthy countries pushed exotic insurance products as the fix to protect against high risk. But it occurred to him that insurance, which is designed to protect against unlikely calamities, was a poor match for the grim certainties of the climate crisis. He thought instead about how debt and equity contracts often have triggers that change the terms when parties aren’t confident about their risk. What if debt relief were to be triggered by a storm? It could guarantee that Grenada would be protected when the next climate catastrophe arrived.

White Oak constructed a contract clause that would automatically grant Grenada a reprieve from payments on much of its commercial debt if another hurricane hit the island, introducing a new tool for managing sovereign debt crises in a climate-plagued region.

As Mottley began to shepherd Barbados through its own insolvency, Grenada’s experience taught her that success would depend on her ability to use the IMF to her advantage. If she failed, Barbados risked being recolonized, this time financially. Moreover, when it came to facing off against the country’s creditors, Mottley didn’t just want a discount on her debts. She wanted the one thing she’d learned would begin to make her public debt resilient to the shocks of climate change — Barbados’ own hurricane clause.

After Mottley announced that Barbados would default on its debts, the IMF wasn’t the main obstacle to restructuring them; instead, it was the financial institutions that held the debts. It might stand as a mystery how anyone thinks he or she can make money off the tribulations of a group of tiny countries. But impoverished Caribbean islands have delivered wealth to larger powers for centuries, and today is no exception. Before, it was risky commodity ventures that made great fortunes. Now it is increasingly the risk itself. Traffickers in debt offer money that is desperately needed. By taking on the risk that these tiny nations will default, they profit handsomely — and if the risk gets to be too high, they can pass the debt on at a discount to more adventurous investors. That’s the nature of finance. But the climate crisis is raising the risks considerably, and in so doing, it is once again binding the destiny of these fragile nations to the speculative will of faraway powers. Postcolonialism barely had a chance to take hold before it gave way to climate colonialism.

Few parts of the planet stand to be as thoroughly assaulted by the changing climate as immediately as the Caribbean. (Erika Larsen/Redux, for The New York Times)

When in 2018 Mottley told Barbados’ creditors that she did not intend to pay them, she and her team had a plan. The country owed approximately $8 billion, much of it to Barbadian banks owned by Canadian institutions like Scotiabank and CIBC, but nearly $1 billion of the total was owed to global financial firms, including Credit Suisse, the investment-management firm Pimco and a Morgan Stanley subsidiary called Eaton Vance. Her goal — drawn up in collaboration with the IMF — was to reduce Barbados’ total debt load by a third within 15 years. She needed to persuade her creditors to take what’s known as “a haircut,” reducing what they were owed, in this case by roughly a third. The old bonds would be exchanged for new ones at a lower interest rate. It was essential that a hurricane clause be included, too.

On the other side of the negotiations was a young, ambitious investment manager out of Boston named Federico Sequeda. A portfolio manager in emerging markets for Eaton Vance, Sequeda was accustomed to buying sovereign-debt stakes in places like Vietnam and Brazil. The mutual funds he oversaw held large positions in Barbados’ bonds. Sequeda, for one, would take umbrage at the suggestion that emerging-markets investors are predatory. Clearly, these developing countries need capital to function, he points out. Nobody is willing to donate that capital, and so accessing it — just like every other service purchased in the world — comes at a price. Ideally, there is sufficient transparency of motive and transaction so that the exchange can be a win for both sides.

In the run-up to Mottley’s election, Sequeda had flown down to the island to meet with Worrell, the former central bank chief, to get a pulse on the changes foreign investors could expect should she be elected. Still, he was caught off guard by both the sweep of Mottley’s plan and her determination to execute it. The creditors thought that Barbados could pay more and that the country was using the IMF’s cooperation to leverage lower payments. They were neither versed in nor particularly concerned with climate change as a unique risk to their investments. The notion that a hurricane clause might be imposed on funds that firms sold to their clients as less volatile than other investments was untenable. Sequeda didn’t think climate change — or the invention of a debt instrument to address it — was his business or responsibility. “We’re not really set up to analyze the probability of a climate-type risk taking place, and we don’t really think we’re actually the investors who want to be taking on that risk,” he told me.

The problem was that Sequeda and others already had huge exposure to climate risk. Commercial banks and private investors now hold approximately $54 trillion, or more than half, of the total global sovereign debt in emerging markets, linking themselves to the fate of the world’s poorest countries in what the Institute of International Finance warns is “a vicious circle of interdependency.”

Complicating matters is that only part of that total debt is publicly known. Bloomberg records, for example, show that before Mottley’s default, Barbados had at least 30 outstanding bonds and loans worth more than $1 billion, at interest rates as high as 12%. Eurodad examined another financial trading database for The New York Times, looking at bonds in Jamaica, the Dominican Republic, Belize and Suriname — four countries with bonds issued in U.S. or European currencies — and found foreign commercial debt worth nearly $10 billion. The records show that almost every major bank and investment house has a stake in these countries. BlackRock, for example, held $840 million in Dominican bonds as of January 2021. Goldman Sachs, Credit Suisse, Deutsche Bank and Citigroup have all held bonds in the countries, some at exorbitant interest rates. Jamaica, for one, recently owed some $208 million to J.P. Morgan Chase at 11.6%.

Almost certainly this is only a glimpse of a bigger and murkier picture. Eurodad researchers estimate that a vast majority of holdings — about 75% — is private debt that cannot be identified. It is obscured by the contracts that funds and equity groups make with governments, which are not required to be disclosed. Sometimes, Persaud said, even governments aren’t sure to whom they are beholden. Or, as one sovereign-debt lawyer once joked, the only reliable way for a country to identify the holders of its bonds is to stop paying.

The lack of transparency raises fundamental questions about the fairness of default negotiations and the inability of the people most endangered by the debt-climate collision to hold their governments — and their creditors — accountable. In many cases, creditors can sue countries, but countries have difficulty suing back, leaving citizens even more exposed. Over the past two decades, according to Eurodad, half of sovereign debt restructurings have led to litigation, often forcing higher payments than a country can afford.

The most aggressive litigators are found within an ecosystem of hedge-fund investors, sometimes called vulture funds, that wait for the most vulnerable moment to buy distressed debt cheaply and then flip it for a profit, often by resisting any sort of restructuring or renegotiation. In 2008, NML Capital, a subsidiary of Elliott Management, a hedge fund, bought a discounted stake in Argentina’s pre-default debt and then pursued a relentless legal strategy for repayment — at one point having an Argentine Navy ship seized off the coast of Ghana. It earned its money back and then some when Argentina issued a new bond deal. A fund called Aurelius Capital Management similarly bought up Puerto Rico’s debt, then argued in court that the island had to repay the fund before it could finance other projects, including hurricane preparedness. That case was dismissed.

In late 2018, Persaud received an email stating that a Connecticut hedge fund called Greylock Capital had bought an undisclosed portion of Barbados’ debt, and with it, a seat at the table among its creditors. The email, as Persaud recalled, warned that “they could take us to court.” But Greylock’s interest offered an opportunity. A distressed-debt fund also doesn’t need to recoup the same value that Sequeda did to make its profit, because it bought the bonds for a lower cost. Greylock might be able to drive down Sequeda’s price, helping Mottley get the terms she wanted.

From almost the start, the disaster clause Mottley sought was a sticking point. Her team would write up a lengthy proposal, always with a natural-disaster clause among Barbados’ demands. The creditors’ committee routinely would remove it. Mottley, patient, held out.

The clause White Oak designed wouldn’t reduce Barbados’ debt directly. But by suspending payments, it provided immediate access to funds in the aftermath of a calamity and shifted payment to the back end of the term. It would avoid disorderly default and keep Barbados, in the event of a catastrophe, at the table. The investors, though, didn’t buy it. Some of them, Persaud says, sharpened their tactics, telling reporters that Barbados was slow-walking its economic repair. The Financial Times reported that some creditors found White Oak’s $27 million fee to be “absurd.” Then, Sequeda and the creditors’ committee went to Washington and lobbied the IMF, demanding that it require Barbados to set aside a larger annual surplus — in essence, to free more cash to repay its debt faster.

The IMF maintains it kept the creditors at arm’s length. But sometime soon after, according to Persaud, its mission chief on the Barbados deal, Bert van Selm, grew impatient for the government to settle — even if it meant the hurricane clause would be lost. “I said, ‘Bert, are you trying to pressure us into a debt restructuring?’” Persaud told me. He says van Selm replied that the IMF needed the restructuring to be finished. Alejandro Werner, though, the IMF’s former director for the Western Hemisphere, is more direct about what occurred. For months, he says, he struggled to keep the IMF’s internal departments aligned so that Barbados’ program could succeed. But the more Mottley delayed, the more the pieces threatened to come apart. Some of the IMF staff thought Barbados was “being very obnoxious in asking for the natural-disaster clause,” he told me. “Everybody was kind of like: ‘OK, we’re so close. Let’s just close.’”

One day in early 2019, with the negotiations at an impasse, Persaud flew to New York for a private meeting with Sequeda. For nearly a year, the two sides had been in a stalemate. In person it was different. They sat for coffee at the luxurious Mandarin Oriental hotel, with views over Central Park and Midtown Manhattan. Sequeda, who was unyielding in previous meetings, softened. His father-in-law and Persaud’s father were both from Guyana. Persaud, once a Wall Street executive himself, could talk Sequeda’s talk. Sequeda wanted to make sure the new bonds would be large enough for him to easily sell his stake later on — something made more likely if the bond met the $500 million threshold to be listed on the J.P. Morgan emerging-market index. Persaud, of course, wanted the disaster clause. “He kept saying liquidity,” Persaud said. “I kept saying disaster clause.”

A few months later, the agreement was signed. There would be a fund of roughly $530 million. Barbados received a 26% reduction in its debt, enough to — at least temporarily — drop its interest payments from 7% of its economy to 3% and free up more than $500 million a year. And it received its disaster protection, making Barbados the largest issuer of bonds with hurricane clauses in the world.

It was a tremendous victory for Mottley and Persaud, but soon afterward, two things happened to remind them just how precarious life on an island can be: The COVID-19 pandemic struck, and a relatively modest storm rolled over the country.

The July 2, 2021, forecast was for blustery rains, but not extreme by Caribbean standards. As the winds picked up in Bridgetown around 7:15 a.m., Sandra Clarke made up some peanut butter on biscuits for breakfast. Clarke had worked as a stenographer for the Health Ministry. She liked Mottley — “She’s down to earth.” When the IMF terms spurred the Barbados government to cut roughly 1,000 jobs, Clarke was among those let go. It hurt her finances, but she still felt that Mottley was acting in Barbadians’ best interests. That morning, the howling grew louder, and the rain came harder. A tearing sound made Clarke look up — there was a gap where a wall and the ceiling met. “Run!” her son shouted. “I can see the sky.”

Sandra Clarke at her former home, which was destroyed by a storm in July 2021 (Erika Larsen/Redux, for The New York Times)

Months later, I met Clarke where she was staying, a government-run emergency shelter in an 18th-century stone seminary overlooking the eastern shore of the island. The good news, she told me, was that the government planned to rebuild her home. The bad news was that progress had been slow, and the house remained a series of dilapidated courtyards, with a yellow dumpster in the front yard filled with soggy mattresses and splintered wood.

Three years after Mottley identified climate change as Barbados’ preeminent threat, and three years into her effort to restructure its economy to better prepare for that threat, the country still hadn’t been able to address one of its highest priorities: shoring up vulnerable, poorly built housing. The storm, called Elsa, which barely ranked as a Category 1 hurricane, happened to fall just short of the catastrophe level that would trigger the country’s hurricane debt relief. It was, however, the kind of routine challenge the government should be able to withstand. Indeed, Clarke had gone to the government a year earlier to apply for a program that would have fixed up her house, but the waiting list was long and the funding short.

The dollars that might have saved Clarke’s home were instead used to amass a surplus that the government had promised the IMF. Mottley had reduced the public work force and raised all sorts of taxes to ballast the government’s balance sheet. All of this was done for the sake of two metrics by which the IMF still judged a country’s success: How much savings could the government set aside, and how quickly could it reduce the ratio of its debt to its GDP? To critics like Mark Weisbrot, co-director of the Washington-based Center for Economic and Policy Research, these metrics weren’t fit to the task, and meeting them was proving to be more than Barbados could bear.

As a key condition of its IMF program, Barbados agreed to produce a surplus of 6% of its GDP each year. Because government revenues — from taxes and fees — were dependent on how well the nation’s economy performed, this assumed that it would grow at a rate it had not in years, if ever, an expectation that several economists described as unrealistic, even cruel. Van Selm, the IMF’s mission chief for Barbados at the time, defends the number. “It can be done,” he told me. The IMF, meanwhile, held Barbados to its second critical measure: It would have to use much of that surplus to slash its debt levels until the debt made up just 60% of the nation’s GDP.

These are metrics that looked great in the textbooks of global economics schools in the 1960s, but they are not the measure by which the ruling economies of the world are judged today. Japan’s economy is doing fine with a debt ratio of 258%, and the United States has a ratio of 150% — both countries, Mottley said, that “did everything that they tell us traditionally not to do.” The 60% ratio, in particular, requires extreme austerity. “It’s a little bit of a matter of theology rather than economics,” Persaud told me. He and many others believe that it’s not the total amount of debt that matters, but to whom it is owed and how much it costs to carry. Development aid, for example, is often delivered as extremely low-interest loans. Should that count the same as high-interest debts to hedge funds? “It’s become a fetish,” Persaud said.

As small nations accumulate substantial debt because of climate change, which they neither caused nor benefited from causing, it raises even larger questions. Should those countries be penalized again for carrying that debt on their balance sheets, even as investors — in the purest distillation of climate colonialism — profit from that debt? Should there not at least be an allowance in IMF policy that distinguishes between climate-caused expenses and other, normal governing expenses?

When she was elected, Mottley thought she could work within the IMF’s system — that it could be flexible enough to let her whittle away at the drastic needs her country faced. A year after the negotiations were complete, though, she was beginning to see this was an illusion. That was when the COVID pandemic kneecapped Barbados’ tourism industry. Government revenues plummeted, the country’s surplus flipped into a 2% deficit and its debt started to rise again. The IMF cut Barbados a break when the pandemic hit, lowering its surplus target, but only temporarily. As the free-fall continued into 2021, the IMF announced that it would soon push Barbados toward its 6% target surplus once again, with van Selm saying that he was “pretty sure that tourism in Barbados will bounce back.” If the IMF’s goal was to support Mottley in building resilience to shock — climate as well as economic — its policies seemed to be having the opposite effect. The fund’s insistence on building a surplus was instead putting Barbados in a holding pattern, effectively sidetracking climate priorities.

While Clarke’s house, first image, remains uninhabitable, she and her son are staying in a government shelter at an 18th-century seminary on the east coast of the island. (Erika Larsen/Redux, for The New York Times)

Why? One reason, according to current and former staff members I spoke to, was that some groups within the IMF still didn’t think that accounting for climate change was essential to their work. Lagarde, who declined to be interviewed for this article, was sympathetic to Mottley’s climate fears, says Mark Plant, a 24-year veteran of policymaking at the IMF who now runs a finance division at the Center for Global Development, but during her tenure the fund made few strides on the issue. Then, in 2019, Kristalina Georgieva, a Bulgarian environmental economist, came from the World Bank to direct the IMF. Climate issues were trending politically, “and so she has pushed it quite hard,” Plant said. The same year, Alejandro Werner and Krishna Srinivasan, then the IMF’s deputy director for the Western Hemisphere, wrote a policy paper that for the first time laid out a broad philosophy for incorporating climate risk into the fund’s analytical framework. It suggested that in the future the IMF should lead countries into considering climate costs and make its support conditioned on it. Implementing those intentions has proved complicated, though. “The fund,” Plant says, is still “struggling to fund the right levers.”

One problem, according to Aldo Caliari, who heads policy and strategy at Jubilee USA, an interfaith group active in development finance, is that the organization is still trying to build the staff and expertise it needs to grasp the fiscal impact of the climate threat. Sometimes, its efforts have appeared borderline disingenuous. A few years back, for example, the IMF began advising countries to build a climate reserve fund made up of roughly 1% of their GDP to help pay for disaster recovery. But that, say analysts of IMF policy like the U.N.’s Munevar, basically is asking struggling countries to not use money that they could spend to prevent a disaster — so that they can use it to mop up afterward instead.

The IMF, through the official statements it offered for this article, says that climate change is “now in the DNA” of the institution and that it is acting aggressively on the issue. “The IMF is a learning institution,” a fund spokesman said. “We recognized the need for change in recent years and are moving fast on that journey.”

The fund points to the paper Srinivasan and Werner wrote in 2019, which called for new mechanisms, like the hurricane clauses Grenada and Barbados enacted, to create fiscal breathing room for countries to pay for climate impacts. It presented a vision for the future in which climate issues rise to such prominence within the organization that climate planning becomes a central criterion for IMF approval.

By 2022, the fund had made some headway. Among other efforts, it and the World Bank have both begun to help countries either self-insure against disaster or secure discounted institutional financing before a catastrophe happens. The two organizations are running a pilot program in six vulnerable countries to assess their climate-change policies. For low-income countries, the IMF now requires the economic shock of a disaster — though not the gradual and corrosive trends of climate change — to be considered in its analysis of debt. Most recently, in April, the IMF announced the creation of a new, $45 billion resilience trust, some of which is likely to head to Barbados. Mottley, for her part, says she has found the IMF increasingly attuned to her country’s needs.

Still, when in late 2020 Eurodad looked for evidence that the climate-change policies were rising to prominence within the IMF, it found little. Researchers examined 80 IMF programs around the world and found that climate was central to the fund’s assessment in only one country — Samoa. Critics and insiders both observe that a sense of urgency is still missing. “Eventually” the IMF will have to figure out how to better incorporate climate vulnerability, Werner told me. “I mean, we’re still advancing on that.”

One evening in January, I visited Persaud at his home atop a neighborhood called Beacon Hill. Winding up his short, steep drive, I parked in front of a set of broad concrete steps with views over Bridgetown. Persaud came to the porch dressed casually, in a light blue button-down and slacks. We headed toward his backyard, where two friends, Barbadians visiting from the United States, sat among trees on a short-cropped lawn.

Much had happened in the previous few months. In November, Mottley announced that Barbados would cast off Queen Elizabeth as the country’s titular head of state and declare itself the world’s newest republic, then called for a snap election, which she won handily. The mood was light; the next day, a new government would swear allegiance to its own country for the first time. Persaud poured a glass of California cabernet while his guests told stories about Mottley from high school.

Then Persaud got serious, returning to Barbados’ precarious future. “We cannot do this just through debt, even if there were no limits,” he said. Nor could any country in the Caribbean — or, for that matter, any vulnerable country in the world — survive the climate crisis by borrowing more money. No amount of economic growth would ever be enough, either. The deeper he and Mottley got into their economic reeducation, he said, the clearer it became that a just future for people in small, front-line countries would require a radical shift in how the IMF and the World Bank applied their resources.

For years, Persaud has been at Mottley’s side, answering midnight text messages, tuning her fiscal options, looking five chess moves ahead, innovating ways to fix the region’s fiscal crisis even as her star rose through international speeches and she worked to raise the issue of sovereign debt from an obscure cause to a global climate concern. When Mottley talks about economics, it’s partly her thinking — she is indisputably the boss and has a striking fluency in policy minutiae — but almost always partly his, too. He writes many of those speeches. If Mottley is the decisive leader, Persaud is the fount of possible solutions, churning out or delving into economic innovations he thinks might save the world.

There are the hurricane clauses, catastrophe bonds, “blue bonds” — which designate money just for ocean conservation — and a trendy new category called debt-for-climate swaps. The list goes on, Persaud said. The problem isn’t lack of ideas. It’s how to scale them so they can have measurable effects.

The South Coast Boardwalk in Hastings, second image, is part of Mottley’s Roofs to Reefs initiative. (Erika Larsen/Redux, for The New York Times)

Lately, he had been focused on a new plan that would draw on two pools of money. The IMF directly controls nearly $1 trillion worth of member reserves, which it can distribute to members using what it calls “special drawing rights” and mostly holds for some larger emergency. Surely the climate crisis counted as an emergency. The IMF could use its internal drawing rights and expand the availability of 0% loans to help fund the kinds of adaptation efforts that the United Nations estimates will soon cost as much as $500 billion annually. Doing so would require changing a lot of rules, particularly about who qualifies for that funding and how it is earmarked. The IMF’s new Resiliency and Sustainability Trust — a catchall for everything from climate mitigation to pandemic costs — is a start, but only just that. “It’s about 10 times too small,” Persaud said.

Persaud’s plan has an even more costly and ambitious element: addressing mitigation, which Morgan Stanley estimates will cost $50 trillion globally over the next 27 years. IMF members hold $13 trillion in national reserves. Persaud proposes using 1% of that larger pool to seed an enormous new climate trust that would attract outside investment for emissions-slashing projects. The trust could make seed loans at a nominal interest rate and target those loans to specific development projects, keeping the debt off governments’ balance sheets — and excluded from debt-ratio calculations. Persaud thinks that funding could attract perhaps another $2.5 trillion in annual investments from banks and equity funds. That, finally, would be big money.

As expensive as these plans may sound, they are likely to save money and ultimately pay for themselves. According to Colin Young, executive director of the regional Caribbean Community Climate Change Center, for every dollar spent on climate resilience, six dollars are saved in recovery efforts. Not doing anything, researchers at Tufts University found, will allow costs to mount so much that they will subsume today’s Caribbean economies even without the shock of devastating storms. By 2050, the researchers wrote, the costs of inaction will amount to 10% of the region’s total economic activity — a fiscal death sentence.

It is possible that none of the approaches that Persaud argues for will ever be enough. But the IMF is increasingly aware that the scale of the problem requires solutions that are antithetical to the old way of thinking. One person close to the IMF’s highest levels of policymaking told me that some of the countries facing the most intense climate peril will never be able to pay back what they owe. “They’re going to require complete debt forgiveness, and some bit of austerity around the edges is not going to change that,” he said. “The order of magnitude of the problem is just too big.”

Persaud, like virtually everyone I spoke to, is hesitant to talk about erasing sovereign debt. After all that Barbados has been through, he would still prefer to work within the global finance system. “I know we don’t want to create the moral hazard of giving away money for free,” he says. Besides, global institutions can forgive only their own loans. Because most of the debt is now held by commercial investors, it stands to reason that to receive relief from them, the development banks or other large economies would have to be willing to pay those investors back.

There is an argument to be made, though, that the loss of the money owed is a minimal price in the context of the profit that has been made, and that there is justice to this form of mercy. BlackRock, for example, is now among the largest holders of Barbados’ publicly traded debt, having purchased large blocks of it once Sequeda and the creditors settled. Consider what BlackRock, which is also the largest global financier of the oil-and-gas industry, has earned directly from the processes that have caused climate warming.

In a capitalist society, it is fair to ask why anyone should get anything free. But Barbados and the countries of the Caribbean are paying a tangible price now in lives and in dollars because of the emissions of wealthier nations. Perhaps the suggestion that lenders forgive debt isn’t about kindness but about obligation — about seeing it as a kind of back tax that they owe to society and to front-line societies, in particular.

Until the recent completion of an infrastructure project, Kenneth Blades was able to keep only part of his farmland watered. (Erika Larsen/Redux, for The New York Times)

Throughout the winter, the pressure mounted on Mottley. The IMF’s three-year program was drawing to a close, and the fund was still insisting that Barbados would have to swing back toward 6% budget surpluses by 2024 — or else it would lose access to promised funding, as well as the credibility that would allow it to borrow from markets in the future. The IMF announced this while Barbados’ economy continued to struggle and while COVID still raged, and so Mottley, perhaps approaching the end of her patience, raged too.

I reached Mottley one afternoon at her house on the beach, a home where she had spent time since she was a little girl. She arrived for our video call late, delayed by a stop she made across the island at a water-pumping station, where she had gone to assure locals that the government would fix its 70-year-old cast-iron foundation. It was the sort of thing, the most basic thing, that her government was managing to address in these difficult budgetary times — but only barely.

She sat on an outdoor sofa, her laptop on her knees, the camera close to her face in the way we have all grown accustomed to in the era of Zoom. It was the second of our three interviews over the course of the past year, and she began by telling me about the beach in front of her house. It used to teem with spiny sea urchins. “As a child, I stepped on more cobblers than I would like to recall,” she said. “Now you can walk, you don’t see anything.” The beach itself was eroding, her house edging into the rising sea.

In four years, Mottley had become a leader not just for Barbados but effectively for dozens of Caribbean countries, many with populations smaller than a midsize American city, all of which had to face these global institutional juggernauts by themselves. In 2018, she excoriated the United Nations General Assembly — “For us, it is about saving lives. For others, it is about saving profits” — in a speech about the forgotten countries on the climate front lines. She spoke, in 2021, at the opening of the 26th annual U.N. Climate Change Conference in Glasgow, in which she pointedly accused the developed world of hypocrisy, asking, “When will our leaders lead?” Since 2008, she pointed out, the G20 nations had spent $25 trillion printing new money to juice their own stalling economies, money they could have used to prevent the worst of the climate crisis instead. That failure “will allow the path of greed and selfishness to sow the seeds of our common destruction,” she said. She left the conference holding hands with President Joe Biden.

All that access to leaders like Lagarde, Georgieva and Biden gave Barbados an advantage over other Caribbean countries — an advantage Mottley was happy to leverage but which meant that even Barbados’ modest successes might be unrealistic for its regional peers. “We are unequally yoked,” she said. If there was any consolation, it was that the IMF itself finally appeared to be attaching action on climate to its reputation. Thanks to Mottley’s efforts, Barbados had become a showcase for the IMF, a way to prove it could be agile on climate issues, too.

Barbados, though, was still being measured against the antiquated convention of its ratio of debt to GDP, which happened to be growing as the pandemic and war unsettled markets. How could the IMF still want the budget to swing back into surplus? Mottley found it infuriating. “I can’t do these things if I have to spend money on augmenting water supply because of the climate crisis,” she said.

Suddenly it seemed as if all of it had become a treadmill exercise. The efforts to win a disaster clause — a clause that the Inter-American Development Bank has now made standard for its loans in the Caribbean. The deep thinking and brainstorming of bigger solutions. The climate swaps to exchange debt-service fees for ecological upgrades. And so on. Maybe her goal hadn’t been big enough. Maybe it wasn’t about finding more money in the current system but about changing the system altogether. “I’m saying the same things over and over, over and over,” Mottley told me. “You begin to feel as though you’re going crazy.”

In March, Mottley was scheduled to give a speech at the World Trade Organization. She has two rules for capitalizing on her high-profile public appearances: Always make a big ask, and never leave the podium without offering a solution. Persaud set to writing the speech, but this time felt different. Neither he nor Mottley was confident that trade helped solve the big problems of the world. It seemed to make them worse.

For Mottley, the fact that Britain was swimming in vaccine doses for months while Barbados had to beg China for a few thousand vials was a prime example. The politics of the pandemic had erased Mottley’s inhibitions about dealing more straightforwardly with the climate crisis, too. The World Trade Organization couldn’t protect against pandemics. It couldn’t preserve peace in Europe. It couldn’t fix climate change. Mottley would now disavow the current global financial system in its entirety, because it was still, at its heart, a colonial system, a system of oppression.

Lately, she told me, she had been thinking a lot about the idea of reparations, and about how Barbadians have struggled, and how far they had come. The horrific paradox, of course, was that after the British banned slavery, they did pay reparations — just not to the victims of the crime. At every step, Mottley reflected, freedom had come incrementally for Barbadians. Or rather, the oppression had found new, seemingly more benign forms. First, it was the decadeslong work-for-land scheme. Later, it was their beaches and banks — almost all of which are foreign-owned. And after that, it was their cash, in the form of interest. What more was there to give?

Elsewhere, the world has confronted its past abuses. Mottley recalled a trip to Europe 20 years ago, during which she observed a ceremony for Germany’s reparations paid to survivors of the Holocaust. While she was there, South Asians were rioting in Britain over their former colonial oppression. She was struck that no such thought was given to the Caribbean. The Caribbean was unseen then, and it remains unseen now. To fight the climate crisis, to fight the pandemic or meet development goals, Mottley said, countries are still fighting for a platform. “You will realize that in almost every instance, we’re fighting our old struggles on the same basis,” she said. “What is its underlying cause? The inequity in the world in which we live, and the inequity is preserved fundamentally because we’ve not changed the power structure.”

There were no misgivings or hesitations about what she was preparing to deliver to the WTO. She and Persaud had decided to be blunt. The rest was a delicate balance. “She does not want to be put into a box,” Persaud said. “She does not want to be put in a female box, I don’t want her in a SIDS box, and we don’t want to be anti-West, because that’s not who we are.” Mottley read the speech the day before and read it again, absorbing it.

My friends,” she began, with a nod across the floor to Director General Ngozi Okonjo-​Iweala, “the global order is not working.” It does not deliver on peace or on prosperity or on stability, she said. The words of global partnerships were hollow, the partnerships themselves glib, corrupted by greed and selfishness — and they remained fundamentally imbalanced. Debt is written off in Ukraine, as it was for Germany after World War II. Other countries, though, the ones subjugated throughout history, have seen their humanitarian crises ignored. The world, she said, “is segregated regrettably between those who came first and in whose image the global order is now set” and a global order that is itself “simply the embalming of the old colonial order that existed at the time of the establishment of these institutions.”

Gone was the patient case-building, the appeals to logic and empathy, that characterized so many of her recent speeches. Her hair, always in a neat Afro, was grayer and frazzled; her fatigue seeped through her expression. “We have therefore to ask ourselves whether we can live in this global order.”

It was time to reset. The war in Ukraine was forcing that reset anyway. She could work with the global economic system to raise capital. She could probably find a strategy to bolster her island’s standing in the face of cataclysmic climate change, at least for a while. But combining both? It had proved impossible. It was time to use the IMF’s drawing rights, the hurricane clauses, all of it. And then Mottley laid out Persaud’s plan to establish a new climate trust based on the IMF’s reserves, her big ask.

But to make these changes, she warned, the world had to get to a new place in spirit. It had to fill some gaping moral cavity. “That we are more concerned with generating profits than saving people,” she said, “is perhaps the greatest condemnation that can be made of our generation.”

Do You Have a Tip for ProPublica? Help Us Do Journalism.

Doris Burke contributed research.

by Abrahm Lustgarten

How Polio Crept Back Into the U.S.

2 years 8 months ago

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

Update, July 26, 2022: This story has been updated to reflect preliminary results of wastewater tests.

About a month ago, British health authorities announced they’d found evidence suggesting local spread of polio in London.

It was a jolt, to be sure. The country was declared polio-free in 2003.

But at least no one had turned up sick. The proof came from routine tests of sewage samples, which can alert health officials that a virus is circulating and allow them to intervene quickly. Based on genetic analysis of those samples, officials in the United Kingdom moved to protect the city’s children by reaching out to families with kids under 5 who hadn’t been fully vaccinated.

Polio’s first appearance in almost a decade in the U.S., confirmed late last week by health officials in New York, would play out quite differently.

In the U.S., public health agencies generally don’t test sewage for polio. Instead, they wait for people to show up sick in doctor’s offices or hospitals — a reactive strategy that can give this stealthy virus more time to circulate silently through the community before it is detected.

In New York, the first sign of trouble surfaced when a young man in Rockland County sought medical treatment for weakness and paralysis in June. By the time tests confirmed he had polio, nearly a month had passed.

Because the majority of polio infections cause no symptoms, by the time there’s a case of paralysis, 100 to 1,000 infections may have occurred, said Dr. Yvonne Maldonado, a professor of pediatrics at the Stanford School of Medicine who chairs the American Academy of Pediatrics’ committee on infectious diseases.

“You’re already chasing your tail if you’re going to wait for a case to show up,” she said.

Only after the case was identified did New York health officials start the sort of surveillance the British did, testing wastewater samples from Rockland County and beyond to help determine if the virus is spreading and where. Like many parts of the U.S., New York already was collecting sewage and analyzing it to track the spread of COVID-19. Health officials say they’re now testing stored samples for signs of polio. They say they’ve detected polio in a few Rockland County samples but need to analyze more to understand what the initial results represent.

For decades, the cost of doing wastewater surveillance for diseases like polio pretty clearly outweighed the benefit.

High U.S. vaccination rates, topping 90%, made the risk of such diseases incredibly low, though there have long been pockets of population in which rates are far lower. Rockland County, a suburban area northwest of New York City, is one such place. It suffered an extended outbreak of measles, another vaccine-preventable disease, in 2018 and 2019 that was largely concentrated in its Orthodox Jewish community, where many opt out of vaccines. Several news organizations have reported that the polio patient is a member of that community.

Nationally and globally, there are signs that the pandemic has opened up new vulnerabilities to diseases long in retreat. Routine immunizations have been hindered by a host of obstacles, including COVID-19-related lockdowns and growing vaccine resistance stoked by misinformation and politicization. A recent analysis by UNICEF and the World Health Organization showed that the percentage of children worldwide who received all three doses of the vaccine against diphtheria, tetanus and pertussis — a measure of overall immunization — dropped 5 points between 2019 and 2021 and that measles and polio vaccinations fell, too. The organizations say that’s the largest sustained decline in childhood vaccinations in the roughly 30 years they’ve been collecting data.

That could create greater risk of polio, a scourge of the first half of the 20th century in the U.S. Highly contagious and potentially life-threatening, polio historically has victimized mostly young children, attacking their spinal cords, brain stems or both.

The virus spreads when fecal material or respiratory droplets from infected people get into water or food or onto other people’s hands, which they then put into their mouths. This may sound unusual, but it’s among the more common ways viruses circulate, especially among children.

Around 70% of those who are infected show no signs of the illness but can infect others. Of those who do get sick, most have mild symptoms, such as fever, sore throat, muscle weakness and nausea. But about 5 in 1,000 infected people develop irreversible paralysis.

At its peak in 1952, polio killed more than 3,000 Americans and paralyzed more than 20,000. Images of children encased in coffin-like iron lungs terrified parents. Those fears faded swiftly after the first polio vaccine was approved in 1955. Within two years, cases dropped by as much as 90%.

Since 1988, when the Global Polio Eradication Initiative began pouring billions into immunization campaigns and surveillance around the world, polio has been eradicated in much of the rest of the world. Wild polio, the kind that occurs naturally, remains endemic in just two countries, Pakistan and Afghanistan.

But there’s another kind of polio that’s circulating, one linked to the type of vaccine that’s used in much of the world, particularly lower-income countries. This oral vaccine, which hasn’t been used in the U.S. since 2000, is easy to administer — just a few drops on the tongue — and cheap to make. It uses weakened live viruses to trigger the immune system to create protective antibodies.

That brings a bonus. When the vaccinated shed the weakened live viruses in their stool, they can spread to the unvaccinated, triggering protective antibodies in them as well.

But it also brings a risk. In rare instances, when the weakened viruses circulate in people who have not had the vaccine or are under-immunized, they revert to a form that can sicken unvaccinated people, causing the disease they were meant to prevent. The injectable polio vaccine used in the U.S. contains only inactivated viruses and cannot cause this.

Cases of vaccine-derived polio have surged in recent years after global health authorities in 2016 decided to remove one strain of polio from the oral vaccine after determining that the wild version had been eradicated globally. That left a growing number of children with no immunity to the vaccine-derived version of that strain, Type 2. (The injectable form of vaccine used in the U.S. conveys protection against all strains of polio.)

Type 2 vaccine-derived poliovirus is the kind that was found in the British sewage samples. It was also the kind that infected the unvaccinated Rockland County man, indicating a transmission chain from someone who received the oral polio vaccine, health officials in New York said.

Officials are still investigating where the man caught the virus, here or abroad. The Washington Post has reported that the man traveled to Poland and Hungary this year, but a spokesperson for the Rockland County Health Department said in an email, “The person did not travel outside the country during what would have been the incubation window.”

Ultimately, New York health officials will use wastewater monitoring to tell them quickly whether they have a bigger problem, essentially allowing them to test thousands of people at once for polio infection rather than individually, David Larsen, an epidemiologist and Syracuse University professor who directs the state’s wastewater surveillance network, said in an email.

Wastewater testing for polio has been a staple in developing nations for decades, but at least a few countries where cases are rare and vaccination rates are high do it, too.

The U.K. began monitoring wastewater in 2016 for polio and several other viruses that occur in the gastrointestinal tract, a spokesperson for the British health security agency said via email. (It has since added the virus that causes COVID-19 to the list.)

Israel has monitored sewage for polio since 1989. In 2013, health officials were able to detect an outbreak of wild polio just from sampling and launch a vaccine campaign in response without ever experiencing a case of paralysis. This year, though, a young child in the Jerusalem area came down with paralytic polio. Public health authorities there found additional infections through sewage tests.

Some U.S. public health officials have been skeptical of the value of such testing here.

“I’ve always been unenthusiastic about doing it for polio in the U.S. and a big supporter of doing it elsewhere, where there are deficiencies in other surveillance systems,” said Mark Pallansch, who retired in 2021 after spending much of his career working on polio eradication efforts for the Centers for Disease Control and Prevention.

COVID-19 has triggered a blast of interest in wastewater surveillance, prompting cities, states and colleges to launch programs and opening a floodgate of funding for them.

The CDC sent federal money to health departments in over 40 jurisdictions to support such tracking efforts, working with them to collect data that’s published on the agency’s National Wastewater Surveillance System website. A spokesperson said in an email that the agency was working to expand the platform to include data on other pathogens, from foodborne infections like salmonella to influenza, but not polio. Testing nationally for polio would be labor and resource intensive, requiring increases in public health laboratory capacity, the spokesperson said.

One asset of wastewater monitoring is the ability to pivot quickly to test something new.

In November 2020, the Sewer Coronavirus Alert Network, based out of Stanford and Emory universities, started daily monitoring at California wastewater plants for the virus that causes COVID-19. It’s since added monitoring for other pathogens, including COVID-19 variants, the common respiratory virus RSV and, most recently, monkeypox. Such additions are relatively economical since the network can test for multiple pathogens from a single sample, said Marlene Wolfe, one of the two principal investigators and an assistant professor at the Rollins School of Public Health at Emory.

In adding more tests, Wolfe said, the question is always whether monitoring a disease this way is likely to surface anything of enough concern to drive public health decisions.

Many question whether the expansion of wastewater testing fueled by the pandemic will last. Maldonado, the American Academy of Pediatrics’ infectious diseases committee chair, said the recent polio case is another signal that more disease tracking is critical.

“Maybe this is a clarion call for us to really start building better surveillance networks,” she said.

by Robin Fields

The Leader of New York’s “City of the Dead” Cashes In. Again.

2 years 8 months ago

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

The stretch where Pinelawn Road turns into Wellwood Avenue on New York’s Long Island is known to locals as Cemetery Row. For 3 1/2 miles, the four-lane road is lined with sweeping, manicured lawns with separate entrances to eight cemeteries set back from the street. Comprising 2,300 acres, almost three times as much land as New York City’s Central Park, it’s the largest contiguous area devoted to burials in the United States.

The business district in Cemetery Row has a power plant, a commuter rail station and a suburban-style commercial strip surrounded by burial grounds. Large signs advertise marble slabs, and you can see smoke wafting up from a crematory. Commercial and religious establishments with names such as St. Charles Monuments, Eternal Memorials and Star of David Memorial Chapel alternate with Kerensky Florist, Michelle’s Florist and Chicky’s Florist, not to mention two gas stations and the Barnwell House of Tires.

The oldest of the cemeteries here, in Farmingdale about 20 miles east of New York City’s eastern border, is Pinelawn Memorial Park. At 839 acres, it’s the second largest nonmilitary cemetery in the country. During the dark early days of the pandemic, when local cemeteries struggled to keep up with the region’s wave of COVID-19 casualties, Pinelawn emerged as a standout; it was able to keep its operations going to meet the needs of grieving families. Pinelawn buried 5,381 people in 2020, up 30% from the year before, according to its filings.

In New York, unlike most other states, cemeteries are not-for-profit organizations. For 175 years, the state has prohibited for-profit cemeteries, largely to ensure that as much money as possible goes to the upkeep of graves and to prevent profiteering from death. Like other cemeteries in New York, Pinelawn is owned by the thousands of people who have bought burial plots there, overseen by a board meant to represent the plot holders’ interests. As a nonprofit, Pinelawn pays no taxes on its land or on the millions of dollars that surged into its coffers during the pandemic.

But Pinelawn doesn’t resemble other New York cemeteries in a key respect: The Lockes, the family that has run Pinelawn since it opened in 1902 and that has passed down the leadership among four generations, have consistently cashed in on its nonprofit operations. During its heroic pandemic efforts in 2020, the cemetery’s revenues rose by a third, and as demand soared, Pinelawn raised the prices of its burial plots as much as 47%, with the price of a plot in one coveted location rising from $7,495 in 2020 to $10,995 a year later. And that doesn’t count the cost of the bronze grave markers, mandatory at Pinelawn (which bars traditional gravestones in favor of markers that are flush to the ground). In all, the grave markers and a long list of additional fees can add another $7,000 to $10,000 on top of the cost of the plot.

Pinelawn president Justin Locke was paid $500,000 in 2020. His wife, Alexandra, who was promoted from office manager to executive vice-president of the organization in 2016, was paid $300,000. Locke’s parents, aunts and uncles split another $2.2 million in dividend-like payments from the sale of cemetery plots.

The combined $3 million made by the Locke family from Pinelawn in 2020 doesn’t capture its total take, nor does it capture the family’s history of using Pinelawn to make money. Justin Locke’s father, Stephen, who ran Pinelawn until 2013, used about a quarter of the cemetery’s land to open a for-profit golf course that he co-owns to this day.

Meanwhile, Pinelawn, which has touted its beauty and tranquility for more than a century — it spends $1 million a year on advertising, according to publicly filed financial reports, more than any cemetery in the state — has embarked on a plan to lease another 100 of its acres to a developer who plans to build warehouses and office buildings.

Pinelawn and the Lockes declined multiple requests to be interviewed for this article. Presented with extensive questions in writing, Katherine Heaviside, a press representative for the family and the cemetery, responded to only one of the scores of points raised. And as this article was nearing publication, the cemetery mailed ProPublica a check for $1,000, which Pinelawn said was intended as a donation. ProPublica returned the check, citing the impending article. Heaviside said the donation was made “in response to a solicitation from Jill Shepherd at ProPublica,” adding, “ProPublica’s ethics are very questionable here.” (Shepherd, ProPublica’s director of online fundraising and outreach, sends out bulk email solicitations that are distributed to hundreds of thousands of people who have agreed to receive emails after signing up for ProPublica’s newsletters or donating. She has never been in individual contact with Pinelawn.)

The Lockes’ ways of cashing in on a nonprofit have caused periodic consternation in New York government circles for the better part of a century. Those practices helped lead to the creation of a state regulatory agency to oversee cemeteries and a legal ban on the sorts of dividends that the Lockes receive. But for nearly 75 years now, that ban has exempted Pinelawn. The cemetery business may have changed a lot during that time, but, it appears, the Locke family’s practices have not.

As other nearby cemeteries struggled to keep up during the early pandemic, Pinelawn was able to maintain its operations. It buried 5,381 people in 2020. (Chris Gregory-Rivera, special to ProPublica)

In the early months of the pandemic in the New York City area, the systems that processed deaths were as overwhelmed as those that worked to save lives. Bodies piled up at hospital morgues. Funeral directors couldn’t quickly answer the calls of grieving families, much less retrieve bodies. Crematories burned around the clock.

Cemeteries, too, struggled to manage during the start of the pandemic. Long Island facilities were booked solid, and wait times for burials increased to weeks. Cemeteries had to begin imposing restrictions. Calverton National Cemetery, the largest military burial site in the country, located about 40 miles from Pinelawn, limited casket burials to 15 per day and stopped accepting cremated remains for burial. Military honors were also suspended. Other operations, such as St. Charles Cemetery, located across the street from Pinelawn, reduced hours and staff. “All funerals Monday through Saturday must arrive by 12 p.m. — There will be no overtime or exceptions,” regulations read.

Many cemeteries, each typically serving hundreds of different funeral homes, limited themselves to 10 burials per day, at a moment when a single funeral home might receive 10 or more bodies a day, according to local funeral directors. “The demand was way higher than the burial limits cemeteries were imposing,” said Michael Hoddinott, a funeral director at Brueggemann Funeral Home in Long Island’s East Northport.

But Pinelawn was able to smoothly accommodate the surging death toll and continued to operate without delays, according to funeral directors and a statement made by the head of the state Division of Cemeteries at a meeting of state regulators. “If I had to choose a cemetery to deal with during the pandemic,” said Hoddinott, who handled 37 burials at Pinelawn in 2020, “it would be Pinelawn.” Nancy White, a funeral director at nearby Arthur F. White Funeral Home, concurred. “Pinelawn was terrific compared to the other cemeteries next to it,” she said.

Burials at Pinelawn continued, albeit with COVID-19 protocols such as limits on the number of attendees, social distancing rules and required face coverings. Rather than restricting the number of funeral directors within the administration office, Pinelawn set up a courtyard table to allow funeral directors to check in safely during the worst periods. Paperwork was handled swiftly, and funerals adhered to a strict schedule to fit as many burials into the day as possible.

Heavy demand, combined with Pinelawn’s ability to maintain seamless operations at a time of maximum duress, allowed it to implement price hikes in 2021. Pinelawn broadly raised the prices for its land graves (which can exceed $30,000), according to price lists filed in November 2021 with the Division of Cemeteries and obtained in a records request.

Pinelawn charges an additional $1,878 to bury a body (plus another $600 if you want to hold the burial on a Saturday). You’ll need to pay $728 to $900 more if you want the grave to have a concrete liner. Bronze plaques, as noted, are mandatory and run $2,345 to $4,698; if you want text inscribed on the plaque or a notation that your loved one was a military veteran, that could cost another $1,000 or so. If you request four folding chairs at the burial, you will be billed $68, and if you want a canopy, that’s another $170. And none of this, it should be noted, includes charges from the funeral home, such as the cost of a casket or embalming.

Pinelawn, seen from the adjacent Long Island National Cemetery, prohibits traditional gravestones. Instead, it mandates bronze grave markers, flush to the ground, in part to preserve open vistas. (Chris Gregory-Rivera, special to ProPublica)

All those new graves and higher prices at Pinelawn translated into cash for the Locke family, the descendents of the cemetery’s founder. The explanation lies in an obscure but lucrative financial instrument called a “land share,” which in Pinelawn’s case dates back to 1904 and pays dividends twice a year. Those payouts more than doubled during the early months of the pandemic, from $13.65 per share in August 2019 to $28 in August 2020, before subsiding to $20.70 in August 2021.

The Locke family owns 51,964 of the 127,850 land shares that were issued by Pinelawn during the presidential administration of Theodore Roosevelt, and which still circulate today. The shares are unusual in another regard: Some of the rest are traded on an over-the-counter financial market — their price has more than doubled over the past five years — and a small coterie of investors have bought shares, coveting their reliable revenue stream. No other cemetery land shares are listed on the OTC Markets Group.

Calling them “land shares” is a bit of a misnomer, since they don’t actually entail owning land. Instead, they’re an investment, originally used to fund the creation of the cemetery, that entitles the holder to dividends derived from the sales of cemetery plots. Half of the proceeds from each sale of a plot go to pay the dividends, with the other half used to take care of the property.

The shares remain valid until the last plot is sold and the empty land at Pinelawn has been used up. That day is far off. Of Pinelawn’s 839 acres, more than 600 remain unsold and undeveloped today. In 2018, Pinelawn president Justin Locke said that at the current pace the cemetery wouldn’t run out of land for at least 206 years.

Using land shares to help raise money for cemeteries was not unusual in the late 19th century, according to the 1991 book “The Last Great Necessity: Cemeteries in American History,” by David Charles Sloane. The book describes such shares as a method of “hiding the profitable nature of the investment” at a time when Americans were uncomfortable with the notion of making money on death. (Today, most states allow for-profit cemeteries, and a handful of national corporations have bought up more and more cemeteries.)

Pinelawn’s land shares have paid out a total of $100 million in dividends since they were first issued more than a century ago, according to ProPublica’s calculations. In 2020, relatives of Pinelawn president Justin Locke received $2.2 million in dividends. (Document obtained from Suffolk Supreme Court)

New York state banned for-profit cemeteries in 1847 — not only to prevent profiteering but to ensure solid financial management. Back then it was common for entrepreneurs to open cemeteries without adequate financial backing. The operations often went bankrupt, leaving untended graves and, sometimes, unburied or partially buried corpses in various states of decomposition.

Pinelawn’s land shares originally sold for as little as $1 a share, but they have delivered huge profits for those lucky enough to have them: more than $100 million since the first distribution in 1904, according to calculations by ProPublica.

The shares come with another boon: By all appearances, holders of land shares don’t have to pay taxes on their dividends. Holders of the shares told ProPublica that Pinelawn does not issue 1099 forms for the shares, which, among other things, would notify the IRS of any income. In addition, a 2008 letter written by Pinelawn’s tax lawyers described the shares as “exempt.” An IRS spokesperson declined to comment, and multiple tax experts contacted by ProPublica said they’d never heard of land shares and couldn’t say whether their dividends should be taxed. Representatives for the Locke family did not respond to ProPublica’s written question asking whether they pay taxes on their land share dividends.

A commercial strip in Cemetery Row near Pinelawn (Chris Gregory-Rivera, special to ProPublica)

The area around Pinelawn looked very different in the late 19th century, when William H. Locke Jr. first began hatching plans for a cemetery. Lush forests of oak and pine thrived. Farms and country estates lined the rural roads.

Locke saw an opportunity: The population of New York City was exploding, and Manhattan in particular was running out of space to bury the dead. In the 1890s, Locke started accumulating large tracts of land. By 1899, he owned 2,300 acres.

At the time, New York state law provided that a private cemetery association could not own more than 200 acres. William Locke got around the limit by splitting his operation into eight separate associations. For reasons that have been lost to time, Locke appears to have persuaded a state court a few years later to order the reassembly of the eight groups into one operation owned by Locke.

Opening a huge cemetery cost money, and Pinelawn embarked on an “innovative sales program,” according to “The Last Great Necessity.” Pinelawn took out newspaper ads and deployed salespeople to sell plots in advance. They were “authorized to offer purchasers a payment plan of 25 cents down and 23 cents until the lot was purchased.”

Pinelawn was also whipping up a frenzy, by the standards of the era, for its land shares. Thousands of people would eventually buy the certificates. A prospectus claimed they would be as safe as government bonds and “produce an income more than ten times greater.” The shares, the prospectus noted, would be “exempt from all taxation.”

The document promised Pinelawn would be “the most elegant cemetery in the world.” It boasted that the Long Island Rail Road “runs through the center of its lands, and the Company is now erecting a private station and mortuary chapel of its own,” and that “a large receiving vault of the most sanitary nature, and under the most improved designs and artistic finish has just been completed.”

From its opening in 1904, Pinelawn was intended to appeal to residents of New York City, which was running out of burial space. Having a train that ran from the city directly to the cemetery was a selling point. (Courtesy of Brad Phillips)

Pinelawn employed the sort of sales hype — “the largest burial place in the world” — that you might associate more with, say, launching the Queen Mary than consecrating a place of mourning and remembrance. The cemetery’s opening in the fall of 1904 was a festive affair. The 47th Regiment Band played, and special trains unloaded dignitaries from New York and Brooklyn at the newly opened station. A bishop and a county judge gave congratulatory addresses.

Despite the gala and Pinelawn’s sales prowess, the cemetery fell into financial trouble almost instantly — and questions about its business practices surfaced. Tension grew among Pinelawn’s directors, who included a raft of bank presidents and R.F. Pettigrew, listed on the cemetery’s prospectus as a “former U.S. Senator and Capitalist.” In 1905, Pettigrew resigned from the board, claiming that Pinelawn was being grossly mismanaged and that its officials had destroyed documents. Pettigrew also claimed that founder William Locke and another executive had sold land shares for their own benefit, rather than to generate revenue for the cemetery.

Locke disputed the claims and fired back in kind. Pettigrew, he said, “claims deception was practiced upon him, but it is also apparent that he made no noise about it until he had disposed of most of his shares and pocketed the money.”

Pinelawn continued to struggle in its early years. It failed to pay dividends on its land shares and in 1915 was placed in receivership. (William Locke’s brother-in-law managed to get himself appointed receiver until a judge discovered his ties to the Lockes and booted him from the role.) At that point, Pinelawn’s only assets were land, a few horses and hearses and $68 in the bank. It had debts of $280,000. Pinelawn claimed it couldn’t pay a judgment in a case brought by land share holders who said they hadn’t gotten their dividends.

As a result, a judge ordered Pinelawn to sell portions of its land to pay the judgment. Over the next 15 years, Pinelawn sold more than 1,400 acres of its original property to other cemeteries. That helped Pinelawn stabilize its finances while reducing its size to its current 839 acres.

It was a precarious period for Pinelawn. William Locke died suddenly at his desk in the cemetery office in 1922 and was briefly succeeded by his wife, Lillian. She then gave way to her sister, Eleanor Hughes, who remained the ultimate power at Pinelawn until Alfred Locke ascended to the presidency of Pinelawn in 1949.

Pinelawn and other New York cemeteries continued to draw suspicion about their business practices. The state attorney general launched an investigation, and, in 1949, released a report that excoriated the industry for “profiteering from sorrow.” Attorney General Nathaniel Goldstein concluded that nonprofit cemetery corporations “have been cynically developed into devices for profiteering on the widest possible scale.” He found evidence that operators were draining millions of dollars from cemetery corporations; that cemetery managers stacked their boards with family and cronies to maintain control; that they paid excessive salaries to executives; and that they secretly sold plots at discounts to friends and family, who would then resell the plots at a big markup.

Pinelawn was cited as an example of the latter abuses. Goldstein pointed out that, under the heading “self-arranged bargains,” Alfred Locke allowed his aunt to buy 40,000 burial plots for 27.5 cents each, which she could then resell for $50 to $100 apiece.

After Goldstein’s report, the state — over vehement protests by the Lockes and others — established a new regulatory agency, the New York State Cemetery Board. All nonprofit cemetery corporations would henceforth be required to file their rates and financial reports with the state and to abide by the board’s rules. The Cemetery Board today regulates the 1,700 cemeteries in New York State, not including religious or municipal facilities and burial grounds operated for family or individual use, which are outside the board’s oversight.

The state legislature then banned the issuance of new land shares but made an exception for existing shares. Today, according to the state cemetery division, only two other cemeteries still have outstanding land shares. But those cemeteries — Cedar Grove and Mount Lebanon, both in Queens — are close to capacity and thus pay only modest dividends today.

The railroad station built specifically for Pinelawn (Chris Gregory-Rivera, special to ProPublica)

Alfred Locke managed to revive Pinelawn’s business in the decades that followed the 1949 attorney general’s report, using what “The Last Great Necessity” described as “inventive advertising, direct mail and door-to-door approaches.” He turned the operation into a financial success.

In 1971, a profile of the cemetery in The New York Times was headlined “Pinelawn Is a Prosperous City of the Dead.” As cemeteries in Queens, Brooklyn and the Bronx approached the “point of saturation,” reporter John Darnton wrote, “the city is reaching farther for room to bury its dead.” He described a steady stream of funeral corteges on the Long Island Expressway. The article quoted Alfred Locke defending Pinelawn’s aesthetic approach. “It’s really a conservationist thing,” he said. “People say, ‘what a waste of land.’ But what would you prefer to see, a factory? A 20 story office building?” Locke went on to say, “I think we’ve got to stop and say we’ve had enough: We can’t look at a place with a lot of industry and say, Isn’t that wonderful! Because industry breeds congestion and pollution.”

By the early 2000s, Alfred had long since been succeeded by his son Stephen, and once again Pinelawn came under scrutiny for its business practices. The questions this time stemmed from a golf course that had opened adjacent to the cemetery a few years earlier.

Like Alfred, Stephen Locke was entrepreneurial. He proposed leasing 225 acres of unused Pinelawn land to create the golf course. “I looked at this as an opportunity to do something that wasn’t merely a continuation of something my father had started,” Locke told The New York Times in 1995 about his then-planned golf course. He called it a “win-win situation.”

Locke would be a co-owner of the golf course, entitled to his share of any profits from that operation. That meant that Stephen Locke (chairman of nonprofit Pinelawn) would be transacting with Stephen Locke (president of the for-profit golf course).

Using cemetery land for another purpose required that Locke obtain approval from state regulators. “At the beginning, the Cemetery Board was sort of dead set against it,” according to Gus Ballard, an investigator with the state Department of Cemeteries from 1993 to 2019. But Locke assured the regulators that Pinelawn would benefit from the golf course — the lease would generate revenues for the cemetery — and that none of his actions would jeopardize the cemetery’s finances or tax-exempt status. He also enlisted support from prominent New York state politicians, including Sen. Daniel Patrick Moynihan and Long Island’s U.S. Rep. Thomas Downey. (Moynihan died in 2003; Downey did not reply to a request for comment.) Locke “turned everything around,” Ballard said. “So that eventually got approved.”

But Locke had withheld key information, according to Ballard, who said he discovered this a few years later, in 2002, when he was performing a routine audit of Pinelawn. Ballard began to uncover what he saw as irregularities. The most consequential, in his view, was the Lockes’ ownership of plots (which equate to votes for Pinelawn’s governing board) that it had not revealed to the Cemetery Board, giving the family what Ballard called “virtual absolute power over Pinelawn’s affairs.”

Ballard also discovered undisclosed details of the golf course arrangement. Locke had used some of the graves he owned as collateral for the loans that financed the golf course, an apparent violation of a state rule that prohibits putting cemetery funds at risk for an outside venture. Since Locke didn’t have the right to sell large numbers of graves on the open market, he created an option agreement that would allow him to sell his lots back to the cemetery if needed. Pinelawn’s board of directors, 11 of whose members were “hand-picked” by Locke, according to the state — three of them, plus Stephen Locke himself, owned a combined 56% of the golf course — approved the option agreement.

Ballard drafted a memo for the Division of Cemeteries that echoed the Goldstein report a half-century before it. “Pinelawn Cemetery has been operated, all along,” he wrote, “primarily for the private benefit of the management and Land Shareholders, with the interests of ordinary plot owners, (and the cemetery’s future), receiving subservient consideration, at best.”

Stephen Locke “was not happy” when authorities began investigating his moves, said Richard Fishman, then head of the state cemetery division. Pinelawn was owned by its plot holders, but Fishman said Locke’s attitude was “he owns the cemetery and it’s his business and he can do whatever the hell he wants, which is a great point of view if he were in any other state than New York.” Fishman’s division forwarded its findings to the state attorney general.

In 2004, then-New York Attorney General Eliot Spitzer filed suit against Locke, Pinelawn and several of its officers and directors, alleging that the Lockes had for decades violated the ban on private ownership of public cemeteries. The suit repeated the charges made by Ballard. And it included an assortment of other allegations, including that the Lockes had diverted proceeds from the sales of mausoleums to benefit the holders of land shares, whose dividends are supposed to flow from sales of plots only.

Spitzer also charged Pinelawn with failing to disclose to taxing authorities millions of dollars paid by the cemetery to land share holders and omitting required disclosures from annual reports filed with the state Cemetery Board. Pinelawn acknowledged not sending 1099s to shareholders, but argued in legal filings that the payments are not dividends but instead repayments of capital, which it contended meant that no taxes were owed. In its court papers at the time, Pinelawn denied “any and all liability with respect to the causes of action alleged in the Action."

The suit was settled in 2006 with no payment by Pinelawn or the Lockes and only one significant concession: Pinelawn agreed that Stephen Locke would sell 51% of the graves he owned. The Lockes would no longer own a majority of graves and, in principle, would no longer be able to dictate the composition of Pinelawn’s board. Ballard called the settlement a “halfhearted attempt to sort of make it so they weren’t solely in charge of the whole operation. I’m not sure we did a very good job with that.”

The board members were slowly replaced, but the new ones seemed to resemble the ones they succeeded: lawyers, politicians and lobbyists, often with ties to the Lockes. Three new directors joined the board in 2007, two of them state or regional power brokers: Arthur Kremer, an attorney who served 13 terms in the New York State Assembly and headed its Ways & Means Committee; Mark Cuthbertson, an attorney and longtime Huntington town councilmember; and Locke’s son, Justin. (Kremer and Cuthbertson did not respond to a request for comment.) The Lockes and Pinelawn “have a lot of political clout,” said Fishman, the former head of the Division of Cemeteries.

The composition of Pinelawn’s board changed — but its amenability to the Lockes didn’t. In 2007, just a year after the settlement with the state, Pinelawn’s board voted to approve another option agreement with Stephen Locke, almost identical to the one that Ballard viewed as illegal. The agreement allows Locke’s ownership of 2,500 graves to be used as collateral for $2.5 million in loans he took out for the golf course.

Today, the golf course, called Colonial Springs, continues to operate. According to Pinelawn’s 990 form, Colonial Springs paid some $400,000 in property taxes last year. It underwent a $4.5 million renovation in 2007 by renowned architect Robert Trent Jones Jr., winning accolades in Golf Digest. In addition to Stephen Locke, three of Pinelawn’s current directors (none of whom responded to requests for comment) are also board members and shareholders of the golf operation.

The for-profit Colonial Springs golf course, partially owned by Stephen Locke, operates on 225 acres leased from Pinelawn, which Stephen Locke formerly headed. (Chris Gregory-Rivera, special to ProPublica)

When Justin Locke first appeared before a meeting of the state Cemetery Board in March of 2018, it offered a rare moment to see Pinelawn’s president, who had acceded to the position five years earlier, in a public forum. In a trim dark suit, his pate glinting from the fluorescent lights in the cramped, low-ceilinged room, Locke cut a confident figure, a video of the meeting shows. He spoke in the urgent baritone of a 1950s-documentary narrator.

The grandson of Alfred Locke, the man who had talked about the importance of conservation and his horror of factories and office buildings, Justin Locke was appearing before the Cemetery Board to sound them out on a new idea: leasing 100 acres of Pinelawn’s property to develop into warehouses and office buildings.

Justin Locke made his case to the Cemetery Board, starting with the surprising claim that the area of the cemetery he wanted to develop was blighted. He described the 100-acre parcel as filled with “crime, trespassing, quality-of-life issues that are affecting the neighbors, complaints. It’s hurting our reputation.” (The “crime” he was describing seemed to consist largely of trespassers riding ATVs on the property.)

Noting Pinelawn’s extensive unused land, Locke touted the potential revenues the cemetery could earn by leasing the parcel. He called it a “cake-and-eat-it scenario where we can leave the property over there, maintain control over it, but generate a substantial income off of it in the meantime.”

He also made a remark that seemed to reflect his awareness of the legacy he inherited as the fourth generation of Lockes to head the cemetery. “I see this as a tremendously beneficial, impactful project for Pinelawn,” he said. “I don’t know if there’s anything I’ll do in my time there that will eclipse the benefit that could be had from this.”

For their part, a few board members showed their own memory of history, alluding to the allegations of self-dealing that were made about Locke’s father and his golf course. One board member said, “Obviously the law has changed since the golf course lease was signed, and what would be a nonstarter would be if your lessee ends up having any relationship to anyone on the cemetery side,” he said. “That ain’t happening.” (“Oh yeah,” a second board member chimed in.) Locke brushed the comment aside with a quip about hoping to have FedEx as a tenant.

Four years and one pandemic later, Pinelawn’s plans have slowly advanced. The cemetery’s representatives shared preliminary documents with the planning department for the town of Babylon, and met with department representatives in January 2022. The plans called for transforming those 100 acres into “the region’s foremost Class-A business Park.” The development, with a budget projected to exceed $175 million, would include nine warehouses and office buildings, totaling 1.6 million square feet, and would be known as the Suffolk Technology Center. Todd McLay, chief financial officer of the developer, the Bristol Group, would not comment on the details of the lease, citing its proprietary status. But he confirmed that the project is actively in the works.

Before the town can consider a formal application, the state Cemetery Board must approve the use of any cemetery lands. The Division of Cemeteries told ProPublica it has received an application from Pinelawn and is reviewing it. It declined to estimate a timeline for a hearing and decision.

Pinelawn has always been strict about the appearance of anything on its grounds. Not only are tombstones barred, but so is anything that might obstruct the open vistas. Only fresh-cut flowers are permitted — nothing artificial — and they are removed at specified times to avoid the potential eyesore of wilted petals. But soon, if the plans proceed, a construction will rise — a rendering shared by Pinelawn suggests it will be around 30 feet tall — dominating the view from one part of the cemetery. The Lockes, it seems, will continue running Pinelawn and profiting from it. Meanwhile, Justin Locke’s son is 9, so there’s a fifth generation in his patrilineal line who could ascend to the helm.

Do You Have a Tip for ProPublica? Help Us Do Journalism.

Correction

July 29, 2022: This story originally misidentified the owner of the OTC Markets Group, the financial market where Pinelawn land shares are traded. It is an independent public company, not operated by Nasdaq.

by Carson Kessler

Richard Glossip Has Eaten Three Last Meals on Death Row. Years Later, the State Is Still Trying to Execute Him.

2 years 8 months ago

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

In the parking lot outside the Oklahoma State Penitentiary, I stood on my toes in a throng of reporters, straining to hear death row inmate Richard Glossip’s words through the speaker of a phone his friend held aloft.

It was 3:45 p.m. on Sept. 30, 2015, and Glossip should have been dead by now from a cocktail of lethal drugs pumped into his body.

I joined reporters, Glossip’s family and supporters outside the prison in McAlester that day — a warm and breezy afternoon — as the condemned man was able to make a phone call from inside the maximum-security facility’s death row. Glossip seemed relieved to be alive but, understandably, wondered why. He’d exhausted his last appeal and eaten his last meal: fish and chips, a Wendy’s Baconator burger and a strawberry shake.

He learned his life was spared because of a technicality: One of the three drugs Oklahoma officials procured for the execution was the wrong one.

“That’s just crazy,” Glossip said over his friend’s phone.

It was the third time the state of Oklahoma had tried to execute Glossip and the latest lapse in a macabre history of failure in its death penalty machinery. As a journalist who covered Oklahoma’s prison system and death row for 25 years, I reported on many of those breakdowns.

Seven years later, the state remains intent on executing Glossip, scheduling its fourth attempt for Sept. 22 despite persistent claims that the 59-year-old is innocent and allegations that prosecutors ordered the destruction of vital evidence in the 1997 murder-for-hire case that resulted in his death sentence.

Glossip’s claims of innocence have drawn an unusually bipartisan array of supporters, including 28 Republican state lawmakers, most of whom support the death penalty. The legislators commissioned an exhaustive review that recently turned up new information about prosecutors’ alleged role in destroying evidence and financial records bringing into question Glossip’s motive in the case. The lawmakers have called on the governor to order an independent review of Glossip’s case and for a state appeals court to conduct a hearing to examine the new evidence.

Calls to halt his scheduled execution come at a time of national reckoning over the death penalty. The Supreme Court’s rulings on the issue — including a 6-3 decision in May barring condemned prisoners from seeking federal court review for ineffective counsel in some cases — are increasingly at odds with public sentiment in many states. Meanwhile, the pace of new death sentences and executions carried out nationally is on track to hit a record low for the eighth year in a row, even with the reopening of courts shuttered during the pandemic, according to the Death Penalty Information Center.

Oklahoma is among a small number of states that routinely carry out the death penalty that are bucking that trend, and it is on pace to outdo them all despite its gruesome history of failures.

The state recently set execution dates for Glossip and 24 other inmates, including several with mental illness, brain damage and claims of innocence. They’re scheduled to die at a fast clip — about one each month through December 2024 — a rate that would eclipse the number of executions by all states combined since 2020.

Many observers, including those who support the death penalty, doubt the state’s ability to carry out executions in a constitutional manner, even for those inmates whose guilt remains unchallenged. If the past is any judge, they’re probably right.

In more than two decades covering Oklahoma’s death row, here are a few of the events I wrote about, including some that I witnessed:

  • In 2014, I heard one inmate say just before he was executed: “Malcom Scott and De’Marchoe Carpenter are innocent.” The inmate had testified years earlier that the two men took part in a killing with him. They were later exonerated, but only after spending more than 20 years in prison.
  • When the state needed to switch to a new lethal drug in 2014, an attorney for Oklahoma’s prison system later said that he looked for a replacement by searching for information about lethal drugs on the internet.
  • A few months later, I was among the media witnesses who watched Clayton Lockett writhe, moan, talk and try to get up from the execution table for three minutes after the drugs were administered and he had been declared unconscious. The prison was using a new, unproven drug that some experts said wouldn’t anesthetize an inmate as the painful second and third drugs were administered. Prison officials closed the blinds and after about 20 minutes told us to leave the death chamber. Lockett died 43 minutes after the execution began.
  • My reporting partner, Cary Aspinwall, and I later reported that the warden called the execution a “bloody mess” and that the doctor had improperly inserted the IV into Lockett, complaining about getting blood on his jacket.
  • State officials used the wrong third drug to execute Charles Warner less than a year later in January 2015 but didn’t make that public. They were poised to use the wrong drug again in Glossip’s third scheduled execution before then-Gov. Mary Fallin halted it at the last minute.
  • A grand jury report blasted state officials’ actions as “inexcusable,” finding that Fallin’s top lawyer wanted to proceed using the incorrect drug anyway. The state’s own attorney general said some officials had been “careless, cavalier and in some circumstances dismissive of established procedures that were intended to guard against the very mistakes that occurred.”

After a six year hiatus, Oklahoma executed John Marion Grant in October. Multiple witnesses said Grant convulsed and vomited during the process. Now, the state is preparing to execute Glossip amid doubts about his guilt.

One of the GOP lawmakers calling on the state to review Glossip’s case, despite a long history of supporting the death penalty, said he’ll advocate to end capital punishment in Oklahoma if Glossip is executed.

“I’m 99% sure that he is not guilty sitting on death row,” state Rep. Kevin McDugle said in an interview with ProPublica. “My stance is not anti-death penalty at all. My stance will be (different) if they put Richard to death, because that means our process in Oklahoma is flawed.”

In a sharply worded dissent in a case challenging Oklahoma’s choice of execution drugs, then-Justice Stephen Breyer argued that the death penalty was no longer constitutional. Among his reasons, Breyer cited studies showing death penalty crimes have a disproportionately high exoneration rate.

In fact, courts have reversed verdicts or exonerated prisoners because of prosecutorial misconduct in 11 death sentences in the same county where Glossip was convicted, according to a study released last month by the Death Penalty Information Center. Another 11 from that county, home to the state Capitol, were put to death using testimony from a disgraced police chemist, the study found.

Though Glossip’s recent appeals have been unsuccessful, a state court judge and a federal judge have noted in appellate rulings the relatively thin nature of the evidence against him. “Unlike many cases in which the death penalty has been imposed, the evidence of petitioner’s guilt was not overwhelming,” the federal judge wrote.

In a letter last year to Gov. Kevin Stitt, McDugle joined more than 30 state lawmakers, nearly all Republicans, in asking him to appoint an independent body to review Glossip’s case and examine what they say is compelling evidence he is innocent.

“Many of those who have signed this letter support the death penalty but, as such, we have a moral obligation to make sure the State of Oklahoma never executes a person for a crime he did not commit,” the letter states. “Mr. Glossip’s case gives us pause, because it appears the police investigation was not conducted in a manner that gives us confidence that we know the truth.”

A portrait of Barry Van Treese from Glossip’s clemency packet.

Glossip was convicted of murder in the 1997 killing of Barry Van Treese, who owned the Oklahoma City budget motel where Glossip worked. Justin Sneed, a maintenance man with a violent record, beat Van Treese to death with a baseball bat and testified Glossip paid him to carry out the killing. Prosecutors alleged that Glossip feared he would be fired because Van Treese had discovered he was embezzling from the motel.

In exchange for his plea and testimony against Glossip, Sneed received life in prison.

After Stitt did not order a new investigation into Glossip’s case, the lawmakers commissioned a review by a law firm. The pro-bono report, released last month, is based on a review of 12,000 documents, 36 witness interviews, seven juror interviews and other evidence.

It concludes that Glossip’s 2004 conviction “cannot be relied on to support a murder-for-hire conviction. Nor can it provide a basis for the government to take the life of Richard E. Glossip.”

Glossip’s attorneys have filed a motion seeking a new hearing on the basis of actual innocence, including witnesses they say were never called in previous hearings. The motion also seeks a hearing to look into who ordered a box of key evidence destroyed, claims of ineffective assistance of counsel, due process violations and testing indicating that Glossip is intellectually disabled.

They are also seeking documents from the Oklahoma County District Attorney’s Office related to the destruction of evidence as well as a videotape from a gas station near the crime scene they say was never handed over.

The law firm’s report quotes an Oklahoma City police officer and a former assistant district attorney talking about the evidence destruction, which included records that could have established whether Glossip embezzled money from the motel, as alleged by prosecutors.

Such claims frustrate the current district attorney, David Prater, a chatty, accessible official I’ve interviewed many times over the years about Oklahoma’s justice system.

Prater, who was not in office at the time the evidence was destroyed, said Glossip’s execution should proceed as scheduled and called the allegation that his office ordered the destruction “an outright lie.”

“There is no documentation as to that,” he said. “The DA’s office does not order the destruction of evidence in cases like that.”

Glossip and his attorney, Don Knight, declined interview requests. Knight said in a written statement provided to ProPublica that the execution should be delayed while the state appeals court reviews new information turned up in the report.

“Richard Glossip has been through three tortuous execution dates already. It does not serve justice to set a fourth execution date for an innocent man before all this new evidence can be fully considered in a court of law,” the statement said.

“Public reaction to this new evidence makes clear that Oklahomans, even those who support the death penalty, do not want to see an innocent man executed.”

Sister Helen Prejean, the anti-death-penalty activist who was portrayed in “Dead Man Walking,” said she plans to be at the prison to support Glossip in September, as she was on his three prior execution dates. (Glossip called Prejean before his first scheduled execution and asked if she would serve as one of his selected witnesses, as she had for six condemned men in other states.)

But Prejean predicts that day won’t come and says she plans to work feverishly to draw attention to his case and win a reprieve.

Sounding more like a publicity strategist than a nun, Prejean said the smartest approach involves letting the “conservative pro-death-penalty legislators” make the case for Glossip rather than celebrity activists who’ve supported Glossip and other condemned inmates.

“I know I have to do everything I know how to do to save the life of this man,” she said, adding: “When it looks like everything is signed, sealed and delivered what do you do? You go to the public and you raise questions.”

by Ziva Branstetter