a Better Bubble™
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In 2018, Darryl Young was hoping for a new lease on life when he received a heart transplant at a New Jersey hospital after years of congestive heart failure. But he suffered brain damage during the procedure and never woke up.
The following year, a ProPublica investigation revealed that Young’s case was part of a pattern of heart transplants that had gone awry at Newark Beth Israel Medical Center in 2018. The spate of bad outcomes had pushed the center’s percentage of patients still alive one year after surgery — a key benchmark — below the national average. Medical staff were under pressure to boost that metric. ProPublica published audio recordings from meetings in which staff discussed the need to keep Young alive for a year, because they feared another hit to the program’s survival rate would attract scrutiny from regulators. On the recordings, the transplant program’s director, Dr. Mark Zucker, cautioned his team against offering Young’s family the option of switching from aggressive care to comfort care, in which no lifesaving efforts would be made. He acknowledged these actions were “very unethical.”
ProPublica’s revelations horrified Young’s sister Andrea Young, who said she was never given the full picture of her brother’s condition, as did the findings of a subsequent federal regulator’s probe that determined that the hospital was putting patients in “immediate jeopardy.” Last month, she filed a medical malpractice lawsuit against the hospital and members of her brother’s medical team.
The lawsuit alleges that Newark Beth Israel staff were “negligent and deviated from accepted standards of practice,” leading to Young’s tragic medical outcome.
Defendants in the lawsuit haven’t yet filed responses to the complaint in court documents. But spokesperson Linda Kamateh said in an email that “Newark Beth Israel Medical Center is one of the top heart transplant programs in the nation and we are committed to serving our patients with the highest quality of care. As this case is in active litigation, we are unable to provide further detail.” Zucker, who is no longer on staff at Newark Beth Israel, didn’t respond to requests for comment. His attorney also didn’t respond to calls and emails requesting comment.
Zucker also didn’t respond to requests for comment from ProPublica in 2018; Newark Beth Israel at the time said in a statement, made on behalf of Zucker and other staff, that “disclosures of select portions of lengthy and highly complex medical discussions, when taken out of context, may distort the intent of conversations.”
The lawsuit alleges that Young suffered brain damage as a result of severely low blood pressure during the transplant surgery. In 2019, when the federal Centers for Medicare and Medicaid Services scrutinized the heart transplant program following ProPublica’s investigation, the regulators found that the hospital had failed to implement corrective measures even after patients suffered, leading to further harm. For example, one patient’s kidneys failed after a transplant procedure in August 2018, and medical staff made recommendations internally to increase the frequency of blood pressure measurement during the procedure, according to the lawsuit. The lawsuit alleges that the hospital didn’t implement its own recommendations and that one month later, “these failures were repeated” in Young’s surgery, leading to brain damage.
The lawsuit also alleges that Young wasn’t asked whether he had an advance directive, such as a preference for a do-not-resuscitate order, despite a hospital policy stating that patients should be asked at the time of admission. The lawsuit also noted that CMS’ investigation found that Andrea Young was not informed of her brother’s condition.
Andrea Young said she understands that mistakes can happen during medical procedures, “however, it’s their duty and their responsibility to be honest and let the family know exactly what went wrong.” Young said she had to fight to find out what was going on with her brother, at one point going to the library and trying to study medical books so she could ask the right questions. “I remember as clear as if it were yesterday, being so desperate for answers,” she said.
Andrea Young said that she was motivated to file the lawsuit because she wants accountability. “Especially with the doctors never, from the outset, being forthcoming and truthful about the circumstances of my brother’s condition, not only is that wrong and unethical, but it took a lot away from our entire family,” she said. “The most important thing to me is that those responsible be held accountable.”
ProPublica’s revelation of “a facility putting its existence over that of a patient is a scary concept,” said attorney Jonathan Lomurro, who’s representing Andrea Young in this case with co-counsel Christian LoPiano. Besides seeking damages for Darryl Young’s children, “we want to call attention to this so it doesn’t happen again,” Lomurro said.
The lawsuit further alleges that medical staff at Newark Beth Israel invaded Young’s privacy and violated the Health Insurance Portability and Accountability Act, more commonly known as HIPAA, by sharing details of his case with the media without his permission. “We want people to be whistleblowers and want information out,” but that information should be told to patients and their family members directly, Lomurro said.
Andrea Young, Darryl’s sister, is now suing the hospital for medical malpractice in her brother’s death. (Demetrius Freeman for ProPublica)The 2019 CMS investigation determined that Newark Beth Israel’s program placed patients in “immediate jeopardy,” the most serious level of violation, and required the hospital to implement corrective plans. Newark Beth Israel did not agree with all of the regulator’s findings and in a statement at the time said that the CMS team lacked the “evidence, expertise and experience” to assess and diagnose patient outcomes.
The hospital did carry out the corrective plans and continues to operate a heart transplant program today. The most recent federal data, based on procedures from January 2021 through June 2023, shows that the one year probability of survival for a patient at Newark Beth is lower than the national average. It also shows that the number of graft failures, including deaths, in that time period was higher than the expected number of deaths for the program.
Andrea Young said she’s struggled with a feeling of emptiness in the years after her brother’s surgery. They were close and called each other daily. “There’s nothing in the world that can bring my brother back, so the only solace I will have is for the ones responsible to be held accountable,” she said. Darryl Young died on Sept 12, 2022, having never woken up after the transplant surgery.
A separate medical malpractice lawsuit filed in 2020 by the wife of another Newark Beth Israel heart transplant patient who died after receiving an organ infected with a parasitic disease is ongoing. The hospital has denied the allegations in court filing. The state of New Jersey, employer of the pathologists named in the case, settled for $1.7 million this month, according to the plaintiff’s attorney Christian LoPiano. The rest of the case is ongoing.
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.
When Hurricane Helene, the 420-mile-wide, slow-spinning conveyor belt of wind and water, drowned part of Florida’s coastline and then barged its path northward through North Carolina last week, it destroyed more than homes and bridges. It shook people’s faith in the safety of living in the South, where the tolls of extreme heat, storms and sea level rise are quickly adding up.
Helene was just the latest in a new generation of storms that are intensifying faster, and dumping more rainfall, as the climate warms. It is also precisely the kind of event that is expected to drive more Americans to relocate as climate change gets worse and the costs of disaster recovery increase.
Researchers now estimate tens of millions of Americans may ultimately move away from extreme heat and drought, storms and wildfires. While many Americans are still moving into areas considered high risk, lured by air conditioning and sunny weather, the economic and physical vulnerabilities they face are becoming more apparent.
One study by the First Street Foundation, a research firm that studies climate threats to housing, found that roughly 3.2 million Americans have already migrated, many over short distances, out of flood zones, such as low-lying parts of Staten Island, Miami and Galveston, Texas. Over the next 30 years, 7.5 million more are projected to leave those perennially flooded zones, according to the study.
All of this suggests a possible boom for inland and Northern cities. But it also will leave behind large swaths of coastal and other vulnerable land where seniors and the poor are very likely to disproportionately remain.
The Southern United States stands to be especially transformed. Extreme heat, storms and coastal flooding will weigh heavily on the bottom third of this country, making the environment less comfortable and life within it more expensive and less prosperous.
The young, mobile and middle class will be more likely to leave to chase opportunity and physical and economic safety. That means government — from local to federal — must now recognize its responsibility to support the communities in climate migration’s wake. Even as an aging population left behind will require greater services, medical attention and physical accommodation, the residents who remain will reside in states that may also face diminished representation in Congress — because their communities are shrinking. Local governments could be left to fend alone, but with an evaporating tax base to work with.
In December, the First Street Foundation created one of the first clear pictures of how this demographic change is unfolding. It looked at flood risk and migration patterns down to the census tract, across the country, and identified hundreds of thousands of so-called abandonment zones where the out-migration of residents in response to rising risk had already passed a tipping point, and people were making small, local moves to higher ground.
The research contains plenty of nuance ⎯ cities like Miami may continue to grow overall even as their low-lying sections hollow out. And the abandonment areas it identified were scattered widely, including across large parts of the inland Northeast and the upper Midwest. But many of them also fall in some of the very places most susceptible to storm surges from weather events like Helene: Parts of low-lying coastal Florida and Texas are already seeing population declines, for instance.
In all, the First Street report identified 818,000 U.S. census blocks as having passed tipping points for abandonment ⎯ areas with a combined population of more than 16 million people. A related peer-reviewed component of the organization’s research forecasts that soon, whole counties across Florida and Central Texas could begin to see their total populations decline, suggesting a sharp reversal of the persistent growth that Florida has maintained as climate pressures rise, by the middle of this century.
Such projections could turn out to be wrong ⎯ the more geographically specific such modeling gets, the greater its margin of error. But the mere fact that climate research firms are now identifying American communities that people might have to retreat from is significant. Retreat has not until recently been a part of this country’s climate change vernacular.
Other research is putting a finer point on which Americans will be most affected. Early this year Mathew Hauer, a demographer at Florida State University who has estimated that 13 million Americans will be displaced by rising sea levels, was among the authors of a study that broke out what this climate-driven migration could mean for the demographics of the United States, examining what it might look like by age.
Hauer and his fellow researchers found that as some people migrate away from vulnerable regions, the population that remains grows significantly older. In coastal Florida and along other parts of the Gulf Coast, for example, the median age could increase by 10 years this century — far faster than it would without climate migration.
This aging means that older adults — particularly women, who tend to live longer — are very likely to face the greatest physical danger. In fact, there is notable overlap between the places that Hauer’s research suggests will age and the places that the First Street Foundation has identified as the zones people are abandoning.
The exodus of the young means these towns could enter a population death spiral. Older residents are also more likely to be retired, which means they will contribute less to their local tax base, which will erode funding for schools and infrastructure, and leave less money available to meet the costs of environmental change even as those costs rise. All of that is very likely to perpetuate further out-migration.
The older these communities get, the more new challenges emerge. In many coastal areas, for example, one solution under consideration for rising seas is to raise the height of coastal homes. But, as Hauer told me, “adding steps might not be the best adaptation in places with an elderly population.” In other places older residents will be less able and independent, relying ever more on emergency services. This week many of Helene’s victims have simply been cut off, revealing the dangerous gaps left by broken infrastructure, and a mistaken belief that many people can take care of themselves.
In the future authorities will have to adapt the ways they keep their services online, and the vehicles and boats they use, in order to keep flooded and dangerous places connected. Such implications are worrisome. But so is the larger warning inherent in Hauer’s findings: Many of the effects of climate change on American life will be subtle and unexpected. The future demographics of this country might look entirely unfamiliar. It’s past time to give real thought to who might get left behind.
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