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Some jump through hoops, metaphorically, to further their academic career. Finn McNamee jumps through hoops, literally, in the circus world.

After three years, the freeze on Medicaid insurance payments, put in place during COVID time, is ending. KC CARE Health Center wants patients to stay informed to avoid losing coverage. 

The lawsuit says the fee violates a provision of the Missouri Constitution limiting how much cities can tax its residents without voter approval.

“We would have had to spend a whole lot more money heading down a road we've been down before,” Rice said.

As the summer travel season approaches, new parents may be navigating airports with their babies — and the complexities of keeping them fed. Despite federal guidelines for airport agents laying out how to treat nursing moms, stories about problem encounters with security sometimes go viral. In 2023, actress and singer Keke Palmer said she was at Houston […]

The post A bipartisan push to make air travel easier for new parents packing breast milk and formula appeared first on Missouri Independent.

St. Louis City leaders are installing Narcan boxes citywide to combat the rising number of opioid overdoses, with the first two boxes installed at 1520 Market and near the main entrance at Soulard Market.

So far, 2024 is one of Missouri’s most active tornado seasons on record. The St. Louis region has been especially stormy, which means meteorologists at the local National Weather Service are busy. St. Louis Public Radio’s Kate Grumke spoke with Ben Herzog, the Science and Operations Manager at the National Weather Service St. Louis. They talked about what goes into tornado warnings and how they are changing.

by Vianna Davila

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.

Texas Attorney General Ken Paxton has repeatedly used the state’s powerful consumer protection laws to investigate organizations whose work conflicts in some way with his political views or the views of his conservative base, an analysis by ProPublica and The Texas Tribune found.

Paxton has been particularly aggressive among an increasing number of attorneys general who are using consumer protection statutes to investigate not only predatory lenders or unscrupulous car dealers but also political targets, experts say. ProPublica and the Tribune identified more than a dozen instances in the past two years in which Paxton has used the state’s consumer protection office to demand records from organizations with which he disagrees politically.

It’s unclear how many similar cases might be underway in Texas. The attorney general’s office told the news organizations it hasn’t consistently maintained a list of the division’s demands to examine records. The agency is also fighting to withhold certain records, citing state public information law exceptions.

The attorney general’s office did not respond to detailed questions about the investigations, including how many remained open.

AbbVie Inc. and Endo Pharmaceuticals Inc.

Date investigations began: February 2022

Stated basis for the investigation: In August 2021, then-state Rep. Matt Krause, a Republican who the same year launched an investigation into school library books that dealt with topics like sexuality and race, requested an opinion from the attorney general’s office about whether certain gender-affirming treatments, including puberty-blocking drugs, were akin to child abuse. After Paxton agreed that they were in a February 2022 nonbinding legal opinion, Gov. Greg Abbott directed the Texas Department of Family and Protective Services to investigate parents who authorized such medical care for their children. The next month, the attorney general demanded to review two pharmaceutical companies’ records, including a list of all hormone blockers they sold and notes from meetings with Texas health care providers discussing those products. Paxton said he wanted to determine if the drug manufacturers had “deceptively advertised and promoted” those hormone blockers without disclosing the potential risks to children and their parents.

Response: AbbVie and Endo Pharmaceuticals declined to comment for this story. In 2022, however, an Endo spokesperson told the Tribune that the company was cooperating with the attorney general’s investigation and did not promote its medications for off-label reasons, which can mean the drug is used for a medical condition it’s not approved by the Food and Drug Administration to treat.

Status: Paxton’s office did not answer questions about the status of the investigations.

GoFundMe

Date investigation began: February 2022

Stated basis for the investigation: The attorney general’s office launched an investigation of GoFundMe days after the company took down a $10 million fundraising campaign launched by Canadian truckers who were protesting vaccine mandates for drivers crossing the U.S. border. GoFundMe said it removed the campaign, which was raising money for truckers’ fuel costs, food and lodging, in response to law enforcement reports of violence connected to the protests. GoFundMe initially posted a statement in 2022 saying the company would refund donations upon request and donate any remaining funds to charities chosen by the event organizers. The company then decided to refund all donations in response to donor feedback. Paxton said in a news release he would investigate GoFundMe for initially planning to shift the funds to other charities.

Response: A GoFundMe spokesperson recently told ProPublica and the Tribune in an email that the company has “clear terms of service that outline acceptable use, and when a fundraiser violates those terms it is removed from our platform.” The spokesperson said the company cooperated with Paxton’s inquiry but did not elaborate on what that entailed.

Status: Paxton’s office did not answer questions about the investigation’s status.

Texas Bar Foundation, American Gateways, Equal Justice Center and Tahirih Justice Center

Date investigations began: May 2022 and November 2022

Stated basis for the investigation: Paxton’s Consumer Protection Division launched a probe into the nonprofit Texas Bar Foundation in May 2022, following allegations by Republican U.S. Rep. Troy Nehls, from Richmond, that the organization was donating to entities that encourage and fund illegal immigration. The foundation issues grants to nonprofits that work on legal issues, including those that provide assistance to underserved people, according to its website. Months later, Paxton launched investigations into three organizations that had received funding from the foundation: American Gateways, Equal Justice Center and Tahirih Justice Center. Paxton said his office was looking into whether the money the organizations received was “being used to exacerbate the current crisis at the border.”

Response: A spokesperson for American Gateways said the organization provides legal services for immigrants, refugees and victims of torture, including human trafficking survivors. The organization provided the attorney general’s office the records the state requested as part of its investigation, including correspondence with the Texas Bar Foundation, “which demonstrates our compliance under all laws,” the spokesperson wrote. A spokesperson for the Tahirih Justice Center declined to comment. The Texas Bar Foundation and Equal Justice Center did not respond to requests for comment.

Status: Paxton’s office did not answer questions about the status of the investigations.

Pfizer, Moderna and Johnson & Johnson

Date investigations began: May 2023

Stated basis for the investigation: Paxton demanded records that included any documents related to the marketing of COVID-19 vaccines in Texas from three pharmaceutical companies: Pfizer, Moderna and Johnson & Johnson. The attorney general wanted information related to their vaccine research, saying that he was investigating whether they misled the public about vaccine effectiveness and alleging that they potentially manipulated drug trial data. In a May 2023 news release explaining the investigations, Paxton raised questions about the money the companies stood to make from the vaccine as well as concerns about side effects. Months later, Paxton’s office sued Pfizer, accusing the company in a news release of “unlawfully misrepresenting the effectiveness of the company’s COVID-19 vaccine and attempting to censor public discussion of the product.” Pfizer’s lawyers filed a motion this March to dismiss the case in federal court, arguing in part that the attorney general can’t bring a claim under Texas’ consumer protection law because the consumers in this case got the vaccines from the federal government, not the state. “Congress has tasked FDA, not state officials, with deciding whether Pfizer’s vaccine is sufficiently safe and effective,” the lawsuit said.

Response: In a statement to the news organizations about the attorney general’s investigation, Pfizer said the company “is deeply committed to the well-being of the patients it serves and has no higher priority than ensuring the safety and effectiveness of its treatments and vaccines.” Moderna and Johnson & Johnson did not respond to requests for comment.

Status: Paxton’s office did not answer questions about the status of the investigations. A Pfizer spokesperson said the motion to dismiss Paxton’s lawsuit is pending.

Dell Children’s Medical Center

Date investigation began: May 2023

Stated basis for the investigation: In April 2023, right-wing activist group Project Veritas published a video that purported to show a social worker at Dell Children’s Medical Center in Austin saying the hospital provided gender-affirming treatment for children as young as 8. In a statement posted on social media at the time, Dell Children’s said hospital officials were reviewing the allegations and would take appropriate action “to the extent that care provided at our clinic may have been inconsistent with our organization’s position on this important issue.” Two weeks later, the attorney general’s Consumer Protection Division sent investigative demands to Dell Children’s, requesting a range of documents related to gender-affirming care, including information about the hospital’s use of puberty blockers for minors. The demand letter also asked the medical center to identify any people or organizations that hospital staff referred minor children to for counseling or treatment related to gender reassignment or gender transitioning. At the time, the treatment was still legal, but a proposed Texas law limiting the age when someone could receive gender-affirming care was making its way through the state Legislature. A week after Paxton launched his investigation, families of teenagers receiving gender-affirming care at the hospital said Dell Children’s had stopped offering those services. The hospital said in a statement that while its adolescent medicine clinic remained open, “the physicians who previously staffed the clinic will be departing.”

Response: Dell Children’s did not respond to an interview request.

Status: Paxton’s office did not answer questions about the investigation’s status or whether it remains open.

Texas Children’s Hospital

Date investigation began: May 2023

Stated basis for the investigation: Houston-based Texas Children’s Hospital said it would stop providing hormone therapy to transgender children after Abbott told the state’s child welfare agency in February 2022 to open investigations into parents who authorize gender-affirming care for their children. But City Journal, a magazine published by the conservative think tank the Manhattan Institute, reported in May 2023 that the hospital was providing those treatments. Paxton’s office then sent a demand letter to Texas Children’s Hospital for documents related to its gender-affirming care for minors. That care was still legal at the time, but state lawmakers passed legislation banning such treatment and sent it to the governor for final approval the same week Paxton launched his investigation. In anticipation of the measure going into effect on Sept. 1, 2023, Texas Children’s CEO told employees that the hospital would discontinue certain services, including hormone therapy. “As the largest pediatric healthcare provider in the nation, being unable to serve and support these children and families the way we have in the past is painful,” the message said.

Response: Texas Children’s Hospital declined to comment. At the time Paxton launched the investigation, a spokesperson for the hospital said in a statement that Texas Children’s “healthcare professionals have always and will continue to prioritize the care of our patients within the bounds of the law.”

Status: Paxton’s office did not answer questions about the investigation’s status.

Yelp

Date investigation began: September 2023

Stated basis for the investigation: Paxton was one of 24 attorneys general who sent a letter to the business search and review site Yelp in February 2023 alleging that the company misled customers. At issue was that Yelp had appended notices to pages for crisis pregnancy centers, which counsel clients against abortion, stating that the sites provided limited medical care. In response to the letter from the attorneys general, Yelp changed the notices to say the centers do not provide abortion or abortion services. On Sept. 26, 2023, however, Paxton’s office notified Yelp that it had launched an investigation and planned to sue the company for allegedly violating state consumer protection law because of the initial notices that were posted. (Paxton is the only attorney general who has investigated the company or filed a lawsuit over the crisis pregnancy center notices.) On Sept. 27, Yelp filed a preemptive lawsuit in federal court in California, where it’s headquartered, asking the court to prevent Paxton’s office from prosecuting the company. Yelp argued allowing the state to pursue a lawsuit would violate the First Amendment. The next day, Paxton filed the state’s lawsuit in Bastrop County in Texas.

Response: In a statement to the news organizations, a Yelp spokesperson said Paxton’s action against the company “sets a dangerous precedent by using the office and powers of a government official to politicize and punish speech on issues that he disagrees with, which in this case harms consumers looking for accurate information about reproductive healthcare.”

Status: The case continues to play out in the two states. In February, a state district court judge in Bastrop County Texas granted Yelp’s motion to toss the lawsuit. Paxton has appealed. Meanwhile, a federal judge in the California case denied Yelp’s request for an injunction and dismissed the company’s lawsuit. Yelp appealed, and the case is now pending in the 9th U.S. Circuit Court of Appeals. Paxton’s office did not answer questions about the status of its investigation.

Media Matters for America

Date investigation began: November 2023

Stated basis for the investigation: Media Matters for America, a progressive media watchdog nonprofit whose mission includes “correcting conservative misinformation,” published a report in November that found ads for major brands like Apple and IBM on the social media platform X were appearing alongside posts promoting antisemitic and white supremacist views. On Nov. 20, X owner Elon Musk filed a lawsuit in federal court in Texas against the nonprofit, arguing its report had disparaged the company. The lawsuit accused Media Matters of using filters on X to produce ad and content combinations it wanted to see. Paxton launched an investigation into Media Matters the same day, saying in a press release that his office was troubled by allegations that the nonprofit had “fraudulently manipulated data.” Within days of announcing his investigation, Paxton appeared on a conservative podcast and encouraged other attorneys general to pursue similar inquiries against the nonprofit. On Dec. 11, Missouri Attorney General Andrew Bailey, a Republican, opened a consumer protection investigation into the organization. He did not mention Paxton in a letter informing the nonprofit of the inquiry. On Dec. 12, Media Matters filed a lawsuit against Paxton in federal court, arguing the attorney general’s investigation violated the nonprofit’s First, Fourth and 14th amendment rights.

Response: Representatives from X did not respond to requests for comment, and spokespeople for Media Matters and Bailey declined to comment.

Status: The Missouri attorney general filed a lawsuit that is ongoing against Media Matters. On April 12, the federal judge in Media Matters’ case against the Texas attorney general granted the nonprofit’s request for a preliminary injunction, preventing Paxton from forcing it to turn over its documents. Paxton’s office did not answer questions about the status of the investigation, but his office has appealed the judge’s decision.

Seattle Children’s Hospital

Date investigation began: November 2023

Stated basis for the investigation: Paxton did not publicize that he’d requested records related to the hospital’s gender-affirming treatment of children who reside or used to reside in Texas as part of an investigation into the Washington-based hospital. The probe came to light after the hospital sued the attorney general in early December to block the release of patient records, arguing that handing them over would violate federal and state health care privacy laws. The hospital has said in legal filings that it had no staff members who treated transgender children in Texas or remotely.

Response: Neither the hospital nor Paxton’s office answered questions about the case.

Status: The hospital and Paxton’s office reached a settlement in April. As part of the settlement, the hospital agreed to withdraw its Texas business license. Paxton, in turn, agreed to drop the request for records.

QueerMed

Date investigation began: November 2023

Stated basis for the investigation: Paxton launched an investigation into the Georgia-based telehealth clinic related to its medical treatment of transgender minors. The attorney general’s office sent the clinic a demand for records on Nov. 17, the same day Paxton opened an inquiry into Seattle Children’s Hospital, according to a report published by the Houston Chronicle. The attorney general is fighting the release of the demand letter it sent seeking records from the telehealth clinic, citing exceptions when information is related to anticipated litigation. QueerMed founder Dr. Izzy Lowell told the Chronicle in January that the clinic served patients in nearly all 50 states but declined to discuss how the clinic worked with Texas patients specifically. She later told The Washington Post that the clinic stopped treating minors in Texas after the state banned gender-affirming care. The state demanded records dating back to January 2022, more than a year before the Texas law was in place.

Response: Lowell declined to comment for this story but told the Post in January that Paxton’s demand for transgender youths’ medical records was “a clear attempt to intimidate providers of gender-affirming care and parents and families that seek that care outside of Texas and other states with bans.”

Status: Paxton’s office did not answer questions about the investigation’s status or whether it remains open.

PFLAG Inc.

Date investigation began: February 2024

Stated basis for the investigation: PFLAG Inc., a national nonprofit that supports LGBTQ+ people and their families, was one of several organizations that, in July 2023, filed a lawsuit challenging Texas’ ban on gender-affirming care for minors. In an affidavit taken as part of the lawsuit, the nonprofit’s chief executive said that families with transgender and nonbinary adolescents were sharing their “contingency plans” at PFLAG chapter meetings in anticipation of the ban. “Those with the resources to move or seek care out of state have begun firming up their plans to do so, while the vast majority without those resources have been asking chapters for alternative avenues to maintain care in Texas,” the chief said. Paxton sent a letter to PFLAG in February asking for records related to those statements and alleging that the nonprofit had information about medical providers in the state who may have been committing insurance fraud. The attorney general accused health care professionals of providing gender-affirming care but disguising it as treatment for an endocrine disorder. PFLAG sued the attorney general’s office in state district court in Travis County on Feb. 28, asking a judge to determine the legality of his demands and for an injunction in order to withhold records. The following day, Paxton’s office issued a news release accusing the organization of hiding “incriminating documents.”

Response: Karen Loewy, a lawyer with Lambda Legal representing PFLAG, told the news organizations that the attorney general’s demand to review the nonprofit’s records was “an unlawful fishing expedition.”

Status: In March, a district court judge temporarily blocked the state from forcing PFLAG to turn over the records. The judge wrote in her order that PFLAG and its members could suffer harm, including limitations on their First Amendment rights to free speech and association and their Fourth Amendment right to be free from unreasonable search and seizure. Paxton appealed the ruling. The 3rd Court of Appeals, which is hearing the case, has issued a temporary order protecting PFLAG from Paxton’s demands for records. Paxton’s office did not answer questions about the status of the investigation.

Annunciation House

Date investigation began: February 2024

Stated basis for the investigation: Paxton demanded records from El Paso-based Annunciation House related to the nonprofit’s work with immigrants, alleging the organization operated as a stash house. Among the materials the attorney general requested were logs identifying immigrants who received services at the nonprofit going back more than two years. Annunciation House sued in state district court in order to get a ruling on which documents the nonprofit actually had to turn over. In response to the lawsuit, the attorney general’s office argued that the nonprofit forfeited its right to operate by failing to immediately allow access to all of its records. Annunciation House primarily serves people who turn themselves in to U.S. immigration officials and are then processed and released while they await their court hearings.

Response: Jerome Wesevich, an attorney representing Annunciation House, called Paxton’s claims about the nonprofit unfounded. He said Paxton’s ultimate goal with the investigation is to find “an excuse to harass and close Annunciation House.”

Status: In March, an El Paso state district judge temporarily blocked the attorney general’s efforts to obtain Annunciation House’s records and said the state must go through the court system to continue the investigation. On May 8, Paxton announced that he had filed a motion for a temporary injunction in El Paso County district court to stop Annunciation House’s “systemic criminal conduct” and again called for the 46-year-old charity to be shut down. On Friday, Annunciation House’s lawyers filed a motion to throw out the attorney general’s case. The nonprofit said in the legal filings that the probe has caused harm that is “not only imminent, it is ongoing.”

Spirit AeroSystems Holdings Inc.

Date investigation began: March 2024

Stated basis for the investigation: On March 28, the attorney general’s Consumer Protection Division contacted Spirit AeroSystems, a Boeing parts supplier, seeking documents and communications related to airplane product defects. The office’s request for records was part of an investigation after a door plug came off a Boeing 737 Max 9 plane in January, an event that forced an emergency landing. (Spirit makes fuselages and installs door plugs like the one that came off the plane.) The attorney general’s investigative letter also demanded records “that Spirit relies on to substantiate its claim that a diverse workplace improves product quality,” enhances performance and spurs the company to make better decisions. In a news release, Paxton’s office said his office was investigating “whether those commitments are unlawful or are compromising the company’s manufacturing processes.”

Response: A spokesperson for Spirit AeroSystems said the company does not comment on investigations but “is wholly focused on providing the highest quality products to all our customers, to include the Boeing Company.”

Status: Paxton’s office did not answer questions about the investigation’s status or whether it remains open.

"We're excited to offer a new venue for the older crowd. I'm not worried about the backlash from the age restrictions," the owner said.

by Vianna Davila

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 men knocked on the door of a two-story, red-brick building in downtown El Paso one chilly morning in February. When a volunteer answered, they handed her a document they said gave them the right to go inside and review records kept by Annunciation House, a nonprofit that for decades has served immigrants and refugees seeking shelter.

An employee phoned Ruben Garcia, the nonprofit’s director and founder, who was at one of the organization’s other properties. Feeling a calling to do more to help immigrants and other people experiencing poverty, Garcia was part of a small group that formed the nonprofit in the 1970s. He’s since become an unofficial historian of the migration patterns and political response to immigration and immigrants.

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But in his nearly five decades helming the nonprofit, Garcia had never encountered a situation like this. Standing on the organization’s doorstep were officials sent there by Texas Attorney General Ken Paxton’s Consumer Protection Division. They were demanding to come inside and search the nonprofit’s records, including all logs identifying immigrants who received services at Annunciation House going back more than two years.

“Is this a warrant?” Garcia recalls asking the group, which included an assistant attorney general and a law enforcement officer from the state agency.

It wasn’t. Still, the letter the men presented stated that the attorney general’s office had the power to immediately enter the building without one.

Consumer protection laws give attorneys general broad legal authority to request a wide range of records when investigating businesses or charities for allegations of deceptive or fraudulent practices, such as gas stations that hike up fuel prices during hurricanes, companies that run robocalling phone scams and unscrupulous contractors who take advantage of homeowners.

But attorneys general have increasingly used their powers to also pursue investigations targeting organizations whose work conflicts with their political views. And Paxton, a Republican, is among the most aggressive. “He’s laying out kind of like the blueprint about how to do this,” said Paul Nolette, an expert in attorneys general and director of the Les Aspin Center for Government at Marquette University.

An analysis by ProPublica and The Texas Tribune shows that in the past two years, Paxton has used consumer protection law more than a dozen times to investigate a range of entities for activities like offering shelter to immigrants, providing health care to transgender teens or trying to foster a diverse workplace.

Not a single one of the investigations was prompted by a consumer complaint, Paxton’s office confirmed. A complaint is not necessary to launch a probe.

The analysis is possibly an undercount. The attorney general’s office said it has not consistently maintained a list of the Consumer Protection Division’s demands to examine records and would need to review individual case files to determine how many requests had been sent. The agency also fought the release of certain records requested under Texas’ Public Information Act, citing exceptions for anticipated litigation.

Paxton’s office did not respond to requests for comment or to detailed questions. It also did not reply to a request to speak with the Consumer Protection Division’s chief.

Two attorneys representing nonprofits that Paxton recently targeted said they believe he launched the investigations simply to harass their clients and to cause a chilling effect among organizations doing similar work. Both said the attorney general’s demands violate the First Amendment, which guarantees the right to free speech, association and religion, and the Fourth Amendment, which offers protection against unreasonable search and seizure.

The political weaponization of consumer protection divisions by Paxton and other attorneys general appears to be “a core violation” of constitutional laws that runs counter to what these divisions were established to do, said Georgetown Law professor Michele Goodwin.

The offices were intended to protect the public, Goodwin said. “Instead,” she added, “what is taking place in these times are efforts that undermine the civil liberties and the civil rights of people who are the public in those states and the people who are in those states who are seeking to aid and assist the public.”

In the Annunciation House case, the attorney general’s office went even further by showing up at the nonprofit’s door and demanding to immediately review documents rather than sending its requests for records by mail and giving organizations weeks to respond, as it often has in other cases ProPublica and the Tribune examined.

Paxton’s office then denied the nonprofit’s request for additional time to determine what information it was legally required to turn over, prompting Annunciation House to sue. In response, the attorney general’s office argued in court documents that the nonprofit had forfeited its right to operate and publicly accused it of acting as a stash house for immigrants he alleges are in the country illegally.

The attorney general’s move to shutter Annunciation House drew swift rebuke from political and religious leaders, who said his characterizations of the nonprofit were a dangerous misrepresentation of the charity. Paxton’s actions also sparked concern as far away as the Vatican. In a recent interview with CBS News, Pope Francis called Paxton’s efforts “madness, sheer madness.”

“The migrant has to be received,” the pope said on the television news program “60 Minutes.” “Thereafter you see how you’re going to deal with them. Maybe you have to send them back. I don’t know. But each case ought to be considered humanely, right?”

Annunciation House primarily serves people who are processed and released into the U.S. by immigration officials. Garcia communicates daily with Border Patrol and other federal agencies that regularly ask for help finding shelter for people who turn themselves in to authorities or are apprehended but have nowhere to go while their cases are processed.

In March, an El Paso state district judge temporarily blocked the attorney general’s efforts to obtain Annunciation House’s records and said the state must go through the court system to continue the investigation. “There is a real and credible concern that the attempt to prevent Annunciation House from conducting business in Texas was predetermined,” the judge wrote in his order.

Even when Paxton doesn’t get speedy access to the documents he wants, he often publicizes these typically confidential cases, putting out news releases that draw headlines and build support among his base of hard-line conservatives.

The simple act of publicizing that he is pursuing an organization can cause irreparable harm, said Jerome Wesevich, an attorney who represents Annunciation House.

“Someone has to say what is the line between a legitimate investigation and harassment,” Wesevich said.

As the Annunciation House case progresses through the courts, Paxton has continued his public attacks on the nonprofit. On May 8, Paxton announced in a press release that he had filed a court injunction to stop what he called Annunciation House’s “systemic criminal conduct.” He then issued a warning to other nonprofits that assist immigrants, saying that those that are “complicit in Joe Biden’s illegal immigration catastrophe and think they are above the law should consider themselves on notice.”

He again called for the charity to be shut down.

Evolving Power

The consumer protection cases that Paxton and like-minded attorneys general are pursuing today are virtually unrecognizable from the historically bipartisan and apolitical ones their counterparts undertook even 20 or 30 years ago, said James Tierney, a former Maine attorney general.

“The people that the laws were designed for were working-class people who were getting ripped off when they bought a used car,” said Tierney, who directs the attorney general clinic at Harvard Law School. While many attorneys general still do that work, consumer protection laws are also increasingly “being used to obviously move social agendas.”

The push to protect consumers was among numerous social movements that began to materialize in the 1960s and 1970s as Americans demanded more government action in areas like civil rights and environmental justice. As a result, states began to adopt laws that gave attorneys general the ability to investigate potential fraudulent activity by businesses.

Federal and state institutions also started encouraging attorneys general to think of themselves as representing not only the state but also the people who lived there. “This shift was significant because by serving as the representatives of individuals and groups allegedly harmed by corporate conduct, AGs essentially became a form of class-action litigator,” Nolette, the Marquette professor, wrote in his book, “Federalism on Trial.”

Initially, attorneys general focused consumer protection investigations in their own states. By the 1980s, however, the scope of the investigations began to change as the attorneys general offices started to work across state lines to target large industries.

Perhaps the most notable example is the decision by all 50 state attorneys general to sue tobacco companies in the 1990s. They successfully argued the industry misled consumers about the dangers of cigarettes and other tobacco products and intentionally marketed them to children. The lawsuits resulted in billions of dollars in settlement money. More recently, attorneys general across the country pursued similar multistate suits against the opioid industry and pharmaceutical supply chain.

The power of attorneys general continued to grow through the decades as Congress passed measures that empowered states to enforce federal law and the courts interpreted ambiguities in the law in such a way that made it easier for states to sue under federal statutes.

A number of other court decisions unrelated to consumer protection further changed the role of attorneys general. As states found it easier to bring cases that are similar to class-action suits, the Supreme Court issued rulings in the early 2010s that made it harder for private litigants to do so. The decisions essentially drove those cases to attorneys general, Tierney said.

A 2014 Supreme Court decision that lifted limits on individual campaign contributions raised the stakes of attorneys general campaigns and created “a funnel for dark money to flow into every AG race,” Tierney said.

“The machine is up and running,” Tierney said, “and will continue to run unless someone figures out how to stop it.”

Stretching the Boundaries

Although Paxton has used consumer protection law to investigate a wide range of organizations with which he disagrees politically, he has perhaps most aggressively pursued those that provide or support gender-affirming care for minors.

Over the past two years, his office has launched at least six investigations into hospitals, pharmaceutical companies and an LGBTQ+ advocacy and support group, often demanding records that include sensitive patient information.

These investigations came amid a growing wave of conservative initiatives in Texas and across the country that have worked to chip away at the rights of transgender people. At least 25 states ban gender-affirming care for minors in some way, according to the Human Rights Campaign.

Texas was not among those states when, in August 2021, then-state Rep. Matt Krause, a Republican who the same year launched an investigation into school library books that dealt with topics like sexuality and race, wrote to Paxton asking for an opinion on whether gender-affirming care for children amounted to child abuse. In February 2022, Paxton issued a nonbinding legal opinion that said it did.

Days later, Gov. Greg Abbott directed the Texas Department of Family and Protective Services to investigate parents who authorized such treatment for their children, a move that spurred both condemnation — including from families, medical professionals and the White House — and fear across the state and country. These investigations are on hold following several court rulings.

As Abbott ordered the state agency to go after parents, Paxton began launching investigations into organizations that provide or support gender-affirming care for transgender minors.

One of those targeted entities was Dell Children’s Medical Center in Austin. In May 2023, one of Paxton’s Consumer Protection lawyers sent a letter to the hospital demanding documents related to the use of puberty blockers and counseling for transgender youth. Three weeks later, the same lawyer sent a letter seeking similar records from Texas Children’s Hospital in Houston. In a news release announcing the investigation, Paxton said his office was examining whether the facility was “unlawfully” providing gender transition care.

At the time that the letters were sent to the hospitals, a law preventing transgender minors from getting puberty blockers and hormone therapies was working its way through the Legislature. The law ultimately passed, but it did not go into effect until Sept. 1.

Dell Children’s did not respond to an interview request. Texas Children’s Hospital declined to comment for this story.

In the months that followed, Paxton went even further. He began to investigate organizations outside of Texas for their connections to gender-affirming care: Seattle Children’s Hospital in Washington state; QueerMed, a telehealth clinic based in Georgia; and PFLAG Inc., a Washington, D.C.-based national nonprofit that supports LGBTQ+ people and their families.

Seattle Children’s Hospital sued the attorney general in December to block the release of any patient records, arguing that handing them over would violate federal and state health care privacy laws. The hospital said in legal filings it had no staff that treated transgender children in Texas or remotely.

Paxton has not answered questions about why he decided to investigate out-of-state facilities, but in court filings in the Seattle case, the attorney general’s office argued it has the right to investigate the hospital and other organizations registered to do business in Texas. The demand letter sent to the hospital asked for records related to the facility’s gender-affirming treatment of children who reside or used to reside in Texas. (The news organizations filed a public information request for the investigative letter Paxton sent to QueerMed, but the attorney general’s office is fighting its release, citing exceptions when information is related to pending or anticipated litigation.)

What seems to unite all three cases is that the attorney general’s office under Paxton “is going to use consumer protection law to stretch the boundaries of what they can do to try to make transgender care as minimal as possible in Texas,” said Colin Provost, an associate professor of public policy at University College London whose research has included how attorneys general in the U.S. work together to enforce consumer protection laws.

Paxton and Seattle Children’s reached a settlement in April. As part of the deal, the hospital agreed to withdraw its Texas business license. In exchange, Paxton dropped his demand for records.

QueerMed founder Dr. Izzy Lowell declined to comment for this story. But the doctor said in an interview with The Washington Post that Paxton’s push to access transgender youths’ medical records was “a clear attempt to intimidate providers of gender-affirming care and parents and families that seek that care outside of Texas and other states with bans.”

PFLAG sued Paxton’s office in February after the attorney general demanded its records. In court filings, Paxton alleged that the nonprofit had information about medical providers in the state that may have been committing insurance fraud. The attorney general accused health care professionals of providing gender-affirming care but disguising it as treatment for an endocrine disorder.

A Travis County district court judge issued an injunction in March that temporarily blocked the state’s access to the records. In her ruling, she wrote that failing to stop the attorney general from getting these records could result in PFLAG and its members suffering harm, including limitations on their First Amendment and Fourth Amendment rights. Paxton appealed her ruling. The 3rd Court of Appeals, which is hearing the case, has issued a temporary order protecting PFLAG from Paxton’s demands for records.

Karen Loewy, a lawyer with Lambda Legal, which is representing PFLAG, said she remains baffled by the attorney general’s decision to use the state’s consumer protection law to investigate organizations like PFLAG, which provides resources to chapter support groups in the state.

“There's no consumer fraud happening here at PFLAG’s hands,” Loewy said.

Yet, she said, the attorney general appears to believe that he can send these demands to anyone his office thinks has information related to an investigation. In a court filing in response to PFLAG's lawsuit, Paxton’s office admitted it does not believe the nonprofit is violating the state’s consumer protection law, known as the Deceptive Trade Practices Act. The attorney general, however, argued in the filing that it can demand records of anyone, “not just those suspected of a violation.”

"The way in which the AG’s office has argued this already shows that they think that their power is unlimited,” Loewy said.

Sending a Message

Just as Paxton’s campaign against transgender care for minors has sent a chill through the network of people who provide this medical care, the impacts of the attorney general’s investigation of Annunciation House are reverberating throughout the community of people who work with migrants.

On Friday, Annunciation House’s lawyers filed a motion to throw out the attorney general’s case. Aside from arguing that Paxton’s claims about the organization are unfounded, the nonprofit said in the legal filings that the probe has caused harm that is “not only imminent, it is ongoing.”

Immediately after the attorney general officials showed up at the nonprofit’s offices in February, three Annunciation House volunteers quit, including the woman who answered the door. They worried the situation was “more unpredictable” than they could handle, Garcia said.

According to court records filed by Annunciation House attorneys, some volunteers have received threatening phone calls. The filings also state that the city of El Paso started stationing security guards at all of the nonprofit’s shelters “around the clock” to protect the people who are staying there.

“It’s scaring people from wanting to volunteer with us,” Garcia said. “It’s scaring people from wanting to work with the refugees.”

Las Americas Immigrant Advocacy Center, an El Paso-based nonprofit that works with Annunciation House and provides legal services to immigrants and refugees on both sides of the border, has not lost volunteers, but the organization’s executive director, Marisa Limón Garza, said people were rattled by the fact that employees from Paxton’s office showed up at a fellow nonprofit’s door demanding access.

“If it’s a letter in the mail, that’s one thing,” Limón Garza said. “But coming and trying to access the space, that’s a different level of state intervention that definitely sends a chilling effect. It sends a message.”

That message changed how Las Americas operates. It updated its security and technology systems at a cost of $25,000, money the nonprofit’s leadership hadn’t planned to spend, Limón Garza said. The organization also better secured its internal files, got new cellphones and laptops, and added new intercom and doorbell screening systems.

It no longer allows walk-ins.

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