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by Patrick Rucker, The Capitol Forum, and David Armstrong and Doris Burke, ProPublica

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

When Shawn Murphy’s wife died in 2009 after a botched gallbladder surgery, he presumed the doctor who performed the operation would be forced out of medicine for good.

Dr. Pachavit Kasemsap, a former Air Force surgeon, had cut Loretta Murphy’s aorta during that common procedure, according to a database of malpractice payments kept by Florida insurance regulators. She never left the hospital and died just shy of her 40th birthday. Shawn Murphy was left to raise their two daughters, then 13 and 17, on his own.

During the weeks that Murphy prayed for his wife to recover and the months that he fought Kasemsap in circuit court in Brevard County, Florida, he didn’t know that other families had complained that their loved ones had suffered under the same doctor’s care.

Kasemsap has settled five malpractice cases for a total of $3 million, according to the Florida malpractice payment database. That includes $1 million paid to the Murphy family. In one of the cases Kasemsap settled, a patient said the doctor negligently stapled and stitched her rectum to her vagina. Kasemsap denied doing that, and in legal filings in all five cases, the doctor denied that he was negligent.

The doctor’s LinkedIn profile says his last job as a surgeon ended in December 2012, months before he settled the last of those five cases. But there was one industry ready to welcome him regardless: health insurance.

Kasemsap got a job as an insurance company medical director, where suddenly he had the power to impact the lives of far more patients than he would ever have seen in the operating room.

For most policyholders, the inner workings of their health insurer are a black box: Requests to cover treatment or pay claims go in, and approvals or rejections are spit out.

The pivotal gatekeepers inside the box are medical directors like Kasemsap. They can, without ever seeing a patient, overrule the judgment of the doctor who did and deny payment for a recommended procedure, test or medicine.

Insurers say medical directors steer patients away from unnecessary or risky care and expensive treatments for which there are less costly, equally effective alternatives. Patients and their physicians complain that insurance company doctors routinely, and wrongly, deny payment for critical lifesaving treatments because they are expensive.

The stakes are high: A refusal to pay for treatment can drive families into bankruptcy. Some patients, facing the cost, forgo care altogether. And a single medical director can rule on 10,000 cases a year, according to court testimony in a case involving Aetna. Some Cigna doctors have ruled on more than 10,000 cases in a month without opening the patient file, as ProPublica and The Capitol Forum have reported.

Despite the key role insurers’ medical directors play in the lives of patients, their identities and backgrounds, and their qualifications for making such life-altering assessments, remain largely hidden.

Many states require medical directors to be licensed physicians, but beyond that it is generally up to insurers to determine which medical professionals are fit for the job.

Patients and the doctors who treat them don’t get to pick which medical director reviews their case. An anesthesiologist working for an insurer can overrule a patient’s oncologist. In other cases, the medical director might be a doctor like Kasemsap who has left clinical practice after multiple accusations of negligence.

As part of a yearlong series about how health plans refuse to pay for care, ProPublica and The Capitol Forum set out to examine who insurers picked for such important jobs.

Reporters could not find any comprehensive database of doctors working for insurance companies or any public listings by the insurers who employ them. Many health plans also farm out medical reviews to other companies that employ their own doctors. ProPublica and The Capitol Forum identified medical directors through regulatory filings, LinkedIn profiles, lawsuits and interviews with insurance industry insiders. Reporters then checked those names against malpractice databases, state licensing board actions and court filings in 17 states.

Among the findings: The Capitol Forum and ProPublica identified 12 insurance company doctors with either a history of multiple malpractice payments, a single payment in excess of $1 million or a disciplinary action by a state medical board.

One medical director settled malpractice cases with 11 patients, some of whom alleged he bungled their urology surgeries and left them incontinent. Another was reprimanded by a state medical board for behavior that it found to be deceptive and dishonest. A third settled a malpractice case for $1.8 million after failing to identify cancerous cells on a pathology slide, which delayed a diagnosis for a 27-year-old mother of two, who died less than a year after her cancer was finally discovered.

None of this would have been easily visible to patients seeking approvals for care or payment from insurers who relied on these medical directors.

When patients look for doctors, they can first check the physicians’ education, experience and qualifications. Most states allow consumers to see if doctors have been sanctioned by a medical board for providing substandard care, and many also provide some information about malpractice payments. But that kind of up-front scrutiny isn’t possible with medical directors because patients typically don’t learn their identity until a denial arrives.

Kasemsap’s history of malpractice payments was no secret before Cigna hired him in 2019. Two years earlier, he was the subject of a front-page story in the South Florida Sun Sentinel headlined “Dangerous Doctors.” In addition to handling appeals for the insurer, Kasemsap obtained a certification through a Cigna physician leadership program and oversees the work of 13 other medical directors there, according to his LinkedIn profile. Cigna CEO David Cordani posed with him and others in a photo at a recent company leadership event.

When told Kasemsap was working in this critical role, Murphy was shocked. “This guy should not be deciding medical questions,” he said. “I don’t care if it’s an earache.”

Kasemsap wrote in an email to ProPublica and The Capitol Forum: “Please know that I carry every patient outcome with me, and those experiences reinforced my commitment to being a compassionate, detail-oriented, dedicated colleague who puts our members at the center of everything I do.” Kasemsap said he was responding on his own behalf, not Cigna’s. He did not answer other questions about his malpractice cases or his role at the insurer.

Cigna, in a statement, said all of its medical directors are board-certified, credentialed physicians and the company holds its medical directors to the same standard as doctors who participate in its network. “We use a comprehensive suite of materials and discussions to assess how our medical directors support patients efficiently and effectively,” a company spokesperson wrote.

In another statement, the spokesperson wrote, “As I’m sure you’re aware, malpractice claims against physicians are common, particularly in high-risk specialties such as surgery, and the settlement of malpractice claims does not necessarily mean that malpractice occurred.”

Between 2005 and 2014, during the time when Kasemsap settled his malpractice cases, only 6% of doctors nationwide had any paid malpractice claims and only 1% had two or more paid claims, according to a study in the New England Journal of Medicine. A study in the same journal found that while surgeons were more likely to face a claim than physicians overall, less than 5% of general surgeons paid a malpractice claim each year between 1991 and 2005.

“I can say in my 35-plus years doing this that this is the most unskilled surgeon I have ever seen in a case,” said Mac McLeod, a malpractice attorney who represented two plaintiffs who sued Kasemsap, including the woman who said Kasemsap connected her rectum to her vagina.

When asked about McLeod’s assertion, Kasemsap wrote, “This is a mischaracterization of a highly complex medical case that occurred more than 15 years ago.” Kasemsap did not say what was mischaracterized.

A Doctor Goes Sleuthing

A few days before Christmas in 2021, Terrold Dance was loaded down with electrical tools when he slipped on some ice at a worksite and went to a Colorado hospital for help. An MRI later showed that Dance had torn his rotator cuff, the muscles and tendons that surround the shoulder joint and keep the upper arm bone in the socket.

Workers’ compensation paid for the scan and some physical therapy, but that didn’t fix the problem. By the next Christmas, Dance was still in pain and couldn’t fully raise his arm over his head. A Colorado orthopedic surgeon, Dr. Braden Jones, examined Dance and concluded that he needed surgery.

“The guy had not gotten better for a year,” Jones recalled. “It was a pretty clear-cut case for surgery.”

Pinnacol Assurance, the workers’ compensation company that handled Dance’s policy, required that the surgery be authorized in advance, and the company hired a medical reviewer named Dr. Jon Erickson to scrutinize Dance’s request and medical records. Like a medical director, a contract medical reviewer for Pinnacol evaluates whether a surgery is medically necessary. In a letter to a case manager, Erickson concluded that steroid injections and some physical therapy would likely be enough to fix Dance’s problem. Pinnacol denied the request for surgery.

“I believe the mechanism of injury is somewhat questionable,” Erickson wrote, “and we would be best served by considering a program of nonoperative care which involves injections.”

The letter baffled Jones. It downplayed Dance’s shoulder injury and brushed aside the MRI report, Jones said. Erickson didn’t cite any published research or medical society guidelines to explain why an operation was not needed. Jones said that the letter was such a break from accepted orthopedic practice that he wondered if Erickson had ever been a surgeon.

So Jones decided to check. The Colorado medical board had a copy of Erickson’s medical license and an explanation for why he hadn’t set foot in an operating room in many years.

A disciplinary report from the medical board said Erickson had performed a “substandard” hip replacement surgery in 2013 that led to irreparable harm to a patient. Erickson tried in three additional operations to fix it, the disciplinary report said, but the patient had to undergo a fifth surgery elsewhere and will always walk with a limp.

That wasn’t all. The report criticized Erickson for another faulty hip replacement six months after the first. The surgery had taken place on a Friday, and by Monday the same patient was back on the operating table with a broken hip. Erickson performed a second surgery but something was wrong. An X-ray showed the problem.

Erickson had put the hip in backwards.

In a 2017 settlement with the Colorado medical board, Erickson was allowed to keep his license as long as he never performed any kind of orthopedic surgery again. As a doctor reviewing cases for an insurer, though, Erickson has the power to decide that orthopedic operations are not medically necessary, when he himself is not allowed to perform them.

In an interview, Erickson defended his decision to deny Dance’s surgery and his work overall. “This was a relatively clear-cut case,” Erickson said. He added, “What we do at Pinnacol when we review these cases is prevent a lot of inappropriate care, and we save a lot of money for our clients.”

In a statement, Pinnacol said Erickson was contracted as an independent reviewer and that he did not work directly for Pinnacol. “He is not and has never been an employee,” a spokesperson wrote, adding that Pinnacol no longer uses Erickson to review cases. “Our mission as a not-for-profit, state-chartered carrier is to serve the workers and employers of Colorado, and we would never, nor do we support denying necessary medical care ‘to save our clients money.’”

The company said its claim denial rates are “roughly half the state average.” While Pinnacol is a nonprofit insurer, it does typically return money to its customers in the form of an annual dividend.

For Jones, the experience confirmed all of his worst suspicions about medical directors.

“If you have ever seen a Lego, you know which way the hip goes,” Jones said. “I always considered these medical directors to be sellouts, but I thought an insurance company would have more dignity than to hire someone like this.”

After Jones complained to Pinnacol about Erickson’s history and the wrongheaded nature of the denial, the insurer approved Dance’s rotator cuff surgery, which he underwent earlier this year. Dance has since regained full strength and motion.

Jones was so disturbed by what he discovered that he complained to the medical board. Chief among Jones’ beefs: If Erickson is not allowed to perform orthopedic surgery due to the board action, why is he allowed to rule on insurance cases that affect what orthopedic surgeons in good standing can do? The medical board acknowledged to Jones in a September letter that his complaint remained open but declined to comment to ProPublica and The Capitol Forum. Erickson said he thought Jones’ decision to file a complaint with the medical board “was a little bit overkill.”

Trouble With Medical Boards

Doctors turn to health insurance company work for many reasons. Some do it after burning out on clinical care or a change in circumstance, such as starting a family or retiring from a practice. Many find the work rewarding, saying they can help patients by flagging care that is unnecessary or even dangerous.

The job offers good pay with potential bonuses and a set schedule without weekend work or night shifts. The median pay for medical directors at insurers like UnitedHealthcare, Cigna and Elevance is around $300,000 a year, with the high end of the salary range over $400,000, according to the job site Glassdoor.

Despite this, ProPublica and The Capitol Forum found, insurance companies still wind up employing doctors who state medical regulators have rebuked for providing shoddy care or being dishonest.

A unit of Cigna called eviCore has employed Dr. Lorraine Driscoll as an associate medical director from 2006 through at least March 2022, according to records filed with the Maryland Insurance Administration. The New Jersey medical board in 2013 found grounds for disciplining Driscoll for “dishonesty, deception, and misrepresentation and/or … for engaging in professional misconduct.”

The board reprimanded Driscoll, an obstetrician-gynecologist, for altering patient records in ways that could help her fight a 2004 malpractice case involving a child born with Down syndrome. That case, which wound up settling for $700,000, was one of six that Driscoll settled, according to her application to be certified as a medical director by the Maryland Insurance Administration. (Maryland officials approved her application.) She did not respond to calls, emails or a letter with detailed questions sent via FedEx.

Other insurers, including Aetna and UnitedHealthcare, hire eviCore to determine whether certain treatments are medically necessary.

When asked if Driscoll still works for eviCore, a company spokesperson declined to answer. In a written statement, eviCore said its medical directors are all board-certified physicians “who are dedicated to ensuring that patients receive safe, effective care guided by the latest clinical evidence.” The company added that its doctors “are held to the same legal, licensing and education requirements that physicians treating patients are held to.”

Aetna has on its in-house team Dr. Beth Ann Binkowski, an internal medicine physician who was censured and reprimanded by the New York state medical board in 2015 for failing to appropriately prescribe medications for five patients at Syracuse University with mental health conditions. Binkowski referred a reporter to Aetna for comment. A company spokesperson said all Aetna medical directors are licensed and board certified and that the company follows accreditation requirements and state and federal regulations.

UnitedHealthcare hired Dr. Dolores Rhymer-Anderson as a medical director in 2015 despite the fact that the Georgia medical board had previously reprimanded her for care related to the delivery of a baby born with severe neurological damage in 2000. She settled a related malpractice lawsuit for $2 million. In a legal filing in that malpractice case, Rhymer-Anderson denied that she was negligent and said she exercised the appropriate degree of care and skill ordinarily employed by doctors in the same circumstance.

A peer reviewer appointed by the medical board faulted Rhymer-Anderson for failing to conform to the minimum standard of acceptable and prevailing medical practice. As part of an agreement with the board in 2006, she was required to complete 20 hours of continuing medical education and pay a fine of $1,500. The board order stated Rhymer-Anderson did not acknowledge any impropriety and agreed not to contest the allegations to avoid protracted litigation.

Rhymer-Anderson excluded obstetrics from her practice before the board order, blaming the move on her experience with the lawsuit, according to a regulatory filing. She said she hoped to avoid another legal action.

But in 2008 she was sued again and settled the case for $1 million. That lawsuit faulted her work during a diagnostic procedure to evaluate a patient’s uterus. The patient went into respiratory distress and suffered a brain injury from lack of oxygen. The patient spent a month in the hospital before being transferred to a long-term care facility. The lawsuit accused Rhymer-Anderson of incorrectly administering anesthesia, failing to properly supervise a nurse assisting and failing to secure an airway by endotracheal tube.

In her application to be certified as a medical director in Maryland, Rhymer-Anderson said she settled because the plaintiff was estimating the cost of future care at $16 million, which exceeded her malpractice insurance, and she was concerned a jury award could put her personal assets at risk. She said in the Maryland filing that three expert witnesses concluded that she met the standard of care in the case. In a court filing in that case, Rhymer-Anderson said she acted within the standard of care in treating the patient and did not commit any act of negligence that resulted in injuries. (Maryland officials approved her application.)

Settlements of $1 million or more, referred to as catastrophic claims, are rare. Only 7.6% of claims saw settlements that large in a study of malpractice cases filed nationwide from 1992 through 2014. The same study found the average malpractice payment by doctors in Rhymer-Anderson’s specialty was $432,959.

Rhymer-Anderson did not respond to phone calls, emails and a letter with detailed questions sent via FedEx.

A UnitedHealth Group spokesperson said Rhymer-Anderson left the company last year. The spokesperson also wrote, “Medical directors go through a rigorous hiring process, to ensure they are qualified for the roles for which they are being considered.” He added, “We review individual performances regularly and provide ongoing training to help them with their various responsibilities.”

“Cranking Out Denials”

When an insurer shoots down a request to pay for care, the patient’s doctor can call the insurance company’s doctor to make the case for why it should be approved. This is known as a peer-to-peer review.

But doctors often complain they’re not actually speaking with peers when they call an insurer. They get exasperated when an orthopedic surgeon weighs in on a procedure to treat an irregular heartbeat or a pediatrician questions an oncologist’s plan for an adult with lung cancer.

In a survey conducted by the American Medical Association, only 2% of the doctors who responded said that health insurance medical directors were “always” appropriately qualified to assess the requested treatment. More than a third said health plan doctors were “rarely” or “never” qualified.

When Orrana Cunningham’s doctor at the MD Anderson Cancer Center in Houston asked her insurer to approve the use of expensive proton beam therapy to attack her cancer, the decision on whether to pay for the care fell to an Aetna doctor who had not treated patients in more than 20 years, according to records from a lawsuit the Cunningham family brought against Aetna.

Dr. David Massman, a medical director at Aetna, denied coverage of the treatment, ruling that it was “experimental or investigational.”

Cunningham’s radiation oncologist, Dr. Clifton Fuller, then requested a peer-to-peer call so that he could explain why proton beam therapy was the best method for treating Cunningham’s stage IV nasopharyngeal squamous carcinoma, a rare cancer located at the base of her skull. Proton beam therapy was needed, he said, because it could precisely deliver radiation to the cancer site while avoiding devastating side effects, such as loss of sight and memory, that could occur with other radiation treatments.

It was a complex procedure. Fuller wanted someone with a background in treating cancer to be on the call. Instead, he was paired with Massman, a family medicine physician who had never worked in radiation oncology and had never seen a proton beam machine.

Massman went to work for health insurers two decades ago after his Illinois medical license was placed on a four-year probation for issues related to a drug addiction, according to state licensing records. His license is in good standing now.

In their peer-to-peer call, Fuller testified in a sworn deposition, Massman acknowledged Fuller may be right that proton beam therapy was a safe treatment for Cunningham but said he “can’t do anything about it” because the therapy did not comply with an Aetna clinical policy guideline.

Appeals of the decision failed. In all, three Aetna medical directors reviewed the treatment request and subsequent appeals. None of them were radiation oncologists.

As the appeals dragged on, Cunningham grew sicker. Out of options, her husband decided to mortgage the family home and sell other assets to pay for the $92,000 treatment.

Cunningham underwent the procedure in April 2015, four months after her doctors first asked Aetna to approve it. When she returned home in May, she started to behave strangely. She didn’t recognize her husband or son. She was diagnosed with herpetic encephalitis, a disease that her family’s attorney contended was unrelated to the cancer treatment and triggered by stress. She died later that month.

Cunningham’s husband sued Aetna in Oklahoma state court, alleging that the insurer breached its contract with his wife, acted in bad faith and inflicted emotional distress.

At the trial, Massman testified that he could not recall details of his peer-to-peer call with Cunningham’s radiation oncologist, but he said that he would never tell a treating physician that they were right about a treatment Aetna was denying.

In his closing arguments at the trial, Cunningham’s lawyer, Doug Terry, condemned Aetna’s medical directors: “These doctors were not properly qualified to know the first thing about the medical issues involved here. None of them had any experience with radiation oncology or proton therapy. They were cranking out denials as fast as they could.”

Aetna’s lawyer countered that the company was proud of the medical directors who denied Cunningham’s care for “standing up for what is right.” Massman and other Aetna medical directors involved in denying Cunningham’s care sat in the front row as the company’s lawyer made his closing argument, said Terry.

The jury in 2018 awarded Cunningham’s estate and her husband $25.6 million. After Aetna appealed the jury verdict, the parties settled the case under confidential terms in 2021.

Massman did not respond to calls, emails and a letter with detailed questions sent via FedEx.

In a statement, Aetna said its “sympathies continue to be with the Cunningham family.” It said that today any clinical reviews or peer-to-peer conversations related to proton beam therapy are conducted by board-certified radiation oncologists. The company did not answer a question about efforts more generally to match specialists to the treatment requested.

“Frequent Flyers”

A small group of doctors — about 2%, termed “frequent flyers” by one study author — are responsible for 40% of medical malpractice claims in the country.

It’s unusual for doctors to make payments in multiple malpractice cases, and that can signal that a physician is providing low-quality care. In Florida, the state health department is mandated to investigate any doctor who has had three or more claims in excess of $50,000 within a five-year period.

In 2013 Dr. John Stripling stopped working as a urologist, according to a deposition he gave in a product liability case. Around that time he faced medical malpractice lawsuits from patients in two states who alleged he botched enlarged prostate procedures.

In total, Stripling settled cases with 11 former patients between 2014 and 2017 with a combined payout of $3.6 million, according to Florida Department of Health records. After receiving “malpractice information,” the Arkansas State Medical Board told Stripling in 2015 that he would have to appear before the board if he wanted to renew his license, which was expiring. He never did.

Stripling was able to maintain his license in Florida, state records show, and he began working for health insurers in 2016, according to his LinkedIn profile. His most recent job, his profile said, was as a medical director for naviHealth, a unit of UnitedHealth Group’s Optum business, where he weighed in on placements of patients released from the hospital. A UnitedHealth Group spokesperson said Stripling left naviHealth in March.

A 2014 lawsuit filed in Arkansas state court by Larry Stanley, a patient of Stripling’s, alleges that dozens of the doctor’s patients in that state and Mississippi experienced severe and unacceptable complications when the doctor performed a procedure known as transurethral laser ablation of the prostate, or TULAP. The procedure uses a laser to treat an enlarged prostate, which can otherwise cause problems with urinating.

The lawsuit alleged that a nurse who worked with Stripling reported to another urologist that 40 of Stripling’s patients who underwent the TULAP procedure experienced “unprecedented complications.” The office manager and head nurse in Stripling’s practice were so alarmed by the high rate of complications that they went directly to the chief executive officer of the company Stripling worked for, according to Stanley’s lawsuit.

After Stanley’s TULAP procedure with Stripling in 2010, he was left incontinent, had to use catheters to drain his bladder and underwent additional surgeries, according to Stanley’s suit. In a court filing in that case, Stripling denied that he was negligent or at fault. The lawsuit was dismissed after both sides said they had resolved the matter, but the court records don’t provide any additional detail. Stanley died in 2019. His son Greg recalled his father received about $300,000 in a settlement.

A steelworker in his younger years, Larry Stanley had later owned and operated a sawmill for 40 years. Greg Stanley said his father was a changed man after the surgery. He rarely left home, worried he would have wet spots on his clothes.

“This doctor butchered him,” Greg Stanley said.

In a 2012 deposition in a malpractice case in Mississippi, Stripling said he stopped doing the laser prostate operation on Dec. 7, 2010, when he had a “coming-to-Jesus meeting” with himself and concluded “this is it.” At least eight of the settlement payments made in his malpractice cases involved incidents that occurred in 2010, according to the licensing records.

Stripling said in the deposition that too many of his patients “were doing poorly” after their operations. “There was something flawed in what was being done; and I didn’t have a clear answer, but it was time to make a decision,” he said. He testified that he went back to performing an older procedure that didn’t involve a laser.

That Mississippi case later settled for $305,000, according to Florida state medical licensing records. In a court filing, Stripling said he complied with the standard of care and was not negligent in his treatment of the patient.

Stripling did not respond to phone messages, emails and letters with detailed questions sent via FedEx. The UnitedHealth Group spokesperson reiterated that the company’s medical directors go through a rigorous hiring process, that their performance is regularly reviewed and that the company provides ongoing training.

Another “frequent flyer” was Cigna’s Kasemsap, who settled five malpractice suits after denying in court filings that he was negligent.

It was in November 2006, during a colostomy reversal surgery, that Kasemsap allegedly connected a 42-year-old woman’s vagina to her rectum, according to a malpractice complaint filed in state court in St. Augustine, Florida. The mistake caused air and feces to pass through the vagina, and the patient had to undergo three more surgeries, according to the complaint.

A month later, according to allegations in another lawsuit, Kasemsap mistakenly cut a patient’s common bile duct and an artery during a gallbladder surgery. A jury found him negligent in that case and awarded the patient $600,000. Kasemsap and the patient subsequently agreed to settle the case.

Kasemsap’s malpractice insurer made another payment to a patient who said in a lawsuit that he had suffered from a mild case of hemorrhoids that Kasemsap wrongly diagnosed as a far more serious case. The doctor then negligently performed a 2007 surgical procedure that left the patient with “constant, severe physical pain and suffering, incontinence and irritation,” the complaint said.

Kasemsap settled two more malpractice cases for incidents in 2009, including one filed by Loretta Murphy’s family after her death, court records show.

Kasemsap started working for insurers in 2013, according to his LinkedIn profile, which boasts about his contributions to companies’ financial health.

As a senior medical director at Highmark, a Blue Cross Blue Shield plan, he claimed credit for saving $3 million a year by removing high-cost specialty drugs from automatic authorization, his profile said. He also said he saved the company $15 million by initiating step therapy in the treatment of macular degeneration. Step therapy generally requires patients to try less expensive treatments before more expensive ones. (When asked about Kasemsap’s profile, a spokesperson for Highmark wrote, “We can’t speak to how Dr. Kasemsap categorizes his work. Medical directors use evidenced-based guidelines and the unique clinical picture of each member’s case to render medical necessity decisions only, which is agnostic of cost.”)

Since late 2019, Kasemsap has worked at Cigna, where he not only has reviewed treatment requests but has also managed other medical directors who handle Medicare Advantage requests for care, according to his LinkedIn profile. Kasemsap has thrived in his role at Cigna, and the company made him part of its Physician Leadership Development Program, which provides business and leadership skills.

Kasemsap’s success at Cigna came as a bitter surprise to the Murphy family.

When Loretta Murphy’s daughter Amanda Cain was young, her mother would play beauty parlor with her. Murphy would do Amanda’s hair like she learned in cosmetology school, and Amanda would paint her mother’s nails — purple with pink and white flowers.

“Her favorite flower was hibiscus, so I would always try that on the toes,” said Cain, who ended up pursuing her own career in cosmetology.

A photo in a family album shows Loretta Murphy kissing her daughter Amanda Cain when Cain was a little girl. Murphy died when Cain was 17. (Greg Kahn, special to ProPublica)

Cain was a junior in high school when her mother went to Kasemsap to get her gallbladder removed. The procedure was only supposed to take about an hour. When more than an hour passed, Cain started to get nervous. Her grandparents were in the waiting room and eventually took her home to look after her younger sister.

The next time Cain saw her mother, she was lying in a hospital bed with a machine helping her breathe.

Murphy died a year before Cain graduated from high school. It was just one of many life events her mother never got to witness, including the birth of Cain’s two children.

That Kasemsap has any say in the well-being and health of vulnerable people is maddening, Cain said.

“What do you say about anyone that would hire this guy knowing what they know?” she asked. “How, how would they still hire him?”

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by Asia Fields, ProPublica, and Becca Savransky, Idaho Statesman

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

It’s no secret that Idaho’s school buildings have problems. The state’s superintendents, maintenance directors, teachers and students see the leaks, pack into crowded hallways and feel the extreme cold and heat throughout the year. But state officials don’t know the extent of the issues because the last full review of school buildings was completed in 1993.

The Idaho Statesman and ProPublica joined forces to explore the deteriorating conditions and the consequences for students and teachers. To identify patterns, we worked with communities to bring together data, documentation and visual evidence from across the state. We spoke to as many people as we could, and visited dozens of schools, to see what conditions were like on the ground.

Here’s what we did.

We surveyed all 115 superintendents in the state and heard from 91% of them. Our data team helped design a survey inviting them to identify significant challenges in their districts. We first showed it to a small group of district leaders, who helped us anticipate and address potential concerns. In May, the state’s association of school administrators shared the link with its members, and regional leaders encouraged them to fill out the survey. We followed up with our own introductions and sent reminders throughout the year.

Our goal was to hear from every public school district so we could analyze how widespread facilities issues were and identify which respondents faced the most serious problems. All but nine responded: Arbon Elementary, Bliss, Council, Culdesac, Mullan, Pleasant Valley, Teton County, Troy and Whitepine. (Prairie Elementary did not complete the survey but provided information in an email.)

The responses came in from May 26 through Dec. 8. Most were filled out by current superintendents or facilities directors, but 14 have since left their positions or changed districts. At least a dozen superintendents shared assessments performed for them by firms or contractors.

Every district said it had at least one problem that posed a significant challenge or required major repairs, and 78% said they had five or more. Twenty percent said they had 10 or more problems. These are the problems, along with the percentage of superintendents who said they had them:

• Heating – 68%
• Cooling – 67%
• Roof – 61%
• Accessibility for people with disabilities – 58%
• Security (locks on classroom doors, secure entrances, etc.) – 58%
• Bathrooms – 58%
• Windows – 55%
• Leaky plumbing, walls, windows or roof – 50%
• Structural issues like cracks in the walls or foundation – 41%
• Traffic safety (at street crossings, in parking lots or in drop-off areas) – 38%
• Electrical (lighting problems, power going out, tripping breakers, etc.) – 35%
• Asbestos – 31%
• Overcrowding or use of portable buildings for extra space – 28%
• Fire and emergency preparedness – 26%
• Outdated technology or equipment – 16%
• Inadequate Wi-Fi – 10%
• Drinking water – 10%
• Other – 9%

Only 4% of superintendents thought they would be able to address the issues in the next year, while 20% said they may be able to.

When asked what was preventing them from addressing facilities problems, 88% mentioned funding.

We also asked superintendents about how they would rate the physical conditions of their schools. Not all respondents rated every school in their district, but together they rated 677 schools and said 21% were in poor condition, 41% were in fair condition and 38% were in good condition. Thirty-five percent said at least one-fourth of their schools were in poor condition.

We heard from 233 students, parents, teachers and others. In April, we published a callout. We wanted to talk to those most likely to be affected by facilities issues, such as people with disabilities or those in the most rural and remote corners of the state — where communities may not come across our online publications.

Dozens of Facebook and Reddit moderators supported our efforts to reach groups of educators, parents or residents in certain parts of Idaho. We spoke about our efforts at a meeting of the state’s special education advisory panel and handed out flyers at a conference for school administrators. The Idaho Education Association shared our callout with 10,000 members and asked for 200 flyers to put up in schools. Students and recent graduates told their friends about the callout while the Idaho Business for Education and the American Institute of Architects Idaho sent it to their members. Some local media outlets also helped spread the word, including Ben Reed with 99.1 La Perrona, who shared the Spanish translation of our callout.

Teachers helped us hear from students. Moscow High School English teacher Rachel Lyon shared essays from her students. Ninth grade student Natasha Gartstein wrote, “The Moscow High School has been in use for nearly 90 years. That’s before the Kardashians, Michael Jackson, and even the Beatles.”

We also worked with artist Pia Guerra to draw illustrations of five students, two educators and a parent to help bring their stories to life.

Diego Hernandez, a 10th grade student at Canyon Springs High School, told us, “The look of the school is kind of deteriorating. … Just walking in and seeing something that looks like this is almost depressing.” (Pia Guerra for ProPublica)

We were given tours of 39 schools from maintenance directors, superintendents or principals. Maintenance staff were able to show us the problems going on behind the walls, which students and educators sometimes couldn’t see, along with the patches they’d used because they couldn’t afford a permanent fix.

During our school visits, we met with students and educators. At six of these schools, we spoke to classes and met with the student government or student media groups. We explained our project and passed out notecards for students to write what they liked about their buildings, what they would change and the impact issues had on them. They often said they appreciated their teachers, who made do with the state of their buildings, and were proud to go to the same schools as their parents and grandparents. But we overwhelmingly heard about facilities problems. It was clear that students were aware of how school funding worked, with some explaining recent bond elections in their community.

ProPublica and Idaho Statesman reporters asked students to write what they liked about their buildings, what they would change and the impact issues had on them. These responses came from Leila Guffey, a senior at Kamiah High School, and Diego Hernandez, a 10th grader at Canyon Springs High School. (Asia Fields/ProPublica)

In some districts, we brought a camera that produces instant prints so students could show us the issues in their school buildings from their own perspectives. We received dozens of photographs back.

Idaho Statesman and ProPublica reporters brought a camera that makes instant prints to school visits so students could show the problems in their schools. Students documented a deteriorating locker at Kamiah High School, leaky ceilings at Moscow High School, and bathroom drains bulging up from the floor at Canyon Springs High School. (Courtesy of Kamiah, Moscow, and Canyon Springs students)

We verified the information. Before publishing, we reached out to the people who shared information with us to collect more details. We checked those accounts with the district to hear their responses and any updates on the conditions.

Nearly every example that made it into our story was something that the districts agreed was an issue. In a few cases where the district disagreed with parts of a student or community member’s account, we noted that in the story.

If you’d like to get in touch with our team, you can email idahoschools@propublica.org. If you’re an educator who might be interested in using our project in your classroom, we’re happy to assist however we can. If you’re interested in classroom materials or updates about this project, send us an email.

If you want to talk to us about schools in another location, you can use our general tip line at propublica.org/tips. We can’t guarantee that we’ll be able to follow up on everything, but we review everything we receive.

After the biggest companies used mergers a decade ago to dominate, now the lower-tier competitors are getting into the game. But they face headwinds from federal regulators.

by Asia Fields, ProPublica, and Becca Savransky, Idaho Statesman, illustrations by Pia Guerra for ProPublica

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

No other state spends less on school infrastructure per student than Idaho. As a result, many students, especially those in rural districts, deal with leaking ceilings, freezing classrooms and discolored drinking water. Some students have to miss school when the power or heat goes out.

School districts often can’t build or repair buildings because Idaho is one of only two states that require two-thirds of voters to approve a bond. Some districts have held bond elections several times only to see them fail despite having support from a majority of voters. But the Legislature has been reluctant to make significant investments in facilities. Administrators say they don’t know how they’ll keep their schools running and worry that public officials don’t understand how bad the problems are.

Idaho hasn’t done an official assessment of school building conditions in 30 years. The Idaho Statesman and ProPublica tried to fill this gap with the help of people who know the system best. We surveyed all 115 public school district superintendents, and 91% responded. Every superintendent who responded said they have at least one facilities problem that poses a significant challenge, and 78% told us they have five or more. Then, we went to communities across the state. Thirty-nine schools took us on tours, often led by district maintenance directors. We also collected stories and photographs from 233 students, parents, educators and others, who described how the conditions affect their lives.

Read more about our survey and outreach efforts.

“Communities show what is valuable by what we build,” said David Reinhart, West Ada School District’s chief operations officer. “When our students are in old and run-down buildings, it signals to them that what they do in school is of little value.”

“It makes school less enjoyable, harder to focus,” said Luke Sharon, a senior at Lake City High School in Coeur d’Alene.

“The kids see it,” said Amy Eslinger, who graduated from Emmett High School in 2009. “I grew up knowing how bonds and levies worked but never saw them pass and watched myself and my peers suffer from it.”

Here’s what students and educators across the state told us about the floods and leaks, overcrowding and inaccessibility, safety and security flaws, structural deficiencies and heating and cooling problems that impact every part of their day.

Discolored Water, Falling Ceiling Tiles, Ruined Projects

50% of Idaho superintendents we heard from said leaks pose a significant challenge or require major repairs, while 61% said they had problems with their roofs and 58% said the same about bathrooms.

“The leak made us feel like there was yet another way our school is falling apart. We were also sad because something like this could damage our precious instruments that we most certainly could not replace for a long time due to cost.”

—Laura Woras, music teacher, Idaho City Middle/High School, Basin School District

Laura Woras’ music classroom has flooded two years in a row.

Woras went to drop off supplies in her Idaho City classroom during spring break in 2022 and found the area around her desk flooded and hot water shooting out of a wall. It destroyed the floor pillows she had bought for students to sit on while playing their instruments. The next year, it happened again. The superintendent told us the old pipes spring leaks once a month and need replacement.

Separately, the school struggles with leaks from its fire sprinkler system. A levy that would have fixed this failed to pass in November.

Video of Woras’ classroom flooding (Courtesy of Laura Woras)

Watch video ➜

Evidence of water damage on the wall months after the second leak (Asia Fields/ProPublica)

“Something is always falling apart in our school district.” —Natalie Kulick, science teacher, Idaho City Middle/High School, Basin School District

In Kulick’s class, multiple leaks have sent water pouring down the walls, destroying cards from former students, workbooks, papers and posters.

“The previously leaking roof hadn’t been addressed due to budgetary constraints. Due to the heavy snow and already bad roof, it caused the ceiling to collapse. We’re hoping the repairs will hold until we can figure something else out about replacing the whole roof.” —Jason Moss, superintendent, Grace Joint School District

“In one area, after a particularly hard snow was melting, the custodians rigged up a tarp across the ceiling to catch all the leaks and funnel them into garbage cans and plastic totes that they could dump,” Moscow School District middle school teacher Cyndi Faircloth said.

(Courtesy of Rachel Aiello)

“At Post Falls Middle School, class would be moved to a different room temporarily because a tile from the ceiling had collapsed due to water damage. Sometimes we would carry on anyway and ignore it.” —Grey Goodwin, 2023 Post Falls High School graduate, Post Falls School District

The district said it has since repaired sections of the roof.

Water damage to the ceiling in the Caldwell School District, first and second image, and the Basin School District, third image. Ceiling tiles are falling in the Plummer-Worley School District’s high school gym, fourth image, which we also saw in two other districts. (First image: Courtesy of Bernie Carreira. Second image: Asia Fields/ProPublica. Third image: Asia Fields/ProPublica. Fourth image: Asia Fields/ProPublica.)

The land that the Basin School District’s schools sit on used to be a pond that had been dredged by miners. During spring runoff, the elementary school floods.

Superintendent Brian Hunicke shows how high the water goes when it floods. (Asia Fields/ProPublica)

Spring runoff goes under the building, creating a musty smell. “My first year here I thought it was a dead mouse.” —Jill Diamond, principal, Potlatch Elementary School, Potlatch School District

“There’s a room that you can’t even go in on a rainy day, because it just smells terrible.” —Michelle Tripp, principal, Ross Elementary School, Kuna School District

“The water is loaded with iron and tastes terrible.” —Scott Davis, Kootenai superintendent. (The district scraped together grants and donations to add a filtered bottle fill station to each building.)

“Old buildings with lead in pipes.” —Mark Kress, Snake River superintendent. (The district said it has mitigated lead levels in drinking water and tests the water monthly.)

“Concerns with drinking water have caused us to get water delivered. … Some of the water is colored in some of the classroom sinks.” —Allen Mayo, Shoshone-Bannock administrator

“We have had to bring in port-a-potty restrooms when plumbing systems have failed.” —Matt Diel, facilities director, Lake Pend Oreille School District

Bathroom drains at Canyon Springs High School, an alternative school in the Caldwell School District, are “popping up out of the ground” because of old rusty piping that has shifted, said Bernie Carreira, the district’s maintenance director.

Bathrooms at Canyon Springs High School. Idaho Statesman and ProPublica reporters brought a camera that makes instant prints to school visits so students could show the problems in their schools. (Courtesy of Canyon Springs students)

Classes in Stairwells and Closets

28% of superintendents we heard from said overcrowding or use of portable buildings is a significant challenge. 58% said accessibility for people with disabilities poses a significant challenge or requires major repairs.

“The first two or three minutes of passing, it’s sardines.”

—Tracy Donaldson, vice principal, Kuna High School, Kuna School District.

Donaldson described the crowded hallways. The high school was designed for about 1,400 students, but it serves about 1,900, according to the district.

“Our biggest concern is lack of space. We are using 18 modular classrooms at Rigby High School.” —Chad Martin, superintendent, Jefferson County School District

The district has been relying on portable buildings because there is a shortage of space.

“Underclassmen without cars are forced to eat on the floor in the halls due to the lack of space in the cafeteria.” —Claire Yoo, 2023 alum, Idaho Falls High School, Idaho Falls School District

The school was built for 900 students but serves about 1,250, according to the district. The cafeteria accommodates about 200 students.

Moscow High School has 814 students but room for only about 100 in the cafeteria.

The cafeteria at Moscow High School doesn’t even fit all students who get free and reduced lunch through the school. (Asia Fields/ProPublica)

At Heyburn Elementary in the St. Maries School District, a stairwell at the front entrance was turned into the music classroom.

(Asia Fields/ProPublica)

Photo class is held in a former storage room in the Plummer-Worley School District.

(Asia Fields/ProPublica)

“Most high school PE classes are not able to use the gym most of the time since it’s too small. … Not enough fields were built on campus for the number of students we have now.” —Natasha Gartstein, ninth grade student, Moscow High School, Moscow School District

As a result, the district has to transport students to nearby parks and the University of Idaho for physical education, cutting into class time. On one busy week in the fall, the district had 28 bus trips from the school.

At Heyburn, a teacher’s lounge is in an old locker room, where showerheads are still attached to the wall.

(Asia Fields/ProPublica)

About half of superintendents said they have buildings that aren’t compliant with the Americans with Disabilities Act.

Schools built before the act have some flexibility in meeting the requirements.

“He can’t ever really just be free to explore because he could tip over the edge. … I think there’s a lot of learning that kids get when they can freely explore their world. My little guy doesn’t get that.”

—Marisa Smith, mother of a second grade student, Discovery Elementary School, West Ada School District

Marisa Smith’s son, Tug, uses a wheelchair and is legally blind. He can’t access the playground unless teachers carry him because it has wood chips and a steep drop from the curb. After reporters reached out, the district said it would make some improvements. But the playground would still have wood chips, which are difficult to navigate in a wheelchair.

“We typically have to move students with physical disabilities out of their neighborhood school to a newer school that can better accommodate their physical needs.” —Wendy Johnson, superintendent, Kuna School District

“It’s kind of just really embarrassing. … I oftentimes would fall out of my wheelchair and hurt my knees again.” —Ammon Tingey, 2023 alum, Highland High School, Pocatello-Chubbuck School District

Ammon Tingey described climbing up and down stairs every day to get to honors classes while he was supposed to be using a wheelchair after an injury. He said he was discouraged from taking the classes because they were on the bottom floor and the school didn’t have an elevator. The district did not list accessibility as an issue in its survey. It said it offers more than one section of honors courses, and there would have been another option for students to access on the main floor. The school also has a wheelchair lift in one section of the building.

Fire Risks, Power Outages, Security Flaws

58% of Idaho superintendents we heard from said security poses a significant challenge. 31% said asbestos does and 26% said fire and emergency preparedness do.

“My heart was racing because I’ve heard in the news of things like this happening. … It’s just hard to think what if this would have been real and there actually was someone there and they made a mistake like this. We were like sitting ducks.”

—Bryn Bowersox, 10th grade student, Moscow High School, Moscow School District

Bryn Bowersox was in PE class earlier this year when the school went into lockdown because of a shooting threat. The announcement couldn’t be heard in the gym, and the door didn’t lock securely, according to the district. Bowersox said the class learned of the threat late when a teacher received a message on his phone. The district has since installed new announcement systems and purchased new locks.

Superintendents across the state were able to make some security upgrades with a state grant created this year that provided each school with up to $20,000, but many said it wasn’t enough to fully secure their older schools.

“Not all students can hear the public announcements, and not all classroom teachers can easily communicate with the office.” —Superintendent *

“We have no secure entries and high concerns for many ‘what if’ security scenarios.” —Superintendent, referring to the main entrances*

*We are not naming the superintendents or their districts to avoid exposing security concerns.

A fire broke out at Highland High School in the Pocatello-Chubbuck School District earlier this year and destroyed the cafeteria, gym and band rooms.

The building had previously failed a fire inspection, but the district said that the alarm system was still operational. During the fire, the school’s sprinklers went off, but the alarm didn’t activate. The district said it has since serviced alarms at all of its schools. The damage will be covered by insurance, but the district ran a bond election in November hoping to expand and upgrade the school while rebuilding. The bond measure failed, despite garnering 56% of votes.

The Highland High School gym was ravaged by a fire. (Pocatello Fire Department, obtained by ProPublica and Idaho Statesman)

“The elementary has no fire suppression system.” —Brian Hunicke, Basin superintendent

“Don’t have a sprinkler system for fires.” —Scott Davis, Kootenai superintendent, about two of the district’s three schools

“Does not have a functioning fire control system.” —David Sotutu, superintendent of New Plymouth School District until June, about the sprinklers in the district’s career technical education building

The boiler at Canyon Springs High School is covered in a material that contains asbestos fibers. (Sarah A. Miller/Idaho Statesman)

“The middle school is loaded with asbestos.” —Scott Davis, superintendent, Kootenai School District

The asbestos is not exposed but makes what would otherwise be simple repairs and upgrades challenging and expensive, Davis said.

“A student plugged their laptop into one of these outlets. There was a pop, a spark.” —Jennie Withers, teacher, Meridian Middle School, West Ada School District

An electrical outlet at Meridian Middle School (Courtesy of Jennie Withers)

“The kids know it will flicker once, and then they’re waiting. They’re like, ‘OK,’ and it’ll flicker twice, and then they’re like, ‘OK, three times.’ … If it hits the third time, then it’s going to be out for a while — and they know that.” —Brian Hunicke, superintendent, Basin School District

Hunicke said the district had eight power outages last year, and its generator only covers refrigeration, the computer server and emergency lights.

Some districts have also had challenges making Wi-Fi work in their older buildings.

“Some days the Wi-Fi will just stop working. This means that some teachers who rely on PowerPoints or internet access can’t continue with what they had planned for that day.”

—Reesa Loewen, senior, Kamiah High School, Kamiah School District

Jill Patton, principal of Pioneer Elementary School in the Salmon School District, said students have been kicked off the internet in the middle of state exams because of the building’s poor Wi-Fi.

At Caldwell’s Syringa Middle School, the breaker trips if a heater and the microwave are turned on at the same time.

(Sarah A. Miller/Idaho Statesman)

Deteriorating Foundations and Falling Bricks

41% of Idaho superintendents we heard from said structural issues like cracks in the walls or foundation pose a significant challenge or require major repairs.

“The look of the school is kind of deteriorating. … Just walking in and seeing something that looks like this is almost depressing.”

—Diego Hernandez, 10th grade student, Canyon Springs High School, Caldwell School District

Caldwell Superintendent N. Shalene French said all 10 of her district’s schools are in poor condition. At Canyon Springs, an alternative school that students describe as deteriorating, about 80% of students are people of color, and more than 96% come from low-income households.

“The foundation is crumbling. … You keep up with what you can; you can’t fix a crumbling foundation.” —Troy Easterday, superintendent at Salmon School District

“Foundation and wall cracks are worrisome.” —Joe Steele, superintendent at Butte County School District

“We know there is probably a crack in the foundation; however, with no money to fix it, we are left to just simply prepare for heavy rains as much as possible and to devote extra time to clean up efforts.” —Megan Sindt, superintendent at Avery School District

First image: Peeling paint and water-damaged ceiling tiles at Canyon Springs High School in the Caldwell School District. Second image: A classroom in the nearly 90-year-old section of Lakeside High School in the Plummer-Worley School District. (First image: Sarah A. Miller/Idaho Statesman. Second image: Asia Fields/ProPublica.)

“The state of our buildings, particularly the outer buildings, is embarrassing. … School should be a place of security and a place to be proud of.” —Jennie Withers, teacher, Meridian Middle School, West Ada School District

“Holes in the walls, leaks, exposed wires — they are distracting.” —Leila Guffey, senior, Kamiah High School, Kamiah School District

At Kamiah High School in the Kamiah School District and other schools we visited, students told us that their schools’ appearance affected how they viewed their schools and themselves.

Wires hanging from the ceiling and a deteriorating locker at Kamiah High School in the Kamiah School District. Kamiah Superintendent Paul Anselmo said exposed wires and pipes make the school look “like a warehouse.” (Courtesy of Kamiah High School students)

Bricks have cracked and pieces have fallen out at Jefferson Middle School in the Caldwell School District.

They haven’t hit anyone, but it’s a potential hazard, said Bernie Carreira, the Caldwell maintenance director. (Sarah A. Miller/Idaho Statesman) A cracked and settled sidewalk caused by poor water drainage and corrosion at the base of a steel entry column at Stephensen Elementary in the Mountain Home School District. (Obtained by ProPublica and Idaho Statesman from a 2020 assessment by a structural engineering firm)

Schools also have structural issues with windows, which were listed as a problem by 55% of superintendents we heard from.

In three districts, teachers or superintendents reported that windows have fallen out. In another, the deteriorated windows allow bats to make their way into the high school two to three times each fall.

“Bats come in through the window casings. … We keep the ‘bat net’ handy at all times.” —Janet Williamson, superintendent, Camas County School District

Blankets, Coal Boilers and Poor Ventilation

68% of Idaho superintendents we heard from said heating poses a significant challenge or requires major repairs. 67% said the same for cooling.

“It’s extremely hard to focus on schoolwork while shivering.”

—Kendall Edwards, ninth grade student, Moscow High School, Moscow School District

Edwards said some rooms are freezing in the winter. Frank Petrie, Moscow’s maintenance director, said heating is a challenge because of antiquated systems.

“Even as a kid in elementary school, I knew that it probably wasn’t normal to have to wear coats inside occasionally.” —Ali Johnson, 2021 alum, Capital High School, Boise School District

“I know one teacher who keeps a stack of blankets in his room so kids can cover up while he teaches.” —Cyndi Faircloth, teacher, Moscow Middle School, Moscow School District

Brian Hunicke, superintendent at Basin School District, told us that at Idaho City Middle/High School, the heat didn’t work about 10 times last year, not including during power outages. When it happens, students “suffer for about a day” before the district can get someone in to fix it.

“The district is still using coal to heat buildings. The coal creates dirty air outside the buildings, and depending on wind direction it can unintentionally compromise indoor air quality. As we have looked for ways to improve air quality, we recognize that dirty air can impact those with compromised immunity and asthma.” —Shane Williams, superintendent, West Jefferson School District

Coal boilers have become increasingly rare in schools and homes across the country over the past few decades.

Coal used to heat the Swan Valley School District elementary school (Courtesy of Michael Jacobson)

Russell Elementary School in the Moscow School District has a boiler from when the school opened in 1926. If it were to break down, it would be hard to find replacement parts, the district said.

(Asia Fields/ProPublica)

Heat is also a problem when school starts in the late summer, educators say.

It’s “sweltering.” —Janet Avery, Potlatch superintendent

“Over 100 degrees in the fall and late spring” inside. —Robyn Bonner, head teacher at Peck Elementary in the Orofino School District

“Melting in the hot conditions.” —Erin Heileman, teacher at Morningside Elementary School in the Twin Falls School District

“It gets so hot in the afternoon that students start to put their head down. … It makes it difficult to teach kids.” —Gerald Dalebout, social studies teacher at Moscow High School in the Moscow School District

“There is no ventilation in that school, and it does not meet any EPA standards for fresh air intake or carbon dioxide levels, which were tested by the district.” —Ken Eldore, facilities director until June, Priest River Junior High School, West Bonner School District

Another administrator also told us about the levels, but interim superintendent Joseph Kren, who was hired in October, said he couldn’t find a record of a test.

“Emmett Middle School lacks adequate ventilation, which I believe is a contributing factor to high levels of flu and illness.” —Craig Woods, superintendent, Emmett School District

Emmett High School’s air quality is better than the middle school’s after upgrades, but is still “not up to today’s required air circulation standards,” according to its superintendent.

Emmett High School (Sarah A. Miller/Idaho Statesman) 88% of superintendents we heard from mentioned that funding is preventing them from addressing facilities problems.

Districts have cobbled together funds to make some improvements over the years. Administrators said federal COVID-19 relief dollars allowed them to replace expensive HVAC systems and roofs. But that money is nearly gone.

Many superintendents said they felt hopeless about ever passing a bond to renovate or replace schools, especially since funding other educational needs is already a challenge. Districts also regularly ask voters to approve supplemental levies to cover some salaries and operating costs that go beyond state funding.

“Rural school districts can’t pass bonds to build new facilities,” said Todd Shumway, superintendent of the North Gem School District. “It only takes a few to defeat a bond.”

Not passing a bond means districts not only worry about maintaining their buildings, but also about what would happen if a gas line shuts down, the boiler stops working or the sewage system fails. And it means that as Idaho faces a teacher shortage, qualified educators can look across state borders at modern schools in better-funded districts — and decide to leave the state behind.

Kuna School District is building a second high school to relieve overcrowding, but it needs more funding to complete it. A bond measure to do this failed in March despite 56% of voters supporting it. District officials say they may have to consider going to school year-round or in split shifts if the student body continues to grow. (Asia Fields/ProPublica)

Design and development by Anna Donlan.

Opener image sources: Asia Fields/ProPublica; Sarah Miller/Idaho Statesman; courtesy of Kamiah High School students; courtesy of Moscow High School students; courtesy of Bernie Carreira; Pocatello Fire Department, obtained by ProPublica and Idaho Statesman

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