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Many school districts on the Missouri side of the river start school Monday, including the largest school district in St. Louis County, the Rockwood School District.

The dangerous heat is here, and it’s sticking around. We hit 100 on Sunday, and some areas saw heat index values above 115.

The shutdowns, beginning at 10:30 p.m. Monday and Tuesday, are to allow patching of the driving surface.

In rural Warren County, west of St. Louis, a clogged court system means serious problems for people facing charges and for public safety.

In the marijuana industry, they say potency is king.  Producers all over the country are competing to put the most intoxicating product on the shelves. And that can leave the labs who test these products in a tough spot. At least, that’s been the case in California and other states where marijuana is legal, said […]

The post Missouri cannabis regulators target ‘lab shopping’ in new rules appeared first on Missouri Independent.

It is August, a time for new beginnings, infused with hope even amid anxiety and trepidation. August is rarely thought of as a time of new beginnings and reflection. But just think about it. Vacations are ending. It’s harvest time for farmers. Kids, young and old alike, are beginning or returning to school. August is […]

The post What you hope for determines what you work for appeared first on Missouri Independent.

America’s pharmaceutical giants are suing this summer to block the federal government’s first effort at drug price regulation. Last year’s Inflation Reduction Act included what on its face seems a modest proposal: The federal government would for the first time be empowered to negotiate prices Medicare pays for drugs — but only for 10 very […]

The post A peek at big pharma’s playbook that leaves many Americans unable to afford their drugs appeared first on Missouri Independent.

by Marcus Baram, Documented, with data analysis by Agnel Philip, ProPublica, and Lam Thuy Vo, special to ProPublica

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

Saprina James was hopeful when she received a letter in 2019 about her wage theft claim against her former employer. The letter said the New York State Department of Labor had substantiated her claim and ordered Mugisha F. Sahini and his company, Riverside Line, to pay her more than $70,000 in back wages. “I was feeling good that the government was on my side, and that I would soon get paid,” she said.

James first started driving a van for Sahini in January 2016, taking people to medical appointments in Buffalo, New York. She often worked six days a week, usually helping dialysis patients who relied on walkers, and drove clients from 4:30 a.m. until 10 p.m. She didn’t mind the long hours — she assumed that her pay would ultimately reflect her hard work.

But James had to lease a Toyota minivan for $700 a week as part of the job. On most weeks, after paying her leasing fee, she was left with less than minimum wage.

“It was very hard for me,” said James, who had a difficult time paying her rent and groceries, as well as taxes owed on her income as an independent contractor.

In late 2017, James quit and filed a wage theft claim with the Department of Labor, accusing Sahini and Riverside Line of violating the minimum wage law. She was later joined by her former co-workers, who also claimed minimum wage violations.

The agency substantiated the workers’ claims two years later, ordering Sahini to pay nearly $425,000 in back wages and $850,000 in penalties.

But the Department of Labor, which is responsible for both investigating wage theft claims and recovering back wages, has not been able to collect even a penny on behalf of James. Sahini flatly refused to pay for more than a year, James said, and then appealed the case, claiming that he wasn’t aware that the workers were earning less than minimum wage. The appeal has since been rejected, but James has yet to receive any payment.

About to turn 60, James said she’s now unemployed and running through her savings to pay her bills. “I’m so upset,” she said. “This is ridiculous. I don’t understand why it takes so long.”

Sahini did not respond to repeated requests for comment.

What happened to James is strikingly common among victims of wage theft in New York state, an investigation by Documented and ProPublica found. She and her former co-workers are among thousands of wage theft victims whose employers were ordered by the Department of Labor to pay, but for whom the agency failed to fully recover back wages, according to an analysis of the agency’s database of wage theft violations from 2017 through 2021.

In all, during the five-year period, the agency determined that at least $126 million in wages had been stolen from workers, the analysis shows. As of Feb. 21, however, the agency still needed to recover about $79 million of that total — or about 63% of the back wages.

Of the outstanding back wages, the agency hadn’t recovered at least $7.8 million because of “uncollectible” circumstances, such as businesses going bankrupt or investigators being unable to track down employers, the analysis shows.

The rest, about $71 million, was labeled by the agency as “pending payment,” which means either that no payments or only partial payments had been made, or that the cases were being appealed.

Of the thousands of businesses in the database, at least 95 with outstanding back wages were repeat offenders, each failing to fully pay in at least two cases during the five-year period, the analysis shows.

A case in point: The agency began investigating Brooklyn-based Reymond Construction in 2018 and opened three additional cases in 2019 based on claims filed by 12 workers. It eventually ordered the company to pay more than $31,950 in back wages, but as of Feb. 21 the payments were still pending. The owner of Reymond Construction did not respond to repeated requests for comment.

Labor experts said it’s hard to compare New York’s wage recovery effort against those of other states because of the paucity of wage theft data. State labor enforcement agencies across the country either do not make such information publicly available or do not maintain it in a standardized format that allows for state-by-state comparisons.

National Mobilization Against Sweatshops, a worker-rights organization, is so frustrated with the Department of Labor’s wage recovery rate that it has mostly stopped sending workers to the agency. “It’s a waste of time,” said JoAnn Lum, the group’s director. “I’ve seen so many workers file claims, and they’re told that they’re owed so much in back wages — and then nothing happens.”

Advocates and labor lawyers, as well as eight former Department of Labor officials interviewed by Documented and ProPublica, said it’s critical for the agency to improve its wage recovery rate. But they said the agency has a number of problems that prevent that from happening: Its enforcement unit is chronically understaffed; it lacks a collections unit tasked with wage recovery; and its investigators, unlike their counterparts in other states, do not have legal authority to take actions against recalcitrant employers.

The former agency officials, some of whom had spent decades working at the Department of Labor, said these challenges often leave investigators incapable of enforcing the law against unscrupulous employers. One official — who still works in state government and did not want his name used out of fear of retaliation — put it this way: “If an employer said, ‘Fuck you,’” in response to a payment demand, “there’s not much the agency can do.”

The Department of Labor, which released wage theft data after Documented sued the agency over its refusal to do so, “works diligently to protect the paychecks of hard-working New Yorkers,” Aaron Cagwin, an agency spokesperson, said in a statement.

Cagwin said the agency is also “consistently making improvements to its wage theft investigations and wage recovery processes,” including improving how wage theft claims can be filed and expanding law enforcement partnerships.

Advocates said workers are the ones who suffer the consequences of the agency’s poor wage recovery rate: They are often forced to move on to other jobs, rely on their family for support, go on public assistance, or relocate to another state or, in the case of immigrants, back to their country of origin.

“Wage theft impacts the lowest-wage workers who need that money to pay the rent, buy groceries, take care of their families,” said Magdalena Barbosa, senior vice president at Catholic Migration Services. She noted that New York has strong labor laws that don’t “trickle down into enforcement — and you have workers waiting sometimes for many years to get a small piece of what they’re owed in back wages.”

Vincent Cao, an organizer with the Chinese Staff & Workers Association, said “it’s the cruelest slap in the face to award them back wages that take so long to arrive.”

On a bitterly cold morning in December, a former senior investigator with the Department of Labor was sitting in a coffee shop in Brooklyn, reflecting on his years at the agency. Bald and bespectacled, he raised his eyebrows and described a Sisyphean environment in which overworked investigators faced scarce resources, bureaucratic obstacles and unscrupulous employers and their lawyers while trying in vain to reduce a backlog of thousands of wage theft cases. “It feels hopeless sometimes,” he said, “but more than hopeless — it makes me angry.”

The former investigator’s assessment was echoed by the seven other agency officials interviewed by Documented and ProPublica. They all expressed their frustration with the agency’s chronic failure to fulfill one of its core mandates: to protect the state’s 10 million workers from wage theft.

The former investigator, who still works in state government and did not want his name used out of fear of retaliation, blamed New York’s political leaders for not prioritizing the agency’s mission and perpetually underfunding it.

Budget figures for the agency’s enforcement arm, the Division of Labor Standards — which the former investigator joined more than a decade ago — are available from 2008 to 2022, and they show that its budget went up by 17.8% from $28 million to $33 million during that period. Just to keep up with the inflation rate, the budget would have had to increase by an additional $5 million.

Some state lawmakers said the agency’s woes were particularly pronounced during the tenure of former Gov. Andrew Cuomo, who ran New York from 2011 to 2021. On the one hand, Cuomo launched two joint task forces made up of multiple agencies to crack down on industries, such as car washes and construction, where wage theft is prevalent. But he also instituted a spending cap that kept most state agencies from increasing their budget by more than 2% each year.

With the tight budget, the Division of Labor Standards reduced the number of employees from 282 in 2008 to 140 in 2017, while the number of open investigations climbed from 6,923 in January 2008 to 15,824 in January 2017, according to agency documents obtained by Make the Road New York, an immigrant-rights organization, and shared with Documented and ProPublica. The vast majority of the division’s employees are investigators, while administrative and support staff make up the rest.

Carmine Ruberto, who ran the Division of Labor Standards from 2007 to 2015, recalled the impact of the tight budget on staff morale and workload. “Do I think we could have done better under Cuomo if we had gotten more people? Sure,” he said.

Richard Azzopardi, a spokesperson for the former governor, said wage theft was “a huge priority” for Cuomo, but his administration’s hands were tied with limited resources.

“In 10 of the 11 years during his administration, we had structural deficits and we came in at the heels of the Great Recession where giant cuts had already been made. And we had to restructure government in order to make things right,” Azzopardi said. “I do understand that some people have different opinions on what the money should have been spent on. But it’s a balance.”

Under Gov. Kathy Hochul, the Division of Labor Standards saw its budget increase by $7 million, or 19.5%, in 2023, but the number of full-time employees now stands at 129 and has increased only by three since the governor took office in 2021.

Justin Henry, deputy communications director for Hochul, declined to comment.

The former investigator said the tight budget also meant that the agency couldn’t form a collections unit fully staffed with those versed in financial fraud investigation, asset tracking and locating employers, which could then be deployed for wage recovery — a task that Terri Gerstein, the agency’s former deputy commissioner, called “a crucial part of the process.”

Instead, the agency has been relying on senior investigators to handle the task, which adds to their workload and sometimes requires them to do tasks they’re not trained for, such as overseeing the payment plans of some employers, several former agency officials said.

The agency needs “a proper collections unit,” Gerstein said.

In addition to the lack of the collections unit, the former agency officials said the process is slowed down because each case has to be reviewed by several layers of officials.

For instance, once a claim is substantiated, the case goes to a senior investigator, who can sometimes take up to a year and a half to review it. Similarly, when an employer is unresponsive, the Division of Labor Standards issues an order to comply, but only after getting approvals from three more layers of officials.

The former investigator said the bureaucratic bottleneck helped create long delays in recovering back wages. “It’s not like we push a button and increase the speed of the machine and then the cases come out at the other end,” he said.

The analysis of the agency’s database appears to back up the former investigator’s claim. As of Feb. 21, the agency had recovered no wages in 8,300 cases — affecting about 29,000 workers — that were at least five years old, or more than a fifth of the total cases from that time period.

Two of the long-pending cases were filed by Fernando, a 49-year-old Mexican immigrant who worked as a delivery driver for two Brooklyn restaurants. He filed his claim against the first restaurant in 2009 and another claim with his co-worker against the second restaurant in 2015.

The agency substantiated the claims, finding that two restaurants owed Fernando and his co-worker a total of more than $380,000 in back wages. Fernando, who requested to be identified by only his middle name because he’s undocumented, said he has not received his back wages. “The most important thing is the DOL could resolve these cases quicker,” he said.

The former agency officials said that when investigators try to go after employers for back wages, they find themselves without effective enforcement tools to force quick payments.

The orders to comply, for instance, can be appealed at the state’s Industrial Board of Appeals, a five-person panel that can take months, or even years, to adjudicate a case. In the vast majority of the cases, the board eventually sides with the agency. But even then, former agency officials said, employers often continue to ignore the orders, knowing that they are unlikely to face any consequences from doing so.

The former agency officials also said filing judgments in court against particularly recalcitrant employers often fails to force quick payments: While it puts a mark on their credit report, employers can and do get around the judgment by conducting their businesses in someone else’s name or getting a private loan from their family and friends.

Advocates and labor lawyers agreed that this was common practice. “Just because you get a judgment doesn’t mean you can collect on it,” said Margaret McIntyre, a lawyer who represents wage theft victims.

Advocates and labor lawyers said New York could adopt a number of tactics that have been successfully deployed in other states.

In Maryland and Wisconsin, for instance, workers are allowed to place a lien on their employers’ personal property to secure the payment of back wages. This has proven to be effective, according to a 2015 report by the Legal Aid Society, Urban Justice Center and the National Center for Law and Economic Justice. “A wage lien not only encourages an employer to dispute the matter and play fair in court, but ensures that if the workers win their case, they may actually be able to enforce a judgment against the employers’ property and collect the wages they are owed,” the report said.

New York, in fact, has had a lien law for decades, but it only applies to certain workers in the construction industry. Industry pressure, especially from the powerful New York City Hospitality Alliance, which represents restaurant owners, has helped defeat legislation introduced in recent years to expand the law’s scope.

In June, after the latest lien bill stumbled in Albany, the Hospitality Alliance issued a statement, saying it would have been a violation of due process to allow an employee to place a lien on “the private property of the owners, investors and even managers of the business based solely on the accusation of wage violations.”

In California, businesses appealing the finding of wage theft violations are required to post a surety bond up to $150,000, which they forfeit if they fail to pay back wages after losing on appeal. Those who fail to post the bond can be and are prohibited from doing business in the state.

In New York, the state has a similar bonding rule, which was implemented in the wake of a 2015 New York Times exposé on working conditions in nail salons, but it only applies to owners of nail salons with at least two workers. New York City also has a limited bonding rule that applies to owners of car wash businesses. Advocates for nail salon and car wash workers said they didn’t have enough data to know whether the bonding rules have significantly helped reduce wage theft.

Some states and local communities have also used the licensing and contracting processes to their advantage.

In 2015, for instance, Cook County in Illinois took aim at violators of state and federal wage laws, disqualifying them from lucrative county contracts. In 2019, Santa Clara County in California also launched a pilot project that would suspend the licenses of any business for five days if it fails to pay back wages. Before the year’s end, the county suspended eight licenses, mostly from restaurants, and each led to the payment, according to the county’s Office of Labor Standards Enforcement. “Being closed for five days is really bad for a restaurant’s business, so they seek to avoid that,” Gerstein said.

Adopting these approaches “wouldn’t make wage theft disappear in New York, but it would make a difference,” said Rick Blum, staff lawyer at the Legal Aid Society.

Some workers have already lost faith in the Department of Labor — and this includes a young woman named Kirsten, who filed a wage theft claim with the agency in August 2020 against a downtown Manhattan bar that had repeatedly failed to pay her. Kirsten, who requested to be identified by only her middle name to protect her future employment prospects, said she submitted documents and pay stubs. She didn’t hear back for more than a year and a half, until a phone call and letter from an investigator in the spring of 2022 asking her for more information about the case.

To this day, Kirsten said she has not received her back wages and has given up altogether. The agency “has been useless to me,” she said. “It just feels hopeless, like workers are all alone.”

About the Data

Determining the prevalence of wage theft in New York is more complicated than in some other states, including California, Massachusetts and Texas, because its Department of Labor does not make the results of investigations readily available to the public.

Documented filed a public records request for that information in 2019. When the department refused to release it, Documented took the agency to court. The agency has since released to Documented and ProPublica its database containing information on nearly 97,000 cases that began and concluded from 2005 to Feb. 21, 2023. Department of Labor officials told us that they began using this database fully in 2008, so we only analyzed cases from that year onward.

The database provides a number of details on each case, including the names and addresses of businesses that committed the violation, the number of workers who were affected and cited labor law violations.

But the database only provides the dates of when cases began, so we focused most of our analysis on cases from 2017 to 2021.

To determine how many businesses had multiple wage theft cases and still owed back wages, we manually standardized business names and addresses and counted instances in which a company still owed back wages in at least two cases.

To determine the percentage of back wages recovered, we tallied the amount of collected back wages and divided it by the amount of outstanding back wages in all cases contained in the database. Our metric may overestimate the percentage of back wages recovered. In some cases, the recovered amount recorded in the database might also include “liquidated damages,” which are payments for the harm caused by the wage theft and interest. The database does not differentiate between these different types of collected funds. In cases where the recovered amount was greater than the outstanding back wages, we adjusted the recovered amount to equal the outstanding back wages.

The analysis does not take into account the cases reported to the U.S. Department of Labor, which also investigates wage theft in New York but does not make public any database showing how much back wages have been recovered by the agency.

Def Leppard is sharing another behind-the-scenes look at their world tour, and this time it comes with a big celebration.  Episode 12 of their video tour diary finds them kicking off the recent…

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by Max Blau

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

By the time 25-year-old Tyler Waite arrived at Methodist University Hospital in Memphis, Tennessee, in May 2020, his skin had turned a sickly shade of yellow. At 6-foot-3, pushing 330 pounds, his appearance was misshapen by a stomach distended with fluid. His liver had failed so much that, unless he got a new one, he likely wouldn’t live to see summer’s end.

A diehard Pittsburgh Steelers fan who loved fishing, Waite worked at a software company and lived at his parents’ home in the north Atlanta suburbs, saving for a place with his fiancee and working on getting his life back on track. Over the past few years, ever since his young daughter had moved away from Georgia with her mom, Waite had struggled. Many nights, he coped by drinking large amounts of vodka in the quiet of his family’s house.

Two weeks before he arrived in Memphis, a doctor at Piedmont Atlanta Hospital had discovered that Waite’s chronic drinking had gravely damaged his liver. Piedmont’s transplant center considered Waite’s case risky due to his obesity and the briefness of his sobriety. But there was a silver lining: The scarring from alcoholic cirrhosis was so advanced and the liver’s failure so swift that the transplant center’s staff determined he would land near the top of the waiting list for a donated organ.

But just before getting placed on the list, Waite abruptly left Piedmont against the advice of the staff. At home, his mother saw the fear in his eyes. Waite, who’d been cut off from his family because hospital visits were restricted at that point in the pandemic, had made what she thought was a shortsighted but forgivable decision. Marci Waite knew that her son couldn’t remain confined in the comfort of home if he wanted to survive. Once she talked him through that, and after he got to see his daughter once more before she flew back to Texas, he became less anxious. He returned to the hospital the next day.

Unfortunately, his departure added another red flag because it disrupted the dialysis treatment that his kidneys, which were also failing, had badly needed. Some of Piedmont’s staffers saw Waite’s departure as a sign that he wouldn’t take appropriate care of a donated liver, one of the transplant center’s leaders later told his mother. Ultimately, Piedmont refused to add him to the list. (A Piedmont spokesperson did not answer questions about Waite’s case.)

One of Piedmont’s doctors, unwilling to give up on Waite, sent his records to hospitals around the South. Emory University Hospital in Atlanta declined his case. UAB Hospital in Birmingham, Alabama, passed, too. So did UT Southwestern Medical Center in Dallas. Then someone from Methodist reached out. Its staff was willing to consider Waite.

Wow, his mother thought. We’re in luck.

Waite’s parents, Marci and John, at their home in Georgia (Lucy Garrett for ProPublica)

The James D. Eason Transplant Institute took pride in replacing the livers of higher-risk patients turned away by other hospitals, according to its former leader. But at the center of this philosophy is a series of difficult decisions: A transplant center willing to consider extremely ill patients like Waite must determine whether that candidate is healthy enough to survive after surgery — and, given America’s shortage of donated livers, whether someone with a better shot of living longer should get that organ instead.

As Methodist embraced that philosophy, it was also under scrutiny for its high rate of failed liver transplants. Between 2014 and 2018, the liver transplant program had twice been investigated by an oversight committee for the United Network for Organ Sharing, the federal contractor that runs the country’s transplant system, as revealed by ProPublica and MLK50: Justice Through Journalism in a recent story. (UNOS would not comment on the outcome of the investigations; a Methodist spokesperson previously told ProPublica and MLK50 that the liver program is no longer under investigation as of last year.)

Waite’s case illustrates both the promise and peril of Methodist’s approach. On the one hand, no one disagrees that without a transplant, Waite would have died imminently. On the other, six transplant experts told ProPublica and MLK50 that failure to heed the warnings of a patient’s psychosocial risks, such as addiction, can lead to greater suffering. “It’s dangerous, clearly, to overlook psychosocial issues,” said Jody Jones, a transplant psychologist for more than two decades.

A 2018 audit of Methodist’s liver transplant program by an external firm found that “a blatant lack of merit” was given to psychosocial issues by the hospital’s transplant selection committee. As a result, the audit found, the program “routinely transplanted patients with significant psychosocial risk,” including people who had a documented history of psychosis or alcohol recidivism. After the audit, a senior leader of the transplant center determined in an internal analysis that psychosocial risks contributed to the deaths of five liver recipients between 2014 and 2018. ProPublica and MLK50 obtained a copy of the analysis, which states that Methodist “should not have listed” those five patients for transplant. Those five deaths are among 25 that the analysis described as “preventable” in that time period.

Dr. James Eason, for whom the transplant center was named and who oversaw it starting in 2006, parted ways with Methodist last year. Both Eason and a spokesperson for the hospital did not respond to interview requests for this story. The spokesperson said in a statement that “our focus remains on providing the highest quality care to all our patients and this community and we will not deviate from this purpose.” Eason and Methodist also declined to answer written questions about Waite’s care, even though his mother waived her right to privacy so that Eason and the hospital could talk about Waite’s treatment.

Dr. James Eason at the transplant center renaming ceremony at Methodist University Hospital in 2019 (Via Methodist Le Bonheur Healthcare’s Facebook)

In a previous statement to ProPublica and MLK50, Eason said that his program had excelled at lowering the extent to which patients died on the waitlist. He also noted that, while Methodist experienced a small number of “unexpected deaths per year,” his program had “saved more than 100 lives each year” of patients with failing livers.

“I would never choose to let a single high-risk patient die instead of giving that individual a good chance of living,” Eason said in another previous statement.

Because the investigations, audit and internal analysis were not public, Marci Waite did not know about Methodist’s history of failed liver transplants when her son arrived there. Instead, when she read about Eason’s liver transplant program, she felt that her son had finally caught a break. After all, Eason was the surgeon who had replaced the liver of Apple co-founder Steve Jobs back in 2009. If the California billionaire had chosen this program, out of any program in America, she figured it was good enough for her son.

But not long after Waite’s transplant in June 2020, his mother’s hopes of a smooth recovery began to fade. A few weeks after the surgery, she learned from a Methodist staffer that a severe infection had spread throughout Waite’s body, overwhelming his organs. The following month, she was told that several of Waite’s ribs had been cracked when a staffer had to perform CPR after his heart stopped beating. The month after that, doctors had to sedate Waite after he experienced brain seizures — and they couldn’t tell her for days whether her son would fully regain his brain function. Ultimately, Waite would undergo 10 unforeseen surgeries in eight months to deal with his post-transplant complications.

Nevertheless, Methodist staffers voiced optimism about Waite’s future. And that, in turn, made his mother feel optimistic. That September, she wrote on Tyler’s GoFundMe page that things “seem to be going in the right direction again, so let’s pray it keeps going that way.”

Tyler Waite and his daughter (Courtesy of Marci Waite)

On any given day in America, more than 10,000 people are waiting for a new liver, and a shortage of them means that some of those people die before an organ becomes available. Hospitals like Methodist are facing an ethical dilemma regarding the sickest of them.

For patients at extreme risk of death because their drinking has compromised their liver, the likelihood of getting a transplant has, over the past two decades, gone from exceedingly rare to entirely possible. Transplant centers that had once required patients to be sober for six months have loosened their policies to allow more of these patients to be eligible for a new liver. But the increased demand for a limited supply of organs means that patients with other kinds of liver failure potentially wait longer for lifesaving care.

“Let’s make no bones about it: This is an extremely controversial topic within each medical center,” said Dr. Shimul Shah, chief of solid organ transplantation with UC Health in Cincinnati.

The experts who conducted the 2018 audit of Eason’s liver transplant program urged Methodist to create a stricter policy that would deem patients with serious psychosocial issues ineligible for transplant. They also recommended that Eason’s team hire an addiction medicine specialist, who could help perform nuanced evaluations of patients and direct them to treatment for their chronic drinking.

Following the audit, Eason and his colleagues provided documents to the UNOS investigative committee that said Methodist would hire a chemical dependency expert and partner with a “specialized” alcohol addiction unit. Eason did not respond to questions about the experts’ findings. Methodist spokesperson Tabrina Davis said in a previous statement that the transplant center had quickly accepted some of the audit’s recommendations and, nearly five years later, is still considering others.

Transplant centers have increasingly devoted more resources to patients facing addiction. According to a recent survey of 100 U.S. liver transplant programs, over 75% of them have a psychologist and addiction medicine specialist, and more than half have their own treatment programs. Transplant experts said these services are intended to help people who recently stopped drinking get healthier before undergoing a transplant. Dr. Michael Lucey, professor of gastroenterology and hepatology at the University of Wisconsin’s medical school, said those resources are an “integral part” of performing more comprehensive psychosocial evaluations.

But when Waite’s ambulance pulled up to Methodist, the week after Memorial Day, the transplant center had yet to fully implement the changes it had pledged to the UNOS oversight committee more than a year earlier, according to employees who worked at the hospital at the time.

The week after Waite was admitted, members of Methodist’s transplant selection committee met to determine whether he was healthy enough to undergo surgery. They were supposed to decline any patient if they could find one issue that could severely threaten the patient’s survival, such as having high pulmonary arterial pressure or having uncontrolled sepsis, according to the committee’s policy. They also were supposed to reject a patient if that person had three health issues that together posed a serious threat.

Davis, the Methodist spokesperson, said in a previous statement that the transplant center has a “rigorous selection criteria” to decide which referred patients should be made eligible for a transplant. She added that the hospital “declines a significant number of individuals who are sick enough to be transplanted but do not meet the criteria to indicate they would have successful outcomes post-transplant.”

Waite’s medical records show that the committee marked the briefness of his sobriety as one red flag. During his evaluation days earlier, Waite told a Methodist staffer that he had never sought treatment for his alcohol use or attended an Alcoholics Anonymous meeting. His doctors wrote that Waite’s brief period of sobriety “seems entirely due to time spent hospitalized.” While doctors labeled Waite a “high-risk candidate for transplant,” one noted that “given his young age I would like to give him a chance.”

His body mass index was also high enough on his patient evaluation to be counted as a second red flag. Despite that, however, the committee members determined that it wasn’t a concern, records show.

Beyond that, there was a potential third red flag: Waite’s risk of not following instructions from his medical providers. Following such instructions is important because, as Michigan Medicine transplant psychiatrist Dr. G. Scott Winder explains, “so much of a transplant consultation is predicated on trusting the patient.”

“If you really want to spook a transplant team, check yourself out of the hospital against medical advice,” Winder said.

During Waite’s evaluation at Methodist, his social worker had written that his departure from Piedmont was an “isolated event” that should not influence his candidacy for transplant. But shortly after Waite was admitted to Methodist, he had discontinued a round of dialysis against the advice of medical staff. (Marci Waite said that her son was scared of dialysis because he had a painful experience with the treatment at Piedmont.) Even with the additional example of Waite not following the staff’s instructions, the selection committee found that he wasn’t likely to disobey instructions again.

After the meeting ended, Methodist shared the news that Waite and his family had been waiting for. The committee had cleared him for a transplant.

John Waite at home (Lucy Garrett for ProPublica)

The reason that Methodist had considered Waite at all was due to a seismic shift disrupting the field of liver transplantation. For several decades, starting in the 1980s, the industry standard was that patients should be six months sober to be approved for a transplant. When Mickey Mantle’s liver failed in 1995, he was approved for a transplant in Texas only after he had achieved more than six months of sobriety and signed a contract vowing to not to drink once a new liver was placed inside of him.

Over time, as addiction became viewed as more of a chronic disease than a moral failing, transplant experts began to see the six-month rule as a practice that unfairly denied lifesaving treatment to people who struggled with drinking alcohol. Since patients with extreme liver failure often don’t have six months to live, experts wrote in the journal Alcohol and Alcoholism that the rule could be ​​“tantamount to a death sentence.”

In the late 2000s, as evidence emerged that six months of sobriety was a bad indicator of whether a liver recipient would relapse, European researchers sought to disprove the rule. Medical providers in France and Belgium “carefully selected” patients with acute alcoholic hepatitis and a brief period of sobriety for an “early” liver transplant. The researchers found those patients not only were more likely to survive longer than people who didn’t receive a new liver, but they also were unlikely to relapse after transplant. In 2011, they wrote in The New England Journal of Medicine that the findings challenged “the notion of a prescribed abstinence period as the only alcoholism-related criterion for transplant eligibility.”

Dr. Brian P. Lee, a transplant hepatologist with Keck Medicine of USC, said the study “really paved the way for huge change in U.S. practice.” In the years after the study, the overwhelming majority of transplant centers dropped the six-month rule, leading to a surge in the number of people with alcohol-associated liver failure who were approved for the surgery. Methodist was among the transplant programs that allowed for a shorter period of abstinence, approving patients with brief sobriety for transplant if they had a “low risk for recidivism,” according to a paper in the journal Experimental and Clinical Transplantation written by Eason and his colleagues.

Following this change, the proportion of liver transplant surgeries performed on people at extreme risk of death due to alcohol-associated liver disease nearly tripled in a decade, from 3.3% in 2011 to 9.3% in 2020. Over that same period, Methodist’s proportion of transplants for these kinds of patients increased even more, from 2.2% to 11.8%.

While some transplant experts were encouraged by this trend, others worried that the fault lines were shifting too fast. Programs that embraced liver transplants for gravely ill patients with a brief period of sobriety often ended up with those patients at the top of their waitlists. Because they were sicker than patients at the top of other programs’ waitlists, they were positioned to receive a liver faster than patients at those other programs.

Last year Dr. James Trotter, a hepatologist at Baylor University Medical Center, wrote in the journal Transplantation that the trend had spurred “local competition for patients” with alcohol-associated liver disease. That, in turn, pushed more liver transplant programs to loosen their policies on accepting such patients to avoid losing patient referrals, case volumes and revenues. A spokesperson for Eason previously said in a statement that he did not receive additional compensation for performing more transplants, “nor was any aspect of his compensation based on such a metric.” Methodist did not respond to questions about the program’s finances.

Some transplant experts have pointed out that UNOS has yet to pass national standards to ensure that every liver transplant program adheres to the same practices for considering patients with an alcohol-associated liver disease. In a recent American Journal of Transplantation article, Lee and a colleague called for UNOS to create national standards to reduce “disparities in transplant access and patient outcomes” among different transplant programs. UNOS spokesperson Anne Paschke said in a statement that no standards exist because each “transplant team is responsible” for approving these kinds of patients for transplant.

“It’s a bit of the Wild West, from program to program, because of the different standards,” said Shah of UC Health in Cincinnati. “It’s happened many times that we will turn someone down for a transplant, but we’ll refer them to a program that has more lenient standards — and they will transplant.”

From the moments after Eason replaced Waite’s liver in June of 2020, his mother tracked the ups and downs of his recovery. By the end of the month, Waite was discharged to a rehab facility and had been told to look ahead to a potential kidney transplant if his progress continued. Marci Waite couldn’t visit for weeks due to Methodist’s COVID-19 restrictions, so she offered a pep talk from afar. “You are NO LONGER in a damn hospital 🙏,” she texted him. “That is very exciting…we are all cheering.”

But around the Fourth of July, Waite landed back in the intensive care unit. He had complained to his mother about having severe stomach pains; not only was he vomiting bile, but fluids were building up in his abdomen. Eason’s team performed four surgeries that July to better understand the cause of those problems but struggled to find a clear answer.

“I’m miserable 😖,” Waite texted his mother after the surgeries.

“I wish we could just hit a fast forward button,” she wrote.

“I’m ready to tap out 😢,” he replied.

“Ty…no, you can’t,” she wrote back.

It’s difficult to know the extent to which any of Waite’s risk factors, including his history of drinking alcohol, contributed to his complications. But as the weeks passed, his condition deteriorated so much that one day that fall, Marci Waite and her husband, John, were quietly pulled aside by one of their son’s doctors. Given the optimism that had been conveyed by Methodist staffers so far, the Waites were caught off guard by what this doctor had to say: The transplanted liver that was supposed to be saving their son’s life had already started to fail.

At around that time, Waite’s fiancée, Sarah Benson, was finally allowed to visit Methodist. She was shocked by his condition. His hair was falling out. He had lost some of his teeth. He winced in pain whenever she touched him. “I started to cope with the inevitability that, no matter what happened, my Tyler was gone,” she said. Waite’s parents were also beginning to lose hope. By the end of 2020, Waite had undergone eight surgeries to address varying complications. After a brief upswing around Christmas — during which he was healthy enough to have his feeding tube removed and chomp down on pizza and McGriddles — he developed a severe infection. Eason’s team performed two more surgeries in February 2021, including one to remove a portion of his stomach that had started to decay.

After all those surgeries, neither his liver nor his kidneys were getting better. Unlike before, Waite was too sick to immediately get placed on the waiting list. He needed to get better before he had a shot at another liver.

One day in early March, when Eason stopped by to check on Waite, his mother asked him to be upfront about her son’s prognosis. “If he’s not going to make it, I need to know,” she remembers telling Eason. She said he later confirmed her suspicions. Her son wasn’t going to live much longer. She looked at him, knowing the tough call ahead.

That afternoon, the staff ceased further rounds of dialysis and doses of his blood pressure medication. They unhooked his ventilator. His mother recalled him taking a few last peaceful breaths. He died before dusk.

During the dark months ahead, the Waites sought to preserve their son’s memory the best they could. In their living room, they placed photos of him around an urn full of his ashes. In the front yard, John Waite dug a large hole for a memorial pond. On her right arm, Marci Waite got a tattoo of a hummingbird alongside three words that her son used to sign his holiday cards with: “love you lots.”

Marci Waite memorialized her son with a tattoo on her arm. (Lucy Garrett for ProPublica)

As she mourned, she thought about how her son had suffered in the nine months following his transplant. And for what, exactly? She had desperately wanted more time with him. But not like this.

In the end, she was left wondering whether the other four hospitals had, in fact, made the right call.

“That’s what it boils down to,” she recently said. “Methodist shouldn’t have given Tyler a transplant.”

Tell Us About Your Experience With the Organ Transplant System

Wendi C. Thomas, MLK50: Justice Through Journalism, contributed reporting.

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