A photographer who covered the war in Iraq appreciates how threats can come to seem routine.
Ashley Gilbertson/VII Photo, special to ProPublica
COLFAX, Louisiana — Early one evening, I went out for a run. I took a route out by Lake Iatt, passing through acre after acre of logged land, trailer homes and lush green farms. It was an easy out and back, but as I rounded the last corner, I was alarmed by clouds of black smoke that were blowing my way. Explosions crackled in the distance. The sounds put me back in Iraq, where I’d spent a bunch of tours as a photographer, listening to gun battles being fought in nearby towns or neighborhoods.
The detonations were coming from the commercial burn facility just outside this speck of a town. The U.S. military has tens of thousands of pounds of its munitions and waste set afire at the facility every year. And has for decades.
The people of Colfax, as a result, long ago stopped being startled in the way I had been. The explosions — “Like World War III or the Fourth of July,” said one resident — are simply the soundtrack to life in a town of some resolve, considerable poverty and lots of resignation.
In the cool hours of the morning, you can see people, mostly African-American, crossing the train tracks to walk to the Dixie pharmacy that doubles as a coffee shop.
By midday, though, Colfax is all but a ghost town, with the exception of Darrell’s restaurant, the only eatery left in town after the other one closed when the owner died of cancer a couple of months back. With the late afternoon, there comes some relief from the heat.
People reappear.
There are men walking with lawn mowers hoping to pick up work. Down a dead-end street, I found two boys breaking a horse in a vacant, rubbish-strewn lot between trailers. The kids were trying to stop the horse from rearing up, though every time it leapt back on its hind legs, the boys’ smiles gave away their joy.
Other boys played ball on the street, refusing to believe a news organization such as ProPublica was visiting their town. When I explained the story I was covering, most of them shrugged and asked if it would be on Instagram.
There were folks fishing, too, including an extended family at Lake Iatt. I asked about the booms and toxic smoke, but Caroline Harrell, the matriarch of the three generations that had rods in their hands, evinced little worry or anger. People just don’t seem to notice. Besides, a fishing competition had started.
I listened again to the sounds of Colfax, and once more was taken back to Baghdad, 7,000 miles away and a couple of lifetimes ago. There, I’d try my best to relax, drinking a beer and having a smoke on an American base or in a news organization’s bureau. Gun battles would break out nearby, but they didn’t register as sounds of fascination. They were part of life there at the time. The danger wasn’t urgently pressing; there was, it seemed, no cause for alarm.
This story is part of a series examining the Pentagon’s oversight of thousands of toxic sites on American soil, and years of stewardship marked by defiance and delay. Read more.
Ashley Gilbertson is an Australian photographer whose work has captured the experiences of soldiers in the wars in Afghanistan and Iraq. In 2004, Gilbertson won the Robert Capa Gold Medal Award from the Overseas Press Club for his work during the Battle for Fallujah. In 2014, Gilbertson’s series of photographs, “Bedrooms of the Fallen,” was published in book form by the University of Chicago Press.
The U.S. military burns millions of pounds of munitions in a tiny, African-American corner of Louisiana. The town’s residents say they’re forgotten in the plume.
by Abrahm Lustgarten, ProPublica
Photography by Ashley Gilbertson/VII Photo, special to ProPublica
COLFAX, Louisiana — Two years ago, the U.S. military had an embarrassment on its hands: A stockpile of aging explosives blew up at a former Army ammunition plant in Minden, Louisiana, sending a cloud of debris 7,000 feet into the sky.
Local residents, alarmed by toxic contaminants from the accident, were nothing short of furious when they learned what the military intended to do with the 18 million of pounds of old explosives still remaining at the depot. The Army was set to dispose of the explosives through what are known as “open burns,” processes that would result in still more releases of pollutants.
Facing an uproar, the Army turned to a familiar partner to help placate the residents of Minden: A private facility in Colfax, 95 miles south, operated by Clean Harbors, a longtime Defense Department contractor and one of the largest hazardous waste handlers in North America.
The Colfax plant is the only commercial facility in the nation allowed to burn explosives and munitions waste with no environmental emissions controls, and it has been doing so for the military for decades. And so while the Army ultimately commissioned a special incinerator to dispose of most of the Minden explosives, more than 350,000 pounds of them were shipped here. Over the ensuing months, the munitions were burned on the grounds of the plant, fueling raging fires that spewed smoke into the air just hundreds of yards from a poor, largely black community.
Beyond the story of the Minden explosives, the Clean Harbors facility here has become an important clearinghouse for military-related waste as the Department of Defense and its contractors struggle to deal with hazardous byproducts from weapons manufacturing and huge stockpiles of aging munitions. For years, defense-related firms have burned this waste at their own facilities, stubbornly clinging to the practice even as it has been outlawed in parts of Europe and Canada. But the permits to do so have become harder to get, the terms less flexible, and, increasingly, the pollution unacceptable to surrounding communities. Clean Harbors offers a legal way to get rid of dangerous materials from a wide range of sites that can’t or don’t want to handle them on their own.
In 2015 alone, 700,000 pounds of military-related munitions and explosives were trucked to Colfax, where both Clean Harbors and the military have so far been able to outmaneuver a community with abundant concerns but little money, and even less political influence, to fight back.
The Department of Defense did not respond to questions regarding its use of the Clean Harbors burn facility in Colfax, or environmental concerns related to it.
That such material is being shipped anywhere appears to contradict the military’s longstanding claim that these wastes are too dangerous to move, so they must be burned in the open where they were made or used. Yet every year, military bases and defense contractors send munitions or other explosive material to Colfax, packing explosives into cardboard boxes, shuffling them onto 18-wheelers and driving them sometimes thousands of miles across the country. Delivery manifests filed with Louisiana regulators detail the variety of materials: rocket fuel from a missile factory near Los Angeles; hand grenades from a munitions factory in Arkansas; detonating fuses from Cincinnati; solid propellant from an Aerojet Rocketdyne factory in Virginia; explosive lead from a North Carolina military aircraft factory; warhead rockets from a Lockheed Martin facility in Alabama.
Once received, they are burned on a set of 20 metal-lined pans on a parking-lot-like patch of concrete with “no risk to human health or the environment,” according to Clean Harbor’s senior vice president for compliance and regulatory affairs, Phillip Retallick.
The burns take place several times each day, and when they do, they turn parts of Colfax into a virtual war zone.
“It’s like a bomb, shaking this trailer,” said Elouise Manatad, who lives in one of the dozen or so mobile homes speckling the hillside just a few hundred yards from the facility’s perimeter. The rat-tat-tat of bullets and fireworks crackles through the woods and blasts rattle windows 12 miles away. Thick, black smoke towers hundreds of feet into the air, dulling the bright slices of sky that show through the forest cover. Manatad’s nephew Frankie McCray — who served two tours at Camp Victory in Iraq — runs inside and locks the door, huddling in the dark behind windows covered in tinfoil.
Like most of the people who live there, Manatad and McCray find it difficult to believe the booms and clouds aren’t also exacting some sort of toxic price.
Colfax is a rough-hewn, mostly black town of 1,532 people that hugs a levee separating it from the surging mud and wild alligators of the Red River. Fleeing former slaves once camped under thatched tents in the bayou, and a historic marker serves as a reminder that more than 150 “negroes” were once massacred here. Another monument, in the graveyard a few steps away, praises the three white men who also died, as “heroes … fighting for white supremacy.”
Frankie McCray, a veteran who served two tours in Iraq, hides inside his trailer on Bush Road in Colfax when the open burning of munitions takes place nearby.
Today the town amounts to a smattering of collapsing historic buildings peppered with two gas stations, a bait and tackle shop, a grocery, a hardware store and a pharmacy where locals gab around a lone red 50s-era diner table with 10-cent cups of coffee. Ever since highways replaced the river barges it’s been difficult to build an economy here, and the average Colfax resident earns about $13,800 each year.
“We might be a little bit woodsy,” said Terry Brown, whose family moved to Colfax in 1817 and who now represents the area in the Louisiana Legislature. “And even though we live in a predominantly black community, when they cut their finger it still bleeds red. And we want a clean environment.”
Last November, state environment officials parked an air monitoring van on Bush road a few doors down from Elouise Manatad’s trailer. Manatad says they never told her what they were doing or what they’d found, but lab samples obtained from the state show environmental regulators detected notable levels of acrolein, a highly toxic vapor commonly associated with open burns of munitions. A division of the U.S. Centers for Disease Control and Prevention describes acrolein as having a “suffocating odor” and causing severe respiratory problems and heart attacks — even at low doses and for as long as 18 months after exposure.
The lab reports also showed low levels of other volatile organic compounds, including benzene, known to cause cancer, and which the World Health Organization warns has “no safe level of exposure.”
Soil, groundwater and stream beds sampled on the Clean Harbors site over the past few months have also been found to contain an array of extremely harmful substances likely connected with the burning of munitions waste. Underground water supplies sampled this spring show perchlorate, a type of rocket fuel, at more than 18 times Louisiana’s trigger levels for additional screening and eight times greater than what California, which sets stringent regulatory limits on perchlorate in groundwater, permits. RDX and HMX, both military explosive compounds, were also detected. Soil tested near the fence line of the facility contained dioxin — a chemical that builds up in fish and affects the human immune, reproductive and nervous systems — at three times the limits that trigger a state safety review. Silt scraped from a stream bed that runs toward the plant’s fence line and a nearby farm contained lead at nearly four times the level that triggers additional state screening.
State inspections also found Clean Harbors in violation of a number of regulations, including handling hazardous waste in unpermitted ways, failing to make repairs to its burn pads, and discharging unauthorized pollutants in violation of its state water permit.
The burn facility first opened in Colfax more than 30 years ago, and Clean Harbors acquired it in 2002 from a company named Safety-Kleen. Retallick says today it’s a squeaky-clean operation, and he dismisses the contaminant findings. The acrolein and benzene were caused by something other than the facility — probably truck traffic or barbeque fires, he said, noting they were detected in background levels the state measured on days without burning. The other contaminants are either contained within the 740-acre Clean Harbors property, or exist at such low concentrations they don’t pose a risk.
“The dose makes the poison, and the dose is concentration over time,” he said, adding that Clean Harbors maintains that its explosives are entirely consumed in the fires. “The community just doesn’t understand the chemistry of toxic substances in the air, water and land.”
“I think their perception of risk has not been borne out by the studies that have been done which show that the risk is not there.”
Brenda Vallee, a resident of Colfax and an environmental activist, watches from her home as a plume of smoke floats above the Clean Harbors plant.
State health department officials bolstered this view when they analyzed the air sampling data — including the acrolein and benzene — and concluded in February that though the findings are “based on a small number of air samples collected over a short period of time and may not reflect actual long-term exposures … the results do not indicate a likelihood of adverse health effects.” State environmental officials are still analyzing the water and soil samples, including the dioxin and lead detections, and but told ProPublica that they expect that by the time those concentrations are likely to be ingested by people, they would be so diluted as to pose no threat.
“The groundwater is restricted to a relatively small area buried within the heart of the facility,” said Gregory Langley, a spokesman for the Louisiana Department of Environmental Quality. The state is pressing Clean Harbors to correct that pollution on its site, but still, he characterized the findings as “not much of concern” to the surrounding residents.
The local Clean Harbors office here in Colfax is located in a double-wide trailer just outside of town. Inside the trailer, a map of the United States hangs on one wall, with strings pinned from at least 42 locations across 22 states, representing U.S. military facilities or defense contractors that ship explosive-laden waste here.
Clean Harbors, based in Massachusetts, won’t say how much the Pentagon pays it to burn its explosives, but it’s likely just a sliver of the company’s continent-spanning business, which brought in $2.7 billion in revenues in 2016. In a normal year, Retallick said, defense-related waste may account for less than a third of the Colfax plant’s business. He blames the controversial offloading of explosives from the Army at Minden for disturbing the company’s otherwise low profile.
“For 30 years, nobody cared about us and we suddenly became a hot topic,” he lamented. “We became a convenient target.”
Many of the black residents living close to the plant see the history differently. They say they have for years harbored concerns over their health. Manatad suffers from recurring strokes and respiratory infections. She says at least five of her neighbors have thyroid disorders, a condition that has been linked to exposure to perchlorate. Residents gossip about former burn facility employees who died of cancer.
When the Minden shipments began, out-of-town activists who opposed the large-scale explosives burns in the northern part of the state came to Colfax and found an organized, vocal audience among the community’s leaders.
On a recent morning, down the hill from Manatad’s trailer and closer to a more moneyed part of Colfax, the dewy air was thick with the smell of firecrackers. Burns from the plant left a dark stain across the sky. In a modest ranch house surrounded by acres of close-cropped green lawn, a mostly white crowd — schoolteachers and parish commissioners and farmers — discussed how to stop the open burning at the Clean Harbors site. The meeting began with a prayer around a circle. A man’s shirt read, “Stop the burns. Refuse to be Collateral Damage.”
“This is a license to print money. I’m tired of these people,” said one woman, Dolores Blalock. “Dumb Yankee carpetbaggers. … They don’t need to be running explosives through this state.”
Some at the meeting, including its host, also suffer from thyroid disorders, and they’ve pressed for months for tests of the air and water around the plant, and for Clean Harbors to install an incinerator to contain the smoke. “They told us they weren’t breaking any laws and they didn’t want to spend the money,” said Wilma Subra, an activist and environmental scientist who often takes up Louisiana contamination concerns.
Brown, the state representative, says he doesn’t believe Clean Harbors would have remained here all these years if Colfax weren’t an undereducated, low-income community. Last year, short on patience, Brown took what seemed like the only remaining step: He sponsored a bill to ban open burning of hazardous waste in Louisiana outright. “Overwhelmingly, people were in favor of it,” he said.
Above: Environmental activists and residents of Colfax at a meeting about the open burns. Below: Louisiana state Rep. Terry Brown, who represents Colfax, seen at the state Capitol building in Baton Rouge. “We might be a little bit woodsy,” Brown said of the town’s residents. “And even though we live in a predominantly black community, when they cut their finger it still bleeds red. And we want a clean environment.”
The legislation, though, drew Louisiana’s chemical industry out of hiding. The state’s business groups warned about losing jobs. Clean Harbors brought in executives from across the country who showed pictures of freshly painted burn pads, with flowers and cut grass, Brown said. “They hired a big, very powerful lobbying firm to lobby against the bill, and I began to see people drop out one by one.”
Then, said Brown, “They brought the brass.” A high-ranking officer from Louisiana’s Fort Polk — which also burns explosives with its own federal hazardous waste permit — came to Baton Rouge with a team of lawyers and public relations professionals. They argued that the burns were part of essential training for U.S. soldiers whose lives would be on the line in Iraq if they didn’t know how to detonate their munitions.
“You have to be able to carry out the training mission,” said Stanley Rasmussen, director of the Army’s environment and energy office for a nine-state region including Louisiana, who met with legislators over the bill, and confirmed the account to ProPublica.
There is no bigger heavyweight in Louisiana than the Department of Defense. It drives much of the state’s economy and employs more than 80,000 people. The Army lined up against Brown’s bill, demanding an exemption. It got what it wanted: Brown, relenting, drew up an amendment permitting the military to continue to burn if the bill passed. “I knew if I didn’t have the military,” said Brown, “I would lose everybody.” But the tide had already turned.
Clean Harbors spent 60 days with legislators in Baton Rouge arguing, as Retallick put it, “to help them understand the science.” The company offered to pay for a sewer infrastructure project in Grant Parish, which Brown declined. (Retallick said Brown asked for it, then declined.) Clean Harbors also offered to install fence line air monitoring systems at its facility in Colfax, which the state accepted, and it has recently put in. (Environmentalists say the monitoring will miss the black smoke they see floating high in the air).
Ultimately, the company seemed to convince the legislature that Brown’s concerns were irrational.
“I think he got ahead of himself a little bit in terms of stating his position,” said Retallick. “Maybe they just didn’t understand all the details of what we did there.”
Neither the Louisiana Chemical Industry Alliance nor representatives from Southern Strategies, the lobbying firm hired by Clean Harbors, responded to requests for comment for this story.
In Colfax, the fight endures. The state is pressing for more water and air samples. It is threatening Clean Harbors with sanctions for some of its violations. Its health department has promised to continue watching the issue. But almost nobody — especially Manatad and others living pressed up against the Clean Harbors fence line — expects officials to force Clean Harbors to stop burning altogether.
“I’m pretty sure if they was living in an environment like this they wouldn’t be pleased either, because it’s not safe,” said Annie Tolbert, 80, resting from the heavy heat in her fenced-in porch. Tolbert takes a puff of steroids from an inhaler, prescribed for her severe asthma. “They are not going to listen to us because we are black.”
“But we are citizens, too.”
Abrahm Lustgarten is a senior environmental reporter, with a focus at the intersection of business, climate and energy.
Nina Hedevang, Razi Syed, Clare Victoria Church, students in the NYU Arthur L. Carter Journalism Institute graduate studies program, contributed reporting for this story. Other students in the program who also contributed were Alex Gonzalez, Lauren Gurley, Alessandra Freitas and Eli Kurland.
Given how President Donald Trump has taken aim at the Environmental Protection Agency with regulatory rollbacks and deep proposed budget cuts, it may come as no surprise that the Office of Environmental Justice is on the chopping block.
This tiny corner of the EPA was established 24 years ago to advocate for minorities and the poor, populations most likely to face the consequences of pollution and least able to advocate for themselves.
It does so by acting as a middleman, connecting vulnerable communities with those who can help them. It heads a group that advises EPA officials about injustices and another that brings together representatives from other federal agencies and the White House to swap proposals.
When it works, all the talk leads to grants, policies and programs that change lives.
In the Arkwright and Forest Park communities in Spartanburg, South Carolina, residents were living near contaminated industrial sites and a landfill — and dying of respiratory illnesses and cancer at extraordinary rates. They used a $20,000 environmental justice grant from the EPA as seed money to form partnerships with local businesses and government agencies. Those alliances, in turn, helped bring more than $250 million in infrastructure, community health centers, affordable housing, environmental cleanups and job training to the area.
Trump’s budget proposal would effectively eliminate the office and the $2 million it takes to operate it. An EPA spokesperson suggested in a statement that the agency doesn’t need a special arm devoted to environmental justice to continue this work.
“Environmental justice is an important role for all our program offices, in addition to being a requirement in all rules EPA issues,” the statement said. “We will work with Congress to help develop and implement programs and continue to work within the Agency to evaluate new ideas to properly address environmental justice issues on an agency-wide basis.“
In theory, this is right. Federal agencies are required to consider the impacts of environmental and health-related decisions on the poor and minorities anyway — President Bill Clinton mandated they do so in an executive order. But, in practice, that order was vague and didn’t carry the force of law, leaving each president to decide how little, or how much, to do.
Now, with the Office of Environmental Justice’s fate in doubt, it’s become achingly apparent that well before Trump, those who purported to champion environmental justice — primarily Democratic legislators and presidents — did little to codify the progress and programs related to it, even when they were best positioned politically to do so.
“We haven’t done enough,” acknowledged Sen. Cory Booker of New Jersey.
Booker and other Democrats are racing to file bills that save the Office of Environmental Justice and similar initiatives on an emergency basis, though they know they have little chance of success.
“There’s no time like the present for doing what is right,” Booker said. “We can’t wait.”
“First Steps”
The concept of environmental justice began bubbling up toward the end of the civil rights movement. But it wasn’t until 1982 that it began to really take hold.
That’s when residents in the town of Afton in Warren County, North Carolina, mounted mass demonstrations against a landfill where the state planned to dump contaminated soil. The dirt was laced with toxins called polychlorinated biphenyls or PCBs, a now-banned substance that even then, the EPA knew to cause birth defects and potentially cancer.
“We know why they picked us,” the Rev. Luther G. Brown, pastor of Coley Springs Baptist Church, said at the time. “It’s because it’s a poor county — poor politically, poor in health, poor in education and because it’s mostly black. Nobody thought people like us would make a fuss.”
The protests and subsequent lawsuits didn’t stop the landfill; in the years since, the site has actually expanded. But the uproar was enough to spark Congress’ attention.
In 1983, a government report found that three of the four landfills it examined were located in some of the region’s poorest or predominantly black communities. In 1987, a more expansive survey by the United Church of Christ Commission for Racial Justice found that nationally, hazardous waste facilities were more likely to be located in predominantly minority communities.
“These were invisible problems in invisible communities until they organized themselves and started to have their own dialogue with EPA,” said Vernice Miller-Travis, a former member of the advisory council convened by the Office of Environmental Justice.
Pressure was mounting for the government to act.
In 1990, the EPA took a look at its policies, for the first time examining environmental risks through the lens of race and class. It issued a report in 1992 that found that “EPA should give more explicit attention to environmental equity issues,” collect better data, revise its enforcement and permitting programs, and communicate more with communities of color.
The Rev. Ben Chavis raises his fist as protesters are arrested at the Warren County PCB landfill near Afton, North Carolina, on Sept. 16, 1982. (Greg Gibson/AP Photo)
It’s worth noting, this was a hot moment in American politics. President George H.W. Bush, a Republican, was defending his place in the White House against a young Democratic governor named Bill Clinton. The tenor of the debate was radically different from the most recent election; these candidates argued over who was a better environmentalist.
Bush announced the creation of the Office of Environmental Equity, which would evolve into today’s Office of Environmental Justice. Its purpose in the 1990s was the same as it is today: Listen to communities, get their concerns in front of policymakers, funnel grant money into local projects. “We have been negligent,” Clarice Gaylord, the office’s first director told the St. Petersburg Times. “Now we will have to focus more on how we affect people.”
Bush lost the election, but his replacement pushed forward on environmental justice, moving the mission beyond that one EPA office.
Clinton signed an executive order in 1994 requiring federal agencies to consider environmental justice in all of their policies. He established policies that would allow people the right to participate in decisions that impacted them and ordered an analysis of health and environmental impacts for projects seeking federal permits. He also declared environmental injustice a violation of Title VI of the Civil Rights Act — the same law that sought to end segregation in schools. Now, communities could ask the EPA to investigate environmental discrimination. EPA could strip violators of funding until they got in line.
“I think it’s important for people to understand that this is a first step,” EPA Administrator Carol Browner said at the time. “There are many, many more steps to come if we are really going to address the problems that these communities are raising.”
In hindsight, this might have been the time to take additional steps.
For the first six years, lawyers were unclear on exactly how much power the executive order gave the EPA to enforce environmental justice via existing laws, like the Clean Air Act. A legal opinion eventually resolved that issue, but a broader problem remained: The executive order was more of a philosophical guide than a rigid list of requirements. Some have wondered, looking back, whether the language directing administrations to enforce environmental justice “to the greatest extent practicable” could have been stronger or more specific.
Those invested in environmental justice would soon learn just how much rode on the sitting president.
Fickle Justice
George W. Bush didn’t approach environmental issues like his father.
In addition to walking back arsenic standards for drinking water and refusing to regulate greenhouse gas emissions from power plants, the younger Bush’s administration began to erode environmental justice programs.
Clinton’s executive order required every federal agency to consider the health and environmental impacts policies had on minority and low-income communities. Under Bush, the focus shifted to ensuring protections for “all people.” The EPA inspector general rebuked that position in a 2004 report, saying that reversing the emphasis on vulnerable communities had led to confusion, a lack of consistency and “return[ed] the Agency to pre-Executive Order status.”
In 2006, the inspector general found that the EPA wasn’t conducting environmental justice reviews of its policies and programs, nor had it developed a framework to do so. The EPA office charged with policing environmental discrimination ground to a halt, amassing a backlog that stretched for a decade.
The weakness of the executive order prompted Democratic legislators to sponsor bills almost every year to legally establish the advisory groups created under the executive order, force the EPA to abide by the IG report recommendations, and give citizens the right to sue under Title VI for environmental discrimination. The bills were often championed by Democratic heavyweights — Sens. John Kerry and Hillary Clinton, and Reps. Hilda Solis and Mark Udall — but even when Democrats held the most power in Congress, they never came close to passing.
“There’s not been an environmental justice bill that’s ever been put to a floor vote,” said Albert Huang, director of environmental justice at the National Resources Defense Council.
“Politically, it’s a very attractive issue to introduce legislation around because it threads so many needles: civil rights, environment, social justice, low-income — so many issues,” said Huang. “But for those same reasons, it’s a lightning rod for moderates and conservatives because those issues are viewed as the most progressive and liberal of each of those topics.”
By 2007, it was becoming clear that the promise of environmental justice was stalled. The United Church of Christ updated its toxic waste report and found that 20 years later, little had changed.
Then, Barack Obama was elected. He’d promised in his campaign to “resurrect” civic environmental responsibility and to prioritize remediation efforts in “neglected communities so that living daily with extreme environmental pollution and health risks will be a condition of the past.”
His administration raised the profile of the Office of Environmental Justice, audited the Office of Civil Rights and eliminated a backlog of cases against polluters (though it drew criticism from those who said it hadn’t done enough).
It also took a laundry list of other incremental steps: developed strategic plans for environmental justice and enforcing civil rights, issued a case-resolution manual to guide investigations, and created a compliance toolkit to help state agencies stay within the bounds of the law. The administration added a senior adviser for environmental justice, who participated in high-level meetings at the EPA and advocated for vulnerable communities in major budget and policy decisions.
But the Obama years also featured plenty of missed opportunities.
Children line up to greet former President Obama’s motorcade before he speaks in Flint, Michigan, about the water contamination crisis there on May 4, 2016. (Bill Pugliano/Getty Images)
Obama could have created an Office of Environmental Justice at the White House or installed senior advisers focused on the issue at every agency — not just the EPA — to help guide policy. He didn’t.
And during the two years Democrats controlled the House, the Senate and the White House, they didn’t file a single bill focused on strengthening environmental justice protections like the ones filed during the Bush administration.
The one big swing on the environment front came in 2009, with the American Clean Energy and Security Act, commonly known as the Waxman-Markey bill or cap-and-trade. It was the first major legislative effort to address climate change by placing limits on the amount of greenhouse gases facilities could emit, and allowing them to buy credits to offset overruns. It passed the House narrowly, but died in the Senate, as legislators focused their political capital on health care reform. When Democrats lost seats in 2010, the prospect for passing major environmental legislation faded.
There were other ways lawmakers could have pushed to protect or even expand environmental justice initiatives. They could have offered up amendments on federal spending bills that required withholding of funds from any jurisdiction that didn’t prioritize environmental justice, similar to riders Rep. Adam C. Powell Jr. proposed for school districts that refused to desegregate.
But when it comes to environmental justice, legislative efforts have tended to be reactive, not proactive.
The one environmental justice law proposed during the Obama administration came with the end of his presidency in sight.
Rep. John Lewis, D-Ga., introduced the Environmental Justice Act in February 2016, with the presidential campaign in full swing and Donald Trump — thanks to a spree of primary wins — emerging as the GOP frontrunner. Even then, the EPA was emerging as a potential target for cuts and regulatory changes.
“Mr. Speaker,” Lewis said on the House floor, introducing the measure, “there is still much work to be done.”
But that bill, like the others that came before it, went nowhere.
Trump Takes Aim
Six months into the Trump administration, environmental regulation and enforcement is in broad retreat.
Changes at the EPA have made it easier to dump coal-mining waste in waterways, spew greenhouse gasses into the atmosphere and spray a pesticide that has been found to damage the developing brains of children.
Attorney General Jeff Sessions has banned settlements in cases that allowed companies to fund community projects not directly related to their violations. For example, when Harley Davidson was cited for selling equipment that polluted the air, it agreed to give $3 million to an American Lung Association program to help people replace wood stoves with cleaner appliances — a move toward clean air that was unrelated to motorcycles, but would’ve helped low-income homeowners. Last week, the Department of Justice said it didn’t have to pay.
“Any settlement funds should go first to the victims and then to the American people — not to bankroll third-party special interest groups or the political friends of whoever is in power,” Sessions said when he announced the policy last month.
Key members of the administration have sharply different views on environmental justice than their Obama administration predecessors. Trump’s nominated top environmental prosecutor Jeffrey Bossert Clark — who defended BP against state claims arising from that same oil spill — once called environmental justice an overstepping “crusade.”
In addition to shutting down the Office of Environmental Justice, the proposed budget reduces funding for civil and criminal enforcement of environmental laws, and directs the agency to curtail enforcement inspections as much as possible.
The proposal prompted the head of the environmental justice office, Mustafa Santiago Ali, to resign in March. The cuts send a message that the opinions and lives of those who live in vulnerable communities aren’t valued — a message that’s clearly intentional, Ali said.
“These are not dumb people leading the agency,” Ali said of the Trump administration’s choices at the EPA. “You may not agree with how they do business, but they have a strategy. You weaken policy development when you don’t have an Office of Environmental Justice to play a role in that space.
“You’re placing communities’ health at risk, and most people don’t get that,” he continued. “When you’re building a house, if you start pulling bricks out of the foundation, it will weaken and eventually, a collapse will happen.”
The White House did not respond to questions from ProPublica about the proposal to cut the office or the president’s position on the federal government’s role in issues of environmental justice. A House Appropriations bill currently awaiting a floor vote proposes a less drastic cut for the EPA.
EPA Administrator Scott Pruitt, who was a longtime opponent of the agency, hasn’t explicitly articulated an approach to environmental justice, but his public statements prior to taking the agency’s reins echo those of the Bush administration.
“I agree that it is important that all Americans be treated equally under the law,” he said in written responses to questions raised during his confirmation hearing, “including the environmental laws.”
The language sounds fair on its face, said Huang, of NRDC, but ignores that environmental harm is not experienced equally by all communities.
“They’re saying environmental justice is for everybody, regardless of your race,” he said. “It’s like saying ‘All Lives Matter’ but for environmental justice.”
Communities have already done the work of proving that minorities and the poor bear more environmental costs than others, Miller-Travis said. “Do we have to do that again? Will they accept that data or will we have to go back to ‘everybody is in harm’s way’ which is where they started?”
Early statistics suggest that Trump’s administration may be less stringent on environmental enforcement than his most recent predecessors.
The EPA Office of Enforcement and Compliance Assurance investigates cases of potential environmental crimes cases, then turns them over to the Department of Justice for prosecution.
It’s unclear how many cases the EPA’s enforcement arm referred to the Justice Department, but in the first four months of the Trump administration, 133 environmental cases have been prosecuted. By comparison, 315 cases were prosecuted in the first four months under George W. Bush and 171 in the first four months under Obama.
Trump’s nominee for head of EPA enforcement, Susan Parker Bodine, a former lobbyist and head of the Office of Solid Waste under Bush, offered her support of environmental justice initiatives during her confirmation hearing.
“Yes, I will be a champion for communities of color and communities of poverty,” she said.
But Clark, who’d decide whether to prosecute the cases Bodine investigated, has been less sympathetic. Clark served as Mitt Romney’s energy policy advisor in the 2012 campaign and is a member of the Federalist Society, a conservative legal group.
During a 2010 Federalist Society panel, Clark said the EPA’s environmental justice focus overstepped its boundaries and that locating a facility in a low-income neighborhood isn’t the same as racial or gender discrimination. “That is just not an equation that works,” Clark said. “And I think actually most of the people who live in those areas now would say if there’s a new plant opportunity, bring it on.”
Former DOJ officials and colleagues spoke positively of Clark’s legal abilities and dismissed concerns that his personal beliefs would filter to his work. At his confirmation hearing, Clark wasn’t asked explicitly about environmental justice, but generally defended his ability to be impartial. “When in private practice, if you have a client, your job is to defend them,” Clark said. “I don’t think [my past work will] affect my general ability to enforce federal law.”
Clark declined an interview request from ProPublica, as did Pruitt. Bodine did not respond to an e-mail requesting an interview.
An Uphill Battle
Just as they did under Bush, Democrats under Trump are once again filing bills to try to preserve environmental justice initiatives.
In the House, two bills proposed in May by three freshmen representatives would create an environmental justice czar in the president’s office and establish by law the Office of Environmental Justice at the EPA. The legislation, and a resolution on the importance of environmental justice, is an extension of the work Washington Rep. Pramila Jayapal, California Rep. Nanette Diaz Barragan and Virginia Rep. A. Donald McEachin did before coming to Congress.
“We’re still trying on numerous levels ... to bring forward the disproportionate burden communities of color face and the institutionalized racism that exists within our systems of government,” Jayapal said. “It’s not easy to talk about, but it’s true. If we want to address environmental justice, we have to recognize that not all people are suffering equally.”
The U.S. military burns millions of pounds of munitions in a tiny, African-American corner of Louisiana. The town’s residents say they’re forgotten in the plume. Read the story.
A photographer who covered the war in Iraq appreciates how threats can come to seem routine. Read the story.
Twenty-two Democratic senators signed a letter in May asking for the Appropriations Committee to override Trump’s budget and fund EPA’s civil rights and environmental justice offices, saying the cuts are “putting all Americans at risk, and especially those Americans who bear a disproportionate burden of exposures to pollution.”
“These communities have long been suffering under unconscionable conditions,” said Booker, one of the signatories. “We’re not doing enough to stop this evil.”
Booker expects to introduce an environmental justice bill after Labor Day, and while the contours are still murky, the legislation is being guided by conversations with advocates and people dealing with environmental hazards, and by his own visits to hog farms in North Carolina and landfills in Alabama.
Public support for environmental justice efforts has gotten a boost from the Flint water crisis and the Standing Rock protests, which raised awareness. This could encourage more legislators to push back against proposed cuts to the EPA, advocates said.
But depending on how the bill is structured, it could open up settled law and make a target of some existing protections, said environmental justice consultant Miller-Travis.
“I wouldn’t want to give them a chance to look at amending the Clean Air Act,” Miller-Travis said. “I don’t trust these people. … We’re in a defensive posture. We’re trying to defend that which we have. I would be elated to be proven wrong at the end of the day, but it’s going to take every ounce of integrity, resources, muscle … to defend and hold onto the rights we have so painstakingly worked to achieve.”
Republicans have sought to add language or otherwise prohibit funding for environmental justice initiatives in at least 13 bills since 2006. In February, Rep. Sam Johnson, R-Texas, re-introduced his Wasteful EPA Programs Elimination Act, which would cut 13 programs — including the environmental justice office — and close EPA field offices. The goal, Johnson told ProPublica, is to “save taxpayers’ money and reduce the size of a government agency that has grown too big for its britches.” Much of the work of the EPA, including environmental justice, Johnson said, would be better handled by states.
The political climate makes it difficult for proponents of environmental justice to be optimistic.
“Unfortunately, for the last 20 years, we’ve been in a period of trying to find the right political moment when the stars align so that you might be able to get a bill through Congress,” said Miller-Travis. “Is this a moment when I think we can get something passed that expands civil rights and equal protection? I don’t think this is that moment. That doesn’t mean we won’t try.”
Last Wednesday, July 19, was something of a busy news day. There was word North Korea was making preparations for yet another provocative missile test. The Supreme Court, in its latest ruling in the controversial travel ban case, said that people from the six largely Muslim countries covered by the immigration enforcement action could enter the U.S. if they had a grandparent here, refusing to overturn a ruling that grandparents qualified as “bona fide relatives.” And then, late in the day, President Donald Trump gave a remarkable interview to The New York Times, one that, among other things, laid into Attorney General Jeff Sessions.
The day also produced its share of what, sadly, has come to qualify as routine news: A Muslim organization in Sacramento, California, received a package in the mail that included a Koran in a tub of lard; police in Boise, Idaho, identified a teenage boy as the person likely responsible for scratching racist words on a car; in Lansing, Michigan, police launched a search for a suspect in the case of an assault against a Hispanic man. The victim had been found with a note indicating his attacker had been motivated by racial animus.
The specter of hate incidents and crimes — some of them fueled by the nastiness of the 2016 presidential campaign — felt white hot months ago. The issue remained high-profile as several horrific murders — a South Asian immigrant slain in Kansas City, a homeless black man butchered near Times Square in New York — generated outrage and national news coverage.
Documenting Hate, an effort by a coalition of news organizations, has sought to sustain a focus on incidents and crimes of racial or religious or sexual prejudice even as the temperature around the issue rises or falls. One of the truths the effort has laid bare is that such crimes are so commonplace that they can seem an almost ordinary part of the fabric of life in America.
Scattered among the news items on that single July day — captured in local write-ups and wire-service briefs — was the attempted murder of a black employee at an auto parts store in Desert Hot Springs, California, an attack during which the shooter repeated racial epithets; the menacing of a mosque in Georgia, where repeated telephone threats warned that “white people are going to kill you”; an Indian-American Ph.D. candidate in California had her car’s windshield shattered by a rock as she drove to work, glass from the window embedding in her skin and hair. “Go back to your own country,” the assailant had screamed.
“I was shocked,” Simranjit Grewal told the India West newspaper. “Another human being was trying to attack me, to hurt me.”
Earlier this year, ProPublica reported on studies done in Great Britain on hate crimes in the aftermath of the Brexit vote. Immigrants in the country faced violence, having been demonized as a threat during the polarizing and ultimately successful effort to withdraw from the European Union. One of the researchers’ findings was that the hate incidents very often did not involve fringe, ultra-nationalist and neo-Nazi groups. Instead, they were perpetrated by, as one researcher put it, “ordinary people.”
The accounts marshaled by the Documenting Hate coalition suggest the same is true in the U.S. Amid the hundreds upon hundreds of news reports of crimes and insults and threats we’ve collected, there’s an everyman quality to the accused. While the black man killed in New York was allegedly slain by a consumer of white supremacy propaganda, the immigrant shot to death in Kansas City was allegedly killed by an unremarkable suspect, a man who had worked menial jobs across his life and, according to some associates, been in a spiral of drinking and depression for months.
It’s been about six months since we joined forces with newsrooms around the country to track hate. We’ve collected information on thousands of incidents, but much remains unknown about the scale of the problem. Read the story.
The kinds of suspects implicated in the events of July 19 — a teen, a somewhat bumbling young man who managed to shoot himself in the course of trying to kill an auto parts worker — turn up on other days, in other crime reports. Two college students in Berkeley, California, were charged on July 18 with spray-painting racist graffiti. A man in Oregon was arrested after swearing at and harassing a Muslim women over a 20-block span, pretending to shoot a gun and screaming at her to leave the country and remove her headdress. The man, in tears, later said his “stupidity” had got the best of him.
The news reports collected as part of the Documenting Hate project include more than just crimes. The project also tracks news accounts dealing with reports on things such as hate crime statistics and calls for new hate crimes legislation. This month, for instance, there was the formal release of a Center on Islamic-American Relations report on anti-Muslim crimes, one that showed a huge spike over the last six months, a 91 percent rise in reported incidents over the same period last year.
Also included, though, are reports of steps being taken to combat the crimes and limit their incidence and damage — committees formed, outreach initiated. This month in Montgomery, Alabama, several organizations joined to run what they called “bystander intervention training,” meant to encourage people to act when witnessing the harassment of people because of their race or religion. In Anne Arundel, Maryland, there was a protest on the courthouse steps organized in part by the NAACP to highlight a recent case of a noose being hung in a local middle school.
And in Washington, D.C., there was a conference on hate crimes run by the Department of Justice overseen by Jeff Sessions. Should the news of July 19 — Trump’s first salvo in what seems to many to be a bid to drive Sessions from office — result in a new attorney general, one of Sessions’ final acts will have been an impassioned promise to fight hate crimes.
NEW YORK — On Rikers Island, in a cell block for the jail’s most violent inmates, young men sit for hours, feet shackled to “restraint desks.”
The school-like desks, outfitted with chains and locks, are located in specialized cell blocks called Enhanced Supervision Housing units. In the most secure levels, inmates who have committed violent infractions — caused injury to another inmate or guard, or attempted to stab or slash someone in jail — can leave their cells for a minimum of seven hours every day, but must be locked to the desks for much of that time.
Officials said they created the units as a more humane alternative to solitary confinement and that the units helped make Rikers the nation’s first jail to stop isolating young inmates. But a new report from the New York City Board of Correction suggests they may have traded one problematic practice for another.
Inmates have been able to finesse their way out of the shackles to attack others as they sit defenseless. One young man, chained to a desk, was slashed in the face while trying to use a phone on the cellblock floor. Another was unable to fight back when he was jumped by four men.
The report released Monday focused on the lives of young adults in these units, which opened first to older inmates in 2015, and a year later, to inmates under 22. It found that inmates often weren’t told how long they’d have to live in the specialized housing units. Some stayed for as little as two days; others, several months. The units are broken into levels, the most secure of which use desk restraints. The board found that many young adults were not given a hearing to determine whether they needed to live in such a restricted environment.
Young adults began moving into the Enhanced Supervision Housing units in September 2016. Over the following six months, they were involved in six slashings in the units. Nearly 40 percent of all unit inmates suffered some form of injury. Rikers officials have long sought to bring down the number of slashings, fistfights and other violent episodes that plague the facility near daily. Neither the board nor the department provided specific details on how inmates smuggled weapons into the units or broke free of their shackles to harm one another.
Some inmates were so scared they refused to leave their cells unless they were allowed to sit, shackled, in what they considered to be the safest part of the room. Others were forced to sit in restraints only because they wanted to attend class, even though they were not deemed enough of a safety threat to live in a more secure unit.
The board found that those who took the risk were not particularly well-served by the classes. The report noted that “young people experience significant distractions during the school time.” The inmates chained to desks are surrounded by inmates in cells who yell and taunt them. A search dog’s barking echoes through the unit. Class often starts more than an hour late.
Rikers officials have insisted that the units are not meant to punish unruly, violent young prisoners, but rather keep other prisoners and guards safe.
Dr. Bobby Cohen, who sits on the Board of Correction, calls that a misrepresentation.
“When the Board voted to end solitary confinement for men and women under 22, we did not vote to chain people to desks,” said Cohen in an email to ProPublica. “The Department of Correction misrepresents reality when it says that shackling men's legs and chaining them together so they can't move is not punishment.”
The units are a response to the department’s decision to end solitary confinement, which research has shown can have a damaging psychological effect, especially on young people. In June 2015, 22-year-old Kalief Browder hanged himself at his mother’s home after spending much of the previous three years in solitary confinement on Rikers, only to have his robbery charges dropped. His turbulent time at Rikers was detailed in The New Yorker, and his death helped prompt pledges of reform at the highest levels of city government. Mayor Bill DeBlasio’s administration promised to end the solitary confinement for young adults on Rikers Island. In its place, Rikers officials have turned to the Enhanced Supervision Housing units.
The Board of Correction, which helps create rules on conditions of confinement in New York City, expressed dissatisfaction with the units earlier this year.
In a January hearing, board member Bryanne Hamill showed photos of young inmates chained to the restraint desks. She said the inmates told her they would rather be in solitary confinement. Members of the department, however, seemed unconcerned. Some, including former Department of Correction Commissioner Joseph Ponte, walked out of the meeting.
Ponte resigned in May, following a report by the Department of Investigation showing he had misused city resources and spent an inordinate amount of time out of state while the city’s correctional facilities struggled with violent incidents.
In an emailed statement, New York City Department of Correction spokesman Peter Thorne described the new housing units as a success.
“Enhanced Supervision Housing has allowed New York City to be the first in the nation to eliminate punitive segregation for young adults,” he said. “It separates the most violent young adult inmates from the general population, while at the same time offering them educational opportunities. The level of security provided by these housing units allows even our most violence-prone young adults the chance to learn. We are working with the Board of Correction on the areas for improvement noted in their report.”
Department officials also pointed out that restraint desks have been used in jails and prisons in Colorado, California and Washington state.
The board acknowledged that in its report, but noted that outside jurisdictions primarily limit the use of restraint desks to two hours at a time.
Cohen, the board member, said that’s not the case at Rikers. He said that young adults at Rikers are often held for more hours across more days than in other places.
“Young adults have been held in leg restraints for months, and could be shackled without end. Restraints should only be used for the minimal amount of time necessary and only to ensure the physical safety of the individual and others,” he said. “As a doctor, I know it is harmful. It is degrading, it is unsafe, and it should stop now.”
Help us investigate: If you have experience with or information about juvenile justice or Rikers Island, email Joaquin.Sapien@propublica.org.
When Amy Jones’ dad, Paul, was diagnosed with glioblastoma last month, she wondered whether it might be tied to his time in Vietnam.
Then, last week, when Sen. John McCain, R-Ariz., also a Vietnam veteran, was diagnosed with the same aggressive brain cancer, Jones searched online for glioblastoma and Vietnam vets.
She soon learned the disease is one of a growing list of ailments that some Vietnam veterans and their relatives believe is caused by exposure to Agent Orange, the toxic herbicide sprayed during the war.
“Honestly, it’s not easy to even admit that this is happening, let alone to even talk about it,” said Jones, whose 68-year-old father has had surgery to remove a brain tumor and now is receiving radiation treatments. “It’s only been six weeks. It’s such a devastating diagnosis.”
McCain’s diagnosis comes as the U.S. Department of Veterans Affairs is under increased pressure to broaden who’s eligible for Agent Orange-related compensation. During the war, the military sprayed millions of gallons of the herbicide in Vietnam to kill enemy-covering jungle brush, and in the process, may have exposed as many as 2.6 million U.S. service members — including McCain.
News of his illness has prompted Amy Jones and others to call on the VA to study a possible connection between their loved ones’ Agent Orange exposure and glioblastoma.
Under current policy, the agency makes disability payments to veterans who develop one of 14 health conditions, but only if they can prove they served on the ground in Vietnam, where the chemicals were sprayed. Veterans who served off the coast in the Navy and those with other diseases not on the list — such as brain cancer — are left to fight the agency for compensation on a case-by-case basis.
Those with glioblastoma — or widows seeking survivor benefits — must prove the disease was “at least as likely as not” caused by Agent Orange, a cumbersome process that often takes years and more times than not results in denial.
Although McCain primarily served at sea from the deck of an aircraft carrier — and survived more than five years in a prison camp after his plane was shot down over North Vietnam — the VA would presume he was exposed to Agent Orange because he also spent time on the ground in Saigon.
Still, McCain never has sought to connect any of his health troubles, including prior bouts with skin cancer, with Agent Orange exposure and has a mixed record when it comes to compensating fellow veterans for wartime exposures. His office did not respond to emailed questions about a possible link between glioblastoma and the chemical.
As a senator, McCain voted to approve the original 1991 law that directed the VA to presume every veteran who served in Vietnam was exposed and to begin compensating those with illnesses scientifically linked to it.
In 2011, however, as many Vietnam veterans aged into their 60s and 70s and annual disability payments to them swelled to more than $17 billion, McCain spoke in favor of an amendment that would have required a higher standard of scientific proof before any new illnesses would be covered.
The goal, McCain said in a floor speech, was to ensure that veterans who actually deserved compensation received it, “but at the same time not have a situation where it is an open-ended expenditure of taxpayers’ dollars.” The amendment was defeated — and since then, Vietnam vet disability payments have grown to $24 billion a year — and the episode damaged McCain’s reputation with veterans groups.
In a statement, a VA spokesman said the agency currently does not recognize a connection between Agent Orange exposure and brain cancer but is examining the topic anew in light of the questions that have been raised. In March, the VA asked a National Academy of Medicine panel studying the effects of Agent Orange to focus special attention on glioblastoma. (Previous reports by the group have not found a connection.) The VA also is asking about brain cancer in a sweeping survey of Vietnam veterans now underway.
VA data provided to ProPublica last fall shows that more than 500 Vietnam-era veterans have been diagnosed with glioblastoma at VA health facilities since 2000. That doesn’t include the unknown number diagnosed at private facilities.
ProPublica and The Virginian-Pilot reported last year how widows of Vietnam vets were banding together to push the VA to add glioblastoma to its list of diseases linked to Agent Orange. Through a Facebook group, they support one another and offer advice on navigating the VA’s labyrinthian process for seeking disability and survivor benefits.
Since news of McCain’s illness broke last week, dozens like Jones have joined the group, whose members mostly include widows and surviving relatives, but also some veterans living with the disease. “Every one of us, our phones were blowing up the day it came out” that McCain had glioblastoma, said Kathy Carroll-Josenhans, one of the group’s leaders.
The group now has some 450 members, about double its size in December.
One of their challenges is that the VA’s handling of claims related to glioblastoma has been somewhat inconsistent. Between 2009 and last fall, the Board of Veterans’ Appeals, the VA’s in-house tribunal for adjudicating benefit denials, issued more than 100 decisions in cases in which widows have appealed benefits denials related to their husbands’ brain cancer, according to a ProPublica analysis of board decisions. About two dozen won. (Here are two additionalapprovals from this year.)
Brad Riddell, a 35-year-old communications specialist living in Austin, Texas, is not a member of the Facebook group but immediately thought of his father when he heard about McCain’s illness. His dad, Jerry Riddell, served in a Navy construction battalion in Da Nang during the war and routinely came in contact with Agent Orange, which was used to clear brush before paving roads and runways.
Jerry Riddell, a Vietnam vet, was diagnosed with glioblastoma when his son, Brad, was in high school. He died 14 months after his diagnosis. (Courtesy of Brad Riddell)
Riddell was in high school when his father had a seizure while driving from work one day. A brain scan later that day revealed a tumor the size of a grapefruit and a medical term that still makes Riddell shudder: glioblastoma.
His father endured three surgeries — including two at MD Anderson Cancer Center in Houston — before doctors told him there was nothing more they could do. He entered hospice and died in February 1999, just 14 months after the diagnosis.
“I absolutely thought about dad when I heard about McCain,” Riddell said. “Anytime I hear that diagnosis, it just feels like, ‘Man, that person is a goner.’ It’s terrible.”
After his father’s death, Riddell’s mother gave him a bag of his military records and told him to hold onto them: “She said, ‘You need to have all these records in case there‘s ever a connection made between your dad’s cancer and Agent Orange.’”
In the wake of the McCain news, Riddell wonders if it’s time to pull the records out.
Heidi Spencer had a similar revelation a year ago. Her father, Jack Niedermeyer, died of glioblastoma at age 58 in June 2004. Her mother didn’t think to apply for benefits until last year when someone at the local Veterans of Foreign Wars post where she works suggested it. Spencer helped her mom fill out the application and the VA approved it in March.
“He never knew his cancer came from Agent Orange. He never talked about his service,” she said of her dad, who worked in a steel mill in Pittsburgh and had six kids.
Spencer, 42, found her dad’s commanding officer in the Marine Corps, who wrote a letter saying her dad had been sprayed by Agent Orange.
“The more you research it, the more it comes into light,” she said. “The VA needs to look at this, they need to link it and they need to look at his [McCain’s] diagnosis and whether or not the Vietnam War played a role in him getting his disease.”
In approving her mom’s claim, the VA wrote that glioblastoma was not recognized as a disease that automatically warranted benefits linked to Agent Orange but that “current medical research has shown a causal relationship between herbicide exposure and glioblastoma multiforme.” This is contrary to the VA’s official policy.
Regardless of McCain’s position on the matter, advocates hope his diagnosis will spark a conversation.
In a statement last week, John Rowan, the president of Vietnam Veterans of America, said he was saddened to learn “yet another Vietnam veteran” had been diagnosed with glioblastoma.
“Unfortunately, brain cancer is not on the presumptive list for exposure to Agent Orange,” Rowan said in a statement, “despite the efforts of our fellow veterans and their family members.”
Last week, Dan Coats, the former senator from Indiana and current head of the U.S. intelligence community, was interviewed by NBC’s Lester Holt in front of a live audience at the Aspen Security Forum, a gathering where diplomats, journalists and top U.S. officials mingle with business executives in between livestreamed panel discussions on world affairs. (The hourlong discussion was posted on YouTube.)
ProPublica has obtained internal talking points, apparently written by one of Coats’ aides, anticipating questions that Holt was likely to ask. They offer a window into the euphemisms and evasions necessary to handle a pressing issue for Coats: how to lead the intelligence community at a time when the president has insulted it on Twitter and denigrated its work while questions about Russian influence consume ever more time and attention in Washington. Sixteen of the 26 questions addressed by the talking points concerned internal White House politics, the Russia investigation, or the president himself. One question put the challenges facing Coats this way: “How can you work as DNI for a president that undermines your work?”
DNI spokesman Brian Hale told ProPublica that the 17-page document was a small, unclassified part of “a thick binder” of preparation documents for Coats’ interview. The other pieces, according to Hale, “had substantive material on Russia, China, Iran, Venezuela, North Korea.” The talking points document, he said, “was designed to address the questions we anticipated being asked because of the news cycle.”
Prepared questions and answers — talking points — have long been standard procedure in Washington for officials facing a major interview or public testimony. In this instance, the document anticipated far sterner questions than Holt posed in the actual interview and Coats, an experienced official, often departed from the script.
In the talking points, Coats was advised to say that he and the president have “a trusted relationship,” framing any disagreements as constructive ones. “We may not always agree,” the document stated. “We must maintain an open dialogue … the relationship portrayed in the media between the president and the intelligence community is a far cry from what I have personally experienced and witnessed … there is a healthy dialogue and a good back and forth discussion.”
There’s no doubt that Coats, the statutory leader of the 16-agency intelligence community, is operating in an unusual environment. Normally, American intelligence agencies do their work quietly, avoid public political disputes, and settle whatever differences they have with the White House privately.
But Trump’s willingness to openly criticize the intelligence community has altered that equation. Days before taking office, he compared America’s spies to Adolf Hitler’s Gestapo. “Intelligence agencies should never have allowed this fake news to ‘leak’ into the public,” Trump tweeted, referring to allegations contained in the Steele dossier, the controversial, unverified research that purportedly raised the possibility that Trump could be susceptible to Russian blackmail. “Are we living in Nazi Germany?”
The differences between the White House and the leadership of the intelligence community are severe, in the view of former CIA and NSA Director Michael Hayden. “This is a bit of a true-believer administration,” he said in an interview with ProPublica at the Aspen conference. “Faith-based, faith with a small ‘f.’ They think they know all the answers. And then you’ve got people living in this fact-based, empirical, inductive world. They’re talking to people who, as an article of faith, know what the answers are. That creates great tension at the very top.” (Hayden had not seen Coats’ talking points when we spoke, and he declined to review them later.)
American spies do not like having their work dismissed by the president. Nor do they appreciate comparisons to Nazi Germany. At Aspen, former CIA Director John Brennan made it clear that the wounds inflicted by Trump’s words had not yet healed. “The person who said that should be ashamed of himself,” Brennan said, during another panel. Coats’ predecessor, Gen. James Clapper, called Trump’s comments “a terrible, insulting affront … completely inappropriate.”
As president, Trump has heaped public scorn on the U.S. intelligence community’s conclusion that the Russian government sought to interfere in the election. “Well, I think it was Russia, and I think it could have been other people in other countries,” the president said earlier this month, when asked during a news conference to give a definitive answer on Russian involvement. The White House continues to cast doubt on Kremlin interference, despite repeated and unequivocal statements to the contrary from the intelligence community.
Trump’s opinions are out of step with the conclusions of the agencies he is supposed to be leading. At Aspen, CIA Director Mike Pompeo said he was “confident that the Russians meddled in this election, as is the entire intelligence community.”
Coats’ script echoed that view. “I stand by the IC’s Assessment,” it stated. “President Putin ordered an influence campaign in 2016 aimed at the US presidential election.”
Matthew Olsen, a senior national security official in both Democratic and Republican administrations, says the ongoing conflict between President-elect Trump and the U.S. intelligence community poses grave risks. Read the story.
The talking points anticipated that NBC’s Holt would ask, “Does it trouble you that President Trump has not come out strongly and said ‘yes’ Russia interfered in the election?” The proposed responses sidestepped the question: “The intelligence community has made it clear as to what our assessment is regarding Russian activity during the 2016 elections. … The president and his policymaking team … must consider intelligence information along with other inputs from other sources too. So intelligence is only one of many inputs,” read the talking points.
“What other inputs should he be listening to?” said a former official from the Obama White House who reviewed the document at ProPublica’s request. “What Putin tells him behind closed doors? What he reads on InfoWars? This answer should be read as a slap in the face of the intelligence community.”
When asked whether Trump’s comments have hurt the community’s morale, Coats was advised to say that he is “so proud to lead the US intelligence community … extremely impressed,” and that he frequently interacts with subordinates “over brown bag lunches.” At the same time, the points emphasize Coats’ close proximity to Trump and his good relations with Pompeo. The word “community” was repeatedly emphasized. Coats was advised to describe his role as “head coach” and say “we’re all on the same team.”
At several moments during his interview (here’s the transcript) Coats appeared to draw from the script. One was his description of Trump himself, who was criticized during the transition for skipping the president-elect’s customary daily intelligence briefing. In response to the question of how Coats can work with a president who undermines him, the talking points advised that Coats describe Trump like this: “He is fully engaged and asks important and insightful questions when being briefed. He is so engaged that sometimes the briefing [sic] go longer than scheduled and we are asked to wrap it up to allow for his next scheduled meeting.”
Coats’ actual description of Trump’s approach to briefings also emphasized the president’s inquisitiveness and appetite for intelligence: “He interjects questions on a very frequent basis and we have to lot of times keep coming back to some of the central points. … What has turned out to be what was thought to be a 10-minute briefing every day is at least 30 minutes has turned into 40 minutes.”
One answer at the end of the document pointed towards substantial differences between the White House and Coats regarding climate change. The talking points characterize climate change as a potential national security risk, one that could potentially “lead to conflict” and is “likely to contribute to migrations that exacerbate social and political tensions.” Trump, meanwhile, has said he will withdraw the U.S. from the Paris climate accord, which seeks to limit the global rise in temperature to 3.6 degrees Fahrenheit.
When asked about morale, Coats used the script’s lines about brown bag lunches and his own pride about leading a talented workforce. “Intelligence officers don’t expect their work to be easy,” was another answer suggested by the document. Coats left that part out.
In the cellphone video, 33-year-old Lauren Bloomstein looks perfectly healthy, radiant even. She is in a hospital room, cradling her newborn baby as her eyes well — a portrait of the miracle of new motherhood.
Hours later, she is dead.
Bryan Anselm for ProPublica
Bloomstein succumbed to preeclampsia, a treatable condition estimated to affect some 200,000 women a year in the U.S.
ProPublica reporter Nina Martin joined NPR’s Renee Montagne and ProPublica’s engagement team to put Bloomstein’s death into a larger context in the story, “The Last Person You’d Expect to Die in Childbirth.” Through their reporting, the team explained how the U.S. health care system sometimes focuses so intently on babies that it ignores mothers, leading to hundreds of preventable deaths every year, from pregnancy to months after birth. They’re still collecting these women’s stories.
On today’s episode of the Breakthrough, Martin describes how she and the team produced the project. She tells us how they scoured Facebook and the crowdfunding website Go Fund Me to find cases of pregnant women and new mothers who perished; how they made dozens of cold calls on a subject that’s beyond sensitive; how the women’s relatives and friends often could not bear to revisit such tragedy.
Finally, she describes how Lauren’s husband, Larry Bloomstein, took the extraordinary step of inviting the reporters into his home, where he recounted his wife’s death with documents and details, and shared that devastating video.
“It was a really shattering moment,” Martin said.
Hear how it all came together on the Breakthrough, the ProPublica podcast where investigative reporters reveal how they nailed their biggest stories.
U.S. Customs and Border Protection will begin constructing the first segment of President Trump’s border wall in November through a national wildlife refuge, using money it’s already received from Congress.
That’s what a U.S. Fish and Wildlife Service official recently told a nonprofit group that raises money to support two national wildlife refuges in South Texas, according to the group’s vice president.
For the past six months, CBP has been quietly preparing a site to build a nearly 3-mile border barrier through the Santa Ana National Wildlife Refuge, according to The Texas Observer. The U.S. Army Corps of Engineers also has reportedly begun drilling and soil testing in California and New Mexico.
But construction on the wall was not expected to begin until January because Congress has yet to approve CBP’s budget. On Thursday, the House approved a spending bill that contained $1.6 billion to build segments of the wall in Texas and California. Its fate in the Senate is uncertain.
However, CBP recently told a senior Fish and Wildlife Service official in Texas that the agency would shift funds to pay for the new segment out of its current budget. The official passed on the news to Chapman’s group this week.
The Fish and Wildlife Service official confirmed the remarks, but asked not to be identified for fear of losing his job.
Customs and Border Protection spokesman Carlos Diaz said it “would be premature to speak about specific locations.” The only South Texas projects authorized under the current budget are the installation of 35 gates at gaps the agency left in the existing border fence, he said.
The 2,088-acre Santa Ana refuge, located along the Rio Grande south of McAllen, Texas, is considered one of the nation’s top bird-watching sites, with more than 400 species of birds. The refuge is also home to two endangered wildcats — the ocelot and jaguarundi — and some of the last surviving stands of sabal palm trees in South Texas.
A wall cutting through the refuge could do serious environmental damage, Chapman said, undermining the reason Congress appropriated money to buy the land in the first place. But under a 2005 law, the Department of Homeland Security can waive any environmental regulations that would normally impede construction in a sensitive wildlife area.
Chapman said his group is now counting on Democrats to halt expansion of the project.
“The Democrats in Congress up to now have been very unified as far as not appropriating money for the wall,” Chapman said.
Trump made construction of a border wall between the U.S. and Mexico the signature promise of his political campaign and told supporters it would be solid concrete, 30 feet high and would stretch the length of the U.S.-Mexico border. Trump estimated it would cost perhaps $10 billion to $12 billion — and he vowed the Mexican government would pay the bill. Five days after his inauguration, he signed an executive order to begin the process.
Since then, the wall has faded from the headlines amid other controversies. But Trump has never ceased pursuing its construction, even as he has backed off the most bombastic of his demands.
In February, the CBP launched a bidding contest to build models for the new wall. Both solid concrete and alternative designs were allowed. The project is months behind schedule. CBP officials recently said the winners will be announced in November.
Earlier in July, Trump told reporters on Air Force One that the wall should be see-through. Border patrol agents needed to be able to spot threats on the other side and avoid any “large sacks of drugs” thrown over the top. He also said he favors a wall with solar panels to generate energy and reduce the building cost.
He also opined that only 700 to 900 miles of wall may be needed. About 650 miles of the 2,000-mile long border already has some type of physical barrier. The remaining miles will be guarded by topography, the president said.
“You have mountains. You have some rivers that are violent and vicious. You have some areas that are so far away that you don’t really have people crossing,” he said.
It remains far from clear, however, whether Trump will be able to achieve even his scaled-down version of the wall. The current border fence, a far more modest project built mostly under President Obama, cost between $2.8 million to $3.9 million on average per mile, according to the Government Accountability Office. CBP previously announced that the agency has $20 million on hand for the current fiscal year.
Both Democratic and Republican lawmakers have balked at paying for the wall, which the Department of Homeland Security estimates would cost around $20 billion. Mexican officials have vigorously rejected any proposition of financing construction.
Trump, however, has already taken credit for beginning to fulfill his campaign promise.
“In a true sense, we’ve already started the wall,” he told the reporters.
It is one of the most striking and curious statistics contained in a recent Bureau of Justice Statistics report on hate crimes in America: 54 percent of the roughly 250,000 people who said they were victimized in recent years chose not to file a formal complaint with the authorities.
The Matthew Shepard Foundation, an advocacy organization based in Colorado that played a role in successfully pushing for national hate crime legislation, has recently tried to better understand the phenomenon. The foundation began asking the Denver residents notifying the organization about being victimized to explain why they did or did not report the incident to the police.
The effort began in February and so far has produced a modest 15 responses — not all of which appear to be crimes. But in a country largely bereft of reliable or probing data on hate crimes, the information collected by the foundation has value.
The foundation, which shared its data as part of our Documenting Hate project, agreed to make public some of the responses to the question on reporting to authorities. The responses are anonymous, but they offer glimpses into the mix of forces at work when victims are deciding what to do: confusion about the definition of hate crimes; skepticism of the commitment by law enforcement to aggressively investigate; fear of retaliation.
“They echo what other organizations have heard through listening sessions, meetings, and the national victims of crime survey responses,” said Jason Marsden, the foundation’s executive director, referencing the Bureau of Justice Statistics’ report.
For one transgender person who reported that homophobic slurs and beer cans were hurled at them, the answer to why they reported the assault to the police was clear: “To get these men charged with a crime.”
For others, there was confusion as to whether what happened to them was worth reporting to the police.
One of the responses came from a gay woman who had felt menaced by a drunk man, who screamed at her: “You fucking dykes are all going to hell.” The woman said her main concern was to flee the scene as quickly as possible.
She said it was also far from clear to her that the menacing amounted to a crime, “since it was just mean words.” It would take a real investigation to answer her uncertainty, but it’s quite likely the incident didn’t qualify as a prosecutable crime.
A Hispanic woman walking through her neighborhood wrote that she felt sexually harassed by passengers in a passing car.
“Working or walking?” she said they asked her. She didn’t call the cops.
“It is just expected that women have to deal with this and it is a fact of our lives,” she wrote. “On a more logistical level,” she added, “I did not get the license plate number.”
A gay woman with short hair reported that another woman tried to bar her from entering the women’s room at a McDonald’s, believing she was transgender.
It was “pointless to report,” she said, though she added she had to physically move the woman from her path.
A number of the respondents did call the police, to mixed effect.
A gay, black man at a rally against President Trump’s travel ban said a passenger in a passing vehicle threw an egg at his face. When he contacted the Denver Police Department, “the dispatcher seemed unsympathetic,” he reported. “No police officer came to my assistance, although I felt I was in distress.”
Another gay man said he was followed around a store by an angry man who yelled homophobic slurs at him. “I refuse to allow anyone to attack me like this, so I reported it,” he wrote. He went on to say, without further explanation, that when it was all over, he wound up being ticketed by the police for “disturbing the peace.”
A disabled lesbian woman in the city’s suburbs said a neighbor tried to run her down with his car. She said she wanted to call the police, but that she was afraid.
Hate crimes and bias incidents are a national problem, but there’s no reliable data on their nature or prevalence. We’re collecting reports to create a national database for use by journalists and civil-rights organizations. See the project.
It’s been about six months since we joined forces with newsrooms around the country to track hate. We’ve collected information on thousands of incidents, but much remains unknown about the scale of the problem. Read the story.
“I often think I will not be believed or taken seriously,” she wrote. When she called the police anyway, she asked the officers not to confront the man, fearing retaliation for filing a report.
“I knew that reporting the incident was important — both to notify authorities to have the incident documented, to have evidence of harassment on file in the event of a future incident, and because no matter who I am or what my sexuality is, I knew this was wrong and potentially criminal,” she wrote.
When a recently disabled gay man said he was attacked by another man who’d asked for bus fare, he said he was prevented from calling the police by his assailant. “Faggot, you calling the police,” the man reportedly said as he punched the victim. Luckily, he wrote, someone else called the authorities for him. He thought the cops were great.
“They were very compassionate,” he wrote, adding that the officers offered to have a victim advocate talk with him, and came back later to check on him.
In all, most of the people surveyed did not report incidents to the police.
“My take on the results mostly is that people are not reporting because they just don’t think the police are going to take it seriously enough, or they don’t think the incident went to that level,” said Stephen Griffin, who the foundation contracted with to implement the survey.
Christine Downs, a spokesperson for the Denver Police Department, said by email that even if a person doesn’t believe what happened to them was a crime, they should report the incident to the police.
“The Denver Police Department strongly encourages all residents to report crime, regardless of how insignificant they may think it is, especially bias-motivated crimes,” she said.
Marsden, the Matthew Shepard Foundation’s executive director, plans to try to expand their survey to other cities to keep learning more about why people don’t report incidents of hate, and to take what they learn to the police officers they work with.
“I think that can help keep people safe and help on the prevention side of things,” he said. “You have to be an optimist in this line of work.”
For years, Westchester County insisted its zoning laws did not prevent black and Latino families from moving into wealthy suburbs north of New York City — even in a town like Pound Ridge, which is 94 percent white.
Almost all homes in that bucolic community accommodate single families. Apartments are hard to come by; in most areas, the zoning law requires a special permit to build a multifamily complex.
It was this kind of setup that led a federal judge to rule in 2009 that Westchester had violated the nation’s fair housing laws. In a landmark order, the judge told the county to identify ways in which its zoning laws impede integrated housing.
Westchester turned in draft after draft of an “analysis of impediments,” and each time, officials in the Obama administration rejected it. The reports laid out demographics and zoning maps, sometimes in more than 200 pages, but insisted “there is no zoning-related barrier to minority populations.” Housing officials argued this refusal to acknowledge the barriers was keeping the county from adequately analyzing them and coming up with solutions.
Last month, the Trump administration allowed Westchester a shortcut: Take out the lines refuting discrimination.
It worked.
On July 18, the Department of Housing and Urban Development accepted the edited report — the county’s 11th revision — just three months after rejecting the last one.
Westchester County Executive Rob Astorino declared victory.
“Westchester vindicated!” he said in a tweet. “HUD capitulates after seven years. Zoning not exclusionary — like we said all along.”
Fair housing advocates are disappointed by the turnabout, but say it’s too soon to tell whether the government’s agreement sends a message about how the Trump administration will handle fair housing issues in the future.
Craig Gurian, the advocate who filed the 2006 lawsuit that led to the court order, believes the effort to transform Westchester was “squandered” long ago, not by Trump, but by seven years of weak enforcement under the Obama administration.
“This,” he said, “is the 100th nail in the coffin.”
In 2012, former ProPublica reporter Nikole Hannah-Jones wrote extensively about this topic. Her series “Segregation Now: Investigating America’s Divide” showed how the federal government failed to promote integration as it was supposed to under the law decades after the 1968 Fair Housing Act. Westchester was one of her primary examples.
In Westchester, federal officials had “repeatedly backed down from strong enforcement when confronted by determined local opposition,” she wrote.
In an interview last week, Gurian said HUD’s recent acceptance of Westchester’s zoning plan is in keeping with that history, and that the courts and government had long “bent over backwards” to accommodate Westchester’s desire not to “intrude on existing ultra-white residential neighborhoods.”
The strongest evidence, he said, was the location of the affordable housing Westchester built under the court order. The goal was to break down the barriers to fair housing and give minorities access to better services, jobs and schools so often located in predominantly white neighborhoods.
Instead, the housing units were built on the outskirts of the towns and villages that make up Westchester County, mostly in areas already occupied by people of color, he said.
The 46-unit development in Larchmont is a perfect example. It is located on a brownfield site, the former home of a moving company, and is just 500 feet from the city of New Rochelle, which already has a high number of African-American and Latino residents.
Then there are the 18 units tucked away in a remote corner of the affluent city of Rye. The apartments are sandwiched between two freeways and reachable only by a road that cuts through Port Chester, which is also poor and majority black and Latino.
That’s not the way it was supposed to work.
As HUD officials said in their announcement of the settlement in 2009:
“The landmark agreement will result in the construction of 750 units of affordable housing in neighborhoods with small minority populations; will remove existing impediments to fair and affordable housing; and will require the County to take active steps to ensure its housing and development practices are fair to families without regard to their race or ethnicity.”
Westchester has delivered the units, but Gurian believes they achieve little of what was promised. They accommodate roughly 3,000 people, a “drop in the bucket” in a county of nearly a million, he said. Many are priced so far below market value they are unattractive to middle class families. Others are priced too high, and therefore out of reach for the population they are meant to serve.
In a phone interview, Astorino spokesman Gerald McKinstry said Gurian’s claims were “false.”
“Westchester County is a welcoming county,” he said, pointing out that Westchester had, in fact, built more than the 750 units required under the order and spent tens of millions of dollars to do so.
He said the housing developments in Larchmont, Rye and elsewhere are highly desirable and that they give residents access to premier school districts.
HUD officials, who said the court order gave them no power to influence the locations of the housing sites, consider this recent agreement a victory.
Brian Sullivan, a HUD spokesman, said the department’s acceptance of the analysis hinged on just a handful of phrases in the 205-page document, specifically those that suggested that local zoning laws had no effect on segregation.
“We insisted the County remove certain language that was unsupported by the facts, and the County ultimately agreed to do so,” Sullivan said.
He said the agency’s acceptance of the plan had nothing to do with the change in administration.
“The same HUD career professionals who have been working tirelessly on this case for years are the same ones who made the call to accept Westchester County’s final analysis,” he said. “Their decision was based upon the substance and nothing else.”
Whatever influence the Trump administration may or may not have had, Westchester County’s top elected official is celebrating.
In 2009, when the consent decree was signed, Astorino campaigned on resisting it. As Hannah-Jones reported, he told local officials “he would not force anyone to build anything.”
After he won his seat, he affirmed his position, telling a local supporter, “I’m holding our ground. ... I’m not yielding a single inch to these guys.”
Now, he is taking a victory lap.
“This is vindication for Westchester County and our local municipalities and a victory won on facts and principles,” he said in a press statement announcing HUD’s acceptance of the plan. “It wasn’t easy, but everyone in Westchester can be very proud of the outcome.”
This week, the Trump administration took the rare step of declaring Venezuelan President Nicolas Maduro a “dictator,” freezing his assets and banning Americans from doing business with him.
It looked like a big deal. Phones pinged with alerts, and cable news channels carried the announcement live. Maduro was now the fourth member of an exclusive club of sanctioned dictators, joining Syria’s Bashar al-Assad, North Korea’s Kim Jong Un and Zimbabwe’s Robert Mugabe.
“Maduro is not just a bad leader; he is now a dictator,” President Donald Trump said in a statement.
I watched this movie again and again in the three years I spent covering Venezuela for the Associated Press. It’s always the same script and the same ending: Maduro blasts the U.S. for its attempted meddling, then goes back to the business of presiding over his country’s economic collapse.
This time around, the U.S. tried to punish Maduro by freezing his American assets; he has none. It forbid Americans from doing business with him as an individual — something he hasn’t seemed interested in doing — but still allowed them to contract with Venezuela as a country.
“Maduro’s going to have a good laugh with this,” said David Smilde, a Tulane University expert on Venezuela. “It’s not going to amount to a lot.”
Venezuela is crossing clear lines. Maduro, the hand-picked successor to late President Hugo Chavez, has grown deeply unpopular since taking power in 2013. People are hungry. Hospitals are in ruins. Four months of daily protests have left more than 120 dead and brought on international condemnation. And over the weekend, Maduro dealt a potentially fatal blow to the country’s once-stable democracy:
He held an election creating a new, all-powerful congress stacked with his supporters. His wife was elected; so was his son. Streets were mostly empty the day of the election, but Maduro said 40 percent of the country voted. International elections observers were banned.
U.S. sanctions already in place didn’t stop any of this from happening. They’ve only helped Maduro argue that his country is in shambles not because of his own mismanagement, but because Americans are out to get him, sabotaging the economy at every turn.
Take what happened in 2015, when the Obama administration declared that Venezuela was “a threat to national security” and sanctioned seven top officials for human rights violations. Maduro, whose approval ratings had been dismal, got one of the biggest bumps of his presidency. The sanctions let him point to an example of imperialist bullying. People rallied around him against this outsider intrusion. Maduro rewarded all seven officials with promotions and covered the capital in anti-sanction billboards that still adorn parts of Caracas, looming over food lines and formations of riot police
The Obama administration saw how Maduro used the sanctions to his advantage and didn’t issue any more. The country’s economy continued to fall apart — three-quarters of Venezuelans were losing weight and 80 percent of medicines were in short supply.
With the arrival of the Trump administration this year, sanctions resumed.
Each time, they gave Maduro an opportunity to blame someone other than himself for the country’s descent.
When the U.S. sanctioned Venezuela’s vice president for alleged involvement in the drug trade, Maduro responded by giving his second-in-command even more power.
When the U.S. sanctioned members of Venezuela’s Supreme Court for abolishing its Congress, Maduro praised them in a public ceremony.
When the U.S. sanctioned more senior Venezuelan officials for corruption, Maduro gave them all special swords on live television.
So it makes sense that when U.S. Congress members and think tanks reacted to Monday’s sanctions by issuing stern statements, Venezuelans were mostly cracking jokes.
The U.S. hasn’t hit Maduro where it truly would hurt — the oil trade.
Almost all of Venezuela’s export revenue comes from oil, and the U.S. is its most important customer. An oil embargo would be as dramatic as Monday’s sanctions were anticlimactic. The Maduro administration might implode, and the country’s hunger crisis could escalate to famine.
The U.S. doesn’t necessarily want to drop that kind of a bomb. It doesn’t want to create a refugee crisis in a country three hours from Miami; already, Venezuela exports more asylum cases than any other nation. Not to mention, an embargo would hike gas prices for American drivers.
So for now, Maduro is thumbing his nose.
“Sanction anyone you want!” he shouted during an address on state television Monday. “The Venezuelan people have decided to be free, and I’ve decided to be the president of a free people.”
The camera panned to an audience of top officials, many sanctioned themselves, all applauding. A minister fiddled with an expensive-looking watch, then went back to clapping.
One thing about those other three men in the sanctioned-leader club: They’re all still in power, and living large. Last year Zimbabwe’s President Mugabe celebrated his 92nd birthday with a million-dollar party, and jetted around the world to places like Cancun and New York while his people starved.
Toward the end of his speech Monday, Maduro issued some sanctions of his own, on private television stations that had not given his Sunday election positive coverage, and said his opponents would get what was coming to them. Early Tuesday, the secret police arrested two high-profile opposition leaders and took them to military prison. Another line crossed.
The federal government appears to have significantly underestimated the amount of lead, arsenic and other dangerous pollutants that are sent into the air from uncontrolled burning of hazardous waste at the Radford Army Ammunition Plant in Virginia, according to a draft of a long-awaited report compiled by researchers at the Environmental Protection Agency.
The report details results from air sampling done last September and October at the Radford plant above an open field where piles of waste from the manufacture of weapons explosives are set afire daily. The plumes drift directly towards an elementary school and residents a little more than a mile away, but the Army and regulators have long maintained that the pollution level is safe, based on its computer-modeled estimates.
Now, it turns out, some of those estimates were wrong.
The data shows that five substances were found at levels greater than the EPA’s models had predicted, meaning that previous health-risk analyses completed by regulators for the burns at Radford did not fully take into account the potential exposure of the surrounding population.
Arsenic, a chemical element known to cause cancer and skin lesions, was found to be emitted at rates 37 times what the previous Radford burn permit estimated. Lead — which can disrupt children’s brain development — was emitted at five times the level previously thought. Cadmium and silver were also present at levels higher than historical models had assumed.
The tests also detected levels of methyl chloride, a chemical used in refrigeration and manufacturing that is known to cause severe neurological effects, high heart rates and high blood pressure, at more than twice the levels previously thought.
The Radford tests are part of a national program to verify the mathematical emissions factors that are used in the permitting dozens of sites that burn similar materials, and so the findings could mean that pollution from the practice of open burning military waste has been underestimated across the country.
The EPA declined to make the researcher responsible for the data available for an interview, but sent a statement pointing out that the research was still in draft form and under active review. ProPublica was given the draft report by a person concerned about the health implications at Radford and other military sites where such burns are conducted.
The Army did not immediately respond to a request for comment.
ProPublica reported on the burn practices at Radford in July as part of an investigation into the environmental implications of the Department of Defense’s handling of munitions and the hazardous waste associated with them. Our investigation showed that the Defense Department and its contractors continue to burn explosives waste with no emissions controls at more than 50 sites across the country, utilizing a loophole in U.S. hazardous waste regulations created on what was supposed to be a temporary basis for the Pentagon in the 1980s.
The burns are allowed by the EPA and state environment regulators based on permits that use computer models to estimate the rate of pollutant released and to calculate whether those emissions are going to make people sick. The burns at Radford, the single largest polluter in Virginia, have long been permitted based on analyses that showed they were safe.
But the actual emissions from the burns at Radford had never been previously measured. For the new research, the EPA, in cooperation with NASA and the Department of Defense, sampled the smoke plumes at Radford last year, gathering the first air samples of toxins released at the site since burning there began in the 1940s.
The Pentagon’s handling of munitions and their waste has poisoned millions of acres, and left Americans to guess at the threat to their health. Read the story.
The report details chemicals measured by a drone flown through the smoke clouds directly above the burn site over the course of two weeks last fall, and provides the first ever confirmation that significant levels of volatile organic chemicals, including acetone, benzene and toluene — all substances known to cause cancer — are widely prevalent.
EPA officials stressed the good news in their draft findings: that the majority of pollutants measured, including aluminum and selenium, dioxin-like chemicals and volatile chemicals like benzene, were detected at levels less than what the computer models used for historical permits had estimated. The agency described the drone technology used to measure the plumes as “a significant advancement.”
While the research is the first of its kind to take direct measurements of the pollutant plume at the burn grounds in Radford, it still does not attempt to measure exposure to those pollutants in the surrounding community, something that state regulators tell ProPublica would be accomplished by placing ambient air monitors at schools and other public places near the burn site. People living near the plant have unusually high rates of cancer, thyroid disease and other health problems and have raised questions about a link to open burns, but so far there’s little evidence to prove or disprove this.
Perchlorate, a rocket fuel which has been recently detected in groundwater samples taken in the community surrounding the Radford plant, and which the Radford plant’s former commander had told the Roanoke Times was detected in the new round of samples, is not listed as a detected pollutant in the draft report.
In July, Virginia environment regulators, who are charged with overseeing the plants’ day-to-day operations, told ProPublica they were awaiting the sampling results to make a new risk assessment for the burn site as part of the process of renewing the Army’s burn permit there, which expired in 2015. Virginia officials told ProPublica that they are evaluating the information and “have not reached any conclusions.”
Four days after Marie McCausland delivered her first child in May, she knew something was very wrong. She had intense pain in her upper chest, her blood pressure was rising, and she was so swollen that she barely recognized herself in the mirror. As she curled up in bed that evening, a scary thought flickered through her exhausted brain: “If I go to sleep right now, I don’t know if I'm gonna be waking up.”
What she didn’t have was good information about what might be wrong. The discharge materials the hospital sent her home with were vague and confusing — “really quite useless,” she said. Then she remembered a ProPublica/NPR story she’d recently read about a New Jersey nurse who died soon after childbirth. Lauren Bloomstein had developed severe preeclampsia, a dangerous type of hypertension that often happens during the second half of her pregnancy. But it can also emerge after the baby is delivered, when it is often overlooked — accounting for dozens of maternal deaths a year. McCausland realized that she might have preeclampsia, too.
The 27-year-old molecular virologist and her husband bundled up their newborn son and raced to the nearest emergency room in Cleveland. But the ER doctor told her that she was feeling normal postpartum symptoms, she said. Even as her blood pressure hovered at perilous heights, he wanted to send her home. Several hours passed before he consulted with an OB-GYN at another hospital and McCausland’s severe preeclampsia was treated with magnesium sulfate to prevent seizures. Without Bloomstein’s story as a warning, McCausland doubts she would have recognized her symptoms or persisted in the face of the ER doctor’s dismissiveness. “I had just come home with the baby and really didn’t want to go back to the hospital. I think I probably would have just wrote it off.” In that case, she added, “I don't know if I'd be here. I really don't.”
McCausland’s experience is far from unique. In the months since ProPublica and NPR launched our project about maternal deaths and near-deaths in the U.S., we’ve heard from 3,100 women who endured life-threatening pregnancy and childbirth complications, often suffering long-lasting physical and emotional effects. (Tell us your story.)
The same themes that run though McCausland’s story echo through many of these survivors’ recollections. They frequently told us they knew little to nothing beforehand about the complications that nearly killed them. Even when the women were convinced something was terribly amiss, doctors and nurses were sometimes slow to believe them. Mothers especially lacked information about risks in the postpartum period, when medical care is often disjointed or difficult to access and the baby is the focus of attention. “Every single nurse, pediatrician, and lactation consultant dismissed my concerns as hormones and anxiety,” wrote Emily McLaughlin, who suffered a stroke and other complications after giving birth in Connecticut in 2015.
These survivors make up an important, and largely untapped, source of knowledge about the dangers that expectant and new mothers may face — and how to avoid disaster. Every day in the U.S., two to three women die from pregnancy- or childbirth-related causes, including preeclampsia, hemorrhage, infection, blood clots and cardiac problems — the highest rate of maternal mortality among wealthy nations. As many as 60 percent of these deaths are preventable, a new report suggests; more than half occur after delivery. (See our story on the lost mothers of 2016.) Each day, another 175 women suffer complications severe enough to require major medical intervention such as massive transfusions, emergency surgery or admission to an intensive care unit — equivalent to about 65,000 close calls annually, according to the Centers for Disease Control and Prevention.
We asked survivors: What can people do to ensure that what happened to Lauren Bloomstein doesn‘t happen to them or their loved ones? How can they help prevent situations like Marie McCausland’s from spiraling out of control? What do they wish they had known ahead of their severe complications? What made a difference in their recovery? How did they get medical professionals to listen? Here is a selection of their insights, in their own words.
Choosing a Provider
“A lot of data on specific doctors and hospitals can be found publicly. Knowing how your physician and hospital rates as compared to others (cesarean rates, infection rates, readmission rates) can give you valuable insight into how they perform. ‘Liking’ your doctor as a person is nice, but not nearly as important as their and their facility’s culture and track record.”
— Kristen Terlizzi, 35, survivor of placenta accreta (a disorder in which the placenta grows into or through the uterine wall) in 2014 and cofounder of the National Accreta Foundation
“Key pieces of information every woman should know before choosing a hospital are: What are their safety protocols for adverse maternal events? No one likes to think about this while pregnant, and providers will probably tell you that it’s unlikely to happen. But it does happen and it’s good to know that the hospital and providers have practiced for such scenarios and have proper protocols in place.”
— Marianne Drexler, 39, survived a hemorrhage and emergency hysterectomy in 2014
“Ask your doctors if they have ever experienced a case of an amniotic fluid embolism [an abnormal response to amniotic fluid entering the mother’s bloodstream] or other severe event themselves. If a birthing center is your choice, discuss what happens in an emergency — how far away is the closest hospital with an ICU? Because a lot of hospitals don’t have them. Another thing many women don’t realize is that not every hospital has an obstetrician there 24/7. Ask your doctors: If they’re not able to be there the whole time you’re in labor, will there be another ob/gyn on site 24 hours a day if something goes wrong?”
— Miranda Klassen, 41, survivor of amniotic fluid embolism in 2008 and founder/executive director of the Amniotic Fluid Embolism Foundation
“While my doctor was amazing, we live in a smaller town and they don’t carry enough blood/platelets on hand for very emergent situations. They have patients shipped to larger hospitals when they need more care. Had I been aware of that we would have decided to deliver at a larger hospital so in case something happened to me or our daughter we wouldn’t be separated, which we were when I was life-flighted out.”
— Kristina Landrus, 26, survived a hemorrhage in 2013
“My best advice for getting a medical professional to listen is to keep searching for one that is willing to listen. Because of my insurance and personal circumstances at the time I felt I had no option but to take whoever my providers [assigned] me, despite several red flags even before my delivery. I was not aware of my right to change providers until it was too late.”
— Joy Huff, 39, survived a blood infection in 2013
Preparing for an Emergency
“A conversation about possible things that could go wrong is prudent to have with your doctor or in one of these childbirth classes. I don’t think that it needs to be done in a way to terrify the new parents, but as a way to provide knowledge. The pregnant woman should be taught warning signs, and know when to speak up so that she can be treated as quickly and accurately as possible.”
— Susan Lewis, 33, survived multiple blood clots and severe hemorrhage in 2016
“Always have somebody with you in a medical setting to ask the questions you might not think of and to advocate on your behalf if your ability to communicate is compromised by being in poor health. … And get emotional support to steel you against the naysayers. It may feel really unnatural or difficult to push back [against doctors and nurses]. Online forums and Facebook groups can be helpful to ensure you’re not losing your mind.”
— Eleni Tsigas, survivor of preeclampsia in 1998 and 1999 and executive director of the Preeclampsia Foundation
“Know your rights. Know what kind of decisions you might have to make and what you want to do before you go. Doctors and nurses are there to make quick decisions, they’re not worried about how you will feel about it afterward. They are worried about a lawsuit, whether they can get you stable quickly so they can move on. I’m not saying they are heartless, far from it. My mother is a nurse, I know what sort of heart goes into that profession. But they have a lot to do and a lot to worry about, your feelings are not at the top of that list. At least not as far as they are concerned in the moment.”
— Carrie Anthony, 36, survived two pregnancies with placenta accreta and hemorrhage in 2008 and 2015
“It isn’t just important to know how you feel about blood transfusions and life-saving measures — you have to communicate these things to your spouse or family member. I was given six blood transfusions, but I was barely conscious when asked if I wanted them. Of course, I wanted any life-saving measures, but my husband should have been consulted, given that I was not of a clear mind.”
— Rachel Stuhler, 36, survived a hemorrhage in 2017
“In case you ever are unable to respond, someone needs to step in and be your voice! Know as much thorough medical history as possible, and let your spouse or support person know [in depth] your history as well.”
— Kristina Landrus
“Also be sure your spouse and your other family members, like your parents or siblings, are on the same page about your care. And if you aren’t married, who will be making the decisions on your behalf? You should put things in order, designate the person who will be the decision maker, and give that person power of attorney. Other important things to have are a medical directive or a living will — be sure to bring a copy with you to the hospital. I also recommend packing a journal to record everything that happens.”
— Miranda Klassen
“Make a list of your questions and make sure you get the full answer. I went to every appointment the second time around with a notebook. I would apologize for being ‘that patient,’ but I had been through this before and I wasn’t going to be confused again. I wanted to know everything. Honestly, it was as harmful as it was helpful. I knew what I was getting into, which made it much scarier. The first time, my ignorance was bliss. I didn’t realize I almost died until two weeks after I had left the hospital. I didn’t even start researching what had happen to me until months later. The second time I was an advocate for myself. Medical journals and support groups were a part of every single visit. And thankfully, I was in good hands.”
— Carrie Anthony
“Write down what each specialty says to you. When I was hospitalized for six weeks prior to giving birth, I was visited 2-3 times a week by someone from each department that would be involved in my life-saving surgery. This means that I saw someone from the neonatal intensive care unit as well as reps from gynecologic oncology, maternal fetal medicine, interventional radiology and anesthesiology. They paraded in on a schedule, checked up on me, asked if I had any questions. I always did, but I regret not writing down what each said each time (along with names!). I got so many different answers regarding how I would be anesthetized, and on the day it all had to happen in an emergency, there were disagreements above me in the OR. between the specialists. It was like children arguing on a playground and my life was in danger. Had I kept a more vigilant record of what each specialty reported to me, perhaps prior to the day I could have confronted each with the details that weren't matching up.”
— Megan Moody, 36, survived placenta percreta (when the placenta penetrates through the uterine wall) in 2016
“People should know that they have a right to ask for more time with the doctor or more follow up if they feel something is not right. The ob-gyns (at least in Pennsylvania) are so busy and sometimes appointments are quite quick and rushed. Make the doctors slow down and take the time with you.”
— Dani Leiman, 37, survived HELLP syndrome (a particularly dangerous variant of preeclampsia) in 2011
“You have a legal right to your medical records throughout pregnancy and anytime afterwards. Get a copy of your lab results each time blood is drawn, and a copy of your prenatal and hospital reports. Ask about concerning or unclear results.”
— Eleni Tsigas
Getting Your Provider to Listen
“Understand the system. Ask a nurse or a trusted loved one in the ‘industry’ how it all works. I've found that medical professionals are more likely to listen to you if you demonstrate an understanding of their roles and the kind of questions they can/cannot answer. Know your ‘silos.’ Don't ask an anesthesiologist how they plan on stitching up your cervix. Specialists are often incredibly impatient. You need to get the details out of them regarding their very specific roles.”
— Megan Moody
“Let doctors know you care about your health and safety as much as they do. Tell them you want to be a partner in your health care. Do not act as an adversary to your doctor.”
— Tricia Fitzgerald, 40, survived a hemorrhage caused by severe preeclampsia in 2014
“First you have to be armed with concrete knowledge with examples about your illness and have a firm attitude. This is why it is important to know your body. Do your research before your appointment, but make it personal. Do not present your case as if you just went on WebMD for the information. Create a log of your health activities. This log should contain all illnesses you are concerned about, when they occurred and how did you feel. Have your questions and concerns written down. You should always carry a list of your medications, dosage, and milligrams. Include any side effects. Ask concrete questions and have the doctors present their findings to you in a language you can understand. If you do not agree [with what one doctor tells you], ask another doctor. Remember, knowledge is power and you must have that power.”
“If your provider tells you, ‘You are pregnant. What you’re experiencing is normal,’ remember — that may be true. [But it’s also true] that preeclampsia can mimic many normal symptoms of pregnancy. Ask, ‘What else could this be?’ Expect a thoughtful answer that includes consideration of ‘differential diagnoses’ — in other words, other conditions that could be causing the same symptoms.”
— Eleni Tsigas
“They only listen if the pain is a 10 or higher. Most of us don't understand what a 10 is. I'd always imagined a 10 would feel like having a limb blown off in combat. When asked to evaluate your pain on a scale of 1 to 10, when you are in your most vulnerable moment, it is very hard to assess this logically, for you and for your partner witnessing your pain. I later saw a pain chart with pictures. A 10 was demonstrated with an illustration of a crying face. You may not actually be shedding tears, but you are most likely crying on the inside in pain, so I suggest to always say a 10. My pain from the brain hemorrhage was probably a 100, but I'm not sure if I even said 10 at the time.”
— Emily McLaughlin, 34, survived a postpartum stroke in 2015
“Crying! I'm only slightly kidding. I truly think the only way to get them to listen is to be adamant and don’t back down. I had a situation where I felt no one was paying attention to me, and I cried out of frustration over the phone. Then they listened to me and snapped into action.”
— Dani Leiman
“So many women do speak up about the strange pain they have, and a nurse may brush it off as normal without consulting a doctor and running any tests.Be annoying if you must, this is your life. … Thankfully, I never had to be so assertive. I owe my life to the team of doctors and nurses who acted swiftly and accurately, and I am eternally grateful.”
— Susan Lewis
“If you have a hemorrhage, don’t clean up after yourself! Make sure the doctor is fully aware of how much blood you are losing. I had a very nice nurse who was helping to keep me clean and helping to change my (rapidly filling) pads. If the doctor had seen the pools of blood himself, rather than just being told about them, he might not have been so quick to dismiss me.”
— Valerie Bradford, 30, survived hemorrhage in 2016
Paying Attention to Your Symptoms
“I had heard of preeclampsia but I was naïve. [I believed] that it was something women developed who didn't watch what they ate and didn't focus on good health prior and/or during pregnancy. I was in great health and shape prior to getting pregnant, during my pregnancy I continued to make good food choices and worked out up until 36 hours before the baby had to be taken. I gained healthy weight and kept my BMI at an optimum number. I thought due to my good health, I was not susceptible to anything and my labor would be easy. So although I had felt bad for 1 1/2 weeks, I chalked it up to the fact that I was almost 8 months into this pregnancy, so you're not supposed to feel great. … I walked into my doctor’s office that Friday and not one hour later I was in an emergency C-section delivering a baby. I had to fully be put under due to the severity of the HELLP, so I didn't wake up until the next day.”
— Kelli Davis, 31, survived HELLP syndrome in 2016
“Understand that severe, sustained pain is not normal. So many people told me that the final trimester of pregnancy is sooo uncomfortable. It was my first pregnancy, I have a generally high threshold for pain, and my son was breech so I thought his head was causing bad pain under my ribs [when it was really epigastric pain from the HELLP syndrome]. I kept thinking it was normal to be in pain and I let it go until it was almost too late.”
— Dani Leiman
“I wish I would have known what high blood pressure numbers were. I had a pharmacist take my blood pressure at a pharmacy and let me walk out the door with a blood pressure of 210/102. She acted like it was no big deal (‘it’s a little high’), and so I believed her. Even after telling my husband, we really thought nothing of it.”
— Melissa McFadden, 36, survived preeclampsia in 2013
“Know the way your blood pressure should be taken. And ask for the results. Politely challenge the technician or nurse if it’s not being done correctly or if they suggest ‘changing positions to get a lower reading.’ Very high blood pressure (anything over 160/110) is a ‘hypertensive crisis’ and requires immediate intervention.”
— Eleni Tsigas
“Please ask for a heart monitor for yourself while in labor, not just for the baby. I think if I had one on, seconds or minutes could have been erased from reaction time by the nurses. They were alerted to an issue because the baby’s heart stopped during labor, and while the nurse was checking that machine, my husband noticed I was also non-responsive. That’s when everything happened (cardiac arrest due to AFE).”
— Kristy Kummer-Pred, 44, survived amniotic fluid embolism and cardiac arrest in 2012
After the Delivery
“My swelling in my hands and feet never went away. My uterus hadn’t shrunk. I wasn't bleeding that bad, but there was a strange odor to it. My breasts were swollen and my milk wasn’t coming in. I was misdiagnosed with mastitis [a painful inflammation of the breast tissue that sometimes occurs when milk ducts become plugged and engorged]. The real problem was that I still had pieces of placenta inside my uterus. Know that your placenta should not come out in multiple pieces. It should come out in one piece. If it is broken apart, demand an ultrasound to ensure the doctors got it all. If you have flu-like symptoms, demand to be seen by a doctor. If you don't like your doctor, demand another one.”
— Brandi Miller, 32, survived placenta accreta and hemorrhage in 2015
“There is a period in the days and weeks after delivery where your blood pressure can escalate and you can have a seizure, stroke, or heart attack, even well after a healthy birth. You should take your own blood pressure at home if your doctor doesn't tell you to. … Unfortunately, I went home from [all my postpartum] appointments with my blood pressure so high that I started having a brain hemorrhage. Not one single person ever thought of taking my blood pressure when I was complaining about my discomfort and showing telltale warning signs of [preeclampsia].”
— Emily McLaughlin
“The ER doctor that I had was not treating me as a postpartum case. He was just thinking of me as a 27-year-old with high blood pressure. I think, if you have the opportunity, the ideal thing would be to go back to the same hospital where you had your baby, because they have a labor and delivery unit and they have your records. But if the closest emergency room isn’t at the hospital where you delivered, then you have to be more vigilant. Make sure they know you just gave birth. If you know something is wrong with you, don’t take no for an answer. Just keep saying, ‘I think this is something serious’ and don’t let them discharge you, especially if it’s someone who isn’t familiar with pregnant women.”
— Marie McCausland
“The postpartum period is when a lot of pregnancy-related heart problems like cardiomyopathy emerge. If there is still difficulty breathing, fluid buildup in ankles, shortness of breath and you are unable to lie flat on your back, go see a cardiologist ASAP. If you have to go to an emergency room, request to have the following tests performed: echocardiogram (echo) test, ejection fraction test, B-type natriuretic peptides (BNP), EKG test and chest x-ray test. These tests will determine if your heart is failing and will save your life.”
— Anner Porter
“Rest as much as possible — for as long as possible. Being in too big a rush to get ‘back to normal’ can exacerbate postpartum health risks. Things that are not normal: heavy bleeding longer than 6 weeks, or bleeding that stops and starts again, not producing milk, fevers, severe pain (especially around incision sites), excessive fatigue, and anxiety/depression. If you don’t feel like yourself, get help.”
— Amy Barron Smolinski, 37, a survivor of preeclampsia, postpartum hemorrhage and other complications in three pregnancies in 2006, 2011 and 2012 and executive director of Mom2Mom Global, a breastfeeding support group
“Know that your preexisting health conditions may be impacted by having a baby (hormone changes, sleep deprivation, stress). Record your health and your baby's in a journal or app to track any changes. Reach out to the nurse or doctor when there are noticeable changes that you have tracked.”
— Noelle Garcia, 33, survived placental abruption (placenta separating from the uterine wall during pregnancy) in 2007
“If your hospital discharges you on tons of Motrin or pain killers, be aware that this can mask the warning signs of headache, which is sometimes the only warning sign of preeclampsia coming on postpartum.”
— Emily McLaughlin
Grappling With the Emotional Fallout
“I wish I had known that postpartum PTSD was possible. Most people associate PTSD with the effects of war, but I was diagnosed with PTSD after my traumatic birth and near-death experience. Almost 6 years later, I still experience symptoms sporadically.”
— Meagan Raymer, 31, survived severe preeclampsia and HELLP syndrome in 2011
“I recommend therapy with a female therapist specializing in trauma. Honestly, I avoided it for 8 months. I was then in therapy for 12 months. I still have ongoing anxiety … but I would be in a very bad place (potentially depression and self-harm due to self-blame) were it not for therapy. It was so hard to admit [what was happening]. I started to get a suspicion when I heard an NPR story about a veteran with PTSD. I thought… that sounds like me. And I started Googling.”
— Jessica Rae Hoffman, 28, survived severe sepsis and other complications in 2015
“The emotional constructs our society puts around pregnancy and childbirth make the ideas of severe injury and death taboo. Childbirth is a messy, traumatic experience. … Many women don't seek care even when they instinctively believe something is wrong because they're supposed to ‘be happy.’ Awareness and transparency are so important.”
— Leah Soule, 33, survived a hemorrhage in 2015
“Having an incredible support network made the greatest impact with my near-death experience, but my family and friends needed their own support as they coped. My mom didn’t leave my side, but she also had a team of friends supporting her so that she could let her guard down and cry when she needed to do so. My husband was at my bedside or with the baby constantly that first week, but he was also suffering from the trauma of everything and was having a really hard time coping and needed to leave the hospital environment. My best friend is an ICU nurse and quickly became the person everyone asked clarifying questions, but she didn’t want to be a nurse in that moment but rather someone who was scared for her friend.”
— Susan Lewis
“I wish I had understood how significant the impact was on my husband. Emotionally, the experience was much more difficult and long-lasting for him than for me, and it continued to affect his relationship with both me and our baby for quite a while, at a time when I didn’t think it was a thing at all.”
— Elizabeth Venstra, 44, survived HELLP syndrome in 2014
“I would suggest establishing yourself ahead of time with a doula or midwife that can make postpartum visits to your home, which can promote health even if everything goes smoothly. Many communities have those services available if you can’t afford them. [A doula] wasn't covered through our insurance, but the social worker at the hospital arranged for someone paid for by [San Diego County] to come and do several checks on me and my son, which was very reassuring to both my husband and me.”
— Miranda Klassen
“If you’re given a diagnosis of a life-threatening pregnancy complication, line up a therapist immediately so can start getting the support you need as soon as you give birth. Don’t wait until your six-week [postpartum] appointment when they do a depression screen and you realize you’re not coping well. You'll have to wait at least another week for the appointment to be made. Why not have that in place? I wish I did.”
— Megan Moody
“Don’t assume everyone gets it. Don’t assume everyone wants to hear it. My story is scary. Some soon-to-be moms have looked horrified by my story. Some already moms have been scared away by it. Most people are happy to listen, like to be informed. But some do not. Some people are happier thinking it’s all going to be ok, not me, I’ll be fine. They should at least know, but that’s their choice. You can’t force people to open their eyes. Be there. Offer help. But don’t force it.”
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)’s Health4Mom site has a “Save Your Life” campaign, including a one-page checklist, to help new mothers recognize post-birth warning signs.
Childbirth Connections provides evidence-based information on maternity care. The Preeclampsia Foundation’s “Wonder Woman” posts (here and here) put the U.S. maternal mortality numbers in context and offer more strategies for self-advocacy.
Postpartum Support International offers many resources for women suffering from pregnancy-related depression, anxiety and mood disorders.
Facebook is a gathering place for thousands of women who’ve experienced life-threatening complications, but many groups are condition-specific and/or closed to non-survivors. One open group worth checking out: The Unexpected Project.
Social justice groups are also becoming active around the issue of maternal deaths and near-deaths, with a focus on why African-American women are disproportionately affected. They include the Black Mamas Matter Alliance and Moms Rising.
Correction, August 4, 2017: In an earlier version of this story, a quote was incorrectly attributed to Kristy Kummer-Pred. It has been deleted.
Federal health officials have backed down from a controversial proposal that would have required private accreditors to publicly release reports about errors, mishaps and mix-ups in the nation’s hospitals and health care facilities.
The Centers for Medicare and Medicaid Services had proposed in April that accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by these accreditors, not the government.
But in a notice released Wednesday afternoon, the government withdrew the proposal. CMS said that federal law prohibits the agency from disclosing the results of inspections performed by the accrediting organizations and that the proposal — though it required accreditors, not the agency, to release the reports — “may appear as if CMS was attempting to circumvent” the law.
“CMS is committed to ensuring that patients have the ability to review the findings used to determine that a facility meets the health and safety standards required for Medicare participation,” the agency said in a fact sheet. “However, we believe further review, consideration, and refinement of this proposal is necessary to ensure that CMS establishes requirements, consistent with our statutory authority, that will inform patients and continue to support high quality care.”
The government’s proposal, and subsequent about face, comes as federal officials have grown increasingly concerned that private accreditors aren’t picking up on serious problems at health facilities.
Health care facilities that receive federal funding are required to comply with Medicare’s requirements and thus are subject to government oversight. But the law allows hospitals, ambulatory surgery centers, home health agencies and hospices to pay private, national accrediting organizations for such oversight instead.
Every year, CMS and state health agencies inspect a sample of hospitals and other health care facilities accredited by private organizations, in order to validate the work of the groups. In a report to Congress last month, CMS noted that its reviews in fiscal year 2015 found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.
Leah Binder, president and CEO of The Leapfrog Group, a coalition of employers that advocates for quality and transparency in health care, criticized the CMS decision to back down.
“This is disgraceful, unfair to patients as well as employers and other purchasers of health care,” she said in an email. “The public deserves full transparency on how the health care industry performs. Instead, transparency has been sacrificed to accommodate special interests that lobby to avoid disclosing embarrassing information about health care quality.”
The government’s proposal to make accreditors’ reports public was strongly protested by accreditors and the hospitals that pay them for their services. Some questioned its legality; all challenged its wisdom. The Joint Commission, for instance, said the proposal would increase costs and decrease patient safety. “The provision will adversely affect the collaborative efforts of accrediting bodies and healthcare organizations to improve patient safety and engage in continuous quality improvement,” the commission said in a June letter. “Ultimately, there will be increased patient harm and lower quality.”
Another accreditor, the Center for Improvement in Healthcare Quality, raised similar concerns. “Knowing that survey [inspection] reports are public knowledge will only incentivize hospitals and other healthcare entities to go back to the days of ‘hiding’ quality of care issues from accreditors, rather than working with us to improve the quality and safety of care rendered to patients.”
But consumer groups, business alliances and a group representing health care journalists were supportive, saying consumers deserve more information about the quality of hospitals. The Medicare Payment Advisory Commission, an independent agency that advises Congress on Medicare policy, had urged CMS to implement the requirement as soon as possible, saying it would “enable Medicare beneficiaries to make more informed decisions” about where to seek health care.
Consumer Reports and its publisher, Consumers Union, likewise supported the proposal. “Such survey [inspection] results provide insight into hospital quality that is not now transparent. … Consumers have a right to know this critical information that is used to determine if facilities are in compliance with health and safety requirements for Medicare patients, and thus, all patients.”
Though accreditors have to be approved by the secretary of Health and Human Services, they rarely take punitive action against the organizations they oversee. Of the 4,010 hospitals listed on The Joint Commission’s website, more than 99 percent have full accreditation and only eight are on track to lose their “gold seal of approval.”
On its website, The Joint Commission allows users to check the accreditation status of hospitals but provides scant information on inspection findings, even when hospitals are described as receiving a “preliminary denial of accreditation.” For one hospital, the explanation is: “Existence at time of survey of a condition, which in The Joint Commission’s view, poses a threat to patients or other individuals served.” The threat itself is not specified.
Other smaller accrediting organizations provide even less information.
Disclosure: Ornstein was previously president of the Association of Health Care Journalists. While he served in that position, AHCJ called for The Joint Commission to make its inspection reports public. The Joint Commission declined to do so.
Have you complained about a hospital to The Joint Commission or another accrediting body? We’d like to hear from you. Email charles.ornstein@propublica.org.
Demonized as immigrants. Mistaken for Muslims. For more than a century, Sikhs in the U.S. have faced suspicion and violence.
by A.C. Thompson, ProPublica
The 1907 episode in a seaside timber town in Washington came to be known as the Bellingham Riots. Really, though, there were no riots. There was a pogrom.
At the time, the U.S. was suffering through deep economic distress, a panic-filled recession that had begun the year before. Angry anti-immigrant sentiment was ascendant. And hundreds of Sikh men who had traveled from India to Bellingham to toil in the lumber mills paid the price.
Some 500 white men, many of them members of the local Asiatic Exclusion League, descended on the Sikhs and other South Asians, routing them from the bunkhouses where they roomed and chasing them into the streets. Within hours, the entire Sikh population of Bellingham had fled, frantically piling onto trains and boats in search of some sort of refuge. Many had been physically battered.
I knew nothing about this incident until I visited Washington state this spring and met with members of the Sikh community there. For them, it was easy to draw at least some parallels between that century-old ugliness and recent events. Immigrants were again being demonized. Lost jobs were fueling white working-class despair and resentment. Hate crimes were reported to be up. Yelling, “Get out of my country!” a gunman had shot two Indian software engineers in an Applebee’s restaurant in Kansas. Closer to home, in Kent, a suburb of Seattle, a man had shot a Sikh in an apparent hate crime.
A few weeks after the shooting, on a gray March day, I met Hira Singh Bhullar at a café in Kent. “The shooting happened four or five blocks from here,” he said, gesturing in the direction of the crime scene with his finger.
Bhullar, who works in the IT department at the Starbucks headquarters in Seattle, was shaken. He’d lived for a time in Chattanooga, Tennessee. He never felt entirely safe there, always worried that somebody would accost or attack him.
But Bhullar had never felt threatened in Washington. Sure, some racists had posted mean comments on his Facebook page when he ran for the Kent City Council. Still, he didn’t take that kind of internet obnoxiousness too seriously. Now, though, things seemed different. He worried about what seemed to him to be a metastasizing meanness towards immigrants and members of minority religions.
Persecution is something Sikhs know well. Their faith began with the teachings of Guru Nanak, born to a peasant family in 1469 in the Punjab region of South Asia, an area that stretches from eastern Pakistan to the northwest edge of India. Nanak’s message was decidedly oppositional, challenging the authority of the region’s two dominant religions, Hinduism and Islam; some scholars compare Nanak’s spiritual revolution to Christianity’s protestant reformation, which was unfolding in Europe at the same time.
Equality — between man and woman, preacher and congregant, ruler and serf, high-born and the untouchable — was central to Nanak’s theology. What has developed over the past 500 years is a monotheistic faith with a heavy emphasis on social justice. Sikh temples, or gurdwaras, make a point of feeding anyone who needs a meal.
Of course, not everyone appreciated his teachings. Early Sikh gurus, or prophets, were tortured to death by the region’s rulers.
There are an estimated 500,000 Sikhs living in the U.S., many in New York and California. In recent years, Yuba City, California, a small city in the middle of the Sacramento Valley, has become a major hub for Sikhs — Yuba City’s annual Nagar Kirtan parade, a key holy event, draws as many as 150,000 people from around the world.
In the U.S., Sikhs are a frequent target for xenophobes and haters. They are often immigrants or the children of immigrants. They tend to have brown skin. And their garb and personal grooming practices set them apart. Following the directives of the gurus, observant male Sikhs do not cut their hair — ever — and many keep their locks covered by a turban whenever they leave the house. They also typically refrain from shaving, often growing robust beards.
Initially, the look was intended to distinguish Sikhs from the adherents of other religions. But in America, the bulk of the populace knows little to nothing about Sikhism, so they see a person with a turban and assume he’s a Hindu or a Muslim.
For a multitude of reasons, there are no credible statistics regarding the number of hate crimes directed at Sikhs each year. But it is not hard to appreciate the very real fact of those crimes. Talk to a member of the faith. They’ll likely know of an incident. They for sure will know of their history of victimization. They might have a personal connection that explains the threat they feel at this moment.
I spent time with three of them in recent months. I also researched the life of the American man who murdered six Sikhs at a temple in Wisconsin. What follows are four profiles, stories of hurt and worry and resilience.
The Driver
Dead Man at the Wheel
Chad Batka, special to ProPublica
Inderjit Singh Mukker probably works harder than you do. The 54-year-old wrenches himself out of bed while the world is still wrapped in darkness, at 3 a.m., for a few moments of prayer and meditation before he climbs into a sleek black sedan and starts driving. And driving.
Working as a limousine driver, Mukker typically logs 12 or more hours behind the steering wheel each day, navigating Chicago’s cratered and traffic-clogged roadways. By the end of the week he’ll have spent at least 60 hours in the car.
“This is not a good job at all. You are working, working, working,” says Mukker, a slight man with oversized eyeglasses and a dark turban. During the course of our conversation, he speaks in clipped, punchy sentences, the remnants of his native Punjabi tinging his words. “I’m killing myself. My back hurts, my shoulder hurts.” It’s difficult, he notes, to get a healthy meal when you’re trapped in traffic for half of your life.
Driving while wearing a turban can also be hazardous.
In 2010, two men assaulted a Sikh cab driver in West Sacramento, California, breaking an orbital bone in his face and fracturing a bone in his spinal column. The men, one of whom was eventually convicted of hate crimes charges, tauntingly called the victim “Osama bin Laden” as they punched him.
A similar crime occurred two years later in Washington, leaving a Sikh taxi driver hospitalized for more than a week with severe kidney injuries. According to a trial brief filed by prosecutors, the attacker, who was drunk, wrestled the driver to the ground and stomped on his stomach repeatedly. The 50-year-old victim began vomiting, possibly due to a concussion.
“Motherfucker, what are you doing here?” screamed the assailant. “Why did you come to my country?” The attacker, who pleaded guilty, told police he assaulted the driver “because he is a towel head.”
A New York City cabbie, Harkirat Singh, was battered earlier this year by a group of intoxicated passengers who punched him and tore his turban off his head. “Ali Baba, fuck you!” they shouted, according to the driver, who was an interviewed by a local newspaper.
Like so many immigrants in the livery business, Mukker once harbored dreams of doing something bigger, better. In India, he earned a master’s degree in agronomy from Khalsa College and figured he’d go on to a career in agribusiness. But then, in 1988, he moved to Chicago in hopes of improving his economic fortunes.
Equipped with only a rudimentary command of English when he stepped off the plane in the U.S., Mukker quickly discovered that his job prospects were extremely limited — the only gig he could find was driving. Since then it’s been cabs, Uber and now limos.
Mukker has tried other things. For a few years he ran a catering company specializing in Indian meals, but he eventually grew weary of it. Then there was the lawn care business. “It was my own company called United Grass and Lawn Care Service. I had a good number of clients in high-end neighborhoods,” he recalls.
But just as the business was starting to take off, Mukker decided to shutter it. This was after 9/11 and he was afraid that people would think he was a jihadi and assault him, or send the cops rushing to stop a potential terror incident by arresting him. His wife, a registered nurse, was worried as well.
At first, when he tells me this, I’m baffled. I wonder if he’s making some kind of joke I don’t comprehend — how could anybody mistake a lawnmower for a weapon of mass destruction?
Mukker is patient with me. The lawnmower wasn’t the problem, he explains. It was the chemicals. He was a swarthy man with an accent and a turban hauling around sizable quantities of fertilizer, pesticides and herbicides; ammonium nitrate, a common fertilizer, has been used as an explosive by guerrilla bomb makers since at least the 1970s. “I was worried about my safety. It was tough out there,” he says.
So he drove.
On a September evening in 2015, he was driving in a personal capacity, picking up food from an Indian grocery store near his home in Darien, Illinois, a comfortable suburb about 20 miles southwest of downtown Chicago.
Mukker was sitting in his Prius at a stoplight when a male teenager in another car started yelling at him. “Bin Laden,” screamed the young man, “go back to your own country!” When traffic started moving, the teen swerved and cut off Mukker, who stopped his car and rolled down the window.
“He came out from the car and started punching me,” recalls Mukker. “He kept on punching me like he was doing boxing or something.”
The blows broke his right cheekbone, damaged both of his eyes, and rendered him unconscious. When Mukker regained consciousness, his mind felt foggy. His eyesight was cloudy. In a photo taken at the hospital, a huge purple hematoma stretches across one cheek, a bandage is taped over the other. Blood is splattered all over his white shirt. “The bruises healed after a month or two, but my vision took a long time to recover. I went to the eye doctor for three different appointments,” he says.
Unable to see clearly, it would be six months before Mukker could return to driving full time. Depression set in. He fell behind on his bills and nearly lost his home to foreclosure. Members of the Sikh community took up donations to help out Mukker and his family, who were stuck with $4,890 in medical costs.
It could have been worse. Just ask Maan Singh Khalsa, a Sikh from Richmond, California, who was brutalized in a roadway altercation late last year. Khalsa’s ordeal started when a Ford F-150 full of oil refinery workers pulled up alongside him at a traffic light. One of the men in the truck hurled a beer can at Khalsa, a 41-year-old IT specialist. Harassment quickly turned to violence, with a pair of men beating Khalsa, yanking his turban from his head and hacking off his hair with a knife.
In the course of the attack, Khalsa’s teeth were knocked loose and his pinky was cut. Doctors had to amputate the injured finger after it developed a virulent infection.
Before the attack, “I was so carefree. I considered myself an American like everyone else,” he said during a court hearing in May. “I had never worried about being the victim of prejudice. I enjoyed my life fully.” Now fear had infected Khalsa. He had trouble leaving the house, found himself treating all strangers as potential aggressors.
Pleading guilty to aggravated assault and hate crimes charges, both assailants received three-year terms in state prison.
In Mukker’s case, the teen, who was prosecuted as a juvenile, was sentenced to 200 hours of community service, monetary restitution — the monthly checks are going to repay Mukker’s medical costs — and counseling.
“I did not expect this would happen to me in my own backyard while I was driving my own private Prius,” says Mukker. “This kid,” he pauses for a second, “he was out of his mind.”
Chad Batka, special to ProPublica
I first interviewed Mukker in his living room in Darien, as he sat beneath a large painting of the Guru Nanak, who founded Sikhism during the 15th century. The conversation was emotionally heavy, but for Mukker it was good day. He had just paid off all the debts that had accrued in the months after the crime, a milestone that gave him reason to smile.
Later I met with him again, hoping to ask a few more questions. This time his mood was gloomy.
A few days earlier, he’d been driving a seven-seat SUV when he picked up a group of young women at a convention of medical professionals. Some of the women started smoking marijuana in the car. He shut that down.
Enraged, one of the women began slinging insults. “Go back to your country,” she snapped. “This is not your country.”
When we spoke, Mukker was still feeling dejected over the incident. He seemed tired. Tired of people calling him towel head or diaper head or terrorist. He was tired of people telling him he wasn’t an American, even though he’s a U.S. citizen and has lived in Illinois for more than half his life.
He said he’d decided to take a different approach to his job. Mukker told me he would drive like “a dead person.”
By that he meant he wouldn’t chat with his passengers or get upset when they verbally abused him. From now on he’d smother all of his emotions, make himself as cold as a corpse.
Because insults and slurs can’t hurt the already dead.
The Advocate
Taking a Stand
Chad Batka, special to ProPublica
Before the towers of the World Trade Center had even come down, five or six Sikhs scattered across the country arranged a conference call. None of them had ever met. None were activists.
But somehow they’d found each other and they were all deeply worried that the days ahead would bring a wave of violence and harassment directed at Sikhs. They figured that people distraught over the terrorist attacks would strike out at Sikhs in the mistaken belief that they were Muslims, and thus, in the eyes of aggressors, potential jihadists. A simple plan emerged: They’d form a group to collect reports of hate crimes against Sikhs and aid the abused.
They called the group the Sikh Coalition, and today, Harsimran Kaur is an attorney with the nonprofit advocacy group. Educated at George Washington University Law School, Kaur is cerebral, dynamic and, more than 15 years after the 9/11 conference call, very busy.
“We definitely saw an increase from about August of 2016 to the election in November,” Kaur said of reports of crimes against Sikhs during a presidential campaign often dominated by talk of immigration bans and border walls and violently eradicating terrorism.
“Then it was quiet,” she said. “And then, since the inauguration, we have seen an uptick in hate crimes against Sikhs.”
To cite one recent example: Somebody spray-painted “KKK” on a Mercedes owned by a Sikh in Vacaville, California, and set it ablaze, totally destroying the vehicle.
While the coalition is a small outfit — the group had a $1.6 million budget in 2015, the most recent year for which tax records are available — it has become a highly effective defender of civil rights. Kaur, 42, who serves as the group’s legal director, works from an office in her home in the Chicago area.
When the coalition receives a report of a potential hate crime, Kaur and her team quickly launch their own investigation. What are the circumstances surrounding the incident? Does the story make sense? Are there any injuries? Was the alleged victim targeted because of their Sikh identity?
If Kaur decides to take on the case, the coalition will reach out to local law enforcement to make sure police or sheriff’s deputies have all the facts. She’ll give them some basic information about the Sikh faith, let them know that Sikhs are not Hindus, not Muslims. Explain that the turban isn’t just a fashion statement — it’s a crucial display of religious devotion for many male Sikhs. And Kaur will ask the detectives the key question: Are you investigating this as a possible hate crime?
“Dealing with law enforcement and prosecutors can be difficult,” she adds. “A lot of times we’ll see police officers who just don’t know how to investigate. Or don’t recognize that if somebody has been assaulted and they’ve been called ‘Bin Laden’ or ‘terrorist,’ that is evidence of a hate crime.”
In that sense, she says, she’s seen some improvement since 9/11 — there seems to be a growing awareness of hate crimes within law enforcement circles — but there are still plenty of police officers who lack the training or inclination to respond effectively to the offenses.
In 2001, the conference call had barely ended before the fears expressed on it were realized. By the evening of Sept. 11, young men armed with baseball bats were beating an elderly Sikh man in Queens. The following days were worse. A man infuriated by 9/11 decided to drive to a Chevron gas station in Arizona and murder the owner, Balbir Singh Sodhi, shooting him with a .380-caliber handgun. By way of explanation, the killer told police, “I’m a patriot and an American.” Teenage arsonists set afire a gurdwara in upstate New York. The beatings piled up, one after another.
In those early days it wasn’t unusual for Sikh men to choose to stay indoors, rather than risk physical harm in the outside world. Others, fearful for their lives, took off their turbans, a painful and humiliating act that contravened the basic tenets of the faith. Outside of the Sikh community, few are aware of this hidden history, as many of the stories from those days weren’t covered by the media.
The coalition, then, wasn’t sure it would hold together under the load and the stress.
“For the first few years things were shaky. It wasn’t clear where the money was going to come from,” says Jasmit Singh, a founding member who served on the coalition’s board from 2001 through 2011.
Today, Kaur tells me, there are still “spikes of hate violence after other terrorist attacks.” Or, she adds, after politicians make “xenophobic or Islamophobic statements in the press. That tends to also foment hate violence.”
Those targeted are often elderly. In 2013, 82-year-old Piara Singh was attacked outside a gurdwara in Fresno, California. The assailant, who later pleaded guilty to a hate crime charge, bludgeoned him with a steel pipe, inflicting head injuries, broken ribs and lacerations of the lung — trauma so serious that Piara Singh slipped into a coma for two days. Last May, two young men in the same city attacked 68-year-old Amrik Singh Bal, thinking for some reason that he was a Muslim extremist or ISIS member just hanging out on a California street. After punching him, they intentionally ran him over with a car, an act captured on surveillance video.
Kaur and the coalition are not alone in the violence they see or the work they do. Other advocacy groups like United Sikhs and the Sikh American Legal Defense and Education Fund (SALDEF) often engage in similar efforts in the aftermath of hate crimes.
Many Sikhs “feel frustrated at the difficulty in convincing police to categorize even obvious hate incidents as such,” says Jaideep Singh, research director at SALDEF. “Another elder was just found murdered in Fresno this week— floating in a drainage canal.” He points to lingering systemic problems — law enforcement officers who lack adequate training, police departments that fail to track hate crimes and report them to the FBI — that need to be addressed.
When Jaideep Singh surveyed 525 Sikhs in the Seattle area about their experiences, he heard about “an awful lot of small, everyday slights” that don’t appear in official hate crimes stats.
The legal defense fund and the coalition went to the media after a Sikh man was assaulted while driving a public bus in Los Angeles in 2015. The assailant called the victim a “suicide bomber” and “terrorist” while punching him. Still, the county sheriff’s department initially classified the matter as a simple misdemeanor assault. Kaur and company had a good story — investigating deputies somehow overlooking key facts in an ugly case — and the local media ran a string of reports on the crime. The sheriff’s department went back and re-examined the case, and in March 2016, the Los Angeles County District Attorney’s Office added a hate crime charge, a move that exposed the attacker to a longer potential prison term.
The case hasn’t yet gone to trial.
Kaur says prosecutors sometimes “acknowledge that there is evidence of a hate crime but are reluctant to file charges because it’s very hard to get a hate crime conviction.”
She continues,“hate crimes require prosecutors to not only prove that an assault has occurred, but also prove that the assault was motivated by bias — and that’s very, very difficult.” In many cases, she says, even “if you do prove that a hate crime occurred, it may not add additional penalties.”
Chad Batka, special to ProPublica
The challenges were on display in 2005, when five men stood trial for allegedly brutalizing and verbally abusing a Sikh community leader outside a New York restaurant. The coalition and other Sikh organizations had urged Queens County prosecutors to use Article 485 of the state penal code, a tough, well-crafted law that bolsters the penalties for those convicted. In the end, though, only two of the five men were found guilty on hate crimes charges.
When talking to Kaur, she stresses that these cases are about more than simply meting out punishment. She doesn’t necessarily advocate for more jail time for defendants. Often, she asks for community service, education, some sort of reconciliation between the aggressor and the abused.
“You know it’s absolutely imperative that as a society we take a stand against hate violence. Hate crimes undermine the fabric of our country. They’re an assault, not only on an individual, but on an entire community and they degrade our democracy. They undermine the American dream and they make us all feel less safe.”
The Gunman
A Skinhead in the Temple
When they hauled Wade Page’s body to the morgue, he’d already been dead for about seven hours.
A doctor with the Milwaukee County Medical Examiner’s Office scrutinized Page’s corpse closely. The dead man was 40. White. A little over 6 feet tall, exactly 212 pounds. His hair was shorn down to the scalp. Then there were the tattoos, lots of them, and they were encoded with secret messages.
On the back of his right hand, in large Old English script, was the letter “W.” On his left was “P.” White Power.
The number 88 was tattooed on one shoulder. It meant Heil Hitler. The letter H is the eighth in the alphabet.
Page had a different number inked on his other arm: 14. For white supremacists like Page, 14 holds special significance. It goes back to a man named David Lane, who led a terror group called The Order, which in 1984 assassinated Jewish talk radio host Alan Berg in Denver. While in prison, Lane drafted a 14-word slogan meant to inspire his fellow racist revolutionaries: “We must secure the existence of our people and a future for white children.”
Page took his racism seriously, and on Aug. 5, 2012, he did his part on behalf of the 14 words.
He massacred six people at the Sikh Temple of Wisconsin; Page died during a gun battle with police in the parking lot of the gurdwara.
The magnitude of the crime spurred a massive investigation by the FBI and its Domestic Terrorism Operations Unit, which worked in concert with local police from multiple jurisdictions. Telling reporters that “in this country, regardless of what we look like, where we come from, who we worship, we are all one people,” former President Obama ordered flags at government buildings to be flown at half-staff in remembrance of the victims.
A bullet hole left by Wade Page at the Sikh temple in Oak Creek, Wisconsin. (Chad Batka, special to ProPublica)
Page grew up in Littleton, Colorado, a suburb of Denver, and does not seem to have had a particularly happy childhood. When he was 13, his mother died, and one friend told the FBI that Page never totally recovered from the loss.
After high school, he joined the U.S. Army and wound up in a PSYOP battalion at Fort Bragg in North Carolina, home of the 82nd Airborne Division. PSYOP is psychological operations or psychological warfare, which includes the creation of propaganda meant to persuade enemy soldiers and hostile civilians to switch their allegiances and rally behind American troops. “WIN THE MIND, WIN THE DAY” is the motto of Page’s former battalion.
Today it’s hard to determine when, precisely, Page became attracted to Nazism and white supremacist ideologies. It’s not clear why this particularly virulent brand of racism appealed to him. But his racist beliefs were definitely on display during his days at Fort Bragg. Former soldiers told FBI agents that Page, who rose to the rank of sergeant, was open about his extremist views; one remembered him getting drunk and singing Nazi marching songs.
He became a member of the Hammerskin Nation, one of the oldest active Nazi skinhead gangs, which was founded in Dallas and now has chapters around the world. The Hammerskins, who do not admit women, have a signature hand gesture — first the member performs a stiff-arm Nazi salute, then he clenches his fists and crosses his forearms, mimicking the group’s logo, a pair of interlocking claw hammers. The group, which has written by-laws but does not appear to have any formal leadership structure, grew out of the punk rock subculture of the 1980s — you could say the Hammerskins were the despised bastard children of the punk scene, which was generally inclusive and anti-racist.
A capable musician, Page lent his skills on guitar and bass to a string of skinhead bands, which generally played stripped down three-chord punk rock accompanied by bloody imagery and aggressive lyrics; the gravel-throated vocalist for one of Page’s bands, called Definite Hate, pledged to “get rid of them/the enemies of the white race” in a typical song. Amazon, through its affiliate marketplace, still sells CDs by at least one of Page’s bands — the cover art features a Confederate flag and a noose hanging from a tree. One of Page’s old friends told the FBI that he wrote lyrics celebrating the “genocide of other races.”
Page spent some time on Stormfront.org, the white power web forum, promoting “hate rock” gigs, including a 2012 St. Patrick’s Day event in Richmond, Virginia. Using the email address jackboot@hotmail.com, he kept in touch with his racist buddies around the country.
Like many skinheads, Page had a strong affinity for alcohol. He “liked to drink Jack Daniels,” said one ex-service member when questioned by investigators. Another former colleague said Page would “consume a liter and a half of Jim Beam every other day.” Several people described him as a “functioning alcoholic.”
Actually, the opposite was true. Page’s drinking made a mess of his life, starting with his military career. After showing up for duty smelling of booze, Page was ousted from the Army in 1998. That humiliation led to a peripatetic existence that saw him bouncing from town to town and job to job. There was a stint crashing on the couch of a fellow Nazi skinhead in Southern California. A gig back in Colorado working as a technician at a Honda motorcycle dealership. A $7.50-an-hour job in the parts department at a Harley-Davidson shop in Fayetteville, North Carolina. The owners of the Harley shop fired Page after he had an “outburst” at a female employee that left the woman fearing for her safety.
For a time, he worked as a big rig truck driver in North Carolina. That ended when Page got arrested for drunk driving and lost his driver’s license. Without a job, his financial woes mounted quickly. Page lost his home to foreclosure and his car to the repo man, and was forced to sell many of his possessions, including his guns, to survive.
In the fall of 2011, he managed to pull together the money to relocate to the Milwaukee area to move in with a girlfriend, someone he’d met through the skinhead scene. He got a job at Lucas-Millhaupt, a metal fabrication and welding supplies company with a large, fortress-like facility in Cudahy, a blue-collar town near the Milwaukee airport. But things fell apart again. Page and his girlfriend split. Perhaps more significant, he was excommunicated from the Hammerskins.
Page was kicked out for violating the gang’s by-laws, says James Santelle, who, as the U.S. attorney for the Eastern District of Wisconsin at the time, helped lead the investigation into the massacre. FBI records show that shortly before the murders, Page got into a street fight with two other skinheads.
Page “became quiet and distant,” one of his co-workers at Lucas-Millhaupt told the FBI. While he “did not mention any plans for destructive behavior,” Page was clearly suffering from emotional distress, his days plagued by mood swings, his nights haunted by insomnia.
In an interview with investigators, Page’s sister, who lived in Colorado, said his “demeanor had changed over the past year and he had become much more intense, as if he had lost his sense of humor and wit and perceived everything very literally.”
In Oak Creek, Wisconsin, the congregation gathers at the gurdwara during prayer services. (Chad Batka, special to ProPublica)
Days before the massacre, Page donated a bunch of white power CDs to a thrift store. He went to a GameStop and sold his Xbox 360 console and headset, and three games for $112. Page headed to a gun shop and legally purchased a 9 mm pistol and three 19-bullet magazines.
On July 31, Page’s landlord knocked on his door. Page was living in a small, second-floor apartment in a home that had been subdivided. The rent was late, the landlord told him. Page replied that he’d pay the rent on August 5 — the day of the murders.
For a white supremacist like Page, there are many potential targets in the Milwaukee area. Lots of synagogues. An African Methodist Episcopal Church on the north side of the city. At least three mosques. Why he chose the Sikh temple remains a mystery. Page didn’t leave behind any sort of note.
After the terror attack, FBI agents fanned out across the country hunting for clues. They urgently wanted to know if any other white supremacists had helped Page plan and carry out the crime.
Over and over, Page’s fellow skinheads denied any involvement. They voiced surprise and disbelief that he’d done something so horrible.
The following statements are typical. One skinhead, interviewed by agents five days after the killings, said he “was completely shocked when he heard of his fellow Hammerskin brother, Wade Michael Page, being involved in the killings at the Sikh temple in Wisconsin. Hammerskins do not advocate this type of violence.”
The skinhead told investigators he was “heartbroken over Page’s death. Page was always a mellow guy and everybody is shocked over what has occurred.” He added that he felt no grief for Page’s victims.
Santelle, the former federal prosecutor, says the bureau found no evidence that anyone aided Page in his terror attack. But he believes the skinhead may have scoped out the temple prior to the shooting. “I wonder if he had been there before,” he says, noting that Page “plainly moved with a certain amount of purposefulness” as he carried out the massacre.
At the Milwaukee County morgue, the doctor carefully studied Page’s body and documented injuries. There was a gunshot wound to the abdomen. A small-caliber bullet had ripped through his gut, punching through his small bowel. That shot had been fired by one of the Oak Creek police officers responding to the attack.
But it was Page who loosed the fatal shot: He’d pointed his 9 mm pistol at the back of his head and squeezed the trigger.
The Son
Are You an Arab?
Chad Batka, special to ProPublica
Harpreet Singh Saini has a memory from his first day at community college. One of his teachers at Milwaukee Area Technical College in Oak Creek, Wisconsin, asked Saini and his classmates to get acquainted by sharing tales from their summer vacations.
“It was very weird. Everybody had great stories,” he recalls. “And mine was very sad.”
One student had gone to Florida. Another went to Vegas. There was one guy who talked about the simple joys of sleeping late and lounging around all day.
Then it was Saini’s turn. His story went something like this: One month earlier, Wade Page, a neo-Nazi skinhead, murdered his mom and five other people. The whole thing happened just a mile-and-a-half down the road, during prayer services at the Sikh Temple of Wisconsin, a blocky beige building topped by five gold-colored minarets.
“The room went completely silent,” says Saini, who was 18 at the time.
His fellow students were kind and sympathetic, but Saini still couldn’t shake the sense of otherness, that he was living a very different reality than his peers. It was a feeling he knew well.
Oak Creek, a small town located south of Milwaukee on the banks of Lake Michigan, is a mix of industrial plants, strip malls full of chain retailers and restaurants, and aging suburban tract homes. The population is 86.6 percent white, according to the most recent U.S. Census figures.
Saini and his family came to the U.S. in 2004. He grew up in Oak Creek, went to Oak Creek High School, home of the Knights. His mom, Paramjit Kaur, worked in a nearby town at a factory that manufactured syringes. His dad ran a convenience store in Milwaukee. “It was very hard to fit in,” he says. “To be honest with you, I never really had any friends. I never went to prom. I was one of the students who decided not to take part in the school activities.”
Now 23, Saini has little of the brashness or swagger often found in young men his age. Sometimes he stammers or hesitates a bit when speaking, like he’s not entirely sure he should be talking. But when he tells me about his friendless days in school, the words flow forth smoothly. His tone is completely neutral, devoid of any sadness or anger, as if he’s ordering a coffee at Starbucks.
He introduces me to a friend, a computer engineer. The woman, also a Sikh, had recently quit her well-compensated job at a prominent local company after six years. “I worked for somebody who was a very strong Trump supporter. He was open about not liking people of color, or immigrants. He would talk about how Indians smelled, how he didn’t like them,” she says, requesting anonymity in order to speak freely about the racial dynamics in Oak Creek. “That was the main reason I left.”
For Saini, high school was pretty tortured. “I was constantly bullied. I mean, it was mostly like name calling and it got to the point where it got physical, as well.” He remembers arguing with his mom, telling her that he wanted to bail on school, that he couldn’t bear going any longer. She insisted that he earn his diploma.
Paramjit was the only woman killed at the temple. She was 41.
A remarkable thing happened after the massacre. Suddenly, people wanted to hear what the quiet outsider kid had to say. Saini penned an op-ed for The New York Times and appeared in a documentary film. Accompanied by his brother, Kamaljit, he testified before the Senate Judiciary Committee.
“Senators, my mother was our biggest fan, our biggest supporter,” he said. “She was always there for us, she always had a smile on her face. But now she’s gone. Because of a man who hated her because she wasn’t his color? His religion?“
He continued, “I want to tell the gunman who took her from me: You may have been full of hate, but my mother was full of love.”
Working with the Sikh Coalition, Saini sought to rectify what he saw as an absurd governmental oversight: the FBI’s failure to track hate crimes against Sikhs. The bureau had long catalogued crimes targeting Jews, Catholics, Hindus, Muslims and adherents of several other faiths. But the FBI had no system for tracking attacks and abuse directed at Sikhs.
After years of pressure, the bureau in 2015 finally added crimes against Sikhs to the national hate crimes database. By the FBI’s tally, there were six such offenses that year.
Saini and other Sikhs are skeptical of the data — “That’s not an accurate number at all. It’s much higher, much higher,” he argues — which is pulled from police and sheriff’s departments around the country and is known to be deeply flawed.
About 20 percent of the law enforcement agencies in the country don’t submit statistics to the FBI, while many agencies that nominally participate in the program provide demonstrably erroneous data. And the database does not include any alleged hate crimes reported to federal agencies.
After three years in college, Saini dropped out. He’d been studying criminal justice with an eye toward becoming a police officer, but he says there didn’t seem to be any openings for new officers in his area.
So he got a job at a gas station at a town outside of Oak Creek. He’s learning the trade and hopes to own his own station in the future. The shifts can be grueling — at one point he offers to meet me for an interview when he gets off work at 11:30 p.m. Saini’s got to be back at the station early the next day. No, I tell him, go home and get some rest.
He enjoys the work. But some of the customers seem wary of him. They want to know if he’s an “Arab.” Saini knows exactly what they’re driving at.
They think he might be a terrorist.
Chad Batka, special to ProPublica
A.C. Thompson covers criminal justice issues for ProPublica. His stories have helped lead to the exoneration of two innocent San Francisco men sentenced to life in prison and the prosecution of seven New Orleans police officers.
by Charles Ornstein, ProPublica, and Katie Thomas, The New York Times,
This article was produced in partnership with The New York Times.
It’s standard advice for consumers: If you are prescribed a medicine, always ask if there is a cheaper generic.
Nathan Taylor, a 3-D animator who lives outside Houston, has tried to do that with all his medications. But when he fills his monthly prescription for Adderall XR to treat his attention-deficit disorder, his insurance company refuses to cover the generic. Instead, he must make a co-payment of $90 a month for the brand-name version. By comparison, he pays $10 or less each month for the five generic medications he also takes.
“It just befuddles me that they would do that,” said Taylor, 41.
A spokesman for his insurer, Humana, did not respond to multiple emails and phone calls requesting comment.
With each visit to the pharmacy, Taylor enters the upside-down world of prescription drugs, where conventional wisdom about how to lower drug costs is often wrong.
Consumers have grown accustomed to being told by insurers — and middlemen known as pharmacy benefit managers — that they must give up their brand-name drugs in favor of cheaper generics. But some are finding the opposite is true, as pharmaceutical companies squeeze the last profits from products that are facing cheaper generic competition.
Out of public view, corporations are cutting deals that give consumers little choice but to buy brand-name drugs — and sometimes pay more at the pharmacy counter than they would for generics.
The practice is not easy to track, and has been going on sporadically for years. But several clues suggest it is becoming more common.
In recent months, some insurers and benefit managers have insisted that patients forgo generics and buy brand-name drugs such as the cholesterol treatment Zetia, the stroke-prevention drug Aggrenox and the pain-relieving gel Voltaren, along with about a dozen others, according to memos and prescription drug claims that pharmacies shared with ProPublica and The New York Times. At the same time, consumers are sounding off on social media.
Now it appears the practice is spreading to biosimilars, the competitors for expensive, complex biologic drugs that are beginning to arrive on the market.
Consumers have become increasingly angry over what they pay for drugs, and that outrage has caught the attention of lawmakers from both parties. Democrats have identified lowering drug prices as a pillar of their economic agenda, and President Donald Trump has raised the issue repeatedly. But for now, solutions have proved elusive.
The continued success of the brand-name drug Adderall XR, long after generic competitors arrived on the market, is a case in point.
Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek, California, said he began noticing “very odd things” going on with Adderall XR and other attention-deficit drugs about two years ago. He began receiving faxes from pharmacies telling him that he had to specify that patients required brand-name versions of the drugs.
Adderall XR has faced generic competition for years, but maker Shire has kept some of its market share by offering deep discounts. (Scott Dalton for The New York Times)
He had been practicing for 40 years, but until then had never had a pharmacy tell him he had to prescribe a brand-name drug instead of a generic.
“It’s Alice-in-Wonderland time in the drug world,” he said.
Some insurers require members to have prescriptions filled with brand-name drugs and do not charge them more than for generics. But 29 percent of Americans with health insurance paid for by their employer have a high-deductible plan. And they acutely feel the cost difference between branded and generic drugs because they often have to pick up the full sticker price of medications until they have paid out thousands of dollars.
Naomi Freundlich, a Brooklyn writer, had been buying the generic version of Adderall XR for two years to treat her son’s attention-deficit hyperactivity disorder. Her family had a $3,000 annual deductible, and the relatively lower price helped keep medical costs down.
Then, in 2014, her pharmacist told her that her insurance plan would cover only the brand-name drug, which cost her family some $50 more a month than the generic. If she paid for the generic herself, it would not have counted toward her deductible. Freundlich complained to her insurer, UnitedHealthcare, but could not get a clear answer.
“It’s hard to explain because it doesn’t really make sense,” she said.
UnitedHealthcare has continued to favor Adderall XR and certain other brand-name drugs over generics, according to claims provided by independent pharmacists and reviewed by ProPublica and the Times. The insurer also recently told health providers that it preferred Remicade, the expensive rheumatoid arthritis drug made by Johnson & Johnson, over biosimilars that have a lower list price and are just beginning to come on the market.
A spokesman for UnitedHealthcare, Matthew N. Wiggin, said the insurer does at times prefer brand-name drugs. “By providing access to these drugs at a lower cost, we are able to improve affordability for our customers and members,” he said in an email.
Asked whether consumers sometimes end up paying more because of these choices, he said pharmacies and doctors could seek an exemption from the insurer if they want the generic instead. Several patients said they had not been told of that option.
Shire, the maker of Adderall XR, and some other brand-name drug manufacturers are no longer content to allow sales of their products to plummet when generic competitors arrive on the market. Instead, they are negotiating deals with insurers and pharmacy benefit managers to give priority to their versions. Consumers are given no details about these deals.
A Shire spokeswoman said the company had been able to hold on to market share for Adderall XR by offering insurers and government programs prices that are competitive with those of generic manufacturers.
Adderall XR, the long-acting version of Shire’s popular treatment Adderall, had for years been the company’s top-selling product, bringing in $1.1 billion in sales in 2008, about one-third of its revenue that year.
But mindful that its blockbuster could soon face generic competition, Shire acted aggressively to protect its franchise.
First, in the mid-2000s, Shire sued generic drug companies to block them from bringing cheaper copies to the market, alleging patent infringement. Then, it made deals with two makers of generic drugs to sell authorized copies of its drug, a tactic in which the branded manufacturer supplies its product in exchange for a share of royalties. Those agreements soured after the two companies, Teva Pharmaceuticals and Impax Laboratories, accused Shire of not playing fair by failing to supply them with enough pills to compete in the marketplace. More lawsuits ensued, followed by settlements.
Then, a few years ago, Shire tried a new tactic: giving ever-larger discounts to pharmacy benefit managers and insurers for preferential treatment over the generics. That did not mean lowering the list price of the drug but rather negotiating rebates that were paid not to the patients, but to insurers and middlemen such as CVS Caremark.
Benefit managers and insurers have been passionate advocates of generic drugs, arguing that the cheaper products save patients and their employers billions of dollars. Indeed, generic drugs have come to dominate the market, and today account for nearly 90 percent of all prescriptions filled in the United States.
Shire has managed to hold on to a much larger share of the market through its deals than most companies do when their drugs come off patent and face generic competition.
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Adderall XR, the brand-name version of extended-release mixed amphetamine salts, accounted for 29 percent of the 13.1 million prescriptions for the drug in 2016, according to QuintilesIMS, a health information company that purchases the data from pharmacies and sells it to clients that include drug companies. The average market share of brand-name products dwindles to less than 6 percent two years after the first generic competitor arrives, according to QuintilesIMS.
The list price of Adderall XR has remained $7.12 per pill since mid-2012. But according to data from SSR Health, a research firm that tracks drug prices, the portion that Shire keeps has steadily declined.
In the first quarter of 2017, SSR estimated that Shire kept only $1.73, down from $2.93 per pill in the first quarter of 2013. Shire does not break out how much it pays to each middleman in the system, from distributors to pharmacy benefit managers.
But Ryan Baum, an analyst at SSR Health, said it was clear that Shire’s declining share of the list price reflected “just a really aggressive instance of trying to hang on.”
“It’s irrefutable, really,” he added.
In contrast, the generics cost as low as $3.89 per pill, but that does not include unspecified concessions that generic makers offer to pharmacies and distributors, according to Truven Health Analytics, another research firm that tracks the prices wholesalers pay for drugs.
A spokeswoman for Shire, Gwendolyn Fisher, said that while Shire did not make decisions about how much patients pay in out-of-pocket costs, “Shire is helping to deliver cost savings to the system and greater patient access to an important medicine.”
Shire said last week that it was considering spinning off the portion of its business that sells attention-deficit drugs in order to focus on developing rare-disease treatments.
Generic drug makers say they have seen an increase in efforts by manufacturers of brand-name drugs to fight to retain sales after they lose patent protection.
“You definitely see a much more aggressive posture than you used to see,” said Christine Baeder, senior vice president for customer and marketing operations at Teva, the world’s largest generic drug manufacturer.
In December, CVS Caremark, one of the largest benefit managers, sent a memo to pharmacies informing them that some of its Medicare prescription drug plans would cover only brand-name versions of 12 drugs. Some of the drugs, such as the antipsychotic medication Invega, have had generic competitors for over a year.
Also on the list was Copaxone, a brand-name drug sold by Teva that treats multiple sclerosis and that recently lost patent protection on its daily injection. Though Teva primarily makes generic drugs, in a twist it has taken a page from brand-name manufacturers to preserve sales of one of its key products.
In a statement, Teva said many patients had moved to its three-times-weekly version of Copaxone, for which there is no generic, but said it wanted to ensure that patients who “wish to remain on therapy continue to have access.”
Lisa Hopkins tried to fill a prescription for generic Voltaren gel earlier this year. She was told her prescription drug plan requires her to get the brand name instead. (Mark Makela for The New York Times)
Consumers taking other medications said they had experienced the same phenomenon. Lisa Hopkins, a disabled food and nutrition supervisor in Pennsylvania, went to fill a prescription for the anti-inflammatory Voltaren gel this year.
Hopkins, 52, said her pharmacist told her that her drug plan, CVS’s SilverScript, denied her claim because it was for a generic.
“I said to the lady at the insurance company, ‘That’s really, really odd to me,’” Hopkins said. “She said, ‘Yes. It’s happening more and more that the name brand is covered but the generic isn’t.’”
Hopkins has osteoporosis and bulging spinal disks and has been on disability for almost a decade. She is covered through Medicare and receives extra help from the government for her medications, lowering her out-of-pocket costs. That means that when her drugs cost a lot, taxpayers pay the bill. By law, Medicare cannot negotiate directly with drug manufacturers and instead gets a share of any rebates collected by insurers and benefit managers, like CVS Caremark, which operate Medicare’s drug plans.
In an email, a spokeswoman for CVS Caremark, Christine Cramer, said consumers never pay more in the rare instances in which the company favors a brand-name drug over a generic. “This generally occurs when there is limited or no competition among generics,” she said.
Pharmacists say they are noticing the trend, too, and it takes time to understand the denied claim and pursue a remedy, including sometimes calling the doctor. While favorable treatment for a brand-name drug doesn’t happen all the time, it is startling when it does, said Robert Frankil, president of Sellersville Pharmacy Inc. in Pennsylvania, which owns two pharmacies.
“There’s only one reason why they’re requiring you to use a more expensive product,” Frankil said. “Because somewhere down the road, somebody is earning more money.”
Have you had trouble paying for prescription drugs? We want to hear from you.
by Robert Faturechi, ProPublica, and Danielle Ivory, The New York Times,
This article was co-published with The New York Times.
When President Trump ordered federal agencies to form teams to dismantle government regulations, the Transportation Department turned to people with deep industry ties.
One appointee had previously lobbied the department on behalf of American Airlines. Another held executive roles for several electric and hybrid car companies regulated by the department. A third was a lawyer who represented United Airlines in regulatory matters.
The three appointees have been identified by ProPublica and The New York Times in a continuing effort to track members of the deregulation teams. The appointments, previously unreported, follow a pattern identified by the two news organizations: By and large, the Trump administration has stacked the teams with political appointees, some of whom may be reviewing rules their former employers sought to weaken or kill.
A full vetting of industry connections has been difficult because some agencies have declined to provide information about the appointees — not even their names.
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The lack of transparency has concerned several top Democratic members of Congress who serve on committees that oversee regulatory matters. In a letter to the White House on Monday, they called on the administration to release the names of all regulatory team members as well as documents relating to their potential conflicts of interest.
“It is unacceptable for federal agencies to operate in such a clandestine and unaccountable manner especially when the result could be the undoing of critical public health and safety protections,” Representatives Elijah E. Cummings of Maryland, John Conyers Jr. of Michigan, Gerald E. Connolly of Virginia and David Cicilline of Rhode Island wrote in the letter.
The congressmen cited a recent investigation by ProPublica and The New York Times revealing that members of the deregulation teams have included lawyers who represented businesses in cases against government regulators, staff members of political dark money groups and employees of industry-funded organizations opposed to environmental rules.
Since the publication of that investigation last month, the news organizations have identified more than a dozen other appointees through interviews, public records and reader tips — including the three appointees to the deregulation team at the Transportation Department.
In all, there are now 85 known current and former team members, including 34 with potential conflicts. At least two of the appointees may be positioned to profit if certain regulations are undone and at least four were registered to lobby the agencies they now work for.
One Transportation appointee, Daniel Elwell, was previously a top lobbyist for American Airlines who sought to influence the Transportation Department. He also held executive positions with the Aerospace Industries Association, a trade group representing aerospace and defense companies, and Airlines for America, a trade association for major airlines.
The airlines group recently applauded the Transportation Department’s decision to suspend a rule that would have required airlines to provide more public information about passenger fees. The Transportation Department has estimated that airlines collected more than $4.1 billion last year in baggage fees.
A department spokesperson said Elwell left the deregulation team after being appointed as deputy administrator of the Federal Aviation Administration in June.
Another Transportation appointee, Marianne McInerney, was president of a trade group representing car dealers. She also held executive positions at several electric and hybrid automotive companies.
The department has oversight over some rules affecting electric cars. For example, this year it delayed new safety requirements that would have forced the vehicles, which are normally quiet, to make a minimum amount of noise to catch the attention of nearby pedestrians.
A third Transportation appointee, Jonathan Moss, was previously managing director of international and regulatory affairs at United Airlines. One of his top responsibilities at the airline, which is regulated by the Transportation Department, was “anticipating and responding to proposed regulations affecting United’s operations.”
Moss also served at the department during the Obama administration. An agency spokeswoman said all deregulation team members had signed agreements requiring them to recuse themselves from issues that narrowly affect recent employers.
The deregulation teams are part of Trump’s push to cut red tape across government, and they have presented a new avenue for industries to shed rules they have argued for years are hurting profits, depressing job creation and raising prices. Environmental, consumer and other liberal groups have argued that such regulations protect the public, keeping drinking water clean and roads safe, for example.
In the recent past, presidents from both parties have entered office pledging to scrutinize regulations, but Trump’s order goes further, putting a premium on cutting rules and empowering teams of political appointees who are typically less wedded to an agency’s existing guidelines.
The agencies have also been opaque about their deregulation teams.
The Justice Department has released the names of only two appointees currently working on its team. In an email exchange, a spokesman, Ian Prior, said he could not provide additional names because “the Task Force is made up of components, not particular employees.”
“A component may have multiple employees assisting with the work,” he added.
Asked if he could name any of those employees, he responded, “Decline.”
The Defense Department and the Department of Homeland Security provided only the titles for most appointees to their review teams, not the names.
In their letter to the White House, the Democratic lawmakers suggested that withholding names could violate the Freedom of Information Act.
“These Task Forces must have an effective and transparent guard against conflicts of interest, especially those in which industry lobbyists seek to overturn environmental and health protections for financial gain,” wrote the lawmakers, who are the ranking Democrats on the House’s Committee on Oversight and Government Reform; Committee on the Judiciary; Subcommittee on Government Operations; and Subcommittee on Regulatory Reform, Commercial and Antitrust Law.
“It appears,” the letter continued, “that the current Task Forces are already failing on this front, and instead are actively hiding their members and their meetings from public view.”
The letter was addressed to Mick Mulvaney, the director of the Office of Management and Budget, and Neomi Rao, the administrator of the Office of Information and Regulatory Affairs, which vets regulatory changes coming out of federal agencies.
by Charles Ornstein, ProPublica, and Katie Thomas, The New York Times,
This article was produced in partnership with The New York Times.
Not all drug prices are going up.
Amid the public fury over the escalating costs of brand-name medications, the prices of generic drugs have been falling, raising fears about the profitability of major generic manufacturers. Last week, Teva Pharmaceuticals reported that it had missed analysts’ earnings estimates in the second quarter and planned to lay off 7,000 workers. Its share price plummeted 24 percent in one day as investors worried there was no end in sight.
Share prices of other generic drugmakers also declined, as did those of wholesalers, which profit from the sales of generic drugs and have said they expect prices to continue declining.
Mylan, another large generic drugmaker, will report its second-quarter earnings on Wednesday. Mylan also sells the EpiPen, the brand-name allergy treatment whose price increases have stoked outrage over the past year, but the company’s primary business is as a seller of generic drugs.
This may seem like good news for consumers, but it’s unclear how much they will save.
Why are generic prices falling?
Generic drugs are copycat versions of brand-name products and — to a point — their prices are expected to drop over time. When a brand-name drug first loses its patent protection, prices fall slowly. Over the next couple of years, as more competitors enter the market, the prices drop even more, until the pills become commodities and sell for pennies. Blockbuster drugs that have recently taken this path include Lipitor and Plavix, the cholesterol-lowering and blood-thinning pills that now cost as little as $10 for a monthly prescription.
Generic drug prices have been declining in the United States since at least 2010, according to a August 2016 report by the Government Accountability Office.
They have fallen even in the face of high-profile exceptions: Dozens of old generic drugs have risen in price in recent years, for reasons that include supply disruptions and competitors’ leaving the market.
For example, the price that pharmacies paid for the antibiotic doxycycline hyclate increased to $3.65 a pill in 2013 from 5.6 cents in 2012, according to an analysis of pricing data by Adam J. Fein, president of Pembroke Consulting, who researches the drug-distribution industry. The spike in prices of doxycycline and other generic drugs led to a congressional investigation as well as state and federal inquiries into price-fixing that are still underway. A coalition of state attorneys general have accused a number of companies of colluding to keep prices high.
Fein said the price of doxycycline has since declined to 60 cents a pill. “That’s a big switch,” he said.
Despite these cases, the trend toward deflating generic prices appears to have accelerated as companies have more aggressively undercut each other’s prices.
Making matters worse for the generics companies, they are missing out on peak profit potential because not as many brand-name products are losing patent protection. The six-month period after a drug goes generic is typically the most lucrative time for the first company to market. And the Food and Drug Administration has been clearing out a backlog of generic-drug approvals, meaning more competitors are now entering markets for certain drugs.
In a recent call with Wall Street analysts, George S. Barrett, the chairman and chief executive of Cardinal Health, a major drug distributor that reported declining profits last week, said generic deflation was not new, but that the company historically had been able to anticipate it. “It just looked a little different than we had seen,” he said.
In recent years, generic companies have gone on acquisition sprees in an effort to head off some of these challenges. But they have been outmaneuvered by those who buy their products, a trend that has been intensifying. Major pharmacy chains, drug wholesalers and pharmacy benefit managers (which operate drug plans for insurers) have united into colossal buying groups. For example, Express Scripts, a large pharmacy benefit manager that runs its own mail-order pharmacy, teamed up with Walgreens Boots Alliance in May to purchase generics.
“What we’re seeing is incredible competition — and we’re causing it,” said Dr. Steve Miller, the chief medical officer for Express Scripts.
So are consumers saving any money?
The declining prices are broadly beneficial to the health care system, and may put some slight brake on rising premiums.
But most of those with health insurance pay a fixed co-payment — $10, for example — for each generic prescription, and therefore don’t pay more or less, regardless of any fluctuation in the actual price. And even those who do pay cash for generics may not notice a drop in price because many generics are already cheap.
Retail drug prices dropped 2.4 percent over the last year, based on a weighted average of 92 generics that have been on the market for at least a year, according to an analysis conducted for The New York Times and ProPublica by GoodRx, a site that tracks prices that consumers pay at the pharmacy. (Weighted averages account for how often each drug is prescribed.)
But that figure hides vast variations. The retail price for clopidogrel, the generic for Plavix, dropped 37 percent, to $3.77 from $6.03 a pill, GoodRx found. Conversely, the blood pressure drug metoprolol went up about 70 percent, to 59 cents a pill from 35 cents. But GoodRx noted that consumers can almost always do better than paying the retail price, or sometimes even their co-payments, using websites — like its own — that offer discounts.
Does this mean the problem with high drug costs has eased?
Overall drug spending is still on the rise because of the skyrocketing price of new, brand-name drugs.
ProPublica and The New York Times are interested in hearing from you if you had any difficulties accessing or paying for your prescription drugs. If this sounds like you, please share your story.
For example, a report by QuintilesIMS, an industry research firm, found that in 2016, drug spending increased by nearly 5 percent, after accounting for discounts and rebates paid by manufacturers. Generic drugs accounted for 89 percent of prescriptions dispensed in 2016, but only 26 percent of the costs, according to QuintilesIMS. Each year, generic drugs make up a larger share of the prescriptions filled, while accounting for a smaller portion of drug costs, said Chester Davis Jr., the president of the Association for Accessible Medicines, the generic industry trade group.
New treatments for conditions like cancer and multiple sclerosis often enter the market with annual price tags in the tens of thousands — and sometimes hundreds of thousands — of dollars. Many manufacturers also raise the price once or twice a year, compounding the problem.
“Generic drugs are among the best-value products in health care,” said Dr. Aaron S. Kesselheim, an associate professor at Harvard Medical School. But for those who must take a brand-name drugs because there is no other alternative, “they’re the ones bearing the burden or the brunt of the drug price increases in recent years.”
Is this trend likely to continue?
Generic manufacturers say they expect it will, and are worried that lower prices could put pressure on profits and threaten the viability of the companies. This could lead to a wave of mergers and acquisitions, reducing competition and leading to higher prices.
David Maris, an analyst for Wells Fargo, dismissed the idea that companies would go out of business. “Right now we have a very healthy generic market,” he said.
The new commissioner of the Food and Drug Administration, Dr. Scott Gottlieb, has made increased competition in the drug market a key part of his policy platform. He said he wanted to make it easier for generics manufacturers to get clearance for hard-to-copy products like eye drops, topical creams and asthma inhalers. And he wants to reduce barriers to ensure new players can enter the market for existing generic drugs, possibly lowering prices further.
“We’re looking to create competition where there isn’t competition,” he said.
Have you had trouble paying for prescription drugs? We want to hear from you.
More than a decade ago, I chatted with Asian-American seniors at Hunter College High School in New York City about their college admission prospects. One young woman told me she had scored 1530 out of a maximum 1600 on the SAT. When I congratulated her, she said that her score was what she and her friends called “an Asian fail.” She predicted it wouldn’t be enough to get into her dream school, Yale. She was right. The next day, she learned that Yale had rejected her.
I remembered our conversation when I read last week that the Justice Department plans to investigate a complaint by Asian-American organizations that Harvard discriminates against them by giving an edge to other racial minorities. My immediate response was: right victim, wrong culprit.
Asian Americans are indeed treated unfairly in admissions, but affirmative action is a convenient scapegoat for those who seek to pit minority groups against each other. A more logical target would be “the preferences of privilege,” as I called them in my 2006 book, “The Price of Admission.”
These policies elevate predominantly white, affluent applicants: children of alumni, big non-alumni donors, politicians and celebrities, as well as recruited athletes in upper-crust sports like golf, sailing, horseback riding, crew and even, at some colleges, polo. The number of whites enjoying the preferences of privilege, I concluded, outweighed the number of minorities aided by affirmative action.
By giving more slots to already advantaged students, these preferences displace more deserving candidates from other backgrounds, including Asian Americans and middle-class whites, without achieving the goals of affirmative action, such as diversity and redressing historical discrimination.
Jared Kushner, President Donald Trump’s son-in-law and senior adviser, has become the poster boy for this practice. As I reported in my book, Harvard accepted Kushner soon after receiving a $2.5 million pledge from his father, a real-estate developer and New York University graduate. While sources at Jared’s high school told me that he wasn’t near the top of his class, and didn’t always take the most challenging courses, a spokeswoman for Kushner Companies has described him as “an excellent student” and denied that his father’s gift was intended to improve his chances of admission.
In my book, I described Asian Americans as “the new Jews.” Like Jews before the 1960s, whose Ivy League enrollment was restricted by quotas, Asian Americans are overrepresented at selective colleges compared with their U.S. population, but are shortchanged relative to their academic performance.
Much as Ivy League administrators once justified anti-Jewish policies with ethnic stereotypes, so Asian Americans, I found, were typecast in college admissions offices. Asked why the Massachusetts Institute of Technology had turned down one high-achieving Korean-American youth, the then dean of admissions told me it was possible that he “looked like a thousand other Korean kids with the exact same profile of grades and activities and temperament. My guess is that he just wasn’t involved or interesting enough to surface to the top.”
My research indicated that college admissions officers tended to compare stellar Asian-American candidates to each other, rather than to the rest of the applicant pool. The result at some universities amounted to an informal quota system, with the percentage of Asian Americans admitted as freshman changing little from year to year. The proportion at Harvard, which long hovered below 20 percent, reached 22.2 percent for the class of 2021. Who takes the places of the spurned Asians? As far back as 1990, an investigation of Harvard by the U.S. Department of Education’s Office for Civil Rights pointed to recipients of so-called “white affirmative action.”
Harvard admitted Asian-American applicants “at a significantly lower rate than white applicants” despite their “slightly stronger” SAT scores and grades, it found. Accounting for most of the admissions gap was “preference given to legacies and recruited athletes — groups that are predominantly white.” In that era, Asian Americans composed 15.7 percent of all Harvard applicants but only 3.5 percent of alumni children and 4.1 percent of recruited athletes.
Unlike affirmative action, the preferences of privilege aren’t inherently race-based, which makes it tougher to challenge them legally.
ProPublica editor Daniel Golden wrote a book a decade ago about how the rich buy their children access to elite colleges. One student he covered is now poised to become one of the most powerful figures in the country. Read the story.
When I was researching my book in the early 2000s, several admissions deans assured me that the ranks of alumni children would become more diverse in future as the children of minorities who gained access to elite universities with the advent of affirmative action attained college age. But that doesn’t seem to have happened.
Based on a Harvard Crimson survey of freshmen entering Harvard in 2016, legacies remain a largely homogeneous group. They made up 15 percent of the student body, but 26.6 percent of those whose parents had a combined annual income of $500,000 or more. Of freshmen who identified themselves as white, 35 percent said that a family member had gone to Harvard as an undergraduate. Two-thirds of students whose parents had a combined annual income of more than $500,000 said that family members had attended Harvard.
Meanwhile, the practice of giving admissions breaks to children of current or prospective donors has only intensified. With other sources of revenue failing to keep pace with costs — the pace of tuition increases is declining, as is the percentage of alumni who donate to the country’s top 20 schools — universities are more dependent than ever on major givers, and thus under more pressure to accept their children. In 2015 alone, seven individuals made gifts of more than $100 million apiece to higher education, including one bequest.
“Recognizing that the market is more competitive and that we’re constrained in our ability to raise prices, we are going to be more dependent on philanthropy,” Donald Heller, provost and vice president of academic affairs at the University of San Francisco, told me last fall. “That means there’s probably more pressure on admissions offices around legacies and development admits” — applicants recommended by the development (i.e., fundraising) office.
In an era of widening economic and social inequity, and of backlash against minority groups, the way to open more slots for outstanding Asian-American applicants is not to ban affirmative action. A better approach for eliminating the “Asian fail” is to curtail preferences for rich whites.
