ProPublica

Democratic Lawmakers Blast Trump Administration’s VA Cuts After ProPublica Investigation

by Vernal Coleman and Eric Umansky

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

Democratic House members on Thursday blasted the Trump administration’s moves to shrink the Department of Veterans Affairs and demanded more transparency from its leaders after a ProPublica investigation revealed widespread disruptions across the agency’s health care system.

“There are real-life dangerous impacts for veterans,” said Rep. Chris Deluzio of Pennsylvania, citing the news organization’s work.

This week, ProPublica reported on dozens of emails sent from staff at VA hospitals and clinics across the country to headquarters warning how cuts could, and in some cases are, degrading the agency’s ability to provide for the roughly 9 million veterans who rely on it.

Hiring freezes and other edicts from the White House have left medical providers scrambling and short-staffed amid an ever-shifting series of policy moves, including the cancellation of contracts with companies that maintain cancer registries, the emails said. Staffers at VA centers in Pennsylvania warned the cuts were causing “severe and immediate impacts,” including to “life-saving cancer trials.”

“Enrollment in clinical trials is stopping,” one wrote, “meaning veterans lose access to therapies.” Staffers at the hospital warned more than 1,000 veterans would lose access to treatment for diseases ranging from metastatic head and neck cancers, to kidney disease, to traumatic brain injuries.

On Thursday, the House members, several of whom are veterans, demanded VA leadership provide more details on how cuts are affecting such work, in which service members often receive treatment they would not otherwise have access to.

“We all want to cut waste, fraud and abuse, but what we see today is when you cancel a contract, it means the end of a clinical trial that’s going to save someone’s life,” Rep. Maggie Goodlander of New Hampshire said.

Notably, Deluzio, an Iraq War veteran whose Pittsburgh-area district includes a VA facility, and other lawmakers said they had learned about the impact for the first time from ProPublica’s reporting. On Thursday, they accused agency Secretary Doug Collins of stonewalling their efforts to find out what positions have been laid off, what contracts have been canceled and what future cuts will look like.

“We want the country to understand that this administration is hiding what they are doing, not just from us and the Congress, but from veterans and the American people,” Deluzio said.

“And the worst part is, we don’t know if anyone has died,” he added.

President Donald Trump has long said his administration will prioritize veterans and not compromise their care.

The disruptions at the VA have come even as the department has laid off just a few thousand staffers — a small fraction of the employees it said it ultimately plans to remove. Collins has said the agency is developing plans with Elon Musk’s Department of Government Efficiency to cut at least 70,000 employees — a number that he has underscored is a “goal.” “Could be more, could be less,” he told lawmakers this week.

On Thursday, in a post on X, Collins pushed back on criticism, calling ProPublica’s reporting “misleading” and saying it was based on “some outdated reports from the internal system VA uses to quickly identify and fix issues across the department.”

In a statement, VA press secretary Pete Kasperowicz said that Collins was working to fix a “broken bureaucracy” that has long had problems with patient safety and access to care, among other issues. “Unfortunately, many in the media, government union bosses and some in Congress are fighting to keep in place the broken status quo,” he said. “Our message to Veterans is simple: Despite major opposition from those who don’t want to change a thing at VA, we will reform the department to make it work better for Veterans, families, caregivers and survivors.”

Kasperowicz previously told the news organization that the issues in Pennsylvania have been resolved, though locals there with knowledge of the issues said that’s not the case and that the impact is ongoing. Kasperowicz also said in regard to the contracts to maintain the cancer registries that there had been “no effect on patients.” He added that the VA is moving to create a national contract to administer them.

According to some providers, even the temporary disruptions have hurt the care of veterans. One clinical trial to treat veterans for opioid addiction was hobbled by temporary layoffs. “We couldn’t give veterans a tool that could save their lives,” said Ellie Gordon, the CEO of the startup Behavior, which is testing biosensors to alert veterans to the risk of relapse.

Collins touted the cuts in a sometimes-contentious hearing on Tuesday before the U.S Senate Committee on Veterans’ Affairs.

“We’re going to maintain VA’s mission-essential jobs like doctors, nurses and claims processors, while phasing out non-mission essential roles like interior designers and DEI officers,” he said in an opening statement. The funds saved will be rerouted into direct health care and benefits for veterans, he added.

Some Republicans at the hearing defended the administration’s proposed cuts. “The VA has become a bloated bureaucracy,” said Sen. Tommy Tuberville, who represents Alabama. “I think most of us will agree with that.”

But Sen. Richard Blumenthal, D-Conn., pushed back on Collins’ statements, saying that laying off such a large portion of the staff will inevitably involve letting go of health care workers, like nurses and doctors. “You cannot slash and trash the VA without eliminating those essential positions which provide access and availability of health care,” he said. “It simply cannot be done.”

Others at the hearing took Collins to task for a lack of transparency. Sen. Angus King, I-Maine, admonished the secretary for refusing to provide a list of the 538 canceled contracts since his appointment. Collins said he would provide the information, but only after it’s finalized.

“We’re looking at every step we can, but also, I’m not going to play it out in a public arena,” he said.

J. David McSwane contributed reporting.

Columbia Will Pay Survivors of Abusive Doctor $750 Million After ProPublica Revealed University’s Failures

by Bianca Fortis

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

Columbia University has agreed to a $750 million settlement with 576 patients of a former doctor who sexually abused them while working at the school.

In 2023, a ProPublica investigation, published with New York Magazine, revealed how Columbia had ignored women, undermined prosecutors and ultimately protected a predator. Obstetrician-gynecologist Robert Hadden worked at the university for 20 years despite decades of complaints about him.

The university had even cleared Hadden to see patients three days after he was arrested when a patient called 911 to report that he had assaulted her during a postpartum exam. University higher-ups had been informed of the arrest but allowed Hadden to continue working for another five weeks. Patients he saw during that time also reported being assaulted.

The latest settlement, combined with payouts from previous cases, means that Columbia will have paid out more than $1 billion to resolve claims of sexual abuse by Hadden. Columbia also said that it has now settled more than 1,000 claims of sexual abuse by Hadden’s former patients.

Hadden was convicted of sex crimes in federal court in January 2023 and is now serving a 20-year prison sentence.

Laurie Kanyok, the patient who called 911, said the settlement is bittersweet. “It’s emotional because it’s been 13 years,” she told ProPublica.

She also said that financial compensation does not amount to justice.

“I’m grateful that I’m involved in this,” Kanyok said. “At the same time, I feel like I want to see people held accountable and not just somebody’s insurance company or checkbook.”

Unlike in other high-profile cases involving sexual abuse by doctors, no administrators from Columbia have been fired or have stepped down as a result of the Hadden case.

In a statement, Columbia acknowledged failing to protect Hadden’s patients. “We deeply regret the pain that his patients suffered, and this settlement is another step forward in our ongoing work and commitment to repair harm and support survivors,” the statement said. “We commend the survivors for their bravery in coming forward.”

The latest settlement puts Columbia on par with the largest payout ever by a university to settle sexual abuse claims. In 2021, the University of Southern California agreed to pay $1.1 billion to survivors of George Tyndall, a university gynecologist who abused thousands of women.

Anthony DiPietro, the attorney who handled most of the Columbia claims, said the lesson from this week’s settlement is clear: Institutions “cannot continue to cover up sexual exploitation and abuse by their doctors because they’re going to be held accountable.”

Weeks after ProPublica’s investigation, Columbia announced that it would set up a $100 million settlement fund for patients who did not want to file civil suits. Survivors have about another week, until May 15, to submit a claim.

As part of the same announcement, Columbia also said it would notify all of Hadden’s nearly 6,500 former patients of the doctor’s crimes and that it would commission an external investigation to examine failures that allowed the abuse to go on for so long.

Asked about the status of that investigation, which was announced a year and a half ago, the university said it is ongoing. Columbia did not give a time frame for the report’s completion.

The Price of Remission

by David Armstrong

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

The pain jolted me awake. It was barely dawn, a misty February morning in 2023. My side felt as if I’d been stabbed.

I had been dealing with pain for weeks — a bothersome ache that felt like a bad runner’s cramp. But now it was so intense I had to brace myself against the wall to stand up.

A few hours after arriving at the emergency room, I heard my name. A doctor asked me to follow him to a private area, where he told me a scan had uncovered something “concerning.”

There were lesions, areas of bone destruction, on top of both of my hip bones and on my sternum. These were hallmarks of multiple myeloma. “Cancer,” he said.

Multiple myeloma is a blood cancer that ravages bone, leaving distinctive holes in its wake. Subsequent scans showed “innumerable lesions” from my neck to my feet as well as two broken ribs and a compression fracture in my spine. There is no cure.

I walked out of the ER in search of fresh air. I sat on a metal bench and did what many patients do. I turned to Google. The first link was a medical review stating that the average lifespan of a newly diagnosed patient was three to five years. My stomach churned.

I soon learned that information was outdated. Most patients today live much longer, in large part due to a drug with a horrific past. It was a doctor at the hospital who first told me I would likely take a thalidomide drug as part of my treatment.

That couldn’t be possible, I told him.

I knew the story of thalidomide, or at least I thought I did. It represented one of the darkest chapters in the history of modern medicine, having caused thousands of severe birth defects after it was given to pregnant women in the 1950s and 1960s. The drug was banned in most of the world, and the scandal gave rise to the modern-day U.S. Food and Drug Administration.

It turns out the drug once relegated to a pharmaceutical graveyard had new life as a cancer fighter.

That drug I take is called Revlimid. It is a derivative of thalidomide, a slightly tweaked version of the parent compound.

Revlimid is now one of the bestselling pharmaceutical products of all time, with total sales of more than $100 billion. It has extended tens of thousands of lives — including my own.

But Revlimid is also, I soon learned, extraordinarily expensive, costing nearly $1,000 for each daily pill. (Although, I later discovered, a capsule costs just 25 cents to make.)

That steep tab has put the drug’s lifesaving potential out of reach for some cancer patients, who have been forced into debt or simply stopped taking the drug. The price also helps fuel our ballooning insurance premiums.

For decades, I’ve reported on outrageous health care costs in the U.S. and the burden they place on patients. I’ve revealed the tactics used by drug companies to drive sales and keep the price of their products high.

Even with my experience, the cost of Revlimid stood out. When I started taking the drug, I’d look at the smooth, cylindrical capsule in my hand and consider the fact I was about to swallow something that costs about the same as a new iPhone. A month’s supply, which arrives in an ordinary, orange-tinged plastic bottle, is the same price as a new Nissan Versa.

I wanted to know how this drug came to cost so much — and why the price keeps going up. The price of Revlimid has been hiked 26 times since it launched. Some of what happened was reported at the time. But no one has pieced together the full account of what the drugmaker Celgene did, how federal regulators failed to rein it in and what the story reveals about unrestrained drug pricing in America.

What I discovered astonished even me.

My journey started with an indefatigable New York City lawyer on a quest to give her dying husband a chance.

Beth Wolmer’s story begins on a moon-splashed beach in the Cayman Islands in the winter of 1995. She and her husband, Ira, were holding hands as they walked in the sand, enjoying a rare break from a hectic life as parents to a 1-year-old daughter and demanding jobs as 30-something professionals in New York City.

They had met through friends and clicked from the start. On Sunday mornings, they sat together for hours, sharing sections of the newspaper and eating bagels. They planned trips to Europe and outings to the Metropolitan Museum of Art.

Ira was an interventional cardiologist who followed his father into medicine. Beth was a lawyer at the high-powered firm Skadden Arps.

“We had a great life,” Beth told me. “I specifically remember coming home on the bus and thinking: ‘My life is just perfect, perfect. I’m not going to change a thing.’”

As they walked that night in the Caribbean, Ira felt a sharp pain in his cheekbone. The pain flared several more times during the trip, becoming so intense that it brought tears to his eyes.

When he got home, Ira made an appointment to figure out what was wrong. Imaging tests revealed multiple myeloma. The prognosis was grim. The couple was told Ira had two years to live.

Specialists recommended treatments that would only provide a brief reprieve. The couple searched for someone who could offer something more. That’s when they found Dr. Bart Barlogie in Little Rock, Arkansas.

I’ve never been more scared of a spouse of a patient than I was of her.

Barlogie had been recruited to the University of Arkansas for Medical Sciences from the more prestigious MD Anderson Cancer Center in Houston. In Texas, Barlogie had been frustrated by a medical culture that he viewed as too timid in its approach to multiple myeloma.

He remembers working on a Sunday when a newly diagnosed patient was admitted to the hospital. With few options, Barlogie decided to put the patient on a taxing, four-drug chemotherapy cocktail used for lymphoma patients. It didn’t work. The patient died from a sepsis infection, a known complication of the treatment.

The attending physician later admonished him, Barlogie said, saying, “Bart, we have to learn to treat myeloma gently.” Barlogie said he thought to himself, “Fuck you.”

In Arkansas, Barlogie was in charge. He quickly developed a reputation as a practitioner willing to try anything to fight the fatal disease. Patients from around the world — including the actor Roy Scheider from the movie “Jaws” — flocked to his clinic.

Beth and Ira heard Barlogie before they saw him. The cowboy boots he’d taken to donning since his time in Houston clacked down the linoleum hallway floors. A short, slight man, Barlogie had a booming voice with a German accent. He wore leather jackets and round, red-framed glasses on his bald head.

When he strode into the exam room, he hugged Beth and Ira and told them they had come to the right place.

Now retired, Barlogie recalls being struck by Beth’s intensity. He said she told him “you must do something” to help Ira.

I met Barlogie at his home in Little Rock. We sat in his office, which is filled with photos of the red Ducati motorcycle he used to ride to work. An old license plate with the letters “MMCURED” sat on a shelf, reflecting his goal to find a cure for multiple myeloma.

When Beth and Ira found him, Barlogie told me, he had been having some success with a novel approach that put patients through two stem cell transplants a few months apart, which he called a tandem stem cell transplant. With a transplant, a patient is bombarded with high-dose chemotherapy to kill the cancerous plasma cells. The patient is then infused with healthy stem cells that travel to the bone marrow.

The intense chemotherapy can be grueling and poses a small risk of death.

Ira underwent three transplants. Each time, he relapsed. By the fall of 1997, after two years of treatment, Ira’s thick black hair was gone. He was losing weight. Then he had a stroke. His kidneys failed and required dialysis. He developed pneumonia and had to be intubated.

Beth was determined to keep him alive long enough for their toddler daughter to remember him. With a photograph of Ira smiling with their baby as motivation, she applied her lawyer’s tenacity to the case. She pored over medical journals and peppered oncologists with questions about why what they were trying wasn’t working or quizzing them about a promising study. When doctors told her there was nothing more they could do for her husband, she refused to accept it.

“She is a tiny person, but she is terrifying,” said Dr. David Siegel, part of the team that treated Ira in Arkansas. “I’ve never been more scared of a spouse of a patient than I was of her.” He meant it as a compliment.

By late fall in 1997, Ira was dying and Beth was desperate.

A researcher told her about the work of Dr. Judah Folkman, a surgeon and researcher at Boston Children’s Hospital. Folkman believed the growth of cancerous tumors could be stunted by starving them of a supply of new blood vessels.

Folkman was a workaholic who, when he wasn’t in the operating room or the research lab, was traveling across the world to promote his novel theory of how to attack cancer. Peers had ridiculed his idea since he first proposed it in the 1970s. The prevailing belief at the time was that tumors didn’t need a new blood supply to grow.

A young researcher in his lab, an ophthalmologist named Robert D’Amato, was at work on the top question Folkman had posed. Could they come up with a drug, in pill form, that blocks the growth of new blood vessels?

Folkman has since died, but it wasn’t difficult for me to track down D’Amato. He still works at Boston Children’s Hospital, where he has his own lab and holds the Judah Folkman Chair in Surgery. Now in his early 60s, D’Amato has a youthful energy and speaks in a rapid, matter-of-fact clip.

D’Amato told me that he had set out to find existing drugs that block blood vessel growth. He started by thinking of his own body and side effects caused by certain drugs. A drug that causes hair loss might be the result of the blood supply to hair follicles being shut off, for example. But this exercise wasn’t producing any viable candidates.

After giving it some thought, D’Amato realized he had myopically narrowed his search. What about a woman’s body? There were drugs that stopped menstrual cycles. Then there were drugs that caused birth defects in pregnant women. In both of those cases, it was possible the drug was inhibiting blood vessel growth. He came up with a list of 10 drugs. At the top of the list was one with a devastating history: thalidomide.

Beginning in the 1950s, pregnant women in Europe, Australia and other countries were frequently prescribed thalidomide as a treatment for morning sickness and to help them sleep. The drug was thought to be harmless and in Germany was sold over the counter. An advertisement for thalidomide in the United Kingdom claimed it could “be given with complete safety to pregnant women and nursing mothers without adverse effect on mother or child.”

They were wrong.

The drug was eventually linked to birth defects in more than 10,000 babies. Those babies were born without limbs or with shortened limbs, malformed hands, disfigured faces and damage to internal organs. Nearly half died within months of being born.

By the early 1960s, the drug was widely banned, considered a shameful chapter in the history of pharmaceuticals. It was never sold in the U.S. thanks to the unwavering objections of a resolute reviewer at the FDA named Frances Oldham Kelsey. The close call, however, prompted Congress to require more rigorous safety and efficacy data from drug manufacturers and empower the FDA to monitor the industry more closely.

D’Amato theorized that the thalidomide birth defects were the result of the drug stopping the growth of new blood vessels that the fetus needs to develop. He walked me through his experiments: He cracked a fertilized chicken egg on a glass petri dish and placed thalidomide on the surface. After two days, if no blood vessels grow on the embryo, a halo should appear around the thalidomide sample, showing the drug worked. It didn’t.

Folkman told D’Amato to move on. But D’Amato couldn’t shake the disappointing results. He did more research and realized thalidomide needs to first be broken down in the body to have an effect on humans. He purchased metabolites of thalidomide, repeated the test and this time found a halo around the sample.

He kept experimenting and in 1994 published a paper finding that thalidomide had “clear implications” for treating tumors.

So when Beth called three years later, Folkman told her they should try it.

Barlogie told me he didn’t think it would work. Beth said she had to convince him to try it.

Barlogie agreed to test it on Ira and two other patients who were out of treatment options in early December.

I wanted him alive forever.

The drug did not work for Ira. Beth said just before he died, Ira sat up in bed, kissed her and smiled. It was March 10, 1998. He was 38.

After years of frantically searching for anything that would help, the finality of his death was difficult to accept, she said. “I wanted him alive forever.”

It is unclear what happened with the second patient. The third patient, however, started to get better.

His name was Jimmy. Little more is known about him except that he was a patient of another oncologist at the hospital, Dr. Seema Singhal, and near death before he started the drug. “I told him it might work, but at the very least it would help him sleep,” Singhal said. Shortly after Jimmy took his first dose of thalidomide, Singhal left for a vacation.

When she returned two weeks later, her mailbox was full of lab results for Jimmy. He was still alive. She sat down to double-check the results, which showed declining amounts of a cancer marker. “For 30 minutes, I was the only person in the world who knew this worked,” she said.

Singhal walked down to Barlogie’s office to give him the news. “He took me by the hand, opened a window and shouted, ‘Thank you, God,’” she said.

Word of Jimmy’s stunning recovery in Arkansas quickly made its way to the offices of Celgene Corp., located in a small corporate park in a rural patch of northern New Jersey.

The company had just wrapped up a brutal year-end accounting, which showed losses of $27 million on revenue of just $1.1 million. Money was so tight that executives engaged in what one of them called “violent arguments” over whether to charge employees for coffee.

Celgene had acquired the rights to thalidomide patents held by researchers at Rockefeller University in 1992. The company, which was new to pharmaceuticals, planned to use the experience of obtaining FDA approval for thalidomide to develop other drugs.

“It wasn’t meant to be a blockbuster,” said Sol Barer, who started at the company in 1987 and later became CEO.

When Celgene announced plans to develop the disgraced drug for new uses, the only analyst following the company on Wall Street dropped coverage and told Celgene officials they didn’t know what they were doing.

The company thought the largest market would be as a treatment for AIDS patients experiencing dangerous weight loss. To win approval of the drug, however, Celgene selected a use that was already in practice in parts of the world for a small group of patients.

In July 1998, the FDA approved thalidomide for the treatment of a painful complication of leprosy. It was a momentous decision, coming just a few decades after the drug caused so much harm.

The market for leprosy was tiny, but what happened with Jimmy in Arkansas changed everything for the company.

The Arkansas doctors had been busy since first testing thalidomide on Ira Wolmer, Jimmy and the other patient. They quickly got approval to conduct a larger experiment funded by a grant from the U.S. National Institutes of Health. Now, in December 1998, they were ready to share their initial findings at the annual meeting of the American Society of Hematology.

It had been three decades since a new therapy for multiple myeloma had been approved, and there was a buzz among the oncologists gathered in Miami Beach for the conference. So many doctors crowded into the room for the presentation that the fire marshal had to intervene several times to clear exit ways. Word had already spread among multiple myeloma specialists about Jimmy. Now, the assembled doctors wanted to know whether it had been a fluke or a discovery that would fundamentally change how they practiced.

Singhal was tasked with presenting the data. It was a big stage for the 32-year-old doctor, who had only been practicing in the U.S. for two years.

It completely changed the treatment landscape.

The 89 patients in the study were high-risk cases who had undergone prior treatment. They were patients who, like Ira, had run out of options. Now, after thalidomide treatment, one-third had declines in myeloma activity.

Those were stunning numbers, unlike anything seen before in the treatment of multiple myeloma. When Singhal finished, the room erupted in applause.

“It completely changed the treatment landscape,” she said.

I wasn’t able to track down Jimmy, but I have a sense of how he might have felt when he realized the treatment was working.

After my initial emergency room visit, it took time to confirm my diagnosis and do some additional testing. While I waited, the pain worsened. Painkillers barely made a dent. All I could picture was this cancer eating away at my bones, doing more damage every day.

Some patients wait months for care. I was lucky enough to meet my oncologist within weeks. He had a script for Revlimid ready to go, part of a regimen of four drugs I would take as standard induction therapy, and I was able to start it within days.

The initial dose of Revlimid cost $18,255 for a month’s supply, and my insurance covered the cost.

Within a month, my blood tests showed a massive drop in a key cancer indicator.

My pain gradually subsided too. By the end of April, I wrote in my journal that the pain was a 3 or 4 instead of the usual 9 or 10. “It doesn’t hurt to get out of bed anymore,” I wrote.

The discovery in Arkansas made thalidomide, which Celgene sold as Thalomid, an instant hit.

As a result, Celgene’s revenue increased nearly sevenfold to $26.2 million in the year after the Miami presentation. It sold its thalidomide pills for $7.50 each.

From those modest beginnings, Celgene took a slightly altered version of that pill and turned it into one of the bestselling and most expensive prescription drugs in history. Celgene’s success with Thalomid was the result of remarkable good fortune, a case where the heavy lifting of discovery and initial testing had already been done, by Beth Wolmer, D’Amato, Barlogie, Singhal and others.

The development of the drug that would become Revlimid took me deep into the confounding, sharp-elbowed world of drug patents, which ostensibly protect drugmakers, allowing them to recoup the massive investments they made in developing a new product. Celgene drew on patent law, a drug safety system and even patient assistance programs to guard the exclusivity of its prized drug and the massive revenue it generated.

Those tactics, detailed in reams of court filings, allowed Celgene to treat Revlimid like a piggy bank, tapping it whenever it wanted.

There was a common internal theme at Celgene that cancer patients were willing to pay almost any amount Celgene charged.

Amid the early success of Thalomid, Celgene identified two potential threats: One was obvious. Thalidomide caused birth defects, a looming risk that could result in it being pulled from the market.

The other was that Celgene held limited patents on the drug. Patents are exclusive legal rights to inventions, and researchers file them on nearly every aspect of drug development as soon as they can, locking up everything from specific sets of ingredients to the way the drug is used and administered. The more robust patents a company has, the longer it can potentially ward off competitors.

Thalidomide was an old drug and Celgene’s patents did not cover the active ingredient, leaving it open to competition. The patents it did have, covering items such as the optimal dosages and its use in treating particular diseases, were considered weaker and open to a court challenge. If Celgene could create a new version of thalidomide — ideally one that didn’t cause birth defects — the company could seek more and stronger patents that would extend beyond those of the original drug.

So researchers at Celgene tested analogs of thalidomide, which are drugs that have a similar effect but are different from the parent compound in minor ways, such as having one less oxygen atom. The analogs are also more potent than the original, meaning they can achieve a similar effect at lower doses.

Celgene was not alone in its efforts. D’Amato was also studying thalidomide analogs and filing patents on their use, which he and Boston Children’s Hospital licensed to a Celgene competitor, EntreMed Inc.

With dueling patents, the companies sued each other in 2002.

Celgene was newly flush with cash from rising sales of thalidomide. EntreMed, on the other hand, was burning through money as it focused most of its resources on developing other drugs discovered in Folkman’s lab.

In December of 2002, the companies settled.

Celgene agreed to pay Boston Children’s Hospital royalties from future sales of Revlimid. In exchange, the hospital and D’Amato licensed their patents of thalidomide analogs to Celgene. Celgene also agreed to pay EntreMed $27 million.

For Celgene, the fight with EntreMed was a valuable experience. It learned that competition can be neutralized.

Celgene had kept the price of Thalomid low when it was initially intended for AIDS patients, CEO John Jackson told investors in 2004, as the company “didn’t want huge numbers of people demonstrating in front” of its office.

That wasn’t a problem with cancer patients. There was “plenty of room for very substantial increases” in the price of the drug now, Jackson told investors.

It is time for us to take Jimbo to the wood shed.

Just two days earlier, Celgene had hiked the price of Thalomid to $47 a pill.

“There was a common internal theme at Celgene that cancer patients were willing to pay almost any amount Celgene charged,” wrote David Schmidt, a former national account manager at the company, in a whistleblower lawsuit he filed after his employment was terminated in 2008. The lawsuit was voluntarily dismissed by Schmidt. (Jackson didn’t respond to requests for comment; Schmidt declined to talk to me.)

When Celgene launched Revlimid in December of 2005, it set the initial price at $55,000 a year, or $218 a pill, which was about double what analysts expected.

Seven months later, when the FDA approved the drug for multiple myeloma, the price jumped to $70,560 a year, or $280 a pill.

Each dot indicates a new manufacturer list price per pill.

The cost to manufacture each Revlimid pill, meanwhile, was 25 cents. I found a deposition marked “highly confidential” in which a top Celgene executive testified that the cost started at a quarter and never changed.

Even on Wall Street, which cheered higher pricing, the initial cost of Revlimid prompted concern among analysts who tracked the company that such aggressive maneuvering would cause insurers to push back. In the U.S., that is one of the only real checks on the price of prescription drugs.

That fear turned out to be unfounded, and Celgene would repeatedly test the bounds of how high it could go.

At the same time, Celgene worked to mute any criticism of Revlimid.

In 2005, Celgene received reports that Los Angeles oncologist Dr. James Berenson was “bashing” Revlimid in presentations sponsored by patient groups.

In one email, a senior company official said, “it is time for us to take Jimbo to the wood shed.” The company discussed a range of options for dealing with the doctor, from taking legal action to arranging a sit-down with Celgene’s chief executive.

Ultimately, the company appears to have decided on a friendlier course of action. Berenson became a frequent paid speaker and consultant for the company, with payments totaling at least $333,000, according to Celgene disclosures. Berenson declined to comment.

He wasn’t the only doctor the company befriended. Payment records show that between 2013 and 2018, Celgene paid doctors $11 million for speaking engagements and consulting work related to Revlimid. At one point, Celgene rented a suite at the Houston Astros baseball stadium to throw a party for the entire multiple myeloma department at the MD Anderson Cancer Center, according to court testimony. The center said it was unable to verify any of those details.

They remind me of an octopus with many, many tentacles, and at the end of each tentacle is a wad of cash.

Celgene went on to spread its largesse across the multiple myeloma world. It funded patient groups, sponsored medical meetings and contracted with prestigious academic medical centers.

“They remind me of an octopus with many, many tentacles, and at the end of each tentacle is a wad of cash,” said David Mitchell, a former Washington, D.C., communications executive who launched a nonprofit organization to fight for lower prices after he was diagnosed with multiple myeloma. “Everybody relies on the money.” Mitchell said his group, Patients For Affordable Drugs, does not accept donations from any entity that profits from the development or distribution of pharmaceuticals.

At the same time it showered doctors and patient groups with money, Celgene was shutting Beth Wolmer out. She told me that John Jackson, the CEO at the time, had promised her a paid board seat at the company as a way of compensating her for her role in the discovery before the company cut off communication.

Wolmer sued Celgene in federal court in 2009, seeking $300 million or more for alleged misappropriation of her idea and what she termed the “unjust enrichment” of Celgene.

Celgene said it never promised to compensate Wolmer. The company also suggested she greatly inflated her role in the discovery and, in any event, waited too long to take legal action.

In 2010, a judge granted Celgene’s motion for summary judgment in the case, agreeing that the statute of limitations had expired while at the same time expressing “admiration” for Wolmer’s “contribution to the struggle against this terrible disease.”

Wolmer has remarried and changed her name to Jacobson. She remains disappointed about the way she was treated by Celgene. “There was no ambiguity about who found the purpose of this drug, and I’m thrilled that it’s helping so many people,” she said. “Why they treated me that way? I don’t know.”

After the FDA approved Revlimid in late 2005, it also granted Celgene something else: seven years of market exclusivity because the drug treats a rare disease. In those seven years, Celgene raised the price of the drug nine times, increasing the price per pill by 82% to $397 in 2012.

The company also fended off challengers by claiming its patents protected the drug from competition until 2027.

But by 2010 generic makers were already working on copies of the drug, preparing to challenge those patents and enter the market earlier. A government analysis has found that generics generally lower the price of brand name drugs by an average of 85% after just one year.

Celgene was well aware of the danger generics posed and warned in a 2012 financial filing that their entry into the market could have a “material adverse effect” on its finances. At that point, Revlimid sales made up 70% of the company’s revenue.

Celgene needed another move.

The drug still posed a risk of birth defects like the parent compound. In approving the drug, the FDA had mandated a strict safety program to control its prescription and distribution.

Celgene realized early on that this could also be a tool to thwart competition. An internal company presentation at the time noted that the safety program could make it “more difficult for generic companies to access” thalidomide for testing.

Generic drug makers are required by the FDA to test their version against the brand name drug, so they need to buy small amounts of Revlimid from the company.

By 2012, at least six generic makers had requested to purchase Revlimid for testing. In every case, Celgene refused.

Federal regulators took notice. The FDA had warned Celgene that it could not use the safety program “to block or delay approval” of generic competitors. Now, it appeared to be doing just that.

The Federal Trade Commission, which enforces antitrust laws, had been investigating Celgene for years and in June of 2012 notified the company it was poised to take action.

In a previously unreported letter, the FTC said that its staff had recommended filing a legal complaint against the company for refusing to sell to competitors, thereby keeping them out of the marketplace.

The commission’s patience is wearing thin.

In its letter, the FTC noted that while Celgene refused to sell its drugs to potential competitors, it routinely provided Revlimid to other third parties around the world, including researchers and universities studying the drug.

Then, in August of 2012, the FDA directed Celgene to sell a small amount of Revlimid to a generic competitor.

With both federal agencies bearing down on Celgene, a closed-door meeting was held at FDA headquarters at the end of August. The FTC sent five lawyers, and 11 FDA staffers attended. Celgene showed up with a large contingent that included in-house lawyers and outside counsel.

Celgene started by denying it was using the safety program to block generics, according to minutes of the meeting. (The minutes were filed in a court case against Celgene, and it is unclear if they were prepared by the agencies or the company.) Citing the threat of birth defects, the company said that it had legitimate safety concerns about selling Revlimid to generic companies and that it needed to protect its investment in the drug.

Jane Axelrad, an associate director for the FDA, told Celgene that it was raising safety concerns because “the company does not want generics on the market,” according to the minutes. She declined to comment.

The meeting ended without a resolution. The FDA had no way of enforcing its directive to Celgene. The FTC staff, however, was still determined to act. The agency had spent more than two years investigating Celgene. It hired experts, deposed Celgene officials and obtained internal company documents.

The staff drafted a complaint alleging the company engaged in unfair actions to maintain a monopoly, hoping either that it would push the company to agree to sell to competitors to avoid legal action or that Celgene would be forced to do so by the courts, according to a person familiar with the agency’s stance.

“The commission’s patience is wearing thin,” FTC official Richard Feinstein wrote to the company’s lawyer in February 2013. “We have reached a point where the staff may be instructed in the very near future to commence litigation.” (Feinstein did not respond to emails seeking a comment.)

Celgene appeared to relent, telling the FTC that it would sell to generic makers, as long as the FDA approved their safety plan. In July, the FDA approved the safety protocols of generic maker Mylan.

Still, Celgene refused to sell.

Jon Leibowitz, who was the chairman of the FTC at the time, told me that Celgene’s promise to cooperate, even if it didn’t result in any sales to generic makers, lessened interest in the case among his fellow commissioners. Three of five commissioners need to vote in favor of commencing litigation. Now, in retrospect, he said that “if we knew then what we know now” about the delays, “we certainly would have brought a case.”

The agency would close its case in 2017 without taking any action.

With would-be generic competitors sidelined by Celgene’s refusal to sell drugs for testing, the company continued to raise the price of Revlimid.

They could raise their price any time they wanted to.

On a Saturday morning in early March of 2014, Celgene President Mark Alles sent an internal email complaining of disappointing first quarter Revlimid sales. Revenue from the star drug, which had surpassed $1 billion the previous quarter, was down by about 1% — or $11.4 million.

“I have to consider every legitimate opportunity available to us to improve our Q1 performance,” he wrote. But the only idea he proposed was a familiar one: raise the price of the drug.

Alles said he wanted a meeting the following Monday to discuss an immediate 4% price increase, followed by another increase of 3% at the beginning of September.

The company implemented those hikes, along with a third in December. It brought the price of Revlimid to $9,854 a month, or $469 a pill, and helped boost Revlimid sales for the year to $5 billion. Alles didn’t respond to my requests for comment.

“They could raise their price any time they wanted to,” said Francis Brown, a former sales executive at the company, in a 2015 deposition. I wasn’t able to reach Brown for comment.

Celgene found a solution to the generic threat when it struck a deal to settle a lawsuit brought by generic maker NATCO Pharma in 2015. NATCO could bring a generic to market, Celgene agreed, but not for seven more years — in March 2022. Even then, the generic would be limited to less than 10% of the total market for Revlimid in the first year, with gradual increases after that.

The deal set the bar for deals with other rivals for limited generic sales, and it ensured that unlimited generic competition — and lower prices — would not arrive until 2026.

The delayed entry of generics may have been bad news for patients and health care payors, but there was one constituency that was thrilled with the 2015 deal. Celgene’s stock jumped nearly 10% the day after it was announced.

Revlimid turned out to be a unicorn for Celgene, a drug whose financial success proved impossible to replicate.

In October of 2017, Celgene announced it was abandoning a once-promising effort to develop a drug for Crohn’s disease. Shares of Celgene declined by 11%.

As it had done so many times in the past, Celgene tapped Revlimid to try to mitigate the damage. The day it announced the failure of the Crohn’s drug, it quietly raised the price of Revlimid by 9%.

By the end of the year, Celgene had cumulatively raised the cost 20% to $662 a pill, the largest one-year increase in the drug’s history.

That made Revlimid the most expensive Medicare drug that year, with the government insurance program spending $3.3 billion to provide it to 37,459 patients.

At Celgene, the brash increases triggered rare internal dissent. Betty Swartz, the company’s vice president of U.S. market access, objected to the measures in a pricing meeting with the CEO, who at the time was Alles, and other top executives. She said her concerns were swiftly dismissed, according to a whistleblower lawsuit she filed and later dismissed.

“Why would you be afraid to take an increase on our products?” she said the CEO told her. “What could be the worst thing that happens ... a tweet here or there and bad press for a bit.” Swartz declined to comment.

The price increases added to the burden faced by many patients. In online groups, patients use words like “ridiculous,” “ugly” and “killer” when talking about the financial pain they have experienced related to the high costs associated with Revlimid. Some have taken out mortgages, raided retirement funds or cut back on everyday expenses like groceries to pay for Revlimid. Others have found overseas suppliers who ship the drug for pennies on the dollar, although doctors caution there’s no way to guarantee quality. Some just decide not to take the drug.

By increasing the price of Revlimid, Celgene executives in several instances boosted their pay. That’s because bonuses were tied to meeting revenue and earnings targets. In some years, executives would not have hit those targets without the Revlimid price increases, a congressional investigation later found.

In total, Celgene paid a handful of top executives about a half-billion dollars in the 12 years after Revlimid was approved.

Robert Hugin, who worked as Celgene’s CEO and then executive chairman, received $51 million in total compensation from 2015 to 2017. Hugin retired in 2018 to launch an unsuccessful Senate bid.

Even sales reps earned more than $1 million a year and were rewarded with trips to resorts such as the Four Seasons in Maui. That pay is more than two times what the average oncologist earns.

I connected with Hugin just before Christmas while he was driving. He was ardent in his defense of the pricing of Revlimid. He told me the drug passes any cost-benefit analysis because of its impact on multiple myeloma patients like myself. “People recognize when you have a breakthrough therapy and you have an opportunity to deliver that, you want to deliver that across the world,” he said. “And I think Revlimid is an example of a product that ends up to be a global lifesaver because of what it did.”

Hugin told me that when Revlimid has unlimited generic competition, the price will be “cheaper than aspirin” and patients will benefit from that low price for many decades.

Celgene also cited the cost of developing drugs and its expansive research efforts as reasons for the high cost of Revlimid. Celgene said it spent $800 million to develop Revlimid and spent several hundred million more on additional trials to study the use of the drug in other cancers. Those combined figures represent about 2% to 3% of Revlimid sales through 2018.

The drug didn’t get any better. The cancer patients didn’t get any better. You just got better at making money. You just refined your skills at price gouging.

By the end of 2018, Celgene’s stock was down 56% over the past 15 months amid development failures. Despite the raft of bad news, Alles’ total pay that year increased by $3 million to $16.2 million.

Celgene tried desperately to boost its flagging stock price by buying back $6 billion of its own shares that year.

Ultimately, the buyback was not enough. Just days into the new year in 2019, Celgene announced it had agreed to be acquired by Bristol Myers Squibb in a deal valued at $74 billion.

As part of a severance agreement, top Celgene executives stood to make millions once the deal closed. For Alles, that meant a potential estimated payday of $27.9 million.

In the fall of 2020, Alles appeared before the House Oversight Committee, which was investigating the high cost of prescription drugs. He said pricing decisions “reflected our commitment to patient access, the value of a medicine to patients and the health care system, the continuous effort to discover new medicines and new uses for existing medicines, and the need for financial flexibility.”

When it came time for questions, then-Rep. Katie Porter, D-Calif., quizzed Alles in rapid-fire style about Revlimid. Did the drug change as the price increased? Did it work faster? Were there fewer side effects? The drug was the same, Alles responded.

“So, to recap here,” Porter said. “The drug didn’t get any better. The cancer patients didn’t get any better. You just got better at making money. You just refined your skills at price gouging.”

High prices have consequences beyond individual patients. While there have been tremendous advancements in the treatment of my disease, there is still no cure. The specter of relapse hovers over every blood test, every new ache or pain.

The day I learned I was in remission, in November 2023, was bittersweet. I wrote at the time that I didn’t get to ring a bell — the traditional sign that a cancer patient has finished treatment. Instead, my doctor explained the next step: “maintenance” treatment.

This includes not only continuing Revlimid, but making monthly visits to my cancer center to get a shot of a bone-strengthening drug, have another drug injected into my stomach and blood drawn for lab tests.

“The visit,” I wrote that day, “only reinforced the fact that I’m a patient, and I always will be.”

For most of us, cancer will return at some point after treatment. And for most patients, the drugs eventually stop working.

Revlimid can also be difficult to live with. Some patients quit the drug after developing severe gastrointestinal issues, infections or liver problems. The drug also poses an increased risk of stroke, heart attack and secondary cancers.

Those are the trade-offs for keeping multiple myeloma in check.

Meanwhile, the drumbeat of price increases continues under Bristol Myers Squibb, helping the company bring in $48 billion in revenue from Revlimid since it purchased Celgene. Bristol said its pricing “reflects the continued clinical benefit Revlimid brings to patients, along with other economic factors.” The company said it is “committed to achieving unfettered patient access to our medicines” and provides some financial support for eligible patients. “While BMS develops prices for its medicines, we do not determine what patients will pay out of pocket.”

Last July, the cost of my monthly Revlimid prescription increased by 7% to $19,660.

At the beginning of this year, my insurer switched me to generic Revlimid. I didn’t fight it, thinking it would result in a dramatic decrease in what ProPublica’s health plan pays for the drug.

It turns out it is not much of a savings: The generic costs $17,349 a month.

Alec Glassford contributed research.

Trump’s NIH Axed Research Grants Even After a Judge Blocked the Cuts, Internal Records Show

by Annie Waldman

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

For more than two months, the Trump administration has been subject to a federal court order stopping it from cutting funding related to gender identity and the provision of gender-affirming care in response to President Donald Trump’s executive orders.

Lawyers for the federal government have repeatedly claimed in court filings that the administration has been complying with the order.

But new whistleblower records submitted in a lawsuit led by the Washington state attorney general appear to contradict the claim.

Nearly two weeks after the court’s preliminary injunction was issued, the National Institutes of Health’s then-acting head, Dr. Matthew J. Memoli, drafted a memo that details how the agency, in response to Trump’s executive orders, cut funding for research grants that “promote or inculcate gender ideology.” An internal spreadsheet of terminated NIH grants also references “gender ideology” and lists the number associated with Trump’s executive order as the reason for the termination of more than a half dozen research grants.

The Washington attorney general’s allegation that the Trump administration violated a court order comes as the country lurches toward a constitutional crisis amid accusations that the executive branch has defied or ignored court orders in several other cases. In the most high-profile case so far, the administration has yet to comply with a federal judge’s order, upheld unanimously by the Supreme Court, requiring it to “facilitate” the return of Kilmar Armando Abrego Garcia, who was mistakenly deported to El Salvador in March.

The records filed in the NIH-related lawsuit last week also reveal for the first time the enormous scope of the administration’s changes to the agency, which has been subject to massive layoffs and research cuts to align it with the president’s political priorities.

Other documents filed in the case raise questions concerning a key claim the administration has made about how it is restructuring federal agencies — that the Department of Government Efficiency has limited authority, acting mostly as an advisory body that consults on what to cut. However, in depositions filed in the case last week, two NIH officials testified that DOGE itself gave directions in hundreds of grant terminations.

The lawsuit offers an unprecedented view into the termination of more than 600 grants at the NIH over the past two months. Many of the canceled grants appear to have focused on subjects that the administration claims are unscientific or that the agency should no longer focus on under new priorities, such as gender identity, vaccine hesitancy and diversity, equity and inclusion. Grants related to research in China have also been cut, and climate change projects are under scrutiny.

Andrew G. Nixon, the director of communications for the Department of Health and Human Services, the NIH’s parent agency, told ProPublica in an email that the grant terminations directly followed the president’s executive orders and that the NIH’s actions were based on policy and scientific priorities, not political interference.

“The cuts are essential to refocus NIH on key public health priorities, like the chronic disease epidemic,” he said. Nixon also told ProPublica that its questions related to the lawsuit “solely fit a partisan narrative”; he did not respond to specific questions about the preliminary injunction, the administration’s compliance with the order or the involvement of DOGE in the grant termination process. The White House did not respond to ProPublica’s questions.

Mike Faulk, the deputy communications director for the Washington state attorney general’s office, told ProPublica in an email that the administration “appears to have used DOGE in this instance to keep career NIH officials in the dark about what was happening and why.”

“While claiming to be transparent, DOGE has actively hidden its activities and its true motivations,” he said. “Our office will use every tool we have to uncover the truth about why these grants were terminated.”

Since Trump took office in January, the administration has provided limited insight into why it chose to terminate scientific and medical grants.

That decision-making process has been largely opaque, until now.

In February, Washington state — joined by Minnesota, Oregon, Colorado and three physicians — sued the administration after it threatened to enforce its executive orders by withholding federal research grants from institutions that provided gender-affirming services or promoted “gender ideology.” Within weeks, a federal judge issued an injunction limiting the administration from fully enforcing the orders in the four states that are party to the suit.

The same day as the injunction, however, the NIH terminated a research grant to Seattle Children’s Hospital to develop and study an online education tool designed to reduce the risk of violence, mental health disorders and sexually transmitted infections among transgender youth, according to records filed in the court case. The NIH stated that it was the agency’s policy not to “prioritize” such studies on gender identity.

“Research programs based on gender identity are often unscientific, have little identifiable return on investment, and do nothing to enhance the health of many Americans,” the notice stated, without citing any scientific evidence for its claims. The NIH sent another notice reiterating the termination four days later.

The Washington attorney general’s office requested the termination be withdrawn, citing the injunction. But the administration refused, claiming that it was in compliance as the termination was based on NIH’s own authority and grant policy and was not enforcing any executive order.

The Washington attorney general asked the judge to hold the administration in contempt for violating the injunction. While the request was denied, the court granted an expedited discovery process to better assess whether the administration had breached the injunction. That process would have required the administration to quickly turn over internal documents relating to the termination. In response, the administration reinstated the grant for Seattle Children’s Hospital and declared the discovery process moot, or no longer relevant. However, U.S. District Judge Lauren J. King, who was appointed by former President Joseph Biden, permitted it to continue.

In recent months, whistleblowers have made the plaintiffs in the lawsuit aware of internal records that more closely connect the grant terminations to the administration’s executive orders.

In an internal spreadsheet of dozens of grants marked for cancellation at an NIH institute, the stated reason for termination for several was “gender ideology (EA 14168),” including the grant to Seattle Children’s Hospital.

The rationale appears to reference Executive Order 14168, which banned using federal funds to “promote gender ideology,” again seeming to conflict with the administration’s stance that the termination was not based on the executive orders. The termination dates of the grants, according to the spreadsheet, were after the injunction went into effect.

Another internal document, which provides extraordinary insight into the administration’s efforts to reshape the NIH, also states the executive order was the impetus for grant terminations.

In the March 11 memo from Memoli, the NIH cataloged all actions that the agency had taken thus far to align with the president’s executive orders. In a section detailing the steps taken to implement the “gender ideology” executive order, one of the 44 actions listed was the termination of active grants.

“NIH is currently reviewing all active grants and supplements to determine if they promote gender ideology and will take action as appropriate,” the memo stated, noting that the process was in progress.

While the administration has said in court filings that it is following the judge’s injunction order, the Washington state attorney general’s office told ProPublica that it disagreed.

“Their claim to have complied with the preliminary injunction is almost laughable,” said Faulk, the office’s deputy communications director. “The Trump administration is playing games with no apparent respect for the rule of law.”

In depositions conducted last month as part of the lawsuit, the testimony of two NIH officials also raised questions about why the research grants were terminated and how DOGE was involved.

Liza Bundesen, who was the deputy director of the agency’s extramural research office, testified that she first learned of the grant terminations on Feb. 28 from a DOGE team member, Rachel Riley. Bundesen said she was invited into a Microsoft Teams video call, where Riley introduced herself as being part of DOGE and working with the Department of Health and Human Services.

Riley, a former consultant for McKinsey & Co., joined HHS on Jan. 27, according to court filings in a separate lawsuit, and has reportedly served as the DOGE point person at the NIH.

The executive order detailing DOGE’s responsibilities describes the cost-cutting team as advisers that consult agency heads on the termination of contracts and grants. No language in the orders gives the DOGE team members the authority to direct the cancellation of grants or contracts. However, the depositions portray Riley as giving directions on how to conduct the terminations.

“She informed me that a number of grants will need to be terminated,” Bundesen testified, adding that she was told that they needed to be terminated by the end of the day. “I did not ask what, you know, what grants because I just literally was a little bit confused and caught off guard.”

Bundesen said she then received an email from Memoli, the NIH acting director, with a spreadsheet listing the grants that needed to be canceled and a template letter for notifying researchers of the terminations.

“The template had boilerplate language that could then be modified for the different circumstances, the different buckets of grants that were to be terminated,” she said. “The categories were DEI, research in China and transgender or gender ideology.”

Bundesen forwarded the email with the spreadsheet to Michelle Bulls, who directs the agency’s Office of Policy for Extramural Research Administration. Bundesen resigned from the NIH a week later, on March 7, citing “untenable” working conditions.

“I was given directives to implement with very short turnaround times, often close of business or maybe within the next hour,” she testified. “I was not offered the opportunity to provide feedback or really ask for clarification.”

Bulls confirmed in her own deposition that the termination list and letter template originally came from Riley. When Bulls started receiving the lists, she said she did what she was told. “I just followed the directive,” she said. “The language in the letters were provided so I didn’t question.”

Bulls said she didn’t write any of the letters herself and just signed her name to them. She also said she was not aware whether anyone had assessed the grants’ scientific merit or whether they met agency criteria. The grant terminations related to gender identity did not stem from an independent agency policy, she testified, appearing to contradict the administration’s assertion that they were based on the agency’s own authority and grant policy.

As of April 3, Bulls said she had received more than five lists of grants that needed to be terminated, amounting to “somewhere between five hundred and a thousand” grants.

Most grant recipients endure a rigorous vetting process, which can involve multiple stages of peer review before approval, and before this year, Bulls testified that grant terminations at the NIH have historically been rare. There are generally two main types of terminations, she said, for noncompliance or based on mutual agreement. Bulls said that she has been “generally involved in noncompliance discussions” and since she became the director of the office in 2012, there had been fewer than five such terminations.

In addition to the termination letters, Bulls said she relied on the template language provided by Riley to draft guidance to inform the 27 centers and institutes at the NIH what the agency’s new priorities were to help them scrutinize their own research portfolios.

Following the depositions, the Washington state attorney general’s office said that the federal government has refused to respond to its discovery requests. It has filed a motion to compel the government to respond, which is pending.

Riley, Bundesen, Bulls and Memoli did not reply to ProPublica’s requests for comment.

While the administration did not answer ProPublica’s questions about DOGE and its involvement in the grant terminations, last week in its budget blueprint, it generally justified its proposed cuts at the NIH with claims that the agency had “wasteful spending,” conducted “risky research” and promoted “dangerous ideologies that undermine public health.”

“NIH has grown too big and unfocused,” the White House claimed in its fiscal plan, adding that the agency’s research should “align with the President’s priorities to address chronic disease and other epidemics, implementing all executive orders and eliminating research on climate change, radical gender ideology, and divisive racialism.”

Jeremy Berg, who led the National Institute of General Medical Sciences at the NIH from 2003 to 2011, told ProPublica that the administration’s assessment of the institution was “not fair and not based on any substantial analysis or evidence,” and the proposed cuts “would be absolutely devastating to NIH and to biomedical research in the United States.”

“It is profoundly distressing to see this great institution being reduced to a lawless, politicized organization without much focus on its actual mission,” he said.

Why Hospital Policies Matter in States That Ban Abortion

by Kavitha Surana, Lizzie Presser and Andrea Suozzo

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Nearly four years ago in Texas, the state’s new abortion law started getting in the way of basic miscarriage care: As women waited in hospitals cramping, fluid running down their legs, doctors told them they couldn’t empty their uterus to guard against deadly complications.

The state banned most abortions, even in pregnancies that were no longer viable; then, it added criminal penalties, threatening to imprison doctors for life and punish hospitals. The law had one exception, for a life-threatening emergency.

Heeding the advice of hospital lawyers, many doctors withheld treatment until they could document patients were in peril. They sent tests to labs, praying for signs of infection, and watched as women lost so much blood that they needed transfusions.“You would see the pain in peoples’ eyes,” one doctor said of her patients.

Not every hospital tolerated this new normal, ProPublica found. A seismic split emerged in how medical institutions in the state’s two largest metro areas treated miscarrying patients — and in how these women fared.

Leaders of influential hospitals in Dallas empowered doctors to intervene before patients’ conditions worsened, allowing them to induce deliveries or perform procedures to empty the uterus.

In Houston, most did not.

The result, according to a first-of-its-kind ProPublica analysis of state hospital discharge data, is that while the rates of dangerous infections spiked across Texas after it banned abortion in 2021, women in Houston were far more likely to get gravely ill than those in Dallas.

As ProPublica reported earlier this year, the statewide rate of sepsis — a life-threatening reaction to infection — shot up more than 50% for women hospitalized when they lost a second-trimester pregnancy.

A new analysis zooms in: In the region surrounding Dallas-Fort Worth, it rose 29%. In the Houston area, it surged 63%.

ProPublica has documented widespread differences in how hospitals across the country have translated abortion bans into policy. Some have supported doctors in treating active miscarriages and high-risk cases with procedures technically considered abortions; others have forbidden physicians from doing so, or left them on their own to decide, with no legal backing in case of arrest.

This marks the first analysis in the wake of abortion bans that connects disparities in hospital policies to patient outcomes. It shows that when a state law is unclear and punitive, how an institution interprets it can make all the difference for patients.

Yet the public has no way to know which hospitals or doctors will offer options during miscarriages. Hospitals in states where abortion is banned have been largely unwilling to disclose their protocols for handling common complications. When ProPublica asked, most in Texas declined to say.

ProPublica’s Texas reporting is based on interviews with 22 doctors in both the Houston and Dallas-Fort Worth metro areas who had insight into policies at 10 institutions covering more than 75% of the births and pregnancy-loss hospitalizations in those areas.

The findings come as evidence of the fatal consequences of abortion bans continue to mount, with a new report just last month showing that the risk of maternal mortality is nearly twice as high for women living in states that ban abortion. Last year, ProPublica documented five preventable maternal deaths, including three in Texas.

One second-trimester pregnancy complication that threatens patients’ lives is previable premature rupture of membranes, called PPROM, when a woman’s water breaks before the fetus can live on its own. Without amniotic fluid, the likelihood of the fetus surviving is low. But with every passing hour that a patient waits for treatment or for labor to start, the risk of sepsis increases.

The Texas Supreme Court has said that doctors can legally provide abortions in PPROM cases, even when an emergency is not imminent.

Yet legal departments at many major Houston hospitals still advise physicians not to perform abortions in these cases, doctors there told ProPublica, until they can document serious infection.

Dr. John Thoppil, the immediate past president of the Texas Association of Obstetricians and Gynecologists, said he was “blown away” by this finding. He said it’s time for hospitals to stop worrying about hypothetical legal consequences of the ban and start worrying more about the real threats to patients’ lives.

“I think you’re risking legal harm the opposite way for not intervening,” he said, “and putting somebody at risk.”

In the summer of 2021, Dr. Robyn Horsager-Boehrer, a Dallas specialist in high-risk pregnancy, listened as hospital lawyers explained to a group of UT Southwestern Medical Center doctors that they would no longer be able to act on their clinical judgment.

For decades, these UT Southwestern physicians had followed the guidance of major medical organizations: They offered patients with PPROM the option to end the pregnancy to protect against serious infection. But under the state’s new abortion ban, they would no longer be allowed to do so while practicing at the county’s safety net hospital, Parkland Memorial, which delivers more babies than almost any other in the country. Nor would they be permitted at UT Southwestern’s William P. Clements Jr. University Hospital.

Lawyers from the two hospitals explained in a meeting that the law’s only exception was for a “medical emergency” — but it wasn’t clear how the courts would define that. With no precedent or guidance from the state, they advised the doctors that they should offer to intervene only if they could document severe infection or bleeding — signs of a life-threatening condition, Horsager-Boehrer recalled. They would need to notify the state every time they terminated a pregnancy. ProPublica also spoke with six of Horsager-Boehrer’s colleagues who described similar meetings.

As the new policy kicked in, the doctors worried the lawyers didn’t understand how fast sepsis could develop and how difficult it could be to control. Many patients with PPROM can appear stable even while an infection is taking hold. During excruciating waits, Dr. Austin Dennard said she would tell patients at Clements, “We need something to be abnormal so that we can offer you all of the options that someone in New York would have.” Then she would return to the physicians’ lounge, lay down her head and cry.

Their only hope, the doctors felt, was to collect data and build a case that the hospital’s policy needed to change.

Within eight months, 28 women with severe pregnancy complications before fetal viability had come through the doors of Parkland and Clements. Twenty-six of them were cases in which the patients’ water broke early. Analyzing the medical charts, a group of researchers led by Dr. Anjali Nambiar, a UT Southwestern OB-GYN, found that a dozen women experienced complications including hemorrhage and infection. Only one baby survived.

The research team compared the results with another study in which patients were offered pregnancy terminations. They found that of patients who followed the “watch and wait” protocol, more than half experienced serious complications, compared with 33% who immediately terminated their pregnancies.

Armed with the research, the doctors, including Horsager-Boehrer, returned to the lawyers for the two hospitals. Everyone agreed the data demanded action. Alongside physicians, the lawyers helped develop language that doctors could include in medical charts to explain why they terminated a pregnancy due to a PPROM diagnosis, Dennard said.

At Parkland, the new protocol required doctors to get signoff from one additional physician, attach the study as proof of the risk of serious bodily harm — part of the “medical emergency” definition in the law — and notify hospital leaders. At Clements, doctors also needed to get CEO approval to end a pregnancy, which could create delays if patients came in on a weekend, doctors said. But it was vastly better than the alternative, Dennard said. The message from the lawyers, she said, was: “We have your back. We are going to take care of you.”

A spokesperson for UT Southwestern said “no internal protocols delay care or otherwise compromise patient safety.” A spokesperson for Parkland said that “physicians are empowered to document care as they deem appropriate” and that hospital attorneys had “helped review and translate the doctors’ proposed language to make sure it followed the law.”

Parkland and UT Southwestern are not the only ones providing this care in Dallas. ProPublica spoke with doctors who have privileges at hospitals that oversee 60% of births and pregnancy loss hospitalizations in the Dallas-Fort Worth region, including Baylor Scott & White and Texas Health Resources. They said that their institutions support offering terminations to patients with high-risk second-trimester pregnancy complications like PPROM.

At Baylor Scott & White, doctors said, the leadership always stood by this interpretation of the law. (When asked, a spokesperson said miscarrying patients are counseled on surgical options, and that its hospitals follow state and federal laws. “Our policies are developed to comply with those laws, and we educate our teams on those policies.”)

Texas Health and other hospitals in the region did not respond to requests for comment.

While efforts to be proactive have meant more patients are able to receive the standard of care in Dallas, that is still not the case at every medical campus in the region. Doctors at Parkland said they have seen patients come to them after they were turned away from hospitals nearby.

In other parts of the state, however, it’s been impossible to know where to turn.

In Houston, one of America’s most prestigious medical hubs, Dr. Judy Levison mounted her own campaign.

The veteran OB-GYN at Baylor College of Medicine wanted hospital leaders to support intervening in high-risk complications in line with widely accepted medical standards. In 2022, she emailed her department chair, Dr. Michael Belfort, who is also the OB-GYN-in-chief at Texas Children’s. She told him colleagues had shared “feelings of helplessness, moral distress and increasing concerns about the safety of our patients.”

They needed training on how to protect patients within the bounds of the law, she said, and language they could include in charts to justify medically necessary abortions. But in a meeting, Belfort told her he couldn’t make these changes, Levison recalled.

He said that if he supported abortions in medically complicated cases like PPROM, the hospital could lose tens of millions of dollars from the state, she told ProPublica. “I came to realize that he was in a really difficult place because he risked losing funding for our residency program if Baylor and Texas Children’s didn't interpret the law the way they thought the governor did.” She wondered if he was deferring to hospital lawyers.

Belfort did not respond to requests for comment about his stance. Nor did Baylor or Texas Children’s.

Although Texas Attorney General Ken Paxton has threatened hospitals with civil action if they allow a doctor to perform what he views as an “unlawful” abortion, he hasn’t filed any such actions. And in the years since the ban, there have been no reports of the state pulling funding from a hospital on account of its abortion policy.

A spokesperson at only one major Houston hospital chain, Houston Methodist, said that it considered PPROM a medical emergency and supported terminations for “the health and safety of the patient.”

Five other major hospital groups that, together, provide the vast majority of maternal care in the Houston region either continue to advise doctors not to offer pregnancy terminations for PPROM cases or leave it up to the physicians to decide, with no promise of legal support if they’re charged with a crime. This is according to interviews with a dozen doctors about the policies at HCA, Texas Children’s, Memorial Hermann, Harris Health and The University of Texas Medical Branch. Together, they account for about 8 in 10 hospitalizations in the region for births or pregnancy loss.

Most of the doctors spoke with ProPublica on the condition of anonymity, as they feared retaliation for violating what some described as a hospital “gag order” against discussing abortion. In a sign of how secretive this decision-making has become, most said their hospitals had not written down these new policies, only communicated them orally.

Several doctors told ProPublica that Dr. Sean Blackwell, chair of the obstetrics and gynecology department at Houston’s University of Texas Health Science Center, which staffs Harris Health Lyndon B. Johnson Hospital and Memorial Hermann hospitals, had conveyed a message similar to Belfort’s: He wasn’t sure he would be able to defend providers if they intervened in these cases. He did not respond to multiple requests for comment, and his institution, UTHealth Houston, declined to comment.

ProPublica reached out to officials at all five hospital groups, asking if they offer terminations at the point of a PPROM diagnosis. Only one responded. Bryan McLeod at Harris Health pointed to the hospital system’s written policy, which ProPublica reviewed, stating that an emergency doesn’t need to be imminent for a doctor to intervene. But McLeod did not respond to follow-up questions asking if patients with PPROM are offered pregnancy terminations if they show no signs of infection — and several doctors familiar with the chain’s practices said they are not.

The state Senate unanimously passed a bill last week to clarify that doctors can terminate pregnancies if a woman faces a risk of death that is not imminent. ProPublica asked the hospitals if they would change their policies on PPROM if this is signed into law. They did not respond.

Last fall, ProPublica reported that Josseli Barnica died in Houston after her doctors did not evacuate her uterus for 40 hours during an “inevitable” miscarriage, waiting until the fetal heartbeat stopped. Two days later, sepsis killed her.

Barnica was treated at HCA, the nation’s largest for-profit hospital chain, which did not respond to a detailed list of questions about her care. With 70% of its campuses in states where abortion is restricted, the company leaves the decision of whether to take the legal risk up to the physicians, without the explicit legal support provided in Dallas, according to a written policy viewed by ProPublica and interviews with doctors. A spokesperson for the chain said doctors with privileges at its hospitals are expected to exercise their independent medical judgment “within applicable laws and regulations.” As a result, patients with potentially life-threatening conditions have no way of knowing which HCA doctors will treat them and which won’t.

Brooklyn Leonard, a 29-year-old esthetician eager for her first child, learned this in February. She was 14 weeks pregnant when her water broke. At HCA Houston Healthcare Kingwood, her doctor Arielle Lofton wrote in her chart, “No interventions can be performed at this time legally because her fetus has a heartbeat.” The doctor added that she could only intervene when there was “concern for maternal mortality.” Leonard and her husband had trouble getting answers about whether she was miscarrying, she said. “I could feel that they were not going to do anything for me there.” Lofton and HCA did not respond to a request for comment.

It was only after visits to three Houston hospitals over five days that Leonard was able to get a dilation and evacuation to empty her uterus. A doctor at Texas Children’s referred her to Dr. Damla Karsan, who works in private practice and is known for her part in an unsuccessful lawsuit against the state seeking permission to allow an abortion for a woman whose fetus was diagnosed with a fatal anomaly. Karsan felt there was no question PPROM cases fell under the law’s exception. She performed the procedure at The Woman’s Hospital of Texas, another HCA hospital. “She’s lucky she didn’t get sick,” Karsan said of Leonard.

Many Houston doctors said they have continued to call on their leadership to change their stance to proactively support patients with PPROM, pointing to data analyses from Dallas hospitals and ProPublica and referring to the Texas Supreme Court ruling. It hasn’t worked.

Houston hospitals haven’t taken action even in light of alarming research in their own city. Earlier this year, UTHealth Houston medical staff, including department chair Blackwell, revealed early findings from a study very similar to the one out of Dallas.

It showed what happened after patients at three partner hospitals stopped being offered terminations for PPROM under the ban: The rate of sepsis tripled.

Still, nothing changed.

To examine second-trimester pregnancy loss outcomes in Houston and Dallas, we used a methodology we developed to determine sepsis rates in inpatient hospitalizations where a pregnancy ended between 13 weeks’ gestation and the end of the 21st week. To assess regional differences, we grouped hospitals by perinatal care region and focused on the two regions with the highest population: Houston and Dallas-Fort Worth.

We grouped hospitalizations in the nine quarters after the implementation of the state’s six-week abortion ban (October 2021 through December 2023) and compared them with hospitalizations in the nine quarters immediately before. Each region had about 2,700 second-trimester pregnancy loss hospitalizations over the course of the time span we examined.

Sophie Chou contributed data reporting, and Mariam Elba contributed research.

DOGE Aide Who Helped Gut CFPB Was Warned About Potential Conflicts of Interest

by Jake Pearson

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

Last month, a Department of Government Efficiency aide at the nation’s consumer watchdog agency was told by ethics attorneys that he held stock in companies that employees are forbidden from owning — and was advised not to participate in any actions that could benefit him personally, according to a person familiar with the warning.

But days later, court records show, Gavin Kliger, a 25-year-old software engineer who has been detailed to the Consumer Financial Protection Bureau since early March, went ahead and participated in mass layoffs at the agency anyway, including the firings of the ethics lawyers who had warned him.

Experts said that Kliger’s actions, which ProPublica first reported on last week, constitute a conflict of interest that could violate federal criminal ethics laws. Such measures are designed to ensure that federal employees serve the public interest and don’t use their government power to enrich themselves. At the CFPB, which regulates companies that provide financial services, there are strict prohibitions on the investments that employees can maintain.

As ProPublica previously reported, Kliger owns as much as $365,000 worth of shares in Apple Inc., Tesla Inc. and two cryptocurrencies, according to his public financial report. Investments in those businesses are off limits to employees since the bureau can regulate them. A further review now shows that he’s invested in even more companies that are on the agency’s “Prohibited Holdings” list. Kliger also disclosed owning as much as $350,000 worth of stock in Google parent Alphabet Inc., Warren Buffett’s Berkshire Hathaway and the Chinese e-commerce company Alibaba.

That means, at a maximum, Kliger could own as much as $715,000 of investments in seven barred companies, the records show.

Experts said a defanged and downsized consumer watchdog is unlikely to aggressively regulate those and other companies, freeing them of compliance costs and the risk associated with examinations and enforcement actions. That in turn could boost their stock prices and benefit investors like Kliger.

Don Fox, a former general counsel of the independent federal agency that advises executive branch workers on their ethical obligations, said that “this looks like a pretty clear-cut violation” of the federal criminal conflict-of-interest statute.

Richard Briffault, a government ethics expert at Columbia Law School, said the fact that Kliger was warned not to take any actions that could benefit him personally showed that “he’s on notice that this is a problem, as opposed to doing this by accident, or unintentionally.”

But Briffault said there would likely be no recourse for Kliger’s actions given that the Department of Justice under President Donald Trump has “greatly deprioritized public integrity, ethics and public corruption as issues for them.” The New York Times reported last week that the section handling such cases is down to just a handful of lawyers.

From the outset, the Trump administration has been dogged by ethics controversies, from the president’s own foray into the cryptocurrency industry to Elon Musk’s dual roles as both the head of DOGE and a major federal contractor. Kliger’s case is “a nice illustration of how even on this micro level, they are violating the law, acting in ways that positively should cause people to not trust what they’re doing because there is no question that these corporations will benefit,” said Kathleen Clark, an expert on government ethics at Washington University in St. Louis.

Kliger hasn’t returned a phone call or email seeking comment. The CFPB didn’t respond to a request for comment.

The White House didn’t answer questions about the warning, whether Kliger had sought ethics waivers or if he was in the process of divesting. Instead, a spokesperson provided ProPublica the same statement it previously had, writing that Kliger “did not even manage” the layoffs, “making this entire narrative an outright lie.” A spokesperson said that Kliger had until May 8 to divest.

The April 10 ethics warning came amid a heated legal battle over the future of the CFPB.

The following day, an appeals court in Washington, D.C., allowed the agency’s acting director, Russell Vought, to implement mass firings after a lower court judge had stayed them. The court instructed Vought to conduct a “particularized assessment” of the bureau and to lay off only those employees who were deemed to be “unnecessary” to perform the agency’s statutorily required duties. In court filings, the government has said that review was done by the bureau’s chief legal officer, Mark Paoletta, and two other attorneys. In court papers, Paoletta has said the cuts are designed to achieve a “streamlined and right-sized Bureau.”

On April 13, Kliger was among a small team of DOGE and agency officials who received an email from Vought about the coming layoffs with the subject line “CFPB RIF Work” — government parlance for reduction in force, according to emails produced in court records. Vought’s email is redacted in the filing, but hours after he sent it, records show the bureau’s chief information officer wrote to Kliger and another DOGE aide regarding a “follow-up on Russ’s note below” and advised Kliger that he’d been granted access to agency computer systems that “should allow you to do what you need to do,” according to the email.

Layoff notices to more than 1,400 bureau employees went out on April 17.

In the preceding 36 hours, “Gavin was screaming at people he did not believe were working fast enough” to get the notices out and “calling them incompetent,” a federal employee on the layoff team using the pseudonym Alex Doe wrote in sworn declaration filed by lawyers for unionized employees trying to stop the administration from dismantling the bureau.

Among those laid off were the agency’s ethics officer and their “entire team” of lawyers, according to court records.

Those are the very employees who’d twice notified Kliger that he was required to identify any investments in companies on the bureau’s Prohibited Holdings list. The warning last month explicitly instructed him not to participate in any bureau activity that could benefit the businesses whose stocks he owned, said the person familiar with the notice, who spoke on condition of anonymity because of its sensitivity.

Last week, the appeals court reversed course and temporarily stopped the firings at the CFPB amid a flurry of legal challenges. Agency officials then notified the more than 1,400 fired employees who’d been told they were being let go that the pink slips were being rescinded.

The court battle over the CFPB’s future is ongoing, though, with oral arguments before appellate judges in Washington, D.C., scheduled for later this month.

How Trump’s Tariffs Could Affect Nike and Its Factory Workers

by Matthew Kish, The Oregonian/OregonLive

This article was produced in partnership with The Oregonian/OregonLive. Sign up for Dispatches to get stories like this one as soon as they are published.

In May 2015, President Barack Obama gave a big speech about dropping trade barriers with other nations. He delivered it on a sunny day at Nike’s world headquarters in Oregon.

“Sometimes when we talk about trade, we think of Nike,” Obama said, before making his pitch for a trade deal with Asian countries that he described as the “highest-standard, most progressive trade deal in history.”

President Donald Trump canceled that deal, known as the Trans-Pacific Partnership, less than two years later.

Now, as Trump erects more trade barriers in his second administration, Nike once again is center stage in conversations about globalization, a familiar place for a company that has its roots importing Japanese track shoes and briefly made sneakers in the United States.

Last month, Trump announced sweeping tariffs that would slam imports from the countries where most Nike sneakers and apparel get made. A close look at Nike’s massive supply chain offers a case study in the possible ripple effects of the escalating global trade war and shows how vulnerable factory workers could get squeezed.

Some degree of taxation on imports has long been a feature of international garment trade, and Nike has decades of experience navigating these tariffs. The company has not spoken about how it will handle the current round under Trump, but it’s among 76 companies that signed a letter to the president last week warning about dire consequences for footwear companies unless there is tariff relief.

In response to questions about how tariffs might impact factory workers, Nike said in a statement it is “committed to ethical and responsible manufacturing.”

“We build long-term relationships with our contract manufacturing suppliers because we know having trust and mutual respect supports our ability to create product more responsibly, accelerate innovation and better serve consumers,” the statement said.

Nike doesn’t own or operate the overseas factories that make its products. Instead, it works with 532 contract manufacturers that employ nearly 1.2 million workers, according to an online Nike map.

No country is more important to Nike’s manufacturing than Vietnam, where the brand works with 131 factories that employ nearly 460,000 workers. Half of Nike’s sneakers were made in Vietnam last year, according to the company’s annual report.

Nike’s second-largest production base is Indonesia, where its 45 contract factories employ more than 280,000 workers.

The company has been moving production out of China over the last decade. It works with 120 Chinese contract factories that employ more than 100,000 workers — down from more than 350,000 workers in 2012. Some of the footwear and apparel that Nike makes in China is sold to Chinese consumers and therefore not subject to tariffs.

Yes. On April 2, Trump announced “reciprocal” tariffs that included 46% on Vietnam, 32% on Indonesia and 34% on China. The next trading day, Nike’s shares fell 14%, wiping out $14 billion in shareholder value.

A week later, the president paused most of the tariffs for 90 days, but a 145% tariff on imports from China and a 10% surcharge on most imports from other countries remain in place.

Tom Nikic, a veteran industry analyst at Needham & Co., calculated that the tariffs, if fully implemented, would nearly wipe out Nike’s profits if the company made no changes to its current pricing or production.

“By my math, their earnings would decline by approximately 95%,” he said in an email.

“Almost certainly,” said Jason Judd, executive director of the Global Labor Institute at Cornell University. “The default for a brand or retailer faced with a tariff or some other shock is to press suppliers for discounts.”

“The COVID shock is a good example,” Judd added. “We know from talking to suppliers that the COVID shock meant canceled orders and renegotiations over price.”

The Worker Rights Consortium, a labor monitoring group, estimated brands canceled $40 billion in orders during the pandemic.

When Trump announced tariffs during his first administration, Nike’s top executives said they’d find savings in their supply chain.

“We have a lot of levers we can work with, from sourcing to other levers,” Andy Campion, then Nike’s chief financial officer, said in 2019.

Factory workers will likely feel the impact directly.

Dara O’Rourke, an associate professor at the University of California, Berkeley, who’s studied wages in Nike factories, said the tariffs could become a “huge hammer.”

“It is likely that you will see this kind of pressure from managers to say to workers, ‘For a period of time, we’re going to have to work harder and longer,’” he said. “Hold the line or you’re going to lose your job.”

That could mean workers are asked to make more sneakers and T-shirts every shift and work longer hours, according to Thulsi Narayanasamy, director of international advocacy for the Worker Rights Consortium.

It is likely that you will see this kind of pressure from managers to say to workers, ‘For a period of time, we’re going to have to work harder and longer.’

“When suppliers are squeezed and workers have unreasonable production targets, they don’t drink water, don’t take food breaks,” she said in an email. She added that in these circumstances, the organization consistently hears about “women having urinary tract infections, struggling with repetitive strain injuries, kidney stones, and having back problems due to rapid, repetitive movements for more than 12 hours a day.”

Narayanasamy said brands like Nike have a choice: “Push costs that they could reasonably absorb onto their suppliers, replete with the knowledge that doing so will immediately harm millions of factory workers, or not.”

In its statement, Nike said it sets clear labor expectations for supplier factories in its Code of Conduct and Code Leadership Standards.

Foreign garment workers could also face furloughs or work without pay, said Cornell’s Judd. That happened across the industry during the pandemic.

In 2021, the Worker Rights Consortium identified 31 garment factories — three of which did work for Nike — that the consortium said didn’t pay $39.8 million in severance benefits owed to 37,637 workers who lost jobs during the pandemic.

Nike previously has disputed that it owed wages to workers at the three factories named in the labor group’s report. In its statement, Nike also said factories are responsible for severance benefits.

“Manufacturing suppliers hold the financial obligation to pay worker severance, social security and other separation benefits to impacted employees in accordance with local law and Nike’s Code of Conduct,” the company said. “And in the event of any closure or divest, Nike works closely with the supplier to conduct a responsible exit.”

“To think this will bring jobs back to the U.S. is poorly thought out, would be the nicest thing I could say,” said Berkeley’s O’Rourke.

Footwear and apparel manufacturing remains labor-intensive. Sneakers require gluing and stitching. T-shirts require sewing. Efforts to automate shoe production have mostly flopped.

That’s part of the reason Nike makes most of its products in countries with low wages. ProPublica reported this month on a former Nike factory in Cambodia where most employees made the minimum wage — about $1 per hour.

Nike also uses huge factories that are filled with equipment that’s difficult to transfer to a new location. They’re often located near materials companies that make the rubbers, nylons and polyesters needed to make sneakers.

“The full production system is not easily movable,” O’Rourke said.

Instead of moving the work back to the U.S., industry watchers expect apparel companies will continue to manufacture products in countries with low wages, but manufacturing will shift to those subject to less onerous tariffs.

That could further harm workers in Vietnam, Indonesia, China and other countries with relatively high proposed tariff rates and a lot of Nike manufacturing jobs. In Indonesia, for example, one labor union expects as many as 50,000 workers could lose their jobs if the full Trump tariffs go into effect.

As the number of people looking for work increases, wages in those countries will decrease.

“The line at the gate to find work gets longer,” Judd said. “And that means employers of any kind can start paying new workers less because unemployment has jumped.”

Estimates vary and depend on how much of the cost Nike passes to consumers.

If the 46% tariff on Vietnam goes into effect, the price of a $155 sneaker made in Vietnam would increase to $220, according to the Footwear Distributors and Retailers of America, a trade group that counts Nike as a member.

The example, which isn’t specific to Nike, assumes the importing company passes nearly all of the tariff cost to customers. No athletic footwear brand has given specifics, although Adidas CEO Bjørn Gulden last week said “higher tariffs will eventually cause price increases.”

But Nike’s been in a slump and has been discounting many of its sneakers to boost sales.

It’s possible that Nike will absorb more of the tariff cost to avoid raising prices too steeply.

“It will likely be hard for Nike to raise prices,” the investment bank UBS recently wrote in a research note.

The DEA Once Touted Body Cameras for Their “Enhanced Transparency.” Now the Agency Is Abandoning Them.

by Mario Ariza

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

The Drug Enforcement Administration has quietly ended its body camera program barely four years after it began, according to an internal email obtained by ProPublica.

On April 2, DEA headquarters emailed employees announcing that the program had been terminated effective the day before. The DEA has not publicly announced the policy change, but by early April, links to pages about body camera policies on the DEA’s website were broken.

The email said the agency made the change to be “consistent” with a Trump executive order rescinding the 2022 requirement that all federal law enforcement agents use body cameras.

But at least two other federal law enforcement agencies within the Justice Department — the U.S. Marshals Service and the Bureau of Alcohol, Tobacco, Firearms and Explosives — are still requiring body cameras, according to their spokespeople. The FBI referred questions about its body camera policy to the Justice Department, which declined to comment.

The DEA did not respond to questions about its decision to stop using the cameras, saying that the agency “does not comment on tools and techniques.” Reuters reported on the change as part of a story about budget cuts for law enforcement offices.

One former federal prosecutor expressed concern that the change would make life more difficult for DEA agents.

“The vast majority of times I viewed body camera footage is based on allegations from a defense attorney about what a cop did,” said David DeVillers, former U.S. attorney for the Southern District of Ohio. “And I would say 95% of the time it absolves the cop of wrongdoing.”

The Justice Department started requiring that its federal agents wear the devices in 2021 in the wake of the protests over George Floyd’s death the previous summer.

“We welcome the addition of body worn cameras and appreciate the enhanced transparency and assurance they provide to the public and to law enforcement officers working hard to keep our communities safe and healthy,” then-DEA Administrator Anne Milgram said in a Sept. 1, 2021, press release announcing the use of the cameras.

In May 2022, then-President Joe Biden issued an executive order expanding the use of body cameras to all federal law enforcement officers.

In January, the incoming Trump administration rescinded that order, along with almost 100 others it considered “harmful.”

In early February, U.S. Immigration and Customs Enforcement, which is part of the Department of Homeland Security, was one of the first agencies to get rid of its body cameras. Subsequent videos show plainclothes immigration agents making arrests with no visible body cameras.

The DOJ wrote in a 2022 Office of Inspector General management report that the cameras were a “means of enhancing police accountability and the public’s trust in law enforcement.” Studies have consistently shown that departments that use body cameras experience a drop in complaints against officers, according to the nonprofit Police Executive Research Forum, though it’s not clear if the drop is due to improvements in officer behavior or to a decrease in frivolous complaints.

“Eliminating these videos is really taking away a tool that we’ve seen be of benefit to law enforcement practices,” said Cameron McEllhiney, executive director of the National Association for Civilian Oversight of Law Enforcement. “It’s also a great teaching tool, besides keeping community members safe from the potential misconduct that could occur.”

The DOJ put a lot of money into the body camera initiative. In August of 2021, it awarded Axon, the company that dominates the body camera market, a $30.4 million contract for cameras and the software to handle the evidence they created. The contract, according to Axon, remains active. But only about one-sixth of it has been paid out, according to federal contracting data.

The most recent publicly available version of the DEA’s body camera policy dates to December 2022. It only required agents to wear the devices when they were conducting preplanned arrests or searches and seizures that required a warrant. It also only required DEA officers to wear their body cameras when they were working within the United States.

Agents had 72 hours after the end of an operation to upload their video evidence, unless there was a shooting, in which case they were instructed to upload the video evidence as soon as possible. The policy laid out in detail how and by whom evidence from the cameras should be handled in the event officers used force, and it authorized the DEA to use the video evidence when investigating its own officers.

The DEA had planned to implement the policy in phases so that eventually its officers nationwide would be wearing the devices when serving warrants or carrying out planned arrests. In its 2025 fiscal year budget request to Congress, the agency asked for $15.8 million and 69 full time employees, including five attorneys, “to enable the DEA’s phased implementation plan of nationwide use of Body Worn Cameras.”

Records obtained via Freedom of Information Act request by Citizens for Responsibility and Ethics in Washington show that the Biden-era DOJ had an ambitious plan to capture agencywide metrics and data about the efficiency and use of body cameras by its law enforcement officers.

Laura Iheanachor, senior counsel at CREW, said that before federal law enforcement started wearing body cameras, several local police agencies had declined to participate in federal task forces because doing so would have forced their officers to remove their cameras.

“It’s a protective measure for officers, for the public,” Iheanachor said. “And it allows state and federal law enforcement to work together in harmony.”

Arizona Has Recovered Just 5% of Taxpayer Dollars Lost in a $2.5 Billion Medicaid Fraud Scheme

by Jasmine Demers, Arizona Center for Investigative Reporting

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Two years after Arizona officials revealed a $2.5 billion Medicaid fraud scheme that targeted Native Americans seeking treatment for addictions, the state has recovered just a fraction of the taxpayer funds lost to fraud.

The Arizona attorney general’s office is leading the criminal investigation into the network of behavioral health providers and sober living homes that from 2019 to 2023 exploited the American Indian Health Program to obtain inflated Medicaid payments. Investigators found fraudulent operators didn’t provide the services they’d billed for and sometimes allowed patients to continue the substance use for which they had sought treatment.

The state has so far indicted more than 100 individuals and recouped $125 million — or about 5% of the funds the state estimates it paid to bad actors.

Attorney General Kris Mayes said in a May 1 press conference that she hopes to retrieve “at least hundreds of millions” from fraudsters. But she warned that “it’s hard, because what happens is these … criminals get the money, they buy lavish homes, they buy multiple expensive cars, they hide the money offshore, they spend the money in ways that is unrecoverable.”

“My team is working day in and day out to seize those assets,” Mayes said.

The Arizona Health Care Cost Containment System struggled to rein in the rampant fraud under two governors, leaving more than 11,000 people vulnerable to the chaos that followed. Prior reporting by the Arizona Center for Investigative Reporting and ProPublica found that at least 40 Indigenous residents of sober living homes and treatment facilities in the Phoenix area died as the state fumbled its response.

The damage also rippled out through the state’s behavioral health industry, which was nearly brought to a standstill when the agency suspended some 300 providers and enacted policies that halted or substantially delayed payments to those still operating. Those reforms included enhanced scrutiny when screening and reimbursing providers.

Gov. Katie Hobbs, a Democrat, recently signed legislation further increasing oversight of sober living homes by requiring the facilities to promptly report resident deaths. But advocates like Reva Stewart, a Diné activist who has helped Indigenous victims of the scheme through her group Stolen People Stolen Benefits, don’t think the state has done enough.

“I feel like I’m on a hamster wheel, and we’re still at the beginning,” Stewart said. “They have a lot of indictments and people being charged, but at the same time … they’re just getting a slap on the wrist.”

The U.S. Department of Justice has also indicted several individuals and is conducting parallel investigations into the fraudulent billing schemes under federal statutes.

Yet despite these state and federal efforts, it’s likely that most of the stolen taxpayer money won’t be recovered.

From 2019 to 2023, the Arizona Health Care Cost Containment System allowed about 13,000 unlicensed providers to enter its system, including some that exploited weak oversight by overbilling or charging for services that were never delivered.

The agency also didn’t act decisively when solutions to stem the fraud were proposed internally. It initially yielded to pressure from special interest groups connected to the behavioral health industry, which argued that reforms to the fee-for-service American Indian Health plan would threaten their financial interests.

Now, AHCCCS says its efforts to unravel the crisis could take many years, describing its investigation as a “highly complex and manual process.”

Officials must review improper payments, whether they were obtained by fraud or not, on a case-by-case basis. Though providers are required to repay AHCCCS as soon as they become aware of overpayments, they often cannot do so in one lump sum. Repayments may occur over months or years.

Because state Medicaid agencies receive much of their funding from the federal government, improper payments come with added financial consequences: States must repay the federal government for its share.

In Arizona, the federal government covered 70% to 76% of Medicaid costs between 2019 and 2023. The rate was even higher for people who received services through the American Indian Health Program.

AHCCCS has repaid $49.1 million to the federal government since January 2023, according to spokesperson Havona Horsefield, who has since left the agency. That amount will likely grow as AHCCCS continues to review fraudulent cases.

The agency is not, however, required to reimburse the federal government for overpayments made to facilities that are now bankrupt or out of business. Of the 322 providers suspended on suspicion of fraud, 90 have closed, according to AHCCCS.

The agency could not provide an estimate of how much those providers were overpaid, but said it notifies the attorney general when a provider goes out of business and provides information to support criminal cases against them.

State Sen. Theresa Hatathlie, a Democrat from Coal Mine Mesa on the Navajo Nation, has been critical of the state’s response and continues to call for stricter regulation of sober living facilities. During a March floor vote, she expressed frustration over the reforms Hobbs later signed into law, contending they did not go far enough.

“It’s time to stop protecting bad actors or even those people who continue to allow bad actors to keep coming back,” she said.

As the state slowly works to untangle the fraud and recover taxpayer funds, national debates over Medicaid’s future are intensifying. Republican majorities in both Arizona’s Legislature and Congress are pushing to cut Medicaid to offset President Donald Trump’s proposed tax cuts. Among their justifications are fraud and abuse of the system.

Health policy experts, however, say that most Medicaid spending pays for legitimate care, and that fraud is typically committed by a small number of providers — not patients.

Instead of the current system where the federal government covers a larger share of Medicaid costs in lower-income states, conservatives are advocating to cap Medicaid funding tied to inflation, a model that would shift more of the cost to state budgets.

Arizona is one of nine states where such a change could trigger the end of Medicaid expansion, which currently insures 648,000 low-income residents, or about 30% of AHCCCS recipients.

Despite Medicaid’s uncertain future, Arizona officials are pressing forward with efforts to address the lasting damage the fraud scandal inflicted on tribal communities. In November, Mayes announced a $6 million grant initiative offering up to $500,000 per organization to fund victim compensation and housing support for those displaced or otherwise affected by fraudulent treatment centers. Recipients include tribal nations and Native health organizations.

But Stewart says the state’s work is far from over, and many of those harmed have yet to see real accountability or support.

“They call it a travesty … and they want to get justice,” she said. “But where’s the justice when it comes to the amount of deaths that we have, the amount of Native relatives that are still missing?”

Hannah Bassett and Christopher Lomahquahu, a Roy W. Howard fellow at the Arizona Center for Investigative Reporting, contributed reporting.

Millions of People Depend on the Great Lakes’ Water Supply. Trump Decimated the Lab Protecting It.

by Anna Clark

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

Just one year ago, JD Vance was a leading advocate of the Great Lakes and the efforts to restore the largest system of freshwater on the face of the planet.

As a U.S. senator from Ohio, Vance called the lakes “an invaluable asset” for his home state. He supported more funding for a program that delivers “the tools we need to fight invasive species, algal blooms, pollution, and other threats to the ecosystem” so that the Great Lakes would be protected “for generations to come.”

But times have changed.

This spring, Vance is vice president, and President Donald Trump’s administration is imposing deep cuts and new restrictions, upending the very restoration efforts that Vance once championed. With the peak summer season just around the corner, Great Lakes scientists are concerned that they have lost the ability to protect the public from toxic algal blooms, which can kill animals and sicken people.

Cutbacks have gutted the staff at the Great Lakes Environmental Research Laboratory, part of the National Oceanic and Atmospheric Administration. Severe spending limits have made it difficult to purchase ordinary equipment for processing samples, such as filters and containers. Remaining staff plans to launch large data-collecting buoys into the water this week, but it’s late for a field season that typically runs from April to October.

In addition to a delayed launch, problems with personnel, supplies, vessel support and real-time data sharing have created doubts about the team’s ability to operate the buoys, said Gregory Dick, director of the NOAA cooperative institute at the University of Michigan that partners with the lab. Both the lab and institute operate out of a building in Ann Arbor, Michigan, that was custom built as NOAA’s hub in the Great Lakes region, and both provide staff to the algal blooms team.

“This has massive impacts on coastal communities,” Dick said.

Multiple people who have worked with the lab also told ProPublica that there are serious gaps in this year’s monitoring of algal blooms, which are often caused by excess nutrient runoff from farms. Data generated by the lab’s boats and buoys, and publicly shared, could be limited or interrupted, they said.

That data has helped to successfully avoid a repeat of a 2014 crisis in Toledo, Ohio, when nearly half a million people were warned to not drink the water or even touch it.

If the streams of information are cut off, “stakeholders will be very unhappy,” said Bret Collier, a branch chief at the lab who oversaw the federal scientists that run the harmful algal bloom program for the Great Lakes. He was fired in the purge of federal probationary workers in February.

The lab has lost about 35% of its 52-member workforce since February, according to the president of the lab’s union, and it was not allowed to fill several open positions. The White House released preliminary budget recommendations last week that would make significant cuts to NOAA. The budget didn’t provide details, but indicated the termination of “a variety of climate-dominated research, data, and grant programs, which are not aligned with Administration policy” of ending “‘Green New Deal’ initiatives.”

An earlier document obtained by ProPublica and reported widely proposed a 74% funding cut to NOAA’s research office, home of the Great Lakes lab.

Vance’s office didn’t respond to questions from ProPublica about how federal cuts have affected Great Lakes research. The White House also didn’t respond to messages.

Municipal water leaders in Cleveland and Toledo have written public letters of support on behalf of the lab, advocating for the continuation of its work because of how important its tools and resources are for drinking water management.

In a statement to ProPublica, staffers from Toledo’s water system credited the Great Lakes lab and NOAA for alerting it to potential blooms near its intake days ahead of time. This has saved the system significant costs, they said, and helped it avoid feeding excess chemicals into the water.

“The likelihood of another 2014 ‘don’t drink the water’ advisory has been minimized to almost nothing by additional vigilance” from both the lab and local officials, they said.

Remaining staff have had to contend with not only a lack of capacity but also tight limits on spending and travel.

Several people who have worked in or with the lab said that the staff was hampered by strict credit card limits imposed on government employees as part of the effort to reduce spending by the Department of Government Efficiency, which has been spearheaded by presidential adviser Elon Musk.

“The basic scientific supplies that we use to provide the local communities with information on algal bloom toxicity — our purchasing of them is being restricted based on the limitations currently being put in by the administration,” Collier said.

NOAA and the Department of Commerce, which oversees the agency, didn’t respond to messages from ProPublica. Neither did a DOGE official. Eight U.S. senators, including the minority leader, sent a letter in March to a top NOAA leader inquiring about many of the changes, but they never received a response.

The department described its approach to some of its cuts when it eliminated nearly $4 million in funding for the NOAA cooperative institute at Princeton University and emphasized the importance of avoiding wasteful government spending. ProPublica has reported on how the loss of research grants at Princeton and the more significant defunding of the NOAA lab it works with would be a serious setback for weather and climate preparedness.

A number of the staffing losses at the Great Lakes lab came when employees accepted offers of early retirement or voluntary separation; others were fired probationary workers targeted by DOGE across the government. That includes Collier, who had 24 years of professional experience, largely as a research professor, before he was hired last year into a position that, according to the lab’s former director, had been difficult to fill.

A scientist specializing in the toxic algal blooms was also fired. She worked on the team for 14 years through the cooperative institute before accepting a federal position last year, which made her probationary, too.

A computer scientist who got real-time data onto the lab’s website — and the only person who knew how to push out the weekly sampling data on harmful algal blooms — was also fired. She was probationary because she too was hired for a federal position after working with the institute.

And because of a planned retirement, no one holds the permanent position of lab director, though there is an acting director. The lab isn’t allowed to fill any positions due to a federal hiring freeze.

At the same time, expected funds for the lab's cooperative institute are delayed, which means, Dick said, it may soon lay off staff, including people on the algal blooms team.

In March, Cleveland’s water commissioner wrote a letter calling for continued support for the Great Lakes lab and other NOAA-funded operations in the region, saying that access to real-time forecasts for Lake Erie are “critically important in making water treatment decisions” for more than 1.3 million citizens.

In 2006, there was a major outbreak of hypoxia, an issue worsened by algal blooms where oxygen-depleted water can become corrosive, discolored and full of excess manganese, which is a neurotoxin at high levels. Cleveland Water collaborated with the lab on developing a “groundbreaking” hypoxia forecast model, said Scott Moegling, who worked for both the Cleveland utility and Ohio’s drinking water regulatory agency.

“I knew which plants were going to get hit,” Moegling said. “I knew about when, and I knew what the treatment we would need would be, and we could staff accordingly.”

The American Meteorological Society, in partnership with the National Weather Association, spotlighted this warning system in its statement in support of NOAA research, saying that it helps “keep drinking water potable in the Great Lakes region.”

Collier, the former branch chief, said that quality data may be lacking this year, not just for drinking water suppliers, but also the U.S. Coast Guard, fisheries, shipping companies, recreational businesses and shoreline communities that rely on it to navigate risk. In response to a recent survey of stakeholders, the president of a trade organization serving Great Lakes cargo vessels said that access to NOAA’s real-time data “is critically important to the commercial shipping fleet when making navigation decisions.”

Because federal law requires NOAA to monitor harmful algal blooms, the cuts may run against legal obligations, several current and former workers told ProPublica. The blooms program was “federally mandated to be active every single day, without exception,” Collier said.

The 2024 bloom in Lake Erie was the earliest on record. At its peak, it covered 550 square miles. Warming temperatures worsen the size and frequency of algal blooms. While the field season was historically only about 90 days, Collier said, last year the team was deployed for 211 days.

As the shallowest of the Great Lakes, Lake Erie is typically first to show signs of problems. But it’s also an emblem of environmental stewardship, thanks to its striking recovery from unchecked industrial pollution. The lake was once popularly declared “dead.” A highly publicized fire inflamed a river that feeds into it. Even Dr. Seuss knocked it in the 1971 version of “The Lorax.” The book described fish leaving a polluted pond “in search of some water that isn’t so smeary. I hear things are just as bad up in Lake Erie.”

But the rise of agencies like the Environmental Protection Agency and NOAA, and labs like the one protecting the Great Lakes, along with legislation that protected water from pollution, led to noticeable changes. By 1986, two Ohio graduate students had succeeded in persuading Theodor Geisel, the author behind Dr. Seuss, to revise future editions of his classic book.

“I should no longer be saying bad things about a body of water that is now, due to great civic and scientific effort, the happy home of smiling fish,” Geisel wrote to them.

Early this year, headlines out of the Midwest suggested that “Vance could be a game-changing Great Lakes advocate” and that he might “save the Great Lakes from Trump.”

A 2023 report to Congress about the Great Lakes Restoration Initiative, a popular funding mechanism for projects that protect the lakes, including the research lab’s, described the lab’s work on harmful algal blooms as one of its “success stories.” Last year, with Vance as a co-sponsor, an act to extend support for the funding program passed the Senate, but stalled in the House. Another bipartisan effort to reauthorize it launched in January.

Project 2025, the plan produced by the Heritage Foundation for Trump’s second term, recommended that the president consider whether NOAA “should be dismantled and many of its functions eliminated, sent to other agencies, privatized, or placed under the control of states and territories.”

NOAA is “a colossal operation that has become one of the main drivers of the climate change alarm industry,” the plan said, and this industry’s mission “seems designed around the fatal conceit of planning for the unplannable.”

“That is not to say NOAA is useless,” it added, “but its current organization corrupts its useful functions. It should be broken up and downsized.”

When asked at his confirmation hearing in January if he agreed with Project 2025’s recommendation of dismantling NOAA, Howard Lutnick, head of the commerce department, said no.

One month later, the Great Lakes lab’s probationary staff got termination notices. That includes Nicole Rice, who spent a decade with NOAA. A promotion made her communications job vulnerable to the widespread firings of federal probationary workers.

In recent testimony to a Michigan Senate committee, Rice expressed deep concern about the future of the Great Lakes.

“It has taken over a century of bipartisan cooperation, investment and science to bring the Great Lakes back from the brink of ecological collapse,” Rice said. “But these reckless cuts could undo the progress in just a few short years, endangering the largest surface freshwater system in the world.”

Vernal Coleman contributed reporting.

Have You Been Affected by Changes at the Department of Veterans Affairs? Tell Us About It.

by Eric Umansky, Vernal Coleman and Maryam Jameel

As the Trump administration pledges to eliminate 80,000 employees at the U.S. Department of Veterans Affairs, ProPublica reporters are investigating how changes at the VA are affecting veterans themselves. Trump has promised to put veterans first, but our reporting shows veterans’ care is suffering amid wide-ranging cuts. If you’ve experienced setbacks in your care, we want to hear from you.

We would also appreciate firsthand insights about changes happening within the VA from agency employees. Please do not fill out this form if you work for the VA or another federal agency. Instead, contact our reporters via the encrypted messaging app Signal:

• Eric Umansky: Ericumansky.04
• Vernal Coleman: vcoleman91.99

We appreciate you sharing your story, and we take your privacy seriously. We are gathering these stories for the purposes of our reporting and will contact you if we wish to publish any part of your story. You can also reach our VA reporting team at VA@propublica.org.

You can share your experience using our form.

Internal VA Emails Reveal How Trump Cuts Jeopardize Veterans’ Care, Including To “Life-Saving Cancer Trials”

by Eric Umansky and Vernal Coleman

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

If you’ve experienced setbacks in your care or benefits amid the changes at the Department of Veterans Affairs, ProPublica wants to hear from you. Share your story.

Earlier this year, doctors at Veterans Affairs hospitals in Pennsylvania sounded an alarm. Sweeping cuts imposed by the Trump administration, they told higher-ups in an email, were causing “severe and immediate impacts,” including to “life-saving cancer trials.”

The email said more than 1,000 veterans would lose access to treatment for diseases ranging from metastatic head and neck cancers, to kidney disease, to traumatic brain injuries.

“Enrollment in clinical trials is stopping,” the email warned, “meaning veterans lose access to therapies.”

The administration reversed some of its decisions, allowing some trials to continue for now. Still, other research, including the trials for treating head and neck cancer, has been stalled.

President Donald Trump has long promised to prioritize veterans.

“We love our veterans,” he said in February. “We are going to take good care of them.”

After the Department of Veterans Affairs began shedding employees and contracts, Trump’s pick to run the agency, Secretary Doug Collins, pledged, “Veterans are going to notice a change for the better.”

But dozens of internal emails obtained by ProPublica reveal a far different reality. Doctors and others at VA hospitals and clinics across the country have been sending often desperate messages to headquarters detailing how cuts will harm veterans’ care. The VA provides health care to roughly 9 million veterans.

In March, VA officials across the country warned that a critical resource — databases for tracking cancer — would no longer be kept up to date. As officials in the Pacific Northwest explained, the Department of Government Efficiency was moving to kill its contract with the outside company that maintained and ran its cancer registry, where information on the treatment of patients is collected and analyzed. DOGE had marked it for “immediate termination.”

The VA in Detroit raised a similar alarm in an email, warning of the “inability to track oncology treatment and recurrences.” The emails obtained by ProPublica detail a wide variety of disruptions. In Colorado, for instance, layoffs to social workers were causing homeless veterans waiting for temporary housing to go without help.

The warnings, sent as part of a longstanding system at the VA to alert higher-ups of problems, paint a portrait of chaotic retrenchment at an agency that just three years ago was mandated by Congress through the PACT Act to expand care and benefits for veterans facing cancer and other issues after exposure to Agent Orange, burn pits or other toxins.

Doctors and other health care providers across the VA have been left scrambling and short-staffed amid an ever-shifting series of cuts, hiring freezes and other edicts from the White House.

The upheaval laid bare in the emails is particularly striking because the cuts so far would be dwarfed by the dramatic downsizing in staff and shift in priorities the administration has said is coming.

The VA has cut just a few thousand staffers this year. But the administration has said it plans to eliminate at least 70,000 through layoffs and voluntary buyouts within the coming months. The agency, which is the largest integrated health care system in the U.S., currentlyhas nearly 500,000 employees, most of whom work in one of the VA’s 170 hospitals and nearly 1,200 clinics.

Despite an expanded role mandated by Congress through the PACT Act, administration officials have said their goal is to trim the agency to the size it was before the legislation passed.

“The Biden Administration understood what it meant to pay for the cost of war; it seems the Trump Administration does not,” said Rep. Mark Takano, a California Democrat and chief author of the PACT Act.

Documents obtained by ProPublica show DOGE officials working at the VA in March prepared an outline to “transform” the agency that focused on ways to consolidate operations and introduce artificial intelligence tools to handle benefits claims. One DOGE document proposed closing 17 hospitals — and perhaps a dozen more.

VA press secretary Pete Kasperowicz told ProPublica that there would be no hospital closures. “Just because a VA employee wrote something down, doesn’t make it VA policy,” he said in a written statement. But he did say that use of AI will be a big part of what he called VA’s “reform” efforts.

Kasperowicz dismissed the idea that the emails obtained by ProPublica show chaos.

“The only thing these reports show is that VA has a robust and well-functioning system to flag potential issues and quickly fix them so we can provide the best possible care to Veterans,” he wrote.

DOGE did not respond to requests for comment.

If you’ve experienced setbacks in your care or benefits amid the changes at the Department of Veterans Affairs, ProPublica wants to hear from you.

Share Your Story

The White House released a budget proposal last week that calls for a 4% increase in the VA’s budget. That total includes more money for medical care, though a portion of that would be used to pay for veterans to seek care outside the VA medical system.

More answers to the VA’s larger plans may come today, when Collins is scheduled to testify before the Senate Veterans Committee, his first hearing on Capitol Hill since coming into office.

David Shulkin, who headed the VA in Trump’s first term, said the administration is too focused on cuts rather than communicating a strategy for improving care for vets.

“I think it’s very, very hard to be successful with the approach that they’re taking,” Shulkin told ProPublica.

One way local VA officials have tried to limit the damage has been by sending warnings — formally known as an issue brief — to higher-ups. And sometimes it works.

After officials in Los Angeles warned that “all chemotherapy” would stop unless Washington backed off killing a service contract, the VA reversed its decision.

And, amid growing scrutiny, the administration also made some researchers in Pennsylvania and elsewhere exempt from cuts. The laid-off social workers who helped homeless vets in Colorado were also brought back after about a month away from their jobs. Kasperowicz said that four social workers were affected but “their caseload was temporarily redistributed to other members of the homeless team.”

The warnings from officials across the country underscore how the comparatively modest cuts so far are already affecting the work of the VA’s medical system, with the study and treatment of cancer cited in multiple warnings to agency leadership.

“We have absolutely felt the impact of the chaos all around us. We’re already losing people,“ said one senior researcher, who spoke to ProPublica anonymously for fear of retaliation.

Referring to studies, he added: “We’re going to be losing things that can’t restart.”

And while Kasperowicz told ProPublica that the issues in Pennsylvania have been resolved, locals there said that’s not the case and that the impact is ongoing.

In Pittsburgh, two trials to treat veterans with advanced head and neck cancer, which officials in March had warned were at risk because of hiring freezes, have still not started, according to Alanna Caffas, who heads a Pittsburgh nonprofit, the Veterans Health Foundation, that partners with the VA on research.

“It’s insane,” Caffas said. “These veterans should be able to get access to research treatments, but they can’t.”

A third trial there, to help veterans with opioid addiction, wasn’t halted. Instead, it was hobbled by layoffs of key team members, according to Caffas and another person involved in the research.

Regarding the issues with cancer registries, Kasperowicz said there had been “no effect on patients.” He added that the VA is moving to create a national contract to administer those registries.

Rosie Torres, founder of Burn Pits 360, the veterans advocacy group that also pushed hard for the legislation, called the emails showing impeded cancer treatment a “crisis in the making” and “gutwrenching.”

That the decisions are being made without input from the communities of vets they affect is worse, she added.

“If they are killing contracts that may affect the delivery of care, then we have a right to know,” she said.

Last week, as the second Trump administration marked its first 100 days in office, Collins celebrated what he described as its achievements.

In a recorded address, he said that under his stewardship the VA processed record numbers of benefit claims, ended “divisive” spending on diversity initiatives and redirected millions of agency dollars from “non-mission-critical” programs back toward services to benefit veterans.

“We will not stop working to put veterans first,” he wrote in an accompanying op-ed.

Others say Collins has done no such thing. Instead of focusing on veterans, said one VA oncologist, “we’re spending an enormous amount of time preparing for a staffing catastrophe.”

“Veterans’ lives are on the line,” the doctor said. “Let us go back to work and take care of them.”

Alex Mierjeski contributed research, and Joel Jacobs contributed reporting.

ProPublica Wins Pulitzer Prize for Public Service

by ProPublica

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

ProPublica on Monday won the prestigious Pulitzer Prize for public service for the series “Life of the Mother,” which the judges described as “urgent reporting about pregnant women who died after doctors delayed urgently needed care for fear of violating vague ‘life of the mother’ exceptions in states with strict abortion laws.” The prize is given to the staff of a news organization that performed “meritorious public service.” This is the second consecutive year the organization was awarded the distinction. It is the eighth Pulitzer for ProPublica.

“America’s Mental Barrier,” an examination of how insurance companies interfere with access to necessary mental health care across the United States, was named a finalist in the explanatory reporting category. In addition to the Pulitzer winners, the designation is ProPublica’s 12th Pulitzer finalist in 17 years.

The “Life of the Mother” series, which ProPublica continues to pursue, is a landmark investigation into the unexamined, irreversible consequences of state abortion bans. Kavitha Surana, Lizzie Presser and Cassandra Jaramillo mined hospital and death records in states whose strict abortion bans threatened physicians with prosecution. From the tragic death of Amber Thurman in Georgia to gutting accounts of women denied lifesaving miscarriage care in Texas, the investigations illuminated the profound human cost of these policies. They exposed the chilling impact on medical professionals forced to choose between their oath and the law, the anguish faced by families and the broader erosion of women’s health and autonomy.

Stacy Kranitz’s immersive photo essay, “The Year After a Denied Abortion,” documented the unraveling of a Tennessee family after a denied abortion for a life-threatening pregnancy, especially in a state with meager support for poor mothers. The piece, reported with Surana, helped audiences see, feel and understand how decisions made by those in power impact families.

These stories ignited outrage around the country, became talking points during the presidential election and inspired action. Lawmakers have filed more than a dozen bills to expand abortion access in at least seven states.

Last week, the Texas Senate unanimously passed Senate Bill 31, called The Life of the Mother Act, which aims to prevent maternal deaths under the state’s strict abortion ban by making clear that a life-threatening medical emergency doesn’t need to be imminent for doctors to follow their medical standards and intervene to terminate pregnancies.

The bill represents a significant reversal for Republican leaders who had for years insisted no changes were needed. It was written by state Sen. Bryan Hughes, the author of the original ban who initially said that exceptions for medical emergencies were “plenty clear.” The bill stops short of removing what doctors say are the ban’s biggest impediments to care, including its threat of major criminal penalties for medical professionals, and it doesn’t expand abortion access to cases of fetal anomalies, rape or incest. Sen. Carol Alvarado, the Democratic lawmaker who co-authored the bill, said that its limits were a “real hard pill to swallow” but that it could still make a difference. “I believe this bill will save lives,” she said.

A U.S. Senate Finance Committee investigation, launched in response to our reporting, released a 29-page report in December 2024 that found that hospitals are providing minimal guidance to doctors navigating abortion restrictions, often leaving them without clear protocols in life-or-death situations.

A host of ProPublicans helped elevate this project, including Alexandra Zayas, Ziva Branstetter, Andrea Wise, Tracy Weber, Boyzell Hosey, Mariam Elba, Robin Fields, Anna Donlan, Allen Tan, Kirsten Berg, Jeff Ernsthausen, Doris Burke, Lexi Churchill, Andrea Suozzo, Audrey Dutton, Anna Maria Barry-Jester, Amy Yurkanin, Emily Goldstein, Diego Sorbara, Samantha Cooney, Grace Palmieri, Colleen Barry, Kassie Navarro, Sarah Childress, Lynn Dombek, Sophie Chou and Sophia Kovach.

“We knew early that abortion bans were likely to have deadly consequences for women, and not just those seeking abortions,” said Weber, ProPublica’s managing editor for the national staff. “Our reporters and their editor, Alex Zayas, were endlessly creative, dogged, humane and careful in surfacing the deaths of these women when the states themselves were not looking. We are so honored that the Pulitzer Board has recognized their efforts.”

In the series honored as a Pulitzer finalist in explanatory reporting, reporters Annie Waldman, Duaa Eldeib, Max Blau and Maya Miller revealed how health insurers are engaging in aggressive tactics that push therapists out of networks; deploying an algorithmic system to limit coverage; creating “ghost networks”; cutting access to treatment for children with autism; relying on doctors whose judgments have been criticized by courts; and using patients’ progress to justify denials.

The reporters crowdsourced thousands of tips; obtained explosive internal company documents; reviewed thousands of pages of lawsuit filings to identify the doctors doling out denials; and included shattering and intimate stories of patients for whom care was prematurely cut off, leading to devastating consequences.

In September 2024, the Biden administration announced that it had finalized new regulations to strengthen protections for mental health care coverage and hold insurance companies accountable for unlawfully denying it. In December 2024, following several of ProPublica’s stories, U.S. Sens. Chris Murphy, Tina Smith and Ben Ray Luján reintroduced the Parity Enforcement Act to better hold insurance companies accountable by providing the U.S. Department of Labor the authority to impose civil monetary penalties for violations of the mental health parity law. The following month, the Labor Department found widespread noncompliance and violations of federal law in how health plans and insurers cover mental health care, findings that mirrored ProPublica’s investigation. The department also began investigating the oversight and management of doctors hired by insurers who repeatedly denied mental health coverage for patients.

Steve Mills, Mara Shalhoup, Charles Ornstein, Ariana Tobin, Zisiga Mukulu, Tony Luong, Alex Bandoni, Agnel Philip, Vanessa Saba, Chris Morran, Cengiz Yar, Isabelle Yan, Lena Groeger, Zayas, Weber, Berg, Ernsthausen, Tan, Goldstein, Palmieri, Sorbara, Wise, Barry, Cooney and Paige Pfleger of WPLN/Nashville Public Radio contributed to the series. Some of the pieces were published in collaboration with NPR.

“People who need mental health care often cannot get it. It doesn’t matter if you are rich or poor, insured or uninsured, the lack of access is widely felt,” said Ornstein, ProPublica’s managing editor for local. “So many people on our staff wanted to be a part of this project. Through immersive storytelling and investigative digging, they adeptly documented the causes of the crisis, those responsible and the regulators who have stood by and done little to fix it.”

ProPublica received Pulitzers for public service in 2024, national reporting in 2020, feature writing in 2019, public service in 2017, explanatory reporting in 2016, national reporting in 2011 and investigative reporting in 2010. Local Reporting Network partner Anchorage Daily News won the Pulitzer for public service in 2020.

The Latest Trump and DOGE Casualty: Energy Data

by Peter Elkind

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

The Trump administration has eliminated or stifled critical data at dozens of federal agencies. Now the administration’s actions are hitting a new realm: the energy industry.

For decades, the Energy Information Administration, an independent agency housed inside the Department of Energy, has provided crucial reports on everything from oil and gas to the future of alternative energy. Relied on by oil company CEOs and government policymakers alike, the EIA’s data has been called the “gold standard” by Daniel Yergin, vice chairman of S&P Global and an éminence grise in the world of oil. No less a source than Project 2025 described the EIA as historically providing “independent and impartial analysis.”

Last month, the EIA released its signature report: the Annual Energy Outlook for the United States. Largely based on data gathered during the administration of Joe Biden, the report projected rapid growth in alternative energy and declines in American reliance on coal, oil and natural gas. Agency officials feared that the findings would rankle the “Drill, Baby, Drill” proponents in the Trump administration, according to multiple EIA sources. So instead of promoting the report’s publication with an hourlong webcast and PowerPoint presentation spotlighting key findings, as it has in recent years, the agency released it without any of that. And at a late stage, the EIA deleted the analytical narrative — then 53 pages in draft form — that is typically the centerpiece of the report. Instead the agency posted links to hundreds of data-filled tables and charts and a seven-page explanation of its methods.

That didn’t stop the Energy Department from pillorying the findings. In a press release on the same day the report was published, a department spokesperson attacked the EIA’s report for featuring “the disastrous path for American energy production under the Biden administration” and failing to reflect Trump-initiated policy changes aimed at “ensuring America’s future is marked by energy growth and abundance — not scarcity.”

Now the EIA has privately informed staff that it is scrapping publication of its closely followed International Energy Outlook for 2025. The previous edition of the international outlook, released every two years, contained 70 pages detailing global trends. The paradox: That will leave the field open to the equivalent publication from the Paris-based International Energy Agency, which conservatives accuse of bending its forecasts to promote climate-change goals. (Unlike the U.S. agency, whose projections take into account only formally adopted policies, the international one includes some policies that haven’t been adopted and are considered “aspirational.”)

In an April 16 internal email announcing the cancellation of the international report, which has not previously been reported, Angelina LaRose, assistant administrator in the EIA’s office of energy analysis, blamed the decision on the departure of so many staff experts. More than 100 of the EIA’s 350 staff have left as a result of firings or resignations, in the wake of “Fork in the Road” buyout offers from Elon Musk’s Department of Government Efficiency. “At this point, you can assume we will not be releasing the IEO this year,” she wrote. “This was a difficult decision based on the loss of key resources.”

In the same memo, LaRose ordered an “‘all hands-on-deck’ type of effort,” before even more EIA analysts departed, to “try to preserve as much institutional knowledge as possible” about the models and procedures used to formulate the international report.

Failing to publish that report is viewed as consequential. Amy Myers Jaffe, a prominent energy consultant and research professor at New York University, called the EIA’s reports and analysis essential. “These are global markets,” she said. “The only way to figure out which policies work or don’t is to have accurate EIA data. Everybody benefits from that analysis, whether you’re in the private sector or the public sector.”

The EIA was established nearly a half-century ago, amid the energy crises of the 1970s, to tackle what had become an urgent need: to collect and report objective data on energy production and consumption. Its regular stream of postings now track oil and gasoline prices, electricity rates, natural gas and crude oil exports, automobile fuel consumption, wind and solar energy generation, coal production and nuclear plant outputs.

Its U.S. Annual Energy Outlook projects long-term trends, based on multiple scenarios, and customarily provides detailed analysis discussing key takeaways from reams of data. For 2025, its baseline “reference case” projected how markets would operate through 2050 under laws and regulations in place as of December 2024, prior to the Trump administration’s efforts to promote fossil fuels. In addition to eight “side cases” based on variations in economic growth, energy pricing and supply, the EIA also modeled two “alternative policy” scenarios. These projected impacts from the elimination of Biden-era laws and regulations reducing carbon dioxide emissions from existing power plants and boosting adoption of electric vehicles.

According to the contents pages from the draft, which ProPublica obtained, the deleted narrative highlighted projections in the reference case showing that increased electricity demand would be met through 2050 “mainly by generation from renewable sources”; that “coal generation falls to close to zero”; and that there would be “declines” in domestic consumption of oil and natural gas.

The decision to jettison the report’s traditional explanatory narrative was announced to EIA staff in a March 10 internal email, after the document was largely complete following months of work. “After conferring with the [EIA] front office, we are shifting gears on the material that will be released with this year’s AEO,” assistant administrator LaRose wrote. “We will not be releasing the narrative as currently written and will not be hosting a release event.”

The omission of the analytical section left readers to sort through the data for themselves. Joseph DeCarolis, who served as EIA administrator under Biden and is now an engineering professor at North Carolina State, called the annual outlook’s narrative “extremely important. It’s important to be able to look at the results, interpret them, and explain to your audience what you think the insights are.”

EIA employees said they believe the changes were made out of fear that spotlighting unwelcome findings and projections would make the agency a Trump target. “There was a concern that any narrative we put out would be seen as ideological,” said Emily Schaal, an EIA statistician who worked on the U.S. report. Another EIA employee commented: “Fewer people were going to get mad if we just threw the numbers out.”

Asked about the decision, EIA spokesperson Chris Higginbotham said the agency’s leadership jettisoned the analysis because it “decided it was most important to prioritize getting our AEO results to the public as soon as we could rather than waiting longer to complete a written market analysis.” He added, “We do not make decisions about our data or our analyses with the goal of influencing outcomes or avoiding pushback.”

With regard to EIA’s international report, Higginbotham said, “We remain committed to maintaining our long-term energy modeling capabilities.” He asserted that the staff reductions will not compromise the agency’s work. “We are committed to meeting EIA’s quality standards,” he said, “and we will not publish any data or analysis that doesn’t meet those standards.”

Meanwhile, the EIA has canceled or delayed other data reports and projects. Those moves, combined with the turmoil and departures, have devastated morale, according to current and former EIA employees.

Schaal was among those grappling with the tumult. After completing a doctorate in math, Schaal, 28, joined the EIA as a statistician in June 2024, working remotely from Michigan, and expected to remain at the agency for years. Instead, she was one of about 30 probationary employees who were abruptly terminated on Feb. 13, just weeks into the new administration. A lawsuit challenging firings at six agencies, filed by a union that represents government workers, prompted a federal judge to order their reinstatement, and Schaal returned to the EIA in mid-March.

“Everyone at EIA had been through a month of torture,” she told ProPublica. Employees were dealing with chaos, uncertainty and fears of termination. In early April, Schaal accepted a new deferred resignation offer, with plans to depart on April 19.

On April 11, hours before a midnight deadline for the resignation program, EIA’s acting administrator presided over an all-hands meeting with a top deputy, where he read a prepared statement urging employees to take the offer. Then the two managers gave assurance they had done “a great job” defending the agency in a meeting with DOGE officials, who were certain to treat them all “appropriately,” according to four people who attended the all-hands meeting.

Schaal was furious. After the session ended, she pounded out an angry email to the two bosses and then shared it with everyone who still remained at EIA. “DOGE doesn’t care what we do and will treat us the same as all other agencies: with contempt,” she wrote. “Shame on you for falling in line and giving up without any perceptible effort to fight. Shame on you for keeping those you purport to lead in the dark. Shame on you for betraying the mission set to us by Congress and selling out the American people.”

On the following Monday, Schaal was summoned to a virtual meeting with her supervisor, where she was presented with a formal letter of reprimand for her “unprofessional and disrespectful email,” as well as a second letter notifying her that she was being placed on administrative leave, a week ahead of her planned departure. The episode made her something of a hero among colleagues who remained behind, who have taken to sharing their frustrations with one another on private Signal groups. (EIA’s spokesperson declined to comment on the episode. Neither DOGE nor the White House replied to requests for comment for this article.)

The EIA, whose director is a presidential appointee, typically chosen from among apolitical academic or industry figures, is poised to get new leadership. Trump’s nominee is Tampa energy consultant Tristan Abbey, a self-described “think-tanker” at conservative groups who has called U.S. dominance in natural gas exports a “generational opportunity.” Abbey, 39, served as an energy staffer on the National Security Council in the first Trump administration. His financial disclosure reports $103,083 in “senior fellow fees” since 2024 from the conservative Texas Public Policy Foundation and $435,833 in income from his consulting business, whose clients included Thiel Capital. (Abbey worked for Trump-friendly billionaire Peter Thiel’s investment firms before going into government.) Abbey’s consulting firm also has an eclectic side business focused on publishing books written by or about explorers and historical figures in philosophy and math.

Abbey enjoyed a friendly confirmation hearing on Wednesday before the Senate Energy and Natural Resources committee. He testified that he would leave his “policy role” behind and affirmed his commitment to the EIA providing “nonpartisan facts.”

Abbey praised the EIA as “the world’s premier energy data agency” but also said it is “in urgent need of revitalization.” He presented an ambitious must-do list seemingly at odds with the current administration’s wholesale cuts. The EIA, Abbey declared, “must clear the decks of unfinished projects,” “recruit and retain the best talent” and “develop the most powerful analytical capabilities.” Among his top priorities, Abbey testified: “the expansion of global energy data collection and analysis.”

Doris Burke contributed research.

This Lender Said Its Loans Would Help Tennesseans. It Has Sued More Than 110,000 of Them.

by Adam Friedman, Tennessee Lookout

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

We are continuing to report on flex loans. Have you been sued by Advance Financial, Harpeth Financial or another flex loan lender? To share your experience, call or text reporter Adam Friedman at 615-249-8509.

Rosita Hansen was working an evening shift at a tubing factory in 2023 when a sheriff’s deputy showed up and handed her a court summons. She was being sued for failing to pay off a loan of $2,050. What confused Hansen was she had already paid a couple thousand more than she borrowed. But now the company, Advance Financial, said she owed more. Between what she’d already paid the company and the lawsuit, Advance stood to receive over $12,500 from Hansen, records show.

Hansen, 57, had taken out the loan in 2021 after her mortgage company threatened to foreclose on her modest three-bedroom house outside Morristown, a small city in East Tennessee. Hansen made enough money to support herself, but after taking in her four grandchildren, she struggled to cover the costs of extra food and school supplies, and she stopped paying her mortgage. That’s when she turned to Advance.

“I was providing for all of them,” Hansen said. “Financially, it was rough.”

Like most borrowers, Hansen could not afford an attorney to handle the suit, but she hoped to work out a payment plan with Advance. When she arrived at the Hamblen County courthouse in Morristown in May 2023, she was directed to a line of half a dozen people waiting to meet with an attorney representing the company.

Across Tennessee, Advance has sued over 110,000 people since 2015, significantly more than any other payday lender, making it one of the largest plaintiffs of any Tennessee-based company collecting debt. In Hansen’s Appalachian county of 66,000, where nearly half the households make less than $50,000, the company has filed one case per every 32 residents over that time, the Tennessee Lookout and ProPublica found.

Advance began filing thousands of lawsuits soon after Tennessee lawmakers approved the Flex Loan, a product pioneered by Advance in Tennessee. The loan’s $4,000 cap is nine times higher than the limit for most payday loans, and the company charges the equivalent of a 279.5% annual interest rate. Before Flex Loans became legal in 2015, payday lenders could only lend $425, and the borrower could never be required to pay back more than $500. Since then, those protections have been eliminated and thousands of borrowers have been defaulting.

Flex Loans only stop growing when they’re completely paid off, when a flex lender declares the loan is in default or when it sues the borrower. If the loans do end up in court, the law allows lenders to recoup attorneys fees — which can’t be done with payday loans — a practice that can add up to a third of the loan amount. Court judgments against customers are often thousands of dollars, with some exceeding $10,000, records show. About 40% of all cases end up with a wage garnishment, court records show.

The consequences of Flex Loans were predicted when the Tennessee legislature legalized them 10 years ago, and the Consumer Financial Protection Bureau wanted to regulate products like Flex Loans when Congress created the agency in 2011. The Trump administration’s efforts to dismantle the CFPB are currently being reviewed by the courts.

Advance has argued that the new product would help consumers by offering them loans that are technically cheaper than a payday loan. It downplayed concerns from consumer advocates that these high-interest loans targeted and trapped low-income borrowers in debt they could never pay off. The company’s leaders made their case just as federal regulators planned to crack down on other Tennessee lenders for making different high-interest loans to people they knew could not pay them back.

After just a few years, evidence started mounting that the loans were exacting a high toll on low-income borrowers while generating huge profits for lenders. Since then, the Flex Loan has buried tens of thousands of Tennesseans such as Hansen in a deep financial hole.

Gabe Kravitz, a consumer finance researcher at The Pew Charitable Trusts, said loans above $1,000 paired with triple-digit interest rates are hard to pay off.

“It gets very expensive very quickly,” he said.

Only a few other states have approved products similar to the Flex Loan but, unlike Tennessee, when other states saw problems with the loans, they acted to rein them in.

Virginia allowed banks to make line-of-credit loans but had never seen the need to cap interest rates as banks competed for customers. But soon after Advance showed up, regulators noticed the company filing thousands of lawsuits. The state attorney general’s office investigated the company for deceptive practices in 2020, ultimately labeling the company as “predatory” and helping to pass legislation to shut down Flex Loan-like products in the state. Advance declined to answer a question about the Virginia attorney general’s investigation. California and North Dakota also passed bills capping interest rates on open-ended lines of credit after Advance and other companies began to operate in those states.

The Lookout and ProPublica sent Advance Financial detailed questions about its operations, including each of the cases cited in the article.

Cullen Earnest, the senior vice president of public policy at Advance Financial, declined to answer specific questions and said he could not discuss individual cases due to privacy concerns. Earnest said in an email that the company has an A+ rating from the Better Business Bureau. He added that the Tennessee Department of Financial Institutions has received just 91 complaints on flexible credit lenders since 2020, representing less than 0.001% of all new flex loan agreements, and that this data reflects the satisfaction of the vast majority of Advance’s customers.

Company records show Hansen made her twice-a-month payments on time, paying over $6,600 in 10 months. The required minimum monthly payments are supposed to act like a safety net, ensuring borrowers pay enough to cover the interest, fees and 3% of the principal.

But many times after Hansen made a payment, the company allowed her to immediately borrow the principal back, which she often did, extending the time it would take to pay off the loan. After almost a year of payments, she still owed more than $3,000.

Hansen said she knew the loan was costly — every loan statement warns, “This is an expensive form of credit. Only borrow what you can afford to pay back” — but she didn’t realize how hard it would be to keep up with the interest and fees.

The loan from Advance only made Hansen’s financial situation worse. As the payments became too much to handle, she lost the house. But the Flex Loan continued to grow, almost doubling in size by the time she received a court summons a year later.

Michael and Tina Hodges started their payday lending business in the 1990s with a few stores in Nashville.

The company, then called Advance Pay Day, steadily expanded, making payday loans and offering products like bus passes, check cashing and money transfers. In 2009, the Hodges told a local news outlet that they wanted to shed the image of a “simple payday advance company,” so the company took on a new name, Advance Financial.

By 2010, Advance had generated a modest $15 million in revenue from about two dozen stores, according to statements it made in news reports at the time.

Not long after, the growing business collided with the Consumer Financial Protection Bureau, a federal regulator Congress created after the banking crisis. The CFPB had started to take aim at high-interest payday lenders, releasing a 2013 report on the dangers of the loans as debt traps. A subsequent agency report found that payday lenders, particularly in Tennessee, relied heavily on offering loans to those who couldn’t afford them. Advance declined to respond to a question about the CFPB report.

Looking for an alternative product that wouldn’t fall under the CFPB’s looming regulations, Advance turned to Tennessee lawmakers, who have power over statewide interest rates. The company hired Earnest, the former top aide for the Tennessee Department of Financial Institutions, which regulates payday lenders. It also opened up a political action committee and began to push lawmakers to allow it to create the Flex Loan.

In a hearing discussing the Flex Loan legislation before its passage, Earnest told a Tennessee Senate committee the new loan was like a line of credit you could get at a bank, acknowledging it would be “a little bit more expensive.”

But the proposal added significant potential costs. To allow lenders to circumvent the state’s interest rate cap, the legislature simply called the interest something else: a “customary fee.” The law would permit flex lenders to charge 24% interest plus a daily fee until the loan is paid off. The fee is calculated by multiplying the loan amount by 0.7%. Over 365 days the fee adds 255.5% to the cost of the loan. Advance’s own documentation tells borrowers that although the state and Advance call it a fee, the federal government sees it for what it is, an interest rate.

The bill passed the state Senate without opposition. In the House, only Democratic state Rep. Mike Stewart spoke against the bill, which passed overwhelmingly and was later signed by Republican Gov. Bill Haslam.

Stewart pointed out the new law allowed companies to recoup attorneys fees in court, something payday lenders had not been allowed to do, and a practice he knew as a lawyer would likely increase the number of lawsuits.

“The legislation was structured to maximize the amount of money they could extract from these debtors,” Stewart, who has since left the legislature, said in an interview.

After legalization of the Flex Loan, Advance Financial’s business boomed. The company expanded to all corners of Tennessee, growing to 105 locations by the end of the 2010s.

As a private company, Advance is not required to release financial information. But Advance and the Hodges were vocal about their success, at least at first. The company self-reported to the Nashville Business Journal in 2019 that it made $392 million, quintupling its revenue from the year before it started offering the Flex Loan, and making more than 25 times as much as it had at the start of the decade. Advance’s revenue no longer appeared on any of the business journals’ lists after 2019.

Those numbers parallel the growth of the flex loan industry in Tennessee. By 2019, all flex lenders across the state had generated about $730 million in operating income, a number that has continued to grow, according to state records. In 2022, the latest available year of data, flex lenders earned $880 million in operating income.

The company is one of the top campaign donors to Tennessee politicians, having spent roughly $2.5 million since 2014. Advance has also spent over $3 million lobbying state lawmakers over the past decade.

The Hodges have also made roughly $10 million in political donations to federal candidates since 2014, including over $3 million to support President Donald Trump’s campaigns. In a 2019 recording obtained by The Washington Post, Hodges told a payday lending industry group his political donations granted him better access to Trump. Hodges told the Post he was an enthusiastic supporter of Trump and never used his status to ask the Trump administration for help.

A Trump-appointed CFPB director rescinded most of the payday lending regulations in 2020.

The new Trump administration has tried to gut the CFPB, but an appeals court on April 28 upheld a lower court ruling preventing the acting CFPB director from firing about 90% of the department’s employees.

Today, Advance’s only product is the Flex Loan.

Before the Flex Loan, court records show that payday lenders like Advance rarely took borrowers to court. The low $500 cap on loan amounts and the prohibition on collecting attorneys fees often made suing people unprofitable.

The Flex Loan law changed all that, unleashing a wave of lawsuits.

Across the 59 counties where electronic court records are available — home to over four-fifths of the state’s roughly 7 million people — Advance has brought one lawsuit for every 50 residents since 2015, according to a data analysis by the Tennessee Lookout and ProPublica.

For Tonya Davis, a single mother who works at a local hospital, Advance waited six years to sue. Tennessee’s debt collection law allows lenders to file a suit within six years and, if the company wins a judgment in court, to pursue the debt for another decade.

Davis lives in Davidson County, where Advance operates more stores than in any other county in Tennessee. Advance has filed over 22,000 lawsuits in Davidson over the decade since it began offering Flex Loans, its highest county total. Its stores in Nashville, which is located in that county, are generally in neighborhoods where households have lower incomes.

Davis said Advance contacted her in 2018, claiming she owed money on a Flex Loan taken out the previous year. Davis said she never borrowed the money and was the victim of identity theft, a claim the company told her it would look into after she told Advance in a phone call that the Social Security number on the account wasn’t hers.

The company never reached back out to her, she said, and for years, she heard nothing from Advance, but in 2024, she received a summons declaring it was suing her for almost $4,800.

At the time Davis was caring for her dying mother and missed her court hearing. Because she didn’t appear, Advance won a default judgment against her for the full amount.

Davis could not afford an attorney, so she filed an appeal on her own, but she never got a chance to challenge the judgment. Soon after the hearing began, attorneys for Advance noted that Davis had filed her appeal one day past the filing deadline and the judge denied her appeal.

The company’s default judgment means Davis is required to pay Advance $175 a month.

“I’m not a lawyer,” Davis said in an interview. “I’m trying to do the best I can with what I have. I don’t know anything about this, or I would have paid, but they didn’t even give me the opportunity to present my information.”

Challenging Advance in court can be daunting. When Advance goes to court for a Flex Loan, it wins a majority of the time, in part because borrowers often fail to show up and in part because the company has more legal resources. The company has won over $200 million in judgments since the start of 2015.

Mandy Spears, the deputy director of the Tennessee-based think tank The Sycamore Institute, said in court that lenders have all the advantages because they have lawyers with vast experience in the system.

“It’s just complicated for the average person versus a more sophisticated business or law firm,” she said. “It’s really a gap in knowledge and expertise.”

Many defendants don’t realize that when they fail to appear in court, the company doesn’t have to provide detailed documents proving what a borrower owes.

Tessa Shearon, a 27-year-old mother in McMinnville, thought she paid off her loan with Advance Financial in 2020. When the company sued her almost three years later, she missed her court hearing because she was eight months pregnant and on bed rest. A judge ruled her in default and Advance won a judgment for $4,700.

Shearon didn’t keep any documentation after paying off her loan, but she said she reached out to Advance’s lawyer to dispute the lawsuit. The company has not sought to garnish her wages. But she remains in limbo: Under the law, the company can choose to file a wage garnishment any time in the next 10 years to recover the judgment amount.

“My only worry is them attempting to collect,” Shearon said. “I don’t have anything.”

Marla Williams, a consumer law attorney for the Legal Aid Society of Middle Tennessee, is one of a handful of lawyers who’ve helped defend borrowers against Advance.

In several cases, Williams has been able to block wage garnishments and reduce the customary fee the company charges.

Williams said that in a 2024 case, she was able to lower the payments from an unaffordable several hundred dollars a month to around $50 per month, which her client could afford. Advance fought the reduction, but a judge ruled in her favor.

In another case, Williams said Advance tried to charge a borrower thousands of dollars in additional fees months after he stopped paying the loan. After a hearing, which most borrowers without lawyers don’t ask for, a judge reduced the fees, calling the added charges “unconscionable and unjust,” court records show.

Williams said the company often uses aggressive tactics in court, something that she’s observed over the past decade.

“This is their business model,” she said.

Advance declined to discuss its business model or legal strategy.

Sometimes Advance has already made money off the borrower before suing them, as in the case of Hansen. Over 10 months, Hansen paid Advance nearly $2,200 more than she borrowed, records show.

She still owed almost $3,000 when she stopped paying Advance. The company waited around three months before declaring her in default, letting her debt grow before it sued her several months later. With the addition of attorneys fees and court-added interest, the company sued her for $6,000.

Hansen, who asked to use her maiden name because she’s no longer married, lost her home in 2022, moving into an apartment, which she said costs more than her mortgage had.

Hansen said she plans to pay Advance by the summer. A February bonus check, which the company garnished 25% of, has helped.

“I understand it’s every person for themselves, and they’re out to make a buck,” Hansen said about Advance. “But you know what, people out there are struggling every single day, and that’s what they take advantage of.”

For this story, the Tennessee Lookout and ProPublica used online portals to find civil cases in Tennessee General Sessions Courts for the 59 counties where electronic court records are available. More than four-fifths of the state’s population lives in these counties. Our analysis included cases filed and uploaded to the online portals from 2009 through 2024. We filtered the data for cases brought by payday lenders in Tennessee, using company names, and found that Advance was filing significantly more suits than any other payday lender, according to court records.

Advance Financial often uses a related company called Harpeth Financial Services to file lawsuits against borrowers. Not every case listed the type of loan behind the lawsuit, but a pattern emerged: After Advance started offering Flex Loans in 2015, the number of lawsuits it filed significantly increased.

Of the cases in our data that were filed by Advance, over half had a judgment amount awarded, indicating the company won its lawsuit. About three-quarters of the cases filed had information on whether a wage garnishment was or wasn’t filed against a borrower. Our analysis found that among cases where that information was available, 40% included wage garnishment.

Have you taken out a flex loan and struggled to pay it back? Have you been sued by Advance Financial, Harpeth Financial or another flex loan lender?

Reporters at the Tennessee Lookout and ProPublica want to hear from you as they investigate flex loan lenders, who have sued more than 100,000 Tennesseans.

To share your experience, call or text reporter Adam Friedman at 615-249-8509.

Mollie Simon contributed research and Joel Jacobs contributed data reporting.

Director of Arizona Medicaid Agency Resigns Following Fraud Scheme Response

by Mary Hudetz

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

The director of Arizona’s embattled Medicaid agency resigned this week, just as she was expected to face questions from lawmakers about her handling of a massive fraud scheme that largely targeted Native Americans.

Gov. Katie Hobbs, a Democrat, announced Wednesday that she had accepted the resignation of Carmen Heredia, director of the Arizona Health Care Cost Containment System. The governor lauded Heredia’s leadership of the agency while blaming Republican lawmakers for politicizing the confirmation process, saying it had become clear they would not confirm Heredia’s nomination.

Sen. Jake Hoffman, a Republican and chair of the Senate’s Committee on Director Nominations, said in a statement that in responding to the fraud scheme, Heredia had “poorly executed” the suspensions of hundreds of behavioral health providers. Heredia had served as the head of AHCCCS without Senate confirmation since early 2023, several years after officials say the fraud likely began during the Republican administration of former Gov. Doug Ducey. In the year before Heredia became director, records show that officials were warned that the fraud was harming patients, but they struggled to respond and failed to alert the public, which Heredia did along with other state leaders in May 2023.

(Earlier this year, a spokesperson for Ducey did not comment on missed opportunities to stop the fraud but said that the former governor went to great lengths to assist in Hobbs’ transition.)

Under Heredia’s leadership, AHCCCS withheld payment to more than 300 businesses as the agency investigated allegations that they were fraudulently billing Medicaid for treatment services. Often, the services had not been provided, and business owners were accused of allowing patients to continue the substance use they had hoped to overcome through treatment.

In a statement, Heredia said she submitted her resignation with a heavy heart and expressed concern that a partisan agenda had resulted in professionals being dragged “through career damaging hearings.” Two years ago, Senate Republicans derailed the nomination of one of Hobbs’ previous picks to lead the health department.

Last September, more than a year after the crackdown began, the Arizona Center for Investigative Reporting and ProPublica reported that the suspensions had rendered patients homeless. Victims of the scheme, some from other states, were also left without access to the drug and alcohol treatment they were seeking.

Over several years, businesses across much of Arizona, but mostly in Phoenix, reaped huge Medicaid reimbursements by enrolling Native Americans in their programs and billing the state’s American Indian Health Program at exorbitant rates for services, like counseling sessions. (The AIHP is a Medicaid insurance option that, until the fraud was discovered, had no set limit on the amount of money providers could bill for services.)

At a news conference Thursday, Attorney General Kris Mayes, a Democrat, said there had been more than 100 indictments and 25 convictions so far related to the scheme. She also said she expected more indictments to come.

AHCCCS said over the past two years that officials’ top priority was patient safety, and in May 2023, the agency set up a hotline for victims. It provided brief hotel stays for people displaced from shuttered facilities. However, AHCCCS said last year that it had no record of what happened to a majority of the hotline’s then 11,400 callers, largely because after six months it had stopped tracking outcomes for people who did not stay in a hotel. According to available data, more than 575 people ended up without housing as of last September. AZCIR and ProPublica also found that at least 40 Indigenous residents of sober living homes and treatment facilities in the Phoenix area died as the state fumbled its response.

A handful of the suspended providers, out of hundreds investigated, were allowed to resume billing Medicaid after clearing allegations with the state. But they said the suspensions still pushed them to the brink financially and upended their patients’ care, AZCIR and ProPublica found. As a result, Heredia’s swift and aggressive response to the crisis — which authorities said was needed to root out fraud and save lives — caused concerns that behavioral health care, especially for Native Americans, was increasingly difficult to access.

“Under Katie Hobbs’ leadership, Heredia’s response has been incredibly disturbing, to say the least,” Hoffman said. “We are left with a broken system due to Heredia’s mismanagement, and our vulnerable populations are caught up in this collapse.”

A spokesperson for Senate Republicans declined a request for an interview with Hoffman.

While Hoffman’s statement mostly focused on the fraud scheme that authorities say cost the state $2 billion, he said he also took issue with other matters within AHCCCS involving long-term care.

In addition to Heredia’s resignation, Jennifer Cunico, the director of the Arizona Department of Health Services, also stepped down this week. Like Heredia, Cunico was set to appear before lawmakers for a confirmation hearing. Cunico said she was proud of her work at the department but made the difficult decision to withdraw her nomination after it became clear she wouldn’t be confirmed either. Her resignation comes two years after Hobbs’ previous pick to lead the health department withdrew her nomination following a heated confirmation hearing.

Hoffman said Cunico had defended public health officials’ pandemic response during meetings with lawmakers but did not provide details. Hoffman previously sponsored legislation that prohibited state and local agencies from enacting vaccine mandates.

The governor defended Heredia’s response to the fraud crisis and said both Heredia and Cunico had worked on a range of initiatives, including improving access to maternal health care.

“Carmen Heredia helped root out a multi-billion dollar wave of Medicaid fraud and the related humanitarian fallout which the previous administration ignored,” Hobbs said in a statement. “Her work to eliminate waste, fraud, and abuse in our healthcare system is a model for the nation, and she always ensured people who needed help continued to get it.”

She added, “The Senate’s unprecedented politicization of the director confirmation process has ended the directorship of two healthcare professionals who have made our state government run more efficiently and more effectively.”

Christopher Lomahquahu, an investigative reporter and Roy W. Howard fellow for AZCIR, contributed reporting.

Help Us Report on How the Department of Education Is Handling Civil Rights Cases

by Asia Fields, Ashley Clarke, Jodi S. Cohen and Jennifer Smith Richards

Since President Donald Trump took office, his administration laid off nearly half of the Department of Education division that handles civil rights investigations and shifted its focus. The administration halted work on thousands of pending discrimination cases while ordering investigations aligned with its priorities.

Some people have spoken out about their cases being in limbo or about not receiving updates. We know there are thousands of other people who are affected. We need your help to see the full picture of how the dismantling of the Office for Civil Rights is affecting students, parents, school employees and their wider communities.

If you submitted a complaint or had a case closed this year, or if you have a currently pending case, we want to hear about your experience. We’re also interested in connecting to people with other insights about the Department of Education.

If you work or worked for the Department of Education, please do not fill out the form. Instead, use Signal to contact reporter Jennifer Smith Richards at jsmithrichards.93 or reporter Jodi Cohen at jodireporter.88.

We take your privacy seriously and will contact you if we wish to publish any part of your story.

We’re gathering these stories for our reporting, which can take several weeks or months. We may not be able to follow up with everyone, but we will read everything you submit and it will help guide our reporting.

As journalists, our role is to write about issues. We cannot provide legal advice or other support. However, there are resources available. We know these cases can stem from painful experiences, and mental health support is available if you need it:

• The National Sexual Assault Hotline is available online or by calling 800-656-4673.
• The National Suicide and Crisis Lifeline is available online or by calling or texting 988.
• The Trevor Project provides support to LGBTQ+ youth. You can connect online, by calling 866-488-7386 or by texting 678678.

You can share your experience using our form.

If you would prefer to connect using the encrypted messaging app Signal, our number is 917-512-0201. You can also contact ocr@propublica.org with any questions.

If you would like to connect with ProPublica reporters about other topics, you can reach out to a reporter or send a tip to our newsroom.

A Gutted Education Department’s New Agenda: Roll Back Civil Rights Cases, Target Transgender Students

by Jennifer Smith Richards and Jodi S. Cohen

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

In California, the federal government was deep into an investigation of alleged racial discrimination at a school district where, a parent said, students called a Black peer racial slurs and played whipping sounds from their cellphones during a lesson about slavery. Then the U.S. Department of Education in March suddenly closed the California regional outpost of its Office for Civil Rights and fired all its employees there. That investigation and others went silent.

In South Dakota, the OCR abruptly terminated its work with a school district that had agreed to take steps to end discrimination against its Native American students. The same office that helped craft the agreement to treat indigenous students equally made a stunning about-face and decided in March that helping Native American students would discriminate against white students.

During its first 100 days, as the Trump administration has dismantled the Education Department, one of its biggest targets has been the civil rights arm. Now, Education Secretary Linda McMahon is “reorienting” what’s left of it.

Part of that shift has been ordering investigations related to the administration’s priorities, such as ending the participation of transgender girls and women in girls’ and women’s sports. After hearing that a transgender woman from Wagner College in New York competed in a women’s fencing tournament at the University of Maryland last month, the head of the OCR launched a special investigation into both schools and threatened their access to federal funding.

Through internal memos and case data, interviews with more than a dozen current agency attorneys, and public records requests to school districts and other targets of investigations across the country, ProPublica has documented how the Trump administration has radically reshaped the OCR.

Only 57 investigations that found a civil rights violation and led to change at a school or college were completed in March, ProPublica has learned. Only 51 were resolved by finding violations in April. The Biden administration completed as many as 200 investigations a month.

Leadership under President Donald Trump also has made it easier for the OCR to drop discrimination complaints quickly. In March, 91% of cases closed by the office were dismissed without an investigation, and 89% were dismissed outright in April, according to internal case data obtained by ProPublica. Typically, 70% of cases are dismissed because they don’t meet criteria to warrant an investigation.

With more than half of the Education Department’s civil rights offices closed and the division reduced to a fraction of its former staff, families’ pleas for updates and action have gone unheard. One OCR attorney, who asked not to be named for fear of retaliation, told ProPublica that their caseload went from 60 to 380 as they absorbed cases previously handled by employees who worked in offices that had been closed. Some remaining employees have not been able to access documents, voicemail and email of fired employees.

As with civil rights divisions in other federal agencies that the Trump administration has fundamentally altered, the OCR has worked for decades to uphold constitutional rights against discrimination based on disability, race and gender.

“OCR is the most useless it’s ever been, and it’s the most dangerous it’s ever been. And by useless, I mean unavailable. Unable to do the work,” said Michael Pillera, who until recently was an OCR attorney in Washington, D.C. He is now with the Lawyers’ Committee for Civil Rights Under Law.

Investigating cases that allege racism, discrimination based on sexual orientation or mistreatment of students with disabilities now requires permission from Trump appointees, according to a memo from OCR leadership. As a result, thousands of discrimination investigations are idled, even ones that were nearing a resolution when Trump took office again.

“I thought we were somewhere, and now we are back to square one because they are closed,” said K.D., the mother of the Black California student who said her daughter has been called racial epithets by her classmates. She emailed the agency more than a month ago to try to get an update on the investigation, but said the agency has not responded. ProPublica is identifying her by initials to protect her child’s privacy. “I never would have imagined that something so essential would go away,” she said.

Education Department spokespeople did not respond to questions and requests for comment sent over several weeks about changes in the civil rights division.

The OCR attorney who said they are working through 380 cases said the job is now “impossible.”

“The people who remain are doing all they can. We’re doing all we can. But it isn’t enough, and it keeps us up at night,” they said.

Another OCR attorney who, like others, asked not to be named for fear of retaliation, said the administration’s new vision for civil rights enforcement has harmed families.

“We were sort of the last bit of hope for them,” he said, “and now they’re calling and emailing and saying, ‘Hey, I thought you all were going to help me.’”

The arduous, grinding work undertaken by OCR attorneys is starkly different from the high-speed investigations that the Education Department announces in press releases every few days.

The OCR, historically one of the government’s largest enforcers of the Civil Rights Act of 1964, has been known for being a neutral fact-finder. Its investigators followed a process to determine whether complaints from the public met legal criteria for a civil rights claim, then carried out investigations methodically.

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The vast majority of investigations were based on discrimination complaints from students and families, and a large share of those were related to disability discrimination. The inquiries typically took months and, in complex cases, years. The lengthy investigations sometimes were a source of criticism. The agency didn’t share details of the investigations until they were completed, and the agreements often involved federal oversight going forward.

Investigations being publicized now have largely bypassed the agency’s civil rights attorneys, according to Education Department employees. McMahon and OCR head Craig Trainor created what amounts to a shadow division.

The Trump administration has ordered more than a dozen investigations in the past three months on its own, not initiated by an outside complainant. These “directed investigations” are typically rare; there were none during President Joseph Biden’s administration.

The investigations have targeted schools with transgender athletes, gender-neutral bathrooms and initiatives that the administration views as discriminatory to white students. OCR attorneys told ProPublica they’ve been given prewritten letters, which they’ve reluctantly signed, to send to targets of these investigations. Some letters describe transgender girls as “biological males,” which is ideologically pointed language that OCR attorneys say they’ve never used before.

“They’re blowing through past precedents, past practices, best practices,” said Catherine Lhamon, who led OCR under former Presidents Barack Obama and Biden and departed the office in January. “And they’re not even attempting to appear like neutral arbiters of the law.”

In a first, McMahon and Trainor created ways to divert complaints and investigations away from the OCR’s legal experts entirely. The administration made an “End DEI” portal that bypasses the traditional online complaint system and seeks only grievances about diversity, equity and inclusion in schools. Unlike the regular complaint system, the diversity portal submissions are not routed to OCR staff.

“We have no idea where that portal goes, who it goes to, how they review the cases. No idea,” said the attorney who said he struggles with being unable to help families. “That avoids us interfering with the games they’re trying to play, if they silo off the real civil rights lawyers.”

McMahon then announced a “Title IX Special Investigations Team” last month to work with the Department of Justice and appointed Trainor to it. It launches its own investigations into schools that include transgender girls in athletics.

In an internal memo to the new team that was obtained by ProPublica, Trainor defined the special team’s purpose: “To effectively and efficiently address the increasing volume of Title IX single-sex sports/spaces cases, expedite those investigations and resolutions, and collaborate seamlessly with DOJ to conclude investigations that go to DOJ for enforcement.”

There’s no indication that more complaints related to transgender students are coming from the public, according to internal case data. Last month, in what appears to be the first case assigned to the Title IX team, the group notified the University of Maryland and Wagner College that it would investigate each school. The investigation began after Fox News and other media reported about a fencing tournament at the University of Maryland in which a transgender player from Wagner competed. Trainor signed the notification letters himself, a departure from Lhamon’s practice.

A Wagner College spokesperson declined to comment. A University of Maryland spokesperson declined to comment about the investigation but said the tournament, while on the university’s campus, was run by USA Fencing.

The public used to be able to see what the OCR was investigating. But an online database that is supposed to list all investigations underway hasn’t been updated since Trump took office.

At that time, about 12,000 pending investigations were listed. Among them were two related to a family’s complaints that their California school district discriminated against students with disabilities, including by barricading them inside what it called a “reset” room. But then the OCR closed its California office and fired its employees.

“All work came to a halt. They stopped responding. Nothing was being done to stop the practice and protect kids,” Genevieve Goldstone, the parent of the Del Mar Union School District student who filed the disability discrimination complaint, said in an interview. “My federal complaints were meant to protect more kids and stop the abuses in the district.”

The district said it could not comment on the pending investigation but said it participated in more than a dozen interviews with an OCR attorney. It also said it conducted its own review of the allegations and determined that they were unsubstantiated.

OCR attorneys say they have been repeatedly blindsided by public announcements about policy changes and investigations. To find out what Trainor and McMahon have launched on their behalf, they check the Education Department’s website daily for press releases.

Those statements sometimes quote Trainor preemptively saying a school “appears to violate” civil rights law. The attorneys worry they will have no choice, despite what their investigations uncover, but to find against schools that have already been excoriated by the department publicly.

For example, in a press release announcing an investigation into a transgender athlete participating in girls’ track and field in Portland Public Schools in Oregon, Trainor said, “We will not allow the Portland Public Schools District or any other educational entity that receives federal funds to trample on the antidiscrimination protections that women and girls are guaranteed under law.”

A third current OCR attorney, who asked not to be named for fear of losing her job, said the administration is misinterpreting civil rights law. “It’s subverting our office, or weaponizing it in these ways, without following our process,” she said.

Conservative groups with complaints about diversity or transgender students have been able to file complaints directly with Trainor and get quick results — another norm-breaking way to operate outside of the OCR’s protocol.

America First Legal, a group founded by Trump deputy chief of staff Stephen Miller that considers itself the “answer to the ACLU,” emailed Trainor a few days after Trump’s “Ending Radical Indoctrination in K-12 Schooling” executive order. The order directs schools to stop teaching about or supporting diversity, equity and gender identity.

“AFL respectfully requests that the Department of Education open investigations into the following public-school districts in Northern Virginia for continuing violations of Title IX,” the letter read, listing five districts that have policies welcoming to transgender students.

Senior leadership in Washington opened the cases the following week. America First issued a press release headlined “VICTORY.” The group declined to comment further.

Remaking the OCR isn’t just about increasing caseloads and reordering political priorities. The Trump administration now is taking steps to roll back OCR’s previous civil rights work.

Last month, Trump issued an executive order that directs all federal agencies, including the Education Department, to stop enforcing cases involving policies that disproportionately affect certain groups — for example, when Black students are disciplined more harshly than white students for the same infractions or when students with disabilities are suspended more than any other group even though they represent a small percentage of student enrollment.

Trump’s order requires the agencies to “assess all pending investigations, lawsuits, and consent judgements” that consider disproportionate discipline and “take appropriate action.” Complaints made to the OCR that students were unfairly disciplined could be thrown out; existing enforcement actions or monitoring of schools that had disciplined students disproportionately could be revoked.

The OCR under Trainor did this in Rapid City, South Dakota — even before the executive order. About a year ago, the office had signed an agreement with Rapid City Area Schools after an investigation found that the district’s Native American students were disciplined far more harshly than white ones. They also were kept from enrolling in advanced courses.

The OCR said that when speaking with an investigator, the superintendent of schools at the time said that Native American students in her district had higher truancy rates because they operated on what she termed “Indian Time.” She said, too, that they don’t value education, according to the investigation’s findings.

The former superintendent, Nicole Swigart, denied saying any of that.

“I recognize those comments are horrendous,” Swigart said in an interview with ProPublica. She noted that the OCR investigation was opened in 2010 and that she first spoke to an investigator in 2022. “I’m not lying when I say I didn’t say it. I didn’t say it, and I don’t know where it came from.”

In the agreement with the OCR, the district promised to examine its practices and make things right; the OCR would monitor its progress. The district also brought in a new superintendent.

But last month, the OCR abruptly terminated that agreement, based on its differing interpretation of civil rights law. The OCR’s new view is that equity and diversity efforts discriminate against white students. It was, in the view of agency attorneys, the most severe breach of the OCR’s mission and methods to date. There was no public announcement.

“Native students in Rapid City just lost a layer of protection,” the Lakota People’s Law Project announced on Facebook. “Native students are still being pushed out of classrooms and denied opportunities.”

Darren Thompson, who is Ojibwe, said the OCR’s decision to abandon the agreement was “another cycle of the federal government failing to uphold its promises.”

“And this time, they are partisan, political,” said Thompson, who works for the nonprofit Sacred Defense Fund affiliated with the Lakota group in Rapid City.

In response to questions from ProPublica, the school district said it has completed much of the work — including broader access to educational opportunities and an improved behavior tracking process — and plans to continue it even without federal oversight. But it also said this week that under the OCR’s new directives, “we must shift our approach.” The district did not elaborate on what will change.

It’s unclear whether the OCR has ended agreements with other districts or colleges. Education Department spokespeople did not respond to questions from ProPublica.

Some subjects of the OCR’s new directives and investigations have capitulated. A school district in Tumwater, Washington, that Trainor targeted for allowing a transgender basketball player from an opposing team to compete responded by voting to support the state athletic association excluding trans players altogether.

But some are pushing back.

Denver Public Schools was the first target of one of Trainor’s “directed investigations” in late January — over the existence of one all-gender, multistall bathroom on one floor of a Denver high school. According to communication obtained by ProPublica through public records requests, the district called out the OCR for “continuing to take a different approach with this case without explanation, a case with no complainant who is awaiting any form of relief or remedy.”

Kristin Bailey, a Denver Public Schools attorney, wrote to an OCR supervisor that the way the investigation is being handled “appears to be retaliatory.”

Since February, at least half a dozen lawsuits have been filed to try to stop the dismantling of the Education Department and its civil rights functions — among them, suits by Democratic state attorneys general and from the National Education Association and American Federation of Teachers. A recent suit by the Council of Parent Attorneys and Advocates on behalf of children and their parents — all of whom have pending complaints alleging discrimination — claims they’re suffering from the OCR’s “abandonment” of its core mission.

The NAACP also sued the department, McMahon and Trainor, citing the “End DEI” portal and seeking a halt to such anti-diversity efforts. And the Victim Rights Law Center, representing students and parents, sued to try to restore what has been cut from the OCR so the agency can fulfill its mandate. It noted that under McMahon and Trainor, “cherry-picked investigations appear to be the only matters the Department is currently pursuing.” Those lawsuits are pending. The government has argued in the NAACP lawsuit that the group lacks standing, and in the other it has not filed a response.

Several OCR attorneys told ProPublica that they hope these groups and school districts continue to push back. In the meantime, they said, they will continue to try to work on behalf of the public to uphold the nation’s civil rights laws.

“I have to keep putting one foot in front of the other, helping the people I can help, and keep my eye on the long game,” said a fourth OCR attorney. “Hopefully we’re still here and can help rebuild in the future.”

Texas Senate Approves Legislation to Clarify Exceptions to Abortion Ban

by Cassandra Jaramillo and Lizzie Presser

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The Texas Senate has unanimously passed legislation that aims to prevent maternal deaths under the state’s strict abortion ban.

Written in response to a ProPublica investigation last year, Senate Bill 31, called The Life of the Mother Act, represents a remarkable turn among the Republican lawmakers who were the original supporters of the ban. For the first time in four years, they acknowledged that women were being denied care because of confusion about the law and took action to clarify its terms.

“We don’t want to have any reason for hesitation,” said Republican state Sen. Bryan Hughes, who authored the state’s original abortion ban and sponsored this reform with bipartisan input and support. Just last fall, he had said the law he wrote was “plenty clear.”

The bill stops short of removing what doctors say are the ban’s biggest impediments to care, including its major criminal penalties, and doesn’t expand abortion access to cases of fetal anomalies, rape or incest. Sen. Carol Alvarado, the Democratic lawmaker who co-authored the bill, said that its limits were a “real hard pill to swallow” but that it could still make a difference. “I believe this bill will save lives,” she said.

ProPublica’s reporting showed how doctors in states that ban abortion have waited to intervene in cases where women ultimately died of high-risk complications.

To address that problem, Senate Bill 31 states that a life-threatening medical emergency doesn’t need to be “imminent.” It also says doctors can terminate ectopic pregnancies, which occur when the fertilized egg implants outside of the uterine cavity. It would allow for a pregnant patient to receive cancer treatment, Hughes said, even if doing so threatened the viability of a fetus.

The bill also clarifies that medical staff or hospital officials can discuss termination with patients without violating a provision of the law that criminalizes “aiding and abetting” an abortion. It had been unclear to doctors whether simply discussing the option could lead to steep criminal penalties; patients have reported not being able to get straight answers from their providers about their prognosis and options for treatment.

It remains to be seen how the bill, if made law, would be interpreted by doctors and hospitals, and whether risk-averse institutions would still delay care during pregnancy complications.

Many reproductive rights advocates are skeptical given that the bill does not explicitly address many high-risk pregnancy complications. The most common one in the second trimester, previable premature rupture of membranes, or PPROM, occurs when someone’s water breaks early. In these cases, the chance of the fetus surviving is low, but delaying a pregnancy termination leaves the patient at risk of infection, which can lead to sepsis, a potentially deadly condition. Since the state banned abortion, lawyers at many hospitals across Texas have advised physicians not to empty the uterus until they can document signs of infection — an indication of a life-threatening emergency.

The death of Josseli Barnica, which ProPublica reported last year, reveals the dangers of forcing miscarrying patients to wait for care. Diagnosed with an “inevitable” miscarriage at 17 weeks, she showed symptoms similar to PPROM without an official diagnosis — her water had not yet broken. While stable, she was made to wait 40 hours until the fetal heartbeat ended before doctors induced delivery. She later died of sepsis, which medical experts say she likely developed because of the wait.

In addition to documenting cases in which women died of sepsis, ProPublica has shown how rates of the potentially deadly complication spiked by more than 50% statewide in second-trimester pregnancy-loss hospitalizations after Texas banned abortion.

Officials with the Texas Medical Association, the Texas Hospital Association and major anti-abortion groups — Texas Right to Life, Texas Alliance for Life and the American Association of Pro-Life OB-GYNs — told ProPublica they believed that this bill would now allow doctors to offer a termination at the point of a PPROM diagnosis, before infection set in.

Dr. Zeke Silva, chair of the Texas Medical Association’s Council on Legislation, included PPROM on a list of potentially life-threatening conditions he believed may fall under the bill’s clarified exception. The list, which is not exhaustive, includes preeclampsia, renal failure, liver failure, cardiac disease, pulmonary hypertension and neurological conditions. He added that decisions to intervene because a medical condition could be life-threatening “are, by definition, subjective, based on multiple clinical considerations” and must be based on “sound medical judgment.”

However, ProPublica spoke with six legal experts who said they were unsure whether hospitals, wary of litigation or penalties, would interpret the bill to mean that doctors can offer a termination to patients with PPROM.

Some PPROM patients can remain pregnant for weeks and not develop infections, while others can contract an infection and deteriorate very quickly, noted Molly Duane, a senior staff attorney at the Center for Reproductive Rights. “I could see some doctors saying this means, ‘I have more leeway to intervene in all PPROM cases,’ and others saying, ‘I still don’t know, so I’ll wait until signs of infection.’”

The largest association of OB-GYNs, the American College of Obstetricians and Gynecologists, said in an emailed statement that it did not support the bill: “This bill would keep Texas’ abortion ban in place and we strongly oppose the abortion ban and will continue to do so.”

Yesterday, the Texas Senate also passed Bill 2880, which would authorize civil lawsuits against anyone in or outside of Texas who distributes or provides abortion medication to someone in the state. It is expected to face pushback in the state House.

The Life of the Mother Act now goes to the House, where it must be voted out of committee before it heads to the House floor. Both chambers would need to agree on a final version before the governor could sign it into law.

Gus Garcia-Roberts Joins ProPublica as National Reporter

ProPublica

ProPublica announced on Thursday that Gus Garcia-Roberts has been hired as a national reporter.

Garcia-Roberts comes to ProPublica from The Washington Post, where he published investigations into the overdose death of Los Angeles Angels pitcher Tyler Skaggs; the sexual abuse allegations against Los Angeles Dodgers pitcher Trevor Bauer and Major League Baseball’s secretive system in examining domestic abuse and sexual assault; and how the NFL has failed in hiring Black coaches, part of a series that won the Associated Press Sports Editors top prize for projects and the Online Journalism Awards’ prize for excellence in sports reporting.

Before joining the Post, Garcia-Roberts worked on investigative teams at Newsday, the Los Angeles Times and USA Today. At Newsday, he was a part of the team whose series on hidden police misconduct was a finalist for the Pulitzer Prize for public service. He is the author of “Jimmy the King: Murder, Vice, and the Reign of a Dirty Cop” and the co-author of “Blood Sport: Alex Rodriguez, Biogenesis, and the Quest to End Baseball’s Steroid Era.”

“We are so thrilled to welcome Gus and his enviable reporting and writing chops to ProPublica and excited to turn ProPublica’s lens on the world of sports,” said managing editor Tracy Weber. “Stay tuned.”

“I’m beyond excited to be joining ProPublica, an institution whose mission and work I’ve admired for years,” said Garcia-Roberts. He starts next week.