by David Armstrong, Eric Umansky and Vernal Coleman

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Veterans hospitals are struggling to replace hundreds of doctors and nurses who have left the health care system this year as the Trump administration pursues its pledge to simultaneously slash Department of Veterans Affairs staff and improve care.

Many job applicants are turning down offers, worried that the positions are not stable and uneasy with the overall direction of the agency, according to internal documents examined by ProPublica. The records show nearly 4 in 10 of the roughly 2,000 doctors offered jobs from January through March of this year turned them down. That is quadruple the rate of doctors rejecting offers during the same time period last year.

The VA in March said it intended to cut its workforce by at least 70,000 people. The news sparked alarm that the cuts would hurt patient care, prompting public reassurances from VA Secretary Doug Collins that front-line health care staff would be immune from the proposed layoffs.

Last month, department officials updated their plans and said they would reduce the workforce by 30,000 by the end of the fiscal year, which is Sept. 30. So many staffers had left voluntarily, the agency said in a press release, that mass layoffs would not be necessary.

“VA is headed in the right direction,” Collins said in a statement.

But a review of hundreds of internal staffing records, along with interviews with veterans and employees, reveal a far less rosy picture of how staffing is affecting veterans’ care.

After six years of adding medical staff, the VA this year is down more than 600 doctors and about 1,900 nurses. The number of doctors on staff has declined each month since President Donald Trump took office. The agency also lost twice as many nurses as it hired between January and June, records viewed by ProPublica show.

In response to questions, a VA spokesperson did not dispute numbers about staff losses at centers across the country but accused ProPublica of bias and of “cherry-picking issues that are mostly routine.”

Agency spokesperson Peter Kasperowicz said that the department is “working to address” the number of doctors declining job offers by speeding up the hiring process and that the agency “has several strategies to navigate shortages,” including referring veterans to private providers and telehealth appointments. A nationwide shortage of health care workers has made hiring and retention difficult, he said.

Kasperowicz said that the recent changes at the agency have not compromised care and that wait times are getting better after worsening under President Joe Biden.

While wait times for primary, mental health and specialty care for existing patients did increase during Biden’s presidency, the VA’s statistics show only slight reductions since Trump took office in January.

However, appointment wait times for new patients seeking primary and specialty care have slightly increased, according to a report obtained by ProPublica.

As of early July, the average wait time nationally to schedule outpatient surgery appointments for new patients was 41 days, which is 13 days higher than the goal set by the VA and nearly two days longer than a year ago.

In some locations, the waits for appointments are even longer.

At the Togus VA Medical Center in Augusta, Maine, internal records show that there is a two-month wait for primary care appointments, which is triple the VA’s goal and 38 days longer than it was at this time last year. The wife of a disabled Marine veteran who receives care at the facility told ProPublica that it has become harder in recent months to schedule appointments and to get timely care.

Her husband, she said, served in Somalia and is completely disabled. He has not had a primary care doctor assigned to him for months after his previous doctor left over the winter, she said.

“He has no person who is in charge of his health care,” said the woman, who did not want to be named because of fears her comments might affect benefits for her husband. “It was never like this before. There’s a lack of staff, empty rooms, locked doors. It feels like something that’s not healthy.”

Kasperowicz said the VA is taking “aggressive action” to recruit primary care doctors in Maine and anticipates hiring two new doctors by the end of the year.

Nationwide, records reviewed by ProPublica show, the vacancy rate for doctors at the VA was 13.7% in May, up from 12% in May of 2024. Kasperowicz said those rates are in line with historical averages for the agency. But while the vacancy rate decreased over the first five months of 2024, it has risen in 2025.

Sen. Richard Blumenthal, D-Conn., who has been critical of Collins’ stewardship, has argued that the VA is heading in a dangerous new direction. He said that ProPublica’s findings reinforce his concerns about “damaging and dangerous impacts” from cuts and staffing reductions.

“Dedicated professionals are fleeing — and recruitment is flagging — because of toxic work conditions and draconian funding cuts and firings,” he told ProPublica. “We’ve warned repeatedly about these results — shocking, but not surprising.”

In the VA’s Texas region, which covers most of the state, officials reported in an internal presentation in June that approximately 90 people had turned down job offers “due to the uncertainty of reorganization” and noted that low morale was causing existing employees to not recommend working at the medical centers.

Anthony Martinez, a retired Army captain who did tours of duty in Iraq and Afghanistan, said he has witnessed a downgrade in care at the Temple, Texas, VA facility. He said that the hospital has lost records of his recent allergy shots, which he now has to repeat, and he has to wait longer for appointments.

“Problems have always existed but not to this degree,” Martinez said.

Martinez, who runs a local nonprofit for veterans, said he’s heard similar frustrations from many of them. “It’s not just me. Many vets are having bad experiences,” he said.

Kasperowicz said the agency couldn’t discuss Martinez’s case without a patient privacy waiver, which Martinez declined to sign. He said wait times for primary care appointments for existing patients at Temple are unchanged over the past fiscal year. But internal records show an increase in wait times for new patients in specialties such as cardiology, gastroenterology and oncology.

Administrators there have expressed concern about the impact of staff losses, warning in their June internal presentation about “institutional knowledge leaving the Agency due to the increase of supervisors departing.”

It is not just the loss of doctors and nurses impacting care. Shortages in support staff, who have not been protected from cuts, are also adding to delays.

In Dayton, Ohio, vacant positions for purchasing agents resulted in delays in acquiring hundreds of prosthetics, according to an internal VA report from May. Kasperowicz said the hospital has recently cut processing time for such orders by more than half.

Some facilities are experiencing trouble hiring and keeping mental health staff.

In February, a human resources official in the VA region covering much of Florida reported in an internal warning system that the area was having trouble hiring mental health professionals to treat patients in rural areas. The jobs had previously been entirely remote but now require providers to be on site at a clinic.

When the region offered jobs to three mental health providers, all of them declined. The expected impact, according to the warning document, was longer delays for appointments. Kasperowicz said the VA is working to address the shortages.

Yet even as the agency faces these challenges, the Trump administration has dramatically scaled back the use of a key tool designed to help the VA attract applicants and plug gaps in critical front-line care.

The VA in recent years has used incentive payments to help recruit and keep doctors and other health care workers. In fiscal 2024, the agency paid nearly 20,000 staffers retention bonuses and over 6,000 new hires got signing bonuses. In the first nine months of this fiscal year, which started Oct. 1, only about 8,000 VA employees got retention bonuses and just over 1,000 received recruitment incentives. The VA has told lawmakers it has been able to fill jobs without using the incentive programs.

Rep. Delia Ramirez, D-Ill., said during a congressional oversight hearing in July that the Trump administration is withholding the bonuses because it “wants them to leave” as part of a plan to privatize services.

“It’s not that VA employees are less meritorious than they were under Biden,” she said. “They want every employee to be pushed out so they can decimate the VA’s workforce.”

Do you have information about the VA that we should know about? Contact reporters David Armstrong on Signal, DavidArmstrong.55, or via email, david.armstrong@propublica.org; Eric Umansky on Signal, Ericumansky.04, or via email, eric.umansky@propublica.org; and Vernal Coleman on Signal, vcoleman91.99, or via email, vernal.coleman@propublica.org.

Joel Jacobs contributed reporting.

This post was originally published on ProPublica.

by Cassandra Jaramillo

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

Seven years ago, when President Donald Trump signed the Preventing Maternal Deaths Act into law, it was hailed as a crucial step toward addressing the nation’s maternal mortality crisis.

The law pumped tens of millions of dollars a year into a program to help fund state committees that review maternal deaths and identify their causes. The committees’ findings have led to new protocols to prevent hemorrhage, sepsis and suicide. Federal money has allowed some states to establish panels for the first time.

The committees’ work only became more urgent after the Supreme Court overturned the constitutional right to abortion. Last year, Georgia’s committee determined the state’s abortion ban contributed to the preventable death of 41-year-old Candi Miller.

But now the program that enabled this progress — known as Enhancing Reviews and Surveillance to Eliminate Maternal Mortality, or ERASE MM — is in danger, maternal health advocates say.

The program’s funding expires on Sept. 30, and efforts to renew it have thus far not succeeded. Congress included money to extend ERASE MM in a broader stopgap funding measure that almost passed in December 2024 before being scuttled by Republican opposition. The program isn’t paid for in the Trump administration’s budget proposal for 2026. Late last week, the Senate Appropriations Committee introduced a bill to fund the Department of Health and Human Services for the next fiscal year that includes money for ERASE MM, but the measure hasn’t moved forward yet.

Adrienne Griffen, executive director of the Maternal Mental Health Leadership Alliance, said she fears how little attention the program’s fraught future has drawn amid waves of layoffs at federal health agencies and ferocious debate over impending Medicaid cuts.

“We were concerned when the president’s budget did not include these programs,” Griffen said. “While we are happy with the progress, there is still a lot that needs to happen.”

The Centers for Disease Control and Prevention, which is responsible for awarding ERASE MM grants and guiding the work of state maternal mortality committees, didn’t answer specific questions from ProPublica about the future of the program. Andrew Nixon, communications director for HHS, the CDC’s parent agency, said in a statement that HHS “is committed to improving maternal and infant health outcomes.”

“We are currently reviewing the maternal and infant health portfolio to identify the most effective ways to collect and analyze data and improve the health and safety of mothers and infants,” the statement said.

HHS Secretary Robert F. Kennedy Jr. didn’t respond to requests for comment on whether advocates’ concerns are warranted.

The Trump administration’s budget proposal jettisons not only ERASE MM but a slate of programs known as the Safe Motherhood initiative, which aims to reduce risks such as premature births and infections that affect mothers and infants. All previously had bipartisan support. That’s left some members of Congress mystified about why their funding is in jeopardy.

At a June budget hearing, Rep. Greg Landsman, D-Ohio, pressed Kennedy on why the administration had proposed eliminating the programs, including ERASE MM.

“I genuinely believed this was zeroed out either accidentally or by some sort of oversight,” Landsman said, asking Kennedy to work with members of the House Committee on Energy and Commerce to restore funding.

After their exchange at the hearing, Landsman told ProPublica that Kennedy had agreed to meet to discuss restoring the funding.

“We want to save this investment,” he said. “It’s critical for expecting moms.”

ERASE MM came about in 2019 after reporting by ProPublica and others showed that hundreds of American women were dying each year from preventable causes related to pregnancy. U.S. maternal mortality rates had risen sharply over two decades as rates in other affluent nations had dropped.

Other countries, particularly the United Kingdom, had reliable national data on maternal mortality, as well as robust case-review systems designed to turn information into improvements in care. In the U.S., by contrast, only two-thirds of states had review processes at all and even those sometimes went years between reports or operated inconsistently.

ERASE MM was designed to plug these holes, ensuring that lessons from maternal deaths didn’t go unlearned.

Over the last five years, the CDC has distributed nearly $90 million to fund the work of state review committees. At least by federal standards, the program is relatively inexpensive; it divvied up a total of about $40 million last year between 46 states, an average of $870,000 apiece.

The members of maternal mortality review committees — usually a mix of physicians, nurses, mental health professionals and advocates — volunteer their time. ERASE MM grants typically pay to hire the staffers who gather records from hospitals, medical examiners, police and other agencies and abstractors who redact private information from case summaries.

Committees are advisory in nature, but their findings have made a difference, advocates say. In recent years, many states have developed mental health initiatives for pregnant people and new mothers based on maternal mortality reviews. Recommendations by New Hampshire’s committee, for example, led to a program in which OB-GYNs collaborate with psychiatrists on treatments for post-partum depression or substance use disorder.

In Indiana, which used ERASE MM funds to establish a maternal mortality review committee in 2018, the panel’s work spurred state officials to expand an initiative to have nurses make post-partum home visits to new mothers.

Indiana is one of at least five states that rely entirely on federal dollars to pay for their maternal mortality reviews (the others are South Carolina, Iowa, Missouri and Utah). Committee members in several states expressed alarm that this money may evaporate.

Before ERASE MM, Utah had a joint committee that reviewed both infant and maternal deaths, said Dr. Marcela Smid, a maternal-fetal health specialist. Utah set up a maternal mortality review committee for the first time in 2019 using funds from ERASE MM, which Smid chairs. It found increasing numbers of maternal deaths by suicide, leading to programs for better mental heath and substance use disorder screening and treatment. Since 2021, the committee has received about $1.7 million from the CDC.

“If we get defunded, I suspect it would be devastating,” Smid said.

As part of reviews, committee members consider the legal and socioeconomic context in which a woman dies. Those steps were critical in Georgia when the committee reviewed deaths that had occurred after Roe v. Wade was overturned in 2022 and the state prohibited abortion. The CDC hasn’t directed committees to ask explicitly about such laws, but committee members say the process has provided a window that could be lost if ERASE MM ends.

Case reviews are typically confidential, but ProPublica reported last year that Georgia’s committee had concluded the abortion-related deaths of Miller and Amber Thurman, 28, had been preventable.

Reviewers found both women had taken abortion pills and suffered a rare complication when they failed to expel all the fetal tissue from their bodies. Miller decided not to go to the doctor when she began having symptoms of sepsis because she feared repercussions related to the state’s abortion ban, the review committee found. Thurman went to the hospital but died after doctors waited 20 hours to perform a dilation and curettage to clear her uterus; the procedure, also used to perform abortions, had become entangled in restrictions subjecting doctors to criminal penalties if they violated the law.

Even before the threat to ERASE MM’s funding emerged, four states, including Florida and Texas, had opted out of accepting money from the program. The Florida Department of Health didn’t respond to questions from ProPublica about why it had done this. The Texas Department of Health said the state Legislature had instructed it not to take the funds and instead allocated funding to create its own system. Texas, which accounts for about 10% of U.S. maternal deaths, also stopped sharing data collected by its maternal mortality review committee with the CDC shortly after restricting abortion access.

Officials at the Texas Department of Health also have chosen not to have the state’s maternal mortality review committee examine cases from 2022 and 2023, a period that includes two preventable deaths ProPublica reported on last year. The panel was nearly four years behind on case reviews, and state officials said skipping two years would help it catch up. The state also forbids its panel from investigating deaths related to abortion.

Dr. Thomas Westover, a maternal-fetal medicine specialist who also sits on the maternal mortality review committee in New Jersey, said he worries that if ERASE MM goes away, there will be no consistency from state to state in how maternal deaths are reviewed or what data is collected on them.

“You’ll have states that pick and choose what to review,” Westover said. He noted that some states likely would ignore accidental deaths to manage their caseloads, while others, like Texas, choose to exclude deaths related to abortions, making data less comparable nationally. “That’s a bad decision.”

As part of ERASE MM, the CDC gives state review committees detailed guidance on what contributing factors to consider when assessing maternal deaths, including obesity, mental health issues, substance abuse and homicide.

This information fuels analysis that goes well beyond what’s in death certificates, said Amy Raines-Milenkov, an associate professor at the University of North Texas Health Science Center and longtime maternal health scholar-practitioner. Based on this information, Texas expanded nurse home visits to post-partum mothers that’s similar to Indiana’s initiative.

“What we choose to measure is what we value in society,” Raines-Milenkov said.

Maternal health advocates say they’re working together to bring national attention to the potential funding threat to ERASE MM. Griffen, the executive director of the Maternal Mental Health Leadership Alliance, said she’s hopeful with more meetings on Capitol Hill that a solution can secure the program.

Women’s lives depend on it, she said.

Kavitha Surana contributed reporting. Mariam Elba contributed research.

This post was originally published on ProPublica.

by Anjeanette Damon

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.

They went to a Las Vegas conference this month that promised pathways to an “unlimited lifespan.” But at least two attendees left in ambulances and were hospitalized in critical condition, requiring ventilators to breathe.

The two women, who are recovering, fell ill after receiving peptide injections at a conference booth. The doctor who ran the booth was a Los Angeles physician specializing in “age reversal” therapies who did not have permission to practice medicine or dispense prescriptions in Nevada. Public health investigators are trying to determine if anyone else who attended the Revolution Against Aging and Death Festival experienced a similar illness.

The investigation comes as peptides grow in popularity, thanks in part to Robert F. Kennedy Jr.’s promotion of the amino acid chains as a way to fight aging and chronic disease. Since becoming Health and Human Services secretary, Kennedy has vowed to end the Food and Drug Administration’s “war on peptides” and other alternative health therapies. Kent Holtorf, the doctor overseeing the booth where the women became ill, also has called for less regulation of alternative therapies and has criticized the FDA for blocking compounds he sees as lifesaving.

Holtorf told ProPublica he is cooperating with the investigation. “Of course, I want to get to the bottom of it. But almost assuredly it will come out that it was not the peptides.”

He said he became convinced the peptides weren’t the cause of the severe reactions after plugging everything he knows about the incident into an artificial intelligence app, which he said gave him a 57-page report that “basically says that it is impossible it was the peptides.” He refused to comment on what the report attributed the illnesses to.

“I don’t think it was the peptides, but I don’t want to try and push the blame and say it wasn’t us,” he said. “We are reassessing everything we are doing.”

Holtorf acknowledged he is not licensed in Nevada but said he hired a practitioner who is and did not personally write prescriptions or administer therapies at his booth. “I knew what was going on but was not hands on,” he said.

He described the situation as “horrific” and “unacceptable” and said he’s “terribly sorry.”

The FDA has approved dozens of peptide-based medications for treating serious health problems such as cancer, obesity and diabetes. But peptide therapies for anti-aging and regenerative health are largely made by compounding pharmacists who use peptide components to formulate drugs that aren’t commercially available or approved for that particular use. Compounded drugs are not reviewed for safety and efficacy by the FDA. The agency also has found “significant safety risks” with at least 18 of the most popular peptide compounding components.

“Anyone who undergoes any sort of medical treatment, no matter how benign, needs to be very wary that even the most benign intervention can have fatal side effects,” said Dr. Amy Gutman, a Florida emergency room doctor who speaks about metabolic research and ketogenic diets and appeared at RAADFest. “And if you are in a hotel and don’t have lifesaving equipment near you, then that is a risk you have to be aware of.”

The two women, a 38-year-old from California and a 51-year-old from Nevada, received injections on July 13 at RAADFest, which is organized by an Arizona-based nonprofit that has built a community hoping to cheat death. According to a police report, both were injected at a booth run by Holtorf, who is licensed in California but not Nevada. Holtorf’s advocacy for alternative therapies has invited controversy in the past, including his criticism of the H1N1 swine flu vaccine in a Fox News interview in 2009. More recently, his practice was advised by the Federal Trade Commission to cease making claims on its website that his peptide therapies could treat or prevent COVID-19. Holtorf said he removed the claims from his website even though he still believes certain peptides can be beneficial in treating COVID-19 and other viral infections.

Both the Southern Nevada Health District and the Nevada Board of Pharmacy confirmed they are investigating what led to the hospitalizations after being notified by the Las Vegas Metropolitan Police that possibly as many as seven people at the conference were hospitalized. According to the police report, detectives were unable to confirm whether additional attendees got sick.

Investigators are examining whether the illnesses were caused by an infection, contamination related to the injections or an issue with the medication itself, according to documents obtained by ProPublica. The two women who were taken by ambulance to the hospital reported feeling as if their tongues were swelling and had trouble breathing and increased heart rates. By the time they reached the hospital, one was already intubated and the other had lost muscle control in her neck and couldn’t open her eyes or communicate with doctors, according to the police report.

Holtorf said he was “so freaked out” by what happened because none of the women’s symptoms “made any sense.” In 30 years of providing such treatments, he said he’s never seen such a reaction.

Event organizer James Strole, an Arizona businessman who has built a 50-year career selling the promise of eternal life to followers, said the two patients are recovering after several days in the hospital. He said “it’s not clear the people got sick as a result of treatment from Dr. Holtorf,” adding he’s “anxious” for the illnesses to be “deeply investigated.” He said nothing similar has happened in the 10 years he has been producing RAADFest.

This is the first year Holtorf offered therapies at the conference, Strole said. He added that Holtorf provided the therapies to 60 people at the event and has attempted to reach them to learn whether they experienced any problems. Holtorf said only six patients received peptides.

Strole said the coalition’s science board scrutinizes therapy providers before granting them permission to operate a booth in the conference’s exhibition hall, which organizers referred to as a clinic.

“The big concern is safety,” he said. “We look at who is doing the administering, whether it’s an injection or supplement. We look at the person and the company itself, what the efficacy is, how they operate, their safety measures. We look at all that.”

Strole said peptides are considered “generally safe” when taken under the direction of a doctor, adding that he takes them regularly. Holtorf also said he believes they are safe and that they saved his life when he was a young man suffering from a severe illness.

A review by ProPublica of both the pharmacy and medical board license databases showed no Nevada licenses for Holtorf or his medical practice. Out-of-state doctors who come to provide care at a conference such as RAADfest are required to obtain a special event license from the Nevada Board of Medical Examiners. (As of Friday, 103 doctors had obtained such a license.) To dispense or possess pharmaceuticals, practitioners must also be licensed by the Nevada Board of Pharmacy. RAADFest’s organizers, however, said they were unaware that Holtorf is not licensed to provide medical care or dispense medications in the state.

“In order to practice medicine in the state, you must be licensed,” said David Wuest, executive secretary of the Nevada Board of Pharmacy.

The Nevada Legislature has passed stricter laws as alternative therapies have become popular outside traditional medical settings. In 2017, for example, the state banned so-called Botox parties, requiring the anti-wrinkle injections only be administered in a medical office or spa equipped to deal with life-threatening emergencies. But beyond its standard medical licensing requirements, the state doesn’t have rules governing an event like RAADFest, where attendees receive an array of anti-aging therapies including gene therapies, peptide injections, dialysis-like blood detoxification, bone scans and light therapy.

Strole said he wasn’t aware that providers need a special in-state license to provide the type of therapies Holtorf offered, which he described as “neutraceuticals.”

“I’ve never heard they had to get from the state permission to do that under the auspices of giving a treatment of that nature, that’s not actually treating some disease or something,” Strole said.

According to the police report, Holtorf contracted with a Nevada-licensed nurse practitioner, who administered the injection to one of the women. He also contracted with another doctor, who mixed the vials and administered the injection to the second woman, the report said. That doctor does not appear to have the necessary Nevada licenses.

Holtorf declined to comment on the practitioners he hired for the event, other than to say he had worked with the doctor in the past.

Wuest said multiple providers might be investigated, but he wouldn’t confirm whether Holtorf is a subject of the probe. The board also is investigating whether the therapy provided to the patients required a medical or pharmaceutical license. The FDA is assisting in the investigation to determine what was in the injections, including whether it was a manufactured pharmaceutical or a compounded medication, Wuest said.

Holtorf’s medical practice and the peptide company he founded are affiliated with an organization, Forgotten Formula, that asserts a constitutional right to provide treatments as they see fit. On its website, the private membership association warns “all bodies in the public sector” that they “do not have any jurisdiction” over their doctors. “All doctors, healers, and members are protected under the shield of this organization,” the website says. “We operate member to member. Ignoring this disclaimer can lead to legal consequences against the party at fault.”

According to the police report, Holtorf told officers he obtained the peptides dispensed at the festival from Forgotten Formula. In the interview with ProPublica, however, he denied that, saying he’s not sure which of the many manufacturers he works with provided the peptides used at the booth.

The women received different peptide concoctions, according to the police report. Both included at least one component described by the FDA as posing significant risks when compounded. Holtorf said it is difficult to keep up with which peptides are banned and which are still acceptable for compounding.

“There is so much gray area,” he said. “People know they just get patients better.”

Despite the FDA warnings, peptides were popular among RAADFest attendees who were promised “beautiful life-saving therapies” at the event’s clinic. Event organizers touted that 70 longevity experts would be on hand during the four-day event at the Red Rock Casino Resort Spa but did not list the vendors providing treatments on the event website.

“We have a RAAD clinic, where people will be able to come in at discounted prices and try and do these therapies safely with doctors,” Strole told a Las Vegas TV news program while promoting the event.

Strole is executive director of the Scottsdale, Arizona-based Coalition for Radical Life Extension, one of a cluster of for-profit and nonprofit entities devoted to helping people achieve immortality founded by Strole and two “immortalist” business partners. Of the three co-founders, only Strole, who is in his 70s, is still alive.

Charles Brown, the original founder, claimed to have had a spiritual experience in the 1950s that showed him the path to immortality and proclaimed he could share that path with others, according to an Arizona Republic story. Brown died of Parkinson’s disease in 2014. His wife, Bernadeane “Bernie” Brown, who operated the for-profit People Unlimited with Strole, died of breast cancer in 2024. Her body is said to have been cryogenically preserved.

The nonprofit organizes the annual anti-aging festival, which charges more than $400 for a ticket, while People Unlimited offers monthly memberships for as much as $255 a month, according to its website. Members get access to weekly meetings, where Strole delivers motivational sermons on immortality and age reversal, as well as talks by guest speakers on wellness, discounts on “longevity protocols” and access to a community of people who “want you to live as much as they want to live.”

Gutman, the Florida emergency room doctor, spoke at the event earlier this month, her first time attending RAADFest. She left before the last day, when the two women were hospitalized, and hadn’t heard about the incident before a reporter called. But she said their symptoms — swollen tongue, trouble breathing, increased heart rate — sounded like an allergic reaction, which she said isn’t terribly common in peptide injections. But she cautioned that before injection the drugs are mixed with an agent that can sometimes pose problems.

Although she was skeptical of some of the therapies provided at the festival’s clinic, she said everyone she met there seemed to have “their heart in the right place” and genuinely wanted to help others “live their best lives.”

This post was originally published on ProPublica.

by Patricia Callahan

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

The Food and Drug Administration is cracking down on a generic drugmaker that was the subject of a ProPublica investigation last year, citing problems with safety tests that delayed the recall of a medicine linked to deaths in the U.S.

In December, ProPublica reported that a Glenmark Pharmaceuticals factory in central India was responsible for an outsized share of recalls for pills that didn’t dissolve properly and could harm American patients. Among the string of recalls, federal regulators had determined that more than 50 million potassium chloride extended-release capsules sold in the U.S. could be deadly. Yet, federal drug inspectors at that point hadn’t set foot in the Madhya Pradesh factory for more than four years, ProPublica found.

Seven weeks after that story was published, FDA inspectors showed up at the plant and found serious problems. Glenmark subsequently recalled an additional two dozen medicines made there and sold to U.S. patients.

Now the FDA has sent Glenmark a warning letter, a disciplinary tool the regulator uses to lay out significant violations of federal requirements and demand changes. If Glenmark fails to fix any of the problems outlined, the FDA warned, it may bar drugs made at the factory from entering the U.S.

What’s more, the FDA pointed out that the company had made similar serious mistakes at three other manufacturing sites and acknowledged that those factories had been the subject of previous warning letters from the agency since 2019. The problems at one were so severe that federal regulators blocked drugs made there from being imported to Americans. ProPublica’s December investigation highlighted this pattern, noting that three of the five factories where Glenmark made drugs for the U.S. market in recent years had been in trouble with federal regulators. Despite that track record, the FDA — backlogged from the pandemic — waited five years before sending its inspectors back to the Madhya Pradesh plant.

In his July 11 warning letter, the director of the FDA’s Office of Manufacturing Quality wrote, “These repeated failures at multiple sites demonstrate that management oversight and control over the manufacture of drugs is inadequate.” (The agency made the letter publiclast week.)

“You should immediately and comprehensively assess your company’s global manufacturing operations to ensure that systems, processes, and the products manufactured conform to FDA requirements,” he added.

A spokesperson for the company said in a written statement: “Glenmark is actively engaging with the U.S. FDA and has initiated corrective actions to address the agency’s observations. Patient safety, product quality and regulatory compliance are foundational to how we operate.”

Citing ongoing litigation the company faces, she declined to comment further.

ProPublica has been investigating the FDA’s oversight of foreign factories that make generic drugs for the U.S. market.

Since last year, ProPublica repeatedly has asked the FDA why it didn’t send inspectors to the Glenmark factory sooner, given the outsized share of recalls and the company’s troubled track record at its other plants. The agency hasn’t answered the question. After the inspection found problems this year, an FDA spokesperson said the agency can only discuss potential or ongoing compliance matters with the company involved.

Among the most serious violations outlined in the FDA letter to Glenmark was the company’s failure to promptly test pills to ensure they dissolve properly during their normal shelf life, the subject of ProPublica’s investigation last year.

Companies hold on to samples of pills from batches sold to U.S. customers and test them periodically until they reach their expiration date. Medicines that don’t dissolve properly can cause perilous swings in dosing. This flaw is what made Glenmark’s potassium chloride pills potentially deadly since high potassium levels can stop the heart, according to the June 2024 recall notice.

Glenmark’s backlogged testing “was overdue by 3 months or longer for a large proportion of your samples,” the FDA wrote in the warning letter. The failure to perform these tests on time held up Glenmark’s discovery of defective pills and delayed the needed recalls, the agency said.

In multiple instances, the FDA found that it took 100 days from the time Glenmark pulled samples of potassium chloride for testing until the company learned the capsules had failed to dissolve correctly.

A delay in that recall could factor into a lawsuit that alleges Glenmark’s potassium chloride pills were responsible for the death last year of Mary Louise Cormier, a 91-year-old Maine woman. A letter alerting Cormier that her pills had been recalled arrived three weeks after she died. In court filings, Glenmark has denied responsibility for her death. The company stopped making the drug for U.S. patients.

Between July and December last year, Glenmark told the FDA that it had received reports of eight deaths in patients who took the recalled potassium chloride, federal records show. The reports, which companies must file so the FDA can monitor drug safety, contained so few details that ProPublica was unable to independently verify what happened in each case. In general, these adverse event reports reflect the opinions of those who filed them and don’t prove that the drug caused the harm, the FDA says. The agency didn’t mention these deaths in the warning letter.

The FDA lambasted Glenmark for failing to thoroughly investigate why pills made at its Madhya Pradesh factory weren’t dissolving properly. The agency listed possible reasons that Glenmark failed to consider, but FDA censors redacted so many passages — citing the protection of trade secrets and confidential business information — that it’s impossible to discern what could have gone wrong.

Citing the same confidentiality provision, the FDA kept secret the name of another Glenmark drug that the agency said failed these same tests. When asked why consumers shouldn’t be told which medication had the problem, the FDA didn’t answer.

More broadly, the FDA’s warning letter criticized Glenmark for failing to validate the tests it relies on to prove that its drugs have the identity, strength, quality and purity that they’re supposed to have.

“Without evaluating the validity of methods, you lack the basic assurance that your laboratory data accurately reflects drug product quality,” the FDA wrote.

This post was originally published on ProPublica.