by Jessica Schreifels, The Salt Lake Tribune

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

Utah legislators this session took aim at life coaches who harm their clients’ mental health, but the law that the governor signed Wednesday stops short of prescribing minimum standards or ethical guidelines for the burgeoning profession.

Anyone can call themselves a life coach, which, unlike being a mental health therapist, does not require any kind of education, training or license.

In Utah, one state agency found that dozens of life coaches are advertising their ability to treat mental health issues even though the vast majority are not trained or permitted to work as therapists. State licensors say they field an average of one complaint each month about life coaches.

The new law strengthens existing regulations that forbid anyone who isn’t a licensed therapist from treating mental health conditions. By clearly defining what only therapists are allowed to do, licensors can more readily cite and fine life coaches who treat mental health, according to state Sen. Mike McKell, the bill’s sponsor.

But the new law does not designate any money to immediately hire more investigators to probe potential problems.

An investigation last year by The Salt Lake Tribune and ProPublica showed that about a third of the 43 Utah therapists whose licenses had been revoked or denied since 2010, or who allowed their suspended licenses to expire, appear to have continued to work in the mental health field. Some rebranded as “life coaches.”

McKell said the new law targets life coaches who had lost their therapist licenses because the state deemed them unsafe to work with patients.

Utahns have struggled to get mental health help, largely due to a shortage of available therapists, according to a recent report from the Utah Behavioral Health Coalition.

In that gap, life coaching has emerged as an unregulated alternative, according to the Utah Office of Professional Licensure Review. At the request of lawmakers, the state office studied life coaching and whether it should be licensed, and found that Utah life coaches advertise using more than 100 titles, including “executive coach,” “relationship specialist” and “soul-sourced consultant,” according to a November 2024 report.

State researchers looked at online advertisements for roughly 220 Utah life coaches and concluded that about 40% may be offering therapy. These coaches say they specialize in addressing mental health struggles, the state found, with some claiming the ability to “conquer” their client’s mental health conditions.

As part of the review, the state office also surveyed Utah’s therapists in an effort to better understand potential risks associated with life coaches. Of the more than 3,500 who responded, a third said they have had at least one client tell them that they were harmed by a life coach.

The state report quoted one unnamed therapist who described treating patients who had hired life coaches: “All 5 reported life coaches had them ‘deep dive’ into their trauma, which sent them into an emotional spiral and then did not provide them with any skills to cope with the emotional distress. 4 of them ended up being hospitalized with severe suicidal ideation.”

Sarah Stroup, a licensed therapist who is on the legislative committee for the Utah Association for Marriage and Family Therapy, said the new law is a starting point “in ensuring that Utahns are receiving ethical care.”

“Our goal from the beginning was to advocate for guardrails to be put in place so that life coaches weren’t providing mental health treatment,” she said, “and therapists who had lost their license couldn’t continue practicing under the guise of life coaching.”

A High-Profile Case of Abuse

Mental health professionals and some lawmakers have pushed for more stringent oversight of life coaches in Utah in the wake of the high-profile 2023 conviction of Jodi Hildebrandt, who is in prison for abusing the children of her life coaching business partner.

Hildebrandt was a licensed clinical mental health counselor, but she had removed references to being a therapist from her website and instead marketed herself as a life coach in the years prior to her conviction. One of her former clients previously told The Tribune and ProPublica that Hildebrandt had said she became a life coach as a way to get around the ethical rules therapists are required to follow. (Hildebrandt’s attorney did not respond to requests for comment.)

Kevin Franke, the father of the children abused by Hildebrandt and his ex-wife, has advocated for more oversight of life coaches since the two women were sent to prison. He said he thinks there should be a state registry where the public can see whether a life coach has had complaints made against them or whether they were ever disciplined, and he hopes the state will eventually mandate standards for life coaches, including a code of ethics.

Kevin Franke, right, has called for more regulations governing life coaches after his ex-wife and their life coach were sent to prison for abusing two of his children.

(Francisco Kjolseth/The Salt Lake Tribune)

“I’m particularly concerned with life coaches who effectively impersonate a therapist or present themselves as some cheaper alternative to a licensed mental health professional,” he said.

While Utah legislators last year floated the idea of requiring life coaches to be licensed— something no other state in the country has done — the new law does not take that step. Utah’s Office of Professional Licensure Review found that licensing life coaches would be challenging given the wide-ranging services they offer and the ambiguity of the titles they use.

The new law, however, clarifies that only licensed therapists can present themselves as having the skills, experience and training to address mental illness and “emotional disorders.”

McKell, the Republican who sponsored the legislation, said that by better defining in state law what a therapist can do, he hopes that licensors can more easily penalize life coaches who harm their clients.

“Instead of trying to create regulation for life coaching, I am drawing this fence around mental health and what mental health professionals do at the exclusion of everyone else,” McKell said.

But some have questioned how effective the new law can be, given the small amount of money that is likely to be allocated to the effort.

The law creates an enforcement fund that will be collected from fines that the state’s licensing division issues to anyone who practices mental health therapy without a license. McKell said the fund signals to licensors that the Legislature wants them to take this issue seriously.

But previous reporting from The Tribune and ProPublica shows these types of citations are rare and unlikely to generate significant revenue: Over the last decade, the licensing department has cited just 25 people for “unauthorized practice” in the mental health field, according to a review of citations and other records. Those citations amounted to just over $10,000.

And last year, while licensors cited nearly 1,000 people, not a single new citation was given to anyone identified as working in the mental health field, according to a review of citations published monthly.

Melanie Hall, spokesperson for the Division of Professional Licensing, acknowledged that the law does not guarantee an influx of resources but said even a small amount of money could help fund social media campaigns to encourage the public to report bad behavior. If the fund grows larger, she said, that money could be used to conduct more investigations or pay for experts to weigh in on complex cases with high public harm.

At the same time, some Utah life coaches say the bill has already gone too far and could restrict their ability to help clients.

Heather Frazier, who advertises her expertise as a “parent-teen connection life coach,” said in a public hearing that restricting the treatment of “interpersonal dysfunction” to just therapists risks putting life coaches out of business. Life coaches can help struggling clients who don’t have a diagnosed mental illness learn how to better communicate with family members, she said.

“Without coaching, they will have to go to a therapist, which is already an overburdened, overworked part of our state,” Frazier said.

by J. David McSwane, ProPublica, and Mara Silvers, Montana Free Press

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

Since at least April 2021, the Montana medical licensing board has had evidence, including thousands of pages of patient files and medical reviews, that Dr. Thomas C. Weiner, a popular Helena oncologist, had hurt and potentially killed patients, ProPublica and Montana Free Press have learned. Yet in that time, the board renewed his medical license — twice.

Weiner directed the cancer center at St. Peter’s Health for 24 years before he was fired in 2020 and accused of overprescribing narcotics, treating people who didn’t have cancer with chemotherapy and providing substandard care. Weiner, who has denied the allegations, was the subject of a December ProPublica investigation, which revealed a documented trail of patient harm and at least 10 suspicious deaths. Many of the records cited in the story had been in the medical board’s custody for nearly four years, St. Peter’s recently confirmed.

The Board of Medical Examiners renewed Weiner’s medical license in March 2023 and this month, authorizing him to treat patients and prescribe drugs. While lawyers for the state agency that oversees the medical board collected records from the hospital under subpoena, including medical reviews that criticized Weiner’s care, that inquiry languished at the staff level, according to one current and one former board member. It’s unclear why Weiner’s case was not elevated to the governor-appointed board members.

Sam Loveridge, a spokesperson for the Department of Labor and Industry, the board’s umbrella agency, did not answer a list of emailed questions, including whether the records provided by the hospital were reviewed by members of the board.

Kathleen Abke, a lawyer representing St. Peter’s, told ProPublica and Montana Free Press that the hospital initially surrendered to the licensing board 160,000 pages of documents relating to the care of 64 patients; the state received those records in early 2021, just months after Weiner was fired.

As part of the subpoena, St. Peter’s supplied the medical records of Scot Warwick, whom Weiner diagnosed with Stage 4 lung cancer in 2009. Even though there had not been a lung biopsy to confirm that Warwick had the disease, Weiner proceeded to give him chemotherapy and other treatments for 11 years. After Warwick died in 2020, an autopsy — which St. Peter’s said it gave to the medical board — found no evidence of cancer. Weiner maintained the patient had terminal cancer for 11 years and said a pathologist and post-mortem medical examiner missed the disease.

Lisa Warwick, Scot’s widow, sued St. Peter’s for his wrongful death and settled for an undisclosed amount. Warwick learned from ProPublica and Montana Free Press this month that the state had her husband’s records and other evidence for years. She called the situation “appalling.”

“I would just like to know what information they’re reviewing that sways their determination to renew this man’s license,” she said. “Because if they are truly doing their job and are reviewing these things and looking at all the cases that have been brought forth — the people who have died, the circumstances under which they died — there is no way they can justify renewing this man’s license.”

Anthony Olson, another Weiner patient who inappropriately received chemotherapy for nearly a decade, expressed shock when he learned Montana regulators had information about his case as early as 2021. Three biopsies confirmed that Olson never had cancer, according to court and medical records. That chemo created severe health complications for Olson.

“So they just really don’t care?” Olson asked. “It gives me the shakes. My heart’s racing, and I literally don’t know what to feel right now.”

Weiner blamed other doctors for Olson’s misdiagnosis but acknowledged he received toxic treatments “needlessly.”

In Montana, medical licenses are up for renewal every two years. A few months after the board renewed Weiner’s license in 2023, its staff subpoenaed the hospital for additional records. Abke said St. Peter’s provided the board with thousands more internal documents and medical reviews. Yet, she said, no one from the hospital was called by the board to testify about Weiner’s practices.

St. Peter’s confirmed that the second tranche included the medical records of Nadine Long, a 16-year-old girl who, court and medical records show, died in 2015 shortly after Weiner ordered the injection of a large amount of phenobarbital, a powerful sedative. Weiner has denied wrongdoing in the case. Maintaining that the girl’s condition was terminal, he said he was providing comfort.

St. Peter’s also reported Weiner’s removal to the National Practitioner Data Bank and alerted the federal Drug Enforcement Administration to his alleged narcotics practices, according to records and interviews.

“We provided information to every entity that had the ability to do something about this,” Abke said. “St. Peter’s took these allegations extremely seriously.”

Dr. James Burkholder, a member of the medical licensing board from 2016 to 2023, told ProPublica and Montana Free Press that Weiner’s name “never came up” during board deliberations. Burkholder, a retired family doctor from Helena, said he’s certain the case didn’t reach the board level because he knows Weiner professionally and would have recused himself. He also served on the screening subcommittee that would have first reviewed the state’s investigation into Weiner and passed it up to the full board to be adjudicated.

Dr. Carley Robertson, a current board member, said she’s never heard of Weiner.

It’s unclear how many complaints have been filed against Weiner, as the medical board keeps information about cases that weren’t substantiated secret. ProPublica and Montana Free Press confirmed that at least one licensing complaint against Weiner, filed in 2021, was pending for three years before being dismissed in December.

Marilyn Ketchum’s husband died while under Weiner’s care. After reviewing her husband’s medical records, she took her concerns about Weiner to the medical licensing board. (Melyssa St. Michael for ProPublica)

A few months after reading local news reports about Weiner being fired by St. Peter’s, Marilyn Ketchum decided to act on concerns about her husband, Shawn Ketchum, who died back in 2016 while under Weiner’s care. After reviewing his medical records, she told the board that Weiner altered her husband’s code status without permission. If his heart stopped, he wanted to be a full code, she said, meaning he wanted to be resuscitated. Instead, when he was rushed to the hospital, Weiner maintained that Ketchum was a DNR/DNI — do not resuscitate and do not intubate — his medical records show. Ketchum died without intervention soon after, according to the records.

In its internal reviews of Weiner’s care, St. Peter’s alleged that unilaterally changing patients’ code status was a “standard practice” of his, which it called “a serious violation of the standard of care and medical ethics.” Weiner did not respond to questions about Ketchum’s case and has denied that he ever changed a patient’s status without permission.

Ketchum, who now lives in Arkansas, said a state employee did not interview her until two years after she made a complaint against Weiner’s license. “I was on their ass to do something about it,” Ketchum said, emailing or calling someone from the labor department “every couple of weeks.”

In a letter sent in late 2024, the board provided no explanation for why it had dismissed her complaint.

Weiner has said he’s not currently treating patients because he can’t get malpractice insurance.

Following the ProPublica investigation published in December, the Montana Department of Justice launched a criminal inquiry into Weiner, according to three people with direct knowledge of the case. Weiner has not been charged with a crime. In separate cases last year, the U.S. Department of Justice sued Weiner and the hospital, alleging they defrauded federal health care programs. The hospital settled for $10.8 million. Weiner has denied the allegations through an attorney and petitioned the court to dismiss the case.

Last month, Weiner lost an appeal of a yearslong court battle over his firing. The Montana Supreme Court ruled that the hospital’s actions were “reasonable and warranted due to the quantity and severity of Weiner’s inappropriate patient care.”

Still, since Weiner’s firing, many Helena residents continue to defend him, including by funding billboards that proclaim “WE STAND WITH DR. WEINER.” Weiner’s supporters, often citing his renewed medical license, have accused the hospital of orchestrating a smear campaign against a dedicated oncologist. Since the winter of 2020, they’ve held protests outside of the hospital.

Abke said many St. Peter’s employees are exhausted by the blowback from Weiner’s supporters and are working to regain trust in Helena. Asked about concerns that the hospital unfairly targeted Weiner, Abke said, “No hospital would want to take the financial, the PR, the personal hit for no reason.”

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 has found problems at an Indian factory that makes generic drugs for American patients, including one medication that was manufactured there and has been linked to at least eight deaths, federal records show.

The agency inspected the factory after a ProPublica investigation in December found that the plant, operated by Glenmark Pharmaceuticals, was responsible for an outsized share of recalls for pills that didn’t dissolve properly and could harm people. Among the string of recalls, the FDA had determined last year that more than 50 million potassium chloride extended-release capsules had the potential to kill U.S. patients.

Still, ProPublica found, the FDA had not sent inspectors to the factory in Madhya Pradesh, India, since before the COVID-19 pandemic.

When FDA inspectors went to the Glenmark plant last month — five years after the agency’s prior inspection — they discovered problems with cleaning and testing that they said could affect medicines that were shipped to American consumers.

In a report detailing their findings, the inspectors wrote that Glenmark failed to resolve why some medicines weren’t dissolving properly, and they raised concerns about the factory’s manufacturing processes.

“Equipment and utensils are not cleaned at appropriate intervals to prevent contamination that would alter the safety, identity, strength, quality or purity of the drug product,” the inspectors wrote.

The FDA redacted large swaths of the inspection report, making it impossible to tell whether inspectors uncovered the reason for the pills not dissolving correctly or which Glenmark drugs sitting in American medicine cabinets were potentially at risk of contamination.

ProPublica obtained the report through the Freedom of Information Act. To justify censoring the document, an FDA attorney cited trade secrets “and/or commercial or financial information that was obtained from a person outside the government and that is privileged or confidential.”

Health and Human Services Secretary Robert F. Kennedy Jr., who was sworn in the day before this inspection wrapped up, has vowed to bring “radical transparency” to his agency, which oversees the FDA. ProPublica asked the HHS media team whether Kennedy thinks the heavily redacted inspection record is in line with his transparency promise and whether he believes the names of drugs that inspectors raised safety concerns about are trade secrets. The media team did not respond.

An FDA spokesperson would not say why the agency waited so long to inspect this factory or what, if anything, federal regulators will require Glenmark do to fix the problems. “The FDA generally cannot discuss potential or ongoing compliance matters except with the company involved,” she wrote.

The FDA’s review of the Glenmark plant, she noted, “was a for-cause inspection, which can be triggered when the agency has reason to believe that a facility has quality problems, to follow up on complaints or other reasons.”

Drugs that fail to dissolve properly can cause perilous swings in dosing. Since Glenmark’s potassium chloride recall in May, the company has told federal regulators it received reports of eight deaths in the U.S. of people who took the recalled capsules, FDA records show. Companies are required to file reports of adverse events they receive from patients or their doctors so the agency can monitor drug safety. The FDA shares few details, though; as a result, ProPublica was unable to independently verify what happened in each of these cases. In general, the FDA says these reports reflect the opinions of the people who reported the harm and don’t prove that it was caused by the drug.

The family of a 91-year-old Maine woman sued Glenmark in federal court in Newark, New Jersey, last year, alleging the company’s recalled potassium chloride was responsible for her death in June. In court filings, the company has denied responsibility.

A spokesperson for Glenmark, which is based in Mumbai, declined to answer detailed questions about the inspection, citing the ongoing litigation. “Glenmark remains committed to working diligently with the FDA to ensure compliance with manufacturing operations and quality systems,” the spokesperson wrote.

Glenmark’s managing director told investors and analysts on an earnings call last month that 25% to 30% of its U.S. revenue comes from drugs made at its Madhya Pradesh factory.

Inspectors visited the factory between Feb. 3 and Feb. 14. Like all such reports, this one notes that the inspectors’ observations “do not represent a final Agency determination” about the company’s compliance with the FDA’s drug manufacturing rules.

Glenmark lacked proper cleaning procedures that prevent residues of one medicine from winding up in batches of the next pills produced with the same machinery, the inspectors found. While Glenmark rejected three batches when tests found cross-contamination, the inspectors said that the same equipment was used to make other drugs that were shipped to the U.S. Their report went on to list the “impacted batches,” but it is unclear what those drugs are because the next three pages are censored.

The FDA heavily redacted the first four pages of a report on its visit to a plant operated by Glenmark Pharmaceuticals. (Obtained by ProPublica)

ProPublica asked the FDA if the agency was testing any of these medicines for contamination. The spokesperson wouldn’t say and instead referred a reporter to an FDA website that shows past test results but does not include any for Glenmark products since the recalls.

Major production equipment is not decontaminated before the company uses it to make some drug products, a Glenmark vice president in charge of quality told the inspectors. It’s unclear what those drugs are because the FDA censored that part of the report.

The inspectors noted that Glenmark received two consumer complaints about adverse reactions to one of its drugs. When Glenmark investigated the complaints, the company failed to assess the potential problems that can occur when pharmaceutical products are manufactured using shared facilities and equipment, the report said. But the name of the drug and the type of potential contamination that inspectors worried about were not clear due to the FDA’s redactions.

Glenmark also didn’t get to the bottom of why some medicines made at the factory weren’t dissolving properly, the FDA inspectors found. The company’s investigations of some batches of faulty medicine didn’t identify specific root causes, and those that did pinpoint a reason weren’t adequately supported with evidence or didn’t explain all the data, the inspectors wrote.

The inspectors also raised concerns that some drugs made at the factory and the key ingredients that go into them “are routinely released by testing with analytical test methods that have not been adequately validated or verified.” The inspectors listed the ones that are currently on the U.S. market, but the FDA redacted the names of the drugs.

When Glenmark analysts’ tests found problems with a medicine, the company at times declared those results invalid and “retested with new samples to obtain passing results,” the FDA report said. “The batches were ultimately released to the US market.”

Glenmark has been the subject of FDA scrutiny for years. Since 2019, the agency’s inspectors have found major deficiencies at three of the company’s four other factories that have made drugs for American patients. The problems at one plant were so bad that in 2022 the agency barred medicines made there from entering the U.S.

The concerning string of recalls stemming from products made at the Madhya Pradesh factory in central India began in October 2023. Over the next 12 months, that single plant accounted for more than 30% of all FDA recalls for pills that didn’t dissolve correctly and could harm patients, a ProPublica analysis found.

The federal government often doesn’t make it easy for consumers to know where their medicines are manufactured. To identify this pattern, ProPublica had to match drug-labeling records from the U.S. National Library of Medicine with details in two FDA databases.

The majority of the factories making drugs for American patients are in foreign countries, but the investigative arm of Congress has repeatedly found that the FDA has too few inspectors to adequately oversee them.

This post was originally published on ProPublica.

by Audrey Dutton, ProPublica, and Kelcie Moseley-Morris, States Newsroom

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.

With a steady but urgent cadence, Dr. Jim Souza told reporters what would become one of the most cited talking points in a protracted legal fight over Idaho’s abortion ban: Without a court order protecting emergency room doctors from prosecution, his hospital system was sending patients to nearby states when certain pregnancy complications meant termination might be necessary.

It was April 2024. Souza said Boise-based St. Luke’s Health System had airlifted six pregnant patients in a span of four months to states where abortion was a legal treatment option in health emergencies. That happened once in all of 2023, a time when a court order kept Idaho from enforcing the ban in those cases.

Souza, the hospital system’s chief physician executive, said Idaho’s law was a looming threat to hospital workers and quality health care. St. Luke’s delivered about 41% of Idaho babies last year.

“Fear is the problem. Fear of prosecution,” Souza said at the time. “And even if it doesn’t occur, it doesn’t fix the jeopardy that is actively eroding our system of care.”

Less than a year later, St. Luke’s is the one major institution — other than advocacy groups — standing in the way of restrictions on emergency abortion care in Idaho, a state with one of the most absolute abortion bans in the country.

The Justice Department on March 5 dropped a lawsuit brought under President Joe Biden that claimed Idaho’s ban, which does not allow abortions to protect a patient’s health, violated a federal law mandating access to emergency medical care. St. Luke’s administrators, who made the same claim in their own lawsuit in January, vowed to press on. A temporary court order in the St. Luke’s case will allow emergency abortions to take place for now.

The abortion lawsuit is the latest controversial stance for a hospital system operating in a state whose political climate treats public institutions — hospitals, libraries, schools, health departments — not as the basic infrastructure of society but as ideological battlegrounds.

St. Luke’s defended its medical staff during the pandemic in 2020 and 2021, when residents objected to masks and vaccines. It took on Ammon Bundy, one of the state’s flagbearers of far-right extremism, whose followers protested against hospital employees caught up in a child welfare case involving the grandchild of one of Bundy’s friends.

St. Luke’s administrators declined to speak with States Newsroom and ProPublica for this story, citing the ongoing litigation.

Idaho Attorney General Raúl Labrador, who is defending against the abortion challenge, has accused health care providers of deliberately misconstruing the ban’s prohibitions. Labrador, whose career was built on being to the right of mainstream Republicans, also has said, without providing evidence, that the reason doctors are leaving Idaho is because they made “the vast majority of their money on abortions, or they wanted to live in a place that allowed abortions.”

The state lost 22% of its OB-GYN workforce and more than half the specialists who handle high-risk pregnancies in the 15 months after the Supreme Court abortion decision, according to a report from the Idaho Coalition for Safe Healthcare.

Odette Bolano, the former CEO of Saint Alphonsus Health System, a St. Luke’s competitor, said health care institutions have historically been reluctant to take on anything with political implications. They often stay neutral because they care for all patients regardless of politics.

But Bolano, who led the Catholic-based system for six years, said everything seems to have taken on political undertones in recent years. She said health systems now have to take difficult positions when they feel something keeps them from delivering safe care.

“The price in reputation — regardless of whatever stance you take and steps you take to safeguard patients, visitors and the community at large — could be significant. It could land you in a very bad place,” she said, “but values, integrity and ability to deliver on commitments have to take precedence.”

St. Luke’s Boise Medical Center (Otto Kitsinger for Idaho Capital Sun)

In a small state like Idaho, where the population just crossed 2 million, St. Luke’s is a behemoth. It has eight hospitals and ranks among the state’s largest employers, with a workforce of 18,000 and more than $4 billion in revenue.

It’s also a nonprofit and unaffiliated with any national chain or any church, despite its name.

During the COVID-19 pandemic, St. Luke’s took in a crush of critically ill patients. Some had ignored public health advice and listened to people who said vaccines were harmful — including a local pathologist who promoted COVID-19 vaccine skepticism and ineffective treatments, then won appointment to a public health board alongside Labrador.

Leading St. Luke’s through the pandemic turmoil was Chris Roth.

Roth joined the system in 2007. He led its Boise-area operations, worked as the system’s chief operating officer, then became CEO when his longtime boss retired in February 2020.

The next month, Idaho went into shelter-in-place mode with the rest of the world. Blaine County, anchored around the Sun Valley ski resort and a tiny St. Luke’s hospital, became one of the nation’s early COVID-19 hot spots.

Roth and other St. Luke’s leaders spoke out in support of public health measures while a small but loud contingent of Idahoans made a show of defying those measures: burning masks at the state Capitol, staging aggressive protests at the Boise region’s health department and showing up at the homes of that agency’s board members.

Souza, who worked as a critical care doctor and pulmonologist in addition to his leadership role at St. Luke’s, gave sobering warnings about the grave reality he saw in the hospital. In the lead-up to the 2020 holiday season, Souza went on a conservative talk radio show and urged listeners to heed public health advice.

When health care organizations including St. Luke’s announced they would require COVID-19 vaccines for employees, anti-vaccine groups set up protests outside hospitals and clinics belonging to St. Luke’s and others.

Roth described a sense of helplessness and anxiety in a 2021 interview with the Idaho Capital Sun: “We’re deeply concerned about our front-line caregivers, and they are just going through hell. Every day. And then they go out to the community, and it’s business as usual — rodeos, fairs, football games, debates in the school boards.”

He spoke of St. Luke’s doctors who faced laughter from the audience at a school board meeting when they described the scene inside hospitals. “It’s like we’re seeing the de-evolution of humanity, right in front of our eyes,” Roth said.

As the nation was starting to emerge from the pandemic in 2022, another source of anxiety arose for St. Luke’s and its hospital workers: Ammon Bundy. The flashpoint was the hospital’s role in a child protection case involving the infant grandson of one of Bundy’s friends.

After police responded to a child welfare report by the baby’s health care provider, the boy was taken to St. Luke’s, where a doctor determined he was malnourished and in need of care, according to the subsequent lawsuit by St. Luke’s and trial testimony. Bundy showed up at the hospital, demanding the baby be returned to his parents. (The baby was returned six days later. No one was charged with child abuse or neglect.)

Bundy was arrested there and later pleaded guilty to trespassing.

Bundy, a self-proclaimed defender against government tyranny, moved to Idaho from Arizona after prevailing against charges associated with the 2016 armed occupation of the Malheur National Wildlife Refuge office in eastern Oregon and a 2014 standoff over his father’s unpermitted use of federal lands for cattle grazing in Nevada.

During the pandemic, Bundy led a crowd that forced its way into the Idaho House of Representatives. He also founded the People’s Rights Network, an organizing apparatus for people with populist, anti-government and survivalist goals.

Bundy, his friend and their followers took to blogs and social media after the friend’s grandson was taken to St. Luke’s, and they coordinated protests outside the hospital, where they were joined by dozens of people, including far-right legislators.

Those protests came to a head one day when Bundy posted a now-deleted video urging people to go to the hospital and begin “making noise” because he believed the baby was about to be transferred to a foster placement and “we need to go back there and get this straightened out. … This is an emergency.”

Demonstrators showed up outside the St. Luke’s hospital in downtown Boise following Ammon Bundy’s calls for protest. (Idaho Capital Sun)

Court records say the hospital went on lockdown and sent ambulances elsewhere for an hour as an angry, armed crowd gathered outside. Callers flooded the switchboard and sent profane and threatening emails to hospital staff and executives. Roth would later read one of the emails from a protester aloud in court. It included antisemitic and homophobic slurs and said Roth was “getting strung up along with everyone else who is complacent in the medical tyranny.”

The hospital system and some of its employees, including Roth, sued Bundy, his friend and their associated commercial operations in May 2022, alleging defamation.

The lawsuit accused them of spinning lies that harmed St. Luke’s and its employees — whose names, photos and personal information spread online via Bundy’s allies and the People’s Rights Network.

Roth, in a court filing, said he worried that parents wouldn’t bring in their children for care if they believed St. Luke’s “secretly vaccinates children and engages in child trafficking.” Citing armed protests against St. Luke’s, Roth said it was important for the health system to stand up to bullying and intimidation.

“Inaction would signal that this type of behavior is acceptable in our community,” Roth wrote. “It is not.”

The baby’s grandfather answered St. Luke’s lawsuit by repeating, without evidence, his allegations against the health system.

Bundy told States Newsroom and ProPublica in a recent interview he personally didn’t make false allegations. He called someone else’s claim that St. Luke’s conspired to kidnap children “so ridiculous.” But in a still-public Instagram post, made while the lawsuit was active, Bundy accused St. Luke’s CEO of being “an accessory to child abduction.”

Bundy decided not to participate in the defamation case against him. For more than a year, he ignored the court proceedings and didn’t show up to the trial to offer a defense.

He thought the worst-case outcome would be a $50,000 default judgment, he told ProPublica.

He was wrong.

A jury rendered a $52 million judgment. Bundy and the People’s Rights Network were responsible for about half. His co-defendant filed an appeal, and the appeal request is pending.

Although Bundy did not appeal, his tangle with St. Luke’s wasn’t over. Bundy had a history of defying legal orders. After state officials barred him from the Capitol, police arrested Bundy multiple times for violating that order. After a court sentenced him to community service, Bundy tried to say campaign events during his failed bid for governor counted as service.

St. Luke’s was not going to let go of its courtroom win.

When Bundy sold his property to a friend so that St. Luke’s would have no claim to it, St. Luke’s sued Bundy again — and it now owns the property.

When he continued to defy court orders, St. Luke’s sought contempt charges. While Bundy was being arraigned, the judge threatened him with arrest if, once again, he failed to show up for a trial. Bundy didn’t show, and the judge issued a $250,000 misdemeanor warrant that remains active in Ada County.

Bundy moved to Utah and, in July, filed for bankruptcy.

Within days of the bankruptcy filing, St. Luke’s was on Bundy’s heels once more. The hospital system has since persuaded the bankruptcy court to order Bundy and his wife to show up and answer questions about their finances and assets.

Bundy has called St. Luke’s actions “lawfare.” When asked for comment on his actions since the defamation suit was decided, Bundy said, among other things, “Sounds like another hit piece.”

The public positions St. Luke’s took during COVID-19 and with Bundy were a precursor to its decision to take a stand on abortion as emergency treatment.

“St. Luke’s is here because we care about the pregnant patients in our community, and we want them to receive the emergency care that is available to anyone who presents to an emergency room,” Peg Dougherty, deputy general counsel for St. Luke’s Health System, said outside Boise’s federal courthouse last week.

Idaho’s trigger abortion ban was ready to go two months after the Supreme Court struck down Roe v. Wade’s protections of abortion rights in 2022. It criminalizes the termination of a pregnancy at any stage. Penalties include prison time, and the physician’s medical license can be revoked. There are exceptions for documented rape and incest or to save a pregnant patient’s life, but not to preserve the patient’s health.

Opponents say a health exception is essential in rare cases where emergency abortion is the best treatment option, such as when a patient’s water breaks before the fetus is viable. That can quickly cause a deadly infection.

In a brief to the Supreme Court describing one such case, an abortion rights group said the doctor, whom it did not name, decided it was necessary to wait until the patient’s condition was life-threatening before feeling legally permitted to end the pregnancy. The group described the experience as “traumatic for the patient and torture for the doctor.”

The Biden Justice Department sued the state in 2022. The agency alleged Idaho’s ban conflicts with a federal law, the Emergency Medical Treatment and Labor Act, requiring any emergency room that accepts Medicare to offer stabilizing treatment to every patient who comes through the door.

A series of shifting appeals and court orders in the case left emergency abortion care in Idaho legal, then illegal, then legal again since June. Anticipating that the Trump administration would drop the Biden-era challenge, St. Luke’s sued in January, seeking a new order while the case proceeds. Senior U.S. District Judge B. Lynn Winmill granted St. Luke’s request for a temporary order on March 5, keeping emergency abortions legal while Winmill considers a longer-term injunction.

Dr. Caitlin Gustafson, president of the Idaho Coalition for Safe Healthcare and a practicing family medicine obstetrician, said it is remarkable that St. Luke’s is willing to use its power so that patients and doctors don’t feel abandoned.

“The need for EMTALA isn’t going away no matter what administration is there, and we’re still stuck,” Gustafson said.

She also suspects the lawsuit could be a bulwark against further attempts by politicians and interest groups to dictate the decisions of health care providers.

Physicians and advocates in other states are watching.

Dr. Christopher Ford, an emergency room physician in Wisconsin, has seen the effects of an abortion ban on emergency care, when abortion was effectively prohibited in Wisconsin for 15 months.

“We had patients presenting with partial surgical or medical abortions who were very apprehensive to seek care,” Ford said. “We had very young patients from age 16, up to age 41 or 42, who were essentially septic and at incredible risk of mortality and morbidity.”

He said it seems atypical for a hospital system to take on a lawsuit of this nature, and he is glad to see it.

“It’s definitely a testimony to how important this is and how other hospitals should follow suit,” he said. “Just reading it from the outside looking in, the hospitals are getting involved as a last-ditch effort as the only way to advocate for their patients sitting in front of them.”

When health systems sue, it is typically over business matters. Individual doctors and patients are the usual plaintiffs in abortion cases, along with advocacy organizations like the Center for Reproductive Rights or Planned Parenthood.

For those reasons, St. Luke’s stands out.

“I think it’s a testament to them meeting the moment,” said Melanie Folwell, executive director for Idahoans United for Women and Families, which is organizing an abortion rights ballot initiative for 2026. “We are at an inflection point, and if they don’t act, who will?”

This post was originally published on ProPublica.

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.

Lincare, a giant respiratory-device supplier with a long history of fraud settlements and complaints about dismal service, is facing its latest legal challenge: a lawsuit that claims its failures caused the death of a 27-year-old man with Down syndrome.

The case, set to go to trial in state court in St. Louis on March 17, centers on the 2020 death of LeQuon Marquis Vernor, who suffered from severe obstructive sleep apnea and relied on a Lincare-supplied BiPAP machine to help him breathe while sleeping. The lawsuit, filed by his mother, accuses Lincare of negligence after the company took seven days to respond to her report that the device had stopped working.

Lincare, the largest oxygen-device supplier in the U.S., with $2.4 billion in annual revenue, has long faced an array of legal issues, but it’s rare for a claim of wrongful death linked to its service and equipment to go to trial. The litigation over what happened to Vernor offers an unusual window into the company’s interaction with a vulnerable patient. This account is based on extensive court filings, including medical records, deposition excerpts and Lincare’s internal “customer account notes.”

Vernor lived with his mother, who was 64 and on disability, in a tidy public housing apartment complex in Madison, Illinois, across the Mississippi River from St. Louis. He suffered from obstructive sleep apnea, a common problem among adults with Down syndrome that is often exacerbated by obesity. Just under 5 feet tall, Vernor weighed 280 pounds.

Since 2015, Vernor had relied on a BiPAP (or bilevel positive airway pressure) machine, which delivers pressurized air through a mask. The device was prescribed after the Sleep Medicine Center at Washington University in St. Louis found that he repeatedly stopped breathing while he slept. “His airway is extremely crowded,” his doctor wrote in his medical notes at the time. Vernor, who was on Medicare, regularly used the device for 10 to 12 hours while he slept, according to his mother.

He spent his days at New Opportunities, a local nonprofit that provides educational opportunities for people with developmental disabilities. “He was a happy young man,” said Kim Fears, executive director of the program.

On Sept. 11, 2020, Vernor’s BiPAP suddenly started making “a loud buzzing or humming sound,” according to his mother, Sharon Vernor. She called the local Lincare office to report the problem, telling the customer service representative that the breathing machine wasn’t working and that it was “something that he needed” and “could not go without.”

The Lincare representative told her that, because his machine was more than 5 years old, under Medicare rules her son was eligible for a replacement BiPAP but that Lincare would first need to obtain a new order from his doctor. This was required for Lincare to collect rental payments for the new device. The representative later recounted making a call that day to the doctor’s office that went unanswered, then faxing the office a request. (Lincare said it was unable to find a copy of the fax among its voluminous records related to LeQuon Vernor.)

In the meantime, the representative suggested unplugging the malfunctioning BiPAP for 30 minutes. That didn’t fix the problem. The representative then promised, according to the account notes, to have a company respiratory therapist contact Sharon Vernor about the problem “until we get him a new machine.”

But that never happened. No one from Lincare, which had an office about 20 minutes away, came out to fix the broken machine or assess LeQuon Vernor’s condition, according to testimony in the case. (Lincare hadn’t performed any home visits or maintenance on the BiPAP since 2015.) As the company acknowledges, Lincare also never offered to provide Vernor with a “loaner” BiPAP to use while waiting for a new device to arrive. Industry veterans say other companies commonly provide temporary replacements while a patient with a malfunctioning device waits for a repair or a new, permanent one to arrive.

Without his BiPAP, Vernor struggled to sleep (and breathe), snoring loudly throughout the night. The Vernors got no further word from the company until seven days later, on Friday, Sept. 18.

Late that morning, Lincare nurse Ann Marie Eberle called Vernor’s mother, explaining that she would be arriving later that day with his new BiPAP. The doctor’s order had finally arrived. Sharon Vernor prepared a breakfast of sausage and biscuits for her son, who hadn’t yet gotten up. She was surprised when he still didn’t appear; the smell of food usually roused him. About 2 p.m., she went upstairs to wake him up.

She opened the door to find her son motionless in bed, with bloody fluid and foam coming out of his mouth and nose. His body was cold. The broken BiPAP sat on the dresser nearby. Frantic, she called 911. “I think my son’s dead! Oh Lord, please God, NO!” she screamed. “Please hurry!”

An ambulance and police cars were still parked in front of the Vernors’ apartment when Lincare’s Eberle pulled up to deliver the new BiPAP machine. “It just gave you a sunken feeling when you saw that,” Eberle later testified. Sharon Vernor met her at the door in tears. Eberle’s notes state that she “SAT WITH MOTHER UNTIL FAMILY MEMBER ARRIVED. POLICE STILL PRESENT UNTIL CORONER ARRIVED WHEN I LEFT.”

An autopsy completed two days later for the Madison County coroner found LeQuon Vernor’s lungs were a “maroon” color, heavily “congested and edematous” — filled with fluid that made it difficult to breathe. The report attributed Vernor’s death to “complications of obstructive sleep apnea.”

In 2022, Sharon Vernor brought a wrongful death suit against Lincare and Washington University, now set for trial next week. Her case accuses Lincare of putting profits ahead of patient care by failing to make sure that her son got a replacement BiPAP quickly and refusing to provide “loaner equipment” in the meantime, because the company didn’t believe it could bill for it.

“In short, when faced with information that LeQuon’s bipap was not working properly, Lincare did nothing,” a December 2024 filing alleged. The company took no action for a week, even though “Lincare knew this was a life-or-death situation for their customer LeQuon.” Johnny Simon, the Vernors’ St. Louis lawyer, said that “this was an avoidable, horrific tragedy.” (Sharon Vernor declined an interview request.)

The suit also accuses the Washington University medical program of failing to respond “in a timely manner” to requests for a new BiPAP order. The clinic’s prescription for LeQuon Vernor’s new BiPAP was signed on Sept. 15 but not sent back to Lincare for two more days. The Washington University medical school declined comment through a spokesperson, citing the litigation. In a legal filing, the university denied the allegations in the suit.

ProPublica has reported extensively on Lincare, which has a decadeslong history of Medicare-related misconduct, including multiple settlements regarding claims of billing fraud. And that misconduct continued even while the company was under government “probationary” agreements requiring it to provide enhanced compliance oversight. On the Better Business Bureau’s website, 939 customer reviews give the company an average 1.28 rating out of 5, offering lacerating complaints about dirty and broken equipment, delivery delays, nightmarish customer service, improper billings, and harassing sales and collection calls.

In emailed responses to questions from ProPublica, Lincare offered its “sympathies” to the Vernor family but asserted that “the allegations against Lincare are false.” The company said that it is legally barred from providing even a loaner BiPAP until it receives a new prescription and suggested that it had no reason to believe LeQuon Vernor faced a life-threatening situation, because “a BiPAP is not a life-sustaining device.” The company added: “Lincare delivers a high level of care to millions of patients in a heavily regulated field. Our response to this case was consistent with legal requirements and our policies.”

Lincare’s lawyers went a step further in a February court filing, blaming what happened on an alleged failure by Vernor’s doctors to provide the new order promptly. “Lincare did its job,” the company argued. “The moment Lincare knew that Decedent needed a new machine, Lincare reached out to Decedent’s medical provider. However, Lincare did not receive an updated prescription until one week later.” The company, they added, was “at the mercy of Decedent’s medical provider to supply an updated prescription.”

Sharon Vernor’s lawyers dispute Lincare’s claim that it was barred from providing a loaner BiPAP without obtaining a new prescription. (A spokesperson for the Centers for Medicare and Medicaid Services declined to address the issue, citing a “pause on mass communications and public appearances” imposed by the new Trump administration.) LeQuon Vernor’s 2015 prescription, filled by Lincare, also specified that he had a “lifetime” need for a BiPAP.

Two former Lincare managers told ProPublica that they were discouraged from dispatching temporary replacement equipment; at least one manager instructed staff to falsely tell customers “all our loaners are out.” One said that, acting on orders from her supervisor, she tossed CPAP and BiPAP devices marked by local offices as loaners into dumpsters. The respiratory companies they later worked for, both said, routinely provided loaner equipment to patients who relied on a breathing device while they awaited a repair or a doctor’s order required to replace it. As one of them put it, “We would make sure the patient is taken care of in that moment.” (“Lincare’s policy is to provide loaner equipment to its patients in accordance with our patient care standards and regulatory requirements,” the company responded.)

In a deposition, Dr. Gabriela de Bruin, a Washington University neurologist who assessed Vernor’s sleep study in 2015, said allowing him to go a week without a functioning BiPAP posed a serious health risk, given the severity of his disease. Noting that Vernor had “severe sleep apnea,” she said, “Anytime we prescribe treatment for obstructive sleep apnea, our recommendation is that patients should use it nightly and should avoid being without their device if they can.” Asked whether Lincare should have understood that Vernor’s apnea created a risk of death, she said, “It’s very difficult for me to say there was this much risk that he could have died.” She added, “But certainly, I would be very concerned.”

A judge in the case dealt Lincare a setback on March 5, ruling that the evidence presented by Sharon Vernor’s lawyers had met the state’s legal standard for seeking punitive damages. That, he wrote, would allow a “trier of fact” to reasonably conclude that “Lincare intentionally acted with a deliberate and flagrant disregard for the safety of others.”

During deposition questioning, Pamela Karban, the manager of the Lincare outlet that handled LeQuon Vernor’s equipment, testified that “we should have referred the mom, if it was that serious, to take him to the nearest emergency room.” Asked whether the company was negligent for not providing Vernor with loaner equipment, she replied: “Yes. We failed to provide that.” Lincare subsequently submitted an affidavit, signed by Karban, stating that she didn’t understand the legal meaning of the term “negligence.”

Doris Burke contributed research.

This post was originally published on ProPublica.

by Audrey Dutton

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.

Idaho lawmakers are moving forward with modest efforts to improve the state’s system for investigating deaths, following reports by ProPublica and others that identified major problems. At the same time, counties are moving to shield from public view records that ProPublica relied on in its coverage.

“Before you today is a bill that is a long time coming, and I say that because over the course of decades, since the 1950s, there have been attempts to reform our coroner system,” state Sen. Melissa Wintrow told lawmakers on Feb. 26, in a nod to ProPublica reporting last year.

The Democrat’s bill would spell out new parameters that clarify a coroner’s role. Where current law says “suspicious” deaths should be investigated, the bill lists circumstances such as a suspected drug overdose or a death on the job. It also makes clear that a law enforcement investigation doesn’t take the place of a coroner’s investigation and that the two should happen in parallel. It requires autopsies to be done by a forensic pathologist, not another kind of doctor.

The legislation crossed its first hurdle last week when it passed in the Republican-controlled Idaho Senate with broad support.

Wintrow said coroners’ investigations must be done right.

“If you’ve seen some of the news reports lately, there are families that are upset because we have not consistently been doing this across our state,” she told lawmakers, “and it is imperative that we do that.”

Last year, a report commissioned by Idaho lawmakers highlighted faults in a system of elected coroners — a system dating to the 19th century — that is marked by limited training, almost no state funding and an absence of statewide standards. The report noted that Idaho ranks last among states for conducting autopsies in suspicious, unexpected and unnatural child deaths.

ProPublica later reported on two grieving parents’ experience with a coroner who did little investigation to identify what caused their baby’s death. ProPublica also used legislative and newspaper archives to pinpoint numerous warnings about Idaho’s coroner system and failed attempts to reform it going back more than 70 years.

What’s different this time is that coroners, a group that has opposed past efforts, drafted the legislation that Wintrow introduced. It’s been in the works since the February 2024 state report, by the Idaho Legislature’s Office of Performance Evaluations, that took aim at the coroner system.

But the proposed legislation does not address some of the key problems identified by the state watchdog agency or ProPublica’s investigation.

ProPublica’s review of hundreds of Idaho coroner reports found little consistency in what coroners did to investigate each death. Some coroners followed national standards; others didn’t. Some ordered autopsies in sudden infant deaths and unexpected child deaths; others didn’t. Other states spell out types of deaths for which an autopsy is required every time.

Idaho requires only 24 hours of training every two years, but ProPublica found that 1 in 4 coroners repeatedly fell short. Other states impose consequences for skipping required training.

Wintrow has tempered expectations about a rapid overhaul, saying her bill is not meant to be comprehensive. She called it a starting point that has the support of the Idaho coroners association.

“Is this the end-all, be-all bill? No, but it is the best start we have had, and will increase consistency in our state,” she said on the Senate floor.

Meanwhile, hearings on Wintrow’s proposal triggered an attempt by counties to wall off coroners’ records from public view in Idaho.

One man testified that his teenage daughter, who had epilepsy, died while taking a bath and that his grief was compounded by knowing investigators possessed photographs taken in her death investigation. In response, Wintrow said she asked the Idaho coroners and sheriffs associations for a way to keep such materials private.

(Although courts have ruled that the dead aren’t entitled to the same personal privacy protections as the living, a U.S. Supreme Court ruling found that the privacy interests of survivors justified withholding autopsy images from the public.)

It turned out that the Idaho Association of Counties had a bill ready to go. But rather than simply protecting photographs of bodies, the proposal would make the entirety of a coroner’s investigation exempt from open records law. All the public could see would be a name, age, gender, hometown and cause of death — not the underlying steps coroners take to reach conclusions.

Diamond and Alexis Cooley’s son Onyxx died in his sleep in February 2024 in eastern Idaho. Records from the coroner’s investigation revealed how little work was done before the coroner concluded Onyxx fell victim to sudden infant death syndrome. (Natalie Behring for ProPublica)

According to the association, the idea came from the coroner of Ada County, home to Boise. Rich Riffle, the Ada County coroner, told ProPublica that a county attorney drafted the proposal based on Riffle’s goal to have Idaho treat coroner records more like law enforcement records.

Police records are available for public inspection in Idaho, with exceptions, such as when police are still actively investigating a crime and releasing their records could imperil the case.

“Although we are separate and independent from law enforcement, that doesn’t mean we want to jeopardize a criminal case, and that’s essentially the bottom line,” he said in an interview Wednesday.

Last year’s state watchdog report also recommended lawmakers consider ensuring disclosure of coroners’ records doesn’t impede a criminal case or violate a family’s privacy. It did not specify creating a broad ban.

Ada County initially denied ProPublica’s request last year for coroner investigative records on the deaths of children, for whom Idaho conducts autopsies at a particularly low rate. Similar record requests went to nine other Idaho counties.

After months of negotiation, Ada County began providing heavily redacted records once ProPublica agreed to pay more than $880 for them.

In Bonneville County, which also resisted disclosure, such records revealed the coroner’s failure to follow national standards. The death of 2-month-old Onyxx Cooley, for example, was determined to be a sudden infant death — one with no explanation — after a terse, one-page report and no autopsy. The since-retired coroner, Rick Taylor, noted that state law didn’t set standards for investigations and said that he relied on an emergency doctor’s opinion.

Most coroners approached by ProPublica released their records after attorneys redacted information they said was protected by state law. Photos weren’t included.

In lending its support to exempting coroner records from disclosure last fall, the association of counties wrote: “While a person may be deceased, their reputation is still subject to harm. Next of kin may also be subject to harm by the release of their loved one’s private medical information, and sensitive information surrounding the circumstances of their death. Given these rights, there is limited public value in the release of detailed information in someone’s death.”

Wintrow saw the draft bill during this year’s legislative session and agreed to sponsor it. But the bill’s future is uncertain.

After fielding questions from ProPublica about the bill last week, Wintrow and a lobbyist for the counties said they want to revisit the legislation before they move forward.

Wintrow said she wants coroners to be treated like law enforcement when it comes to open records laws.

“My intention always as a lawmaker is to make sure there’s good balance with everything, so that privacy is maintained and the interest of the public is maintained as well,” Wintrow told ProPublica last week.

Kelli Brassfield, a lobbyist for the counties association, said, “After some discussion, it looks like the language may need to be amended. We are currently working on this.”

This post was originally published on ProPublica.

by Jeremy Kohler

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.

In an unprecedented move to funnel more public tax dollars toward groups that oppose abortion, Republican lawmakers in Missouri are advancing a plan to allow residents to donate to pregnancy resource centers instead of paying any state income taxes.

The proposal would establish a 100% tax credit, up from 70%, and a $50,000 annual cap per taxpayer. The result: Nearly all Missouri households — except those with the highest incomes — could fully satisfy their state tax bill by redirecting their payment from the state to pregnancy centers.

The move comes four months after Missouri voters reversed one of the nation’s strictest abortion bans, and just as clinics have begun performing the procedure again after overcoming Republican obstacles.

Supporters of the bill, which last month cleared a key legislative hurdle in the state House, say it gives taxpayers more control over where their tax dollars go and allows them to support organizations that help pregnant women and provide alternatives to abortion. Alissa Gross, CEO of Resource Health Services, which runs four pregnancy resource centers in the Kansas City area, told the committee in written testimony that tax credits have led to a surge in donations to her organization and that a 100% tax credit could bring in even more.

“Our ability to impact more men and women for life as well as build healthy families has been substantial,” she said.

Critics argue the state’s support for pregnancy resource centers, also known as crisis pregnancy centers, diverts tax revenue away from essential services such as health care and public education and becomes a funding stream for anti-abortion advocacy. They say many centers do little to actually help women; instead, they say they merely discourage women from getting abortions.

“A 70 percent tax credit with no cap was excessive. A 100 percent tax credit is absurd,” Katie Baylie, a lawyer and reproductive rights advocate based in the Kansas City area, wrote in testimony submitted to the committee. “It is an insult to Missourians that our lawmakers are spending time even considering this bill.”

Experts in tax policy and philanthropy said a dollar-for-dollar tax credit — for any purpose — is rare and could be much costlier for the state than intended, especially if pregnancy centers actively promote it.

There is a big psychological difference for donors between a 100% tax credit and a 70% credit, the experts said. At 70%, donors still have to pay some taxes, but at 100%, there is no reason to make a donation less than their tax liability.

“I could imagine a possibility where there’s a big publicity campaign by these centers, or a viral campaign, and massive numbers of conservative Missourians decide to effectively defund state government in favor of these pregnancy resource centers,” said David Gamage, a professor of tax law and policy at the University of Missouri law school.

However, expansion of tax credits clashes with another Republican push to eliminate Missouri’s income tax altogether. Two proposals to replace it with a higher sales tax recently advanced in the state Senate, although it was unclear whether they could pass. If Missouri were to abolish state income taxes, tax credits would become meaningless.

The bill represents one more expansion of a measure Missouri lawmakers have been growing for several years. Until 2021, Missouri taxpayers who donated to pregnancy resource centers were able to claim a 50% tax credit for their donations, meaning for every $1,000 in donations, a taxpayer’s bill dropped by $500. That’s when an expansion approved by the legislature in 2019 took effect and raised the rate to 70%. That shifted more of the cost of those contributions to the state, since tax credits work by directly reducing the amount of money a taxpayer owes to the state. Unlike deductions, which lower taxable income, tax credits are a dollar-for-dollar reduction in tax liability. When these credits are redeemed, they prevent the state from collecting that revenue, effectively reducing the total income available for public services.

The legislature also removed a $3.5 million-per-year cap on the program and removed its expiration date.

At the time, the change drew little attention because it was tucked into the same legislation that created Missouri’s trigger law to ban abortion if Roe v. Wade were overturned — a move that dominated headlines. And there were few warnings about how much it could cost.

The bill’s official cost estimate, prepared by nonpartisan legislative oversight staff, projected only a modest increase in taxpayer expense. Raising the tax credit to 70% was expected to increase annual tax credits from $3.5 million to $4.9 million. That estimate assumed donations would remain steady.

But they didn’t. The program has grown significantly, with $11.8 million in tax credits authorized in the past year alone. Still, it remains a small fraction of Missouri’s overall budget; Gov. Mike Kehoe has proposed a $54 billion spending plan for next year.

Once again, legislative research is downplaying the potential impact on Missouri’s budget. The fiscal note for the bill accounts only for the jump from a 70% to a 100% tax credit, without considering the likely surge in donations that such an incentive would trigger — even though increasing giving is the entire point of the policy.

The note says that it was “unclear” whether the enhanced tax credit would encourage more people to contribute and claim the credit, which would lead to more foregone tax revenue for the state.

The legislative research staffer who authored the impact statement declined to comment, and the bill’s House sponsor, Rep. Christopher Warwick, did not respond to questions from ProPublica.

Warwick, a Republican from Bolivar, in southwest Missouri, told the tax reform committee that his proposal empowers taxpayers to support important work without the state “trying to verify what programs work.” He said, too, that he would oppose requirements for pregnancy resource centers to report how they spend the money, saying he wanted to “limit the bureaucracy.”

Warwick’s bill would also increase the tax credit for donations to maternity homes from 70% to 100% and for diaper banks from 50% to 100%. The state has not yet studied the impact of those changes.

A matching bill has been introduced in the Senate but has not yet advanced.

Rep. Steve Butz, a Democrat from St. Louis, argued the tax credit would effectively shift charitable giving from individuals to the state.

“This will be the fourth bill I’ve heard that will reduce revenue, which I guess is clearly your goal here — to reduce the revenue to the state,” Butz told Warwick during a legislative hearing on the bill. He argued that if donors receive a full tax credit for their contributions, they aren’t really giving their own money — rather, the state is effectively making the donation for them. “So I don’t know that I’d consider that much charitable giving.”

In an interview, Butz said he considers himself pro-life and has donated to pregnancy resource centers, receiving the 70% tax credit. However, he said he does not believe the program should take priority over others that receive less or no tax incentives for giving.

Missouri’s approach to crisis pregnancy centers reflects a growing divide between red and blue states. While Republican-led states such as Florida, Texas and Tennessee have ramped up funding for pregnancy resource centers, states led by Democrats, including Massachusetts and California, have warned residents the centers mislead patients by posing as medical clinics while steering them away from abortion.

Missouri is among the national leaders in per capita spending on pregnancy resource centers even before tax credits are factored in, according to data from states that fund them. Kehoe has proposed increasing direct state funding by almost 50% to more than $12 million in the fiscal year that starts July 1.

In a statement, Gabby Picard, communications director in Kehoe’s office, said the governor “is committed to supporting services that help women choose to carry their unborn child to term, which is why his budget recommends increased funding” for abortion alternatives, including pregnancy resource centers.

Missouri was the first state to use tax credits to fund pregnancy centers, becoming a model for other states looking to support the anti-abortion movement. One public health expert who has tracked the impact of pregnancy centers said Missouri has been a leader and innovator in this effort. “What Missouri is proposing really makes them an outlier at the top of the game,” said Andrea Swartzendruber, an associate professor of epidemiology and biostatistics at the University of Georgia.

Warwick’s initiative follows sweeping changes to Missouri’s abortion laws.

In November, voters approved a constitutional amendment guaranteeing the right to abortion and other reproductive health decisions, effectively nullifying a near-total ban that had been in place since 2022, when the U.S. Supreme Court overturned Roe v. Wade.

The first abortion performed under the new amendment took place in Kansas City on Feb. 15, after a judge struck down restrictive licensing rules that had prevented providers like Planned Parenthood from resuming services in the state.

In response, Republican lawmakers have introduced a wave of bills aimed at limiting the amendment’s impact. Among the measures is another proposed constitutional amendment that would restrict abortion and ban gender-affirming care for minors — an effort to combine something that voters support with something they don’t in the hopes it’ll turn off abortion-rights supporters.

Some abortion-rights advocates in the legislature see the expanded tax credit as part of a broader push by anti-abortion lawmakers stung by the repeal of the abortion ban. After the amendment passed, those legislators “needed some wins,” said Rep. Kemp Strickler, a Democrat from the Kansas City suburbs.

“But even if the amendment had lost,” Strickler said, “they probably would have been coming forward with these kinds of things.”

This post was originally published on ProPublica.