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.

Josh Dallin spends his workdays talking to Utahns who raise cattle and grow crops, and knew that many were in distress. Everyone from neighbors to fertilizer dealers to equipment suppliers were telling him they were worried that a farmer or rancher they knew was at risk of suicide.

Then in 2023, with money allocated by Congress, Dallin had new help to offer: As executive director of an agriculture center at Utah State University Extension, he had scores of $2,000 vouchers that Utahns working in agriculture could use to get free therapy.

Dallin feared no one in the typically stoical farming community would take him up on the federally funded offer. He was wrong.

Farmers and ranchers across Utah quickly accepted the money, which ran out in just four months — well before he expected — and his office had to start turning people away. It convinced Dallin of the deep need in the state’s agricultural communities, and people’s openness to getting help when cost is not a barrier. “I want you to know,” he recalled one voucher recipient telling him, “that this saved my life.”

“It was heartbreaking,” he said, to have to put “the brakes on the program.”

The money for the vouchers was part of a one-time $28 million allocation sent to states to help Americans producing food handle the extra stresses of the coronavirus pandemic. Any state that applied to the U.S. Department of Agriculture was awarded up to half a million dollars — which was used to hold trainings, start hotlines staffed by mental health workers and, like in Utah, provide therapy.

With that funding now mostly spent, leaders in some states have tapped state funds or leaned on private donors to ensure mental health support continues.

Josh Dallin helped run a program that used federal money to connect Utah farmers and ranchers to free therapy. (Trent Nelson/The Salt Lake Tribune)

Utah has not — and, at least according to one legislator, has no intention to do so.

Republican state Sen. Scott Sandall, a third-generation rancher and farmer who is the Executive Appropriations Committee vice chair, criticized Congress for creating a program with a one-time boost of money, saying that without ongoing funding it was destined to fail.

“The way they set it up,” he said, “was eventually to have it go away.”

The Salt Lake Tribune and ProPublica reached out to Gov. Spencer Cox — himself a farmer who has advocated for better mental health resources in the state. In 2022, he acknowledged in a Utah Farm Bureau article that poor mental health was a problem affecting the state’s farmers and said he hoped investments in rural mental health could better support the agriculture industry. His office did not respond to interview requests for this story.

If You or Someone You Know Needs Help

Although Utah does not currently have funds to pay for therapy for the agricultural industry, there is still support available.

You can dial 988 to reach the National Suicide Prevention Lifeline. If you live in Utah, it will route you to the Utah Crisis Line, which is staffed by certified crisis workers at the Huntsman Mental Health Institute. The call is free and confidential, and you can reach someone at any time of day.

Another hotline, 1-800-FARM-AID, has staffers who can talk with you about what you are going through and connect you to resources.

Utah State University Extension has other resources available as well. You can listen to its podcast, “AgWellness,” which organizers say is aimed at teaching you to open up about what concerns you and how to help others who feel stressed. There are also free online courses that can teach you how to find relief from stress, or learn what to say and how to help if you know someone else who is struggling.

Farmers in the United States are 3.5 times more likely to die by suicide than the general population, according to the National Rural Health Association. Utah’s suicide rate has consistently been among the nation’s highest, and farmers and ranchers struggle with the volatility that comes with working in the dry mountain region. They die by suicide at the third-highest rate by vocation in the state, according to state data, behind miners and construction workers.

Fluctuating market prices, unpredictable weather and a stigma that farmers should be “tough” and can handle their mental stress themselves were constant pressures described by more than a dozen people The Tribune and ProPublica interviewed — farmers and ranchers, their families and those who support mental health programs for them.

The American Farm Bureau has emphasized in recent news releases that the Trump administration’s shifts in policy around tariffs and federal grant funding have increased the uncertainty faced by America’s farming communities — a population that overwhelmingly backed President Donald Trump in the 2024 election, according to an analysis by the nonprofit newsroom Investigate Midwest.

Trump acknowledged in his March speech to Congress that tariffs in particular may bring “a little bit of an adjustment period” for America’s farmers but said that he believes they will ultimately help by reducing competition from producers in other countries.

President Donald Trump said during an address to Congress in March that he thinks new trade policies will benefit American farmers. (Win McNamee/Pool Photo via AP)

“Our farmers are going to have a field day right now,” Trump said. “So, to our farmers, have a lot of fun. I love you, too.”

Federal funding to support farmer mental health is tied up with ongoing debates over the Farm Bill, a sweeping package of legislation that Congress has been unable to move forward since it expired in 2023. The USDA said it will be ready to implement mental health programs if federal lawmakers appropriate more money for them.

Sandall, the state legislator, said he knows that the stress of working in an unpredictable industry like agriculture can cause anxiety and mental health challenges. But when he was presented with the data about the high suicide rates in Utah agricultural communities, he said he doesn’t think Utah lawmakers would be interested in funding a program intended to help one specific profession. There is “so much demand” for mental health support throughout the state, he said, adding that targeting certain professions would create a “battle for funding.”

“Whether they’re a mechanic,” he said, “or whether they’re a school teacher, or a doctor, or someone in agriculture, I just think it would be a little hard to start separating out and creating just mental health programs for individual industries.”

“We Carry the Burden”

Mitch Hancock, owner of NooSun Dairy in Corinne, Utah (Trent Nelson/The Salt Lake Tribune)

The stress of owning a dairy fell on Mitch Hancock’s shoulders overnight after his father-in-law died by suicide in 2014. Hancock’s father-in-law hadn’t shared with his family that he was in crisis.

Mental health, Hancock said, isn’t a topic discussed often among farmers. “I think we struggle in quiet.”

For Hancock, too, there was no time for him to grieve. It was early August, and there were still two more cuttings of alfalfa that needed to be made, another month of harvesting corn and the daily needs of milking cows.

He had been involved with the dairy because his father-in-law had been hoping to transition into retirement, Hancock said. Still, “I had never driven a tractor,” he said. “Never driven a semi in harvest, never driven a chopper. Never done any of that. So it was very much, ‘Well, let’s figure it out as we go.’”

That was more than a decade ago. Hancock and his wife have run NooSun Dairy since on 2,400 acres of land in Box Elder County, where the snow-capped Wasatch Mountains stretch to the east and the Great Salt Lake can be seen past acres of fields and homes looking west.

When he speaks, Hancock is taciturn and straightforward, a trained civil engineer who takes a pragmatic approach to running the dairy farm. But he has new insight now into what his father-in-law faced, he said, a weight far heavier than just having a successful business. He has employees who need these jobs and neighbors who count on him to buy their crops to feed his cows.

“We carry the burden to make sure that we can take care of all of those around us like we always have,” he said, “even in times of low milk prices.”

But being able to pay the dairy’s bills can be challenging, Hancock said, because the price he can sell at can fluctuate. Milk price regulations are set by a complex government process that can cause prices to change as often as daily. When prices are volatile, Hancock said, “it’s hard to look past the doomsday.”

NooSun Dairy (Trent Nelson/The Salt Lake Tribune)

Like fluctuating market prices, farmers face other elements of their work they can’t control: the price of fertilizers and equipment, how much it rains or whether animals get sick. And their workdays are long.

In addition, in Utah and the arid West, farmers and ranchers worry about water, said Craig Buttars, the outgoing Utah Department of Agriculture and Food commissioner. In one recent year when rainfall was particularly scarce, he recalled, ranchers scrambled to find enough feed and had to haul water to cattle — many of which graze on remote public lands.

“That just added another level of stress,” he said. “It seems like those things can just add on to one another. And at some point, producers, sometimes they just feel like, ‘Why am I doing this?’”

Some farmers have also felt villainized by the public for their water use, including by a recent study that suggested that farmers need to cut back or stop growing altogether in order to help stop the shrinking of Utah’s Great Salt Lake. This takes a toll, said Caroline Hargraves, the marketing director with the state agriculture department. “I can’t tell you how often I hear people say that farmers should just quit. Like we shouldn’t even grow our own food,” she said. “Just really demonizing anyone for their water use.”

Chris Chambers is an alfalfa and hay farmer in northern Utah who sells his crop to local cattle producers. He said it’s frustrating to read online comments posted in response to news articles about declining lake levels from people who think farmers should give up their water rights or stop farming.

“It’s your livelihood,” he said. “Water is the key, and we’ve got the senior priority rights to use the water from the state of Utah. And now we’re bad guys for doing it? We feel like we’re doing a good service for feeding people.”

In Rural Utah, Few Therapists and More Guns

In a state that has consistently higher rates of self-reported depression than the rest of the United States, residents in rural areas — where many farmers and ranchers live — face unique challenges in getting help. In the two counties that have the highest amount of farmland in the state, each has about one therapist for every 550 people, according to County Health Rankings, which pulls data from the National Provider Identification registry. (The national ratio is one therapist for every 300 people.)

Without that type of specialized care, doctors in rural areas often rely only on prescription medications, said Tiffany McConkie, a rancher in northeastern Utah who also works as a nurse at a clinic in the town of Altamont, in a three-room medical office decorated with photos of sun-drenched farm landscapes. It’s where people can go for general medical care in their own town in the Uintah Basin, a rural area known for its oil production and agriculture.

But if someone is seeking behavioral health treatment from that same medical system, Uintah Basin Healthcare, the only two therapists on staff work at a larger medical clinic that’s about 20 miles away, according to the health care system’s online provider list.

McConkie said some people hesitate to ask for mental health care, telling her that they are afraid of being medicated or that health care workers will call the police and they’ll be put into a “mental home.”

“And that’s not the case,” she said. “We just want to get them the help they need.”

Where rural Utah lacks easy access to therapists, there is also an abundance of firearms — and a higher suicide rate compared with urban areas, according to a 2018 Harvard study. That study found that the elevated suicide rate in rural Utah is not because people there attempt suicide more often but because they are using guns, which are more lethal than other methods.

“We all feel like we’re tough, right?” said Tiffany McConkie, a Utah rancher and a nurse. “I just feel like we still have that stigma that we can’t say that we’re struggling. We can’t go for help.” (Trent Nelson/The Salt Lake Tribune)

In the basin where McKonkie lives, the local state-run mental health clinic has responded to those statistics by focusing on gun safety, handing out gun locks and secure ammo boxes at gun shows. They also travel to oil fields to do suicide prevention trainings with workers, an effort to meet their most at-risk population — middle-aged men — where they are.

“It has required some creativity on our part,” said Catherine Jurado, who works at Northeastern Counseling Center, adding that being in a smaller rural area allows them better opportunities to create relationships. “Who else in the United States thinks, ‘I need to go to a beef expo to do suicide prevention?’”

Seeking a Way Forward

The shortfall in funding for farmer mental health has been going on for years. In 2008, Congress created the federal Farm and Ranch Stress Assistance Network but, for more than a decade, put no money into it. The network eventually was funded as part of the 2018 Farm Bill, but its annual $10 million covers the entire country across four regional offices and today generally does not support individual therapy.

Since the Farm Bill expired in September 2023, Congress has been unable to agree on a new legislative package, nor did it pass a proposed bill last year to give $5 million more in funding for the Farm and Ranch Stress Assistance Network. Right now, the network has continued to be funded through temporary extensions.

When the pandemic-era funding injected a new surge of money at the state level in 2021, Utah’s agriculture department and Utah State University Extension — the state’s land-grant university — jumped at the opportunity.

The two organizations used some of the money at first for an educational podcast and online stress courses. And in 2023, they paid for therapy for about 240 farmers and ranchers. There are about 33,000 producers in Utah, according to 2022 Census of Agriculture data, most of whom work other jobs besides farming, which makes up nearly 3% of the state’s economy. As is the case throughout the United States, most Utah farms are family-run.

Buttars, the Utah agriculture department commissioner, said he was surprised by how many people sought the therapy vouchers.

“It really did wake me up to the number of people we have in the state, in our agricultural community, that felt the need for this type of program,” he said.

Dallin, with Utah State, said health care providers reported that those using the vouchers were improving, and that they were receiving positive feedback from those who went to therapy. But the money ran out more than a year ago, and the program has been halted.

In the absence of federal funds, some states have locked in state funding or private donations to keep supporting their farmers.

In Michigan, a program offering free therapy and online stress courses has been in place for nearly a decade, according to Remington Rice with Michigan State University Extension. He said state agriculture leaders advocated for the program after seeing distress among dairy farmers.

“Agriculture is a pillar of society,” Rice said. “No farmers, no food. … And so we need to address an issue that threatens our food supply.”

More recently, he said, a private business — a company that makes cherry products — reached out to donate a portion of its sales to help pay for therapy.

In Washington, a private donor — from a farming family who lost someone to suicide — has provided funding for no-cost therapy sessions for farmers and ranchers, said Don McMoran, who works at Washington State University Extension and is the Western regional lead for the national Farm and Ranch Stress Assistance Network.

In Utah, those who ran the therapy voucher program have been hesitant to approach lawmakers for state support.

Hargraves, with the state’s agriculture department, said it can be tough to get state legislators to fund new programs. And Dallin said his office has shied away from approaching legislators because the money would be earmarked as part of the higher education budget due to its association with the university. Utah’s legislative leadership has cut $60 million in funding from the public higher education system this year — the biggest budget cut to schools here in at least a decade.

Since the therapy voucher program ended, USU Extension has continued to run awareness campaigns encouraging farmers to invest in their mental health care. And the Utah Department of Agriculture and Food has also introduced mental health workshops into some certifications and courses that farmers and ranchers enroll in.

Dallin said his office has also been working with the University of Utah — a health research university that runs its own hospital system — to try to collect survey data to prove the voucher program’s effectiveness as they try to drum up more money in the future. He said he hopes by partnering, they can lean on the other university’s medical expertise and designation as a health care system.

“I honestly believe,” he said, “that if the government or if some organization were to give us a million dollars a year, I think we could spend it.”

This post was originally published on ProPublica.

by Mary Hudetz

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

Arizona Gov. Katie Hobbs has signed legislation increasing oversight of sober living homes, two years after state officials announced that a Medicaid fraud scheme had targeted Native Americans seeking drug and alcohol treatment.

The bill, sponsored by three Republicans, amends state law for the regulation and licensing of sober living homes. It places new demands on the Arizona Department of Health Services, though a lawmaker from the Navajo Nation expressed concern that the bill does not go far enough in addressing root causes of the fraud.

Hobbs’ office announced late Friday that the bill, expected to take effect in the fall, was among dozens she had signed into law. The governor did not explain her decision to sign the legislation but she has been vocal in her support of reforms over the past two years to help authorities “go after bad actors.”

The legislation’s passage comes after ProPublica and the Arizona Center for Investigative Reporting reported in January that former state Medicaid officials had failed for years to stem the $2 billion fraud scheme, despite repeated warnings. Starting around 2019, people were lured into substance abuse treatment programs and housed in sober living homes where operators often allowed patients to continue using drugs and alcohol, according to officials. Meanwhile, many providers excessively billed the state’s American Indian Health Program, Medicaid insurance available to tribal citizens, for treatment they did not deliver.

At least 40 people died in sober living homes from the spring of 2022 to the summer of 2024 as the crisis escalated, Maricopa County Medical Examiner records reviewed by the news organizations showed. Victims’ advocates say they are certain the scheme’s toll is far higher. In interviews, victims’ relatives told ProPublica and AZCIR that they had been left in the dark about the circumstances of their loved ones’ deaths, including not knowing the names or addresses of the facilities where their family members had been staying because no one had informed them.

“I believe that this bill will set standards,” Rep. Cesar Aguilar, a Democrat from Phoenix, said before voting for the measure. “It will force businesses to actually help the most vulnerable.”

The League of Arizona Cities and Towns, a nonprofit that lobbies on behalf of municipalities and that supported the measure, said in a news release that a noteworthy component of the bill includes “mandating timely reporting” to the Arizona Department of Health Services — in addition to family members and emergency contacts — when a resident dies, overdoses or suffers severe harm in a facility. The health department will also be required to notify local governments when new licenses are issued to operators of sober living homes, which the league said will “improve transparency and community awareness.”

Under the bill, the health department’s director will set standards and requirements for sober living homes to maintain a drug- and alcohol-free environment and promote health and addiction recovery. Health officials could revoke or suspend licenses depending on the severity of a violation or issue fines of up to $1,000 for each day that a violation goes unaddressed.

At a minimum, the health department will conduct annual inspections of facilities and report to lawmakers on the number of complaints received regarding licensed or unlicensed facilities and how many resulted in investigations or other enforcement actions.

The bill received bipartisan support. However, critics said it did not address additional factors that contributed to the fraud scheme: Many victims stayed in unlicensed facilities and, despite warnings, the Arizona Health Care Cost Containment System, the state’s Medicaid agency, was slow to grasp the scope of the fraud and stop it.

It wasn’t until May 2023 that AHCCCS and the governor, who took office that year, announced a sweeping investigation of hundreds of facilities and launched a hotline to help victims who were recruited into fraudulent programs or displaced after AHCCCS suspended payments to the businesses. The agency has since enacted a series of reforms in response to the fraud. In an interview last year, a deputy director for AHCCCS also acknowledged that the agency’s American Indian Health Program lacked safeguards for fraud.

Supporters of this year’s bill have touted support from tribes.

Reva Stewart, who is Diné and an advocate for victims of the scheme and their families, opposed the bill. She anticipates the measure will make it more burdensome for licensed facilities to help people seeking treatment, while failing to stop the unlicensed homes, where most of the harm was done. ProPublica and AZCIR found that officials’ botched response to the crisis resulted in Native Americans losing access to behavioral health services that were being provided to them.

Sen. Theresa Hatathlie, a Democrat from Coalmine Mesa on the Navajo Nation, was also critical of the legislation. She voted against it, noting that a bill she sponsored last session would have required more accountability not only from the health department related to its oversight of the homes but also from the Arizona Corporation Commission, where the businesses must be registered.

Hatathlie, whose niece died in one of the homes, said this year’s Republican sponsors of sober home legislation did not include her in their discussions.

“We’re actually not solving the problem,” she said during a Senate floor vote last month. “So to say it’s good enough now, when we still have people dying and getting lost in the system, is a disservice to human lives. These are my relatives. These are my family members.”

Sen. Frank Carroll, the bill’s lead sponsor, didn’t immediately respond to an email and phone calls requesting comment.

Maria Polletta, a senior reporter and associate editor at AZCIR, contributed reporting.

This post was originally published on ProPublica.

by Patricia Callahan

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Glenmark Pharmaceuticals has recalled two dozen generic medicines sold to American patients because the Indian factory that made them failed to comply with U.S. manufacturing standards and the Food and Drug Administration determined that the faulty drugs could harm people, federal records show.

In February, the FDA found problems with cleaning and testing at the plant in Madhya Pradesh, India, which was the subject of a ProPublica investigation last year. The current recalls, listed in an FDA enforcement report last week, cover a wide range of commonly prescribed medicines, including ones that treat epilepsy, diabetes, multiple sclerosis, heart disease and high blood pressure, among other ailments. ​​A full list of the recalled medications is available here.

The agency determined that the drugs could cause temporary or reversible harm and that the chance of more serious problems was remote. However, the FDA didn’t say what symptoms the flawed drugs could cause. ProPublica asked the FDA and Glenmark for more specifics, but neither responded.

Records show that Glenmark first alerted wholesalers about the recalls in a March 13 letter. That letter suggests that Glenmark pulled the drugs because of potential cross-contamination. Thomas Callaghan, Glenmark’s executive director of regulatory affairs for North America, wrote that 148 batches of the recalled medicines were made “in a shared facility” with two cholesterol-lowering drugs, ezetimibe and a combination of that drug and simvastatin.

That’s a concern because the chemical structure of ezetimibe contains what’s known as a beta-lactam ring. FDA safety experts pay attention to this because many beta-lactam drugs, particularly penicillin, can cause life-threatening allergies and hypersensitivity reactions. It’s the most commonly reported drug allergy in the U.S. Because of that danger, the FDA requires manufacturers to follow special precautions to prevent cross-contamination with drugs that contain a beta-lactam ring, even if they aren’t antibiotics.

The chemical structure of ezetimibe, Callaghan wrote to Glenmark’s wholesalers, shows it is unlikely to cause such hypersensitivity reactions. Nevertheless, Glenmark was recalling the drugs “based on risk assessment and out of an abundance of caution,” Callaghan wrote. He added, “This recall is being made with knowledge of the Food and Drug Administration.”

According to Callaghan’s letter, the potential problem dates back years. The executive wrote that Glenmark began shipping the drugs on Oct. 4, 2022.

In December, ProPublica revealed that the Glenmark factory was responsible for an outsized share of U.S. recalls for pills that didn’t dissolve properly and could harm people. At the time, the FDA hadn’t inspected the plant since before the COVID-19 pandemic, even though one of those recalls had been linked to deaths of American patients.

About two months after that investigation was published, FDA officials returned to the factory — the agency’s first inspection in five years. Inspectors discovered that Glenmark hadn’t properly cleaned equipment to prevent contamination of medicines with residues from other drugs. The federal investigators also noted that Glenmark routinely released some drugs to the U.S. market using test methods that hadn’t been adequately validated, according to the inspection report.

What’s more, when some Glenmark tests found problems with a drug, the company at times declared those results invalid and “retested with new samples to obtain passing results,” the inspection report said. “The batches were ultimately released to the US market.”

In their detailed report, the inspectors listed drugs shipped to U.S. customers who had been affected by the potential contamination and testing problems, but FDA censors redacted page after page, making it impossible to know which medicines may not be safe. An FDA attorney said the information was being withheld because it contained trade secrets or commercial information that was considered privileged or confidential.

ProPublica first asked Glenmark about that inspection on March 7 after obtaining the FDA report through the Freedom of Information Act. Glenmark alerted wholesalers about the recalls less than a week later, but the company and the FDA didn’t tell ProPublica.

Instead, a Glenmark spokesperson sent a statement saying the company was “committed to working diligently with the FDA to ensure compliance with manufacturing operations and quality systems.” And the FDA said it could discuss potential compliance matters only with the company involved.

The FDA first mentioned the recalls publicly in its April 8 enforcement report, which is like an electronic filing cabinet for recalls. The recalls do not appear on the FDA’s recalls website, which compiles press releases written by pharmaceutical companies.

ProPublica asked the FDA and Glenmark why they didn’t alert the public last month that these medicines had been recalled, but neither responded.

Glenmark is embroiled in a federal lawsuit that alleges recalled potassium chloride capsules made at its Madhya Pradesh factory caused the death of a 91-year-old Maine woman in June. The FDA had determined last year that more than 50 million of those recalled Glenmark extended-release capsules had the potential to kill U.S. patients because they didn’t dissolve correctly and could lead to a perilous spike in potassium. In court filings, Glenmark has denied responsibility for the woman’s death.

Since that potassium chloride recall, Glenmark has told federal regulators it has received reports of eight deaths in the U.S. of people who took the recalled capsules, FDA records show. Companies are required to file such reports so the agency can monitor drug safety. The FDA shares few details, though, so ProPublica was unable to independently verify what happened in each case. In general, the FDA says these adverse event reports reflect the opinions of the people who reported the harm and don’t prove that the drug caused it.

This post was originally published on ProPublica.

by Duaa Eldeib and Patricia Callahan, and photography by Sarahbeth Maney

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In the past six months, two babies in Louisiana have died of pertussis, the disease commonly known as whooping cough.

Washington state recently announced its first confirmed death from pertussis in more than a decade.

Idaho and South Dakota each reported a death this year, and Oregon last year reported two as well as its highest number of cases since 1950.

While much of the country is focused on the spiraling measles outbreak concentrated in the small, dusty towns of West Texas, cases of pertussis have skyrocketed by more than 1,500% nationwide since hitting a recent low in 2021 amid the COVID-19 pandemic. Deaths tied to the disease are also up, hitting 10 last year, compared with about two to four in previous years. Cases are on track to exceed that total this year.

Pertussis Cases Surged in 2024

Cases had been decreasing in the years before the COVID-19 outbreak and dropped further when schools were closed in response to the pandemic.

Source: Centers for Disease Control and Prevention. (Lucas Waldron/ProPublica)

Doctors, researchers and public health experts warn that the measles outbreak, which has grown to more than 600 cases, may just be the beginning. They say outbreaks of preventable diseases could get much worse with falling vaccination rates and the Trump administration slashing spending on the country’s public health infrastructure.

National rates for four major vaccines, which had held relatively steady in the years before the COVID-19 pandemic, have fallen significantly since, according to a ProPublica analysis of the most recent federal kindergarten vaccination data. Not only have vaccination rates for measles, mumps and rubella fallen, but federal data shows that so have those for pertussis, diphtheria, tetanus, hepatitis B and polio.

In addition, public health experts say that growing pockets of unvaccinated populations across the country place babies and young children in danger should there be a resurgence of these diseases.

Many medical authorities view measles, which is especially contagious, as the canary in the coal mine, but pertussis cases may also be a warning, albeit one that has attracted far less attention.

“This is not just measles,” said Dr. Adam Ratner, a pediatric infectious diseases doctor in New York City and author of the book “Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children’s Health.” “It’s a bright-red warning light.”

At least 36 states have witnessed a drop in rates for at least one key vaccine from the 2013-14 to the 2023-24 school years. And half of states have seen an across-the-board decline in all four vaccination rates. Wisconsin, Utah and Alaska have experienced some of the most precipitous drops during that time, with declines of more than 10 percentage points in some cases.

“There is a direct correlation between vaccination rates and vaccine-preventable disease outbreak rates,” said a spokesperson for the Utah Department of Health and Human Services. “Decreases in vaccination rates will likely lead to more outbreaks of vaccine-preventable diseases in Utah.”

Measles Vaccination Rates in Most States Were Below Herd Immunity in 2023 Data is for school year 2013-14 through 2023-24. The CDC recommends a vaccination rate of at least 95% to achieve herd immunity, to help prevent outbreaks and to protect communities. Source: Centers for Disease Control and Prevention Vaccination Coverage and Exemptions among Kindergartners. (Lucas Waldron/ProPublica) Pertussis Vaccination Rates Decreased in Most States Between 2013 and 2023 Note: Decrease means that the rate in school year 2013-14 was higher than the rate in school year 2023-24. If no data was reported for 2013-14, data from the next earliest year was used. Source: Centers for Disease Control and Prevention Vaccination Coverage and Exemptions among Kindergartners. (Lucas Waldron/ProPublica)

But statewide figures alone don’t provide a full picture. Tucked inside each state are counties and communities with far lower vaccination rates that drive outbreaks.

For example, the whooping cough vaccination rate for kindergartners in Washington state in 2023-24 was 90.2%, slightly below the U.S. rate of 92.3%, federal data shows. But the statewide rate for children 19 to 35 months last year was 65.4%, according to state data. In four counties, that rate was in the 30% range. In one county, it was below 12%.

“My concern is that there is going to be a large outbreak of not just measles, but other vaccine-preventable diseases as well, that’s going to end up causing a lot of harm, and possibly deaths in children and young adults,” said Dr. Anna Durbin, a professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health who has spent her career studying vaccines. “And it’s completely preventable.”

The dramatic cuts to public health funding and staffing could heighten the risk. And the elevation of Robert F. Kennedy Jr., a longtime vaccine critic, to the secretary of the federal Department of Health and Human Services, several experts said, has only compounded matters.

The Trump administration has eliminated 20,000 jobs at agencies within HHS, which includes the Centers for Disease Control and Prevention, the nation’s public health agency. And late last month, the administration also cut $11 billion from state and local public health agencies on the front lines of protecting Americans from outbreaks; the administration said the money was no longer necessary after the end of the pandemic.

Several city and county public health officials had to move quickly to lay off nurses, epidemiologists and disease inspectors. Some ceased vaccination clinics, halted wastewater surveillance programs and even terminated a contract with the courier service that transports specimens to state labs to test for infectious diseases. One Minnesota public health agency, which had provided 1,400 shots for children at clinics last year, immediately stopped those clinics when the directive arrived, court records show.

A federal judge temporarily barred HHS from enacting the cuts, but the ruling, which came more than a week after the grants were terminated, was too late for programs that had already been canceled and employees who had already been laid off. Lawyers for HHS have asked the judge to reconsider her decision in light of a recent Supreme Court ruling that allowed the Department of Education to terminate grants for teacher training while that case is being argued in lower courts. The judge in the HHS case has not yet ruled on the motion.

But in tiny storefronts and cozy homes, at school fairs and gas stations, many residents in West Texas, near where the measles outbreak has taken hold, appear unfazed.

“I don’t need a vaccine,” one man sitting on his porch said recently. “I don’t get sick.”

“It’s measles. It’s been around forever,” said a woman making her way to her car. “I don’t think it’s a big deal.”

When asked why they weren’t planning on vaccinating their baby, a husband walking alongside his wife who was 27 weeks pregnant simply said, “It’s God’s will.”

Seminole last month. Many residents in West Texas appear unfazed by the measles outbreak.

In word and deed, Kennedy has sown doubt about immunizations.

In response to the measles outbreak, Kennedy initially said in a column he wrote for Fox News that the decision to vaccinate is a “personal one.” HHS sent doses of vitamin A alongside vaccines to Texas, and Kennedy praised the use of cod liver oil. Only the vaccine prevents measles.

About a week later, in an interview on Fox News, while Kennedy encouraged vaccines, he said he was a “freedom of choice person.” At the same time, he emphasized the risks of the vaccine.

Only after the second measles death in Texas did Kennedy post on X, formerly known as Twitter, that the “most effective way to prevent the spread of measles is the MMR vaccine.”

But even that is not the unequivocal message that the head of HHS should be sending, said Ratner, the infectious diseases doctor in New York. It is, he said, a tepid recommendation at best.

“It gives the impression that these things are equivalent, that you can choose one or the other, and that is disingenuous,” he said. “We don’t have a treatment for measles. We have vitamin A, which we can give to kids with measles, that decreases but doesn’t eliminate the risk of severe outcomes. It doesn’t do anything for prevention of measles.”

In the past, Kennedy has been a fierce critic of the vaccine. In a foreword to a 2021 book on measles released by the nonprofit that he founded, Kennedy wrote, “Measles outbreaks have been fabricated to create fear that in turn forces government officials to ‘do something.’ They then inflict unnecessary and risky vaccines on millions of children for the sole purpose of fattening industry profits.”

A spokesperson for HHS said, “Secretary Kennedy is not anti-vaccine — he is pro-safety, pro-transparency and pro-accountability.” Kennedy, the spokesperson said, responded to the measles outbreak with “clear guidance that vaccines are the most effective way to prevent measles” and under his leadership, the CDC updated its pediatric patient management protocol for measles to include physician-administered vitamin A.

Kennedy, the spokesperson added, “is uniquely qualified to lead HHS at this pivotal moment.”

Late last month, leaders at the CDC ordered staff to bury a risk assessment that emphasized the need for vaccines in response to the measles outbreak — in spite of the fact the CDC has long promoted vaccinations as a cornerstone of public health. While a CDC spokesperson acknowledged that vaccines offer the best protection from measles, she also repeated a line Kennedy had used: “The decision to vaccinate is a personal one.”

Among the approximately 2,400 jobs eliminated at the CDC was a team in the Immunization Services Division that partnered with organizations to promote access to and confidence in vaccines in communities where coverage lagged.

The National Institutes of Health, which is also under HHS, recently ended funding for studies that examine vaccine hesitancy. In early April, researchers, the American Public Health Association and one of the largest unions in the country sued the NIH and its director, Jay Bhattacharya, along with HHS and Kennedy, alleging they terminated grants “without scientifically-valid explanation or cause.” The government hasn’t filed a response in the case.

The NIH cancellation notices stated that the agency’s policy was not to prioritize research that focuses on “gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.”

“These grants are being canceled in the midst of an outbreak, a vaccine-preventable outbreak,” said Rupali Limaye, an associate professor at George Mason University who has spent the past decade studying vaccine hesitancy. “We need to better understand why people are not accepting vaccines now more than ever. This outbreak is still spreading.”

That vaccines prevent diseases is settled science. For decades, there was a societal understanding that getting vaccinated benefited not only the person who got the shot, but also the broader community, especially babies or people with weakened immune systems, like those in chemotherapy.

An investment in public health and a sustained, large-scale approach to vaccines is what helped the country declare the elimination of the measles in 2000, said Lori Tremmel Freeman, the CEO of the National Association of County and City Health Officials.

But she has watched both deteriorate over the last few months. Nearly every morning since notices of the federal funding cuts began going out to local public health agencies, she has woken up to texts from panicked public health workers. She has led daily calls with local health departments and sat in on multiple emergency board meetings.

Freeman has compiled a list of more than 100 direct consequences of the cuts, including one rural health department in the Midwest that can no longer carry out immunization services. That’s vital because there are no hospitals in the county and all public health duties fall to the health department.

“It’s relentless,” she said. “It feels like a barrage and assault on public health.”

Vaccines were available at the health department in Lubbock, Texas, last month.

More than 1,600 miles away from Washington, D.C., in Lubbock, Texas, the director of the city’s health department, Katherine Wells, sighed last week when she saw the most recent measles numbers. She would have to alert her staff to work late again.

“There’s a lot of cases,” she said, “and we continue to see more and more cases.”

She didn’t know it at the time, but that night would mark the state’s second measles death this year. An earlier death in February was the country’s first in a decade. Both children were not vaccinated.

Kennedy said he traveled to Gaines County to comfort the family who lost their 8-year-old daughter and while there met with the family of the 6-year-old girl who died in February.

He also visited with two local doctors he described as “extraordinary healers,” he said in his post on X. The men, he claimed, have “treated and healed some 300 measles-stricken Mennonite children” using aerosolized budesonide — typically used to prevent symptoms of asthma — and clarithromycin — an antibiotic. Medical experts said neither is an effective measles treatment.

State health officials have traced about two-thirds of the measles cases in Texas to Gaines County, which sits on the western edge of the state.

Seminole, one of the county’s only two incorporated towns, has emerged as the epicenter of the outbreak, with Tina Siemens acting as a community ambassador of sorts.

Seminole has become the center of the measles outbreak.

Siemens, a tall woman with glasses and a short blonde bob, runs a museum that combines the area’s Native American history and Mennonite community with traditional skills like calligraphy and canning fruit.

On a recent Tuesday, atop the museum’s dark coffee table, notes scrawled onto white paper listed the latest shipments of vitamin C and Alaskan cod liver oil.

The supplies, Siemens said, were for one of the local doctors who met with Kennedy.

As measles tears through the community, Siemens said families have to decide whether to get vaccinated.

“In America, we have a choice,” she said, echoing Kennedy’s messaging. “The cod liver oil that was flown in, the vitamin C that was flown in, was a great help.”

Tina Siemens

Dr. Philip Huang, director and health authority for the Dallas County Health and Human Services Department, is working to keep the measles outbreak from reaching his community, just five hours east of Seminole. He wrote letters to the public school superintendents and leaders of private schools that had large numbers of unvaccinated or undervaccinated students offering to set up mobile vaccine clinics for them.

“Overall, the rates can look OK,” he said, “but when you’ve got these pockets of unvaccinated, that’s where the vulnerability lies.”

Huang has had to lay off 11 full-time employees, 10 temporary workers and cancel more than 50 vaccine clinics following the HHS cuts. The systemic dismantling of the CDC and other federal health agencies, he said, will have a grave and lasting impact.

“This is setting us back decades,” Huang said. “Everyone should be extremely concerned about what’s going on.”

Across the country, pediatricians are petrified, said Dr. Susan Kressly, who serves as president of the American Academy of Pediatrics, the largest professional organization of pediatricians in the country.

“Many of us are losing sleep,” Kressly said. “If we lose that progress, children will pay the price.”

She’s carefully watching the spread of several vaccine-preventable diseases, including an increase in whooping cases that far outpace the typical peaks seen every few years. Although the whooping cough vaccine isn’t as effective as the ones for measles and protection wanes over time, the CDC says it remains the best way to prevent the disease.

Babies under the age of 1 are among the most at risk of severe complications from whooping cough, including slowed or stopped breathing and pneumonia, according to the CDC. About one-third of infants who get whooping cough end up in the hospital. Newborns are especially vulnerable because the CDC doesn’t recommend the first shot until two months. That’s why experts recommend pregnant mothers and anyone who will be around the baby to get vaccinated.

The number of whooping cough cases dropped significantly during the pandemic, but it exploded in recent years. In 2021, the CDC reported 2,116 cases; last year, there were 35,435.

The numbers this year appear set to eclipse 2024. So far in 2025, 7,111 cases have been reported, which is more than double this time last year. Cases tend to spike in the summer and fall, which adds to experts’ concern about high numbers so early in the year.

States on the Pacific Coast and in the Midwest have reported the most cases this year, with Washington leading the country with 742 cases so far, more than five times as many as at this time last year.

The Washington child who died of whooping cough had no underlying medical conditions, according to a spokesperson for the Spokane Regional Health District. The death was announced in February but occurred in November.

While Washington’s overall vaccination rate for whooping cough has remained relatively steady over the last decade at around 90%, pockets of low vaccination rates have allowed the disease to take root and put the wider community at risk, said Dr. Tao Sheng Kwan-Gett, a pediatrician and chief health officer of the Washington State Department of Health.

This is the time to strengthen the public health system, he said, to build trust in those areas and make it easier for children to get their routine vaccines.

“But instead, we’re seeing the exact opposite happen,” he said. “We’re weakening our public health system, and that will put us on a path towards more illness and shorter lives.”

Washington was one of 23 states and the District of Columbia that sued HHS and Kennedy following the $11 billion cuts, which rescinded approximately $118 million from the state. Doing so, the state said in court records, would impact 150 full-time employees and cause an immediate reduction in the agency’s ability to respond to outbreaks.

Washington’s Care-A-Van, a mobile health clinic that travels across the state to provide vaccinations, conduct blood pressure screenings and distribute opioid overdose kits, was a key element in the department’s vaccination efforts.

But that, too, has been diminished.

An alert on the department’s website cataloged the impact.

“Attention,” it began.

As a result of the unexpected decision to terminate grant funding, “all Care-A-Van operations have been paused indefinitely, including the cancellation of more than 104 upcoming clinics across the state.”

The department had anticipated providing approximately 2,000 childhood vaccines as part of that effort.

The frustration came through in Kwan-Gett’s voice. Many people think that federal cuts to public health mean shrinking the federal workforce, he said, but those clawbacks also get passed down to states and cities and counties. The less federal support that trickles down to the local level, the less protected communities will be.

“It really breaks my heart,” he said, “when I see children suffering from preventable diseases like whooping cough and measles when we have the tools to prevent them.”

Agnel Philip contributed data analysis.

This post was originally published on ProPublica.

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.