by David Armstrong, Eric Umansky and Vernal Coleman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Joel Jacobs contributed reporting.

This post was originally published on ProPublica.

by Cassandra Jaramillo

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Women’s lives depend on it, she said.

Kavitha Surana contributed reporting. Mariam Elba contributed research.

This post was originally published on ProPublica.

by Anjeanette Damon

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This post was originally published on ProPublica.

by Patricia Callahan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This post was originally published on ProPublica.

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.

Five months after taking over the federal agency responsible for the health of all Americans, Robert F. Kennedy Jr. wants to overhaul an obscure but vital program that underpins the nation’s childhood immunization system.

Depending on what he does, the results could be catastrophic.

In his crosshairs is the Vaccine Injury Compensation Program, a system designed to provide fair and quick payouts for people who suffer rare but serious side effects from shots — without having to prove that drugmakers were negligent. Congress created the program in the 1980s when lawsuits drove vaccine makers from the market. A special tax on immunizations funds the awards, and manufacturers benefit from legal protections that make it harder to win big-money verdicts against them in civil courts.

Kennedy, who founded an anti-vaccination group and previously accused the pharmaceutical industry of inflicting “unnecessary and risky vaccines” on children for profits, has long argued that the program removes any incentive for the industry to make safe products.

In a recent interview with Tucker Carlson, Kennedy condemned what he called corruption in the program and said he had assigned a team to overhaul it and expand who could seek compensation. He didn’t detail his plans but did repeat the long-debunked claim that vaccines cause autism and suggested, without citing any evidence, that shots could also be responsible for a litany of chronic ailments, from diabetes to narcolepsy.

There are a number of ways he could blow up the program and prompt vaccine makers to stop selling shots in the U.S., like they did in the 1980s. The trust fund that pays awards, for instance, could run out of money if the government made it easy for Kennedy’s laundry list of common health problems to qualify for payments from the fund.

Or he could pick away at the program one shot at a time. Right now, immunizations routinely recommended for children or pregnant women are covered by the program. Kennedy has the power to drop vaccines from the list, a move that would open up their manufacturers to the kinds of lawsuits that made them flee years ago.

Dr. Eddy Bresnitz, who served as New Jersey’s state epidemiologist and then spent a dozen years as a vaccine executive at Merck, is among those worried.

“If his unstated goal is to basically destroy the vaccine industry, that could do it,” said Bresnitz, who retired from Merck and has consulted for vaccine manufacturers. “I still believe, having worked in the industry, that they care about protecting American health, but they are also for-profit companies with shareholders, and anything that detracts from the bottom line that can be avoided, they will avoid.”

A spokesperson for PhRMA, a U.S. trade group for pharmaceutical companies, told ProPublica in a written statement that upending the Vaccine Injury Compensation Program “would threaten continued patient access to FDA approved vaccines.”

The spokesperson, Andrew Powaleny, said the program “has compensated thousands of claims while helping ensure the continued availability of a safe and effective vaccine supply. It remains a vital safeguard for public health and importantly doesn’t shield manufacturers from liability.”

Since its inception, the compensation fund has paid about $4.8 billion in awards for harm from serious side effects, such as life-threatening allergic reactions and Guillain-Barré syndrome, an autoimmune condition that can cause paralysis. The federal agency that oversees the program found that for every 1 million doses of vaccine distributed between 2006 and 2023, about one person was compensated for an injury.

Since becoming Health and Human Services secretary, Kennedy has turned the staid world of immunizations on its ear. He reneged on the U.S. government’s pledge to fund vaccinations for the world’s poorest kids. He fired every member of the federal advisory group that recommends which shots Americans get, and his new slate vowed to scrutinize the U.S. childhood immunization schedule. Measles, a vaccine-preventable disease eliminated here in 2000, roared back and hit a grim record — more cases than the U.S. has seen in 33 years, including three deaths. When a U.S. senator asked Kennedy if he recommended measles shots, Kennedy answered, “Senator, if I advised you to swim in a lake that I knew there to be alligators in, wouldn’t you want me to tell you there were alligators in it?”

Fed up, the American Academy of Pediatrics and other medical societies sued Kennedy last week, accusing him of dismantling “the longstanding, Congressionally-authorized, science- and evidence-based vaccine infrastructure that has prevented the deaths of untold millions of Americans.” (The federal government has yet to respond to the suit.)

Just about all drugs have side effects. What’s unusual about vaccines is that they’re given to healthy people — even newborns on their first day of life. And many shots protect not just the individuals receiving them but also the broader community by making it harder for deadly scourges to spread. The Centers for Disease Control and Prevention estimates that routine childhood immunizations have prevented more than 1.1 million deaths and 32 million hospitalizations among the generation of Americans born between 1994 and 2023.

To most people, the nation’s vaccine system feels like a solid, reliable fact of life, doling out shots to children like clockwork. But in reality it is surprisingly fragile.

There are only a handful of companies that make nearly all of the shots children receive. Only one manufacturer makes chickenpox vaccines. And just two or three make the shots that protect against more than a dozen diseases, including polio and measles. If any were to drop out, the country could find itself in the same crisis that led President Ronald Reagan to sign the law creating the Vaccine Injury Compensation Program in 1986.

Back then, pharmaceutical companies faced hundreds of lawsuits alleging that the vaccine protecting kids from whooping cough, diphtheria and tetanus caused unrelenting seizures that led to severe disabilities. (Today’s version of this shot is different.) One vaccine maker after another left the U.S. market.

At one point, pediatricians could only buy whooping cough vaccines from a single company. Shortages were so bad that the CDC recommended doctors stop giving booster shots to preserve supplies for the most vulnerable babies.

While Congress debated what to do, public health clinics’ cost per dose jumped 5,000% in five years.

“We were really concerned that we would lose all vaccines, and we would get major resurgences of vaccine-preventable diseases,” recalled Dr. Walter Orenstein, a vaccine expert who worked in the CDC’s immunization division at the time.

A Forbes headline captured the anxiety of parents, pediatricians and public health workers: “Scared Shotless.” So a bipartisan group in Congress hammered out the no-fault system.

Today, the program covers vaccines routinely recommended for children or pregnant women once Congress approves the special tax that funds awards. (COVID-19 shots are part of a separate, often-maligned system for handling claims of harm, though Kennedy has said he’s looking at ways to add them to the Vaccine Injury Compensation Program.)

Under program rules, people who say they are harmed by covered vaccines can’t head straight to civil court to sue manufacturers. First, they have to go through the no-fault system. The law established a table of injuries and the time frame for when those conditions must have appeared in order to be considered for quicker payouts. A tax on those vaccines — now 75 cents for every disease that a shot protects against — flows into a trust fund that pays those approved for awards. Win or lose, the program, for the most part, pays attorney fees and forbids lawyers from taking a cut of the money paid to the injured.

The law set up a dedicated vaccine court where government officials known as special masters, who operate like judges, rule on cases without juries. People can ask for compensation for health problems not listed on the injury table, and they don’t have to prove that the vaccine maker was negligent or failed to warn them about the medical condition they wound up with. At the same time, they can’t claim punitive damages, which drive up payouts in civil courts, and pain and suffering payments are capped at $250,000.

Plaintiffs who aren’t satisfied with the outcome or whose cases drag on too long can exit the program and file their cases in traditional civil courts. There they can pursue punitive damages, contingency-fee agreements with lawyers and the usual evidence gathering that plaintiffs use to hold companies accountable for wrongdoing.

But a Supreme Court ruling, interpreting the law that created the Vaccine Injury Compensation Program, limited the kinds of claims that can prevail in civil court. So while the program isn’t a full liability shield for vaccine makers, its very existence significantly narrows the cases trial lawyers can file.

Kennedy has been involved in such civil litigation. In his federal disclosures, he revealed that he referred plaintiffs to a law firm filing cases against Merck over its HPV shot in exchange for a 10% cut of the fees if they win. After a heated exchange with Sen. Elizabeth Warren during his confirmation proceedings, Kennedy said his share of any money from those cases would instead go to one of his adult sons, who he later said is a lawyer in California. His son Conor works as an attorney at the Los Angeles law firm benefiting from his referrals. When ProPublica asked about this arrangement, Conor Kennedy wrote, “I don’t work on those cases and I’m not receiving any money from them.”

In March, a North Carolina federal judge overseeing hundreds of cases that alleged Merck failed to warn patients about serious side effects from its HPV vaccine ruled in favor of Merck; an appeal is pending.

The Vaccine Injury Compensation Program succeeded in stabilizing the business of childhood vaccines, with many more shots developed and approved in the decades since it was established. But even ardent supporters acknowledge there are problems. The program’s staff levels haven’t kept up with the caseload. The law capped the number of special masters at eight, and congressional bills to increase that have failed. An influx of adult claims swamped the system after adverse reactions to flu shots became eligible for compensation in 2005 and serious shoulder problems were added to the injury table in 2017.

The quick and smooth system of payouts originally envisioned has evolved into a more adversarial one with lawyers for the Department of Justice duking it out with plaintiffs’ attorneys, which Kennedy says runs counter to the program’s intent. Many cases drag on for years.

In his recent interview with Carlson, he described “the lawyers of the Department of Justice, the leaders of it” working on the cases as corrupt. “They saw their job as protecting the trust fund rather than taking care of people who made this national sacrifice, and we’re going to change all that,” he said. “And I’ve brought in a team this week that is starting to work on that.”

The system is “supposed to be generous and fast and gives a tie to the runner,” he told Carlson. “In other words, if there’s doubts about, you know, whether somebody’s injury came from a vaccine or not, you’re going to assume they got it and compensate them.”

Kennedy didn’t identify who is on the team reviewing the program. At one point in the interview, he said, “We just brought a guy in this week who’s going to be revolutionizing the Vaccine Injury Compensation Program.”

The HHS employee directory now lists Andrew Downing as a counselor working in Kennedy’s office. Downing for many years has filed claims with the program and suits in civil courts on behalf of clients alleging harm from shots. Last month, HHS awarded a contract for “Vaccine Injury Compensation Program expertise” to Downing’s firm, as NOTUS has reported.

Downing did not respond to a voicemail left at his law office. HHS didn’t reply to a request to make him and Kennedy available for an interview and declined to answer detailed questions about its plans for the Vaccine Injury Compensation Program. In the past, an HHS spokesperson has said that Kennedy is “not anti-vaccine — he is pro-safety.”

While it’s not clear what changes Downing and Kennedy have in mind, Kennedy’s interview with Carlson offered some insights. Kennedy said he was working to expand the program’s three-year statute of limitations so that more people can be compensated. Downing has complained that patients who have certain autoimmune disorders don’t realize their ailments were caused by a vaccine until it’s too late to file. Congress would have to change the law to allow this, experts said.

A key issue is whether Kennedy will try to add new ailments to the list of injuries that qualify for quicker awards.

In the Carlson interview, Kennedy dismissed the many studies and scientific consensus that shots don’t cause autism as nothing more than statistical trickery. “We’re going to do real science,” Kennedy said.

The vaccine court spent years in the 2000s trying cases that alleged autism was caused by the vaccine ingredient thimerosal and the shot that protects people from measles, mumps and rubella. Facing more than 5,000 claims, the court asked a committee of attorneys representing children with autism to pick test cases that represented themes common in the broader group. In the cases that went to trial, the special masters considered more than 900 medical articles and heard testimony from dozens of experts. In each of those cases, the special masters found that the shots didn’t cause autism.

In at least two subsequent cases, children with autism were granted compensation because they met the criteria listed in the program’s injury table, according to a vaccine court decision. That table, for instance, lists certain forms of encephalopathy — a type of brain dysfunction — as a rare side effect of shots that protect people from whooping cough, measles, mumps and rubella. In a 2016 vaccine court ruling, Special Master George L. Hastings Jr. explained, “The compensation of these two cases, thus does not afford any support to the notion that vaccinations can contribute to the causation of autism.”

Hastings noted that when Congress set up the injury table, the lawmakers acknowledged that people would get compensated for “some injuries that were not, in fact, truly vaccine-caused.”

Many disabling neurological disorders in children become apparent around the time kids get their shots. Figuring out whether the timing was coincidental or an indication that the vaccines caused the problem has been a huge challenge.

Devastating seizures in young children were the impetus for the compensation program. But in the mid-1990s, after a yearslong review of the evidence, HHS removed seizure disorder from the injury table and narrowed the type of encephalopathy that would automatically qualify for compensation. Scientists subsequently have discovered genetic mutations that cause some of the most severe forms of epilepsy.

What’s different now, though, is that Kennedy, as HHS secretary, has the power to add autism or other disorders to that injury table. Experts say he’d have to go through the federal government’s cumbersome rulemaking process to do so. He could also lean on federal employees to green-light more claims.

In addition, Kennedy has made it clear he’s thinking about illnesses beyond autism. “We have now this epidemic of immune dysregulation in our country, and there’s no way to rule out vaccines as one of the key culprits,” he told Carlson. Kennedy mentioned diabetes, rheumatoid arthritis, seizure disorders, ADHD, speech delay, language delay, tics, Tourette syndrome, narcolepsy, peanut allergies and eczema.

President Donald Trump’s budget estimated that the value of the investments in the Vaccine Injury Compensation Program trust fund could reach $4.8 billion this year. While that’s a lot of money, a life-care plan for a child with severe autism can cost tens of millions of dollars, and the CDC reported in April that 1 in 31 children is diagnosed with autism by their 8th birthday. The other illnesses Kennedy mentioned also affect a wide swath of the U.S. population.

Dr. Paul Offit, a co-inventor of a rotavirus vaccine and director of the Vaccine Education Center at Children’s Hospital of Philadelphia, for years has sparred with Kennedy over vaccines. Offit fears that Kennedy will use flawed studies to justify adding autism and other common medical problems to the injury table, no matter how much they conflict with robust scientific research.

“You can do that, and you will bankrupt the program,” he said. “These are ways to end vaccine manufacturing in this country.”

If the trust fund were to run out of money, Congress would have to act, said Dorit Reiss, a law professor at University of California Law San Francisco who has studied the Vaccine Injury Compensation Program. Congress could increase the excise tax on vaccines, she said, or pass a law limiting what’s on the injury table. Or Congress could abolish the program, and the vaccine makers would find themselves back in the situation they faced in the 1980s.

“That’s not unrealistic,” Reiss said.

Rep. Paul Gosar, an Arizona Republican, last year proposed the End the Vaccine Carveout Act, which would have allowed people to bypass the no-fault system and head straight to civil court. His press release for the bill — written in September, before Kennedy’s ascension to HHS secretary — quoted Kennedy saying, “If we want safe and effective vaccines, we need to end the liability shield.”

The legislation never came up for a vote. A spokesperson for the congressman said he expects to introduce it again “in the very near future.”

Renée Gentry, director of the George Washington University Law School’s Vaccine Injury Litigation Clinic, thinks it’s unlikely Congress will blow up the no-fault program. But Gentry, who represents people filing claims for injuries, said it’s hard to predict what Congress, faced with a doomsday scenario, would do.

“Normally Democrats are friends of plaintiffs’ lawyers,” she said. “But talking about vaccines on the Hill is like walking on a razor blade that’s on fire.”

This post was originally published on ProPublica.

by Cassandra Jaramillo and Jeremy Kohler

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

Texas health officials are overhauling a program designed to steer people away from abortion following a ProPublica and CBS News investigation that found that the state had funneled tens of millions of taxpayer dollars into the effort while providing little oversight of the spending.

The money has been flowing to a network of nonprofit organizations that are part of Thriving Texas Families, a state program that supports parenting and adoption as alternatives to abortion and provides counseling, material assistance and other services. Most of the groups operate as crisis pregnancy centers, or pregnancy resource centers, which often resemble medical clinics but are frequently criticized for offering little or no actual health care and misleading women about their options.

In its 20 years of existence, the program’s funding has grown fortyfold — reaching $100 million a year starting Sept. 1 — making it the most heavily funded effort of its kind in the country.

Under new rules set to take effect then, the organizations in the program must now document all of their expenses, and they will be reimbursed only for costs tied to services approved by the state. And they cannot seek reimbursement when they redistribute donated items, an effort to prevent taxpayer money from going to organizations for goods they got for free.

Meanwhile, Texas is opening administration of the program to a competitive selection process instead of automatically renewing agreements with contractors, including one contractor that has overseen most of the program for nearly two decades.

The changes address failures uncovered a year ago by the ProPublica/CBS News investigation. As Thriving Texas Families currently operates, most providers are paid a flat rate for each service they claim to provide, regardless of the actual cost of that service. As a result, a single client visit can generate multiple stacked charges, significantly increasing the amount of public money being spent. In some cases, providers billed separately for each item or service given to a client — such as diapers, baby clothes, blankets, wipes, snacks and even educational pamphlets — according to records reviewed by ProPublica and CBS News.

That arrangement allowed organizations to bill the state for more than the services actually cost to provide — and keep the difference. One group, Sealy Pregnancy Resource Center, more than quintupled its assets in three years by banking some reimbursements. Its executive director, Patricia Penner, acknowledged the practice, saying her goal was “to make sure we have enough for this center to continue and to continue for the years to come.”

“There’s no guarantee the funds we receive is going to be sufficient to keep the center going,” Penner added, “and it’s my duty as a director to ensure we are taking whatever service funds we are receiving to ensure we can take care of these young ladies when they come in the door.”

Two others, McAllen Pregnancy Center and Pregnancy Center of the Coastal Bend in Corpus Christi, used reimbursements to finance real estate deals. The McAllen center, which receives nearly all its revenue from the state, bought a building that had previously housed an abortion clinic. The Coastal Bend center openly acknowledged using state funds to buy land for a new facility. The centers did not respond to questions.

In San Antonio, Thriving Texas Families cut off funding to a pregnancy center known as A New Life for a New Generation after a local news outlet reported it had spent taxpayer money on vacations, on a motorcycle and to fund a smoke shop business owned by its president and CEO. The center did not respond to a request for comment.

ProPublica and CBS News also found that state health officials had no visibility into what services were being delivered or whether they were reaching the people most in need. In many cases, the state reimbursed providers $14 each time they handed out donated goods or materials, regardless of their cost or how they got them.

That included distributing pamphlets on parenting, fetal development and adoption, which could trigger the same reimbursement as providing tangible aid like diapers or formula. The state could not say exactly how much it had spent on these materials because it did not track what was being distributed.

State-approved pamphlets and lessons reviewed by a reporter stated inaccuracies — such as that a fetal heartbeat starts 21 days after conception — and painted single motherhood as risky and lonely, with marriage or adoption as better options.

While flat-rate reimbursement is sometimes used in government contracting, nonprofit and accounting experts said applying it to the distribution of donated goods — without clear standards for quantity or value — was highly irregular.

Officials with the state Health and Human Services Commission, which oversees Thriving Texas Families, did not say what prompted the policy shift, only that it was following guidance from the state comptroller. That guidance recommends awarding state grants as reimbursements for actual expenses.

The state has long allowed its main contractor, Texas Pregnancy Care Network, to handle most of the program’s oversight. The network told the news organizations last year that once state funds were passed to subcontractors, “it is no longer taxpayer money” and those groups were free to spend it as they saw fit. HHSC pushed back against the network, saying it still considered the money to be taxpayer dollars and expected it to be used in line with state guidelines.

The shift to a cost-reimbursement model appears to bring the program more in line with how public money is typically distributed across state agencies in Texas.

Texas Pregnancy Care Network, which in recent years has received nearly 75% of the Thriving Texas Families funding and distributed it to dozens of crisis pregnancy centers, faith-based groups and other charities that serve as subcontractors, did not respond to questions about how it plans to approach the new contract or adapt to the stricter reimbursement rules.

State Rep. Donna Howard, a Democrat from Austin and a vocal critic of the state’s support for anti-abortion programs, said in an interview that while she opposes taxpayer support for anti-abortion programs, she sees the new rules as a step in the right direction.

But with the new reimbursement requirements in place, Howard questioned whether many of the centers would even be able to make use of the funding. Unlike the previous flat-fee system, providers must now track costs, document services and submit receipts to justify their spending. “Who knows if they can actually use the funds now that they have to show receipts,” she said.

By requiring pregnancy centers to track clients’ income, education level and employment — and to provide clients with information about public benefits available to them — the state is moving away from a system that allowed nonprofits to collect funds without regard for who was receiving help.

Pregnancy resource centers and anti-abortion activists lobbied Republican lawmakers to block the policy change during the most recent legislative session, and some publicly denounced it.

On the social media platform X, Rep. Jeff Leach, a Republican from the northern Dallas suburbs, urged the agency to “not give veto power” over the program “to biased media reporters.” Leach did not respond to requests for comment.

In an interview, Texas Right to Life President John Seago warned that the new reimbursement model would discourage participation. He said it was “not worth small providers getting into the program because of all the red tape.”

And in written testimony, Penner, from Sealy, implored legislators to preserve the current model, saying it allowed her team “to focus on serving our clients rather than staffing up in order to handle the paperwork” required for reimbursement.

Despite the pushback, lawmakers did not take action to block the new rules.

Ge Bai, a professor of accounting and health policy at Johns Hopkins University, said switching to a cost-reimbursement system could help prevent waste by making sure organizations only get paid for what they actually spend.

But she warned that this model has its own risks. Since providers know they will be reimbursed, they might not be as careful about keeping costs down — or could even inflate their expenses to get more money. She pointed to Medicare, which used a similar system in the past but abandoned it after costs spiraled out of control.

To avoid the same problem, she said, the program will need strong public oversight to make sure organizations aren’t overspending just because they know the state will cover the bill.

One reproductive health policy specialist who has closely tracked Texas’ spending on crisis pregnancy centers cautioned that the reforms do little to address the broader gaps in the state’s social safety net.

“You can’t really make up for a lack of Medicaid health insurance for the very poor in Texas by giving people educational services, pamphlets and diapers,” said Laura Dixon, a researcher with Resound Research for Reproductive Health, based in Austin.

But at the very least, she said, “understanding where money is going is a really good first step for this program.”

This post was originally published on ProPublica.