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by Justin Elliott and Joshua Kaplan ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. Elon Musk’s SpaceX has taken money directly from Chinese investors, according to previously sealed testimony, raising new questions about foreign ownership interests in one of the United States’ most important military contractors. The recent testimony, coming from a SpaceX insider during a court case, marks the first time direct Chinese investment in the privately held company has been disclosed. While there is no prohibition on Chinese ownership in U.S. military contractors, such investment is heavily regulated and the issue is treated by the U.S. government as a significant national security concern. “They obviously have Chinese investors to be honest,” Iqbaljit Kahlon, a major SpaceX investor, said in a deposition last year, adding that some are “directly on the cap table.” “Cap table” refers to the company’s capitalization table, which lists its shareholders. Kahlon’s testimony does not reveal the scope of Chinese investment in SpaceX or the identities of the investors. Kahlon has long been close with the company’s leadership and runs his own firm that acts as a middleman for wealthy investors looking to buy shares of SpaceX. SpaceX keeps its full ownership structure secret. It was previously reported that some Chinese investors had bought indirect stakes in SpaceX, investing in middleman funds that in turn owned shares in the rocket company. The new testimony describes direct investments that suggest a closer relationship with SpaceX. SpaceX has thrived as it snaps up sensitive U.S. government contracts, from building spy satellites for the Pentagon to launching spacecraft for NASA. U.S. embassies and the White House have connected to the company’s Starlink internet service too. Musk’s roughly 42% stake in the company is worth an estimated $168 billion. If he owned nothing else, he’d be one of the 10 richest people in the world. National security law experts said federal officials would likely be deeply interested in understanding the direct Chinese investment in SpaceX. Whether there was cause for concern would depend on the details, they said, but the U.S. government has asserted that China has a systematic strategy of using investments in sensitive industries to conduct espionage. If the investors got access to nonpublic information about the company — say, details on its contracts or supply chain — it could be useful to Chinese intelligence, said Sarah Bauerle Danzman, an Indiana University professor who has worked for the State Department scrutinizing foreign investments. That “would create huge risks that, if realized, would have huge consequences for national security,” she said. SpaceX did not respond to questions for this story. Kahlon declined to comment. The new court records come from litigation in Delaware between Kahlon and another investor. The testimony was sealed until ProPublica, with the assistance of lawyers at the Reporters Committee for Freedom of the Press and the law firm Shaw Keller, moved in the spring to make it public. SpaceX fought the effort, but a judge ruled that some of the records must be released. Kahlon’s testimony was publicly filed this week. Buying shares in SpaceX is much more difficult than buying a piece of a publicly traded company like Tesla or Microsoft. SpaceX has control over who can buy stakes in it, and the company’s investors fall into different categories. The most rarefied group is the direct investors, who actually own SpaceX shares. This group includes funds led by Kahlon, Peter Thiel and a handful of other venture capitalists with personal ties to Musk. Then there are the indirect investors, who effectively buy stakes in SpaceX through a middleman like Kahlon. (The indirect investors are actually buying into a fund run by the middleman, typically paying a hefty fee.) All previously known Chinese investors in SpaceX fell into the latter category. This year, ProPublica reported on an unusual feature of SpaceX’s approach to investment from China. According to testimony from the Delaware case, the company allows Chinese investors to buy stakes in SpaceX so long as the money is routed through the Cayman Islands or other offshore secrecy hubs. Companies only have to proactively report Chinese investments to the government in limited circumstances, and there aren’t hard and fast rules for how much is too much. After ProPublica’s report, House Democrats sent a letter to Defense Secretary Pete Hegseth raising alarms about the company’s “potential obfuscation.” “In light of the extreme sensitivity of SpaceX’s work for DoD and NASA, this lack of transparency raises serious questions,” they wrote. It’s unclear if any action was taken in response. Kahlon has turned his access to SpaceX stock into a lucrative business. His investor list reads like an atlas of the world. The investors’ names are redacted in the recently unsealed document, but their addresses span from Chile to Malaysia. One is in Russia. At least two are in mainland China. One is in Qatar. (In one email to SpaceX’s chief financial officer, Kahlon said a Los Angeles-based fund had money from the Qatari royal family and was already invested in SpaceX.) “You made a big fortune,” a China-based financier wrote to Kahlon four years ago. “Lol something like that. SpaceX has been the gift that keeps on giving,” Kahlon responded. “All thanks to you.” Kahlon first met with SpaceX when it was a fledgling startup, according to court records. SpaceX’s CFO, Bret Johnsen, who’s been there for 14 years, testified that Kahlon “has been with the company in one form or fashion longer than I have.” Johnsen also testified that SpaceX has no formal policy about accepting investments from countries deemed adversaries by the U.S. government. But he said he asks fund managers to “stay away from Russian, Chinese, Iranian, North Korean ownership interest” because that could make it “more challenging to win government contracts.” There are indications that by 2021, Kahlon was wary of raising funds from China. The U.S. government had grown increasingly concerned about Chinese investments in tech

by Renee Dudley ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. What Happened The Defense Department has tightened cybersecurity requirements for tech companies that sell cloud computing services to the Pentagon. The updates, issued this month, ban IT vendors from using China-based personnel to work on department computer systems and require companies to maintain a digital paper trail of maintenance performed by their foreign engineers. Background The changes follow a ProPublica investigation that exposed how Microsoft used China-based engineers to maintain government computer systems for nearly a decade — a practice that left some of the country’s most sensitive data vulnerable to hacking from its leading cyber adversary. U.S.-based supervisors, known as “digital escorts,” were supposed to serve as a check on these foreign employees, but we found they often lacked the expertise needed to effectively supervise engineers with far more advanced technical skills. What They Said The Defense Department now says in its “Security Requirements Guide” that only “personnel from non-adversarial countries” may work on its cloud systems and that the escorts supervising those foreign workers “must be technically qualified in the code/system or technology they are providing access to.” In addition, cloud providers must maintain detailed audit logs, a digital trail of actions in computer systems. The logs “must include identification of the escort and escorted,” including country of origin, as well as details of commands executed and settings changed. Why It Matters Until our reporting, top Pentagon officials said they had been unaware of Microsoft’s digital escort system, which the company developed as a work-around to a Defense Department requirement that people handling sensitive data be U.S. citizens or permanent residents. Cybersecurity and intelligence experts have told ProPublica that the arrangement poses major risks to national security, given that laws in China grant the country’s officials broad authority to collect data. Leading members of Congress, in turn, have called on the Defense Department to strengthen its security requirements while blasting Microsoft for what some Republicans called “a national betrayal.” The Pentagon is now conducting an investigation into the digital escort program, with a focus on Microsoft’s China-based engineers. Response Following ProPublica’s reporting, Microsoft announced in July that it would stop using China-based engineers to service Defense Department cloud systems. In a statement for this article, a spokesperson said the company was committed to implementing the department’s new requirements. “Our commitment to national security is foundational, and we remain focused on providing the most secure services possible to the US government,” the spokesperson said. “We recently implemented changes to our Department support model, and will continue to work with our national security partners to evaluate and adjust our security protocols in light of the new directives.” Doris Burke contributed research.

by Anna Clark ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. Just 15 months after receiving an award from the Centers for Disease Control and Prevention for excellence in community water fluoridation, the city of Grayling, Michigan, changed course. With little notice or fanfare, council members voted unanimously in May to end Grayling’s decadeslong treatment program. The city shut down the equipment used to deliver the drinking water additive less than two weeks later. Although it already paid for them, the town returned six unopened barrels of the fluoride treatment to the supplier. Personal choice was the issue, said City Manager Erich Podjaske. “Why are we forcing something on residents and business owners, some of which don’t want fluoride in their water?” he said. He saw arguments for and against treatment in his research, he said, and figured that those who want fluoride can still get it at the dentist or in their toothpaste. Drinking water fluoridation is widely heralded as a public health triumph, but it’s had critics since it was pioneered 80 years ago in Grand Rapids, about 150 miles southwest of Grayling. While once largely on the fringes, fluoridation skeptics now hold sway in federal, state and local government, and their arguments have seeped into the mainstream. Even in the state where the treatment began, communities are backpedaling. And because customer notice requirements are patchy, people may not even know about it when their fluoridation stops. Robert F. Kennedy Jr., secretary of the Department of Health and Human Services, has called fluoride “industrial waste” and supports an end to community water fluoridation. The head of the Food and Drug Administration said on a newscast that the CDC’s online description of water fluoridation as one of the greatest public health achievements is “misinformation.” The CDC, which is in the midst of a leadership exodus and staff revolt, and the Environmental Protection Agency are reviewing their respective approaches to fluoride in drinking water. At the same time, President Donald Trump’s administration dismantled the CDC’s Division of Oral Health, which, among other initiatives, provided research and technical assistance on fluoridation. That’s the office that helped present awards for well-run programs like the one in Grayling. Since Kennedy was elevated to the nation’s top health post, Utah and Florida became the first states to ban communities from adding fluoride to public drinking water. The Utah ban included measures to make prescription fluoride supplements more accessible — but now, the FDA is moving to remove certain types of those supplements for children from the market. Altogether, legislation was introduced this year in at least 21 states to prohibit or roll back provisions related to adding fluoride to public water systems, according to Abby Francl, policy analyst at the National Conference of State Legislatures. In addition, citing Kennedy’s “Make America Healthy Again” initiative, Oklahoma’s governor issued an executive order instructing state agencies to cease promotion of fluoridation in the public water supply while it reviews the practice. Some local communities across the country opted to stop treatment this year, including at least four in Alabama, the state with the second-lowest number of dentists per resident. Others are debating it. On Michigan’s east side, the medical director of St. Clair County’s health department urged the agency to take steps to “prohibit the addition of fluoride” to public water systems. Two Upper Peninsula cities with a shared water system had special council meetings this summer on fluoridation. In Hillsdale, the acting mayor has said that ending fluoridation is a top priority. “I want to reform the water system now that we have RFK in Health and Human Services,” Joshua Paladino told a local paper in November. Paladino added in an email to ProPublica that he sees public water fluoridation as an imprecise tool because it gives a standard dose across the population. According to Michigan’s environmental agency, some communities had temporarily stopped fluoridation and were “hesitant to restart because of uncertainty.” That prompted it to issue a five-page statement with the state health department in March, stressing that the levels recommended for water suppliers — 0.7 milligrams per liter of water — have no adverse health effects and that fluoridation benefits everyone. “Local anti-fluoride movements can be vocal and persistent, but do not necessarily represent the viewpoints of the greater community,” the statement said. Communities that end fluoridation will see more decaying teeth, according to Margherita Fontana, a professor at the University of Michigan School of Dentistry. Young children, older adults, people with disabilities and people who are poor are especially at risk, she said, but everyone will be vulnerable. Excessive tooth decay in children can require treatment in hospitals, under anesthesia. In rare but extreme cases, it can lead to death. “It’s unfortunate, because we know how to prevent the disease,” Fontana said. “So it just seems like we’re going backwards in time rather than forward.” A handful of states require customer notification when fluoridation ends. New York mandates such notice, yet fluoridation in Buffalo lapsed for years before it was widely known. Outside Detroit, the city of Wyandotte suspended treatment about a decade ago, despite saying on its website until early this summer that it used fluoride. The claim was removed only after a local reporter raised the issue. Michigan doesn’t have a statewide protocol for notifying residents when fluoridation stops. The environmental agency’s spokesperson said in an email that while it strongly recommends that communities inform customers, it doesn’t have the authority to compel them. Grayling’s water operator, Josh Carlson, said a district engineer at the agency told him he just needed to tell the state if the town decided to stop fluoridating the water. “It was almost like she was caught off guard that we actually did it,” Carlson said. From Fringe to Mainstream Water fluoridation began in 1945 in Grand Rapids, Michigan’s second-largest city, as part of a planned trial intended to last 15 years.

by Jeremy Kohler ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week. After a fight with a Black student in a St. Louis suburb left a white student badly injured in March 2024, Missouri Attorney General Andrew Bailey blamed their school district for unsafe conditions, even though the incident occurred after classes and more than a half-mile from campus. Bailey seized on the fight as evidence of what he called the Hazelwood School District’s misplaced priorities. He sent a letter to the superintendent demanding documents on the district’s diversity policies and accused leaders of “prioritizing race-based policies over basic student safety.” Bailey argued that the district’s dispute with local police departments over its requirement that officers participate in diversity training — an impasse that resulted in some departments leaving schools without resource officers — had left students vulnerable. In response, the school board’s attorney said Bailey had misrepresented basic facts: The district employed dozens of security guards at schools where it could not assign resource officers, and even if it did have police officers stationed at the school, those officers would not have handled an after-hours, off-campus fight. Finally, police found no evidence that race played a role in the fight. The attorney general’s office took no further action. “He was just trying to get attention,” said school board President Sylvester Taylor II. The legal skirmish was the kind of publicity-getting move that defined Bailey’s two years and eight months as Missouri’s attorney general before his surprise selection last month by President Donald Trump as a co-deputy director of the FBI, according to experts who study the work of attorneys general. As Missouri’s top law enforcement officer, Bailey repeatedly waded into fights over diversity, gender, abortion and other hot-button issues, while casting conservatives and Christians as under siege by the “woke” left. Bailey had pledged at the start of his tenure in early 2023 not to use the state’s open public records law “as an offensive tool” to demand bulk records from school districts in broad investigations — a tactic used by his predecessor, Eric Schmitt, now a U.S. senator. Still, he made frequent use of cease-and-desist letters, warning school districts that their diversity initiatives or handling of gender and sex-education issues violated the law. Some efforts, like his letter to the Hazelwood School District, amounted to little more than a press release. Others ended in defeat, with judges calling his arguments unpersuasive or “absurd” or, in one case, dismissing them without comment. One lawsuit, against China, ended in a judgment against the country that experts said will likely never be enforced. Bailey, who was sworn in to the FBI position on Sept. 15, did not respond to messages left with the FBI’s press office and with James Lawson, a longtime friend who managed his attorney general campaign and served in various roles on his staff. Bailey’s actions as attorney general, according to legal observers, stood apart from the office’s core, nonpolitical duties: defending the state against lawsuits and handling felony criminal appeals. That work, by most accounts, continued as usual. His Republican predecessors, Schmitt and, before him, Josh Hawley, also used the position to advance conservative causes, wage fights against progressive ones and raise their national profiles. During his stint as attorney general, Hawley — like Schmitt now in the U.S. Senate — delivered a speech in which he claimed the elimination of social stigmas to premarital sex and contraception during the 1960s had degraded the treatment of women and promoted sex trafficking. And he fought to uphold state restrictions that threatened to shut down Planned Parenthood clinics four years before Missouri’s near-total abortion ban took effect after the U.S. Supreme Court overturned Roe v. Wade in June 2022. Missouri Attorney General Andrew Bailey (Galen Bacharier/Springfield News-Leader/Imagn) Schmitt was named to succeed Hawley in November 2018. During his four years in office, he defended Christian prayer in public schools and sued several local school districts that had enforced mask requirements during the pandemic. In 2022, he joined a small group of conservative attorneys general in withdrawing from the National Association of Attorneys General, a bipartisan group that had long coordinated multistate investigations in cases against industries ranging from tobacco to opioids. In a letter posted to the social media platform now known as X, Schmitt joined Texas Attorney General Ken Paxton and Montana Attorney General Austin Knudsen in arguing that NAAG had taken a sharp “leftward shift” and that continued membership was intolerable. Neither Hawley nor Schmitt, through their spokespeople, responded to requests for comment. Chris Toth, the executive director of NAAG who retired from the organization weeks after the letter became public, said in an interview that the claims in the letter were “completely unsupported by facts.” Republicans, he added, were involved “in every facet of the organization.” The move reflected a broader shift in how many attorneys general now use their offices — not only to defend their states in court, but to score political points on the national stage. Few have embodied that strategy more than Paxton, who has often been described as focusing on culture war issues as attorney general. ProPublica and The Texas Tribune have reported how Paxton has transformed the attorney general’s office into an agency that seems less focused on traditional duties like representing other state offices in court to one preoccupied with fighting culture wars. His office has increasingly used the state’s powerful consumer protection laws to investigate organizations whose work conflicts with his political views. At the same, he’s started increasingly outsourcing major cases to private law firms. Paxton’s office has said most of the instances when it declined to represent a state agency were due to practical or legal limits — some agencies chose their own attorneys; others were barred by statute. He’s also argued that certain cases would have required reversing earlier positions or advancing

by Eli Cahan for ProPublica ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. As the share of U.S. adults receiving mental health care treatment steadily grows, for-profit companies are playing an increasingly important role. More than 40% of inpatient mental health beds were operated by for-profit entities as of 2021, according to unpublished data from Morgan Shields, an assistant professor at Washington University in St. Louis who studies quality in behavioral health care. That’s up from about 13% in 2010. (The number of mental health beds held relatively constant during that time.) Experts tie this growth to provisions of the Affordable Care Act, which made mental health care an essential health benefit that all insurance plans are required to cover. Before the law, millions of Americans lacked meaningful mental health care coverage by their insurers — if they had any coverage at all. That changed with the law’s passage in 2010. Three years later, the Obama administration went further, issuing rules that require plans to pay more for mental health care, and to pay for it as long as patients need it. (Some plans had previously imposed hard caps on the number of days they would cover.) Wider access to and increased reimbursement of mental health services piqued the interest of for-profit corporations, said Eileen O’Grady, who until recently served as program director at the Private Equity Stakeholder Project, a nonprofit organization that researches the industry. “Investors in for-profit entities see that as an opportunity to make money,” she said, “in a space that had not historically been seen as super profitable.” Shields and other researchers have repeatedly flagged concerns about lower quality of care at mental health facilities owned by for-profit corporations, in part due to efforts to cut staff and reduce costs. Companies have defended the quality of care they provide. ProPublica reported Monday that over 90 psychiatric hospitals across the country have violated the Emergency Medical Treatment and Labor Act in the past 15 years. The vast majority of them — around 80% — are owned by for-profit corporations. Yet only a handful have faced any consequences from either the U.S. Centers for Medicare and Medicaid Services or the inspector general of the Department of Health and Human Services, both of which are responsible for regulating the law. In the rare cases when hospitals have faced fines, the penalties have been trivial compared to the earnings of each for-profit hospital chain, the investigation found. According to ProPublica’s analysis of CMS data, about half of all the hospitals cited were owned by just two corporations — Universal Health Services and Acadia Healthcare — which together operate hundreds of inpatient and outpatient behavioral health facilities, in addition to psychiatric hospitals. (UHS made nearly $16 billion in revenue last year, and Acadia collected more than $3 billion.) From 2010 through the second quarter of this year, 34 of UHS’ psychiatric hospitals had been cited with EMTALA violations. Two, Brentwood Behavioral Healthcare of Mississippi and Three Rivers Behavioral Health in South Carolina, settled with the HHS inspector general for a total of $375,000. In its May 9 enforcement action against Brentwood, the inspector general of HHS found that, in June 2021, the hospital’s interim CEO directed staff to refuse to accept seven patients from other facilities under the pretense that the facility “did not have the capacity” to treat them. “In each instance, however, Brentwood had the capacity,” an inspector general press release accompanying the enforcement action said, “but refused the transfer because the individual needing treatment was uninsured.” UHS spokesperson Jane Crawford said the company has 134 facilities that are subject to EMTALA. “While there have been isolated citations associated with technical EMTALA compliance over the 15-year time period in question at some of our facilities, over 75% of UHS Behavioral Health (BH) facilities did not have any EMTALA citations during this time period,” Crawford said. “As such, the narrative or belief that UHS’ facilities as a whole do not comply with EMTALA or attempts to circumvent its requirements is inaccurate and incorrect.” In a separate statement, she said the company’s psychiatric hospitals “do not select patients based upon insurance status or ability to pay. All UHS facilities are committed to complying with their EMTALA obligations as applicable and provide the requisite care and treatment to all patients who present to the facility regardless of ability to pay.” As for what happened at Brentwood, Crawford said that the hospital “inadvertently violated rules and regulations” due to “poor internal communication and process failure in a one-month period of time.” Brentwood “promptly revised its practices to address any such future concerns and has not had any EMTALA related issues since that time,” she added. On the events at Three Rivers, Crawford said that of the 11 patients that CMS said it denied to accept for transfer, citations related to 10 of them were ultimately “rescinded as it was determined that EMTALA did not apply to those patients.” She added that “at no time did Three Rivers fail to respond or accept a fax request based upon any prospective patient’s insurance status or ability to pay.” CMS did not respond to requests to clarify whether the citations were rescinded, but they remain on its website. Inspectors have cited 12 Acadia hospitals for EMTALA violations since 2010. However, only one — Park Royal Hospital in Florida — has been fined by the inspector general; in 2019, the agency fined the hospital just over $52,000. “Our goal is always to provide the best quality care to anyone seeking treatment at one of our facilities, and we take our compliance obligations very seriously,” Acadia spokesperson Tim Blair said in an email. He did not respond to subsequent questions about quality of care at Park Royal. Dr. Jane Zhu, an associate professor of medicine at Oregon Health and Science University, said decisions made by for-profit psychiatric hospitals may be driven by financial

by Eli Cahan for ProPublica This article describes attempted suicide. ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. Late one Saturday night in May 2023, Melissa Keele’s phone rang. Her son had been found alone in the desert of Colorado’s Grand Valley. He was naked; his clothes, phone, keys and car were nowhere to be found. Keele rushed out to her own vehicle and floored it, her headlights piercing through the pitch black. For years, her son had been dealing with severe mental illness. At the peak of the COVID-19 pandemic, he hit a breaking point and attempted suicide by driving off a cliff on the highway. “God told him he needed to die,” Keele recalled him telling her. Eventually, she picked him up — and he didn’t look good. Fearing for his safety, Keele immediately took her then-21-year-old son to West Springs Hospital in Grand Junction. If you or someone you know needs help, here are a few resources: Call the National Suicide Prevention Lifeline: 988 Text the Crisis Text Line from anywhere in the U.S. to reach a crisis counselor: 741741 The facility, which called itself “Colorado’s Best Psychiatric Hospital,” touted “exceptional psychiatric care in a world-class environment,” including a “state-of-the-art” 63,000-square-foot facility decked out with crafts areas, light therapy rooms and “cozy nooks.” During the intake process, Keele said she told a nurse about her son’s yearslong battle with mental illness, how he had struggled to keep up with his treatments, hold down a job and keep a roof over his head. How he had stopped taking his psychiatric medications. How just before he left that night he had told his fiancee that he wanted “some alone time” in the valley’s rolling hills. But 102 minutes after he arrived at West Springs, a nurse discharged him. Back at home, he slipped out a few hours later while his fiancee was at work. Police found him and quickly called his mother. He again was naked; this time, he was also sunburned and dehydrated. He couldn’t explain what had happened, and he didn’t understand why he was there. Police took him to another emergency room, which deemed him “gravely disabled.” That determination was critical. It meant that the doctors believed sending Keele’s son home could put him in imminent danger. And it meant, legally, that they could keep him against his will until he was safe. Ultimately, he was transferred to a psychiatric hospital 240 miles east in Denver, where he stayed for more than a week. The speed with which West Springs released him prompted federal officials to investigate the hospital for failing to properly screen and stabilize him before his discharge. Within days, regulators determined the hospital had violated federal law. The hospital had failed to comply with the Emergency Medical Treatment and Labor Act, better known as EMTALA. The law, enacted in 1986, requires hospitals to screen and stabilize all emergency patients regardless of whether they have insurance. West Springs, the inspectors found, had missed key red flags related to Keele’s son’s grave disability, which could have left him seriously harmed. It was the second time in a year that West Springs had violated EMTALA. In October 2022, inspectors declared that patients were in “immediate jeopardy” of harm or death because the hospital had failed to properly screen and treat 21 patients who showed up to its emergency room. Two other times, it was cited for providing deficient emergency care in violation of other rules, according to federal regulators. Just one day after the October 2022 inspection report, regulators found that the hospital did not ensure that some low-level staff were “trained” or “qualified” to monitor patients being assessed for a crisis. And in February 2023, the hospital was hit with another violation for discharging suicidal patients without “evidence of being stabilized and deemed safe.” In each instance, the Centers for Medicare and Medicaid Services, the agency primarily responsible for enforcing EMTALA, asked West Springs to come up with a plan for how it would ensure the problems didn’t happen again. (ProPublica requested the plans of correction in May 2025 from CMS but has not yet received the records.) CMS could have terminated the hospital’s Medicare funding. Another arm of the federal government, the inspector general of the Department of Health and Human Services, could have imposed monetary penalties for the EMTALA violations. But neither of those things happened, though the state of Colorado increased its own oversight of the hospital, mandating that it hire an outside management company in order to keep treating patients. First image: A road near where Melissa Keele’s son attempted suicide during the peak of the COVID-19 pandemic. Second image: West Springs Hospital in Grand Junction, Colorado, violated a federal law guaranteeing emergency treatment on two separate occasions in one year. (Rachel Woolf for ProPublica) West Springs Hospital did not respond to repeated inquiries from ProPublica over a year of reporting about what actions it took to prevent future EMTALA violations. In public statements, it said it was committed to providing quality care and subsequently noted that the state restored its full unconditional license at the end of 2024. Keele’s son did not respond to multiple requests for comment and we are not publishing his name; this account is based on documents and interviews with his mother. Over 90 psychiatric hospitals across the country have violated EMTALA in the past 15 years and almost all have faced the same lack of consequences, a ProPublica investigation has found. Since 2019, the HHS inspector general has only issued three penalties involving EMTALA violations by psychiatric hospitals. Taken together, these penalties totalled $427,000. (The inspector general has levied additional fines against medical hospitals for inadequate care of patients with mental illness.) CMS has pulled Medicare certification, and funding, from a handful of psychiatric hospitals, and a number of others have shut down after officials threatened to stop paying. But

by Hannah Allam ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. An Egyptian chaplain whose detention sparked a community uproar and became a test of counterterrorism powers in immigration court was released from an Ohio jail on Friday as the Department of Homeland Security abruptly withdrew its case against him. The outcome is a victory for 51-year-old Ayman Soliman, a popular Muslim cleric whose hundreds of supporters include families he counseled at Cincinnati Children’s Hospital. The DHS move to restore his asylum status and drop deportation efforts comes after court filings documented errors and inconsistencies in the government’s evidence portraying him as a terrorist. Just before 1 p.m., Soliman walked out of Butler County Jail with a broad smile and a plastic bag containing his belongings, a moment filmed by his friends and advocates. He had been scheduled for an immigration trial next week and faced deportation to Egypt, which he fled in 2014 because of political persecution. “This is beyond my dreams,” Soliman told ProPublica in a call minutes after he was freed. “I’m still overwhelmed by the surprise.” Soliman’s asylum status was reinstated and his application for a green card has been revived, said Robert Ratliff, one of his attorneys. Early Friday, Ratliff had filed documents showing wording discrepancies in what should have been identical asylum termination notices to Soliman. One version called him a “member” of a terrorist group and the other accused him of providing illegal aid to a terrorist group. Soliman has denied both contentions. The filing on Friday documented the latest in a series of inconsistencies in the government’s evidence, which ProPublica reported this month. “From the beginning, everything was flawed,” Ratliff said. “This is certainly a victory for him, and it’s huge. Unfortunately, he had to spend approximately 70 days in jail to get to this point.” A DHS official said immigration authorities “cannot discuss the details of individual immigration cases and adjudication decisions.” But the official added, “An alien — even with a pending application or lawful status — is not shielded from immigration enforcement action.” The agency is “responsible for administering America’s lawful immigration system, ensuring the integrity of the immigration process.” After leaving the jail, Soliman joined Friday communal prayers at a local mosque, where an imam welcomed his release as a godsend and celebrated his friend as “a free man, as he always should be.” Flanked by supporters at a news conference Friday evening, Soliman said he was still in disbelief that his day had begun in custody. He’d just come from a restaurant where he enjoyed “salad and fruit and meat” after weeks of jail food. He said he was “out of words” for the support system that sprang to his defense. He said he received 760 letters while in jail from people he’d never met. “I’m free today because of this advocacy,” Soliman said. “Don’t underestimate your voice.” Ayman Soliman Is Free Soliman is greeted as he exits Butler County Jail in Ohio. (Courtesy of Ahmed Elkady) Watch video ➜ Soliman’s ordeal, which spanned two administrations, is more complex than most targets of President Donald Trump’s immigration crackdown. After fleeing persecution over his journalistic and protest activities in Egypt, Soliman had been granted asylum in 2018 under the first Trump administration. Then, in the last month of the presidency of Joe Biden, immigration authorities moved to revoke the status based on sharply disputed claims of fraud and aid to a terrorist group. Once Trump returned to office weeks later, court records show, immigration officials bumped up the terrorism claims and formalized the asylum termination on June 3. DHS had built the case on allegations that Soliman’s involvement with an Islamic charity provided illegal aid, or “material support,” to the Muslim Brotherhood. But neither the charity nor the Brotherhood is a U.S.-designated terrorist organization, and an Egyptian court found no official ties between the groups. Material support laws ban almost any type of aid to U.S.-designated foreign terrorist groups. Prosecutors describe the laws as an invaluable tool against would-be attackers, but civil liberties groups have long complained of overreach. The Biden-era DHS, which first flagged the charity issue, said it would revoke Soliman’s asylum if “a preponderance of the evidence supports termination” after a hearing, according to the December 2024 notice. At the time, court records show, the material support allegation was listed as a secondary concern after more common asylum questions about the veracity of official documents and Soliman’s claims of persecution in Egypt. Once Trump came to power weeks later, Soliman’s attorneys said, the material support claims metastasized, with U.S. authorities declaring the Muslim Brotherhood a Tier III, or undesignated, terrorist group and adding new arguments about ties to Hamas. The Brotherhood, a nearly century-old Islamist political movement, renounced violence in the 1970s, though Hamas and other spinoffs are on the U.S. blacklist. Court filings show DHS attorneys introducing, then withdrawing or amending, materials to build a case linking Soliman to the Brotherhood through the charity. Almost immediately, the evidence began unraveling. Among the supporting documents filed by the government were three academic reports by scholars with deep knowledge of Islamic charities in Egypt. Soliman’s legal team filed statements from all three balking at how DHS had cherry-picked their research. The scholars described “important mistakes of fact and interpretation,” “a mischaracterization” and “a dishonest manipulation of my text.” Separate from U.S. attempts to tie Soliman to the Brotherhood was a puzzling footnote in which DHS attorneys alluded to warrants for “murder and terrorism” in Iraq, a country Soliman has never visited. DHS acknowledged in court that the line had been an error — after it had been included in the government’s successful argument for keeping him in custody. Legal scholars specializing in national security were monitoring the case as a gauge of how much power the Trump administration could wield at the intersection of counterterrorism and immigration. Ratliff said that the

by Debbie Cenziper and Megan Rose, ProPublica, and Katherine Dailey, Medill Investigative Lab ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. Two prominent U.S. senators are demanding the Food and Drug Administration provide an immediate accounting of the foreign generic drugmakers allowed to skirt bans meant to keep dangerous medication out of the United States. The top members of the Senate Special Committee on Aging cited a recent ProPublica investigation that exposed how the FDA quietly awarded special passes to troubled manufacturers so they could continue shipping medication to Americans even after the agency barred their factories because of serious quality concerns. “These exemptions undermine the goals of U.S. policy, threaten the safety of drugs, and place Americans’ health at risk,” the senators wrote in a bipartisan letter to FDA Commissioner Marty Makary. Committee Chair Rick Scott, R-Fla., and ranking member Kirsten Gillibrand, D-N.Y., described “urgent concerns” about the FDA’s oversight of foreign drugmakers and whether medication coming into the United States was safe. ProPublica found the agency granted exemptions from import bans to more than 20 foreign factories since 2013, including a Sun Pharma plant in India where quality breaches repeatedly risked the contamination of sterile injectable drugs. All told, ProPublica found, the FDA allowed more than 150 drugs or their ingredients into the United States from banned factories, including antibiotics, anti-seizure drugs and chemotherapy treatments. The FDA said the exemptions were used to prevent shortages of essential medication. The practice, however, was largely kept hidden from doctors, pharmacists, consumers and lawmakers. Despite a 2012 law requiring the FDA to describe all the ways it was dealing with drug shortages, the agency didn’t mention the practice to Congress until 2024 — and even then, only in a single footnote of a 25-page report. Scott said he fears for patient safety. “We’ve seen the FDA impose import bans on foreign drug manufacturing facilities for violating basic quality and safety standards, only to later issue exemptions … that allow drugs from those same facilities to still be imported simply because they’re on a shortage list,” he said in a statement to ProPublica. “That means the FDA may be allowing potentially unsafe, low-quality drugs into American homes, and our seniors are especially at risk. That’s unacceptable.” Sun Pharma has said it maintains “a relentless focus on quality” and is working with the FDA to resolve regulatory issues. The FDA did not immediately respond to a request for comment. The agency previously said that companies receiving exemptions from import bans were required to conduct extra drug quality testing with third-party oversight to “help assure consumer safety.” Makary is new at the FDA: He took the helm of the agency earlier this year after he was appointed by President Donald Trump and has called for “radical transparency” in agency decision-making. The letter from Scott and Gillibrand comes on the heels of a Senate hearing on drug safety, where a former FDA inspector who spent years in India and China said he repeatedly found “shortcuts and fraud” at substandard factories and feared bad medicine was being shipped en masse to the United States. “What we found was terrifying,” said Peter Baker, who reported a series of failures overseas from 2012 to 2018. Baker said his findings and those of other inspectors were undermined by the exemptions from import bans. Inspectors over the years have uncovered filthy water, vials of medication that were “blackish” from contamination and raw materials tainted with unknown “extraneous matter” at foreign factories, government records show. Documents on drug quality testing have been destroyed, and in one case, workers poured acid on some that had been stuffed in a trash bag. ProPublica found the decisions to override those findings and exempt drugs from import bans were made by a small, secretive group of agency insiders who reported to the longtime head of drug safety, Janet Woodcock. In an interview, Woodcock told ProPublica that the FDA believed the exempted drugs were safe. “We felt we didn’t have to make it a public thing,” she said. Woodcock retired in 2024 after nearly four decades at the agency. In their letter to Makary, the senators asked the FDA to explain how it defines a drug shortage and provide market share data for all drugs exempted from import bans since 2020. They also asked for a complete list of those drugs. The FDA has never released such a list. ProPublica published one in August after a yearlong investigation. Reporters harnessed artificial intelligence and wrote code that used keyword search and pattern matching to pull exempted drug names and manufacturing locations from hundreds of old reports that were put out by the FDA and are no longer on the agency’s website. The reports identified factories barred from shipping drugs to the United States and at times referenced the exemptions with almost no explanation. ProPublica found the FDA did not regularly test the exempted drugs to ensure they were safe or use its massive repository of drug-related complaints to proactively track whether they were harming unsuspecting patients. “I am deeply concerned by the FDA’s pattern of allowing foreign generic drugmakers to export drugs to America even when their facilities have been found to fall below our standards,” Gillibrand said. “This is a threat to our seniors and our national security.” Several House members have also raised concerns. “The FDA should never have allowed corporations with unsafe foreign factories to import risky drugs or ingredients,” Rep. Chris Deluzio, D-Pa., said in a statement. “We need stronger and better domestic pharmaceutical manufacturing, and we need a government that refuses to roll the dice on our health.” The senators asked the FDA to provide more information about the exemptions by mid-October. The committee is planning to hold a second hearing.

by ProPublica ProPublica has hired Nick McMillan as a computational journalist on our data and news apps team. In this role, McMillan will use technology and data in innovative ways to find and report stories that would otherwise be out of reach. “Nick has an impressive track record of using cutting-edge technology to unlock reporting paths,” said Ken Schwencke, senior editor for data and news applications. “I’m excited for him to use those skills to hold power to account at ProPublica.” McMillan comes to ProPublica from NPR, where he was a data journalist on the investigations team. At NPR, he combined reporting with data analysis, building tools that transformed raw records into evidence for investigations. His work included developing a custom optical character recognition program to parse more than 7,000 government work task files, which helped to reveal how a federal program was killing thousands of wild animals with little accountability. He also co-reported a story revealing how power lines operated by Southern California Edison sparked new fires as crews battled existing ones, creating a tool that processed and transcribed more than 2,000 hours of first responder radio into searchable, time-stamped timelines. Before NPR, he worked on investigative documentaries at Newsy, contributing to reporting on white supremacists in the U.S. military and on the long-term effects of Hurricane Maria on Puerto Rican schoolchildren. Stories that McMillan has worked on have been recognized nationwide with honors including the National Press Award and an Edward R. Murrow Award. “ProPublica has led the way for applying data and computational methodologies to uncover abuses of power,” McMillan said. “I am excited to join the team and grateful for the opportunity to contribute to investigations that serve the public.”

by Margaret Coker, The Current This article was produced for ProPublica’s Local Reporting Network in partnership with The Current. Sign up for Dispatches to get stories like this one as soon as they are published. Update, Sept. 24, 2025: This story has been updated to reflect that on Sept. 23, 2025, the Centers for Medicare and Medicaid Services extended the Georgia Pathways program through 2026. Most of the tax dollars used to launch and implement the nation’s only Medicaid work requirement program have gone toward paying administrative costs rather than covering health care for Georgians, according to a new report by the Government Accountability Office, the nonpartisan agency that monitors federal programs and spending. The government report examined administrative expenses for Georgia Pathways to Coverage, the state’s experiment with work requirements. It follows previous reporting by The Current and ProPublica showing that the program has cost federal and state taxpayers more than $86.9 million while enrolling a tiny fraction of those eligible for free health care. The GAO analysis, which does not include all the Pathways administrative expenses detailed by the news outlets, shows that as of April the Georgia program had spent $54.2 million on administrative costs since 2021, compared to $26.1 million spent on health care costs. Nearly 90% of administrative expenditures came from the federal budget, the report concluded, meaning that Georgia’s experiment is being funded by taxpayers around the country. Federal spending will likely increase given that the Centers for Medicare and Medicaid Services has approved $6 million more in administrative costs not reflected in this report because it was published before the state submitted invoices. The spending watchdog agency echoed its 2019 criticism of the Centers for Medicare and Medicaid Services for a lack of oversight of administrative costs associated with state initiatives approved in the name of Medicaid reform. The September GAO report said the Medicaid agency never required Georgia to detail the costs of building and implementing the program. The federal approval process for states that want to experiment with their Medicaid systems “does not take into account the extent to which demonstrations will increase administrative costs,” the report said. Georgia Gov. Brian Kemp, a Republican, promoted Pathways as an example of how fellow conservatives around the country could overhaul federal safety net benefits and end reliance on what critics deride as handouts to low-income Americans. Congressional Republicans cited Pathways as a model for the federal Medicaid work requirement law passed in July that will take effect in 2027. The Georgia Pathways program was slated to expire Oct. 1, but the Trump administration on Tuesday approved an extension of the experiment through Dec. 31, 2026. The Georgia program was supposed to expand free health care to a group the state had previously deemed ineligible for Medicaid: adults under 65 years old who earn less than the federal poverty line of $15,650 a year. To qualify, Georgians had to prove that they work, study or volunteer at least 80 hours a month. But enrollment in Georgia Pathways has remained low. The most recent state data shows that 9,175 of the nearly quarter-million low-income Georgians eligible for the program were enrolled as of Aug. 31. Previous reporting by The Current and ProPublica revealed that was due to glitches in the digital platform people must use to enroll, chronic understaffing in the state agency charged with enrollment help and a maze of bureaucratic red tape. Georgia officials previously told The Current and ProPublica that Pathways was never designed to maximize enrollment. Carter Chapman, Kemp’s spokesperson, said Monday that the Kemp administration remains committed to Pathways and making refinements to meet the health care needs of Georgians. In December Democratic senators critical of Medicaid work requirements, including Georgia’s Jon Ossoff and Raphael Warnock, had asked the GAO to report on the administrative costs of implementing Pathways and verifying that recipients are working, studying or volunteering. “Administrative spending has outpaced spending for medical assistance (e.g., health care services)” for Georgia Pathways, the report said. “This was likely driven by the up-front administrative changes needed to implement the demonstration, the delayed start date for enrollment, and any duplication in administrative spending due to the delay.” Georgia officials told the GAO that the administrative costs associated with Pathways increased by 20% to 30% because of a two-year delay caused by legal battles with the Biden administration, which tried to end all Medicaid work requirement programs that had been approved before the Democratic president took office in 2021. State officials said the delay resulted in having to duplicate some spending, including IT system changes, staff training and other implementation costs, the report said. The report did not provide evidence to support the state’s assertion. “This report was requested by the same individuals who have no new or good ideas for addressing healthcare needs in Georgia,” Chapman said in a statement. “Now, as other states prepare to adopt our model and reject one-size-fits-none big government healthcare, Democrats like Senators Ossoff and Warnock are trying to rewrite history after four years of inaction and blame the State for costs associated with their own stonewalling.” Warnock said the GAO’s findings reinforce his opposition to the Trump administration’s push to nationalize work requirements because of the amount of tax dollars going to expenses other than health care. “Now the entire country can see what we in Georgia already know: Georgia’s Medicaid work reporting requirement program is the real waste, fraud, and abuse,” Warnock said in a statement. “This report shows that Pathways is incredibly effective at barring working people from health coverage and making corporate consultants richer.” Ossoff called Georgia Pathways “a boondoggle that’s wasted tens of millions on pricey consultants while Georgia hospitals struggle and Georgians get sick without health insurance.” The GAO report does not include the $27 million that Deloitte Consulting earned to market Pathways or the approximately $10 million that went toward additional consulting, including by other firms, and legal fees related to the state’s two-year court battle with the