WASHINGTON (AP) — Federal authorities expressed increased alarm Thursday about a long-undetected intrusion into U.S. and other computer systems around the globe that officials...
Presley Ann/Getty Images for GUESS?, Inc. As for his Jan. 30 thread, Dylan began by tweeting, "Cancel ABC and The Bachelor. Kinda wanna air out their dirty laundry mom got me riled up." When one fan asked if there was "anything they told you to say that you refused," Dylan replied, "Yes all the time. You gotta understand the game. They get paid off you doing s--t that warrants screen time." Another individual asked Dylan, "Who from your season do you feel got the most screwed over by production?" and the reality TV personality responded with, "Jed [Wyatt]." A user then asked, "Are you saying he didn't cheat on Hannah?" and Dylan replied, "Yes." Dylan acknowledged that he himself has a happy ending from his time on the ABC franchise, given that his relationship with Hannah is still going strong. But he claimed to be looking out for "the other 99% of people" that didn't have a similar outcome. He had concluded his thread with, "My last thought: they need you until they don't. Each person is a pawn in a larger scheme, and they do not have contestants [sic] best interests in mind. Mental health is not a concern. Multiple people develop issues post-show and they do nothing to help. If anything, they fuel hate." E! News reached out at the time to reps for the show and host Chris Harrison, and did not hear back.
Almost a year into a pandemic that’s cost the state more than 40,000 lives and countless sums in lost economic activity, New York is leaving few stones unturned when it comes to finding revenue that can shore up its budget. Among the proposals outlined by Governor Andrew Cuomo is a new proposal that would find home-sharing businesses passing on tax revenue to the state. As part of Cuomo’s proposed $193 billion state budget for the fiscal year starting April 1, 2021, popular vacation rental booking platforms like Vrbo and Airbnb would assume statewide responsibility for collecting the 4% state sales tax on bookings made through their platforms. Though such sales taxes technically already apply to home-sharing transactions, putting booking platforms in charge of collecting the money and remitting it to the state would simplify collection by taking responsibility out of the hands of individual hosts, a spokesman for the state’s Budget Division explained to The Wall Street Journal. Cuomo aides estimate the proposal could provide New York with $10 million in additional state tax revenue in the upcoming fiscal year, increasing to $18 million in subsequent years. Governor Andrew Cuomo gives his a press briefing about the coronavirus crisis in Albany, New York. Photo: Getty Images If adopted, the new tax home-sharing tax collection and remittance scheme would put all of New York’s 64 counties on a level playing field of sorts when it comes to tax collection. Currently, Airbnb has forged voluntary agreements with 34 of the state’s counties, all of which are upstate from New York City and Long Island. In total, Airbnb says, it distributed $3.3 million in county-level revenues for New York in 2019. Essex County, home to popular vacation spots like Lake Placid and the Adirondacks, pulled in $690,000 in 2019 from its 3% occupancy tax. Currently, New York’s absence of a state-level remittance scheme is more the exception than the rule when it comes to Airbnb’s tax collection. A significant number of states, including Florida and Texas, already have state-level tax remittance agreements with Airbnb. If enacted, California and Ohio would become the two most populous state-level holdouts in the U.S. Even the notoriously tax-averse New Hampshire gets occupancy tax remittance through Airbnb. Globally, the company says, it’s collected $2.6 billion in total tax revenue over a seven-year period ending September 30, 2020. Given that Airbnb has pushed for New York to adopt legislation including tax collection for more than four years, the proposal’s inclusion in Cuomo’s budget is a welcome sight. “The announcement from the governor is an important step forward for the thousands of Airbnb hosts across New York who pay bills sharing their homes, and will bring millions of dollars in new revenue across the state each year,” Airbnb’s Northeast policy director Alex Dagg said in a statement. As can often happen with statewide ordinances in New York, it’s likely that such a scheme could affect New York City and the rest of the state unevenly. The tax proposal in no way augments an existing law against renting apartments in three-unit-plus buildings for less than 30 days at a time without a tenant present. That may help Cuomo avoid objections from the city’s hotel owners, as well as from legislators wary of how short-term rentals can affect rents across the five boroughs. Of course, $10 or even $18 million is ultimately nowhere near enough to close a shortfall estimated at $10.2 billion. A Cuomo plan to collect $1.5 billion in additional taxes from New Yorkers earning more than $5 million and the prospect of federal funding may help, but it’s evident that in a crisis like this, every last dollar will count.
The legal status of weed in Canada is perhaps the best thing that cannabis enthusiasts may have come across in recent years. Buying and consuming cannabis is easy if you are past the legal age, but there are still several province-specific regulations you need to follow. You must be all the more careful if planning to travel around the country with your stash because you will not want to get into legal hassles when away from home. Whether you plan to drive or jet to a destination of your choice, here is a cannabis user’s travel safety guide that will keep you on the right side of the law. Watch your age The legal age for buying and using marijuana in the country varies from province to province, so you need to know your facts right before stepping out. It is 19 years for most provinces, though the age ranges from 18 to 21 years across the country. If you plan to travel to another province or territory, invest in some research to find the legally permissible age at your destination. Ensure that you are allowed to buy or consume weed there, or you may land into trouble for being under-aged. Check how much you can carry If you use recreational marijuana, the permitted limit you can carry is up to 30g of dry form, whether you pack it in your checked luggage or carry-on. You can pack only up to 100mL of cannabis oil in your carry-on baggage, and it is also subject to general liquid restrictions. You may take along a greater amount but only with a medical marijuana prescription for documentary evidence that you use it for medicinal purposes. Proper documents are essential if you do not want to encounter any hassles. Choose a 420-friendly accommodation Despite the legal status of cannabis in the country, not all hotels and vacation homes allow guests to consume it on their premises. Before you embark on a trip, make sure that you book a weed-friendly destination. Thankfully, there are options where you can easily order marijuana online and get it delivered while you stay. You can explore a specialized weed retreat that offers cannabis on its wellness menu. Researching your options online before planning a trip is a good idea. RELATED: Growing Pains: What’s Next For The Cannabis Industry In Canada Photo by Sahil via Pexels Be careful while driving As road trips become a popular option for travel buffs in the country, cannabis lovers are increasingly opting for them. However, you must be extra careful about steering clear of cannabis when behind the wheel. Store your stash in the trunk for extra safety and use it only once you are in your hotel room. While driving under the influence is dangerous for you and others on the road, it can get you heavy penalties and even jail time. It is the last thing you will want to happen when you are on vacation. RELATED: COVID Might Be The Least Of Your Worries If Traveling With Weed While these regulations and guidelines apply to travelers within the country, you cannot carry it to and fro the border because it is illegal. Stay updated on the current travel guidelines and regulations at your destination, pack appropriately, and follow the rules, and you are good to go! This article originally appeared on Green Market Report and has been reposted with permission.
HENNOPS, South Africa (AP) — Stacks of bright green cannabis plants, freshly harvested from nearby hothouses, are expertly sorted on a lab table by workers wearing...
Social distancing means that we’re all spending a lot more time at home, canceling or rescheduling vacations, and probably not going out to things...
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. This article was produced in partnership with The Bay City News Foundation, which was a member of the ProPublica Local Reporting Network. Utility giant Pacific Gas & Electric accused two of its former employees of accepting bribes to funnel business to a waste-hauling company after the Camp Fire, the deadliest wildfire in California history. One supervisor for PG&E allegedly had his driveway paved on the power company’s dime. A subordinate is accused of having received a bribe in an unorthodox property transfer of a multimillion-dollar house in a wealthy suburb of San Francisco. A new court filing by PG&E alleges that in exchange for these kickbacks, the employees provided lucrative clean-up jobs to Hayward-based Bay Area Concrete Recycling. The allegations track closely with the results of an investigation last year by ProPublica and the Bay City News Foundation, which found that PG&E had overlooked numerous warning signs when it hired Bay Area Concrete. The company is owned and managed by the husband-wife team Yadwinder “Kevin” Singh and Preet Johal, according to local and state documents. The firm was tied to illegal dumping on federally protected wetlands and had engaged in a long conflict with regulators in the city of Hayward, where Bay Area Concrete operates a dump. Later, the news agencies revealed a suspicious real estate transaction that connected Singh and one of the PG&E employees. Singh did not respond to requests for comment. PG&E’s filing is in response to a breach of contract lawsuit filed against the utility in October by Bay Area Concrete. Dawn Sweatt, an attorney for Bay Area Concrete, said her clients “vehemently deny” the allegations by PG&E. “The allegations are patently false and not supported by the evidence,” she said. “The litigation process will make this clear in time.” The accused PG&E employees, Ronald Huggins Jr. and Ryan Kooistra, did not respond to requests for comment. Huggins retired, and Kooistra sold his home and moved out of state after being confronted by PG&E investigators, the counterclaim by PG&E said. In a statement, PG&E spokesperson James Noonan called the alleged actions of Bay Area Concrete “completely unacceptable.” “We will pursue every available action to remedy the situation and do right by those that we have the privilege to serve,” Noonan said. “As we have stated previously, PG&E will continue to hold ourselves and those that do work on our behalf to the highest ethical standards.” The new court filings show that PG&E had a longer business relationship with Bay Area Concrete than previously known. PG&E first started disposing of waste in the company’s Hayward yard in 2016, and the business expanded to include the cleanup of PG&E yards throughout Northern California. That business grew substantially in November 2018, when a PG&E transmission line sparked a wildfire in Butte County that destroyed more than 18,000 structures and killed 85 people. PG&E hired Bay Area Concrete to dispose of waste from hydrovac trucks — special vacuum trucks that use pressurized water for precise excavation. Bay Area Concrete opened a dump in Paradise to take the waste from the cleanup. In its suit, Bay Area Concrete alleged that it had saved PG&E millions of dollars by doing disposal work in Paradise more cheaply than a competitor. Bay Area Concrete also said that it continued to work for PG&E as other companies fled when the utility declared bankruptcy in January 2019. At the time, PG&E owed Bay Area Concrete nearly $4 million, according to bankruptcy filings. Bay Area Concrete stuck around and opened a new dump on PG&E property in Petaluma. According to the disposal company, it racked up $14 million in unpaid invoices. Bay Area Concrete has said that PG&E’s accusations of fraud are false and the bankrupt utility was just trying to get out of paying its bills. PG&E’s counterclaim, filed earlier this month, names Bay Area Concrete, both former PG&E employees, Singh, Johal, several of their other companies and Bay Area Concrete CEO Kevin Olivero as defendants. PG&E alleges that Kooistra and Huggins steered PG&E contracts to Bay Area Concrete and other companies controlled by Singh and Johal. As a result, the value of Bay Area Concrete’s contracts with PG&E increased “exponentially” over a period of four years, the lawsuit said. Meanwhile, competing companies lost work with PG&E. PG&E did not say how much the utility believes it was overcharged by Bay Area Concrete as it continues to investigate. Public records show that the company’s income increased substantially, from $16.5 million to $43.5 million, after receiving a contract to dispose of waste in connection with the Paradise fire. Here’s how the scheme worked, according to PG&E’s allegations in court filings. Bay Area Concrete overcharged for travel time while hauling and billed PG&E for work that was never done or was unnecessary. The complaint alleges that Huggins and Kooistra approved the overbilled work in exchange for kickbacks. The pair were careful to keep Bay Area Concrete’s purchase orders low enough that Huggins would not have to seek approval from his supervisors. To pay the bribes, Singh used a series of real estate transactions involving a 5,600-square-foot home in Saratoga to transfer money to Kooistra, PG&E alleges. The Bay City News Foundation and ProPublica first reported the exchange, which one expert described as possible money laundering. PG&E’s court filing alleges that Regal Rose LLC, a shell company established by Singh, was also in possession of a property in Arizona when it was transferred to Kooistra. Another shell company, CCI Management, was owned by Kooistra and acted as a subcontractor for Bay Area Concrete in Paradise. According to PG&E’s complaint, CCI did hauling work for Bay Area Concrete, which would submit invoices directly to PG&E. PG&E paid CCI $150,000 over five weeks without knowing that the company was owned by Kooistra, a violation of PG&E employment and supplier policies. PG&E alleges that Huggins was aware of Kooista’s actions and did not disclose them. In late 2019, PG&E learned of the alleged fraud and launched an investigation. Kooistra was interviewed in January 2020 by PG&E investigators, who confronted him with evidence of his interest in companies connected to Bay Area Concrete. According to the countercomplaint, Kooistra denied any wrongdoing or having an interest in the companies, despite the interest being disclosed in public records. PG&E asked Kooistra to turn over his company-issued phone, which he did, but he refused to provide his passcode so investigators could access text messages and other data. Two days later, Kooistra quit his job, according to the complaint. He sold his home in Rocklin and moved to Arizona. The Mystery House: How a Suspicious Multimillion Dollar Real Estate Deal Is Connected to California’s Deadliest Fire PG&E alleges that Huggins approved false invoices and concealed fraudulent charges throughout PG&E’s contract with Bay Area Concrete. In exchange, the lawsuit alleges, a company linked to Johal and Singh repaved Huggins’ driveway while they were supposed to be working on a PG&E job. When confronted by PG&E investigators, Huggins told the investigators he had paid the $16,750 bill in cash, which he happened to have on hand in his house. Four days later, he retired. In February 2020, PG&E canceled Bay Area Concrete’s contracts and publicly announced its belief that the waste company had committed fraud. Butte County District Attorney Michael Ramsey said last year that PG&E alerted his office to the allegations against Bay Area Concrete. Ramsey said in an email that he received no further information from PG&E but had determined that his office did not have jurisdiction in the case.
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. As Turkey launched a military offensive against Kurdish minorities in neighboring Syria in early 2018, Facebook’s top executives faced a political dilemma. Turkey was demanding the social media giant block Facebook posts from the People’s Protection Units, a mostly Kurdish militia group the Turkish government had targeted. Should Facebook ignore the request, as it has done elsewhere, and risk losing access to tens of millions of users in Turkey? Or should it silence the group, known as the YPG, even if doing so added to the perception that the company too often bends to the wishes of authoritarian governments? It wasn’t a particularly close call for the company’s leadership, newly disclosed emails show. “I am fine with this,” wrote Sheryl Sandberg, Facebook’s No. 2 executive, in a one-sentence message to a team that reviewed the page. Three years later, YPG’s photos and updates about the Turkish military’s brutal attacks on the Kurdish minority in Syria still can’t be viewed by Facebook users inside Turkey. The conversations, among other internal emails obtained by ProPublica, provide an unusually direct look into how tech giants like Facebook handle censorship requests made by governments that routinely limit what can be said publicly. When the Turkish government attacked the Kurds in the Afrin District of northern Syria, Turkey also arrested hundreds of its own residents for criticizing the operation. Publicly, Facebook has underscored that it cherishes free speech: “We believe freedom of expression is a fundamental human right, and we work hard to protect and defend these values around the world,” the company wrote in a blog post last month about a new Turkish law requiring that social media firms have a legal presence in the country. “More than half of the people in Turkey rely on Facebook to stay in touch with their friends and family, to express their opinions and grow their businesses.” But behind the scenes in 2018, amid Turkey’s military campaign, Facebook ultimately sided with the government’s demands. Deliberations, the emails show, were centered on keeping the platform operational, not on human rights. “The page caused us a few PR fires in the past,” one Facebook manager warned of the YPG material. The Turkish government’s lobbying on Afrin-related content included a call from the chairman of the BTK, Turkey’s telecommunications regulator. He reminded Facebook “to be cautious about the material being posted, especially photos of wounded people,” wrote Mark Smith, a U.K.-based policy manager, to Joel Kaplan, Facebook’s vice president of global public policy. “He also highlighted that the government may ask us to block entire pages and profiles if they become a focal point for sharing illegal content.” (Turkey considers the YPG a terrorist organization, although neither the U.S. nor Facebook do.) The company’s eventual solution was to “geo-block,” or selectively ban users in a geographic area from viewing certain content, should the threats from Turkish officials escalate. Facebook had previously avoided the practice, even though it has become increasingly popular among governments that want to hide posts from within their borders. Facebook confirmed to ProPublica that it made the decision to restrict the page in Turkey following a legal order from the Turkish government — and after it became clear that failing to do so would have led to its services in the country being completely shut down. The company said it had been blocked before in Turkey, including a half-dozen times in 2016. The content that Turkey deemed offensive, according to internal emails, included photos on Facebook-owned Instagram of “wounded YPG fighters, Turkish soldiers and possibly civilians.” At the time, the YPG slammed what it understood to be Facebook’s censorship of such material. “Silencing the voice of democracy: In light of the Afrin invasion, YPG experience severe cyberattacks.” The group has published graphic images, including photos of mortally wounded fighters; “this is the way NATO ally Turkey secures its borders,” YPG wrote in one post. Facebook spokesman Andy Stone provided a written statement in response to questions from ProPublica. “We strive to preserve voice for the greatest number of people,” the statement said. “There are, however, times when we restrict content based on local law even if it does not violate our community standards. In this case, we made the decision based on our policies concerning government requests to restrict content and our international human rights commitments. We disclose the content we restrict in our twice-yearly transparency reports and are evaluated by independent experts on our international human rights commitments every two years.” The Turkish embassy in Washington said it contends the YPG is the “Syrian offshoot” of the Kurdistan Workers’ Party, or PKK, which the U.S. government considers to be a terrorist organization. Facebook has considered the YPG page politically sensitive since at least 2015, emails show, when officials discovered the page was inaccurately marked as verified with a blue check mark. In turn, “that created negative coverage on Turkish pro-government media,” one executive wrote. When Facebook removed the check mark, it in turn “created negative coverage [in] English language media including on Huffington Post.” In 2018, the review team, which included global policy chief Monika Bickert, laid out the consequences of a ban. The company could set a bad example for future cases and take flak for its decision. “Geo-blocking the YPG is not without risk — activists outside of Turkey will likely notice our actions, and our decision may draw unwanted attention to our overall geo-blocking policy,” said one email in late January. But this time, the team members said, the parties were embroiled in an armed conflict and Facebook officials worried their platform could be shut down entirely in Turkey. “We are in favor of geo-blocking the YPG content,” they wrote, “if the prospects of a full-service blockage are great.” They prepared a “reactive” press statement: “We received a valid court order from the authorities in Turkey requiring us to restrict access to certain content. Following careful review, we have complied with the order,” it said. In a nine-page ruling by Ankara’s 2nd Criminal Judgeship of Peace, government officials listed YPG’s Facebook page among several hundred social media URLs they considered problematic. The court wrote that the sites should be blocked to “protect the right to life or security of life and property, ensure national security, protect public order, prevent crimes, or protect public health,” according to a copy of the order obtained by ProPublica. Kaplan, in a Jan. 26, 2018, email to Sandberg and Facebook CEO Mark Zuckerberg, confirmed that the company had received a Turkish government order demanding that the page be censored, although it wasn’t immediately clear if officials were referring to the Ankara court ruling. Kaplan advised the company to “immediately geo-block the page” should Turkey threaten to block all access to Facebook. Sandberg, in a reply to Kaplan, Zuckerberg and others, agreed. (She had been at the World Economic Forum in Davos, Switzerland, touting Facebook’s role in assisting victims of natural disasters.) In a statement to ProPublica, the YPG said censorship by Facebook and other social media platforms “is on an extreme level.” “YPG has actively been using social media platforms like Facebook, Twitter, YouTube, Instagram and others since its foundation,” the group said. “YPG uses social media to promote its struggle against jihadists and other extremists who attacked and are attacking Syrian Kurdistan and northern Syria. Those platform[s] have a crucial role in building a public presence and easily reaching communities across the world. However, we have faced many challenges on social media during these years.” Cutting off revenue from Turkey could harm Facebook financially, regulatory filings suggest. Facebook includes revenue from Turkey and Russia in the figure it gives for Europe overall and the company reported a 34% increase for the continent in annual revenue per user, according to its 2019 annual report to the U.S. Securities and Exchange Commission. Yaman Akdeniz, a founder of the Turkish Freedom of Expression Association, said the YPG block was “not an easy case because Turkey sees the YPG as a terror organization and wants their accounts to be blocked from Turkey. But it just confirms that Facebook doesn't want to challenge these requests, and it was prepared to act.” “Facebook has a transparency problem,” he said. In fact, Facebook doesn’t reveal to users that the YPG page is explicitly banned. When ProPublica tried to access YPG’s Facebook page using a Turkish VPN — to simulate browsing the internet from inside the country — a notice read: “The link may be broken, or the page may have been removed.” The page is still available on Facebook to people who view the site through U.S. internet providers. How the Police Bank Millions Through Their Union Contracts For its part, Facebook reported about 15,300 government requests worldwide for content restrictions during the first half of 2018. Roughly 1,600 came from Turkey during that period, company data shows, accounting for about 10% of requests globally. In a brief post, Facebook said it restricted access to 1,106 items in response to requests from Turkey’s telecom regulator, the courts and other agencies, “which covers a range of offenses including personal rights violations, personal privacy, defamation of [first Turkish president Mustafa Kemal] Ataturk, and laws on the unauthorized sale of regulated goods.” Katitza Rodriguez, policy director for global privacy at the Electronic Frontier Foundation, said the Turkish government has also managed to force Facebook and other platforms into appointing legal representatives in the country. If tech companies don’t comply, she said, Turkish taxpayers would be prevented from placing ads and making payments to Facebook. Because Facebook is a member of the Global Network Initiative, Rodriguez said, it has pledged to uphold the group’s human rights principles. “Companies have an obligation under international human rights law to respect human rights,” she said. Mollie Simon contributed reporting.
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. This article was produced in partnership with The Maine Monitor, which was a member of the ProPublica Local Reporting Network. Soon after receiving his license to practice law in Maine in May 2015, Jeremiah McIntosh, 36, began a new career as a small-town lawyer in the northeast corner of the state’s rural Aroostook County. McIntosh advertised online that he had spent almost a dozen years working as a civilian employee for the Defense Department. Now, he quickly fell back into life in his hometown. He volunteered for the town planning board, helped the library register as a nonprofit and opened a rural law office in the small, close-knit community of Washburn, where fewer than 2,000 people live. Among McIntosh’s clients were poor residents of the county who had been accused of crimes. Unique among states, Maine has no public defenders. Instead, private lawyers like McIntosh contract with the Maine Commission on Indigent Legal Services, or MCILS, to represent impoverished defendants in criminal cases and other legal matters. The agency is supposed to screen attorneys to make sure they have enough legal and trial experience to represent their clients, especially those charged with violent felonies or complex criminal matters. Under the agency’s rules, McIntosh, as a new lawyer, lacked the required years of experience to handle dozens of cases in which he served as counsel. In an interview, McIntosh said he felt qualified to work on the cases even though state rules said he wasn’t eligible to take them. At a certain point, McIntosh gained the appropriate amount of experience to apply to MCILS to work on more complex criminal cases, but he never did. “If you look at the amount of trials and other experience I’ve had, then am I the most experienced up here? No. Am I brand new? No,” said McIntosh, now six years into his career. “Do I have the experience to handle these cases? Sure.” McIntosh was one of scores of attorneys in Maine who represented clients when they did not have the training or experience required by state rules, according to an investigation by The Maine Monitor and ProPublica based on state records, court files and interviews. The news organizations identified at least 2,000 case assignments — ranging from murder cases to children charged with felonies — that had been handed off to ineligible lawyers over a period of five years. This means more than 1 of every 8 case assignments that required specialized representation was given to an attorney who was supposed to be ineligible to serve, the analysis found. In some cases, the attorney lacked experience and could not have qualified to represent clients under state rules. In other cases, they had the necessary expertise, but they failed to apply to MCILS to represent defendants facing serious charges. Maine’s top judges and court clerks claim they were unaware of the problem until contacted by the news organizations. “That shouldn’t have happened. Period,” said Superior Court Chief Justice Robert Mullen, who oversees Maine’s trial courts. No single person or agency is responsible for enforcing Maine’s court appointment rules. MCILS, judges, clerks and individual lawyers all play a role in making sure that a private attorney has met the requirements before representing a defendant. To work on serious cases, such as drunk driving or domestic violence, an attorney must have at least a year of legal experience and have represented people in two trials and hearings. As the severity of the crime climbs, lawyers need additional trials and experience. The executive director can grant waivers for either requirement. MCILS’s standards for attorney qualifications are “too lenient” and lack “appropriate supervision,” according to a 2019 report by public defense experts commissioned by the state legislature. Any lawyer with two years of experience and a handful of trials is eligible to try every case type except sex offenses and murders. Yet lawyers are falling short of even these minimal standards. Court clerks are often the ones tasked with assigning an attorney to a case, but they must rely on MCILS’s lists of qualified attorneys, which do not always offer enough information to determine whether an attorney is eligible to represent a specific case or charge, state officials said. Over five years, clerks made 15,700 assignments for cases where the charges were serious enough to merit a lawyer with elevated experience and training under MCILS rules, The Maine Monitor and ProPublica found. Elizabeth Maddaus, the statewide director of clerks of courts, had clerks review some of the 2,000 assignments to ineligible lawyers, which were provided to her by the news organizations. Many of the appointed attorneys fell short of the agency’s standards. After the review, Maddaus said that her office would implement reforms to require eligibility verification, add more training and instruct judges to note any special arrangements when assigning attorneys to cases. But, she said, she didn’t see widespread problems in the system. “As always, we could do better,” Maddaus said. The effect of assigning ineligible lawyers to cases is unclear. A review of Maine’s Supreme Court decisions did not find any cases that were overturned as a result of ineffective representation by an attorney who didn’t have the proper MCILS credentials. There were also no public disciplinary sanctions of attorneys who accepted court appointments that they were unqualified for. MCILS officials intervened in few of the incorrect assignments in the past 10 years, even though they received automatic alerts whenever an ineligible attorney received a case, according to one agency employee. Lynne Nash, one of four employees in the small agency, repeatedly tried to alert her bosses to the problem, according to interviews and emails reviewed by The Maine Monitor and ProPublica. Nash said that she questioned John Pelletier, who was then the head of the agency, and his deputy, Eleanor Maciag, about better enforcement of attorney assignments. The three employees argued about whether Pelletier or the lawyers were to blame for letting the incorrect assignments go forward, she said. Pelletier resigned last year after an investigation by The Maine Monitor and ProPublica found that he had hired attorneys with criminal convictions and histories of professional misconduct to represent the state’s poorest clients. Neither he nor Maciag, who remains in her role as deputy director, responded to requests for comment. “If we have an attorney out there that’s taking a serious violent felony case and they’re not eligible — that’s poor representation, in my world,” Nash said. “That’s just wrong. We have very few rules or policies that exist within this agency. If there’s one that should really be abided by, I would think that would be one at the top.” Maine lawyers risk having clients sentenced to more jail time and causing a loss of public trust in the criminal justice system when the state does not enforce standards for attorney qualifications, said Ernie Lewis, the former Kentucky public advocate who oversaw that state’s public defender system and past director of the National Association for Public Defense. “Simply adopting standards or adopting qualifications without some enforcement mechanism is pretty worthless, really,” Lewis said. Josh Tardy, who chairs the commission that oversees MCILS, said that attorneys could be qualified to handle a case even if they didn’t appear on MCILS’s list of eligible attorneys. Some of the 2,000 case assignments may have gone to attorneys with sufficient experience and knowledge, but who were ineligible simply because they had not submitted the correct paperwork. Some lawyers identified by the news organizations were “more than qualified,” while others could be “very problematic,” Tardy said. Still, said Tardy, the public defense agency needed to do a better job. “I find it unacceptable that we have these rules and that we haven’t as a commission addressed that they haven’t been enforced,” Tardy said. “We just can’t accept that if we don’t like a rule on the book, we’re just going to look the other way and not enforce it. We have to figure out a way that our rules are enforceable and that they mean something.” Several defendants represented by such attorneys said they felt the state was wrong to have assigned them a lawyer who may not have been equipped to handle their case. David Crandall was arrested in 2015 on felony drug trafficking charges. McIntosh represented him in the case, which resulted in a three-year prison sentence. Before Crandall could begin serving the sentence, he was arrested again in February 2016 for allegedly operating a methamphetamine lab in Ludlow, Maine. Three people told agents with the Maine Drug Enforcement Agency that he had visited a home and shaken a bottle they had used to make meth. They were all arrested. A court clerk in Aroostook County again assigned McIntosh to defend Crandall. Now, however, prosecutors were seeking a 12-year prison sentence, Crandall said. The two men met a few times in a small conference room in the Houlton courthouse. “I want to take this to jury trial,” Crandall said he told McIntosh. But McIntosh, he recalled, told him he didn’t stand much chance of winning, assuming any of the three witnesses testified against him. McIntosh declined to comment on the specifics of the conversation, citing attorney-client privilege. A review of state records showed no disciplinary actions against McIntosh. Deflated, Crandall decided that fighting the charges would be futile. In October 2016, the father of two pleaded guilty in exchange for a half sentence, six years, of which he would serve three years in prison for his prior conviction. Crandall believes the state failed in its duties by providing him a lawyer with too little experience. In August, police reported finding meth on Crandall and charged him with violating his probation. His case is pending. “A judge will tell you: A client who represents himself has a fool for a lawyer,” Crandall said. “They pick their fool, and put your life in their hands.” McIntosh began accepting court appointments in July 2015. By early 2016, he was being assigned one or more violent felony cases almost every month by the courts in northern Maine, records show. These cases should have been restricted to attorneys with much more experience than he had, and McIntosh never applied to be allowed to represent clients facing such charges. At least 23% of the attorneys flagged by the news organizations’ analysis did not have the minimum years of legal experience necessary to defend against the charges in at least one of the cases they were assigned. McIntosh explained that the reason he hadn’t applied to be able to accept such cases was that he saw himself as a backup option. If no other attorney was available to defend a client, McIntosh was willing to do the job. McIntosh said he was never afraid to pick up a phone to seek advice from a more experienced lawyer or request co-counsel from MCILS. “I personally didn’t want to be priority for those cases,” McIntosh said. “That was my thought: ‘Hey, if someone else wants them, let them have it.’ If you can’t find any help, then you can let me know.” McIntosh said he assumed the clerks had run through the list of eligible attorneys before turning to him. In five years, McIntosh was assigned at least 900 cases, including dozens that he was ineligible to work on. With more cases came more money. McIntosh soon became one of the highest paid public defense attorneys in Maine, records show. McIntosh’s law office billed over $200,000 in fiscal year 2018, according to records obtained as a result of a lawsuit against the state filed by The Maine Monitor and ProPublica. The money raised red flags. In 2018, former executive director Pelletier opened an investigation into the state’s highest paid defense attorneys. One of the attorneys self-reported overbilling $35,000 in response to Pelletier’s inquiry, according to a government investigation into MCILS’s finances published in November. The attorney was not identified, but interviews with sources and records reviewed by a reporter indicate McIntosh was the attorney in question. McIntosh partially responded to questions about his representation, but he declined to answer questions about his billing and did not respond to follow-up emails from a reporter. “That’s Not Up to Us” A decade ago, when Maine overhauled its public defense system and opened MCILS, attorney Ron Schneider helped write the rules for vetting lawyers and helped create a set of specialized panels from which experienced lawyers would be appointed to difficult cases. The goal was to make sure that only qualified and capable lawyers were assigned to complex cases where the risk of jail time was high, said Schneider, who served as the first chairman of the commission that oversees MCILS. Under the rules, attorneys must have a license to practice law and attend a one-day commission-approved training course before they can accept misdemeanor and some felony cases. To serve as counsel on more serious cases, lawyers need additional classes and to show additional experience. Once approved by MCILS, attorneys are placed on the specialized panel. Each month, the agency sends lists of the eligible attorneys on each panel to the courthouses so clerks can base assignments for indigent defendants on them. That’s how the system is supposed to work. But MCILS’s four employees were unable to keep pace with the assignments to verify whether all attorneys had applied or were qualified for the appointments the courts assigned them, Schneider said. “We don’t have the resources to make sure that the lawyers assigned are the most qualified lawyers,” said Schneider, who was appointed again as a commissioner in 2019. Delays implementing the panels and unclear instructions created a patchwork system in each courthouse. In Aroostook County, clerks and judges appoint attorneys that defendants have worked with in the past or request by name, said Diane Glidden, a clerk in the superior court. The clerks will check the commission’s list, but the instructions were often unclear. For instance, MCILS lists attorneys cleared to represent “serious violent felonies” but does not spell out which crimes fall within that category. As a result, clerks leave it up to attorneys to decide whether they are qualified enough to handle a case. “We wouldn’t make a determination of what is a serious and violent felony compared to what’s not. That’s not up to us to do that,” Glidden said. “When we ask an attorney to take a case, we explain to that attorney what the charges are, and then they are the ones to let us know whether or not they can take the case.” Maddaus, the statewide director of the clerks of courts, acknowledged that clerks had made mistakes when assigning attorneys to cases in the past. But she also found cases that were exceptions to the rules, where attorneys were allowed to practice without being listed as members of the specialized panels. For instance, some attorneys worked under the mentorship of more experienced attorneys, which allowed them to work on complex cases that were beyond their level of experience. In other cases, judges asked attorneys who had not applied to MCILS to represent an indigent defendant. Sometimes, attorneys were appointed to represent a defendant despite a lack of training or experience in order to preserve an existing legal relationship. Private attorneys who were not on the specialized panels said they were sometimes unaware that they were violating eligibility rules. Christopher Berryment runs a small law firm in Mexico, Maine. For years, courts assigned him to represent children facing felony charges in juvenile court or adults in violent felony and sex offense cases, despite his lack of eligibility for such cases. Sometimes he sought permission from the MCILS director to work on cases he should have been ineligible for. Other times he did not. Berryment, who is now eligible to represent those facing serious violent felony charges, said he knew lawyers needed to apply to be on the specialty panels. He believed he was qualified for the cases even though he hadn’t applied. When asked if he wanted the cases, he claimed he hadn’t thought it through. “I hate to lawyer the question, but define the word ‘want,’” Berryment said. “I’m willing to do them. I’m also not necessarily wanting to be first priority on it, or whatever.” Brian Lamper was arrested for felony aggravated assault and domestic violence in November 2018. The courts assigned Berryment as his attorney even though, at that point, he wasn’t on MCILS’s serious violent felony panel. On the day Lamper appeared in court, he watched other attorneys go back and forth between the judge’s chamber and their clients to negotiate lesser sentences and reach deals, he said. But Berryment refused to go back for another offer, Lamper said. “My lawyer wouldn’t do that. He came out and was like, ‘This is it. This is what we’re doing. We’re moving forward,’” Lamper said. “I said, ‘Chris, I have a sick mother, I have a lot of problems outside of here and I need to get out of here as soon as possible.’ And he told me straight up, ‘The fastest way out of here, Brian: Cop a deal.’” The men barely spoke, and by the end of the day, Lamper had pleaded guilty to the three domestic violence charges in exchange for prosecutors dropping the violent felony. He was sentenced to three years and ordered to serve six months in jail. But Lamper said he felt that Berryment could have negotiated a better plea deal with prosecutors. Berryment billed MCILS for less than 13 hours of work on Lamper’s case, records show. Maine attorney Stephen Schwartz responded to a written list of questions on Berryment’s behalf about his representation of Lamper. Schwartz said Berryment met the criteria set by MCILS when he represented Lamper “whether or not he was rostered for the particular matter,” and that Berryment achieved a “good disposition in a serious, difficult case.” Schwartz referenced two cases where Berryment had achieved an acquittal at trial for one client and had a guilty verdict vacated by the state supreme court for another. A review of state records showed no disciplinary actions against Berryment. “He has stepped up to help the bench and bar in accepting matters helping indigent people in a system that due to lack of funding has difficulty delivering constitutionally mandated criminal defense to indigent accused,” Schwartz wrote on Berryment’s behalf. It is the responsibility of the state to ensure the poor are being appointed qualified lawyers, said Jonathan Rapping, president of the criminal justice reform nonprofit Gideon’s Promise, which was named after the landmark U.S. Supreme Court case, Gideon v. Wainwright, that guaranteed the poor the right to be appointed counsel by the states nearly 60 years ago. States often fall short of holding lawyers and themselves responsible for that goal, Rapping said. “They do a terrible job and no one holds them accountable. I absolutely think there has to be accountability, but the accountability isn’t just for the lawyer doing the representation, it’s got to be for the very government that is approving the people who do it,” Rapping said. Some states that use private attorneys have far more rigorous systems in place to check attorney qualifications. In Massachusetts, considered by many experts to be a gold standard for the training of court-appointed counsel, a lawyer needs to be approved by the local bar advocate program and pass a seven-day training course to work on similar cases in district court. Their qualifications are then reviewed again during a performance evaluation within 12 to 24 months. Applicants must have worked on at least six jury trials to represent clients in superior court and have handled at least 10 serious and complex cases to join the state’s list of attorneys eligible to defend murder cases. Applicants are vetted by a panel of experienced criminal lawyers before the state certifies them, according to the state’s defense agency, the Committee for Public Counsel Services. Massachusetts’ billing system also automatically rejects assignments made to ineligible attorneys, and rejected assignments are reviewed by the director of the criminal trial support unit to verify if the case needs to be reassigned. In September, MCILS agreed to pay more than $92,000 to develop a new five-day minimum standards training course for Maine lawyers to cover “the basics of ethical, constitutionally-competent lawyering.” There is currently no time frame for implementing it. A Problem in Plain Sight At a meeting in April 2020, commissioners wanted to know whether ineligible attorneys were routinely defending clients. Pelletier assured them it was not the norm. The former director estimated he was finding one to two cases a month. In reality, the figure was closer to 30 to 35 case assignments per month, according to the analysis by The Maine Monitor and ProPublica. But the full extent of Pelletier’s misleading remarks was not revealed until after his resignation in December. Later that month, his deputy, Maciag, announced at a public hearing that some of the eligibility rules were not being enforced at all. By then, The Maine Monitor and ProPublica had been asking about the thousands of cases where attorneys lacked the experience and training needed to represent clients. Maciag blamed Pelletier, who had spent a decade in charge. “Over the years, the previous executive director didn’t always make folks withdraw from cases that they weren’t eligible for,” Maciag said. “Roster eligibility has not routinely been strictly enforced.” In mid-January, Justin Andrus took charge as interim director of MCILS. Andrus has vowed to improve the system. He is creating a qualified roster of attorneys for child abuse cases, which Pelletier had never implemented. Yet problems persist. A backlog of nearly 50 cases assigned to ineligible attorneys before Andrus joined the agency is awaiting his approval. He has already identified another four cases where he intends to ask lawyers to withdraw because they lack the required qualifications. In his first weeks on the job, Andrus also approved an application by Pelletier, who opened a law practice after resigning. Pelletier will be allowed to work on all adult and juvenile criminal cases, even though he has not completed the required number of jury trials during the past decade he spent as the head of MCILS. “I would not approve an application for a person that I didn’t think was competent and qualified,” Andrus said of Pelletier. At the time of publication, commissioners and clerks had taken no steps to contact past defendants who were assigned attorneys that may not have been qualified. The lack of action has worried defenders of civil rights. The local chapter of the ACLU has considered for more than a year taking legal action to secure court-ordered changes to Maine’s public defense system. The news that defendants were improperly assigned lawyers was both “tremendously concerning and yet not at all surprising,” said Zach Heiden, legal counsel of the state chapter. There exists a “severe and unacceptable risk of denial of the right to counsel” in Maine, Heiden said. “This isn’t some outsider saying this lawyer wasn’t good, or this lawyer wasn’t qualified. This is the state’s own standards that the state is going on to ignore,” Heiden said. “But on the other hand, given the structure — structure seems like an overstatement — how could the state expect anything else?” Methodology To analyze the eligibility of attorneys handling serious cases, The Maine Monitor and ProPublica obtained billing and case data from the Maine Commission on Indigent Legal Services, or MCILS. The news organizations initially submitted a public records request for the data in January 2020, but the agency denied the request. The news organizations then filed an appeal in February and entered into mediation with the state. After six months of negotiations, the state agreed to release a portion of the data for $5,333. We then used this data to find individual case assignments based on the assigned attorney, case assignment date and docket number. Maine Governor Won’t Fund Reforms for Public Defense Agency Without Accountability The agency has special eligibility requirements for its most serious cases, including homicides, sex offenses, serious violent felonies, domestic violence, drunk driving and juvenile felonies. Once an attorney is approved for these cases, MCILS places them on a “specialized panel” and distributes lists of qualified attorneys to each court. We compiled thousands of these lists dating back to 2011. The lawyers on each list vary each month, so we combined the information into a single database for analysis. We matched this database with about 15,700 case assignments, derived from the billing data, that required a specialized panel attorney between 2015 and 2019. The state redacted the assignment date for some specialized panel cases such as those involving protective custody because it deemed them as confidential. These cases weren’t included in the analysis. To find the case assignments that went to ineligible attorneys, we compared the assignment date to the earliest date that an attorney appeared on a list in any court in the state. This controlled for instances in which an attorney was properly rostered in a different court than the one where he or she was assigned the case, and for circumstances in which an attorney was taken off a list for a period of time. Furthermore, we counted an attorney as being eligible if the person was added to a MCILS list for that case type up to 30 days after the assignment date, and we excluded cases in which two attorneys were assigned the case on the same day and at least one of them was eligible. In some instances, ineligible attorneys had a “mentor” or eligible attorney working alongside them. However, this was not consistently tracked by the courts or MCILS, and the agency’s database didn’t allow us to track these types of arrangements. This gave us our list of 2,000 assignments in which attorneys were ineligible for their cases, which translates to more than 1 in every 8 assignments with specialized panel requirements. We then reviewed the bar admittance dates listed on the Maine Board of Overseers of the Bar website for these attorneys and compared that to the case assignment date to determine how many attorneys did not have enough years of professional experience to qualify for those case types. This analysis showed that at least 23% of the 300 attorneys who handled cases they were ineligible for didn’t have the required years of experience for at least one of their case assignments.
This article is co-published with The Texas Tribune, a nonprofit, nonpartisan local newsroom that informs and engages with Texans. Sign up for The Brief weekly to get up to speed on their essential coverage of Texas issues. In January 2014, power plants owned by Texas’ largest electricity producer buckled under frigid temperatures. Its generators failed more than a dozen times in 12 hours, helping to bring the state’s electric grid to the brink of collapse. The incident was the second in three years for North Texas-based Luminant, whose equipment malfunctions during a more severe storm in 2011 resulted in a $750,000 fine from state energy regulators for failing to deliver promised power to the grid. In the earlier cold snap, the grid was pushed to the limit and rolling blackouts swept the state, spurring an angry Legislature to order a study of what went wrong. Experts hired by the Texas Public Utility Commission, which oversees the state’s electric and water utilities, concluded that power-generating companies like Luminant had failed to understand the “critical failure points” that could cause equipment to stop working in cold weather. In May 2014, the PUC sought changes that would require energy companies to identify and address all potential failure points, including any effects of “weather design limits.” This story is part of a collaboration between ProPublica and the Texas Tribune. Learn more Luminant argued against the proposal. In comments to the commission, the company said the requirement was unnecessary and “may or may not identify the ‘weak links’ in protections against extreme temperatures.” “Each weather event [is] dynamic,” company representatives told regulators. “Any engineering analysis that attempted to identify a specific weather design limit would be rendered meaningless.” By the end of the process, the PUC agreed to soften the proposed changes. Instead of identifying all possible failure points in their equipment, power companies would need only to address any that were previously known. The change, which experts say has left Texas power plants more susceptible to the kind of extreme and deadly weather events that bore down on the state last week, is one in a series of cascading failures to shield the state’s electric grid from winter storms, ProPublica and The Texas Tribune found. Lawmakers and regulators, including the PUC and the industry-friendly Texas Railroad Commission, which regulates the oil and gas industry, have repeatedly ignored, dismissed or watered down efforts to address weaknesses in the state’s sprawling electric grid, which is isolated from the rest of the country. About 46,000 megawatts of power — enough to provide electricity to 9 million homes on a high-demand day — were taken off the grid last week due to power-generating failures stemming from winter storms that battered the state for nearly seven consecutive days. Dozens of deaths, including that of an 11-year-old boy, have been tied to the weather. At the height of the crisis, more than 4.5 million customers across the state were without power. Snow surrounds an Austin Energy station in Austin, Texas, on Thursday, Feb. 18, 2021. Many Texas residents are still without power and working water. Credit: Sergio Flores for The Texas Tribune As millions of Texans endured days without power and water, experts and news organizations pointed to unheeded warnings in a federal report that examined the 2011 winter storm and offered recommendations for preventing future problems. The report by the Federal Energy Regulatory Commission and the North American Electric Reliability Corporation concluded, among other things, that power companies and natural gas producers hadn’t properly readied their facilities for cold weather, including failing to install extra insulation, wind breaks and heaters. Another federal report released three years later made similar recommendations with few results. Lawmakers also failed to pass measures over the past two decades that would have required the operator of the state’s main power grid to ensure adequate reserves to shield against blackouts, provided better representation for residential and small commercial consumers on the board that oversees that agency and allowed the state’s top emergency-planning agency to make sure power plants were adequately “hardened” against disaster. Experts and consumer advocates say the challenge to the 2014 proposal by Luminant and other companies, which hasn’t been previously reported, is an example of the industry’s outsize influence over the regulatory bodies that oversee them. “Too often, power companies get exactly what they want out of the PUC,” said Tim Morstad, associate director of AARP Texas. “Even well-intentioned PUC staff are outgunned by armies of power company lawyers and their experts. The sad truth is that if power companies object to something, in this case simply providing information about the durability of certain equipment, they are extremely likely to get what they want.” Luminant representatives declined to answer questions about the company’s opposition to the weatherization proposal. PUC officials also declined to comment. Michael Webber, an energy expert and mechanical engineering professor at the University of Texas at Austin, said the original proposal could have helped in identifying trouble spots within the state’s power plants. “Good engineering requires detailed understanding of the performance limits of each individual component that goes into a system,” Webber said. “Even if 99.9% of the equipment is properly rated for the operational temperatures, that one part out of 1,000 can bring the whole thing down." Luminant defended its performance during last week’s deep freeze, saying it produced about 25% to 30% of the power on the grid Monday and Tuesday, compared with its typical market share of about 18%. In a public statement, officials said the company executed a “significant winter preparedness strategy to keep the electricity flowing during this unprecedented, extended weather event.” They declined to disclose whether any of the company’s generating units failed during last week’s winter storms. State officials are again promising reforms. Lawmakers have called on officials with the PUC and the Electric Reliability Council of Texas, which operates the power grid that spans most of the state, to testify at hearings later this week. Gov. Greg Abbott has called on lawmakers to mandate the winterization of generators and power plants, and Texas Attorney General Ken Paxton said he was launching an investigation into ERCOT and almost a dozen power companies, including Luminant. Separately, the PUC announced its own investigation into ERCOT. The Blanco Vista neighborhood of San Marcos was blanketed with several inches of snow Feb. 15 after a massive winter weather system engulfed Texas, causing widespread power outages across the state. Credit: Jordan Vonderhaar for The Texas Tribune Texas is the only state in the continental U.S. that operates its own electric grid, making it difficult for other regions to send excess power in times of crisis, especially when they are facing their own shortages, as they were last week. All other states in the Lower 48, as well as peripheral areas of Texas, are connected to one of two grids that span the eastern and western halves of the country. Because Texas operates its own grid, the state isn’t subject to federal oversight by FERC, which can investigate power outages but can’t mandate reforms. Many energy experts say the very nature of the state’s deregulated electric market is perhaps most to blame for last week’s power crisis. In Texas, a handful of mega-utilities controlled the distribution and pricing of the power they produced until two decades ago, when the Legislature shifted to a system where companies would compete for customers on the open market. Lawmakers said the change would result in lower power bills and better service, a promise that some experts and advocates say hasn’t been kept. But under this system, power companies aren’t required to produce enough electricity to get the state through crises like the one last week. In fact, they are incentivized to ramp up generation only when dwindling power supplies have driven up prices. Other states with deregulated power markets, including California, have made reforms and added additional safeguards after experiencing similar catastrophes. “The fault on this one is at the feet of the Legislature and the regulators for their failure to protect the people rather than profits, the utility companies, rather than investing millions of dollars in weatherization that had been recommended in review after review of these kinds of incidents,” said Tom “Smitty” Smith, a longtime Texas consumer advocate and environmental activist. “They have chosen not to do that because it would be too expensive for the utilities and ultimately to the consumers.” “We'll Be Opportunistic” Three years after the 2011 storms, the Texas electric grid faced another major cold weather test when a polar vortex swept across the state. Freezing temperatures helped to knock out nearly 50 generating units at Texas power plants in the first week of 2014, bringing ERCOT perilously close to ordering rotating outages. The event quickly faded from public attention because it was a near-miss that didn’t actually leave people without electricity or heat. But because the state had come so close to blackouts, the North American Electric Reliability Corporation, which has some authority to regulate power companies in the country, launched an investigation. The probe found similar problems to those that dogged the state after the 2011 storms, primarily equipment that failed to stand up to the freezing temperatures. Despite the equipment failures that brought the electric grid to the brink of disaster, the polar vortex was a financial windfall for power-generation companies. In the months that followed the storm, some of the companies stressed to investors the financial benefits of the two days of cold weather and accompanying high energy prices. “This business benefited significantly from increased basis and storage spreads during the polar vortex earlier this year,” Joe McGoldrick, an executive with Houston-based CenterPoint Energy, said in a November 2014 earnings call. “To the extent that we get another polar vortex or whatever, absolutely, we’ll be opportunistic and take advantage of those conditions.” The company did not respond to requests for comment. Texas has relied on the principle that higher prices will spur greater power generation when the state needs it most, a structure that helps explain the persistence of blackouts, said Ed Hirs, a University of Houston energy expert. In extreme weather events like last week’s freeze, prices per megawatt jumped from an average of around $35 to ERCOT’s maximum of $9,000. Hirs said it’s in the power generators’ interest to “push ERCOT into a tight situation where price goes up dramatically.” “They are giving generators incentive to withdraw service,” he added. “How else do you get the price to go up?” Texans have already been hit with sky-high bills since last week’s event, with some climbing as high as $16,000, according to The New York Times. At an emergency meeting Sunday, the three-member PUC ordered electric companies to suspend disconnections for nonpayment and delay sending invoices or bill estimates. Power companies weren’t the only ones that saw the 2014 event more as a success story than a sign of weakness. ERCOT concluded that operators “handled a difficult situation well” and took “prompt and decisive actions” that had prevented systemwide blackouts. In the “lessons learned” section of its final report, the agency promoted the continuation of its winterization site visits, which are not mandatory. Winterization efforts were paying dividends in the form of fewer generating units falling victim to cold weather, the report stated. Federal regulators agreed. During a meeting of the National Association of Regulatory Utility Commissioners in February 2014, a month after the storm, a top-ranking official from NERC stated that the response showed “industry is learning [and] using the resources and tools available to improve their preparations and operations of the grid during a significant weather event.” But NERC’s investigation exposed problems that would bring Texas to a crisis point last week. A car moved Thursday through a West Austin neighborhood that was without power. Credit: Jordan Vonderhaar for The Texas Tribune In the 2014 report, NERC methodically laid out how power-generating equipment failed during the cold snap, detailing 62 examples that included frozen circulating water that caused a supply loss and moisture in the air causing valves to freeze. In all, those cold-related failures were responsible for the vast majority of lost power during the event, the agency found. The incident also highlighted the need to improve winter performance of natural gas pipelines, which NERC found hampered the ability of gas-fired power plants to generate electricity. The agency declined to comment, saying it doesn’t discuss investigations. Natural gas and power generation are highly dependent on each other: Natural gas processing requires electricity, which may be produced in turn by burning natural gas. Citing preliminary figures from ERCOT that show natural-gas-fired power plants performed worse than those fueled by other types of energy during this year’s power crisis, energy experts say producers and distributors of that fossil fuel played a major role in the catastrophe. Natural gas producers and pipeline companies in Texas are regulated by the Railroad Commission. R.J. DeSilva, a spokesperson for the agency, declined to say whether it requires natural gas producers and pipeline companies to weatherize wellheads or pipelines. He noted that poor road conditions made it impossible for crews from natural gas companies to inspect wells and said some producers reported “the inability to produce gas because they did not have power.” Because so many homes are heated with natural gas, fossil fuel plays a much more central role in the winter than it does in the hot summer months. “When all this began, millions of Texans wrapped their pipes to keep them from freezing, and the Railroad Commission didn’t order — has never ordered — the gas companies, the gas producers and gas pipeline companies … to wrap their pipes to protect them from freezing,” said Smith, the consumer advocate. Failed Legislation After days of scrambling to address the myriad crises that pummeled his city last week, former longtime state Rep. Sylvester Turner — now mayor of Houston, the state’s largest city — had a message for his former colleagues. “You need to dust off my bill, and you need to refile it,” the Democrat said during a press conference Friday, referring to legislation he filed in 2011 that would have required the PUC to ensure ERCOT maintained adequate reserve power to prevent blackouts. “Because it’s not about just holding hearings.” The state’s deregulated market is to blame for the crisis, according to some experts who say the catastrophe shows that the system ultimately prizes profits over people. But some of the architects of the system are doubling down. In a blog post published last week on the website of U.S. House Minority Leader Kevin McCarthy, former Texas Gov. Rick Perry suggested that the current disaster was worth it if it keeps rates low and federal regulators from requiring changes to the system. “Texans would be without electricity for longer than three days to keep the federal government out of their business,” said Perry, who was governor from 2000-15 and presided over the early days of energy deregulation in Texas. “Try not to let whatever the crisis of the day is take your eye off of having a resilient grid that keeps America safe personally, economically, and strategically.” Perry, who returned to his job on the board of Dallas-based pipeline giant Energy Transfer LP after serving as energy secretary in the Trump administration, received at least $141,000 in campaign contributions from Luminant’s former parent company, TXU Corp., between 2002 and 2009, when he was governor. On Saturday, Turner warned about the soaring residential utility bills that Texans would be getting in the coming weeks. In 2012, when Turner was still a state representative, he wrote a letter to the then-chairman of the House State Affairs Committee, raising concerns about PUC rule changes that increased the price caps companies could charge for power to $9,000 per megawatt. Those price caps remain the same today. This time, Turner called on lawmakers to pursue substantive reforms that don’t simply “scapegoat” ERCOT, referring to the increasing calls for an investigation into the council, including by Abbott. “You must include the Public Utility Commission in these reforms because they provide direct oversight over ERCOT, and all of those commissioners are appointed by the governor,” Turner said. In 2013, Turner attempted, unsuccessfully, to pass a measure that would have replaced the governor’s appointees on the PUC with an elected commissioner. The same year, he tried to salvage a measure that would have increased the administrative penalty for electric industry participants that violate state law or PUC rules. The Texas Sunset Advisory Commission, which audits state agencies every 12 years to determine how they can better function or if they should be abolished, recommended in 2013 that the PUC exercise additional oversight of ERCOT, including a review and approval of annual budgets and annual review of “PUC-approved performance measures tracking ERCOT’s operations.” One of the recommendations called on the PUC to increase the administrative penalty to $100,000 a day per violation, stating that the $25,000 daily penalty “may not be sufficient for violations that affect grid reliability, which can cause serious grid failures, such as blackouts.” Lawmakers passed a bill during that year’s legislative session that adopted many of those recommendations, but the change in penalties was left out. An amendment by Turner to restore the higher fee in the bill failed. Another former Democratic lawmaker who now leads a major Texas city similarly tried and failed to pass legislation that would bring greater accountability to the state. In 2015, Dallas Mayor Eric Johnson, then a state representative, authored a bill that would have required state agencies, including the PUC, to plan and budget for severe weather using state climatologist data. “It would have forced state agencies to prepare for an event like what just happened and to account for that in their agency plans,” Johnson said during a Thursday press conference addressing the crisis. “It was quite unfortunate, because we can’t say that it would have prevented this situation but certainly may have.” Then, two years ago, facilities owned or controlled by utilities regulated by the PUC were exempted from legislation that requires the Texas Division of Emergency Management to “identify methods for hardening utility facilities and critical infrastructure in order to maintain essential services during disasters.” The bill’s author, Republican state Rep. Dennis Paul, declined to comment. State Sen. Eddie Lucio Jr., who co-sponsored the measure, said he did not know why the PUC was exempted. Jacob Duran warmed his hands over a grill Thursday after his apartment lost power due to the severe winter storm that hit Texas. Credit: Miguel Gutierrez Jr./The Texas Tribune “Demanding Answers” For the past two decades, consumer groups have fought without success for a larger role in how the state manages its power grid. Giving residents a stronger presence on the ERCOT board would have forced the agency to take the lessons of extreme winter storms in 2011 and 2014 more seriously, said Randall Chapman, a ratepayer attorney and longtime consumer advocate. “It would have changed things entirely,” Chapman said. “Residential consumers are the ones who have been through outages before. They are the ones with the broken water pipes, the ones freezing in their homes. They would be demanding answers.” Chapman said the groups were stymied when the Legislature agreed to reserve only a single seat on the ERCOT board for a representative of residential consumers. In comparison, eight seats, including alternates, are filled by representatives of energy retailers, power generators and investor-owned utility companies. “Residential consumers need a stronger voice over at ERCOT,” Morstad of AARP Texas said. “Decisions are made every week that affect the health and safety of millions of Texans. You need a strong voice there to call B.S. when companies aren’t following through on winterizing or other things that are critical to reliability of the electric system.” How the Police Bank Millions Through Their Union Contracts In 2011, Texas Comptroller Glenn Hegar co-authored a bill while serving in the state legislature that would have increased the size of the ERCOT board and allowed for more consumer representation. It didn’t pass. Hegar said the failures displayed in the last week once again bring the significance of representation to the forefront. “As a result of this extremely unfortunate event where so many people were out of power and now have damage to their homes and their businesses, there needs to be a broader range of representation on the board and to bring those voices as we move forward in trying to decide what we want our electric grid to be,” Hegar said. Lexi Churchill and Perla Trevizo contributed reporting.
ProPublica es un medio independiente y sin ánimo de lucro que produce periodismo de investigación en pro del interés público. Suscríbete para recibir sus historias en español por correo electrónico. A principios de diciembre, Miguel Fernández yacía inconsciente en la unidad de cuidados intensivos de un hospital de la zona de Los Ángeles. Un respirador artificial le bombeaba oxígeno a sus pulmones, devastados por COVID-19. El hombre de 53 años fallecía. La mejor posibilidad de que Miguel sobreviviera, quizás hasta la única, era una terapia llamada oxigenación por membrana extracorpórea, mejor conocida como ECMO (extracorporeal membrane oxygenation, en inglés). Dicho tratamiento permitiría que sus pulmones descansaran mientras que una máquina le infundía la sangre con el oxígeno que necesitaba. Sin embargo, el Hospital PIH Health Whittier, donde estaba internado, no contaba con equipo de ECMO ni el personal altamente capacitado que se necesita para operarlas. Solo unos cuantos hospitales del sur de California las tenían y estaban sobrepasados con casos de COVID-19. Desde el comienzo de la pandemia, los expertos en salud pública habían advertido acerca de la necesidad de “aplanar la curva” para evitar que el número de casos de COVID-19 se disparara y los hospitales se vieran saturados. Sin embargo, a partir de principios de noviembre, la cantidad diaria de hospitalizaciones por COVID-19 se disparó en el condado de Los Ángeles, multiplicándose ocho veces desde entonces y hasta la cresta de la ola que sucedió justo después del día de Año Nuevo. En pocas semanas, los hospitales desbordados se enfrentaron exactamente al tipo de decisiones de racionamiento de atención médica que los expertos temían. Montaron carpas para aumentar su capacidad y las ambulancias circulaban alrededor de los hospitales durante horas esperando a que hubiera camas disponibles. Hacia principios de enero, el personal médico de emergencia del condado de Los Ángeles recibió instrucciones de conservar el oxígeno suplementario y administrárselo únicamente a los pacientes más necesitados. Tampoco debían trasladar al hospital a pacientes cardíacos que no pudieran ser resucitados en su sitio. Los funcionarios estatales despacharon a la región camiones con refrigeración y miles de bolsas para cadáveres. En los hospitales, y para pacientes como Miguel, progresaba una situación terrible alejada de la vista del público. Los pacientes críticamente enfermos que podrían sobrevivir con ECMO no podían obtener el tratamiento. Los médicos tenían que elegir quién recibiría la terapia basándose en las probabilidades de supervivencia de cada paciente. Algunos recibieron aprobación, pero fue necesario colocarlos en una lista de espera. Muchos pacientes fallecieron mientras esperaban. “Creo que nunca pensamos que llegaríamos a este punto, no en California”, dijo el Dr. Jack Sun, que supervisa el programa que incluye terapia de ECMO en UCI Health del condado de Orange, 50 kilómetros al sureste de Los Ángeles. “Sabemos que, si no tenemos una cama para alguien, esa persona va a morir”. En ciertas partes del país, los médicos pueden recurrir a sistemas centralizados para rápidamente encontrar cualquier cama disponible para ECMO en algún hospital de la región. Ese no es el caso en Los Ángeles. Los cuidadores de Miguel y su familia tendrían que abrirse paso ante la burocracia y navegar por un sistema opaco, desconectado y a veces injusto para intentar salvar su vida. Miguel, el mayor de siete hermanos de una familia de inmigrantes mexicanos, era siempre el que arreglaba las cosas. Si alguien necesitaba un trabajo, él le ayudaba a encontrarlo. Si un coche no funcionaba, él lo reparaba. Su hermana, Margarita Rodríguez, lo describió como un “gran oso cariñoso” que le daba abrazos y siempre la hacía sonreír. Justo antes de ser hospitalizado, había pasado por su casa para reparar una gotera del techo. Ahora la familia tenía que encontrar la manera de arreglar a Miguel. Recorrieron el Internet con búsquedas como, “¿Qué se hace cuando falla un respirador?”. Una noche, Margarita encontró una historia de éxito sobre el uso de la terapia ECMO en San Diego. El aparato de ECMO asume el trabajo de los pulmones del paciente. Extrae la sangre del cuerpo y la hace circular a través de un pulmón artificial que elimina el dióxido de carbono y añade oxígeno antes de devolver la sangre al cuerpo. En un estudio de pacientes de 68 hospitales estadounidenses, se descubrió que los pacientes de COVID-19 en estado crítico como Miguel “tenían un riesgo de muerte considerablemente menor” si recibían ECMO durante sus primeros siete días en una unidad de cuidados intensivos. Miguel estaba relativamente sano aparte de tener COVID-19. No fumaba ni tenía enfermedades preexistentes como la diabetes. Tenía sobrepeso, pero estaba por debajo de los límites que utilizan los centros de ECMO para seleccionar a los candidatos adecuados para la terapia. En todo el país, pacientes como Miguel, que un día habían estado a punto de morir conectados a un respirador artificial, sobrevivían y abandonaban el hospital semanas después de haber recibido terapia de ECMO. Miguel Jr., su hijo mayor, sabía por sus conversaciones con los médicos que su padre no iba a mejorar si seguía conectado al respirador. “La ECMO era su última esperanza, su mejor oportunidad de sobrevivir”, comentó. “Era terapia de ECMO o morir”. Una búsqueda desesperada Miguel y su familia habían intentado protegerse del virus. Tres de sus cuatro hijos adultos viven en su casa, y cuando se infectaron en otoño, la familia se aisló todo lo posible. Miguel se mantuvo distanciado algunas noches durmiendo en una vieja caravana que tenía en el patio trasero. Debido a la pandemia, el extenso clan Fernández de vio obligado a reducir las reuniones familiares. Antes de COVID-19, Miguel a menudo organizaba convivios en su casa del sureste de Los Ángeles para festejar cumpleaños o graduaciones, o para ver el fútbol o disfrutar una parrillada. El año pasado, después de que su única hija, Jeannette, fue aceptada en la universidad de UCLA, se paseó con orgullo por su fiesta de despedida con una camiseta que decía “Papá de UCLA”. Credit: Sam Alden, especial para ProPublica Sin embargo, Miguel tuvo que seguir trabajando. Tenía un negocio de construcción junto con dos de sus hermanos, dedicado a comprar y renovar casas. Habían invertido en cientos de propiedades para remodelar y vender, comenzando hacía 12 años con un proyecto de 80 mil dólares en Compton y, más recientemente, un proyecto de 2.5 millones de dólares en Pasadena. Dos de los tres hijos de Miguel trabajaban con él. Incluso después de que COVID-19 afectara a la familia, Miguel tuvo que seguir yendo por materiales y pasar por las obras. A principios de noviembre, empezó a sentirse mal y acudió a un centro de pruebas de coronavirus en un centro de recreación de su localidad. Dos días después recibió un correo electrónico en el que se le comunicaba lo que ya sospechaba: tenía COVID-19. Para el 15 de noviembre, tenía fiebre y sudores nocturnos y le era difícil respirar. Aunque estaba cada vez más enfermo, Miguel no quería ir al hospital. Sabía que personas como él estaban muriendo. Los angelinos latinos han sufrido la mayor tasa de mortalidad por COVID-19 en el condado de Los Ángeles: casi el doble de la tasa de los negros y aproximadamente el triple de la de los blancos. Para el 17 de noviembre, a Miguel le costaba respirar cuando caminaba del baño al sofá. La familia había comprado un oxímetro, dispositivo que mide los niveles de oxígeno en la sangre cuando se coloca en un dedo. Su nivel de oxígeno había bajado al 77 %, cifra peligrosa y mucho menor al 95 % que se considera como límite de lo normal. “Nos dimos cuenta de que realmente se trataba de una emergencia”, dijo Jeannette, su hija de 21 años. Justo antes de la medianoche, dos de los hijos de Miguel lo ayudaron a subirse al asiento del copiloto del Ford Explorer de la familia. Jeannette tomó el volante y la esposa de Miguel, Alejandrina, se subió al asiento trasero. Jeannette se dirigió al hospital PIH Health Whittier, un centro médico de 523 camas cerca de su casa. En la entrada de sala de emergencias, el personal ayudó a Miguel, que pesaba 275 libras, a sentarse en una silla de ruedas además de ponerle un monitor de oxígeno en el dedo. El monitor sonó una alarma. Su mujer y su hija pudieron ver el miedo en sus ojos; él no dijo ni una palabra cuando lo llevaban al hospital. Jeannette y Alejandrina ni siquiera tuvieron la oportunidad de despedirse. PIH Health se negó a poner a su personal médico a disposición para entrevistas ni a responder a preguntas relacionadas con el cuidado de Miguel. “PIH Health no podrá ofrecer una declaración para este reportaje”, dijo un portavoz del hospital en un correo electrónico. Los expedientes del hospital muestran que a Miguel se le administró oxígeno de alto flujo a través de una máscara facial, y que lo instalaron en una cama que permitía que personal del hospital lo pusiera boca abajo, lo cual aumentó su nivel de oxígeno a un 93 %. Recibió tratamiento con esteroides y un fármaco antiviral. Las cosas parecían ir mejorando dos días después de que lo internaron. En la madrugada del 22 de noviembre, Jeannette Fernándes, hija de Miguel, envió un mensaje de texto al grupo familiar para informar que Miguel iba mejorando. Credit: Cortesía de la familia Fernández Jeannette comenzó a enviar actualizaciones a través de un grupo de mensajes de texto titulado “Familia”. El grupo incluía a los muchos hermanos, primos y sobrinos de Miguel, así como a sus padres y sus cuatro hijos. Miguel “iba bien”, informaba. Se pasaba el día leyendo mensajes en su teléfono incluso cuando estaba tumbado boca abajo. Enviaba fotos de su comida a su familia y le pedía al personal del hospital cosas especiales como pan tostado con mantequilla y jugo de ciruela con el desayuno. La familia esperaba que regresara a su casa para el Día de Acción de Gracias. Sin embargo, el curso de COVID-19 es impredecible. A las 11 de la noche del 22 de noviembre, Miguel envió un mensaje de texto a su familia, haciéndoles saber que esperaba tener una larga noche. Escribió en un mensaje: “si quiero llegar al Día de Acción de Gracias, debo permanecer despierto y reponer mis niveles de oxígeno.” Cuatro días después, cuando llegó el Día Acción de Gracias, un escaneo de sus pulmones reveló inflamación y tejido cicatricial. Los médicos comenzaron a suministrarle un curso de diez días de un medicamento antiinflamatorio. “Saldré para la Navidad”, comentó Miguel en un mensaje de texto. La familia respondió con ánimos. “Sigue adelante. Estamos todos contigo”, escribió su hermana Margarita. “Diez días se van rápido”. Miguel y su esposa, Alejandrina Fernández, hablaban por FaceTime cuando el estaba en el hospital. Credit: Cortesía de la familia Fernández Pero ocho días después, el 4 de diciembre, los niveles de oxígeno de Miguel se desplomaron y los médicos lo conectaron a un respirador artificial. Ahora Miguel luchaba por su vida. Sin poder visitarlo, su familia oraba para que se recuperara. Comenzaron a reunirse cada noche por Zoom mientras Miguel estaba en el hospital. Su madre Martha, de 71 años, y su padre, Salvador, de 73, dirigían una hora de oración, aferrándose a las cuentas del rosario. La separación fue especialmente difícil para Alejandrina, esposa de Miguel desde 1991. A Miguel le gustaba bromear con ella cuando veía sus telenovelas mexicanas: “¿Por qué las ves si me tienes a mí?”. El año pasado, para el Día de las Madres, Miguel la sorprendió cuando compró un par de anillos y se arrodilló frente a ella para proponerle matrimonio nuevamente. La pareja hizo planes para renovar sus votos en su 30º aniversario de boda, para el verano de este año. Cuando enfermó de COVID-19, Miguel le aseguró a Alejandrina que se recuperaría para que se pudieran casar otra vez. Ella le prometió que lo esperaría. Después de que lo intubaron, la familia de Miguel se reunió en el estacionamiento del edificio de cuidados intensivos para estar lo más cerca posible de él. Su madre se arrodillaba en el pavimento durante 40 minutos, con las manos unidas en oración. Les decía a sus nietos que rezar implicaba un sacrificio. Tenía que doler para que funcionara. A los familiares de Miguel les resultaba difícil ponerse en contacto con los médicos para hablar sobre las opciones de su tratamiento, en parte porque no podían visitarlo. Era imposible entablar una relación con sus médicos desde su habitación o aproximarse a ellos durante sus rondas, como podrían haberlo hecho si no hubiera pandemia. Llamaban varias veces al día, pero era difícil obtener información clara. Cuando un médico llamaba para ponerlos al día, Jeannette, su hija, se ponía en contacto con su hermano, Miguel Jr. y con la sobrina de Miguel, Jhaimy Fernández, estudiante de cuarto año de medicina en la Facultad de Medicina Larner de la Universidad de Vermont. Los familiares de Miguel comentaron que ellos fueron quienes mencionaron la terapia de ECMO poco después de que lo intubaran. Recuerdan que el médico de la unidad de cuidados intensivos encargado de su tratamiento les indicó que la ECMO no era una opción. Jhaimy pidió una consulta con el equipo de cuidados paliativos que se especializa en ayudar a los pacientes en estado crítico, y a sus familias, a tomar decisiones de tratamiento, pero ese personal estuvo de acuerdo con el médico de la UCI, dijo ella. “Pensaron que era una barbaridad que siquiera pensáramos en la ECMO”, dijo Jhaimy acerca de los médicos del hospital. Miguel Jr. dijo que parecía que los médicos no conocían el historial médico de su padre. Agregó que le preguntaron si tenía diabetes, pero él no tenía ninguna de las enfermedades preexistentes que suelen hacer que los pacientes no sean aptos para la ECMO. Aunque algunos centros de ECMO establecen límites de edad, Miguel, con 53 años, era lo suficientemente joven para ser considerado adecuado para la terapia. Carlos Fernández, su hermano menor y socio, dijo que era frustrante que la familia tuviera que plantearle la opción de la ECMO al los médicos. “Simplemente la descartaron”, comentó, añadiendo que es posible que el personal que lo atendía estuviera simplemente abrumado. “Es un hombre mayor, latino y con sobrepeso. Ese es el grupo demográfico que busca el coronavirus”. En una conversación con la hija de Miguel a primeras horas de la tarde del 7 de diciembre, un médico calificó su pronóstico como “muy malo”, según las notas en su expediente del hospital. Sin embargo, esa actualización fue seguida por noticias más esperanzadoras. La insistencia de la familia había dado sus frutos. Sus médicos habían decidido que, efectivamente, sí era candidato para la ECMO. La familia no sabe qué los hizo cambiar de opinión, y los archivos no describen cómo los médicos llegaron a esa decisión. El equipo médico le informó a la familia que Miguel sería trasladado pronto a un lugar donde podría recibir el nuevo tratamiento. Un sistema enredado Esa tarde, un administrador de casos de pacientes del hospital empezó a buscar una cama para que Miguel recibiera el tratamiento de ECMO. No existe una base de datos central a la que el personal del hospital pueda recurrir para averiguar rápidamente en qué lugar de la zona metropolitana de Los Ángeles existe una cama vacía para recibir terapia de ECMO. Los administradores de casos suelen tener que llamar a los hospitales, uno por uno, navegando por la burocracia particular de cada centro y coordinando todo con la aseguradora, en este caso, la de Miguel. “Es un conjunto absurdo y desordenado de partes interesadas, y la pandemia ha destacado las brechas que tiene el sistema”, dijo el Dr. Douglas White, médico y director del programa sobre ética y toma de decisiones durante enfermedades críticas, de la Facultad de Medicina de la Universidad de Pittsburgh. Leer más La niñez robada de obreros adolescentes La falta de coordinación regional es una de las principales razones por las que la ECMO está siendo racionada en Estados Unidos, dijo White. “Si un hospital no tiene [unidades] de ECMO, pero otra institución, a 80 kilómetros, sí cuenta con una, debería existir un sistema para conectarlos”, dijo White. “Así se evita la necesidad de racionar”. En Arizona, el departamento de salud estatal creó la Línea de escalada de Arizona (Arizona Surge Line) a principios de la pandemia para coordinar la atención en todo el estado de los pacientes en condiciones críticas, agregó. De acuerdo con este médico, más de 4 mil pacientes, muchos de ellos procedentes de reservas indígenas muy afectadas, fueron trasladados a través de este centro de intercambio de información. El sistema se enfoca en la capacidad para todo paciente en estado crítico, por lo que va más allá que solo el tratamiento con ECMO. También es un ejemplo de cómo conectar a los pacientes con los recursos que necesitan en tiempo real, agregó. En Washington y Oregón, los directores de programas de ECMO pueden acceder a un documento que muestra la disponibilidad de camas para recibir ECMO en toda la región. En 2016, los directores de los seis centros de ECMO de Minnesota crearon un consorcio para ayudar en las operaciones de emergencia y de la pandemia, dijo el doctor Matthew Prekker, neumólogo y especialista en cuidados críticos del Centro Médico del Condado de Hennepin en Minneapolis. El consorcio estableció directrices uniformes de elegibilidad para garantizar que todos los pacientes gravemente enfermos tengan una oportunidad justa para recibir la terapia. Si la mitad de los centros médicos del estado llenan su capacidad, se activa una conferencia telefónica de emergencia entre los directores de los centros de ECMO, quienes a su vez dirigen a los pacientes hacia las camas disponibles. “Estamos bien organizados”, señaló Prekker. “No trabajamos de manera aislada”. Los Ángeles cuenta con vastos centros médicos académicos, pero no hay coordinación en tiempo real para encontrar camas para recibir ECMO. Antes de COVID-19 no era necesario coordinar un volumen tan alto de pacientes, dijo el Dr. Peyman Benharash, director del programa de ECMO para adultos en UCLA Health. Benharash indicó que cuando apareció esta enfermedad, los médicos de ECMO crearon un chat informal de grupo para poder coordinar tanto a pacientes como recursos; sin embargo, los administradores de casos no tienen acceso a algo así. También comentó que su centro no utiliza una lista de espera porque se desea que los administradores de casos sigan buscando algún hospital que pudiera tener una cama disponible. Si no hay cupo en UCLA, se les indica a los administradores de casos que llamen nuevamente pasadas 12 horas. Cuando la vida de los pacientes pende de un hilo, la falta de un sistema centralizado en Los Ángeles puede ocasionar una lucha entre administradores de casos y médicos. De acuerdo con el historial médico de Miguel, el 7 de diciembre por la tarde el administrador de casos de PIH Whittier llamó a la aseguradora del paciente. No había ninguna garantía de que esta aceptara una terapia que fácilmente puede costar una cantidad de seis cifras. De acuerdo con los directores de ECMO, es frecuente que las empresas de seguros rechacen las solicitudes para que se administre esta terapia. No obstante, en el caso de Miguel, eso no parecía ser un obstáculo. La aseguradora le indicó a PIH que el Hospital Keck de la Universidad del Sur de California, el Centro Médico Ronald Reagan de UCLA y el Centro Médico Cedars-Sinai podrían ser opciones. El administrador del caso dejó un mensaje en la USC y proporcionó la información de Miguel a la UCLA. El Cedars-Sinai respondió con un no, diciendo que Miguel no cumplía sus criterios para la terapia de ECMO. Tras hablar con la aseguradora, el administrador del caso de Miguel hizo intentos con otros dos hospitales. Uno de ellos, UCI Health en el condado de Orange, no tenía ninguna cama para ECMO disponible. Un segundo, el Centro de Salud Providence Saint John de Santa Mónica, dijo que evaluaría los expedientes del paciente. Durante la oleada de COVID-19, los centros de ECMO estaban evaluando el creciente número de pacientes para dar prioridad a quienes tenían más posibilidades de sobrevivir. A las 5:08 p.m., después de tres horas de llamadas telefónicas, el administrador del caso le pasó la búsqueda a un colega. Poco después, la UCLA llamó para decir que no aceptaría a Miguel porque tenía un hematoma y coagulación de sangre. Una oración escuchada Mientras que los administradores del caso buscaban una cama para ECMO, la madre de Miguel regresó al estacionamiento del hospital para velar por su hijo. Esta vez, escondió una estampa de oración y un rosario por debajo de las hojas de unos lirios, para que protegieran a Miguel cuando ella no estuviera allí. Jeannette actualizó al grupo de mensajes de texto el 7 de diciembre, informando que Miguel aún dependía del respirador artificial. Credit: Cortesía de la familia Fernández La búsqueda de una cama para ECMO no avanzó durante la mayor parte del 8 de diciembre. Entre más tiempo dependiera Miguel de un respirador, mayores serían las probabilidades de que muriera o sufriera complicaciones que pudieran descalificarlo para la ECMO. Incluso sin complicaciones, el tiempo prolongado de respiración artificial podría descartar esa terapia. Llevaba cuatro días intubado, y varios de los programas no aceptan a pacientes que estén así durante más de una semana. “Cuando se trata de alguien que necesita ECMO, esos son pacientes que pueden fallar muy rápidamente”, dijo Sun. Al día siguiente, el 8 de diciembre, el equipo de cuidados paliativos ofreció un pronóstico sombrío en una llamada telefónica con la familia de Miguel: “Les dijimos que era improbable que el Sr. Fernández se recuperara a esas alturas”, indican los expedientes del hospital. La familia dijo que todavía querían que el hospital hiciera todo lo posible por salvarle la vida si su corazón dejaba de latir. Durante todo ese día, un empleado del centro de traslados del hospital de Saint John intentó ponerse en contacto con alguien de PIH para hablar acerca del caso de Miguel. A las 8:33 p.m., una trabajadora social de PIH escribió que había recibido una llamada del hospital de Saint John. La persona de contacto para traslados indicó que “había estado tratando de comunicarse con [el administrador de casos] todo el día y había dejado mensajes de voz, pero que nadie le había devuelto la llamada”. El día siguiente, una trabajadora de caso de PIH anotó en el expediente que no había escuchado los mensajes del hospital de Saint John por ser ese su día libre. El hospital de Saint John le había llamado a PIH con buenas noticias: habían aceptado a Miguel en su programa de ECMO y lo admitirían tan pronto como hubiera una cama disponible. Durante las horas siguientes, los hospitales intercambiaron documentos por fax y se estableció contacto con la compañía de seguros para obtener su aprobación. “¡Excelentes noticias!!!” anunció Jeannette en un mensaje en el chat del grupo familiar, añadiendo un emoji de corazón. “¡Aceptaron a mi papá en el hospital de St. John en Santa Mónica!!” El plan, le dijo al grupo, era que Miguel fuera trasladado ese mismo día. Credit: Sam Alden, especial para ProPublica Una terapia que puede salvar vidas En el hospital de Saint John, la Dra. Terese Hammond recibía hasta tres solicitudes diarias para utilizar terapia de ECMO para atender a pacientes como Miguel. Hammond había sido fundamental para iniciar el programa de ECMO de ese hospital, cuando la contrataron en 2018 para supervisar la sección de atención crítica. Había trabajado con la terapia en USC, donde dirigía a los becarios de atención crítica pulmonar. Los hospitales comunitarios como el de Saint John no suelen tener presupuesto ni personal especializado para un programa de ECMO. De hecho, en Estados Unidos (que gasta aproximadamente el doble por persona en atención médica comparado con otros países desarrollados), más del 90 % de los hospitales no ofrece ECMO. En Los Ángeles, los programas establecidos se encuentran en grandes centros médicos académicos como USC, UCLA y Cedars-Sinai. En el hospital de Saint John, un grupo de donantes privados aportaron los fondos para adquirir una docena de unidades de ECMO, las cuales pueden costar hasta 85,000 dólares cada una, dijo Hammond. El hospital puede atender hasta ocho pacientes de ECMO a la vez, dependiendo del personal. Hammond fue una de las primeras en creer en el uso de ECMO para ayudar a pacientes de COVID-19 con pulmones que comenzaban a fallar. Casi todos los pacientes con COVID-19 tratados con ECMO en el hospital de Saint John fueron trasladados de otras instituciones, algunas a más de una hora de distancia. “Tenemos que validar que existe un beneficio y que logramos hacerlo”, comentó. “Tengo a gente que está viva actualmente gracias a la terapia de ECMO”. La familia de Miguel no tuvo que buscar mucho para enterarse de esas historias de éxito. El detective Michael Chang del Departamento de Policía de Los Ángeles fue uno de los primeros pacientes de ECMO en el hospital de Saint John y su experiencia casi mortal fue presentada en varios noticieros locales. Chang había sido asignado a investigaciones sobre robos y pandillas, pero al principio de la pandemia lo cambiaron a trabajar uniformado en centros de pruebas de COVID-19 además de centros de distribución de alimentos y supermercados. El 30 de marzo, ingresó con COVID-19 a un pequeño hospital cerca de su casa en el condado de Orange. Seis días después lo intubaron y conectaron a un respirador artificial. En cuanto sucedió eso, su mujer, Dana Chang, recurrió a una red de contactos policiales en busca de cuidados más avanzados. Un capitán la puso en contacto con un reservista de la policía de Los Ángeles que también es cirujano, dijo ella. Ese médico le habló del hospital de Saint John y de su programa de ECMO. Él mismo llamó a Hammond y se organizó su traslado. “Empeoraba rápidamente”, comentó Dana acerca de su esposo. “Habría muerto si lo hubiéramos dejado allí”. Chang llegó en ambulancia a Saint John el 7 de abril y lo conectaron inmediatamente a una máquina de ECMO. Se la retiraron por la noche del 12 de abril, y salió del hospital cinco días después. Michael Chang todavía tiene momentos en los que le falta el aliento, además de ataques de tos seca, pero atribuye a la ECMO el haberle salvado la vida. “Nunca había escuchado acerca de la terapia con ECMO antes de que me la dieran”, comentó. “No tenía idea de qué hace esa máquina. Todo el mundo debe enterarse de ella”. De los 39 pacientes con COVID-19 que han recibido tratamiento con ECMO en el hospital de Saint John desde el inició la pandemia, 15 siguen vivos en la actualidad. Hammond señaló que es casi seguro que la mayoría de ellos habría muerto sin la ECMO. Ella es la primera en advertir que esta terapia no es una cura milagrosa. Aproximadamente la mitad de los pacientes con COVID-19 que reciben terapia de ECMO mueren en el hospital, según un registro de más de 3,400 pacientes de COVID-19 en todo el mundo. Sin embargo, algunos centros han registrado tasas de supervivencia de hasta dos tercios. La familia de Miguel dijo que sabían que la ECMO no era una garantía sino más bien una oportunidad, algo con lo que no contaban los médicos del PIH según lo informado. Si no funcionaba, comentaron, quedarían reconfortados al saber que se había hecho todo lo posible para ayudarlo. La lista de espera La noticia del traslado pendiente de Miguel a al hospital de Saint John rápidamente dio paso a una realidad mayor: en Los Ángeles había muchos pacientes iguales a Miguel. COVID-19 iba aumentando. La cantidad de pacientes con COVID-19 en las unidades de cuidados intensivos se había duplicado en las tres semanas que pasaron desde que Miguel fue hospitalizado. En PIH Whittier había 17 pacientes dos semanas antes de ser internado. La cantidad aumentó a 47 durante la semana en la que entró Miguel. En el momento en que lo intubaron, había 76. Hacia el 7 de diciembre, cuando comenzó la búsqueda de la ECMO, eran 93. En el hospital de Saint John, la unidad de cuidados intensivos estaba repleta y era imposible aceptar a más pacientes. Aunque Hammond había autorizado el traslado de Miguel y tenía un aparato de ECMO para darle tratamiento, no había camas disponibles. La lista de espera no era algo que la familia pudiera ver ni monitorear. No había forma de saber quién ocupaba el lugar previo a Miguel, o por qué, ni qué tan rápido movían a los pacientes de la lista. Al menos, en el mostrador de una carnicería o en el departamento de licencias de conducir, se podían ver los números en una pizarra, estar al pendiente de su avance y asegurarse de que nadie se saltara la fila. Con la vida de Miguel en la balanza, su familia estaba completamente a oscuras. “Mi padre no tenía a nadie que llamara a su nombre para darle prioridad”, dijo Miguel Jr. “No había forma de hacer que alguien nos rindiera cuentas por lo que decían. Tuvimos que tomarles la palabra”. Credit: Sam Alden, especial para ProPublica Hammond dijo que en la lista de espera no influye la riqueza o el estatus social del paciente; sólo se toma en cuenta si este cumple con los requisitos médicos y “tiene posibilidades de sobrevivir la terapia”. En el caso de Miguel, se le había aprobado la ECMO cuando otros hospitales dijeron que no tenían sitio o no cumplía sus criterios. El 10 de diciembre, Miguel Jr. compartió la mala noticia en el chat familiar de que el traslado de su padre no se había producido la noche anterior como se esperaba. Envió un mensaje de texto al grupo familiar con lo siguiente: “Hemos estado llamando al administrador del traslado de mi padre en el hospital, e incluso a Saint John, y hablamos con uno de sus administradores de casos para tratar de acelerar el proceso de traslado, pero no podemos hacer mucho más que esperar a que haya disponibilidad de una cama”. Los dos días siguientes también fueron de espera. El 11 de diciembre, la administradora del caso de Miguel en PIH anotó esto en su expediente: “Llamada al Providence Saint John para darle seguimiento a la ECMO, hablé con Rachel, aún no hay cama, ningún movimiento, mismo estado. Para entonces, Miguel llevaba una semana sin respirar por sí mismo y cada vez era “más difícil administrarle respiración artificial”, según los archivos del hospital. La familia no entendía qué significaba que los hospitales informaran que “no había camas” en sus unidades de cuidados intensivos. Jeannette y Miguel Jr. llamaron al hospital Saint John para preguntar si podían comprar una cama para su padre. Investigaron para averiguar si los donativos podían financiar camas adicionales en el hospital, pero les dijeron que las cosas no funcionaban de esa forma. Jeannette imaginaba maneras de entrar al hospital para verificar por sí misma que cada una de las 266 camas estuviera ocupada. Buscó cómo hacerse voluntaria del hospital y encontró una solicitud en línea. Hammond dijo que la frase “no tener una cama” era un eufemismo para referirse a la falta de suficientes enfermeras, terapeutas respiratorios, perfusionistas y médicos para atender a los pacientes que necesitan cuidados intensivos. El hospital de Saint John amplió la capacidad de su UCI de las 23 camas normales a 40, pero añadir más significaba abrumar demasiado al personal. Los expedientes médicos indican que, por la mañana del 12 de diciembre, casi cinco días después de que comenzara la búsqueda de una cama para la ECMO, el administrador del caso le informó a la familia de Miguel que tenía uno de los tres lugares principales en la espera de una cama en la unidad de cuidados intensivos del hospital. Jeannette actualizó al grupo de mensajes de texto el 12 de diciembre, informando que Miguel tenía uno de los tres lugares principales en la lista de personas que esperaban una cama de cuidados intensivos en el Centro Médico Providence Saint John. Credit: Cortesía de la familia Fernández Menos de una hora después, un equipo de médicos y enfermeras se apresuró a la habitación de Miguel en el centro médico PIH. El hospital iniciaba un código azul debido a que su corazón había dejado de latir. El equipo comenzó a darle compresiones torácicas y le administraron fármacos para reiniciar su corazón. Eso funcionó, pero Miguel había sufrido daños en los riñones y otros órganos. Al día siguiente, hacia el mediodía, alguien del centro de traslados del hospital de Saint John llamó a una enfermera de PIH Whittier para informarle nuevamente que aún no había camas disponibles. El administrador de casos de PIH informó al hospital de Saint John que Miguel ahora tenía insuficiencia en varios órganos y podría no sobrevivir el viaje en ambulancia a otro hospital. Dos horas más tarde, Saint John informó a PIH que ya no aceptaría a Miguel como paciente “debido a su cambio de estado”. A las 5:23 p.m., se dio otra señal de código azul. Esta vez Miguel no sobrevivió. En su habitación, un empleado del hospital juntó los objetos que dejó tras su estadía de 26 días: una computadora Apple portátil, un teléfono iPhone y un par de anteojos con armazón negro con roturas. A las 5:23 p.m., se dio otra señal de código azul. Esta vez Miguel no sobrevivió. En su habitación, un empleado del hospital juntó los objetos que dejó tras su estadía de 26 días: una computadora Apple portátil, un teléfono iPhone y un par de anteojos con armazón negro con roturas. “La gente muere esperando” Alejandrina, esposa de Miguel, en su sepelio del 30 de diciembre de 2020. Credit: James Carbone para ProPublica La historia de la muerte de Miguel, y la lucha que entabló su familia por conseguir un tratamiento que podría salvarle la vida, se han convertido en una historia que Hammond ha llegado a reconocer. Dice que ha tenido hasta siete personas en su lista de espera al mismo tiempo, todas en situaciones de desesperación. “Parte del trastorno de estrés postraumático que tengo, las pesadillas que tengo, es por tener que decir que no en tantas ocasiones y porque la gente muere estando en la lista de espera”, añadió. “Todas esas cosas representan un gran daño moral para los médicos. Conocemos las limitaciones que nos impone la oleada de la pandemia para desempeñar nuestra labor de la mejor forma posible. “La gente muere esperando”. El racionamiento no se limita a Los Ángeles, sino que sucede en todo el país. En Dallas, la unidad de ECMO del Centro Médico de la Universidad de Baylor recibe diariamente solicitudes de todo Texas, y de estados vecinos, en nombre de pacientes gravemente enfermos de COVID-19. Su última oportunidad de supervivencia podría depender de la disponibilidad de camas en esa institución. “Hace unos días tenía a cinco pacientes en mi lista de espera”, dijo en una entrevista el Dr. Gary Schwartz, cirujano de trasplantes pulmonares y director del programa de ECMO en Baylor. “Ayer fallecieron dos mientras esperaban. Es algo absolutamente terrible”. Schwartz dijo que su centro, uno de los más activos del país, tenía un promedio anual de 120 pacientes de ECMO antes de COVID-19. En 2020, esa cifra aumentó a 158 y la cantidad habría sido mayor si tuvieran cupo adicional. “Sinceramente, había entre 50 y 100 pacientes calificados adicionales, pero no hubo recursos para ellos”, dijo. Las pautas nacionales que creó la Organización de Soporte Vital Extracorpórea (Extracorporeal Life Support Organization), un consorsio de cientos de centros de ECMO, básicamente exigen que se racione la terapia a medida que la demanda de ECMO se dispara en las regiones saturadas de casos de COVID-19. Conforme aumentan los niveles de la oleada, “recomendamos que los criterios de selección se vuelvan más estrictos para que este recurso se utilice en las personas con las mayores probabilidades de beneficiarse”, indican las directrices. Algunos centros han comenzado a aplicar un límite de edad para la ECMO, o a rebajar la edad que se indica en las directrices existentes. En el Baylor, se redujo a 60 años la edad máxima para ser considerado como persona adecuada para ECMO. Schwartz indicó que la edad era de 75 años antes de COVID-19. Este médico también señaló que otro centro de la región redujo su rango a personas menores de 50 años, debido a la cantidad abrumante de solicitudes recibidas. “Al principio, muchos de los pacientes eran ancianos y temíamos que, si teníamos mucha gente de ese grupo, las personas jóvenes de 30 a 40 años no tendrían esa disponibilidad”, dijo Schwartz, agregando que tiene colegas en Europa que piensan que no es ético implementar una restricción de edad. “En un mundo perfecto, utilizaríamos [la ECMO] para las personas con la mayor probabilidad de supervivencia”, dijo. Schwartz y los directores de otros centros de ECMO en Dallas crearon un chat de grupo ad hoc en WhatsApp para tratar de mantenerse al tanto de las camas disponibles a medida que los hospitales se llenan. “La verdadera cuestión es si aprenderemos de esto y cambiamos a algún tipo de proceso centralizado en el futuro”, indicó Schwartz. Hammond dijo que los directores de ECMO en Los Ángeles tienen un arreglo similar con el que se envían mensajes de texto para encontrar camas vacías. La oleada en Los Ángeles se está reduciendo, y los casos en todo el país también están bajando. Sin embargo, aparecen nuevas variantes de COVID-19 y eso supone una amenaza de nuevas oleadas. Hammond espera que la experiencia con COVID-19 impulse la creación de una red formal y permanente para coordinar la atención y el traslado de los pacientes en estado crítico en el sur de California. La sobrina de Miguel, Jhaimy, se convertirá en médico dentro de cinco meses y ha sido entrevistada para hacer su residencia de medicina familiar en Los Ángeles. Siempre ha estado al tanto de las disparidades en la atención médica y estudió medicina para buscar formas de mejorar el sistema. “Me duele ver lo típico que fue el caso de mi tío”, dijo “Era hispano, de cincuenta y tantos años, trabajador esencial que no confiaba en el sistema médico. Queda en todas las categorías”. El 30 de diciembre, Jhaimy fue una de las decenas de familiares que se reunieron para enterrar a Miguel en un extenso cementerio cerca de su casa. Un amigo de la familia organizó una recaudación de fondos para ayudarlos a cubrir los costos del sepelio. Miguel era la fuente principal de ingresos de su familia y las cuentas se han ido acumulando desde su muerte. Cerca de su tumba, colocaron un arreglo floral azul y blanco con la inscripción de “PAPÁ”. Debajo había una fotografía de un Miguel más joven, con una camisa blanca y una chaqueta de cuero. El espectro de COVID-19 se cernió sobre la ceremonia. Todos traían cubrebocas. La madre de Miguel se desplomó sobre el féretro, sujetándose con las manos cubiertas de guantes médicos transparentes. Llevaba puesto un protector facial y un cubrebocas de tela. La hermana de Miguel (izquierda) y su madre junto a su féretro. Credit: James Carbone para ProPublica El entierro no le dio un sentido de cierre a la familia de Miguel. Jhaimy dijo que se ha preguntado qué habría pasado si su tío no hubiera tenido tanto miedo de ir al hospital. ¿Habría sobrevivido si se hubiera atendido antes? A Miguel Jr. y a Jeannette les inquieta que los médicos de su padre no les hayan presentado la ECMO como una opción, y que se resistieran a la idea cuando ellos la sugirieron. La familia todavía piensa en qué habría sucedido si hubieran tenido una cama a tiempo. “Yo creo que con la ECMO, seguiría aquí el día de hoy”, comentó Miguel Jr. “No tuvo la oportunidad de luchar”.
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. President Joe Biden has ordered enough vaccines to immunize every American against COVID-19, and his administration says it’s using the full force of the federal government to get the doses by July. There’s a reason he can’t promise them sooner. Vaccine supply chains are extremely specialized and sensitive, relying on expensive machinery, highly trained staff and finicky ingredients. Manufacturers have run into intermittent shortages of key materials, according to the U.S. Government Accountability Office; the combination of surging demand and workforce disruptions from the pandemic has caused delays of four to 12 weeks for items that used to ship within a week, much like what happened when consumers were sent scrambling for household staples like flour, chicken wings and toilet paper. People often question why the administration can’t use the mighty Defense Production Act — which empowers the government to demand critical supplies before anyone else — to turbocharge production. But that law has its limits. Each time a manufacturer adds new equipment or a new raw materials supplier, they are required to run extensive tests to ensure the hardware or ingredients consistently work as intended, then submit data to the Food and Drug Administration. Adding capacity “doesn’t happen in a blink of an eye,” said Jennifer Pancorbo, director of industry programs and research at North Carolina State University’s Biomanufacturing Training and Education Center. “It takes a good chunk of weeks.” And adding supplies at any one point only helps if production can be expanded up and down the entire chain. “Thousands of components may be needed,” said Gerald W. Parker, director of the Pandemic and Biosecurity Policy Program at Texas A&M University’s Scowcroft Institute for International Affairs and a former senior official in the Department of Health and Human Services office for preparedness and response. “You can’t just turn on the Defense Production Act and make it happen.” The U.S. doesn’t have spare facilities waiting around to manufacture vaccines, or other kinds of factories that could be converted the way General Motors began producing ventilators last year. The GAO said the Army Corps of Engineers is helping to expand existing vaccine facilities, but it can’t be done overnight. Building new capacity would take two to three months, at which point the new production lines would still face weeks of testing to ensure they were able to make the vaccine doses correctly before the companies could start delivering more shots. “It’s not like making shoes,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview with ProPublica. “And the reason I use that somewhat tongue-in-cheek analogy is that people say, ‘Ah, you know what we should do? We should get the DPA to build another factory in a week and start making mRNA.’ Well, by the time a new factory can get geared up to make the mRNA vaccine exactly according to the very, very strict guidelines and requirements of the FDA ... we already will have in our hands the 600 million doses between Moderna and Pfizer that we contracted for. It would almost be too late.” Fauci added that the DPA works best for “facilitating something rather than building something from scratch.” The Trump administration deployed the Defense Production Act last year to give vaccine manufacturers priority in accessing crucial production supplies before anyone else could buy them. And the Biden administration used it to help Pfizer obtain specialized needles that can squeeze a sixth dose from the company’s vials, as well as for two critical manufacturing components: filling pumps and tangential flow filtration units. The pumps help supply the lipid nanoparticles that hold and protect the mRNA — the vaccines’ active ingredient, so to speak — and also fill vials with finished vaccine. The filtration units remove unneeded solutions and other materials used in the manufacturing process. These highly precise pieces of equipment are not typically available on demand, said Matthew Johnson, senior director of product management at Duke University’s Human Vaccine Institute, who works on developing mRNA vaccines, but not for COVID-19. “Right now, there is so much growth in biopharmaceuticals, plus the pinch of the pandemic,” he said. “Many equipment suppliers are sold out of production, and even products scheduled to be made, in some cases, sold out for a year or so looking forward.” In the meantime, the shortage of vaccines is creating widespread frustration and anxiety as eligible people struggle to get appointments and millions of others wonder how long it will be before it is their turn. As of Feb. 17, the U.S. had distributed 72.4 million doses and administered 56.3 million shots, but fewer than 16 million people have received both of the two doses that the Pfizer and Moderna vaccines require for full protection. The Biden administration has said it is increasing vaccine shipments to states by 20%, to 13.5 million doses a week, and encouraged states to give out all their shots instead of holding on to some for second doses. But now that second-dose appointments are coming due, many jurisdictions are having to focus on those and stepping back from vaccinating uninoculated people. Even as the total number of vaccinations increased last week, the number of first doses fell to 6.8 million people, down from 7.8 million three weeks ago, according to Centers for Disease Control and Prevention data. At best, it will take until June for manufacturers to deliver enough doses for the roughly 266 million eligible Americans age 16 and over, according to public statements by the companies. That includes expected deliveries of Johnson & Johnson’s one-dose vaccine, which is widely expected to win emergency authorization from the FDA shortly after a public advisory committee meeting on Feb. 26. But Johnson & Johnson has fallen behind in manufacturing. The company told the GAO it will have only 2 million doses ready to go by the time the vaccine is authorized, whereas its $1 billion contract with HHS scheduled 12 million doses by the end of February. It’s not clear what held up Johnson & Johnson’s production line; the company has benefited from first-priority purchases thanks to the DPA, according to a senior executive close to the manufacturing process. A Johnson & Johnson spokesman declined to comment on the cause of the delay, but said the company still expects to ship 100 million U.S. doses by July. Vaccine supply won’t cover all Americans until late spring, at best Public statements from vaccine developers Pfizer, Moderna and Johnson & Johnson illustrate how many people could be covered by the available U.S. supply from now until the end of the summer. Sources: U.S. Census 2020 Demographic Analysis estimates, company press releases and statements, news reports, GAO. Information as of Feb. 16. Note: Chart assumes supply will increase evenly from week to week, but actual supply may vary. Credit: Graphic: Lena V. Groeger/ProPublica Moderna declined to comment on “operational aspects” of its manufacturing, but “does remain confident in our ability to meet contracted quantities” of its vaccine to the U.S. and other nations, a spokesperson said in a statement. Pfizer did not respond to ProPublica’s written questions. Ramping up production is especially challenging for Pfizer and Moderna, whose vaccines use an mRNA technology that’s never been mass-produced before. The companies started production even before they finished trials to see if the vaccines worked, another historic first. But it wasn’t as if they could instantly crank out millions of vaccines full blast, since they effectively had to invent a novel manufacturing process. “Putting together plans 12 months ago for a Phase 1 and 2 trial, and making enough to dose a couple hundred patients, was a big deal for the raw material suppliers,” said Johnson, the product manager at Duke University’s vaccine institute. “It's just going from dosing hundreds of patients a year ago to a billion.” Raw materials for the Pfizer and Moderna vaccines are also in limited supply. The manufacturing process begins by using common gut bacteria cells to grow something called “plasmids” — standalone snippets of DNA — that contain instructions to make the vaccine’s genetic material, said Pancorbo, the North Carolina State University biomanufacturing expert. Next, specific enzymes cultivated from bacteria are added to cause a chemical reaction that assembles the strands of mRNA, Pancorbo said. Those strands are then packaged in lipid nanoparticles, microscopic bubbles of fat made using petroleum or plant oils. The fat bubbles protect the genetic material inside the human body and help deliver it to the cells. Only a few firms specialize in making these ingredients, which have previously been sold by the kilogram, Pancorbo said. But they’re now needed by the metric ton — a thousandfold increase. Moderna and Pfizer need bulk, but also the highest possible quality. “There are a number of organizations that make these enzymes and these nucleotides and lipids, but they might not make it in a grade that is satisfactory for human consumption,” Pancorbo said. “It might be a grade that is satisfactory for animal consumption or research. But for injection into a human? That’s a different thing.” Johnson & Johnson’s vaccine follows a slightly more traditional method of growing cells in large tanks called bioreactors. This takes time, and the slightest contamination can spoil a whole batch. Since the process deals with living things, it can be more like growing plants than making shoes. “Maximizing yield is as much of an art as it is a science, as the manufacturing process itself is dependent on biological processes,” said Parker, the former HHS official. The vaccine developers are continuing to find tweaks that can expedite production without cutting corners. Pfizer is now delivering six doses in each vial instead of five, and Moderna has asked for permission to fill each of its bottles with 15 doses, up from 10. If regulators approve, it would take two or three months to change over production, Moderna spokesman Ray Jordan said on Feb. 13. “It helps speed up and lighten the logistical side of getting vaccines out,” said Lawrence Ganti, president of SiO2, an Alabama company that makes glass vials for the Moderna vaccine. SiO2 expanded production with $143 million in funding from the federal government last year, and Ganti said there aren’t any hiccups at his end of the line. Dying on the Waitlist Despite the possibility of sporadic bottlenecks and delays in the coming months, companies appear to have lined up their supply chains to the point that they’re comfortable with their ability to meet current production targets. Massachusetts-based Snapdragon Chemistry received almost $700,000 from HHS' Biomedical Advanced Research and Development Authority to develop a new way of producing ribonucleoside triphosphates (NTPs), a key raw material for mRNA vaccines. Snapdragon’s technology uses a continuous production line, rather than the traditional process of making batches in big vats, so it’s easier to scale up by simply keeping production running for a longer time. Suppliers have told Snapdragon that they have their raw materials covered for now, according to Matthew Bio, the company’s president and CEO. “They’re saying, ‘We have established suppliers to meet the demand we have for this year,’” Bio said. Mollie Simon and Caroline Chen contributed reporting.
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. A federal appeals court on Tuesday affirmed a lower court ruling allowing New York officials to release police discipline records that had been kept secret for decades. In the wake of protests over the killing of George Floyd last spring, New York state repealed its controversial 50-a law that had shielded the records from being released. Unions representing New York City’s police officers, firefighters and corrections officers then sued to prevent the disclosures. A federal judge temporarily barred city officials from releasing the records. But ProPublica, which had previously obtained a portion of the information through a public records request and was not a part of the case, published thousands of the records while the case was being considered. “Are you asking to put that particular genie back in the bottle?" U.S. District Judge Katherine Polk Failla asked the unions at a hearing held shortly after ProPublica published the records. The judge then ruled the records should be released, and the New York Civil Liberties Union quickly published more of them. The unions have argued, in part, that records of unproven allegations would harm officers’ chances of finding other jobs, even if the accusations were labeled as unproven. The unions also asserted that publishing the information would put officers in danger. During a hearing on the unions’ appeal of Failla’s ruling, one of the three judges on the 2nd Circuit panel had noted, “The cat is not only out of the bag, it’s running around the streets.” The NYPD Files: Search Thousands of Civilian Complaints Against New York City Police Officers This week, the appeals court affirmed the decision, saying the unions hadn’t offered convincing evidence of those outcomes in states where the records are public. “We have considered the Unions’ remaining arguments and conclude that they are without merit,” the judges wrote. It’s not clear when further disciplinary records will be released. “Good riddance to 50-A,” Mayor Bill de Blasio said in a statement. “We look forward to releasing this data and will seek clarity from the court regarding when these records can be released.” A spokesperson for the unions told reporters, “We are determining options.” The unions could seek to appeal to the U.S. Supreme Court, which could choose to take the case or not. In the meantime, ProPublica and others have used the records in stories revealing that officers were promoted to the department’s highest ranks despite troubling complaint records; that the police commissioner exercises unchecked power in downgrading or dismissing discipline and overturning the department’s own misconduct rulings; and that officers continue to use chokeholds while facing few consequences.
Léonie Alma Mason sitting on her custom-designed dining room table with a lava stone top and solid oak base. The bookcase is also one of her custom designs. Léonie Alma Mason begins, “I was born in Switzerland, grew up in Paris, but also spent five years in Germany. I come from a family of art historians and grew up with art.” Though it is the tip of the iceberg when it comes to her art education, it will do for now. Years later, fresh with a degree in interior architecture and design from the prestigious École Camondo in Paris, Léonie began to carve out her own career in the art world with a three-year stint at a design agency before she launched her own firm, LA.M Studio in 2014. It will come as no surprise that her current space is full of works of art, each and every one of them with a story. Visiting her gracious, light-filled apartment in the tony 8th arrondissement of Paris is a study in cool contemporary meets custom design and beautiful materials. At approximately 1,600 square feet, the space is large enough to accommodate her studio office as well as her family and visitors. “We have this nice large terrace with a great view of Paris,” she adds. Léonie describes her apartment, originally and intentionally a blank slate, as an opportunity. “This is a rented place and we really wanted a white box, a classic space. This one has nice floors and moldings. We didn’t change anything and I really just built it up. We just came in and added lots of custom furniture, which is a specialty of the studio.” Léonie adds that her fiancé has influenced the design as well. “We are both collectors and there is lots of vintage.” The main salon has a large custom sofa in tinted oak covered with a blue linen velvet. The ikat pillows are from Turkey and the room is anchored by a painting by French artist Robert Combas. The two table lamps are prototypes by Léonie’s grandmother, artist Odile Mir. The larger marble coffee table is a custom design and the smaller one is Italian vintage from the 1970s. Léonie’s apartment is full of art, both received as gifts throughout the years and collected with intention and care. There are also design pieces by her grandmother, artist Odile Mir. Léonie enthusiastically adds, “I have a project of editions I am doing with my grandmother. A few years ago, completely by chance, we discovered a series of designs she did ages ago. She had never told me about them before, and when we found all of these models, some lighting, we decided to do a book together and to launch reeditions. At the time, they were sold at a store called Prisunic, a precursor to IKEA.” Although her style has been described as very French, she begs to disagree, stating, “I’m not sure about that description. I am inspired by travel and lots of other things. I pay attention to colors and materials, plus vintage and contemporary art. I want to design a personality for each project.” The big lithograph on the right is by German artist Georg Baselitz, a portrait of his wife, Elke. Léonie designed the light blue velvet stool for a hotel project in Dinard, France. The floors are the original parquet. CLAIRE ISRAEL 2019 ⚒ Do It Yourself Paint it out Léonie says the original kitchen was all wood and felt like a chalet. She decided to paint it light blue with green trim and is now, in her opinion, “one of the prettiest kitchens ever! A super simple thing, but it changed everything.” Art everywhere There are no rules when it comes to hanging art. Lean it, or hang it solo or in clusters. Léonie likes to group things around a theme, like women, which she has done in the Main Salon. The pink silk curtains are by an Indian sari maker. The pair of vintage lounge chairs are from the 1930s and were reedited by Andrée Putman for Ecart International. The vintage dining chairs in the background are covered in khaki-colored leather found at the Parisian Flea Market at Saint-Ouen. On the wall are artworks by Abdelkader Benchamma, Man Ray, and the works around the theme of women. In the fireplace is a chrome magazine stand designed by Odile Mir, which will be rereleased this year. 🛍 Shop It Out All products featured on Architectural Digest are independently selected by our editors. However, when you buy something through our retail links, we may earn an affiliate commission. Crescent Moon Club Chairs, Ralph Pucci Prints by Georg Baselitz, Lumas The commode is custom designed. The vintage wall lights are from the Parisian Flea Market at Saint-Ouen and the photograph is by Raymond Depardon. “Depardon came from a family of farmers. So does my fiancé." Léonie shares. "This is one of his pieces and he said he wanted to wake up with this image of a cow every day. All of our art is super personal.”
Emma Holland Denvir, formerly head of U.S. business development at Hem, and co-curator of the quarterly Object Permanence show in Los Angeles, was listening to an episode of popular podcast How I Built This featuring Birchbox, the beauty subscription service, when a connection was made. “I remembered gifting various subscription boxes to people and receiving them myself, and recalled how fun that experience was, as both the gifter and recipient,” shares Denvir. “[It] led to the idea that we could create branded monthly gift boxes that we send to our clients, sponsored by our brand partners as a group.” The Box of Delight from Denvir Enterprises Denvir Enterprises Denvir Enterprises, her multiline agency which officially launches this month, focuses on connecting clients with sustainable products and commercial-grade vendors. The subscription box seemed like a good fit for delivering samples to potential clients in this isolation era—but with a playful twist. “Every month, we send around 100 designers across the country a curated gift box. The box always includes something that represents one of our brand partners. Instead of sending a finish sample, we send a unique custom item created for these boxes that represents the brand’s capabilities and materiality.” The service, called Box of Delight, now has a waitlist. Emma Holland Denvir Michelle Pullman The boxes are largely tied to themes—September’s theme was self-care. “We worked with Bläanks [a Los Angeles knit throw and pillow brand] to figure out what they could manufacture that would not only be on-brand for them, but that would also be a fun gift to receive at home that would promote self-care. They created a custom eye mask with a lavender fill, highlighting one of their standard textures and their recycled cotton knit. We also put in hand-picked eucalyptus, palo santo, and essential oils that encouraged relaxation. In September, fires were ravaging California, and the mood of the country was melancholy. We received so many thank-yous from clients stating that our gift box was extremely thoughtful and well-timed, and lifted their spirits during an extraordinary year.” Denvir Enterprises’ first furniture piece launches this week, a coffee table collaboration with RAD Furniture and Los Angeles glass artist Debbie Bean. Nicolas Harvard While the service infuses fun into the sourcing process, it is also a testament to the agency’s values. “We partner with and represent brands who meet our list of specific criteria. They must be commercial-grade, sustainable, and meet our standards of design. It’s very important to us to represent a diverse set of brands—50% of the brands we work with are minority- or woman-owned, and 100% of them are small businesses. We represent these brands to the interior design community in order to increase their exposure in the B2B market.” Denvir’s creative background—in woodworking and furniture design—has played into another of the agency’s launching initiatives: a furniture collection called Specifications, with the first product created in collaboration with design brand RAD Furniture and stained glass artist Debbie Bean, something of a delayed dream come true for Denvir. “I always imagined that I would have my own line and that would be my entire life and career. I ended up taking a different path and falling in love with a completely different side of the industry and found myself growing in business development and sales,” says Denvir. The first piece is RAD Furniture’s Radius Coffee Table, with a hand-made piece of stained glass courtesy of Bean inlaid. “I’m not the designer anymore, but it’s much more fun than I could have ever imagined. I’ve found my energy is much better spent encouraging collaboration and letting others do what they do best,” says Denvir. “Like the gift boxes, launching our own line of furniture is another way to differentiate ourselves from the pack and bring more eyes to [our brand] as a whole—and therefore the brands that we partner with.”
Measured and precise. That was the approach legal analyst and TV and radio host Dan Abrams took to creating and decorating his West Village town house. The four-bedroom, five-bedroom triplex sits on a narrow, picturesque side street and has bones that date back to the 1830s. “I had rented one of the [original] apartments from 2004 to 2006, then bought one of the apartments in 2006, and then bought the other one in 2009,” says Abrams. “I ended up combining them in 2018, and then there was an interior design phase that went through 2020.” Before the renovation there was a kitchenette on the ground level, so Abrams decided to knock it down completely and create something larger and much more open. Dusty Blue backsplash tiles are from Fireclay Tile. Nordic Modern Brooks Knot pendant lamp replicas are from Bonanza. Sean Litchfield “I had to figure out how to make the space make sense,” recalls Abrams. “There were two kitchens, and two sets of laundry rooms, etc.” Once he decided to build the home’s future kitchen on the ground floor, everything else flowed from there. Abrams then worked with Hyphen & Co., an interior design firm that had also worked on Abrams’s Southampton home. The brief? To perform a “mild cosmetic facelift” on the finished property—renovate bathrooms, paint walls, refinish floors, install new lighting, relandscape yard, and furnish every room. The home office is where Abrams hosts his radio show. Three pictures in the room provide daily inspiration: (1) a sketch of Abrams’s father, attorney Floyd Abrams, arguing in front of the U.S. Supreme Court; (2) an old photo of the Supreme Court under Chief Justice Burger, signed by all the members of the court; and (3) an AP photo of convicted Oklahoma City bomber Timothy McVeigh’s father watching Abrams on television reporting that his son had exhausted his appeals and would now be facing execution. “It’s important to always remember how impactful reporting can be,” says Abrams. The room features a custom-built desk by Iron Oaks, a Linkka 6 chandelier from Arteriors, and a Tufenkian carpet. Sean Litchfield Abrams’s son, Everett, loves his bedroom, especially his Orbit chair from RH Baby and Child. “This was one of my favorite things the designers selected,” says Abrams. “It’s incredibly comfortable, and my son just loves to climb on it as well.” The bedroom will soon temporarily convert to a nursery as Abrams and partner, PR executive Florinka Pesenti, plan on welcoming their second child, a daughter, in the coming weeks. The Nelson Bubble Lamp ball pendant is from Design Within Reach, and the Harper denim rug is from Serena and Lily. Sean Litchfield “Dan has incredible taste,” says Shelly Lynch Sparks, Hyphen’s principal designer. “He has a real appreciation of antiques. He was open to color and loves texture which is why we layered pops throughout rooms in the house.” Sean Litchfield The dining room features one of the home’s four working fireplaces. Abrams made a specific request for bench seating after seeing something similar at a friend’s home. “I just felt that the casual nature of the benches would work really well for this space,” says Abrams. “With the caveat that at the heads of the table we would have these grand chairs available for those who needed them to sit.” Halifax, a piece by artist Abby Elizabeth, hangs over the mantle. It is made from hundreds of plastic toy soldiers melted to the base and then painted. The table and chairs are from RH, and Raphael Diamond benches are from Klasp Home. The extensive stemware collection includes vintage midcentury, as well as 1930s Hollywood Regency, pieces. The house is “designed for the life that I aspire to live,” says Abrams. “One where guests are coming in and out of the home all the time. The reality is that it doesn’t happen almost ever, but after COVID, I will certainly be continuing in that aspirational mode!”