A federal crackdown on professors' undisclosed outside activities is achieving what China has long struggled to do: spur Chinese scientists to return home.

This article was first published on Wednesday, March 18, 2020 in ProPublica.

By David Armstrong, Annie Waldman and Daniel Golden

On the fourth floor of the University of Florida cancer research building, the once-bustling laboratory overseen by professor Weihong Tan is in disarray. White lab coats are strewn over workbenches. Storage drums and boxes, including some marked with biohazard warnings, are scattered across the floor. A pink note stuck to a machine that makes copies of DNA samples indicates the device is broken.

No one is here on this weekday afternoon in February. On a shelf, wedged next to instruction manuals and binders of lab records, is a reminder of bygone glory: a group photo of Tan surrounded by more than two dozen smiling students and employees.

As the Florida lab sat vacant, a different scene unfolded half a world away in China, where a team of 300 scientists and researchers worked furiously to develop a fast, easy test for COVID-19. The leader of that timely project? Tan, the former Florida researcher.

The 59-year-old Tan is a stark example of the intellectual firepower fleeing the U.S. as a result of a Trump administration crackdown on university researchers with ties to China. Tan abruptly left Florida in 2019 during an investigation into his alleged failure to fully disclose Chinese academic appointments and funding. He moved to Hunan University in south-central China, where he now conducts his vital research.

Tan, a chemistry professor whose research has focused on diagnosing and treating cancer, quickly pivoted to working on a coronavirus test when the outbreak began in China. Boosted by a Chinese government grant, he teamed up with researchers at two other universities in China and a biotechnology company to create a test that produces results in 40 minutes and can be performed in a doctor's office or in non-medical settings like airport screening areas, according to a 13-page booklet detailing the test's development and benefits. It has been tried successfully on more than 200 samples from hospitals and checkpoints, according to the booklet, which Tan shared with a former Florida colleague. It's not clear how widely the test is being used in China.

Epidemiologists say that testing is vital to mitigate the spread of the virus. But the U.S. has lagged well behind China, South Korea, and Italy in the number of people tested. It's hard to know if Tan's test would have made a difference. The slow U.S. ramp-up has been blamed largely on bureaucratic barriers and a shortage of chemical agents needed for testing.

A star researcher funded by the National Institutes of Health, Tan taught for a quarter century at Florida and raised two sons in Gainesville. He was also a participant in the Thousand Talents program, China's aggressive effort to lure top scientists from U.S. universities, and had been working part time at Hunan University for even longer than he had taught at Florida. Last year, alerted by NIH, Florida began investigating his outside activities.

Tan declined to answer questions about his departure from Floria or his new test, but he provided documentation that his department chairman at Florida was "supportive" of his research in China as recently as 2015. He is one of three University of Florida researchers — along with others from the University of Texas MD Anderson Cancer Center and the University of Louisville — who relocated to China while under investigation for allegedly hiding Chinese funding or affiliations with universities there.

Such nondisclosure may well be pervasive. A ProPublica analysis found more than 20 previously unreported examples of Thousand Talents professors who appear not to have fully revealed their moonlighting in China to their U.S. universities or NIH.

NIH has contacted 84 institutions regarding 180 scientists whom it suspects of hiding outside activities or funding, and it has referred 27 of them for federal investigation, said Michael Lauer, the agency's deputy director for extramural research. "There's no reason why the U.S. government should be funding scientists who are engaged in unethical behavior. It doesn't matter how brilliant they are," said Lauer, who declined to discuss specific professors under scrutiny. "If they don't have integrity, we can't trust them for anything. How can we be sure that the data they're producing is accurate?"

Yet the government's investigations and prosecutions of scientists for nondisclosure — a violation previously handled within universities and often regarded as minor — may prove counterproductive. The exodus of Tan and his colleagues highlights a disturbing irony about the U.S. crackdown; it is unwittingly helping China achieve a long-frustrated goal of luring back top scientific talent.

Thousand Talents aimed to reverse China's brain drain to the West by offering elite Chinese scientists premier salaries and lab facilities to return home permanently. Finding relatively few takers, it let participants like Tan keep their U.S. jobs and work in China on the side.

By investigating Tan and other Chinese researchers for nondisclosure, the U.S. government is accomplishing what Thousand Talents has struggled to do. None of the professors identified in this article have been charged with stealing or inappropriately sharing intellectual property. Yet in the name of safeguarding American science, federal agencies are driving out innovators, who will then make their discoveries and insights in China instead of the U.S. The potential drawbacks hark back to an episode in the McCarthy era, when a brilliant rocket scientist at the California Institute of Technology was deported by the U.S. for supposed Communist sympathies and became the father of China's missile program.

John Brown, the FBI's assistant director of counterintelligence, told the U.S. Senate in November that participants in Thousand Talents and other Chinese talent programs "are often incentivized to transfer to China the research they conduct in the United States, as well as other proprietary information to which they can gain access, and remain a significant threat to the United States."

A spokesperson for the Chinese Embassy in Washington, D.C., disputed such characterizations. "The purpose of China's 'Thousand Talents Plan' is to promote talent flow between China and other countries and to galvanize international cooperation in scientific and technological innovation," Fang Hong said. While firmly opposing any "breach of scientific integrity or ethics … we also condemn the attempt to describe the behaviors of individual researchers" as "systematic" intellectual property theft by the Chinese government. "It is extremely irresponsible and ill-intentioned to link individual behaviors to China's talent plan."

Steven Pei, a University of Houston physics professor and former chair of the advocacy group United Chinese Americans, said that both countries have gone too far. "The Chinese government overreached and the American government overreacted," Pei said. "China tried to recruit but it was unsuccessful. Now we help them do what they cannot do on their own."

Pei added that U.S. universities are failing to protect their Chinese faculty: "When the pressure comes down, they throw the researchers under the bus."

NIH has long viewed collaborations with China as a boon for biomedical research, even initiating a formal partnership with China's National Natural Science Foundation in 2010. But it became concerned in 2016 when it learned from the FBI that an Asian faculty member at MD Anderson had shared federal grant proposals he was reviewing with researchers at other institutions — a violation of NIH rules.

Examining the grant applications of its federally funded researchers, NIH found many undisclosed foreign ties, particularly with research institutions in China. Some researchers were accepting dual appointments at Chinese universities and publishing results of U.S.-funded research under their foreign affiliation. Often, these foreign positions were not reported to the NIH or even the researchers' own American universities.

In August 2018, the NIH launched an investigation to ensure that its researchers weren't "double dipping" by receiving foreign funds for NIH-funded work or diverting intellectual property produced by federally backed research to other countries. The NIH found at least 75 researchers with ties to foreign talent programs who were also responsible for reviewing grant proposals. In some cases, Lauer said, Thousand Talents scientists with access as peer reviewers to confidential grant applications have downloaded them and emailed them to China. Other researchers have disclosed consulting or teaching in China but haven't acknowledged that they've signed an employment contract with a Chinese university or are heading a lab, he said. NIH gave the names of "individuals of possible concern" to the researchers' institutions but did not make them public.

To gauge the extent of the problem, ProPublica matched Thousand Talents recipients identified on Chinese-language websites with their disclosures to their universities and grant applications to NIH, which we obtained through public records requests. We found at least 14 researchers who apparently did not disclose foreign affiliations to their U.S. universities, which included the University of Wisconsin, Stony Brook University and Louisiana State University. We couldn't determine if these researchers were also on NIH's confidential list.

Of 23 Thousand Talents recipients in our survey who have sought NIH funding, none reported conflicts of interest with Chinese universities to the agency. Just three revealed these positions in the bio sections of their grant applications. Because NIH redacted foreign funding from the applications it provided to us, citing personal privacy restrictions, we couldn't tell if the researchers reported any grants from institutions in China.

It's not always easy to define or prosecute theft of intellectual property in academia, especially if the research is considered basic and doesn't require a security clearance. Unlike corporations that protect trade secrets, universities see science as an open, global enterprise and promote international collaborations. Practices such as photographing another research team's specially designed lab equipment may be considered unethical by some, but they aren't necessarily unlawful. Thus the U.S. government is trying to clamp down on suspected intellectual property theft by targeting nondisclosure.

Yet the link between hiding Thousand Talents affiliations and stealing research secrets may be tenuous. Universities bear some responsibility for the nondisclosure, because they are supposed to certify the accuracy of information supplied to NIH. Until recently, many schools were lax in enforcing disclosure rules. "It's fair to say, at some universities, they have not really been paying attention to how their faculty spend their time," Lauer said. One professor was away for 150 days a year and the university didn't notice, he said.

Non-Chinese scientists, including doctors paid by pharmaceutical                                                           , also underreported outside income. Nor did universities want to restrict partnerships with Chinese universities; in the prevailing culture of globalization, they encouraged foreign collaborations and sought to open branches in China to boost their international prestige and attract outstanding, full-tuition-paying students.

Now times have changed, and Chinese scientists at U.S. universities are trapped in the backwash. Even those who rejected overtures from China have been hounded. Xifeng Wu, an epidemiological researcher, worked at MD Anderson for nearly three decades and amassed an enormous dataset to help cancer researchers understand patient histories. She twice turned down invitations to join Thousand Talents. But she collaborated with and accepted honorary positions at research institutions in China, where she grew up and attended medical school. Although she said she earned no income from these posts, NIH identified her as a concern, and MD Anderson found that she did not always fully disclose her Chinese affiliations.

In early 2019, she left MD Anderson — one of at least four researchers who were pushed out of the center in the wake of the federal investigations. She has become dean of the School of Public Health, with a well-equipped laboratory, at Zhejiang University in southeast China.

Dong Liang, Wu's husband and the chair of the pharmaceutical and environmental health sciences department at Texas Southern University, felt that MD Anderson buckled under pressure from NIH, which provided the institution with more than $145 million in federal grants in 2018.

"A few years back, they wanted the collaborations [with China]," said Liang. "And now, they take it back." The disclosure rules, said Liang, weren't clear, "and now it becomes a violation."

Professors who were in the process of being fired could have exercised their rights to a hearing before a faculty panel as well as "several rounds of peer discussions," but they instead left "on their own volition," MD Anderson spokeswoman Brette Peyton said. "As the recipient of significant NIH funding," MD Anderson had a responsibility to follow up on the agency's concerns, or risk losing federal money, she said.

Baylor College of Medicine in Houston took a less punitive approach than MD Anderson. When NIH alerted the Baylor College of Medicine that at least four researchers there — all ethnically Chinese — erred in their disclosures, Baylor corrected the documents and allowed them to continue working.

China began sending students to the U.S. in the late 1970s in the hope that they would return with American know-how and foster China's technological prowess. But, especially after the Tiananmen Square massacre in 1989, many of the students stayed in the U.S. after earning their degrees.

The Chinese government has been the most assertive government in the world in introducing policies targeted at triggering a reverse brain drain.

A 2012 paper by David Zweig and Huiyao Wang

Established in 2008, Thousand Talents was intended to lure prominent scientists of Chinese ethnicity under age 55 back to China for at least half the year with generous salaries and research funds and facilities, as well as perks such as housing, medical care, jobs for spouses and schools for children. Some Thousand Talents employment contracts require members to sign nondisclosure agreements related to their research and employment with Chinese institutions, according to a November 2019 report by the U.S. Senate's Permanent Subcommittee on Investigations.

"The Chinese government has been the most assertive government in the world in introducing policies targeted at triggering a reverse brain drain," David Zweig, a professor at Hong Kong University of Science and Technology, and Huiyao Wang, director general of the Center for China and Globalization in Beijing, wrote in 2012.

The program succeeded in attracting 7,000 foreign scientists and researchers as of 2017, the Senate subcommittee reported. But it had trouble enticing professors at elite U.S. universities, who were reluctant to uproot their families and leave their tenured sinecures. It created a second tier for recruits who were "essentially unwilling to return full-time," Zweig and Wang wrote. They could keep their U.S. jobs and come to China for a month or two. Complaints arose in China about "fake returnees" who "work nominally in China for six months" but "in fact, most of them are still abroad," according to a 2014 op-ed on the BBC News Chinese website.

Scandals marred the program's reputation in the U.S. In 2014, Ohio State contacted the FBI about engineering professor Rongxing Li, who had fled to China. Li, a Thousand Talents member, allegedly had access to restricted NASA information. The U.S. attorney's office did not bring charges against Li, who is teaching at Tongji University in Shanghai. Another Thousand Talents member, Kang Zhang, a professor of ophthalmology at the University of California, San Diego, resigned last year after reports that he failed to disclose being the primary shareholder of a Chinese company whose focus overlapped with his UC research. No charges were filed against Zhang, now a professor at Macau University of Science and Technology.

Struggling to attract top researchers, Thousand Talents also reached out to non-Chinese scientists, like Charles Lieber, the Harvard chemistry chairman charged in January with making false statements to the U.S. government by denying his involvement with Thousand Talents and with Wuhan University of Technology. His three-year Thousand Talents contract called for Wuhan to pay Lieber $50,000 a month plus more than $1.5 million for a research lab, according to the Department of Justice. Lieber has not yet entered a plea. His attorney, Peter Levitt, declined comment.

"In the last five years, there has been a definite deliberate move toward targeting non-ethnic Chinese," said Frank Figliuzzi, former FBI assistant director for counterintelligence. "They've been getting so many rejections from their own people who don't want to go back home and have fallen in love with their Western culture and their life. Or their wife won't go back. Or their kids won't go back.

"The other thing that we've seen, which I think is very troubling, 'Hey, you don't have to come back home full time.' In the intel community, we call that a RIP, recruitment in place."

Staying in the U.S. meant that Thousand Talents recipients had to report their Chinese positions to their American universities. Some didn't. Richard Hsung, a professor of pharmaceutical sciences at the University of Wisconsin, affirmed annually on disclosure forms that he had "no reportable outside activities." He acknowledged in an interview that, from 2010 to 2013, he was in Thousand Talents and worked part time as a visiting professor at Tianjin University, which has 25,000 students and is 70 miles southeast of Beijing.

He said that he didn't mention the Tianjin position because the disclosure forms confused him. He includes "National Thousand Talent Distinguished Visiting Professor at Tianjin University" among his honors on the faculty website. "I was not flaunting it, but I was not hiding it," he said.

His stints in China helped the University of Wisconsin, he said. "When there's an opportunity such as this one, you take it, it expands the visibility, it expands interacting with more students in training, and they come here to help us."

Also unreported was Hsung's relationship with a biotech company in Shanghai. In corporate records, Shanghai Fangnan Biological Technology Co. says that it "was founded by the national 'Thousand Talents Plan' specially invited experts," and it names Hsung as a director. Hsung said he was unaware of being listed as a board member and is asking the company to remove his name. He has consulted for the company "from time to time" but is compensated for expenses only, he said. "I have not been involved in any of their projects nor have they supported my research here," he added in an email.

When there's an opportunity such as this one, you take it, it expands the visibility, it expands interacting with more students in training, and they come here to help us.

Richard Hsung, professor of pharmaceutical sciences

University of Wisconsin spokeswoman Meredith McGlone said that Hsung should have reported his job at Tianjin on outside activities forms, as well as an "unexpected honorarium of less than $5,000" from the Shanghai biotech firm. He has since updated his disclosure form to reflect the honorarium, she said. While the university has no "uniform penalty" for nondisclosure, she said, the appropriate response in cases, like Hsung's, where there is no "evidence of intent to mislead" would be "additional training and perhaps a letter to the personnel file."

The university convened a working group last year to "consider policies and practices intended to bolster security without sacrificing the free exchange of ideas," McGlone said. It then added a question to the disclosure form: "Do you have an ongoing relationship with a foreign research institute or foreign entity?"

Each year, the University of Florida's chemistry department evaluates its 40 or so faculty members by criteria that include amounts raised for research funding and the number and impact of studies published. Weihong Tan, who joined the department in 1996, was usually ranked among the top three professors every year, said a department official who asked not to be identified.

Tan's research group developed a new way of generating molecules that bind to targeted cells, as a possible approach to identifying and treating cancers. He collaborated with researchers in other departments and became close with top deans and research officials on campus. He was popular with students. Each week, dozens of graduate and postgraduate researchers lined up in the hall outside his office, waiting to meet with him. He also won prestigious chemistry awards and developed an international reputation.

While at Florida, Tan maintained a co\nnection to Hunan University in China, where he studied as an undergraduate. His curriculum vitae states he was an adjunct professor at the school from 1993 through at least 2019, when he left Florida. The part-time teaching job is the CV's only reference to any professional work in China.

In his annual disclosures to Florida, Tan did report positions and income in China, but not everything alleged by university investigators. In 2017, he said he was working 10 hours a week at Hunan for a salary of $30,000. In 2018, he said his hours had doubled to 20 a week, for $50,000. In 2019, he reported working a total of 20 hours a week for Hunan and the Institute of Molecular Medicine at Renji Hospital in Shanghai. His combined pay from the positions was $120,000, according to his form.

The association with Hunan began during a gap in Tan's resume — between receiving a 1992 doctoral degree from the University of Michigan and starting postdoctoral work in 1994 at the U.S. Department of Energy's Ames Laboratory.

In recent years, according to colleagues, Tan's work in China intensified. He was making frequent trips there, sometimes traveling twice a month from Gainesville, one said. Tan told colleagues that his research in China complemented his Florida work, and that it was easier to conduct testing on people in China than in the U.S. His research in Florida focused on basic science testing that didn't involve patients.

Tan knew his increasing workload in China was putting a strain on his full-time position in the U.S. He told a colleague he was considering asking for a leave of absence from Florida. It's unclear if he did request a leave.

In January 2019, the NIH notified Florida that Tan might have undisclosed affiliations with foreign institutions as well as foreign research funding. The university then launched its own inquiry. It provided investigator notes regarding Tan and two other researchers allegedly involved in Chinese talent programs to a special state legislative committee reviewing foreign influence on publicly funded research. Those notes do not name the faculty members under investigation, instead referring to them by numbers such as "faculty 1." The details for faculty 1 — including date of hire, area of research, department and Chinese affiliations — match those of Tan.

Faculty members two and three appear to be Lin Yang, an NIH-funded professor of biomedical engineering, and Chen Ling, an up-and-coming pediatric cancer researcher.

Florida hired Yang from the University of Kentucky in 2014 as part of a "Preeminence Initiative" to boost its ranking among public universities. Yang traveled to Beijing for a Thousand Talents interview in 2016, according to the university's investigative notes. The following year, he was selected for the program at a Chinese university.

The effect of this is universities are bleeding good people.

Peg O'Connor, attorney for Lin Yang, ex-Florida professor of biomedical engineering

Yang resigned his Florida position last year after the university began looking into his alleged failure to disclose his association with China's Thousand Talents program. University investigators also allege that he hid being chief executive, founder and owner of an unidentified China-based company.

In an email, Yang said he disputes many of Florida's findings. He said he applied for a talent program but then turned it down. He said he never had any foreign grants or academic appointments in China while employed by Florida. Yang's attorney, Peg O'Connor, said the University of Florida began a push in 2010 to encourage overseas collaborations. "To be punished for doing what the university called on you to do doesn't make sense to me," she said. "The effect of this is universities are bleeding good people."

Ling, a part-time research associate professor, won multiple grants to study gene therapy techniques that target the most common pediatric liver cancer. "Early in a very promising career, Ling is already making great strides in the development of innovative therapies for cancer," the chairman of the medical school's pediatrics department said in a 2012 press release.

Ling left Florida last year. The university investigative notes that appear to refer to Lin allege that he failed to inform NIH that he was participating in a Chinese government sponsored talent program, and that he received an unreported research grant from a Chinese foundation.

However, Ling did report working at Fudan University in Shanghai to University of Florida officials in 2018. His disclosure, which can be viewed at ProPublica's Dollars for Profs site, shows that Fudan paid him $53,732 for activities that included "establishing a regular molecular biological laboratory, conducting gene therapy research, teaching curriculum, publishing manuscripts." He indicated that the activity would require eight months of work each year. It's unclear if Florida officials relayed this information to NIH.

Ling, who did not respond to emails seeking comment, is continuing his research as a professor at Fudan. A former Florida colleague described him as "very smart" but somewhat naive in dealing with conflict of interest issues. "I don't think he did anything with malicious intent," said the colleague. "He paid a heavy price for this."

Mengsheng Qiu, a neurobiologist at the University of Louisville, not only disclosed a part-time position in China to his department, but he even accepted a pay cut at Louisville to offset his foreign income. Nevertheless, NIH targeted him.

Qiu, 56, received his bachelor's and master's degrees in China and his doctorate from the University of Iowa in 1992. After spending five years as a postdoctoral fellow at the University of California, he joined the Louisville faculty in 1997 and was tenured in 2001.

Qiu has received several NIH grants over the past two decades. Fred Roisen, the department's former chair, described Qiu as an excellent and dedicated researcher. "He had a very active lab that published extensively," Roisen said. "His students were highly sought after for postdocs at all the best schools in the U.S. Some were Chinese and some were not. I could only give him the highest recommendation. His lab, if I went in Saturday and Sunday, there were always people working there."

Qiu joined the Thousand Talents program in 2009, taking a part-time job at Hangzhou Normal University, which announced that it had hired him as its first scholar "under a high-level creative talents program" that aimed to "attract elites from all walks of life at home and abroad." Someone at Hangzhou sent the announcement to Louisville administrators, who did not know that Qiu was seeking a position in China and were taken aback, according to a friend of Qiu's. The friend said that Qiu had not informed Louisville because terms of the Hangzhou job were still being negotiated.

I just knew he had access to a lab in China. I never had a negative thought connected with him whatsoever.

Fred Roisen, former department chair, University of Louisville

Louisville and Qiu then agreed to reduce his salary to compensate for his time in China. "We negotiated a pay cut that was proportional to the time he was away," Roisen said. "If he was taking two months off, that was two months' pay you don't get."

Roisen said he didn't know about Qiu's participation in the Thousand Talents program. "I just knew he had access to a lab in China. I never had a negative thought connected with him whatsoever." By working in China, Qiu "was trying to get additional help for projects," Roisen said. "Some tissues were not readily available in the U.S." The current chair, William Guido, declined comment.

His wife, Ling Qiu, said that each time Qiu visited China, he received the university's approval. "They wanted him to report everything," she said. "He said, 'I did.' Every time I go to China, I tell you."

"He is a good citizen," she said. "He does not even use a coupon if it is expired." Thousand Talents paid for his travel to China and his work there, she said, but it wasn't big money. "I wish," she said. She added in an email, "He did not do anything wrong but I don't know the details about his research activity."

In recent years, a Louisville colleague said, Qiu had a "lag" in federal funding, and NIH turned down one of his grant applications. "I suspect, and we all felt, that this might have been due to him putting a lot of emphasis on his Chinese involvement in those laboratories and less here," the colleague said.

The colleague added that at Qiu's most recent career review, "We did think it was interesting he managed to publish 17 papers in the previous five years, some in prestigious journals, with such a small laboratory. I think some of it was done in China. That might be why they're looking into it."

People close to Qiu said that the probe has been going on at least since the summer of 2019, and that he met for half a day on campus with investigators. University of Louisville spokesman John Karman III declined comment, citing "an ongoing investigation involving this former faculty member." Also citing the investigation, Louisville declined to provide any outside activity forms that Qiu submitted to the university.

Last December, Qiu retired from Louisville. He's now head of the Life Science Research Institute at Hangzhou Normal University. Friends said that he preferred working in China because he helped set up the institute there and the lab conditions and students were better than at Louisville. He felt unjustly overshadowed at Louisville by more prominent Ivy Leaguers in his field. When Hangzhou Normal renewed Qiu's 10-year appointment in 2019, a friend said, it asked him to become full-time, forcing him to choose between China and Louisville. "He must have balanced the two," the friend said. "Finally, he came up with a choice."

Qiu's wife, a doctor who was in private practice in the U.S., said that the investigation drove him out. It made him "very, very depressed," she said. He told her that it reminded him of China's persecution of intellectuals during the Cultural Revolution. "They sent me an email and asked me a bunch of questions," he told her. "Maybe I go to jail."

Qiu declined comment through his wife. She said in a February email that he was quarantined at home in Hangzhou because of the coronavirus, while she was fighting the epidemic at an international hospital in Shanghai. "We try to comfort each other by phone or video chat," she said. "We are not able to see each other since my job is high risk."

In 2015, when Weihong Tan was up for election to the Chinese National Academy of Sciences, his chemistry chairman at the University of Florida recommended him and lauded his ongoing research in China.

"We are very happy to see his great success at Hunan University in research and education," William Dolbier wrote in the letter provided by Tan. "We are very supportive of his research and educational activities there."

Tan's positions were also publicly listed on the web before NIH notified the University of Florida that there might be an issue.

The English language website of Hunan University, beginning in at least March 2018, listed Tan as a vice president and director of a chemistry lab. According to the site, Tan had run the lab since 2010 and had been a vice president of the school since August 2017. The school also indicated Tan was a full professor there and supervised doctoral students. Tan appeared in an English-language video in 2017 to promote a textbook he edited and described himself as a distinguished professor of chemistry at both Florida and Hunan.

On several occasions, Hunan University publicly lauded Tan. In 2017, when he was named an associate editor of the Journal of American Chemical Society, both the University of Florida and Hunan University put out press releases announcing the appointment. Florida officials at the time were apparently unaware of Tan's positions in China, and the school's release makes no mention of them. Hunan, on the other hand, lists his position in Florida.

Tan was also named an "honored professor" in 2017 at the East China University of Science and Technology. A story about a ceremony marking the appointment on that university's website includes photographs of Tan touring school labs and meeting with faculty. It lists him as holding several academic posts in China as well as his University of Florida professorship.

After NIH notified Florida at the beginning of 2019 about a potential problem with Tan, the university's office of research began reviewing Tan's emails. In correspondence, Tan acknowledged his Hunan jobs, according to the notes. He also allegedly used his Florida email account to conduct Hunan business.

The investigators found evidence that Tan had significant ties to Chinese government-sponsored talent programs and helped recruit U.S. researchers to those programs. The emails also indicated Tan received at least four research grants from Chinese government programs and didn't tell the NIH about them. Of all of Tan's extensive university and government ties with China, the only item he appears to have disclosed to the NIH and Florida was an adjunct teaching position at Hunan.

When Tan suddenly resigned his position in Florida last year, he told colleagues he was going to work full time in China but was vague about the reasons for leaving after almost a quarter century on campus. Administrators scrambled to find new mentors for the more than dozen graduate and postgraduate students working in his two labs on campus. The move was so abrupt that Tan's wife stayed behind in Gainesville, according to colleagues.

Tan didn't answer questions sent to him by email, although he did acknowledge receiving them. A federal investigation of Tan's relationships in China is ongoing, according to the investigative summary provided by the university to state legislators.

The University of Florida said in a statement that it has taken steps to prevent other professors from joining Thousand Talents and concealing foreign positions. As a result of a new risk assessment process for detecting foreign influence that it introduced in 2018, it said, Florida is denying most requests from faculty to participate in foreign talent programs.

The university said it "maintains a robust and vigilant program to safeguard our technology and intellectual property from undue foreign influence, and to extend appropriate oversight to UF activities (and those of its faculty members) in connection with foreign organizations." A spokesman declined to answer questions about individual professors, citing ongoing investigations.

William Dolbier, the former chemistry chairman at Florida and now an emeritus professor, said Tan's departure could have been avoided if he had disclosed all of his work in China. "He was not a money guy," Dolbier said. "He was not out to steal from the United States. The development of these drugs was his primary focus and goal." Dolbier added that Tan told him he would be glad to try to make his COVID-19 test available in the U.S.

Jeff Kao and Doris Burke contributed reporting.

The FDA's strict guidance on test confirmations is one of several obstacles that has slowed the federal government's response to COVID-19.

This article was first published in ProPublica on Thursday, March 12, 2020.

By Lydia DePillis and Caroline Chen

 A federal directive that's supposed to speed up the response to a pandemic is actually slowing down the government's rollout of coronavirus tests.

The directive, issued by the U.S. Food and Drug Administration, requires that the Centers for Disease Control and Prevention, a sister agency, retest every positive coronavirus test run by a public health lab to confirm its accuracy. The result, experts say, is wasting limited resources at a time when thousands of Americans are waiting in line to get tested for COVID-19.

The duplicative effort is the latest obstacle that is slowing the federal response to COVID-19, which has infected more than 1,300 people and resulted in 38 deaths in the United States. Progress was already delayed because the CDC decided to make its own test rather than adopting the design endorsed by the World Health Organization. The test then didn't work properly and had to be fixed. The problems were further compounded by delays in certifying tests by private laboratories as well as a shortage of supplies and raw materials used for testing.

On Feb. 4, the FDA, which regulates devices as well as drugs, released a document called an Emergency Use Authorization to govern the use of the test. The goal of the emergency authorization is to short-circuit the typically onerous regulatory review that the agency imposes on new diagnostic devices — a process that can take months to years.

In the face of an imminent outbreak, however, the stringently written EUA appears to have become more of a hindrance than a help. Because of the requirement that the CDC rerun tests conducted by public health labs, as of two weeks ago the CDC's website was lagging in its tally because it was only reporting confirmed cases. The CDC is now reporting both presumptive positives, which have been tested only by local labs, as well as cases it has confirmed.

"This is the time when we need as many tests as we can very quickly, because we need to know what is happening in this country," said Dr. Leana Wen, an emergency physician and former health commissioner for the city of Baltimore. "Right now we are in the dark about the degree of COVID-19 spread. It's hard for us to proceed to do our work in public health without concrete information."

The CDC says it is simply following the process set out by federal regulations, though it couldn't say how many false positives, if any, have shown up in the verification process.

"The regulatory language of the EUA dictated that," CDC spokesman Richard Quartarone said. "We have to follow the rules. If we don't follow the rules, FDA could shut us down. That is a real thing."

The CDC is designed to serve as a short-term bridge to widespread testing while it analyzes a new disease and makes sure diagnostic tests are working correctly before handing the role off to the private sector, Quartarone said. If duplication hadn't been required, the CDC may have been able to help with more front-line testing before private-sector labs took over, he said.

The emergency authorization also slowed the process of tests offered by private labs, which became available last week. The FDA initially required private labs to copy the CDC's test design and have the agency review their tests before allowing them to begin testing. It took more than three weeks and growing criticism for the FDA to update its guidelines to allow certain academic labs to start testing once they had validated their tests internally.

In response to questions, FDA spokeswoman Stephanie Caccomo referred a reporter to a speech by FDA Commissioner Stephen Hahn on March 7, in which he defended the agency's process.

"In the U.S., we have policies in place that strike the right balance during public health emergencies of ensuring critical independent review by the scientific and public health experts and timely test availability," Hahn said. "The CDC test is a high-quality test, and it's important to remember that false negatives or positives can be detrimental to making sure we are treating patients early, without delay, and also not quarantining healthy individuals."

Joshua Sharfstein, vice dean for public health practice and community engagement at Johns Hopkins' School of Public Health, said the FDA's high standards might have been appropriate for smaller outbreaks. The FDA issued EUAs for diagnostics during the 2014 Ebola crisis and in 2016 for the mosquito-borne Zika virus. The coronavirus, however, is moving too fast to maintain absolute control — and the FDA could have ordered up a more flexible process, Scharfstein said.

"If you were to go back in time and tell the FDA 'you've got a month to get a million tests ready,' I imagine they wouldn't have chosen this strategy," said Sharfstein, who oversaw EUAs while he served as deputy commissioner of the FDA during the Obama administration.

The CDC designed a flawed test for COVID-19, then took weeks to figure out a fix so state and local labs could use it. New York still doesn't trust the test's accuracy.

Requiring confirmatory tests not only adds time to the process but also uses crucial chemicals needed to set up the tests. "You need some of the reagents that now are in short supply to prepare the tests," said CDC Director Robert Redfield in a hearing before the House Oversight Committee on Thursday, explaining the difficulty in expanding capacity even as private labs received green lights to start testing.

Private labs need only get confirmation for their first five positive and first five negative clinical specimens, according to the FDA's Feb. 29 guidance. Commercial giants like LabCorp and Quest Diagnostics say they are now able to run thousands of tests a day.

"We want them to come online, because we don't have the manufacturing capacity; our system in place is not designed for that massive amount," Quartarone said of the private labs. "In general, CDC testing is a drop in the bucket for the overall testing that happens."

According to the American Enterprise Institute, as of Thursday afternoon, nationwide testing capacity was at about 20,695 people a day. California public and private labs accounted for 39% of capacity, and the CDC and public health labs together accounted for about 17% of available tests.

That's only testing capacity, however. According to Redfield, actual testing is still hampered by shortages of essential equipment and manpower.

The CDC designed a flawed test for COVID-19, then took weeks to figure out a fix so state and local labs could use it. New York still doesn't trust the test's accuracy.

This article was first published on Friday, February 28, 2020 in ProPublica.

By Caroline Chen, Marshall Allen, Lexi Churchill and Isaac Arnsdorf

As the highly infectious coronavirus jumped from China to country after country in January and February, the U.S. Centers for Disease Control and Prevention lost valuable weeks that could have been used to track its possible spread in the United States because it insisted upon devising its own test.

The federal agency shunned the World Health Organization test guidelines used by other countries and set out to create a more complicated test of its own that could identify a range of similar viruses. But when it was sent to labs across the country in the first week of February, it didn't work as expected. The CDC test correctly identified COVID-19, the disease caused by the virus. But in all but a handful of state labs, it falsely flagged the presence of the other viruses in harmless samples.

As a result, until Wednesday the CDC and the Food and Drug Administration only allowed those state labs to use the test — a decision with potentially significant consequences. The lack of a reliable test prevented local officials from taking a crucial first step in coping with a possible outbreak — "surveillance testing" of hundreds of people in possible hotspots. Epidemiologists in other countries have used this sort of testing to track the spread of the disease before large numbers of people turn up at hospitals.

This story is based on interviews with state and local public health officials and scientists across the country, which, taken together, describe a frustrating, bewildering bureaucratic process that seemed at odds with the urgency of the growing threat. The CDC and Vice President Mike Pence's office, which is coordinating the government's response to the virus, did not respond to questions for this story. It's unclear who in the government originally made the decision to design a more complicated test, or to depart from the WHO guidance.

"We're weeks behind because we had this problem," said Scott Becker, chief executive officer of the Association of Public Health Laboratories, which represents 100 state and local public laboratories. "We're usually up-front and center and ready."

The CDC announced on Feb. 14 that surveillance testing would begin in five key cities, New York, Chicago, Los Angeles, San Francisco and Seattle. That effort has not yet begun.

On Wednesday, under pressure from health experts and public officials, the CDC and the FDA told labs they no longer had to worry about the portion of the test intended "for the universal detection of SARS-like coronaviruses." After three weeks of struggle, they could now use the test purely to check for the presence of COVID-19.

It remains unclear whether the CDC's move on Wednesday will resolve all of the problems around the test. Some local labs have raised concerns about whether the CDC's test is fully reliable for detecting COVID-19.

In New York, scientists at both the city's and state's laboratories have seen false positives even when following the CDC's latest directions, according to a person familiar with their discussions.

"Testing for coronavirus is not available yet in New York City," city Department of Health spokeswoman Stephanie Buhle said in an email late Thursday. "The kits that were sent to us have demonstrated performance issues and cannot be relied upon to provide an accurate result."

Until the middle of this week, only the CDC and the six state labs — in Illinois, Idaho, Tennessee, California, Nevada and Nebraska — were testing patients for the virus, according to Peter Kyriacopoulos, APHL's senior director of public policy. Now, as many more state and local labs are in the process of setting up the testing kits, this capacity is expected to increase rapidly.

So far, the United States has had only 15 confirmed cases, a dozen of them travel-related, according to the CDC. An additional 45 confirmed cases involve people returning to the U.S. having gotten sick abroad. But many public health experts and officials believe that without wider testing the true number of infected Americans remains hidden.

"The basic tenet of public health is to know the situation so you can deal with it appropriately," said Marc Lipsitch, professor of epidemiology at the Harvard T. H. Chan School of Public Health. He noted that Guangdong, a province in China, conducted surveillance testing of 300,000 people in fever clinics to find about 420 positive cases. Overall, Guangdong has more than 1,000 confirmed cases. "If you don't look, you won't find cases," he said.

Janet Hamilton, senior director of Policy and Science at Council of State and Territorial Epidemiologists, said that with the virus spreading through multiple countries, "now is the time" for widespread surveillance testing.

"The disease," she said, "is moving faster than the data."

It remains to be seen what effect the delay in producing a working test will have on the health of Americans. If the United States dodges the rapidly spreading outbreaks now seen in Iran and South Korea, the impact will be negligible. But if it emerges that the disease is already circulating undetected in communities across the country, health officials will have missed a valuable chance to lessen the harm.

The need to have testing capacity distributed across local health departments became even more apparent Wednesday, when the CDC said it was investigating a case in California in which the patient may be the first infected in the United States without traveling to affected areas or known exposure to someone with the illness.

Doctors at the University of California, Davis Medical Center, where the patient is being treated, said testing was delayed for nearly a week because the patient didn't fit restrictive federal criteria, which limits tests only to symptomatic patients who recently traveled to China.

"Upon admission, our team asked public health officials if this case could be COVID-19," UC Davis said in a statement. UC Davis officials said because neither the California Department of Public Health nor Sacramento County could test for the virus, they asked the CDC to do so. But, the officials said, "since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered."

After this case, and under pressure from public officials, the CDC broadened its guidelines Thursday for identifying suspected patients to include people who had traveled to Iran, Italy, Japan or South Korea.

The debate over whether federal, state and local officials should have already been engaged in widespread surveillance testing has become more heated as the virus has spread globally. The CDC had said the purpose of its five-city surveillance program was to provide the U.S. with an "early warning signal" to help direct its response. The cities were selected based on the likelihood that infection would be present, Hamilton said.

But Mark Pandori, director of the Nevada State Public Health Laboratory, which began offering testing on Feb.11, said surveillance testing may not be the best use of resources right now. "A lot of people look at lab tests like they are magic," Pandori said. "But when you run lab tests, the more chances you have for getting false answers."

There are other ways to expand the country's testing capacity. Beyond the CDC and state labs, hospitals are also able to develop their own tests for diseases like COVID-19 and internally validate their effectiveness, with some oversight from the federal Centers for Medicare and Medicaid Services. But because the CDC declared the virus a public health emergency, it triggered a set of federal rules that raises the bar for all tests, including those devised by local hospitals.

So now, hospitals must validate their tests with the FDA — even if they copied the CDC protocol exactly. Hospital lab directors say the FDA validation process is onerous and is wasting precious time when they could be testing in their local communities.

Alexander Greninger, an assistant professor in laboratory medicine at the University of Washington Medical Center, said after he submitted his COVID-19 test, which copies the CDC protocol, to the FDA, a reviewer asked him to prove that his test would not show a positive result for someone infected with the SARS coronavirus or the MERS coronavirus — an almost ridiculous challenge. The SARS virus, which appeared in November 2002, affected 26 countries, disappeared in mid-2003 and hasn't been seen since. The MERS coronavirus primarily affects the Middle East, and the only two cases that have been recorded in the U.S., in 2014, were both imported.

There are labs that can create parts of a SARS virus, but the FDA's recommended supplier of such materials said it would need one to two months to provide a sample, Greninger said. He spent two days on the phone making dozens of calls, scrambling to find a lab that would provide what he needed.

Greninger said the FDA was treating labs as if they were trying to make a commercially distributed product. "I think it makes sense to have this regulation,'' he said, when "you're going to sell 100,000 widgets across the U.S. That's not who we are."

Commercial manufacturers are working to mass-produce coronavirus tests, but there isn't a precise timeline for their release. The drug company Cepheid, based in California, is targeting the second quarter of this year for the release of its test, a company spokeswoman said in an email. Massachusetts-based Hologic didn't have an estimated release date for its test, a company spokesman said. "We're responding to the public health need as rapidly as possible," the spokesman said.

Correction, Feb. 28, 2020: This story originally misstated the number of positive COVID-19 cases found via surveillance testing in the Chinese province of Guangdong. The testing found 420 positive cases, not 1,000.

A government investigation found that the New Jersey hospital's transplant team was failing to learn from surgical errors.

This article was first published on Tuesday, January 21, 2020 in ProPublica.

Newark Beth Israel Medical Center's heart and lung transplant program was putting patients in "immediate jeopardy" before the hospital began to implement corrective measures, according to federal regulators.

In a pair of reports sent to the Newark, New Jersey, hospital on Dec. 12, the Centers for Medicare and Medicaid Services found that the transplant program repeatedly failed to fix mistakes. Spurred by ProPublica articles, the CMS investigation uncovered a series of incidents in which the hospital identified areas for improvement following botched surgeries but didn't carry out its own recommendations, allowing "subsequent adverse events to occur."

As a result, CMS determined that patients were in "immediate jeopardy," which is the regulator's most serious level of violation. It is invoked when "noncompliance has placed the health and safety" of patients "at risk for serious injury, serious harm, serious impairment or death."

Newark Beth Israel spokeswoman Linda Kamateh said in a statement that the hospital does not agree with all of CMS' findings, and that they did not warrant the "immediate jeopardy" designation. It will send a letter identifying "certain objections" to CMS, she said.

In particular, Kamateh criticized findings that attributed adverse events to "compliance failures in the transplant program." CMS' survey team, she said, lacks the "evidence, expertise and experience" to assess and diagnose patient outcomes. "Root cause analysis is a complicated exercise requiring much more extensive training, and much greater analysis than is reflected" in the CMS reports, she said.

On Dec. 15, three days after the hospital received the findings, it submitted a plan to remove the "immediate jeopardy" label by making certain policy changes, Kamateh said. The New Jersey Department of Health, which works in coordination with federal regulators, determined that those measures were enough to lift the designation, according to the hospital and CMS.

CMS also required the hospital to submit plans of correction, which are "under various stages of review and implementation," Kamateh said. As part of the plans, which the hospital shared with ProPublica, Newark Beth Israel has created a transplant steering committee to oversee the transplant program. Staff responsible for quality review in the transplant program will report directly to hospital management and not to the program's leaders.

Nevertheless, the hospital remains out of compliance with federal rules for quality assessment and performance improvement, surgical services, and patient rights, as well as special requirements for transplant centers, according to a CMS letter to the hospital on Jan. 12. In the letter, CMS warned Newark Beth Israel that, unless the issues are resolved by March 21, it will take steps to terminate the hospital from the Medicare program, which means the federal insurer would end reimbursements for Medicare patients. Medicare primarily insures people who are 65 or older.

CMS' December reports also cited violations of patient rights, including failures to obtain informed consent and to seek information from patients and family members on advance directives such as do not resuscitate orders. Although the reports do not identify patients or doctors by name, surgery dates and other specifics indicate that at least two of the cases were those brought to light by ProPublica articles last year.

CMS' findings may help to explain why the heart transplant program's one-year survival rate fell to 84.2% in 2018, well below the national average. The concern for statistics prompted the transplant team to keep Darryl Young, a patient in a vegetative state, alive without offering palliative options such as hospice care to the family, ProPublica reported last October.

Besides CMS and the New Jersey Department of Health, the FBI and New Jersey's Board of Medical Examiners are also investigating the hospital in the wake of ProPublica's reporting. Newark Beth Israel has placed Dr. Mark Zucker, the head of the transplant program, on administrative leave while it conducts an internal investigation.

Darryl Young suffered brain damage during a heart transplant at Newark Beth Israel and never woke up. But, hardly consulting his family, doctors kept him alive for a year to avoid federal scrutiny.

Legislators are seeking answers as well. On Jan. 14, citing ProPublica's "concerning reports," three members of New Jersey's congressional delegation asked CMS how it planned to hold Newark Beth Israel "and other programs that may engage in similar behavior" responsible and improve oversight "to ensure that this does not happen in New Jersey or any other state," according to a letter obtained by ProPublica.

"This lack of transparency, compassion, and communication" in the cases exposed by ProPublica "was cruel," wrote U.S. Sen. Robert Menendez, and U.S. Reps. Bill Pascrell Jr. and Donald M. Payne Jr., adding, "Both cases show a serious breach of the trust we place in health care providers and a clear violation of the Hippocratic Oath." CMS is working on a response, according to a spokeswoman.

The CMS reports focused mainly on Newark Beth Israel's heart and lung transplant programs, though one case involved patient safety in a psychiatric unit. Newark's heart program is one of the 20 largest in the country by volume, having transplanted more than 1,000 patients over the last three decades. Its lung transplant program is smaller.

Three patients suffered brain damage within a seven month span, apparently due to similar causes, according to the reports. In March 2018, a patient suffered a "neurological deficit" after a heart transplant operation. The hospital's own outcome report recommended a review of its blood pressure monitoring equipment, but CMS couldn't find evidence that any review took place. Less than a month later, another heart transplant patient suffered a "severe neurological deficit" during surgery. The outcome report gave the same recommendation. Again, CMS found no review occurred.

Then in September 2018, Darryl Young suffered brain damage during his heart transplant and never woke up again, ProPublica reported last year. CMS found that an unnamed patient — whose surgery date matches Young's — had a heart transplant resulting in "altered mental status." The hospital's outcome report recommended more frequent blood pressure monitoring, but CMS said it was unable to find evidence that staff were educated or that the change was implemented.

Before and after Young's surgery, in August and October 2018, a heart transplant patient and a lung transplant patient suffered complications during their operations that resulted in kidney failure. After the first incident, the hospital recommended increasing the frequency of blood pressure readings. In the second incident, the hospital report said the complication was "likely due to hypotension" — low blood pressure — in the operating room, and recommended monitoring for future occurrences. CMS said it could not find evidence that the recommendations were implemented.

Other improvement suggestions were also ignored. In January 2018, after a heart transplant patient died after surgery, the hospital's outcome report recommended having "a 2nd surgeon available for difficult and prolonged cases." The following May, after a complication occurred in another heart transplant operation, a similar note called for a "plan to encourage transplant physicians to ask and offer assistance for difficult and lengthy cases." However, CMS said it found no evidence that Newark Beth Israel educated its physicians to do so.

ECMO machines, which temporarily replace a patient's heart and lung function by pumping and oxygenating blood outside the body, malfunctioned during a lung transplant in December 2018, CMS found. The patient wasn't harmed, but the hospital noted it was a "near miss event" and recommended using what is known as a primed cardiopulmonary bypass machine in the event of problems with ECMO machines. "Perfusionists will be informed," the note said. However, CMS said it found no evidence that perfusionists — who operate bypass machines — were told. Then, the following February and April, ECMO equipment issues led to two other mishaps during lung transplant surgeries. The first patient ended up with a "neurological compromise," CMS found, and the second died in the operating room.

As part of its plans of correction, Newark Beth Israel said it has implemented a policy that makes sure backup equipment is available for any transplant procedure that involves an ECMO. It has has educated all perfusion and anesthesia staff, it said. It is also planning to review and monitor its blood pressure equipment, with the anesthesia department observing all transplant cases to make sure the equipment is properly placed "until 100% compliance has been achieved for three consecutive months."

In total, CMS detailed 10 "adverse events" from January 2018 to April 2019. As ProPublica reported last year, the heart transplant team became worried that its slipping survival rates — specifically, the proportion of patients who reached the one-year anniversary of their surgeries — would attract federal scrutiny. Zucker said at a staff meeting in May 2019 that Darryl Young "unfortunately became the seventh potential death in a very bad year, all right, and that puts us into a very difficult spot," according to an audio recording of the meeting obtained by ProPublica. Treating Young aggressively without offering other options to the family, Zucker said, "is a very, very unethical, immoral but unfortunately very practical solution, because the reality here is that you haven't saved anybody if your program gets shut down."

Young's sister and health proxy, Andrea Young, had told ProPublica that she felt doctors at Newark Beth Israel were "hiding something" from her, that her brother's prognosis wasn't fully explained to her and that she wasn't asked about her goals for his care until 10 months after his transplant surgery.

CMS' report corroborated this lack of candor. In the case of an unnamed patient, whose details, including transplant date and hospital admission date, matched Young's, the federal inspectors found that physicians wrote information including "prognosis is not great" in medical records in March and "overall prognosis is poor" in June. But CMS found no evidence that the patient's next of kin was given this information.

CMS located a social worker's note that Andrea Young had requested weekly updates on her brother's condition. The medical record "lacked documented evidence that the physicians contacted … next-of-kin on a regular basis, or a weekly basis as requested, regarding the progress of the patient," CMS said.

The hospital "is developing and will implement a standard for communications with patients and their authorized representatives," according to its plans of correction. Its spokeswoman, Kamateh, said medical records show that doctors and staff communicated repeatedly with Young's family and that family members "were contemporaneously informed of his status, his expected clinical trajectory, and his treatment options."

Told of CMS' findings in her brother's case, Andrea Young said in a statement: "It is my hope that NBI's Transplant Unit will implement the appropriate corrective measures to address the many existing deficiencies that plague their transplant program. Trust is especially paramount in the medical profession and restoration of that trust is essential to every patient and every family."

ProPublica reported in December on Andrey Jurtschenko, a heart transplant recipient at Newark Beth Israel who suffered brain damage during his operation. In earlier conversations, Jurtschenko had made clear to his children, Chris and Megan, that he didn't want to be a burden on them. The children told ProPublica that, when they sought a DNR order for their father after his surgery, they were initially rebuffed. The family continued to press the issue and secured a DNR more than a month after his surgery.

Again, the CMS investigation bore out the family's concerns, though it focused on a later incident when Jurtschenko was readmitted to the hospital from a rehabilitation facility. Describing a patient whose details — including transplant surgery and other procedure dates, as well as quotes from medical records — matched Jurtschenko's, CMS found that Newark Beth Israel violated its own policy on advance directives. The hospital's policy states that "an inquiry will be made of each adult patient, at the time of admission … concerning the existence and location of an Advance Directive for Health Care. If the patient is incapable of responding to this inquiry, the medical center will ask the family or person with knowledge of the patient." Yet, when the hospital admitted Jurtschenko, it marked "NO" in his paperwork to the question of whether he had an advance directive, even though his children, who were his health proxies, would have requested a DNR order if it had consulted them.

Kamateh said that families "make these very personal decisions following a dialogue with the clinical team taking into consideration the best medical advice," adding, "Mr. Jurtschenko's medical record confirms that his family's decision to implement a DNR in June rather in April did not change his outcome."

CMS also found that Newark Beth Israel "failed to ensure a patient's right to have a family member notified of his/her admission to the hospital" because it had admitted Jurtschenko to the hospital from the rehabilitation facility without informing family members.

The hospital will train staff in obtaining information about advance directives, health care proxies, and surrogate decision-makers, according to the correction plans.

Andy Jurtschenko told his children that he didn't want to be a burden on them. But after he suffered brain damage during a heart transplant at a New Jersey hospital, his medical team deflected their request for a DNR.

In a reference to ProPublica's reporting, CMS found that hospital staff members violated patients' rights by sharing patients' information with a journalist "for purposes other than treatment, payment and health care operation." It noted that Newark Beth Israel had an internal compliance hotline and ethics consultation team, which did not receive any complaints or reports of concerns regarding transplant patients.

Unrelated to the transplant program, CMS also found that a 14-year-old patient was left unsupervised in October 2019 in the presence of an adult patient "with a history of aggressive, violent and erratic behavior," according to the report. The minor, who wanted to use the bathroom, was brought there by a staff member and left there. Afterward, she told the staff that "a patient walked into the bathroom and kissed" her. The incident violated a patient's right to receive care in a safe setting, CMS said.

Immediately after the incident, Newark Beth Israel interviewed the patient and notified the parent, the Newark Police Department and the New Jersey Division of Mental Health Addiction Services, according to the hospital. According to its correction plans, the hospital has adopted a new policy to minimize contact between minor and adult patients in its psychiatric emergency screening services unit. "Policies around the monitoring of minor patients were immediately strengthened," Kamateh said.