Without a federal system of NICU-specific oversight, regulation of the units falls to each state — and New Mexico isn't doing much. But over 30 other states show it can be done.
This article was published on Wednesday, March 31, 2021 in ProPublica.
New Mexico parents worrying over the health of an extremely preterm baby have another reason to be concerned: Their state government provides almost no oversight of the care provided by neonatal intensive care units.
Thirty-one states, including neighboring Arizona, Oklahoma, Texas and Utah, have laws or rules requiring oversight of neonatal intensive care hospitals, according to a 2020 Centers for Disease Control and Prevention study. Some of these states make sure that hospitals provide care at the levels they claim to, and some periodically review data on patient admissions, transfers and outcomes to identify potential problems.
Some states, like California, do both. New Mexico does neither.
The federal government does not set standards for NICUs.
A New Mexico In Depth and ProPublica analysis published Tuesday found that an Albuquerque hospital, Lovelace Women’s, had a death rate for extremely preterm babies roughly twice that of Presbyterian, a nearby maternity hospital that has a comparable NICU. Clinicians voiced concern about aspects of neonatal care at Lovelace. The hospital defended the care it delivered and objected to the news organizations’ focus on extremely preterm babies, noting that these newborns represent only 2% of the hospital NICU’s admissions. The hospital also questioned comparing its performance to that of another hospital rather than to national benchmarks. But experts said the disparity warranted further investigation.
It is unclear, however, who would conduct such an inquiry because New Mexico requires little oversight of neonatal intensive care facilities and does not monitor their patients’ outcomes. New Mexico’s hospital regulators have not set foot in Lovelace’s NICU, or the other two Albuquerque NICUs, Health Department spokesperson James Walton acknowledged.
Other states take a variety of steps to ensure the quality of neonatal care. Experts point to Texas and California as gold standards for NICU oversight.
Twenty-two states, including California, Nevada, Utah and Illinois, have legislation or policies describing plans that advise lower-level hospitals on where preterm babies should be sent to receive the best care, according to a 2017 CDC study. But New Mexico has no perinatal-care regionalization plan, Walton said. Medicaid records indicate that some extremely preterm babies wind up at New Mexico hospitals that are not equipped to care for them. Statewide, between 2015 and 2019, more than 300 extremely preterm babies were admitted to hospitals that didn’t have a NICU, according to state Medicaid program records. (More than 70% of births in the state are covered by Medicaid.)
Regional plans allow hospitals to specialize and make better use of their expertise in caring for preterm babies, said Dr. José Antonio Perez, a clinical professor of pediatrics at the University of Washington in Seattle and the NICU medical director at Swedish Issaquah Medical Center.
Lovelace and Presbyterian are both level 3 neonatal intensive care hospitals, which the American Academy of Pediatrics defines as facilities equipped and staffed to care for high-risk infants. In California and Illinois, top-tier, level 4 NICUs, which care for the sickest premature babies, monitor level 3 hospitals. In New Mexico, such an agreement would give University of New Mexico Hospital oversight of Lovelace and Presbyterian.
Some states assemble groups of hospital officials, experts and community members to study and make recommendations about hospital practices and policies. But New Mexico’s version of these perinatal-care collaboratives focuses on maternal rather than neonatal care, noted Dr. Scott A. Lorch, a professor of pediatrics and associate chair of the Division of Neonatology at the Children’s Hospital of Philadelphia, and a NICU oversight and outcomes expert.
In Arizona, Oklahoma, Utah and Texas, officials conduct on-site inspections to confirm each NICU’s level of care.
In Texas, inspections are done before the state officially designates a facility as a level 1, 2, 3 or 4 neonatal hospital. The American Academy of Pediatrics conducts the Texas inspections using teams that include clinicians who care for newborns at similar facilities, including a neonatologist, a NICU nurse and, if surgeries are performed on-site, a pediatric surgeon. The inspections include checking staff credentials and reviewing patient records.
“You can really tell by reading patient charts and seeing what they do, whether they adhere to their own policies, if they’re consistent,” said Harvard Medical School professor Dr. Ann Stark, who pioneered the American Academy of Pediatrics’ guidelines for levels of neonatal care and who leads its NICU Verification Program.
Evaluations are repeated every three years.
“We learn from every survey,” Stark said. “The more you do something, the better you get.”
But in New Mexico, the state government has no legal authority to verify whether hospitals meet specific standards. Any level-of-care requirements, if they exist at all, would be set in contracts between the hospital and Medicaid managed-care organizations hired by the state, according to Jodi McGinnis Porter of the state Human Services Department. Those agreements are secret. Not even the state can access them. “They’re proprietary,” McGinnis Porter said.
For the public, the shortcomings of New Mexico’s system — and the disparity in hospitals’ death rates for extremely preterm infants — are nearly invisible. The state does not analyze or publicly disclose specific hospitals’ outcomes, which could inform parents’ decisions about where to seek care.
Parents facing the birth of an extremely premature baby “literally have no way to tell or to compare” if their baby might do better at another hospital, said a Lovelace clinician who asked not to be named for fear of retribution. Making hospitals’ newborn outcomes public could force them to identify the causes of problems and address them, the clinician said. “Hospital transparency could save babies’ lives and save New Mexico families in the future from devastating heartbreak.”
Lovelace did not respond to questions about lax state oversight and later declined to respond to any comments made by clinicians who had been granted anonymity by New Mexico In Depth and ProPublica.
New Mexico parents are not the only ones in the dark about how well their local neonatal intensive care hospitals perform. Across the country, expectant parents have no way to assess which maternity hospitals have the best newborn outcomes, neonatal hospital experts and clinicians noted.
“A mom comes into labor at 25 weeks, and at one center you have 21% mortality, and at the other one you have 36% mortality. That information is not provided to the family,” said Perez.
For adult patients, a hospital’s survival or success rates for stroke, heart surgery or cesarean sections are available online. But similar information isn’t available for newborns. No government website compares babies’ outcomes like Medicare’s hospital comparison site does for adults. The Vermont Oxford Network, a hospital research collaborative that tracks infant care, does not publicly disclose hospitals’ NICU statistics. U.S. News & World Report has ranked 50 neonatal hospitals, but not Lovelace or Presbyterian.
There’s a “wall of silence that families and the public face with regard to the quality of care in NICUs,” said Dr. David C. Goodman, a professor at the Dartmouth Institute for Health Policy & Clinical Practice at Dartmouth College. Goodman has studied dozens of U.S. hospitals’ track records in caring for extremely preterm babies.
This dearth of information on neonatal hospital care also slows academic research that could improve outcomes, said Lorch and Goodman. (Lorch’s research team was unable to obtain data on outcomes at New Mexico NICU hospitals, data that researchers can readily obtain in other states, thanks to legal restrictions on the disclosure of the patient-level information.)
Experts said expectant parents should not have to wonder about the quality of newborn care when they choose a maternity hospital.
“It points to the need for greater transparency in health care outcomes, particularly for our most vulnerable populations,” Goodman said. “We can only improve care if it’s measured routinely and shared.”
House Democrats investigating the COVID-19 response say Trump adviser Peter Navarro pressured agencies to award deals worth hundreds of millions of dollars.
This article was published on Wednesday, March 31, 2021 in ProPublica.
A top adviser to former President Donald Trump pressured agency officials to reward politically connected or otherwise untested companies with hundreds of millions of dollars in contracts as part of a chaotic response to the COVID-19 pandemic, according to the early findings of an inquiry led by House Democrats.
Peter Navarro, who served as Trump’s deputy assistant and trade adviser, essentially verbally awarded a $96 million deal for respirators to a company with White House connections. Later, officials at the Federal Emergency Management Agency were pressured to sign the contract after the fact, according to correspondence obtained by congressional investigators.
Documents obtained by the House Select Subcommittee on the Coronavirus Crisis after a year of resistance from the Trump administration offer new details about Navarro’s role in a largely secretive buying spree of personal protective equipment and medical supplies.
But they also show he was among the first Trump officials to sense the urgency of the building crisis, urging the president to push agencies and other officials to “combat the virus swiftly in ‘Trump Time’” and cut through the red tape of the federal purchasing system.
In another communication, Navarro was so adamant that a potential $354 million contract be awarded to an untested pharmaceutical company that he told the top official at the Biomedical Advanced Research and Development Authority, or BARDA, “my head is going to explode if this contract does not get immediately approved.”
Navarro did not immediately respond to a request for comment.
The committee’s work backs up investigations by ProPublica and other news outlets into the more than $36 billion the federal government has awarded, much of it without traditional bidding and with little scrutiny, to address the COVID-19 pandemic.
At least five of the committee’s lines of inquiry are exploring issues reported by ProPublica, including the $96 million no-bid deal for respirators that was ordered by Navarro, a $34.5 million deal signed by the U.S. Department of Veterans Affairs that fell apart and ended with a contractor pleading guilty to fraud, a contract for masks awarded to a former Trump administration official, and the revelation that FEMA had paid millions to a contractor with a history of fraud allegations for unusable and unsanitary fake test tubes.
In a letter describing the subcommittee’s findings, Democrat James Clyburn of South Carolina and members of the committee told President Joe Biden’s emergency response team that Trump’s lack of action worsened the health crisis.
“The President rejected calls from governors to ensure that the country had sufficient (personal protective equipment) and other supplies to address the crisis, leading to severe shortages and forcing states and cities to compete on the open market,” they wrote.
The committee asked officials overseeing FEMA and the U.S. Department of Health and Human Services, along with the director of the National Archives, to provide records detailing Navarro’s actions and the circumstances behind several questionable contracts awarded in response to the pandemic, which has left more than 550,000 Americans dead and many more suffering.
“In the absence of a coordinated national plan, various White House officials pursued ineffective, ad hoc approaches to procuring certain supplies. Recently obtained documents show that White House officials pushed federal agencies to issue non-competitive contracts for certain pharmaceutical ingredients and other items — some of which would not be ready for many months or even years — even as acute shortages for surgical masks, nitrile gloves, gowns, and other items continued,” members of the subcommittee wrote.
The respirator deal, with Airboss Defense Group, a subsidiary of Canadian company Airboss of America, was reported by ProPublica in April 2020 after a highly unusual entry in federal procurement data indicated the contract had been directly ordered by the White House. The Trump administration provided few answers about the award, but records the company provided to Congress indicate the firm used an influential consultant to connect Navarro with Airboss CEO Patrick Callahan.
Retired four-star Army Gen. John Keane, whom Trump had recently awarded the Medal of Freedom, reached out to Navarro on behalf of Airboss and the company got a phone meeting with the White House Coronavirus Task Force, emails show. The emails indicate that the company delivered an initial batch of respirators to FEMA before any contract was awarded, and the company upped its production on the promise that the White House, and Navarro, would make a contract official. Emails indicate the company expected to be paid upfront, at contract signing. The federal government typically doesn’t pay until a contract is agreed to and a product is delivered.
Airboss’ parent company nearly tripled its sales in large part because of the deals Navarro helped broker, the subcommittee wrote, and saw a $12 million increase in profit from April to June 2020. The company said it hadn’t seen the subcommittee’s letters but defended its work with FEMA.
An Airboss spokesperson said in a statement that the company is “proud of its successful efforts to rapidly respond to the urgent requests of the then White House Coronavirus Task Force to help supply the U.S. Government with urgently-needed PPE equipment to save lives, and protect our front-line healthcare professionals in the battle against the COVID-19 pandemic. Within days of the request, ADG mobilized its extensive U.S. PPE manufacturing capabilities, and vast supply chain network to produce and begin delivering this critical equipment.”
In a separate contract negotiation, this time for generic pharmaceuticals, Navarro pressured FEMA and officials leading the effort to beef up a depleted national stockpile to award a potential $354 million deal to Phlow to make drug ingredients. In an email pressing BARDA officials Navarro wrote:
“This is a travesty. I need PHLOW noticed by Monday morning. This is being screwed up. Let’s move this now. We need to flip the switch and they can’t move until you do. FULL funding as we discussed.”
Democrats on the subcommittee noted that Phlow had never before received a federal contract and had incorporated just a couple months earlier, in January 2020. ProPublica left a message with a company spokeswoman, who has not yet responded.
In another public letter this month, the subcommittee expressed concern that Robert Stewart, the CEO of Federal Government Experts LLC, which was awarded a no-bid $34.5 million contract with the VA and a smaller deal with FEMA, wasn’t cooperating with its investigation.
This contradicts statements his lawyer made before a federal district judge just weeks before, that Stewart was helping congressional investigators, as he pleaded guilty to multiple counts of fraud. Stewart did not immediately respond to calls and text messages.
The two largest maternity centers in this state have drastically different death rates for extremely preterm babies. Here's how we analyzed the data for our investigation.
This article was published on Tuesday, March 30, 2021 in ProPublica.
A New Mexico In Depth and ProPublica investigation found that the tiniest, most premature babies born at Lovelace Women’s Hospital in Albuquerque died at higher rates than they did at a hospital a few miles away, Presbyterian.
The for-profit Lovelace and nonprofit Presbyterian are New Mexico’s largest maternity centers.
Data Sources
The most comprehensive data on newborn hospital outcomes is collected by the Vermont Oxford Network, or VON, an international neonatal intensive care unit research collaborative. VON maintains patient-level intake and care data for member NICUs, including those at Lovelace, Presbyterian and the University of New Mexico Hospital. The data can be used to calculate death rates at individual hospitals. Maternal and newborn demographics, prenatal care, medical procedures and complications, neonatal hospital transfer history and babies’ outcomes are also captured in the data.
VON data, however, is not public; the network discloses outcomes only to member hospitals. The group declined the news organizations’ request for mortality rates of extremely preterm babies at Lovelace and Presbyterian. UNM, which runs the state’s highest-level NICU, shared its de-identified VON database and annual reports in response to a public records request, but neither Lovelace nor Presbyterian would do the same. The hospitals and VON also refused to share the network’s national average death rate for extremely preterm babies.
Since we did not have access to VON data for Lovelace and Presbyterian, the news organizations obtained aggregate birth and death certificate data for extremely premature babies from the state Health Department’s Bureau of Vital Records and Health Statistics. Hospitals submit data on each live birth and in-hospital newborn death for babies born to legal residents of New Mexico. We initially analyzed data for the most recent available five years (2015-2019), broken down by gestational age and birth weight. We used this data to calculate hospital death rates. To do a more detailed secondary analysis, the news organizations obtained data for babies born during the most recent available 10 years, 2010-2019, based on gestational age. Because the longer time period included more births, it allowed comparisons of additional patient subgroups and variables.
Hospitals also report diagnostic and billing code data to the state Health Department’s Hospital Inpatient Discharge Database, or HIDD, which collects diagnosis and treatment information about patients admitted to every hospital in the state, except those operated by the federal government. We obtained aggregate HIDD data from the Health Department.
In devising our analysis, we worked with national experts in neonatal intensive care, including Dr. Scott A. Lorch, a professor of pediatrics and associate chair of the Division of Neonatology at the Children’s Hospital of Philadelphia and a leading authority on NICU outcomes, and Dr. David C. Goodman, a professor at the Dartmouth Institute for Health Policy & Clinical Practice at Dartmouth College. Goodman helped analyze the data, and the analysis was reviewed by Lorch.
What We Found
Babies born weighing less than 1,000 grams (or about 2 pounds) are called extremely low birth-weight, while those born before 28 weeks of pregnancy are labeled extremely preterm. (A full-term pregnancy is 39-40 weeks.) While most babies born before 28 weeks are also extremely low birth-weight babies, that is not always the case. To account for that, the news organizations initially evaluated death rates using both birth weight and gestational age for the most recent five years for which Health Department data was available: 2015-2019.
Using the Health Department birth and death certificate data, we calculated a neonatal death rate at each hospital, which measured the percentage of live-born babies who died at their birth hospital within 28 days of delivery. We found that:
Between 2015 and 2019,34% of Lovelace’s 88 extremely low birth-weight infants died at the hospital, compared to 17% of Presbyterian’s 197.
In those same years, 36% of Lovelace’s 84 extremely preterm babies died there, compared to 21% of Presbyterian's 170.
The extremely preterm neonatal death ratesat each hospital didn’t change much when calculated for the entire 10 years between 2010 and 2019: 36% for Lovelace vs. 22% for Presbyterianwhen calculated by gestational age, and 33% vs. 20% using birth weights.
The news organizations’ analysis found no disparity between the hospitals’ death rates for babies born at older gestational ages and higher birth weights.
Hospital-wide death rates were calculated, accounting for deaths regardless of whether babies were admitted to the hospitals’ NICUs. Goodman, who was the lead author of the September 2019 report Dartmouth Atlas of Neonatal Intensive Care, advised New Mexico In Depth and ProPublica that the most accurate comparisons include the deaths of all extremely preterm babies, whether or not they were admitted to a NICU.
Only babies born at each hospital were counted toward the number of births. Only those who died at their birth hospital within 28 days were counted toward the number of deaths. (Including babies who died after being transferred to UNM’s NICU raised Lovelace’s extremely preterm neonatal death rate to 39%. Because Presbyterian transferred only one extremely preterm baby to UNM, in 2013, and they survived, that hospital’s death rate was unaffected.)
The analyses omitted babies considered “pre-viable” (those delivered before 21 weeks of pregnancy or weighing less than 350 grams), because they would likely die regardless of medical intervention, according to the state Health Department.
As discussed, some babies born at Lovelace and Presbyterian were transferred to UNM for care. Additionally, neonatal transport team logs suggest each hospital sent a handful of babies to out-of-state hospitals. The transport team logs were not detailed enough to allow us to remove all extremely preterm babies who were transferred out of state from our death-rate calculations. Therefore, our death rate treated all babies transferred out of Lovelace and Presbyterian as if they had received care at their birth hospital and lived, almost certainly making our death rates underestimates.
In addition to in-hospital deaths, we also examined how frequently Lovelace and Presbyterian transferred newborns to UNM Hospital, the state’s only top-tier, level-4 NICU hospital.
Having the UNM NICU’s VON data allowed us to analyze the frequency of transfers to UNM, and the condition of and outcomes for those transferred babies. We found:
Lovelace transferred more than three times as many newborns as Presbyterian to UNM between 2015 and 2019. Lovelace sent 66 babies, both full term and preterm, while Presbyterian transferred 17 babies, none of them preterm.
Close to half (46%) of Lovelace-born extremely preterm babies either died at the hospital or were transferred to UNM between 2015 and 2019.
Of 18 babies with necrotizing enterocolitis, or NEC — an inflammatory intestinal disorder and leading cause of extremely preterm newborn hospital deaths — who were transferred to UNM since 2012, 15 came from Lovelace. Twelve required intestinal surgery, and two died within hours of their arrival. Only one Lovelace baby was transferred with NEC and survived without surgery.
We also found a discrepancy in the number of Lovelace babies diagnosed with NEC when we compared the HIDD data and UNM’s VON intake logs. The hospital reported four cases of neonatal NEC to the state between 2015 and 2019, but the UNM VON data documented the arrival of 11 Lovelace babies with NEC during those years. Lovelace declined to explain the discrepancy.
In addition to comparing Lovelace to Presbyterian, the news organizations sought a national comparison rate for extremely preterm babies’ death rates at level-3 neonatal hospitals, but found a dearth of publicly available data. Most published studies are based on data that is more than a decade old.
In response to questions from the news organizations, however, the Centers for Disease Control and Prevention provided a national death rate for extremely preterm infants. The CDC’s rate included all hospitals, regardless of the facility’s level of care, using the same gestational age and birth weight parameters used in New Mexico In Depth and ProPublica’s analysis. The CDC found a national, hospital-wide extremely preterm neonatal death rate for 2010-2018 of 28%, near the midpoint between Lovelace’s 36% and Presbyterian’s 22% for 2010-2019.
The CDC’s national death rate might be higher than a rate for only level 3 hospitals would be, because it includes hospitals with level 1 and 2 neonatal designations, which are less equipped to care for these babies.
Experts advised against comparing level 3 facilities like Lovelace and Presbyterian to level 4 neonatal hospitals like UNM, because level 4 hospitals treat the sickest newborns and have more medical subspecialists and surgical experts on staff, making it difficult to interpret differences. However, for completeness, we calculated death rates for UNM, using the Health Department data and the same methods described above for Lovelace and Presbyterian. The 2015-2019 death rates for extremely low birth-weight babies and extremely preterm babies born at UNM were 29% and 33%, according to the news organizations’ analysis.
Scrutinizing Risk Factors
The cause of the disparity in Lovelace’s and Presbyterian’s extremely preterm neonatal death rates is not clear. Possibilities include one hospital having a sicker patient population, differences in patient care, or both.
The Health Department provided additional breakdowns of outcomes by patient demographics and treatment details, none of which alone explained the difference in death rates. The summary-level data did not allow us to examine several variables in combination.
Babies born at 21 to 23 weeks’ gestation are considered “peri-viable” and resuscitation practices for these babies vary between hospitals, experts and Albuquerque clinicians said, which may lead to differing outcomes.
After excluding babies born at 21-23 weeks’ gestation who died without being resuscitated at delivery from the analysis, Lovelace’s extremely preterm neonatal death rate was 29%, compared to 19% at Presbyterian. Excluding all babies who died within an hour of delivery, regardless of gestational age or resuscitation reports, Lovelace’s death rate was 26%, compared to 18% at Presbyterian and a CDC-provided national rate of 22%.
(Goodman warned that resuscitation numbers are unreliable because hospitals frequently fail to report them.)
By 24 weeks’ gestation, resuscitation at delivery is always attempted, experts and clinicians said. When only babies born at 24-27 weeks’ gestation were included in the analysis, the death rate at Lovelace was 23% vs. 9% at Presbyterian for 2010-2019. The CDC-provided national rate for this group was 15%.
Another explanation for the death-rate disparity could have been if Lovelace had a disproportionate number of 21- or 22-week-gestational-age babies, who have poorer outcomes than babies born at 24-27 weeks. But we found that the distributions of births by week of gestation at the two hospitals were very similar.
The state Health Department provided demographic and medical treatment details for extremely preterm babies born at 24-27 weeks’ gestation. Lovelace’s higher death rate persisted in analyses of that data. For example, extremely preterm twins and triplets often fare worse than single-born babies. But this did not explain the hospitals’ death-rate disparity. Nor did maternal race or ethnicity, differences in the proportion of extremely preterm babies who were boys (boys tend to have worse outcomes than girls), or differences in prenatal therapies. Medically induced labor and other risk factors for extremely preterm babies, such as the proportion of teen mothers, mothers who underwent infertility treatment or mothers who had cesarean-section deliveries also did not account for the disparity.
Discrepancies in numbers for NICU admissions and birth defects precluded analysis of that data. All extremely preterm babies who survive delivery should be admitted to the hospitals’ NICUs, clinicians and experts agreed, but there were babies at both hospitals for whom there were neither NICU admissions records nor death certificates. Neither Lovelace nor Presbyterian reported birth defects with extremely preterm babies’ birth certificate data, but a handful of death certificate reports note birth defects as a cause of death. There was only one record of a Lovelace extremely preterm baby being transferred to UNM in the first 24 hours after delivery, so transfers should not explain the missing NICU admissions data. When asked for comment, the hospitals did not acknowledge or explain the discrepancies.
Identifying the causes of the hospitals’ extremely preterm neonatal death rate disparities would require access to patient records or to completely reported, patient-level records, experts said.
Lovelace Responds
Lovelace presented several objections to our analyses. The hospital objected to comparing its extremely preterm newborns’ death rates to those of Presbyterian or any other individual hospital, arguing that comparisons should only be made to national benchmarks.
Goodman defended comparisons of outcomes between nearby level 3 neonatal hospitals: “A comparison within the same community, serving similar populations, operating under similar state policies and regulations, is of the highest value.”
And the news organizations obtained a national rate from the CDC, as described above, which was lower than Lovelace’s death rate.
In addition, the hospital contested the decision to look at hospital-wide outcomes for babies, regardless of whether or not they were admitted to the hospitals’ NICUs. Lovelace asserted that only NICU deaths should be measured because hospital-wide rates include deaths in the delivery room and could include nonviable babies. Presbyterian officials did not object to a hospital-wide comparison.
Lovelace said its NICU-only 2015-2019 death rate for extremely low birth-weight newborns was 22%. They would not say how the 22% NICU-only death rate compared to national rates in the VON. Presbyterian refused to disclose its NICU-only death rate.
Goodman rejected Lovelace’s objection to hospital-wide comparisons, noting that NICU staff should be present at the delivery of extremely preterm babies and that his research team includes “every extremely preterm baby who dies ... in our research. They are cared for by the NICU team and are the responsibility of the NICU team whether or not they are administratively admitted to a hospital’s NICU.”
Another objection from Lovelace was the decision to calculate death rates for extremely low birth-weight newborns in the first place, noting that babies born weighing less than 1,000 grams represent only 2% of the hospital’s NICU-admitted babies. “This sample size is too small from which to derive any conclusions about the overall quality of care being provided,” Lovelace Vice President for Marketing Serena Pettes wrote in an email.
But extremely preterm babies are a formally recognized and widely studied patient population at neonatal hospitals. The American College of Obstetricians and Gynecologists defines as extremely preterm babies born before 28 weeks of gestation, the definition we employed. While extremely preterm babies do make up a small portion of all NICU admission, between 2010 and 2019, more than 500 such babies were born at Lovelace and Presbyterian.
Lax state oversight leaves unanswered questions about the deaths of extremely preterm babies at Albuquerque's Lovelace Women's Hospital, which markets itself as a state-of-the-art newborn facility. Experts say transparency could save lives.
This article was published on Tuesday, March 30, 2021 in ProPublica.
Note: This story contains a description of the death of an infant.
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It was morning shift change at Lovelace Women's Hospital in Albuquerque, New Mexico. In the neonatal intensive care unit, the lights were dimmed, as usual. People spoke in hushed tones typical of the NICU. But an arriving clinician knew immediately that something had gone wrong.
A "crash cart" carrying resuscitation equipment was positioned next to a newborn incubator, the enclosed cribs that keep preterm babies warm. Nurses stood nearby with grim expressions.
The incubator light illuminated an infant's swollen, discolored belly.
"I'll never forget what this baby looked like," recalled the Lovelace clinician, who asked not to be identified for fear of retribution. "His abdomen was black and taut and almost the size of a grapefruit."
The day before, the infant had been a little cold and had spit up, which wasn't particularly unusual. "It was something to watch, but nothing was horribly wrong," the clinician said.
Overnight, the baby's condition had worsened. Now, he was on a ventilator, his tiny heart's contractions slowing. His swollen abdomen prevented staff from administering chest compressions.
"There was nothing we could do," the clinician said. "He died."
The infant's gut had stopped functioning, clogging his feeding tube with undigested food. That is sometimes a sign of an inflammatory condition of the intestines, called necrotizing enterocolitis or NEC, that's a leading cause of hospital deaths among extremely preterm babies.
These babies' problems can spiral into life-threatening conditions in a matter of hours. There's no indication that Lovelace improperly handled the infant's treatment. But extremely preterm babies died at the hospital with striking frequency, according to an analysis of state health data by New Mexico In Depth and ProPublica.
A yearlong investigation by the news organizations found that at Lovelace, the tiniest, most premature babies died at up to twice the rate as they did a few miles away, at Presbyterian Hospital, another major maternity and newborn facility.
New Mexico In Depth and ProPublica also found that Lovelace transferred more than three times as many newborns as Presbyterian to the University of New Mexico Hospital, the state's only top-tier, level-4 regional referral NICU, where the sickest of the state's newborns are sent for care.
All told, between 2015 and 2019, close to half — 46% — of the 84 extremely preterm babies born at Lovelace either died at the hospital or were transferred to UNM, according to Health Department data and UNM NICU records. Twenty-one percent of the 170 extremely preterm babies born at Presbyterian died, and none was transferred to UNM during those years.
Experts said the findings should be investigated.
The disparity "should be of concern to families, the community, and the state of New Mexico," said Dr. David C. Goodman, a professor at the Dartmouth Institute for Health Policy & Clinical Practice at Dartmouth College. Goodman, who was the lead author of the September 2019 report Dartmouth Atlas of Neonatal Intensive Care, has studied the track records of dozens of U.S. hospitals that care for extremely preterm babies.
It is also a concern to Albuquerque medical professionals who care for these babies. Three Lovelace and UNM Hospital clinicians who contacted New Mexico In Depth and ProPublica about Lovelace voiced concerns about extremely preterm babies' outcomes and pointed to broader issues related to their care. Those issues included the lack of an on-site surgeon and other specialists, the timing of transfers to UNM when babies needed higher-level care, and disagreement over how best to care for these fragile newborns.
Lovelace and Presbyterian initially agreed to share detailed data on their neonatal outcomes with New Mexico In Depth and ProPublica, but ultimately refused to provide most of the promised information. To investigate the clinicians' concerns, the news organizations obtained state Health Department data on these newborns' deaths.
To better understand the disparity in outcomes between Lovelace and Presbyterian hospitals, New Mexico In Depth and ProPublica also obtained UNM hospital-transfer and intake logs, along with emails and other documents, and interviewed more than two dozen people, including current and former Albuquerque clinicians, neonatal transport team members, hospital officials and nationally recognized NICU experts. NICU administrators at Lovelace and Presbyterian spoke to the news organizations in early 2020. Since then, Lovelace has not made administrators available for comment.
Lovelace rejected any comparison that focused only on extremely preterm babies or that contrasted their death rates to Presbyterian's.
"Comparing us to only one other hospital as opposed to national benchmarks is flawed and not an appropriate basis for drawing broad conclusions," Lovelace Vice President for Marketing Serena Pettes wrote in an email.
Pettes said the news organizations were "seeking to undermine our quality of care" through a "misinterpretation of data." Asked how the hospital's data had been misinterpreted, she did not respond.
Three experts told New Mexico In Depth and ProPublica that it's cause for concern when level 3 neonatal hospitals, a designation that covers both Lovelace and Presbyterian, have higher death and transfer rates than neighboring facilities. Without access to patient records, numbers for neighboring hospitals were the best proxy to use in gauging outcomes, they said.
"Anytime you have a hospital that is delivering a lot of tiny babies that it has to send out or that die before you can send them out, you really have to ask the question, 'Are the mothers delivering at the right place?'" said Dr. Jeffrey B. Gould, a professor of pediatrics at Stanford University. A pioneer in NICU quality improvement, Gould is co-founder and chief executive of the California Perinatal Quality Care Collaborative.
Moreover, lax state oversight and a lack of hospital transparency about outcomes severely curtails the public's ability to know just how well hospitals are serving this vulnerable population. The state's loose regulations stand in sharp contrast to other states, like Texas and California, which mandate periodic inspections of neonatal intensive care hospitals and scrutiny of newborn outcomes.
The Lovelace clinician who witnessed the baby boy's death said New Mexico's lack of oversight is one reason families are in the dark about extremely preterm babies' outcomes at the hospital. Another is a culture of silence at the hospital when things go wrong: "We don't even talk about it within the NICU, but especially to the parents."
Comparing Lovelace and Presbyterian
Lovelace delivered about 2,700 babies in 2019; nearby Presbyterian delivered about 3,000, making those two hospitals the state's largest maternity centers. They are also the state's only level 3 neonatal intensive care hospitals, according to the state Health Department. Together, they delivered 28% of babies born statewide between 2010 and 2019, and 37% of the state's extremely preterm babies.
"If your pregnancy falls into the high-risk category, you can rest assured you'll be getting the best medical care available anywhere in the region," a Lovelace advertisement states.
Overall, Lovelace and Presbyterian had similar newborn death rates, the news organizations found — except when it came to the tiniest and most premature newborns.
Babies weighing less than about 2 pounds at birth are called extremely low birth weight, while those born before 28 weeks of pregnancy are labeled extremely preterm. While most extremely preterm babies are also extremely low birth-weight babies, that is not always the case. To account for all of these vulnerable infants, the news organizations evaluated death rates using both birth weight and gestational age.
Between 2015 and 2019, 34% of Lovelace's 88 extremely low birth-weight infants died, compared to 17% of Presbyterian's 197, according to the New Mexico in Depth and ProPublica analysis, which compared birth and death certificate data at the two hospitals. The calculations excluded babies who were born elsewhere and transferred to Lovelace or Presbyterian, and babies born weighing less than 350 grams, who are not considered viable.
The analysis also found a disparity in the death rate when calculated by gestational age, instead of by birth weight. Lovelace's hospital-wide death rate for extremely preterm babies was 36%, compared to Presbyterian's 21%.
"The differences are meaningful," Goodman said of the hospitals' death rates. "They're not slight differences. These are large differences."
"Thirty-six percent is higher than expected for this gestational age group," Goodman said. "It raises the question as to whether the care provided meets the needs of the newborn patients."
The news organizations also found that Lovelace transferred 66 infants, both full term and preterm, to the level 4 NICU between 2015 and 2019, while Presbyterian sent 17 babies, none of them preterm, UNM records showed.
"Every time we have a tiny baby, I cringe. We have a terrible track record with them," said the Lovelace clinician who was present when the baby died.
Another Lovelace NICU clinician voiced similar concerns about extremely preterm babies' outcomes, both in the delivery room and the NICU.
"They have only rudimentary policies in place for micropreemies, but not nearly as comprehensive as things that I've seen at other hospitals," the second Lovelace clinician said. (A copy of Lovelace's NICU infant care guidelines, reviewed by the news organizations and dated Feb. 1, 2017, briefly mentions extremely preterm and extremely low birth-weight babies' care in sections about nurse-to-patient ratios, thermoregulation and water loss, skin care, and body positioning.)
The clinicians were two of eight current and former Lovelace care providers who spoke to New Mexico In Depth and ProPublica about newborn care at the facility on the condition that they remain anonymous because speaking publicly could hurt their employment within New Mexico's small medical community. Not all of them were critical of the hospital.
"It's a well-run unit," a former Lovelace clinician said of the NICU. "I wouldn't hesitate to have my own child in that unit."
Pettes declined to respond to clinicians' concerns and criticized the news organizations' decision to grant them anonymity. "We are not able to respond to anonymous sources," she wrote in an email, calling the clinicians' comments "opinions, and not facts."
New Mexico's NICU Hospitals Face Little Regulatory Scrutiny
The American Academy of Pediatrics defines level 3 NICU hospitals as facilities equipped to care for high-risk babies. Unlike lower-level hospital nurseries, they are staffed by specialists experienced in treating the most at-risk and medically complex newborns.
In New Mexico, however, there's no legal definition of what constitutes a level 3 NICU. The state has no NICU-specific legal or regulatory oversight authority. Nor does the state have a role in certifying NICUs or monitoring newborn outcomes. The state has not conducted on-site inspections of any of the three Albuquerque NICU hospitals and has not analyzed neonatal death rates at the facilities, state Health Department spokesperson James Walton acknowledged.
The New Mexico Department of Health collects some details from the hospitals about mothers and newborns, including which mothers received infertility treatments to become pregnant, whether labor was induced and whether the delivery was by cesarean section. But the state cannot impose penalties on hospitals that fail to report such data, Health Department officials confirmed.
For example, New Mexico In Depth and ProPublica identified a discrepancy in Lovelace's reporting of cases of NEC, the dangerous intestinal condition. Lovelace reported only four neonatal NEC cases to the Health Department between 2015 and 2019, but NICU intake records at UNM showed 11 babies who were transferred from Lovelace with NEC during those years, including four in 2019 alone.
Goodman helped New Mexico In Depth and ProPublica analyze the Health Department's birth and death data.
The causes of disparities in outcomes between institutions are not always clear. Possibilities include a sicker patient population and less effective care, Goodman said.
Lovelace repeatedly declined to identify demographic or patient factors that might explain the disparity in the hospitals' extremely preterm neonatal death rates.
Identifying those factors requires careful review of patients' medical records, experts said. New Mexico In Depth and ProPublica did not have access to patient records. But the news organizations attempted to identify possible explanations using the data Lovelace and Presbyterian reported to the state Health Department from 2010 to 2019.
Babies born at 21 to 23 weeks' gestation frequently die shortly after delivery, and resuscitation practices for the age group vary, which could lead to differing outcomes. But a 2-to-1 death-rate disparity persisted when the analysis included only babies born at 24-27 weeks' gestation, who are less likely to die shortly after delivery. The number of extremely preterm twins and triplets, who often fare poorly, also did not explain the death-rate disparity. Nor did differences in maternal race or ethnicity, prenatal therapies or other potential risk factors for extremely preterm babies, including the proportion of boy births, teen mothers, mothers who underwent infertility treatment or induced labor, or mothers who had cesarean-section deliveries.
Pettes claimed that for all NICU-admitted newborns — including lower-risk full-term babies and premature babies — Lovelace's neonatal death rate is "significantly lower than the national average," and has declined over time. "As a whole, our mortality rate is less than half of the national NICU average."
But according to the Health Department data, full-term babies make up a much larger proportion of the hospital's NICU population than extremely preterm newborns, obscuring the death rate for the hospital's most at-risk babies.
Pettes declined to share the national benchmark she cited from a neonatal intensive care unit research collaborative, the Vermont Oxford Network. The network discloses outcomes only to member hospitals and declined the news organizations' request for extremely preterm babies' mortality rates at Lovelace and Presbyterian.
Pettes also objected to the news organizations' comparison of hospital-wide death rates.
Pettes disclosed that 22% of Lovelace's extremely low birth-weight babies died after admission to the NICU during 2015-2019.
But Goodman said NICU-only rates are not a true reflection of a hospital's outcomes.
"We include every extremely preterm baby who dies … in our research," said Goodman. "They are cared for by the NICU team and are the responsibility of the NICU team whether or not they are administratively admitted to a hospital's NICU."
Lovelace did not provide a hospital-wide death rate for these fragile babies.
Hospital-wide death rates are important indicators because labor and delivery unit practices can also affect survival, and babies who die in the NICU are not always recorded as NICU deaths, a Lovelace clinician noted.
It was impossible for the news organizations to compare NICU-only data between the hospitals. Presbyterian would not provide its NICU-only death rate. In addition, birth and death certificate data showed discrepancies in the Health Department's data on NICU admissions. Extremely preterm babies who survive delivery should always eventually be admitted to NICUs, experts said, but the news organizations found infants for whom there was no record of a NICU admission or a death certificate.
The hospitals did not acknowledge or explain the discrepancies.
"Lovelace Specials"
Lovelace transferred more than three times as many newborns to UNM's level 4 NICU as did Presbyterian, UNM intake logs show. Ten of the Lovelace transfers were extremely low birth-weight infants, three of whom died at UNM. None of Presbyterian's transferred babies were extremely preterm or extremely low birth-weight infants.
Information about neonatal transfers can help regulators identify facilities that aren't meeting babies' needs or find problems that hospitals should address, experts say.
Comparing UNM NICU intake logs with state data showed that close to 90% of Lovelace and Presbyterian's transfers to UNM were not captured in Health Department data, because the state only requires hospitals to report transfers occurring in the first 24 hours after delivery.
"If you don't have the data, you can't make change," said Dr. Scott A. Lorch, a professor of pediatrics and associate chair of the Division of Neonatology at the Children's Hospital of Philadelphia, and a leading authority on NICU outcomes.
At UNM Hospital, babies who arrived in dire condition were sometimes called "Lovelace Specials," according to two former UNM NICU clinicians who asked not to be named for fear of retribution.
Some of the Lovelace babies who had NEC arrived at UNM without needed X-ray reports, or with X-rays taken from angles that can miss signs of a worsening condition, a UNM pediatric radiologist said.
"That's what I've seen based on imaging: Patients often arrived at UNM in more advanced stages of NEC," the radiologist said. Unlike UNM and Presbyterian, Lovelace does not have a pediatric radiologist on staff, the radiologist noted. Lovelace declined to comment.
One of the two former UNM clinicians said that when babies arrived from Lovelace, "you just had no idea what you were getting into."
Clinicians questioned not only the number of newborn transfers but their timing.
Lovelace is sometimes too slow to send babies in crisis to UNM Hospital, where surgery can be performed if needed, four clinicians from both Lovelace and UNM said. Lovelace declined to respond to their allegation.
The pace of transfer matters because NEC can progress in a matter of hours from subtle symptoms to a life-threatening condition requiring emergency surgery. It is not unusual for level 3 NICUs to have surgeons on call or to have a transfer agreement with other hospitals. But if a surgeon cannot perform emergency procedures on-site, timely transfers to surgical hospitals can be a matter of life or death.
Of 18 babies with NEC who were transferred to UNM since 2012, 15 came from Lovelace. There isn't a hard-and-fast rule about when to transfer a sick infant to a higher-level facility, but transfer logs showed that of the 15 Lovelace babies sent to UNM, 12 were in a condition that required surgery when they got there, and two — a 5-day-old girl and a 12-day-old boy — died within hours of their arrival. Only one Lovelace baby with NEC was transferred and survived without surgery.
When NEC is caught early, it can be treated with antibiotics, a former UNM clinician said. "But you don't want to wait until they're so, so, so, so sick and then try to send them," the clinician said.
"They just wait too long," said the Lovelace clinician who witnessed the boy's death, referring to cases the clinician handled. "Babies that might otherwise have survived did not because they didn't get them to a place where they could have a surgeon if they needed it."
The former UNM clinician added a key explanation: "That's really where we get a lot of the kids, especially from Lovelace, is not having those pediatric surgeons available."
Does Lovelace Have a Pediatric Surgeon?
The question of whether Lovelace does, in fact, have an on-site pediatric surgeon, as Presbyterian does, is subject to debate.
In March 2019, the New Mexico Health Department and the Centers for Disease Control and Prevention informed Lovelace that a survey of the state's maternity and neonatal hospitals had concluded that Lovelace was not operating a level 3 NICU, but instead a level 2 special-care nursery. State officials based their conclusion on the lack of a pediatric surgeon and a pediatric anesthesiologist at Lovelace.
Hospital administrators successfully appealed that determination, claiming in an email obtained by the news organizations that among the "providers available" at Lovelace was a pediatric surgeon and other experts "on site 24/7."
But Lovelace clinicians told New Mexico In Depth and ProPublica that the claim was misleading.
"They've been saying they're going to have pediatric surgery for almost a decade," one Lovelace clinician said.
In some states, hospitals are required to support such claims with documentation. But emails indicate the state Health Department's chief medical officer, Dr. Thomas Massaro, prevented other Health Department staff from asking Lovelace to provide the names and board certifications of medical specialists. Massaro told New Mexico In Depth and ProPublica, "Neither we nor CDC required documentation of any of the hospital claims or submissions."
There's a reason hospitals fight for level 3 status.
Lovelace Women's Hospital opened its $11 million NICU in September 2007, positioning itself to compete with Presbyterian and UNM in the state's lucrative newborn acute healthcare market. Lovelace markets itself as a state-of-the-art maternal and newborn hospital. Expectant parents are told that should anything go wrong, maternal and neonatal medical specialists are available to provide expert care. Front and center in that promise is the "Level 3 Neonatal Intensive Care Unit."
Extremely preterm babies cared for in the NICU are known as "million-dollar babies," several clinicians said. That's no exaggeration: Hospital price sheets suggest care for these babies may bring Lovelace more than $1.2 million per baby from insurers.
Newborn intensive care has brought a lot of money to Lovelace and its privately owned parent company, Nashville-based Ardent Health Services. Between 2015 and 2019, Lovelace Women's 53-bed facility received more than $99 million in payments from Medicaid for NICU patient care, while Presbyterian's 58-bed NICU received $75 million during the same period, according to state data.
"It is no secret that the NICU is Lovelace Women's Hospital's golden goose," said Wendy Walter, a former adult ICU charge nurse at Lovelace who provided "helping hands" when the NICU was short-staffed. (Walter was fired by the hospital in January for working more hours than authorized. She contends that she worked additional hours at shift's end to properly document patients' treatments.)
Months after successfully defending its level 3 status, Lovelace went further, informing the state Health Department last year that the facility merited recognition as a level 4 NICU. That could put it in competition with UNM, where extremely preterm babies can bring in more than $2 million per infant.
In a Jan. 10, 2020, email to Massaro, Lovelace's director of women's services, Dr. Abraham Lichtmacher, wrote that the hospital now had "pediatric surgery, which is represented by the pediatric surgeons from UNM as they have finalized and obtained their privileges at Lovelace Women's Hospital allowing them to perform their procedures on site."
Three current and former Lovelace clinicians expressed dismay that an administrator at the hospital made such a claim.
"They don't have surgical support staff, pediatric surgical nurses — or even a place to do baby surgeries," one said.
A few weeks after Lichtmacher emailed the state, UNM pediatric surgeon Dr. Jason McKee contradicted Lichtmacher's claim in an interview with New Mexico In Depth and ProPublica. Asked if he had surgical privileges at Lovelace, McKee told the news organizations in early 2020: "I have consulting privileges at Lovelace so I can go and see a child, but as of now we don't do surgery over there."
McKee was noncommittal when asked if that would change in the near future, but noted that it would require Lovelace to hire surgical support staff.
Lovelace recently declined to say if any pediatric surgeries have been performed at the hospital or if it has surgical support staff available to perform such operations.
"We have, and continue to maintain, pediatric surgeon availability for our patients but defer to the surgeon's clinical judgement as to the best place for those surgeries to occur to achieve the best outcomes for the patient," Pettes, the Lovelace vice president for marketing, wrote in an email. She declined to say if Lovelace employed a pediatric surgeon or pediatric surgery support staff, or if any neonatal surgeries have been conducted at Lovelace in recent years.
Job listings for Lovelace Women's posted as recently as Feb. 27 stated that the hospital "hopes to establish Pediatric Surgery in the future."
Lovelace last sought the Health Department's acknowledgement of its NICU as a level 4 facility in August, according to Walton, the department spokesman.
Lovelace refused to comment on its efforts to be recognized as a level 4 neonatal hospital.
A November 2020 Health Department document still listed Lovelace as a level 3 neonatal facility.
Why Lovelace Might Lag
One situation that experts say can cause disparities in outcomes at neonatal facilities is the number of patients they treat, or what researchers call "patient volume."
Hospitals that care for a larger number of high-risk babies have better outcomes, likely the product of their experience, said Lorch, the authority on NICU outcomes. Teams need practice working together to meet the needs of high-risk babies, experts said.
While it is unclear whether patient volume was a factor in higher death rates among the tiniest babies at Lovelace, the hospital had less than half the patient volume of extremely preterm babies that Presbyterian had. Each year, between 2010 and 2019, Lovelace delivered on average 16 extremely preterm babies, compared to 38 at Presbyterian.
Research by Lorch and others shows that patient volume can predict survival rates for more developed "very" preterm babies, those born at 28 to 32 weeks' gestation.
"You need experience caring for those babies," said Harvard Medical School professor Dr. Ann Stark, who pioneered the American Academy of Pediatrics' guidelines for levels of neonatal care.
The role hospitals' patient volumes plays in survival among extremely preterm babies — those born before 28 weeks of pregnancy — has not been studied. But research has shown that dedicating an expert clinical team to care for extremely preterm babies can improve outcomes. In that light, having three Albuquerque hospitals within a few miles of each other that each care for a relatively small number of extremely preterm babies might not make sense, some experts said.
"Maybe having one high-volume center is better than having two or three centers that take care of those same babies," said Dr. José Antonio Perez, a clinical professor of pediatrics at the University of Washington in Seattle and the NICU medical director at Swedish Issaquah Medical Center.
One way neonatal hospitals improve the quality of care after things go wrong is by convening formal staff morbidity and mortality, or "M&M," case reviews. New Mexico regulators do not require M&M case reviews, but NICU staff at both Presbyterian and UNM hold them anyway.
Lovelace officials repeatedly declined to say if they do.
New Mexico In Depth and ProPublica asked eight current and former clinicians who worked at the Lovelace NICU over the past decade if they had participated in M&M case reviews at Lovelace. None had. They spoke with the news organizations without the hospital's permission.
It would be "egregious" for a facility to not conduct M&M case reviews, Goodman said.
"Each newborn with a significant event, be it death or a significant morbidity that could even possibly be related to the care administered, I think those all require careful discussion to see if there is any systemic cause," Goodman said.
ProPublica's deputy data editor, Hannah Fresques, reviewed the analysis.
Like every other storefront in downtown Lincoln, Nebraska, the Coffee House — a cavernous student hangout slinging espresso and decadent pastries since 1987 — saw its revenue dry up almost overnight last spring when the coronavirus pandemic made dining indoors a deadly risk. Unlike most, however, the business wouldn’t have access to the massive loan fund that Congress made available for small enterprises in late March.
The reason had nothing to do with the business itself, which had been having one of its best years ever, according to its owner, Mark Shriner. Rather, it all came down to one box on the application for the Paycheck Protection Program money, which asked whether the company or any of its owners were “presently involved in any bankruptcy.” Shriner had filed for Chapter 13 in 2018 after a divorce and was still making court-ordered debt payments, so he checked “yes.” He was automatically rejected and lost about $25,000 in payroll and other costs that the program would have covered.
“My money is my store’s money. When I got divorced and she was entitled to half, it’s not like a company can raise money real quick,” Shriner said, noting the way in which many small businesses are structured as pass-through entities that pay taxes on any profits as individual income. “All these businesses that had a tough time and are trying to make payments at the same time are getting kind of hosed.”
Thousands of people file for Chapter 13 bankruptcy every year — 282,628 did so in 2019 alone. Although it’s not clear how many of them own businesses, all of those individuals were barred from the PPP program, along with the thousands of businesses currently working through a reorganization plan under Chapter 11 and the family farms that file under the lesser-known Chapter 12.
In December, Congress allowed the Small Business Administration to give exceptions to some debtors. But so far the SBA has stuck to its position that debtors in bankruptcy aren’t entitled to government aid. “Currently, the SBA is administering the law as written,” SBA spokeswoman Shannon Giles emailed in response to questions.
Although Shriner did receive the $10,000 Economic Injury Disaster Loan advance payment, which doesn’t have to be repaid, the SBA turned him down for a larger Economic Injury Disaster Loan because of his personal credit. Instead, he took out two loans worth $107,000 from Square — with total fees of nearly $12,000 — to keep the lights on and the staff paid as they operated on a drastically limited basis, still down by more than half since before the pandemic.
“The biggest consequences are that we haven’t had the time to take a week and shut down and plot our way forward, come up with a to-go menu or some new things, because we’re busy working the counter trying to save money,” Shriner said. “A lot of other businesses that got PPP have been able to hire people to help them head in a different direction, get apps made, fix their websites, that kind of thing.”
The prohibition on PPP loans going to debtors began with the SBA’s original concept for the program: It extended its 7(a) loan program, its most common credit offering for small businesses, which already bars bankrupt companies. New pandemic relief measures were basically grafted on to those rules, which reflect an agency position dating back to its beginnings in the 1950s that bankrupt companies were more likely to default.
“SBA has an institutional prejudice against people who file bankruptcy,” said Ed Boltz, a North Carolina bankruptcy lawyer who serves on the board of the National Association of Consumer Bankruptcy Attorneys. “The attitude of government in a lot of things is, ‘Bankruptcy is hard and confusing and these people are probably bad people.’”
Almost immediately, this position was challenged in courts across the country. In Hidalgo County, Texas, for example, an emergency medical transportation company in bankruptcy sued after it was denied a PPP loan. A bankruptcy judge issued a temporary injunction against the SBA, saying it was in the public interest during the pandemic to make sure the company’s trucks and helicopters could keep ferrying patients to hospitals. In June, the 5th U.S. Circuit Court of Appeals vacated that decision, saying the judge had exceeded his authority.
Meanwhile, the SBA hastily published a rule explicitly barring companies in bankruptcy from participating in its pandemic relief program. “The Administrator, in consultation with the Secretary, determined that providing PPP loans to debtors in bankruptcy would present an unacceptably high risk of an unauthorized use of funds or non-repayment of unforgiven loans,” the rule read. “In addition, the Bankruptcy Code does not require any person to make a loan or a financial accommodation to a debtor in bankruptcy.”
Around the same time, a Florida radiology center also serving COVID-19 patients received a PPP loan, even though it was reorganizing under Chapter 11 bankruptcy. When it filed for approval with its bankruptcy court to take on the additional debt, the SBA objected again. The bankruptcy court found in favor of the radiologists in June, writing that “it is plain Congress did not intend to exclude chapter 11 debtors from the Paycheck Protection Program.” In December, however, the 11th Circuit overturned the lower court and sided with the government.
Maury Udell, the radiology company’s lawyer, said he plans to appeal to the Supreme Court. The PPP is more of a grant than a loan, he argues, since all companies had to do in order for the money to be forgiven is spend most of it on payroll. Bankrupt companies are arguably more likely to do so, given that they’re on court-ordered plans for how they must manage their expenses. Besides, the program did not require that companies demonstrate their ability to repay — plenty of businesses on very shaky footing applied for and received funding, sometimes filing for bankruptcy later.
“The SBA’s argument for not allowing Chapter 11 debtors is that the risk of nonpayment is high,” Udell said. “That’s not a factor in whether you were approved. It’s just as high as anyone else, because there’s no other underwriting guidelines.”
Frustration with the SBA’s position mounted through the fall until December, when Congress passed a fresh round of $900 billion in pandemic-related relief, along with the regular budget. It included $285 billion for a second draw of PPP loans, and a bit of potential relief for debtors: an amendment to the U.S. Bankruptcy Code that allows PPP loans to businesses that have filed for bankruptcy under Chapters 12, 13 and Subchapter V, a new category for small businesses established in 2019. (Chapter 11 debtors were left out.)
However, there was a catch: In order to trigger the exemption, the SBA would have to write a letter to the Executive Office of the U.S. Trustee, an division of the Justice Department that oversees U.S. bankruptcy courts, alerting it to the change. So far it has not done so, even as Congress has extended the deadline for PPP applications to May 31, with $103 billion in authorized funds yet to be expended.
President Joe Biden’s choice to run the SBA, Isabella Guzman, was confirmed on March 16. The SBA would give no indication of whether she plans to change course. Spokespeople for senators on the committees of jurisdiction either had no comment or said they were looking into the issue.
Last week, as his hope of getting a PPP loan waned, Mark Shriner set up a GoFundMe page to try to keep his doors open. More than $21,000 has flowed in. Meanwhile, he also learned about the Restaurant Revitalization Program established by the $1.9 trillion American Rescue Plan. So far, since it’s a straightforward grant rather than a loan, it doesn’t seem to prohibit applications from companies — or company owners like him — who’ve filed for bankruptcy. But he’s not counting on anything, since aid programs have been so disappointing.
It’s a difficult contrast, he said, when he looks around town and sees all the federal money that helped people who didn’t always need it.
“I’m not a wealthy person at all, but I have many millionaire friends who own businesses, insurance firms, architecture firms,” Shriner said. “These millionaires got money and money and money and money from the government, and they’re all driving on the golf course. It is tough when I think about it.”
When Congress earmarked hundreds of billions of dollars for the Paycheck Protection Program, ProPublica believed the public had a right to know how the money was being spent. A federal judge agreed.
This article was published on Friday, March 12, 2021 in ProPublica.
On March 16, 2020, our world, like everyone else’s, was falling apart. We were suddenly homebound. Our incredible staff was juggling pandemic fears, upended home lives and uncertainty. But one thing was immediately clear: We would not stop reporting.
Our reporters and editors immediately scheduled a Zoom meeting with me, their newly minted general counsel. They were interested in public records requests. They needed a strategy. Now. This was an unprecedented health crisis that would require action at every level of local and federal government. It is the press’ responsibility to hold them accountable, but to figure out how effective the government response was, we’d need information.
That afternoon, I wrote to my lawyer colleagues at The New York Times, The Washington Post and The Wall Street Journal (yes, we all know one another; no, we have no other friends). “Not sure if this is a dumb idea,” I wrote, but these extreme times might call for deep collaboration among competitors. Let’s strategize together, sue together and share documents together. This moment is too overwhelming, and government agencies were in disarray.
For all their rivalry, news organizations actually work together all the time, especially on the legal side. The reaction was enthusiastic.
But it wasn’t until the end of April that my colleague at the Post had a brilliant idea. Congress had earmarked hundreds of billions of dollars for the Paycheck Protection Program (the PPP) to help small businesses weather the crisis. But as gobs of money flew out of the government, it was quickly clear that there were issues. The rollout was a mess. Money seemed scarce. And we couldn’t answer basic questions: Were the people who were supposed to get help actually getting it? Were the politically connected disproportionately benefiting? What about small businesses? Rural businesses? Minority-owned businesses? Were they getting enough? Too much? We had no idea.
Of course, all of the major news organizations had similar questions. But the government — specifically, the Small Business Administration — was stonewalling everyone. The agency would make the data public when it damn well pleased (and with the virus, who could say when that would be?), and then only the information it thought we should have. The public interest in this data seemed so obvious. There were livelihoods at stake and astonishing amounts of taxpayer money cascading into the economy. Readers needed to know whether we, as a society, could meet the moment. It was bigger than one news organization. Maybe together, we wouldn’t be ignored.
The Post led the charge into federal court, welcoming a motley crew. First the group from the March email chain. Then Bloomberg. Soon The Associated Press was there too. NBC. ABC. CNN. Reveal. American City Business Journals. They had hired a law firm, Ballard Spahr, where I used to work. (I highly recommend turning your old boss into your client who has to tell you your ideas are great. The tables have turned, Chuck!)
After we sued, the SBA finally posted some information. But, in the words of the judge, it contained “glaring gaps”; the agency wouldn’t give the precise amounts of loans over $150,000 and the identities of many recipients. We pressed. As the judge would later write, there were many reasons to think that shoving billions of dollars out the door needed public scrutiny. Among them, this was likely “the ideal environment for fraud.”
The judge also pointed out that everyone who applied for a PPP loan was told that their information could be public, and that the nature of the PPP program rules meant that people looking at the data would generally not be able to discern other potentially sensitive information about the recipients, like the size of their payroll or individual salaries. As we note on our site, the data reflects loan applications that have been approved, but not necessarily money distributed to or used by a given company.
In November, the judge issued a 40-page . He said it better than we ever could: “Here, the Court has little doubt that disclosure of the withheld information would serve the public interest. In light of SBA’s awesome statutory responsibility to administer the federal government’s effort at keeping the nation’s small businesses afloat amidst an economic and health crisis of unprecedented proportions, the public interest in learning how well the agency fulfilled its charge is particularly pronounced.” (That’s the judge equivalent of lighting fireworks in the street.) In the end, he said, the decision was “not particularly close.”
ProPublica decided to turn this trove of data into a to let the public see in an organized way what its government has been up to. It’s a journalistic strategy that has become a ProPublica signature. Recent projects have included a collection of that showed the extent of the insurrection at the Capitol on Jan. 6, a tracker for all of the “” the Trump administration tried to impose in its waning days (and of the Biden administration’s efforts to undo them) and thousands of that give an unprecedented look into how internal police discipline actually works.
We included some, but not all, of the information we got from the SBA (we didn’t include street addresses, for example). The data helped our reporters . And the app, originally published in July and since updated, has continued to be a valuable resource for and many readers.
Interestingly, we have heard recently from a number of people — mostly small-business owners — who found themselves in the app. Some swere upset and disagreed with the finding that the public interest in scrutinizing the government justified making this information available, saying that this data should be private. Some were confused, saying that they don’t think they ever applied for a loan in the first place (if this happened to you, our reporters ). What’s clear is that the range of businesses that used the PPP reflects the fact that the pandemic a swath of our nation. That includes many people who never thought they would be on the receiving end of taxpayer assistance.
What this tragedy, and our attempt to make this information available, also shows us, I think, is that there isn’t, and shouldn’t be, any stigma. This is a story about government doing big things and quickly, both a sign of relief working as intended and a way to identify how it fails. And the only way we can parse it out is if we can actually look at what happened.
The court ordered the government to pay more than $100,000 in lawyer fees for making us fight so hard, but we are pressing for the release of even more critical information. ProPublica separately filed suit against the Department of Health and Human Services for information about the federal stockpile that was woefully lacking in the early days of the pandemic. And we’ll keep digging for more. Agencies around the country have been stalling in getting us records, but we haven’t given up.
Who knows. We may just get the coalition back together again.
Jim Malatras stood by a Cuomo administration report on nursing home deaths he knew undercounted the true loss of life. Today, he is chancellor of New York State's public university system.
This article was published on Thursday, March 11, 2021 in ProPublica.
Last July, when the New York State Department of Health issued a absolving the Cuomo administration of responsibility for the soaring number of COVID-19 deaths in the state’s nursing homes, Jim Malatras was tasked with handling what quickly became a storm of criticism.
Health care experts and lawmakers had derided the report as deeply flawed and designed to provide political cover for Gov. Andrew Cuomo. But Malatras, a former administration official who had been brought back from a job in higher education to assist Cuomo in responding to the pandemic, did not shrink from his assignment.
In an interview with ProPublica days after the report’s release, Malatras defended the integrity of the report, which he said had been developed by health department experts with data analysis help from the consulting firm McKinsey & Company.
Malatras said the report’s authors had used a sophisticated statistical model to reach a persuasive conclusion: Infected nursing home staff had been the chief driver of the spread of disease and death, not the thousands of potentially still-contagious patients transferred from hospitals to the homes under a Cuomo administration policy adopted early in the pandemic.
Malatras told ProPublica the report should silence the administration’s many critics, who he said had engaged in a cynical effort to blame Cuomo for contributing to the deaths of more than 6,000 nursing home residents by early last summer. He said he looked forward to the report’s critics doing their own studies.
“Write a public letter countering the report, run their own tests, and we’ll see what it looks like,” Maltatras said. “Let’s see their tests.”
One month after the release of the report, Malatras was appointed chancellor of the State University of New York system, one of the largest public university systems in the country, with scores of campuses and about 400,000 enrolled students. At the time, the SUNY Board of Trustees described Malatras as a “visionary” whose work with Cuomo made him uniquely qualified to run the sprawling higher education system at a critical moment in its history.
In the wake of new reporting by and , it is clear Malatras had not told the full story of the health department’s report. The Cuomo administration, it turned out, had removed from its analysis the state’s count of nursing home residents believed to have died of COVID-19 after being transferred from the homes to local hospitals. The administration’s changing of the report meant that the sophisticated analysis offered to the public last July had failed to account for thousands of additional COVID-19 deaths among nursing home residents, and the administration knew it.
In a statement, Malatras said he had played a role in shaping and editing the health department report, but had not been the one to remove the hospital deaths data. Beth Garvey, counsel to Cuomo, said in a statement the hospital deaths had been omitted at the time because the state was then still trying to make sure the count was accurate. The administration did not release the true total of nursing home deaths due to COVID-19 until last month, and when it did, the number grew by some 50%, from more than 8,000 to more than 12,000.
Gary Holmes, a spokesperson for the health department, said in a statement that the department in fact performed an analysis last July that included all deaths of nursing home residents — those who died in facilities and in hospitals — and the result was the same: The greatest surge in deaths at the homes resulted from infected workers and not the state’s policy requiring homes to accept potentially contagious patients who had tested positive for COVID.
Holmes offered no explanation for why the health department had not said so at the time. The department, he said, had now made public both the truncated July report and the more complete report including all nursing home deaths. He said the department stood by both reports.
Ron Kim, the Democratic chair of the State Assembly Committee on Aging, said anybody involved in the July report ought to resign from their positions.
“In my personal opinion, they conspired in a coordinated fraud,” Kim said.
In February, Kim accused Cuomo of personally threatening to ruin him over Kim’s criticism of the state’s handling of nursing home deaths. Cuomo has denied he ever threatened Kim.
ProPublica contacted Malatras again this week, and asked why he hadn’t previously disclosed the removal of the hospital deaths from last July’s report, whether he’d agreed at the time with the decision to remove the additional deaths, and whether he stood by the integrity of the health department’s work and his defense of it.
Citing ongoing federal and state investIgations into the Cuomo administration’s handling of the COVID-19 crisis in the state’s nursing homes, Malatras issued a short statement: “Thank you for your follow up. As I’m sure you can appreciate, given the nature of the various inquiries, I’m not going to respond to any questions beyond what I said the other day. My focus and my energies are on my job as Chancellor of SUNY, which I will continue to do every day.”
Malatras, who from 2017 to 2019 ran the Rockefeller Institute of Government, a SUNY-affiliated think tank, directed ProPublica to remarks he had made last week about his involvement with the health department report.
“Given my expertise in public policy including public health issues such as opioid misuse and health care, I was asked to help review feedback on the scientific language in that public report to make it more accessible for a general audience,” Malatras said on Mar. 5 at an event in the Bronx. “That’s the exact role I played while at the Rockefeller Institute of Government on dozens of reports as they neared publication. As with many reports, there were back and forth with structure, citations and other language during the process, but to be clear, I included the fatalities data provided by the New York State Department of Health which I did not alter and change.”
ProPublica reached out to Merryl Tisch, chair of the SUNY Board of Trustees, to ask if she had any concerns about the role Malatras had played in the July report on nursing home deaths, but received no response. Cesar Perales, the board’s vice chair, would not comment when asked about Malatras.
The Cuomo administration’s official count of nursing home deaths due to COVID-19 has been a source of controversy almost from the outset of the pandemic. At first, New York state only counted confirmed cases of deaths from COVID-19, while other states reported both confirmed and presumed cases. New York eventually began to formally record both confirmed and presumed cases, but refused to include deaths of residents that occurred at hospitals in nursing home figures, record keeping that was routine in many other states.
Republican and Democratic lawmakers in both Albany and Washington hammered the administration for refusing to disclose the deaths in hospitals, and accused Cuomo of trying to hide the full scale of the state’s failures to protect the population most at risk of being killed by the virus.
For months, the Cuomo administration claimed it couldn’t release the number of additional deaths because it was struggling to make sure they were accurate, an assertion ridiculed by public health experts and nursing home industry leaders. Counting COVID-19 deaths of nursing home residents no matter where they died was not complicated, they said, especially for a health department regarded as among the best in the nation.
Questions about the true scope of nursing home deaths in the state intensified after the Cuomo administration issued a policy on Mar. 25, 2020, stating that nursing homes had to accept patients who were released by hospitals after testing positive for COVID-19 and deemed “medically stable” enough to be transferred. The homes were barred from testing the patients to see if they were still infected.
Nursing home operators and families of residents objected to the policy, saying it needlessly put already vulnerable residents at greater risk. Republican critics of Cuomo claimed the policy led to thousands of needless deaths.
The July report issued by the Department of Health asserted that such claims were not true. It said data showed that the greatest peaks of deaths in the homes mostly followed peaks in infections of staff members, and preceded peaks in nursing home admissions from hospitals. It dismissed the idea that the Mar. 25 policy had any strong impact on the number of deaths.
The revelations of the last week, however, make clear that the July report had omitted many deaths from its analysis. The health department indeed tracked the numbers of residents who died of COVID-19 in nursing homes and at local hospitals, and was confident enough of the accuracy of the numbers to include them in a draft of the July report, according to interviews and a review of documents by The New York Times. Those numbers showed that the true death toll was closer to 9,000 by July than the publicly acknowledged 6,000.
“The health department knew what the numbers were, and wanted them in the July report,” said Bill Hammond, a policy analyst at the Empire Center, an Albany think tank. “They were the ones with the Ph.D.s. They were the scientists. They had done the work. Taking the numbers out was simply indefensible.”
Denis Nash, an epidemiologist who is executive director of the City University of New York’s Institute for Implementation Science in Population Health, agreed.
“The original approach was flawed from an epidemiological and causal inference standpoint,” Nash said. “The missing deaths was one of several red flags. Would any study be valid if it excluded deaths known to occur in hospitals versus in a nursing home? No, that would be a fatal flaw.”
The Empire Center, which successfully sued the Cuomo administration this fall to force the release of the hospital deaths, recently issued on the possible impact of the administration’s Mar. 25 directive, which led to more than 6,000 transfers of COVID-19 patients from hospitals to nursing homes. Hammond said that while the study showed the directive had not been the primary cause of the greatest surges in nursing home deaths, there was still reason to believe it had led to as many as 1,000 additional deaths in the homes.
“The entire thrust of our report was that the health department’s claims that the Mar. 25 directive did not have any meaningful correlation to deaths in the homes was wrong.”
The administration did not respond when told of Hammond’s assertions.
Malatras is a longtime confidante of Cuomo, having served as his chief of operations from 2014 to 2017. He rejoined Cuomo as the pandemic worsened last spring, and became one of the governor’s three or four closest advisers on the state’s response.
The New York Times reported late last week that Malatras and several other senior advisers to Cuomo reworked the health department’s July report, and that a decision was made to remove the hospital deaths for fear the complete numbers would be an embarrassment for the governor.
Garvey, Cuomo’s counsel, issued a statement after the Times’ report, saying that the ultimate decision to remove the hospital deaths was made by “the Chamber.” Hammond said he regarded “the chamber” to be a coy way of conceding without saying so directly that the governor himself made the decision. An administration spokesperson did not respond when asked what Garvey meant by “the chamber,” and about Hammond’s interpretation.
Garvey said the Cuomo administration had long acknowledged it wasn’t making public the count of deaths in hospitals, but noted that the deaths had always been included in the total figures for COVID-19 deaths in New York state.
Back in July, days after the health department report was made public, ProPublica asked Malatras about what methodology the report had used, who had written it and why the administration had claimed it was peer-reviewed. Malatras would not say who authored the report and conceded the analysis had not been peer-reviewed in the way a report in a medical journal would have been.
At the time, Malatras said nothing about the removal of hospital deaths or whether he or any other senior aide to Cuomo had played a role in reworking aspects of the report.
“Some people alleged that the spread of infection came from early cases; some people said it was due to the amount of personal protective equipment; some said it was the relative age of residents; some said it was the quality of the facilities,” he said of the questions the report tried to answer. “So we measured that. We took the independent variables and measured it against the fatalities.”
Malatras added at the time: “This is a sort of academic study. You can’t with 100% certainty say none of the cases were due to admissions or age or other things. Of course not. That’s not what an academic study does; it takes data and says what are the strongest variables. We found it was the workforce.”
ProPublica asked a McKinsey spokesperson if the firm had been aware of the removal of the hospital deaths and whether it was comfortable with that decision and with the limited report that was released last July. The firm said it could not comment.
When the SUNY Board of Trustees named Malatras as chancellor last August, the board said it had forgone a national search, instead looking only at candidates within its ranks, because of the urgency of the moment, as colleges across the country wrestled with how to deliver for their students during the pandemic. Malatras had served as chancellor at a SUNY campus, Empire State College, prior to rejoining the administration during the pandemic.
“A critical lesson learned from Covid-19 is that a pandemic demands urgent action,” board member Stanley Litow wrote after Malatras had been appointed. Of Malatras, Litow wrote, “Importantly, New York Governor Andrew Cuomo turned to him to help manage the overall effective response to the pandemic where he worked closely with all agencies, especially those in health and economic development areas.”
Lawmakers from both major parties raised alarms about the appointment of Malatras, objecting to the decision not to conduct a national search and questioning whether someone so close to Cuomo could truly be an independent protector of the state university system. The Board of Trustees was unmoved.
“Covid-19 is a pandemic with no precedent,” Litow wrote. “Finding the right new leadership for SUNY required prompt and effective action. Breaking with tradition will prove to be the right decision.”
Litow did not respond to a request for comment on Malatras and his role in crafting and defending the July report.
Oportun Inc., a small-dollar loan company, disclosed to investors that it is the subject of a probe by the Consumer Financial Protection Bureau following reporting by ProPublica and The Texas Tribune.
This article was published on Monday, March 8, 2021 in ProPublica.
A federal consumer watchdog agency has launched an investigation into a company that aggressively sued thousands of Latino borrowers in Texas during the coronavirus pandemic while depicting itself as a financial ally of the community.
Oportun Inc., a Silicon Valley-based installment lender, which was founded to help Latino immigrants build credit so they can go on to achieve the American Dream, disclosed to investors last week that it had received a from the Consumer Financial Protection Bureau.
The company indicated that it was part of a larger probe of small-dollar lenders by the federal watchdog, which was formed by Congress in the wake of the 2008 financial crisis in an effort to better guard Americans from abusive lending practices.
The investigation comes after ProPublica and The Texas Tribune last year that Oportun had become the most litigious personal loan company in Texas, suing thousands of lower-income borrowers at a rapid pace even as other lenders halted or slowed legal action during the pandemic.
An analysis of court records in nine of Texas’ 10 largest counties — home to the vast majority of the 80 kiosks and strip mall storefronts the company operates in the state — found that Oportun sued Texas borrowers more than 47,000 times from May 2016 through July 2020. More than 5,000 lawsuits were filed after the World Health Organization declared the coronavirus a pandemic.
The company also routinely charged high interest rates and kept borrowers on the hook, sometimes for years, by offering increasingly larger loans with slightly lower rates, the news organizations found.
In its latest quarterly financial , Oportun told investors that the federal investigation would “focus on the company’s legal collection practices from 2019 to 2021 and hardship treatments offered during the COVID-19 pandemic.”
Company officials told investors that they were unable to predict the outcome of the federal probe and did not know if it would “result in any action or proceeding against the company or in any changes to its practices.”
In a statement to ProPublica and the Tribune, Oportun said it would cooperate with the investigation but that it “believes our practices have been in full compliance with CFPB guidance” and that it has “followed all published authority on these matters.”
The CFPB didn’t respond to a request for comment.
The federal investigation comes as President Joe Biden’s administration began staff at the bureau in anticipation of more enforcement activity.
In a letter to staff in January, acting Director Dave Uejio said his two top priorities are to assist consumers who have been economically impacted by the COVID-19 pandemic and to address racial inequality.
“On COVID-19, we need to take swift action now, in order to make sure our actions help people in the middle of the crisis, rather than just cleaning up after the fact,” Uejio . “(W)e will also look more broadly, beyond fair lending, to identify and root out unlawful conduct that disproportionately impacts communities of color and other vulnerable populations.”
Horacio Mendez, president and CEO of the Woodstock Institute, a nonprofit policy group that advocates for fair lending and economic equality, said that, in the past, many bureau investigations ended in settlements that he and other advocates believed were too lenient to change behavior.
In Oportun’s case, he said the behavior was particularly egregious because the company was certified as a , an esteemed federal designation for banks, credit unions and other lenders that largely serve low-income or underserved communities of color.
“What they showed us before is that the drive for profitability often overrides ethical behavior,” Mendez said of Oportun. “And the fact that they were a CDFI and did that, it was an extra cross in their obituary.”
In December, the Woodstock Institute and dozens of other consumer advocacy organizations and Latino civil rights groups to become a national bank, citing the ProPublica and Tribune investigation and another by The Guardian into the company’s prolific legal debt collection practices in California.
Oportun made some changes to its debt collection and business practices last year.
After ProPublica and the Tribune began asking questions about its debt collection practices, the company announced that it would drop all pending lawsuits, temporarily suspend new filings and file 60% fewer cases in the future. It also vowed to cap interest rates on its loans at 36%.
Consumer advocates have said those measures don’t go far enough.
Ann Baddour, director of the Fair Financial Services Project at the nonprofit advocacy group Texas Appleseed, described the bureau’s investigation of Oportun and other small-dollar lenders as encouraging.
“Families in Texas are suffering right now from a double whammy with financial setbacks due to the pandemic compounded by the winter storm,” she said, referencing the cold blast last month that left millions of residents without power and water. “It is essential that businesses that lend in our state are held accountable to the law and that they treat customers fairly.”
After COVID-19 hospitalizations peaked, the number of Texans dependent on home oxygen equipment was at "an all-time high" when a winter storm overwhelmed the state's power grid in February, leaving many struggling for air.
This article was published on Tuesday, March 9, 2021 in ProPublica.
HOUSTON — Mauricio Marin felt his heart tighten when the power flicked off at his Richmond, Texas, home on the evening of Feb. 14, shutting down his plug-in breathing machine. Gasping, he rushed to connect himself to one of the portable oxygen tanks his doctors had sent home with him weeks earlier to help his lungs recover after his three-week stay in a COVID-19 intensive care unit.
Between the two portable tanks, he calculated, he had six hours of air.
Marin, 44, and his wife had heard there might be brief, rolling power outages — 45 minutes or an hour, at most — as a massive winter storm swept across Texas last month, overwhelming the state’s electric grid. After more than two hours without electricity, he started to worry.
Marin tried to slow his breathing, hoping to ration his limited oxygen supply as he lay awake all night, watching the needle on each tank’s gauge slowly turn toward zero. The next morning, his wife, Daysi, made frantic calls to the power company and Marin’s doctor’s office, but nobody was answering in the midst of the storm.
For the next two days, Marin struggled for air and shivered under a pile of blankets. On the morning of Feb. 17, as they were still without power, his wife begged him to return to the hospital. But they feared driving on icy roads, and by then neither of them could get a consistent signal to call for help, as the widespread outages had knocked cellphone towers offline. And Marin didn’t want to go. He was terrified by the prospect of another hospital stay without visitors.
Marin’s skin was slowly turning purple, and he began to cry.
“Honey,” he later remembered telling his wife, straining with each word, “at least I’m going to die with you and my kids and not alone at the hospital.”
Marin said his life was spared when a neighbor showed up at the door with an oxygen tank a few hours later, sustaining him until the power returned. But he said his doctors fear that the weeklong ordeal inflicted additional damage on his lungs and jeopardized his already tenuous recovery.
Medical experts say Marin is part of a particularly vulnerable group who suffered significant hardships and potentially lasting harm as a result of the outages: those recovering at home from COVID-19.
At the peak of the outages last month, nearly 4.5 million Texas homes and businesses were without power, sparking calls for investigations of the Electric Reliability Council of Texas, the nonprofit that operates the power grid spanning most of the state, and the Texas Public Utility Commission, which oversees the state’s electric and water utilities. Two board members of the utility commission and six members of the ERCOT board resigned and the ERCOT CEO was fired after sharp criticism that they had not done enough to prepare for winter storms and had ignored warnings about the danger severe weather poses to the state’s electric grid.
Meanwhile, the human toll is still being tallied. Dozens of Texans have filed lawsuits against ERCOT and local power companies. Some of the suits allege that medically fragile children and adults suffered permanent or severe injuries because they were unable to get electricity to power life-sustaining medical equipment. Others have been filed by the surviving loved ones of older residents who died of hypothermia in their homes.
Among those demanding accountability are some Texans recovering from COVID-19 who say the prolonged outages further imperiled their already fragile health.
said she was diagnosed with a fairly minor case of COVID-19 in early February. But after more than two days in her frigid Houston home without power or heat, she said, her symptoms became severe. She had dizziness and difficulty breathing, forcing her to seek care at an emergency room, according to a lawsuit filed in Harris County that accuses ERCOT and her utility CenterPoint Energy of negligence.
Five hours southwest, in Hidalgo County, was sent home with an oxygen machine to recover from COVID-19 after a three-week hospital stay. As she struggled for days to breathe and keep warm without power, she feared she was going to die, according to a lawsuit she filed against ERCOT and her power company, AEP Texas. After her power was restored, the woman had trouble breathing even with her oxygen machine, forcing her to seek medical care, the complaint alleges.
Mauricio and Daysi Marin have in Harris County district court against ERCOT and CenterPoint Energy.
“I told Mauricio, ‘We've got to do something about this. This cannot happen again,’” Daysi Marin said. “We need to speak out and we need to say something.”
ERCOT said it had no comment regarding the Marin lawsuit, and did not respond to a subsequent email seeking comment on the two other cases. A spokesperson for AEP said the company does not comment on pending litigation. In a statement, Olivia Koch, a spokesperson for CenterPoint Energy, said that though she couldn’t comment on pending litigation, the company is fully committed to working with stakeholders to address the issues related to the storm.
“We understand the severe impact that the historic weather and generation shortfall emergency had on all Houstonians and Texans,” she wrote in an email.
“Medical Disaster”
In an effort to reduce the strain on limited hospital resources during the pandemic, it’s become standard practice for hospitals to send most COVID-19 survivors home before their lungs have fully recovered, said Dr. Jamie McCarthy, chief physician executive for the Memorial Hermann Health System in Houston. Those patients often spend several days or weeks dependent on breathing equipment, such as oxygen concentrators or BiPAP machines, that require electricity.
As a result, McCarthy said, the number of Texas residents dependent on home oxygen was “at an all-time high” as the winter storm hit last month. With statewide COVID-19 hospitalizations peaking at more than 14,200 people in mid-January, medical experts say thousands of Texans like Marin had been sent home with plug-in breathing machines and portable oxygen tanks in the days and weeks before the electric grid failure.
When the power went out for millions of households, many recent COVID-19 survivors were left straining to breathe and unsure where to turn for help, setting back their recoveries, doctors say.
Unlike other patients with chronic lung problems who’ve spent years dependent on breathing machines and who have endured severe weather events and outages in the past, McCarthy said, patients recovering from COVID-19 likely didn’t have access to backup power sources or other contingency plans.
“Most of the people that had been sent home on oxygen concentrators related to COVID, especially this time of year, we were not sending them all home saying, ‘OK, you need to be prepared to be without power for two days, what's your plan?’” McCarthy said.
Dr. Bela Patel, the chief of critical care medicine at UTHealth’s McGovern Medical School, said that during the power outages some recovering COVID-19 patients showed up at emergency rooms, filling up already crowded hospitals. Others told her they couldn’t get to a hospital and instead spent days struggling at home.
“It was really devastating for them,” said Patel, who runs a clinic for those recovering from long-term symptoms of COVID-19. “They were panicking because they weren't getting enough oxygen, their oxygen levels were dropping and they were trying to figure out what they could do.”
Patel said she was aware of about 40 calls to her clinic throughout the outages from recovering COVID-19 patients in need of oxygen, but in most cases her team couldn’t get it to them and instead directed them to go to an emergency room. While she said she is hopeful that many of those patients will recover from the damage caused by hours or days spent in frigid homes without access to supplemental oxygen, others may not be able to bounce back.
When patients with serious respiratory conditions spend several hours or days without access to supplemental oxygen, doctors say, it puts a significant strain on their heart and lungs, limiting the flow of oxygen-rich blood to vital organs and leading to potentially life-threatening complications. Frigid temperatures like those seen during the outages — the inside of many Texas homes dropped below 40 degrees — can further complicate breathing conditions, leading to lung spasms.
“We certainly hope that most of them will get to their baseline, and some of them already have,” Patel said. “But we do know of examples where patients didn’t recover and continue to deteriorate.”
Across the state, at least 40 deaths have been directly attributed to the storm and power failure, according to The Associated Press. Experts say the figure is likely much higher, but it before the total death toll is known, as officials comb through records and certify deaths across the state. It’s unclear if any of the 40 reported cases involved people who were recovering from COVID-19.
Beyond the harm that can result from a lack of oxygen and a lack of heat, the emotional stress resulting from a dayslong power outage can also affect a patient’s heart and lung function and require additional medical care, Patel said. That’s an extra challenge in a state like Texas, with the of uninsured residents in the country.
It could have all been prevented, she said.
“When you look at the long-term effects of what this had on our patient population,” Patel said, “it’s really a medical disaster.”
“It Happened Again”
Marin, a filmmaker who moved to the United States from Colombia two decades ago after meeting Daysi at a California film festival, thought he had a bad cold when he started feeling sick in early December. But then he awoke in a panic a few days later, unable to draw in a full breath.
His wife called 911 and an ambulance rushed him to Houston Methodist Sugar Land Hospital, where doctors diagnosed him with COVID-19 and admitted him to the ICU. That night, as doctors contemplated whether to connect him to a ventilator, Marin said he silently begged God to spare his life.
He called his wife from his hospital bed, barely able to speak, and told her to tell their two children, ages 18 and 20, that he loved them, and that he was proud of them.
“I truly believed I was going to die, but somehow I was given another chance,” said Marin, who slowly recovered over the next three weeks before being sent home with supplemental oxygen. “And not even two months later, it happened again.”
On the morning of Feb. 17, Daysi Marin said, after her husband had been without power for more than two days, she feared he was dying. He told her he was having severe chest pains after so many hours straining for air.
“I have never been in a situation like that, where you see somebody dying in front of your face, and you cannot do anything,” she said. “It was terrifying.”
She felt like God was answering a prayer when a neighbor, responding to a plea she’d posted on Facebook, showed up that evening with a six-hour supply of oxygen — “like a miracle from out of nowhere,” she said.
Following the ordeal, Marin said, he feels worse than when he was initially discharged from the hospital. He can’t walk around the house without becoming winded and can’t go even a moment without being connected to supplemental oxygen. After the back-to-back traumas, he said, he feels like he’s always on edge, worried about what would happen if any of his breathing equipment fails him.
Marin said his doctors prescribed additional medication to help his body recover in the wake of the outages and have asked him to return for additional tests to determine whether his heart or lungs were further damaged.
Daysi Marin isn’t sure if her husband will ever fully recover from the ordeal — or if she will.
“Last night, Mauricio was choking again and water was coming out his nose and his mouth,” she said, two weeks after the outages. “At night, I sleep a few hours and then I’m always up, checking if he’s breathing.”
She’s had to resort to anxiety medication to manage her panic attacks, she said. “I’m worried all the time.”
In Hobbs, New Mexico, the high school closed and football was cancelled, while just across the state line in Texas, students seemed to be living nearly normal lives. Here’s how pandemic school closures exact their emotional toll on young people.
This article was published on Monday, March 8, 2021 in ProPublica.
Everything looks the same on either side of the Texas-New Mexico border in the great oil patch of the Permian Basin. There are the pump jacks scattered across the plains, nodding up and down with metronomic regularity. There are the brown highway signs alerting travelers to historical markers tucked away in the nearby scrub. There are the frequent memorials of another sort, to the victims of vehicle accidents. And there are the astonishingly deluxe high school football stadiums. This is, after all, the region that produced “Friday Night Lights.”
The city of Hobbs, population just under 40,000, sits on the New Mexico side, as tight to the border as a wide receiver’s toes on a sideline catch. From the city’s eastern edge to the Texas line is barely more than two miles. From Hobbs to the Texas towns of Seminole and Denver City is a half-hour drive — next door, by the standards of the vast Southwestern plains.
In the pandemic year of 2020, though, the two sides of the state line might as well have been in different hemispheres. Texas’s response to the coronavirus was freewheeling. Most notably, it gave local school districts leeway in deciding whether to open for in-person instruction in August, and in conservative West Texas, many districts seized the opportunity to do so, for all grades, all the way up through high school. Students wore masks in the hallways and administrators did contact tracing for positive cases of coronavirus, but everything else went pretty much as usual, including sports. On Friday nights, high schools still played football, with fans in the stands.
New Mexico’s response last year was the opposite. The state, led by Democratic Gov. Michelle Lujan Grisham, took one of the most aggressive lockdown stances in the country, and issued stringent guidelines for school reopening, so stringent that Hobbs was allowed to bring back only a sliver of its students for in-person instruction.
For high school junior Kooper Davis, whose family lives 10 minutes west of the border, this meant no school and no football. This was a problem, because he loved both of them.
Kooper had always gotten straight A’s, despite a tendency to leave big assignments to the last minute. He charmed classmates and teachers alike with his playful ebullience. His natural high spirits had carried him through his life’s primary challenge to date, his parents’ breakup when he was a small child. He started playing organized football at age 5 and could not get enough of it. He played basketball, too, but football had his heart. When the youth minister at church once apologized for missing one of his high school games, Kooper reassured him that it was okay, that he did not depend on an audience: “I play for myself,” he said.
Kooper started heading off to quarterback camps and private training — in Atlanta, New Orleans and Tucson, among other cities — hoping to better his odds of getting to play in college, an aspiration that became more feasible as he sprouted to 6 feet, 4 inches tall, ideal for throwing over linemen, if only he could get his agility and coordination to catch up with his height. His parents encouraged him to aim for the Ivy League, but he knew its football was middling. Instead, he set his sights on Stanford, which excelled in sports and academics, and which he had visited for another football camp.
For student-athletes aspiring to play in college, junior year is key. It’s that year’s video that recruiters will look at, and that year’s grades that admissions officers will scrutinize. Kooper already had a highlight reel, and it included some nice-looking throws, but it was from his sophomore season on the junior varsity team. Junior year was everything: He would be vying for the starting QB slot on varsity and taking a fistful of Advanced Placement courses. He would, in general, be getting to enjoy the experience of being Kooper Davis, a well-liked kid in a small city where the admiration flowed even from the youngsters he helped out at church, one of whom, a 9-year-old boy, was overheard gleefully reporting to his father that Kooper Davis knew his name.
But the start of the school year arrived, and there was no school. Kooper and his classmates would take their courses at home using an online program, with barely any contact with teachers or each other. His teammates would be allowed to practice only in small pods, which left them mostly doing just weightlifting sessions and agility drills. There would be no actual games.
The hope was that all this would be temporary. That was what the kids heard from the adults in charge, and they tried to believe it.
The coronavirus pandemic has been not only a health catastrophe, but an epic failure of national government. The result of the abdication of federal leadership in 2020 was an atomization of decision-making that affected the lives and well-being of millions of people. States, and frequently individual school districts — sometimes even individual schools and sports leagues — have been forced to grapple with emerging and occasionally conflicting science that has sought to decode the mysteries of a newly discovered virus. Local governmental and educational officials — the vast majority of whom aren’t epidemiologists or experts on indoor airflow — have had to formulate policy under intense time pressure while being buffeted by impassioned constituencies on every side and facing the reality that any decision would impose costs on somebody.
One of the few aspects of this terrible pandemic to be grateful for is that it has taken a vastly lesser toll on children and young adults than its major precursor of last century, the flu pandemic of 1918-1920. That earlier pandemic’s victims tended to be in the prime of life, withmortality peaking around age 28.
The novel coronavirus, by contrast, has hit the elderly the hardest. Themedian age for COVID-19 fatalities in the U.S. is about 80. Of the nearly 500,000 deaths in the U.S. analyzed by the Centers for Disease Control and Prevention as of early March, — five hundredths of a percent of the total. The CDC has also recorded about 2,000 cases of aninflammatory syndrome that has afflicted some children after they contracted the virus, resulting in about 30 additional deaths. Doctors are still uncertain whether children who survived that syndrome will experience long-term heart issues or other health problems.
Plenty of parents continue to worry for their children’s health amid the pandemic. But the primary concern from a public health standpoint has been the role that children and young adults might play in transmitting the disease to others. A growing body of evidence suggests that younger children are the to transmit the virus, but that as children older, their capacity for transmission approaches that of adults.
This has posed a conundrum from early in the pandemic: How much should children be prevented from doing outside the home, to keep them from contributing to community transmission of a highly contagious virus? Or to put it more broadly: How much of normal youth should they be asked to sacrifice? It has been a difficult balance to strike, on both a societal and family level.
In many parts of the country, particularly cities and towns dominated by Democrats, concerns about virus spread by children has resulted in all sorts of measures: closures of playgrounds, requirements that kids older than 2 wear masks outdoors, at colleges that reopened. “We should be more careful with kids,” wrote Andy Slavitt, a Medicare and Medicaid administrator under President Barack Obama who was named senior advisor for President Joe Biden’s coronavirus task force, in a . “They should circulate less or will become vectors. Like mosquitos carrying a tropical disease.”
In Los Angeles, county supervisor Hilda Solis, a former Obama labor secretary, urged young people to stay home, noting the risk of them infecting older members of their households. “One of the more heartbreaking conversations that our healthcare workers share is about these last words when children apologize to their parents and grandparents for bringing COVID into their homes for getting them sick,” she . “And these apologies are just some of the last words that loved ones will ever hear as they die alone.”
As time has gone on, evidence has grown on one side of the equation: the harm being done to children by restricting their “circulation.” There is thewell-documented fall-off in student academic performance at schools that have shifted to virtual learning, which, copious evidence now shows, is exacerbating racial and class divides in achievement. This toll has led a growing number ofepidemiologists,pediatricians andother physicians to argue for reopening schools as broadly as possible, amidgrowingevidence that schools are not major venues for transmission of the virus.
As many of these experts have noted, the cost of restrictions on youth has gone beyond academics. The CDC found that the proportion of visits to the emergency room by adolescents between ages 12 and 17 that were mental-health-related during the span of March to October 2020, compared with the same months in 2019.A study in the March 2021 issue of Pediatrics, the journal of the American Academy of Pediatrics, of people aged 11 to 21 visiting emergency rooms found “significantly higher” rates of “suicidal ideation” during the first half of 2020 (compared to 2019), as well as higher rates of suicide attempts, though the actual number of suicides remained flat.
Doctors are concerned about in childhood obesity — no surprise with many kids housebound in stress-filled homes — whileaddiction experts are warning of the long-term effects of endless hours of screen time when both schoolwork and downtime stimulation are delivered digitally. (Perhaps the only indicator of youth distress that is falling — reports of child abuse and neglect, whichdropped about 40% early in the pandemic — is nonetheless worrisome because experts suspect it is the reporting that is declining, not the frequency of the abuse.)
Finally, the nationwide surge in gun violence since the start of the pandemic has included, in many cities, a sharp rise incrimes involving juveniles, including many killed or arrested during what would normally be school time. In Prince George’s County, Maryland, a Washington, D.C., suburb where school buildings have remained closed, in just the first five weeks of this year.
“An entire generation between the ages of 5 and 18 has been effectively removed from society at large,”wrote Maryland pediatrician Lavanya Sithanandam in The Washington Post. “They do not have the same ability to vote or speak out.”
It has, instead, been left largely up to parents to monitor their children for signs of declining mental health as they determine whether to allow their kids to return to college or summer camp, to have a friend over, to go to the mall.
My family was among those facing these decisions. Our sons, now 16 and 13, have had fully remote learning in their Baltimore public schools for nearly a year now. For them, the primary release from the hours staring at the laptop screen would be sports, and for us, the answer was clear: My wife and I would let them play. The boys’ respective high school and rec-league baseball seasons were canceled last spring, but their club teams were still playing through the summer and fall. This proved a godsend, a way for the boys to keep being active outdoors and around other kids, doing something they loved to do. For my older son, the baseball meant frequent traveling to tournaments out of state, in Virginia and Pennsylvania. Almost every weekend, we’d be back on near-empty highways, staying in near-empty motels, subsisting on endless takeout chicken sandwiches whenever we couldn’t find an outdoor place for a meal.
This all started before the resumption of Major League Baseball and other professional sports, and it sometimes seemed as if our tournaments were the only serious competitive sports happening in the country, a sort of speakeasy baseball. Some precautions were taken, such as umpires calling balls and strikes from behind the mound instead of behind the catcher at home plate. The boys and their parents wore their masks inside the motels; at games, the parents spread out in the bleachers or on the sidelines. The parents ran the political gamut: liberals from Baltimore, conservatives from rural towns in Pennsylvania. But there was an implicit agreement that we were fortunate that our kids could keep playing, and we wouldn’t do anything to screw it up. Those weekends remain for me some of the only redeeming moments of an awful year.
Football at the teenage level differs from baseball in a crucial respect: It is based almost entirely around high schools, without a parallel universe of clubs and tournaments. If high school teams aren’t playing football, there is no football being played.
In New Mexico, Gov. Lujan Grisham that football and soccer would be prohibited for the fall season. “No contact sports are going to be permitted this fall,” she said. “These contact sports are just too high-risk. If we do well, if we work hard, it is possible we could just be delaying them and they could be played later in the year and later into the season. Fingers crossed, and I believe in you that we can get this done.”
As the hot Southwestern summer dragged on, Kooper Davis and his teammates placed faith in that possibility. In August, they were allowed to hold practice sessions capped at nine players each — not enough for a real practice, with offense running plays against defense, but better than the July sessions, which had been capped at five players. Kooper was vying against three other players for the starting quarterback spot. His arm strength had improved in the past year, so much so that his best friend Sam Kinney, a wide receiver, jokingly complained about the passes starting to hurt. And Kooper was a great student of the quarterback position; he had “the intangibles,” his coaches said. But he knew he needed to work on his agility, which is one reason he took the practices so seriously. He was the first to come, and last to leave.
Even with fall sports canceled, the Hobbs school district, with almost 10,000 students, was still hoping to open the new school year for as much in-person instruction as possible. More than just scholastic considerations were driving this. In late April, six weeks into the spring’s pandemic lockdowns, the community had been stunned by the suicide of an 11-year-old boy, Landon Fuller, an outgoing kid who loved going to school and had, his mother said, struggled with the initial lockdowns.
New Mexico has consistently had one of the highest in the country — it’s roughly twice the national average — and preliminary state statistics would later show the 2020 rate as unchanged. Nationwide, increased by half between 2007 and 2018, a trend that has been linked to multiple factors, from the growing availability of guns to the spread of smartphones and social media. In New Mexico, mental health experts say, the factors also include high rates of depression on Native American reservations, and rural isolation in general.
Still, the news of an 11-year-old taking his life — after riding his bike to a field near his house — had the power to shock in Hobbs. “I think the big question we all have is why, and we will never know the reason why,” his mother, Katrina Fuller, told an Albuquerque TV talk show in July. “The only thing that I was able to find was in his journal, was that he had wrote that he was going mad from staying at home all the time and that he just wanted to be able to go to school and play outside with his friends. So that was the only thing that I can imagine what was going through his head at that time.”
Hobbs is heavily conservative. Lea County, of which it is part, would vote 79% for Trump in 2020. And unlike in many other, more Democratic parts of the country, the city’s school administrators had the support of many teachers when it came to reopening: A survey in late summer found more than 70% of teachers in favor of in-person instruction. But the district’s push to reopen was rebuffed by the state education department. After initially barring any schools from reopening in August, the state released “gating criteria” for districts that wanted to resume in-person instruction in the fall. They were among the strictest in the country. They allowed only for elementary-school instruction, and required a district to stay below an average of eight new cases per day per 100,000 residents over a two-week period. For Hobbs and the rest of Lea County, population 70,000, that meant no more than five new cases per day in the whole county. (By , Kentucky’s daily threshold was 25 cases per 100,000 people and Oklahoma’s was 50 cases. Hawaii, one of the states least affected by the pandemic, put its threshold at 360 cases over a 14-day period.)
Statewide in New Mexico, the restrictions resulted in zero high schools or middle schools reopening anywhere in the state. This confounded Hobbs school officials, especially because they could see open schools across the border in Texas. “We’ve got districts 30 miles away doing it safely,” associate superintendent Gene Strickland said. “I get the fear level, but we see models that show it can be done. Allow us that opportunity.”
Kooper Davis had always thrived in school. He liked his teachers, and they liked him. He had won over his ninth-grade English teacher, Jennifer Espinoza, with his willingness to engage on the works they were reading: “The Outsiders,” “Romeo and Juliet,” “To Kill a Mockingbird.”
“He was very opinionated about why a character did this, or whatever something meant,” Espinoza said. “Even if he was wrong or going in the wrong direction, he wasn’t afraid to put his thoughts out there.” It was a great class in general, she said: “Those kids fed off each other. They would come out with amazing answers.” Kooper and Sam Kinney ribbed her about her tendency to lose her phone and took daily attendance for her. When Kooper was the only boy at Hobbs to make the Junior National Honors Society alongside 20 girls, Espinoza asked him if it felt weird. He grinned. “No, I like it!”
But Kooper hated virtual school. There were no friends to cajole, no teachers to charm. Hobbs wasn’t even holding synchronous classes online for older high schoolers. They mostly watched video lessons on their own, using an online curriculum called Edgenuity. Kooper procrastinated, as usual, but now also found it harder to focus when deadlines hit. His grades started slipping from his usual all-A’s. And these were the grades that colleges were going to be looking at.
As it was sinking in with Kooper and his classmates that school would remain remote for the rest of the fall, they got word in early October of an additional setback on the sports front. Not only would New Mexico remain one of a handful of states to bar high school sports, but practices would now be limited to just four players per coach. This meant they would mostly just be lifting weights, never mind that this often meant having many players in the weight room at a time (albeit in four-player pods), seemingly a riskier proposition than a regular practice outdoors. The football coach, Ken Stevens, could sense the morale plunging. “I seen a lot of disappointment,” he said. “Lost hope.” Some players stopped showing up. Making it especially tough, he said, was the nearby contrast. “That’s the frustration,” he said. “How come 10, 15 miles away, these kids can compete, can live a somewhat normal life?”
Kooper was despondent. “Man, this ,” he told his teammates. “We need to be back on the field.” He missed football so much that, on some Friday evenings, he headed across the state line to Texas to watch a game.
The schools in Denver City, population 5,000, had shut down amid the coronavirus lockdowns in the spring of 2020, but there wasn’t really any question about whether the 1,700-student district would reopen schools in the fall. The Texas Education Agency was letting districts make the decision. The Texas Classroom Teachers Association had nowhere near the sway of unions in other states. This didn’t keep many large urban districts in the state from starting the school year with remote learning. But Denver City and nearby small cities in West Texas opened schools. Students could choose a virtual option, but only a few dozen of Denver City’s 492 high school students took it. As for teachers, there was no option: Their job was in the classroom.
Denver City is a humble-looking town, with a Family Dollar and no Walmart, but oil-and-gas revenues had allowed it to build a new high school two years ago. The building has good ventilation, and enough space that it wasn’t hard to spread desks to allow for 4 to 6 feet between them, even in a class of 20 or more. Students were attending five days a week, without the hassle of hybrid schedules used in much of the country. They were required to wear masks in the hallways or while moving around a classroom, but many teachers allowed them to take their masks off at their desks, judging the spacing sufficient, though the teachers kept their own masks on. Lunch was still served in the cafeteria, but it never got crowded because many students went into town for lunch, at the McDonald’s drive-through or elsewhere.
The school did not administer coronavirus tests on its own, but if a student or teacher tested positive locally, the school conducted contact tracing to determine if any other teacher or student had been exposed to them for 15 minutes or more, unmasked, within six feet. Anyone who fit that definition had to quarantine at home, initially for two weeks, eventually only for 10 days, in line with CDC guidelines. The district, which offered daily and weekly tallies of cases on its website, determined that the vast share of transmissions seemed to be happening outside school, as to be the case in other places, too. “The weekends is where they’re getting it,” said principal Rick Martinez. “If we could have them all week, this is the best place for them to be.”
Over the course of the fall semester, about a dozen of the 70 staff members in the Denver City school missed time for quarantine, mostly after testing positive themselves, forcing the district to find substitutes — no easy task, but not insurmountable. All of the teachers returned. There were other challenges, such as the time in August when a player on the girls volleyball team tested positive and the school made the decision to shut down the team for two weeks, just in case another player had been exposed.
Overall, though, the fall was going so relatively well that many students who had chosen the remote option at the outset decided to come back to school, to the point where only about half a dozen were still learning at home. “It’s been stressful at times,” said the district superintendent, Patrick Torres. “It’s taken a lot of time and effort, but our kids are getting instruction face to face.”
Football went forward, too. The school capped attendance at its field, and required people to register for tickets online. The team in Seminole, 20 miles south, needed to cancel some games as the result of player quarantines, but Denver City managed to get through the fall without any cancellations, though there were some weeks where the roster got thin.
Kooper Davis came across the border once with a friend to see a game in Levelland, northeast of Denver City, and another time with his father, Justin, to see a game in Seminole. Justin, who works for a company that services oil-field equipment and runs a lawn care business on the side, noticed the reaction his tall, athletic son was getting in the Seminole stands. “People looked at us, like, ‘Who is this kid and why is he not playing?’”
Kooper’s father and his stepmother Heather, who had been together since Kooper was nine, had considered transferring him to a school in Texas, as other families were doing. This would have entailed sending Kooper to live with Heather’s brother. (Kooper had limited contact with his biological mother.) They were even considering sending Kooper and Heather to Atlanta to live near one of the coaches he’d trained with. But Heather and Justin had just had newborn twins. Plus, Kooper wanted to play with team, his friends.
His parents began to notice how much the disruption and uncertainty was wearing on their normally buoyant son. On Oct. 9, Heather went on Facebook and posted a plea for reopening. “So honestly when do we stand up for our kids?? When do we all protest and say this is enough, do we wait until our kids lose life completely?” she wrote. “So many kids are turning to the wrong things to fill a void. Sad, it’s so sad. Let’s respect the ones who wanna stay home and respect the ones who are ready to go back!!”
Two days later, the town learned of another life lost: an 18-year-old who had graduated from Hobbs High that spring at a local park after receiving a medical discharge from the Navy. Kooper did not know him well, but went out to join friends who had gathered to mourn him.
The next day, a Monday evening, Kooper and his classmates held a demonstration for reopening school and school sports, one of several across the county that day. They held theirs at the high school football stadium, a hulking edifice that can seat 15,000. The students wore masks and sat spaced apart on the stands, holding signs that said “Let Us Play” and “SOS Save Our Students.” They had the tacit support of their coaches and many of their parents, some of whom had helped shoot a testimonial video that was going to be shown on the scoreboard screen. But the video wouldn’t load right, so several students went onto the field to give impromptu speeches before the 175 or so people who were gathered there.
Kooper was among the speakers, which surprised his friend Sam Kinney. “I knew he was pretty brave, but didn’t know he was that brave,” Sam said later.
At the microphone, Kooper introduced himself, then said, “I play football and basketball and those sports make up a big part of my life, and when I’m not here every day doing something with those sports, honestly, I feel really lost in life. Since I’m a junior, college is starting to cross my mind, and without this essential year of learning, I feel completely unprepared for college. I know I’ve still got another year, but time goes faster than you really think.”
He continued, “I just believe we should be here at school and we should be here playing football. It’s crazy to think that just down the road, they’re playing a football season — they’re almost with their football season. It’s honestly ridiculous. And I’m willing to keep my teammate and classmates in line, minding whatever rules, just so I can be back here doing the stuff I love.”
Mental health experts struggle to identify a precedent for the challenge this pandemic is producing for many Americans. In prior pandemics where the technology was not available for remote work or remote schooling, lockdowns and social isolation were not as extreme and did not last as long as what we’ve lived through this past year. And the psychological stress that the pandemic has produced for so many Americans of all ages is unlike so many more acute crises that we might experience in life, said Nick Allen, a professor of clinical psychology at the University of Oregon. “There’s a difference between a stressor that makes your life unpleasant and intolerable and a stressor that takes away good things,” he said. “For a lot of people, the stressor that COVID represents is one that takes away good things. You can’t go to sporting events, you can’t see your friends, you can’t go to parties. It’s not necessarily that you’re experiencing abuse, though some may be. What’s happening is that we’re taking away high points in people’s lives that give them reward and meaning. That may have an effect over time. The initial response is not as difficult as something that’s stressful, but over time, the anhedonia, the loss of pleasure, is going to drive you down a lot more.”
Even before the coronavirus arrived, teen mental health was a cause for growing concern. Researchers and mental health professionals had come to the conclusion that, as David Brent, a University of Pittsburgh psychiatry professor, put it to me, “One thing that’s protective against it is connection to school and family and peers. We know that participation in sports and a connection to school can have a profound protective effect.”
That social connection has been attenuated in the parts of the country that have largely shuttered school buildings and associated activities. The closures have also inhibited young people’s striving for independence, youth mental health experts say. “A key developmental task of adolescence is autonomy-building,” said Jessica Schleider, an assistant psychology professor at Stony Brook University. “That is what teens are driven to do: to grow self-esteem and a strong sense of who they are.” With school and so much else closed off to them, and daily life mostly limited to the home, “the little bit of self-directedness they had before is gone. A lot are stuck in environments they didn’t choose. The futures they had been working toward aren’t options anymore.”
As the pandemic carried through the summer, worrisome signals started appearing across the country. In addition to the on the rising share of visits to emergency rooms by teenagers in distress, a University of Wisconsin survey of more than 3,000 high school athletes during the summer found that more than two-thirds reported high levels of anxiety and depression, .
For Kooper, autumn brought no relief. Every weekday morning except Wednesday, he got up at 6:30 a.m., drank a protein shake, then drove to McDonald’s for more breakfast, before arriving at school at 7 a.m. for a weightlifting session. On the way back, he’d pick up some Burger King breakfast for his two younger sisters, ages 11 and 5. The younger one would ask why he couldn’t get McDonald’s, which she preferred, on the way back, and he’d explain that traffic made it easier for him to do them in this order. Kooper would chat a bit with Heather and then shower and get to work on the computer.
There were signs that mental health was on his mind. On Oct. 16, Kooper shared a grim claim from a state representative on his Facebook account, which he seldom used: “The New Mexico Athletic Association reports there have been 8 student-athlete suicides since March 20.”
Kooper looked so alone and hunched over as he worked that Heather one day posted a picture of him online to share his struggle with others. “I know my kid isn’t the only one hurting,” she wrote. “How is this life that they are living.”
The Davises were sufficiently attuned to the mental health challenges of the pandemic that they held regular family visits with a therapist, and Kooper had gotten a couple of solo sessions as well before he and the therapist decided that was no longer necessary.
For a while, Kooper went to do some of his schoolwork at the Starbucks near the local Walmart, just to get out of the house, but then it closed down again when state restrictions tightened further. On some Tuesdays and Thursdays, he’d head to school for an afternoon session with the other quarterbacks, learning how to read defensive coverage. Some afternoons, he’d head over to the church his family belongs to, Christian Center Church, which is led by Sam’s father, Jotty Kinney, who set up a small weight room for the boys to use. On Sunday mornings, Kooper would be back at the church for his youth-group service and to help lead sessions for the younger kids. And one weekend late afternoon in November, when it was below 30 degrees out, two dozen boys went to school to play touch football, the closest they had come to having a game.
On Sunday, Dec. 6, as semester finals were getting underway for school, Kooper was at church as usual, dressed as a baby for a monthly skit he and Sam did for the little kids. Later that day, he put up another Facebook post, his first since the one in October: “With these tough times going around, I know there are many of those in need, and I want to give back to my community,” he wrote. “If any of y’all know anyone unable to leave their homes, I am willing to wait in line and pick up their groceries for them, or even run simple errands. Please pm me if you or anyone you know could use a helping hand.”
The next morning, Dec. 7, Kooper went to his Monday weightlifting session. As he left, he told Sam, in typically unabashed fashion, “Love you.” “Love you, too,” Sam responded. On the way out of the athletic building, Kooper swung by to see the basketball coach, Eddy Martinez, to tell him he thought he might be able to play with that team, too, if the schedule that the state had floated the previous week actually came to pass: a truncated football season in February, followed by a truncated basketball season. Martinez said he’d be glad to have Kooper and that he was welcome to join one of their four-person practice pods that very day. Kooper said he didn’t have his basketball shoes, but he would come the next day.
Coach Stevens got the news from the school principal that afternoon. Like others in Hobbs, he was not unprepared for such calls: There had been at least six suicide attempts by Hobbs students during the pandemic, according to district officials. But when he heard the name, Stevens was stunned. He asked, “Are you sure you got the name right?” The principal said he thought he had, but that he’d double-check with the school’s designated police officer. He called back five minutes later to say that yes, he had gotten the name right.
Jennifer Espinoza got word from fellow teachers, one of whom asked her, “Hey, did you have Connor Davis?” The name meant nothing to her, but, she asked, did they mean Kooper Davis? No, they said. “Good,” she said, “because Kooper would be out of the question.”
It had happened while Heather was at the grocery store picking up baby formula and something for dinner. At about 1 p.m., Kooper had texted Sam on Snapchat: “Love you, bro.” “Love you, too,” Sam wrote back. That was the last he heard from his friend.
The next day, Coach Stevens gathered his players and assistant coaches in the team meeting room to discuss Kooper’s death. There were counselors on hand, as well as Pastor Kinney, Sam’s dad. The adults encouraged the players to speak about what they were feeling, not to hold things in. But the players ended up just wanting to go lift weights together.
The day after that, Wednesday, a fleet of empty school buses arrived at the high school from other towns, one from as far as Clovis, 130 miles away. The buses had condolence messages painted on the windows: “We are here for you,” read the writing on the bus from Portales. “Pray for Hobbs,” said the bus from Eunice. “Artesia loves you,” said the bus from Artesia.
I reached Justin Davis on the phone that Saturday, after learning of Kooper’s death from a mother in northwestern New Mexico whose daughter had also struggled with the absence of school and sports. Justin, as I would soon learn, is a large and taciturn man, but he was eager to talk, and urged me to come to New Mexico to learn more about what Kooper and his friends had been through. He was at a loss over what he and Heather might have missed. “I had an open relationship with my son,” he said. “It’s baffling to us to figure out why he didn’t come to us.”
Suicide is ultimately an unfathomable act, but Justin said he was sure of one thing. “No doubt, if my son had been in school on Monday this wouldn’t have happened,” he said. “He would’ve had an adult standing next to him, a coach saying, ‘Kooper, quit being a dummy.’” The only way he could make sense of it, Justin said, was that “for about fifteen seconds of Kooper’s life, he let his guard down and the devil came in and convinced him of something that was wrong.” His only solace was seeing the effect the loss had on Kooper’s classmates, who were, he said, turning their lives over to God, sending letters to the governor, and generally spreading word of his son’s goodness far and wide.“I believe God needed him now,” he said.
I arrived in Hobbs two days later, just in time for the memorial inside Christian Center Church. The parking lot was jammed with oversized pickups, and the sanctuary was standing room only. The stage was dominated by balloons in black and yellow, the Hobbs High colors, and large white letters and numbers, aglow with lights, that spelled KD 10, Kooper’s jersey number. His home and away jerseys, his school backpack and a school photograph were also displayed. I found an empty space to stand in the back. There were many kids in the audience, and some were wearing raspberry-colored shirts with Kooper 10 written on them. Few people were wearing face masks.
A four-person band with two backup singers played “Another in the Fire,” a stirring song by the Australian worship band Hillsong United: “There was another in the fire/ Standing next to me/ There was another in the waters/ Holding back the seas…”
Stevens was one of several coaches and trainers who spoke via a recorded feed played on the big screen over the stage. “I have no doubt that God is not done using Kooper,” he said. “He is going to continue to use him to impact those around him, and God’s glory will shine through.”
Then the screen played a long loop of photos and videos of Kooper: wearing a Halloween costume, holding his younger sister on the beach, wearing braces, buried in sand, grinning behind Justin and Heather as they kissed at their wedding, attending a Dallas Cowboys game, singing in a school musical, holding a newspaper with his name in a sports story, sitting on a hay bale, holding the newborn twins, wearing a tux for a dance.
Heather came to the stage with Kooper’s sisters. She began by reading some lines Kooper had written in his journal, including his paraphrase of a verse of Scripture, “If your enemy is hurting give him food. If he’s thirsty, give him water,” and his interpretation of it: “No matter who it is, no matter who the person is, if they’re in need, help them. Help them. I don’t know who it is, but you need to help them.” She talked about Justin’s love for his son: “That’s his boy. Kooper’s been Justin’s rock.” She recounted all their morning chats together, after his workout sessions. “I want him to come in from football practice and tell me how practice went. I want him to tickle the babies while I go eat,” she said. “But that’s me being selfish. And I want his happiness more than I want mine.”
Pastor Kinney spoke last. “When you’d see him smile, you didn't know what was going on under that mop of hair he had,” he said. “He was one of the most driven people I have known.” He described Kooper’s “protective loyalty,” how he once ran in from the outfield of a church softball game to confront someone who was having words with Heather. He joked about Kooper letting one of his sisters sleep in one of his shirts, his willingness to dress up as a baby during the church skit for the little kids, and how Kooper was the only one of the young people he knew who would actually call him on the phone sometimes, just to talk. “No other kid in this day and age called,” he said. “He didn’t text you or put it on Snap. He called you.”
When the service ended, people stayed on for a while to talk and hug each other. It was unnerving to watch: lots of people, few masks, no windows. The event was in gross violation of the state rules on indoor gatherings, which were supposed to be capped at 40 people, but no sheriff’s deputy was about to intervene on this day. (The mass exposure did not lead to any reported local outbreaks.)
The people of Hobbs had for months been barred from letting their kids go to school or letting them play football and soccer. And now, after the death of a boy that many of them saw as linked to those restrictions, they were effectively, saying, screw it.
I chatted with some of Kooper’s teammates, asking them how they were handling remote learning. “It’s trash,” said one, Kevin Melissa. “It’s crazy,” said another, Carter Johnson. “Everyone tells us to keep positive, but it’s been almost a year. It’s hard to be positive.”
Before the event broke up, someone encouraged all of Kooper’s classmates to get together on stage for a group photo. They eagerly did so, several dozen of them bunched together, beaming for the camera. The smiles were jarring in the context of a memorial service until one remembered the broader context: It was the first time they had all gotten to be together since March.
The next morning, I met Katrina Fuller, the mother of 11-year-old Landon, in the windswept parking lot of a strip mall. She had come to bring her teenage daughter to an outdoor kids’ workout session that had been arranged hastily a few days earlier, after the news of Kooper’s death. Despite the cold, two dozen kids, most in their early teens, had come out to the parking lot and were now doing various kickboxing exercises — spaced apart and with masks on — under the guidance of some martial arts instructors.
Katrina, a prenatal educator, had been trying for months to draw attention to the mental health needs of Hobbs’ young people. She had been writing and calling elected officials and state bureaucrats and finally, with the help of the local state senator, Gay Kernan, had gotten the state to provide some training for local teachers in recognizing youth mental health troubles.
More resources had belatedly started pouring into the state: a $10 million federal grant for school-based mental health services, plus $500,000 in CARES Act funds. The challenge was less the lack of money than the lack of people to administer it: the state education department has only a single behavorial health coordinator, Leslie Kelly, who was struck by the rising concern about youth suicide during the pandemic given that the problem had existed for years in New Mexico. “I’m glad we care about this now, but our state was high pre-pandemic,” Kelly said.
Even if New Mexico’s overall numbers were holding steady, to those in Hobbs, three youth suicides plus a half-dozen other attempts by students in a matter of months in a population of 39,000 felt like its own epidemic. Shivering in the parking lot, Fuller told me about Landon, who had “just wanted to be everyone’s friend.” He was the sort, she said, who always went over to any kid sitting by themselves on the playground. And Fuller told me about the difficult weeks of the initial lockdown in the spring, when both she and her husband were feeling the stress of a loss of income. They had tried to make things as nice as possible in those weeks, with an online birthday party for the two kids, and an Easter egg hunt. But it was still hard. “All of our moods changed,” she said. And it was so hard for someone of Landon’s age to grasp time; the six weeks of closure seemed like forever.
I asked if she thought school should have opened in the fall, and she hesitated. She took the coronavirus seriously, she said. Her grandfather recently died of COVID-19. She was heartened by the launch of the exercise class but knew the town needed to come up with more, “just to let them know that we love them and they’re so wanted and they’re not alone.” She started to cry.
She said she had started hearing from many other families around the country whose kids were struggling, including a mother who’d discovered her 6-year-old’s plans for how to end her own life. “These are kids without mental health issues, with good families, kids that are loved,” she said. Definitive explanations were, of course, impossible to come by. “I’ve heard it all,” Fuller said. “I’ve blamed myself.”
She had done a lot of reading on youth suicide since Landon’s death, and had learned that rates were especially high in indigenous communities, like the Aboriginal community of Australia. In reading that, she had drawn a connection to American children who were being forced into a whole different way of life during the pandemic. “The theory is they’re reacting to modern society,” she said of the Aboriginal children. “Well, we’re introducing them to a new society here, and they’re rejecting it.”
Recently, Fuller told me, she had received an envelope in the mail from the New Mexico education department. She opened it and found a letter demanding to know why Landon had been truant from his online classes during the fall semester. The bureaucratic oversight stunned her. “He would be in school if he wasn’t dead,” she said.
After my meeting with Fuller, I went back to the church. Sam was lifting weights with another friend in the small workout room that his father had set up. After I chatted with Sam, I walked with his father back to his office. He told me that he had been running through his last interactions with Kooper, over and over, searching for a warning sign, to no avail. All he knew was that Kooper had been upset about the closures. “When you put most of your things into achieving scholastic, and achieving athletic, and those things aren’t available to you, your whole life, every goal you wanted to achieve is being taken away from you,” he said.
Kinney said he and the Hobbs school superintendent had been talking a few days earlier about the need to get kids back in school. “Like Texas, we have to learn to live with it,” he said. “You know, marginalizing our teens for other people that are high-risk, what do you pick? You know? Because, I mean, we’re losing them. Not only that, we’re losing years of their educational development.”
Kinney said his brother-in-law, also a pastor, had become seriously ill with coronavirus, and he did not doubt its danger. But, he said, the current generation of kids “are the people that are going to be running our country one day. We’re losing their leadership. They’re going to be taking care of us one day, and this is how we’re treating them?” He noted that one student at the October protest had carried a sign that read, “I’m able to vote in your next election.”
“They’ll remember these times,” he said.
That night, I went to meet with Kooper’s father and stepmother at their house, which sits out on the edge of town, near a small cattle farm. Meals cooked by friends covered the island in the kitchen. Justin and Heather told me how much comfort they were taking in the outpouring over Kooper, especially among his classmates.
But they said they were thinking of all the other kids in another way, too. If normally lighthearted Kooper, despite a loving family and natural gifts, had been struggling so much, what about all the others? How much distress was invisible to parents? “He was a kid who had everything, and this is where we’re at,” said Justin. “What’s going on with those other kids?”
On my final day in Hobbs, I made the short drive across the Texas border to Denver City. It was startling to pull into the high school parking lot and see dozens of teenagers strolling out of the school building, wearing masks and carrying backpacks, on their way to lunch. Even more startling was hearing from school administrators about how well the football season had gone — the Denver City team made it to the second round of the playoffs — and about the great event of the night prior: the holiday band concert. To avoid dense crowds, the band had held three performances, with several hundred people attending each. In the large band hall, the band director showed me the dots he had taped on the floor to keep the 70-odd musicians spaced 7.5 feet apart even as they marched, and the cloth covers that one student’s grandmother had made, decorated with the school’s mustang logo, to go over the tubas, to keep them from emitting moisture. It was hard not to be impressed by the ingenuity, the determination to try to make things work, even now. “Whatever it takes,” said Rick Martinez, the principal.
After being in Denver City, things seemed emptier than ever at the Hobbs high school complex — in normal times, the center of communal life in Hobbs. I was there to meet with Coach Stevens, who had also been wracking his mind trying to think of clues he hadn’t picked up from Kooper. He could think of nothing, other than the fact that he had noticed that one of Kooper’s grades had slipped below his norm. But he also knew how adolescents had the natural tendency to magnify troubles. “I fear for all the kids,” he said. “One thing that maybe our decision makers don’t remember is that when you’re in high school or you’re a kid, thinking you’re the only one dealing with something. That’s what you think when you’re 16: Nobody is dealing with what I’m dealing with.” Not to mention, he said, that the closures have simply given kids too many empty hours. “They’ve got so much time on their hands,” he said. “I don’t care how good a kid you are, if you have so much time on your hands, you’re going to find mischief.”
He told me how dearly he hoped the state stuck to its plan for a football season, truncated though it was. “My biggest fear is, you pull the rug on these kids,” he said. “All we’ve been doing is trying to sell hope and belief to these kids that it’s going to happen, but at some point, they’re going to quit believing in you.”
My last visit in Hobbs was to the home of Jennifer Espinoza, Kooper’s favorite teacher. When I entered her bungalow, Espinoza, a friendly woman in her 40s, said that I should feel welcome to take my mask off, because she had already been through a serious case of COVID-19, several weeks earlier. This startled me, but not nearly as much as what she told me next: that soon after her own illness, her partner of 18 years, Abe, had died of what had strongly resembled COVID-19, though his initial test had come back negative. He had been away from Hobbs at the time, working an oil-field job in Odessa, Texas, and a co-worker he had shared a truck with later tested positive. Abe died on Nov. 30, at 49, before she could see him.
And then Kooper had died, a week later. It had been a terrible month, and it had left her uncertain about the best course for the Hobbs schools and sports teams. As the school year started, she had been among the majority of teachers who were willing to return to classrooms. This had only been confirmed for her as she saw how poorly the remote learning was going: not only did most students leave their cameras off, some wouldn’t even turn on their microphones. “I can’t see them, I can’t even hear them,” she said. “They didn’t want to talk.”
But then she herself had gotten the virus — she wasn’t sure where — and its severity had hit home, even before her partner’s death. She had swung the other way on reopening. Now Kooper’s death was making her reconsider again. “If it would prevent another Kooper, then definitely, yes,” she said. “We just have to weigh the good and the bad. Do we fear everyone coming back and possibly getting COVID, or do we fear losing another student more?”
In late January, Gov. Lujan Grisham would announce that schools could reopen for all ages on Feb. 8, but at maximum 50% capacity, which meant only a couple of days per week, and under the condition that they would close if cases rose again. Sports could start a few weeks after that, with masks and without fans. Nationwide, meanwhile, President Biden’s push to reopen schools was explicitly leaving out high schools, leaving millions of teenagers with the likelihood of remote learning through the end of the school year.
In the same week as Lujan Grisham announced her reopening plan, I made another check of the coronavirus toll in Hobbs’ Lea County. The county had suffered 112 deaths attributed to COVID-19, which worked out to a per capita rate slightly lower than that in the three Texas counties abutting Lea. New Mexico as a whole had lost 3,145 people, two-hundredths of a percentage point higher than Texas in per capita terms. The overall per-capita case numbers in Lea County were slightly higher than the three counties across the border, while the case numbers in Texas were slightly higher than in New Mexico.
Numerous factors had affected these outcomes, needless to say. The states had taken very different approaches with regard to their young people, but ended up in almost identical places as far as their coronavirus tolls.
Other tolls would be harder to assess, in a year of so much damage done, in so many ways. “There’s too much hurt,” Espinoza said as I headed out of her house after our conversation. “There always seems like there’s something new to cry about.”