State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a ºÚÁϳԹÏÍø News investigation showed.
These benefits, provided to the poorest Americans, can mean the difference between someone obtaining medical care and having enough to eat — or going without.
States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax and domestic spending law. The changes will add red tape and restrictions. They are coming at a steep price — both in the cost to taxpayers and coverage losses — according to state documents obtained by ºÚÁϳԹÏÍø News and interviews.
The documents show government agencies will spend millions to save considerably more by removing people from health benefits. While states sign eligibility system contracts with companies and work with them to manage updates, the federal government foots most of the bill.
The law’s Medicaid policies will cause to become uninsured by 2034, according to the nonpartisan Congressional Budget Office. Roughly will lose access to monthly cash assistance for food, including those with children.
In five states alone, for state officials and reviewed by ºÚÁϳԹÏÍø News show that changes will cost at least $45.6 million combined.
“This is a pretty big payday,” said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard’s T.H. Chan School of Public Health.
The law, which grants tax breaks to the nation’s wealthiest people, requires most states to tie Medicaid coverage for some adults to having a job, and imposes other restrictions that will make it harder for people with low incomes to stay enrolled. SNAP restrictions began to take effect in 2025. Major Medicaid provisions begin later this year.
Documents prepared by consulting company Deloitte estimate that a pair of computer system changes for Medicaid work requirements in Wisconsin will . Two other changes related to the state’s SNAP program will cost an additional $4.2 million, according to the documents, which for the Wisconsin Department of Health Services.
In Iowa, changes to its Medicaid system are expected to cost at least $20 million, , a consulting company that operates the state’s eligibility system.
Optum — which operates the platform Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act — to evaluate and incorporate new health coverage restrictions.
Initial changes in Kentucky, which has had a contract with Deloitte since 2012, . And in Illinois, will cost at least $12 million.
A Historic Mandate
For six decades after President Lyndon Johnson created the government insurance program in 1965, Congress had never mandated that Medicaid enrollees have a job, volunteer, or go to school.
That will change next year. The tax and spending law enacted by Trump and congressional Republicans requires millions of Medicaid enrollees in 42 states and the District of Columbia to prove they’re working or participating in a similar activity for 80 hours a month, unless they qualify for an exemption. The CBO projected, based on an early version of the bill, that 18.5 million adults would be subject to the new rules — .
Vermont Medicaid officials expect it will cost $5 million in fiscal 2027 to implement changes in response to the federal law, said Adaline Strumolo, deputy commissioner of the Department of Vermont Health Access. About $1.8 million is for Optum to make eligibility system adjustments. Optum is a subsidiary of UnitedHealth Group.
The One Big Beautiful Bill Act will subject nearly 55,000 Vermont Medicaid recipients to work requirements — about a third of the state’s enrollees.
The law forced the state “to essentially drop everything else we were doing,” Strumolo said in an interview. “This is a big, big lift.”
Optum’s contract with the state was as of October.
of adult Medicaid enrollees nationally are already working, according to KFF. Advocacy groups for Medicaid recipients say work requirements will nonetheless cause significant coverage losses. Enrollees will face added red tape to prove they’re complying. And eligibility systems already prone to error will have to account for employment, job-related activities, and any exemptions.
An estimated 5.3 million enrollees will become uninsured by 2034 due to work requirements, the .
In Wisconsin, state officials estimate could lose coverage after work requirements take effect. Not covering those people would in Medicaid spending for one year.
Wisconsin’s eligibility system for Medicaid and SNAP — known as CARES — in 1994, and initially was a transfer system from Florida, according to a 2016 state document.
Deloitte submitted its cost estimates for Medicaid and SNAP changes to the state in September and December. Elizabeth Goodsitt, a spokesperson for the Wisconsin Department of Health Services, declined to answer questions about whether additional changes will be needed, how much it will cost to make all eligibility system changes to comply with the new federal law, and whether the state negotiated prices with Deloitte.
Bobby Peterson, executive director of the public interest law firm ABC for Health, said Wisconsin has invested “very little” to help people navigate the Medicaid eligibility process, which soon will become more difficult.
“But they’re very willing to throw $6 million to their contractors to create the bells and whistles,” Peterson said. “That’s where I feel a sense of frustration.”
New Hurdles for Vets and Homeless People
Medicaid work requirements are only one change required by Trump’s tax law that will make it harder to obtain safety-net benefits.
Starting in October, the law prohibits several immigrant populations from accessing Medicaid and ACA coverage, including people who have been granted asylum, refugees, and certain survivors of domestic violence or human trafficking. Beginning Dec. 31, states must verify eligibility twice a year for millions of adults — doubling state officials’ workload. And the law restricts SNAP benefits by requiring more adult recipients to work and by removing work exemptions for veterans, homeless people, and former foster youth.
Days after Trump signed the bill in July, Kentucky health officials raced to make changes to the state’s integrated eligibility system, which verifies eligibility for Medicaid, SNAP, and other programs. Deloitte operates the system under a five-year . , initial changes costing $1.6 million were labeled a “high priority” and approved on an “emergency” basis, with some of the changes to the nation’s largest food aid program going into effect almost immediately.
Officials with Kentucky’s Cabinet for Health and Family Services declined to answer a detailed list of questions, including how much it will cost to make all the modifications needed.
Deloitte spokesperson Karen Walsh said the company is working with states to implement new requirements but declined to answer questions about cost estimates in several states. “We are delivering the value and investments we committed to,” Walsh said.
In most states, government agencies rely on contractors to build and run the systems that determine eligibility for Medicaid. Many of those states also use such computer systems for SNAP. But the federal government — that is, taxpayers — to develop and implement state Medicaid eligibility systems and pays 75% of ongoing maintenance and operations expenses, according to federal regulations.
“Five, 10 years ago, I’m not sure if you would hear much mention of SNAP from a Medicaid director,” Melisa Byrd, Washington, D.C.’s Medicaid director, said in November at an annual conference of Medicaid officials. “And particularly for those with integrated eligibility systems — as D.C. is — I’m learning more about SNAP than I ever thought.”
The federal law was the topic du jour at last year’s gathering in Maryland, held at the Gaylord National Resort and Convention Center, the largest hotel between New Jersey and Florida.
Consulting companies had taken notice. Gainwell, an eligibility contractor and one of the conference’s corporate sponsors, emblazoned its logo on hotel escalators. Companies set up booths with materials promoting how they could help states and handed out snacks and swag.
“Conduent helps agencies work smarter by simplifying operations, cutting costs and driving better outcomes through intelligent automation, analytics, and innovation in fraud prevention,” read one such handout from another contractor. “Together, we can better serve residents at every step of their health journeys.” Conduent holds Medicaid eligibility and enrollment contracts in Mississippi and New Jersey, their Medicaid agencies confirmed to ºÚÁϳԹÏÍø News.
In handouts, Deloitte touted its role in “building a new era in state health care” and as “a national leader in Medicaid program and technology transformation, building a strong track record across the federal, state, and commercial health care ecosystem.” ºÚÁϳԹÏÍø News found that Deloitte, a global consultancy that generated in revenue in fiscal 2025, dominates this slice of government business.
“With Medicaid Community Engagement (CE) requirements, states are tasked with adding a new condition of Medicaid eligibility to support state and federal objectives,” added another brochure. “Deloitte offers strategic outreach and responsive support to help states engage communities, lower barriers, and address access to coverage.”
A $20.3 Million Bill in Iowa
Before Trump signed the One Big Beautiful Bill Act, Iowa lawmakers wanted to impose their own version of work requirements. They would have applied to 183,000 people before any exemptions. The new law would necessitate a change to Iowa’s Medicaid eligibility system, according to documents prepared by Accenture, which operates Iowa’s system through a .
Adding the ability to verify work status would cost up to $7 million, . By July, the cost to implement the One Big Beautiful Bill Act’s work requirements and other Medicaid provisions . Accenture’s analysis said the federal law necessitated . Making employment a condition of Medicaid benefits could cause an estimated 32,000 Iowans to lose coverage, according to a
Cutting 32,000 people from coverage in one year, a fraction of the Iowa and the federal government spend on Medicaid in a given year.
In Cedar Rapids, most of Eastern Iowa Health Center’s patients rely on Medicaid, CEO Joe Lock said. He questioned the government’s logic of spending tens of millions of dollars on a policy to remove Iowans from Medicaid.
Most of the health center’s patients live at or below the federal poverty level — currently .
“There is no benefit to this population,” Lock said.
Danielle Sample, a spokesperson for Iowa’s Department of Health and Human Services, did not answer questions about how much it will cost to implement changes to the state’s separate SNAP eligibility system.
In Illinois, the state’s work this year is largely focused on meeting major provisions of the One Big Beautiful Bill Act. The state estimates that as many as 360,000 residents could lose Medicaid, largely due to the work requirements, said Melissa Kula, a spokesperson for the Illinois Department of Healthcare and Family Services.
Kula confirmed that — priced at $12 million — is related to Trump’s law. The estimate also mentions other work. Kula said Deloitte is charging the state a $2 million fixed fee related to work requirements.
The Trump administration has acknowledged that the work is coming at a cost. In January, top officials for the Centers for Medicare & Medicaid Services said government contractors, including Deloitte, Accenture, and Optum, have and reduced rates through 2028 to help states incorporate system changes.
“The companies were extremely excited to do this,” , the top CMS Medicaid official. “Everyone’s really focused on getting to work.”
CMS spokesperson Catherine Howden declined to answer questions about the discounts.
Goodsitt, the Wisconsin Medicaid spokesperson, declined to answer questions about whether Deloitte has discounted its rates. Officials with Kentucky’s Cabinet for Health and Family Services did not answer a detailed list of questions, including whether Deloitte extended discounts to make these changes.
It’s unclear what discounts, if any, Deloitte and Accenture have offered to individual states. Walsh, the Deloitte spokesperson, declined to answer detailed questions about the discounts the Trump administration announced this year. Accenture did not respond to repeated requests for comment.
Strumolo, the Vermont health official, said state officials discussed the announcement with Optum “in detail.”
Optum for a specific module related to Medicaid work requirements. That product is unworkable for Vermont because it would mean “moving to a new system when we don’t have to.” When asked about whether the company offered discounts, Strumolo said “not explicitly.”
In a statement, UnitedHealth Group spokesperson Tyler Mason said Optum supports state implementation of new federal requirements “with a range of options to meet their unique cost and policy needs.”
He declined to specify whether Optum discounted Vermont’s rates and how it calculated the costs of doing its work. “Optum is helping mitigate upfront implementation expenses so states can focus on approaches that reduce duplication, accelerate implementation, and manage costs over time — supporting better outcomes for individuals covered by Medicaid,” Mason said.
Strumolo said Optum’s initial changes in Vermont cover items that take effect this year and in 2027 — Medicaid work requirements, checking eligibility every six months, and prohibiting certain immigrants from qualifying for health programs.
“There’s a lot more that could come,” she said.
ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/insurance/state-medicaid-work-requirements-eligibility-systems-deloitte-accenture-optum/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2174991&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>The upshot, : Babies fed rival Mead Johnson Nutrition’s acidified liquid human milk fortifier — a nutritional supplement used in neonatal intensive care units — developed certain complications at higher rates than those given an Abbott fortifier, a researcher at the University of Nebraska had found.
At least one of those complications .
The Abbott scientist, Bridget Barrett-Reis, described the results in the email to colleagues, using two exclamation points. Then she proposed that Abbott test the Mead Johnson fortifier, acidified for sterilization, against another Abbott product.
The clinical trial among preterm infants that Abbott subsequently sponsored, , is a case study of corporate warfare in the high-stakes business of infant nutrition, wherein preemies have been coveted like commodities; their anxious, vulnerable parents have been — whether they know it or not — targets of calculated commercial pursuit; and scientific research has been used as a marketing tool.
In hospitals around the country, dozens of babies born an average of 11 weeks early were fed Mead Johnson’s fortifier. Dozens of others were fed an Abbott fortifier that wasn’t acidified.
The clinical trial became a boon for Abbott, which to wrest market share from Mead Johnson. But for some of the babies enrolled, it didn’t turn out so well, a ºÚÁϳԹÏÍø News investigation found.
Far more infants given Mead Johnson’s product developed a buildup of acid in the blood called metabolic acidosis than those fed Abbott’s product — 19 versus four, according to results published in the journal .
Two outside doctors monitoring infants in the study became so alarmed that they refused to enroll any more babies, according to an April 2016 email one of them sent to Abbott.
In a related email to Abbott, neonatologist Robert White of Memorial Hospital in South Bend, Indiana, and Pediatrix Medical Group — an investigator in the study — .
“We had another SAE” — serious adverse event — “today in which a child developed profound metabolic acidosis while on the study fortifier,” White wrote. The severity was “unlike what we would see in most children with these issues.”
A manager at Abbott replied that the company was “taking your concerns very seriously.”
The study continued for almost a year.
At least some of the consent forms used to inform parents about risks did not mention metabolic acidosis or the often-fatal necrotizing enterocolitis, another condition identified in the 2013 email that led to the study.
In a November response to questions for this article, Abbott spokesperson Scott Stoffel said the clinical trial “was safe and ethical” and that the fortifiers it compared were “on the market and widely used.”
The study was “led by 20 non-Abbott investigators,” Stoffel said.
According to a federal website, chaired the study.
Stoffel added that the study was approved “by 14 independent safety review boards at hospitals” and “published in a leading peer-reviewed scientific journal.”
“It is reckless and not credible to suggest that these doctors and institutions conducted and then published the results of an unsafe or unethical study,” Stoffel said.
A spokesperson for Mead Johnson, Jennifer O’Neill, did not comment on Abbott’s clinical trial but said in a November statement to ºÚÁϳԹÏÍø News that existing studies “cannot responsibly support” any connection between the acidified fortifier and conditions such as necrotizing enterocolitis or metabolic acidosis.
Mead Johnson executive Cindy Hasseberg argued in a deposition that Abbott waged a “smear campaign” against the acidified fortifier that was “very hard to come back from.”
In 2024, Mead Johnson discontinued the product.
Winning the ‘Hospital War’
Behind their warm-and-fuzzy marketing, industry giants Abbott, maker of Similac products, and Mead Johnson, maker of the Enfamil line, have turned neonatal intensive care units into arenas of brutal competition.
This article quotes from and is based largely on records from three lawsuits against formula manufacturers that went to trial in 2024 and are now on appeal. The cases are , , and The records include emails, internal presentations, and other company documents used as exhibits in litigation, as well as court transcripts and witness testimony from depositions.
The records provide an inside view of the business of infant formula and fortifier, a nutritional supplement added to a mother’s milk. For example, a Mead Johnson slide deck for a 2020 national sales meeting — later used in the Whitfield trial — outlined a plan for “Branding NICU Babies.”
Urging employees to win more sales from neonatal intensive care units, the document said: “’”
In internal documents and other material from litigation reviewed by ºÚÁϳԹÏÍø News, formula makers described hospitals as gateways to the much larger retail market because parents are likely to stick with the brand their babies started on. Products used in the NICU help win hospital contracts, and hospital contracts help establish brand loyalty, according to court records.
Manufacturers vie for contracts that can be “exclusive” or nearly so, according to records from the litigation, including company documents and testimony by people who have worked in management for the companies.
An undated Abbott presentation used in the Gill case, apparently referring to inroads with hospitals in its rivalry with Mead Johnson, boasted of “MJ Strongholds Broken!”
It saluted two employees who “Own 27K Babies Exclusively,” and said another “Stole 600 formula feeders from MJ.”
Still others were praised for “Playing in Mom’s mailbox” or “kicking … and ‘taking names.’”
In July 2024, Abbott CEO Robert Ford said in a conference call for investors that formula and fortifier for preterm infants generated total annual revenue of about $9 million — a small portion of Abbott’s total sales of $42 billion in 2024 and its $2.2 billion of sales in the United States from pediatric nutritional products.
Industry documents cited in litigation provide a different perspective.
“‘,” stated an Abbott training presentation from about a decade ago used in the Gill and Whitfield trials.
That described a baby’s first formula feeding in the hospital, the document said. Over 74% of the time, an infant fed formula in the hospital stays on that brand at home, the document said.
Abbott’s goal was that the first-bottle-fed strategy , the document showed. A staff training slide displayed during the Whitfield trial showed how that momentum could pay off in bonuses for Abbott sales representatives, leading to a “Happy Rep.”
Mead Johnson has espoused a similar strategy.
The company rolled out a with cash rewards for flipping hospitals from Abbott, according to a 2019 document marked for internal use by Mead Johnson and its parent company, England-based Reckitt Benckiser Group, and admitted into evidence in the Watson case.
“ is critical to contract gains and acquisition,” stated a company plan for 2022 that was cited in the Whitfield case.
One Abbott document shown in the Whitfield trial said more than half of first feedings happen at night, adding, “.”
A “Mead Johnson University” training document described a scenario in which a sales rep overhears patient information in a NICU and encouraged the rep to promote the company’s products. The document, titled “,” was admitted as evidence in the Watson case.
“[Y]ou are walking back into your most important NICU,” it said. “You overhear the HCP’s” — health care providers, apparently — “stating all of the notes,” it said. “There may be some information that may help you to position your products as a resource for this patient and to handle any objections that the HCP may present you with.”
To win parents’ business, companies have supplied formula to hospitals free or at a loss, court records show. That has resulted in such curiosities as a Mead Johnson “purchasing agreement” cited in the Watson case, listing the price for product after product as “no charge.”
In a 2017 strategy document prepared for Mead Johnson, a consulting firm laid out a plan “to win hospital war.”
Why focus on hospitals? “,” it explained.
The document was displayed in the Whitfield case.
In the market for preterm nutrition, Abbott and Mead Johnson compete with each other, not against the use of human milk, the companies told ºÚÁϳԹÏÍø News.
“Thus, references in documents about wanting to ‘win’ or ‘own’ the NICU refer to out-performing Mead Johnson by offering the highest-quality products,” Abbott’s Stoffel said in February.
Asked specific questions about business strategies and internal documents, Mead Johnson’s O’Neill said the company was “concerned that you are presenting a misleading and incomplete picture.”
Mead Johnson’s products “are safe, effective, and recommended by neonatologists when clinically appropriate,” O’Neill added.
On the Defensive
In courthouses around the country, Abbott and Mead Johnson are on the defensive — and have been for years.
In hundreds of lawsuits, parents of sickened or deceased preterm infants have alleged that formula designed for preemies has caused necrotizing enterocolitis, or NEC, a devastating condition in which immature intestinal tissue can become infected and die, spreading infection through the body.
Lawsuits also accuse the manufacturers of failing to warn parents of the risk.
One of the cases on which this article is based, , resulted in a against Mead Johnson. , Gill v. Abbott Laboratories, et al., resulted in a against Abbott. , Whitfield v. St. Louis Children’s Hospital, et al., resulted in a , but the judge found errors and misconduct on the part of defense counsel, faulted his own performance, and .
The cases have involved children like Robynn Davis, who was born at 26 weeks, lost 75% to 80% of her intestine to NEC, suffered brain damage — and, at almost 3 years old, couldn’t walk, couldn’t really talk, and was eating through a tube, as Jacob Plattenberger, an attorney representing her, in 2024.
An attorney for Abbott, James Hurst, that Robynn suffered a catastrophic brain injury at birth, 10 days before she received any Abbott formula, and that her NEC resulted not from formula but from many health problems.
In at least three cases, a federal judge has in favor of Abbott — ruling for the company before the lawsuits even reached trial.
The formula makers have repeatedly denied fault.
Addressing stock analysts in 2024, as “without merit or scientific support” the theory that preterm infant formula or milk fortifier caused NEC.
In a issued in 2024, the FDA, the Centers for Disease Control and Prevention, and the National Institutes of Health said there was “no conclusive evidence that preterm infant formula causes NEC.”
Mead Johnson’s O’Neill said the scientific consensus is that there is no established causal link between the use of specialized preterm hospital nutrition products and NEC.
Neonatologists use the products routinely, O’Neill said.
O’Neill cited a statement by the saying the causes of NEC “are multifaceted and not completely understood.”
In a legal brief filed with an Illinois appeals court in the Watson case, the company said “the NEC-related risks” of a formula for preterm infants “are the subject of medical debate,” adding that trial evidence “demonstrated, at a minimum, uncertainty as to the magnitude of the risk, as well as the causal role of various feeding options in the development of NEC.”
Manufacturers say formula is needed when mother’s milk or human donor milk isn’t an option. Fortifier, a product tailored to preemies, is meant to augment mother’s milk when babies are born prematurely and a mother’s milk alone doesn’t deliver enough nutrition. The Mead Johnson fortifier used in the head-to-head clinical trial sponsored by Abbott was acidified to prevent bacterial contamination.
In March 2025, Health and Human Services Secretary Robert F. Kennedy Jr. announced that his department, which encompasses the FDA, was undertaking a review of infant formula, dubbed “Operation Stork Speed.” It includes and increasing testing for heavy metals and other contaminants, HHS said.
However, is limited. The agency doesn’t approve the products or their labeling. Whether to report adverse events — illnesses or deaths potentially related to the products — to the FDA is largely at manufacturers’ discretion.
The business of infant formula further spotlights a central contradiction in the Trump administration’s health policies. When it comes to food and medical products, the administration has criticized industry-funded research as unworthy of trust. Yet under Kennedy, it has disrupted, defunded, or sought to cut government-funded research, which could leave industry-funded research with a larger and more influential role.
It “is entirely appropriate for the Department to scrutinize research design, conflicts of interest, and funding sources, particularly when research is used to inform public policy,” HHS spokesperson Andrew Nixon said.
‘At the Table’
Company emails cited in litigation shed light on the industry’s approach to research.
In a 2015 email, when Mead Johnson was considering supplying some of its formula to a researcher for a study, a company neonatologist expressed concern that the results could be spun to make the preemie product look unsafe.
“However, we are more likely to have control over final language if we provide the small support and are ‘at the table’ with him,” Mead Johnson’s Timothy Cooper added in the email, which was cited in the Watson trial.
In 2017, Abbott with researchers at Johns Hopkins University about a study on how the composition of infant formula might affect NEC in mice. The email thread became an exhibit in the Whitfield case.
Abbott was both funding and collaborating on the work, shows.
Forwarding a draft of the resulting paper to Abbott, David Hackam, chief of pediatric surgery at the Johns Hopkins University School of Medicine, said in one of the emails, “We hope you like it.” He also requested help from Abbott in filling in information.
“The manuscript looks great!” Abbott’s Tapas Das , after a back-and-forth.
But Abbott had some changes, the email thread shows.
“We (VM & DT) made some edits in the text especially to soften a bit with the statement ‘infant formula seems responsible for developing NEC,’” Das wrote.
“Instead, we thought if we could state as ‘infant formula is linked to severity of NEC’. So we made changes throughout the text emphasizing on severity of NEC by infant formula rather than development of NEC by infant formula,” Das wrote.
Das wrote that “other factors are involved for NEC development as described in the text.”
Hackam did not respond to questions ºÚÁϳԹÏÍø News sent by email.
Efforts to reach Das and Cooper — including by phoning numbers and sending letters to addresses that appeared to be associated with them — were unsuccessful.
When Mead Johnson provided support to scientific researchers, the company would want to make sure they reported the results “in an honest way,” Cooper said in a deposition played in the Watson trial.
The Abbott co-authors “proposed routine edits to the article for scientific accuracy and for the consideration of the other authors, some of the most well-respected NEC researchers in the world,” Abbott’s Stoffel said.
“Abbott regularly collaborates with and publishes studies with leading NEC scientists for the benefit of both premature infants and the entire scientific community,” Stoffel said.
“The research studies Mead Johnson supports are conducted independently and appropriately, with full transparency,” said O’Neill, the Mead Johnson spokesperson.
‘In the Wrong Direction’
Transparency can be subjective.
More than a decade ago, Mead Johnson sponsored a clinical trial testing what was then a new acidified liquid fortifier against a powdered fortifier already on the market.
In the study, which enrolled 150 babies, 5% of infants fed the acidified liquid developed NEC compared with 1% of infants fed the powder, according to deposition testimony and a record of the clinical trial used in the Watson case.
That information was not included in a 2012 that reported the study results.
The article, in the journal Pediatrics, whose authors included two Mead Johnson employees, concluded it was safe to use the new liquid fortifier instead of the powdered one. The article also said that, comparing babies fed the liquid with those fed the powder, the study observed no difference in the incidence of NEC.
The unpublished finding of 5% to 1% represented so few babies that it was not statistically significant.
Nonetheless, retired neonatologist Victor Herson, who ran a NICU in Connecticut and has studied fortifiers, said in an interview he would have wanted to see those numbers.
“The trend was in the wrong direction,” Herson said, “and would have, I think, alerted the typical neonatologist that, well, maybe not to rush in and adopt” the new fortifier.
It’s common for study publications to include tables showing complications even if they aren’t statistically significant so that readers can draw their own conclusions, Herson said.
Neonatologist Fernando Moya, a co-author of the Pediatrics article, had a different perspective.
“You may not be very familiar with medical literature but when there are no ‘statistically significant’ differences, we do not comment on whether something was increased or decreased,” Moya said by email. He referred questions to Mead Johnson.
Mead Johnson’s O’Neill gave several reasons why “the data you cite was not included in the publication.” She said the study was designed to examine infant nutrition and growth, NEC was a “secondary outcome,” the NEC numbers weren’t statistically significant, and the size of the study, “while appropriate, was not powered to draw any conclusions with respect to any potential differences in NEC.”
In a deposition used in the Watson trial, Carol Lynn Berseth — a co-author of the paper and Mead Johnson’s director of medical affairs for North America when the study was completed — testified that the article was peer-reviewed and that no reviewer asked for additional data.
“Had they asked for it, we would have shown it,” Berseth testified.
Berseth did not respond to a phone message or to an email or letter sent to addresses apparently associated with her.
‘It Should Not Be in a NICU’
The Abbott scientist who flagged research on Mead Johnson’s acidified fortifier in 2013, Bridget Barrett-Reis, was later of AL16, the follow-up clinical trial Abbott sponsored, and of .
In a deposition, she was asked why she conducted the study.
“I conducted that study because I thought [the acidified fortifier] could be dangerous,” she said, “and I thought it would be a good idea to find out if it really was because nobody was doing anything about it.”
Elaborating on the thinking behind the study, she testified: “It should not be in a NICU in the United States. That product should not be anywhere for preterm infants.”
In her 2013 email recommending that Abbott conduct a study, Barrett-Reis cited findings by “an independent investigator,” Ann Anderson-Berry, that showed, compared with preterm infants fed an Abbott powder, those on Mead Johnson’s acidified liquid “had slower growth, higher incidence of metabolic acidosis and NEC!!”
Asked about the exclamation points, Barrett-Reis testified in a January 2024 deposition used in the Gill case that she wasn’t excited about the findings. “I am known to put exclamation points instead of question marks and everything anywhere, so I have no idea at the time what those meant,” she testified.
The research that caught her eye in 2013 reviewed patient records from the Nebraska Medical Center. The institution had switched to the acidified fortifier with high hopes but stopped using it after four months because it was concerned about patient outcomes, Anderson-Berry and Nebraska co-authors .
In an interview, Anderson-Berry said she set out to analyze why, during those four months, babies’ growth “fell apart in our hands.”
Abbott was “very pleased” with Anderson-Berry’s findings and paid her to go around the country discussing them, she said.
Metabolic acidosis can be fatal, Anderson-Berry said. But typically it can be managed, she said, adding that she didn’t know of deaths from metabolic acidosis caused by the acidified fortifier.
Research has found that metabolic acidosis “is associated with poor developmental and neurologic outcomes in very low birth weight infants,” according to . In addition, it is “a risk factor for neonatal necrotizing enterocolitis,” the paper said.
Barrett-Reis did not respond to inquiries for this article, including a message sent via LinkedIn and a letter sent to an address that appeared to be associated with her.
In court, Abbott representative Robyn Spilker testified that metabolic acidosis and that nobody should knowingly put kids at risk for getting NEC in an effort to make money.
Before infants were enrolled in the AL16 study, their parents or guardians had to sign consent forms disclosing, among other things, the risks that clinical trial subjects would face.
International ethical principles for medical research on humans, known as the , say each participant must be adequately informed of the “potential risks.”
Questioning Abbott’s Spilker in litigation, plaintiff’s attorney Timothy Cronin said, “Ma’am, despite the hypothesis going in, are you aware Abbott on the informed consent form given to parents that signed their kids up for that study?” Spilker, who identified herself in court as a senior brand manager, said she didn’t know what was on the consent forms.
Through a request under a Kentucky open-records law, ºÚÁϳԹÏÍø News obtained an informed consent form for the AL16 study used at a public institution, the University of Louisville. The form mentioned risks such as diarrhea, constipation, gas, and fussiness. It did not mention metabolic acidosis or NEC.
ºÚÁϳԹÏÍø News also reviewed an informed consent form for the AL16 study used at Memorial Hospital of South Bend. It was largely identical to the one used in Louisville and did not mention metabolic acidosis or NEC.
Cronin, the plaintiff’s attorney, said in an interview that Abbott showed disregard for the health and safety of premature babies participating in the AL16 clinical trial.
“I think it’s unethical to do a study if you know you are subjecting participants in the study to an increased risk of a potentially deadly disease and you don’t at least tell them that,” Cronin said.
Anderson-Berry told ºÚÁϳԹÏÍø News that Abbott was “ethically well positioned” to conduct the AL16 clinical trial because her paper was not definitive.
Yet she said she was unwilling to enroll any of her patients in the Abbott clinical trial because she didn’t want to take the chance that they would be given the acidified liquid.
White, the neonatologist who stopped enrolling patients in the study, defended the decision to conduct it. In an interview, he said it was appropriate to conduct a large, properly controlled clinical trial to see whether concerns raised in earlier research were borne out. The two babies whose serious adverse events he reported to Abbott ended up doing fine, he said.
But White, who went on to be listed as a co-author of the study, told ºÚÁϳԹÏÍø News that parents should have been informed that the risks included metabolic acidosis and NEC.
“In retrospect, obviously, that is something that we, I think, should have informed parents of,” he said.
Abbott did not directly answer questions about the consent forms.
The results of AL16 were in 2018. The conclusion: Infants fed the acidified product — in other words, the Mead Johnson fortifier — had higher rates of metabolic acidosis and poorer feeding tolerance. Plus, poorer “initial weight gain.”
The title of the article trumpeted “Improved Outcomes in Preterm Infants Fed a Nonacidified Liquid Human Milk Fortifier” — in other words, the Abbott product.
Eight of the 78 infants receiving the Mead Johnson fortifier were treated for metabolic acidosis, compared with none of the 82 receiving the Abbott product, the article said. Four infants on Mead Johnson’s product experienced serious adverse events, compared with one on the Abbott product, the article reported.
One infant receiving the Mead Johnson product died — from sepsis, the article said. One had a case of NEC, and infants on Mead Johnson’s fortifier “had significantly more vomiting,” the article said.
However, in a pair of letters to the editor published in the Journal of Pediatrics, the article as hyped. Writers said the article emphasized findings that were .
In its business battle with Mead Johnson, Abbott deployed the study. It produced an annotated copy for its sales force, which was shown in the Whitfield trial.
Abbott’s use of AL16 as a marketing tool worked.
In 2019, when Barrett-Reis applied for a promotion at Abbott, she wrote that the results of the study had been “leveraged to secure whole hospital contracts which have increased hospital share to > 70%.”
Her letter was displayed in a deposition video filed in the Gill litigation.
Internally, Mead Johnson conceded it had been beaten in the fight over fortifiers. In the slide deck for a 2020 national sales meeting, the company said, “Abbott won the narrative.”
Share your story with us: Do you have experience with infant formula or any insights about it that you’d like to share? We’d like to hear from you. Click here to contact our reporting team.
This <a target="_blank" href="/health-industry/infant-formula-fortifier-high-stakes-corporate-battle-preemies-abbott-mead-johnson/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2165280&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>The American Society of Plastic Surgeons, which represents 12,000 doctors, is now warning patients to “do their homework” before getting liposuction, a Brazilian butt lift, a “Mommy Makeover,” or other cosmetic procedures.
“Plastic surgery is real surgery with real risks, and the risk of complications is never zero,” said Scott Hollenbeck, immediate past president of the plastic surgeons group.
And in an exclusive interview, TJ Watkins, a member of California’s medical licensing board, called for greater transparency in the secretive process for disciplining physicians, saying the board should alert the public about doctors under investigation for alleged misconduct.
Hollenback and Watkins were reacting to the “Body Shops” series, which examined allegations of disfiguring injuries or even deaths tied to cosmetic surgeries.
One story revealed that California plastic surgeon Heidi Regenass had three patients die within a few months after liposuction and fat transfer operations, according to medical malpractice lawsuits filed in California courts.
A complaint to the medical board from a patient’s daughter triggered an internal board review of the surgeon, but the public will hear nothing until the investigation is concluded, which can take years.
“If you were really protecting the patients, there would be a notice right now that says this doctor is being investigated,” said Watkins, one of seven nonphysicians appointed to the medical board to represent consumers.
Regenass, a board-certified plastic surgeon, did not respond to numerous requests for comment on the patient deaths. In response to medical malpractice lawsuits filed by families of the three women, she has denied any negligence or that her actions caused any deaths. One case was settled in 2024, while the two others are pending in California courts.
On Feb. 9, the California medical board filed an against Regenass unrelated to the three patient deaths. The complaint accuses Regenass of “repeated negligent acts” in caring for a 49-year-old woman who had liposuction on her abdomen and arms with a fat transfer to her buttocks in July 2022. The board alleged that the surgeon “failed to document an appropriate physical examination prior to surgery” and did not keep “adequate and accurate records” of the woman’s care. The board requested an administrative hearing on the accusations, though no date has been set. Lawyers for Regenass didn’t respond to a request for comment on the new complaint.
Some patient lawsuits have accused cosmetic surgery companies of hiring doctors who lacked adequate training or had troubled pasts, and of using high-pressure sales tactics and misleading advertising pitches that downplay safety risks, federal and state court records show. The companies dispute these allegations and have won dismissal of some suits. Other cases have been settled under confidential terms, although a Georgia judge late last year to the family of a woman who died after liposuction and a Brazilian butt lift.
Christopher Nuland, an attorney and lobbyist for the Florida Society of Plastic Surgeons, said that the “Body Shops” investigation “underscores the need for vigilance from all parties.”
“There is an opportunity for better legislation, such as regulating post-surgical recovery centers and better enforcement of existing laws,” he said in an email. “But patients need to take an active part by ensuring that they are seeing a board-certified plastic surgeon in an accredited facility and that neither has a history of bad outcomes.”
Nuland said his group supports pending in the Florida Legislature that would require licenses and set quality standards for recovery houses where patients often stay to recuperate for a few days after cosmetic surgery. Florida officials for years to regulate unlicensed facilities that often charge patients hundreds of dollars per night, though they may lack adequate medical staffing.
Cosmetic surgery companies, some financed by , are competing in a growing U.S. body-contouring market in which patients are charged up to $20,000 out-of-pocket, or on credit, for these procedures. Ads promise life-changing body reshaping techniques with minimal risk and .
As the cosmetic surgery companies have grown, there’s been little regulatory oversight. There’s no federal public database to assist patients in tracking these companies’ safety records, their staffing standards, or how commonly patients suffer severe complications. And complaints to medical boards about surgeons or other doctors can remain under wraps for years.
Ste’Aira Ballard, whose mother, Tamala Smith, died in 2023 after Regenass operated on her, filed a complaint with the California Medical Board in early 2025.
In March 2025, the board notified Ballard it had forwarded her complaint to the state Department of Consumer Affairs Health Quality Investigation Unit’s Santa Ana field office “for further investigation.” Ballard said a state investigator interviewed her in June, but neither the existence of the review nor its status has been made public. Ballard provided copies of her correspondence with the state to ºÚÁϳԹÏÍø News and NBC News.
Asked for comment, California Medical Board spokesperson Alexandria Schembra said the board “is not authorized to post complaint information about a physician” unless it obtains an emergency suspension of the doctor’s license or files a formal administrative complaint.
“The public reporting of a patient death prior to the Board having sufficient evidence to prove that the licensee violated the Medical Practice Act would require the Legislature and Governor to enact a law change,” she wrote in an email.
But the board’s Watkins said he believes that the disciplinary process is rigged in favor of doctors, mostly because of the power of medical groups in the state lobbying to thwart change.
“Nobody is protecting the patient,” he said.
NBC News producer Jason Kane and correspondent Erin McLaughlin contributed to this report.
ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/health-industry/body-shops-cosmetic-surgery-injuries-deaths-investigation/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2148730&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>After a routine doctor visit revealed Josie had lead poisoning, Hess quickly traced the source to the crumbling paint in her family’s century-old home in the Bayou St. John neighborhood. While it underwent lead remediation, the family stayed in a newer, lead-free house near Markey.
“Everyone was telling us the safest place to play was outside at playgrounds, so that’s where we went,” Hess said. Josie became a Markey regular, playing on the swings and slides.
Josie’s next blood test was a shock. “It skyrocketed,” Hess said. Josie’s lead levels had leaped to nearly five times the national health standard. The likely culprit, according to scientists at the time, was Josie’s favorite park. Soil testing found it had dangerously high levels of lead.
City officials took no action to inform Markey’s users or make the park safe. But parents started posting warning signs at the park and flooded City Hall with calls and emails. With Josie on her hip, Hess made an impassioned speech at a City Council meeting.
In short order, the city hired a company to test Markey and other parks and pledged to fix the lead problem wherever it was found.
“My impression was they were going to make them all lead-free parks,” Hess said.
But a Verite News investigation conducted over four months in 2025 found that lead pollution in New Orleans parks not only persists — it is more widespread than previously known. Dozens of city parks with playgrounds remain unsafe, including Markey and other parks that underwent a city-sponsored lead remediation in 2011.
The findings indicate that city officials fell short in their cleanup efforts then, and that a very large number of New Orleans children are exposed to excessive amounts of lead, said Howard Mielke, a retired Tulane University toxicologist and one of the nation’s top experts on lead contamination.
“It’s a failed program,” he said. “They didn’t do what they needed to do to bring the lead levels down in a single park.”
Verite News reporters tested hundreds of soil samples from 84 city parks with playgrounds in fall 2025. Adrienne Katner, a lead-contamination researcher with Louisiana State University, verified the results. The testing found that about half the parks had lead concentrations that exceeded the established in 2024 for soil in urban areas.
“If there’s evidence of kids playing in soils that are as high as you described, that’s kind of horrifying,” Gabriel Filippelli, an Indiana University biochemist who studies lead exposure, told Verite News.
Public health researchers and doctors say that children under 6 absorb lead-laden dust more easily than adults, contaminating their blood and harming the long-term development of their brains and nervous systems. There is no known safe exposure level for children, and even trace amounts can result in behavioral problems and lower cognitive abilities.
Larry Barabino is the CEO of the New Orleans Recreation Development Commission, which oversees most of the city’s parks. He said the city doesn’t routinely test for lead in parks, and he confirmed that the last significant effort to do so was in 2011.
He called Verite’s results “definitely concerning” and pledged to work with city officials, local experts, and a city environmental consultant, Materials Management Group, to potentially remediate unsafe parks.
“It’s definitely concerning if it’s at the level that’s considered a true risk or threat, and we would get it to Capital Projects immediately to get MMG out there,” Barabino said, referring to the . “If there’s anything that’s a true environmental concern or risk, that’s something that we believe in definitely making sure we take action.”
But New Orleans is in financial straits, with a of about $220 million, and it’s unclear what resources new mayor Helena Moreno would be able to devote to restart lead remediation efforts. In response to the financial crisis, Moreno has already eliminated dozens of positions and plans to furlough 700 employees one day per pay period to save money. Moreno’s administration did not respond to requests for comment.
Andrea Young heard pledges similar to Barabino’s 15 years ago. Like Hess, Young had a child who frequented Markey and had high lead levels in her blood. Alongside other mothers, she helped push the city to take action. Young thought they had succeeded but said she now realizes that the city didn’t do enough.
“It makes me question the value” of the work the city did, Young said, “and the safety we felt in letting our kids play there again.”
Testing New Orleans Parks
Lead is typically found in very small amounts in natural soil. The average lead abundance in U.S. soils is , equivalent to less than an ounce of lead per ton of soil.
But New Orleans, like many other cities, has a long history of lead contamination in its soil, from sources including lead-based paint, leaded gasoline, and emissions from waste incinerators and other industrial facilities. Lead particles spread easily by wind, eventually settling in the topsoil.
The federal hazard level for lead in soil was 400 ppm , when the Environmental Protection Agency lowered it to 200 ppm for most residential areas and 100 ppm in urban areas like New Orleans with multiple sources of lead exposure. Last fall, the Trump administration , arguing it was confusing to have two thresholds. It didn’t argue that the 100-ppm level was safe.
More of a guide than a mandate, the EPA screening levels can steer federal cleanup actions and are often adopted by state and city governments to inform local responses to lead contamination. California has long had a much of 80 ppm.
Mielke said the Trump administration’s change doesn’t align with the science, which has long shown that children are harmed when exposed to soil with levels below 100 ppm. He was one of several scientists who had pushed for lower thresholds after the EPA established its first screening levels more than 30 years ago.
He said the 100-ppm level should still be applied in urban areas, especially New Orleans.
Verite conducted soil tests on the 84 city parks that property inventories and maps list as having play structures. Samples were taken from surface soil, which is most likely to come into contact with children’s hands and toys or be inhaled when kicked up during play or blown by the wind.
The average soil sample collected by Verite contained lead levels of about 121 ppm. Elevated lead levels tended to follow the age of the neighborhood. The city’s older neighborhoods, including the Irish Channel and Algiers Point, had some of the highest lead levels, while places like Gentilly and New Orleans East, developed mostly after the 1950s, tended to have lower levels, according to Verite’s findings.
The highest lead levels were found at Evans Park in the Freret neighborhood. Beside a low-hanging oak branch, on ground worn bare by children’s play, Verite recorded lead at 5,998 ppm, nearly 60 times the 100-ppm urban soils threshold.
Verite spoke to more than a dozen parents at playgrounds throughout the city, and most were surprised at the levels of lead in the parks.
In the Irish Channel, Meg Potts watched her son run around the dusty Brignac playground. All of Verite’s samples at that park surpassed the threshold the EPA deemed safe for urban areas, reaching nearly 600 ppm.
Potts knew high lead levels existed in the city but said she didn’t realize her neighborhood park could be a source of exposure for her son.
“ I’m just, like, thinking about all of this now because he’s had to go in and have his lead tested,” she said. “He’s like right on the cusp of having too-high lead.”
Katner, the LSU researcher, said Verite’s results can serve as a starting point for city officials to conduct more comprehensive testing in parks, noting that even a single lead hot spot in a park is concerning.
“The kid playing in that part of the park is going to get the highest dose,” she said.
A Legacy of Lead
Before the 1970s, lead was ubiquitous. A that most of the U.S. population born before the 1980s was poisoned by dangerously high levels of lead in early childhood, resulting in an average loss of at least one IQ point.
Lead pollution from cars spread into areas near roads, especially major thoroughfares, until leaded gasoline was phased out by 1996. Similarly, emissions from trash incinerators and industrial sites contaminated the surrounding soil in some New Orleans neighborhoods until they were closed in the 1970s and ’80s.
Today, the most pervasive source of lead in soil is degraded paint. Lead-based paint was used extensively for homes and buildings until it was banned in 1978. In New Orleans, most of the houses were built before 1980, according to the . As the paint deteriorates, Tulane University epidemiologist Felicia Rabito said, it can chip or turn into toxic dust.
“ The leaded paint goes straight into the dust and it goes straight into the soils, which is a major source of exposure for young children in the city,” said Rabito, who studies lead poisoning and other health conditions.
Children under 6 are especially vulnerable, in part because they like to stick their hands in their mouths. A child eating a dropped Cheerio or putting their thumb in their mouth after playing on a seesaw can be enough to cause harm. Rabito recommended that parents avoid contaminated playgrounds.
The only way to know whether a child has lead poisoning is a medical test. By , Louisiana health care providers to ensure every child between 6 months and 6 years of age receives at least two blood tests, recommended at age 1 and age 2.
But the law does not include a way to enforce those testing requirements, so many health care providers don’t test, according to a from the Louisiana Department of Health. In 2022, fewer than 1 in 10 children under 6 were screened for lead poisoning in the city, according to data from the Centers for Disease Control and Prevention.
“ There’s not anything that we can say about lead poisoning or lead levels in children in Orleans Parish with any scientific certainty,” Rabito said. “ Parents really need to get their children tested.”
Limited Soil Testing, Patchy Fixes
In 2011, the last time there was outcry over lead pollution in parks, the New Orleans health commissioner at the time, Karen DeSalvo, said the city should do “everything we can to understand what the risk might be and to remediate it.” But she also called it “not the greatest challenge, honestly,” .
Then-Mayor Mitch Landrieu promised a comprehensive response.
“The city will take all necessary measures to investigate possible lead contamination in other parks and playgrounds and remediate them as soon as possible,” he said .
Two months later, testing and remediation were completed at several parks. Parents brought their children back to the reopened playgrounds.
Despite city leaders’ assurances of a broad response, only 16 parks were tested in 2011 and the city’s piecemeal cleanup covered only patches of contaminated soil rather than entire parks, according to documents obtained through public records requests.
That stunned the vocal group of parents who had pushed for cleaning up the Markey playground. Young, one of the mothers, said the scope of the 2011 testing and remediation was much more limited than she thought.
“If the majority of the parks they tested were high, what would make them think all the others are fine?” she said.
Verite’s testing found high levels of lead at several playgrounds that were remediated in 2011, including Markey.
The results disturbed Mielke, the Tulane toxicologist.
In 2010, Mielke led an effort to reduce lead exposure at 10 private child care center playgrounds in New Orleans. He and his team covered the entire footprint of each playground with water-pervious plastic fabric and then 6 inches of Mississippi River sediment from the Bonnet Carré Spillway, a source of clean, cheap, and easily accessible soil. Lead levels fell, with most playgrounds testing below 10 ppm.
In contrast, the city’s remediation was mostly limited to areas with lead levels above 400 ppm, leaving many hazardous areas exposed. Testing and remediation reports obtained by Verite typically showed MMG focused on two or three spots in each park, with the rest going untreated.
At Easton Park in Bayou St. John, for instance, the 2011 remediation covered four areas totaling about 4,700 square feet, but the park’s playground was left untouched. Verite measured four samples around the playground that exceeded the 100-ppm threshold, including 1,060-ppm and 603-ppm readings near Easton’s swing set.
One park, Evans in the Freret neighborhood, wasn’t remediated despite lead levels as high as 610 ppm in 2011. The reason wasn’t clear in progress reports submitted by MMG. In Verite’s 2025 tests, Evans recorded the highest level, with 5,998 ppm in one location.
MMG did not respond to requests for comment.
Landrieu did not respond to a request for comment. DeSalvo, who retired last summer as Google’s chief health officer, said “extremely limited resources” forced the city to weigh its response to lead contamination in parks with the many other health threats residents faced.
“We worked to address the range of exposures whenever possible with the resources we could muster,” she said.
A Road Map for Cleanup?
Filippelli, of Indiana University, said the city should conduct comprehensive testing of every park and do regular checkups.
But because lead contamination in New Orleans parks is extensive and city leaders are struggling to close a large budget deficit, Filippelli recommends that the city remediate the worst parks first.
He and Mielke don’t believe the city must go the expensive route of full remediation, which involves digging up lead-tainted soil and trucking it to a hazardous waste landfill. It’s usually unnecessary if a park is properly capped with clean soil, Filippelli said.
Verite obtained cost estimates for 10 of the 13 parks targeted for remediation in 2011. The total cost was $83,000 in 2011, or about $120,000 today. The work covered just more than 1.3 acres across the 10 properties. Filippelli estimated that similar work could be done today for about $20,000 per acre — about a fifth of what was spent to remediate just over an acre at New Orleans parks.
Remediation should be coupled with efforts to reduce contamination from nearby sources, primarily old houses shedding lead-based paint, Rabito said.
“When you clean up soil, you’re not going to do it much good if you haven’t identified what’s contaminating the soil,” she said.
Cleaning up New Orleans parks is also likely to require sustained public pressure, said the parents involved with the lead issue in 2011.
“I was not intending to kick butts or make anybody look bad,” Claudia Copeland said of her efforts to alert parents about the dangers at Markey. “But nothing would have happened unless all these parents were calling in to the city.”
Methodology
Verite News reporters Tristan Baurick and Halle Parker were trained to use , or XRF, a handheld device that can detect the unique traits of lead at trace levels, down to 10 parts per million. The analyzer is widely used by government and university scientists.
The reporters tested 531 soil samples over a month in late 2025, following protocols developed by retired Tulane University toxicologist Howard Mielke and vetted by three other lead-contamination researchers. The reporters tested surface soil in and around play structures and other areas of parks that children use. Of the more than 110 parks in New Orleans, Verite concentrated on the 84 that city property inventories and maps list as having play structures. The reporters took between three and 11 samples at each park, depending on the size, site accessibility, and levels of contamination. A GPS device was used to record each sample’s location.
Verite’s results were reviewed by Adrienne Katner, a lead-contamination researcher at Louisiana State University. She verified the accuracy of the testing by comparing it with a smaller set of park soil samples collected by her team last summer.
While valid, the method did have limitations. The results can’t be used to determine the state of a whole park. But even one elevated soil sample can provide a starting point for city officials to conduct more comprehensive testing.
This article was produced in collaboration with . The four-month investigation was supported by a Kozik Environmental Justice Reporting grant funded by the National Press Foundation and the National Press Club Journalism Institute. It was also produced as a project for the USC Annenberg Center for Health Journalism’s National Fellowship fund and Dennis A. Hunt Fund for Health Journalism.
This <a target="_blank" href="/public-health/new-orleans-lead-contamination-parks-playgrounds-testing/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2151295&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>The retiree, 70, was diagnosed with glaucoma in her right eye in 2019. She had a laser procedure to treat it in 2022, and she uses medicated drops in both eyes to prevent more damage. She is supposed to be checked regularly, she said.
During the May appointment, Tuszynski’s optometrist examined her eyes and reassured her that the glaucoma had not worsened.
Tuszynski, who lives in central Wisconsin, had looked up beforehand whether the clinic in nearby Madison participated in her insurance plan. The insurer’s website listed the optometrist’s name with a green check mark and the words “in-network.” She assumed that meant her policy would cover the appointment.
Then the bill came.
The Medical Procedure
An optometrist tested Tuszynski’s vision and took pictures of her optic nerves.
The Final Bill
$340, which included $120 for vision testing and $100 for optic nerve imaging.
ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .
This <a target="_blank" href="/health-care-costs/medicare-advantage-eye-care-wisconsin-bill-of-the-month-january-2026/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2149694&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>Bostic learned of a federal program designed to help people who suffer rare vaccine reactions.
The Vaccine Injury Compensation Program was created in 1986 after a flood of vaccine injury lawsuits drove drugmakers from the market. Congress aimed to offer a faster and more generous path to compensation for people injured by vaccines, while shielding manufacturers from liability. The VICP, commonly known as vaccine court, is taxpayer-funded. The government pays any award to claimants as well as attorneys fees.
Bostic filed a claim in 2022 for compensation to cover her son’s spiraling medical bills. She then contacted the Carlson Law Firm, which referred her to Arizona-based attorney Andrew Downing — who now serves as a senior adviser to Health and Human Services Secretary Robert F. Kennedy Jr.
Downing declined to comment and HHS did not respond to requests for comment for this article.
Downing, who has represented hundreds of plaintiffs in vaccine court in Washington, D.C., signed on to take their case, according to reviewed by ºÚÁϳԹÏÍø News. They agreed Downing would pursue the claim before the VICP.
Bostic shared documents and medical records as he requested them. Months passed as she waited for news on her son’s case.
After several months of making court filings, Downing told her it was time to opt out of the vaccine program and sue the drugmaker. When she refused to opt out, he withdrew from the case.
The government paid Downing $445 an hour for representing Bostic, for program attorneys with his experience, according to court records.
Three years later, Bostic said, she hasn’t received a dime for her son’s injury. Thomas, now 18, endures debilitating pain that doctors say may never go away.
Rather than help them work through the program, Bostic feels that Downing steered them away from it and toward a lawsuit against the manufacturer. The VICP ultimately dismissed her case.
Bostic was furious that the court paid Downing anything.
“Y’all could’ve gave that to me for my son,” she said. “How dare y’all.”
In Business With Washington
In June, Kennedy’s HHS also awarded Downing’s law firm, Brueckner Spitler Shelts, a to consult on an overhaul of the VICP. The contract has grown to $410,000. Downing is the only attorney listed on the firm’s website who has practiced in vaccine court.
Kennedy has routinely questioned vaccine safety and saying it shields drug companies from some liability “.” As a personal injury lawyer, Kennedy previously spearheaded civil litigation against vaccine maker Merck.
Downing and about a dozen other lawyers have transferred hundreds of clients from the vaccine program to civil suits, where the financial rewards — for patients and their lawyers — could run far higher, according to a ºÚÁϳԹÏÍø News analysis of court records and program data. They’ve collected millions of taxpayer dollars in attorneys fees from vaccine court while launching precisely what it was designed to avoid: lawsuits against vaccine manufacturers.
This shift in legal strategy has fueled Kennedy’s crusade against Merck, and it could end up hurting some vaccine-injured clients, several experts said.
University of California Law-San Francisco professor Dorit Reiss has studied vaccine court for over a decade and has tracked the rise of anti-vaccine forces in American politics. She said VICP attorneys who are also suing vaccine makers have “incentives to direct more people” to lawsuits, “when it might not be in their best interest.”
A Delicate Balance
Kennedy has criticized the VICP as a barrier to accountability. But for Bostic, vaccine court offered an opportunity to hold the government to its promise of caring for casualties of widespread immunization.
Like any medication, vaccines can have side effects. Serious reactions to routine shots are rare, but for the unlucky few who bear this burden, the government promises recourse through its administrative program.
Vaccine court aims to strike a balance between protecting public health and helping individuals who may pay its price. The no-fault program allows claimants with vaccine-related injuries to get help without showing that the vaccine maker did anything wrong, even when the evidence doesn’t meet courtroom standards.
The program has made more than 12,500 awards, totaling roughly $5 billion in compensation. Historically, nearly half of claims have been resolved with some kind of award.
If patients aren’t satisfied with the outcome or don’t get a ruling within 240 days, they may leave the administrative program and sue the vaccine maker in civil court. Plaintiffs could potentially win larger awards. Lawyers could obtain higher fees, which they can’t in vaccine court.
But winning a civil suit is far more difficult, in part because plaintiffs have a greater burden of showing the vaccine caused their injury and that the maker was at fault. Since the VICP was created, no vaccine injury lawsuit has won a judgment in regular court, records show.
That hasn’t stopped some lawyers from trying. After the requisite 240 days, they have transferred hundreds of VICP claims into civil litigation against HPV vaccine manufacturer Merck, the ºÚÁϳԹÏÍø News analysis found.
The lawyers who represented those claims include Downing and other VICP attorneys with ties to Kennedy, court records show. Those include Kennedy advisers and people who work in the law office of his longtime personal lawyer Aaron Siri or with Children’s Health Defense, the anti-vaccine outfit Kennedy founded, as well as a former Kennedy co-counsel in suits against Merck over its HPV vaccine, Gardasil.
Downing, whose describes him as “one of the preeminent litigation attorneys in the Court of Federal Claims,” has not won an HPV vaccine injury claim in the past five years, records show. Vaccine court did compensate dozens of HPV vaccine claims in that time, but most — including nearly all of Downing’s — were withdrawn upon reaching the opt-out period.
VICP data and court records show that over the past five years, Downing and other lawyers withdrew roughly 400 Gardasil claims from vaccine court before a ruling was issued. The plaintiffs received nothing from the program. Hundreds of these cases joined the litigation against Merck, according to court records.
Once the opt-out period arrived in Bostic’s case, Downing informed her that he was preparing to withdraw her son’s claim and move the case back to the original law firm for a lawsuit against Merck.
“That,” he wrote in an email, “was the plan all along.”
Fighting for Compensation
Thomas, who hopes to enroll in community college and become a computer programmer, has intermittent numbness in his fingers and stabbing sensations in his arm nearly every day. The pain often radiates across his back or up his neck, and he’s developed migraines. Once an active kid who dreamed of playing basketball professionally, he now spends his time playing video games and trying to sleep during lulls in his pain.
Bostic’s claim on behalf of her son made him one of about 1,000 people who have filed with vaccine court for HPV vaccine injuries. More than 200 have received compensation — just over one for every million shots given. Court records show program awards were typically $50,000 to $100,000, with some also covering past medical bills or future health care expenses.
Richard Hughes IV, a health care attorney and former pharmaceutical executive who teaches vaccine law at George Washington University Law School, reviewed Thomas’ records and said cases like his were exactly what the vaccine program was designed to address.
“That just seems straightforward,” Hughes said of Thomas’ claim. “That should have gotten compensated.”
Bostic wanted the federal agencies that had approved and recommended Gardasil to answer for her son’s injuries. The single mother hoped compensation from the program would allow Thomas to see specialists including neurologists, afford natural treatments, and enroll in physical therapy.
“He would have had the best of the best health care,” she said.
When Downing took their case, Bostic said, he told her during a phone call that vaccine court’s $250,000 limit on pain and suffering was too low for her son’s injury. Bostic said Downing advised she could get more money by suing Merck, though that could take longer.
“I said, ‘No, that will take years. My son needs help now,’” Bostic recalled.
Bostic said she told Downing she wanted a fund set up for Thomas’ health care as soon as possible.
In the following weeks, Bostic sent paperwork to Downing’s office but had difficulty getting in touch with him, email and text messages show. Downing’s show a gap in his work on the case from late September until mid-November.
In November 2022, Downing emailed Bostic, “The opt out date for K.T.’s case is set for April 23, 2023. At that point, we will be in a position to opt K.T.’s case out of the Vaccine Program and move the case back over to the Carlson Law Firm for handling in the Merck litigation.”
Bostic said she was confused at the time by that language. But she remembers being emphatic in a follow-up phone call with Downing, repeatedly telling him she would not opt out.
After that, Bostic said, she didn’t hear from Downing for months despite calling his office and leaving messages with secretaries.
Downing’s billing records show that he and his paralegals spent fewer than nine hours on Bostic’s case in that stretch. This included time spent requesting, reviewing, and filing medical records, as well as drafting and filing extension requests. The billing records did not include any communication with Bostic during that time.
The court granted each of Downing’s extension requests, pushing back the deadline a month at a time.
In April 2023, Downing sent Bostic an email noting that 240 days had passed, so he could drop their government claim and they could sue Merck.
“Gardasil cases do not receive very fair treatment in the Vaccine Program,” Downing wrote, adding that he would withdraw as her attorney if Bostic stayed in the program.
Bostic chose to stick with vaccine court, later telling the vaccine court judge by email that she’d advised her attorney “I was not trying to become a millionaire.”
That exchange of emails in April is when Bostic said she learned Downing was already representing plaintiffs in lawsuits over Gardasil. The litigation encompassed hundreds of other patients who — most of them under Downing’s counsel — had filed VICP claims in recent years.
Running out the 240-day clock, critics say, is allowed but subverts the program’s intent.
Some legal experts criticize the way Downing handled Bostic’s case.
“They trusted him to file the VICP case,” Reiss said. “It’s his job to zealously advocate for his clients. In this case, his clients want to go through VICP. It’s his job to fight for them in VICP, not to wait for 240 days.”
When Downing joined HHS as a senior adviser to Kennedy, court records show, he handed off his remaining vaccine court cases to other attorneys in firms involved in the litigation against Merck.
A New Approach
The vaccine program has long faced criticism for giving claimants too little, too late. Even VICP advocates see the need for reform, with eight officials deciding a growing , driving up wait times. The cap on pain and suffering payments has not changed since 1986. But the court can award further compensation like a fund for lifetime medical care that can reach millions.
Most vaccine-injured individuals are better off in the administrative program than in civil litigation, legal experts said.
Renée Gentry, director of GWU’s Vaccine Injury Litigation Clinic and a founding member of the Vaccine Injured Petitioners Bar Association, has represented hundreds of families alleging vaccine injuries. Most of them, she said, aren’t focused on big payouts; rather, they “want their kid taken care of or they want to be taken care of.”
For claims that often fail in vaccine court, however, Gentry said a lawsuit may be the best option. According to Gentry, HPV vaccine claims like Thomas’ are particularly challenging to win in the VICP.
“If you’re not going to win, then you want those clients to have at least an opportunity at something,” she said.
For Mark Sadaka, a prominent vaccine court lawyer representing some claims in Merck litigation, sending clients to regular court is a last resort.
Sadaka said certain Gardasil injury claimants, such as those alleging mental rather than physical harm, might be better off in litigation. But by sticking it out in the VICP, Sadaka has won HPV vaccine injury claims that were the first of their kind, including for narcolepsy, alopecia, and even a deadly arrhythmia.
“He’s going to get taken care of for the rest of his life,” Sadaka said of his client who won compensation for narcolepsy in 2023. “And he doesn’t have to pay me anything.”
Sadaka, like all program lawyers, gets an hourly rate from the VICP. He said that he could make much more money representing the same claims in traditional litigation, since he could get a cut of any awards.
“It’s a better thing for me to file in regular court and get a higher fee, but for the client, sometimes it makes sense, sometimes it doesn’t,” Sadaka said. “My role is to explain both sides in gross detail for them and give them as much information as possible so they can make an informed decision.”
According to Sadaka, some lawyers in the VICP automatically advise their clients to leave vaccine court and file a lawsuit.
“If they can extract settlements, they’re going to be very happy to put that money in their pockets,” Hughes noted.
Winning a lawsuit or reaching a major settlement could also spell trouble for nationwide vaccine access, replaying the events that gave rise to vaccine court in the 1980s.
Some vaccine lawyers and policymakers believe Kennedy and his colleagues might welcome a return to those days.
“If they can bring down the system, that’s a feather in their cap,” Hughes said.
Lawyers cannot win contingency fees in vaccine court. They get paid for time spent on reasonable claims whether they win or lose. Downing made more than $1 million representing clients before the VICP in recent years, according to court records.
A shows that since fiscal year 2020, the program has paid scores of attorneys about $280 million — including over $43 million for cases they did not win.
In each of the last two fiscal years, lawyers got roughly $9 million for VICP claims in which their clients got nothing. That was more than the program had ever previously paid to attorneys for unsuccessful claims, according to vaccine court data.
‘Learning How To Cope’
After discovering her attorney would not pursue VICP compensation for her son, Bostic decided to advocate for Thomas herself.
“Please help me,” she wrote in a letter to the court.
VICP staff gave Bostic extra time to find a new lawyer and gather records.
The following months proved difficult for the family. Bostic was hospitalized with a life-threatening condition. Her mother’s health declined. She was laid off and lost her family’s health insurance.
By the time Bostic could take Thomas to a pediatric neurologist to get medical records for his VICP case, she said, the doctor had moved hours away to Orlando.
Bostic repeatedly missed deadlines and failed to communicate with program staff as required, court records show. Emails, docket entries, and letters suggest she may have misunderstood some court orders and not received others.
When Thomas’ medical records remained incomplete for another year, the presiding official dismissed Bostic’s claim, writing that while he had sympathy for what she and her son had endured, “the case cannot be allowed to remain pending indefinitely.”
Thomas said he can no longer play basketball with friends. He can’t even help his mother carry groceries into the house.
“I got to live with this, and there’s pain,” he said.
Bostic now works from home as a bank fraud analyst. With an income just above the cutoff for government assistance, she puts in overtime in hopes of affording health insurance for Thomas and her six other children.
“People are asking, ‘How’s your son doing?’” Bostic said. “I normally say, ‘Still the same. We just learning how to cope with it.’”
Methodology
The ºÚÁϳԹÏÍø News analysis began with court records for cases in the U.S. Court of Federal Claims, which includes vaccine court. We first identified all cases since 2006 (when the HPV vaccine was introduced) in which the “nature of suit” field explicitly mentioned human papillomavirus, or in which “nature of suit” was categorized as “other” vaccine injury/death and the case text included the word “papillomavirus.” The latter made up about 10% of identified cases, mostly claims filed before the HPV vaccine was added to the program or claims involving multiple vaccines. We cross-referenced the number of cases with data from VICP reports to verify completeness.
After identifying the relevant vaccine court cases, we pulled these claims’ filing and closing dates and took the difference to find the number of days that each case spent in vaccine court. To estimate total attorneys fees awarded for these claims, we added the fee amounts recorded in dozens of the VICP rulings and derived a minimum estimate based on the number of such cases.
We then searched federal court records for litigation over Merck’s HPV vaccine, Gardasil, and pulled the names of the plaintiffs and attorneys involved. To gauge the scale of claims diverted from the VICP to litigation, we searched for each attorney in the Gardasil-related vaccine court cases and searched for the last name of each plaintiff in the titles of those cases.
This <a target="_blank" href="/public-health/vicp-vaccine-court-cases-moved-lawsuits-lawyers-merck-hpv-rfk-allies-hhs/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2126630&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>The nurse who took the call at the Sono Bello center in Addison, Texas, told her she “absolutely should not” go to the ER — even though Farris “had a large gush of foul fluid” leaking from the incision, according to records in the malpractice case she filed against the cosmetic surgery chain in 2024.
The nurse told Farris she “only needed to reinforce her dressing to collect the fluid drainage and give it time,” filings in the lawsuit alleged.
“Thankfully, Ms. Farris did go to the ER where she was diagnosed with sepsis from her surgery complications,” a medical expert for her legal team wrote in a court filing. Left untreated, sepsis can lead to death.
Sono Bello officials declined to discuss malpractice cases filed against the company, citing patient privacy laws. But in court filings, the company has disputed Farris’ claims. The case is set for trial early next year.
The Farris lawsuit is one of dozens of medical malpractice cases filed over the past three years that accuse cosmetic surgery chains of failing to provide adequate care for patients in the days and weeks after their procedures — in many cases by allegedly neglecting to promptly treat painful infections and other serious complications — including for four patients who died, a ºÚÁϳԹÏÍø News investigation found.
In some cases, patients who traveled hundreds of miles or more for seemingly routine surgeries allegedly suffered painful complications while recuperating in hotel rooms or unlicensed “recovery homes,” which they said lacked adequate medical staff and supervision, according to court filings.
While complications, such as infections, can occur after any surgical procedure, problems related to postoperative care are blamed for contributing to injuries in over two-thirds of the cosmetic surgery cases ºÚÁϳԹÏÍø News reviewed.
The surgery companies involved — some, like Sono Bello, financed by — offer elective procedures such as liposuction and “” to patients who pay thousands of dollars out-of-pocket or on credit. Ads promise life-changing body reshaping techniques with minimal risk and .
Medical malpractice lawsuits have trailed behind the growth of these companies. Suits have accused the chains of hiring doctors who lacked adequate training or had , and of using high-pressure sales tactics and misleading advertising pitches that downplay safety risks, court records show. The companies dispute these allegations and have won dismissal of some suits.
Patrick Schaner, a plastic surgeon and a Sono Bello medical director, stressed that the company has performed more than 300,000 cosmetic operations with minimal complications. “That context is very important,” he said in an interview.
Schaner said Sono Bello surgeons are “good at what they do” because of the large numbers of procedures they perform. “We do a great job of getting safety protocols in place,” he said.
Many patients who file lawsuits blame disfiguring injuries on what happened after their operations, such as office visits in which medical staff allegedly didn’t recognize, or dismissed, evidence of worsening surgical complications, court records show.
A nurse at a Sono Bello center outside Chicago allegedly failed to alert doctors when Mary Anne Garcia, a patient who had had liposuction at the center about three weeks earlier, showed up there with her aunt. Garcia was dizzy and so weak she required a wheelchair to get back to the car, according to a lawsuit her estate filed in September.
Rather than tell Garcia to go to an emergency room, the Sono Bello nurse told her to “drink more fluids and try to eat something,” according to the complaint.
Garcia died the next day from cardiac arrest, according to the lawsuit. Sono Bello has yet to file a response to the lawsuit in court.
‘It Was Horrifying’
Susan Easley, 59, a veteran U.S. Agency for International Development executive who spent two decades working on AIDS projects in Africa, died in a Washington, D.C., short-term apartment last year.
Her son Gavin found her body May 13, 2024, four days after she had an AirSculpt liposuction and fat transfer operation at Elite Body Sculpture in nearby Vienna, Virginia, according to a lawsuit filed in November.
“It was horrifying,” Gavin Easley told ºÚÁϳԹÏÍø News in an interview. “My mother was the definition of kind, caring, and unconditionally loving. She was the most incredible woman I’ve ever known,” said Easley, 29, who runs an organic farm in Arkansas with his wife.
The suit alleges that surgeon Dare Ajibade gave Easley an excessive amount of the anesthetic lidocaine during the 6½-hour procedure and failed to recognize persistent vomiting afterward as a sign of toxicity. She called the clinic to report her condition, but her concerns were dismissed, the suit alleges.
“When she called to report complications, they didn’t take it seriously,” said Virginia attorney Peter Anderson, who filed the suit. He said Easley presented “clear signs and symptoms” of problems.
is a brand of Elite Body Sculpture, a Miami Beach-based chain founded by cosmetic surgeon Aaron Rollins. The company, which is financed by private equity investors, has about 30 branches across the country. Neither the company nor Rollins responded to repeated requests for comment on patient lawsuits. In court filings, the company has denied the allegations.
Ajibade has since relocated to Texas, where he works for Sono Bello in San Antonio, according to the company. Neither the surgeon nor the Virginia surgery office, which is also a defendant in the case, returned calls for comment. The defendants have yet to file an answer in court.
A Booming Business
Sono Bello, with more than 100 centers nationwide, bills itself as “America’s #1 Cosmetic Surgery Specialist.”
Patients filed seven malpractice cases against Sono Bello in September — each in a different state. In an interview, Marcy Norwood Lynch, a Sono Bello executive vice president and chief legal officer, speculated that the spurt in cases was related to reporting by ºÚÁϳԹÏÍø News and NBC News about the company. There “could be alignment” between the coverage and the filing of the suits, she said. The company has denied the allegations in court.
ºÚÁϳԹÏÍø News reviewed a sample of more than 100 medical malpractice cases filed against multistate surgery chains from the start of February 2023 through November 2025. Malpractice suits do not by themselves prove substandard care, though many medical authorities and licensing boards consider them a tool for helping to judge medical quality.
Heather Faulkner, a plastic surgeon and associate professor at Emory University School of Medicine in Atlanta, said surgeons must quickly recognize before they progress and become serious, even life-threatening conditions.
At Emory, she said, surgeons must attend their patients’ first visit after cosmetic surgery. “Ultimately, the physician is the one responsible,” she said. “The patient has to be seen by the person who did the operation and knows how to recognize something is wrong,” Faulkner said in an interview.
Patients suing cosmetic surgery chains often argue that they were seen by nurses or other staff members who, they allege, lacked the training to recognize and deal with problems before they required emergency wound care.
Schaner, the Sono Bello medical director, said the company has a phone messaging system that ensures patients can get in touch with their surgeon or other company physicians. While nurses see some patients, the “ultimate decision-making is passed to the surgeon,” he said.
Five patients treated at Sono Bello centers who sued the company during 2025 alleged that surgical wound complications were dismissed after medical staff, including surgeons, viewed pictures of the injuries, court records show. The cases are pending.
Schaner said Sono Bello sometimes has patients submit photos of wounds but the images are “not the sole means of triage” of patient injuries or complications.
Joshua Kiernan sued Sono Bello after having liposuction on May 28, 2024, at the branch in Columbia, South Carolina. On June 8, 2024, he stumbled and fell in a gym parking lot, causing drainage around the incision in his stomach, according to the suit. On June 17, 2024, Kiernan visited the office complaining of “redness and pain” around the incision, according to his suit.
The surgeon, Stancie Rhodes, didn’t examine him in person but had an office staff member take a picture “so that she could view it from another part of the office,” according to the complaint.
The surgeon sent back word that the photo “looked fine,” and Kiernan was told to take Tylenol for the pain and follow up at the office a week later, the complaint alleged.
Two days before his appointment, Kiernan required emergency hospital treatment for “abdominal hematoma and infection,” according to the suit.
Kiernan underwent six surgical procedures and ran up medical bills of more than $325,000 to treat his condition, according to the suit. In court filings, Sono Bello denied the allegations.
“Surgical care does not end at the last stitch,” said Mark Domanski, a plastic surgeon in Virginia, who believes the chain clinics in general are more adept at marketing than providing patients with top-notch care. “It involves postoperative visits with the surgeon who did the procedure, who is there to respond to the patient’s concerns, questions, especially if things are not going well,” he said.
Recovery Houses
Many patients who travel for cosmetic surgery, either to save money or because services aren’t available in their area, can’t return home right away.
Yet there’s little agreement on where patients should recuperate, for how long, and what medical services should be readily available to them.
Scott Hollenbeck, immediate past president of the American Society of Plastic Surgeons, said laws or regulations in most states don’t spell out requirements.
“This can create a wide variation of oversight, staff qualifications, and available medical support,” he said.
The plastic surgery society has a cottage industry of recovery houses that often charge patients hundreds of dollars a night while they recuperate, even though they may lack medical staff capable of handling possible surgical complications.
Court filings in Florida show patients staying in recovery houses and hotels have died or suffered untreated complications, mostly in South Florida, where officials have struggled for a decade or more to regulate unlicensed facilities. One local lawmaker recently to rein them in.
Hollenbeck said patients who recuperate in a hotel or other facility need to find out in advance what “level of care” will be available. He said ads touting “luxury” accommodations or “conveniently located” do not make a hotel “clinically qualified to provide recovery care.”
Easley, whose mother died in Washington, D.C., said he is struggling to understand what happened after a medical transportation service took her from the Virginia surgery center to a temporary apartment.
He said his mother, who was born in a small village in Uganda before emigrating to the U.S. as a teen and joining the U.S. Army, “had so many plans” for the future.
Susan Easley had been medically cleared for a . After that, she planned to retire and start a farm in Tanzania, among other things, according to her son.
The lawsuit alleges the surgery center discharged her prematurely given signs of a dangerous condition called caused by an overdose of lidocaine.
Susan Easley called the surgery center that day and reported “multiple instances of nausea and vomiting,” but there’s “no evidence” that anyone told her to head to an emergency room, according to the suit.
“I don’t know what they said to her,” Gavin Easley said. “It’s a horrifying thought for me. I have no idea how to get to the bottom of that mystery.”
‘Preventable Death’
Some lawsuits take aim at decisions made by support staff members, who help monitor patients after surgery.
That’s a critical issue in the case of Mary Anne Garcia, the Illinois woman who died after her aunt drove her to the Sono Bello office in Oakbrook Terrace, Illinois, on June 4, 2024.
Garcia “was feeling sluggish, dizzy, and nauseated,” according to the suit. She also had a rapid heartbeat and low blood pressure, according to the complaint. But registered nurse Lucia Raddatz did not notify the surgeon or urge Garcia to seek emergency care even though Raddatz had to help her back to the car in a wheelchair due to Garcia’s “severely weakened condition,” according to the suit.
Filed on behalf of Garcia’s estate, the suit names Raddatz and Sono Bello as defendants. An emergency room physician hired as an expert in the case opined that had Garcia gone to the emergency room on June 4, “she would have received care which would have avoided her death,” court records state. Sono Bello had no comment and has yet to file an answer in court.
Established plastic surgeons say they are often called upon to treat patients who arrive in the emergency room with complications because surgeons working for the chains may lack local hospital privileges or are otherwise not available for consultations.
“There is not one colleague of mine who has not dealt with the complications of these types of facilities or med spas on more than one occasion,” said Charles Pierce, president-elect of the New Jersey Society of Plastic Surgeons.
‘Angry and Betrayed’
Doctors at an Austin, Texas, hospital expressed such frustration while caring for Anna Palko, a 33-year-old mother of four, according to a malpractice suit she filed in November against surgeon Rambod Charepoo and his employer, Mia Aesthetics. The Miami-based cosmetic surgery company, which operates in about a dozen cities, including Austin, advertises that it delivers the .
A doctor at St. David’s Medical Center in Austin wrote in Palko’s medical record: “Unfortunately patient has had postoperative complications from a physician who is well-known to our emergency department for similar post-op complications associated with cosmetic surgery through MIA (sic) Aesthetics,” according to the suit.
Palko is one of five Texas women who sued Charepoo and Mia Aesthetics for malpractice this year, between mid-July and the end of November, court records show.
Four women allege the surgeon and the company failed to adequately treat infections that developed after surgery, while the fifth alleged other complications. Mia Aesthetics was dismissed from one case. The surgeon and the company have denied the allegations in court filings, court records show.
Charepoo also has been the subject of a lengthy investigation by the Texas Medical Board, which licenses doctors.
In August 2021, the board alleged that the surgeon “failed to meet the standards of care” in treating six patients, including one he placed “at risk” by allowing the patient to leave the surgery center for the emergency room in a private vehicle after the person “experienced significant hypotension and hemorrhagic shock.”
In October 2024, the medical board found that Charepoo had failed to meet standards of care for five of the six patients. The board required him to have a surgical proctor oversee 20 of his operations per quarter for two years. The board also ordered him to take medical education courses, pass an exam, and pay a fine of $4,000.
Charepoo is fighting the order in court. Charepoo, Mia Aesthetics, and lawyers representing Charepoo and the company did not respond to requests for comment.
In January, he sued the Texas Medical Board, arguing the penalty is “both excessive and unjustified” and should be invalidated. The medical board declined to comment on the suit, which is pending in Travis County District Court.
Hearing of the surgeon’s problems came as a shock to patient Palko, who said she had chosen Mia Aesthetics because of ads promising high-quality doctors.
“I felt so disgusted, angry, and betrayed,” Palko said in an email sent through her attorney.
Have you had liposuction, a “Mommy Makeover,” a tummy tuck, a Brazilian butt lift, or another type of cosmetic surgery? We’d like to hear about your experience. Click here to contact our reporting team.
This <a target="_blank" href="/health-industry/recovery-houses-outpatient-cosmetic-surgery-patient-risks/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2131622&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>Genesis HealthCare, once the nation’s largest nursing home chain, filed for Chapter 11 reorganization bankruptcy in July with a proposal to protect its controlling investor, Joel Landau, from legal liability. In court papers, Genesis had originally estimated all its settled and pending cases — which it said numbered nearly a thousand — would cost $259 million to resolve.
ºÚÁϳԹÏÍø News reported this month that in the years before filing for bankruptcy, Genesis had settled at least 155 patient injury and death lawsuits with provisions that allowed it to delay paying, sometimes for more than a year. As a result, when Genesis filed for bankruptcy in July, it still owed $41 million out of the $58 million promised in those settlements with families of current or former residents, according to the bankruptcy and case records ºÚÁϳԹÏÍø News reviewed.
In hearings Wednesday and last week in U.S. Bankruptcy Court in Dallas, Judge Stacey G.C. Jernigan said she would not approve a sale of the company’s assets that included legal releases from liability for Landau and a private equity associate, David Gefner. Landau, who was seeking to purchase the assets through another company he controlled, did not attend the bankruptcy hearings or respond to a subpoena, lawyers said in court.
“I’m very encouraged that someone is watching and paying attention to this,” said Erin Pearson, whose father, James Sanderson, died in 2018 after spending less than a month in a Genesis facility in Albuquerque. “And the guy who owns the most shares, not only did he not show up but doesn’t just get to move things around and rebuy” the nursing homes.
According to Pearson’s lawsuit, filed in 2019, Sanderson developed a bowel obstruction and sepsis while at the facility but was not sent to the hospital for more than a week.
Genesis did not pay Pearson the $500,000 it agreed to in a settlement, according to Pearson’s claim filed in bankruptcy court. “I don’t know if I’ll ever see that settlement, but I would like to be hopeful,” Pearson said in an interview Dec. 17.
Genesis, Landau, Gefner, and their attorneys did not immediately respond to requests for comment. In a public statement last week, David Harrington, the executive chairman of Genesis’ board of directors, praised Landau and his company’s investment in Genesis for helping it avoid bankruptcy in 2021. That “lifeline,” he said, enabled Genesis to transform into a “nimble, market-based model dedicated to prioritizing resident and patient care.”
Ian Norris, who represents 19 clients with lawsuits against Genesis — including four who have not been paid their settlements — said the judge’s ruling was “a huge win for all those who were confronting the possibility that they would not be able to recover the settlements that were promised to them by Genesis prior to the bankruptcy.”
According to Genesis’ bankruptcy filings, the company owes more than $1.6 billion in unpaid claims that are not secured by liens, including claims not only from former residents and their families but also from a pension fund; contractors that provided health services and equipment; and Pennsylvania, New Mexico, and West Virginia, which are owed provider taxes. Daniel Simon, a lawyer representing Genesis’ owners, said in court on Dec. 17 that $155 million would be available from the proceeds of the sale for these creditors under a bid for the nursing home assets from a new company controlled by Landau and Gefner.
Genesis last month held an auction for its assets and announced that Landau’s bid was the best, but the U.S. Trustee’s Office and creditors objected, saying Genesis had unfairly excluded one group from bidding and downplayed the value of another group’s bid that would have provided more money to creditors. Jernigan said there were too many irregularities in the auction for her to approve it and ordered it be redone under the watch of the U.S. Trustee’s Office.
“I am aware that there is huge concern about Mr. Landau, and he is not here,” Jernigan said last week. “There is no way I can approve these releases without him on the witness stand and me being convinced of his good faith.”
Sen. Elizabeth Warren (D-Mass.), who along with two Senate colleagues filed an amicus brief questioning the fairness of the auction, said in a media statement: “A private equity company tried to abuse the bankruptcy system to slither out of paying what they owe to neglected seniors in its nursing homes. This is a textbook case of why we need to get private equity out of health care altogether, and this decision is a good step forward in the fight to deliver relief for the victims of Genesis.”
In the Dec. 17 hearing, representatives of the company controlled by Landau and Gefner said they would bid again for the remains of Genesis without the promise of liability releases. The auction is expected to occur in January. Simon, the lawyer for Genesis, said at the hearing that the judge’s ruling “has humbled us.”
Lawyers for former and current Genesis residents said they hope to sue Landau and other parties that controlled the company and led it into bankruptcy. John Anthony, a Tampa attorney who represents 341 claimants, said, “The victims believe that Mr. Landau richly deserves his day in court, so he can explain to a jury of his peers how he has apparently gotten so rich running all these supposedly insolvent facilities into the ground.”
ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/health-industry/nursing-homes-genesis-bankruptcy-judge-ruling-delayed-settlement-payments/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2134922&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>The April wind was chilly at one of the tribes’ highest vistas in remote southeastern Idaho.
“Our goal is to bring fiber out here,” Goli said, sweeping one hand across the horizon. The landscape below is scattered with homes, bordered in the east by snowcapped mountain peaks and to the west by “The Bottoms,” where tribal bison graze along the Snake River.
In between, on any given day, a cancer patient drives to the reservation’s casino to call doctors. A young mother asks one child not to play video games so another can do homework. Tribal field nurses update charts in paper notebooks at patients’ homes, then drive back to the clinic to pull up records, send orders, or check prescriptions.
Three years ago, the Shoshone-Bannock Tribes were awarded more than $22 million during the first round of the federal Tribal Broadband Connectivity Program. But tribes that were awarded millions in a second round of funding saw their payments held up under the Trump administration. Last month, federal leaders to tribal broadband programs as part of a larger effort to “reduce red tape.” The National Telecommunications and Information Administration said it plans to “promote flexibility” and launch a new grant in the spring.
Federal regulators declined to provide details. The announcement comes after a year of upheaval for federal broadband programs, including the elimination of Digital Equity Act funding, which President Donald Trump has called “racist,” and a restructured $42 billion Broadband, Equity, Access, and Deployment program, which U.S. Commerce Secretary Howard Lutnick said was influenced by “.”
Across Indian Country and on the Fort Hall Reservation, high-speed despite billions set aside for tribes. In early November, U.S. Sens. Maria Cantwell (D-Wash.) and Brian Schatz (D-Hawaii) why funds already awarded had not been released to tribes and whether federal regulators were providing adequate technical assistance.
So far, the $3 billion tribal program has announced $2.24 billion in awards for 275 projects nationwide. But tribes that won awards have drawn down only about $500 million, according to a from the Commerce Department’s Office of Inspector General.
The agency on the broadband programs, offering tribal leaders two dates in January for online meetings.
The Shoshone-Bannock Tribes have drawn down less than 2% of their awarded funding and the program has not yet connected a single household, Goli said. NTIA spokesperson Stephen Yusko said the Shoshone-Bannock Tribes are still slated to get their full grant award and, he confirmed, future spending will not be subject to the administration’s recalibrations.
Gaps in high-speed internet can be profound and urgent on tribal lands. Tribal members are historically underserved and, on average, live with the highest rates of chronic illnesses and die than the average U.S. resident.
Diabetes and high suicide rates are among the most pernicious tribal health challenges — and federal research confirms telehealth . A ºÚÁϳԹÏÍø News analysis showed that people tend to live sicker and die younger in America when they live in dead zones, or places where poor internet access intersects with shortages of health care providers, leaving patients who need it most unable to use telehealth.
“We’re in survival mode,” said Nancy Eschief Murillo, a longtime Shoshone-Bannock leader. The tribes, which have an on-site clinic, need more health care both in person and with telehealth, she said. “Right now, our reservation? We don’t have accessibility.”
‘Not 100% Accurate’
Inside a trailer that serves as the temporary headquarters for Fort Hall’s tribal broadband office, Goli sat at a desk in June and scanned the Federal Communications Commission’s most recent online map of the reservation.
As the tribes’ broadband project manager, Goli didn’t like what she saw on the map. Blue hexagons highlighted varying rates of high-speed coverage and signified that high-speed internet is available on much of the reservation. Companies have told federal regulators they provide fast transmission speeds to homes there.
“These are untrue,” Goli said. Fort Hall has about 2,400 households, and nearly all of them live without high-speed internet, she said.
When it comes to tracking who on a reservation has high-speed internet, “everybody acknowledges, including the FCC, that the map is not 100% accurate,” said Robert Griffin, co-chair of the Fiber Broadband Association Tribal Committee, an industry trade group. He is also the broadband director for the Choctaw Nation of Oklahoma.
Attempting to correct the maps is one of the many tasks Goli has taken on since becoming the Shoshone-Bannock Tribes’ broadband project manager in January 2023 — seven months after the tribes won the award.
A series of hurdles, including flaws in the plan initially approved by the federal government and a cyberattack, have delayed the project, she said. The attack hit in August 2024 and for months shut down nearly all phones and computers on the reservation.
“We didn’t have access to any of our information,” Goli told ºÚÁϳԹÏÍø News this month, adding that the tribes are still “in recovery mode” from the attack.
Goli, who grew up on the reservation and still plays basketball at the tribal gym, left her job as a data analyst in Seattle to return home to be with family and to work. For two years, and with no broadband industry experience, Goli has overseen the multimillion-dollar grant without a staff.
Her first task, she said, was to collect data that could help create a realistic plan to deliver broadband to every home on the reservation. “Data tells a story,” Goli said.
Fort Hall and many other tribal lands are remote with rugged, expansive terrain. To build fiber-optic cables underground, the tribes must navigate lava rock and work with the Bureau of Indian Affairs to get permits. To build communications towers, the tribes must ensure they follow migratory bird rules for American bald eagles. To provide wireless connections, the tribes must buy or license spectrum from federal regulators, Goli said.
When the federal tribal broadband program launched, more than — pitching projects totaling $5 billion — submitted requests to the NTIA. During a later round of funding, asked for more than $2.6 billion, even though only $980 million was available. There are 574 federally recognized tribes in the United States.
The tribal program funding was not enough to “build out Indian Country,” said Joe Valandra, chief executive and chairman of the broadband consulting firm Tribal Ready. Valandra is a member of the Rosebud Sioux Tribe of South Dakota.
Congress created the tribal program to be used in combination with funds from the larger $42 billion Broadband, Equity, Access, and Deployment, or BEAD, program, Valandra said.
But now, it seems “the administration has no appetite for expensive broadband infrastructure builds in rural areas,” said Jessica Auer, a senior researcher with the community broadband networks team at the Institute for Local Self-Reliance, a research and advocacy nonprofit.
Auer, who has of tribal programs, said the administration may think the money already given to states for BEAD, as well as the use of satellite internet connections, will be enough for tribal lands.
“They seem to have a strong interest in declaring this problem solved,” she said. Low-earth-orbit satellites, though, are costly for the consumer and do not always offer the consistent high speeds they should, she said.
Goli’s plan does not include the use of satellites. On Fort Hall, the few households that have fast speeds now buy Starlink, but tribal leaders say the $80 to $120 monthly subscription costs are too expensive for most members.
The newly revised plan will use a hybrid of fiber-optic cables and wireless internet to ensure that people can “live their lives, whether it be health, education, telehealth,” Goli said.
The Test
Ladd Edmo, a councilman for the Shoshone-Bannock Tribes, thinks the tribal broadband project is taking too long.
Goli “is doing the best she can,” Edmo said.
But when he thinks about the millions waiting to be spent, Edmo said, he worries federal regulators “can just grab it back.”
“I’m not afraid of the current administration,” said Edmo, who is in his fifth term on the tribes’ business council. “I just think that they’re looking for money everywhere they can.”
Edmo lives about half a mile from the Fort Hall townsite and said he can’t really use his internet because he “gets a tremendous amount of buffering.” When he travels to doctors for his prostate cancer treatment, Edmo has them print paper schedules to keep track of his treatment.
He said he is not a big fan of telehealth, “probably because I don’t know how to use it.”
For 53-year-old Carol Cervantes Osborne, who also lives on the reservation, having internet is a necessity. Osborne is in constant pain from severe rheumatoid arthritis.
“I’m just all broke down,” Osborne said as she stared at the open pasture last June. She talked about how she misses riding cattle roundups. At times, Osborne has been bed-bound because of her arthritis and bad knees. She said she tapped her credit line, which uses land and cattle as collateral, and signed up for Starlink so that she can connect with doctors remotely through telehealth appointments.
“I’m poor because of it, but we’ve got to have it,” Osborne said.
Meanwhile, nearly 15 months after the cyberattack, Goli said the tribes are beginning to hire vendors.
“Things happen very slow when it comes to processing things in the tribal government,” Goli said, adding there are a lot of “checks and balances.”
This month — as the holidays approached — Goli said she was excited.
“We’ve actually started our first segment of fiber,” Goli said. The engineering work is done, and they have begun issuing permits, she said. The fiber-optic lines, built by a private vendor, will cover a two-mile segment on the northern end of the reservation. The line will come from outside the reservation and connect to the tribes’ data hub, which is an old radio station still being converted into broadband offices.
“It’s our first segment, and we’re really using this as a test,” Goli said.
Eventually, the old radio station will be central to operations, with fiber-optic cable lines that web out over about 800 square miles to reach the reservation’s five district lodges. Each lodge will establish a communications tower, which will use the fiber line to power wireless antennas that will then provide high-speed internet to the reservation’s most remote homes.
Goli said the tribes are applying for another extension — and, she said, they would not be the only award winners of the Tribal Broadband Connectivity Program to ask for more time. Working with tribes, she said, takes time.
“It really saddens me that we’ve been left behind all these years,” Goli said, but “this is our opportunity. We want to do it right, slow and steady.”
Sarah Jane Tribble, ºÚÁϳԹÏÍø News’ chief rural correspondent, spent more than a year interviewing Frances Goli through calls, texts, and emails. She traveled to Fort Hall Reservation twice, having received tribal approval to visit the land: in spring 2024 and again in summer 2025. Tribble also reviewed publicly requested copies of the tribal contract and interviewed dozens of industry and regulatory broadband experts.
This <a target="_blank" href="/rural-health/internet-broadband-digital-divide-tribal-health-disparities/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2131137&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>Hunt died five days later. Her death certificate said the foot injury was a “significant” factor. Genesis denied wrongdoing but agreed to pay $3.5 million in a settlement Hunt’s son signed in August 2024.
Yet Genesis hasn’t paid most of that debt, court records show. It may never have to.
Once the nation’s largest nursing home chain, it was spending $8 million a month defending and settling lawsuits over resident injuries and deaths in recent years. But the company is now poised to wipe the liability slate clean by seeking refuge in the most protective corner of the legal system for the nursing home industry: bankruptcy court.
The Genesis case, one of 11 large senior care bankruptcies this year, illustrates how health care companies can dodge public and financial accountability for alleged negligence through delays, confidentiality clauses, and bankruptcy maneuvers, a ºÚÁϳԹÏÍø News investigation found.
When it filed for bankruptcy in Dallas in July, Genesis estimated its total liability for nearly a thousand settled and pending lawsuits at $259 million. A ºÚÁϳԹÏÍø News review of the terms of 155 settlement agreements and shows Genesis officials knew insolvency was possible yet included provisions in its settlement agreements allowing it to defer payment, often for a year or more.
As a result, Genesis paid nothing in 85 cases and only a portion in the other 70, according to civil court records and bankruptcy claims made available through people with access to them. It still owes $41 million of the $58 million it had agreed to pay in those cases, the records show.
“It just feels like they killed my mom and got away with it,” said Vanessa Betancourt, whose mother, Nellie Betancourt, a retired nurse, fractured her hip at a Genesis home in Albuquerque, New Mexico — an injury the medical examiner’s report said led to her death. Genesis agreed to a $650,000 settlement with Betancourt’s family in April under the condition it would not need to pay the first of seven installments for another year, according to the settlement document.
Genesis denied wrongdoing in all lawsuits and settlements. In a written statement, the company did not answer questions about individual personal injury cases. The statement said Genesis remained “focused on delivering high-quality, compassionate care to our patients and residents without disruption” during bankruptcy.
One lawsuit Genesis settled for nearly $1 million alleged nursing home managers ignored repeated warnings about a male resident’s behavior before he sexually assaulted a female Alzheimer’s patient, according to court records. In a case the company resolved for $500,000, a Genesis nursing home was accused of delaying the hospitalization of a resident who had vomited brown mucus. He died of a bowel obstruction. Genesis has paid nothing for either settlement, according to bankruptcy claims.
Creditors, including families of the deceased, are expected to salvage a fraction of what they were promised, if anything. On Dec. 10, the company’s owners were scheduled to seek approval by the U.S. Bankruptcy Court for the Northern District of Texas to sell its nursing homes and other assets to its largest investor, a private equity firm. In court papers, lawyers for residents and other creditors say the complex plan will from pursuing Genesis’ new ownership and other companies the company’s collapse.
John Anthony, a bankruptcy attorney representing 340 personal injury claims against Genesis, said, “They never had any intention to honor these deals.”
Low Ratings and Fines
During years of financial turmoil, Genesis has frequently struggled to provide top-notch care, federal records show. Using its five-star system, the Centers for Medicare & Medicaid Services affiliated with Genesis as below average or much below average. CMS Genesis homes $10 million for violating federal health standards over the past three years.
In 2022, a Genesis home after two deaths and multiple violations. The company this year after residents twice were evacuated over safety concerns.
In its filing, Genesis said it cared for about 15,000 residents in 165 nursing homes and 10 assisted living facilities in 18 states. They are centered in Pennsylvania, West Virginia, New Mexico, New Hampshire, New Jersey, Maine, Alabama, Maryland, and North Carolina, according to the bankruptcy filing.
The company said it owed $709 million in secured debt to lenders and the IRS. Under bankruptcy rules, those debts, backed by Genesis collateral, take precedence over the $1.6 billion in unsecured debt Genesis said it owes. Unsecured creditors include a pension fund; contractors that provided health services and equipment; Pennsylvania, New Mexico, and West Virginia for unpaid provider taxes; and former residents and their families who sued.
Dangers in Memory Care
Sandia Ridge Center, a Genesis home in Albuquerque, was repeatedly faulted by health regulators for not preventing sexual misbehavior in its memory care unit. In November 2021, CMS for lacking enough nurses to prevent sexual abuse among residents. An inspection report the following August inappropriate sexual contact. Police were called to investigate sexual assault allegations in and of 2023, police reports show; neither resulted in criminal charges.
Then in April 2023, a 61-year-old male resident with alcohol-related dementia sexually assaulted a female resident with Alzheimer’s in the dining room, according to a and an . When the resident screamed for him to stop and that he was hurting her, he responded “shut up bitch I know you like this,” according to a lawsuit brought on behalf of the woman, identified in court papers as R.S.
Sandia Ridge management had been aware of the male resident’s behavioral issues for months, according to employee depositions in the case. Police had investigated a against him the previous year without bringing charges. In one deposition, a former activities assistant testified he hit her and twice pushed her into a bathroom while announcing, “I want to have sex with you.” When she reported him to a senior Genesis manager, she said in the deposition, the manager put his finger over his lips and said, “Shhh.”
The activities worker testified that R.S. used to happily sing along with Elvis Presley songs. After the assault, the worker said, R.S. “don’t sing anymore.”
Inspectors cited the home for failing to protect R.S. The same report said the home didn’t provide a therapist for another female resident who was being sexually harassed. Medicare fined Sandia Ridge Center $91,247. Genesis denied liability but settled R.S.’ lawsuit for $925,000 in May, according to the bankruptcy claim.
“We just felt we have to hold them accountable,” R.S.’ daughter said in an interview, speaking on the condition that she and her mother not be identified, because of the nature of the assault. “Maybe I’m wrong, maybe I’m naive, but the only way to do that is to sue someone, right?”
Genesis has not paid any of the settlement, according to the family’s claim filing.
Growth and Debt
Genesis’ downfall can be , when affiliates of two private equity firms acquired the company in a $1.5 billion leveraged buyout, taking on substantial debt, according to its bankruptcy filing. Private equity also has been involved in other health care bankruptcies, including those of the nursing home chain, the prison health care contractor , and two for-profit hospital systems, and .
In 2011, Genesis raised $2.4 billion by transferring substantially all its nursing home buildings and other real estate to Welltower, a publicly traded real estate investment trust, according to Genesis’ bankruptcy filing. Genesis then rented the buildings back from Welltower, which made leasing costs a significant expense.
Genesis went on a nationwide buying spree. At its peak in 2016, it had grown to more than 500 nursing homes. In a court declaration, Louis Robichaux IV, a consultant overseeing Genesis’ bankruptcy restructuring, wrote that as the company expanded, it became harder to manage and “mired in corporate inefficiencies.” Robichaux wrote that Genesis’ financial woes were exacerbated by rapidly increasing labor costs and lawsuits, including some predating the covid pandemic.
Starting in 2021, Genesis avoided bankruptcy after from a founded by Joel Landau, the owner of a , according to Robichaux’s filing.
But Genesis continued to teeter on the edge of insolvency. In for 2022 and 2023 submitted to a California oversight agency, management and auditors said rent and debt obligations raised “substantial doubt about the company’s ability to continue as a going concern.”
In a court filing, a committee appointed by the U.S. Trustee’s Office to represent the unsecured creditors in the bankruptcy accused Landau and Welltower of that allowed Welltower to keep getting its rents while Landau could run the company and “siphon value to himself.” The committee alleged their efforts forced the company into insolvency while “staffing levels and patient care declined precipitously.” Landau and Welltower did not respond to requests for comment.
Drawn-Out Lawsuits
Erin Pearson sued Genesis over the death of her father, James Sanderson, a retired mining company executive who died in 2018 after spending less than a month at Bear Canyon Rehabilitation Center in Albuquerque. In the memory care unit, Sanderson fell repeatedly, suffered medication errors made by nursing home staff, and developed a bowel obstruction and sepsis, according to the lawsuit, filed in 2019. Pearson’s lawyers said he was not hospitalized until eight days after nurses noticed he was vomiting brown mucus.
After the judge rejected Genesis’ request to force Pearson into arbitration, Genesis appealed. It took 2½ years before an appeals court affirmed the original decision to let the case go forward in court, records show.
This past May, more than five years after suing, Pearson reached a $500,000 settlement, with the first payment required by November, according to a copy of the agreement. Nothing was paid, according to the bankruptcy claim.
“It was so drawn out and for so long,” Pearson said in an interview, calling Genesis’ bankruptcy “despicable.”
Payouts Postponed
Jennifer Foote, an Albuquerque attorney who represents clients in multiple lawsuits against Genesis, including Pearson’s, said the company frequently filed appeals. “They did not usually win them on these issues,” she said, “and our sense was that they were doing it as a delay tactic.”
Genesis started using installment payments around 2018, said Dusti Harvey, Foote’s law partner. “The payments wouldn’t start for several months out,” Harvey said. Foote said Genesis’ lawyers often wanted to time the payments to start the month the trial in the case was scheduled to occur.
Families had to wait even when comparatively small amounts of money were involved, settlement agreements show. Genesis’ settlement agreements also included a confidentiality clause prohibiting discussion of the incidents.
Genesis agreed to pay $42,000 in a November 2024 settlement, but the first payment was not due until nine months later. It was not paid, according to the bankruptcy claim.
A $250,000 settlement signed in October 2023 did not start paying out until the following September. When Genesis declared bankruptcy — 21 months after the case was resolved — it still owed $100,000, according to the family’s claim.
‘We Never Found Out the Truth’
Settling cases allowed Genesis to avoid the expense and publicity of a trial, at which details of how its nursing homes functioned might have been revealed. In October 2020, Margarett Johnson, a retired school bus driver, fell out of her wheelchair at a Genesis nursing home in Waldorf, Maryland, fracturing her jawbone, nose, and neck, according to a lawsuit brought by her family. Johnson was sent to a trauma center and placed on a ventilator. She died three months later, at age 76, from ventilator-associated pneumonia, the lawsuit said.
“It looked like she was hit by a truck,” Angelina Harley, one of her daughters, said in an interview. “I knew my mom was not going to come home. I knew the Lord was not going to punish her more.”
The company denied negligence and blamed the accident on Johnson’s jacket getting tangled in the wheel of her wheelchair, according to the lawsuit. Harley and her sister Angela Swann were dubious.
“We never found out the truth,” Harley said. “They wanted to settle out of court.”
The company denied liability but agreed to a $950,000 settlement in October 2024. It never paid the final $112,500 installment, according to a letter Johnson’s five children sent to the bankruptcy judge.
“If you settle out of court, you know doggone well you did something wrong,” Harley said.
Maddening Judges
By summer 2025, judges in some civil cases had run out of patience.
Alma Brown, a retired day care manager and accordion teacher living in a Genesis nursing home in Clovis, New Mexico, suffered falls, infections, bedsores, and other neglect that hastened her death in 2023, according to her estate’s lawsuit. In Santa Fe District Court, Judge Kathleen McGarry Ellenwood castigated Genesis after it failed to pay $2 million of the $3 million settlement to Brown’s estate or explain the delay.
Genesis “obviously benefited by not having to go to trial,” McGarry Ellenwood said in one hearing, according to a court transcript. “They assure me that they’re not trying to renege on their contract, but it certainly seems like they haven’t lived up to what the bargain was.”
Genesis declared bankruptcy the day McGarry Ellenwood announced she would impose more than $100,000 in fines, plus $10,000 more each day until the settlement was paid.
In Pennsylvania, Greg Hunt petitioned a judge to punish Genesis after it stopped payments of the $3.5 million settlement after the death of his mother, Nancy, the resident with the gangrenous foot. She had spent eight months in 2019 at Brandywine Hall, a Genesis facility in West Chester that was later sold and renamed.
In a filing with the Common Pleas Court of Montgomery County, Genesis admitted it was in arrears but asked the judge for more time, citing “unforeseen and exigent financial challenges.” Genesis said care for patients at its nursing homes would suffer if it had to pay immediately.
Unswayed, Judge Richard Haaz in June ordered Genesis to pay up, along with punitive interest. But the bankruptcy court stayed that order. Genesis still owes $1.4 million of the $2 million it was supposed to pay, according to Hunt’s claim. (The rest of the $3.5 million settlement is supposed to be paid by an insurer in January 2026.) Ian Norris, Hunt’s lawyer, declined to comment, citing confidentiality provisions in the settlement.
Court records indicate Genesis lawyers never disclosed in either case that it was preparing to declare bankruptcy.
‘Bankruptcy as a Tool’
In the first nine months of 2025, 10 other senior living companies with liabilities over $10 million entered Chapter 11 bankruptcy, according to , a consulting firm.
Hamid Rafatjoo, a bankruptcy lawyer representing nursing homes who is not involved in the Genesis bankruptcy case, said filings may increase as the industry has become costlier to run and class action lawsuits have become a fixture.
“Nursing homes get sued all the time for everything,” Rafatjoo said. “A lot of operators wait too long to use bankruptcy as a tool.”
On Dec. 1, Genesis announced the , saying it had elected to to a private equity firm controlled by Landau. In a court filing, Anthony, the attorney for the personal injury claimants, in Landau’s favor despite an “objectively better and higher competing bid” from another private equity investor that would have provided more money to creditors. Genesis said in its statement that Landau’s group had increased its bid during the auction.
Sen. Elizabeth Warren (D-Mass.) and two other senators last month to intervene in the case, out of concern that “individuals who already own or control Genesis are trying to sell it to themselves, wiping away legal and other creditor debts in the process.” Lawyers representing those in charge of the auction did not respond to a request for comment.
Families of former Genesis residents said they fear the capacity to purge lawsuits through bankruptcy emboldens nursing home owners who provide deficient care.
“They can file bankruptcy again,” said Gabe Betancourt, whose wife, Nellie, died after her stay at Uptown Rehabilitation Center in Albuquerque. “And we’re the ones that will pay for it, with our memories, our lives.”
This <a target="_blank" href="/aging/nursing-homes-genesis-bankruptcy-liability-settlements-dallas-new-mexico/">article</a> first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2129309&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>