USDA Failed To Curtail Salmonella Outbreak That's Still Spreading Illness

USDA Failed To Curtail Salmonella Outbreak That's Still Spreading Illness

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In May 2018, a rare and virulent strain of salmonella caught the attention of America's top disease detectives. In less than two months, the bacteria had sickened more than a dozen people, nearly all of them on the East Coast. Many said they'd eaten chicken, and federal food safety inspectors found the strain in chicken breasts, sausages and wings during routine sampling at poultry plants.

But what seemed like a straightforward outbreak soon took a mystifying turn. Cases surfaced as far away as Texas and Missouri. A 1-year-old boy from Illinois and a 105-year-old woman from West Virginia fell ill. There was a teenager who'd just returned from a service trip in the Dominican Republic and a woman who'd traveled to Nicaragua. But there were also people who hadn't traveled at all.

Victims were landing in the hospital with roiling stomach pains, uncontrollable diarrhea and violent bouts of vomiting. The source of the infections seemed to be everywhere.

Even more alarming was that this strain of salmonella, known as multidrug-resistant infantis, was invincible against nearly all the drugs that doctors routinely use to fight severe food poisoning.

With a public health threat unfolding across the country, you might have expected federal regulators to act swiftly and decisively to warn the public, recall the contaminated poultry and compel changes at chicken plants. Or that federal investigators would pursue the root cause of the outbreak wherever the evidence led.

None of that happened.

Instead, the team at the Centers for Disease Control and Prevention closed the outbreak investigation nine months later even though people were continuing to get sick. The U.S. Department of Agriculture, which oversees meat and poultry, was not only powerless to act but said nothing to consumers about the growing threat. So supermarkets and restaurants continued selling chicken tainted with drug-resistant infantis.

And they continue to do so today.

An eight-month ProPublica investigation into this once rare, but now pervasive form of salmonella found that its unchecked spread through the U.S. food supply was all but inevitable, the byproduct of a baffling and largely toothless food safety system that is ill-equipped to protect consumers or rebuff industry influence.

Several European countries have dramatically reduced salmonella in poultry by combating it on the farms where chickens are raised. But over the past 25 years, the U.S. has failed to bring down the incidence of salmonella food poisoning — even as the rates for E. coli and other bacteria have fallen dramatically.

Consumers may get the impression that the meat and poultry they find at supermarkets is safe because it bears the USDA seal of approval. But the agency doesn't prohibit companies from selling chicken contaminated with dangerous salmonella like infantis. And even when people get sick, it has no power to order recalls.

Instead, the agency relies on standards it can't enforce and that don't target the types of salmonella most likely to make people sick. The USDA's Food Safety and Inspection Service, unlike its counterparts in some countries, has no authority to control salmonella on farms, where the bacteria often spreads. And even when there's persistent evidence of contamination in a plant's products, the USDA can't use those findings to suspend operations. All the agency can do is conduct a general review of the plant, and that rarely leads to a shutdown.

“It's a system that's untenable," said Sarah Sorscher, a consumer advocate at the Center for Science in the Public Interest.

ProPublica, as part of its food safety investigation, has created an online database that lets consumers look up the salmonella records of the plants that processed their chicken and turkey.

Last week, after repeated interview requests from ProPublica and years of criticism from consumer groups, the USDA announced that it was rethinking its approach to salmonella. The agency didn't announce any concrete changes but said it would set up pilot projects and hold meetings in an effort to come up with a plan.

“Whether it should have been done sooner or could have been done sooner, the good news is we're doing it," said Sandra Eskin, the agency's deputy undersecretary for food safety. “We're going to really take a look at everything we could look at and, I hope, develop a different approach that winds up being more effective."

Scientific advancements over the last decade have provided the USDA with tools to identify the most dangerous strains of salmonella. But the agency isn't using those tools to prevent it from spreading in our food supply.

To piece together how food safety officials and the poultry industry allowed infantis to spread, ProPublica used the same genetic data available to the USDA and other agencies, analyzing seven years of infantis samples taken from food and patients and catalogued by the National Institutes of Health.

Through dozens of public records requests, ProPublica was then able to link the genetic information on those 8,000 samples to the foods that victims ate and the processing plants the chicken samples came from.

The analysis, along with hundreds of internal government records and interviews with nearly two dozen scientists, allowed us to uncover that the infantis outbreak never abated and has continued to run rampant through the chicken industry.

In fact, ProPublica found that more than twice a day this year, on average, USDA inspectors detected multidrug-resistant infantis in poultry that's genetically similar to the outbreak strain. Each month, the CDC continues to receive dozens of reports of people getting sick from it.

“Many people are still becoming ill, and some of them gravely ill," Robert Tauxe, director of the CDC's Division of Foodborne, Waterborne and Environmental Diseases, told ProPublica.

One internal CDC presentation noted that this single strain is “responsible for an estimated 11,000-17,000 illnesses per year." But the CDC is limited in its ability to protect American consumers from foodborne illnesses. It has no power to order companies to take action or to provide information that would help it solve outbreaks.

And the CDC, despite noting that the strain was “widespread in the chicken industry," took the spotlight off infantis when it closed its outbreak investigation in February 2019. Tauxe said the investigation ended because the agency had learned as much as it could. “That does not mean that the outbreak was over," he said. “In fact, we think it may still be expanding."

As the CDC has contended with infantis, the agency has held several private meetings with the chicken industry, which has publicly downplayed the threat of the strain and its ability to do something about it.

But since closing the investigation, neither federal health officials nor the USDA has said anything to consumers about what the CDC quietly regards as an “epidemic."

Marva Lamping knew none of this in July 2019 when she took her longtime partner, Arthur Sutton, out to celebrate his 70th birthday at their favorite Mexican restaurant in Bend, Oregon. As Lamping tested her luck at the restaurant's video slot machines, Sutton snacked on chips and salsa while waiting for a platter of chicken enchiladas.

That night, Sutton began vomiting repeatedly, his stomach aching so badly that he couldn't lay down. By the next morning, the pain was unbearable, and Lamping rushed him to the emergency room.

At the hospital, doctors would discover that Sutton's intestines were leaking. Again and again, surgeons opened his abdomen to repair the tears and cut out dead segments of his bowels.

Doctors had quickly identified the cause of Sutton's ailments as salmonella. But for reasons they couldn't understand, his body was wasting away.

None of the antibiotics were working.

Missed Opportunities

As sudden as the infantis outbreak seemed to investigators at the CDC, it wasn't the first time the government had seen this strain, known as Infantis Pattern 1080. In the three years before the outbreak started, USDA inspectors had found the strain 74 times. But they could do nothing to stop the chicken from going to supermarkets and restaurants nationwide.

By the summer of 2018, people all over the country were falling ill. And as investigators studied the cases, clues soon emerged from the USDA, which oversees meat and poultry, and the Food and Drug Administration, which regulates almost all other foods.

The FDA had received a complaint that a dog had recurring diarrhea after eating raw pet food, and samples of chicken-and-vegetable dog food tested positive for multidrug-resistant infantis. A few months later, a Chicago woman fell sick with the outbreak strain after feeding her dog the same brand. Could the pet food be the source of the outbreak? Possibly, but not all the victims had a dog.

There was another lead. Victims reported eating Perdue Farms chicken more than any other brand. Public health officials in Pennsylvania and Minnesota found the outbreak strain in packages of Perdue wings, thighs and drumsticks in three supermarkets. And when USDA inspectors found the strain in raw chicken, more than a quarter of the samples came from Perdue plants.

The FDA's investigation had quickly led to a pet food recall. But while the FDA prohibits salmonella in the foods it oversees — including dog and cat food — the USDA allows it in raw meat and poultry destined for human consumption.

When people fall ill, the USDA can only request that a company voluntarily recall its products. But to do even that for salmonella, regulators face a high bar: To ensure a strong case, they're expected to try to find a patient with an unopened package of meat that tests positive for the same strain that made the outbreak victims sick.

“Often, by that time, most of the meat that's going to be eaten has been eaten," said Sorscher of the CSPI.

In June 2018, what could have been a key piece of evidence surfaced. An Illinois victim who'd been hospitalized told investigators that he still had a package of Perdue chicken tenders in his freezer. The USDA could have tested the package, but nobody ever went out to collect it, he said.

Perdue did not respond to more than a dozen calls and emails seeking comment, and it didn't answer questions sent to top company officials.

Wade Fluckey, Perdue's senior director of food safety at the time, told ProPublica that the company was targeted because Perdue has better brand recognition than other chicken companies, which skewed patient interviews.

“I don't know that any one company could say they didn't have it," said Fluckey, now a vice president at a pork processor. “Had they focused on other places, they would have found the same thing."

While no company showed up more frequently than Perdue, food inspectors were finding the Pattern 1080 strain in dozens of chicken processing plants as well as raw pet food and live chickens. To investigators, that was unusual because it meant that the salmonella couldn't have come from a single company or chicken product. It had to be coming from somewhere upstream in the supply chain — perhaps the farms or the few companies that breed nearly all the nation's chickens.

The country's antiquated meat safety system virtually ensured it would be no match for a germ like infantis.

The USDA operates under a law passed in 1906, where inspectors physically examine every carcass for signs of animal disease, illegal additives and spoilage. The system didn't account for invisible pathogens like salmonella and E. coli, which had not yet been linked to eating meat.

That did not change until 1994 after four children died from eating Jack in the Box hamburgers. The USDA made it illegal to sell meat tainted with a strain of E. coli called O157:H7. But it didn't ban salmonella despite a series of high-profile outbreaks in chicken. Instead, the USDA required processing plants to limit how often salmonella was found on their products and began testing for it. Plants that repeatedly violated these standards faced a shutdown.

That powerful threat didn't last long. In 1999, a Texas meat processor challenged the USDA's authority to close plants, arguing that salmonella “appears naturally" in raw meat. Two years later, the 5th U.S. Circuit Court of Appeals agreed that Congress hadn't given the agency the power to regulate salmonella that's present before products enter processing plants or to deem a facility unsanitary based on the bacteria alone.

The decision, Supreme Beef Processors v. USDA, has left the agency gun-shy, according to former department officials and food safety advocates. And Mansour Samadpour, a microbiologist who runs a testing and consulting firm that works with the food industry, said the decision distorts the underlying science. Just because salmonella “colonizes" chickens' guts doesn't mean it's “the natural state of the animal," he said. “It's nonsense."

The court ruling severely clipped the USDA's powers. So it has tried to pressure plants to improve by creating standards for how often salmonella should be found. Plants are rated on the results, which are published online. Violating those standards doesn't carry a penalty, but it allows the agency to visit the plant and look for more general problems like unsanitary conditions. If they can document significant problems, the USDA can temporarily shut down the plant, though the agency rarely takes such action.

Today, food poisoning sickens roughly 1 in 6 Americans every year, according to the CDC, and salmonella hospitalizes and kills more people than any other foodborne pathogen. Each year, about 1.35 million people get sick from salmonella. While most recover, more than 400 people die and 26,500 people are hospitalized. Some are left with long-term conditions like severe arthritis and irritable bowel syndrome. Salmonella costs the economy an estimated $4.1 billion a year, more than any other type of food poisoning.

Salmonella outbreaks have been linked to other foods like onions, but poultry remains the biggest culprit, and people are eating more of it than ever. On average, people in the U.S. eat nearly 100 pounds of chicken each year, a number that has grown by about 40 percent in the last 25 years.

Cooking poultry to an internal temperature of 165 degrees will kill salmonella. But studies by the USDA and others have found that despite decades of consumer education, home cooks routinely cross-contaminate their kitchens, and few use a meat thermometer to ensure their poultry is cooked properly.

Illnesses haven't declined even as salmonella rates in raw poultry have. And infections are getting harder to treat. The CDC recently found that salmonella infections were becoming increasingly resistant to antibiotics. In contrast, food poisoning related to E. coli O157:H7 has dropped by about 70 percent.

Consumer advocates, industry consultants and former USDA officials say that's because the agency focuses solely on whether salmonella is found in chicken or turkey at the processing plant.

This approach has been criticized for years. One former meatpacking executive called it “worthless." Even the USDA's own research arm has said the agency's measure for salmonella is “not a good indicator" of food safety.

The USDA doesn't consider two key risk factors: how much salmonella is in the poultry and how dangerous that type of salmonella is. There are 2,500 types of salmonella, but only a fraction cause the vast majority of illnesses.

The industry has greatly reduced the prevalence of one common type of the bacteria, known as salmonella Kentucky, which rarely causes illnesses in the U.S. But it's made far less progress with the types of salmonella most likely to make people sick, the ProPublica analysis found.

The rate of infantis, for example, has more than quintupled over the past six years.

The full extent of the salmonella problem isn't even known. The agency does little testing for salmonella to begin with. On an average day in 2020, the USDA took about 80 samples of raw poultry across hundreds of processing plants. But those plants slaughter more than 25 million chickens and turkeys a day.

In recent years, consumer advocates have recommended the agency ban the sale of raw meat carrying the types of salmonella that most often make people sick. That approach has contributed to improvements in Europe. In the U.S., the FDA has seen a dramatic decrease in salmonella outbreaks tied to eggs since the 1990s when it began targeting the most common type.

Last month, a few of the largest poultry companies, including Perdue and Tyson, joined with the CSPI and other consumer advocates to urge the USDA to fix the system. But the letter to the agency didn't outline specific reforms, and a consensus on salmonella regulations has long proved elusive.

The last push came during the Obama administration, but citing the need for more data, the USDA rejected a proposal to ban certain antibiotic-resistant strains. The agriculture secretary at the time was Tom Vilsack, who now leads the agency again under President Joe Biden.

As the food safety project director for the Pew Charitable Trusts before joining the USDA, Eskin also pushed for reform, but her efforts were met with resistance. With food safety directors from some of the largest companies, she helped craft recommendations to Congress to modernize the meat safety system, including setting new limits on salmonella contamination and giving regulators oversight of farms.

The group sought to enlist trade associations, which represent not only the biggest players but hundreds of other companies. But when it comes to regulation, divergent interests often leave the trade groups lobbying for the lowest common denominator. “They shut us down," she said in an interview before taking her government post. “They're the ones that blocked us — not the companies, the trade associations."

Asked what was standing in the way of change, she said, “I'll make it simple: Powerful interests in the industry do not want it."

“Only Talking About Protecting Industry"

Just months before the infantis outbreak started, the USDA gathered representatives from the food industry, researchers and regulators at the agency's brick-and-limestone headquarters in Washington to discuss a scientific breakthrough that one participant called the “biggest thing" for food safety in 100 years.

Whole-genome sequencing had given food safety researchers an unprecedented look at the DNA of foodborne bacteria. New technology, known as “next-generation sequencing," was creating a trove of new information and revealing connections that could help investigators stop outbreaks before they spun out of control.

As stakeholders took turns presenting slides in the wood-paneled auditorium, some spoke of the possibility that genome sequencing might help solve the stagnant rate of salmonella poisoning.

The new technology would help identify pathogens in foods like raw flour, peaches and romaine lettuce that were once rarely seen as sources of outbreaks.

While whole-genome sequencing couldn't confirm the source of an outbreak without additional evidence, it provided powerful clues about the bacteria's genetic history that could point epidemiologists in the right direction.

But for all the potential, much of the conversation that day in October 2017 centered on how to make this scientific breakthrough palatable to industry. Trade groups had requested the meeting, and they voiced concerns about how the new tool could be used for enforcement or might inaccurately connect companies' products to outbreaks. Speakers, including USDA officials, emphasized the importance of proceeding with caution. They discussed strengthening firewalls to keep testing data private and establishing “safe harbors" from USDA enforcement.

During a roundtable discussion, one representative from the United Fresh Produce Association raised concerns about the idea of companies sharing genome sequencing data with the government. “I think right now, it's viewed as very one-sided," she said. “We see the benefit to the agencies, but it's less clear how a company would directly benefit."

The industry's influence wasn't lost on regulators. Former USDA officials hold key posts at some of the food industry's biggest companies. Indeed, two people who led the 2017 meeting for the agency now work for the food industry.

Sitting in the auditorium, Jørgen Schlundt, the former head of food safety for the World Health Organization, was growing increasingly frustrated. Schlundt had helped achieve dramatic reductions in salmonella in Denmark while working for the country's food agency.

“I understand that I'm in the U.S., but surely this must also be about protecting consumers," he told the audience. “We are basically only talking about protecting industry here. I thought that this was, the basic purpose was to protect consumers, avoid American consumers and other consumers from dying from eating food."

While the USDA tiptoed around the new technology, whole-genome sequencing, which is now used to solve criminal cases and track COVID-19 variants, would prove pivotal to the CDC's infantis investigation.

As the infantis outbreak spread, epidemiologists noticed something unusual: The outbreak strain, Pattern 1080, carried an unusual combination of antibiotic-resistance genes that looked similar to another strain they'd seen before, Louise Francois Watkins, an epidemiologist at the CDC, said in an interview.

At the time, the CDC was still using a method called pulsed-field gel electrophoresis, or PFGE, which produced barcode-like patterns from the bacteria's DNA that scientists used to connect cases. So the investigators asked the lab to line up the patterns and compare the two strains.

“And sure enough," Francois Watkins said, the strains were so similar, they differed by “only a single band" of the barcode. With that clue, they decided to analyze the strains using whole-genome sequencing.

That allowed scientists to compare the individual building blocks in the genomes of bacteria. And the infantis investigators discovered that not only were the two strains genetically similar but that PFGE was masking the scope of the problem.

In fact, Pattern 1080 was just one wave in a much larger surge of drug-resistant infantis — one that had been detected nearly a decade ago in Israel and was now circulating worldwide in countries as far apart as Italy, Peru and Vietnam.

One of the reasons the U.S. variant is so concerning is that it typically carries a unique gene that makes it especially hard to treat.

“It's resistant to four of the five antibiotics that are commonly recommended for treatment," Francois Watkins said. “The antibiotics that your doctor is going to pick when they suspect you have a salmonella infection are pretty likely not to be effective."

The strain is also a major public health concern because it has the ability to pass those genes to other bacteria, adding to the growing global problem of antibiotic resistance.

“We don't want to see resistance climbing in our food supply because it's not going to stay in that one space," Francois Watkins said.

Whole-genome sequencing had helped investigators discover that the outbreak was actually a widespread problem in the country's chicken supply.

But even with these new revelations, public health officials still lacked one of the most basic tools to control the strain.

“A Gap in Our Regulations"

CDC investigators knew that infantis was spreading in chickens long before the birds arrived at the slaughterhouse. But enlisting the USDA's Food Safety and Inspection Service would be a dead end because the agency has no regulatory authority over farms. The USDA can only force farms to take measures when animals get sick, not when humans do.

That also made it difficult for the CDC investigators to pursue leads involving breeders and feed suppliers to trace back how dangerous bacteria got into the food supply.

“That's a gap in our regulations," Tauxe of the CDC said.

Nearly all the chickens we eat descend from birds bred by two companies, Aviagen and Cobb-Vantress, a subsidiary of Tyson Foods. This breeding process has allowed consumers to walk into any grocery store and find chicken of the same quality. But that pyramid structure also makes it possible for salmonella to circulate since the bacteria can be transferred from hens to their offspring, and a single breeding flock might produce 3 million chickens over several years. (Both companies declined to comment.)

And nearly every step of their journey from chicken house to our plates presents an opportunity for salmonella to spread.

As far back as 2005, the USDA has held public meetings exhorting the poultry industry to take steps at the farm. It has recommended that farmers change or chemically treat the litter between flocks, use traps and bait to eliminate pests and vaccinate hens and chicks against salmonella.

Denmark, Sweden and Norway have largely eradicated salmonella on farms by keeping chicken houses clean, frequently testing the birds and destroying infected breeding flocks.The United Kingdom has dramatically reduced salmonella illnesses by pressuring the industry to vaccinate.

The structure of the U.S. chicken industry makes it ideally suited to implement such interventions. The same company that slaughters the chickens often owns the hatchery and feed mill, and it contracts with farmers to raise the chickens to its specifications. The catch is that because companies are essentially doing business with themselves, there's little incentive for any of them to press others to reduce salmonella, the industry consultant Samadpour said.

“If it was four or five different companies," he said, “the processing plant would tell the farms, 'If you are more than so much positive, you can't send it here,' the farm would tell the hatchery, 'If the chicks coming in are positive, we are not going to take them.' They would tell the feed mill that if the feed is contaminated with salmonella, 'We are not going to bring it in.' Can you do that? No, it all belongs to you."

Because more isn't done on the farm, the birds' skin and feathers are often highly contaminated with salmonella by the time they reach the processing plant, according to the USDA. And in the plant, there are many ways bacteria can spread.

Birds can be further cross-contaminated when workers cut carcasses into breasts, legs and wings. The USDA recommends workers wash their hands and sanitize knives between each bird. But workers often have a few seconds to make each cut.

Ground chicken, which has become increasingly popular, is especially prone to contamination. Meat sent to the grinder comes from multiple birds, increasing the chance of cross-contamination. The fine texture of ground chicken can also get caught in small pieces of equipment, potentially tainting multiple batches.

While salmonella is found in 8 percent of the chicken parts tested by the USDA, 25 percent of ground chicken samples contain the bacteria.

And when the USDA tested for salmonella during the infantis outbreak, more than half of the positive samples were found in ground chicken.

“The Company Can Do Whatever It Wants"

In July 2018, as outbreak investigators began to discover infantis in Perdue products, the USDA had a chance to press the company for answers. Routine salmonella testing had found that the company's plant in Cromwell, Kentucky, was exceeding the USDA's salmonella standards, which say no more than 15.4 percent of chicken parts at a plant should test positive for the pathogen.

So USDA staff were sent to conduct an assessment of the plant, which might have seemed well-timed. Of the 76 plants where the infantis outbreak strain had been found, Cromwell, with 8 percent of the positive samples, had more than any other facility. But failing the agency's salmonella standard doesn't give the USDA the power to do anything more than review the plant's practices.

The USDA noted that Perdue had responded to its high rate of salmonella by adding more chemical dip tanks and sprays to disinfect the chicken. Because Perdue's internal sampling data showed the new steps appeared to be reducing the bacteria, the agency gave Perdue more time and recommended “no further action be taken."

According to the USDA report, Fluckey, then the food safety director at Perdue, told auditors that the agency's testing didn't paint an accurate picture of the plant because it wasn't measuring the quantity of salmonella. He added that Perdue managers hadn't concentrated on the salmonella types most likely to make people sick because they were focused on “meeting the performance standard."

A year later, USDA sampling indicated that the plant had continued to violate salmonella standards, with a third of chicken parts testing positive for the bacteria. In addition, the USDA said 12 of Perdue's samples were highly related genetically to samples from people who'd recently gotten sick.

Still, the agency once again deferred to the company's testing results, which showed a decrease in the rate of salmonella at the plant. The USDA decided it couldn't cite the plant and that no action was necessary.

ProPublica found that many plants have repeatedly violated the agency's standards without being shut down or facing any recent public sanction. According to the most recent data, more than a third of the plants producing ground chicken are violating the USDA standard. And many large companies — including Tyson, Pilgrim's Pride, Perdue, Koch Foods and the processors that produce chicken for Costco and Whole Foods — currently have plants with high rates of the types of salmonella most likely to make people sick.

Whole Foods said it has a team of experts who review the salmonella results of its suppliers and works with them to lower their salmonella rates. The processor, Pine Manor Farms, said it has “worked diligently to make corrections." Tyson and Costco declined to comment; Pilgrim's and Koch didn't respond to questions.

Other Perdue plants where the infantis outbreak strain was found also had a poor track record with salmonella overall. In the last three years, its plants in Rockingham, North Carolina, and Georgetown, Delaware, had more than 35 percent of their ground chicken samples test positive for the bacteria, and nearly all of them were types commonly linked to human illnesses. Yet neither plant has faced any recent public enforcement action, according to a review of USDA reports. (In April, ProPublica requested detailed files for both plants, but the USDA has yet to provide them.)

In an interview before she joined the USDA, Eskin said the consequences for companies violating the standards aren't “anything meaningful in terms of enforcement." “At the end of the day," she said, “I think the company can do whatever it wants."

The USDA doesn't appear to have traced the supply chain for the plants that tested positive for the outbreak strain. Detroit Sausage had one of the highest numbers of samples with the strain.

Phil Peters, one of the owners, said he doesn't remember anyone from the USDA asking the company who supplied its chicken. “I can't control something that's coming in from somewhere else unless I stop using it," he said.

The company no longer produces chicken sausage because his clients no longer order it. But as a small processor, Peters said, he has little ability to demand chicken companies provide him meat carrying less salmonella. “They're too big to worry about us," he said.

A Hidden “Epidemic"

With no powers of its own and stuck with a hesitant regulator in the USDA, the CDC's investigators needed the industry's help.

On Aug. 8, 2018, the CDC offered a stark assessment of the outbreak to representatives of the industry's trade group, the National Chicken Council: Drug-resistant infantis had become a “particular clinical and public health concern" because it was spreading through the chicken industry and increasingly making people sick.

The USDA seemed to take a less urgent approach. After an Aug. 16 foodborne illness investigations meeting with infantis on the agenda, an agency official wrote that there were “zero active illness investigations." The USDA had begun tracing victims' grocery purchases, but beyond that, it decided infantis was an “illness cluster" to watch — not a situation that required additional resources.

By then, three months into the outbreak investigation, neither the CDC nor the USDA had said anything to consumers.

People continued to get sick. Twelve days after the USDA meeting, a New York City resident began having stomach cramps. The patient's spouse told investigators the victim had eaten and shopped in the Flatbush section of Brooklyn. The patient went to the hospital but died two days later, the first known fatality from the infantis outbreak.

For nearly two months, there was still no public warning.

In October 2018, the CDC privately met again with the National Chicken Council. By then, public health officials were convinced that the outbreak strain originated high up in the chicken supply chain.

“The outbreak strain may be persisting in chicken populations, their environments or their feed," according to the CDC's presentation to the industry group. “Further investigation is needed to help prevent new illnesses and similar outbreaks in the future."

The CDC drew up a list of questions for the National Chicken Council:

How was it possible that so many different companies could have the same strain of salmonella infantis? Were common sources of chickens, eggs or other farming products widely used? Would one or more companies be willing to partner with the CDC and USDA to explore possible connections?

The council didn't have many answers. According to a government official's notes, the industry said that it “does a lot to try to reduce salmonella across the board," but that it didn't have a specific preventative measure for infantis. An industry representative added that it “might have been helpful to have the discussion 4 years ago," when the first signs of drug-resistant infantis popped up in processing plants.

A few days after the October meeting, a 2-year-old Michigan girl began rubbing her belly before developing a fever and diarrhea, making her the latest Pattern 1080 patient. Her parents said that before she got sick, she'd eaten chicken nuggets and touched a package of raw chicken in their kitchen.

The next day — more than nine months after the first patient from the outbreak got sick — the CDC issued its first public notice. By then, 92 people in 29 states had been infected with the outbreak strain. But the number was likely far higher: The CDC estimates that for every confirmed salmonella case, an additional 30 are never reported. That meant that nearly 3,000 people had likely been infected.

Though the CDC knew that infantis wasn't a typical outbreak strain, the notice offered little advice to consumers other than to remind them to follow standard food safety steps when handling raw poultry. The CDC told ProPublica that there was little more it could say to consumers. Infantis was so pervasive, Tauxe said, that the CDC couldn't tell consumers to avoid any specific kind of chicken or brand.

Instead, public health officials held another private meeting with the chicken industry in February 2019, telling trade organization officials that they considered this strain of infantis to be an “epidemic."

The CDC emphasized how risky this particular bacteria was because of its resistance to first-line drugs used to treat salmonella, especially illnesses involving children and patients with blood infections.

Health officials also presented the clues that had pointed toward Perdue as a potential source of some of the illnesses. The agency wanted to sit down with Perdue, but with no power to compel the company to answer questions, it would be months before a meeting happened.

A little over a week after the February 2019 meeting with industry, the CDC closed its investigation. In its second and last public notice about the outbreak, it said 129 people had gotten sick, 25 had been hospitalized and one person had died. There was no mention of Perdue or any other company.

In ending the investigation, the CDC seemed to send mixed messages. While the agency noted that “illnesses could continue because this salmonella strain appears to be widespread in the chicken industry," it also told Consumer Reports that the decision was prompted by a decrease in new cases.

Infantis Strikes Another Victim

Five months after the CDC closed the infantis investigation, Arthur Sutton and Marva Lamping walked into El Rodeo, a lively Mexican restaurant in Bend, Oregon, where copper art hangs on rustic yellow walls and red-clay mosaics line the archways.

The couple typically went there at least once a month after paying their mortgage or when friends were in town. Sutton's stomach had been bothering him since eating there the week before, but he didn't know why. He decided he was up for going out anyway. It was his 70th birthday, and the couple always went to El Rodeo for their birthdays.

Lamping and Sutton had met 15 years earlier at the local community college when Sutton decided to put his past struggles with addiction to constructive use by becoming a counselor. After math class, a group of students would go out to a Mexican restaurant.

“He just one day said, 'I noticed when we go out for nachos, that you don't have a margarita with all the other ladies,'" Lamping said. “And I said, 'No, I don't drink and drive.' And he said: 'Well, I'll give you a ride. If you'd like a margarita, I'll take you.'"

Lamping, 63, was drawn to Sutton's warm and accepting way of engaging with the world — a demeanor that seemed perfectly suited for his counseling work. Lamping said his clients clearly had a bond with him. Once, while he and Lamping were stuck in construction traffic, a former client working as a flagger recognized Sutton and came over to shake his hand.

Sutton, a large man with a square chin, broad forehead and glasses, was quieter than usual that night as a waiter brought out tortilla chips, salsa and a small oval dish of chopped cabbage slaw mixed with diced jalapenos, tomatoes and cilantro. Lamping went to play a few rounds of video slots in the back of the restaurant before dinner while Sutton dug into the salsa and slaw.

Those appetizers would take on grave importance for Lamping after Sutton developed severe food poisoning that night. She said that during its investigation of Sutton's illness, the county Health Department would ask her if Sutton had eaten salsa and slaw, which an investigator later described in an internal email as the “likely culprit" behind multiple food poisoning cases connected to the restaurant.

El Rodeo's owner, Rodolfo Arias, said he “didn't know anything" about the investigation.

An inspection of the restaurant would find concerns with cross-contamination because El Rodeo thawed and washed frozen chicken in the same three-compartment sink in which it washed lettuce, tomatoes and cilantro. Inspectors also noted the faucet was “uncleanable" because it was wrapped in black tape.

Arias denied that his restaurant was responsible for Sutton's illness. “I don't think it was possible," Arias said.

After dinner, the ache in Sutton's stomach erupted. He began vomiting and couldn't lay down to sleep. By the next morning, he could no longer stand the pain. He called Lamping at work, where she handles patient admissions at St. Charles Medical Center. She went home and took him to the emergency room, several hundred feet from her desk.

After a CT scan, a doctor diagnosed Sutton, who was obese and had other medical problems, with a hernia. He was discharged with plans for surgery.

But the pain didn't go away. Ongoing diarrhea sent him to the toilet every 10 minutes. He tried to hide his pain, but Lamping finally convinced him to return to the hospital. “I'm looking into your eyes right now, Arthur," she remembers telling him. “You're dying."

Sutton's hospital stay, detailed in 2,000 pages of medical records provided by Lamping, would be marked by one wrenching episode after another. In the emergency room, when a nurse put a feeding tube up his nose, blood started gushing out.

Still, Sutton maintained his signature equanimity. Medical staff described him in notes as “very relaxed and accepting and taking it all in stride."

Initially, the intensive care doctors thought Sutton was still struggling with the effects of a complex hernia. But in the operating room, it became clear that things were worse than doctors imagined. His bowels were severely damaged. Surgeons set about removing dead segments of his intestines and reconnecting the functioning parts. They also noted that Sutton had an acute kidney injury caused by “profound" dehydration and septic shock from a widespread infection.

Over 16 days, Sutton underwent a similar procedure seven more times. Surgeons cut out pieces of dead intestine, centimeter by centimeter, and tried to repair tears and leaks in his bowels. Sutton was going in for surgery so often they placed a medical dressing over his abdomen so they wouldn't have to cut him open every time.

Throughout, Sutton cycled through periods of decline followed by flashes of normalcy. Sleep-deprived, he began hallucinating that there were monkeys in trees and sailboats emerging from the ceiling. But he was also able to sit in a hallway chair in the sun with Lamping, eat a popsicle and jokingly tell the physical therapist, “You look like Tom Cruise."

Still, Sutton was deteriorating. One day, Lamping found a note on the bedside table that Sutton had scratched out: “Why is this happening?"

Sutton's doctors were also puzzled. After the first surgery, they'd quickly identified salmonella as the source of Sutton's illness and immediately started antibiotics. But after nearly a week, they couldn't understand why there was no improvement.

What Sutton's doctors didn't yet know was that a pernicious type of bacteria was poisoning Sutton's blood: the strain of multidrug-resistant infantis circulating throughout the chicken industry.

To Industry, the Mystery of Infantis “Went Away"

A month before Sutton got sick, the CDC's top foodborne disease experts held another meeting with the National Chicken Council. This time Perdue and four other big chicken processors were at the table.

Internal agency notes drafted before the meeting showed officials bracing for an unreceptive audience. “They have known about our concerns for years," the notes read. “They know about European practices. As a member-run trade association, their position is often driven by the lowest common denominator. Business margins are 'razor' thin; some companies are unable or unwilling to embrace expensive control strategies upstream."

During the three-hour meeting, the group discussed salmonella prevention and lessons learned from infantis.

But the CDC's message — that infantis was a serious problem that demanded action — doesn't seem to have resonated with Ashley Peterson, the industry representative who organized and attended the meeting. In September 2019, Peterson, the National Chicken Council's senior vice president of scientific and regulatory affairs, told trade magazine Poultry Health Today that infantis wasn't a problem anymore, according to a video of the interview.

“We don't really understand where it came from or why it went away," Peterson said.

Learning of Peterson's comments, Tauxe of the CDC seemed surprised and puzzled.

“It didn't go away," he said. “We have met with the NCC repeatedly and have emphasized with them that it's an ongoing problem. That's wishful thinking of some kind."

National Chicken Council spokesperson Tom Super said Peterson was referring to the CDC investigation ending and only learned later that the CDC was still seeing cases of infantis. He added that the industry has invested tens of millions of dollars a year in food safety and it has never downplayed infantis.

More than two years after Peterson's comments — as infantis has sickened thousands more people — the trade group still hasn't answered most of the CDC's questions about the strain and has shared little with the agency about efforts to curb it, Tauxe said.

“How it got into the chickens in the first place, and why it expanded across the country through the chickens and why it's persisting remain open questions for us," he said. “Stopping it is going to depend on what the industry is willing to step up to and do."

Super denied that the industry hadn't answered the CDC's questions but didn't provide responses when ProPublica posed them again. “The industry never stopped working to address salmonella infantis — an effort that continues today," he said.

Swifter action might have made the difference for Sutton.

At the hospital in Oregon, Sutton's prognosis worsened. By mid-August 2019, the doctors had learned that the type of salmonella ravaging Sutton's body was infantis. The finding might have helped doctors change course, but it was too late. The bacteria had already taken its toll.

Back in his room after a half-dozen surgeries, Sutton signaled to Lamping, waving two hands to show that he was done. “He just kept going: 'Enough, enough. No more,'" Lamping said.

She looked at Sutton and shook her head, refusing to give up. But there wasn't much the doctors could do.

During his eighth visit to the operating room, a surgeon noted that the leak in his bowels was probably so deep that it wasn't accessible to surgeons: “Any further dissection would be significantly risking more bowel injury and making his current problem worse," the medical records said.

More than two weeks into his hospital stay, Sutton's salmonella infection had led to kidney failure. Sutton would need round-the-clock dialysis and a feeding tube to survive.

Lamping and Sutton's brother, Jim, gathered in Sutton's room to decide what to do. They agreed that Sutton wouldn't want to live constantly hooked up to machines.

They told the hospital to stop treatment and move him to comfort care. “Time for him to go to heaven," Jim Sutton said. After life support was removed, Lamping sat next to the bed and rested her head on Arthur's hand.

The next day, on Aug. 16, 2019, Arthur Sutton died. The cause was severe blood poisoning and acute organ dysfunction brought on by salmonella. Lamping was paralyzed by grief. Her visions of the future had always included him.

“I watched a man go from happy-go-lucky — someone who should have been with me another 20 years — I lost him," Lamping said. “I Iost him."

Two years later, she still replays Sutton's battle with salmonella over in her mind, certain that something could have been done differently.

Lamping has focused on potential problems with how their food was handled at El Rodeo and hired a lawyer to file a lawsuit against the restaurant in 2020. She blames the restaurant, in part, because a county health inspection after Sutton died noted that it had told El Rodeo about the “findings from the state health lab on salmonella infantis cases." In court filings, the restaurant denied the allegations.

But Lamping also says there are things that food safety regulators and the industry could have done long before the chicken arrived at El Rodeo.

“If they know that infantis is in the chicken, if they know it's there, why are they selling it to us?" Lamping asked.

The USDA, to this day, has never said anything to consumers about the risk of multidrug-resistant infantis.

Because of the pandemic, Lamping and Jim Sutton have had to delay Arthur's memorial. They hope that someday soon, they'll be able to gather his friends and family on a hill overlooking a canyon in central Oregon.

They'll walk through shale rock, wildflowers and junipers, and look over the canyon's edge where a buck can sometimes be seen running through the sagebrush. They'll open Sutton's urn and let the wind carry his ashes away.

How ProPublica Analyzed Bacterial Pathogen Presence:

Data Used

ProPublica obtained bacterial pathogen genomic sequencing data from the National Center for Biotechnology Information's Pathogen Detection project. The project integrates data from bacterial pathogens sampled from food, the environment and human patients by participating public health agencies in the United States and around the world. The NCBI analyzes data as it is submitted, and the results are monitored by public health agencies, including the CDC as part of foodborne illness outbreak investigations. The data includes metadata about each bacterial isolate submitted by the person or institute who collected the bacterial sample, as well as computational predictions by NCBI.

Through Freedom of Information Act requests, ProPublica obtained epidemiological information about bacterial samples taken as part of the 2018-19 salmonella infantis outbreak investigation and samples obtained during routine testing in establishments regulated by the USDA's Food Safety and Inspection Service. ProPublica also obtained epidemiological information connected to patients considered part of this outbreak, including the date of sample collection and details about a patient's illness, recent food consumption and demographics — details crucial to foodborne illness investigations. Data about bacteria found during USDA inspections also included the type of meat or poultry the sample was obtained from, the date of collection and the name and location of the facility. Integrating these details with the NCBI metadata offered a way to group samples together not just by genetic similarity, but also by location and time.

The USDA posts public datasets containing the results of its salmonella sampling at poultry processing plants since 2015, which detail the collection date, type of poultry product sampled and, if salmonella was present, information on type and any antimicrobial resistance. The datasets include both routine sampling, conducted at every plant, and follow-up sampling, conducted at plants where the agency has identified high levels of salmonella. (Samples from USDA inspections that contain salmonella are reflected in both the NCBI data and the agency's inspection data.)

Analysis Decisions

To confirm the persistence of multidrug-resistant infantis in food processing facilities, grocery stores and patients with salmonella infections, ProPublica relied on both metadata submitted to NCBI and genetic features computed by NCBI. ProPublica restricted its analysis to isolates in the NCBI data belonging to what was known as SNP cluster PDS000089910.78, as of Oct. 19, 2021. This cluster contains most isolates involved in the infantis outbreak, and the CDC said it is monitoring most of the isolates in the cluster. ProPublica also filtered for isolates that were reported to be serotype infantis by the submitter or, when user-submitted information was unavailable, were computationally predicted to be infantis by the NCBI data processing pipeline.

ProPublica used data about evolutionary modeling computed by NCBI to establish the degree of genetic similarity between bacterial isolates from the outbreak and isolates collected more recently.

ProPublica's analysis of salmonella rates in poultry plants is based on methods the USDA uses, using the agency's routine sampling data to calculate positivity rates — that is, the number of positive tests compared with all salmonella tests taken at the facility — for each type of poultry a plant processed. ProPublica also calculated the high-risk salmonella rate for plants, determining the percentage of samples at the facility that tested positive for one of the 30 salmonella types the CDC has found to be most associated with human illnesses.

The USDA inspection data was also used to compare the number of samples found to contain salmonella infantis and salmonella Kentucky with the total number of routine samples taken each year to determine the rate at which each was occurring in the sampling program across all plants and poultry types.

Congress Launches Probe Of Meatpacking Worker Fatalities In Pandemic

Congress Launches Probe Of Meatpacking Worker Fatalities In Pandemic

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

A key congressional panel launched an investigation this week into the wave of COVID-19 infections that killed hundreds of workers at meatpacking plants nationwide last year and highlighted longstanding hazards in the industry.

Since the start of the pandemic, the meat industry has struggled to contain the virus in its facilities, and plants in Iowa, South Dakota and Kansas have endured some of the biggest workplace outbreaks in the country.

The meat companies' employees, many of them immigrants and refugees, slice pig bellies or cut up chicken carcasses in close quarters. Many of them don't speak English and aren't granted paid sick leave. To date, more than 50,000 meatpacking workers have been infected and at least 250 have died, according to a ProPublica tally.

The congressional investigation, opened by the House Select Subcommittee on the Coronavirus Crisis, will examine the role of JBS, Smithfield Foods and Tyson Foods, three of the nation's largest meat companies, which, the subcommittee said, had “refused to take basic precautions to protect their workers" and had “shown a callous disregard for workers' health."

The subcommittee is chaired by Rep. James E. Clyburn of South Carolina, the No. 3 Democrat in the House.

In response to the subcommittee's announcement, officials for JBS and Tyson said that the companies had spent hundreds of millions of dollars to implement coronavirus protections and to temporarily increase pay and benefits, and they looked forward to discussing their pandemic safety efforts with the panel. Smithfield said in a statement that it had also taken “extraordinary measures" to protect employees from the virus, spending more than $700 million on workplace modifications, testing and equipment.

The House subcommittee noted that reports from a variety of news organizations had illuminated problems with how the meatpacking companies handled the pandemic, and with the Occupational Safety and Health Administration's enforcement efforts. The subcommittee cited ProPublica's reporting on how meat companies blindsided local public health departments, and on Nebraska Gov. Pete Ricketts' efforts to intervene when local health officials tried to temporarily shutter a JBS plant amid an outbreak.

ProPublica has also documented how meat companies ignored years of warnings from the federal government about how a pandemic could tear through a food processing facility, and chronicled the role that meatpacking plants like a Tyson pork facility in Waterloo, Iowa, have played in spreading the virus to the surrounding community.

The subcommittee's inquiry will also scrutinize the federal government's shortcomings in protecting meatpacking workers. “Public reports indicate that under the Trump Administration, the Occupational Safety and Health Administration (OSHA) failed to adequately carry out its responsibility for enforcing worker safety laws at meatpacking plants across the country, resulting in preventable infections and deaths," according to the subcommittee's letter to OSHA.

The subcommittee also said that the agency had issued only a “few meager fines" and “failed to show urgency in addressing safety hazards at the meatpacking facilities it inspected." The letter noted that OSHA had received complaints about JBS and Smithfield plants months before the agency conducted inspections.

David Seligman, a lawyer who helped meatpacking workers in Pennsylvania file a lawsuit against OSHA during the pandemic, said he hopes the subcommittee's efforts are “just one of the initial steps" to holding companies accountable and ensuring workers are safe. “The harm inflicted on meat-processing workers during this pandemic, in service of the profits of corporate meat-packing companies and under a government that seemed happy to turn a blind eye, is a grave scandal," Seligman wrote in an email.

In a statement, a Department of Labor spokesperson said that the subcommittee's inquiry is “focused on the Trump administration's actions surrounding the protection of workers from COVID-19 related risks," and the agency is committed to protecting workers, and that new guidance on coronavirus enforcement that was issued in late January will serve as a “first step."

In its Feb. 1 letters to OSHA, JBS, Tyson and Smithfield, the subcommittee has requested documents related to government inspections at meatpacking plants and COVID-19 complaints lodged with the companies. OSHA was asked to brief the subcommittee by Feb. 15.

meatpackers, meat packing

Meatpacking Lobby Wrote Trump’s Executive Order To Keep Plants Open

Reprinted with permission from ProPublica

In late April, as COVID-19 raced through meatpacking plants sickening and killing workers, President Donald Trump issued a controversial executive order aimed at keeping the plants open to supply food to American consumers.

It was a relief for the nation's meatpackers who were being urged, or ordered, to suspend production by local health officials worried about the spread of the coronavirus.

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Meatpacking Companies Dismissed Years Of Warning About Pandemic Potential

Reprinted with permission from ProPublica

At the end of June, with hundreds of his workers already infected with COVID-19 and several dead, Kenneth Sullivan, the CEO of Smithfield Foods, the world's largest pork producer, sent a pointed letter to two U.S. senators who had launched an investigation into outbreaks in meatpacking plants and industry warnings of an impending food shortage.

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Eugene Scalia

OSHA Failed These Meatpacking Workers — And Now They’re Suing Agency

Reprinted with permission from ProPublica

Frustrated by the lack of response to their complaint of the “imminent danger" posed by COVID-19, three meatpacking workers at the Maid-Rite Specialty Foods plant outside of Scranton, Pennsylvania, took the unusual step Wednesday of filing a lawsuit against the Occupational Safety and Health Administration and Labor Secretary Eugene Scalia.

The lawsuit, filed in a Pennsylvania federal court, accuses the government of failing to protect essential workers from dangerous conditions that could expose them to the coronavirus. It relies on a rarely used provision of the Occupational Safety and Health Act that allows workers to sue the secretary of labor for “arbitrarily or capriciously" failing to counteract imminent dangers.

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Emails Reveal Chaos In Meatpackers’ Response To Virus Outbreaks

Emails Reveal Chaos In Meatpackers’ Response To Virus Outbreaks

Reprinted with permission from ProPublica.

For weeks, Rachel Willard, the county health director in Wilkesboro, North Carolina, had watched with alarm as COVID-19 cases rolled in from the Tyson Foods chicken plant in the center of town. Then Tyson hired a private company to take over testing, and the information suddenly slowed to a trickle.

Blinded to the burgeoning health crisis, Willard and her small staff grew increasingly agitated. The outbreak had already spread across 100 miles of the North Carolina piedmont, and two workers had died. But nearly a week after Tyson's testing ended in May, the county health agency had received less than 20 percent of the results. The little information it did receive was missing phone numbers and other data, hindering critical efforts to follow up with infected workers, to tell them to isolate and to trace their contacts.

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Virus Exploded After Nebraska Governor Refused To Close Meatpacking Plant

Virus Exploded After Nebraska Governor Refused To Close Meatpacking Plant

Reprinted with permission from ProPublica.

On Tuesday, March 31, an emergency room doctor at the main hospital in Grand Island, Nebraska, sent an urgent email to the regional health department: “Numerous patients" from the JBS beef packing plant had tested positive for COVID-19. The plant, he feared, was becoming a coronavirus “hot spot."

The town's medical clinics were also reporting a rapid increase in cases among JBS workers. The next day, Dr. Rebecca Steinke, a family medicine doctor at one of the clinics, wrote to the department's director: “Our message is really that JBS should shut down for 2 weeks and have a solid screening plan before re-opening."

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Doctor Who Treated Immigrant Children Reported Serious Problems In Shelters

Doctor Who Treated Immigrant Children Reported Serious Problems In Shelters

Inside a weathered green group home in southern New Jersey, Yosary grew weaker and weaker. She felt tired all the time, and when she got out of bed in the morning, she sometimes became so dizzy she needed to lie back down. Bruises started appearing all over her body. She craved ice, chewing cups of it whenever she could.

For months, the slender 15-year-old, who’d fled Honduras with her 2-year-old son, had been reporting her symptoms to the shelter’s staff. But they dismissed her pleas for help, she said: She was dizzy because she’d just stood up too fast. Her bruises? She probably bumped into something and didn’t remember. Chewing ice was a bad habit she needed to break.

By the time someone finally took her to one of the shelter’s pediatricians last summer, Yosary was in such bad shape she had to be hooked up to an IV at a local hospital. The pediatrician, Elana Levites-Agababa, recognized the telltale signs of severe anemia, which, untreated, could have resulted in heart failure and damage to other organs. The staff should have known — the teen’s history of anemia was documented in the shelter’s records.

“I was devastated by the care she got,” Levites-Agababa said. “Her hospitalization could likely have been prevented if she had been brought in when she first started raising concerns that she needed to see a doctor.”

For Levites-Agababa, a pediatrician for CAMcare, it was another alarming lapse. For months, she’d been noticing a lax attitude about the medical needs of children at the federally funded immigrant youth shelters run by the Center for Family Services, a nonprofit based in Camden, New Jersey. So, she decided to review the charts of the 90 CFS patients the community health center had seen.

Children, including infants, were showing up as many as 10 weeks late for their booster vaccines, increasing their risk of contracting infectious diseases, she said. There were an unusual number of no-shows and cancellations, even though nearly all the health center’s clinics are within a half-hour of the shelters. And the shelters routinely failed to schedule the prescribed follow-up appointments after emergency room visits, psychiatric admissions and hospitalizations.

She reported her findings to CAMcare, which had been hired by CFS to provide medical care for its immigrant youth, many of whom crossed the U.S.-Mexico border, seeking asylum. But as months passed and the situation didn’t improve, Levites-Agababa escalated her concerns, filing complaints earlier this year with the federal Office of Refugee Resettlement and authorities in New Jersey, which separately regulate the shelters.

While she awaited a response, Levites-Agababa said the medical office received a troubling new request: CFS wanted doctors’ approval to physically restrain kids in its care.

“They feel no obligation to provide appropriate care to the kids or follow any recommendations by a medical provider,” said Levites-Agababa, who has worked at CAMcare since 2015. “And that’s demonstrated over and over again to the point where it interferes with our ability to practice medicine.”

CFS denied wrongdoing but declined to answer specific questions.

“The program’s main objective is the safety and wellbeing of all of the children under our care,” Eileen Henderson, the chief operating officer, said in an email. “CFS continues to work with the Office of Refugee Resettlement and our medical providers to ensure that the children receive proper medical treatment in accordance with our directives from ORR.”

The care of immigrant children in U.S. custody has faced intense scrutiny over the past year as thousands of sexual abuse allegations and reports of personal enrichment by some nonprofit operators have raised questions about the federal government’s ability to monitor its network of about 100 shelters.

Now, a surge of families and unaccompanied children at the border is testing the system as never before. The U.S. Department of Health and Human Services was already scrambling to find new places to house immigrant kids after policies by the administration of President Donald Trump resulted in more children being housed for longer periods. Trump’s recent ousting of his top immigration officials is expected to herald even harsher policies — and possibly a ramped-up effort to separate children from their families.

There were 13,500 children in shelters as of the end of February, more than five times as many as there were two years ago. On Wednesday, Trump requested congressional funding to nearly double the number of beds.

The medical care for these new arrivals became a focus in December, when two ill children died in Customs and Border Protection custody near the border. But unlike those children, Yosary, who asked that only her first name be used, developed her symptoms long after crossing the border. She and the other children Levites-Agababa saw were in a place that was supposed to be safe, staffed by youth care workers trained to recognize medical symptoms and overseen by federal and state agencies responsible for health and social services.

ORR declined a request to interview its medical staff. The agency said that after investigating Levites-Agababa’s complaint, it temporarily suspended CFS from receiving new kids until problems were addressed. But it didn’t say when the suspension happened, how long it lasted or what CFS did to fix the problems.

ORR also wouldn’t say how many complaints about medical care it has received but said that “physicians and nurses who have medical-related concerns often reach out” to staff to discuss and resolve them.

The lapses documented by Levites-Agababa raise critical questions about the patchwork of state regulations that ORR relies on to monitor the shelters, which range from tiny group homes to 2,000-bed facilities and are often tucked in small towns and remote locations. On Tuesday, a 16-year-old boy died shortly after arriving at an ORR shelter in Texas.

Levites-Agababa’s concerns were recently substantiated by New Jersey regulators, who found numerous failures in CFS’ care of immigrant children. But despite the violations, the state agency lacks the ability to fine the shelter operator or remove kids from its care.

Levites-Agababa said she fears she could be fired for speaking out but agreed to go public in hopes of drawing attention to the care of children in the shelters.

CAMcare did not return calls for comment.

With access to children’s health records strictly limited, it’s hard to tell if the problems Levites-Agababa reported are isolated or emblematic of more widespread issues. A review last year of the Yolo County Juvenile Detention Facility in California found similar problems with immigrant teens’ access to medical care, including a failure “to follow up on serious injuries” and long waits for urgent medical needs.

Concerns over such lapses have prompted the HHS inspector general to conduct a nationwide review of the medical and mental health care provided in the youth shelters.

The American Academy of Pediatrics has expressed serious concern about the mental health consequences of detaining children, noting that even short periods can cause psychological trauma and carry lifelong consequences. But its policy statement doesn’t mention the ORR shelters, which were designed as community-based alternatives to detention but are now holding children for longer amounts of time.

Levites-Agababa said her experience has led her to believe that pediatricians should take a firmer stand. She compared it to when doctors started refusing to participate in lethal injections, deciding that their role in relieving suffering was outweighed by the harm of aiding execution. Levites-Agababa said she similarly believes that providing medical care to immigrant kids does not outweigh the traumatic effects of being held in a shelter.

“They are using us as a medical rubber stamp to keep these kids detained,” she said. “And by us participating in this without objection, we’re allowing for the detention of thousands and thousands of kids to continue.”

Who monitors the care of immigrant children in shelters — and how vigilantly they do it — depends a lot on where the children end up.

All shelters must follow ORR rules, but the agency leans heavily on the states to license the facilities and ensure the children’s safety. And that has resulted in a haphazard set of standards.

In Texas, the shelters are considered residential child care centers and must follow stringent regulations set by child welfare officials. In Arizona, the shelters are deemed behavioral health facilities, with a more limited set of rules that hinder state inspections.

In New Jersey, child welfare officials, who normally oversee facilities with children, are prevented by statute from inspecting the immigrant youth shelters because they’re not funded by the state, said Tammori Petty, spokeswoman for the New Jersey Department of Community Affairs.

Instead, the ORR facilities are licensed as emergency homeless shelters and inspected by the department’s Bureau of Rooming and Boarding House Standards. The rules permit children to live in the shelters as long as they’re part of a family. In the case of immigrant children, Petty said, the department decided that ORR qualifies because it provides custodial care to the children.

The bureaucratic restriction makes for an interesting juxtaposition. CFS’ immigrant youth shelters — which can’t be overseen by child welfare — are known as the Juntos program, the Spanish word for “together.” In contrast, the center’s crisis program for American teens, simply called the Together shelter, is regulated by the state’s child welfare agency.

“I’m concerned about the lack of state oversight, that these shelters are not being licensed by any state agency that looks into child care,” said Farrin Anello, senior staff attorney with the American Civil Liberties Union of New Jersey.

Under a federal court settlement, the shelters are required to provide routine medical care and emergency services, including a medical exam, immunizations and screening for infectious diseases within 48 hours of admission.

ORR’s guidelines further require shelter workers to observe children for signs of illness and to respond to nonemergency requests for medical attention within 24 to 48 hours. The shelters must notify ORR within four hours of an emergency room visit, review hospital discharge plans and follow doctors’ treatment recommendations.

But while ORR has the power to remove kids from shelters and cut off funding, it’s also desperate for beds, and any major reduction in capacity could create a crisis. Those conflicting priorities are why child advocates say state oversight is important.

The care delivered by the shelters has become more critical as their role has evolved. Originally, the shelters were viewed as short-term way stations where children would stay while the government located and vetted relatives who could care for them while their asylum cases were reviewed. But under the Trump administration, the average stay grew to three months last fall.

The New Jersey shelters have largely existed in obscurity even as last summer’s family separation crisis cast a spotlight on the government’s network of facilities, which have received $5 billion since rising numbers of unaccompanied minors started arriving in 2014.

CFS, which has provided social services in Camden and southern New Jersey for nearly 100 years, opened its first shelter for unaccompanied minors in 2017. It has since received nearly $11 million in federal funds. One group home behind a church in Burlington houses 20 kids ages 13 and 17. Another in Woodbury is designated for up to 10 teen mothers who cross the border with their children. The program was recently approved to open a third shelter near Atlantic City later this year.

A review of inspection records shows that before Levites-Agababa’s complaint, the Bureau of Rooming and Boarding House Standards had cited the shelters for relatively minor violations: a loose toilet, a shower fixture that needed repair, a reminder to conduct monthly fire drills. Once last fall, it cited CFS for operating its Burlington shelter with an expired licensed and fire certificate. But the Department of Community Affairs later said the bureau simply hadn’t mailed the new license in time for the inspection.

New Jersey’s regulations for emergency homeless shelters contain little in regard to child welfare. The shelters must provide three meals a day, refer residents to medical care, report child abuse to the Department of Children and Families and have an undefined “sufficient number of competent staff” on-site to supervise the premises.

Police reports obtained by ProPublica show a few incidents that would typically draw additional scrutiny from regulators. In November, a 16-year-old boy ran away from the Burlington shelter. And last April, police responded to a report that a male staff member had made inappropriate comments and touched a girl while conducting an assessment in a closed office.

In other states, similar incidents have resulted in citations for failure to maintain supervision and proper boundaries around children. But the New Jersey inspection reports don’t mention any of these incidents.

Nor did the inspections address any medical issues. Department of Community Affairs officials insist they never received Levites-Agababa’s complaint. But after a referral of medical neglect by the Department of Children and Families, where Levites-Agababa had also complained, and several calls from ProPublica, an inspector visited the shelter in late March and found a number of violations.

CFS had failed to ensure that staff were properly trained to monitor changes in residents’ behavior, the inspector concluded. It had failed to ensure that staff understood how to handle emergencies. It had failed to arrange medical care after a resident developed a condition that required attention. It had failed to investigate and maintain records of incidents involving child endangerment. And it had failed to report child abuse and mistreatment to the state’s child welfare agency.

The “facility must exercise care in handling and documenting emergencies, including referring residents for medical care or other emergency services and maintaining records of any special medical needs or conditions, the prescribed regimen to be followed and the name and phone numbers of medical doctors to contact” in an emergency, the report said.

The Department of Community Affairs later said CFS had in fact submitted the child abuse report, attributing it to a paperwork mix-up at the bureau.

Still, while the bureau has OK’d CFS’ plan to fix the violations, it doesn’t have many other options. The only enforcement tool the bureau has at its disposal is to revoke the shelters’ licenses, which it has no plans to do.

The consequence of that? Instead of being regulated as homeless shelters, the facilities would be regulated as hotels according to New Jersey law. Under the state’s hotel statute, there are no rules regarding the care of children.

After arriving at Cooper University Hospital in Camden, Yosary received the first of what would be several iron infusions. Lying in the hospital bed, separated from her toddler and far from other family members who’d fled with her from Honduras, Yosary thought of her mother, who died of cancer when Yosary was very young.

“I was really scared,” she recalled. “I was thinking, I don’t want to die.”

Yosary had come to the United States last March to seek asylum. In Honduras, she said, she had been raped when she was 12 and became pregnant with her son. After the family reported the attack, she said, they began receiving a series of threats. The lines between the local gang and the police and military in her city seemed increasingly blurry.

As the child got older, Yosary said, her attacker started lingering near her house, and she feared her son would be kidnapped.

So Yosary decided to flee with several members of her family, carrying her toddler by foot, by truck and finally by inflatable raft across the Rio Grande. After finding Border Patrol agents, she was taken to a processing station, where she was separated from the rest of her family and sent with her son to CFS’ mother-and-children’s home in New Jersey.

The first few months she felt fine, she said. But by late spring, she started feeling dizzy and sleepy all the time, and she noticed the bruises popping up on her legs and arms.

“I told them several times,” she said. “But they wouldn’t take me seriously.”

Yosary began to feel trapped inside the shelter. There were only three other girls with their babies there, she said. And they were rarely allowed out of the home even to get fresh air. Her only connections to the outside world were two brief calls a week with family members in the same precarious immigration situation.

Finally, there was a meeting at the home that included outside staff members. Yosary told one of them about the bruises.

But even in the doctor’s office and hospital, Yosary said, CFS staff wouldn’t let her talk to the doctor alone. “There was always somebody with me,” she said.

Levites-Agababa said this was a recurring problem with patients in the program, and she worried that it might make kids afraid to be forthcoming about their care in the shelter.

“When I insisted that chaperones leave the exam room so I could talk to the kid alone, they refused to leave and insisted it was policy,” she said.

After a few days, Yosary was discharged from the hospital with instructions to get another IV treatment. But CFS failed to inform CAMcare about the treatment, according to Levites-Agababa’s complaint.

The failure to schedule follow-up visits and heed doctors’ recommendations to see specialists or get lab tests or radiological studies became routine, said Levites-Agababa, who confronted CFS staff over the lapses.

At first, she said, shelter staff told her that ORR wouldn’t approve them, but she later learned that CFS hadn’t even submitted some of the orders.

A nurse at CAMcare, who asked not be identified, echoed Levites-Agababa’s concerns. “There were many appointments I had that got declined or they no-showed,” the nurse said. Another CAMcare doctor said that she was aware of the issues but didn’t have enough information to speak about them.

In some cases, Levites-Agababa said, the mothers of the babies actually had vaccination records from their home countries, but shelter staff failed to bring the paperwork to the initial medical exam.

“The poor teenage mom has painstakingly traveled through numerous countries and protected [the vaccination record] to bring it with the kid,” she said, “and they don’t even bring it to the visit?”

Yosary, who has since settled in Alabama with her older sister, said she couldn’t forget her five months in the shelter and wanted to speak up to help other girls there.

“I hope they don’t have to go through what I went through,” she said, her curly-headed toddler resting against her, “because being locked in that place, it was horrible.”

Even now, she said, she is reminded of the lack of concern about her well-being. According to ORR’s rules, upon release, shelters are supposed to give unaccompanied minors a copy of their medical records.

Yosary’s sister, who didn’t want her name used to protect the family, took out a thick manila envelope containing the records for Yosary and her son. While some pages are printed clearly, page after page are illegible.

“They told me these are the papers from the school, from the hospital, from everything,” Yosary said. But the printer had apparently run out of ink. “You couldn’t even read it,” she said. “One of the papers even looked blank.”

Back in New Jersey, Levites-Agababa said she worries about “what’s happening systemically throughout the United States in all these countless other homes” and whether other doctors will be emboldened to complain. “I just don’t know who else could raise this concern to the public or to ORR.”

Yosary and her sister said they’re glad Levites-Agababa decided to speak up.

“Nobody from the shelter is going to report anything,” said Yosary’s sister, who also stayed in a federal youth shelter when she arrived.

“I wouldn’t have done it because I’m an immigrant here,” Yosary said.

“And,” her sister added, “she doesn’t know the rules or the laws.”

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

IMAGE: Photo of immigrant child by Tim Brown via Flickr.

TSA Reveals Passenger Complaints…Four Years Later

by Michael Grabell,ProPublica.

From intrusive pat-downs to body scans to perceived profiling, the Transportation Security Administration always seems to be the target of complaints.

Here’s another one: It took the TSA almost four years to tell me what people complained about — in 2008.

In my first week at ProPublica in June 2008, I filed a public records request for the agency’s complaint files. Such records can provide good fodder for investigations.

For example, amid the brouhaha over the agency’s introduction of intensive full-body pat-downs in 2004, I requested complaints and discovered an untold story of the pain and humiliation suffered by rape victims and breast cancer survivors. In one incident that I found from that request — while I was a reporter at the Dallas Morning News — a woman complained that a screener asked her to remove her prosthetic breast to be swabbed for explosives.

When I made a similar FOIA request in 2008, I assumed the TSA would respond in a few months. Government agencies have about a month to respond to public record requests, though they often take longer. I figured even if their response took months, I’d be able to repeat it regularly to get a timely, inside look as to what passengers were complaining about and find out about incidents that required some more digging.

Boy, was I wrong.

After waiting and waiting and narrowing my request and some more waiting, the files finally arrived this week.

The information is now four years old — but it echoes much of what people are still complaining about.

For instance, an elderly woman in a wheelchair was asked to walk through security and fell at Orlando International Airport.

In another case, someone expressed concerns about a lethal plastic knife that can reportedly pass through metal detectors. (This was two years before the TSA widely deployed body scanners, which can detect plastic.)

In another complaint, a man flying to Cancun demanded an investigation after finding that the bottle of Jack Daniels he packed in his luggage was empty by the time he arrived.

Rather than let the files gather dust at the bottom of my desk drawer, I’m posting them for your perusal.

Why did the files take so long to release? Various FOIA officers over the years blamed the delay on the agency’s backlog and on the volume of the records that had to be reviewed. It turned out to be 87 pages.

When I reached out again today to the TSA, spokeswoman Lorie Dankers provided a statement pointing out that the agency has received an average of more than 800 requests annually over the past four years. Then the TSA apologized.

“TSA should have responded to ProPublica’s request sooner,” the statement said. “TSA currently is working on 12 requests that are more than three years old. The agency is working diligently to finalize and respond to these requests.”

I just filed my request for the 2012 complaints.

Hopefully, we won’t have to wait until 2016 to see those.


How The Stimulus Revived The Electric Car

by Michael Grabell, ProPublica.

This story was adapted from “Money Well Spent?: The Truth Behind the Trillion-Dollar Stimulus, the Biggest Economic Recovery Plan in History,” which will be published Tuesday by PublicAffairs.


A common criticism of President Obama’s $800 billion stimulus package has been that it failed to produce anything 2013 that while the New Deal built bridges and dams, all the stimulus did was fill some potholes and create temporary jobs.

Don’t tell that to Annette Herrera. She was 50 when the auto supplier she worked for in Westland, Mich., closed its factory and moved the work to Mexico. Then, after being unemployed for 2½ years, she got a job in October 2010 with A123 Systems, which had received $250 million in stimulus money to help open a new lithium-ion battery plant in nearby Romulus, Mich.

“The first thing I did was call my husband and tell him, ‘You’re never going to guess! I got a job!'” Herrera recalled. “And then it was like celebration time.”

One success the Obama administration can duly claim is the rebirth of the electric-car industry in the United States. Automakers have unveiled a number of mass-market electric cars, which have seen small but rising sales. Battery and parts manufacturers are building 30 factories, creating thousands of new jobs. A123 has hired 700 workers at Herrera’s plant and a second one in nearby Livonia, and plans to hire a couple thousand more people over the next few years.

If it wasn’t for the stimulus, the companies say, they would have built these plants overseas.

It was all part of an effort to promote “green” manufacturing and put a million electric cars on the road by 2015.

The question is: Will it last?

Elkhart, Ind., once believed it would. It saw electric vehicles as its salvation after watching its unemployment rate hit 20 percent. Eager to seed a new industry, the county witnessed electric-vehicle ventures sprout out of nowhere as the stimulus took off in 2009.

But by late summer 2011, what had sprouted were weeds. The parking lot of the Think electric-car plant was full of them, some more than a foot high growing from the cracks. Out front were two pickups and a motorcycle.

Hundreds of laid-off factory workers were supposed to have found jobs churning out the Norwegian company’s bug-like, plastic-bodied cars, which ran solely on electricity.

Today the Elkhart factory employs two. Its parent company filed for bankruptcy in June. Its largest shareholder and battery maker, Ener1, which received $118 million in stimulus money, did the same last week.

A second life

Electric cars began appearing on California roads in the mid-1990s after state regulators mandated that a certain percentage of automakers’ fleets include zero-emissions vehicles.

But within a few years, they were deemed a failure by car companies, which stopped making them and took back those they had leased.

Much had changed in the eight years leading up the stimulus package. The lead-acid and nickel-metal hydride batteries that weighed as much as 1,200 pounds were replaced with lithium-ion batteries that weighed as little as 400 pounds.

In the early 2000s, gas hadn’t even passed $2 a gallon. Less than a decade later, it was twice that. Toyota had proven the demand with its long waiting list for the Prius hybrid.

Government policy had changed, too, with a 2007 energy bill that increased fuel-efficiency standards and provided $25 billion in loans for automakers to upgrade their plants.

But until the economic stimulus package was passed in 2009, the manufacture of electric cars and their batteries in the United States was nearly nonexistent.

The United States had only two factories manufacturing less than 2 percent of the world’s advanced batteries. Most were made in Korea and Japan. In America, only Tesla manufactured an electric car 2014 which sold for a cool $100,000. Across the entire country, there were a mere 500 electric charging stations.

But as the stimulus kicked in, there was suddenly no better environment for the electric car to thrive.

With more than $2 billion in federal grants, matched by another $2 billion in private investment, the Obama administration was supporting electric cars from the mine to the garage.

Chemetall Foote Corp., which operates the only U.S. lithium mine, received $28 million to boost production at its plants in Nevada and North Carolina. Honeywell received $27 million to become the first domestic supplier of a conductive salt for lithium batteries. More than $1 billion was spent to open and expand battery factories, many of them in hard-luck towns across Michigan. Through a separate federal program, automakers received loans to retool their assembly lines.

Customers could receive a $7,500 tax credit for buying an electric car. The stimulus provided funding for 20,000 electric charging stations by 2013. In many cities, drivers could get a home charger for free.

Although electric cars would not make up for the generation-long loss of manufacturing jobs, at least not yet, it was novel to see companies creating jobs in the Rust Belt instead of outsourcing them.

In July, Johnson Controls opened the first U.S. factory to produce complete lithium-ion battery cells for electric vehicles. Compact Power is building a $300 million factory in Holland, Mich., to produce batteries for the Chevy Volt and the electric Ford Focus. A123 now supplies the luxury electric carmaker Fisker Automotive and the manufacturers of electric delivery trucks used by FedEx and Frito-Lay.”Quite simply, if we didn’t get that grant, we wouldn’t have built [the factory] in the U.S.,” A123 spokesman Dan Borgasano said.

The battery grants have created and saved more than 1,800 jobs for assembly workers, toolmakers and engineers, according to a ProPublica analysis of stimulus project reports filed by the companies. That number doesn’t include the workers who constructed the plants or those hired by the matching private investment the companies had to make to get the grants.

Killed again?

The problem: Consumers have been slow to embrace the electric car.

The price of the battery is still too high, and the price of gas is still too low, the Government Accountability Office warned in June 2009 before the grants were awarded. The starting price for the all-electric Nissan Leaf is $33,000, while the hybrid Volt sells for about $40,000 before tax credits 2014 far more than many middle-class families can afford.

About 40 percent of drivers didn’t have access to an outlet where they park their vehicles, the GAO noted.

“Although a mile driven on electricity is cheaper than one driven on gasoline,” the National Research Council reported, “it will likely take several decades before the upfront costs decline enough to be offset by lifetime fuel savings.”

Perhaps the biggest obstacle, though, was what the automobile represents in the American psyche: the freedom of the open road. While most people drive less than 40 miles per day, consumers want cars that they can also take on summer vacations 2014 and they don’t want to have to constantly worry about looking for a charging station.

The Leaf’s range is just 73 miles, according to the official government rating, well below the much-advertised 100 miles.

By the end of 2011, fewer than 18,000 Leafs and Volts had been sold in the United States.

A report by congressional researchers last year concluded that the cost of batteries, anxiety over mileage range and more efficient internal combustion engines could make it difficult to achieve Obama’s goal of a million electric vehicles by 2015. Even many in the industry say the
target is unreachable.

While the $2.4 billion in stimulus money has increased battery manufacturing, the congressional report noted that United States might not be able to keep up in the long run. South Korea and China have announced plans to invest more than five times that amount over the next decade. Even A123 had to lay off 125 workers in November 2014 though Borgasano says the company plans to rehire them all by June 2014 because Fisker reduced orders.

Dick Moore, the mayor of Elkhart, had hoped the area known for its recreational-vehicle factories would one day be not just the “RV Capital of the World” but the “EV Capital of the World” as well.

Navistar International had received $39 million in stimulus money to build 400 electric delivery trucks in the first year. But by early 2011, it had hired about 40 employees and assembled only 78 vehicles.

Think had rallied into 2011 with plans to start production in Elkhart earlier than expected. But in April, assembly work suddenly stopped as the plant awaited parts from Europe.

In June, Think’s parent company filed for bankruptcy. The decision left the Elkhart plant slouching toward extinction until the American subsidiary was purchased by a Russian entrepreneur who promised to restart production in early 2012.

But on Thursday, its battery maker, Ener1, also filed for Chapter 11 bankruptcy, reporting that the demand for electric vehicles “did not develop as quickly as anticipated.”

Elkhart’s dream of becoming the EV capital?

Moore put it this way: “The fact that this hasn’t moved very quickly, that doesn’t bode well for that idea.”

The future

The fate of the electric car depends greatly on whether sales take off soon.

There are other factors, such as the price of gas and whether Congress approves proposed standards requiring automakers to raise the average fuel economy of their vehicles to 55 miles per gallon by 2025.

The electric car has always struggled with a chicken-and-egg dilemma: Automakers have been reluctant to build electric cars without consumer demand. But consumers won’t buy them until automakers develop cheaper, longer-range batteries.

One of the goals of the ongoing stimulus spending is to solve this problem. By 2015, the 30 battery and component factories will be able to produce 40 percent of the world’s batteries, according to the administration.

The investments would help manufacturers increase the batteries’ life from four years to 14 and cut their cost from $33,000 to $10,000, the administration said in a report on innovation. That would make the electric car more competitive.

Herrera noted that many people at the A123 factory believe they will never be able to afford the cars powered by the batteries they make. But, she says, “you never know.”

“When the flat-screen TVs first came out, they were way expensive, and now they’re reasonably priced,” she said. “I think that’s going to be the same thing with electric automobiles. This is a new product. It’s going to take time.”