ProPublica

by Daniel Victor

Here are some of this year's top must-read stories from #MuckReads, ProPublica's ongoing collection of the best watchdog journalism.

This is far from an exhaustive list of the year's best work. Please contribute more suggestions in the comments section here, on Twitter with the #MuckReads2011 hashtag (see more worthy submissions here), or by sending an email to MuckReads@ProPublica.org. We'll continue to add links to the story.

Highlights of AP's probe into NYPD intelligence operations, Associated Press
"Mosque crawlers" who monitor sermons and "rakers" who embed themselves into minority neighborhoods are among the tactics the New York Police Department has used since 9/11. It was done with the assistance of the CIA, which is prohibited from spying on Americans.
Contributed by @srubenfeld

A little house of secrets on the Great Plains, Reuters
A 1,700-square-foot house with a manicured lawn in Wyoming is home to more than 2,000 companies, at least according to their registration addresses. It's a little taste of the Cayman Islands here in the U.S., as a business uses the home to establish shell companies, or on-paper-only companies able to hide assets.
Contributed by @claudiaparsons

Deadly Force: When Las Vegas police shoot, and kill, Las Vegas Review-Journal
Analyzing each police shooting in the region since 1990, the Review-Journal found "an insular department that is slow to weed out problem cops and is slower still to adopt policies and procedures that protect both its own officers and the citizens they serve."
Contributed by @blasky

Jerry Sandusky, former Penn State football staffer, subject of grand jury investigation, The Patriot-News
Back in March, long before the abuse scandal led to the downfall of a legendary coach and the school's president, The Patriot-News broke the story of an ongoing grand jury investigation. It didn't register on the national radar until charges were filed against Sandusky in November, and even the in-state media did little to follow on the initial report. But the story ended up being the first indicator of major trouble in Pennsylvania.
Contributed by @bydanielvictor

The Shame of College Sports, The Atlantic
Written well before the Penn State scandal brought new definition to "college sports scandals," The Atlantic detailed how the flawed structure of the National Collegiate Athletic Association lends itself to corruption.
Contributed by @dafnalinzer

Japan Held Nuclear Data, Leaving Evacuees in Peril, New York Times
Believing the winds to be blowing south and carrying radioactive air away from them, the residents of one Japanese town headed north. But the wind was actually blowing straight toward their path, a fact the government knew but didn't publicize. It was part of "a culture that sought to avoid responsibility, and, above all, criticism."

Terrorists for the FBI, Mother Jones
Almost all of the high-profile domestic terror plots of the last decade were actually FBI stings. The story details "how informants are recruited and used and how and why agents are pursuing these aggressive sting operations."

How the world failed Haiti, Rolling Stone
The money that was raised hasn't been spent. The buildings that were pledged haven't been built. American and international officials said they would be "Building Back Better," mountains of rubble remain in the streets, and some three million people "languish in permanent misery" in Port-au-Prince.
Contributed by @pgmila

A vicious cycle in the used-car business, Los Angeles Times
About one in four buyers default at Buy Here, Pay Here used-car lots, of which there are 33,000 across the nation. That'd be trouble in most other industries, but it's another profit generator when the cars are repossessed and sold anew. The victims tend to be those saddled with debt in low-paying jobs, who need cars to get to work.
Contributed by @awaxman

These stories and many more can be found at ProPublica. You can also subscribe to a daily #MuckReads email or follow ProPublica on Twitter. Reader submissions are key to making #MuckReads a success -- please contribute!

UPDATE:

As we continue to get worthy reader submissions, we'll add more here.

Marines promoted inflated story for Medal of Honor recipient, McClatchy
The story was honorable enough, as seven witnesses attested to great bravery "in the face of almost certain death." But crucial parts of a Medal of Honor nominee's story, as publicized by the Marine Corps and described by Barack Obama, were untrue, ubsubstantiated or exaggerated.  
Contributed by @ProPubPR

by Abrahm Lustgarten

This is part of our year-end series, looking at where things stand in each of our major investigations.

This was the year that "fracking" became a household word.

It wasn't just that environmental concerns about the underground drilling process finally struck a mainstream chord -- after three years of reporting and more than 125 stories. For the first time, independent scientific investigations linked the drilling technique with water pollution, and a variety of federal and state agencies responded to the growing apprehension about water contamination with more studies and more regulation.

The most important development -- and perhaps a crucial turning point -- was in December. In a landmark finding, the Environmental Protection Agency concluded that hydraulic fracturing was the likely culprit in a spate of groundwater contamination that had forced residents to stop using their water in dozens of homes in central Wyoming. The agency had been investigating since 2008.

Earlier in the year, a study published through the National Academy of Sciences determined that in Pennsylvania, private water wells in close proximity to fracked gas wells were 17 times more likely to be contaminated with methane gas.

Those studies are separate from a national research project the EPA has undertaken to assess the risks fracking poses to water resources. The agency is examining five case studies across the country and is now estimating that some of its report will be complete by the original 2012 deadline and the rest will continue into 2014.

The study is meant to help Congress and regulators determine whether fracking should be regulated like other similar processes under the Safe Drinking Water Act and whether companies that frack should be forced to disclose the details about the chemicals they use.

Last winter, the Obama administration -- which has repeatedly referred to natural gas as a bridge fuel and encouraged its development -- urged the Department of Energy to conduct its own assessment of fracking's safety on a quicker timeline than the EPA.

In a matter of months, a DOE panel determined that the environmental risks were substantial and needed to be addressed in order to safely develop more natural gas resources. The panel raised concerns that pollution could have serious health consequences for those who live close to drilling operations.

Indeed, a report published by ProPublica in September found that residents in drilling areas across the country complained of serious health symptoms ranging from skin lesions to tumors, and that health and science organizations had yet to develop any comprehensive system for studying such problems.

While water pollution is one concern, many of the health effects reported are believed to be related to air pollution and emissions released in the natural gas development and drilling process.

Earlier in the year, a ProPublica investigation found that the EPA had grossly underestimated the amount of methane that seeps out of pipelines and drill rigs as gas is produced, and reported that the agency was doubling its calculations. Our analysis of the new emissions levels showed that they threaten to offset the relative advantages presented by cleaner-burning natural gas over oil and carbon in combating climate change and reducing carbon emissions.

In some cases, government officials didn't just debate fracking and call for additional study. They enacted real changes in how drilling is overseen.

The EPA announced that the drilling industry would have to comply with tough new industrial emissions standards. Then it said that it would issue new rules governing how wastewater from fracking is disposed of; this addressed concerns first raised by ProPublica in 2009 that in eastern drilling areas, which cannot inject waste into underground wells the way the industry does in the west, chemical-laden waste is winding up in river systems, and then drinking water. In December, Colorado implemented the toughest law yet requiring comprehensive disclosure of frack fluids, following similar but weaker laws in Texas and Wyoming.

This was also the year fracking went global. While France banned fracking outright and South Africa enacted a temporary moratorium, multi-national energy companies began exploring shale reserves in Poland, Argentina and China.

Closer to home, New York state officials continued to inch closer to allowing drilling to take place in the coveted Marcellus Shale. After a multi-year process and its own temporary moratorium on some fracking activity, New York finished up the latest version of its environmental review and has signaled that it intends to begin permitting more drilling early next year.

According to the state's environmental assessment, no fracking will be allowed on state lands, and the process will be severely limited within the New York City watershed.

Still, the state's chief environmental regulator, Joe Martens, told ProPublica he is confident the drilling can proceed safely, and that he does not expect there will be much to learn from the EPA's research into the issue. New York's draft plan is in its final stage of public review, and is expected to be completed on Jan. 11, 2012.

Staff reporter Nicholas Kusnetz contributed to this report.

by Nicholas Kusnetz

Early last year, deep in the forests of northern British Columbia, workers for Apache Corp. performed what the company proclaimed was the biggest hydraulic fracturing operation ever.

The project used 259 million gallons of water and 50,000 tons of sand to frack 16 gas wells side by side. It was "nearly four times larger than any project of its nature in North America," Apache boasted.

The record didn't stand for long. By the end of the year, Apache and its partner, Encana, topped it by half at a neighboring site.

As furious debate over fracking continues in the United States, it is instructive to look at how a similar gas boom is unfolding for our neighbor to the north.

To a large extent, the same themes have emerged as Canada struggles to balance the economic benefits drilling has brought with the reports of water contamination and air pollution that have accompanied them.

The Canadian boom has differed in one regard: The western provinces' exuberant embrace of large-scale fracking offers a vision of what could happen elsewhere if governments clear away at least some of the regulatory hurdles to growth.

Even as some officials have questioned the wisdom of doing so, Alberta and British Columbia have dueled to draw investment by offering financial incentives and loosening rules. The result has been some of the most intensive drilling anywhere.

"There definitely is concern on the part of people living in northeast B.C. on the scale of developments, which are quite significant already and are only in their infancy,"said Ben Parfitt, an analyst with the Canadian Centre for Policy Alternatives, a research institute that promotes environmental sustainability. "We are seeing some of the largest fracking operations anywhere on earth."

Canada's eastern regions have proceeded more cautiously. In March, Quebec placed a moratorium on shale development pending further study. Protesters have taken to the streets in New Brunswick demanding the same.

Public opposition, coupled with low gas prices, has slowed drilling over the past year. Still, the Canadian Association of Petroleum Producers expects production from shale and other unconventional sources to more than triple in the next decade.

The industry's aggressive plan for growth has drawn an ambivalent response from the nation's top environmental officials.

In March, Canada's deputy minister of the environment sent an internal memo warning that more work was needed to assess the risks from shale gas drilling. The memo, obtained by an Ottawa-based newspaper and addressed to Environment Minister Peter Kent, said water use and contamination top a list of environmental concerns including air pollution, greenhouse gas emissions and the use of unknown toxic chemicals. Kent subsequently ordered two studies looking at the safety and environmental impacts of shale drilling.

Yet, in a written response to questions from ProPublica, the environment ministry affirmed its commitment to continued development.

"Our Government believes shale gas is an important strategic resource that could provide numerous economic benefits to Canada," the ministry's statement said. Gas is an important part of a clean energy future, the ministry added, saying that "a healthy environment and a strong economy go hand in hand."

B.C., Alberta Lure Drillers

Canada's current drilling boom dates to the late 1990s, when Encana began using fracking to extract gas from dense rock in northern British Columbia.

The second-largest gas driller in North America, Encana also started fracking shallow coal seams, or coalbed methane, in Alberta in the early 2000s, using nitrogen rather than water to free the gas. Coalbed methane drilling generally requires less fluid than fracking shale but occurs much closer to drinking water. In some cases, Encana and other companies have drilled wells directly into aquifers, injecting fracking fluids into groundwater suitable for drinking.

In the middle of the last decade, Encana and other operators started exploring northern British Columbia's shale gas reserves. The formations were promising, holding at least 200 trillion cubic feet of gas, according to industry estimates.

But drillers faced formidable hurdles to get to it. Unlike the Barnett and Marcellus shales in the U.S., Canada's best shale basins are far from most markets and existing infrastructure. Soggy ground slows drilling in the spring and summer, and the average high temperature hovers around zero degrees Fahrenheit in January.

To encourage development, British Columbia enacted a series of incentives, including reduced royalties for deep drilling and credits for building roads and pipelines in the remote regions.

These changes, combined with the area's severe conditions, spurred companies to concentrate and scale up their operations in British Columbia in an effort to cut costs, industry experts say. The result: a string of record-breaking fracks.

In a written response to questions from ProPublica, Apache said this approach reduces surface disturbance. It also can heighten the risk of air and water pollution, said Bruce Kramer, an expert in oil and gas law with McGinnis, Lochridge and Kilgore, a Texas-based law firm.

In both western provinces, the regional authorities responsible for regulating drilling have passed rules to allow more intensive drilling.

In Alberta, drillers can now pack wells closer together and pump more water out of shallow coal seams to free gas more efficiently. British Columbia issued detailed regulations last year that limit where and when companies can drill and set rigorous environmental standards but also gave its Oil and Gas Commission the authority to exempt drillers from virtually all of these provisions.

The commission referred an inquiry from ProPublica to its parent organization, the Ministry of Energy and Mines. In written responses to questions, the Ministry said the new regulations adequately address environmental concerns over drilling activity in the province. Pointing to an upcoming health study and new rules that compel companies to disclose chemicals used in fracking, officials said they would continue to review and revise standards as necessary.

Still, the regulatory shifts have prompted environmental advocates in Alberta and British Columbia to question whether officials are prepared to cope with rising concerns about water use, contamination and unchecked development.

"We just don't have a clue how big this issue is from a public policy perspective,"said Bob Simpson, a member of British Columbia's legislative assembly and an outspoken critic. "We really don't know what we're doing."

Jessica Ernst's Water Problems

Over the last five years, there have been several prominent cases in which Alberta residents have said gas drilling contaminated their water.

There are no hard numbers. The government does not track such complaints. But in some instances, residents' frustration has been exacerbated by their sense that regulators have not properly investigated their claims.

In 2005, Jessica Ernst noticed strange things happening to her water. The toilet fizzed. The faucets whistled. Black particles clogged her filter. Then she began getting rashes.

Ernst, a longtime environmental consultant for oil and gas companies, wondered whether the changes could be connected to drilling nearby. Encana had been drilling shallow coalbed methane wells near her home outside of Rosebud, about 50 miles northeast of Calgary.

She asked Alberta Environment and Water, the agency that oversees groundwater, to test her well. When the well was drilled in 1986, tests showed it had no methane. The new tests, however, showed high levels of the gas, as well as a hydrocarbon called F2 and two other chemicals.

But in 2007, a government research agency concluded it was unlikely that drilling had affected her water. The final report said the chemicals found were not typically used in coalbed methane drilling, and that one had probably come from a plastic tube used to test the water.

Ernst wasn't satisfied with the province's response, however. The government's report concluded that the methane in her well might be occurring naturally because tests showed similar levels of gas in nearby wells. But the tests were conducted after Ernst noticed the changes in her water -- she saw the results as an indication that the contamination might be more widespread.

The government's report also ignored evidence provided by one of its own analysts, a professor of geochemistry at the University of Alberta. When Karlis Muehlenbachs analyzed the gas in Ernst's well for Alberta Environment and Water, he found ethane, a gas often found with methane, with a chemical signature indicating that it had come from deep underground, below the depth of the well. Muehlenbachs told ProPublica that the ethane's signature meant that it could not have been there naturally. He said he is convinced that it resulted from drilling.

As Ernst searched for answers to what happened to her water, she unearthed evidence of other problems related to drilling. She found an Alberta Environment and Water report that listed cases in which the fracking of shallow wells resulted in gas or fluid leaking into nearby gas wells or spraying into the air. She also found government gas well records that said Encana had fracked into the aquifer that supplies her water well.

"The community was used as a test tube,"she said. "I was used as a test tube."

Earlier this year, Ernst sued Encana, Alberta Environment and Water and the Alberta Energy Resources Conservation Board, which regulates drilling, alleging that Encana's drilling was negligent and that the government agencies had covered up the company's contamination and failed to enforce regulations.

Ernst, who is asking for about $33 million Canadian in damages and return of wrongful profits, has vowed she will not accept a settlement that includes a confidentiality agreement, as others have done.

"Somebody has to do this,"she said.

Alan Boras, a spokesman for Encana, said the company would not comment on the case.

The Energy Resources Conservation Board denied a request for an interview. In written responses to questions, spokesman Bob Curran said he could not comment on the specifics of Ernst's case, but the agency is confident it has conducted itself appropriately.

Carrie Sancartier, a spokeswoman for Alberta Environment and Water, would not comment on Ernst's allegations because of the lawsuit but said there have been no confirmed cases of gas drilling contaminating water wells in the province.

Muehlenbachs, whose work has been used in several government investigations, said that is "simply false." He said he's analyzed thousands of cases of gas leaking up well bores and knows of at least a dozen cases of water contamination.

Alberta has introduced several measures to safeguard water from shallow drilling. In 2006, it established a buffer zone between shallow gas wells and water wells and required drillers to test nearby water wells before drilling into an aquifer.

Nevertheless, last January, as part of a review of drilling regulations, the Energy Resources Conservation Board said shallow fracking poses a risk to groundwater.

Is 'Communication' a Risk?

There have been no reports of groundwater contamination related to new drilling in British Columbia.

Increasingly, however, there are reports of something called "communication" -- events in which a fracture travels through the ground and connects two gas wells.

Ken Paulson, chief engineer at the province's Oil and Gas Commission, said these events do not pose a contamination risk. Other experts say their principal impact is to undermine production.

But opponents of expanded shale drilling say instances of communication show that drillers lack a full understanding of what happens when wells are fracked closer together, increasing the risk of contamination. Anthony Ingraffea, an engineering professor at Cornell University, said that if a fracture hit a natural fault, it could allow contaminants to enter aquifers.

Communication has occurred in the U.S. as well: Regulators in Texas, Oklahoma, Michigan and Pennsylvania reported such events to Canadian officials as part of the Energy Resources Conservation Board's regulatory review.

Documents provided to ProPublica show that energy companies have reported 25 cases of communication in British Columbia since 2009. Companies are not required to report such events, so the list isn't comprehensive, Paulson said.

In May 2010, the province's Oil and Gas Commission issued a warning when a drilling company inadvertently shot sand from one fracking job into another well being drilled more than 2,000 feet away.

The advisory said the operator contained the resulting jump in pressure within the well but warned of a "potential safety hazard." When communication occurs, Paulson said, the biggest concern is that an operator could lose control of a well and cause a blowout.

Concerns Over Water Consumption

As the debate over communication continues, Parfitt and other Canadian environmentalists have raised more immediate concerns about water use. Fracking requires lots of water -- on their biggest reported fracking job, Apache and Encana used an average of 28 million gallons of water per well.

While the oil and gas industry says it is responsible for 1 percent or less of British Columbia's overall water use, environmental advocates say that may not reflect the full extent of the industry's consumption or long-term needs.

Drillers use both surface and groundwater. Access to surface water is regulated by two agencies that issue long-term licenses or year-long permits. Overwhelmingly, energy companies have chosen to obtain permits, which require less regulatory review.

Most groundwater withdrawals aren't regulated at all. Drillers need permits to sink water wells, but there are no limits on the amount of water that can be taken from them. They can also purchase water from other well owners, so there's no way to track overall use.

"How much water is actually being used and, more importantly, how much water is projected to be used over next the 10 to 15 years? Because of the scattershot approach of regulation, this isn't something we can actually answer right now,"said Matt Horne, acting director of the climate change program at the Pembina Institute, an environmental think tank that published a report on the gas industry's water use.

Last year, in a report focusing on province-wide groundwater oversight, British Columbia's auditor general said the province was not adequately protecting aquifers from overuse and potential contamination. Agencies lacked the basic data necessary to assess the risks, such as the number and extent of the province's aquifers, the report said.

The Ministry of Energy and Mines, in a written response to questions, said the province is taking several steps to improve oversight of water use, including a research project studying aquifers. The agency said it can review large groundwater withdrawal projects and that pending changes to the province's water law would regulate withdrawals.

Drillers themselves are also moving to address water concerns. Encana and Apache have started using saline water not suitable for drinking or irrigation in some of their projects. Alan Boras, the Encana spokesman, said the company uses non-potable water almost exclusively in its main operating area in the Horn River Basin, where the largest frack jobs were reported.

Environmentalists say they welcome the effort, but caution that these projects are tiny compared to the industry's overall water use.

Governments, Industry Get Cozy

Public backlash to fracking has become such a concern for drillers and provincial governments in western Canada that last year they launched a joint effort to counter it.

In December 2010, the governments of British Columbia, Alberta and Saskatchewan signed a memorandum of understanding laying out a plan to share information and develop standards for hydraulic fracturing and water use. The provinces invited only one non-governmental entity to participate in the project: the Canadian Association of Petroleum Producers.

The memo, which was leaked in August and published by the Alberta Federation of Labour, a union group, said the provinces and petroleum producers would work together to develop "key messages" on shale drilling to persuade the public not to fear fracking.

"The project will help to demonstrate that shale gas extraction is viable, safe and environmentally sustainable," the memo said.

The memo blamed environmental groups for spreading misleading information and stirring opposition to drilling.

"Environmental Non-Government organizations (ENGOs) are supporting a ill-informed [sic] campaign on hydraulic fracturing and water related issues in British Columbia and in other jurisdictions," it said. "This is expected to grow as shale gas development expands into Alberta and Saskatchewan."

In a separate memo, Alberta Environment and Water reported that the Canadian Association of Petroleum Producers had approached the province to work on a joint public relations campaign.

Ultimately, no campaign materialized.

Janet Annesley, a spokeswoman for the Canadian Association of Petroleum Producers, said the group hadn't wanted to join forces on PR but was just informing the province of plans to publish voluntary standards for shale gas drilling.

Still, critics saw the memo as proof of an overly cozy relationship between the government and the industry.

Bart Johnson, a spokesman for Alberta's Energy Minister, said the petroleum producers had suggested a joint PR initiative but dropped the request. Such a collaboration, however, would not have been inappropriate, he said. The government works with industry groups all the time, he said, citing a campaign with education groups against bullying in schools.

"Oil and gas is huge in Alberta. It fuels our economy. Indeed it fuels the economy of Canada," Johnson said. "Any suggestion that we shouldn't meet with that industry is ridiculous."

by Michael Grabell

This is part of our year-end series, looking at where things stand in each of our major investigations.

It has become routine for airline passengers across the country: Instead of walking through a metal detector, they now step into a body scanner, hold their arms over their heads and wait until a machine peers through their clothing to make sure they're not hiding explosives.

The Transportation Security Administration has deployed more than 500 of the body scanners, which they call "advanced imaging technology." And the agency plans to install them at nearly every security lane by 2014.

The TSA has insisted that the new scanners present "no health or safety concerns for any passenger." The agency has said they have been used around the world. And it has reiterated that the machines were evaluated by the Food and Drug Administration, leading many to believe that one of the government's top safety regulators approved the technology.

But a ProPublica/PBS NewsHour investigation this year detailed how the TSA had glossed over cancer concerns about one kind of scanner that uses X-rays. In independent, peer-reviewed studies, radiation experts concluded that the X-ray scanner could cause six to 100 airline passengers each year to develop cancer. Outside the United States, few countries use X-ray imaging machines, also known as backscatters, in their airports. And the FDA has no authority to approve body scanners before they are sold because they are electronic products, not medical devices.

In 1998, an FDA advisory panel recommended a federal safety standard for the X-ray scanners. But the agency decided to go with a voluntary standard set by an industry group made up mostly of manufacturers and government agencies that wanted to use the machine.

In November, the European Union decided to prohibit X-ray body scanners in European airports. In the United States, members of Congress have pushed the TSA to conduct a new, independent safety review. And in Florida earlier this month, Broward County commissioners voted to demand the TSA prove that the X-ray imagers at Fort Lauderdale-Hollywood International Airport are safe.

The TSA uses two types of body scanners:

• The backscatter X-ray machine looks like two blue boxes and is used at major airports, such as Los Angeles, Chicago O'Hare and John F. Kennedy in New York.
• The millimeter-wave machine looks like a round glass booth and is used at hubs such as Atlanta, Dallas-Fort Worth and San Francisco.

The X-ray scanner emits extremely low levels of ionizing radiation, a form of energy that strips electrons from atoms and damages DNA, potential leading to cancer. That risk, although small, has led some prominent scientists to ask why the TSA doesn't use just the millimeter-wave scanner, which uses low-powered electromagnetic waves that have not been linked to adverse health effects.

The TSA has said that keeping both technologies in play encourages the manufacturers to improve detection capability while lowering the cost for the taxpayer. The agency says the X-ray machine is safe because the radiation is equivalent to the amount passengers receive in two minutes of flying at altitude.

But ProPublica found some potential problems with the millimeter-wave scanner. Several other countries have reported a high rate of false alarms caused by innocuous things, such as folds in clothing, buttons and even sweat.

Other studies and a congressman briefed on classified tests have suggested the scanners could miss carefully concealed plastic explosives like the weapon used by the underwear bomber on Christmas Day 2009.

As Congress continues to debate the safety and quality of the body scanners, government investigators are set to release two important reports in the new year. The inspector general of the Department of Homeland Security is evaluating how well the TSA is monitoring the radiation of the backscatters. Meanwhile, the Government Accountability Office is wrapping up an investigation of the machines' detection capability, the results of which are likely to be classified.

by Marian Wang

This is part of our year-end series, looking at where things stand in each of our major investigations.

If last year was the year in which faulty foreclosures and bank errors became a full-blown scandal, this has been the year of waiting for something to be done about it.

First, there's the still-to-come multi-state settlement over alleged fraud on the part of the country's five largest mortgage servicers. That's the settlement being brokered by a coalition of state attorneys general and once touted as homeowners' best bet for redressing banks' flaws in foreclosure and mortgage documentation. Over the past year, one story after another declared such a deal was imminent, but the details -- the total price tag, the deal's framework, and the expected date -- have continually been changing.

Earlier this month, the Des Moines Register reported Iowa Attorney General Tom Miller -- a point man for the attorneys' general probe -- as saying that the final deal should be complete before Christmas and would include a measure to reduce the total debt owed by underwater homeowners. No deal has yet been announced. Miller wouldn't disclose a dollar figure on the size of the settlement -- or whether California, one of the hardest-hit states, would participate.

Over the course of the year, some state attorneys general seemed to lose faith in the coordinated effort, voicing concerns that the eventual settlement would be too easy on the banks.

California Attorney General Kamala Harris signaled her hesitation too, as did the attorneys general of New York, Delaware, Nevada, Massachusetts, Kentucky and Minnesota. These state attorneys general -- many of whom have filed their own suits against major servicers, foreclosure processing firms, and other players -- questioned whether the settlement would limit their ability to take more aggressive action against foreclosure abuses in their states and either expressed doubts about whether they'd sign on to the final settlement or pulled out of the talks altogether.

Banks, meanwhile, have pushed for the settlement to include broader releases from legal liability over mortgage-related abuses. According to a recent Wall Street Journal piece, they've tried to make their participation in the settlement contingent on being shielded from the possibility of lawsuits brought by the new Consumer Financial Protection Bureau.

Also still to be determined? An official to monitor the banks and servicers and ensure they comply with whatever agreement is eventually reached.

Meanwhile, federal banking regulators have also begun to act. In April, the Office of the Comptroller of the Currency, the Office of Thrift Supervision, and the Federal Reserve accused eight mortgage servicers and two third-party mortgage processing firms of “unsafe and unsound" foreclosure practices and ordered them to come up with a plan to prevent the same errors going forward. (Read the orders they received.) But the revamp plans drawn up by the banks are kept confidential. And no financial penalties have been issued, though regulators have said that they're still to come.

Regulators also launched an interagency foreclosure review program [PDF] this year to identify and compensate homeowners who were wronged in the foreclosure process. The plan is to review sample loan files pulled from the files from 14 largest mortgage servicers, as well as files from homeowners who submit a request for a review.

The regulators in charge of the program have so far declined to disclose information on key aspects of the review, such as what kinds of compensation are available to homeowners, how compensation would be calculated, and for what specific offenses. (Homeowners with questions can see our FAQ on the reviews to see whether they're eligible for review and how to apply.)

The reviews themselves are being conducted by outside consulting firms that will be supervised by the regulators but paid by the banks. As we've reported, some lawmakers have raised concerns about the experience of the reviewers and whether they will truly be able to operate independently of the banks.

Finally, it bears mentioning that despite the efforts on both the federal and state level to address the systemic failures of banks and mortgage servicers, errors are continuing -- and they're still causing wrongful foreclosures.

The only subset of homeowners who seem to have gotten a break -- or redress for botched foreclosures -- is military families. Earlier this year, the Justice Department settled lawsuits against subsidiaries of Bank of America and Morgan Stanley over allegations that they wrongfully foreclosed on active duty service members, in violation of a law that specifically offers them greater protection from foreclosure. As part of that settlement, the two companies apologized and paid a combined penalty of $22 million, plus compensation to certain service members who suffered wrongful foreclosures.

by Joaquin Sapien

This is part of our year-end series, looking at where things stand in each of our major investigations.

For the past two years, ProPublica and NPR have collaborated on an investigation that looks in-depth at the military's handling of traumatic brain injuries, a signature wound of the conflicts in Iraq and Afghanistan.

More than 115,000 soldiers have sustained mild traumatic brain injuries, also called concussions, in the wars when shock waves from bombs rippled through their brains. Most have recovered quickly, but some have suffered lasting cognitive problems, from headaches and dizziness to problems with memory and reasoning.

As a result of our work, Congress and government investigators have pressed the Defense Department to fix flaws that have prevented troops with TBIs from being properly diagnosed and treated.

In January, Sen. Claire McCaskill, D-Mo., questioned the Pentagon's decision to deny cognitive rehabilitation therapy to troops with brain injuries. Her inquiry came after a story we did about how the Pentagon based its decision not to pay for such care on a much-criticized report from the ECRI Institute. Following the story and McCaskill's inquiry, the Pentagon solicited the help of the Institute of Medicine, which released a report in October urging the Defense Department to do more research on the therapy before offering it more broadly.

Investigators at the U.S. Government Accountability Office have also scrutinized military programs developed to address brain injuries. In a February report, the GAO said that the Pentagon's Defense Centers of Excellence was plagued by weak leadership, uncertain priorities and flawed accounting. The DCOE, which was created after a 2007 Washington Post series exposed the poor living conditions of concussed troops at Walter Reed Army Medical Hospital, couldn't explain exactly how much taxpayer money it received or how it was spent, the GAO report said.

In March, the Army responded to a story we published last year about how soldiers had been denied Purple Hearts after suffering concussions on the battlefield. The Army issued new guidance, making it easier for brain-injured soldiers to get recognition.

Among the reasons the military has struggled to treat brain-injured troops, one of the most obdurate is a lack of neurologists, according to interviews and documents we obtained earlier this year. Policies issued in June 2010 requiring soldiers to receive a comprehensive evaluation when they suffer three or more mild traumatic brain injuries in one year have intensified the need for qualified doctors.

Plus, as we reported in May, more than half of all Iraq and Afghanistan veterans treated in Department of Veterans Affairs hospitals since 2002 have been diagnosed, at least preliminarily, with mental health problems.

One such veteran is Brock Savelkoul, a troubled young man who survived a blast in Iraq. Back home in North Dakota, he embarked on an equally harrowing journey that ended in an armed standoff with local law enforcement officers, who spent hours persuading him not to commit suicide.

Savelkoul, who we featured in a Kindle Single earlier this year, was one of about 300 troops examined in a study conducted by then-Lt. Col. Mike Russell, the Army's leading neuropsychologist. Russell presented his findings in November 2009 and concluded that a computer test being used to evaluate whether soldiers had suffered concussions was "only slightly better than a coin toss."

Russell was referring to the Automated Neuropsychological Assessment Metrics, or ANAM, which the military has given to 1 million troops since 2008 in response to an order from Congress.

Last month, we published a story about how the military came to spend $42 million on the ANAM program, despite the fact that the test was never scientifically proven to detect brain injuries. As part of our investigation, we released a withering report on the ANAM that Russell delivered to members of Congress, which was not previously available to the public. In his critique, Russell lambastes nearly every aspect of the program, saying that "the selection of ANAM was nepotistic, and the long delay in examining alternative instruments is baffling."

Following our story, McCaskill began an investigation into contracts surrounding the ANAM program. Rep. Bill Pascrell, D-N.J., co-chairman of the Congressional Brain Injury Task Force, proposed an amendment to the 2012 National Defense Authorization Act to help fix the beleaguered testing program, but it was pulled from the legislation. Pascrell is now pushing for a large increase in funding for the military's TBI services in this year's appropriations bill.

by Paul Steiger

This has been a year of impact for ProPublica's journalism. We're making a difference.

So as 2011 comes to a close, please consider making a tax-deductible donation to help ProPublica continue this important work.

What do I mean by impact? I hope two examples -- one "big" and one "small," both profoundly important, and both in the news this month -- give you an idea.

First is fracking -- the hydraulic fracturing method of drilling for natural gas. When we first wrote about the subject (in 2008), the industry was in denial about any threat to our water from unsafe drilling methods, and was refusing to disclose the toxic chemicals used in the process. New York's governor, unaware of the issues, was about to approve unfettered drilling. Our first story changed that, and we've kept at it.

This month, the EPA finally confirmed that reckless fracking can—and has—polluted drinking water. Texas and Colorado have mandated disclosure of those chemicals. New York officials are limiting drilling. The U.S. Department of Energy will recommend safety steps.

And everybody, it seems, is talking about fracking. It was the subject of an Oscar-nominated movie, and of numerous newspaper reports. ProPublica broke the key stories on drinking-water contamination, maneuvers to gain exemption from environmental laws, chemicals left in the ground, effluent in our rivers and streams, and health impacts on local communities—more than 150 stories over three and a half years. The result is one of those shifts in popular outlook that alters the world just a bit.

Impact can also be more personal. Also in 2008, we started writing about violence in New Orleans after Hurricane Katrina. Two years ago, we spotlighted the shooting death by police of a man named Danny Brumfield. This month, an NOPD officer was convicted of perjury and obstruction of justice in that shooting. One family had achieved a measure of justice.

This is the kind of work your support helps make possible. It's the kind of work that has won us Pulitzer Prizes two years in a row, the first ever for an online news organization. And 85 cents out of every dollar we receive is spent on news.

In 2011, we have definitively documented racial and ethnic bias in the awarding of presidential pardons, put persistent heat on bankers and regulators for their diffidence in the face of the continuing foreclosure fiasco, given parents new tools to assess how their kids' schools are performing, called out abuses by both parties in the redistricting process, revealed conflicts of leading medical societies and pinpointed the cancer risk in those proliferating new airport scanners.

ProPublica had 100 donors two years ago, 1300 last year. We need your help today to end 2011 on a strong note, and to propel our efforts to hold powerful interests accountable in 2012. Please click here to join us in that work.

A statement from Commissioner Stan Forbes, current Chair of the Citizens Redistricting Commission:

"Of course partisan political interests tried to influence the Commission's independent process, but that goes with the territory, and the Commission had its eyes wide open and was very aware of that possibility. The important point is that the Commissioners were not unduly influenced by that. We drew district maps that were fair and representative. In fact the California Supreme Court unanimously, by a 7-0 vote, dismissed litigation against the maps finding that the Commission followed the Constitution, Federal Voting Rights Act and the Voters First Act.

If the Democrats successfully gamed the system then why are there two Congressional districts in the Los Angeles area where Democratic incumbents are having to run against each other? One of the match-ups includes two of the most influential and powerful Democratic Congressmen in the nation, Howard Berman and Brad Sherman. In Central California, Democratic Congresswoman Lois Capps, who was in the infamous "Ribbon of Shame" Gerrymandered district, is in a more competitive district and faces a strong Republican challenge. ProPublica neglected to point out those facts.

ProPublica was just dead wrong when it stated that the Commission shut down its public input process and decided to hold remaining meetings in Sacramento. This was following an unprecedented 34 public input hearings. When the Commission held remaining meetings in Sacramento it was in order to work with mapping consultants to draw the lines. Every one of those meetings was streamed live, archived on the Commission's website along with transcriptions. The Commission received thousands of comments in writing from the public during this time. In fact many Commissioners referred to the comments as they came in real-time during the meetings.

I believe that ProPublica was in error when it suggested that the Commission could have, referenced political party registration data during our process. The Commission was barred from drawing districts in consideration of incumbents, candidates or political parties. To reference political party registration numbers would have looked highly suspicious to the public. It also begs the question: If the Commission is barred from drawing partisan maps, why reference the registration data?

There has never been a more transparent or open redistricting process in California history. The Commission drew districts that were based on the totality of the wide and varied testimony, not just listening to one group or maybe the last person we heard."

by Olga Pierce , Jeff Larson and Lois Beckett

Earlier this week, we reported on efforts by California’s Democratic congressional delegation to influence the state's redistricting commission. As we detailed, Democrats surreptitiously enlisted local voters, elected officials, labor unions and others to testify in support of district lines that coincided with the party's interests. In one instance, party operatives invented a local group to advocate for a Democratic-friendly map.

Here are the most common questions about our reporting -- and answers. Feel free to ask additional questions in the comments section or email us directly.

If California Democrats actually succeeded in manipulating the redistricting commission, then why did some Democratic incumbents lose?

Our story did not assert that every Democrat got what they wanted from the Commission. Indeed, we noted that Democrats faced a particularly difficult challenge getting what they wanted in densely populated, ethnically diverse Southern California.

Still, fewer Democrats might have lost than it seems.

Some have argued, for instance, that the high-profile retirement of Rep. Lynn Woolsey, in Northern California, was a result of redistricting.

But as it turns out, Woolsey announced her retirement before the lines were completed, and has said redistricting had nothing to do with her decision.

What about Reps. Berman and Sherman getting drawn into a district together?

As many have noted, Democratic U.S. Reps. Brad Sherman and Howard Berman were drawn into the same district, and as were Reps. Janice Hahn and Laura Richardson.

Several people -- including members of the redistricting commission -- have pointed to the Berman-Sherman face-off, in particular, as evidence that the commission was not manipulated by Democrats.

But even in that case, there appears to be evidence of an effort to influence the process.

According to FEC records, on May 23, Sherman's PAC paid $15,000, to an entity it called "PMPA" in their disclosures. The address of PMPA is the home of redistricting consultant Paul Mitchell's mother in Glendale. One of Paul Mitchell's firms is called Paul Mitchell Public Affairs, or PMPA. It's not clear what the work was for. Mitchell didn't respond to our request about his work about Sherman.

In the end, Sherman appears to have come out ahead. The so-called Berman-Sherman district was 60 percent from Sherman's old district, and 16 percent from Berman's district.

Sherman's office did not return our requests for comment.

As for Berman, he told ProPublica he didn't try to influence the commission: "I'm not unfamiliar with the redistricting process. I wasn't caught flat-footed. I just chose not to do what many on both sides of the aisle did: try to sway the commission to do something that was good for one member. The whole process was supposed to draw lines without consideration to incumbents. I respected that process."

Didn't Republicans and others try to influence the commission too?

Yes, they did. In fact, our reporting began with one such attempt. But we also found that Republicans were far less organized or effective than Democrats.

For instance, Howard "Buck" McKeon, chairman of the House Armed Services Committee, tried to enlist his allies to urge the commission to draw him a friendly district. Last April, McKeon emailed a local trade group with defense industry tries encouraging them to "advocate to the Redistricting Commission" for McKeon's ideal district. (Read the email.) McKeon didn't return our requests for comment.

The group, the Antelope Valley Board of Trade, did not testify in favor of his district. McKeon ended up getting part of what he wanted but not all of it.

California is a blue state. In a fair process, shouldn't the Democrats "win" redistricting?

There haven't yet been elections based on the newly redistricted lines. So any projections about how Democrats and Republicans will fare are just that, projections.

We interviewed multiple experts who said that Democrats could be expected to gain a seat or two via redistricting. The previous district lines had actually been the result of a bi-partisan backroom gerrymander that created a few Republican seats. A fair redistricting process might have eliminated those safe seats.

But after the districts were drawn, internal Democratic Party analyses projected a gain of six or seven seats.

More importantly, the way lines are drawn doesn't just affect the balance of power between Democrats and Republicans. Particular lines can also protect particular politicians.

Rep. Judy Chu's Southern California district, for example, would likely remain safely Democratic in any redrawing. But, as our story shows, a group with ties to Rep. Chu successfully intervened in the commission process at the last minute to tweak lines that will likely make it easier for Chu herself to defeat any Democratic challenger.

That's particularly relevant because California is moving to a new "open primary" system where the politicians who get the largest number of votes go on to face each other in a second round -- regardless of party affiliation.

The Commission was never meant to be non-partisan.

We'll let readers judge for themselves. The voter referendum creating the commission called for "nonpartisan rules designed to ensure fair representation."

Here is the language voters saw in the ballot box:

The People of the State of California hereby make the following findings and declare their purpose in enacting this act is as follows:

(a) Under current law, California legislators draw their own political districts. Allowing politicians to draw their own districts is a serious conflict of interest that harms voters. That is why 99 percent of incumbent politicians were reelected in the districts they had drawn for themselves in the recent elections.

(b) Politicians draw districts that serve their interests, not those of our communities. For example, cities such as Long Beach, San Jose and Fresno are divided into multiple oddly shaped districts to protect incumbent legislators. Voters in many communities have no political voice because they have been split into as many as four different districts to protect incumbent legislators. We need reform to keep our communities together so everyone has representation.

(c) This reform will make the redistricting process open so it cannot be controlled by the party in power. It will give us an equal number of Democrats and Republicans on the commission, and will ensure full participation of independent voters—whose voices are completely shut out of the current process. In addition, this reform requires support from Democrats, Republicans, and independents for approval of new redistricting plans.

(d) The independent Citizens Redistricting Commission will draw districts based on strict, nonpartisan rules designed to ensure fair representation. The reform takes redistricting out of the partisan battles of the Legislature and guarantees redistricting will be debated in the open with public meetings, and all minutes will be posted publicly on the Internet. Every aspect of this process will be open to scrutiny by the public and the press.

(e) In the current process, politicians are choosing their voters instead of voters having a real choice. This reform will put the voters back in charge.

Why do you say the commission limited opportunities for public input? Didn't it have dozens of hearings?

The public hearing transcripts clearly show that a lot of testimony was received by the commission. But the commission cancelled a second round of draft maps and the hearings they said they would do with them. Many groups criticized this move as limiting citizen input.

Instead of releasing a promised second round of draft maps, the commission chose to release daily 'visualizations,' which were drawn at meetings in Sacramento. While the general public could comment via email, transcripts show individuals in attendance joined what became impromptu hearings at the beginning of each meeting. Transcripts show that these in-person comments and map submissions were influential. But they were only an option for those with the resources both to anticipate which districts would be discussed on a particular day, and appear in person in Sacramento.

Here is the commission's statement on our article.

by Charles Ornstein and Tracy Weber

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A version of this story ran in the Washington Post.

The news about narcotic painkillers is increasingly dire: Overdoses now kill nearly 15,000 people a year -- more than heroin and cocaine combined. In some states, the painkiller death toll exceeds that of car crashes.

The head of the Centers for Disease Control and Prevention has declared the overdoses from opioid drugs like OxyContin an "epidemic." And a growing group of experts doubts that they work for long-term pain.

But the pills continue to have an influential champion in the American Pain Foundation, which describes itself as the nation's largest advocacy group for pain patients. Its message: The risk of addiction is overblown, and the drugs are underused.

What the nonprofit doesn't highlight is the money behind that message.

The foundation collected nearly 90 percent of its $5 million funding last year from the drug and medical-device industry -- and closely mirrors its positions, an examination by ProPublica found.

Although the foundation maintains it is sticking up for the needs of millions of suffering patients, records and interviews show that it favors those who want to preserve access to the drugs over those who worry about their risks.

Some of the foundation's board members have extensive financial ties to drugmakers, ProPublica found, and the group has lobbied against federal and state proposals to limit opioid use. Painkiller sales have increased fourfold since 1999, but the foundation argues that pain remains widely undertreated.

The group says industry money has had no effect on its advocacy.

"I'm convinced with every shred of my body that our interest is improving the lives of people affected by pain," said Will Rowe, the foundation's chief executive, "and we want to do that the best way we can."

The problem isn't opioids, Rowe and other group leaders say. It's poorly trained doctors who prescribe them too easily or in excess.

Yet, critics say the Baltimore-based foundation is making it harder to address a major public-health problem.

"If you were a drug company, wouldn't it be smart to make it look like you had a patient-oriented group?" said Dr. Gary Franklin, a Washington state official who tussled with the foundation over new restrictions on high-dose painkillers.

Its funding makes the group "one and the same" with the pain industry, Franklin said.

In stories this year, ProPublica has detailed the close entanglements between pharmaceutical companies and groups representing doctors. Reporting showed that the positions of societies representing specialty physicians often reflected the views of their major funders.

The American Pain Foundation falls into a different category -- health advocacy. It harnesses the power of patient stories to sway politicians, state medical boards, judges and government health regulators, emphasizing that it represents grassroots voices.

ProPublica's review found that the foundation's guides for patients, journalists and policymakers play down the risks associated with opioids and exaggerate their benefits. Some of the foundation's materials on the drugs include statements that are misleading or based on scant or disputed research.

The group has intervened in court cases in ways that appear to counter its stated mission. In one example, it sided with Purdue Pharma, its longtime funder, to block a 2001 class-action case filed by Ohio patients who had become addicted to or dependent on the company's blockbuster painkiller, OxyContin.

And the foundation mobilizes patients to send "outraged" email messages to news organizations that run stories it believes reinforce "stigmas and stereotypes" about the risks of pain medication.

The group's board includes some patients but also doctors who are paid to speak and consult for drug companies, a researcher whose clinic has relied on their funding for survival and a public-relations executive whose firm represents them.

Last year, one board member was the lead author of a study about a Cephalon drug. Cephalon sponsored the study, and its employees were co-authors. The study found that the drug, Fentora, was "generally safe and well-tolerated" in non-cancer patients even though it is only approved for severe cancer pain.

Dr. Andrew Kolodny, a New York psychiatrist who heads Physicians for Responsible Opioid Prescribing, said the foundation has built credibility with politicians and regulators who may not be aware of the extensive industry ties.

"I don't think they realize that in many ways the American Pain Foundation is a front for opioid manufacturers," Kolodny said.

Rowe, however, said it can be hard for critics to understand the mindset of patients whose pain is so severe they are willing to risk serious side effects to gain relief.

"Policymakers can go to bed at night and say, 'Well, I protected society,'" by restricting access to a risky painkiller," he said. "The person with pain or the person with cancer could say, 'You know, I'm sorry. I'm living with this, and I want to take this chance.'"

'The System Is Awash in Opioids'

In the late 1980s and early '90s, physicians who cared for pain patients excitedly embraced opioids as a low-risk treatment for suffering.

Derived from the opium plant, opioids reduce the perception of pain by attaching to opioid receptors in the brain, spinal cord and elsewhere in the body.

"We bought into this idea that opioids would be effective and that the risk of addiction would be low," said Dr. Jane Ballantyne, a longtime pain expert and a professor at the University of Washington.

But along the way, pain doctors split. Some, like Ballantyne, began decrying the increasingly widespread use of opioids and questioned whether the drugs worked. Others, like the foundation's leaders, said the drugs were being unfairly maligned, making pain patients feel like criminals and discouraging doctors from prescribing them.

Despite the debate, sales of the drugs have skyrocketed.

Last year, $8.5 billion worth of narcotic painkillers were sold in the United States, according to the prescription-tracking company IMS Health. Enough of the drugs were prescribed last year to "medicate every American adult around the clock for a month," the CDC said.

"Right now, the system is awash in opioids, dangerous drugs that got people hooked and keep them hooked," said CDC Director Thomas Frieden in a recent news briefing.

Some of the pills have become household names: Vicodin, Percocet, OxyContin. On its own, OxyContin, an extended-release painkiller, accounted for $3.1 billion in sales last year, up from $752 million in 2006, according to IMS Health.

There's little dispute that many people endure chronic pain. In the past, many doctors, especially those providing primary care, ignored pain as a condition that warranted its own treatment.

A report from the prestigious Institute of Medicine last summer said 116 million American adults suffer from chronic pain. The report also cited legal and regulatory barriers to opioids, especially for cancer and end-of-life pain. The findings are lauded by the foundation as underscoring the concern about undertreatment.

In an email to ProPublica, however, the report's chairman said the study panel took a broad look at chronic pain and didn't examine the use of opioids with "rigor or detail."

"It does seem like the issue of opioid use is worthy of a separate study," wrote Dr. Philip A. Pizzo, dean of Stanford University's medical school.

Guides Offer Reassurance About Pain Drugs

The American Pain Foundation's website offers publications for patients, policymakers and even journalists. Each depicts the benefits of opioids, and each is underwritten by the makers of those drugs.

Its patient guide, paid for by four companies, discusses several treatments for pain. It says such pain relievers as aspirin, ibuprofen and naproxen commonly cause gastrointestinal bleeding or ulcers, delay blood clotting, decrease kidney function and may increase the risk of stroke or heart attack. And it warns patients to use these pain pills at the lowest dose and stop them unless clearly needed.

The side effects of opioids, on the other hand, are minor, and most go away "after a few days," the foundation's guide says. The underuse of opioids, it says, "has been responsible for much unnecessary suffering."

Patients, it says, shouldn't worry if they need more of a drug. They are not developing an addiction.

"Many times when a person needs a larger dose of a drug," the guide says, "it's because their pain is worse or the problem causing their pain has changed."

Another guide, written for journalists and supported by Alpharma Pharmaceuticals, likewise is reassuring. It notes in at least five places that the risk of opioid addiction is low, and it references a 1996 article in Scientific American, saying fewer than 1 percent of children treated with opioids become addicted.

But the cited article does not include this statistic or deal with addiction in children.

"I would much prefer that they would put in there something that could be substantiated by a real reference," said Dr. Leonard Paulozzi, a CDC medical epidemiologist specializing in drug overdoses. "That would present a much less rosy picture of the risk."

A recent report by the National Institute on Drug Abuse said estimates of addiction among chronic pain patients using opioids range from 3 percent to as high as 40 percent.

One Foundation-related publication this year provided a case study of how physicians could convince patients that the drugs are not addictive.

In an e-newsletter paid for by a drug company, Florida family physician Louis Kuritzky summed up the advice he'd give to a patient with knee pain: "We have learned that when patients have important pain problems like you do, they can use such medications successfully over the long term without any major risk of addiction."

This advice is contradicted by a respected medical review organization that looked at research on the use of opioids for osteoarthritis of the knee or hip. The Cochrane Collaboration concluded that "the small to moderate" benefits of opioids "are outweighed by large increases in the risk of adverse events" and the drugs should not be routinely used.

Kuritzky said he had not read the Cochrane review but believes that the downside of opioids is "very, very small" based on his experience with his patients.

"There are many issues where you will see wise men and women differ about the right answer to a difficult and important question," he said.

Rowe, the foundation's chief executive, acknowledged that some of its publications need updating. He pointed to additional materials on the group's new PainSAFE website, which include a broader description of the risks. But the foundation continues to post outdated guides and even refers to them in newer materials.

And while the PainSAFE site discusses the risks more completely, it is based on the assumption that the drugs have proven to work well for chronic pain sufferers. The site says studies have shown opioids improve daily function and quality of life for such patients. In contrast, a new guide by New York City's Department of Health and Mental Hygiene says there is "insufficient evidence" that "pain relief is sustained or function improves."

Dr. Lewis Nelson, chairman of the federal Food and Drug Administration's Drug Safety and Risk Management Advisory Committee, said he believes the foundation's guides can't help but be biased.

"If you're taking drug-company money and you're working as an advocacy group for patients, I think by definition you're biased," said Nelson, an emergency room physician in New York. "I take everything they say with a grain of salt."

Fighting in Court for Painkiller Access

The foundation doesn't just offer advice about opioids; it takes its arguments into court.

In 2005, it filed a friend-of-the-court brief in the U.S. Fourth Circuit Court of Appeals in support of Dr. William Hurwitz, a pain doctor in Virginia who had been convicted on 50 counts of drug trafficking.

The doctor had been accused of prescribing a single patient as many as 1,600 Roxicodone pain pills in one day. Hurwitz allegedly had prescribed that patient alone more than 500,000 pills between July 1999 and October 2002.

The pain foundation and its allies argued that the jury instructions in the case didn't distinguish between criminal behavior and mistakes by a well-intentioned physician. "It is not drug dealing to prescribe opioids to patients that might be 'suspected' addicts or substance abusers," the foundation and two other groups wrote in a brief.

Rowe said the foundation intervened in the case on principle, fearing the drugs would be "demonized." The appeals court threw out the conviction, but Hurwitz was retried and convicted on 16 counts of trafficking.

Years earlier, the foundation opposed several pain patients who had sued Purdue Pharma in an Ohio county court for allegedly obscuring the risks of OxyContin.

The foundation filed a friend-of-the-court brief backing Purdue, arguing that the health of all pain patients would be harmed if the class-action lawsuit went forward because doctors would become fearful of prescribing opioids.

Ohio was plagued by "opiophobia" according to a brief co-authored by the foundation and two smaller pain nonprofits. "Consequently many, if not most, of the state's residents had been deprived of adequate pain care," it said.

The Ohio Supreme Court decided in 2004 not to allow a class action.

In a separate federal case in 2007, Purdue pleaded guilty to misbranding OxyContin "in an effort to mislead and defraud physicians and consumers," according to a statement from prosecutors. The company agreed to pay $600 million in penalties. Three top officials also pleaded guilty to misdemeanors and agreed to pay $34.5 million.

Two months after the conviction, however, then-foundation chairman Dr. James Campbell praised Purdue in a statement to a U.S. Senate committee.

"I believe Purdue and its management deserve recognition for their contribution to the welfare of these many patients," Campbell wrote. Prosecuting the executives, he wrote, sent a "chilling message to those who dare to develop high-risk drugs for important diseases."

Campbell mentioned his foundation role in his remarks. Rowe said the former board chairman was not speaking for the group, and stressed that strict rules keep funders from influencing its work. The foundation is working to diversify its support, Rowe and others said.

Nevertheless, the group often finds itself on the same side as drugmakers in state and federal debates over how to regulate painkillers.

In 2009, the FDA suggested changes to address concerns about the risks of long-acting opioids, recommending that physicians and pharmacists be certified to ensure they had been educated about those risks.

Although foundation officials blame poorly educated physicians for the growing problems with opioids, the officials joined with other pain groups and drugmakers to assail the plan.

The FDA backed off key elements of its proposal last year and said doctors could voluntarily attend courses about the risks.

That move was criticized by an FDA advisory committee, which voted overwhelmingly that it wasn't enough to stem the tide of overdose deaths.

"When you look at 14,000 people dying on an annual basis, that's more than we've lost in Iraq and Afghanistan since 2001 in active duty," Dr. Mori Krantz, an advisory panel member and director of the prevention center at the University of Colorado in Denver, said during the meeting.

Little Evidence That Narcotics Work for Chronic Pain

Missing from the American Pain Foundation literature is any suggestion that the drugs don't work for many chronic pain sufferers.

Recent editorials in medical journals and scientific reviews cite little evidence of long-term benefit.

Most of the clinical trials for opioids to treat chronic pain "were small, lasted less than 16 weeks and excluded patients with a history of substance abuse, psychiatric illness and depression, who are at increased risk for opioid misuse and abuse," three physicians wrote in an editorial this year in the Archives of Internal Medicine.

"How can a therapy be considered if there's no evidence that it works and there's evidence of lots of side effects?" Dr. Mitchell Katz, one of the authors and director of the Los Angeles County Department of Health Services, said in an interview.

Rowe said he knows plenty of patients for whom the drugs work, "and their lives are together because they use them."

The foundation board's chairman and president, Dr. Scott Fishman, is stepping down at the end of the month. In a statement to ProPublica, he said his views have evolved and that he now believes opioids are both overused and addictive. But he defended the group.

"I have not always agreed with APF positions and have had disagreements with some APF leaders and patient advocates about many issues in pain management, including the appropriate place of chronic opioid therapy," wrote Fishman, chief of pain medicine at University of California, Davis.

"Nonetheless, I have always believed that patients in pain in the United States need strong patient advocacy, which APF has offered."

by Tracy Weber and Charles Ornstein

Google Dr. Scott Fishman, chairman and president of the American Pain Foundation, or Dr. Perry Fine, a prominent board member, and it's quickly clear that their ties to the world of pain are legion.

Here (and at right) is a photo of Fishman at a forum with U.S. Surgeon General Regina Benjamin. Here is his book about opioid prescribing that has been distributed to physicians in a couple of dozen states.

Multiple videos feature Fine delivering educational talks about the drugs. He appeared at the 2010 criminal trial of Anna Nicole Smith's boyfriend and two doctors accused of conspiracy in fostering the late celebrity's addiction to drugs. Fine testified that the 1,500 pills a month Smith was given did not make her an addict, according to news reports.

Fishman, chief of pain medicine at the University of California, Davis, and Fine, a professor of anesthesiology at the University of Utah School of Medicine, have authored articles on the foundation's website. They've testified in court cases and before state and federal committees, and each has been president of the American Academy of Pain Medicine, a doctors' group.

Last year, the pair and a third physician wrote a strongly worded column in The Seattle Times opposing a bill passed by Washington state lawmakers that required doctors and others to consult pain specialists before prescribing high doses of opioids to non-cancer patients. The governor signed it into law nonetheless.

Like the American Pain Foundation, both men have had longstanding ties to the pharmaceutical industry -- direct and indirect. The foundation received 88 percent of its $5 million income last year from drug and medical-device makers.

This fall, the physicians acknowledged they had failed to disclose all their potential conflicts of interest in a letter to the editor of the Journal of the American Medical Association, which had been published in July. The journal requires all authors, even of letters, to disclose commercial ties.

In his correction, Fine listed 12 more companies for which he consulted, gave legal advice, delivered promotional talks or provided medical education. Among other things, he listed a 5 percent stake in a medical education company whose programs are funded by drugmakers.

Fine also appears to have played a role in launching a painkiller in 2009, ProPublica found. A subsidiary of Johnson & Johnson quoted him in its media release touting its new opioid.

ProPublica also found discrepancies in Fine's disclosures to his employer, the University of Utah. For example, Fine told the university that he had received less than $5,000 in 2010 from Johnson & Johnson for providing "educational" services. On its website, however, the company says it paid Fine $32,017 for consulting, promotional talks, meals and travel that year. (The University requires doctors to disclose all ties to drug companies, even situations in which they are not compensated.)

In an interview, Fine said he tries to be fully transparent about his industry ties. After reviewing his tax records, Fine said in an email, he discovered he had made several errors on his university disclosure and would amend it.

Fine said his relationships with drug companies add to his knowledge about their products. "Does it bias me and cause me to be prejudiced?" he said. "I really don't believe so."

Fine said he is a prominent speaker and teacher on pain because it remains undertreated. "Chronic pain is sort of the modern day leprosy," he said. "It's been sort of hidden away. There are a lot of people affected."

In his initial JAMA disclosure, Fishman said he had written a book about responsible opioid prescribing but received no royalties. In his correction, he acknowledged receiving fees for teaching medical education courses, some of which were funded by drug-company grants.

Over time, Fishman has had relationships with at least eight companies, including OxyContin maker Purdue Pharma, for which he was a consultant, paid speaker and recipient of research support. In an email to ProPublica, Fishman said he had stopped taking money from drug companies in recent years to avoid the perception of a conflict of interest.

He does appear to maintain some ties. Last year, for example, he and Fine appeared in videos on a website sponsored by drugmaker Cephalon to educate patients about the safe use of prescription pain pills. Fishman's opioid book, written for the Federation of State Medical Boards, was financed in large part by drug companies. The federation would not provide specific dollar amounts.

Fishman, who is stepping down as chairman of the pain foundation this month, said he often receives honoraria for teaching medical education courses but doesn't discuss them with drug-company funders and completely controls the content.

Fishman also said his position on opioids has evolved. He now believes they are overused, often in cases in which the risks outweigh the benefits. "Opioids represent only a small part of the spectrum on options for mitigating pain, but they carry a disproportionate level of risk," he wrote to ProPublica.

Fine's defense of doctors who prescribe opioids was criticized last year by a top U.S. Drug Enforcement Administration official.

The agency's deputy administrator slammed Fine for his testimony in support of a Utah physician accused of doling out pain medication indiscriminately, several times after sexual activity with a patient.

In revoking the doctor's ability to prescribe narcotics, the official called Fine's testimony “patently disingenuous.”

Asked whether it would be outside the standard of practice for a doctor to "go to the home of his patient, have her take off her clothes, digitally penetrate her vagina and then issue her a controlled substance prescription," Fine initially said no, according to a revocation of registration for the accused physician, published in the Federal Register in August 2010.

Although Fine "eventually acknowledged" it was wrong, the administrative law judge in the case said Fine's testimony was "evasive" and "bias[ed] in favor of assuming the correctness of the actions of any doctor," according to the revocation notice in the Federal Register. The judge found a colleague of Fine's from the University of Utah, who had testified against the accused doctor, to be more believable.

Fine went on to testify at the doctor's criminal trial in federal court in Salt Lake City this year. The doctor was convicted of two counts of distributing a controlled substance resulting in death, as well as 38 other counts.

In an interview, Fine defended his participation in both cases, saying he did not believe the doctor's conduct was criminal. He said the prosecution had to attack him or its case would have fallen apart.

"They had to cast me in a bad light; of course they did," Fine said. "They were too deep into this." As for his colleague who testified for the other side, Fine said, "I believe he's wrong."

by Daniel Victor

Here are this week's top must-read stories from #MuckReads, ProPublica's ongoing collection of the best watchdog journalism. Anyone can contribute by tweeting a link to a story and just including the hashtag #MuckReads or by sending an email to MuckReads@ProPublica.org. The best submissions are selected by ProPublica's editors and reporters and then featured on our site and @ProPublica.

Gangs and Politicians in Chicago: An Unholy Alliance, Chicago Magazine
Violent street gangs put aside bloody rivalries to meet with politicians who were courting their votes. "All of [the political hopefuls] were aware of who they were meeting with," a former gang leader said. "They didn’t care. All they wanted to do was get the support."
Contributed by @sewella

How Ethiopia’s Adoption Industry Dupes Families and Bullies Activists, The Atlantic
In Ethiopia, where some locals say adoption is "becoming the new export industry for our country," those trying to track down birth families are uncover fraud, and facing threats and violence.
Contributed by @TheAtlantic

Kentucky Lenient on Troubled Doctors Accused of Pill Pushing, The Courier-Journal
A "pattern of permissiveness" means Kentucky doctors get second and third chances after illegally prescribing drugs. One doctor made $15 million in Internet sales from patients he never saw, but had his ban on prescribing such drugs quickly lifted.
Contributed by @charlesornstein

In Strikes on Libya by NATO, an Unspoken Civilian Toll, The New York Times
NATO’s secretary general said in November there were no confirmed civilian casualties from airstrikes. But on-the-ground reporting revealed found credible accounts of at least 40 deaths, and maybe more than 70, that weren’t acknowledged until the Times presented the evidence.
Contributed by @AlejandroLazo

Phantom Firms Bleed Millions From Medicare, Reuters
A sham AIDS clinic -- complete with patients getting kickbacks but no treatment -- stole $4.5 million from Medicare. According to Reuters, similar schemes are bilking hundreds of millions of dollars from Medicare.
Contributed by @Reuters

Millions in VA Funds Go to Ineligible Firms, Dayton Daily News
The program is designed to help disabled veterans find work or start small businesses. But $500 million has gone to ineligible businesses, including some who qualified by putting disabled veterans in charge of front companies that exist only on paper.
Contributed by @ITeamOhio

These stories and many more can be found at ProPublica. You can also subscribe to a daily #MuckReads email or follow ProPublica on Twitter. Reader submissions are key to making #MuckReads a success -- please contribute!

by Michael Grabell

It was the end of a four-hour congressional hearing, and Florida Rep. John Mica was fuming at Transportation Security Administration officials.

The TSA had begun deploying hundreds of body scanners to prevent suicide bombers from smuggling explosives onto planes. But Mica, the Republican chairman of the House Transportation Committee, had asked the Government Accountability Office to test the machines. The results, he said, showed the equipment is "badly flawed" and "can be subverted."

"I've had it tested, and to me it's not acceptable," Mica said at the hearing earlier this year. "If we could reveal the failure rate, the American public would be outraged."

Mica's comments received almost no press coverage. But his outrage, together with other reports by government inspectors and outside researchers, raise the disturbing possibility that body scanners are performing far less well than the TSA contends.

The issue is difficult to assess since the government classifies the detection rates of the devices, saying it doesn't want to give terrorists a sense of their chances of beating the system.

But the evidence is mounting.

Just last week, Department of Homeland Security investigators reported that they had "identified vulnerabilities" in the scanners' detection capability, though the specifics remain classified. Previous research cast doubt on whether the scanners, which are designed to see underneath clothing, would detect a carefully concealed plastic explosive like the one used by the underwear bomber on Christmas Day 2009. One study suggests the $170,000 scanners would likely miss some explosives that could be found during a pat-down.

And recently, Mica and other members of Congress were briefed by the GAO on the full findings of its covert tests. The results, Mica told ProPublica, are "embarrassing."

Other lawmakers who have also been briefed declined to comment.

How effective the machines are at thwarting terrorism is critical for evaluating whether the TSA is making airline passengers more secure or wasting taxpayers' money -- and possibly jeopardizing their safety. Research shows that one type of scanner, which uses X-rays, could slightly increase the number of cancer cases. The other scanner, using millimeter waves, has been hampered by false alarms caused by folds in clothing and even sweat.

The TSA says the body scanners are the best technology available and an improvement by leaps and bounds over the metal detectors, which cannot detect explosives or other nonmetallic weapons.

The agency says its body scanners have found more than 300 dangerous or illicit items -- everything from a loaded .380-caliber Ruger handgun to exotic snakes that a man tried to smuggle inside his pants.

Last month, TSA administrator John Pistole boasted to Congress that a scanner had picked up a piece of Nicorette gum. And in Buffalo recently, a passenger who was caught with a ceramic knife after a pat-down admitted that he had opted out of the scanner because he figured it would find the knife.

Although the TSA's machines have yet to find an explosive, screeners frequently come across bottles of alcohol and drugs, which could easily have been a powder or liquid explosive, spokesman Greg Soule said.

Two homeland security officials, who asked not be identified speaking about vulnerabilities, said recent intelligence that terrorists are considering implanting explosives inside their bodies shows that the scanners are forcing would-be suicide bombers to adapt their methods. The body scanners see only underneath clothing, not inside the body. Carrying out an attack with an implanted weapon, the officials said, would be technically more difficult than if an attacker had a bomb strapped to their chest.

The GAO reported in 2010, however, that it was "unclear" if the scanners would have caught the explosive PETN that underwear bomber Umar Farouk Abdulmutallab tried to detonate on a Northwest Airlines flight over Detroit.

After the failed attempt, the TSA ramped up its deployment of two types of body scanners -- one using backscatter X-rays and another using low-powered electromagnetic waves, known as millimeter waves. The TSA says both are highly effective, but a small number of studies that have been released publicly raise questions about each machine's ability to detect explosives.

Last year, Leon Kaufman and Joe Carlson, two physicists at the University of California, San Francisco, simulated what the backscatter X-ray scanners might see if a passenger carefully molded explosives to blend in with the human body. The machines were effective for seeing metal objects hidden on the human body and could detect the hard edges of organic materials, such as a brick of explosives, according to the study published last year in the Journal of Transportation Security.

But a thin, irregularly-shaped pancake taped to the abdomen would be invisible in images because it would be easily confused with normal anatomy, Kaufman and Carlson wrote. "Thus, a third of a kilo of PETN, easily picked up in a competent pat-down, would be missed by backscatter 'high technology,'" they concluded.

"The amount of contrast between an explosive and tissue is very, very low and not in the range where someone viewing the images could discriminate it by eye," Carlson said in an interview.

Peter Kant of Rapiscan Systems, which makes the backscatter machine, declined to comment on the researchers' study but said the scanner "has exceeded all aviation security detection testing globally."

No recent study of the millimeter-wave machine, manufactured by L-3 Communications, could be found. But initial tests at Seattle-Tacoma International Airport in 1996 showed a detection rate of 73 percent.

Bulk plastic explosives were the hardest threat to detect, according to the study by researchers at the Pacific Northwest National Laboratory. Screeners who were new to the machine found nearly all the Glock pistols in the images, but they were able to identify the bulk explosives only 56 percent of the time.

Another study a few years later tested a primitive version of the privacy software now used in airports in which detection is performed by a computer, not a person. The detection rate was comparable, the researchers concluded, but the test did not break down the results by type of threat.

"Certain objects are tougher to find than others," said Tom Ripp, president of L-3's security and detection division. "I would think that both technologies have the capability to find these threats. Is it easy to find these threats? I would not say it's easy to find these threats. But they can be detected."

Prompted by an outcry over the graphic images the body scanners produce, the TSA began installing privacy software on all of its millimeter-wave machines this summer. Instead of creating an image of the passenger's body, the machines now display a generic outline of a human body with potential threats highlighted by yellow boxes.

"The TSA has said that automated detection had to be as good as or better than the required detection by an operator," said Bill Frain, a senior vice president at L-3. "Right now, we're on par."

The X-ray body scanner, however, still produces images of passengers' bodies, which are examined by TSA screeners in a separate room. Rapiscan has developed an automated system, but it is undergoing tests in TSA research labs.

Before such software was developed, many security and imaging experts believed the backscatter X-ray machine produced sharper images than the millimeter-wave machine. Millimeter waves have longer wavelengths than X-rays, resulting in a lower resolution.

But with automated detection software, the machines would no longer produce images, and the ability of the machines to detect threats is more dependent on the algorithms used in the software.

The TSA has spent more than $100 million on the body scanners and plans to spend hundreds of millions of dollars more as it outfits nearly every airport security lane with a scanner by 2014.

by Lois Beckett

Early reactions to ProPublica’s report on the ways California Democrats manipulated the state’s citizen redistricting commission split along partisan lines.

The Chairman of California’s Republican Party called for “an immediate and thorough investigation.”

“No fair minded person can now say the process or the result was fair,” Chairman Tom Del Beccaro said in a press release. “I am calling for an immediate and thorough investigation, by Congressional and State authorities, to get to the bottom of this obviously corrupted process.  Beyond that, the Congressional and Senate lines as drawn by the Commission should not be used in any way for the upcoming elections." (One note: The press release says our piece detailed a “relationship between [commission] members and officials from the DNC;” our story doesn’t note any such relationships.)

Del Beccaro has long been critical of the redistricting commission.

In contrast, Democratic state party chair John Burton told the San Francisco Chronicle that the story was “complete bulls..t, an absolute f..king fabrication.”

“As the chair of the party, I know the party didn’t do this…the Democratic Party didn’t do sh..t,” Burton said. “As far as I was concerned, there was nothing you could goddamned do.” (Our story detailed the maneuvering of congressional Democrats in Washington, and not state Democrats such as Burton.)   Update: Burton also released a statement calling ProPublica's report "pure fantasy."

A spokesman for the state Democratic Party did not immediately return our request for comment.

Democratic strategist Bob Mulholland also told the Chronicle that it would have been “easier to influence North Korea” than influence the redistricting commission.

by Olga Pierce and Jeff Larson

This spring, a group of California Democrats gathered at a modern, airy office building just a few blocks from the U.S. Capitol. The meeting was House members only — no aides allowed — and the mission was seemingly impossible.

In previous years, the party had used its perennial control of California’s state Legislature to draw district maps that protected Democratic incumbents. But in 2010, California voters put redistricting in the hands of a citizens’ commission where decisions would be guided by public testimony and open debate.

The question facing House Democrats as they met to contemplate the state’s new realities was delicate: How could they influence an avowedly nonpartisan process? Alexis Marks, a House aide who invited members to the meeting, warned the representatives that secrecy was paramount. “Never say anything AT ALL about redistricting — no speculation, no predictions, NOTHING,” Marks wrote in an email. “Anything can come back to haunt you.”

In the weeks that followed, party leaders came up with a plan. Working with the Democratic Congressional Campaign Committee — a national arm of the party that provides money and support to Democratic candidates — members were told to begin “strategizing about potential future district lines," according to another email.

The citizens’ commission had pledged to create districts based on testimony from the communities themselves, not from parties or statewide political players. To get around that, Democrats surreptitiously enlisted local voters, elected officials, labor unions and community groups to testify in support of configurations that coincided with the party’s interests.

When they appeared before the commission, those groups identified themselves as ordinary Californians and did not disclose their ties to the party. One woman who purported to represent the Asian community of the San Gabriel Valley was actually a lobbyist who grew up in rural Idaho, and lives in Sacramento.

In one instance, party operatives invented a local group to advocate for the Democrats’ map.

California’s Democratic representatives got much of what they wanted from the 2010 redistricting cycle, especially in the northern part of the state. “Every member of the Northern California Democratic Caucus has a ticket back to DC,” said one enthusiastic memo written as the process was winding down. “This is a huge accomplishment that should be celebrated by advocates throughout the region.”

Statewide, Democrats had been expected to gain at most a seat or two as a result of redistricting. But an internal party projection says that the Democrats will likely pick up six or seven seats in a state where the party’s voter registrations have grown only marginally.

“Very little of this is due to demographic shifts,” said Professor Doug Johnson at the Rose Institute in Los Angeles. Republican areas actually had higher growth than Democratic ones. “By the numbers, Republicans should have held at least the same number of seats, but they lost.”

As part of a national look at redistricting, ProPublica reconstructed the Democrats’ stealth success in California, drawing on internal memos, emails, interviews with participants and map analysis. What emerges is a portrait of skilled political professionals armed with modern mapping software and detailed voter information who managed to replicate the results of the smoked-filled rooms of old.

The losers in this once-a-decade reshaping of the electoral map, experts say, were the state’s voters. The intent of the citizens’ commission was to directly link a lawmaker’s political fate to the will of his or her constituents. But as ProPublica’s review makes clear, Democratic incumbents are once again insulated from the will of the electorate.

Democrats acknowledge that they faced a challenge in getting the districts they wanted in densely populated, ethnically diverse Southern California. The citizen commission initially proposed districts that would have endangered the political futures of several Democratic incumbents. Fighting back, some Democrats gathered in Washington and discussed alternatives. These sessions were sometimes heated.

“There was horse-trading throughout the process,” said one senior Democratic aide.

The revised districts were then presented to the commission by plausible-sounding witnesses who had personal ties to Democrats but did not disclose them.

Commissioners declined to discuss the details of specific districts, citing ongoing litigation. But several said in interviews that while they were aware of some attempts to mislead them, they felt they had defused the most egregious attempts.

“When you’ve got so many people reporting to you or making comments to you, some of them are going to be political shills,” said commissioner Stanley Forbes, a farmer and bookstore owner. “We just had to do the best we could in determining what was for real and what wasn’t.”

Democrats acknowledge the meetings described in the emails, but said the gatherings “centered on” informing members about the process. In a statement to ProPublica, Rep. Zoe Lofgren, head of California’s delegation, said that members, “as citizens of the state of California, were well within their rights to make comments and ensure that voices from communities of interest within their neighborhoods were heard by the Commission.”

“The final product voted on by the Commission was entirely out of the hands of the Members,” said Lofgren. “They, like any other Californian, were able to comment but had no control over the process.”

“At no time did the Delegation draw up a statewide map,” Lofgren said. (Read Lofgren’s full statement.)

California’s Republicans were hardly a factor. The national GOP stayed largely on the sidelines, and individual Republicans had limited success influencing the commission.

“Republicans didn’t really do anything,” said Johnson. “They were late to the party, and essentially non-entities in the redistricting process.”

Fed-up voters create a commission

The once-a-decade redistricting process is supposed to ensure that every citizen’s vote counts equally.

In reality, politicians and parties working to advance their own interests often draw lines that make an individual’s vote count less. They create districts dominated by one party or political viewpoint, protecting some candidates (typically incumbents) while dooming others. They can empower a community by grouping its voters in a single district, or disenfranchise it by zigging the lines just so.

Over the decades, few party bosses were better at protecting incumbents than California’s Democrats. No Democratic incumbent has lost a Congressional election in the nation’s most populous state since 2000.

As they drew the lines each decade, California’s party bosses worked in secret. But the oddly shaped districts that emerged from those sessions were visible for all to see. Bruce Cain, a legendary mapmaker who now heads the University of California’s Washington center, once drew an improbable-looking state assembly district that could not be traversed by car. (It crossed several impassable mountains.)

Cain proudly told the story of the district, which was set up for one of the governor’s friends. Cain said he justified the odd shape by saying it pulled together the state’s largest population of endangered condors. “It wasn’t legitimate on any level,” Cain recalled.

The 2010 ballot initiative giving the citizen commission authority over Congressional districts was sold to voters as a game changer. Not surprisingly, it was strenuously opposed by California’s Democrats, who continue to control the Statehouse.

No fewer than 35 Democratic politicians — including Minority Leader Nancy Pelosi — and their allies spent a total of $7 million to campaign against the proposition. The effort included mailings from faux community groups that derided the commission’s $1 million annual budget as “bureaucratic waste.” Despite this effort, Californians voted 61 percent to 39 percent to wrest federal redistricting from the hands of state lawmakers.

Immediately, Democrats began organizing to influence the citizen commission. There were numerous opportunities.

According to civics textbooks, the aim of redistricting is to group “communities of interest” so that residents in a city, neighborhood or ethnic group wield political power by voting together. The commission took an expansive view of this concept, ultimately defining a “community of interest” as anything from a neighborhood to workers on the same commute, or even areas sharing “intense beach recreation.”

This gave savvy players an opening to draw up maps that benefited one party or incumbent and then find — or concoct — “communities of interest” that justified them.

Democrats set out to do exactly that.

On March 16, members of the California delegation gathered at Democratic Party offices to discuss how to handle redistricting. They agreed that congressmen from the various regions of California — North, South and Central — would meet separately to “create a plan of action,” according to an email recounting the day’s events by Alexis Marks, the House aide. Among the first tasks, Marks wrote, was determining “how to best organize communities of interest.”

Democrats were already working “BEHIND THE SCENES” to “get info out” about candidates for the job of commission lawyer who were viewed as unfriendly. “I’ll keep you in the loop, but do not broadcast,” Marks wrote.

“The CA delegation has been broken down into regions that will be discussing redistricting at the member level,” read another party email from late March. “Members will be asked to present ideas on both issues” — communities of interest and district lines — “and will be asked to come to some consensus about how to adopt a regional strategy for redistricting.”

Over the next several weeks, California Democrats huddled with Mark Gersh, the party’s top mapmaking guru. Officially, Gersh works with the Foundation for the Future, a nonprofit whose declared goal is “to help Democrats get organized for the fight of the decade; the fight that will determine Democratic fortunes in your state and in Washington, D.C. for years to come: Redistricting!”

The foundation is well funded for this fight. Its supporters include longtime supporters of the Democratic Party: the American Federation of State, County and Municipal Employees as well as the American Association for Justice (previously known as the Association of Trial Lawyers of America). The foundation was launched in 2006 when Nancy Pelosi’s office worked with both groups to start it.

Neither Gersh nor participants would describe in detail what was discussed at the meetings. But from Marks’ emails and other sources, it is clear that California’s Democrats sat down together to discuss mutually agreeable districts that would protect incumbents.

The value of coordinating efforts to influence the commission cannot be overstated. If each Democrat battled separately for the best district, it was likely that one Congress member’s gain would harm countless colleagues. Creating Congressional districts is a lot like a Rubik’s cube: Each change reshapes the entire puzzle. The Democrats’ plan was to deliver synchronized testimony that would herd the commission toward the desired outcomes. If it worked perfectly, the commissioners might not even know they had been influenced.

Over the summer, Marks sent out more than 100 emails about redistricting, according to multiple recipients of the messages. According to House records, Marks earned $112,537 in 2010 in her post as deputy director of the California Democratic delegation. That makes her a federal employee. But although many of the messages were sent during the work day, a spokesman insisted Marks did so in her after-hours role as a political staffer for Democrats. They were sent from a Gmail account. Lofgren's office did not make Marks available for comment, citing policy that staffers do not speak on the record. Instead, they pointed to Rep. Lofgren's statement.

Federal employees are not allowed to do campaign work on government time, or use government resources, according to House ethics rules.

The emails alerted staff and legislators when the commission was scheduled to discuss their districts and they encouraged them to have allies testify to “community of interest” lines that supported their maps.

Marks told members they would be asked to raise money for a legal challenge if things didn’t work out. The delegation, she said, was working with Marc Elias, who heads an organization called the National Democratic Redistricting Trust. (The trust shares a website with The Foundation for The Future.)

Last year the trust persuaded the Federal Election Commission to allow members to raise money for redistricting lawsuits without disclosing how the money was spent, how much was raised, and who had given it.

The commission blinds itself

Back in California, the commission was getting organized. Its first task was to pick commissioners. The ballot initiative excluded virtually anyone who had any previous political experience. Run for office? Worked as a staffer or consultant to a political campaign? Given more than $2,000 to a candidate in any year? “Cohabitated” for more than 30 days in the past year with anyone in the previous categories? You’re barred.

More than 36,000 people applied. The state auditor’s office winnowed the applicants to a group of 60 finalists. Each party was allowed to strike 12 applicants without explanation. Then, the state used Bingo-style bouncing balls in a cage to pick eight commissioners — three Republicans, three Democrats and two people whose registration read “decline to state” (California-speak for independent). The randomly selected commissioners then chose six from the remaining finalists to complete the panel.

The result was a commission that included, among others, a farmer, a homemaker, a sports doctor and an architect. Previous redistrictings had been executed by political pros with intimate knowledge of California’s sprawling political geography. The commissioners had little of that expertise — and one of their first acts was to deprive themselves of the data that might have helped them spot partisan manipulation.

The law creating the commission barred it from considering incumbents’ addresses, and instructed it not to draw districts for partisan reasons.

The commissioners decided to go further, agreeing not to even look at data that would tell them how prospective maps affected the fortunes of Democrats or Republicans. This left the commissioners effectively blind to the sort of influence the Democrats were planning.

One of the mapping consultants working for the commission warned that it would be difficult to competently draft district lines without party data. She was overruled.

The lack of political data was “liberating,” said Forbes, the commissioner. “We had no one to please except ourselves, based on our best judgment.”

“I think,” he said, “we did a pretty good job.”

The commission’s judgments on how to draw lines, Forbes and others said, was based on the testimony from citizens about communities of interest.

“We were provided quite a number of maps from various organizations,” said another commissioner, attorney Jodie Filkins-Webber. If the groups were basing their maps on political data to favor one party, “they certainly did not tell us that.”

“Districts could have been drawn based on voter registration,” Filkins-Webber said, “but we would never have known it.”

The commission received a torrent of advice — a total of 30,000 separate pieces of testimony and documents. Records suggest the commission never developed an effective method for organizing it all. The testimony was kept in a jumble of handwritten notes and computer files. The commissioners were often left to recall testimony by memory.

The difficulties in digesting and weighing the reams of often-conflicting testimony enhanced the value of people or groups who came bearing draft maps.

“Other people offered testimony; we offered solutions,” said Stuart Waldman, president of the Valley Industry and Commerce Association, a powerful business group outside Los Angeles that persuaded the commission to adopts its Congressional map for the San Fernando Valley.

How Democrats locked down Northern California

Redistricting is a chess game for people with superb spatial perception. Sometimes, anchoring a single line on a map can make everything fall into place.

According to an internal memo, Democrats recognized early on that they could protect nearly every incumbent in Northern California if they won a few key battles. First, they had to make sure no district crossed the Golden Gate Bridge.Then, they had to draw a new seat that pulled sufficient numbers of Democrats from Contra Costa County into a district that included Republicans from the San Joaquin Valley.

The man with the most to lose was Rep. Jerry McNerney, who represented an octopus-shaped district that had scooped in Democrats from the areas east of San Francisco. McNerney’s prospects seemed particularly dismal. Early in the year, he made The Washington Post’s national list of top 10 likely redistricting victims.

Republicans moved first, attempting to create a district that would keep San Joaquin County whole and pick up conservative territory to the south. But then a previously unknown group calling itself OneSanJoaquin entered the fray.

OneSanJoaquin described itself as a nonprofit, but records show it is not registered as such in any state. It has no identifiable leadership but it does have a Facebook page, called OneSanJoaquin, created by the Google account OneSanJoaquin.

The page was posted in early April, just as the commission began taking testimony. Its entries urged county residents to download maps and deliver pre-packaged testimony.

On the surface, the OneSanJoaquin page seemed to be serving Republicans’ interests. But Democrats were one move ahead and understood that a united valley would inevitably lead to a Democratic-leaning district. (Republicans apparently did not understand that federal voting rights requirements ruled out their proposed district, since it would have interfered with the Latino district to the south. That misconception was encouraged by the maps on the OneSanJoaquin page, which were drawn to make this look possible.)

In fact, the only way to make a district with “one San Joaquin” was to pull in the Democrats in eastern Contra Costa — the far reaches of San Francisco’s Bay-area liberals.

The author of OneSanJoaquin’s maps was not identified on the Facebook page, but ProPublica has learned it was Paul Mitchell, a redistricting consultant hired by McNerney.

Transcripts show that more than a dozen people delivered or sent the canned testimony to the commission, which accepted it without question. There’s no sign that commissioners were aware some of the letters had been downloaded from the mysterious OneSanJoaquin page.

After the commission finished, McNerney announced he was moving to the newly created San Joaquin district to run for re-election. It was a huge improvement for him. In 2010, he barely won his district, beating his opponent by just one point. If the 2010 election were re-run in his new district, he would have won by seven points, according to the Democrats’ internal analysis. (McNerney’s office did not respond to requests for comment.)

Summing up the story, an internal Democratic memo said the GOP had been decisively out-maneuvered “Their hope was to create a Republican Congressional seat,” the memo said. “Their plan backfired.”

“McNerney ends up with safer district than before,” Mitchell’s firm tweeted, after McNerney announced his candidacy in his new district. “Wow! How did he do that?”

An under-funded commission

While players attempting to influence the process were well funded, the commission struggled with a lack of time and money. They responded, in part, by reducing citizens’ opportunities for input.

The budget for the whole map drawing undertaking was just over $1 million. At first, the commission had its public hearings transcribed — then the money ran out and they stopped.

The commissioners received $300 per day as compensation and were eligible for reimbursement of travel and out of pocket expenses. Most kept their day jobs at the same time they tried to juggle their roles as commissioners.

It was a grueling schedule, with 35 public hearings taking place over just three months. “I had three days off between” April and August, said Commissioner Filkins-Webber, who maintained her legal practice while serving. “I was working basically on average18 hours a day.”

The commissioners also had to deal with public anger. The Tea Party in California decided to use the hearings as a forum to protest the Voting Rights Act, for instance, and at one hearing got so rowdy that police intervened.

Experts hired by the commission to actually draw the maps were also overworked and underpaid. Half a dozen times the meeting transcripts contain references to map drawers working overnight to prepare maps.

Overwhelmed by the task at hand, the commission decided to essentially shut down public participation halfway through the process. After the first round of drafts, which were widely criticized and abandoned, the commission stopped releasing formal drafts. More importantly, commissioners stopped holding hearings, which meant the next draft was prepared without public input.

The commission moved its meetings to Sacramento, not far from where party bosses had once gathered in secret to set the lines. The commission’s meetings were webcast to the public. But only those with the resources and time could participate.

“You have to ask yourself, who has the money to send people up to Sacramento like that,” said Eugene Lee, voting rights project director at the Asian Pacific American Legal Center, which was active in organizing grassroots participation in the redistricting process.

“We didn’t have the money to do that. No way.”

The commission released no further drafts. In July, it made public a “draft final.” Voters had two weeks to submit comments before it became final. Most of those comments came from insiders who had been closely watching the Sacramento meetings.

Southern California Democrats also win

For those who could stay engaged, the Sacramento phase of the commission’s work proved rewarding. One politician who benefited was Southern California Congresswoman Judy Chu.

When it appeared that Chu would get an unfavorable district late in the game, a group with ties to the congresswoman went before the commission in Sacramento and convinced the commissioners to draw a favorable map that included her political stronghold, a town called Rosemead. Chu enjoyed broad support in Rosemead, where she was first elected to the school board in 1992 and later served in the state assembly.

The group, which called itself the Asian American Education Institute, worked with Paul Mitchell, the same consultant who helped engineer the triumph of Northern California Democrats.

Records show that crucial last-minute testimony in favor of Chu’s district was delivered by Jennifer Wada, who told commissioners she was representing the institute and the overall Asian-American community. Wada did not mention that she lives and works as a registered lobbyist in Sacramento, 400 miles from the district, or that she grew up in rural Idaho, where most of her family still lives. Wada says she was hired by the institute to “convey their concerns about Asian and Pacific Islander representation” to the commission.

The second witness was Chris Chaffee, who said he was a consultant for the institute and an employee of Redistricting Partners, Mitchell’s firm.

Commissioners accepted this map without asking a basic question: Who, exactly, was the Asian American Education Institute representing?

The group’s tax records show it had no full-time employees. Its website is barebones, and clicking on the “get active” button on the home page leads nowhere, simply returning users to the home page.

There’s another interesting feature of the Web site: the domain name is registered to a man named Bill Wong, a political consultant who has worked on multiple Chu campaigns, as well as her husband’s successful bid for Judy Chu’s old state assembly seat. Chu paid Wong $5,725 for consulting work in 2010, FEC records show. Her husband, Mike Eng, donated $4,500 to the Asian American Education Institute in 2010 and 2011.

The institute, said Wong, “argued to keep communities of interest together. Since Rep. Chu has been a strong advocate for Asian communities, it would make sense for her to represent them.” Wong added that he “discussed redistricting with a number of Asian-American legislators.”

An email obtained by ProPublica shows Amelia Wang, Chu’s chief of staff, telling Chu and Bill Wong about testimony submitted by another Asian group, Coalition of Asian Pacific Americans for Fair Redistricting, which also intervened at the last minute to offer similar maps. In case that didn’t do the trick, Mitchell himself went before the commission, urging the commissioners to accept the maps submitted by the institute (his employer) and the coalition.

And that’s what the commission did, incorporating proposed lines for both groups and drawing a map that included Rosemead in Chu’s new district.

Wang told ProPublica that Chu’s office and the institute “did communicate about keeping communities of interest together, including Rosemead. However, Rep. Chu did not hire Bill Wong for redistricting or to testify on her behalf before the commission.”

“Rep. Chu has represented a united Rosemead city since 2001,” said Wang, “it would have been a tragic mistake to divide it.”

Though the process turned out well for Chu, it didn’t work out so well for the town of South El Monte.

To make room for Rosemead in Chu’s district, South El Monte — 85 percent Latino — got bumped into another district across the mountains that is much less Latino, and much more affluent.

The town’s mayor, Luis Aguinaga, say the new lines “don’t make sense.” South El Monte is now split off from sister communities in the San Gabriel Valley — including North El Monte and El Monte.

“We’re always on the same side, always fighting for the same issues,” Aguinaga said. “On this side of the San Gabriel Valley we have a voice. If we’re apart it will be much harder to be heard.”

Other communities lost, too.

Outside Los Angeles, residents of what’s known as Little Saigon begged the commission to undo what they saw as decades of discrimination and put the U.S.’s largest Vietnamese community together in one district. Instead, the community was split in two — a result of testimony by supporters of Rep. Loretta Sanchez, including a former staffer and one of her wedding guests, to get her a safe district. A large section of Little Saigon ended up in a district with Long Beach, a town that is 1 percent Vietnamese.

“Residents who live in Little Saigon share the same needs, but if they’re in two different districts they may not be represented,” said Tri Ta, a City Council member from the area.

“This district is characterized by the Port of Long Beach,” the commission writes in its final report, “one of the world’s busiest seaports and the area’s largest employer.”

“It does not make sense to put the area known as Little Saigon in a district with Long Beach,” Ta said. “The two areas are distinctively different.”

"Congresswoman Sanchez believed strongly throughout the redistricting process that the population growth of the Latino community should be accurately reflected in the newly drawn congressional districts," said Adrienne Elrod, Sanchez's Chief of Staff, in a statement, "She's glad that members of the Orange County community shared her views, and as a result, was pleased to see them take an active role."

Paul Mitchell, the consultant whose work had such a large impact on the commission’s decisions, said voters benefited from the work done by him and others deeply involved in the process. The commissioners, he said, “knew some of the testimony was being fabricated by outside groups. But what were they to do? They couldn’t create a screen of all testimony and ferret out all the biases.”

The work he did on behalf of his diverse group of clients, he said, “created better maps — regardless of if they came with the additional benefit of helping some local city, union, or incumbent that was the client,” Mitchell said.

“My only regret is that we didn't do more.”

Corrections: This story originally stated that the Asian population of Long Beach was less than 1 percent. It has been corrected to say that the Vietnamese population of Long Beach is 1 percent. The story also previously stated that Rep. Judy Chu previously served as a state senator. In fact, she served in the state assembly. This story originally stated the commission worked for free, with a small stipend for expenses. It has been corrected to say, the commissioners received $300 per day as compensation and were eligible for reimbursement of travel and out of pocket expenses.

by Chisun Lee and A.C. Thompson, ProPublica, and Carl Byker, PBS "Frontline"

Nothing, it seemed, was unusual about Joseph Shepter's death.

A retired U.S. government scientist, Shepter spent his final two years dwelling in a nursing home in Mountain Mesa, Calif., a small town northeast of Bakersfield. A stroke had paralyzed much of his body, while dementia had eroded his ability to communicate.

He died in January 2007 at age 76. On Shepter's death certificate, Dr. Hoshang Pormir, the nursing home's chief medical officer, explained that the cause was heart failure brought on by clogged arteries.

Shepter's family had no reason to doubt it. The local coroner never looked into the death. Shepter's body was interred in a local cemetery.

But a tip from a nursing-home staffer would later prompt state officials to re-examine the case and reach a very different conclusion.

When investigators reviewed Shepter's medical records, they determined that he had actually died of a combination of ailments often related to poor care, including an infected ulcer, pneumonia, dehydration and sepsis.

Investigators also concluded that Shepter's demise was hastened by the inappropriate administration of powerful antipsychotic drugs, which can have potentially lethal side effects for seniors.

Prosecutors in 2009 charged Pormir and two former colleagues with killing Shepter and two other elderly residents. They've pleaded not guilty. The criminal case is ongoing.

Health-care regulators have already taken action, severely restricting the doctor's medical license. The federal government has fined the home nearly $150,000.

Shepter's story illustrates a problem that extends far beyond a single California nursing home. ProPublica and PBS "Frontline" have identified more than three-dozen cases in which the alleged neglect, abuse or even murder of seniors eluded authorities. But for the intervention of whistleblowers, concerned relatives and others, the truth about these deaths might never have come to light.

For more than a year, ProPublica, in concert with other news organizations, has scrutinized the nation's coroner and medical examiner offices, which are responsible for probing sudden and unusual fatalities. We found that these agencies -- hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards -- have sometimes helped to send innocent people to prison and allowed killers to walk free.

When it comes to the elderly, the system errs by omission. If a senior like Shepter dies under suspicious circumstances, there's no guarantee anyone will ever investigate. Catherine Hawes, a Texas A&M health-policy researcher who has studied elder abuse for the U.S. Department of Justice, described the issue as "a hidden national scandal."

Because of gaps in government data, it's impossible to say how many suspicious cases have been written off as natural fatalities. However, the limited evidence available points to a significant problem: When investigators in one jurisdiction comprehensively reviewed deaths of older people, they discovered scores of cases in which elders suffered mistreatment.

An array of systemic flaws has led to case after case being overlooked:

• When treating physicians report that a death is natural, coroners and medical examiners almost never investigate. But doctors often get it wrong. In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall.
• In most states, doctors can fill out a death certificate without ever seeing the body. That explains how a Pennsylvania physician said her 83-year-old patient had died of natural causes when, in fact, he'd been beaten to death by an aide. The doctor never saw the 16-inch bruise that covered the man's left side.
• Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.

Dr. Michael Dobersen, a forensic pathologist and the coroner for Arapahoe County, Colo., said he worries about suspicious deaths in nursing homes. "Sometimes, if I don't want to sleep at night, I think about all the cases that we miss," Dobersen said. "I'm afraid we're not looking very hard."

With the graying of the baby boom generation, such concerns will only grow in urgency. Within a few years, nearly one-third of all Americans will be over 60.

In a handful of locales, coroners and medical examiners have begun to view older Americans as a vulnerable population whose deaths require extra attention. Some counties have formed elder death review teams that bring special expertise to cases of possible abuse or neglect. In Arkansas, thanks to one crusading coroner, state law requires the review of all nursing-home fatalities, including those blamed on natural causes.

But those efforts are the exception. In most places, little is being done to ensure that suspicious senior deaths are being investigated.

"We're where child abuse was 30 years ago," said Dr. Kathryn Locatell, a geriatrician who specializes in diagnosing elder abuse. "I think it's ageism -- I think it boils down to that one word. We don't value old people. We don't want to think about ourselves getting old."

Checking the Wrong Box

There were two reasons that Joseph Shepter's passing initially triggered no scrutiny from authorities. He was in a doctor's care. And his physician classified the death as natural.

Across the country, state laws rely on doctors to separate extraordinary fatalities from routine ones, principally by what they record on death certificates.

When a doctor encounters an unusual fatality -- a death that may have been caused by homicide or suicide or accident -- the physician must report it to the coroner or medical examiner for further investigation. The investigative work can be as minimal as gathering clues from the place where a body was found, or as extensive as a full autopsy -- the dissection and evaluation of a corpse to pinpoint the precise reason for death.

In Shepter's case, Pormir, the nursing-home doctor, checked off a small box on the death certificate indicating that he never contacted the county coroner. There was no autopsy.

The laws assume physicians like Pormir will report deaths accurately and fully, flagging suspicious cases.

In reality, though, death certificates are frequently erroneous or incomplete, academic research has shown. A study published last year in The American Journal of Forensic Medicine and Pathology found that nearly half of 371 Florida death certificates surveyed had errors in them.

Doctors without training in forensics often have trouble determining which cases should be referred to a coroner or medical examiner.

In a 2008 study, 225 physicians were asked to determine what killed an elderly man who had fallen and suffered a severe head injury. Just over half of the doctors correctly identified bleeding of the brain as the primary cause of death. Nearly two-thirds didn't list the fall as a contributing factor.

"I knew people were going to get it wrong, but it was a surprise just how poorly people did," said Dr. Marian Betz, who led the study and teaches medicine at the University of Colorado.

Robert Anderson, chief of mortality statistics for the Centers for Disease Control and Prevention, said some doctors don't grasp the significance of death certificates.

"I've had instances where the physician just doesn't understand the importance of what they're writing down," said Anderson, who trains doctors in how to certify deaths. "I'm appalled when I hear that."

State officials in Washington and Maryland routinely check the veracity of death certificates, but most states rarely do so, Anderson said.

In Seattle, Dr. Richard Harruff has gone a step further. As the chief medical examiner for King County, Harruff launched a program in 2008 to double-check fatalities listed as natural on county death certificates. By 2010, the program had caught 347 serious misdiagnoses. Two cases were actually homicides. Two were suicides. More than 100 were accidental deaths due to falls or choking.

"If we want ensure that all death certificates are accurate, there has to be a professional, independent review process," said Harruff.

In Shepter's case, the death certificate deflected any investigation until an employee came forward with concerns about conditions at the nursing home, a public, 74-bed facility run by the Kern Valley Healthcare District.

The same month that Shepter died, a nurse told state officials that staffers were using potent antipsychotic drugs to "chemically restrain" residents with dementia, which can cause unruly and erratic behavior. Her complaint prompted the California Department of Public Health to cite the nursing home for unnecessarily doping 23 seniors and led to the federal fine.

It also spurred the California attorney general's office to open a criminal inquiry. Prosecutors asked Locatell, the elder abuse specialist, to evaluate the medical files of the nursing home's residents, including Shepter.

"I saw all kinds of indicators of neglect," said Locatell, noting that Shepter had lost almost 20 percent of his body weight over the span of three months. She said she was shocked by the "callousness of the staff towards this man."

In early 2009, prosecutors charged Pormir and two former co-workers with elder abuse that led to the deaths of Shepter and two additional residents, and with mistreating five others.

Kern Valley Healthcare District chief executive Timothy McGlew said he could not comment on the case except to say that his staff is cooperating with investigators.

The case has not yet gone to trial. Pormir and his co-defendants declined to comment.

For Shepter's son, the charges of criminal elder abuse came as a terrible surprise.

"I had no idea anything was wrong," said Joseph Shepter III, who goes by Joe. He and his sister have filed a civil lawsuit in Kern County Superior Court against the nursing home, Pormir and other staffers, alleging that they committed elder abuse and violated Shepter's rights. Pormir and the others have denied the allegations, court records show.

Joe Shepter used to think that his father "died a somewhat peaceful death" surrounded by caring professionals. Instead, he now believes, his "father was lying in a hospital bed essentially dying of thirst, unable to express himself -- so people could have a nice, quiet cup of tea."

Signing Off Without Seeing the Body

In many states, laws are so lax that doctors can sign off on death certificates without having seen a patient in months or actually viewing the body. As a result, even obvious signs of abuse have gone unnoticed by authorities in some instances.

Take the case of William Neff, a diminutive 83-year-old who passed away in an assisted-living facility in Bucks County, Pa. A World War II veteran, Neff suffered from advanced Alzheimer's disease, which had tangled the delicate fibers within his brain cells, limiting his speech.

After Neff died on Sept. 11, 2000, a doctor employed by the facility signed his death certificate, citing a "failure to thrive" due to "dementia" as the reason for his demise.

The physician, Anne Whalen, would later testify that she hadn't seen Neff for 13 days before his death. She wasn't at the assisted-living home when he died and never saw his corpse.

Still, it was perfectly legal in Pennsylvania for Whalen to decide how Neff had died and what should be written on the death certificate.

Neff's family arranged for his body to be transported to a funeral home to be prepared for burial. The moment the funeral home's director, Jeffrey Thompson, saw the corpse, he knew something was wrong.

"I'm no CSI expert, but I've been doing this for 25 years, and I've seen a lot of dead people," Thompson recalled. "He was all bruised up and purple, and his ribs were all broken." A bruise stretched from the man's left hip to the middle of his torso.

Thompson contacted the Bucks County Coroner's Office, urging staffers to perform an autopsy. The autopsy showed that some kind of violent impact had snapped five of Neff's ribs. One of the broken bones had pierced his left lung, flooding his chest with blood. The damage was fatal.

If Thompson hadn't spoken up, Neff's injuries probably would never have been detected.

"It could've fallen through the cracks," said Joseph Campbell, the Bucks County coroner.

The autopsy spurred county prosecutors and police to launch an 18-month criminal investigation, which eventually led them to Heidi Tenzer, an employee at the assisted-living facility.

Prosecutors accused Tenzer of stomping on Neff's chest, charging her with third-degree murder, neglect of a care-dependent person and aggravated assault. In 2003, a jury convicted Tenzer of the charges; three of her former colleagues were convicted of related offenses.

Attorney David Zellis prosecuted Tenzer. "Dr. Whalen's testimony was interesting because she didn't know the first thing about" Neff's death, Zellis recalled.

Whalen did not return calls from ProPublica and PBS "Frontline" seeking comment.

Zellis was astounded that a doctor could legally determine how Neff had died without actually seeing his body. "I was stunned," said the attorney, who is now in private practice. "To this day, I find it outrageous."

Ageism and Autopsies

Erroneous death certificates and faulty reporting practices are partially responsible for few senior deaths being investigated. But there's another factor: Many coroners and medical examiners resist looking into these cases.

Of the 1.8 million seniors who died in 2008, post-mortem exams were performed on just 2 percent. The rate is even lower -- less than 1 percent -- for elders who passed away in nursing homes or care facilities.

To a certain extent, the statistics reflect medically reasonable assumptions. The death of a young person is inherently unusual. By the time people reach their 60s, 70s and beyond, aging and disease have caught up to them, and death is more expected.

But Hawes, the Texas A&M professor who studies elder abuse, thinks the numbers also reflect bias. For a 2005 report to the Justice Department, Hawes interviewed 40 coroners and medical examiners about how they handle deaths among the elderly. In anonymous sessions, they voiced deep reluctance to autopsy seniors.

"Many of them made the blanket assumption that when an elderly person dies, it must have been because 'their time had come,'" she said. "But they don't make that assumption about any other part of the population."

In many jurisdictions, coroners and medical examiners are already struggling to autopsy the bodies coming into their morgues. Bringing in more seniors would further stretch their overtaxed resources.

"Coroners will say, 'We don't have enough money to autopsy every old person who dies,'" said Dr. Laura Mosqueda, a professor of geriatrics at the University of California, Irvine, and co-director of the Orange County Elder Abuse Forensic Center. The problem, she said, "is that coroners around the country are using the fact that they can't autopsy all older people who die as an excuse not to autopsy any older person who dies." She trains coroners and their investigators to zero in on signs of abuse and target their efforts strategically.

Some death investigators think concerns about elder abuse and neglect are overblown.

Dr. Jon Thogmartin, the chief medical examiner for Florida's Pasco and Pinellas counties, takes on more than 500 senior deaths per year, ordering full autopsies or checking bodies for external signs of injury. Thogmartin said "95 percent" of the elder abuse allegations he comes across "are completely false," and that many of the claims originate with personal injury attorneys.

But others in the field worry that some coroners and medical examiners may not be distinguishing fatal conditions caused by disease and aging from those caused by abuse and neglect.

When younger people wind up in the morgue, death investigators typically have a clear trail to follow. Was the person shot? Killed in a car crash? Beaten? Did he or she overdose on painkillers?

With seniors, however, they must hunt for more subtle clues. Harruff, the King County, Wash., medical examiner, teaches seminars about finding the forensic signs of elder abuse or neglect.

Some of his colleagues "don't take jurisdiction over neglect cases," Harruff said. "I take the attitude that these are potential homicides."

When Harruff scrutinizes an older person, he checks out the stomach to see if the person had eaten recently. He tests eyeball fluid to see if the person was getting enough to drink. Often, seniors who are neglected or abused are malnourished or dehydrated.

Harruff takes X-rays to search for broken bones, but he also looks for evidence of osteoporosis, which can cause bones to fracture easily without any sort of violence.

Harruff pays close attention to the body's hygiene and cleanliness, and takes note of what the person was wearing. He gets concerned when he finds a senior clad in filthy clothes who hasn't bathed recently.

It's never simple separating the damage done by natural processes from damage done by other people. "In an elderly individual, invariably there's a combination of processes -- if there's neglect, there's usually disease and neglect," he said.

Decubitus ulcers, better known as pressure sores or bed sores, are a possible indication of abuse or neglect. If a person remains in one position for too long, pressure on the skin can cause it to break down. Left untreated, the sores will expand, causing surrounding flesh to die and spreading infection throughout the body.

People with limited mobility are at greater risk of pressure sores. For patients in nursing homes, sores can mean that staffers aren't turning or moving them enough, a serious violation of accepted standards of care. Federal data show that more than 7 percent of long-term nursing-home residents have pressure ulcers.

The wounds can kill, notes Dr. James Lauridson, the retired chief medical examiner for the Alabama Department of Forensic Sciences. "Very often, that is the way these folks die," he said. "It is a preventable mechanism of death that we're missing."

Lauridson, who now performs autopsies for private clients, added, "Occasionally, there are elderly people who are being assaulted. But this issue of pressure ulcers is a far, far bigger issue, and really nationwide."

'I Don't Think We Understood the Level of Poor Care We Would Find'

There is a model for conducting elder death investigations effectively. It has taken root in Arkansas, thanks to the unyielding efforts of a man named Mark Malcolm.

In the late 1990s, while serving as the coroner of Pulaski County, which includes Little Rock and the surrounding area, Malcolm received a string of complaints about seniors dying in nursing homes under suspicious circumstances. He ordered the exhumation of six people, all of whom had supposedly died of natural causes.

The autopsy results were stunning: Four seniors had been killed by suffocation; two had died from medication errors.

Malcolm's experiences prompted him to push for a new state law requiring nursing homes to report all deaths, including those believed to be natural, to the local coroner. The law, enacted in 1999, authorizes coroners to probe all nursing-home deaths, and requires them to alert law enforcement and state regulators if they think maltreatment may have contributed to a death.

In the first four and a half years after the measure's passage, Malcolm reported 86 deaths to other authorities. The number represented a small fraction of the roughly 4,000 nursing-home deaths he and his staff investigated, but it was big enough to suggest there were widespread care problems.

"I don't think we understood the level of poor care that we would find. It came fast, it came furious," recalled Malcolm, who now runs a private disaster management consultancy.

After a death, Malcolm's investigators would visit the nursing home, taking photographs, reviewing medical records and looking for potential signs of poor care such as multiple pressure sores, undocumented injuries or unsanitary conditions.

They found such problems repeatedly at Riley's Oak Hill Manor North in North Little Rock.

Lela Burns remembers watching her mother, Irene Askew, rapidly deteriorate during the four and a half months she spent at Riley's in 2000. Admitted for rehabilitation after hip surgery, Askew soon developed ghastly pressure sores, including one that resulted in the amputation of her lower right leg. Askew died on Nov. 17, 2000. Malcolm ordered an autopsy, which concluded that another massive pressure sore had contributed to her death. The hole was the size of a fist and so deep it exposed bone on her lower back.

"It was a horrible place," said Burns. "You think to yourself, 'How could this happen?' It was just devastating."

The home came to a financial settlement with Askew's family, the terms of which are confidential.

The same year Askew died, another Riley's resident died with five pressure sores so severe they were deemed to be potentially life-threatening. Yet another died with 28 pressure sores. Riley's executives told the Arkansas Democrat-Gazette that they had done everything possible to meet government standards and had an explanation for every complaint. Malcolm's investigations led state regulators to shut down the facility, in part because of the home's failure to prevent and treat pressure sores.

A 2004 review of Malcolm's efforts by the U.S. Government Accountability Office concluded that the "serious, undetected care problems identified by the Pulaski County coroner are likely a national problem not limited to Arkansas."

Malcolm's initiative prompted Medicare inspectors to start citing nursing homes for care-related deaths and to undergo additional elder-abuse training.

Still, nursing homes inspections are not designed to identify problem deaths. The federal government relies on state death-reporting laws and local coroners and medical examiners to root out suspicious cases, said Thomas Hamilton, director of the Survey and Certification Group at the Centers for Medicare & Medicaid Services.

So far, other states have not followed Arkansas' lead. Its law remains the only one of its type in the country, according to experts who track legislation that affects elders.

Another Approach

While Malcolm focused on nursing homes, investigators in some communities are developing new strategies for pinpointing suspicious deaths that occur in private residences.

In 2007, Ingham County, Mich., formed an elder death review team made up of police, prosecutors, adult protective services, the medical examiner, emergency personnel and others to evaluate cases.

Across the country, several counties have created such panels, including King County in Washington, and San Bernardino, San Diego and Los Angeles counties in California. It's an idea borrowed from child-abuse investigators, who have established similar multidisciplinary teams to probe the deaths of young children.

Shortly after Ingham County's team began meeting, Margaret Robinson, 94, died at her home in Lansing, the county's largest city.

Robinson had been living with a man paid $220 a month by the state to care for her.

Since Robinson died at home rather than in a medical facility, a police officer paid a visit to the scene, as is customary in most places. Piles of clutter littered the home, and the place reeked of dog feces and cigarette smoke. Robinson's shriveled body, clad only in a T-shirt and an adult diaper, lay on a bed. The officer would later testify that he didn't spot "any type of foul play," so he called the medical examiner to collect the body.

That's when Connie McQuaid, an investigator with the medical examiner's office, got involved.

Fresh from a training session on how to detect elder abuse, McQuaid spent the night combing through Robinson's medical records.

She spotted "red flags" in the files, she recalled in an interview. Robinson's paid attendant, Ira Gudith, had failed to provide her with medication or diapers. Doctors had noted that Robinson looked "very thin" and emitted a "foul odor." McQuaid said she was bothered by "what appeared to be a lack of concern about her well-being. ... He was not attending to her daily needs."

McQuaid voiced her concerns to supervisors and police detectives. The medical examiner ordered an autopsy.

Forensic pathologist Brian Hunter found that Robinson was emaciated, weighing just 82 pounds, dehydrated and covered with pressure sores festering with staph and E. coli bacteria. Her brain displayed the signs of advanced Alzheimer's disease. These problems contributed to her death.

But the chief cause, Hunter said, "came as a surprise."

Tests of Robinson's blood showed lethal amounts of morphine. No doctor had prescribed it for her, and it seemed impossible that in her bed-ridden state Robinson could have gotten the drug herself.

Criminal charges quickly followed, and in October 2007, Gudith pleaded guilty to second-degree murder. He appealed the conviction and lost.

Gudith's lawyer, Paul Toman, said in an interview that his client had struggled to meet Robinson's mounting needs. "Ira's just a simple fellow," Toman said. "He was in way over his head."

For Ingham County, Gudith's arrest proved the value of its new approach.

"Without the elder death review team, this case would not have gotten the attention of the autopsy team. It would not have gotten the attention of the prosecutor's office," McQuaid said. "This man would have gotten away with murder."

ProPublica's Krista Kjellman Schmidt, Joe Kokenge, Sergio Hernandez and Marshall Allen contributed to this report.

This spring, PBS “Frontline” and ProPublica will explore how flaws in the American system of death investigation have left the elderly vulnerable to neglect, abuse and even murder and how a small cadre of innovators are working to bring such cases to light.

by Lena Groeger

A bill to strengthen pipeline safety regulations passed the House and Senate last week and now awaits President Obama’s signature. But while many applaud Congress’s move toward more oversight, others question whether the impending law goes far enough to prevent oil and natural gas pipeline accidents.

The pipeline industry reports more than 100 significant hazardous liquid spills each year. (See a map of those spills). Every year, an average of 275 accidents kill 10 to 15 people and injure five to six times as many.

The “Pipeline Safety, Regulatory Certainty, and Job Creation Act of 2011” would double potential fines for violations (up to a max of $2 million), require automated shutoff valves for new and replaced pipelines, and hire 10 new safety inspectors to join the current 124.

“This is a huge step forward for the safety of America’s pipelines,” Senator Frank R. Lautenberg (D-NJ) said in a statement.

But as the Associated Press noted, the bill doesn’t implement several recommendations from a National Transportation Safety Board investigation of the natural gas pipeline explosion in San Bruno, California that killed eight people last September (the San Francisco Chronicle has a recent series on the disaster). One of those recommendations is that automated shutoff valves be installed on already existing pipelines (particularly old ones in highly populated areas, which are prone to accidents).

Safety experts also say that the Pipeline and Hazardous Materials Safety Administration, the federal agency responsible for regulating the vast network of 2.5 million miles of pipelines, needs many more inspectors to do the job right. The pipeline agency simply doesn’t have enough inspectors, or money to hire them, a New York Times investigation recently found.

A recent Congressional Research Service report on pipeline safety found a long-term pattern of understaffing. Which means that it’s often pipeline workers who notice and report problems – if they catch them in time.

In recent years, a series of major accidents have further raised the profile of dangerous pipelines. In addition to the San Bruno blast, 800,000 gallons of oil spurted into Michigan’s Kalamazoo River last July after a 30-inch pipeline sprung a leak. Another 42,000 gallons spilled in July into the Yellowstone River in Montana from a ruptured pipe.

Thousands of other pipelines could potentially share the same fate. More than 60 percent of the country’s gas pipelines are at least 40 years old, and they often aren’t compatible with the latest in safety technology (the Philadelphia Inquirer has a recent series on aging pipelines).

We’ve covered the recurring troubles with Alaska’s pipelines, which federal agencies have repeatedly flagged, urging repairs or entire replacements of dangerously corroded pipes. Even portions of the pipelines that BP inspectors didn’t give an “F” ranking (BP is the largest single owner of the Alaska pipelines) have burst, spewing thousands of gallons of oily water and methanol.

Another problem, as we’ve noted previously, is who writes the regulation standards. As it happens, the gas and oil industry has written at least 29 ­of the standards later adopted by the pipeline agency.

The bill comes alongside a Republican attempt to speed up the approval of the controversial Keystone XL Pipeline, a 1,700 mile long pipeline that would run from Canada to the Gulf of Mexico, carrying a particularly viscous form of crude called oil sands. As mentioned in the Times, the bill makes no reference to Keystone, but calls for more studies on whether oil sands needs extra regulation.

by Marian Wang

 

It’s no secret that Republicans don’t like the idea of President Obama exercising his power to make recess appointments. As we noted earlier this year, they’ve repeatedly used a procedural move to block the president from making this sort of temporary appointment, even though it’s a presidential power laid out in the Constitution. (Of course, the tactic isn’t specific to Republicans -- Democrats used it too under the Bush administration.)

But now, as winter recess approaches, Senate Republicans have been trying a different tactic: holding up other appointments as a bargaining chip. Senate Minority Leader Mitch McConnell has pledged to block the confirmation of three uncontroversial nominees for key banking regulator positions. Here’s how the Wall Street Journal described those nominees and what positions they’d fill:

The three nominees -- Martin Gruenberg, Thomas Hoenig and Thomas Curry -- would be charged with implementing last year's Dodd-Frank financial-overhaul law, which imposes a raft of restrictions on the financial industry. They are expected to take a tough line on the nation's largest banks, in a climate where both political parties are increasingly embracing to efforts to rein in the power of the nation's largest financial institutions.

All three of Mr. Obama's nominees have long histories as regulators and there was little controversy at their confirmation hearings.

At the heart of the standoff are fears that President Obama will use recess appointments to fill key vacancies in the new Consumer Financial Protection Bureau -- a consumer watchdog agency that the GOP believes has too much power -- and the National Labor Relations Board, the government’s independent arbiter of labor disputes.

Earlier this month, Republicans blocked the nomination of former Ohio attorney general Richard Cordray to head of the CFPB, though other Republicans have praised his qualifications. Keeping the agency without a director, as we’ve noted, limits its powers over payday lenders, certain mortgage servicers, and other under-regulated parts of the financial industry.

They’ve also asked President Obama not to use recess appointments to fill vacancies on the NLRB, which after December 31st essentially will cease to function because it will have too few members to issue regulations and decide cases.

Republicans have targeted the federal agency for the better part of the year, and a group of GOP lawmakers wrote a letter to the president this week, warning that if Obama makes recess appointments to the NLRB, it would set a “dangerous precedent” that could “provoke a constitutional conflict.”

But why that is isn’t exactly clear. President George W. Bush managed to seat more than a half dozen nominees at the NLRB through recess appointments. And overall, President Obama has made somewhat fewer recess appointments than his predecessors -- 28 so far, according to a recent Congressional Research Service report. 

by Marian Wang

Update, 12/19: A deal brokered last week by Senate Democrats and Republicans to extend the payroll-tax cut now looks likely to be blocked by House Republicans. House Speaker John Boehner said that the Senate proposal — a short-term deal that would only extend the payroll-tax cut by two months  — would simply be “kicking the can down the road. The House votes tonight on the bill. As we’ve noted in our earlier explainer about the payroll tax cut, economists say allowing the cut to expire could have serious consequences for the still fragile economy.

As Congress tries to deal with its long list of unfinished business, among the top and most contentious items has been the proposed extension of the payroll-tax cut.    

It has certainly inspired plenty of political posturing. Democrats have charged Republicans with hypocrisy for opposing a measure that would put hundreds of dollars into the pockets of American workers; Republicans have fired back, accusing President Obama of failed economic policies and misguided efforts to grant tax relief to some while upping taxes on the rich, who they say often create jobs.

But looking beyond the rhetoric, how much has the cut helped the economy? And what do economists say would happen if it’s not extended? We run through the facts.  

First, what is the payroll tax — and how big has the cut been?

Take a look at your paycheck, and it will be very clear: The tax is the part of your wages withheld for Social Security and Medicare.

The Social Security portion of the tax has long been split evenly between employers and employees. Until last year, this meant that employees were paying 6.2 percent of their earnings and employers were paying the other 6.2 percent — a total of 12.4 percent. The Medicare part of the tax is smaller — 1.45 percent for employees and 1.45 percent for employers.

But a deal struck last December to extend the Bush tax cuts included a one-year cut to the Social Security portion of the tax. Employers kept paying 6.2 percent, but employees got a reduction of two percentage points.

That worked out to about $900 in savings for the average U.S. household last year, according to calculations by the Tax Policy Center. Unless Congress decides to extend it for another year, that tax cut will disappear.

It’s also worth noting that the payroll tax is a regressive tax. The main portion of it — the part that goes to Social Security trust funds — is a flat percentage on the first $106,800 of your paycheck. What that means is that people making more than $106,800 end up paying a smaller percentage of their wages in payroll taxes than do those whose paychecks fall short of that benchmark.  For instance, the cut aside, somebody making about $500,000 a year would pay only a little more than 1 percent to Social Security. (University of Chicago economics professor Casey Mulligan has a post in The New York Times’ Economix blog with some helpful background on the tax.)

So what’s Congress going to do?

The details are still being worked out, but it looks as if Republicans are moving toward reluctantly backing an extension of the tax cut, though not an expansion of it.  

The Obama administration originally proposed increasing the size of the cut and also cutting the portion employers pay. The administration put that proposal in its jobs bill, but that legislation is dead.

Divided on whether to even extend the 2011 cut, Republicans aren’t likely to back changes beyond the levels agreed upon last year, according to The Wall Street Journal. They’ve also opposed Democrats’ current proposal to offset the revenue gap by raising taxes on people making more than $1 million.

What’s the upside of extending the Social Security tax cut?

Well, you can see for yourself how it changes your paycheck. The White House has a payroll-tax cut calculator that can show how much you stand to lose if Congress doesn’t extend the tax cut.

But in terms of the larger picture, economic analysts have said that unless the payroll-tax cut and other short-term measures are extended, “fiscal drag will be intense in 2012.” Here’s The Washington Post:

Goldman Sachs economic forecaster Alec Phillips estimated that allowing the payroll-tax cut to expire would reduce growth by as much as two-thirds of a percentage point in early 2012. Macroeconomic Advisers estimates that it would reduce GDP growth by 0.5 percent and cost the economy 400,000 jobs by the fourth quarter. 

Mark Zandi, chief economist at Moody’s Analytics, went a little further [PDF], estimating that if both the payroll-tax cut and extended unemployment insurance are allowed to expire, real GDP growth will fall by nearly a percentage point and about 1 million jobs will be lost by the end of 2012.

Ultimately, a simple extension of the payroll-tax cut means a continuation of what workers already have. That’s why economists and analysts talk less about any possible upside — such a boost to consumer spending — and cast it as a way to avert further damage to the economy.

What are the limitations and downsides?

The tax cut isn’t cheap. This year, it cost the Social Security trust funds $110 billion in lost revenue — money that the federal government reimbursed by borrowing.

So, while it’s not true that a payroll-tax cut is bankrupting Social Security, it is adding to the deficit. Critics worry that, over time, a pattern of shifting funds from general revenue to the Social Security trust funds will weaken what was a largely self-funded program.

Another obvious limitation to the payroll-tax cut is that only workers — not the unemployed — benefit directly from it, which is why a proposed extension of unemployment benefits is often mentioned in the same breath. It’s also why the Obama administration has pushed to expand the tax cut to employers, hoping it’ll spur hiring.

But if boosting spending and creating jobs is the ultimate goal, some policy experts such as Bruce Bartlett, who once held top policy positions in the Reagan and George H.W. Bush administrations, note that cutting the payroll tax isn’t the best way of accomplishing that. After all, consumers or employers may have a bit more to spend, but that doesn’t mean they’ll spend that money or use it to hire people. Some of those dollars will undoubtedly end up in personal savings or company profits, muting the macroeconomic benefit.

Ultimately, Bartlett writes, directly spending the money, such as launching a public works project, would pack a bigger punch, even if it would be a tougher sell in Congress.

by Michael Grabell and Christian Salewski, ProPublica

While X-ray body scanners used in airports face concerns about potentially increasing cancer cases, a safer type of scanner has been plagued by another problem: a high rate of false alarms.

The scanner, known as the millimeter-wave machine, uses low-level electromagnetic waves that, unlike X-rays, have not been linked to cancer. The Transportation Security Administration already uses the millimeter-wave machine and says both types of scanners are highly effective at detecting explosives hidden under clothing.

But two of Europe's largest countries, France and Germany, have decided to forgo the millimeter-wave scanners because of false alarms triggered by folds in clothing, buttons and even sweat.

In Germany, the false positive rate was 54 percent, meaning that every other person who went through the scanner had to undergo at least a limited pat-down that found nothing. Jan Korte, a German parliament member who focuses on homeland security, called the millimeter-wave scanner "a defective product."

While it's difficult to know for sure if the millimeter-wave machine has a worse false-alarm rate than the X-ray machine, recent tests suggests that it does. The TSA wouldn't release its results, citing national security. But a British study found the X-ray machine had a false-alarm rate of just 5 percent.

For the millimeter-wave machines, a complicating factor is new privacy software that was installed in many countries after a public outcry over the scanners' graphic images. The software automates detection and no longer creates an image of a passenger's body. While false alarms were reported before automation when human screeners interpreted images, the software appears to have made the problem worse.

The privacy safeguards are also an obstacle to lowering the false-alarm rate, researchers say. The machines do not save images or data, which could be used to teach the software how to distinguish real threats from false ones.

The problem of false alarms comes down to fundamental physics. Millimeter waves penetrate clothing and reflect off objects. But because of their frequency, millimeter waves also reflect off water, which can cause the scanner to mistake sweat for a potentially dangerous object, said Doug McMakin, the lead researcher who developed the millimeter-wave scanner at the Pacific Northwest National Laboratory. (X-rays, which operate at a higher frequency, pass through water more easily.)

In addition, millimeter waves penetrate clothing materials differently, and layers of clothing can create a barrier, triggering a false alarm.

"These are known as clutter issues in the imaging," McMakin said.

The manufacturer, L-3 Communications, said that in the United States the scanners have not experienced a high rate of false alarms caused by either clothing or sweat. L-3 executives noted that the millimeter-wave machine is installed in airports in some of America's most humid cities, including Houston, New Orleans and Miami.

But as late as last November, the head of the TSA told Congress that false alarms were too frequent to deploy the privacy software. The TSA said the rate has improved since then and now meets its standards, which it would not disclose.

"As with many types of technology, there will be an anticipated amount of false alarms that are considered acceptable, and we continue to work with industry vendors to improve both the detection and operational capabilities for all of our technology," spokesman Greg Soule said.

But results from other countries, as well as tests conducted in the United States before 9/11, show false alarms occurred between about a quarter and half of the time. Moreover, dozens of U.S. travelers told ProPublica they had to get a pat-down despite passing through the body scanners.

Only one report of the false alarm rate for the X-ray body scanners could be found. At Manchester Airport in the United Kingdom, where 13 machines have been tested on more than 2.5 million people, the rate has been less than 5 percent -- and that includes passengers who left items such as keys in their pockets, said airport spokesman John Greenway.

Referring to the false alarm rate, Peter Kant of the manufacturer, Rapiscan Systems, said, "Our numbers internally are in the very low single digits." The company, as well as several physicists, said sweat does not cause false alarms with the X-ray scanners.

In an effort to close a gaping hole in its ability to catch explosives, the TSA in 2009 began installing body scanners alongside metal detectors for routine screening. The deployment ramped up quickly after a Nigerian man tried to blow up a plane that Christmas with explosives hidden in his underwear.

The TSA purchased both types of scanners with plans to deploy them at nearly every security lane by 2014. In hubs, such as Atlanta and Dallas-Fort Worth, it installed millimeter-wave machines, which look like round glass booths and emit low-powered electromagnetic waves similar to those found in police radar guns.

In other major airports, such as Los Angeles and Chicago O'Hare, it installed X-ray machines, also known as backscatters, which look like two large blue boxes and emit extremely low levels of ionizing radiation, a form of energy that strips electrons from atoms and damages DNA, potentially leading to cancer.

The possible health risk of the X-ray scanners, while small, has prompted several prominent radiation experts to ask why the TSA doesn't just use the millimeter-wave machine. The agency has said keeping both technologies in play encourages the contractors to improve their detection capabilities and lowers the cost for taxpayers.

The United States is almost alone in deploying the X-ray body scanners for airport security: Nigeria has installed them, and the United Kingdom is testing them for random screening and to check passengers who have set off the metal detector. Last month, the European Union prohibited the X-ray machines, effectively leaving the millimeter-wave scanner as the only option in Europe.

The United Kingdom will have to stop using the machines once its test is completed, according to the European Commission. But the commission has also asked one of its scientific committees for a health study that could change its position on the backscatters.

Guns, Sweat and Privacy Fears

During a Republican presidential debate in 1988, George H.W. Bush, pulled out a .22-caliber miniature revolver made with only a small amount of metal to dramatize the new types of guns that could pass through airport metal detectors.

"That weapon at this point cannot be detected," he said. "That weapon can kill the pilot of an airplane."

The comments, along with concerns over a new Glock pistol made of plastic, spurred the Federal Aviation Administration, which was then in charge of security, to fund research into a millimeter-wave imaging system at the Pacific Northwest National Laboratory.

After 9/11, the lab licensed the technology to a startup company, which was acquired by L-3 in 2006.

When the scanners debuted, TSA officials boasted that they were so good at detection, that screeners could literally see the sweat on someone's back.

At that time, human operators viewed the image. Although sweat might appear similar to a threat, trained officers learned to recognize normal sweat patterns, said Kip Hawley, TSA administrator from 2005 to 2009. In fact, sweat could help officers detect a sheet explosive, he said, because something taped or glued to the body changes the natural sweat pattern.

"It never popped up where we said, 'Oh God, we're getting killed with false positives,'" Hawley said. "I think it's a training issue, training the officers on interpreting the images."

But because of the uproar over agents seeing passengers' bodies -- what critics decried as a "virtual strip search" -- other countries began installing automated detection software last year, and the TSA followed suit in July.

Now, instead of displaying an image of a particular passenger's body, the machine shows a generic, unisex outline that's reminiscent of the cartoon character Gumby. Any potential threat is indicated by a yellow box that shows up roughly where the software detected it -- on the right ankle, for example, or the left elbow.

"It looks for abnormalities," said Tom Ripp, president of L-3's security and detection division. "It looks for objects that are not supposed to be there."

The advantage, L-3 officials said, is that screeners can focus their checks on the highlighted area instead of patting down a passenger's entire body.

"If you go out to an airport like D.C., Reagan, you'll see how easily the process works," said senior vice president Bill Frain. "Usually somebody left something in their pocket. We sat there and watched for 20 minutes. The duration between an alarm and a check -- they were just putting people through. It was a very quick check."

The European Experience

That wasn't the case in Germany.

The German interior ministry tested two L-3 body scanners with the automated detection software at Hamburg Airport, screening 809,000 airline passengers from September 2010 through July 2011. Despite the high rate of detection, the delays caused by frequent false alarms were so unbearable that Germany decided that the technology was not ready for everyday use.

Nearly seven out of 10 passengers had to be stopped for further screening. Although some passengers had forgotten coins or tissues in their pockets, 54 percent of all passengers who went through the scanners triggered true false alarms -- meaning that no hidden objects were found on those people, a ministry spokesperson said.

The vast majority of false alarms, affecting 39 percent of all passengers, were attributed to sweat, buttons or folds in clothing. Another 10 percent resulted from passengers moving during the scan, while 5 percent couldn't be explained at all.

Ripp from L-3 said the high alarm rate comes down to how diligent the screeners are about asking passengers to take off belts and boots, remove bulky sweaters and assume the proper stance with their hands over their heads. In the United States, the stance has become routine, he said.

"That was not the case in these trials in Hamburg," Ripp said.

The German interior ministry, however, dismissed the idea that it hadn't followed the manufacturer's protocol. Officials there provided ProPublica with a flier that was handed out to passengers before the screening that specifically tells them how to stand and to remove sweaters, belts and boots.

"Prior to the field test, the security personnel was specially trained to deal with body scanners and has adhered to the control procedure," the spokesperson said via email. "The passengers were asked to take off the named items."

Germany wasn't the only country to have problems with false alarms.

France tested the scanners with and without the privacy software on more than 8,000 passengers flying out of Paris's Charles de Gaulle Airport to New York from February to May 2010. But the government decided not to deploy them because there were too many false alarms, said Eric Heraud, a spokesman for the French civil aviation authority.

Heraud wouldn't release specific figures but said the false alarm rate was higher with the automated detection than when officers interpreted the images. France plans to conduct a new test of the millimeter-wave scanners in 2012.

In Italy, the rate of false alarms was 23 percent, said Giuseppe Daniele Carrabba, head of the airports coordination department for the Italian civil aviation authority.

Italy tested two L-3 scanners with the automated detection software at the airports in Rome and Milan. The test ended in September, and officials are awaiting a final decision on whether to deploy the machines later this month. Carrabba said he thinks Italy will use them, and that the false positive rate will improve with more training and better preparation of the passengers for screening.

L-3 attributed the variations in experiences to the different settings that countries choose for what to detect and what to ignore.

Other countries that have deployed millimeter-wave scanners -- Canada with 51 machines and the Netherlands with 60 -- said they had not experienced problems with false alarms. They declined to disclose their false-positive rates.

The American Experience

In the United States, the TSA has deployed more than 250 millimeter-wave machines and plans to install 300 more by next spring.

The TSA declined to answer detailed questions. Instead, the agency released a statement saying that it had tested the automated detection software rigorously.

"Once it met the same high standards as the technology currently in use, TSA successfully tested the software in airports to determine whether it was a viable option for deployment," the statement said. "While there are no silver bullet technologies, advanced imaging technology with this new software is effective at detecting both metallic and non-metallic threats."

Shortly after the machines were developed, preliminary tests at Seattle-Tacoma International Airport in 1996 resulted in a false alarm rate of 31 percent, according to a research paper presented at a conference the following year. During the tests, screeners who were new to the machine viewed images of people carrying various weapons, explosives and innocuous objects and had up to 27 seconds to identify them. According to the paper, researchers did test the results with layered clothing.

In 2000, those same images were run through a primitive model of the automated detection and privacy software. The false alarm rate increased to 38.5 percent when the machine was set on high sensitivity but decreased to 17 percent when set on low sensitivity, according to another study by the same researchers at the Pacific Northwest National Laboratory.

"Overall, these results show comparable performance" between the software and the human screeners, the researchers concluded.

The TSA ran additional tests over several years before deploying the scanners, but late last year, administrator John Pistole told Congress the tests were still showing a high rate of false alarms with the software. Officials said the false alarm rate improved, and the agency began installing the software over the summer.

Still, American travelers frequently complain about false positives similar to those experienced in Europe.

Lynne Goldstein, an archaeologist at Michigan State University, said she generally prefers the scanners because, with two knee replacements, she always sets off the metal detectors and has to undergo a pat-down.

But, she said, a cotton shirt she frequently wears while traveling set off the millimeter-wave machine several times while flying out of Detroit. TSA agents told her it was the shirt's "kangaroo pocket" similar to those found on sweatshirts that triggered the alarm.

"The last time, they did a full pat-down," Goldstein said. "The thing that's ironic to me: I actually like the machine."

Many travelers, however, also reported false alarms with the X-ray body scanner.

Jason Ritchie, an associate chemistry professor at the University of Mississippi, said he was flying out of Memphis on his way to a conference in August when the operator of the X-ray machine spotted something that required further checking.

The suspicious item: The pockets of his cargo pants, he was told.

"It kind of annoys me when I have to go through the X-ray system because I don't like to be irradiated unnecessarily," Ritchie said. "To have to go through that and then be told I also had to get a pat-down was frustrating."

ProPublica tried to get a handle on the false alarm rate in the United States by commissioning a poll by Harris Interactive. The poll of 2,198 people was conducted online to ensure that those who responded could view images of the machines in addition to reading a description.

Of the 581 people who said they had taken a flight in the past six months, nearly two-thirds, or 367, reported going through a body scanner.

About 11 percent of those scanned said they were patted down anyway despite having nothing on them -- the equivalent of a false alarm.

Among this group, the rate of false alarms was slightly higher for the millimeter-wave machine over the X-ray scanner. But Harris Interactive cautioned that because the sample size of people reporting this experience was small, the result cannot be generalized to the population at large.

Possible Solutions

Improving the technology to increase detection but limit false alarms is extremely challenging because of the great variety of body shapes and clothing, said McMakin of the Pacific Northwest National Laboratory.

The machine can be taught to recognize patterns in clothing such as a left breast pocket in men's dress shirts, he said. But whereas screeners could generally see the outline of an abnormal pocket or buttons in an image, the privacy software eliminates such human discretion.

One option is to combine the millimeter-wave scan with an optical camera to weed out those issues, McMakin said. For example, software could compare the millimeter-wave scan with the photograph to determine if a button or a zipper was causing the alarm. Developers could also increase or decrease the frequency of the waves or improve the shape and location information in the algorithm, he added.

"We're just at the beginning of where this technology can go," McMakin said.

Ripp from L-3 said it all comes down to "machine learning."

Getting the information of what's normal in order to improve the technology requires many thousands of scans. But because of the privacy outcry, the machines used in airports do not save the images or data from the scans. Without that real-world data, developers have to find other ways to teach the software to distinguish real threats from false ones.

Christian Salewski, a former fellow at ProPublica and a staff writer for the Financial Times Deutschland, reported from Hamburg.