Last month, reporter Anna Clark and I hosted an in-person photo gallery and group discussion about what motivated us to tell stories of Flint, Michigan, residents 10 years after the start of the water crisis and to talk about how we work to understand the communities we serve. As a visual fellow at ProPublica, I’m focused on documenting the lives of people in our stories through photography. Throughout history, photography has been a powerful tool for recording moments in time, providing visual evidence and evoking emotions that urge us to understand experiences outside of our own. Here are suggestions for aspiring visual storytellers who may find themselves in similar situations.
Ask “Why Does This Story Need to be Told?”
Anna and I previously worked in Flint in different capacities: I interned as a photojournalist at the Flint Journal; Anna wrote a book, “The Poisoned City: Flint’s Water and the American Urban Tragedy.” To us, Flint is not just a news story, it’s a complex place full of real people who have been and continue to be denied adequate resources and support. We wanted the public to know that generations of Flint residents still live with physical and psychological challenges. By sharing what Flint residents think accountability would look like, we were able to show how many feel betrayed by the failure to hold anyone criminally responsible. They also remain frustrated by how long it’s taking to fix the local water system and the lingering mental wounds that may never be repaired.
The photo essay gave a glimpse into the experience of three residents and how their present-day concerns, fears and decisions are shaped by the water crisis. Over about four months, I made frequent visits to Flint — stopping by nonprofits, churches, after-school programs and other places that are part of everyday life. I spoke with incredibly kind people. Some wanted to help me; others were hesitant, usually because they wanted to move on or felt things would never change. Robert McCathern, Teagan Medlin and Jacquinne Reynolds granted me a great deal of trust. They were able to open up and make themselves vulnerable because of their commitment to cultivating change for future generations. I tried to represent that through the environment in the photographs.
Be Sincere With Your Approach
During the discussion at the visual storytelling event at Totem Books in Flint, we asked residents to ponder what type of stories resonate with them most, what questions they wish someone would ask them and who is one person they would like to interview. We discovered a common thread of wanting to feel more connected as neighbors and fellow human beings.
Then we flipped the exercise to challenge ourselves as journalists and receive questions from residents. “Why Flint?” one participant asked us. We told her how we’d come to admire the community and wanted to present a multidimensional view of it to readers. “Something about this place seems to get in people’s blood,” the participant told us, and it does seem that for a city of its size, Flint has attracted a disproportionate number of storytellers — even before the water crisis. And yet, some residents still wonder: What has changed? Over the past decade, Flint residents have been in the public eye not by choice, but as a result of a disaster created and prolonged by public officials. So what does that mean for us and our responsibility as storytellers?
Being in the business of transparency requires us to also be transparent with the communities we document. Without transparency, it’s hard to build mutual trust, especially in communities that have faced betrayal and have had little control over how their stories are shared with the world.
During the early stages of the project, before lifting my camera to make any photos, I listened to Flint residents and learned about their stories, then let what they told me naturally guide the photos I made. Early on, I also stressed that I believe their stories are important to share because people outside of Flint should know that for many Flint residents, the crisis is still not over.
I also should note that our stories go through many layers of revisions and fact-checking. From beginning to end, I tried to communicate how the project was developing and made sure that our sources were aware of how the story would be framed, how they would be portrayed and how they would be quoted. Once the story was published, I followed up to gauge how they were feeling, and later made them aware that photographs of them would appear at our galley in Flint.
Look for Connection and Insight
The beauty of visual storytelling is that the story can always change shape. Let go of any assumptions and let the story lead you where it may. Anna and I learned so much by taking this approach.
We found that, after a decade, many residents are still waiting for the change they want to see. The flood of the resources and attention Flint initially received has dwindled. But one of the reasons I wanted to revisit this story is because of the people I’ve met and will continue to meet. The city has introduced me to people who care deeply about their community and embrace one another with generosity, care and compassion. And I learned about a host of local programs, from the Flint Rx Kids program that provides financial support for mothers to the McKenzie Patrice Croom Flint Community Water Lab, which trains youth to give back and provides free water testing. Although communities like Flint shouldn’t need to be resilient, we can learn from their empathy, advocacy and support for one another during hard times. My job is to make photographs, but a big part of the fulfillment I get is from making connections.
We closed out our event in Flint by making photographs of attendees that they could have as keepsakes. One woman, who told me she had recently been displaced from her home, said she was going to email the photos of herself to her grandchildren who live in another state. It reminded me that photographs are invaluable in many facets of our lives. They keep us connected.
ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Sarahbeth Maney is ProPublica’s first Diamonstein-Spielvogel Visual Journalism Fellow, focused on documenting in-depth investigative stories through photography.
Keywords: Photojournalism, Visual Storytelling, Telling stories through pictures, More than taking pictures, Documenting history
New York -- Last month, Brenda Foster stood on the railroad tracks at the edge of her yard in East Palestine, Ohio, and watched a smoky inferno billow from the wreckage of a derailed train. The chemicals it was carrying — and the fire that consumed them — were so toxic that the entire area had to evacuate. Foster packed up her 87-year-old mother, and they fled to stay with relatives.
With a headache, sore throat, burning eyes and a cough, Foster returned home five days later — as soon as authorities allowed. So when she saw on TV that there was a hotline for residents with health concerns, she dialed as soon as the number popped up on the screen.
What she didn’t realize is that the page of test results that put her mind at ease didn’t come from the government or an independent watchdog.
The people who arrived offered to test the air inside her home for free. She was so eager to learn the results, she didn’t look closely at the paper they asked her to sign. Within minutes of taking measurements with a hand-held machine, one of them told her they hadn’t detected any harmful chemicals. Foster moved her mother back the same day.
What she didn’t realize is that the page of test results that put her mind at ease didn’t come from the government or an independent watchdog. CTEH, the contractor that provided them, was hired by Norfolk Southern, the operator of the freight train that derailed.
And, according to several independent experts consulted by ProPublica in collaboration with the Guardian, the air testing results did not prove their homes were truly safe. Erin Haynes, a professor of environmental health at the University of Kentucky, said the air tests were inadequate in two ways: They were not designed to detect the full range of dangerous chemicals the derailment may have unleashed, and they did not sample the air long enough to accurately capture the levels of chemicals they were testing for.
“It’s almost like if you want to find nothing, you run in and run out,” Haynes said.
About a quarter century ago, the Center for Toxicology and Environmental Health was founded by four scientists who all had done consulting work for tobacco companies or lawyers defending them. Now known by its acronym, CTEH quickly became a go-to contractor for corporations responsible for industrial disasters. Its bread and butter is train crashes and derailments. The company has been accused repeatedlyof downplaying health risks.
In since-deleted marketing on its website, CTEH once explained how the data it gathers about toxic chemicals can be used later to shield its clients from liability in cases brought by people who say they were harmed: “A carrier of chemicals may be subjected to legal claims as a result of a real or imagined release. Should this happen, appropriate meteorological and chemical data, recorded and saved ... may be presented as powerful evidence to assist in the litigation or potentially preclude litigation.”
Despite this track record, this company has been put in charge of allaying residents’ concerns about health risks and has publicly presented a rosy assessment.
It was CTEH, not the Environmental Protection Agency, that designed the testing protocol for the indoor air tests.
And it is CTEH, not the government, that runs the hotline residents are directed to call with concerns about odors, fumes or health problems. Local and federal officials, including the EPA, funnel the scared and sick to company representatives.
In a statement, Paul Nony, CTEH’s principal toxicologist and senior vice president, said the company has responded to thousands of incidents, and its environmental monitoring and sampling follows plans approved and directed by the incident commanders of each response. “Our highly skilled, certified specialists include Ph.D. toxicologists, masters in public health, industrial hygienists and safety professionals, as well as hazardous materials and registered environmental managers,” he wrote.
He added that CTEH has been “working side-by-side” with the EPA in East Palestine “and comparing data collected in the community and in people’s homes to ensure that we are all working with the most accurate data.” Hotline callers receive information, Nony wrote, that is “based on the latest data collected by CTEH and EPA, vetted together to ensure the accuracy of the public health information provided.”
The circumstances of the testing are unclear. The EPA said its representatives have, indeed, accompanied CTEH to residents’ homes, overseen the company’s indoor air tests and performed side-by-side testing with their own equipment. But some residents told ProPublica that even though multiple people came to their doors, only one person had measuring equipment. An agency spokesperson said CTEH’s testing protocol “was reviewed and commented on by EPA and state and federal health agencies.”
Stephen Lester, a toxicologist who has helped communities respond to environmental crises since the Love Canal disaster in upstate New York in the 1970s, said he was concerned about Norfolk Southern’s role in deciding how environmental testing is done in East Palestine. “The company is responsible for the costs of cleaning up this accident,” Lester said. “And if they limit the extent of how we understand its impact, their liability will be less.”
An EPA spokesperson said that the federal blueprint for responding to such emergencies requires responsible parties, in this case Norfolk Southern, to do the work — not just pay for it. But the agency has the authority to perform or require its own testing.
The relationship between CTEH and Norfolk Southern wasn’t clear to several residents ProPublica interviewed. Before testing begins, people are asked to sign a form authorizing the “Monitoring Team,” which the document says includes Norfolk Southern, “its contractors, environmental professionals, including CTEH LLC, and assisting local, state, and federal agencies.” An earlier version of the form included a confusing sentence that suggested that whoever signed was waiving their right to sue. Norfolk Southern said that was a mistake and pulled those forms.
In a written response to questions, Norfolk Southern said it “has been transparent about representing CTEH as a contractor for Norfolk Southern from day one of our response to the incident.” The company also pointed to a map on its website displaying CTEH’s outdoor air-monitoring results that says “Client: Norfolk Southern” in tiny type in the corner. “We are committed to working with the community and the EPA to do what is right for the residents of East Palestine,” a Norfolk Southern spokesperson wrote in an email.
When told by a reporter that the contractor, CTEH, was hired by the rail company, Foster’s face fell. “I had no clue,” she said. Looking back, she said, the people who came to her door never said anything about Norfolk Southern. They didn’t give her a copy of the paper that she had signed.
Before the derailment, East Palestine offered its 4,700 residents some of the best in small-town life. Its streets are lined with trees and charming houses. After school, kids played in the street, in the well-maintained park or in its affordable swimming pool. At Sprinklz on Top, a diner in the center of town, you can get a full dinner for less than $10.
Everything changed after the Feb. 3 derailment and the subsequent decision to purposefully ignite the chemicals, sending a toxic mushroom cloud over the town. Dead fish floated in local waterways, and “Pray for EP” signs appeared in many windows. Furniture is piled up on the curbs. Foster said some of her neighbors are replacing theirs because of concerns about contamination. But the 57-year-old, who works shifts painting firebrick, says she doesn’t have the money to do that. So she has come up with a solution she hopes will reduce her exposure: She sits in a single chair.
Tests May Miss Some Dangers
From the earliest days of the disaster, CTEH’s work has been at the center of the rail company’s reassuring messages about safety. Norfolk Southern’s “Making it Right” website cites CTEH data when stating that local air and drinking water are safe. (An EPA spokesperson said the agency has not “signed off” on any of Norfolk Southern’s statements “with regard to health risks based on results of sampling.”)
A video posted on Norfolk Southern’s YouTube account shows footage of a man in a CTEH baseball cap looking carefully at testing machinery. “All of our air monitoring and sampling data collectively do not indicate any short- or long-term risks,” a CTEH toxicologist says.
According to the EPA, CTEH’s indoor air testing in East Palestine consists of a one-time measurement of what is known as volatile organic compounds, or VOCs. These airborne chemicals can cause dizziness and nausea, and, over the long term, some VOCs can cause cancer. Vinyl chloride, a VOC that was carried by the derailed train and later ignited, can cause dizziness and headachesand increase the incidence of a rare form of liver cancer, according to the EPA. The machine that CTEH uses in East Palestine captures VOCs if they’re above 0.1 parts per million, but it doesn’t say which specific compounds are present.
CTEH said that when VOCs are detected, the company then tests for vinyl chloride. According to the EPA, the indoor testing has detected VOCs in 108 buildings before Feb. 21 and 12 buildings after that. Follow-up tests found no vinyl chloride, according to CTEH and the EPA. CTEH’s Nony said, “CTEH has not considered conducting long-term VOC air sampling in the homes because real-time air monitoring results do not indicate a significant impact of VOCs related to the derailment in the homes.”
But five experts on the health effects of chemicals consulted for this story said that the failure to detect VOCs should not be interpreted to mean that people’s homes are necessarily safe.
“VOCs are not the only chemicals that could have been in the air,” said Haynes, the environmental health professor. Haynes also said that because the testing was a snapshot — as opposed to an assessment made over several days — it would not be expected to detect VOCs at most household levels.
Many of the toxic chemicals that were airborne in the early days after the derailment, including pollutants that can cause cancer and other serious problems, may have settled out of the air and onto furniture and into crevices in houses, Haynes said. So she also recommended testing surfaces for compounds that could have been created by the burning of vinyl chloride, such as aromatic hydrocarbons, including the carcinogen benzene. Young children who play on the floor are especially vulnerable, Haynes added.
Even a week after the derailment, Haynes said VOCs likely would have dissipated. “To keep the focus on the air is almost smoke and mirrors,” she said. “Like, ‘Hey, the air is fine!’ Of course it’s going to be fine. Now you should be looking for where those chemicals went. They did not disappear. They are still in the environment.”
In addition, Dr. Ted Schettler, science director at the Science and Environmental Health Network, noted that some VOCs can cause symptoms at levels below 0.1 parts per million, which CTEH’s tests wouldn’t capture. Schettler gave the example of butyl acrylate, one of the chemicals that was carried by the derailed train. “The symptoms are irritation of the eyes and throats, headaches and nausea,” he said.
In its statement, Nony acknowledged that some homes in East Palestine had the odor of butyl acrylate, but he said that “current testing results do not indicate levels that would be associated with health effects.”
Health experts are particularly concerned about dioxins in East Palestine because the compounds can cause health problems, including cancer. The combustion of vinyl chloride and polyvinyl chloride, two of the chemicals that were on the train and burned after it derailed, have been known to produce dioxins.
But, in his statement, Nony dismissed the idea that the incident could have created dioxins “at a significant concentration” and said testing for the compounds was unwarranted. The company based that assessment on air monitoring it did with the EPA when the chemicals were purposefully set on fire; they were looking for two other chemicals that are produced by burning vinyl chloride.
Last week, the EPA said it would require Norfolk Southern to test for dioxins in the soil in East Palestine. And the agency has since released a plan for soil sampling to be carried out by another Norfolk Southern contractor. But some are arguing that the EPA should do the testing itself — and should have done it much earlier.
Results Used to Deny Relief
The results of CTEH’s tests in East Palestine were used at one point to deny a family’s reimbursement for hotel and relocation costs. Zsuzsa Gyenes, who lives about a mile from the derailment site, said she began to feel ill a few hours after the accident. “It felt like my brain was smacking into my skull. I got very disoriented, nauseous. And my skin started tingling,” she said. Her 9-year-old son also became sick. “He was projectile puking and shaking violently,” said Gyenes, who was especially concerned about his breathing because he has been hospitalized several times for asthma. “He was gasping for air.”
Gyenes, her partner and son left for a hotel. At first, Norfolk Southern reimbursed the family for the stay, food and other expenses. The company even covered the cost of a remote-controlled car that Gyenes bought to cheer up her son, who was devastated because he was unable to attend school and missed the Valentine’s Day party.
But the reimbursements stopped after Gyenes got her air tested by CTEH. Gyenes was handed a piece of paper with a CTEH logo showing that the company did not detect any VOCs.
The next time Gyenes brought her receipts to the emergency assistance center, she said she was told that no expenses incurred after her air had been tested would be reimbursed because the air was safe.
A post office clerk, Gyenes described her financial situation as “bleeding out.” Nevertheless, she continued to foot the hotel bill. “I still feel sick every time I go back into town,” she said.
When she called the hotline, she got upset when she said a CTEH toxicologist told her that there was no way her headache, chest pain, tingling or nausea could be related to the derailment.
ProPublica asked Norfolk Southern about Gyenes’ situation. A spokesperson said the company reimbursed her $5,000, including some lodging and food expenses, after the initial air tests even though the company said her home is outside the evacuation zone. It noted that Gyenes used “abusive language” when questioning the toxicologist. (Gyenes acknowledged that she called her a “liar.”)
Norfolk Southern said it is working with local and federal authorities to arrange another test of the air in her home. “We’ll continue to work with every affected community member toward being comfortable back in their homes, including this resident,” a Norfolk Southern spokesperson said in an email.
After ProPublica asked about the family, Norfolk Southern restarted payments.
On Wednesday, when Gyenes returned to the emergency assistance center, she said that she was given $1,000 on a prepaid card to cover lodging, food and gas.
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For the funeral industry, the COVID-19 pandemic has meant flush times.
Revenues have surged at Service Corporation International, the largest such
chain in the U.S., with more than 1,500 funeral homes and 400 cemeteries.
And “COVID impact,” according to a recent investor fact sheet, helped
SCI more than double its earnings per share
between 2019 and 2021.
The federal government has done little to regulate the industry.
Thirty-eight years ago, the Federal Trade Commission tiptoed into this
realm, mandating that funeral homes disclose their prices. But cemeteries,
some of which are overseen by states, were exempted from those rules. For
two years now, the FTC has been conducting a rare review of its rules and
examining a wide series of proposals, including extending its rules to
cemeteries, requiring that prices be posted online, and disclosing that
embalming is not legally required. Presented with a series of questions
about the status and timing of the process, an FTC spokesperson would say
only “the review is ongoing.”
Joshua Slocum, executive director of the
Funeral Consumers Alliance, the only
national consumer organization that monitors the funeral industry, has been
advocating for
changes to the FTC’s Funeral Rule
for decades. Regardless of what the agency decides, Slocum wants consumers
to know their rights, as well as have a few tips at their disposal when
preparing to put a loved one to rest.
This conversation has been edited for length and clarity.
Many people might be surprised to know that at least part of the death
industry is regulated. What is regulated and what isn’t?
Let’s talk about the federal [rules] because that’s most important to the
basics of what people need to know. There’s something called the Funeral
Rule, a regulation from the Federal Trade Commission, which gives consumers
particular rights, and they would be very wise to exercise these rights.
One, they have a right to get price quotes by phone.
Number two, when they go to a funeral home in person to talk about a funeral
arrangement, they have a right to a printed, itemized price list — think of
it just like a menu at a restaurant.
Number three, they have a right to pick and choose item by item. Funeral
homes are not allowed to offer you only a package. They will try to offer
you a package and they will often say, “You save money if you buy everything
together in a bundle.” But just like all bundles, you have to take a look
and see, is this actually something I would have spent money on, on its own?
Am I really saving money? Or am I just getting a bunch of things that I
wouldn’t have picked anyway?
What are the first steps to take after a loved one’s death?
Number one, remember that death is not an emergency. When death occurs, by
definition, that means the emergency is now over. The worst thing that can
happen has already happened. The person isn’t going to get any deader, to
put it plainly.
Get on the phone and call at least five different funeral homes within a 20-
to 30-mile radius of where the dead person is. Get price quotes. Take the
time to at least look it over and compare some of the prices before you
commit to having the funeral home remove the body. If the person dies at a
hospital, which is more common, you have more options. Ask the hospital if
the body can stay in the morgue for a couple of days while you make a
considered decision about which funeral home to call.
Two, take stock of your budget. You need to know that figure. Decide ahead
of time what you can comfortably afford. And for God’s sake, please don’t do
this: “Oh, money is no object. It’s my mother. She deserves the best,” and
then three months from now, you’ve got a $15,000 bill that you can’t pay.
What happens when you comparison shop?
Anytime you pick five or six funeral homes, all within the same city or
region, and you canvass them, you will find that there’s a price difference
of thousands of dollars for exactly the same service all within a service
area available to you. And you will not know this because the vast majority
of people will say, “Oh, well, we just use our family’s funeral home.” And I
will ask them, “Why is that the one you always go to?”
The bottom line is nobody has a family car dealer, nobody has a family
utility company, nobody has a family anything else. They compare prices and
services. The problem here is that because this is the death transaction,
and it’s a transaction we’re only going to sign a check for on average once
in our lives, we don’t have practice with it. And because it is the most
emotional business transaction we will ever encounter, many make the mistake
of thinking of the funeral home in the same emotional category that their
church lives in. That’s a mistake. Your funeral home is not your minister.
Your undertaker is not your counselor. Your undertaker is your car dealer
for death. And I do not mean that in an insulting way. I mean it in a
straightforward business way.
How did it come to be that funeral homes are governed by some federal
regulation, but cemeteries aren’t?
The cemetery regulation is so poor that I consider it an unregulated
industry, even if it is technically regulated under state law.
Cemeteries before the 20th century were never considered a capitalistic,
profit-making venture. They were, either by law or by community consensus,
conceived of as doing a public good, something closer to what the church
does. So they were seen as nonprofit community service entities that weren’t
subject to regular business regulation. That changed in the 20th century
when it did become possible in many parts of the country to run a for-profit
cemetery.
But the regulations never caught up. The same kinds of deceptive practices
that were documented that led to the Funeral Rule have always been going on
at cemeteries.
I think there’s very little chance that the FTC is going to bring cemeteries
under the funeral rule this time around. We’ve tried many times. There are
complicated reasons for it. One of the reasons is that many cemeteries in
many states are organized under nonprofit corporation law. The FTC does not
have jurisdiction over that, which is an actual genuine, systemic problem.
What kind of deceptive cemetery practices are you referring to?
The same things as what funeral homes did before the law changed. The FTC
rule doesn’t apply to cemeteries, so they don’t have to give out a printed
price list. They don’t have to let you pick a la carte. Many cemeteries get
up to nonsense games, like if you don’t want to buy that cemetery’s
headstone, they get sore that they’re not getting that profit out of you. So
if you go to a third-party monument dealer, the cemetery will tack on what
they will call an “inspection fee” that just happens to be the exact
difference in cost that they lost if you didn’t buy their stone.
What has changed now for the FTC to consider amending the Funeral Rule and
what needs to happen for some of these proposals to be implemented?
Well, the FTC needs to act. It’s been two years since the FTC announced that
they were reviewing the rule, and a review means considering changes. I
don’t have a lot of inside knowledge, but what I can say is in communicating
with the staff, I believe that they are taking this issue seriously. I
believe that they are seriously considering updating the rule to mandate
online pricing for funeral homes.
The current federal regulations entitle you to a paper price list if you
show up in person at the funeral home. We believe that funeral homes should
have to post their prices on their website. But until they do, you are
probably going to have to telephone shop.
Do many funeral homes post their prices online, even though it’s not legally
required at this point?
We, the Funeral Consumers Alliance and our partner organization, Consumer
Federation of America, have done two surveys on the rate of online price
posting. We did one in 2018, sampling 25 cities. We found only
16% of funeral homes posted their price lists online. We just did a new version of the survey, which was greatly expanded to a
sample size of 1,046 funeral homes in 35 different states, and
we only found 18% of them posting their prices. So no, most funeral homes hide their prices online.
Do you think the industry’s profits from COVID-19 will affect the FTC’s
decision?
I think our perception and reaction to COVID has played roles in most
things. One of the things that was really unfortunate for funeral consumers
is that COVID was exactly the period when an online price list would have
been most helpful to grieving families and we didn’t have it. People were
afraid to go into businesses in person, or there were actually state-based
restrictions about transacting business in person. So a lot of people were
making arrangements over the phone or in some long-distance way.
The big corporations, which own hundreds of funeral homes and cemeteries
across the country, are opposing changes to the rule — what’s their stated
reason? What’s your take?
Things like, “We believe that this is a very personal transaction, and we
believe it’s most appropriate for the price discussion to be had in the
traditional manner, and consumers aren’t shopping for price anyway, so
there’s no need for this.” That’s what they say. It’s not complicated. It’s
simply that they don’t want to be regulated. From my point of view, they
have a very weak case. First of all, requiring online posting of price lists
literally costs the funeral industry $0. Do you know what it costs them? It
costs them the time it takes to click that button that says “upload PDF.”
More broadly, how have multibillion-dollar conglomerates like SCI changed
the funeral industry?
Here’s the reality: They still only have about 12% of the funeral homes in
this country. And that’s been pretty steady over 20 to 30 years. In some
cities, places like Seattle, many cities in Florida, where there’s a heavy
concentration of elderly people, then SCI has a much greater percentage of
the market share. That is true. In those places, SCI particularly tends to
be the highest-priced funeral home in any market. So if it matters to you,
find out who owns your local funeral home. Just because it still says
McGillicuddy on the sign doesn’t mean Mr. McGillicuddy still owns it.
Are there practical things that consumers can do to bring the cost of a
funeral down?
The most cost-effective thing is to choose a funeral home that already has
reasonable prices. Your choice of funeral home is the No. 1 driver of cost.
Once you choose a funeral home, look carefully at their offerings and see
how much of it you can afford that’s within your budget. Remember that you
can shop a la carte. So if your budget says $2,000, you need to face
reality. $2,000 is not going to buy you a traditional funeral with
embalming, public viewing of the body, metal casket, graveyard burial. You
are not going to get that for $2,000 anywhere in the United States. That
means your choice is going to be something like simple cremation, even if
that’s not your favorite. People have to be realistic.
Is price negotiation ever an option? How would that work?
Yes, just the same way you would do it with any other business that you were
negotiating with. They don’t have to haggle with you, but you have the right
to do so. We get people who are like, “Well, the funeral home has already
picked up the body and we do like this funeral home, but they’re more
expensive than another one we found in town, we simply can’t afford it.” And
my suggestion is talk to the funeral director and say, “Listen, you’ve taken
good care of us before, we appreciate that you came to pick our grandmother
up, but we literally cannot afford your price on this direct burial. We
would love to give you our business. Can you meet your competitor’s price?
We realize you don’t have to lower your prices. But we would like to do
business with you. If you can’t lower your prices, we’ll have to have her
body removed to a different place.”
And that’s OK to do?
Well, why wouldn’t it be OK? Here’s what I hear underneath this, and I think
you’re channeling it correctly from people: What people are doing is asking
for permission. But you’re not breaking a social rule. You’re not being
cheap. I know what people are thinking: “I don’t want to do that. It’s
gauche. It means I don’t care about my mother.” Stop that. That’s nonsense
talk. If you showed how much you loved your mother by how much you spent on
her funeral, you’d go bankrupt. Love cannot be expressed by money.
Lastly, what are some of the biggest misconceptions about navigating this
process?
Most of what people think they are required to purchase is not true. For
example, many people think embalming is legally required if you’re going to
view the body. That is not true in any U.S. state. It’s also not true that
embalming is required as a condition of being buried in the ground. These
are in-house funeral home policies, not laws. So there’s very little that
you are legally required to purchase. Basically, the only thing that has to
happen, when a person dies, in order to satisfy the laws, there has to be a
death certificate signed by a doctor, the body has to be buried, cremated or
donated to anatomical science within a certain period of time, and that’s
literally all that is required. Everything else is optional.
Go into this transaction knowing that although it’s emotional, you are a
consumer, you get to decide what you put in your cart. You’re not obliged to
buy these things. These are choices and you should make choices that fit
your family’s budget and your family’s emotional preferences.
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Ngô Minh Hiếu was once a fearsome hacker who spent 7 1/2 years incarcerated in the U.S. for running an online store that sold the personal information of about 200 million Americans. Since leaving prison, Hiếu has become a so-called white hat hacker, attempting to protect the world from the sorts of cybercriminals he once was.
These days, Hiếu said, it doesn’t take much hacking to access sensitive details about Americans. Companies and governments routinely leave databases exposed online with little or no protection, as we’ve reported, giving cybercriminals an easy way to harvest names, emails, passwords and other info. While in prison, Hiếu wrote an online security guide for the average internet user. As he and others have pointed out, it’s impossible to create an impenetrable shield. But here are some of his tips for how you can mitigate your risks, along with some other practical online security advice.
1. Stop reusing passwords
Make 2022 the year you finally stop reusing passwords. Once a password is exposed in a data breach, as routinely occurs, cybercriminals may use it on other websites to see if it grants them access and lets them take over an account or service. To help you generate lengthy, difficult-to-guess passwords without having to commit them to memory, use an encrypted password manager such as 1Password or LastPass. These services, which typically charge $3 to $4 per month, also monitor databases of breached passwords, like Have I Been Pwned, which can identify some passwords that have already been made public.
2. Delete unused accounts
Another benefit of using a password manager is that every time you create a new account at a website, you can log it in your password app. The app will track when you created a password and when you last modified it. If you notice that you haven’t used a website in a few years, and you don’t think you’re likely to use it again, delete your account from that website. It will mean one less place where your data resides.
3. Add an additional layer of security
Use multifactor authentication — which requires a second, temporary code in addition to your password to log in to a site or service — whenever possible. Some services send a six-digit code via text message or email. But the most secure method is to use an app that generates a numerical code on your phone that’s in sync with an algorithm running on the site. To make the process easier, you can download an app like Authy that, like a password keeper, helps you generate and manage all your multifactor authentications in one spot.
4. Manage your apps’ privacy settings
A lot of the data about us that gets leaked consists of information we don’t even realize apps and services collect. To limit that risk, check the privacy settings for any new app that you install on your computer, smartphone or other device. Deselect any services you don’t want the app to have access to, such as your contacts, location, camera or microphone. Here are some guides on how to manage your apps’ privacy settings for iPhone and Android devices.
5. Think before you click
Clicking on a link from a text message, an email or a search result without first thinking about whether it’s secure can expose you to phishing attacks and malware. In general, never click on any links that you didn’t seek out and avoid unsolicited emails asking you to open attachments. When in doubt, hover your cursor over a hyperlink and scrutinize the URL. Avoid it if it would lead you to somewhere you don’t expect or if it contains spelling errors like a missing or extra letter in a company’s name. And for safer online browsing, consider paying for an antivirus tool like Malwarebytes that helps you avoid suspicious URLs online (or sign up for a free browser guard extension).
6. Keep your software up to date
Whether it’s your web browser or the operating system on your computer or smartphone, it’s always a good idea to download and install the latest software update as soon as it’s available. Doing so fixes bugs and helps keep your systems patched against the latest security threats. To make sure you don’t forget, turn on notifications for new updates or enable autoupdate settings if they’re available.
7. Limit what you’re sharing online
Some of the large collections of personally identifiable information that have been floating around online weren’t hacked or stolen: They were simply scraped from social media websites like LinkedIn or Facebook. If you don’t want a particular piece of info about you out there, don’t put it on your social media profile. Scrub anything you don’t want exposed in your profiles, and check the platforms’ privacy settings to see who can access whatever is left. You can also pay for a service like DeleteMe, which helps centralize and pursue requests to delete your personal information from various data brokers.
8. Secure your SIM
One technique that has become increasingly common in recent years is SIM swapping: A cybercriminal tries to dupe your mobile carrier into switching your number from a SIM (the memory card that tells your phone it’s yours) that you control to a SIM that they control. The goal is to commandeer your phone so they can get around multifactor authentication settings that protect your financial accounts. To guard against SIM swaps, contact your carrier to establish an account PIN, or follow these directions if you’re with Verizon, AT&T or T-Mobile. And if you switch carriers, change your PIN.
9. Freeze your credit reports
If you’re afraid that a scammer might use your identity to open a fraudulent credit line in your name, consider placing a freeze on your report. A freeze will restrict access to your credit report, meaning that no one (not even you) will be able to open a new credit line while it’s in place. If you decide to apply for a loan or a new credit card, you can always unfreeze your credit later on. Freezing and unfreezing your credit is free, but you have to contact each of the three major credit bureaus separately to do it. Here’s a guide on how to get started.
10. Back up your data
Don’t assume that you’ll always have access to all your files and folders. Backing up your data can help you guard against virus infections as well as hard drive failure and theft or loss of your computer. You could use well-known cloud storage providers such as Dropbox or Google Drive to save copies of your data or buy a subscription to an online cloud backup service that automatically saves your files and lets you restore them if anything happens. All such services offer encryption, but if you’re afraid of storing your data in the cloud, keep an encrypted copy on a separate hard drive.
ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
by Bernice Yeung, Michael Grabell, Irena Hwang and Mollie Simon
ProPublica
In May 2018, a rare and virulent strain of salmonella caught the attention of America’s top disease detectives. In less than two months, the bacteria had sickened more than a dozen people, nearly all of them on the East Coast. Many said they’d eaten chicken, and federal food safety inspectors found the strain in chicken breasts, sausages and wings during routine sampling at poultry plants.
But what seemed like a straightforward outbreak soon took a mystifying turn. Cases surfaced as far away as Texas and Missouri. A 1-year-old boy from Illinois and a 105-year-old woman from West Virginia fell ill. There was a teenager who’d just returned from a service trip in the Dominican Republic and a woman who’d traveled to Nicaragua. But there were also people who hadn’t traveled at all.
Victims were landing in the hospital with roiling stomach pains, uncontrollable diarrhea and violent bouts of vomiting. The source of the infections seemed to be everywhere.
Seasoned chicken thighs from a local supermarket retailer are waiting to go into the oven. During an investigation from ProPublica, they found meat and poultry from some stores that bears the USDA seal approval may not be safe. According to their research, the USDA does not prohibit companies from selling chicken contaminated with salmonella. (Photo: PhotoNews Media)
Even more alarming was that this strain of salmonella, known as multidrug-resistant infantis, was invincible against nearly all the drugs that doctors routinely use to fight severe food poisoning.
With a public health threat unfolding across the country, you might have expected federal regulators to act swiftly and decisively to warn the public, recall the contaminated poultry and compel changes at chicken plants. Or that federal investigators would pursue the root cause of the outbreak wherever the evidence led.
None of that happened.
Instead, the team at the Centers for Disease Control and Prevention closed the outbreak investigation nine months later even though people were continuing to get sick. The U.S. Department of Agriculture, which oversees meat and poultry, was not only powerless to act but said nothing to consumers about the growing threat. So supermarkets and restaurants continued selling chicken tainted with drug-resistant infantis.
And they continue to do so today.
...even when there’s persistent evidence of contamination in a plant’s products, the USDA can’t use those findings to suspend operations.
An eight-month ProPublica investigation into this once rare, but now pervasive form of salmonella found that its unchecked spread through the U.S. food supply was all but inevitable, the byproduct of a baffling and largely toothless food safety system that is ill-equipped to protect consumers or rebuff industry influence.
Several European countries have dramatically reduced salmonella in poultry by combating it on the farms where chickens are raised. But over the past 25 years, the U.S. has failed to bring down the incidence of salmonella food poisoning — even as the rates for E. coli and other bacteria have fallen dramatically.
Consumers may get the impression that the meat and poultry they find at supermarkets is safe because it bears the USDA seal of approval. But the agency doesn’t prohibit companies from selling chicken contaminated with dangerous salmonella like infantis. And even when people get sick, it has no power to order recalls.
Instead, the agency relies on standards it can’t enforce and that don’t target the types of salmonella most likely to make people sick. The USDA’s Food Safety and Inspection Service, unlike its counterparts in some countries, has no authority to control salmonella on farms, where the bacteria often spreads. And even when there’s persistent evidence of contamination in a plant’s products, the USDA can’t use those findings to suspend operations. All the agency can do is conduct a general review of the plant, and that rarely leads to a shutdown.
"It’s a system that’s untenable," said Sarah Sorscher, a consumer advocate at the Center for Science in the Public Interest.
Last week, after repeated interview requests from ProPublica and years of criticism from consumer groups, the USDA announced that it was rethinking its approach to salmonella. The agency didn’t announce any concrete changes but said it would set up pilot projects and hold meetings in an effort to come up with a plan.
"Whether it should have been done sooner or could have been done sooner, the good news is we’re doing it," said Sandra Eskin, the agency’s deputy undersecretary for food safety. "We’re going to really take a look at everything we could look at and, I hope, develop a different approach that winds up being more effective."
Scientific advancements over the last decade have provided the USDA with tools to identify the most dangerous strains of salmonella. But the agency isn’t using those tools to prevent it from spreading in our food supply.
To piece together how food safety officials and the poultry industry allowed infantis to spread, ProPublica used the same genetic data available to the USDA and other agencies, analyzing seven years of infantis samples taken from food and patients and catalogued by the National Institutes of Health.
Through dozens of public records requests, ProPublica was then able to link the genetic information on those 8,000 samples to the foods that victims ate and the processing plants the chicken samples came from.
The analysis, along with hundreds of internal government records and interviews with nearly two dozen scientists, allowed us to uncover that the infantis outbreak never abated and has continued to run rampant through the chicken industry.
In fact, ProPublica found that more than twice a day this year, on average, USDA inspectors detected multidrug-resistant infantis in poultry that’s genetically similar to the outbreak strain. Each month, the CDC continues to receive dozens of reports of people getting sick from it.
"Many people are still becoming ill, and some of them gravely ill," Robert Tauxe, director of the CDC’s Division of Foodborne, Waterborne and Environmental Diseases, told ProPublica.
One internal CDC presentation noted that this single strain is “responsible for an estimated 11,000-17,000 illnesses per year.” But the CDC is limited in its ability to protect American consumers from foodborne illnesses. It has no power to order companies to take action or to provide information that would help it solve outbreaks.
And the CDC, despite noting that the strain was "widespread in the chicken industry," took the spotlight off infantis when it closed its outbreak investigation in February 2019. Tauxe said the investigation ended because the agency had learned as much as it could. "That does not mean that the outbreak was over," he said. "In fact, we think it may still be expanding."
As the CDC has contended with infantis, the agency has held several private meetings with the chicken industry, which has publicly downplayed the threat of the strain and its ability to do something about it.
But since closing the investigation, neither federal health officials nor the USDA has said anything to consumers about what the CDC quietly regards as an "epidemic."
Marva Lamping knew none of this in July 2019 when she took her longtime partner, Arthur Sutton, out to celebrate his 70th birthday at their favorite Mexican restaurant in Bend, Oregon. As Lamping tested her luck at the restaurant’s video slot machines, Sutton snacked on chips and salsa while waiting for a platter of chicken enchiladas.
That night, Sutton began vomiting repeatedly, his stomach aching so badly that he couldn’t lay down. By the next morning, the pain was unbearable, and Lamping rushed him to the emergency room.
At the hospital, doctors would discover that Sutton’s intestines were leaking. Again and again, surgeons opened his abdomen to repair the tears and cut out dead segments of his bowels.
Doctors had quickly identified the cause of Sutton’s ailments as salmonella. But for reasons they couldn’t understand, his body was wasting away.
None of the antibiotics were working.
Missed Opportunities
As sudden as the infantis outbreak seemed to investigators at the CDC, it wasn’t the first time the government had seen this strain, known as Infantis Pattern 1080. In the three years before the outbreak started, USDA inspectors had found the strain 74 times. But they could do nothing to stop the chicken from going to supermarkets and restaurants nationwide.
By the summer of 2018, people all over the country were falling ill. And as investigators studied the cases, clues soon emerged from the USDA, which oversees meat and poultry, and the Food and Drug Administration, which regulates almost all other foods.
The FDA had received a complaint that a dog had recurring diarrhea after eating raw pet food, and samples of chicken-and-vegetable dog food tested positive for multidrug-resistant infantis. A few months later, a Chicago woman fell sick with the outbreak strain after feeding her dog the same brand. Could the pet food be the source of the outbreak? Possibly, but not all the victims had a dog.
There was another lead. Victims reported eating Perdue Farms chicken more than any other brand. Public health officials in Pennsylvania and Minnesota found the outbreak strain in packages of Perdue wings, thighs and drumsticks in three supermarkets. And when USDA inspectors found the strain in raw chicken, more than a quarter of the samples came from Perdue plants.
The FDA’s investigation had quickly led to a pet food recall. But while the FDA prohibits salmonella in the foods it oversees — including dog and cat food — the USDA allows it in raw meat and poultry destined for human consumption.
When people fall ill, the USDA can only request that a company voluntarily recall its products. But to do even that for salmonella, regulators face a high bar: To ensure a strong case, they’re expected to try to find a patient with an unopened package of meat that tests positive for the same strain that made the outbreak victims sick.
“Often, by that time, most of the meat that’s going to be eaten has been eaten,” said Sorscher of the CSPI.
In June 2018, what could have been a key piece of evidence surfaced. An Illinois victim who’d been hospitalized told investigators that he still had a package of Perdue chicken tenders in his freezer. The USDA could have tested the package, but nobody ever went out to collect it, he said.
Perdue did not respond to more than a dozen calls and emails seeking comment, and it didn’t answer questions sent to top company officials.
Wade Fluckey, Perdue’s senior director of food safety at the time, told ProPublica that the company was targeted because Perdue has better brand recognition than other chicken companies, which skewed patient interviews.
“I don’t know that any one company could say they didn’t have it,” said Fluckey, now a vice president at a pork processor. “Had they focused on other places, they would have found the same thing.”
While no company showed up more frequently than Perdue, food inspectors were finding the Pattern 1080 strain in dozens of chicken processing plants as well as raw pet food and live chickens. To investigators, that was unusual because it meant that the salmonella couldn’t have come from a single company or chicken product. It had to be coming from somewhere upstream in the supply chain — perhaps the farms or the few companies that breed nearly all the nation’s chickens.
The country’s antiquated meat safety system virtually ensured it would be no match for a germ like infantis.
The USDA operates under a law passed in 1906, where inspectors physically examine every carcass for signs of animal disease, illegal additives and spoilage. The system didn’t account for invisible pathogens like salmonella and E. coli, which had not yet been linked to eating meat.
That did not change until 1994 after four children died from eating Jack in the Box hamburgers. The USDA made it illegal to sell meat tainted with a strain of E. coli called O157:H7. But it didn’t ban salmonella despite a series of high-profile outbreaks in chicken. Instead, the USDA required processing plants to limit how often salmonella was found on their products and began testing for it. Plants that repeatedly violated these standards faced a shutdown.
That powerful threat didn’t last long. In 1999, a Texas meat processor challenged the USDA’s authority to close plants, arguing that salmonella "appears naturally" in raw meat. Two years later, the 5th U.S. Circuit Court of Appeals agreed that Congress hadn’t given the agency the power to regulate salmonella that’s present before products enter processing plants or to deem a facility unsanitary based on the bacteria alone.
The decision, Supreme Beef Processors v. USDA, has left the agency gun-shy, according to former department officials and food safety advocates. And Mansour Samadpour, a microbiologist who runs a testing and consulting firm that works with the food industry, said the decision distorts the underlying science. Just because salmonella "colonizes" chickens’ guts doesn’t mean it’s "the natural state of the animal," he said. "It’s nonsense."
The court ruling severely clipped the USDA’s powers. So it has tried to pressure plants to improve by creating standards for how often salmonella should be found. Plants are rated on the results, which are published online. Violating those standards doesn’t carry a penalty, but it allows the agency to visit the plant and look for more general problems like unsanitary conditions. If they can document significant problems, the USDA can temporarily shut down the plant, though the agency rarely takes such action.
Today, food poisoning sickens roughly 1 in 6 Americans every year, according to the CDC, and salmonella hospitalizes and kills more people than any other foodborne pathogen. Each year, about 1.35 million people get sick from salmonella. While most recover, more than 400 people die and 26,500 people are hospitalized. Some are left with long-term conditions like severe arthritis and irritable bowel syndrome. Salmonella costs the economy an estimated $4.1 billion a year, more than any other type of food poisoning.
Salmonella outbreaks have been linked to other foods like onions, but poultry remains the biggest culprit, and people are eating more of it than ever. On average, people in the U.S. eat nearly 100 pounds of chicken each year, a number that has grown by about 40% in the last 25 years.
Cooking poultry to an internal temperature of 165 degrees will kill salmonella. But studies by the USDA and others have found that despite decades of consumer education, home cooks routinely cross-contaminate their kitchens, and few use a meat thermometer to ensure their poultry is cooked properly.
Illnesses haven’t declined even as salmonella rates in raw poultry have. And infections are getting harder to treat. The CDC recently found that salmonella infections were becoming increasingly resistant to antibiotics. In contrast, food poisoning related to E. coli O157:H7 has dropped by about 70%.
Consumer advocates, industry consultants and former USDA officials say that’s because the agency focuses solely on whether salmonella is found in chicken or turkey at the processing plant.
This approach has been criticized for years. One former meatpacking executive called it “worthless.” Even the USDA’s own research arm has said the agency’s measure for salmonella is “not a good indicator” of food safety.
The USDA doesn’t consider two key risk factors: how much salmonella is in the poultry and how dangerous that type of salmonella is. There are 2,500 types of salmonella, but only a fraction cause the vast majority of illnesses.
The industry has greatly reduced the prevalence of one common type of the bacteria, known as salmonella Kentucky, which rarely causes illnesses in the U.S. But it’s made far less progress with the types of salmonella most likely to make people sick, the ProPublica analysis found.
The rate of infantis, for example, has more than quintupled over the past six years.
The full extent of the salmonella problem isn’t even known. The agency does little testing for salmonella to begin with. On an average day in 2020, the USDA took about 80 samples of raw poultry across hundreds of processing plants. But those plants slaughter more than 25 million chickens and turkeys a day.
The new technology would help identify pathogens in foods like raw flour, peaches and romaine lettuce that were once rarely seen as sources of outbreaks.
In recent years, consumer advocates have recommended the agency ban the sale of raw meat carrying the types of salmonella that most often make people sick. That approach has contributed to improvements in Europe. In the U.S., the FDA has seen a dramatic decrease in salmonella outbreaks tied to eggs since the 1990s when it began targeting the most common type.
Last month, a few of the largest poultry companies, including Perdue and Tyson, joined with the CSPI and other consumer advocates to urge the USDA to fix the system. But the letter to the agency didn’t outline specific reforms, and a consensus on salmonella regulations has long proved elusive.
The last push came during the Obama administration, but citing the need for more data, the USDA rejected a proposal to ban certain antibiotic-resistant strains. The agriculture secretary at the time was Tom Vilsack, who now leads the agency again under President Joe Biden.
As the food safety project director for the Pew Charitable Trusts before joining the USDA, Eskin also pushed for reform, but her efforts were met with resistance. With food safety directors from some of the largest companies, she helped craft recommendations to Congress to modernize the meat safety system, including setting new limits on salmonella contamination and giving regulators oversight of farms.
The group sought to enlist trade associations, which represent not only the biggest players but hundreds of other companies. But when it comes to regulation, divergent interests often leave the trade groups lobbying for the lowest common denominator. "They shut us down," she said in an interview before taking her government post. "They’re the ones that blocked us — not the companies, the trade associations."
Asked what was standing in the way of change, she said, "I’ll make it simple: Powerful interests in the industry do not want it."
"We Are Basically Only Talking About Protecting Industry"
Just months before the infantis outbreak started, the USDA gathered representatives from the food industry, researchers and regulators at the agency’s brick-and-limestone headquarters in Washington to discuss a scientific breakthrough that one participant called the "biggest thing" for food safety in 100 years.
Whole-genome sequencing had given food safety researchers an unprecedented look at the DNA of foodborne bacteria. New technology, known as "next-generation sequencing," was creating a trove of new information and revealing connections that could help investigators stop outbreaks before they spun out of control.
As stakeholders took turns presenting slides in the wood-paneled auditorium, some spoke of the possibility that genome sequencing might help solve the stagnant rate of salmonella poisoning.
The new technology would help identify pathogens in foods like raw flour, peaches and romaine lettuce that were once rarely seen as sources of outbreaks.
While whole-genome sequencing couldn’t confirm the source of an outbreak without additional evidence, it provided powerful clues about the bacteria’s genetic history that could point epidemiologists in the right direction.
But for all the potential, much of the conversation that day in October 2017 centered on how to make this scientific breakthrough palatable to industry. Trade groups had requested the meeting, and they voiced concerns about how the new tool could be used for enforcement or might inaccurately connect companies’ products to outbreaks. Speakers, including USDA officials, emphasized the importance of proceeding with caution. They discussed strengthening firewalls to keep testing data private and establishing “safe harbors” from USDA enforcement.
During a roundtable discussion, one representative from the United Fresh Produce Association raised concerns about the idea of companies sharing genome sequencing data with the government. “I think right now, it’s viewed as very one-sided,” she said. “We see the benefit to the agencies, but it’s less clear how a company would directly benefit.”
The industry’s influence wasn’t lost on regulators. Former USDA officials hold key posts at some of the food industry’s biggest companies. Indeed, two people who led the 2017 meeting for the agency now work for the food industry.
Sitting in the auditorium, Jørgen Schlundt, the former head of food safety for the World Health Organization, was growing increasingly frustrated. Schlundt had helped achieve dramatic reductions in salmonella in Denmark while working for the country’s food agency.
"I understand that I’m in the U.S., but surely this must also be about protecting consumers," he told the audience. "We are basically only talking about protecting industry here. I thought that this was, the basic purpose was to protect consumers, avoid American consumers and other consumers from dying from eating food."
While the USDA tiptoed around the new technology, whole-genome sequencing, which is now used to solve criminal cases and track COVID-19 variants, would prove pivotal to the CDC’s infantis investigation.
As the infantis outbreak spread, epidemiologists noticed something unusual: The outbreak strain, Pattern 1080, carried an unusual combination of antibiotic-resistance genes that looked similar to another strain they’d seen before, Louise Francois Watkins, an epidemiologist at the CDC, said in an interview.
At the time, the CDC was still using a method called pulsed-field gel electrophoresis, or PFGE, which produced barcode-like patterns from the bacteria’s DNA that scientists used to connect cases. So the investigators asked the lab to line up the patterns and compare the two strains.
"And sure enough," Francois Watkins said, the strains were so similar, they differed by “only a single band” of the barcode. With that clue, they decided to analyze the strains using whole-genome sequencing.
That allowed scientists to compare the individual building blocks in the genomes of bacteria. And the infantis investigators discovered that not only were the two strains genetically similar but that PFGE was masking the scope of the problem.
In fact, Pattern 1080 was just one wave in a much larger surge of drug-resistant infantis — one that had been detected nearly a decade ago in Israel and was now circulating worldwide in countries as far apart as Italy, Peru and Vietnam.
One of the reasons the U.S. variant is so concerning is that it typically carries a unique gene that makes it especially hard to treat.
"It’s resistant to four of the five antibiotics that are commonly recommended for treatment,"” Francois Watkins said. "The antibiotics that your doctor is going to pick when they suspect you have a salmonella infection are pretty likely not to be effective."
The strain is also a major public health concern because it has the ability to pass those genes to other bacteria, adding to the growing global problem of antibiotic resistance.
"We don’t want to see resistance climbing in our food supply because it’s not going to stay in that one space," Francois Watkins said.
Whole-genome sequencing had helped investigators discover that the outbreak was actually a widespread problem in the country’s chicken supply.
But even with these new revelations, public health officials still lacked one of the most basic tools to control the strain.
“A Gap in Our Regulations”
CDC investigators knew that infantis was spreading in chickens long before the birds arrived at the slaughterhouse. But enlisting the USDA’s Food Safety and Inspection Service would be a dead end because the agency has no regulatory authority over farms. The USDA can only force farms to take measures when animals get sick, not when humans do.
That also made it difficult for the CDC investigators to pursue leads involving breeders and feed suppliers to trace back how dangerous bacteria got into the food supply.
"That’s a gap in our regulations," Tauxe of the CDC said.
The CDC emphasized how risky this particular bacteria was because of its resistance to first-line drugs used to treat salmonella...
Nearly all the chickens we eat descend from birds bred by two companies, Aviagen and Cobb-Vantress, a subsidiary of Tyson Foods. This breeding process has allowed consumers to walk into any grocery store and find chicken of the same quality. But that pyramid structure also makes it possible for salmonella to circulate since the bacteria can be transferred from hens to their offspring, and a single breeding flock might produce 3 million chickens over several years. (Both companies declined to comment.)
And nearly every step of their journey from chicken house to our plates presents an opportunity for salmonella to spread.
As far back as 2005, the USDA has held public meetings exhorting the poultry industry to take steps at the farm. It has recommended that farmers change or chemically treat the litter between flocks, use traps and bait to eliminate pests and vaccinate hens and chicks against salmonella.
Denmark, Sweden and Norway have largely eradicated salmonella on farms by keeping chicken houses clean, frequently testing the birds and destroying infected breeding flocks.The United Kingdom has dramatically reduced salmonella illnesses by pressuring the industry to vaccinate.
The structure of the U.S. chicken industry makes it ideally suited to implement such interventions. The same company that slaughters the chickens often owns the hatchery and feed mill, and it contracts with farmers to raise the chickens to its specifications. The catch is that because companies are essentially doing business with themselves, there’s little incentive for any of them to press others to reduce salmonella, the industry consultant Samadpour said.
"If it was four or five different companies," he said, "the processing plant would tell the farms, ‘If you are more than so much positive, you can’t send it here,’ the farm would tell the hatchery, ‘If the chicks coming in are positive, we are not going to take them.’ They would tell the feed mill that if the feed is contaminated with salmonella, ‘We are not going to bring it in.’ Can you do that? No, it all belongs to you."
Because more isn’t done on the farm, the birds’ skin and feathers are often highly contaminated with salmonella by the time they reach the processing plant, according to the USDA. And in the plant, there are many ways bacteria can spread.
Birds can be further cross-contaminated when workers cut carcasses into breasts, legs and wings. The USDA recommends workers wash their hands and sanitize knives between each bird. But workers often have a few seconds to make each cut.
Ground chicken, which has become increasingly popular, is especially prone to contamination. Meat sent to the grinder comes from multiple birds, increasing the chance of cross-contamination. The fine texture of ground chicken can also get caught in small pieces of equipment, potentially tainting multiple batches.
While salmonella is found in 8% of the chicken parts tested by the USDA, 25% of ground chicken samples contain the bacteria.
And when the USDA tested for salmonella during the infantis outbreak, more than half of the positive samples were found in ground chicken.
“The Company Can Do Whatever It Wants”
In July 2018, as outbreak investigators began to discover infantis in Perdue products, the USDA had a chance to press the company for answers. Routine salmonella testing had found that the company’s plant in Cromwell, Kentucky, was exceeding the USDA’s salmonella standards, which say no more than 15.4% of chicken parts at a plant should test positive for the pathogen.
So USDA staff were sent to conduct an assessment of the plant, which might have seemed well-timed. Of the 76 plants where the infantis outbreak strain had been found, Cromwell, with 8% of the positive samples, had more than any other facility. But failing the agency’s salmonella standard doesn’t give the USDA the power to do anything more than review the plant’s practices.
The USDA noted that Perdue had responded to its high rate of salmonella by adding more chemical dip tanks and sprays to disinfect the chicken. Because Perdue’s internal sampling data showed the new steps appeared to be reducing the bacteria, the agency gave Perdue more time and recommended “no further action be taken.”
According to the USDA report, Fluckey, then the food safety director at Perdue, told auditors that the agency’s testing didn’t paint an accurate picture of the plant because it wasn’t measuring the quantity of salmonella. He added that Perdue managers hadn’t concentrated on the salmonella types most likely to make people sick because they were focused on "meeting the performance standard."
A year later, USDA sampling indicated that the plant had continued to violate salmonella standards, with a third of chicken parts testing positive for the bacteria. In addition, the USDA said 12 of Perdue’s samples were highly related genetically to samples from people who’d recently gotten sick.
Still, the agency once again deferred to the company’s testing results, which showed a decrease in the rate of salmonella at the plant. The USDA decided it couldn’t cite the plant and that no action was necessary.
ProPublica found that many plants have repeatedly violated the agency’s standards without being shut down or facing any recent public sanction. According to the most recent data, more than a third of the plants producing ground chicken are violating the USDA standard. And many large companies — including Tyson, Pilgrim’s Pride, Perdue, Koch Foods and the processors that produce chicken for Costco and Whole Foods — currently have plants with high rates of the types of salmonella most likely to make people sick.
Whole Foods said it has a team of experts who review the salmonella results of its suppliers and works with them to lower their salmonella rates. The processor, Pine Manor Farms, said it has “worked diligently to make corrections.” Tyson and Costco declined to comment; Pilgrim’s and Koch didn’t respond to questions.
Other Perdue plants where the infantis outbreak strain was found also had a poor track record with salmonella overall. In the last three years, its plants in Rockingham, North Carolina, and Georgetown, Delaware, had more than 35% of their ground chicken samples test positive for the bacteria, and nearly all of them were types commonly linked to human illnesses. Yet neither plant has faced any recent public enforcement action, according to a review of USDA reports. (In April, ProPublica requested detailed files for both plants, but the USDA has yet to provide them.)
In an interview before she joined the USDA, Eskin said the consequences for companies violating the standards aren’t "anything meaningful in terms of enforcement." "At the end of the day," she said, "I think the company can do whatever it wants."
The USDA doesn’t appear to have traced the supply chain for the plants that tested positive for the outbreak strain. Detroit Sausage had one of the highest numbers of samples with the strain.
Phil Peters, one of the owners, said he doesn’t remember anyone from the USDA asking the company who supplied its chicken. "I can’t control something that’s coming in from somewhere else unless I stop using it," he said.
The company no longer produces chicken sausage because his clients no longer order it. But as a small processor, Peters said, he has little ability to demand chicken companies provide him meat carrying less salmonella. "They’re too big to worry about us," he said.
A Hidden "Epidemic"
With no powers of its own and stuck with a hesitant regulator in the USDA, the CDC’s investigators needed the industry’s help.
On Aug. 8, 2018, the CDC offered a stark assessment of the outbreak to representatives of the industry’s trade group, the National Chicken Council: Drug-resistant infantis had become a "particular clinical and public health concern" because it was spreading through the chicken industry and increasingly making people sick.
The USDA seemed to take a less urgent approach. After an Aug. 16 foodborne illness investigations meeting with infantis on the agenda, an agency official wrote that there were "zero active illness investigations." The USDA had begun tracing victims’ grocery purchases, but beyond that, it decided infantis was an "illness cluster" to watch — not a situation that required additional resources.
By then, three months into the outbreak investigation, neither the CDC nor the USDA had said anything to consumers.
People continued to get sick. Twelve days after the USDA meeting, a New York City resident began having stomach cramps. The patient’s spouse told investigators the victim had eaten and shopped in the Flatbush section of Brooklyn. The patient went to the hospital but died two days later, the first known fatality from the infantis outbreak.
For nearly two months, there was still no public warning.
In October 2018, the CDC privately met again with the National Chicken Council. By then, public health officials were convinced that the outbreak strain originated high up in the chicken supply chain.
“The outbreak strain may be persisting in chicken populations, their environments or their feed,” according to the CDC’s presentation to the industry group. "Further investigation is needed to help prevent new illnesses and similar outbreaks in the future."
The CDC drew up a list of questions for the National Chicken Council:
How was it possible that so many different companies could have the same strain of salmonella infantis?
Were common sources of chickens, eggs or other farming products widely used?
Would one or more companies be willing to partner with the CDC and USDA to explore possible connections?
The council didn’t have many answers. According to a government official’s notes, the industry said that it “does a lot to try to reduce salmonella across the board,” but that it didn’t have a specific preventative measure for infantis. An industry representative added that it “might have been helpful to have the discussion 4 years ago,” when the first signs of drug-resistant infantis popped up in processing plants.
A few days after the October meeting, a 2-year-old Michigan girl began rubbing her belly before developing a fever and diarrhea, making her the latest Pattern 1080 patient. Her parents said that before she got sick, she’d eaten chicken nuggets and touched a package of raw chicken in their kitchen.
The next day — more than nine months after the first patient from the outbreak got sick — the CDC issued its first public notice. By then, 92 people in 29 states had been infected with the outbreak strain. But the number was likely far higher: The CDC estimates that for every confirmed salmonella case, an additional 30 are never reported. That meant that nearly 3,000 people had likely been infected.
Though the CDC knew that infantis wasn’t a typical outbreak strain, the notice offered little advice to consumers other than to remind them to follow standard food safety steps when handling raw poultry. The CDC told ProPublica that there was little more it could say to consumers. Infantis was so pervasive, Tauxe said, that the CDC couldn’t tell consumers to avoid any specific kind of chicken or brand.
Instead, public health officials held another private meeting with the chicken industry in February 2019, telling trade organization officials that they considered this strain of infantis to be an "epidemic."
The CDC emphasized how risky this particular bacteria was because of its resistance to first-line drugs used to treat salmonella, especially illnesses involving children and patients with blood infections.
Health officials also presented the clues that had pointed toward Perdue as a potential source of some of the illnesses. The agency wanted to sit down with Perdue, but with no power to compel the company to answer questions, it would be months before a meeting happened.
A little over a week after the February 2019 meeting with industry, the CDC closed its investigation. In its second and last public notice about the outbreak, it said 129 people had gotten sick, 25 had been hospitalized and one person had died. There was no mention of Perdue or any other company.
In ending the investigation, the CDC seemed to send mixed messages. While the agency noted that "illnesses could continue because this salmonella strain appears to be widespread in the chicken industry," it also told Consumer Reports that the decision was prompted by a decrease in new cases.
Infantis Strikes Another Victim
Five months after the CDC closed the infantis investigation, Arthur Sutton and Marva Lamping walked into El Rodeo, a lively Mexican restaurant in Bend, Oregon, where copper art hangs on rustic yellow walls and red-clay mosaics line the archways.
The couple typically went there at least once a month after paying their mortgage or when friends were in town. Sutton’s stomach had been bothering him since eating there the week before, but he didn’t know why. He decided he was up for going out anyway. It was his 70th birthday, and the couple always went to El Rodeo for their birthdays.
... the county Health Department would ask her if Sutton had eaten salsa and slaw, which an investigator later described in an internal email as the "likely culprit" ...
Lamping and Sutton had met 15 years earlier at the local community college when Sutton decided to put his past struggles with addiction to constructive use by becoming a counselor. After math class, a group of students would go out to a Mexican restaurant.
"He just one day said, ‘I noticed when we go out for nachos, that you don’t have a margarita with all the other ladies,’" Lamping said. "And I said, ‘No, I don’t drink and drive.’ And he said: ‘Well, I’ll give you a ride. If you’d like a margarita, I’ll take you.’"
Lamping, 63, was drawn to Sutton’s warm and accepting way of engaging with the world — a demeanor that seemed perfectly suited for his counseling work. Lamping said his clients clearly had a bond with him. Once, while he and Lamping were stuck in construction traffic, a former client working as a flagger recognized Sutton and came over to shake his hand.
Sutton, a large man with a square chin, broad forehead and glasses, was quieter than usual that night as a waiter brought out tortilla chips, salsa and a small oval dish of chopped cabbage slaw mixed with diced jalapenos, tomatoes and cilantro. Lamping went to play a few rounds of video slots in the back of the restaurant before dinner while Sutton dug into the salsa and slaw.
Those appetizers would take on grave importance for Lamping after Sutton developed severe food poisoning that night. She said that during its investigation of Sutton’s illness, the county Health Department would ask her if Sutton had eaten salsa and slaw, which an investigator later described in an internal email as the "likely culprit" behind multiple food poisoning cases connected to the restaurant.
El Rodeo’s owner, Rodolfo Arias, said he “didn’t know anything” about the investigation.
An inspection of the restaurant would find concerns with cross-contamination because El Rodeo thawed and washed frozen chicken in the same three-compartment sink in which it washed lettuce, tomatoes and cilantro. Inspectors also noted the faucet was “uncleanable” because it was wrapped in black tape.
Arias denied that his restaurant was responsible for Sutton’s illness. “I don’t think it was possible,” Arias said.
After dinner, the ache in Sutton’s stomach erupted. He began vomiting and couldn’t lay down to sleep. By the next morning, he could no longer stand the pain. He called Lamping at work, where she handles patient admissions at St. Charles Medical Center. She went home and took him to the emergency room, several hundred feet from her desk.
After a CT scan, a doctor diagnosed Sutton, who was obese and had other medical problems, with a hernia. He was discharged with plans for surgery.
But the pain didn’t go away. Ongoing diarrhea sent him to the toilet every 10 minutes. He tried to hide his pain, but Lamping finally convinced him to return to the hospital. "I’m looking into your eyes right now, Arthur," she remembers telling him. "You’re dying."
Sutton’s hospital stay, detailed in 2,000 pages of medical records provided by Lamping, would be marked by one wrenching episode after another. In the emergency room, when a nurse put a feeding tube up his nose, blood started gushing out.
Still, Sutton maintained his signature equanimity. Medical staff described him in notes as “very relaxed and accepting and taking it all in stride.”
Initially, the intensive care doctors thought Sutton was still struggling with the effects of a complex hernia. But in the operating room, it became clear that things were worse than doctors imagined. His bowels were severely damaged. Surgeons set about removing dead segments of his intestines and reconnecting the functioning parts. They also noted that Sutton had an acute kidney injury caused by “profound” dehydration and septic shock from a widespread infection.
Over 16 days, Sutton underwent a similar procedure seven more times. Surgeons cut out pieces of dead intestine, centimeter by centimeter, and tried to repair tears and leaks in his bowels. Sutton was going in for surgery so often they placed a medical dressing over his abdomen so they wouldn’t have to cut him open every time.
Throughout, Sutton cycled through periods of decline followed by flashes of normalcy. Sleep-deprived, he began hallucinating that there were monkeys in trees and sailboats emerging from the ceiling. But he was also able to sit in a hallway chair in the sun with Lamping, eat a popsicle and jokingly tell the physical therapist, “You look like Tom Cruise.”
Still, Sutton was deteriorating. One day, Lamping found a note on the bedside table that Sutton had scratched out: "Why is this happening?"
Sutton’s doctors were also puzzled. After the first surgery, they’d quickly identified salmonella as the source of Sutton’s illness and immediately started antibiotics. But after nearly a week, they couldn’t understand why there was no improvement.
What Sutton’s doctors didn’t yet know was that a pernicious type of bacteria was poisoning Sutton’s blood: the strain of multidrug-resistant infantis circulating throughout the chicken industry.
To Industry, the Mystery of Infantis "Went Away"
A month before Sutton got sick, the CDC’s top foodborne disease experts held another meeting with the National Chicken Council. This time Perdue and four other big chicken processors were at the table.
Internal agency notes drafted before the meeting showed officials bracing for an unreceptive audience. "They have known about our concerns for years," the notes read. "They know about European practices. As a member-run trade association, their position is often driven by the lowest common denominator. Business margins are ‘razor’ thin; some companies are unable or unwilling to embrace expensive control strategies upstream."
During the three-hour meeting, the group discussed salmonella prevention and lessons learned from infantis.
But the CDC’s message — that infantis was a serious problem that demanded action — doesn’t seem to have resonated with Ashley Peterson, the industry representative who organized and attended the meeting. In September 2019, Peterson, the National Chicken Council’s senior vice president of scientific and regulatory affairs, told trade magazine Poultry Health Today that infantis wasn’t a problem anymore, according to a video of the interview.
“We don’t really understand where it came from or why it went away,” Peterson said.
Learning of Peterson’s comments, Tauxe of the CDC seemed surprised and puzzled.
“It didn’t go away,” he said. “We have met with the NCC repeatedly and have emphasized with them that it’s an ongoing problem. That’s wishful thinking of some kind.”
National Chicken Council spokesperson Tom Super said Peterson was referring to the CDC investigation ending and only learned later that the CDC was still seeing cases of infantis. He added that the industry has invested tens of millions of dollars a year in food safety and it has never downplayed infantis.
More than two years after Peterson’s comments — as infantis has sickened thousands more people — the trade group still hasn’t answered most of the CDC’s questions about the strain and has shared little with the agency about efforts to curb it, Tauxe said.
"How it got into the chickens in the first place, and why it expanded across the country through the chickens and why it’s persisting remain open questions for us," he said. "Stopping it is going to depend on what the industry is willing to step up to and do."
Super denied that the industry hadn’t answered the CDC’s questions but didn’t provide responses when ProPublica posed them again. “The industry never stopped working to address salmonella infantis — an effort that continues today,” he said.
Swifter action might have made the difference for Sutton.
At the hospital in Oregon, Sutton’s prognosis worsened. By mid-August 2019, the doctors had learned that the type of salmonella ravaging Sutton’s body was infantis. The finding might have helped doctors change course, but it was too late. The bacteria had already taken its toll.
Back in his room after a half-dozen surgeries, Sutton signaled to Lamping, waving two hands to show that he was done. "He just kept going: ‘Enough, enough. No more,’" Lamping said.
She looked at Sutton and shook her head, refusing to give up. But there wasn’t much the doctors could do.
During his eighth visit to the operating room, a surgeon noted that the leak in his bowels was probably so deep that it wasn’t accessible to surgeons: "Any further dissection would be significantly risking more bowel injury and making his current problem worse," the medical records said.
More than two weeks into his hospital stay, Sutton’s salmonella infection had led to kidney failure. Sutton would need round-the-clock dialysis and a feeding tube to survive.
Lamping and Sutton’s brother, Jim, gathered in Sutton’s room to decide what to do. They agreed that Sutton wouldn’t want to live constantly hooked up to machines.
They told the hospital to stop treatment and move him to comfort care. “Time for him to go to heaven,” Jim Sutton said. After life support was removed, Lamping sat next to the bed and rested her head on Arthur’s hand.
The next day, on Aug. 16, 2019, Arthur Sutton died. The cause was severe blood poisoning and acute organ dysfunction brought on by salmonella. Lamping was paralyzed by grief. Her visions of the future had always included him.
"I watched a man go from happy-go-lucky — someone who should have been with me another 20 years — I lost him," Lamping said. "I Iost him."
Two years later, she still replays Sutton’s battle with salmonella over in her mind, certain that something could have been done differently.
Lamping has focused on potential problems with how their food was handled at El Rodeo and hired a lawyer to file a lawsuit against the restaurant in 2020. She blames the restaurant, in part, because a county health inspection after Sutton died noted that it had told El Rodeo about the "findings from the state health lab on salmonella infantis cases." In court filings, the restaurant denied the allegations.
But Lamping also says there are things that food safety regulators and the industry could have done long before the chicken arrived at El Rodeo.
“If they know that infantis is in the chicken, if they know it’s there, why are they selling it to us?” Lamping asked.
The USDA, to this day, has never said anything to consumers about the risk of multidrug-resistant infantis.
Because of the pandemic, Lamping and Jim Sutton have had to delay Arthur’s memorial. They hope that someday soon, they’ll be able to gather his friends and family on a hill overlooking a canyon in central Oregon.
They’ll walk through shale rock, wildflowers and junipers, and look over the canyon’s edge where a buck can sometimes be seen running through the sagebrush. They’ll open Sutton’s urn and let the wind carry his ashes away.
About the Data: How ProPublica Analyzed Bacterial Pathogen Presence Data Used
ProPublica obtained bacterial pathogen genomic sequencing data from the National Center for Biotechnology Information’s Pathogen Detection project. The project integrates data from bacterial pathogens sampled from food, the environment and human patients by participating public health agencies in the United States and around the world. The NCBI analyzes data as it is submitted, and the results are monitored by public health agencies, including the CDC as part of foodborne illness outbreak investigations. The data includes metadata about each bacterial isolate submitted by the person or institute who collected the bacterial sample, as well as computational predictions by NCBI.
Through Freedom of Information Act requests, ProPublica obtained epidemiological information about bacterial samples taken as part of the 2018-19 salmonella infantis outbreak investigation and samples obtained during routine testing in establishments regulated by the USDA’s Food Safety and Inspection Service. ProPublica also obtained epidemiological information connected to patients considered part of this outbreak, including the date of sample collection and details about a patient’s illness, recent food consumption and demographics — details crucial to foodborne illness investigations. Data about bacteria found during USDA inspections also included the type of meat or poultry the sample was obtained from, the date of collection and the name and location of the facility. Integrating these details with the NCBI metadata offered a way to group samples together not just by genetic similarity, but also by location and time.
The USDA posts public datasets containing the results of its salmonella sampling at poultry processing plants since 2015, which detail the collection date, type of poultry product sampled and, if salmonella was present, information on type and any antimicrobial resistance. The datasets include both routine sampling, conducted at every plant, and follow-up sampling, conducted at plants where the agency has identified high levels of salmonella. (Samples from USDA inspections that contain salmonella are reflected in both the NCBI data and the agency’s inspection data.)
Analysis Decisions
To confirm the persistence of multidrug-resistant infantis in food processing facilities, grocery stores and patients with salmonella infections, ProPublica relied on both metadata submitted to NCBI and genetic features computed by NCBI. ProPublica restricted its analysis to isolates in the NCBI data belonging to what was known as SNP cluster PDS000089910.78, as of Oct. 19, 2021. This cluster contains most isolates involved in the infantis outbreak, and the CDC said it is monitoring most of the isolates in the cluster. ProPublica also filtered for isolates that were reported to be serotype infantis by the submitter or, when user-submitted information was unavailable, were computationally predicted to be infantis by the NCBI data processing pipeline.
ProPublica used data about evolutionary modeling computed by NCBI to establish the degree of genetic similarity between bacterial isolates from the outbreak and isolates collected more recently.
ProPublica’s analysis of salmonella rates in poultry plants is based on methods the USDA uses, using the agency’s routine sampling data to calculate positivity rates — that is, the number of positive tests compared with all salmonella tests taken at the facility — for each type of poultry a plant processed. ProPublica also calculated the high-risk salmonella rate for plants, determining the percentage of samples at the facility that tested positive for one of the 30 salmonella types the CDC has found to be most associated with human illnesses.
The USDA inspection data was also used to compare the number of samples found to contain salmonella infantis and salmonella Kentucky with the total number of routine samples taken each year to determine the rate at which each was occurring in the sampling program across all plants and poultry types.
ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
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