Phoebe Putney Memorial Hospital Katie Campbell/ProPublicaEarly morning, May 26, 2022Anthony Parker was tired of feeling tired. He was approaching his 70th birthday and his third decade as president of Albany Technical College in southwest Georgia. He was close to accomplishing the professional project of his dreams, a brand-new center for training nurses, when his heart began to give him trouble. Hed found that it was hard to walk short stretches across campus without getting winded. Hed stopped using the pedestrian bridge that connected the east and west sides of the college because it had become too difficult to climb the stairs. His wife and three adult children were struck by his sudden urge to take afternoon naps, something hed once ribbed them about, saying they were sleeping their lives away.But perhaps what most bothered Dr. Parker which is what everyone called him because hed earned a Ph.D. and because honorifics are considered good manners in the South was that his severely irregular heartbeat had begun to affect his golf game. So, on the day before he checked into Phoebe Putney Memorial, Albanys only hospital, Dr. Parker was anxious to get his stamina back.His cardiologist, Dr. Jos Ernesto Betancourt, recommended a procedure called an ablation. It involved running a catheter through a blood vessel from his groin to his heart and applying extreme heat or cold to create tiny patches of scar tissue on the outer walls of the organ, blocking the electrical signals that were causing his arrhythmia. Betancourt told Dr. Parker the procedure was minimally invasive and had a high success rate in men his age. In most cases, patients were sent home the day after the procedure and able to return to normal activities in a day or two.Because Betancourt was relatively new to Phoebe, the Parkers sought a second opinion from a close friend, a cardiologist who was godfather to their second child. After he heard what other measures had been taken to try to address Dr. Parkers condition, he agreed that an ablation was an appropriate next step.Next came the decision about whether to have the procedure at Phoebe. The Parkers had heard horror stories about the hospital from friends and colleagues over the years. But every hospital had stories like that as far as they were concerned, those were isolated incidents. Dr. Parker was confident that what might have happened to other people would never happen to him. If thered been anything serious to worry about, some systemic problem, he would have heard about it. For much of the time the Parkers had lived in Albany, hed served on Phoebes board of directors, one of the few African Americans invited to do so. He was a member of what the hospital called the Phoebe Family.He scheduled the ablation for the Thursday before Memorial Day in 2022. He assured his staff hed be back at work by the following Tuesday and even half-joked about getting out to hit a few golf balls during the break.When the day arrived, Sandra, Dr. Parkers wife of nearly 50 years, drove him the 15 minutes to Phoebe. By 7:30 a.m., he had checked into the surgery center. A nurse arrived to wheel him to the catheter lab, where the procedure would take place. Mrs. Parker walked alongside them as far as the entrance. Before saying goodbye, Dr. Parker pulled off his wedding ring and handed it to her for safekeeping. She slipped it on top of her own ring. Then she kissed her husband and told him she loved him as the nurse rolled him away.One of her younger daughters best friends from high school called to check on Mrs. Parker.Phoebe better not mess up, she said.Anthony Parker with his family in 1990 after he earned his Ph.D. at the University of South Carolina and with his wife, Sandra, in 2008CHAPTER 1Albany, Georgia, is a sleepy, majority African American city of some 67,000 that sits along the banks of the Flint River, more than a three-hour drive south from Atlanta. Its not on any major interstate. Getting there isnt easy, though theres not much reason to go without family ties. Its one of the states poorest cities in one of its poorest counties, Dougherty. Its so isolated and so untouched by time that its own residents like to joke that when the world ends, Albany is the place to be because it will take another 20 years for the end to arrive there.COVID-19 upended that way of thinking. In early March 2020, Albany became one of the countrys first hot spots. It had the fourth-highest per capita case rate in the world (after Wuhan, China, the Lombardy region of Italy and New York), and the virus was taking a disproportionate toll on neighborhoods with the highest concentrations of poor, Black residents. Suddenly a city that most Americans couldnt place on a map had become a harbinger of doom: If the virus could strike Albany, nowhere was safe. Phoebe Putney Memorial, the primary command center for the regional COVID-19 response, was inundated with calls from journalists seeking to make sense of how the virus was being transmitted, who was most affected and whether our health care system could save us.The storylines that were drawn tended to cast American hospitals as national heroes, and Phoebe, like its counterparts elsewhere, embraced the role. Its doctors, nurses and chaplains appeared on magazine covers and morning news shows. They testified at congressional hearings, hosted delegations of state and federal elected officials, were honored at area military ceremonies and virtually presided at the opening bell of the New York Stock Exchange. Phoebes executives used daily livestreamed press briefings to appeal for calm and answer questions about whatever new federal guidelines were being issued for preventing the virus from spreading.Sometimes the executives tripped over the color line, like when the hospitals chief medical officer, Dr. Steven Kitchen, who is white, announced that thanks to prudent medical history-taking, Phoebe had discovered that the outbreak was touched off by an infected visitor from Atlanta who came to attend a service with more than 100 other mourners at a Black funeral home. Many of them went to a second funeral the following weekend. The assertion was so clearly loaded in a town once considered a bulwark of the Confederacy that the chair of the Dougherty County government, who was also white, quickly chimed in, saying, This is not to besmirch anyones reputation, adding, No one did anything wrong by going to any of these funerals.Most of the messaging, though, celebrated the miracles happening inside the hospitals COVID-19 wards. One video that the press office circulated featured a 99-year-old patient named Maude Burke, who Phoebe had determined was well enough to be discharged from the hospital. In her honor, nurses and doctors had staged their own version of a ticker-tape parade. Burke, peeking out from beneath a poofy hair bonnet, was propped up on a gurney that orderlies pushed through hallways thronged withstaff who cheered and waved balloons as it, and she, glided by.We continue to celebrate with our COVID-19 patients when they get well enough to go home, Phoebe wrote in a statement that was released along with the video. The statement noted that Burke was a few months shy of her 100thbirthday, which made her the oldest COVID-19 patient it had been able to discharge. Her strength and determination are amazing, the statement read, adding, Thank you for being an inspiration Ms. Maude!The Harlem neighborhood, once the center of African American culture and commerce in Albany, Georgia Katie Campbell/ProPublicaI was among the throng of journalists who rushed to report about what was happening in Albany. I thought, at first, that it was a compelling place to tell a story about a small town facing a mammoth crisis: David versus Goliath. I interviewed intensive care doctors and emergency room nurses who would call to update me on conditions at the hospital at the end of their shifts. I monitored livestreams of city council meetings and church services. I gathered data about the identities and comorbidities of people who were dying of COVID-19. As I watched the pandemic unfold, I realized I was chasing the wrong story.COVID-19 was just the latest in a long list of health crises to hit the city. Since the 1990s, its residents had suffered some of Georgias highest death rates from heart and kidney disease, according to the states Department of Public Health. Data from the Centers for Disease Control and Prevention showed that theyd also suffered some of the highest rates of diabetes in the country. Life expectancy rates in the census tracts immediately adjacent to the hospital were lower than the state average. Teen pregnancy rates were higher. And the indicators that affect a communitys well-being, known as the social determinants of health such as poverty, unemployment, educational attainment, violent crime and food insecurity had been going in negative directions for the previous two decades.Albanys Poverty Rate Was More Than Double the National Rate in 2023Source: American Community Survey 2023 Five-Year EstimatesPerhaps the most important determinant of a communitys health, however, is access to care. In this, Albany seemed more fortunate than other cities its size because it has Phoebe, a self-described world-class health system that is so intimately woven into residents lives that they call it by its first name. Its main hospital in Albany is licensed to operate 691 beds, and it owns two other area hospitals, a cancer center, a hospice, as well as numerous outpatient clinics, urgent care facilities and medical practices covering specialties, including bariatrics, cardiology, anesthesiology, gastroenterology, neurology, urology and sports medicine. It has long run training programs for specialists in family medicine and pharmacists. Over the past three decades, the system has not only grown into the largest provider of health care in southwest Georgia, but it has also become the regions largest employer with more than 5,500 employees and a footprint that covers a large swath of the center of town.I began to focus on the relationship between Phoebes breakneck growth and the rates of chronic illnesses among Albanys residents and wondered whether the city was more of a microcosm than a hot spot. It wasnt the only place where the poorest among us are also the sickest. The United States is blessed with one of the most scientifically and technologically advanced health care systems in the world, a sprawling industry so vast and lucrative that it is now one of the largest drivers of the economy, accounting for more jobs and revenue than manufacturing. But for all the money flowing in and out, Americans have more chronic illnesses and shorter lifespans than people in other wealthy nations. When it comes to health outcomes among those countries, the United States ranks last.I set out to answer a question I hoped would resonate with anyone whos ever struggled to get the health care they need. Why are people in Albany and, for that matter, the city of Albany itself so sick when its most powerful institution is a hospital?I started by speaking to dozens of people whose loved ones had died at Phoebe during COVID-19. It didnt surprise me to learn that not all the miracles posted on Phoebes Facebook page were true. Maude Burkes relatives told me she hadnt fully recovered from COVID-19. Shed been readmitted to the hospital a couple days after she was discharged and died shortly thereafter. Nor did it surprise me that relatives like hers were bitter about their loss and that some blamed Phoebe for mishandling their loved ones cases. (A Phoebe spokesperson said, We are confident that Ms. Burke received quality, compassionate care during her stay at Phoebe and that she was appropriately discharged.)What I didnt expect was how fearful people were to criticize Phoebe on the record and how powerless they were to hold the hospital to account. The same was true of many of the current and former employees of the hospital.Phoebe Putney Memorial Hospital at sunrise Almudena Toral/ProPublicaStill, people encouraged me to keep digging. Among them was Pastor Daniel Simmons at Mt. Zion Baptist Church, home to one of the Rev. Martin Luther King Jr.s earliest and least successful civil rights campaigns. He told me that he had serious doubts about Phoebes account of the outbreaks origins and that rather than bringing the community together it had cast African Americans as culprits. Even Georgias governor, Brian Kemp, picked up the explanation, telling the press, We had an infected person do the wrong thing and go to a funeral service. The funerals, Simmons said, were not the only potential superspreader events to have occurred in the weeks leading up to the outbreak. The city had also hosted a marathon to raise money for Phoebe that drew runners from across the country.I later learned that Simmons was on to something when I met an epidemiologist named Daniel Pollock, whod retired from the CDC and was researching a paper that examined the origins of Albanys outbreak. He told me that Phoebes assertions were, at best, highly speculative and, at worst, deliberately misleading. Phoebes COVID-19 narrative, he told me, was deeply flawed from an epidemiological perspective, stigmatizing from a health communications perspective and unjust from an ethical perspective.There was no conclusive scientific evidence linking the viruss introduction in Albany to a single person, Pollock said. Yes, he told me, Patient Zero, as he came to be called, could have carried the virus to the city. But theres compelling evidence that the virus was circulating widely and undetected in Georgia, including in Albany, weeks before the patient arrived at Phoebe. Doctors there mistakenly thought his rapidly deteriorating condition was connected to a previous and long-standing respiratory illness, not a new one. They never tested him for COVID-19, which Pollock said went against the CDCs recommendations at the time.That patient spent seven days at Phoebe before he was transferred to a hospital back in the Atlanta area, where he could be closer to home. That hospital notified Phoebe that the patient was COVID-19 positive.Because Phoebe failed to test the patient, its impossible, Pollock told me, to know for sure whether he carried the virus into the hospital or contracted it there. Whats certain, though, is that the phone call from Atlanta was the first time Phoebe understood that dozens of its staff had been exposed to the virus. At the minimum, the hospital was as much a superspreader location for Albanys outbreak, Pollock said, as the two Black funerals that Phoebe officials had called out in that March 2020 press briefing.It was an abject failure on Phoebes part not to test him and isolate him as soon as he entered the hospital, Pollock said. He pointed out that although tests were hard to come by at the time, the Atlanta-area hospital tested the patient as soon as he arrived. Phoebes failure to do so, he said, made it difficult to pinpoint when and where the first case occurred. Instead of admitting as much, Phoebe wanted to find an explanation that omitted their medical mishaps. It amounted to a cover up.Kitchen agreed that without having tested Patient Zero for COVID-19, it was impossible to definitively say that he was the source of the outbreak. However, he added, I think its very likely that he was. His conclusions, he said, were based on the best information he had at an extraordinarily chaotic time. Pollock has had the luxury of investigating the matter long after the crisis ended.A Phoebe spokesperson echoed Kitchens views. He said: It is a fact that the first confirmed COVID patient treated at Phoebe was visiting Albany for a funeral. It is also true that most of the sickest patients who filled our critical care units in the first days of our COVID battle were connected to several gatherings in the community.When I asked Kitchen about the stigmatizing effect of Phoebes initial assertions about the origins of the outbreak, he seemed taken aback. How could telling the public what he knew as soon as he knew it be stigmatizing? He hadnt said anything in any way that had blamed anyone. Why would Black people feel that he had?There was no suggestion or tone of judgment or blame, he said. I was simply conveying information factually and with great sensitivity and compassion for everyone who was affected.Simmons didnt know about Pollocks paper. His skepticism about Phoebes funeral explanation came from what hed learned during his years living in Albany about how power works there. It was part of a familiar pattern, he said, and with time, I would see it, too.If Albany, Georgia, had done things differently over the years, our community wouldnt have been as vulnerable as it was, he told me. If the health care system was different, if it had a different relationship with poor people and people of color, the outcome would have been different.The main lesson he said that he hoped I and other people would take from Albanys COVID-19 crisis was, It didnt have to be this way.*Responses From Phoebe**Ginger Thompson emailed a detailed set of questions to former Phoebe Putney Health System CEO Joel Wernick, left multiple voicemail messages and sent him three letters by FedEx but received no response. She sent a letter with questions to Phoebes former attorney, Robert Baudino, and received no response. She also sent letters with questions to those involved in Dr. Anthony Parkers care Dr. Jos Ernesto Betancourt, Dr. Jyotir Mehta, Dr. Dianna Grant, Dr. James Palazzolo, Dr. William Garrett, Alan-Wayne Howard, Dr. Michael Coleman and Dr. Marla Morgan and received no response.In response to questions, a Phoebe spokesperson accused ProPublica of intentionally excluding positive patient stories. Most patients have positive experiences at Phoebe, he said. Ignoring that fact is wrong.*Anthony Parker and his son, Richard, in 1986Late afternoon, May 26, 2022Mrs. Parker felt her eyes well up as she arrived at the waiting room. Sixty-seven years old, compact, with a dark complexion and close-cropped hair, she had been a high school assistant principal for many years and had a lot of practice projecting confidence under pressure. But her wide, expressive eyes gave her away. The clerk took Mrs. Parker by the hand and promised to pass on any and every update she received about her husband.Mrs. Parker took a seat in a less-crowded corner of the waiting room and pulled a bag of peppermints and her iPad from her purse, hoping shed find enough reading to distract her. On the wall above her, she caught sight of a portrait of the late Dr. Carl Gordon, a towering figure in the hospitals history and a friend of the Parkers.Gordon had left Albany after high school in the mid-1940s to attend college. Afterward he joined the military, served in Korea and Vietnam, then returned to Albany in 1968 because there were no Black surgeons in the city. He told people that conditions at Phoebe had improved 100% since hed left by which he meant they were still bad, but less bad. Federal law had forced Phoebe to integrate its staff and patient wings. Dr. Gordon became the second Black physician granted privileges at Phoebe and, in 1993, its first Black chief of staff.The Parkers moved to Albany two years later when Dr. Parker took over running Albany Tech. The two families became close, partly because they were among the handful of African Americans in high positions at major institutions, whod bought homes in neighborhoods next to country clubs, and moved easily or knew how to make it look like they moved easily across the color line.Looking up at the portrait, Mrs. Parker tapped out a text to Dr. Gordons son. Your Dad, she wrote, is keeping me company and giving me comfort.Relationships like that made Phoebe feel like more than a hospital to the Parkers. In the weeks leading up to the procedure, theyd received well wishes from the hospitals president and the health systems CEO and chief medical officer, along with nurses whod been students of hers and her husband. Phoebe had recently hired the Parkers elder daughter, Kim, who has a Ph.D. in public health, and had agreed to a $40 million deal with Albany Tech to significantly expand its nursing program. It was a project that Dr. Parker for years had pressed Phoebe to support. He believed it would create good jobs for a community badly in need of them, revitalize the school and address critical staffing shortages at the hospital.The morning and afternoon passed with no word, except that the procedure was still underway. Around 4 p.m., Mrs. Parker asked for the umpteenth time about her husband. A nurse arrived from the catheter lab to tell her that there was nothing to worry about. It was not unusual for an ablation to take longer than expected because of the time required to map the arteries of a patients heart. The receptionist told Mrs. Parker that the waiting room would close soon, but that she could stay there as long as she needed.Around 4:30, Betancourt arrived. He seemed a bit out of breath, but he was smiling. The procedure had gone well, he told Mrs. Parker. Her husbands blood pressure was running low, but they were giving him some medication to stabilize it, and they were going to have him spend a night in the ICU so that he could be closely monitored.He told her that her husband might be out of it for the next six to 12 hours but that he believed they had accomplished what they wanted. He asked Mrs. Parker to give him an hour to get her husband ready for transfer and then hed take her back to see him. She could stay with him for a while, if she liked, but he said she should go home and get a good nights sleep since Dr. Parker was unlikely to be awake before morning.Relieved, Mrs. Parker dashed off texts to her three kids and eight siblings. She packed her iPad and sat back down to wait for Betancourt to return.When Betancourt reappeared, she thought he looked pale and panicked.He pulled up a chair and told her there had been some complications. Her husband had gone into cardiac arrest.Mrs. Parker felt the room spin and blinked hard to try to keep herself focused. Maybe she misunderstood the doctor. He was Cuban-born and -trained and spoke with a thick accent.She thought to herself, Did he just say Anthony had a heart attack?Before she could open her mouth to ask, Betancourt told her that hed responded to the arrest as soon as it happened. As for how long her husbands heart had stopped beating, it couldnt have been more than five or six minutes.Thats not a lot of time, she thought. Is it?CHAPTER 2In May 2020, after the first wave of the pandemic had subsided, Albanys mayor, Kermit Bo Dorough, discussed the citys response to the crisis in an interview with a monthly current affairs program called The Buzz on Queen Bee radio station.Video of the show was livestreamed, so I was able to watch it. Queen Bees studios were inside a downtown brewpub. Like the mayor, the two hosts were white and had long been fixtures on the local political scene: Carlton Fletcher, the longtime editor of the Albany Herald, the areas one daily newspaper, and B.J. Fletcher, no relation, a rare Republican member of the City Commission, what Albany calls its city council.The mayor, a workers compensation lawyer in his early 60s, had only been in office for four months, a tenure that had been consumed entirely by COVID-19. Hed long been an opponent of the citys establishment, especially Phoebe. His election had been attributed more to abysmally low turnout among Black voters rather than a surge among whites.After opening the conversation on a congratulatory note, the hosts turned quickly to the crisis at hand, and Carlton Fletcher asked his co-host and guest to share their thoughts about Phoebes performance.B.J. Fletcher answered first. Just as shed been raised to show respect to military officers and preachers by standing up when they walked into a room, she said, she now felt compelled to do the same for health care workers. I cant see Albany without Phoebe, she said, and called the hospitals response to the pandemic top of the line.When she finished speaking, Dorough pounced like a dog on a rib eye. Thats a juvenile statement, he said. Then he cleaved his hands to his chest and reminded those listeners living in Albany, or anywhere else in Dougherty County, that the hospital belonged to them.WeownPhoebe Putney, he huffed.Rainbow Records in Harlem Katie Campbell/ProPublicaA car hobbyist meetup in North Albany Ross Landenberger for ProPublicaDorough wasnt just spouting a political talking point. Founded in 1911, Phoebe Putney Memorial was operated by the county government from 1941 until the early 1990s. But then, in a move that allowed the hospital to expand its services beyond the county limits, Dougherty officials agreed to lease the facility to a private nonprofit entity with the same name. Thats when Phoebe Putney Health System was born. Under the new arrangement, the county kept ownership of the building in which the main hospital operated, but it lost control of the day-to-day management of the hospital, including, to Doroughs chagrin, how much it charges its patients.Dorough told Queen Bee listeners that he was convinced Phoebes patients paid way too much. Just because Phoebe Putney has made such valiant contributions to our community in the last few months, he said, doesnt change the fact that health care costs are higher here than anywhere else in the southeast United States.Cost is one of the great mysteries of American health care, and few communities have fought over the issue more vigorously than Albany. Phoebe hasnt always been Albanys only hospital. It became so after a long and highly contentious fight that was the subject of countless newspaper articles, a feature-length documentary and a lawsuit by the Federal Trade Commission that went all the way to the Supreme Court. Throughout that fight, Phoebe had denied that its prices were out of line, but, like most hospitals, it refused to divulge them for competitive reasons.Dorough reminded listeners that on the night he became mayor he pledged to find a way to get an independent study of health care costs across the region to determine how Phoebes fees compared with those of other hospitals, something hed been demanding for years. Now that he was mayor he felt confident he was in a position to get it done, and he challenged his colleagues on the city and county commissions to join him, saying that Albanys future was at stake.I dont think its a community hospital that first and foremost benefits the community, he said of Phoebe. I think it is a business model where youre driven by profits.A few weeks later, I met a young Black man named Clifford Alexander Thomas. We met at a sandwich shop downtown. Hed lost his 61-year-old mother, Beverly Kay Thomas, to COVID-19 not long after the outbreak and was still grieving. It was hard enough, he told me, to make peace with the fact that a virus from China had made its way to Small-bany, as he called his hometown, and took away his favorite person in the world. But he doubted hed ever be able to make peace with Phoebe, not because it didnt know how to save her but because of the way it had treated her, and him, after she died.Thomas, tall and thick through the middle, pulled out his cellphone and showed the last photo hed taken of his mother. She was lying on her bed at the hospital, her mouth caked in mucus, her torso half-exposed and tangled in tubes and tape. Judging from the way his mother looked and by the gowns and sheets that littered the floor, Thomas guessed that his mothers final moments had caused some commotion. But what he couldnt understand was why the hospital staff hadnt taken the time to clean her and her room, even though hed told them that he and his sister were on their way to the hospital to say their goodbyes.Why would they leave her like that? Thomas asked. Is that what they call taking care of someone? Did they really do everything they could to save her life? Did they think about how it would feel if that was their momma left like a lab rat?I suggested there might be an explanation. Hospital staffers were probably so busy handling the crush of COVID-19 cases that they couldnt clean his mother up as quickly as they should have. Perhaps theyd had to rush away to try to save other lives?Thomas didnt budge. He told me that while he and his sister were standing over their mothers body, a white nurse walked into the room and, without saying a word, began disconnecting the IV.He said he broke the awkward silence by asking her whether he could retrieve his mothers belongings. The nurse, he told me, looked over at him and said, This one didnt have any belongings.He said he struggled to keep his composure because thats what his mother would have wanted. Shed been born at Phoebe, delivered by an obstetrician who used forceps to pull her into the world, leaving her with a permanently disfigured right limb. Her parents sent her to Atlanta for surgeries to try to repair the damage. But they never filed a complaint against Phoebe or its obstetrician because Black people didnt sue white doctors in those times, and no one, particularly poor African Americans, dared get on the wrong side of the only hospital in town.Watching that nurse removing tubes from his mother without acknowledging his and his sisters loss, Thomas said, his anguish got the best of him. He told the nurse, Be mindful of the next words that come out of your mouth. Then he asked her to get out of his mothers room altogether.He said the nurse left and came back with a security guard who ordered him to leave.That definitely tore me with Phoebe, he said.Remembering Beverly Kay Thomas1958-2020Beverly Kay Thomas Courtesy of the Thomas familyThomas with her son, Clifford Alexander Thomas, top; his wife, Diamond Thomas, left; their son, CaMarion Alexander Thomas; and Cliffords sister, Zandria Thomas, right Courtesy of the Thomas familyA Phoebe spokesperson said that while the hospital could not confirm Thomas encounter with the nurse, his perception indicates that she and we as an organization could have done better.All across Albany, I found evidence of tattered relations between the hospital and the city. Those with insurance many of them white or well-off were critical of the hospital in the same ways as Dorough. They described Phoebe as a behemoth that had unfairly driven off its competition, jacked up its prices and pumped more money into executive salaries than into improving its services. They complained that the hospitals nonprofit status created a drain on the countys tax base, and they blamed the hospitals high fees for their exorbitant health insurance rates.Those without insurance or on Medicaid many of them Black and employed in low-wage jobs complained about the quality of care. They described everything from long waits in the emergency room and dismissive attitudes among nurses and doctors to lapses that cost them or their relatives life and limb. They almost never claimed ownership of the hospital but instead described its leadership and their own stubbornly high rates of disease as vestiges of the institutions history, throughout which whites set the hospitals priorities and expected African Americans to go along or go elsewhere, knowing there wasnt anywhere else.Both critiques were not only commentaries on Phoebes economic and political power but echo American sentiments about our health care system as a whole. Thats largely because most people dont think of hospitals the way they think of themselves. Although the United States is the only industrialized country without universal health insurance, we cling to the notion of our health care system as a public service because thats often how hospitals portray themselves.The reality, however, is that hospitals are businesses, first and foremost. The decisions they make about the kinds of services they provide, the staffing they need to provide them and even the amount of financial assistance they offer to the poor are not driven first by the health needs of a community but by what the hospital needs to maintain its bottom line. Thats even true at the nearly 60% of hospitals that are nonprofits, which enjoy tax exemptions worth $37.4 billion a year.Nearly 1,600 mergers over the past two decades have made hospitals some of the biggest companies in the country. They have played leading roles in the redevelopment of old industrial capitals like Cleveland, Buffalo, Baltimore and Pittsburgh and turned their downtrodden centers into gleaming, glass-encased landscapes. All this consolidation, however, has its pernicious effects. Its not the pharmaceutical industry that is most responsible for driving up the nations health care costs; its the hospital industry. The Centers for Medicare & Medicaid Services recently reported that hospitals account for nearly one-third of the $4.9 trillion the nation spends on health care. Retail and prescription drugs, according to the report, account for only 9% of spending.Just like any other industry, the more concentrated the money becomes, the fewer incentives there are to lower costs or improve quality and the less communities can do about either. The imbalance is most acute in small cities like Bryan, Ohio; Beatrice, Nebraska; St. Joseph, Missouri; Owensboro, Kentucky and Albany, Georgia. Their survival is hitched to the fates of oligopoly health systems the way towns in West Virginia and Kentucky once were to coal. Theyve become hospital towns.Doretha Moultrie, bottom row, second from left, with her nursing school classmates and instructor in 1963. She went on to work at Phoebe. Courtesy of Doretha MoultrieEarly evening, May 26, 2022Kim, the Parkers elder daughter, was the first to show up at the hospital after her mother alerted the family about Dr. Parkers cardiac arrest. The two of them had barely stepped off the elevator on their way to one of Phoebes intensive care units when his cardiologist, Dr. Jos Ernesto Betancourt, and three other physicians rounded the corner. For Mrs. Parker, the sight of them, shoulder to shoulder, all in white coats, conjured the image of the Four Horsemen of the Apocalypse. This isnt good, she whispered to Kim.Dr. Jyotir Mehta, the chief of Phoebes critical care team, stepped ahead of the pack to take Mrs. Parkers hand and asked whether she knew who he was. Of course she did, Mrs. Parker thought to herself. Shed known Dr. Mehta for years. Hed served on the health systems board with her husband. What he was really asking, Mrs. Parker thought, was whether she had her wits about her; whether she was mentally capable of understanding what he was about to tell her; that if she wanted to fall apart, now was not the time.Yes, Dr. Mehta, she nodded, thanking him for being there.Dr. Dianna Grant, the health systems chief medical officer and a friend shed been the one whod hired Kim arrived shortly after. She told Mrs. Parker that the health systems entire executive team had been notified about what had happened. Your Phoebe family is here, she said, and we love you.This was the embrace Mrs. Parker had hoped for the one Phoebe reserved for its inner circle. Whether Grant intended it, her words felt to Mrs. Parker like a secret handshake, an invitation to let down her guard and cry, and she did, falling into Grants arms sobbing.Friends and colleagues from Albany Tech began arriving. Betancourt pulled Mrs. Parker and her daughter aside and began going over what hed said before: how hed been right there when the cardiac arrest occurred and how quickly hed gotten Dr. Parkers heart beating again. It couldnt have been more than five minutes. It appeared the cardiac arrest hadnt caused any significant harm to Dr. Parkers heart. It was functioning well. What worried Betancourt and the rest of the critical care team was the extent of damage to their patients brain, which had been starved of oxygen when his heart had stopped beating.He told her that Dr. Parker had not awakened. Another doctor, whom Mrs. Parker didnt recognize, joined the conversation and told her that the medical team wanted to try a treatment that would involve cooling her husbands body below normal to slow his metabolism and reduce his brains need for oxygen, giving it time to rest and restore. The cure is a little R&R, she thought to herself.The doctor explained that therapeutic hypothermia had been developed by doctors whod found that they could revive skiers whod fallen unconscious below sheets of snow and ice for long periods. Betancourt assured Mrs. Parker that her husband would be kept comfortable throughout the treatment, which he estimated would last 72 hours. In the final phase, he told her, theyd slowly return Dr. Parkers temperature to normal and wake him.Mrs. Parker took the doctors plans to wake him as a promise. The sooner the doctors got started, the sooner shed have her husband back. Thats no time at all, she said to Kim. Hell, we can stand on our heads for 72 hours if we need to.Anthony Parker with his elder daughter, Kim, in 1999, celebrating her masters degree from the University of South CarolinaCHAPTER 3More than a century ago, the great sociologist and civil rights activist W.E.B. Du Bois wrote about Albany in his landmark The Souls of Black Folk, and the city still looks and feels a lot like the place he described: wide-streeted and placid. The Flint River, which once separated Black neighborhoods from white ones, still serves as an economic dividing line, with wealth concentrated on its far west side and poverty on the east. The town, Du Bois wrote, takes frequent and prolonged naps. There were many afternoons when I drove through Albany and felt as if I were the only one there except for Phoebe.Phoebes everywhere. Its logo and advertising can be found on the sides of high school sports stadiums and on billboards rising above the fast-food restaurants, Dollar Generals, discount strip malls and liquor stores that line commercial thoroughfares. There are Phoebe golf tees. Phoebe pens find their way into glove compartments and purses.I went to the beach with Clifford Thomas family, and he offered me a Phoebe beach chair. At almost every community event I attended, at least one person wore a Phoebe T-shirt, cap or jacket.The hospital itself isnt much to look at. Its a blond brick-and-concrete structure with a spearmint-colored roof, made up of a main building with nine patient floors and two adjoining wings for outpatient services and a new trauma tower. Those facilities occupy more than five square blocks at the center of the city.. The hospital towers over the properties that surround it, including nearly 100 that Phoebe had acquired over the years. It has turned a bit more than half of those properties into facilities for its own use an energy plant, parking lots, housing for cancer patients, a day care center for its employees. It has left many vacant and unattended.A block from Phoebe, on one of my solitary drives through town, I spotted an elderly man watering a rose bush with deep fuschia blooms outside a red brick Craftsman-style home. His name was Nathaniel Smith. He and his wife, Mary, seemed happy to have some company, and they invited me up to their porch to talk.Are you the only people living on this block? I asked.He smiled, and nodded yes, as if hed heard that question before. Then he asked whether I worked for Phoebe and was interested in buying his place. The hospital began acquiring the other houses on his block in 1986. It now owned all but one, he told me. I looked around roofs had fallen in, lawns were littered with empty liquor bottles and fast-food wrappers, there were holes in walls where windows used to be.The Smiths asked me if I had any idea whether the hospital had a plan for the houses. I told them that I did not. Then Mr. Smith shook his head and scowled, It dont make sense for a nonprofit hospital to buy up all these houses and let them go to waste like that.Nathaniel and Mary Smith were in their 80s. When they moved into their home in 1987, he worked as a peanut sorter at the M&M Mars plant. They paid $46,000 for the house. They told me they put down all the money they had, but they saw it as a smart investment in a home where they could comfortably live out their days and then pass on to their daughter. When they arrived in the neighborhood, it was filled with working families like theirs. Their daughter was able to walk to school. Mary, a seamstress, converted the shed out back into her sewing studio. Nathaniel doted on his flowers. It was a real nice place to live, he told me.By the time I showed up, Phoebe and Mr. Smiths rosebush seemed about the only thing flourishing in his neighborhood. The Smiths had stayed put all those years because they couldnt afford to leave. Phoebe, they said, had been the only buyer to express interest in their property, but the hospital had only offered a little more than what theyd paid for it, which wasnt enough to cover their mortgage and the cost of settling elsewhere.When I first told Mr. Smith that I was a reporter, his eyes lit up and he asked whether Id ever met Oprah. I shook my head and told him that Id spent the bulk of my career reporting from Latin America. Then he said something that made me think he was reading my mind.I bet you aint never seen a place like Albany.Nathaniel and Mary Smiths home in Albany, Georgia, a block from Phoebe Katie Campbell/ProPublicaOne of the many ironies about Albany, a city where Confederate flags still fly, is that its most important institution was founded with money from a man who fought for the North. Francis Flagg Putney, a New Hampshire native and a veteran of the Union Army, arrived in Albany shortly after the Civil War. A supporter of Black civil rights, he was shot in the shoulder in 1868 in what became known as the Camilla Massacre when whites opened fire on a political rally he helped lead in a nearby town, leaving 12 dead and dozens injured.Putney abandoned politics soon after; instead, he devoted his energy to building the regions largest and most profitable cotton farm. In 1909, a womens association asked his support for the construction of the citys first hospital. He agreed to donate $25,000 on three conditions: that the hospital be made of bricks, so that it was fire resistant; that it bear his mothers name; and that it serve both Blacks and whites.The women agreed, which set the hospital apart from most others in the country. But just because Phoebe admitted Blacks, it didnt mean they received the same treatment as whites. There were only a small number of Black nurses until the mid-1950s, and they were almost exclusively assigned to Black patients or to night shifts. White nurses were addressed by their last names; Black nurses were just called nurse. The cafeteria had white-only counters. Until at least 1960, Black patients were housed in the basement, alongside the furnace, steam pipes and laundry machines. Black doctors were denied privileges until 1965.Phoebe acknowledges its segregated past in a 230-page book it published called A History from the Heart, but it makes few mentions of how Black patients and doctors were treated, and even those minimize the nature and effects of the indignities Blacks endured. Heres one passage:Queen Jenkins, R.N., Phoebes only African American registered nurse in 1960, remembers some difficulties with patients, black and white, and co-workers. White patients often asked for a white nurse, and so did some black patients. LPNs and nurses aides sometimes did not want to take orders from her. Remembering her mothers advice, let your work speak for you, Mrs. Jenkins tried to ignore the racial prejudice.Before World War II, Albany was an impoverished agricultural town, its majority black population working mostly in the surrounding cotton and pecan fields. After the war, thanks largely to the opening of a nearby B-52 bomber base and, later, a Marine logistics base, it experienced an economic boom. In 1952, Merck opened a pharmaceutical factory on a 640-acre lot, drawing hundreds of chemists and their families.The influx of money and educated workers contributed to changing Albany to a majority white town but also to making race relations there different from the poorer, rural counties around it. Although the Ku Klux Klan openly held meetings around the city, Albany did not experience the lynchings and other forms of terrorism that raged elsewhere. Amid the relative calm grew a small, but notable Black elite, made up of doctors, lawyers, business owners, ministers and educators, who held onto their gains, as nurse Jenkins did, by not openly challenging the racial status quo mostly because they knew things could be much worse.The quiescence was disrupted in 1961, when the citys Black high school and college students, emboldened by the sit-ins and Freedom Rides challenging segregation throughout the South, launched a series of protests at the Trailways bus station. Administrators at the historically Black Albany State University attempted to quell the demonstrations by suspending protesters. There were discussions among ministers about driving the organizers out of Albany, though no one acted on them. When the students pressed on, and the police chief began sending them en masse to jail, the elders rushed to take control of the movement, hoping to stop the tensions from turning violent.They turned for leadership to the 32-year-old Rev. Martin Luther King Jr., who had gained renown five years earlier for organizing the Montgomery bus boycott in Alabama. Albany became his second major civil rights campaign and is widely considered the only one that failed. The city was seized by demonstrations and arrests, with at least 1,000 people following King to jail. But the resentments between the older and younger factions of the movement never mended. They were unable to agree on the goals of their campaign, much less the tactics for winning them. In the end, the movement ran out of money and foot soldiers before the police chief ran out of jail cells.Demonstrators in front of Albany City Hall in January 1962 Donald Uhrbrock/Getty ImagesAlbany taxicabs with the words White Only in August 1962 Warren K Leffler/PhotoQuest/Getty ImagesThe Rev. Martin Luther King Jr. and the Rev. Ralph Abernathy, far right, talking with a group in an Albany pool room in July 1962 Bettmann Archive/Getty ImagesA Ku Klux Klan gathering of approximately 3,000 outside of Albany in September 1962 Bettmann Archive/Getty ImagesKing left Albany defeated. Managers at the public library closed its doors when Blacks attempted to check out books. Public transit administrators shut down service rather than allow Blacks to occupy any seats on buses that they wanted. Park supervisors took down nets at an African American tennis court when integrated doubles attempted to play there. After Congress passed the Civil Rights Act in 1964, whites established private schools or moved to surrounding counties to keep their kids out of integrated classrooms. And in 1970, a group of white neurosurgeons opened a new medical center, less than 2 miles from Phoebe, called Palmyra Park.The neurosurgeons had joined forces with what would become the largest for-profit hospital chain in the country the Hospital Corporation of America. Its founders patterned the company after fast-food franchises, seizing on the fact that the newly enacted Medicare bill essentially allowed hospitals and doctors to charge the federal government what they wanted. With its manicured gardens, high-end meals and private rooms, the 223-bed Palmyra quickly became the hospital for people with means.The Phoebe swag that blankets the region today? No one went near it back then, according to Duncan Moore, who ran Phoebe in the mid-1980s. Throughout his time in Albany, Moore told me, white people referred to Phoebe as the nigger hospital. He said he had a hard time getting doctors to stop sending all their well-insured patients to Palmyra and all their underinsured patients to Phoebe. He would wander the hospital floors, scanning daily admissions sheets and engaging in hallway shouting matches with offending doctors. It got to be like hand-to-hand combat, he said.Late evening, May 26, 2022After giving Phoebes doctors permission to begin the hypothermia, Mrs. Parker asked to go see her husband. When she got to his room, she barely recognized him. He looked nothing like the person shed kissed that morning. That man was vibrant, upbeat and indomitable. This one prone, pale, cold to the touch was at the mercy of others.Thats so not Anthony, she thought, not the man who in most crises during their 50 years of marriage had taken charge.She started talking to him with all the confidence she could gather, hoping that he was able to hear her. I love you. Im here. Im not going anywhere. I know youre going to pull through this. You always do.This will be one more thing well have to talk about.From the moment he escorted her to the junior prom in Orangeburg, South Carolina, she and Anthony talked about everything. Like so many teenage love affairs, their attraction was primarily physical at first. He was tall and had a mustache. She had curves and a blinding smile. His parents were friends with her grandparents. Shed been raised in a big, raucous family by a father who was a truck driver and a mother who was a cosmetologist. Hed been the sheltered only child of an elementary school teacher and the principal at a nearby high school that was segregated like hers. But their different temperaments complemented each other. Shes the nicest girl Ive ever met, he wrote in his senior memory book. And somehow Im going to get it through her thick head that I love her.Two years later, when she was a freshman and Anthony a sophomore at the historically Black South Carolina State University, he asked her to marry him. She skipped gym class and he took the night off from his job as an orderly at the campus hospital to elope. His mother swore shed never forgive her new daughter-in-law for denying her the joy of a big wedding, but then Kim was born and any hard feelings were forgotten.Mrs. Parker wasnt worried that Anthony lacked a clear plan when he earned his business degree. They would figure it out. After getting laid off from an administrative job in a nearby factory, he went back to South Carolina State for a masters in rehabilitation counseling and landed a job in the marketing department of Augusta Technical Institute, which was part of Georgias system of technical colleges. It was there that he found his calling. Hed run a school, like his father.He received a Ph.D. in education administration at the University of South Carolina. Few of the white administrators at Georgias technical colleges had doctorates. They also didnt have to get over the same hurdles he did. Still, that awareness didnt prevent him from being deeply wounded when he was passed over for president of the technical college in Statesboro in favor of a white man. He declared himself done with Georgia and took a job at a trade school in South Carolina. Then in 1995, one of his former colleagues called to tell him that the presidents position was open at Albany Tech and that the commissioner of the states trade schools wanted him to apply.A nurse tapped on the door of Dr. Parkers room. She gently mentioned to Mrs. Parker that it was getting late and offered to take her to a place where she and her children could make themselves comfortable during the 72-hour cooling period. It wasnt going to be necessary for them to contort themselves into rigid chairs. Phoebe had set them up in what it called its hospit-el hotel rooms in a hospital that it offered to VIPs. The nurse said that Mrs. Parkers family had been assigned one of the nicest rooms.It had two double beds, a flat-screen television and a desk.Not at all plush, Mrs. Parker thought, but it was comfortable, and she was grateful for it.Her water aerobics bag with a change of clothes was in the trunk of her car, and after shed unpacked, the nurse returned with a goodie basket, filled with snacks and soft drinks, wrapped in colored cellophane.Anthony Parker with Sandra on prom night in 1971 and with their first child, Kim, in 1973CHAPTER 4Moore didnt stay long in Albany. He knew the fight to overcome the competition from Palmyra would always be ugly. Closer to the end of his career than the beginning, he didnt have the energy for it. But he knew someone who did, his 34-year-old protg, Joel Wernick. The two men had met when Wernick was a star right guard on his high school football team in Fort Smith, Arkansas, and worked as a groundskeeper at the hospital that Moore ran. Wernick was brash and competitive, Moore told me, and he encouraged him to go to business school and pursue a job like his.Wernick took Moores advice and became part of a growing number of hospital administrators whod been trained in business, not medicine. They were the kind of men and the vast majority of them were men who would walk into a room with a pregnant woman and immediately know how much her care was going to cost, rather than the kind of person who could walk into that same room and know immediately what care that woman would need for a safe delivery, said Richard Ray, a former Phoebe vice president. Theyre both important, but they have different priorities.In 1988, Moore recommended Wernick to the Hospital Authority of Albany-Dougherty County, whose nine members approved Phoebes spending and operations. From the moment Wernick arrived in Albany, his No. 1 priority was to get rid of Palmyra. He had a powerful ally in the chair of the authority, William Harry Willson, who would hold the position for 31 years. A Harvard Business School graduate, Willson had converted his familys pecan farm into a successful mail-order business, helped found a local bank and became the citys leading philanthropist.Albanys economy had shifted from agriculture to industry. In 1968, Firestone had opened a factory that employed some 1,600 workers. Procter & Gamble had built a paper products plant in 1973. Within the citys white establishment, old and new money were vying for influence. Willson and Phoebe represented the old, Palmyra the new. To hear Phoebes supporters explain it, Palmyra was driven by racism and greed. Not only did it provide scant care to the poor, but it had no obligations to invest any of the money it was making off of Albany into Albany. Meanwhile, as a public hospital, Phoebe was legally obligated to serve the poor, and in the years when the hospital ran a deficit, the countys taxpayers were on the hook to make up the difference.Willson moved to make Phoebe a business, too. Among his first instructions to Wernick was to reach out to Palmyras parent company and offer to buy it out. When the Hospital Corporation of America turned him down, they decided that the only way Phoebe could compete was to expand, and the only way it could expand was to change its governance.The two persuaded Dougherty County to relinquish oversight of Phoebe and transfer it to a private management company that would also finance its operations. Under the new structure, the county would retain ownership of the actual building but lease it to the new entity for $1 a year.That lease still stands as the countys only leverage over how the hospital is run. County officials can revoke it without warning, although the conditions of the lease leave a lot to Phoebes discretion. It broadly requires that Phoebe provide quality care to the community at a reasonable cost without defining what that means that it spend 3% of its revenue on free and subsidized care for the poor and that it uphold Phoebes founding promise to treat all people, no matter their ability to pay.Hospital authority chair William Harry Willson, left, and Phoebe CEO Joel Wernick in 1988. Courtesy of Phoebe Putney Memorial Hospital The construction site for Phoebes medical tower two years later. Courtesy of Phoebe Putney Memorial Hospital With that move, Phoebe Putney Memorial Hospital became the centerpiece of the Phoebe Putney Health System. Controlled by Wernick, the health system was now free to pursue business ventures in the wealthier suburbs outside the county limits with the same tax-free status as before but without the same burden of public scrutiny.Under Wernick and Willsons leadership, the hospital authority approvedhundreds of millions of dollars in bonds for the construction of new clinics, office towers and medical wings, including some that werent in Dougherty County.Rather than staging hallway tirades to get doctors to refer their paying patients to Phoebe, Wernick bought their practices. He lobbied to prevent Palmyra from obtaining a state license to deliver babies by using Georgias strict certificate-of-need provisions, which put limits on the kinds of health care services that can be provided in any one market.The laws are meant to prevent massive chains from squeezing out smaller hospitals, but in practice they often stifle the competition. Wernick refused to negotiate rates with managers of factories who complained that the costs to insure their workers in Albany were higher than in other cities. When Blue Cross, Georgias largest health insurer, moved to include Palmyra in its health care plans, Wernick threatened to withdraw from the network if it went ahead with the deal. It did not.In 10 years, Wernick dramatically reshaped Phoebe from a small community hospital in a small city to a behemoth hospital system spread across the state. In 1998, a decade after Wernick arrived, The Wall Street Journal reported that the hospitals profit margins were double the national industry average. Along the way, though, he had made enemies. In 2003, Phoebes chief of surgery and a local health care accountant started sending a series of anonymous faxes to businesses, accusing Phoebe and Wernick of an array of excessive and predatory behavior. The faxes, called Phoebe Factoids, were drawn from public records and leaks. A lot of the allegations they made were true that Phoebe paid its executives high six-figure salaries; that it treated the members of its board of directors to all-expenses-paid trips to Europe and the Caribbean; and that it employed aggressive measures to collect medical debts from the poor. But the information was couched in so much spin and crude innuendo that it wasnt easy to tell what was accurate and what wasnt.A Phoebe Factoid critical of Wernick and the hospital Obtained by ProPublica For months, the Factoids held Albany in thrall. Wernick used his connections in the district attorneys office led by a Putney descendant and a former FBI agent to help him investigate who was behind them. Once he knew who the authors were, Phoebe sued one of them for defamation. They brought their own suits against Wernick and Phoebe, accusing them of retaliation. Each side denied the allegations.Eventually the faxes stopped, and the lawsuits were dismissed or dropped, but not before attracting attention from state and national media, which, in turn, got the attention of Iowa Republican Sen. Charles E. Grassley. The chair of the Senate Finance Committee, he was launching an investigationinto whether nonprofit hospitals like Phoebe were giving enough back to their communities to justify what they were receiving in tax breaks.The committee released its findings in 2006, and they were devastating. Among the 10 hospitals that answered the senators questions, eight of them submitted information about the amount of free and discounted care they provide to the poor. According to the committee, Phoebes terms were the least generous. It offered free services only to people whose income was under 125% of the poverty line and discounted care to those below 200%. Under those terms, a single mother with two dependent children who earned more than $21,000 a year would not qualify for free care. The other seven hospitals covered patients whose income was at least one and a half times that much.Even more damning was how aggressively Phoebe pursued patients with medical debt. The hospital told the committee that it had filed lawsuits against more than 1,000 people during the previous five years and that nearly 40% of those suits involved people who owed less than $500.Decades later, when I spoke with Dean Zerbe, who led the Grassley investigation, he got worked up again about Phoebes debt collection practices. They werent doing that because they genuinely expected to collect $500, he said. When hospitals go after people like that, its because they dont want them to come back.One of the many Phoebe billboards in Albany Katie Campbell/ProPublicaThree former executives at Phoebe told me that the Grassley report rattled Wernick, because he couldnt disparage the findings as a terrorist conspiracy the way he had done with the Factoids. It wasnt the only public relations hit. The Albany Herald published an accounting of the properties the hospital was acquiring in the downtown historic district, raising questions about the drain on the countys property tax base. In 2006, The Associated Press reported that Phoebe had used its relationship with the county government, which has the power of eminent domain, to force a 93-year-old retired domestic worker named Julia Lemon out of her home. The hospital wanted to raze the house so that it could expand a day care center for its employees. A jury ruled in Lemons favor.That same year, the Albany Herald obtained a deposition in which the hospitals chief financial officer revealed that Wernicks compensation came with a long list of perks, including a country club membership, six-figure bonuses, an automobile of his choice every three years and a termination agreement guaranteeing that if he was fired for cause, hed receive three years pay unless he was convicted of a felony. This was on top of a $650,000 salary.If all that wasnt enough, in 2009, the battle between Wernick and the authors of the Factoids became the subject of a feature-length documentary. The timing of all the coverage couldnt have been worse. Plants in Albany had begun to shut down, and thousands of people were being thrown out of work: Bobs Candies (236 employees); Merck (273 employees); MacGregor Golf (200 employees); Flint River Textiles (230 employees); and, the biggest hit, Cooper Tire, which had replaced Firestone (1,268 employees). On their way out of town, plant managers complained that one of the reasons for the closures was the high cost of health care.Sandra Morris was a human resources manager at the Procter & Gamble plant, which didnt close but whose workforce has shrunk over the years. I was trying to do everything I could to lower our costs, she told me. But, she added, I was fighting a monstrosity of a hospital.Men playing checkers across the street from the checker club in downtown Albany Katie Campbell/ProPublicaThe battle with Palmyra ended when Phoebe least expected it when it looked like it had lost. Palmyra applied in 2008 for a license to deliver babies. Phoebe spent millions of dollars, including $8.8 million to the firm of its lead attorney, Robert Baudino, to challenge the request. Palmyra took its case to court, charging Phoebe with a host of antitrust violations, and it won. In April 2010, the 11th U.S. Circuit Court of Appeals ruled against Phoebe and, in remanding the case, recommended that the health system could be held liable for damages amounting to three times the value of any provable harm.Those who worked with Wernick told me that he saw the ruling as a matter of life and death. The damages Phoebe might have to pay would gut its finances. Just as troubling was that Palmyras ability to begin delivering babies would have dealt a significant blow to Phoebes ability to compete for patients. Ive spoken to numerous people about Wernick, and the one quality that both his allies and detractors agree on is that his determination to win was extreme. Where they disagree is about his motives. His supporters say that he operated on the belief that what was good for Phoebe was good for Albany and that it was his commitment to doing right by the community that compelled him to fight as hard as he did.To his critics, he was only interested in building a health care empire, whether that was what Albany needed or not. Lynda Hammond, a former Phoebe vice president, told me that for Wernick it was all about being the only hospital, not the better hospital.Three months after the 11th Circuits ruling, Wernick dispatched Baudino to Hospital Corporation of Americas headquarters to discuss, again, Phoebes interest in buying Palmyra. The only public records of how the deal was consummated come from the filings made by the Federal Trade Commission, which mounted a legal battle to undo it.According to those records, HCA seized on Phoebes vulnerability and asked for $195 million in cash, which was more than twice Palmyras net revenue for the previous 12 months and which the FTC said far exceeded other recent hospital deals. HCA demanded that the agreement be kept confidential until it was signed. Also, if the acquisition failed to go through, either because of antitrust challenges or opposition from the hospital authority, Phoebe would have to pay the chain a breakup fee of some $52.5 million.Wernick presented the terms to the hospital authority a week before Christmas. Baudino, Phoebes lawyer, was assigned to represent the authority. As the FTC would later point out in a legal complaint, this put him in the position of both pitching the merger and weighing its merits. He recommended that the authority approve the deal. Seven of its nine members attended the meeting, and they voted unanimously in favor.Feelings among the residents of Albany, who didnt learn about the purchase until after it was signed, ranged from confusion to outrage.The Albany Herald quoted opponents to the deal saying that it was mind-boggling that the hospital authority would agree to a merger of this magnitude without taking time to do an independent assessment of its potential impact on the cost and quality of care. They accused the members of the authority of conducting themselves as agents of the hospital rather than representatives of the public good.Within months, the FTC sued Phoebe, describing the hospital authority as a rubber stamp and the deal as a merger to monopoly that would cause consumers and employers in the Albany region to pay dramatically higher rates for vital health care services. The agency pointed out that many people in the city were already struggling to keep up with rising medical expenses. It added that the merger was also likely to reduce the quality and choice of services available.Over the years Phoebe had done many things to lose the confidence of the community it was supposed to serve, but the purchase of Palmyra at a huge cost, revealed only at the last minute, without public input or any assessment of its repercussions was a turning point for many residents.The hospital authority didnt call a public hearing on the merger until May 2012, some 17 months after the deal was announced. It attracted an overflow crowd and lasted more than three hours, as one impassioned speaker after another shared their views. Why did it take the FTC to recognize what you did not the need to protect our citizens from an overreaching hospital, asked a resident named Hope Campbell, speaking for many in the room.In response, Wernick promised that, in order to keep the merger from draining revenue from the county, Phoebe would voluntarily continue to pay what had been Palmyras property taxes. Not only would there be no increases in the cost of care, Wernick said, but ending the rivalry between two hospitals would allow Phoebe to streamline services in a way that would reduce costs and broaden its ability to provide the region with high-quality, affordable and accessible health care.He explained that Phoebe Putney Health System had grown to cover 35 counties. As a result, it had to expand to keep up with the demand, and buying a facility was much cheaper and much less disruptive than building one. Phoebe would finally have the space and resources, he said, to address some of the regions most pressing needs, including establishing a trauma center. And he pledged to convert Palmyra into a medical facility that focused on care for women and children.The matter of the merger was not settled for five years, and although Phoebe lost the legal battle, it ultimately won. The Supreme Court ruled against the merger, but by then Phoebe had taken control of Palmyra, combining its services and staff and even giving the facility a new name, Phoebe North. The FTC fought another couple of years to find a way to separate the two entities, but it eventually decided that Georgias strict certificate-of-need provisions would make it almost impossible for an outside health system to sustainably take over Phoebe North.Richard Ray, the former Phoebe vice president, recalled being summoned to an executive meeting shortly after the settlement with the FTC was announced.He said that the mood at the meeting was anything but celebratory. The purchase had thrust Phoebe deep into debt. Nobody was sure how the hospital was going to keep its doors open.Wasnt the plan to turn Phoebe North into a women and childrens facility? I asked.It was clear that no real due diligence on the idea had ever been done, he said. We had bought this facility that we couldnt use.How did Phoebe explain that to the public? I asked.We knew we couldnt say that to the public, he said, so we really didnt say anything.Rosalynn Almond holding the urn containing the ashes of her sister LaTosha Almudena Toral/ProPublicaMay 27-29, 2022Just a little more than 24 hours had passed when Mrs. Parker realized that word about her husbands condition had gotten out. She received a text from someone she and Anthony barely knew, a middle manager in Phoebes human resources department. But somehow the woman had heard he was in critical condition and messaged to say that she was praying for him.How does she know? Mrs. Parker wondered. Had news about Anthony gotten out?If that wasnt intrusive enough, the woman stopped by the room. You dont want to move him to Emory or somewhere? she whispered. Shouldnt you get him out of here?It seemed an inappropriate question on so many levels, not the least of which was how little they knew each other. Still, Mrs. Parker was polite. Were good, she responded. I appreciate your concern, but were good.Other people might not have a high opinion of Phoebe, but Mrs. Parker did. She was confident its staff was going to save Anthony. She compared it in her mind to when President Donald Trump came down with COVID-19 and had to be rushed to Walter Reed National Military Medical Center. That was an all-hands-on-deck emergency, and the staff at Phoebe, whose senior executives milled in and out of Anthonys room, had made it clear that this was an all-hands-on-deck emergency, too.Andrea, the Parkers middle child, who was 43 and served as a commander in the Coast Guard, had arrived from suburban Washington, D.C., late the previous evening. So had Richard, a UPS long-haul driver, based in Atlanta, who was 39 and the youngest sibling. None of them doubted that their father was in good hands. They supported their mother, and their mother was going to stick with Phoebe.Thats what Anthony had always done when others raised questions about the hospital. When doctors shared concerns about staffing issues that were leading to poor patient outcomes, Anthony questioned the propriety of their actions, not Phoebes. When friends complained about loved ones dying in Phoebes care, he didnt use his position on the board to press the hospital for an inquiry. He would say he was confident Phoebe had acted appropriately. When he asked Phoebe to invest in Albany Techs nursing program and instead it gave money to the predominantly white community college, he stewed privately, but he didnt raise a ruckus. They just dont know they need us yet, hed say to his staff. Well be here when they do.Mrs. Parkers loyalties also ran deep. When the spouse of a co-worker had nearly died from an infection shed gotten after a hysterectomy at Phoebe, she asked Mrs. Parker to help get a letter to CEO Joel Wernick. Mrs. Parker didnt do it. Who knew whether Phoebe was responsible? she reasoned. It didnt feel like something she should take to Anthony, much less for Anthony to take to Wernick.Yes, there was the time years earlier when he was being treated for lymphoma and had been admitted for what was supposed to be a laparoscopic biopsy of a spot that had been detected on one of his lungs. The doctor emerged from the biopsy saying hed ended up performing major surgery. Did he just tell me he opened Anthonys chest? she said to herself, feeling a lot like she would when Dr. Jos Ernesto Betancourt told her that her husband had gone into cardiac arrest. The surgeon back then explained that hed changed plans because hed had a hard time reaching the section of the lung that hed wanted to check for cancer and that fortunately hed found no signs of disease. But afterward, Dr. Parkers radiation oncologist complained that the biopsy hadnt been necessary.Why hadnt her husbands doctors communicated with one another? Mrs. Parker wondered. A lawsuit certainly crossed her mind but not her husbands. He would have never considered such a thing. Not when it came to Phoebe. Hed have a longer recovery, but hed be fine. His thinking was, Lets move on.She was praying that her husband would be fine this time, too, that his faith in Phoebe would be vindicated. On Sunday, three days after the ablation, it seemed that might be the case. The cooling period had ended. Dr. Parkers body was being returned to normal temperature. His three children were in his room, singing along with a recording of the South Carolina State fight song Get up for the Bulldogs. Everybody, get up! hoping their father could hear them, when suddenly he opened his eyes.Anthony Parker pinning a corsage on his younger daughter, Andrea, in 1997 and with Andrea during parents weekend at the Coast Guard Academy the following yearCHAPTER 5Phoebe spending nearly $200 million to buy and then mothball most of Palmyra while so many Albany residents were struggling to pay their medical bills was disastrous for its reputation and its finances. The hospital had paid cash for Palmyra, cobbling together the financing afterward, including arranging for the hospital authority to issue yet another bond this one for $108 million. The additional debt helped send Phoebes expenses soaring from $508 million in 2012 to $576 million the next year.I spoke with several former Phoebe executives about what things were like during that time. They told me that conditions were bleak. One recalled Joel Wernick, whod now run the health system for 25 years, spending millions of dollars on a communications expert to come up with a branding campaign. We had soiled beds, waiting rooms with holes in the chairs, mounting sepsis issues and had just laid off 200 qualified nurses, he recalled, but we had a new logo.A former vice president at Phoebe showed me an email chain that shed saved from around that time. It had been written under the subject line ICU Morale. The emails captured a conversation among a group of intensive care nurses who were encouraging one another to try to make the best of the conditions because there wasnt much else they could do.Money problems in the hospital (despite all of our opinions) have dictated that cutbacks are necessary, one of the nurses wrote. People and family are going to die, our patients are going to die, sometimes quick sometimes not sometimes despite everything we do. The nurse went on. People are going to be treated wrong, people will suffer, work will not be the best at times, he wrote. We will continue to feel underpaid no matter what job, company or title we attain.One of the nurses colleagues thanked him for speaking up. A supervisor encouraged everyone on the email chain to try to make the best of a bad situation. However, there was a long response from a nurse whose positivity was spent.She wrote that during a typical shift in the ICU, it wasnt unusual for a single nurse to manage three critically ill patients at a time, while guidelines advise only being responsible for one to two. She described how doctors ignored late-night calls, leaving her and her colleagues scurrying on their own to figure out how to save patients whose vital signs were crashing. She recalled running out of essential supplies and having to spend hours on the phone and away from her patients to get them restocked.She despaired about having to answer questions from patients and families about why something wasnt done or checked, when youve been doing your best just to stay afloat.Its easy to talk about keeping a positive attitude, she wrote. But when youre hit with tidal wave after tidal wave, night after night, even the most faithful, positive person will start to waver.A Phoebe spokesperson said the emails represent the opinions of a few individuals, not facts. At the time, he said, Phoebe was not under undue financial strain and never prioritized financial considerations over quality and safety.The conversation in those emails resonated because Id pored over hundreds of pages of Phoebes financial records. Revenue from patient stays was flat. The former Phoebe vice president told me that Palmyras patients were so upset by the merger that those who could afford to travel for health care, which often included people with decent insurance, went out of their way not to go to Phoebe. Providing care for the poor and uninsured became an even bigger burden. The amount of bad debt that Phoebe accumulated because patients werent paying their bills increased from $16.5 million in 2012 to more than $121.7 million in 2018.Despite Wernicks promises, the cost of care at Phoebe increased immediately after the merger, and, a year later, so did the cost of health insurance. An Atlanta Journal-Constitution examination in 2013 of the online market that had been established by the Affordable Care Act found that a middle-tier insurance plan for a typical 30-year-old consumer in Albany was the highest in the state.The following year, The Washington Post published a national study of the online marketplace. It found that southwest Georgia was one of the most expensive health insurance regions in the country. The only places with higher premiums were in the areas around the Colorado resort towns of Vail and Aspen.If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month, the Post story opened. If he lived in Beverly Hills, he would pay $1,405. But Mullins, who builds custom swimming pools, lives in southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.What that meant, I was told over and over again in Albany, was that the poor and uninsured stopped seeking routine care, and the rates of treatable illnesses began to climb.I sought out Wesley James, a sociologist at the University of Memphis, whose research focuses on health, mortality and life expectancy in rural parts of the country, and asked him to analyze mortality rates for Dougherty County over the past 50 years. Drawing on Centers for Disease Control and Prevention data, he found that for most of that time, the countys diabetes mortality rate had tracked closely with the rates for the state and nation. In the decade after the merger, however, it leaps off the charts like rocket trails, going from 36 to 76 per 100,000 people.James told me that it wasnt unusual to see modest upticks in poor, rural communities that have experienced steep population decreases and been hit by economic turmoil but that hed rarely seen spikes as high as the ones hed recorded in Dougherty County.The Rate of Deaths from Diabetes Was Far Higher in Dougherty County than in Georgia or the United StatesSource: Centers for Disease Control and Prevention WONDER DatabaseNone of this affected Wernicks compensation. In 2017, the year he turned 63, the health system provided him with a $6 million retirement package, in addition to his more than $1.1 million in salary and deferred pay.In 2018, Wernicks last full year as CEO, his earnings per bed were more than twice as much as that of the CEO at the Mayo Clinic, one of the top-rated health systems in the country. In the two years following his departure, Wernick was paid almost $2.8 million, because the board had extended his contract in case it wasnt able to find a replacement.If Wernick had made peace with his opponents by the time he left, he gave no sign of it in the exit profile that the Albany Herald published. The kind of unwarranted criticism I was subjected to never really hurt my pride, as it was intended to do, he told the paper. Nor, he said, did it diminish his commitment to Albany. This is a place where thousands live, and millions wish they could, he said. I intend to continue contributing to it.Eight months later, he moved to the other side of the state.May 29, 2022When Dr. Parker opened his eyes, his pupils rolled upward. He didnt say anything. His body was clenched and trembling as if hed felt a jolt of electricity. The entire episode only lasted a few seconds, but that was the signal Mrs. Parker and her family had been praying for the Greys Anatomy moment she had told everyone was going to happen. Anthony was coming back. He would wake up. He might not remember who they were right away, but hed wake up.There were so many big things ahead for him. His and Mrs. Parkers 50thwedding anniversary. Andreas retirement from the Coast Guard. His newly elected position on the Rotary Club board. And the launch of Albany Techs partnership with Phoebe that would double the colleges nursing enrollment. The project marked the culmination of Dr. Parkers effort to transform the image of his school from one that gave students manual skills to one that turned them into professionals.Mrs. Parker remembered the naysayers people who never believed it would happen or believed it shouldnt. At lunch one day, William Harry Willsons wife, like her husband, a major benefactor of the hospital and community, took Dr. Parker playfully by the hand and cautioned him against trying to turn the school into something for which it was not intended. Willson didnt say it in so many words, but the message Dr. Parker took from her was: Dont forget what your school is there for. Teach those kids to use their hands, not their brains.She remembered her husband repeatedly asking the hospital to support Albany Techs nursing program and Wernick regularly turning him down. The one time Phoebe did give a large donation, Wernick insisted that Dr. Parker keep it anonymous. It ticked Dr. Parker off. It felt to him like the same kind of hush money that Strom Thurmond, the segregationist senator from South Carolina, had secretly sent to the Black child hed fathered but never publicly acknowledged.Dr. Parker never let on publicly how he really felt about Wernicks request, and he told his wife not to do so either. He did what hed always done: accepted the gift, privately thanked the hospital and made the most of the money without saying where it came from.Anthony Parker with his children in 1986CHAPTER 6Before coming down with COVID-19, LaTosha Almond earned about $9 an hour working for a company that laundered the hospitals linens. Her health habits were typical of the poor and uninsured. She couldnt afford regular checkups. She sought medical help usually by going to the emergency room only when she was sick, which was a lot. She was raised in the tiny town of Cotton, where her mother, grandmother and great-grandmother had worked on a farm, both in the fields and in the kitchen.Almond was the youngest of six children, raised by a mother who struggled with mental health and a father with a violent temper. She spent her childhood bouncing between a troubled home and foster care and her adulthood bouncing between dead-end jobs.By the time she was about to turn 42, she was morbidly obese, diabetic and in the early stages of congestive heart failure. If that wasnt enough to make her a perfect target for COVID-19, shed been hospitalized with the flu just months before the start of the pandemic.But it wasnt COVID-19 that killed Almond. Her medical records show that she died from cardiac arrest and severe brain damage, which her family believes was caused by a series of alarming and inexplicable lapses by medical staff at Phoebe. Three nurses, who were either involved in Almonds care or had detailed knowledge of it, agreed.According to her medical records, Almond was admitted to Phoebe with COVID-19 in early April 2020 and was hospitalized there until June 1. She announced that she was being discharged on Facebook. Her voice was weak and raspy, but her mood was upbeat. Shed not only beaten COVID-19, shed shed 100 pounds. Im getting fine, girl, she said to one friend who typed a comment congratulating her. Fine, fine, fine.That wasnt all. My life has changed, she went on. I feel better about myself. No matter what nobody say, you cant bring me down.The day after Almond arrived home, her mother, Tersas Laster, detected an awful stench coming from her daughters bedroom.I went in and asked Tosha, Whats that smell, baby? Laster said. She told me, Ma, its that wound. Almond had a severe bedsore on her lower back. Laster described it as big as a dinner plate and so deep that she could see her daughters bone. It was pouring out yellow and gray pus, she said. Smelling like a dead carcass on the side of the road thats how they sent my baby home.A home health nurse whom Phoebe had assigned to follow up with Almond instructed Laster to get Almond back to the hospital. The nurse told me they should have never discharged my baby with that wound, Laster said. Almonds medical records indicate that she underwent emergency surgery to debride the wound. The surgeons also performed a tracheotomy because her airway had narrowed, making it hard for her to breathe.Almond spent an additional three weeks at Phoebe and was discharged on June 25 with a tracheostomy tube that required regular cleaning to keep her airway open. Laster only attended school until the eighth grade and acknowledged to me that she doesnt read or write well. She said that Phoebe did not teach her or her daughter how to manage the trach, as required for discharge. According to Almonds medical records, she was rushed back to the emergency room three times after the trach became clogged.The first time was on June 27. Records indicate that doctors in Phoebes emergency room removed a large mucus plug and sent her home. She was back in the ER again on July 12, with another plug, which doctors removed. A few minutes before noon the next day Almond was back at Phoebe for the third and final time.Patient arrived in cardiac arrest, which seemed secondary to respiratory arrest, her medical records said. Her heart had stopped beating for nearly 15 minutes before doctors were able to revive her, according to the records. They removed her trach and put her on a ventilator and tried treating her with hypothermia cooling her body to give her brain time to recover. However, the records said, the heart attack had caused too much damage. Almond was not exhibiting any purposeful activity or signs of brain activity.She was pronounced dead shortly before 10 a.m. on July 15. Her sister Rosalynn Almond said the way Phoebe had treated Almond was inhumane, adding, What kind of doctor sends a person home with an open wound like that?Citing privacy protections, a Phoebe spokesperson said he could not comment on the specifics of Almonds case but added we believe Phoebe provided appropriate care.She and her mother attempted to find a lawyer who would represent them against Phoebe, but no one would take their case. Georgia, like many other states, enacted an emergency immunity law that shielded health care providers from civil liability in COVID-19 cases, except when plaintiffs could meet the nearly unattainable standard of proving gross negligence or willful misconduct. Almond was classified as a COVID-19 death, even though that wasnt what killed her.I feel like if theyd have done what they were supposed to, my child would be here now, Laster said. I wouldnt have had to bury my baby.Remembering LaTosha Almond1978-2020LaTosha Almond Courtesy of the Almond familyAlmond with her sister Vontressia Almond at a nightclub Courtesy of the Almond familyTwo of Almonds home health nurses told me that in the chaos of COVID-19 families were not always getting the supplies and the training they needed to properly manage trach patients, because Phoebe either didnt have the resources or didnt provide them. Another nurse, who knew of Almonds case but was not assigned to it, said she scoured Amazon every day looking to buy inner cannulas, the tubes that are placed inside the trach, that were the right sizes for her patients needs. She said that cannulas were so hard to find that she asked patients to reuse them more times than standards advised, and she reluctantly asked for them back from patients who had recovered.A Phoebe spokesperson said the hospital had no recollection of anyone ever reaching out to complain about a lack of home health supplies or to indicate they were scouring Amazon in search of proper supplies.Cases like Almonds had me wondering how well Phoebe had tended to its patients before the pandemic. In 2012, the year after it acquired Palmyra, Phoebe was rated one of the worst hospitals in the country by a coalition of large health insurers and leading patient safety experts known as the Leapfrog Group. The groups members had been alarmed by reports that across the country 200,000 people were being killed or injured each year by medical mistakes and wanted to provide patients a way to evaluate their health care options.The Leapfrog Group began giving letter grades to hospitals based on information it gathered from the institutions themselves and on an analysis of public data from the Centers for Medicare & Medicaid Services. The Albany Herald reported that part of the reason for Phoebes poor first grade it got an F was that Leapfrog gave the hospital only 5 points out of 100 for ICU physician staffing. The hospitals senior vice president of medical affairs told Georgia Health News that he was troubled by Leapfrogs methodology, which he described as inaccurate and misleading. The score resonated with me because it tracked with what Id read in the email exchange Id obtained and with what Id been told by several nurses who worked at Phoebe during that time. They said that the ICUs back then were not staffed 24 hours and that getting critical care physicians to respond to emergencies was hit or miss.In 2015, CMS developed a star system to rate the quality of care at the nations hospitals, based on reports of hospital-acquired illnesses, readmissions, emergency room wait times and overall patient satisfaction. The ratings, while imperfect, are widely cited among industry analysts because of the agencys regulatory authority.According to the system, one star indicates poor performance, and five indicates excellence. Phoebe received one star when the first reports were published in 2016. CMS rated Phoebe below national averages in the most crucial categories, including hospital mortality rates, the rigor of the safety measures practiced by its staff, the numbers of preventable readmissions and general patient satisfaction. The hospitals Medicare reimbursements were docked because of high rates of hospital-acquired infections and rates of readmission.Phoebe responded by pointing to one of the glaring weaknesses in the CMS rating system, which is that it puts hospitals that serve predominantly poor and uninsured populations on equal footing with hospitals in wealthier communities. Dr. Steven Kitchen, the chief medical officer, said, The ratings given to hospitals like Phoebe show that this simple star system does not accurately represent the quality or complexity of care provided by teaching hospitals. However, to put Phoebes score in context, 96% of the nations hospitals rated by the agency scored higher. All the other hospitals within a 100-mile radius of Albany received three or four stars. Only four other hospitals in Georgia received one star, including Grady Memorial Hospital, a publicly run, 634-bed safety-net hospital in Atlanta.A banner in the lobby of Phoebe Putney Memorial Hospital announcing it received an A rating in 2022 from a patient safety group. Its rating has since dropped to a C. Almudena Toral/ProPublicaThe Georgia Department of Community Health examined Phoebes surgical records. It found two separate incidents of surgeons who operated on the wrong section of a patients spine and another where doctors operated on the wrong hip. Home health nurses, according to the inspection reports, were not keeping adequate service records, making it hard to scrutinize whether patients were receiving the medications and therapy they needed. Inspectors obtained audio recordings that showed Phoebes physicians refusing to accept critically ill and injured patients who had been referred by emergency rooms at smaller facilities. One case involved a patient with a serious head injury, whom Phoebes neurosurgeon dismissed as a serial drunk.CMS gave the hospital a two-star rating in 2017. Then in 2018, under enormous pressure from the American Hospital Association, one of the most powerful lobbies in Washington, CMS paused its rating system to adjust its metrics. That year, state officials inspected the death of a Phoebe patient whod arrived at the emergency room complaining of weakness and persistent diarrhea. The hospital had initially reported the death as a freak incident. However, the states investigation revealed that staff either ignored or silenced alarms that indicated the patient was in distress 19 times until relatives discovered the patient unresponsive. Inspectors found that the patient was down for possibly thirty (30) minutes before CPR was initiated.A Phoebe spokesperson said any health system of its size will sometimes have patient outcomes that are not optimal. It is the responsibility of every hospital to learn from those cases and do everything in their power to do better the next time.When the results of the new CMS system were back online in 2019, Phoebe received one star again. It had a one-star rating in 2020, when Albany was hit by COVID-19 and patients like Almond flooded in for care. Phoebe is still struggling to address the issues raised by Almonds case. In 2023, it was penalized for a high readmission rate, which tracks patients who return to a hospital within 30 days after their discharge. That metric can serve as an indication that they may have been released too early or without proper instructions. According to that data, Phoebe also continued to have a problem with bedsores in 2023. The hospital has two stars today, which places it among the bottom 30% of all CMS-rated hospitals in the country.An email sent this year from an ICU nurse to hospital leaders suggests that some of the same staffing issues nurses complained about more than a decade ago persist.The nurse described staffing levels at Phoebes ICUs as a crisis. She wrote that charge nurses, who supervise their units and therefore are not supposed to participate directly in patient care, routinely manage two patients. Nurses who should be handling no more than two patients were often assigned three. This is not only unsafe for patient care, but also unsustainable for staff morale and retention, the nurse wrote.If immediate action is not taken to correct the staffing crisis, the hospital will not only see a decline in patient outcomes, she continued, but also a significant loss of experienced ICU nurses who cannot continue to work under these unsafe conditions.A Phoebe spokesperson disputed the nurses charge, saying, We have not had a staffing crisis in our ICUs. He added, We staff for the volume and acuity of our patients and currently do not have any issues with staffing in our critical care unit.Downtown Albany Katie Campbell/ProPublicaJune 1, 2022On Wednesday, Mrs. Parkers sixth day sitting vigil, Dr. James Palazzolo introduced himself, explaining that he was now the critical care specialist on call. Mrs. Parker had seen Palazzolo around the hospital over the years. Shed been put off a bit by his formal bearing until a close friend who had been Palazzolos patient told her how much she liked him. Palazzolo, in fact, was warm, but he hadnt come to bring Mrs. Parker good news. He wanted to know whether Dr. Parker had signed a living will that explained how he wanted her and his doctors to manage the end of his life, in the event that he was unable to tell them himself.Mrs. Parker froze for a second and then asked Palazzolo what he meant. She hadnt been preparing for the end of her husbands life. Shed been preparing for a Greys Anatomy moment. He seemed so close. Hed already opened his eyes.Palazzolo asked her if she had spoken with a neurologist.Mrs. Parker shook her head. Should she have? she wondered to herself. How was she supposed to know that? Palazzolo said that her husband was being seen by a neurologist and that hed arrange for her to meet with him. She didnt even know a neurologist had been involved in her husbands care. Palazzolo explained that he wanted her to get a specialists opinion of her husbands condition, but his reading of the medical records suggested that Dr. Parkers brain damage was extensive. He wasnt getting progressively better, and it seemed unlikely that he would.Mrs. Parker suddenly didnt know whom to believe. The previous doctors had told her that they were going to give her husbands brain time to rest and recover and then would wake him. No one had raised the possibility that he wouldnt recover. Anthony opened his eyes, she reminded Palazzolo.That was a reflex, a spasm, the doctor said. It wasnt a sign of brain activity. There hadnt been any meaningful sign of brain activity since the surgery, he told her.Mrs. Parker stood in stunned silence. Why hadnt anyone told her that? She didnt want to think the worst of Phoebe, that the hospital had been deliberately keeping the truth from her, but she couldnt help herself.Palazzolo asked her whether she and her husband had ever discussed what they would want the other to do under these kinds of circumstances. He encouraged her to summon her children to discuss next steps, and he repeated that he would make sure to have a neurologist meet with her before the end of the day.Andrea, the Parkers middle child, arrived at the hospital soon after. They were sitting in a waiting area outside of Dr. Parkers room when Dr. William Garrett, the neurologist on call, appeared in a white lab coat and bow tie. He invited the Parkers to talk in his office. The space, little bigger than a closet, was cramped and cluttered. Garrett sat behind a desk and turned his computer monitor toward them, calling up different models of the brain, and proceeded to show images and charts that explained the various kinds of damage that could have been caused during the four to 14 minutes Dr. Parkers heart had stopped beating.Andrea, taking notes, wrote, 4-14, and then looked up. We thought it had only been a few minutes, five at the most, she said. Now youre saying it could have been 14?The neurologist told her that the records hed seen from the day of the procedure werent clear, so he couldnt be sure, but it looked to him like it might have taken much longer than five minutes to restore her dads heartbeat. Then he turned back to his models, describing something about inconclusive clinical trials, which made it hard to assess certain kinds of damage to the brain and the chances for recovery.Mrs. Parkers face went blank again. She was unable to absorb most of what Garrett was saying. What did those images on his computer have to do with Anthony? she thought to herself. Why is this man speaking to me like Im one of his med students?Andrea was also losing patience. She was scribbling the doctors words extensive posturing in all extremities, flexor response at day six, reminiscent of diffuse expression but she had no idea what they meant. When he told her that there was no single data point that he could use to provide a conclusive prognosis, she stopped him. I know neurology isnt an exact science, she said, but I dont want to talk about models.Pointing at herself and then at her mother, she went on, I want to talk about this case about my dad, her husband.The doctor said he wished he knew more about the extent and severity of the brain damage, but he hadnt been able to perform a scan because Phoebe didnt have a mobile MRI machine and her dad was too unstable to be moved.Based on the little he knew, Andrea asked, what would he do if this was his loved one?Garrett turned away from his computer and toward Mrs. Parker. He told her that he was married to a sweet, beautiful woman whom he loved dearly, but that he didnt think it would be useful to speculate on what hed do in Mrs. Parkers shoes. He told her that his clinical assessment of her husbands condition was the same as Palazzolos. It wasnt getting progressively better. As for what she should do, he said perhaps she wouldnt have to do anything. Sometimes, he told her, God makes the decision for us.The room went silent. Mrs. Parker could feel her daughter about to explode. Why was this doctor talking in circles? Was he hiding something? Was Phoebe hiding something? Suddenly its embrace seemed more like a trap.Anthony Parker soon after he became president of Albany Technical College in 1995CHAPTER 7Scott Steiner, who succeeded Joel Wernick as the CEO at Phoebe, was happy to cooperate with my reporting when I was focused on the hospitals response to COVID-19. But he was less enthusiastic when I told him that my focus had shifted to the health systems relationship with Albany. He explained why when I met with him in his office, and he told me about the first time he sat with Wernick.It was 2018, and the office looked different back then. Wernick, he said, kept it like a bunker dimly lit with a dark carpet, hunter-green furniture and thick velvet drapes that were drawn shut. Steiner had been told that Wernick barely left the office during work hours anymore and that he never opened the drapes. According to Steiner, when he asked Wernick why not, the CEO looked at him with a little wily smile and said, For fear of being shot.Leading Phoebe during COVID-19 hadnt been easy, Steiner said, but distancing himself from his predecessor was even more challenging. In his first year, hed held 570 meetings with community groups, churches and medical practices, many of them taken up with decades-old grievances what Steiner described as the ghosts that will outlast me.Steiner, who is 57, grew up in St. Louis. His mother was an intensive care unit nurse, his father an executive at a printing company. He received his MBA from nearby Webster University. Before joining Phoebe he had been the CEO for a group of Detroit hospitals, owned by Tenet Healthcare, the second-largest for-profit health system in the country. It was a miserable experience, he told me. He oversaw five layoffs in his first two and a half years. Then he had to manage the fallout from a series of newspaper stories that revealed how some of the hospitals had nearly lost their licenses after doctors filed complaints about dirty and broken surgical instruments.Three prominent cardiologists claimed that the health system fired them for making those complaints public, and two filed a wrongful termination suit against Tenet and Steiner. The cardiologists eventually won a $10.6 million award. (Officials at Tenet did not respond to multiple requests for comment.) Steiner didnt want to talk about his role in the matter when we met, except to say that the turmoil made him open to calls from a headhunter who told him about the opportunity at Phoebe.I didnt think places like this existed anymore, he told me. Compared to the shit show in Detroit, he said, Phoebe Factoids, the anonymous fax campaign against the hospital that consumed Albany in the early 2000s, seemed like a lot of external nonsense. Phoebes future direction would ultimately rest with him, not distant corporate overlords. All he had to do was get people in Albany to trust him, to put the past behind them. What Ive tried to say to people is, its a new chapter. he told me. My reporting, he said, threatened to stir up old tensions.The Westgate neighborhood of Albany Ross Landenberger for ProPublicaNorthwest Albany Ross Landenberger for ProPublicaHe knew such tensions were already stirring well before I came along. Hed heard them firsthand during his numerous meetings with the community. Mayor Kermit Bo Dorough, whod been a critic of the hospital since the Factoid days, was threatening to commission a study of health care costs. And in early 2020, nearly a year after Steiners arrival and weeks before COVID-19 hit the city, The Albany Southwest Georgian, a weekly Black newspaper, published the official portraits of Phoebes executive team across its front page. Most were people Steiner had inherited. None was Black.The racial composition of Albanys political hierarchy had shifted in the previous 20 years. The citys manager and police chief were both Black, and so was the county district attorney and chief judge of the county court. Until Doroughs election as mayor in 2019, African Americans had held the office for four straight terms. The majority of the members of the hospital authority was Black. Among them was a retired civil rights lawyer named Nyota Tucker, who was alarmed by the Southwest Georgians front page. Why were there no Blacks on the health systems executive team, she asked Steiner during one authority meeting.A front page of The Albany Southwest Georgian from February 2020 showing Phoebes executive team The Albany Southwest Georgian Bespectacled and silver-haired, Tucker, 76, carries herself with quiet reserve. As a teenager, she was one of six students all girls to integrate her hometowns high school. She went on to become the first African American woman to graduate from the University of Georgia School of Law. Afterward, she moved to Albany to work for Georgia Legal Aid, where judges in her first cases demanded she provide proof that she was a member of the bar. She left Albany for a few years to join the NAACP Legal Defense Fund in San Francisco and then returned, eventually becoming a member of the faculty at the historically Black Albany State University and later its chief counsel.She didnt know much about the health care system or how it worked when she agreed to serve on the hospital authority in 2017. She saw volunteering as a way to stay active after she retired and to serve the community. The authority was not known to cross Phoebe, Tucker told me. Quickly, she established herself, according to one board member, as the contrarian in the room the person who said what nobody else wanted to say.In late 2020, Steiner added Dr. Dianna Grant, a Black physician, to his executive team. The next year, the hospital authority elected its first African American chair, a businessman named Glenn Singfield. When I interviewed Singfield, he made clear he was also aware of the authoritys history as a rubber stamp. He told me he wanted to break from the days when the authority consisted of people whod been handpicked by Phoebe to do the hospitals bidding. He said, I can assure you those days are over.There were reasons to be skeptical. The authority relied on Phoebe for its funding as well as for its administrator and lawyer. The hospital managed the authoritys website and routinely hosted its meetings in the Phoebe board room. And five out of its nine members were doctors or had other financial ties to Phoebe, including a former mayor who had received numerous campaign contributions from Phoebe executives and Singfield, who owned a construction company that had contracts with the health system.Still, Tucker wanted to believe Singfield and wanted to believe that Steiner would lead Phoebe in a new direction. But she soon found herself at odds with him. As the pandemic loosened its grip on Albany, she resurfaced a proposal she had made the year before to have the authority hire a consultant to assess whether the hospital was meeting its lease obligations to provide safe and affordable care to the community.The previous review had been done in 2012, before the advent of Obamacare and Georgias decision not to expand Medicaid. The assessment would allow the authority to get a better sense of those policies effects. Besides, she was new to the authority, and Steiner was new to the health system, and it seemed like a good way to get a baseline understanding of where things at the hospital stood so they could see where things could be improved.Steiner told the authority he was not opposed to a review but wondered whether hiring an outside consultant was a good use of precious resources. He said that Phoebe would provide any information the authority requested to assess how well the health system was managing the hospital.Tucker argued that hiring an outside firm was the only way to get an assessment that was free of any hidden agendas, even though the money for the review would ultimately come from Phoebe. Since several members of the authority, including herself, had little to no experience in health care, they might not know what questions to ask, she said.Retired lawyer Nyota Tucker sat on the hospital authority board from 2017 to 2022. Alyssa Pointer for ProPublica The authority voted in favor of hiring outside consultants. They presented their findings at a meeting in May 2021. Marvin Laster, president of the citys Boys and Girls Club and a member of the hospitals board of directors, attended. Tucker was surprised. Laster hadnt ever come to an authority meeting that Tucker could remember, but she knew him she was on the clubs board and she was happy to have a friend in the room.The analysis read like an exercise in damning with faint praise. Phoebe, the consultants wrote, was committed to providing quality care and was delivering comparable or better quality than its peers in many areas. However, when they zeroed in on the seven metrics that make up the Centers for Medicare & Medicaid Services star rating system, they found that Phoebe currently ranks below the national average in five of the areas, including mortality, readmission, patient experience, effectiveness of care and timeliness of care.While Phoebe had spent hundreds of millions of dollars in building, buying and equipping new facilities, the consultants pointed out, its investments in the maintenance and modernization of the old buildings which the consultants emphasized were among the health systems core obligations to the county were consistently on the lower end of its peers.The hospitals financial margins were comparable if not better than its peers, the report concluded, but it relied more heavily on long-term debt to fund its operations an indication that Phoebe still hadnt fully absorbed the cost of the Palmyra merger 10 years earlier.As for the percentage of gross revenues that Phoebe spent to help the poor, the report found it had a lower charity/indigent care percentage than its local, regional and national peers, in all years except 2015. And finally, the report found that Phoebes cost of services are, on average, higher than local, regional and national peers. In short, the issues that had bedeviled the hospitals relations with its community the quality of care, cost of care and its outreach to the poor hadnt changed.When the consultants concluded their presentation, the first questions to arise were less about the findings and more about what to do with them, according to two authority members attending the meeting.Singfield was emphatic, Tucker said. He declared the report was not for public consumption. (Singfield did not respond to questions about the meeting.) Another member of the authority told me that everyone saw the finding regarding cost of care as the big elephant in the room. The member said, There wasnt any way to sugarcoat it.Steiner did not offer an opinion, but Laster weighed in. It was understood that he was speaking on Phoebes behalf, according to two members of the authority. Laster said that even though most of the assessment was upbeat, the information about the high costs of care could hurt the hospitals image. He compared the potential effect to rat poison. Ninety percent of its not toxic, Tucker and the other member recalled him saying, but its the 10% thatll kill you. (Laster later denied that he was proposing keeping the report secret.)The consultants reminded the authority that because it was subject to open records laws, the report was going to get out. However if the authority released it, members would have better control of how it was perceived: It would demonstrate the bodys independence and its fidelity to its oversight responsibilities.Tucker spoke vigorously in support of this view and suggested that if the authority was uncomfortable with announcing the report, it should at least post the findings on its website. That had been the practice until 2012, when, at Wernicks urging, the authority voted not to release that years report. She said the authority should not condone that kind of secrecy anymore.An authority member, who did not want to be named, told me the rest of the board was not convinced: Even if the cost of care is too much, there was agreement in the room that undermining Phoebe, damaging Phoebe publicly, criticizing Phoebe too harshly in public is bad for the community in that Phoebe is the biggest employer and the only place you can go if youre getting sick.Singfield suggested tabling the discussion until the next meeting, saying he was committed to releasing the report but wanted to give the authority time to work on how to do so. Four years later, the authority has still not made the report public.June 1-2, 2022Palazzolo returned to meet with Mrs. Parker, Andrea and her sister, Kim. He asked again whether Dr. Parker had signed a living will. Andrea said that he had, but there was no need for one. Her mother knew her fathers wishes. She would make any and all calls on her fathers care, and the children would support her 100%. What they needed from Phoebe was a clear assessment of their fathers condition. She asked whether he was brain dead.Palazzolo said that he wasnt and that, in fact, Dr. Parker was largely breathing on his own. His cognitive function, though, had been damaged beyond repair and would likely make it impossible for him to ever be the person he was.Kim asked him to say more. Palazzolo stammered, searching for the right words. That man in there, he said, is not our dad, Kim said, finishing his sentence.Palazzolo nodded.Kim kept going. Because our dad left the day of the procedure.Palazzolos eyes lowered.Mrs. Parker wanted another opinion. How could Phoebe have gone from telling her one minute that there was a chance to save her husband to saying that hed been doomed from the time his heart stopped beating a week ago? She tried to come up with the name of a doctor she trusted to put her familys interests ahead of Phoebes. There wasnt anyone who didnt have ties to the hospital. She immediately thought of her own neurologist, Marla Morgan. On staff at Phoebe, shed become close to Mrs. Parker. Morgan came from another of Albanys prominent Black families. Her late father had served as president of Albany State University for 16 years. She arrived at Phoebe late Thursday afternoon and spent about 20 minutes in Dr. Parkers room. Afterward, she asked Mrs. Parker whether hed ever responded to the sound of her voice, to her pleas to open his eyes or squeeze her hand? Mrs. Parker shook her head.Morgan said she didnt see any sign of cognitive brain function. There was only the slimmest chance there ever would be.She used the same language Mrs. Parker had heard from Palazzolo. Her husband wasnt getting progressively better.That was enough for Mrs. Parker. Anthony would never want to live in a vegetative state. She instructed the medical staff to withdraw nutritional and respiratory support. In the previous days, Phoebe executives had stopped coming by Dr. Parkers room. She wondered whether their absence was a gesture of respect or avoidance. Ever since her meeting with Garrett, the kids were increasingly unable to keep up a polite front and were fine not to see them. Kim and Andrea did not want to watch their father die. They said their goodbyes and asked their mother to call them when it was over. Richard offered to stay.Mrs. Parker felt that she and her family were on their own and that they always had been. She couldnt make sense of how this had happened, of how Phoebe had allowed this to happen. She wanted so badly to scream at someone and demand an explanation, but there was no one around.She needed to write a text to her siblings, Dr. Parkers staff and several of their close friends, but how was she going to explain what had occurred, much less what was ahead for her husband? The cruel truth, she thought to herself, was that he was doped up and dying she knew she couldnt say that, though. She pulled out her phone, summoned what felt like her last shred of sanity and composed a message, which said only that he had begun transitioning and thanked them for their prayers.Anthony Parker and a pregnant Sandra in 1973 and the Parker children, Andrea, Kim and Richard, on a trip to Tennessee in 1984CHAPTER 8Mt. Zion Baptist Church, the home of the 1961 civil rights protests, remains one of the most influential Black congregations in the city. Its pastor, Daniel Simmons, told me that in 2007 his members helped fund the opening of a free clinic, called Samaritan, across the street from Phoebe, for people without health insurance. The country was in the throes of the Great Recession. People were dying in our backyard, he said. It wasnt because they didnt want to go to the doctor. It was because they couldnt afford it.Phoebe donated one of its properties a single-story brick building across the street to the clinic and agreed to provide lab work for patients who qualified for state indigent funds. When I sat down with Simmons 13 years later, the need for the clinic wasnt all that different from when it had opened. Some 16% of Albany residents were uninsured, almost double the national average, in part because the governor and the legislature had decided not to expand Medicaid. Albany, though, had Phoebe, a hospital whose mission was to care for people no matter their race or ability to pay. So I asked Simmons why a safety-net hospital needed a safety net.Simmons arranged for me to meet Nedra Fortson, the nurse practitioner who runs the clinic. The day I met Fortson, she wasnt seeing patients but was waiting for a repairman to come patch two holes in the buildings leaky roof. Phoebe hadnt done much to maintain the property, she told me. (A Phoebe spokesperson said that over the years the hospital had invested significantly in maintenance and repairs to the building.)As I began to ask the same question I had asked Simmons why would people seek care at the clinic when Phoebes emergency room was right across the street there was a knock at the door. In came a tall, muscular man wearing carpenters jeans, a face mask with Phoebes logo and a T-shirt with the words, I am Phoebe. His jaw was swollen from an infected tooth, and he was wondering whether Fortson could help him find someone to take it out.The man told me he was 36 and worked on contract as a groundskeeper at the hospital. I recalled that Wernick had gotten his start as a hospital groundskeeper. I also thought that this mans story was such a perfect illustration of the clinics importance that if his jaw hadnt been oozing with pus, I might have thought I was being set up.I asked him whether hed sought help from Phoebe. He explained that hed gone to the emergency room a few days earlier, and after a 10-hour wait and a 10-minute examination by a nurse, he walked out with two slips of paper: one with a prescription for antibiotics, the other with a list of dentists. I asked what happened to the slips of paper. He rolled his eyes and said, I threw em away.On his $9-an-hour salary, he said, he couldnt afford health insurance, and without insurance, he couldnt afford antibiotics or a dentist. He had tried home remedies mostly gargling with saltwater but the pain in his mouth got worse. It feels like I got hit with a fastball, he said. The groundskeeper, who asked not to be identified because he didnt want to put his job at risk, still forced himself to go to work because he needed the money. That turned out to be a good thing, he said, because one of his colleagues spotted Fortson driving into the clinic parking lot and sent him over to see whether Samaritan could refer him to a dentist who could treat him for free.Then it was Fortson who rolled her eyes, not about the request of finding a dentist, which she managed to do that afternoon, but about someone doing work for Phoebe and coming to her for medical care. The groundskeeper wasnt an anomaly, she told me. Nodding in the direction of the hospital, she said: They all know us over there. Their cafeteria workers, their janitors, their clerks, their nursing assistants and so on.With more than 5,500 workers, Phoebe Putney Health System is the largest employer in southwest Georgia. Its growth tracks with whats happening across the country as the health care sector expands and manufacturing declines. But national studies have shown that hospital jobs are not like the manufacturing jobs theyve replaced. The latter generally pay salaries that help lift unskilled workers into the middle class. Most hospital jobs dont, which has an effect on both the workers and their ability to stimulate the local economy.One 2017 study of workers in 11 industrial states found that for every higher-paying job held by doctors, six health care employees including phlebotomists, orderlies, cooks make less than $15 an hour. In Albany, where 78% of residents do not have college degrees, they were making on average less than $10.Jack Nicholas Hilton, a former Cooper Tire worker, told me that at the time hed gotten laid off, he was making $24 an hour. He said he was lucky enough to have a wife who was working as a nurse at Phoebe and could support him while he went back to school for a nursing degree. He made $21 an hour when he started at Phoebe in 2010. In addition, health benefits for him and his family of four came with a $5,000 deductible. If he had a kidney stone, which he did from time to time, that was $2,500 out of his pocket. People think that if you work in health care you get good benefits, he said. Mine were terrible. Hilton left Phoebe after three years and no longer works as a nurse.Numerous other nurses at Phoebe shared similar stories. One former senior nursing manager told me she paid $300 every two weeks to cover herself, her husband and two children, including one in college, who had to drive home three hours for routine exams because Phoebes health plans did not cover those services elsewhere. The nurse now works for a hospital in California and pays $80 a month for the same coverage, and her daughter can receive care in the town where she goes to school.An ICU nursing supervisor, who suffers serious allergies, told me he got his EpiPens from a school nurse, who would give him the extras she had every month. One day he and his wife went to see a Phoebe doctor to discuss a vasectomy and were told hed have a $900 copay up front, which was not reimbursable. He said that he joked about it with his wife, saying, $900 will buy us a lot of condoms.East Albany Almudena Toral/ProPublicaA Phoebe spokesperson said the health system offered high-deductible health insurance plans for those who wish to minimize premiums, as well as offering a co-pay plan for those who prefer not to have a high-deductible plan. This year, he added, Phoebe is paying 87% of the cost of health insurance premiums for employees.Like hospitals across the country, Phoebe has been overwhelmed by nursing and physician shortages. According to the hospitals financial records, between 2014 to 2022, its spending on contract staff exploded from $2.5 million to $150.2 million. Administrators told me that about $100 million of that went to pay for traveling nurses. Although they dont receive health benefits, traveling nurses fetch salaries that are at least twice as high as those paid to the permanent nursing staff. This transient staff is not only a drain on Phoebes resources but typically doesnt invest in the community by buying homes or sending their children to local schools.Its part of a vicious cycle that incentivizes permanent nurses to travel, further crippling Albanys economy. The people who remain in town, for the most part, are low-skilled, low-paid employees, like the certified nursing assistant who worked part-time as a DoorDash delivery driver; the oncology scheduler whose colonoscopy bill had been sent to a collection agency; and Louise Williams, 51-year-old single mother and grandmother, known by her nickname, Weezie. She worked 22 years at Phoebe in what is called the environmental services cleaning and disinfecting patient rooms. During the first year of the pandemic, she was the only person on Phoebes staff to die of COVID-19.In her honor, the hospital renovated the environmental services staff break room, installing recliners, a refrigerator stocked with healthy snacks and a flat-screen TV. At a ribbon-cutting ceremony that was attended by Steiner and other hospital executives, the room was christened Weezies Place. The hospital invited her family, including her daughter, Shabreka Dent, who thanked Phoebe for remembering unsung heroes like her mother. My mom was a Phoebe person, she said. She loved working here.Remembering Louise Weezie Williams1968-2020Williams in her Phoebe uniform and with her daughter Shabreka Dent Courtesy of the Williams familyA few months before the dedication, I had gone to see Williams family because two nurses at the hospital had told me they were taking up a collection to help pay her funeral costs. Dent said the same thing to me that she would say at Phoebe: Her mother loved working at the hospital.Nothing we ever said would get her to leave that place, Dent told me.Did you try to get her to leave? I asked.I used to tell her all the time she should quit that job, she said.Why? I asked.Because she was always struggling.Dent said that when her mother first started at Phoebe more than 20 years ago, she worked part time, thinking shed eventually find a different job with better hours and better pay. But Williams prospects were limited, because she hadnt finished high school, factories were starting to lay people off and the only employer whose future looked bright was the hospital. Two decades later, Williams was earning less than $10 an hour, often taking home less than $300 a week.When Williams died, she was late on her rent, which Dent said happened frequently. Her mothers day-to-day existence, she said, was a gantlet of overdue bills and payday loans, which became even more crushing in 2014, after Dents older sister died of cervical cancer and Williams took custody of her two teenage grandsons.She would call me, and say, Hey, Im fine, but if you could get the boys something to eat. Or there were several times I paid the light bill for her, or shed come around, and Id pay her cellphone bill, or when time for school came around, Id get clothes for all the kids.Dent showed me where shed gotten her mothers name tattooed on her right forearm. She used to say she liked taking care of people, she said. I told her, Thats all good, but you got to take care of you, too.Sandra Parker in front of a portrait of her husband at Georgias Albany Technical College Alyssa Pointer for ProPublica June 3-6, 2022There was no longer any reason to keep Dr. Parker in the ICU. On Friday, Mrs. Parker agreed to have him moved to a regular medical floor. The next day, a nurse asked whether she wouldnt like to have him transferred to Phoebes hospice, which is set in a quiet, wooded area of northwest Albany. Its design was inspired by Frank Lloyd Wright, and it was named for William Harry Willson, the pecan magnate whod first invited Dr. Parker to join the hospitals board.This room was made for daddy, Richard said when he walked in, marveling at the prints of World War II fighter planes on the walls and at the floor-to-ceiling windows that looked out onto a patio, shaded by pine trees.On Sunday afternoon, Mrs. Parkers nephew brought ribs from the Parkers favorite barbecue restaurant in Columbus. Two friends, including a woman whod worked as the executive assistant to Joel Wernick, the former CEO, joined for lunch. Pastor Daniel Simmons of Mt. Zion Baptist Church stopped by to pray. And then Mrs. Parker spoke by telephone with her daughters, giggling with them about the plans shed made for that evening. The NBA finals were on television. She was going to put the game on and cheer for Steph Curry while cuddling beside her husband, as theyd done on so many date nights.When Mrs. Parker scooted in the bed, Dr. Parker began to spasm. She hopped out and made a joke of the whole thing to the kids. Can you believe your daddy kicked me out of the bed? she texted. I told him,Thats fine. I didnt really want to sleep with you either.After the game, she brushed her teeth and then sat next to the bed to pray. She started by thanking God for the time shed had with Anthony and for whatever time they had left. Let your will be done, she said, and allow us to be able to accept your will. Then she looked up at her husband. He would have hated the way he looked, she thought; unbathed, mouth stuck open, face covered with stubble, a cold sore on his top lip. She whispered to him: Were going to be OK. Dont worry about us. Then she laid her head on his stomach and was lulled to sleep by the rise and fall of his breathing.At about 1:30 in the morning, she woke up with a start. His stomach had stopped moving.Well, damn, she whispered. For some crazy reason, she had held out hope that her husband would prove the doctors wrong.She drew his South Carolina State blanket up over his chest, pulled out her phone and took a couple of pictures in case she wanted to remember the moment, in case there came a time when shed want others to know.Then she kissed him, told him she loved him and let the undertaker take him away.Anthony Parker watching his son, Richard, play Pee Wee football in 1990 CHAPTER 9I learned about Dr. Parkers death from Nyota Tucker. The hospital authority board member knew the Parker family because her daughter, who was chief of pediatrics at a large Boston hospital, was close to Andrea, the Parkers younger daughter. In a small town like Albany, the death of someone as important as Dr. Parker was big news. Phoebe issued a statement lamenting the loss of a beloved board member that didnt mention hed died in its care. The Albany Herald ran statements of appreciation from other leaders in the community and an obituary, without saying how and where hed died. There was a flurry of posts on the not-always-reliable Phoebe Factoids Facebook page, alleging that something at the hospital had gone terribly wrong.If true, the quality of care Phoebe provided was worse than Id thought. Dr. Parker had not died like so many of the patients Id learned about amid the chaos of the pandemic Maude Burke, LaTosha Almond and Louise Williams. He wasnt a poor, uninsured person unable to afford to take care of himself, like the people Id met at the Samaritan clinic. He was a well-known, well-off, widely respected pillar of the community who seemed to have gone to the hospital for a routine, elective procedure. Even more than that, he was a member of the health systems board. If he couldnt get good care at Phoebe, then who could?Tucker was sure that Mrs. Parker would hire a lawyer to demand answers from the hospital and file suit for restitution. She wasnt sure what the CEO, Scott Steiner, would do, though. Would he help the Parkers get to the bottom of what happened or fight them? That, in her mind, would indicate how much Phoebes relationship with Albany had or had not changed.She had no idea, however, that there was another clash looming between Phoebe and Albany, that it would play out in the open and that Tucker would wind up on the losing side.The issue was such a hyperlocal affair that I ignored it for the longest time. It involved the hospitals plans to demolish the old Albany Middle School and use the property for the construction of the nurses living and learning center that had been Dr. Parkers dream. Phoebe had acquired the building 20 years earlier, shortly after it had been replaced by a modern facility. Like so many of its properties, the hospital had done little to maintain it. Now Phoebe was saying that the school had fallen into such disrepair that demolishing it was much cheaper than restoring and adapting it. But to raze the school, Phoebe had to gain the approval of Albanys Historic Preservation Commission, an eight-member panel of volunteers appointed by the city and county councils.In a 4-3 vote, the commission denied Phoebes request. The majority argued that the school, which opened in 1925 for whites only, was one of the last remaining examples of Beaux Arts architecture in town and was on the commissions register of historically significant structures. The city planning department also recommended that the building be preserved and urged Phoebe to consider one of its other properties for the project, including the old Palmyra building.The hostility coming from the overwhelmingly white crowd felt so visceral to the preservationists that the one Black member of the commission, whod voted in favor of the demolition, felt compelled to defend her colleagues on the other side. She told the crowd that there was more than bricks and mortar at stake, that landmarks held history.Were not the enemy sitting up here, she said. I was born at Phoebe Putney hospital. My grandfather installed the first air conditioning at Phoebe Putney hospital. She went on to say, My aunt was one of the first African American social workers at the hospital.The editor of the Albany Herald, Carlton Fletcher, had weighed in with a column under the headline Attempt to stop Phoebe/Albany Tech project beyond ridiculous. He laid out an argument that was so similar to the one I had heard from Steiner that if I didnt know better, Id have thought he had written it. Opponents to the demolition were motivated by old grudges toward Wernick, Fletcher wrote. Their position was an example of the depths to which some would sink to sabotage the health care facilitys moving forward.Tucker was paying close attention to the fight. She had no doubt the new nursing school would be good for Albany and Phoebe. But she didnt think the preservationists were being unreasonable either, and she was increasingly troubled by the tone of the hospitals campaign. Phoebe had plenty of other properties that could be used for the living and learning center, and even if the hospital was dead-set on tearing down the school, she hoped it, and Steiner, would proceed with the same together-we-rise spirit that theyd professed during the pandemic.A week after the vote, Phoebe and the hospital authority filed an appeal with the City Commission, accusing the preservation commission of abusing its discretion. Tucker didnt believe me when I asked her about the appeal. The authority, she said, had never held a vote to take such an action. I sent her a copy of the appeal, which showed that it had been filed by the authority and signed by Phoebes lawyer.Tucker said she had no idea what was going on. The authority was independent of the hospital, or at least thats what shed been led to believe. Phoebes lawyer should not be acting on the authoritys behalf, she said. She called Glenn Singfield, the authoritys chair. According to Tucker, he told her he believed the members of the authority supported the hospital and had taken it upon himself to sign on to the appeal, at Phoebes request. She told him his actions bordered on unethical behavior and could be seen as a violation of public trust.Singfield refused to talk to me about the phone call with Tucker but insisted that he was not doing the hospitals bidding. He said the same to her and later, in a text, promised, I will protect our independence. He convened a special meeting of the authority for later that day to take a formal vote on what hed already done without one. Tucker called as soon as the meeting was over and told me that several members expressed concern about the way Singfield had handled the appeal but still threw their support behind Phoebe. She was the only one who voted against the appeal.A month later, the Albany City Commission convened to consider Phoebes appeal. Mayor Kermit Bo Dorough, who had long vowed to rein in Phoebe, oversaw the proceedings. I was watching the livestream but couldnt see the crowd. Tucker and the mayor told me the room was packed.Bryant Harden, a political science professor at Mercer University and chair of the preservation commission, spoke first to explain the groups vote against demolition. Its majority wasnt opposed to the construction of a nursing school, he said, but the hospital had so many places it could build the new campus without knocking down an important part of the citys history. What was the harm in considering other options?The Steiner who took the podium sounded different from the man Id met during the pandemic. From his first words he was confrontational. He said there were a few loud people in our country, our state of Georgia and here locally in Dougherty County and Albany that seek to keep us all divided. The projects opponents were pushing their own selfish causes and not whats in the best interests of our businesses, our people, our police, our region, our nurses, our schools, our churches and certainly not our community.When a city council member asked Steiner about the preservation commissions plea to find an alternative location for the project, he thought for a second and said: You know, if you just salvaged the front exterior or the whole building and created the worlds biggest liquor store, it would be OK with the HPC.Tucker told me people gasped the proliferation of liquor stores in poor Black neighborhoods had long been a sensitive subject in Albany and her hope for a new kind of leadership at Phoebe evaporated. She lamented that Steiner would take such a cheap shot, and added, At that moment, he reminded me of Joel Wernick.Ill admit that I gasped too not just because it seemed like such a gratuitous comment; it was how it embodied the hospitals conduct during the entire fight. At every turn, Phoebe sought to beat the preservationists into submission. Ultimately it worked. The City Commission, which includes the mayor, voted unanimously to approve the demolition. Weve only got one hospital, Dorough told me, and were not going to get another one.The preservationists took their fight to the Dougherty County Superior Court and found Phoebes reach extended even there. The chief judge recused himself because his daughter worked for the hospital. The next judge, who acknowledged that she served on a bank board with Steiner and Phoebes outside counsel, denied the preservationists request that she recuse herself and ruled in favor of the demolition.If that wasnt enough of a victory, the City Commission voted not to renew two of the four members who had opposed the demolition, prompting two other members to resign in protest. The city commissioners replaced them with four new members. One of them had financial ties to Phoebe, another to Albany Tech. A city commissioner told the Albany Herald that he certainly wasnt letting politics get in the way of my vote. Another said, We chose who we thought were the best.Then Albany and Phoebe turned on Tucker. She had come to the end of her first five-year term on the hospital authority and was up for reappointment, which required a vote by the county commission. Reappointment to the authority had previously been a perfunctory affair. All a sitting member needed to do was to tell the county that they were willing to serve again. Tucker was so sure of it that she didnt attend the vote. Afterward, however, a clerk called to notify her that she hadnt been renewed.I asked a board member who served with Tucker about her removal. He told me that the hospital and the authority didnt see her as a team player and wanted her off. She was for sure not reappointed for that reason, he said. I have no doubt about that. (When asked about Phoebes role in her departure, a hospital spokesperson said the Dougherty County Commission has the sole responsibility of deciding whether to reappoint any member.)Several weeks later, Tucker addressed the county commission. She had no illusions about getting reinstated, and she had no intention of asking. Nervous and halting, she said that when she joined the hospital authority, she committed herself to serving the public, not Phoebe. The commissions decision made her wonder whose team they were on. An independent hospital authority board does not happen in a vacuum, she said. It cannot happen if members are removed from the board who question or who point out discrepancies. When they are removed from the board, you can expect that independence will end.Crews demolish the old Albany Middle School to make way for Phoebe Putney Memorial Hospitals living and learning center. Alyssa Pointer for ProPublicaAugust 2023Shortly after her husband died, Mrs. Parker retained a lawyer named Adam Malone. She was prepared to sue, she told her kids, but she was hoping she wouldnt have to. Malone had won some of the largest malpractice awards in Georgias history. But what appealed to Mrs. Parker was that although he lived in Atlanta, he had grown up in Albany. His father had been a prominent lawyer there in the 1950s and 60s and was one of the few whites willing to collaborate with Black law firms and take on Black clients. If she sued, she believed, Malone would understand the forces he was up against and not be intimidated by them.Mrs. Parker had no idea what had caused her husbands death. None of the executives who had sat with her and her family at her husbands bedside had called or visited to offer an explanation. Shed invited Steiner to speak at the funeral, but that was to keep up appearances. She took his invitation to attend a health system board ceremony in honor of Dr. Parker as evidence of his trying to do the same. Phoebes silence felt like a conspiracy. Even worse, at times, were calls from people she and Phoebe had in common. They always left her wondering whose side were they really on.It was a question that nagged at her as she considered the lawsuit. She doubted that many of those people would stand with her if she sued at least not publicly. People like Glenn Singfield, who would check in from time to time to see how she was doing and say how sorry he was about what had happened. She had every right to demand an explanation, hed say, but she kept her plans to herself because as close as the two were, he was chair of the hospital authority.The relationship with her husbands successor at Albany Tech changed, too. Hed been her husbands protg, but the school needed the financial boost from its new partnership with Phoebe. She knew he couldnt risk that project by calling out the hospital. (He did not respond to a request for comment.)I asked Mrs. Parker what she thought her husband would have done if he was alive and a different board member had died under the same circumstances. She said she would like to think that he would privately press the hospital for answers, but she doubted that hed have questioned or criticized the hospital in public. Dr. Parker was a loyal member of the Phoebe family, she said, adding air quotes. Whenever the hospital had come under fire, he gave it the benefit of the doubt, partly because he didnt want to be marked as a traitor, much less painted as a crank like the people behind Phoebe Factoids, and lose his place on the board, and partly because few people had ever taken on Phoebe and won.He wasnt a naive man, Mrs. Parker said, but I think he drank the Kool-Aid.In August 2023, 14 months after Dr. Parker died, Mrs. Parker filed a lawsuit against both the hospital and the health system, as well as three members of the anesthesiology team involved in her husbands operation, accusing them of negligence. She told me she wanted Phoebe to pay restitution to her and her children. She wanted answers about what caused his death, and she believed Phoebe wouldnt give them to her unless it had to. She wanted to give her husbands death, and her own future, some meaning. But there was something else. She worried about what message it would send if she didnt sue: I dont want them to get away with it this time.CHAPTER 10Over a couple of days, at the end of last year, Scott Steiner and I talked. He looked like a different person than when we first met. Hed lost a lot of weight. Hed previously struck me as someone who didnt fuss over his appearance, but it was hard to miss the attention he now paid to his hair, beard and close-fitting blazer. I would have been embarrassed to tell him that he seemed like a guy in the throes of a midlife crisis, but, without prompting, he admitted as much, sharing a picture of his new car: a 1979 Pontiac Trans Am. It was either a new car or a girlfriend, he joked. A car is cheaper.With some $200 million in new projects nearly half of which was funded with county bonds parts of Phoebe looked different, too. A glass-encased trauma center had recently opened, with an ICU for newborns and a helipad on the roof, which was now the highest point in Albany. At the same time, hed begun to put several of Phoebes unused properties on the market and donated four of them to Habitat for Humanity.Steiner took me on a short tour of the new living and learning center, whose lobby is dominated by a large mural that includes likenesses of the hospitals first Black nurses and whose 80 fully furnished apartments have walk-in closets that I told him might qualify as bedrooms in New York City. He pointed out that some of the brick, benches and light fixtures inside the lobby were original to the building. So, too, were some of the arches and moldings on the facade. Id been warned that he wasnt going to comment on the Parkers lawsuit. Still, I thought it was telling that he didnt show me Dr. Parkers portrait, which was hanging in an alcove toward the rear. What was even more telling was how a man whod made so many changes at Phoebe and whod insisted that he wanted everyone to let go of past grudges was still quick to raise them. Within 20 minutes after we sat down in the lobby, I asked him how hed describe Albany to someone who wasnt from there, and the words Joel Wernick were part of his answer.Hed begun by riffing on how Albany is a very historical community and a melting pot of race. He said it has issues like any community and that Albanys were crime and poor schools. As for the people, he recalled how friendly they were to him and his wife when they first arrived. Hed gotten used to their tendency to obsess over the things Albany could have been. But there were qualities that still really bothered him. I think theres a segment of the population that doesnt want to see it better, he said. Then he added: People want to live in the past so much. People still want to talk about Joel Wernicks shortcomings.I wanted to make clear thats not why I was there and tried to move the focus of our conversation to some of the things Id learned during my reporting, like the way diabetes rates spiked in the years after Phoebe acquired Palmyra. I hadnt come up with a way to explain it, I told Steiner, but in reading the hospitals nonprofit filings, I couldnt help noticing that the spike coincided with a decline in the share of revenue that Phoebe spent on preventive health services and on providing free and subsidized care to the poor.Steiner pointed out that Phoebes lease with the county only required it to spend 3% of its revenue on charity care and that it had never never failed to meet that requirement. That was true, I acknowledged, but I reminded him that Phoebes own lease analysis showed that at the time Steiner arrived the hospital wasnt providing as much assistance to the poor as its state and regional peers. Some of them were spending as much as 10% of their revenue on charity care.Steiner held firm. But we still met the lease.Actually, Steiner had done more than that. After getting the results of the lease analysis, which showed that Phoebe was not spending as big a share of its revenue on free and subsidized care as its peers, he expanded the pool of people who were eligible for assistance. His staff had also increased its efforts to get more patients to apply for care.Steiner said he wasnt measuring the hospitals contributions entirely on dollars spent. I want to do the most impactful programs. I want to impact the most lives, he said.He looked around at the soaring lobby in which we were sitting and talked about how the living and learning center would address one of the biggest drains on the hospitals budget: traveling doctors and nurses. People could question: Whyd yall spend money on this? Yall spent $40 million, $45 million. And yeah, I can understand that, but I also know the cost and the impact of having a rotating staff and that its not good. Its not good financially. Its not good from a patient care standpoint. Its not good for our community.He said that the nursing shortage at Phoebe was nowhere near what it had been during the pandemic, but that even as we spoke, half of the 500 job openings at the hospital were for nurses. When I asked whether that affected the quality of care, he said, Absolutely, 100%.Speaking about the differences between staff nurses and travelers, he said, We know that when its our own team, when its a Phoebe employee, there are less errors and qualitys higher, and we know when its contract nurses, there are higher errors, and our patients are less safe.I brought up the hospitals persistently poor quality of care scores that Phoebe still only had two stars from the Centers for Medicare & Medicaid Services, and its grade from the Leapfrog Group, a coalition of large health insurers and leading patient safety experts, had gone down from an A in 2022 to a C in 2024 and remained there in 2025. The ratings reports indicated that the hospital had made improvements in crucial areas like sepsis prevention, but it continued to have trouble with readmission rates, accidental cuts and tears after surgery, bedsores and dangerous blood clots.Steiner didnt deny the findings but criticized them as unreliable because theyre based on data that is at least three years old. CMS ratings were particularly misleading, he said, because they included how patients feel about being in the hospital as well as how well a hospital follows standards of care and no patient likes being in the hospital. Consumers are inherently unhappy, he said, whether its Subway, whether its a gas station.I pressed him to clarify, because Subway sandwiches are different from readmission rates. Im just saying there are big chunks of these ratings, theyre saying patient safety is how good the food is, he said.When I returned to the hospitals high readmission rates, Steiner retreated. We have work to do, no doubt, he said and then went back to laying the blame elsewhere. Would I like to be a five star? Absolutely. But when you look at who four- and five-star hospitals are, theyre usually not in challenging communities that have a lot of poverty.Thats not entirely true. A good number of hospitals with three and four stars are in poor places. What Steiner said next made clear he knew that. Were not OK being a one- or two-star hospital, he said. Were not OK being a C. Our community deserves for us to be better.Then I talked to Steiner about some of the patients whose stories Id looked into during my time in Albany. I told him about LaTosha Almond having been sent home with a bedsore so severe she was readmitted to the hospital the day after shed been discharged, then was sent home with a trach no one had taught her to manage and ultimately died. I also brought up the hospital groundskeeper Id met at the Samaritan clinic and asked Steiner why he thought a man who worked for a safety-net hospital would have to turn to a free clinic for medical care?Steiner seemed moved. He told me that he didnt know Almond but that if what Id told him was true, there was no excuse for what happened to her. As for the groundskeeper, he was troubled by that story, too. But he painted it as less an indictment of Phoebe and instead as part of the brokenness in general of the health care system. He said, Even though I think we are a safety net were an essential hospital for tens of thousands of people a year a net still has openings. He added, I dont think the health care system in the United States is set up to help him.The Westover neighborhood of Albany Ross Landenberger for ProPublicaAfter about two and a half hours, Steiners spokesperson reminded him it was time to wrap up. Before we did, I wanted to go back to something hed said earlier. Hed told me that when it came to choosing which services Phoebe provides, he made the call, and he wasnt afraid to be held responsible. What I asked him was: Who holds him to account?He said something that surprised me. Or perhaps it was me not thinking of Phoebe the way it thinks of itself as a business. I hope that our consumers do, right? he said. They can do that by electing to get care elsewhere.What he didnt say was that most people in Albany dont have anywhere else.A couple of days later, Steiner agreed to meet again. I wondered, with the passage of time, whether he regretted his liquor store comment during the Albany Middle School fight. But nope, he repeated it. I could have opened Georgias largest liquor store, and that group didnt care, he told me. They wouldve said, We approve.For his part, hed been mulling over what Id told him about the groundskeeper and the Samaritan clinic. Theres a fine line between providing everything at no cost and at no responsibility and being able to run any business, he said. I think its just like somebody walking into a grocery store saying: Im hungry. My children are hungry. Im malnourished, so Im going to fill my cart up and Im going to walk out. Wheres that balance, right?Yes, he said, the hospitals mission is to provide care regardless of race, religion and ability to pay, but were always trying to balance that out with paying the bills. He added, Weve got human beings lives in our hands. Most days we get it absolutely correct, and some days we dont.He reminded me that Phoebe had allowed the clinic to operate in one of the health systems properties without charging rent. He said it had done so precisely because it understood there were uninsured people who might fall through the cracks. The clinic, he said, was not some separate safety net, it was part of Phoebes.I asked Steiner whether he was aware that the net had collapsed: Samaritans offices and exam rooms had been so overtaken by mold that theyd been deemed unsafe and had been shuttered for more than a month.A few days later, Nedra Fortson, the clinics administrator, called to tell me that Steiner had surprised her with a request to visit the facility. He did a walk-through and arranged for the clinic to move into another building.EpilogueIn April, a Dougherty County jury awarded $70 million to a woman from nearby Camilla who had accused Phoebe and three Albany-area physicians of negligence. She charged that the doctors administered an overdose of blood pressure medications without adequate oversight for more than 40 hours. The blood flow to her extremities was severely constricted, she argued, and caused such irreparable damage to her legs they had to be amputated above the knee. She was 28 at the time.Phoebe reached a settlement with her before the case went to trial. A spokesperson described what had happened to the patient as undeniably tragic but added that the evidence indicates she would have died without the interventions provided by the care teams. The physicians held out. They, too, asserted that they had saved the patients life. After the verdict one of the largest in Georgias history the doctors settled for an undisclosed amount.I suspected that Phoebe would quickly settle the Parker lawsuit, making it almost impossible for the family to find out what had happened to Dr. Parker. Instead, the case stretched out for almost 20 months, with both parties gathering medical records and conducting depositions. What occurred during his ablation began to emerge. Most damning was a statement from Dr. Jos Ernesto Betancourt, the cardiologist who oversaw the procedure to correct Dr. Parkers irregular heartbeat. He described Dr. Parkers cardiac arrest as a preventable event, saying it happened very unfortunately.According to the depositions, Dr. Parkers blood pressure plummeted so low partway through the procedure that Betancourt paused to make sure that he hadnt inadvertently punctured Dr. Parkers heart. Once he determined that he hadnt, he gave the nurse anesthetist, Alan-Wayne Howard, time to stabilize Dr. Parker with medication, then resumed the procedure, finishing a little before 4 p.m.At this point, Howard took over Dr. Parkers care. Neither he nor Betancourt were on staff at the hospital. Both were contract workers. Both lived hours away in Florida but stayed in Albany when on duty. Its also important to know that Howard was a nurse practitioner, not a doctor. Nurse anesthetists who have advanced degrees specializing in anesthesia care are often used at hospitals and surgery centers as a way to cut costs or fill staffing shortages. Because they dont have the same years of training as a physician, their work is usually done under supervision by an anesthesiologist, who is responsible for the care they provide. He is supposed to check in on them from time to time and is on call for any emergencies.Betancourt testified that after the ablation Howard recommended sending Dr. Parker to the ICU for observation before removing his breathing tube and withdrawing anesthesia. He said Howard wanted to make sure Dr. Parkers vital signs were stable before extubating him, and he also wanted Dr. Parker to have the medical support he needed if his blood pressure crashed. We will need a couple of hours to be able to titrate down the medication to support the blood pressure until it can be completely withdrawn, Betancourt recalled Howard saying.Betancourt agreed with that plan, and he left the recovery room to talk to Mrs. Parker. He said he was gone for 10 minutes.When he returned, at about 4:44 p.m., he said that he looked in again on Dr. Parker and found that Howard had changed the post-operative plan. The anesthetist had removed the breathing tube and begun withdrawing anesthesia. Betancourt said he was surprised but didnt question the decision: It was Howards call to make. He said he asked how Dr. Parker was doing, and Howard assured him that everything was great. He left to start his report.A minute later, Dr. Parker went into crisis. According to handwritten notes by Dr. Michael Coleman, one of the two anesthesiologists assigned to supervise Howard, Dr. Parker developed bradycardia and hypotension, leading quickly to asystole. In lay terms that meant that his heart rate and blood pressure plummeted, losing oxygen to his brain, until his heart eventually stopped.In his deposition, Howard said that it wasnt until 4:54 nine minutes later that he summoned Betancourt and Coleman for help. Betancourt said he was at Dr. Parkers side at 4:55 10 minutes with little to no oxygen going to his brain and began chest compressions. Coleman arrived a minute later and helped Howard reintubate Dr. Parker, whose heart began beating again at 5 p.m.None of the doctors or nurses who testified could say exactly when Dr. Parkers heart had stopped beating during that 15-minute window, which is why there was, and still is, confusion about whether his brain went without oxygen for five or 14 minutes. When asked whether her record was reliable, the nurse assigned to keep track of the time testified that based on my documentation, I dont think they have an accurate time. No.Howard wasnt asked during his deposition about why hed decided to remove respiratory and blood pressure support earlier than initially planned. (His deposition occurred months before Betancourts.) However, Howard did let on that he was in a hurry that afternoon. He said that he had hoped to tend to his elderly father in Florida and that Dr. Parkers procedure went on for so long that he was running late.In its initial response to the lawsuit, Phoebe argued that because the health system did not employ any nurse, physician or advanced practice provider involved in Dr. Parkers care, it was not liable for his death. Its an argument that many hospitals make when they are sued and traveling nurses and doctors are involved. Howard denied that he was negligent in any manner whatsoever.This summer, Phoebe, the two supervising anesthesiologists and Howard settled for an undisclosed sum. The three clinicians declined to comment. A Phoebe spokesperson said: While rare, complications like those that occurred in this case are possible with a cardiac ablation. The care provided in this instance matched the standard of care that should be expected, and we do not believe there is evidence of negligence or malpractice.As part of the agreement, Mrs. Parker promised not to disclose the sum but made clear that she was relieved that she and the hospital had come to terms before Georgia capped malpractice awards at $1.05 million. By this time Mrs. Parker had moved to South Carolina, where she could be closer to her siblings.Before leaving Albany, shed hired painters to help get her house ready to put on the market. The crews chief came to the door to express his condolences. He knew a little something about her pain, he said.His 35-year-old brother had recently died from sepsis at Phoebe and left him and his family with a lot of questions. Mrs. Parker asked whether they had tried to get answers. The painter shrugged and shook his head no. When she asked him why not, he said, What good would it do? Its Phoebe.Kim and Sandra Parker in South Carolina in 2024 Almudena Toral/ProPublicaHow We Reported This StoryGinger Thompson interviewed more than 150 current and former residents of Albany, Georgia, as well as more than 75 current and former staff members of Phoebe Putney Memorial Hospital and Phoebe Putney Health System. She consulted with dozens of public health professionals, medical and legal experts, health care economists and strategists, and historians. Two of those interviewed, Demetrius Young and Nathaniel Smith, have since died.To reconstruct Sandra Parkers experiences before, during and after the surgery of her husband, Anthony Parker, Thompson drew from extensive interviews with her and her children as well as from texts, emails, medical records and depositions.She and Doris Burke reviewed the minutes of the hospitals board as well as those of the Hospital Authority of Albany-Dougherty County. They examined text messages and emails; medical records; nonprofit IRS filings; Centers for Medicare & Medicaid Services data; census records; Georgia public and community health data; Georgia death records; tax assessor data; federal and state court filings; federal, state and local campaign contribution filings; municipal bond offering documents; and bond rating agency reports.The post Sick in a Hospital Town appeared first on ProPublica.

President Trump is shifting from discussion of the long-lasting competition among the worlds biggest economies and nuclear powers.

Netflixs blockbuster deal to buy Warner Bros., including HBO, is the latest twist in a rivalry that has reshaped the entertainment industry.

President Trump has repeatedly ousted leaders of independent agencies despite federal laws meant to shield those regulators from politics.

Franklin D. Roosevelts efforts to oust a Federal Trade Commission leader offer parallels to the current fight over President Trumps actions.

A New York Times review of President Joseph R. Biden Jr.s actions on immigration showed that they created an opening for a more aggressive Trump administration agenda.

Lszl Krasznahorkai, laureate in literature, speaks during the signing of the Nobel chair at the Nobel Museum in Stockholm, Sweden, Saturday, Dec. 6, 2025. (Claudio Bresciani/TT News Agency via AP)2025-12-07T10:59:26Z STOCKHOLM (AP) Nobel week was underway in Stockholm and Oslo with laureates holding news conferences and lectures before they will be awarded the prestigious prizes. Hungarian Lszl Krasznahorkai, who won the Prize in literature for his surreal and anarchic novels that combine a bleak world view with mordant humor, was expected to give a lecture in Stockholm on Sunday in one of his rare public appearances.When the Nobel judges announced the award in October, they described the 71-year-old as a great epic writer whose work is characterized by absurdism and grotesque excess. Krasznahorkais work can be seen as part of a Central European tradition, the Nobel Prize organization said. Important features are pessimism and apocalypse, but also humor and unpredictability.Last years winner was South Korean author Han Kang. The 2023 winner was Norwegian writer Jon Fosse, whose work includes a seven-book epic made up of a single sentence. Meanwhile, the director of the Norwegian Nobel Institute, Kristian Harpviken, said Saturday that Venezuelan Peace Prize laureate and opposition leader Mara Corina Machado will come to Oslo this week to receive her award in person. The 58-year-old, who won for her struggle to achieve a democratic transition in the South American nation, has been hiding and has not been seen in public since January.Harpviken told Norwegian public broadcaster NRK that Machado was expected to personally pick up the prize on Wednesday. I spoke with the Peace Prize winner last night, and she will come to Oslo, Harpviken said, according to NRK.Nobel Prize award ceremonies are held on Dec. 10, the anniversary of Alfred Nobels death in 1896. The award ceremony for peace is in Oslo and the other ceremonies are in Stockholm.

An Axon body camera is worn by MSGT Matt Gilmore who is one of the officers using Axon's Draft One AI software at OKCPD headquarters on Friday, May 31, 2024 in Oklahoma City, Oklahoma. (AP Photo/Nick Oxford, File)2025-12-07T11:22:12Z Police body cameras equipped with artificial intelligence have been trained to detect the faces of about 7,000 people on a high risk watch list in the Canadian city of Edmonton, a live test of whether facial recognition technology shunned as too intrusive could have a place in policing throughout North America.But six years after leading body camera maker Axon Enterprise, Inc. said police use of facial recognition technology posed serious ethical concerns, the pilot project switched on last week is raising alarms far beyond Edmonton, the continents northernmost city of more than 1 million people.A former chair of Axons AI ethics board, which led the company to temporarily abandon facial recognition in 2019, told The Associated Press hes concerned that the Arizona-based company is moving forward without enough public debate, testing and expert vetting about the societal risks and privacy implications. Its essential not to use these technologies, which have very real costs and risks, unless theres some clear indication of the benefits, said the former board chair, Barry Friedman, now a law professor at New York University. Axon founder and CEO Rick Smith contends that the Edmonton pilot is not a product launch but early-stage field research that will assess how the technology performs and reveal the safeguards needed to use it responsibly. By testing in real-world conditions outside the U.S., we can gather independent insights, strengthen oversight frameworks, and apply those learnings to future evaluations, including within the United States, Smith wrote in a blog post.The pilot is meant to help make Edmonton patrol officers safer by enabling their body-worn cameras to detect anyone who authorities classified as having a flag or caution for categories such as violent or assaultive; armed and dangerous; weapons; escape risk; and high-risk offender, said Kurt Martin, acting superintendent of the Edmonton Police Service. So far, that watch list has 6,341 people on it, Martin said at a Dec. 2 press conference. A separate watch list adds 724 people who have at least one serious criminal warrant, he said. We really want to make sure that its targeted so that these are folks with serious offenses, said Ann-Li Cooke, Axons director of responsible AI. If the pilot expands, it could have a major effect on policing around the world. Axon, a publicly traded firm best known for developing the Taser, is the dominant U.S. supplier of body cameras and has increasingly pitched them to police agencies in Canada and elsewhere. Axon last year beat its closest competitor, Chicago-based Motorola Solutions, in a bid to sell body cameras to the Royal Canadian Mounted Police.Motorola said in a statement that it also has the ability to integrate facial recognition technology into police body cameras but, based on its ethical principles, has intentionally abstained from deploying this feature for proactive identification. It didnt rule out using it in the future. The government of Alberta in 2023 mandated body cameras for all police agencies in the province, including its capital city Edmonton, describing it as a transparency measure to document police interactions, collect better evidence and reduce timelines for resolving investigations and complaints.While many communities in the U.S. have also welcomed body cameras as an accountability tool, the prospect of real-time facial recognition identifying people in public places has been unpopular across the political spectrum. Backlash from civil liberties advocates and a broader conversation about racial injustice helped push Axon and Big Tech companies to pause facial recognition software sales to police.Among the biggest concerns were studies showing that the technology was flawed, demonstrating biased results by race, gender and age. It also didnt match faces as accurately on real-time video feeds as it did on faces posing for identification cards or police mug shots.Several U.S. states and dozens of cities have sought to curtail police use of facial recognition, though President Donald Trumps administration is now trying to block or discourage states from regulating AI. The European Union banned real-time public face-scanning police technology across the 27-nation bloc, except when used for serious crimes like kidnapping or terrorism. But in the United Kingdom, no longer part of the EU, authorities started testing the technology on London streets a decade ago and have used it to make 1,300 arrests in the past two years. The government is considering expanding its use across the country.Many details about Edmontons pilot havent been publicly disclosed. Axon doesnt make its own AI model for recognizing faces but declined to say which third-party vendor it uses. Edmonton police say the pilot will continue through the end of December and only during daylight hours. Obviously it gets dark pretty early here, Martin said. Lighting conditions, our cold temperatures during the wintertime, all those things will factor into what were looking at in terms of a successful proof of concept.Martin said about 50 officers piloting the technology wont know if the facial recognition software made a match. The outputs will be analyzed later at the station. In the future, however, it could help police detect if theres a potentially dangerous person nearby so they can call in for assistance, Martin said.Thats only supposed to happen if officers have started an investigation or are responding to a call, not simply while strolling through a crowd. Martin said officers responding to a call can switch their cameras from a passive to an active recording mode with higher-resolution imaging. We really want to respect individuals rights and their privacy interests, Martin said. The office of Albertas information and privacy commissioner Diane McLeod said she received a privacy impact assessment from Edmonton police on Dec. 2, the same day Axon and police officials announced the program. The office said Friday its now working to review the assessment, a requirement for projects that collect high sensitivity personal data.University of Alberta criminology professor Temitope Oriola said hes not surprised that the city is experimenting with live facial recognition, given that the technology is already ubiquitous in airport security and other environments. Edmonton is a laboratory for this tool, Oriola said. It may well turn out to be an improvement, but we do not know that for sure.Oriola said the police service has had a sometimes frosty relationship with its Indigenous and Black residents, particularly after the fatal police shooting of a member of the South Sudanese community last year, and it remains to be seen whether facial recognition technology makes policing safer or improves interactions with the public. Axon has faced blowback for its technology deployments in the past, as in 2022, when Friedman and seven other members of Axons AI ethics board resigned in protest over concerns about a Taser-equipped drone.In the years since Axon opted against facial recognition, Smith, the CEO, says the company has continued controlled, lab-based research of a technology that has become significantly more accurate and is now ready for trial in the real world. But Axon acknowledged in a statement to the AP that all facial recognition systems are affected by factors like distance, lighting and angle, which can disproportionately impact accuracy for darker-skinned individuals.Every match requires human review, Axon said, and part of its testing is also learning what training and oversight human reviewers must have to mitigate known risks.Friedman said Axon should disclose those evaluations. Hed want to see more evidence that facial recognition has improved since his board concluded that it wasnt reliable enough to ethically justify its use in police cameras. Friedman said hes also concerned about police agencies greenlighting the technologys use without deliberation by local legislators and rigorous scientific testing. Its not a decision to be made simply by police agencies and certainly not by vendors, he said. A pilot is a great idea. But theres supposed to be transparency, accountability. ... None of thats here. Theyre just going ahead. They found an agency willing to go ahead and theyre just going ahead.-AP writer Kelvin Chan in London contributed to this report. MATT OBRIEN OBrien covers the business of technology and artificial intelligence for The Associated Press. mailto GARANCE BURKE Burke is a global investigative journalist with The Associated Press based in San Francisco. She focuses on artificial intelligence and government accountability, and her work has been honored as a Pulitzer finalist and with a documentary Emmy Award. She can be reached on Signal at garanceburke33. twitter mailto

Tom Hicks, the former owner of the Texas Rangers and Dallas Stars during an NHL hockey game in Dallas, Saturday, Oct. 29, 2011. (AP Photo/LM Otero, File)2025-12-07T06:54:58Z DALLAS (AP) Tom Hicks, the Texas businessman and philanthropist who owned two Dallas-area professional sports franchises and an English Premier League soccer team, died Saturday. He was 79.Spokesperson Lisa LeMaster said in statement that Hicks died peacefully in Dallas surrounded by family.Hicks owned the NHLs Dallas Stars from 19952011, winning the Stanley Cup in 1999. He also owned baseballs Texas Rangers from 19982010, leading them to three American West Division titles and a World Series appearance. In 2007, he acquired a 50% stake in Liverpool.Being shoulder to shoulder with him was always about more than ballparks and stadiums, though, Dallas Cowboys owner Jerry Jones said in a statement. It was about personal respect, trust and friendship. We shared a lot of miles together, and Ill miss him greatly. My heart goes out to his family. Hicks co-founded Hicks & Haas in 1984 and Hicks, Muse, Tate & Furst in 1989, helping reshape private equity and investing strategy. Tom Hicks was an innovative businessman and a pioneer in private equity, fellow Texas businessman Ross Perot Jr. said in a statement. He combined his commitment to business and sports through his ownership of the Stars and the Rangers.Hicks served as paratrooper in the Army Reserves and was Commissioner of the American Battle Monuments Commission. He served on the University of Texass Board of Regents from 1994 to 1999. Hicks is survived by his wife of 35 years, Cinda Cree Hicks, and his six children Thomas Ollis Hicks Jr., Mack Hardin Hicks, John Alexander Hicks, Robert Bradley Hicks, William Cree Hicks and Catherine Forgrave Hicks.His children released a joint statement, saying:Of everything he accomplished in his remarkable life, Tom Hickss most cherished title was, Dad. No matter the trials and tribulations he faced in life, he was constant in his generosity and love for his family. He remains a guiding force for our family, and we are deeply honored to continue expanding his legacy. Although we are devastated by this loss, we are profoundly grateful to have been his children.___AP sports: https://apnews.com/sports

People read the candidates information at a polling station near the site of the fire at Wang Fuk Court in the Tai Po district during the Legislative Council General Election in Hong Kong on Sunday, Dec. 7, 2025. (AP Photo/Chan Long Hei)2025-12-07T00:14:35Z HONG KONG (AP) Hong Kong voters are casting ballots Sunday in their second legislative election since a 2021 overhaul of the system eliminated the pro-democracy opposition in the Chinese territory. The poll, coming less than two weeks after an apartment fire that killed at least 159 people, is a possible test of public sentiment about the governments handling of the tragedy. Flames engulf a building after a fire broke out at Wang Fuk Court, a residential estate in the Tai Po district of Hong Kongs New Territories, on Nov. 26, 2025. (AP Photo/Chan Long Hei) Flames engulf a building after a fire broke out at Wang Fuk Court, a residential estate in the Tai Po district of Hong Kongs New Territories, on Nov. 26, 2025. (AP Photo/Chan Long Hei) Add AP News on Google Add AP News as your preferred source to see more of our stories on Google. Share Share Facebook Copy Link copied Print Email X LinkedIn Bluesky Flipboard Pinterest Reddit Read More The focus is on voter turnout, which fell to about 30% in the last election in 2021, after the overhaul dampened interest. Some analysts believe mounting public anger over government accountability in the blaze could suppress turnout further.Turnout stood at about 20% of eligible voters at 3:30 p.m. local time, after the polls had been open for eight hours. The polls close at 11:30 p.m.Im performing my civic duty as a citizen to vote but Im not too certain which candidate is hardworking and which is not, retiree Kwan Lam said outside a polling station. I chose the one who cares for the elderly.City leader John Lee called on citizens to vote, saying it would send a signal on promoting reforms. He said he would put forth a proposal to the new legislature on how to support the fire survivors, many of whom have been left homeless.Ahead of the vote, Chinese authorities called foreign media to a rare meeting to warn them that they need to comply with the citys national security laws. Deadly blaze stalled get-out-the-vote efforts Pedestrians walk past a banner promoting the Hong Kong Legislative Council election ahead of the vote. (AP Photo/Chan Long Hei) Pedestrians walk past a banner promoting the Hong Kong Legislative Council election ahead of the vote. (AP Photo/Chan Long Hei) Add AP News on Google Add AP News as your preferred source to see more of our stories on Google. Share Share Facebook Copy Link copied Print Email X LinkedIn Bluesky Flipboard Pinterest Reddit Read More Election campaigning was suspended after the fire and remained subdued in the final days out of respect for the victims. Government efforts to drive up turnout, seen as a referendum on the new electoral system, had been in full swing before the blaze. Officials held candidate forums, extended voting by two hours, added polling stations and offered subsidies to older people and centers for people with disabilities to help their clients vote, along with hanging promotional banners and posters throughout the city. Authorities arrested people who allegedly posted content that incited others not to vote or cast invalid votes.Hong Kongs deadliest fire in decades has raised questions over government oversight and suspected bid-rigging in building maintenance projects. The 1980s-era apartment complex was undergoing renovations.Some candidates pledged to combat bid-rigging.Lee said last week that going ahead with the election, rather than delaying it, would better support the response to the fire.They have all experienced this fire and shared the pain, he said of the citys Legislative Council. They will certainly work with the government to promote reforms, diligently review funding, and draft relevant laws.Candidates are required to be Beijing loyalists People read the candidates information at a polling station near the site of the fire at Wang Fuk Court in the Tai Po district during the Legislative Council General Election in Hong Kong on Sunday, Dec. 7, 2025. (AP Photo/Chan Long Hei) People read the candidates information at a polling station near the site of the fire at Wang Fuk Court in the Tai Po district during the Legislative Council General Election in Hong Kong on Sunday, Dec. 7, 2025. (AP Photo/Chan Long Hei) Add AP News on Google Add AP News as your preferred source to see more of our stories on Google. Share Share Facebook Copy Link copied Print Email X LinkedIn Bluesky Flipboard Pinterest Reddit Read More Many of the citys 4.1 million eligible voters, especially democracy supporters, have turned away from politics since a crackdown that followed massive anti-government protests in 2019. Even before the 2021 electoral changes, only half of what had been a 70-member legislature was chosen by the general electorate.Now, that has been reduced to 20 out of 90 seats and 40 others are chosen by a largely pro-Beijing election committee. The remaining 30 represent various groups mainly major industries such as finance, health care and real estate and are elected by their members. Candidates are vetted to ensure they are patriots loyal to the central government in Beijing.The candidate pool seems to reflect Beijings desire to have more lawmakers who are more in tune with its agenda, some observers said, in what they see as signs of Beijings tightening control even over its loyalists.Lee has said that personnel changes are normal during an election. He criticized attempts to distort these changes to smear the new election system.A fall in turnout would show that even some government supporters are staying away, said John Burns, an honorary professor of politics and public administration at the University of Hong Kong.Some might want to show support for the governments response to the fire, but others might have reservations because of the high death toll and reports of systemic problems in the building maintenance industry.It is a reflection of public sentiment, he said. China warns foreign media in Hong KongBeijings national security arm in Hong Kong summoned representatives of several foreign news outlets, including The Associated Press, on Saturday.Some foreign media had spread false information and smeared the governments disaster relief efforts after the fire, as well as attacked and interfered with the legislative elections, the Office for Safeguarding National Security said in a statement.No media outlet may use freedom of the press as a pretext to interfere in Chinas internal affairs or Hong Kong affairs, the statement said.Authorities have warned the general public against using the fire to try to undermine the government and have arrested at least one person on suspicion of inciting hatred against government officials. ___Moritsugu reported from Beijing. Associated Press writer Chan Ho-him in Hong Kong contributed to this report. KANIS LEUNG Leung covers Hong Kong, Macao and mainland China for The Associated Press. She is based in Hong Kong. twitter KEN MORITSUGU Moritsugu covers political, economic and social issues from Beijing for The Associated Press. He has also reported from New Delhi, Bangkok and Tokyo and is the APs former news director for Greater China and for Japan and the Koreas. twitter

People enjoy the sunny weather with the Helsinki Cathedral of the background in Helsinki, Finland, Friday, Nov. 14, 2025. (AP Photo/Sergei Grits)2025-12-07T07:17:12Z The Nordic countries are no strangers to the long, dark winter.Despite little to no daylight plus months of frigid temperatures people who live in northern Europe and above the Arctic Circle have learned how to cope mentally and physically with the annual onset of the winter blues, which can begin as early as October and last into April for some.The winter solstice will occur Dec. 21, marking the shortest day and longest night of the year in the Northern Hemisphere. While sunlight increases daily after that, winter wont be over for a while yet.The Associated Press spoke to experts in Norway, Sweden and Finland about the winter blues. Heres how they suggest looking for light, literally and figuratively, during the darkest months of the year: Maintaining sleep and social habits are keyDr. Timo Partonen, a research professor at the Finnish Institute for Health and Welfare, said the dark winter affects our circadian rhythm. With limited daylight, our internal body clocks cannot reset or synchronize properly and it throws off our sleep. We may sleep longer in the winter, he said, but we dont wake up refreshed and can remain tired the rest of the day. Partonen recommended trying a dawn simulator, sometimes known as a sunrise alarm clock, to gradually light up your bedroom and ease you awake. This article is part of APs Be Well coverage, focusing on wellness, fitness, diet and mental health. Read more Be Well. In addition to being more tired, were more likely to withdraw from others socially in the wintertime. Were more irritable, Partonen said, and more prone to fights with friends. Its important to maintain our relationships, he said, because symptoms rarely improve in isolation.And since keeping up with exercise is also key to combating the winter blues, consider inviting a friend along for a workout. It could also help keep off the wintertime weight gain typically 2 to 5 kilograms (4 to 11 pounds) a year, Partonen said thats fed by cravings for carbohydrates, especially in the evenings. Light therapy encouraged for a range of symptomsMillions of people worldwide are estimated to suffer from seasonal depression. Also known as seasonal affective disorder, or SAD, patients typically have episodes of depression that begin in the fall and ease in the spring or summer. A milder form, subsyndromal SAD, is recognized by medical experts, and theres also a summer variety of seasonal depression, though less is known about it.Scientists are learning how specialized cells in our eyes turn the blue wavelength part of the light spectrum into neural signals affecting mood and alertness. Sunlight is loaded with the blue light, so when the cells absorb it, our brains alertness centers are activated and we feel more awake and possibly even happier.Researcher Kathryn Roecklein at the University of Pittsburgh tested people with and without SAD to see how their eyes reacted to blue light. As a group, people with SAD were less sensitive to blue light than others, especially during winter months. That suggests a cause for wintertime depression.In severe cases, people need clinical support and antidepressant medications. Christian Benedict, a pharmacology professor at Uppsala University in Sweden, suggests light therapy for people with SAD as well as those who have a milder case of the winter blues. Its not like its a fate, an annual or a seasonal fate, and you cannot do anything about it, Benedict said. There are possibilities to affect it.A routine of morning light therapy, using devices that emit light about 20 times brighter than regular indoor light, can be beneficial for both people with and without SAD.The light therapy helps to kickstart your circadian rhythm and increases serotonin in your brain, Benedict said.Research supports using a light thats about 10,000 lux, a measure of brightness, for 30 minutes every morning. Special lights run from $70 to $400, though some products marketed for SAD are not bright enough to be useful. Your insurance company might cover at least part of the cost if youve been diagnosed with SAD.Partonen recommended using both a dawn simulator and a light therapy device each day before noon.Yale has tested products and offers a list of recommendations, and the nonprofit Center for Environmental Therapeutics has a consumer guide to selecting a light. Prioritizing a positive outlook as a survival strategyAnd dont forget to, well, look on the bright side. Its crucial to embrace winter instead of dreading it, according to Ida Solhaug, an associate professor in psychology at the University of Troms, also known as the Arctic University of Norway the worlds northernmost university.Prioritize a positive outlook as a survival strategy and learn to appreciate the change in seasons. Its a typical Norwegian way of thinking, she said, that can make all the difference when theres very little daylight for months.Its part of the culture, she said.And dont forget to take advantage of both outdoor and indoor hobbies, she said. Inside, channel hygge the Danish obsession with getting cozy and snuggle up on the couch with blankets and a movie. But dont hibernate all winter. After the film finishes, head outside with a thermos for fika, the traditional Swedish coffee break. Even during cloudy days, a quick walk in the fresh air will help, she said. And if youre brave enough, do a cold plunge like many people in the Nordics. Solhaug tries to jump into the frigid waters off the coast of Troms, an island 350 kilometers (217 miles) north of the Arctic Circle, at least once a week, adding that it makes her feel revitalized during the long winter.Challenge yourself to look for light in the darkness, she said.After all, as many Nordic people say, theres no such thing as bad weather only bad clothing.Finlands President Alexander Stubb, too, had some tips for how to tackle Nordic winters. When asked in an interview with The Associated Press last month how to survive the cold season, he had some very specific advice. Take an ice bath and then followed up by a sauna and do one more ice bath, one more sauna, then a shower and go out there. Youll manage, Stubb said.__Dazio reported from Berlin. STEFANIE DAZIO Dazio covers Northern Europe from Berlin for The Associated Press. She previously covered crime and criminal justice from Los Angeles.

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Benin's President Patrice Talon attends a meeting with Brazilian President Luiz Inacio Lula da Silva at Planalto presidential palace in Brasilia, Brazil, on May 23, 2024. (AP Photo/Eraldo Peres, File)2025-12-07T08:43:34Z COTONOU, Benin (AP) A group of soldiers appeared on Benin s state TV Sunday to announce the dissolution of the government in an apparent coup, the latest of many in West Africa.The group, which called itself the Military Committee for Refoundation, announced the removal of the president and all state institutions. Lt. Col. Pascal Tigri has been appointed president of the military committee, the soldiers said.Following its independence from France in 1960, the West African nation witnessed multiple coups, especially in the decades following its independence. Since 1991, the country has been politically stable following the two-decade rule of Marxist-Leninist Mathieu Krkou.Everything is fine, Wilfried Houngbedji, the spokesperson for the Benin Government, told The Associated Press without expanding. There is no official news about President Patrice Talon since gunshots were heard around the presidential residence. The signal to state television and public radio was cut off after the military announcement. Talon had been in power since 2016 and was due to step down next April after the presidential election. Talons party pick, former Finance Minister Romuald Wadagni, was the favorite to win the election. Opposition candidate Renaud Agbodjo was rejected by the electoral commission on the grounds that he did not have sufficient sponsors.In January, two associates of Talon were sentenced to 20 years in prison for an alleged 2024 coup plot. Last month, the countrys legislature extended the presidential term of office from five to seven years, keeping the term limit at two.The coup is the latest in a string of military takeovers that have rocked West Africa. Last month, a military coup in Guinea-Bissau removed former President Umaro Embalo after a contested election in which both he and the opposition candidate declared themselves winners.Adetayo reported from Lagos, Nigeria. OPE ADETAYO Adetayo is a West Africa reporter for The Associated Press. He covers news and regional development across West and Central Africa. twitter facebook mailto

Petr Yan celebrates with a member of his team after defeating UFC bantamweight champion Merab Dvalishvili during UFC 323 Saturday, Dec. 6, 2025, in Las Vegas. (Steve Marcus/Las Vegas Sun via AP)2025-12-07T06:40:36Z LAS VEGAS (AP) Petr Yan stunned Merab Dvalishvili with a dominating effort to capture the bantamweight championship by unanimous decision at UFC 323 on Saturday night.With punishing strikes and several crushing kicks to the rib cage, Yan (20-5) ended Dvalishvilis 14-match winning streak.Im very happy to stand here with the championship belt, thank you to all the fans, Yan said, through an interpreter. I worked so hard, I prepared so hard for this moment.Dvalishvili (21-5) hadnt lost since April 21, 2018, when Ricky Simon won by submission. It was his fourth title match of 2025.Yan exacted revenge for his last loss when Dvalishvili defeated the 32-year-old by unanimous decision on a UFC Fight Night card on March 11, 2023.Dvalishvili, 34, closed a -425 favorite, which meant a bettor laid $425 to $100 at BetMGM. Anyone wagering $100 on Yan would have won $320. I lost today, Dvalishvili said. Congratulations to him.In the co-main event, challenger Joshua Van won the flyweight belt from former champion Alexandre Pantoja with a TKO just 26 seconds into the first round after a quirky finish.In what appeared to be a freak accident, Pantoja (30-6) injured his left shoulder just after throwing a right roundkick to Vans head. But as Van (16-2) blocked the kick, Pantoja used his left arm to brace his fall, but his arm buckled, and he immediately grabbed it and waved to referee Herb Dean to stop the bout at 26 seconds. In a display of sportsmanship, Van immediately joined Pantoja on the canvas to check on him once the bout was called.Also from the main card:In what was a scheduled three-round flyweight bout, No. 5 Tatsuro Taira (18-1-0) earned the biggest victory of his career, a first-round stoppage over No. 2 Brandon Moreno (23-9-2) at the 2:24 mark of the second round after capitalizing on a rear-mount ground-and-pound. In a three-round bantamweight match, unranked rising star Payton Talbott (11-1-0) dominated 10th-ranked Henry Cejudo (16-6-0) to earn a 30-27 unanimous decision over the former two-division champion. Cejudo, who fought for the last time, was honored with a tribute video after the bout.In a three-round light heavyweight bout, fifth-ranked Jan Blachowicz (29-11-2) and 11th-ranked Bogdan Guskov (18-3-1) fought to a majority draw. Blachowicz was given the 29-28 edge by one judge, while two others had it 28-28.It marked the last UFC pay-per-view fight after the organization agreed to a seven-year contract with Paramount Plus under which future bouts will be on the streaming service. The partnership, which includes the two popular series Dana Whites Contender Series and The Ultimate Fighter, begins Jan. 24 with UFC 324 in Las Vegas.___AP sports: https://apnews.com/sports

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2025-12-07T12:24:38Z KYIV, Ukraine (AP) Russian missile and drone attacks overnight into Sunday killed at least one person in Ukraine, after U.S. and Ukrainian officials wrapped up a third day of talks aimed at ending the war. A man was killed in a drone attack on Ukraines northern Chernihiv region Saturday night, local officials said, while a combined missile and drone attack on infrastructure in the central city of Kremenchuk caused power and water outages. Kremenchuk is home to one of Ukraines biggest oil refineries and is an industrial hub.Kyiv and its Western allies say Russia is trying to cripple the Ukrainian power grid and deny civilians access to heat, light and running water for a fourth consecutive winter, in what Ukrainian officials call weaponizing the cold.The latest round of attacks came as Ukrainian President Volodymyr Zelenskyy said Saturday evening he had a substantive phone call with American officials engaged in talks with a Ukrainian delegation in Florida. He said he had been given an update over the phone by U.S. and Ukrainian officials at the talks. Ukraine is determined to keep working in good faith with the American side to genuinely achieve peace, Zelenskyy wrote on social media. Speaking Saturday at the Reagan National Defense Forum, U.S. President Donald Trumps outgoing Ukraine envoy, Keith Kellogg, said efforts to end the war were in the last 10 meters. He said a deal depended on the two outstanding issues of terrain, primarily the Donbas, and the Zaporizhzhia Nuclear Power Plant. Russia controls most of Donbas, its name for Donetsk and neighboring Luhansk, which, along with two southern regions, it illegally annexed three years ago. The Zaporizhzhia Nuclear Power Plant is in an area that has been under Russian control since early in Moscows invasion of Ukraine and is not in service, but it needs reliable power to cool its six shutdown reactors and spent fuel, to avoid any catastrophic nuclear incidents. Kellogg is due to leave his post in January and was not present at the talks in Florida.Separately, officials said the leaders of the United Kingdom, France and Germany would participate in a meeting with Zelenskyy in London on Monday. Meanwhile, Kremlin spokesman Dmitry Peskov welcomed the Trump administrations new national security strategy. In comments published Sunday by Russian state news agency RIA Novosti, he said the strategy was encouraging. There are statements there against confrontation and in favor of dialogue and building good relations, he said.The document released Friday by the White House makes clear that the U.S. wants to improve its relationship with Russia after years of Moscow being treated as a global pariah and that ending the war is a core U.S. interest to reestablish strategic stability with Russia.___Follow APs coverage of the war in Ukraine at https://apnews.com/hub/russia-ukraine

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The 2025 Kennedy Center Honorees, front row from left, Sylvester Stallone, George Strait, Gloria Gaynor and Michael Crawford; back row from left, members of the rock band KISS, Paul Stanley, Gene Simmons and Peter Criss, pose for a group photo at the 48th Kennedy Center Honors Medallion Reception, hosted at the U.S. Department of State, Saturday, Dec. 6, 2025 in Washington. (AP Photo/Kevin Wolf)2025-12-07T13:06:08Z WASHINGTON (AP) Sylvester Stallone, Kiss and Gloria Gaynor are among the luminaries being celebrated Sunday at the annual Kennedy Center Honors, with Donald Trump hosting the show, the first time a president will command the stage instead of sitting in an Opera House box.Since returning to office in January, Trump has made the John F. Kennedy Center for the Performing Arts, which is named after a Democratic predecessor, a touchstone in a broader attack against what he has lambasted as woke anti-American culture. Trump said in August that he had agreed to host the show. The Republican president said Saturday at a State Department dinner for the honorees that he was doing so at the request of a certain television network. He predicted that the broadcast, scheduled to air Dec. 23 on CBS and Paramount+, would have its best ratings ever. Its going to be something that I believe, and Im going to make a prediction: This will be the highest-rated show that theyve ever done and theyve gotten some pretty good ratings, but theres nothing like whats going to happen on Sunday night, Trump said. Trump is assuming a role that has been held in the past by journalist Walter Cronkite and comedian and Trump nemesis Stephen Colbert, among others. Before Trump, presidents watched the show alongside the honorees. Trump skipped the honors altogether during his first term. Since 1978, the honors have recognized stars for their influence on American culture and the arts. Members of this years class are pop-culture standouts, including Stallone for his Rocky and Rambo movies, Gaynor for her feminist anthem I Will Survive and Kiss for its flashy, cartoonish makeup and onstage displays of smoke and fire. Country music superstar George Strait and Tony Award-winning actor Michael Crawford are also being honored.The ceremony is expected to be emotional for the members of Kiss. The bands original lead guitarist, Ace Frehley, died in October after he was injured during a fall. Previous honorees have come from a broad range of art forms, whether dance (Martha Graham, Merce Cunningham), theater (Stephen Sondheim, Andrew Lloyd Webber), movies (Meryl Streep, Tom Hanks) or music (Bob Dylan, Joni Mitchell). Trump has taken over the Kennedy Center Trump upended decades of bipartisan support for the center by ousting its leadership and stacking the board of trustees with Republican supporters, who then elected him chair. He has criticized the centers programming and the buildings appearance and has said, perhaps jokingly, that he would rename it as the Trump Kennedy Center. He secured more than $250 million from Congress for renovations of the building.Presidents of each political party have at times found themselves face to face with artists of opposing political views. Republican Ronald Reagan was there for honoree Arthur Miller, a playwright who championed liberal causes. Democrat Bill Clinton, who had signed an assault weapons ban into law, marked the honors for Charlton Heston, an actor and gun rights advocate. During Trumps first term, multiple honorees were openly critical of the president. In 2017, Trumps first year in office, honors recipient and film producer Norman Lear threatened to boycott his own ceremony if Trump attended. Trump stayed away during that entire term. Trump has said he was deeply involved in choosing the 2025 honorees and turned down some recommendations because they were too woke. While Stallone is one of Trumps Hollywood special ambassadors and has likened Trump to George Washington, the political views of Sundays other guests are less clear. Honorees views about Trump Strait and Gaynor have said little about their politics, although Federal Election Commission records show that Gaynor has given money to Republican organizations in recent years. Kiss co-founder Gene Simmons spoke favorably of Trump when Trump ran for president in 2016. But in 2022, Simmons told Spin magazine that Trump was out for himself and criticized Trump for encouraging conspiracy theories and public expressions of racism. Fellow Kiss member Paul Stanley denounced Trumps effort to overturn his 2020 election defeat to Democrat Joe Biden, and said Trump supporters who stormed the Capitol on Jan. 6, 2021, were terrorists. But after Trump won in 2024, Stanley urged unity.If your candidate lost, its time to learn from it, accept it and try to understand why, Stanley wrote on X. If your candidate won, its time to understand that those who dont share your views also believe they are right and love this country as much as you do.-Italie reported from New York. DARLENE SUPERVILLE Superville covers the White House for The Associated Press, with a special emphasis on first ladies and first families. HILLEL ITALIE Italie has covered the publishing industry since 1998. He writes about notable books, industry trends and ongoing issues such as book bans, AI, consolidation and copyright. twitter instagram mailto RSShttps://feedx.net https://feedx.site

Australia's captain Steve Smith reacts after winning the second Ashes cricket test match between Australia and England in Brisbane, Sunday, Dec. 7, 2025.. (AP Photo/Tertius Pickard)2025-12-07T06:21:04Z BRISBANE, Australia (AP) Steve Smith took a brilliant reflex catch to swing momentum, got into a heated exchange with Jofra Archer and then slogged the winning runs Sunday as Australia beat England again to take a 2-0 Ashes lead.Set a target of 65 for victory in the second test after dismissing England for 241 in the second innings, Australia raced to an eight-wicket win late on Day 4 as storms brewed in and around the stadium.Archer was bowling around 150 kph (93 mph) under the lights and it only fired up Smith.The adrenaline was pumping at the end of the end, yeah. Jofra was bowling pretty quick, Smith said. It was a huge win. Great to go 2-nil up.There were some theatrics involving the Australia captain and Englands strike pace bowler, with Smith ducking under a short ball and then critiquing Archer for bowling fast when theres nothing going on, champion. He then hit a four and a six to bring up 1,000 test runs at the Gabba. With Australia at 63-2 and needing just two runs to win the day-nighter, Smith hit a six to seal it and finished unbeaten on 23 from nine deliveries.Not really too sure what he said, and not sure what I said, Smith told a post-match news conference. Its not any of your business, either, he added, laughing. So well leave it out there. Bazball shelvedDay 4 was a tale of two captains.England skipper Stokes curbed his attacking instincts, dispensing with Bazball and pragmatically setting about reviving Englands Ashes prospects.England had resumed Sunday at 134-6, and took an hour and 36 minutes 18.2 overs to erase the first-innings deficit.The Australian attack bowled a tight line and length and mixed it up with some short-pitch deliveries in an attempt to entice the usually aggressive England batters to have a go.Stokes (50) and Will Jacks (41) resisted the temptation for the entire first session, knowing that a wicket would expose the tailenders. It was a completely different approach to Englands usual attack-at-all costs mentality that has attracted wide criticism in the first two Ashes tests so far. The seventh-wicket pair put on a 96-run stand to get England to the brink of the night session, but that ended when Smith Australias stand-in captain took a stunning one-hander diving to his left at slip off Michael Nesers bowling to dismiss Jacks.That was the momentum changer. The subsequent slide happened quickly, with England losing its last four wickets for 17 runs and Neser finishing with a five-wicket haul.Stokes reached his 50 from 148 balls, the second-slowest half-century of his career. It was only four balls behind the 152 he took to make 50 at Headingley in 2019, where he scored an unbeaten 135 to guide England to one-wicket Ashes victory.This time, he didnt go on. The 34-year-old was incredibly caught behind by wicketkeeper Alex Carey standing up to the stumps to Neser (5-42). Stokes twirled his bat in the air in disbelief before striding back to the pavilion. Smith took two more catches as Englands lower-order crumbled. Australia won the series-opening test on Day 2. At least the second test went four.Very disappointing, Stokes said. A lot of it, to me, comes down to not being able to stand up to the pressure of this format when the game is on the line. In small passages weve been able to bring the game back into some kind of control, and then weve let it slip away.England has been criticized for its bowling attack failing to hit the right lengths consistently, for its dropped catches and for its top-order again throwing away wickets chasing fast and furious runs.We need to think a bit harder and a little bit deeper about those moments, Stokes said, and show a little bit more fight when its needed.Starc performanceAustralian pace spearhead Mitchell Starc was voted player of the match for the second time in the series, following his 10-wicket haul in Perth with six wickets in Englands first innings in Brisbane and then scoring a team-high 77 as Australia took a 177-run first-innings lead.He took another two wickets late on Day 3, increasing his series haul to 18. The series continuesThe third test starts Dec. 17 at the Adelaide Oval with England needing a win to have any chance of reclaiming the Ashes. The fourth test starts Boxing Day at the Melbourne Cricket Ground and Sydney will host the fifth test from Jan. 4. ___AP cricket: https://apnews.com/hub/cricket JOHN PYE Pye is based in Australia and covers sports news across the Asia-Pacific and at major events. He has reported from six continents since joining The Associated Press in 1998, including 12 Olympic Games and multiple World Cups. mailto

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Rosa Parks delivers remarks in front of the Alabama State Capitol at the conclusion of the 54 mile march from Selma to Montgomery. Alabama State Capitol, Montgomery, Ala., March 25, 1965. (Matt Herron/Jeannine Herron and Stanford University Libraries via AP)2025-12-07T14:04:24Z MONTGOMERY, Ala. (AP) Seven decades after Rosa Parks was thrust indelibly into American history for refusing to give up her bus seat in Montgomery, Alabama, new photos of the Civil Rights Movement icon have been made public for the first time, and they illustrate aspects of her legacy that are often overlooked.The photos were taken by the late Civil Rights photographer Matt Herron, and they depict Parks at the march from Selma to Montgomery in 1965 a five-day-long, 54-mile (87-kilometer) trek that is often credited with galvanizing political momentum for the U.S. Voting Rights Act of 1965.History lessons tend to define Parks by her act of civil disobedience a decade earlier, on Dec. 1, 1955, which launched the Montgomery Bus Boycott. On Friday, some boycott participants and many of the boycott organizers descendants gathered to mark 70 years since the 381-day struggle in Alabamas capital caught national attention, overthrowing racial segregation on public transportation. The never-before-seen photos released to the Rosa Parks Museum in Montgomery on Thursday, taken a decade after the boycott, are a reminder that her activism began before and extended well beyond her most well-known act of defiance, said Donna Beisel, the museums director.This is showing who Ms. Parks was, both as a person and as an activist, Beisel said. Never printed beforeThere are plenty of other photos placing Parks among the other Civil Rights icons who attended the march, including some that were taken by Herron. But others were never printed or put on display in any of the photographers numerous exhibits and books throughout his lifetime. Herron moved to Jackson, Mississippi, with his wife and two young kids in 1963 after Civil Rights activist Medgar Evers was assassinated. For the next two years, his photos captured some of the most notable people and events of that time. But in most of his photos, Herrons lens was trained on masses of everyday people who empowered Civil Rights leaders to make change. Herrons wife, Jeannine Herron, 88, said that the photos going public this week were discovered from a contact sheet housed in a library at Stanford University. The photos werent selected for print at the time because they were blurry or included people whose names werent as well known In Parks case, the new photos show her sitting among the crowd, looking away from the camera. Now, Jeannine Herron is joining forces with historians and surviving Civil Rights activists in Alabama to reunite the work with the communities that they depict.Its so important to get that information from history into local peoples understanding of what their families did, Jeannine Herron said. A joyous reunionOne of Herrons most frequent subjects throughout the Selma to Montgomery march was a 20-year-old woman from Marion, Alabama, named Doris Wilson. Decades after he captured her as she endured the historic march, he still expressed his desire to reconnect with her. I would love to find where she is today, Herron said in a 2014 interview among Civil Rights activists and journalists who witnessed that transformative period in the Deep South. Herron died in 2020, before he had the chance to reconnect with Wilson. But on Thursday, Wilson joined other residents of Marion, a rural town in the Black Belt of Alabama. Milling around an auditorium in Lincoln Normal School, a college founded by nine formerly enslaved Black people after the Civil War, people looked at black and white photos that Herron took over the years, pointing out familiar faces or backdrops.Some photos were familiar to the 80-year-old. But others, including ones where she was the subject, Wilson had never seen before.One of the photos depicts Wilson getting treatment at a medical tent along the path of the march. Wilson had intense blisters on her feet from walking over 10 miles each day.The doctor who was tending to her injuries, June Finer, also flew in from New York to reunite with Wilson for the first time since Finer gently cared for Wilsons bare feet six decades earlier. Are you the one who rubbed my feet? Wilson asked, as the two women laughed and embraced. Finer, 90, said she wasnt even aware that people were taking photos she was laser-focused on the safety of the marchers. Later, Wilson reflected on how meaningful the reunion had been. I longed to see her, Wilson said.Robert E. Wilson, Wilsons eldest son, said he had never seen the photos of his mother that were on display in the old school building where she went to school. He was a young child when she completed the march.Im so stunned. She always said she was in the march, but I never knew she was strong like that, the now 62-year-old who was raised in Marion said. Years of searching Cheryl Gardner Davis has faint recollections of the evening in 1965 when her family hosted the weary walkers on the third night of the march to Montgomery. She remembers hordes of strangers erecting tents on her familys farm in the rural Lowndes County, Alabama. Just four years old at the time, she remembers how her mother and older sister had to mop up mud inside their hallway from people who had come in to use their landline phone.It wasnt until she was an adult that she fully understood the significance of her familys sacrifice: Her moms job as a teacher was threatened, the familys power was cut off and a neighbor menaced them with his rifle. For years, she scoured the internet and libraries for photo evidence of their hardship or at least a picture of her familys property at the time.Among the hundreds of photos that made their way back to Alabama in the first week of December, were pictures of the campsite at Davis childhood home. Davis, who had never seen the photos before, said it was a vital way to bring light to the people who often are an afterthought in the recounting of that transformative historical period. Its, in a sense, validation. This actually happened, and people were there, Davis said. SAFIYAH RIDDLE Riddle covers the Alabama statehouse with a focus on law enforcement. She is based in Montgomery, Alabama. mailto

Descendants of Mary Turner, who was lynched in 1918, pose with her historic marker and artist Lonnie Holley, fourth from left, at the National Center for Civil and Human Rights, on Dec. 6, 2025 in Atlanta. (AP Photo/Michael Warren)2025-12-07T14:06:30Z ATLANTA (AP) A historical marker from the site of a 1918 lynching that was repeatedly vandalized in recent years is now safely on display in Atlanta in an exhibit that opens Monday.It memorializes an event that some people in rural southern Georgia have tried hard to erase: the killing of Mary Turner by a white mob that was bent on silencing her after she demanded justice for the lynching of her husband, Hayes Turner, and at least 10 other Black people.Pocked with bullet holes and cracked at its pedestal by an off-road vehicle, the Georgia Historical Society marker reads in part: Mary Turner, eight months pregnant, was burned, mutilated, and shot to death by a mob after publicly denouncing her husbands lynching the previous day. No charges were ever brought against known or suspected participants in these crimes. From 1880-1930, as many as 550 people were killed in Georgia in these illegal acts of mob violence. Now each word damaged by bullets is projected on a wall, and visitors hear those words spoken by some of Turners six generations of descendants.Im glad the memorial was shot up, great-granddaughter Katrina Thomas said Saturday night after her first look at the exhibit in the National Museum for Civil and Human Rights. Millions of people are going to learn her story. That her voice is continuing years and years after, it shows history does not disappear. It lives and continues to grow. Americans learned about these lynchings in 1918 because they were investigated in the immediate aftermath by Walter White, who founded the Georgia chapter of the National Association for the Advancement of Colored People and would become an influential voice for civil rights nationwide. A light-skinned Black man who could pass for white, he interviewed eyewitnesses and provided names of suspects to the governor of Georgia, according to his report in the NAACPs publication, The Crisis. Stay up to date with the news and the best of AP by following our WhatsApp channel. Follow on Georgia was among the most active states for lynchings, according to the Equal Justice Initiative s catalog of more than 4,400 documented racial terror lynchings in the U.S. between Reconstruction and World War II. The organization has placed markers at many sites and built a monument to the victims in Montgomery, Alabama. The nations first anti-lynching legislation was introduced in 1918 amid national reaction to deaths of Mary and Hayes Turner and their neighbors in Georgias Brooks and Lowndes counties. It passed the House in 1922, but Southern senators filibustered it and another century would pass before lynching was made a federal hate crime in 2022. The same injustice that took her life was the same injustice that kept vandalizing it, year after year, said Randy McClain, the Turners great-grandnephew. He grew up in the same rural area where the lynchings happened but did not know much about them or discover his family connection until he was an adult. Here it feels like a very safe space, McClain said. Shes now finally at rest, and her story can be told. And her family can feel some sense of vindication. MICHAEL WARREN Warren is an AP Global Desk editor and member of the APs Race and Ethnicity team. He previously reported for AP from Latin America. mailto

This photo combo shows candidates for Mayor of Miami, from left, Republican Emilio Gonzalez and Democrat Eileen Higgins. (AP Photo/File)2025-12-07T15:01:31Z MIAMI (AP) It has been nearly three decades since a Democrat held the mayors office in Miami, a span of futility the party is hoping to reverse during a special runoff election this week in one of the last electoral showdowns before next years midterms.While it is a local race, this election has become the latest test of the nations political mood nearly a year into President Donald Trumps second term.Trump and other big-name Florida Republicans, including Gov. Ron DeSantis and Sen. Rick Scott, have weighed in for the conservative candidate, former city manager Emilio Gonzalez, in the otherwise nonpartisan race. Nationally known Democrats, including former Transportation Secretary Pete Buttigieg, have offered support on behalf of Eileen Higgins, a Democrat who served on the county commission before winning a runoff spot last month. An upset for the Democrats on Tuesday would give the party an additional burst of momentum heading into a crucial election year when control of Congress will be at stake, especially in a region that has become increasingly friendly turf for Republicans and where Trump plans to build his presidential library. Higgins, who lives in the Cuban enclave of Little Havana and had represented a district that leans conservative, proudly wears the label of La Gringa, a term Spanish speakers use for white Americans. A Spanish speaker herself, Higgins has focused her campaign relentlessly on local issues such as the cost of housing while capitalizing on national ones, including the treatment of immigrants under the Trump administration in a city with sizable Hispanic and foreign-born populations.I have been a Democrat serving in a primarily Republican district, and all I have done is work for the people, she told The Associated Press. Democrats will try to break Republicans grip on powerMiami is Floridas second most populous city, behind Jacksonville, but is the epicenter of the states diverse culture and is among the nations most prominent international destinations, giving its mayor an outsize platform.The city of 487,000 is part of Miami-Dade County, which Trump flipped last year, handily defeating Democrat Kamala Harris after losing the county to Democrat Joe Biden in 2020. A loss for Gonzalez would be perceived in Florida as a setback for the GOP and Trump.Christian Ulvert, Higgins campaign manager, said early returns of mail ballots are encouraging. About 44% had been cast by registered Democrats as of Thursday, a day before early in-person voting began, compared with about 30% by registered Republicans.What youre seeing is great Democratic enthusiasm and turnout that matches that enthusiasm, he said.Higgins, who would be the first non-Hispanic mayor of Miami in almost 30 years if elected, said she is confident she will receive support not only from Democrats, but also from unaffiliated voters and some Republicans because of her work as an elected official.Her pitch to voters includes finding city-owned land that could be turned into affordable housing and cutting unnecessary spending. She was asked during a recent forum sponsored by the Greater Miami Chamber of Commerce if she would try to turn the more ceremonial role of mayor into a full-time job and not take on other work, something that raised ethical concerns for the current mayor, term-limited Francis Suarez. I do not have outside employment now. I was a full-time commissioner. Im going to be a full-time mayor, Higgins said as the interviewer continued to press her about whether that meant not accepting any outside employment.In a blunt-talking style, Higgins responded sternly: All right, do I have to say it more clearly? No! Its a full-time job. Republicans worry as Latino support waversWhile Latino voters nationally have traditionally leaned Democratic, Republicans in Florida have found strong backing among Cuban, Venezuelan and Nicaraguan immigrants, who resist socialist inclinations likened to the ones from the governments they fled. Trump tapped into those sentiments in winning Miami-Dade County last year, a turnaround from his 30 percentage point loss there to Democrat Hillary Clinton in 2016.Yet some Florida Republicans began sounding the alarm after Novembers elections, when Democrats secured wins in nationally watched governors races in New Jersey and Virginia. Both winning candidates had strong performances with nonwhite voters, and the Democratic winner in the New Jersey race received two-thirds of the Hispanic vote, according to the AP Voter Poll.Those results were largely seen as a reflection of concerns over rising prices and the Trump administrations aggressive immigration policies.U.S. Rep. Maria Elvira Salazar, a Republican whose district includes the city of Miami, called the elections elsewhere a wake-up call. Ileana Garcia, a Florida state senator who in 2016 founded the group Latinas for Trump, has said about immigration arrests that what we are witnessing is inhumane. Gonzalez, a former director of the U.S. Citizenship and Immigration Services under Republican President George W. Bush, said during a debate sponsored by Miamis CBS affiliate that he supported immigration arrests against those who committed crimes. But he demurred when the moderator said most of those arrested had not committed violent offenses: But this is a federal issue, Gonzalez said. This is not an issue that has to do with the mayor of Miami.Higgins has spoken about Miamis signing on to a federal program that delegates immigration authority to local police, county sheriffs and state agencies and said she would find legal options to unwind that decision to rebuild trust between residents and law enforcement.When we start to enforce whatever shenanigans is coming out of the federal government to just randomly pick people up, we could erode that trust, she said.Florida Democrats hope to kickstart their climb back to relevancyHiggins has received support from Florida Democrats looking to show the party still has a foothold in the formerly swing state.Some Democrats who could be considering a presidential run in 2028 also are backing her campaign. Buttigieg encouraged voters in a video to make a plan to vote for her, and U.S. Sen. Ruben Gallego of Arizona planned to join her on Sunday for early voting stops.Many of the local issues at play in the race resonate nationally, including income inequality and one of the nations least affordable housing markets.Gustavo Ascani, a 30-year-old Miami voter, said the city has long-standing problems that need addressing. He said he has not decided whom he will vote for, but said tackling homelessness and traffic is a priority for him.Maybe Republicans have overlooked, after having locally been in power for so long, certain issues that are important for the people in Miami, Ascani said.Robin Peguero, a former prosecutor who is running for the chance to challenge Salazar for her congressional seat, said voters concerns center around affordability, an issue that has become a focal point of both parties after Democrats wins in New Jersey and Virginia.That includes the sharp health insurance premium spikes expected to start Jan. 1 after subsidies under the Affordable Care Act expire. The Obama-era health law remains popular in South Florida, and recent polling shows most people who will be affected by the increases blame Trump and Republicans. Its kitchen table issues, whether its an election for local officials or whether there is an election for the president, Peguero said. Its a rejection of what is happening in this country. ADRIANA GOMEZ LICON Gomez Licon writes about national politics for The Associated Press. She is based in Florida. twitter mailto

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Former FBI Director James Comey speaks during a Senate Intelligence Committee hearing on Capitol Hill, in Washington, June 8, 2017. (AP Photo/Andrew Harnik, File)2025-12-07T15:50:28Z WASHINGTON (AP) A federal judge has dealt a setback to Justice Department efforts to seek a new indictment against former FBI Director James Comey, temporarily barring prosecutors from using evidence they had relied on when they initially secured criminal charges.The ruling Saturday night from U.S. District Judge Colleen Kollar-Kotelly does not preclude the department from trying again soon to indict Comey, but it does suggest prosecutors may have to do so without citing communications between Comey and a close friend, Columbia University law professor Daniel Richman.Comey was charged in September with lying to Congress when he denied having authorized an associate to serve as an anonymous source for media coverage about the FBI. In pursuing the case, prosecutors cited messages between Comey and Richman that they said showed Comey encouraging Richman to engage with the media for certain FBI-related coverage. The case was dismissed last month after a different federal judge ruled that the prosecutor who filed the charges, Lindsey Halligan, was unlawfully appointed by the Trump administration. But that ruling left open the possibility that the government could try again to seek charges against Comey, a longtime foe of President Donald Trump. After the case was thrown out, lawyers for Richman sought a court order that would bar prosecutors from continued access to his computer files, which the Justice Department obtained through search warrants in 2019 and 2020 as part of a media leak investigation that was later closed without charges. But Richman and his lawyers say that in preparing the criminal case against Comey, prosecutors relied on data that exceeded the scope of the warrants, illegally held onto communications they should have destroyed or returned and conducted new, warrantless searches of the files. Kollar-Kotelly on Saturday night granted Richmans request for a temporary restraining, instructing the department not to access the covered materials once they are identified, segregated, and secured, or to share, disseminate, or disclose the covered materials to any person, without first seeking and obtaining leave of this Court. She gave the Justice Department until Monday afternoon to certify that it is compliance with the order.Petitioner Richman has also shown that, absent an injunction, he will be irreparably harmed by the ongoing violation of his Fourth Amendment right against unreasonable seizures arising from the Governments continuing retention of the image of his computer and related materials, she wrote.A Justice Department spokesperson declined to comment Sunday on the ruling and what it meant for revived charges against Comey.It is not clear that the Justice Department could secure new charges against Comey even if it could rely on Richmans communications. Comeys lawyers have said the statute of limitations on such a case the congressional testimony at issue was given on Sept. 30, 2020, or more than five years ago has expired. A separate attempt by the Justice Department to a file a new indictment against New York Letitia James, another perceived Trump adversary who was also charged by Halligan, failed last week when a grand jury refused to sign off on charges. ERIC TUCKER Tucker covers national security in Washington for The Associated Press, with a focus on the FBI and Justice Department. twitter mailto

McLaren driver Lando Norris of Britain celebrates after becoming a world champion after the Formula One Abu Dhabi Grand Prix at the Yas Marina Circuit in Abu Dhabi, UAE, Sunday, Dec. 7, 2025. (AP Photo/Altaf Qadri)2025-12-07T13:05:38Z McLaren driver Lando Norris held his nerve but could not hold back the tears after clinching his first Formula 1 title at the season-ending Abu Dhabi Grand Prix on Sunday.Red Bull driver and defending champion Max Verstappen won the race with Norris placing third behind his McLaren teammate Oscar Piastri in second, which allowed Norris to finish two points ahead of Verstappen in the season-long standings. Its incredible. It is pretty surreal. Ive dreamed of this for a long, long time, said the 26-year-old Norris, who started his F1 career as a test and reserve driver with McLaren. I feel like I did my part for the team this year and Im very proud of myself for that. Im even more proud for everyone who I hopefully made cry.Norris became Britains 11th F1 champion, a racing journey that began with kart racing when he was eight years old. The first of his 11 F1 race wins came last year, when he finished second overall in the standings. Piastri was also in contention for his first F1 title and finished third in the standings, 13 points behind Norris, who ended the season with seven wins and 423 points. Norris became the first British champion since Lewis Hamilton won his record-equaling seventh title in 2020, and also denied Verstappen a fifth straight title.Oh God. Ive not cried in a while. Its a long journey. First of all, I want to say a big thanks to my guys, my parents, Norris said a few minutes after the race. I now know what Max feels like a little bit. I want to congratulate him and Oscar, too. Its been a long year but we did it. Norris entered the three-way battle 12 points ahead of Verstappen and 16 ahead of Piastri, who also won seven races but none since the Dutch GP on Aug. 31.Verstappen started from pole position for with Norris on the front row beside him and Piastri third on the grid. Verstappen needed Norris to be fourth or lower and Norris had to finish outside the top five if Piastri won. Verstappens astounding late-season charge came close to unseating both McLaren drivers after they had shared the lead throughout the season and then were undone by driver and team-strategy errors.Verstappens title chances were dramatically improved with two races to go after Norris and Piastri were disqualified in Las Vegas.But even Verstappens season-leading eighth win and 71st of his career could not stop Norris, who kept his composure on Sunday, having been under severe pressure in recent weeks.Oscar and Lando have been awesome all year, McLaren CEO Zak Brown told broadcaster Sky. This Max guy is pretty hard to beat.The McLaren motorhome erupted with joy when Norris clinched it and Brown congratulated Norris on the team radio in his usual jovial manner.Lando, this is Zak from McLaren. Is this the world champion hotline? You did it! You did it! Awesome, Brown said.Norris didnt know whether to laugh or cry. He did both.Oh my God, thanks so much. I love you guys. Thanks for everything, Norris said and then broke down in tears. After crossing the line, Norris stayed in his car for a few moments, visibly emotional. His parents were on the side of the track and he went over to hug them before celebrating with his McLaren engineers and mechanics.Piastri was looking to become the first Australian champion since Alan Jones in 1980, but his failure to win a race after Zandvoort cost him.Pole position was crucial on the 58-lap circuit in Abu Dhabi, where overtaking is hard, and so it proved again as Verstappen joined the long list of race winners from pole since 2015. Charles Leclerc finished fourth for Ferrari ahead of George Russell in a Mercedes and Aston Martins Fernando Alonso in sixth.Verstappen gets awayVerstappen made a clean start with Piastri overtaking Norris at the end of Lap 1, while the slick Leclerc was soon behind Norris.Norris was the first of the contenders to change tires when he came in on Lap 17. But he was caught behind some traffic and had Verstappens Red Bull teammate Yuki Tsunoda ahead of him in third spot, which in turn allowed Leclerc to gain some ground on Norris. Tsunoda penalizedNorris overtook Tsunoda on Lap 23 but went very wide and off track limits but race stewards gave Tsunoda a 5-second time penalty for zig-zagging in front of Norris, who was cleared of wrongdoing. Tsunoda, who is being replaced at Red Bull next year by Isack Hadjar, reacted angrily when informed he had moved more than once in front of Norris when defending his position.Slick Leclerc This pace is mega, Ferrari told Leclerc over team radio.Norris pitted again on Lap 41, with Verstappen overtaking Piastri moments later to move into the lead. Piastri came in a lap later for his one and only change but Norris still held the cards because both McLarens had covered an eventual second tire change for Verstappen.The main threat for Norris was Leclerc and he was about 4 seconds behind him with 10 laps left. Is Charles catching him or not? Verstappen asked his race engineer. Leclerc couldnt get closer, meaning Norris could coast to the title barring any mishap or a late safety car.___AP auto racing: https://apnews.com/hub/auto-racing___Formula 1: https://apnews.com/hub/formula-one

Israeli Prime Minister Benjamin Netanyahu, left, and German Chancellor Friedrich Merz leave the podium following a joint press conference in Jerusalem Sunday, Dec. 7, 2025. (AP Photo/Ariel Schalit, Pool)2025-12-07T14:04:48Z TEL AVIV, Israel (AP) Israeli Prime Minister Benjamin Netanyahu said Sunday that Israel and Hamas are very shortly expected to move into the second phase of the ceasefire, after Hamas returns the remains of the last hostage held in Gaza.Netanyahu spoke during a news conference with visiting German Chancellor Friedrich Merz and stressed that the second phase, the disarming of Hamas and the demilitarization of Gaza could begin as soon as the end of the month.Hamas has yet to hand over the remains of Ran Gvili, a 24-year-old police officer who was killed in the Hamas-led Oct. 7, 2023, attack that sparked the war. His body was taken to Gaza.The ceasefires second stage also includes the deployment of an international force to secure Gaza and forming a temporary Palestinian government to run day-to-day affairs under the supervision of an international board led by U.S. President Donald Trump. Netanyahu says second phase will be challengingThe return of Gvilis remains and Israels return of 15 bodies of Palestinians in exchange would complete the first phase of Trumps 20-point ceasefire plan.Hamas says it has not been able to reach all remains because they are buried under rubble left by Israels two-year offensive in Gaza. Israel has accused the militants of stalling and threatened to resume military operations or withhold humanitarian aid if all remains are not returned.A group of families of hostages said in a statement that we cannot advance to the next phase before Ran Gvili returns home. Netanyahu said few people believed the ceasefires first stage could be achieved, and the second phase is just as challenging.As I mentioned to the chancellor, theres a third phase, and that is to deradicalize Gaza, something that also people believed was impossible. But it was done in Germany, it was done in Japan, it was done in the Gulf States. It can be done in Gaza, too, but of course Hamas has to be dismantled, he said.Merz said Germany, one of Israels closest allies, is assisting with the implementation of the second phase by sending officers and diplomats to a U.S.-led civilian and military coordination center in southern Israel, and by sending humanitarian aid to Gaza. Germany says support for Israel is unchangedMerz said Germany will always stand up for Israels existence and security after the atrocities of the Holocaust: This is part of the unchanging core of our relationship. This applies today, it applies tomorrow and it applies forever.The chancellor also said Germany still believes that a two-state-solution is the best possible option but that the German federal government remains of the opinion that recognition of a Palestinian state can only come at the end of such a process, not at the beginning.The U.S.-drafted plan for Gaza leaves the door open to Palestinian independence. Netanyahu has long asserted that creating a Palestinian state would reward Hamas and eventually lead to an even larger Hamas-run state on Israels borders. Netanyahu also said that while he would like to visit Germany, he hasnt planned a diplomatic trip because he is concerned about an arrest warrant issued by the International Criminal Court, the U.N.'s top war crimes court, last year in connection with the war in Gaza. Merz said there are currently no plans for a visit but he may invite Netanyahu in the future. He added that he is not aware of future sanctions against Israel from the European Union nor any plans to renew German bans on military exports to Israel.Germany had a temporary ban on exporting military equipment to Israel, which was lifted after the ceasefire began on Oct. 10.Israel kills militant in GazaThe Israeli military said it killed a militant who approached its troops across the so-called Yellow Line that divides the Israeli-controlled majority of Gaza from the rest of the territory.Gazas Health Ministry says Israeli forces have killed more than 370 Palestinians since the start of the ceasefire, and that the bodies of six people killed in attacks had been brought to local hospitals over the past 24 hours.In the original Hamas-led attack in 2023, the militants killed around 1,200 people and took more than 250 others hostage. Almost all the hostages or their remains have been returned in ceasefires or other deals. Israels offensive in Gaza has killed at least 70,360 Palestinians, according to Gazas Health Ministry, which operates under the Hamas-run government. The ministry does not differentiate between civilians and combatants, but says that nearly half the dead have been women and children. The ministry is part of Gazas Hamas government and its numbers are considered reliable by the U.N. and other international bodies.___Grieshaber reported from Berlin.___Find more of APs Israel-Hamas coverage at https://apnews.com/hub/israel-hamas-war MELANIE LIDMAN Lidman is an Associated Press reporter based in Tel Aviv, Israel. KIRSTEN GRIESHABER Grieshaber is a Berlin-based reporter covering Germany and Austria for The Associated Press. She covers general news as well as migration, populism and religion. mailto

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Wilma Fuentes yells at Customs and Border Patrol commander Gregory Bovino and some of his agents as they walk through a neighborhood during an immigration crackdown, in Kenner, La., Dec. 5, 2025. (AP Photo/Gerald Herbert, File)2025-12-07T18:35:49Z NEW ORLEANS (AP) State and federal authorities are closely tracking online criticism and demonstrations against the immigration crackdown in New Orleans, monitoring message boards around the clock for threats to agents while compiling regular updates on public sentiment surrounding the arrests, according to law enforcement records reviewed by The Associated Press. The intelligence gathering comes even as officials have released few details about the first arrests made last week as part of Catahoula Crunch, prompting calls for greater transparency from local officials who say theyve been kept in the dark about virtually every aspect of the operation. Online opinions still remain mixed, with some supporting the operations while others are against them, said a briefing circulated early Sunday to law enforcement. Earlier bulletins noted a combination of groups urging the public to record ICE and Border Patrol as well as additional locations where agents can find immigrants. Immigration authorities have insisted the sweeps are targeted at criminal illegal aliens. But the law enforcement records detail criminal histories for less than a third of the 38 people arrested in the first two days of the operation. Local leaders told the AP those numbers which law enforcement officials were admonished not to distribute to the media undermined the stated aim of the roundup. They also expressed concern that the online surveillance could chill free speech as authorities threaten to charge anyone interfering with immigration enforcement. Stay up to date with the news and the best of AP by following our WhatsApp channel. Follow on It confirms what we already knew this was not about public safety, its about stoking chaos and fear and terrorizing communities, said state Sen. Royce Duplessis, a Democrat who represents New Orleans. Its furthering a sick narrative of stereotypes that immigrants are violent.The U.S. Department of Homeland Security did not respond to questions about the intelligence gathering and referred the AP to a prior news release touting dozens of arrests. The agency has not released an accounting of the detainees taken into custody or their criminal histories. Few initially arrested had violent criminal recordsDHS has publicly detailed only six arrests stemming from the operation all people with criminal histories including a man they vaguely said was convicted of homicide and another convicted of sexual assault. The agency, which has several hundred agents on the ground in southeast Louisiana, has said it aims to make at least 5,000 arrests in the region over an operation expected to last up to two months.Americans should be able to live without fear of violent criminal illegal aliens harming them, their families or their neighbors, DHS spokesperson Tricia McLaughlin said. DHS and Republican leaders have framed the crackdown as targeting the most violent offenders. But the records reviewed by the AP identify only nine of the 38 people arrested in the first days as having criminal histories that rose beyond traffic violations information the intelligence bulletins warn should not be distributed to the media. New Orleans City Council President J.P. Morrell said the stated goals of the operation to arrest violent offenders did not align with the reality of what is taking place. Theres literally no information being given to the city of New Orleans whatsoever, Morrell said. If the goal was for them to come here and augment existing law enforcement, to pursue violent criminals or people with extensive criminal histories, why wouldnt you be more transparent about who youve arrested and why?Morrell and other officials have said the crackdown appears to be a dragnet focused on people with brown skin, citing viral videos of encounters such as masked agents chasing a 23-year-old U.S. citizen returning home from the grocery store. Law enforcement officials have been carefully tracking such footage and public reaction. For some supporters, the videos with sounds of children crying in the background as their parents are placed under arrest, is weighing heavy on their hearts, one briefing stated. Authorities monitoring public sentiment and protestsThe records also shed new light on cooperation among state and federal authorities in an operation welcomed by Louisianas Republican Gov. Jeff Landry. Both the FBI and Customs and Border Protection have stationed agents at the Louisiana State Analytical and Fusion Exchange, an intelligence and data sharing center that is closely following discussions on the online forum Reddit that local residents have used to exchange information about the immigration raids.One briefing noted that some have gone so far as to accuse agents of racially profiling Hispanic areas specifically. Another flagged social media posts suggesting agents are not keeping with the mission of targeting criminal immigrants only. And a third pointed out that critics of the raids bring up past hurricanes and the work done by immigrants in their aftermath. The chatter is slower during the night, mainly just commenting on posts from earlier in the day, one of the briefings states. Once daylight arrives and agencies are back out, the chatter and new posts will pick back up. The briefings have identified no threats to law enforcement, but the fusion center has sought to debunk what it called false reports that a pedestrian was fatally struck by law enforcement. It has been confirmed that this actually did not occur, the center told law enforcement on Saturday.One briefing described an incident involving suspicious persons/protesters who showed up early Saturday at an ICE facility in St. Charles Parish, where records show the detainees were expected to be processed.Some local officials said they had been unaware of the states role in the online monitoring. Louisiana State Police pledged operational support to immigration authorities and warned the public that troopers will arrest anyone who assaults a federal agent or causes criminal damage to property. The Louisiana State Police remains vigilant in monitoring social media activity related to protests, activism and other forms of public response, Trooper Danny Berrincha, a state police spokesperson, wrote in an email to the AP. Through the LSP Fusion Center, we actively track developments and facilitate the sharing of information and communication among our partner agencies.The fusion center also has tracked the tools used by protesters to foil federal immigration enforcement, highlighting social media links to whistle handouts, trainings on filming federal agents and the emergence of a hotline for reporting arrests. The surveillance extended to activist discussions about immigration authorities presence near an elementary school and recapped demonstrations inside the New Orleans City Council chambers and elsewhere. They can monitor me all they want, said Rachel Taber, an organizer with the New Orleans-based grassroots advocacy group Union Migrante, which shares crowdsourced reports and videos of the federal immigration enforcement operations. We are not doing anything illegal. Beth Davis, a spokesperson for Indivisible NOLA, which has organized some of the trainings described in the law enforcement briefings, said it was sad authorities seemed preoccupied with law-abiding citizens. That they feel threatened by a bunch of community organizers that have nothing other than phones and whistles blows my mind.__Mustian reported from New York. JIM MUSTIAN Mustian is an Associated Press investigative reporter for breaking news. twitter mailto JACK BROOK Brook covers Louisiana government, infrastructure and environmental issues from New Orleans. He is a Report for America corps member. twitter mailto

Ohio State's Lorenzo Styles Jr. breaks up a pass intended for Indiana's Omar Cooper Jr. during the first half of the Big Ten championship NCAA college football game in Indianapolis, Saturday, Dec. 6, 2025. (AP Photo/Michael Conroy)2025-12-07T11:10:08Z Get the AP Top 25 college football poll delivered straight to your inbox every week with AP Top 25 Poll Alerts. Sign up here. Nobody paying attention for the past 24 months would be surprised to see Indiana yes, Indiana leading the way into this years College Football Playoff.But anyone paying attention over the last 24 hours knew the only sure thing beyond that was that the selection committee that set this 12-team bracket was destined to get destroyed when it released the pairings Sunday. All that second-guessing and vitriol will be coming from Notre Dame, which was passed over for Alabama and Miami for two bubble spots in the bracket. The Fighting Irish dropped two notches in the rankings over the last two weeks despite a 10-game winning streak, winning their finale by 29 points and sitting on the couch Saturday. Add AP News on Google Add AP News as your preferred source to see more of our stories on Google. Share Share Facebook Copy Link copied Print Email X LinkedIn Bluesky Flipboard Pinterest Reddit Read More Alabama didnt move at all in the CFP rankings after a 28-7 loss to Georgia that looked worse than that, but that the committee didnt count that against the Tide in keeping with a hazy policy that refrains from penalizing teams for playing in their league title game. Miami didnt play either, but the Hurricanes win over Notre Dame in Week 1 played a role in their move once the teams were grouped right next to each other after BYU lost its game on Saturday. Committee chairman Hunter Yurachek said he directed the committee to rewatch Miamis win over Notre Dame way back on Aug. 31. Once we moved Miami ahead of BYU, we had the side-by-side comparison that eveyrone had been hungy for, Yurachek said. Think you know who belongs in the Top 25? Now its your turn to vote with the AP Top 25 fan poll. The committees other key decision was choosing James Madison over Duke for the final spot, a selection that left the Atlantic Coast Conference champion out of the mix, but didnt fully exclude the ACC because of Miamis move into the bracket. Yurachek insisted that including the ACC one of the Power Four conferences in the playoff in some form played no role in the deliberations.The rest of the field includes No. 2 Ohio State, No. 3 Georgia and No. 4 Texas Tech, which joined Indiana in getting first-round byes. Then it was No. 5 Oregon, followed by Ole Miss, Texas A&M, Oklahoma, Alabama, Miami, Tulane and James Madison. The playoffs start Dec. 19-20 with first round games: James Madison at Oregon; Tulane at Misssissippi; Miami at Texas A&M; and Alabama at Oklahoma. The final is set for Jan. 19 outside of Miami. ___Get poll alerts and updates on the AP Top 25 throughout the season. Sign up here and here (AP News mobile app). AP college football: https://apnews.com/hub/ap-top-25-college-football-poll and https://apnews.com/hub/college-football

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