Programs that send mental health teams in response 911 calls have proved successful in over cities — so why aren’t they flourishing in Chicago?

Chicago Mayor Brandon Johnson touted a plan for Chicago’s program during his campaign. But in an exclusive interview, a whistleblower said the mental health crews want to work — but are being held back from helping people by limited hours and red tape.

On a bridge over the Stevenson Expressway on Wednesday, a man needed help, as his leg was over a ledge as traffic flowed on the expressway near 25th Street and Michigan Avenue. Police talked him off the ledge and may have saved his life around 8 p.m. Wednesday.

The Chicago Police Department was there. CARE, the city’s Crisis Assistance Response and Engagement program that tasks mental health professionals with responding to 911 calls, was not there.

“It is you, the general Chicagoan, who deserves to know what is happening with the CARE team — the program that has been lauded by the Mayor’s office that has been so looked forward to for so many years and has so much potential,” said a whistleblower. “It’s important for you to know that that potential is not being reached.”

The whistleblower, who has worked with CARE, had their identity concealed. They explained why the program championed by the Johnson administration has been failing.

“Working in a new response team that is only available from 10:30 [a.m.] to 4 [p.m.], only available Monday to Friday — that’s a complicated thing to remember to keep track of,” said the whistleblower, “and only available in parts of the city.”

In addition to the limited hours, CBS News Chicago is told the CARE program only responds in seven of the city’s 22 police districts:

Central (1st), which includes the Loop, the South Loop, the Near South Side, and parts of the West Loop.

South Chicago (4th), which parts of the South and Southeast sides from the southern part of South Shore to Hegewisch.

Gresham (6th), which includes the Auburn Gresham and Chatham communities

Englewood (7th), which includes the Englewood and West Englewood communities.

Chicago Lawn (8th), which includes much of the Southwest Side.

Near West (12th), which includes the Near West Side and much of the West Loop and West Town.

Town Hall (19th), which includes the communities of Lakeview, Lincoln Square, North Center, and parts of Uptown and Lincoln Park.

Previously, CARE reams were able to self-dispatch, meaning they could listen to the scanner and respond themselves.

Jason Lerner, director of the University of Chicago Health Lab, studied the program in its pilot form. He said self-dispatch made up about half of the calls to which CARE responded.

“Self-dispatch were by far the highest percentage of dispatches,” said Lerner. “It worked effectively then.”

But without self-dispatch as an option now, CBS News Chicago is told CARE waits for 911 operators from the Office of Emergency Management and Communications to tell them where to go.

The whistleblower said this just makes CARE teams’ jobs more difficult.

“Now, the CARE team is never dispatched to calls. So in some ways, sure, it made it easier, because they have nothing to do — and there’s only been 12 calls in the last three weeks,” the whistleblower said. “But in terms of doing what the CARE team was actually meant to do, yeah, it definitely made it more difficult.”

In 2023, the Johnson administration promised to quadruple the number of CARE teams. So far, only one has been added — making five teams composed of EMTs and mental health professionals.

Earlier this year, Mayor Johnson spoke about CARE’s successes.

“The City of Chicago continues to lead the way transforming the way government shows up for people,” Mayor Johnson said on Jan. 8.

Meantime. CBS News Chicago is told those who work with CARE, which is funded by grant money until the end of 2026, feel Chicago has not been showing up for them.

“That the program is being set up to fail in a way that these obstacles are being put in place so that when it comes to 2026, someone can say: ‘Well, this didn’t work. Let’s use this money in a different way,'” the whistleblower said.

At a news conference 2024, the city gave out a booklet that among other things, discussed the hours and planned improvements for CARE. CBS News Chicago is told that many of the plans outlined in the booklet have not happened.

There had been no response from the Mayor’s office as of Thursday night.

The string of coincidences that initially appeared to link the New Year’s Day tragedies in New Orleans and Las Vegas have been overtaken by mounting evidence that the Tesla Cybertruck bombing at the Trump International Hotel was in fact a public display of a private tragedy, new information and interviews show.

Decorated U.S. Army Special Forces Master Sgt. Matthew Livelsberger sent a disjointed email on the morning of New Year’s Eve to Samuel Shoemate, a retired Army intelligence officer and military pundit. It outlined a constellation of grievances and dire warnings related to his military service, but gave no hint of, or explanation for, his actions.

In a text made public by local authorities, Livelsberger wrote: “I needed to cleanse my mind of the brothers I’ve lost and relieve myself of the burden of the lives I took.”

And in an interview Friday, a former girlfriend of Livelsberger’s said he told her he suffered a traumatic brain injury while serving in the Middle East. Alicia Arritt, who was in a relationship off and on with Livelsberger from 2018 to 2021, told CBS News that she exchanged around 30 texts with Livelsberger in the days leading up to the bombing.

She said he gave no indication that he was planning to take his own life or blow up a Tesla Cybertruck outside the Trump hotel in Las Vegas.

“He loved the Army and he gave his life and his mind for it,” Arritt said.

An Army spokesperson confirmed to CBS News in a statement Saturday that Livelsberger had received counseling through its Preservation of the Force and Family program.

“Master Sgt. Matthew Livelsberger had access to and used the POTFF program; he did not display any concerning behaviors at the time, and was granted personal leave. All relevant records were provided to the FBI as the lead investigative agency,” the spokesperson said.

Experts told CBS News that Livelsberger may have been the latest illustration of an ongoing concern facing the U.S. military’s most elite special operators — the heightened risk of brain injury, traumatic stress and mental health struggles.

According to the National Center for PTSD, research on veterans from the wars in Iraq and Afghanistan suggests that 10% to 18% of those troops are likely to have post-traumatic stress disorder and be at risk for other mental health problems. Depression rates among troops returning from overseas range as high as 24%.

The high-risk, high-intensity career has for years raised concerns about the toll that long-running exposure to combat violence can take on special forces soldiers.

Livensberger’s father told CBS News he had been at home in Colorado Springs with his wife and 8-month-old child on Christmas, on an approved military leave, before he rented the Cybertruck and began his meandering drive towards Las Vegas.

The Pentagon told CBS News there “were no red flags” prior to Livelsberger’s departure from Germany, where he was stationed with 1st Battalion, 10th Special Forces Group. A CNN report Friday said Livensbeger visited military behavioral health services multiple times.

A review of Livensberger’s social media posts, interviews with friends who knew him well, and most pointedly, his email to Shoemate, offered indications he may have been struggling with those issues. On Friday, Shoemate discussed the letter on The Shawn Ryan Show, a podcast where Ryan, a former Navy SEAL and CIA contractor, interviews individuals primarily from the national security space.

In the email obtained by CBS News, Livensberger referenced his ongoing concerns about civilian casualties caused by an airstrike in Afghanistan. The incident he mentioned appears to align with reports of U.S. airstrikes in May 2019 targeting alleged drug-processing facilities in Afghanistan, where more than 30 civilians, including children, were reportedly killed.

CBS could not independently verify the letter’s authenticity.

Investigators said at a briefing Friday that Livelsberger planned and prepared for the Las Vegas bombing alone.

On Sunday morning, the day after authorities say he rented the Cybertruck, Livelsberger sent Arritt photos of the Tesla and said, “I rented a Tesla Cybertruck. It’s the s***.” She also told CBS News that Livelsberger sent her playful videos of himself listening to rap on the drive to Las Vegas.

Arritt said the FBI visited her after the explosion. She said they told her he had been in contact with several other women in the days leading up to the bombing.

Arritt said Livelsberger suffered a traumatic brain injury before she met him while deployed in the Middle East and he told her it caused a change in his behavior. He said he didn’t want to get treatment for it.

“He felt it would ruin his career if he sought help,” she said. “All he wanted to do was deploy and get back to it.”

He suffered a lot of memory problems as a result of injuries he sustained during his service, including poor concentration, brain fog and headaches, she said.

Arritt, a registered nurse, said she recognized these as symptoms of a TBI because she had worked on wards for service members with brain injuries and amputations at Walter Reed National Military Medical Center from 2008 to 2009.

“I understood him, even if he didn’t know the words for it,” she said.

Arritt said he had guilt over some of his actions while deployed, expressing concern that his actions may have contributed to the deaths of innocent civilians.

She said Livelsberger went through periods of isolation while they were together. “He would disappear and just go cold for a couple of weeks. He was depressed but he always wanted to get through the depression. He recognized it and he was working on it. He pushed himself hard to get through it.”

Arritt described Livelsberger as kind and said she was shocked at his actions.

“I never saw him angry or act impulsively and he was always thoughtful in the things he did,” she said. “He was always the first person to jump into battle and stand up for someone else.”

Many former colleagues interviewed by CBS News expressed shock and sadness, including Fardin Fetwat, a former Afghan interpreter who deployed alongside Livelsberger. Fetwat credited Livelsberger with saving his life during combat and later helping him and his family resettle in Colorado, though they had not been in contact for several years. Describing Livelsberger’s death, Fetwat said it felt like losing a brother, not just a colleague.

contributed to this report.

House Speaker Mike Johnson (R-La.) slammed the Biden administration after a “stunning” inspector general’s report released Tuesday found that nearly 300,000 migrant children are presumed to be missing in the US.

“This administration’s failure to secure our border is facilitating what is the equivalent of a modern-day slavery operation,” Johnson told reporters on a press call Tuesday evening.

“The southern border is a national security disaster and a humanitarian catastrophe and Kamala Harris cannot be trusted to fix it,” he thundered.

7 House Speaker Mike Johnson (R-La.) slammed the Biden administration after a “stunning” inspector general’s report released Tuesday found nearly 300,000 migrant children have gone missing in the US. REUTERS

“And this is one of the biggest scandals in American history; it’s one of the most tragic; and we have to hold emergency hearings.”

Immigration and Customs Enforcement (ICE) “as of May 2024” failed to provide court dates to 291,000 unaccompanied children that had been released to domestic sponsors, according to the Department of Homeland Security Office of Inspector General.

Another 32,000 were released by ICE with notices to appear for immigration removal proceedings — but never showed up for their court dates, the 14-page report reveals.

7 A total of 448,820 unaccompanied children were shuttled from ICE to the Department of Health and Human Services (HHS) and then to sponsors nationwide between fiscal years 2019 and 2023. REUTERS

Just one of the eight ICE Enforcement and Removal Operations offices audited had even “attempted to locate” the missing immigrant kids — and the rate of serving them with notices to appear in immigration court at one location stood at only 16%.

A total of 448,820 unaccompanied children were shuttled from ICE to the Department of Health and Human Services (HHS) and then to sponsors nationwide between fiscal years 2019 and 2023.

HHS Secretary Xavier Becerra, amid a surge of illegal entries in 2022, pushed his staff to release the children to sponsors so quickly that he wanted the turnover to resemble an “assembly line,” according to the New York Times.

7 “The southern border is a national security disaster and a humanitarian catastrophe and Kamala Harris cannot be trusted to fix it,” Johnson said. Saquan Stimpson / CNP / SplashNews.com

Some were put in “unsafe conditions” with sponsors, but ICE officers said the agency had “limited authority to respond” — even in cases with an unaccompanied child “whose sponsor claimed the UC was in an inappropriate relationship with her husband.”

One HHS whistleblower also revealed that an agency attorney had confessed the rapid release was due to fears of being “sued for keeping them too long,” whereas there was no threat of a lawsuit “by traffickers.”

“Without an ability to monitor the location and status of UCs, ICE has no assurance UCs are safe from trafficking, exploitation, or forced labor,” the DHS inspector general’s report notes.

7 “Without an ability to monitor the location and status of UCs, ICE has no assurance UCs are safe from trafficking, exploitation, or forced labor,” the DHS inspector general’s report notes. AP

“They ended Title 42, and they made the policy choice to resettle these children with unvetted sponsors as rapidly as possible because they wanted to avoid optics about their policy,” Johnson said of the findings.

“We have no degree of certainty and no confidence at all — these innocent children who have been trafficked by cartels and all these other things — that the most unspeakable evils have not befallen them,” he added. “And that is what kept us up at night.”

The report comes after an internal DHS report earlier this month on a program flying migrants into the US found potentially massive fraud occurring among thousands of sponsors for the migrants.

7 Homeland Security Committee Chairman Mark Green (R-Tenn.) said the Biden administration was sneaking in more than a million migrants via the CBP One app. CQ-Roll Call, Inc via Getty Images

The Biden administration subsequently halted the flights program to review the applicants.

President Biden crowed to delegates and attendees at the Democratic National Convention in Chicago on Monday night that immigration was under control, with crossings at their lowest level since he took office in January 2021.

“Border encounters have dropped over 50%,” Biden said in his speech. “In fact, there are fewer border crossings today than when Donald Trump left office.”

7 President Biden crowed to delegates and attendees at the Democratic National Convention in Chicago on Monday night that immigration was under control. REUTERS

Homeland Security Committee Chairman Mark Green (R-Tenn.), who was also on the Tuesday press call, said that figure excluded since January 2023 more than a million admissions into the US via the CBP One app and the flights program bringing in 30,000 migrants per month from Cuba, Haiti, Nicaragua and Venezuela.

“It’s a shell game,” Green said. “This idea that somehow the flood of people from all over the world is diminished because of some policy from Joe Biden and Kamala Harris. It’s absolutely absurd.”

The House voted to impeach Homeland Security Secretary Alejandro Mayorkas in February for failing to enforce immigration law — but Senate Democrats voted against putting Biden’s top border official on trial.

7 The House voted to impeach Homeland Security Secretary Alejandro Mayorkas in February for failing to enforce immigration law — but Senate Democrats voted against putting him on trial. Getty Images

Johnson said Biden’s remarks were part of “the largest gas lighting operation in the history of American politics.”

“ICE is committed to the protection and well-being of children and works closely with U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR) and other federal partners to fulfill its obligations under law,” a spokesperson said in a statement. “While we concur with the Inspector General’s recommendations to improve information sharing within Immigration and Customs Enforcement (ICE) and externally with HHS, we are concerned that the report’s findings are misleading and may be misconstrued because they fail to acknowledge key facts.”

“In general, ICE does not issue Notices to Appear (NTAs) to unaccompanied children until after they have been placed with sponsors who have been vetted by HHS,” the spokesperson added. “This gives them time to get settled in their new surroundings and provides them with an opportunity to consult with legal counsel. Unaccompanied children are entitled to certain procedural protections under our laws and, in many cases, may be eligible for immigration relief with U.S. Citizenship and Immigration Services (USCIS), instead of in the immigration court system. If they are ineligible for relief, USCIS will issue an NTA.”

“Since last year, ICE has taken steps to automate information sharing related to unaccompanied children’s attendance at immigration court proceedings. We will continue to improve these procedures and implement the OIG’s recommendations,” the spokesperson also said.

The Harris campaign declined to comment.

This article appears in the December 2024 issue of The American Prospect magazine. Subscribe here.

Monday manager meeting, Spring 2023, Insight Chicago hospital, second floor. Department heads were taking turns briefing one another on the “special challenges” they were facing. A quality assurance manager from the compliance department rose to speak.

“We’re still working to locate a family member of the patient who has been in the morgue since last year …” the manager told the group, according to someone who attended the meeting.

Last year?

“We’re taking care of it,” a top hospital official interjected, silencing the gasps. End of discussion.

The corpse, internally named “John Doe,” would come up again every few Mondays. Invariably, someone would ask when it would be removed. There was never a straight answer, only the reassurances: We’re taking care of it.

In July, the compliance department finally reported that they’d found someone—no one asked who—to pick up the body.

More from Maureen Tkacik

The legend of John Doe would live on among staff, especially after the morgue’s chillers broke a few months later, causing temperatures to rise and one or two of the bodies to leak so profusely the stench spread through the basement. This warranted additional Monday updates from facilities management.

The mystery corpse wasn’t the worst or even weirdest development at the Insight Chicago hospital. But of all the exotically awful things ten former employees of Insight Health divulged to the Prospect about working there, it was the most, as the kids might say, “iconic.” Even terrible hospitals usually treat death seriously, because in-hospital deaths have a substantial impact on a hospital’s Medicare reimbursement rates and by extension its bottom line. Insight was so chaotic and dysfunctional, it couldn’t identify a dead patient; by the time it was discovered, no one who might have remembered him worked there any longer.

IN A STRETCH OF FLINT, MICHIGAN, once inhabited by a sprawling General Motors campus and now populated by an abundance of “meth heads” according to a former employee, a Pakistan-born neurosurgeon named Jawad Shah has been cobbling together a burgeoning health care empire, replete with sports medicine and rheumatology clinics, an Olympic-sized swimming pool and fitness center, a postoperative nursing home, an imaging center, a toxicology lab and specialty pharmacy, and even facilities for growing and provisioning medical marijuana.

The empire is called Insight Health, and over the past year it has embarked on an ambitious nationwide expansion, adding eight community hospitals in five states, from California to New Jersey, to its portfolio of just two hospitals and the medical mall in Flint. Most recently, Insight took over Trumbull Regional Medical Center and a sister long-term hospital called Hillside Rehabilitation in Trumbull County, Ohio.

But former employees at Insight’s acute care hospital in Chicago’s Bronzeville neighborhood, which it purchased from the Trinity Health system for all of a dollar in 2021, told the Prospect that Insight lacks the resources—both financially and managerially—to functionally operate that single facility, much less any others. Court documents filed in an array of criminal and civil disputes, coupled with the accounts of former Insight physicians and nurses, suggest that a not insubstantial portion of Insight’s revenues are derived from various forms of what has been termed in those cases as insurance fraud. And interviews with current and former Insight employees and patients in Illinois and Ohio portray an institution that falls well short of its stated commitment to patient care.

And let’s not forget John Doe.

Shah is part of a class of entrepreneurs who fly from fading rural town to postindustrial urban neighborhood promising to “save” decrepit hospitals.

In a statement to the Prospect, Insight defended its work, while not answering any specific allegations from this article. “We’ve developed a distinct approach to assuming management of troubled hospitals experiencing unique challenges that often result from years of mismanagement,” an Insight spokesperson said. “Our goal with every engagement is to make a positive difference and ensure patients have access to care that is second to none.”

Insight’s Jawad Shah is part of a class of entrepreneurs who fly from fading rural town to postindustrial urban neighborhood promising to “save” decrepit hospitals. These modern-day Music Men are perfect for the Gary, Indianas of 2024, trading in Professor Harold Hill’s bandleader outfit for blue suits and arcane knowledge about the latest obscure CMS rule revision. Invariably, the hospitals don’t have many options: 90 percent of metropolitan areas in the country have high or extreme levels of concentration in their hospital markets. But the men who promise to break that cycle often end up accelerating it, leaving new health care deserts in their wake.

Eight years ago, a pair of brothers from Miami promised to save 18 rural hospitals by building lucrative urine testing labs in their basements. The scheme raked in more than a billion dollars for the brothers, but workers didn’t get paid for nearly a year and most of the hospitals shut down for good. In 2018, a Los Angeles investor named Joel Freedman promised to “save” Philadelphia’s 139-year-old Hahnemann University Hospital and a nearby children’s hospital, only to file for bankruptcy protection the following year; the hospital was sold to a private equity firm that specializes in conversions into mixed-use commercial projects. A few months before the bankruptcy, a close friend of Freedman’s teamed up with a close friend of Barack Obama’s to “save” a failing hospital in Chicago and ended up closing it almost immediately; subsequent bankruptcy filings revealed the terms of the transaction had actually required them to close the hospital.

And of course, there’s the infamous Steward Health, which billed itself as a “savior” of a doomed system of Catholic neighborhood hospitals; instead, owner Ralph de la Torre triple-mortgaged every lab, office building, parking lot, medical device, and Medicare receivable in its possession to finance a vast portfolio of international villas, and oceanworthy yachts and private jets in which to travel to them. (De la Torre, currently under federal criminal investigation, recently launched a website to dispel “myths” about his deeds, with such explanations as “Dr. de la Torre’s compensation, even including the use of a plane, is still well below market as determined by a third-party independent compensation consultant.”)

As a result, most observers doubted there was any juice left to squeeze when Steward’s raided hospitals needed re-saving. But rather than take more write-downs on its battered portfolio, Steward’s landlord Medical Properties Trust (MPT) announced in September it had found operators to take on the unwanted leases of 15 Steward hospitals. Two of them, Quorum Health and American Healthcare Systems, had considerable pre-existing financial ties to MPT. But Insight Health seemed different.

Until early 2024, it operated just a single acute care hospital in Chicago but had received fawning media coverage from Bloomberg Businessweek, the Detroit Free Press, and especially various outposts of the Crain’s local business journals, which have published a dozen positive stories about or substantially informed by the company. Insight’s suave, cerebral founder, Shah, insisted that Insight abided by the tenets of Islamic finance and would never saddle his hospitals with the kind of debt that had doomed Steward. Perhaps most assuringly, he volunteered his services for much of the month of June to the Indonesian hospital in northern Gaza, where he saw as many as 100 patients a day and performed surgery on an average of 17 of them.

An employee at Insight’s Hillside Rehabilitation Hospital said a recent town hall meeting left the staff full of hope that the charismatic neurosurgeon would “make Hillside great again.”

“Dr. Shah is an incredible speaker, he really is. When I left the town hall I was like, ‘Holy moly, this is actually good!’ And then about an hour later I thought to myself, ‘Oh my god, they just brainwashed me!’”

× Expand Trumbull County, Ohio, commissioner Niki Frenchko has been fighting to save the local hospital in Warren.

LIKE MANY BUILDINGS IN WARREN, OHIO, the nine-story Trumbull Regional Medical Center exudes a big-city grandeur that seems slightly out of place in a town of 40,000. A skybridge connects the main hospital building to the physician offices across East Market Street. Every yard of eye-level wall space is adorned with prints commemorating exhibits at the Cleveland Museum of Art or the Metropolitan Museum in New York, or posters memorializing chapters of regional history: the nursing school whose students staffed the hospital from 1951 to 1968, the defunct local industrial giants that built automobiles and factory equipment, an artsy black-and-white print of Pittsburgh Plate Glass Plaza photographed by one of the hospital’s late internists.

In 2017, Trumbull Regional Medical Center was sold to Steward Health, and the cuts commenced. A nurse standing in the elevator bay complained to me that two elevators are down. “First they shut down peds [pediatrics], then OB, pathology, geriatric behavioral health …” she ticks off the specialties and patients lost to “Ralph’s yachts,” referring to de la Torre, who bought two.

In May 2024, Steward finally filed for bankruptcy protection, disclosing it had already spent more than $11.2 million retaining investment bankers to sell off the company’s 30 remaining hospitals. (The dollar amount would more than double.) But in late July, restructurers canceled a scheduled auction for Trumbull and two other nearby hospitals, blaming an absence of “qualified” bids. The few hundred remaining employees organized a rally, where a union leader challenged Gov. Mike DeWine to get his “ass down here and help these people.”

Within weeks, though, came a flash of hope: A group of local business leaders and physicians founded Warren City Hospital, Inc., and told local media they were putting together a bid to save Trumbull. Local county commissioner Niki Frenchko, a Republican former social worker, was relieved but skeptical. Her backyard faces the hospital’s parking lot; one of her daughters and several friends used to work there, and close family members had leaned on the behavioral health wing in times of crisis.

Like all would-be saviors in Trumbull County, the Warren City consortium first needed public handouts, and Frenchko was dismayed when the group made its formal pitch. The appointed spokesmen were two out-of-towners: an Atlanta-based consultant named Tom McNaull and an Akron-based health care attorney named Jack Diamond, whose associate claimed he was working on the project “for free” but would not disclose whether he was doing it on behalf of a client. (Diamond and McNaull did not respond to a request for comment.) Their revenue projections had been inexplicably calculated by applying a 15 percent across-the-board increase over 2019, when the hospital still had a busy maternity ward.

Most alarmingly, McNaull mentioned that the new hospital would be obligated to pay $7 million a year to Steward’s old landlord, Medical Properties Trust. Frenchko, a licensed real estate appraiser who owns ten rental properties along with a small house she purchased for $20,000 in cash, doubted whether she could sell the entire hospital complex for $7 million, much less the dubious $70 million “value” upon which the lease was based. An underwriter at a local bank estimated the hospital building would appraise somewhere between $10 and $15 million.

Six years of paying an impossible lease had left the Trumbull hospital with $25 to $30 million in deferred maintenance. (Frenchko knew as much because the state had been forced to gift the hospital a new morgue after the hospital’s chillers failed and the temperature inside shot to 90 degrees.) And even by the group’s optimistic projections, $7 million would consume almost the entirety of the hospital’s profits. A realistic plan for “saving” the hospital, Frenchko believed, might start with seeking permission from the state to declare a health care emergency, so the county could invoke eminent domain to buy the property at its fair market value.

“The reason for this failure is because [of] MPT and the lease not being affordable,” Frenchko said at a public meeting in late August. “I just don’t want to see this kind of situation where you’re throwing good money after bad, [using] the county’s money to prolong the inevitable.”

“You’re absolutely wrong, you’re misinformed, and if you’re going to be Negative Nancy over here, there is the door,” interjected Denny Malloy, another county commissioner who said he had worked for 16 hours straight the day earlier hammering out the details. “You can put all of the trash out of your mouth that you want,” he went on. “We’re here to be positive.”

Insight’s Jawad Shah has said that he wanted to transform Flint, Michigan, into “the next medical Silicon Valley.”

After a local news station covered the controversy, the hospital president sent a message to her contacts in the health group, warning them that asking too many questions or speaking to the media could lead to “bad press” and jeopardize the hospital’s survival. But MPT had been the subject of bad press nationwide that month, after the Steward estate had sued the REIT for sabotaging its attempts to sell off its hospitals by forcing bidders to accept the same “burdensome, significantly above-market and inflated leases” that had “crippled [Steward’s] operations for years.”

There was not much Frenchko, a lame duck whose own party successfully primaried her last spring and who was generally regarded as a “troublemaker,” could do. She wrote letters and emails and gave local news interviews, but she kept hearing information about the hospital that was not given to her directly. When she finally lined up a meeting with the state attorney general’s office and delivered her spiel on how much Steward and MPT had, in her words, “stolen” from the community, the staffer literally asked if she’d filed a police report.

And so she was dumbfounded when, on the morning of Tuesday, September 10, she received an email in her in-box from Dayne Walling, director of public policy and government relations for something called Insight Health Group. “We are getting into a position of stepping in with hospital management,” he wrote. “We have been extremely impressed by the city and county commitment to saving the hospital.”

Walling, a Rhodes scholar who served as Flint’s mayor during its lead poisoning scandal, told Frenchko that he and Insight’s founder Jawad Shah had flown in to tour the hospital over the weekend in Dr. Shah’s BAE-800 business jet, and MPT had decided to hand them the proverbial keys at midnight on September 11. Articulate and refreshingly non-condescending, Walling cut an impressive figure, but Frenchko was full of questions. What exactly was Insight? What had happened to Jack Diamond?

She wasn’t the only one who felt blindsided. A Florida investor and onetime resident at the Warren hospital named Benjamin Yates soon approached her to complain that he had been working with Warren City Hospital, Inc., since mid-July to—successfully, he claims—procure $30 million in loans to back a bid, only to find himself ghosted by everyone involved in the project. Yates told the Prospect that the group used his financing proof of funds documentation to stave off a planned closure of the hospital in July, only to drop him from the discussion when Insight stepped in. He added that the Trumbull hospital had reported healthy profits before it began slashing services in 2023.

Yates said he would have reopened Trumbull’s dormant maternity ward, along with a section of a massive shuttered hospital just south of Warren in Youngstown. But after Insight came along, MPT began trying to convince him to bid on another property that already had a bidder. (MPT did not comment.) Warren City Hospital, Inc., for its part, claims on its website to have disbanded because “Insight Health Care emerged with goals similar to ours.”

Yet one month into the Insight takeover, dozens of longtime employees had been terminated, the hospital’s dwindling supply of toilet paper had just about run out, and three patients had died in as many weeks, an unusually high number for a facility with 40 patients at most. Employees alleged that a post-op cardiac patient in his sixties had a heart attack in the service elevator after being taken off his morphine drip to go downstairs for an MRI. A 26-year-old psych patient was discovered by a fellow patient after dying from an apparent aneurysm. And a patient in her seventies scheduled to undergo surgery apparently died shortly after an EMT wheeled her into her pre-op room, according to an employee who discovered her body. Ohio regulators asked about the deaths told the Prospect to check inspection records, but none were available.

“I wanted this place to stay open so bad, but not if we’re not committed to giving the best care,” an employee told the Prospect. “It seems like everyone’s just given up.”

× Expand Mark Bugnaski/AP Photo A Michigan law requiring auto insurance policies to cover medical expenses for car accidents has created opportunities for fraud.

IN PUBLIC, INSIGHT PRESENTS ITSELF as a model corporate citizen and a driving force behind the revitalization of Flint, which Dr. Shah has told the local newspaper he wanted to transform into “the next medical ‘Silicon Valley.’” City leaders bought into the hype. “When people hear Flint … before the water crisis, they thought of Roger & Me. You know, then they think of the water crisis … [Insight has] given them something else to think about,” said former Flint mayor Karen Weaver at a hearing about Insight’s acquisition of the Chicago hospital in 2021. “I cannot say enough about what they have done for this community.”

But a former Insight hospital administrator says matter-of-factly: “Dollar signs are what Insight sees. They do not know how to run a hospital, and they don’t care that they don’t know.”

Insight was incorporated in 2008 as the Insight Institute for Neurosurgery and Neuroscience (IINN) by Shah and Amer Iqbal, childhood friends who grew up in Winnipeg, Canada, and reunited in Flint after the former completed his residency and married a local immigration attorney. A 2010 newspaper story announcing the institute’s official launch mentions its plan to “invest $18 million” to expand the company into a “world class research incubator,” but the launch of IINN largely amounted to renaming Shah’s medical practice and moving it into a gargantuan building in a blighted section of town, which qualified for special tax breaks. Detroit-area real estate was so depressed that year that Shah told Crain’s Detroit Business he purchased some 600,000 square feet of Class A office space for less than $200,000 cash.

When the water poisoning crisis struck a few years later, Shah bought the campus of a shuttered vocational school and opened a food pantry that distributed free bottled water. By 2018, the effort had blossomed into the Sylvester Broome Empowerment Village, an ambitious community center that touts on its website free classes in everything from journalism to violin to skateboarding, though only four programs are currently listed on its registration app and all are wait-listed. In 2022, the most recent year for which figures are available, Sylvester Broome spent $2.1 million on its various programs, though roughly half of that budget was spent on “management fees” and “occupancy fees,” suggesting the charity may be empowering Insight and other affiliated entities as much as anyone else. (Sylvester Broome didn’t respond to a request for comment.)

By 2011, a former administrator claimed in a whistleblower lawsuit that the Insight Institute had been systematically upcoding and double-billing the Centers for Medicare & Medicaid Services for years. The claim alleged that an administrator had collected a folder “more than an inch thick” of documented overpayments that Iqbal had warned not to bring up in company meetings. The Justice Department declined to intervene in the lawsuit, which was just seven pages long, and the whistleblower dismissed it voluntarily.

But two former employees of Insight’s emergency room in Chicago told the Prospect they were regularly pressured to admit Medicare patients to the hospital who did not need inpatient care, using vague diagnosis codes like “failure to thrive” that had no connection to their symptoms. Separately, a former Insight neurologist named Shanele Vaughn alleged in a lawsuit last December that another unnamed physician had been filling up the operating room schedule with surgeries she viewed as unnecessary. (Vaughn refused to comment on her case to the Prospect.) Another physician told the Prospect that certain Insight-affiliated specialists troll nearby nursing homes for patients on whom they might perform lucrative but unnecessary procedures, “like stripping the varicose veins of a patient with kidney failure.” An Ohio clinician told the Prospect in early November that a new patient had said she’d been “recruited” from her nursing home by Insight to come to the hospital.

In Ohio, a 72-year-old heart patient named Linda Cool told the Prospect Insight had “held [her] hostage” for ten days in October and November after her physicians had told her she’d been cleared to return home. First, she says, a nurse explained that they needed approval from Medicare to order a portable ventilator; then they wanted to test her liver function. “But no one could tell me who ordered the liver test,” Cool said, “and I later learned from Medicare that the home ventilator they wanted cost $5,000 a month and they would never approve it without a sleep study first, which no one was asking to do.” Cool says the nurse then gave her a choice: stay in the hospital, get transferred to a rehab facility, or discharge herself but pay the bill in cash. “That’s when I had a little fit and told them I was going to call the evening news,” she says. She was discharged.

Former employees say Insight used unethical and highly unusual means to increase elective surgeries at the Chicago hospital.

Back home in Michigan, Insight has been accused of other schemes. State law requires drivers to buy auto insurance policies that cover virtually limitless medical expenses of anyone injured in a car accident, regardless of who caused it. Personal injury lawyers and individual drivers have long exploited those laws to extract windfall payments from car insurers, but a 2014 law banning attorneys from soliciting clients in the 30 days after a collision placed doctors at the center of the ecosystem.

“Michigan has built a big fraud industry around no-fault medical benefits,” a personal injury lawyer in the state told the Prospect. “Lots of people run bullshit chiropractors, physical therapy, MRI places, that basically only provide fraudulent treatment to auto patients. They pay ‘marketers’ to listen to police scanners for car crashes, recruit patients at the accident scene, and pay the ‘patients’ to attend treatment. Some of them are vertically integrated with the personal injury lawyers, where a lawyer secretly owns the MRI place or physical therapy practice through a friend or relative. I know people in Detroit that pay $700 a month for minimum coverage auto insurance, because the insurers just pass the cost on to drivers in low-income areas.”

Shah leaned into the new law, filing hundreds of lawsuits against auto insurers that denied coverage for certain procedures, while casting himself in the press as a Robin Hood figure standing up to greedy insurance companies by treating patients on contingency. He sued the state over reforms the legislature passed to rein in the system’s abuse, and in 2018 he acquired a suburban Detroit surgery center with a robust auto accident business. Insight physicians or the company itself have filed or otherwise become involved in hundreds of lawsuits against insurance companies in Genesee, Macomb, and Oakland Counties in the decade since the state law originally passed, while Shah has personally filed more than 100 cases in those three counties.

In 2022, Allstate filed a civil racketeering lawsuit accusing Insight’s suburban Detroit surgery center of recruiting some of the most dubious doctors in the state, creating a kind of assembly line to exploit the auto insurance rules. There was Sam Hakki, who’d used two separate fake names to conceal his ownership stake in a urine testing clinic to which he was unnecessarily referring patients, as well as “conceal[ing] that he had pending disciplinary actions in other states”; David Jankowski, who is serving a 20-year sentence for using oxycodone prescriptions to lure drug addicts into participating in his elaborate $35 million insurance fraud scheme; Syed Moosavi, who had been under investigation by the state medical board for being one of Macomb County’s top five prescribers of commonly diverted controlled substances; and various affiliates of a clinic that got its patients from a lawyer who pled guilty in 2020 to stealing crash reports from the Detroit Police Department. The case was settled in September.

Shah also had a 25 percent stake and a board seat at Pontiac General Hospital, about a half-hour west of Flint. In 2022, Allstate had filed a similar racketeering lawsuit against Pontiac and a group of doctors, including a business partner of Jankowski’s, allegedly operating a parallel scheme there with a shocking twist: In addition to recruiting patients under false pretenses, the hospital’s residency program was also recruiting unqualified medical students who’d failed to match into other programs to train at the hospital in exchange for “donations” that totaled $400,000 for one student who applied. That case is ongoing, but one of the doctors who had to pay to be admitted to residency successfully sued Pontiac General. Shah’s name was never in the flurry of headlines, despite being a part owner.

Separately, a 2021 lawsuit filed by Genesis Alternative Finance, a shadow bank that apparently offers specialized “no fault” lending facilities for medical providers in Michigan, claimed that Insight had “deliberately withheld” settlement funds it had received from auto insurers to the tune of an unspecified amount over $75,000. The lawsuit was settled out of court a few months after it was filed.

The business model was a success, at any rate: After losing nearly $3 million in the year before it was acquired, Insight’s 20-bed surgery center in Warren, Michigan, generated some $13 million in management fees between 2019 and 2023, according to the hospital’s cost reports.

Insight might have stayed in that business but for the pandemic, which caused elective surgery volume to plunge and rained public funds on acute care hospitals. Early in the first COVID-19 surge, Shah brokered a deal with Steward landlord MPT and Wayne County to reopen a shuttered rehab hospital in the Detroit suburbs as an overflow facility. A photographer who specializes in exploring Detroit’s long-vacant commercial real estate told the Prospect that the hospital shut in early 2022; the Insight crew appears to have abruptly abandoned the property, leaving behind seemingly all of the hospital’s furniture and supplies, boxes full of personal protective equipment, even wastebaskets that remained full of trash earlier this year when he returned to film a video.

By then, Shah had become consumed with a more ambitious project.

× Expand ZOL87/WIKMEDIA COMMONS CCBY Chicago’s oldest hospital, in the city’s Bronzeville neighborhood, was taken over by Insight in 2021.

CHICAGO’S OLDEST HOSPITAL SITS in the city’s Fourth Ward, between the gleaming downtown Loop and the northernmost edge of South Side, far enough from the center to have survived the Great Fire of 1871, close (and old) enough to have treated its victims. “No other ward sees such wealth and such poverty in such proximity,” the Chicago historian David Fremon wrote in 1988.

Inequality may be great for restaurants and nail salons, but for hospital finances it has generally proven ruinous, because Medicaid recipients and uninsured people are inevitably far heavier users of hospital services than the luxury condo dwellers. By the pandemic year of 2020, the hospital’s owner, suburban Detroit-based Trinity Health, said it was losing $4 million a month and would need to shut down unless the state stepped in.

A coalition of physicians and activists protested the closure and looked for new owners. A local Allstate insurance franchisee and state representative named Lamont Robinson emerged to broker talks between the Health Equity group and Trinity; the group was close to a deal to be acquired by another hospital on the northwest edge of town. But in March 2021, the advocacy group learned in a meeting with Gov. JB Pritzker’s staff that Trinity had decided to sell the hospital for $1 to Insight, a company no one in the room had ever heard of.

The ward alderman, Sophia King, who had organized many of the advocacy group’s meetings, was blindsided, and said as much in a hearing that month to discuss the sale. “I am curious why this meeting was called with such haste. I had to have the lobbyist for Insight inform me about it. Unfortunately, Insight and their team would not share much else with me,” she said, continuing that she wasn’t sure how “managing a 20-bed hospital for orthopedics and neurosurgery … translates into running a 400-bed hospital.” She pointed out that Insight had refused to agree to offer a seat on the hospital’s board to a member of the coalition, on grounds that they hadn’t done enough due diligence. “Well, that’s exactly how I feel here. It would be irresponsible for us to allow Insight to proceed without more due diligence.”

But proceed they did, and when King resigned from the alderman post to mount an ultimately unsuccessful mayoral bid, Robinson ran for her seat on the city council and won handily; Insight executives Atif Bawahab and Nadir Ijaz were two of the five biggest individual donors to his campaign. Neither Robinson nor the area’s current state representative responded to a request for comment, though an anonymous tipster phoned the Prospect within an hour of our emailing certain local officials to advise that the hospital had retained a powerful lobbyist named Victor Reyes, who most recently made news for his appearance on a list of two dozen favored “magic lobbyists” presented as evidence in the corruption trial of former Illinois House Speaker Mike Madigan.

“What kind of hospital doesn’t have a maintenance budget?” asked a facilities consultant who worked on-site in Chicago.

Insight’s pitch made a certain kind of theoretical sense. The hospital needed to jump-start its volume of elective surgeries in order to offset losses from unprofitable specialties, and Insight was an elective surgery powerhouse. But ten former physicians and other employees, some of whom were fired and some who left voluntarily, say Insight used highly unusual means to this end.

Four former employees independently named one doctor who instructed his assistant to scour the emergency department waiting room and book consultations with any patient who complained of back or neck pain. Separately, two former physicians and an administrator claimed that the hospital’s chief medical officer had performed hysterectomies on patients despite lacking board certification in obstetrics/gynecology. (This certification is not technically needed, though it’s unusual to practice without one.) Earlier this year, two of the hospital’s busiest pain physicians opened a handsomely appointed new practice on the 12th floor, where one administrator says both regularly see as many as 30 patients per day. One clinician told the Prospect about a new patient who burst into the hallway one afternoon and shouted, “Why am I waiting here? [The doctor] keeps saying I need to get presurgical clearance because my legs are weak but look!” (The patient began doing squats and jumping up and down in the hallway.) “My legs work fine! And this guy is telling me my legs don’t work!”

Insight deployed unusual work-arounds to convince insurers to pay for questionable procedures, according to four former employees. Two former Insight physicians said that surgeons sometimes scheduled procedures in the emergency room in order to bypass prior authorization requirements, and a former administrator said specialists would sometimes scrub the results of tests and imaging, or the notes of other physicians, from patients’ medical records before they submitted them to insurers.

Meanwhile, outside the operating room, the Chicago hospital continued to deteriorate, employees say. A clinic that had been located in the building’s basement was forced to move upstairs due to a rat infestation. The hospital ran out of wheelchairs and lacked the funds to buy new ones; elevators are consistently out of service. A representative of one of Insight’s long-unpaid suppliers showed up in the ER one day and began repossessing all of the curtains separating the patient care areas; they were forced to make do with curtains borrowed from the old pediatric wing.

But Insight adamantly refused to refer ambulances to other hospitals, even when staffing and supply shortages and equipment malfunctions meant they couldn’t realistically treat patients, according to two physicians who no longer work at the hospital.

Despite prior promises, the only substantial renovation employees say Insight undertook entailed spending lavishly to convert the hospital’s old chapel into a miniature mosque to accommodate the prayer requirements of the company’s pious top brass and the expensively dressed foreigners who periodically flew in for investor meetings. This created something of a culture clash at the hospital. (“It’s absolutely beautiful,” a former administrator said of the prayer room. “But … there just aren’t many Muslims in this neighborhood.”)

“They didn’t want to fix anything,” said a health care facilities consultant who worked on-site at the hospital briefly in 2023. “They have 12 floors of hospital and only five of them were at code. The air handlers, the boilers, the soft water systems are all shot. Chunks of ceilings are falling on patients’ heads, climate control is nonexistent, and when it rains the 12th floor is like a sieve. But they didn’t want to hear it; anything I told them to fix [an Insight official] would say, ‘That’s not in the budget.’ Finally I asked, ‘What is your budget?’ And he said they didn’t have one. What kind of hospital doesn’t have a maintenance budget?”

After two months of begging to bring the hospital into compliance with the health code, the facilities consultant asked his company to put him on another account. “If I stay here a minute longer this place will destroy my reputation,” he remembered saying. His company did not object; according to the consultant, Insight had been late to pay three invoices and they weren’t sure how much more of its business they wanted.

And then there was John Doe, the unidentified man whose body turned up in the morgue, according to six former employees. The body’s provenance was a mystery; everyone assumed it was a homeless gentleman who had come to the emergency room and been treated by one or two of the countless clinicians who had quit or been fired since Insight had taken possession of the hospital.

Insight refused to respond specifically to any of the allegations about which the Prospect inquired regarding the Chicago hospital or anywhere else, but a spokesman advised in an email that our questions contained “numerous inaccuracies and falsehoods in these accusations that misrepresent Insight’s positive impact on these facilities and the communities they serve—including Insight Chicago, where we not only kept the hospital’s doors open three years ago, but have since reestablished its emergency department, expanded service offerings and implemented youth engagement and empowerment programs to promote health and wellbeing in the community.”

As the months wore on, employees say, Insight increasingly imported executives and administrators from Flint, many of them in their twenties and early thirties, and fired local hospital veterans who had pushed back against the company’s practices. “[Insight] doesn’t care how much experience anyone has, because if you know how to run a business you can run a radiology department, or an operating room,” said a former administrator with Insight Chicago. “But there is a lot more than that to running a hospital.”

Insight also imported other “friends” to the hospital, albeit not to fill jobs but to fill beds on the old labor and delivery floor, which Trinity had shut down in 2019. “People were living on the second and third floors, and at night they would walk the halls and sometimes even walk into patients’ rooms,” said a former employee of the emergency room, whose account was corroborated by three other employees. Most of them were seemingly recent émigrés to the country who only stayed for a week or two, but one bachelor who’d hauled a queen-sized bed and mini-fridge into his room appeared to live there for several months.

Nurses, surgical techs, and doctors said they repeatedly called federal and state regulatory agencies, officials, and the office of the new alderman, Robinson, to report the weird goings-on and deteriorating conditions within the Insight hospital. “They just did not want to hear it,” said a former employee who says they contacted numerous officials about the hospital.

Documents released to the Prospect in a Freedom of Information Act request filed with the Illinois Department of Public Health show that CMS inspectors have investigated at least fourteen complaints into the Insight Chicago hospital since Insight assumed leadership in mid-2021. Those complaints alleged violations of health and safety codes, deficient emergency room operations, and patients rejected from receiving care. One 2022 survey found that seven of eleven sexual assault victims over a six-month period had been sent home without medical forensic services, because Insight either lacked the supplies or the staff to perform rape kits.

At one point in early spring 2023, inspectors following up on an incident in the behavioral health unit determined that the hospital had placed the lives of patients in “Immediate Jeopardy,” a status that can lead to the loss of a hospital’s Medicare billing privileges. The designation was removed following a follow-up inspection that April.

In July, complaints involving ER staff turning away patients with serious injuries (including atrial fibrillation and gastrointestinal bleeding) alleged potential noncompliance with the Emergency Medical Treatment and Active Labor Act, which requires acute care hospitals to treat all patients at the ER regardless of their insurance status.

The most recent financial statements available for the Chicago hospital are from the 2022 tax year, during which it reported booking $103 million in revenue and $110 million in expenses. But for the Insight corporate empire, the year was a success: Its IMCS staffing subsidiary collected $12.7 million in management fees from the facility, according to the hospital’s official cost reports.

Notably, that year the hospital also added a $19.75 million liability described as a “secured mortgage and notes payable to unrelated third parties” to its balance sheet, though Cook County records list no mortgages on the property. A search with the county treasurer’s department suggests Insight has not paid real estate taxes on the property since taking it over in 2021, and currently owes the county more than $10.3 million in property and assessment taxes.

MEANWHILE IN FLINT, INSIGHT EXECUTED a strategy of growth through acquisitions. In 2023, it bought a shuttered 49-bed hospital in tiny Keokuk, Iowa, a town of about 9,000 with a median household income of barely more than $30,000. The hospital had suffered from extremely low emergency room traffic and an estimated $20 million in debt due to facility upgrades; its owner had closed it just over a year after acquiring it from a previous owner. Insight’s business plan involved converting the facility to a Rural Emergency Hospital, a new CMS designation that boosts reimbursement to small-town hospitals that exclusively operate ERs. Insight is rumored to have this in mind for the Trumbull hospital. (Benjamin Yates, the investor who put together a competing offer for the hospital, said the designation is “highly inappropriate for a hospital like Trumbull.”)

In 2024, Insight brokered deals to take over similar small-town hospitals in central California and southern Michigan. And in April, the company was reported to have assumed operations of the notorious for-profit CarePoint Health system in New Jersey, a three-hospital chain that made headlines in 2016 for charging $9,000 to bandage a wound that did not require stitches. A state investigation revealed in 2019 that the previous ownership had received $157 million in “management fees” from the facilities over a four-year period. By the time Insight appeared, the hospitals were ghost towns with ERs attached to them, bereft of basic supplies and reliant on an $8 million-a-month bailout from the state of New Jersey to make payroll.

As with the Steward hospitals, staffers at CarePoint were initially elated to be welcoming new management, assuming nothing could be worse. But something about the New Jersey assignment did not agree with Dr. Shah, who abruptly resigned as CarePoint’s CEO on October 28 following a tense board meeting the night earlier in which he’d clashed with the mayors of Hoboken and Jersey City, the latter of whose super PAC had been the recipient of a $1 million donation from CarePoint’s founder in 2016. Two days later, yet another savior had swooped in to save the hospitals: Hudson Regional Hospital of nearby Secaucus, whose CEO Yan Moshe—a six-figure donor to Jersey City Mayor Steven Fulop’s super PAC—had been attempting to merge his hospital into the CarePoint empire for years. Yet when CarePoint filed for Chapter 11 bankruptcy protection in Delaware on November 4, it maintained in its first-day motions that Insight was still the manager of the Hoboken and Jersey City hospitals.

It’s a shame Moshe and Shah couldn’t work out a deal: The two appear to have much in common. Like Shah, Moshe comes to the hospital business from a career spent in surgery centers; also like Shah, Moshe and his companies have been named in multiple lawsuits in which auto insurers allege he defrauded them of millions by referring patients who weren’t really injured for unnecessary procedures they sometimes did not even undergo. But in 2022, when the police visited Moshe’s hospital after someone called in a bomb threat, a bomb-sniffing dog led them to an unlocked closet containing 39 guns, including an assault rifle. They were apparently being stockpiled by the marketing guy, but a police report revealed that Moshe admitted he knew they were there. Why? The Hudson County prosecutor dropped the charges against the marketing guy last year without a plausible explanation. Moshe did not respond to a request for comment.

But if one day a harried hospital clinician rifling through supply closets for toilet paper or IV tubing instead finds a stockpile of guns and does something unwise, don’t say we didn’t warn you.

In a small southern Illinois town earlier this year, a 58-year-old employee at the Choate Mental Health and Developmental Center was accused of sexually assaulting a person with a “severe or profound intellectual disability.”

The victim, who was unable to give consent, was only identified in court records with the initials “E.K.” and the alleged assailant was later identified as a mental health technician at the 270-bed, state-run home who also was accused of a separate sexual assault of a girl under 13.

The shocking charges against Charles Mills this March were the latest in a string of scandals at Choate, a home in downstate Anna for people with developmental disabilities and mental illnesses, though few significant reforms at the home had been taken.

But on the same day Mills was charged, Gov. J.B. Pritzker’s chief counsel sent an email to the governor with the subject line: “choate — privileged and confidential,” emails obtained by the Chicago Tribune through a public records request show. A few months later, Pritzker administration officials finally announced increased training and staffing at Choate, in addition to outside monitoring and the installation of new cameras to monitor conditions there.

Administration officials have refused to detail the contents of the email sent to Pritzker or the single-line reply he also sent to other top aides. But critics say the reaction from the governor and his administration was too little too late.

While problems at the Illinois Department of Human Services facility had existed for years, employees at Choate have been charged 14 times since Pritzker became governor. The accusations have included employees abusing residents, obstructing investigations or participating in other misconduct. The state’s watchdog cited dozens of other incidents of abuse and neglect in the same timespan.

The ongoing problems at Choate also raise questions about the Pritzker administration’s oversight of social service agencies in general during his first term in office as he runs for reelection against GOP nominee Darren Bailey.

The state auditor general has blamed Pritzker’s Public Health Department for failing to adequately respond to a COVID-19 outbreak at a state home for veterans that led to the deaths of 36 residents. And child-welfare advocates have repeatedly hammered the administration’s oversight of the Department of Children and Family Services that resulted in a judge ordering Pritzker’s hand-picked DCFS director to be held in contempt of court a dozen times for failing to find appropriate placements for children.

“I have to lay it at the feet of the governor because the buck stops with him,” state Sen. Terri Bryant of Murphysboro said of the incidents at Choate, which is just west of her district. The Republican minority spokesperson for the Senate’s Committee on Behavioral and Mental Health added: “The things that are a priority, you put all hands on deck.”

The criminal charges at Choate have ranged from residents being beaten to a resident being forced to drink a cup of hot sauce to employees not reporting abuse, as well as obstruction of investigations or lying to state police. A recent joint investigation by ProPublica, Capitol News Illinois and Lee Enterprises found state police have launched at least 40 criminal investigations over the past decade into alleged employee misconduct at Choate.

Illinois state Sen. Terri Bryant, R-Murphysboro, on the floor of the Illinois Senate at the Illinois State Capitol in Springfield on Sept. 13, 2021. Bryant’s district is just west of the Choate Mental Health and Developmental Center.

Since Pritzker took office in 2019, the inspector general for the Human Services Department has issued 41 reports substantiating other troubling incidents of abuse and neglect, including one employee punching a resident so hard it broke the resident’s ribs, another employee grabbing a resident by the throat and slamming that person to the ground, and yet another employee threatening to smother a resident with a pillow if the resident failed to stop talking.

Officials with Pritzker’s administration say the problems at Choate are long-standing and are taking time to address while also laying blame on the previous Republican administration for budget cuts to social services.

“Any allegation of abuse or neglect is taken seriously and thoroughly investigated working in close partnership with the IDHS office of inspector general, the Illinois State Police and the Illinois Department of Public Health,” Pritzker spokesperson Jordan Abudayyeh said in an emailed statement. “As we work to ensure the safety of those who reside at Choate, continuing to address these deeply entrenched challenges and make positive steps forward is a top priority for this administration.”

But some advocates for people with developmental disabilities question whether Pritzker’s reforms are enough and why Choate continues to operate. Experts who’ve studied and monitored residential services in Illinois and nationally say harmful conditions can flourish in large, state-run homes for people with developmental disabilities — of which Choate is one of seven in Illinois. Federally funded research shows 16 other states and the District of Columbia had “closed, downsized, privatized or converted” all of their similar facilities as of 2018.

“Look at your neighbors in Michigan and in Indiana. They’re serving the same people with the same characteristics” in smaller settings, said Steven Eidelman, a professor of human services policy at the University of Delaware and past president of the American Association on Intellectual and Developmental Disabilities. “We know how to do this.”

Indeed, one group of experts called for Choate’s closure years ago.

Following a damning 2005 report from the independent advocacy group Equip for Equality that called for the center’s closure, the U.S. Department of Justice found Choate had failed to provide its residents with adequate protection from harm, had a “critical lack of oversight and supervision” and “substantial underreporting of incidents.” The DOJ later declined to intervene because, by 2013, Illinois had “significantly expanded its commitment to community-based services.”

By then, Gov. Pat Quinn had set out to scale back the state’s network of such facilities — closing one in 2012 and planning to close others before organized family groups pushed back. His successor, Gov. Bruce Rauner, kept open the next state home slated to be shuttered, then engaged in a yearslong budget battle that left the state’s social service agencies tattered.

While serious issues at group homes can be found systemwide, some of the problems at Choate are acute — and since Pritzker has taken office his administration has been made aware of them.

Among those who rang alarm bells was Barry Smoot, a former security chief at Choate who emailed the head of IDHS with an urgent message in late May 2021.

“What I am presently seeing occur at Choate and hearing occur at other facilities concerns me more than it has my entire career in relation to the safety of the vulnerable populations that we serve,” he wrote to IDHS Secretary Grace Hou.

Smoot had worked for IDHS for decades, including as the statewide training coordinator for the office’s inspector general and as head of security at the Chester Mental Health Center. In the email, he requested an in-person meeting with Hou to “discuss possible solutions that will greatly reduce instances of abuse and neglect.”

A Pritzker appointee to the role, Hou was formerly IDHS assistant secretary between 2003 and 2012, when both the Equip for Equality and DOJ reports landed. Hou replied to Smoot within hours, offering a meeting with her chief of staff and the director of the division that oversees state-operated developmental centers, known as SODCs.

IDHS Secretary Grace Hou speaks alongside Gov. J.B. Pritzker during a news conference in Chicago on Sept. 14, 2022.

But seven months later, on his last day of work with the state in December 2021, Smoot wrote again to tell Hou no one in her office had ever reached out or met with him about the issues he raised in his earlier email.

Earlier this month, IDHS spokesperson Marisa Kollias said in a statement that the agency had “determined, based on information gathered after the Secretary’s message was sent to Mr. Smoot, that it was inadvisable for IDHS management staff to communicate with him any further.”

Kollias added that Smoot was in regular contact with other leaders at IDHS and “had several other avenues to raise any concerns,” including with state police and the watchdog that oversees executive offices across the state. Smoot told the Tribune he wrote to Hou directly because going up IDHS’ chain of command had been unsuccessful.

Kollias declined to elaborate on the department’s decision to not meet with Smoot. IDHS personnel records do not indicate any reprimands. He is named among multiple defendants in a pending civil suit brought by a former Chester resident alleging that Smoot “turned a blind eye” to a culture of intimidation, harassment and retaliation.

Smoot has denied any wrongdoing and said during his years of service he had “a history of showing that I didn’t cover anything up … I did everything by the book and what was required.”

This March, Smoot self-published a book titled “Failure to Protect,” which detailed a code of silence at Choate and scant reporting of abuse and intimidation. In an email to officials in the governor’s office, an official from the state Guardianship and Advocacy Commission said Smoot’s accounts “jive with” many of the reports released by the Illinois Human Rights Authority. The GAC provides legal representation and guardianship to those with disabilities and investigates complaints of rights violations.

Bryant, the state senator from Murphysboro, also reached out to IDHS leadership after hearing a resident had been beaten by an employee with a belt and that the incident had been seen through a window from outside. The employee, Kevin Jackson, was one of five Choate employees arrested in October 2020.

“When I first brought this to (IDHS’) attention, I believed that they were doing something about it,” Bryant, a former Department of Corrections employee who knows two families with adult children at Choate, told the Tribune.

She later learned that paper was placed over the upstairs windows. After driving to Choate to confirm it, Bryant called an IDHS legislative liaison “and said, ‘I think you guys need to check this out.’ He called back and said, ‘That’s not the case.’ I said, ‘I’m sitting outside the facility, the paper’s on the windows.’ “

Bryant said she was taken aback by the denial, and the presence of the paper at all. “Their response to someone saying I’m standing outside and seeing someone getting whipped with a belt is to put butcher paper over the windows,” she said.

IDHS said the paper was put up for residents’ privacy after curtains were damaged and removed. “When the use of paper was brought to the attention of Choate administration, it was investigated, removed and new window fixtures were purchased and put in place,” Kollias said.

Three top administrators at the facility were later charged with official misconduct and interfering in a state police investigation of the alleged belt beating. Bryant and others in Springfield pushed publicly to have the accused administrators fired or placed on leave until the allegations were fully investigated. State officials later opted to reassign them. Charges against all three were later dropped, though the Union County state’s attorney has left the door open to recharging them.

Dozens of heavily redacted communications obtained through an open records request show several people in the governor’s immediate orbit were aware of those arrests and other issues dating back to January 2020.

Sol Flores, Pritzker’s deputy governor for Human Services, approved hiring a replacement interim director at Choate after the accused administrators were reassigned, emails show.

Flores also was sent at least 20 e-newsletters from a disability industry insider with blaring headlines about the facility last year. The author of those newsletters, Ed McManus, has a daughter with a disability and works as a consultant for disability agencies, law firms and families. A former Chicago Tribune editor and reporter who later worked at DCFS and IDHS, McManus began sharing details of the criminal cases with clients and others in March 2021.

Though he applauds the reforms, McManus was disappointed they took so long.

“I found out about this in March of last year,” he told the Tribune in July. “They never lifted a finger — to my knowledge, at least they certainly didn’t make it public — to do anything about it.”

Pritzker’s office said the June memo announcing interventions at Choate “documented several years of reviews and work,” and that “robust internal policy improvements are ongoing,” including training and administrative oversight.

The governor’s general counsel, Ann Spillane, was in frequent contact with IDHS attorneys about Choate dating back to at least October 2020. Emails indicate she was kept apprised of legal developments surrounding the administrators’ arrests, policies around facility leadership access to investigatory files and a separate whistleblower suit.

Spillane’s monitoring was not unusual, a Pritzker spokesperson said. She oversees the attorneys at all executive agencies and is “regularly updated on all legal matters throughout agencies and works closely” with other attorneys “to respond to critical issues.”

Media questions about Charles Mills’ employment at Choate made their way to Flores and Pritzker’s communications staff and soon thereafter Spillane, her deputy and IDHS counsel John Schomberg drafted the “email to the governor to give him some background,” titled “choate — privileged and confidential.”

Pritzker’s spokesperson declined to say whether that email was the first time the governor was made aware of issues at Choate.

She similarly did not disclose the nature of the other redacted discussions, saying they contain attorney-client privileged discussions, and that it is “important to ensure staff can freely express opinions and make recommendations.”

Mills, who was charged two years after he allegedly orally penetrated “E.K.” in 2020, is scheduled to go on trial later this year. He’s pleaded not guilty.

The changes at Choate that Hou and IDHS announced in June included independent monitoring from Equip for Equality, increasing security staff by four positions, boosting afterhours staffing and monitoring from regional developmental center personnel, and temporarily assigning a psychologist “to provide staff support.”

They also announced they would install 10 cameras at the facility, which advocates and the GAC had sought. In addition, the IDHS inspector general repeatedly recommended cameras be installed at Choate between 2015 and 2021, according to the ProPublica investigation.

Aside from helping to quickly rule out false allegations, cameras can serve as eyes and ears for residents who could not advocate for themselves, some advocates argue. Of Choate’s roughly 230 current residents, 10% are nonverbal.

Four months after the June announcements, however, cameras have yet to be installed at Choate. A contract to buy them “is being finalized,” IDHS’ Kollias said, and they will be put “in public locations where there is a low, or no reasonable expectation for privacy.”

Specifically, the cameras will be placed outside, which critics like Smoot say defeats their purpose. While cameras can’t catch everything, the critics say surveillance of hallways and common areas in other state-run residential facilities has improved the quality and speed of some investigations.

But some parents and guardians have pushed back on installing them at all. Liz Gersbacher, a guardian of two Choate residents, said it is debatable whether cameras deter abuse and could make the facility feel less like a home to residents.

Beyond cameras and extra security, experts and advocates say, the Pritzker administration has not addressed the larger problem of whether the state continues investing in Choate and places like it. Pritzker has faced criticism for not fully funding disability services in past budgets, and the state remains under a federal consent decree that seeks to make community services more accessible to those with disabilities.

It’s “disappointing” many of the problematic conditions Equip for Equality and the Justice Department identified more than a decade ago still exist, Equip’s Program Vice President Stacey Aschemann told the Tribune. That includes a lack of adequate programming and resident engagement as well as psychiatric and psychological treatment. Creating long-term improvement is “going to require a lot of attention by the state to get things where they need to be,” she said.

As part of the Choate reforms, the Illinois Crisis Prevention Network has been brought in to train staff on topics such as de-escalation, and to counsel residents who want to successfully transition into a smaller community home.

But there often isn’t enough capacity, according to Caitlin Crabb, a researcher with the University of Illinois Chicago’s Institute on Disability and Human Development, which helps evaluate certain IDHS services and has been contracted by IDHS to study barriers to access.

“People in SODCs are living in SODCs because there’s not really a lot of other places to go,” she said. A lot of the problems at Choate stem from the lack of community-based options, Crabb said.

Best practices equate to supporting people with disabilities to live like people who don’t — from having locks on doors to the ability to host guests and hold jobs, according to Crabb.

Community-based settings also aren’t perfect. Illinois has its own troubled track record of transitioning residents to group homes, and supply remains low.

Dozens of Choate residents would transition out of the facility if they could, according to state data. As of the beginning of October, 32 people or guardians were pursuing a move to a community provider, while another 156 can’t pursue a transition because community providers can’t currently meet certain medical or behavioral needs, an IDHS report shows.

A sign outside the Choate Mental Health and Developmental Center in downstate Anna.

Eidelman said “the small percentage of people whose needs are extraordinary” should not stop Illinois from keeping up with the quality of care provided elsewhere. He and other experts acknowledged some family members oppose a transition to smaller-scale, community settings. After the most recent Illinois closure, of the Jacksonville Developmental Center in 2012, a follow-up study with residents’ relatives showed most saw in community settings an improved quality of life and health outcomes for their loved ones.

Officials in the governor’s office and IDHS say Pritzker’s last two budgets made major investments in the Division of Developmental Disabilities that helped pay for wage hikes for front-line workers and direct support professionals, and added staff to help individuals transition out of SODCs like Choate. The pandemic also delayed community transitions.

According to Amie Lulinski, executive director of The Arc of Illinois, a statewide advocacy organization serving people with disabilities and their parents, the budget increases were still only about half what a study for IDHS deemed necessary. She hopes to see Pritzker’s administration plan a thoughtful closure of Choate and for Illinois to follow suit with other states in providing more alternatives to SODCs.

“Are we so broken that we can’t do it? Or is it just the fact that we haven’t put enough resources into the (community) system?” Lulinski asked.

Choate’s closure is “not something that we’re looking at right now,” the governor said on Sept. 6. “The question is, can we prevent that (abuse) in the future and if not, then obviously that’s not a facility that should remain open.”

Yet even when an election isn’t looming, political tension surrounds the issue of jobs at scandal-tainted centers like Choate, according to Eidelman and other experts.

Bryant, the state senator, doesn’t want to see the facility close. She and others acknowledged the good employees doing tough work at Choate. “Even legislators who work around this a lot, we’re sensitive to the fact that if we raise too much of a stink,” that a closure could threaten some of the area’s best-paying jobs.

But in the face of mounting claims of abuse, Eidelman said the Pritzker administration and legislators need to step up.

“This isn’t supposed to be a jobs program or a funding program,” he said. “It’s supposed to be services for people who are vulnerable. It’s about quality of care and people’s lives.”

aquig@chicagotribune.com

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