The Tennessee mother was around 13 weeks pregnant when, according to a lawsuit filed against the state of Tennessee, doctors gave her the devastating news that her baby had .

The genetic disorder causes serious developmental defects and often results in miscarriage, stillbirth, or death within one year of birth. Continuing her pregnancy, doctors told her, could put her at risk of infection and complications that include high blood pressure, organ failure, and death.

But they said they could not perform an abortion due to a Tennessee law banning most abortions that went into effect two months after the repeal of Roe v. Wade in June 2022, court records show.

So Kelly traveled to a northwestern Florida hospital to get an abortion while about 15 weeks pregnant. She is one of seven women and two doctors because they say the state’s near-total abortion ban imperils the lives of pregnant women.

More than 25,000 women like Kelly traveled to Florida for an abortion over the past five years, state data shows. Most came from states such as Alabama, Louisiana, and Mississippi with little or no access to abortion, . Hundreds traveled from as far as Texas.

But a recent Florida Supreme Court ruling paved the way for the Sunshine State to enforce a six-week ban beginning in May, effectively leaving women in much of the South with little or no access to abortion clinics. The ban could be short-lived if 60% of Florida voters in November approve a constitutional amendment adding the right to an abortion.

In the meantime, nonprofit groups are warning they may not be able to meet the increased demand for help from women from Florida and other Southeastern states to travel for an abortion. They fear women who lack the resources will be forced to carry unwanted pregnancies to term because they cannot afford to travel to states where abortions are more available.

That could include women whose pregnancies, like Kelly’s, put them at risk.

“The six-week ban is really a problem not just for Florida but the entire Southeast,” said McKenna Kelley, a board member of the . “Florida was the last man standing in the Southeast for abortion access.”

Travel Bans and Stricter Limits

Supporters of the Florida restrictions aren’t backing down. Some want even stricter limits. Republican state Rep. voted for both the 15-week and six-week bans. He said the vast majority of abortions are elective and that those related to medical complications make up a tiny fraction.

shows that 95% of abortions last year were either elective or performed due to social or economic reasons. More than 5% were related to issues with either the health of the mother or the fetus.

Beltran said he would support a ban on travel for abortions but knows it would be challenged in the courts. He would support measures that prevent employers from paying for workers to travel for abortions and such costs being tax-deductible, he said.

“I don’t think we should make it easier for people to travel for abortion,” he said. “We should put things in to prevent circumvention of the law.”

Both abortion bans were also supported by GOP state lawmaker . As a physician, Rudman said, he has delivered more than 100 babies and sees nothing in the current law that sacrifices patient safety.

“It is a good commonsense law that provides reasonable exceptions yet respects the sanctity of life for both mother and child,” he said in a text message.

Last year, the first full year that many Southern states had bans in place, more than 7,700 women traveled to Florida for an abortion, an increase of roughly 59% compared with three years ago.

The Tampa Bay Abortion Fund, which is focused on helping local women, found itself assisting an influx of women from Arkansas, Georgia, Mississippi, Louisiana, and other states, Kelley said.

In 2023, it paid out more than $650,000 for appointment costs and over $67,000 in other expenses such as airplane tickets and lodging. Most of those who seek assistance are from low-income families including minorities or disabled people, Kelley said.

“We ask each person, ‘What can you contribute?’” she said. “Some say zero and that’s fine.” 

Florida’s new law will mean her group will have to pivot again. The focus will now be on helping people seeking abortions travel to other states.

But the destinations are farther and more expensive. Most women, she predicted, will head to New York, Illinois, or Washington, D.C. Clinic appointments in those states are often more expensive. The extra travel distance will mean help is needed with hotels and airfare.

North Carolina, which allows abortions through about 12 weeks of pregnancy, may be a slightly cheaper option for some women whose pregnancies are not as far along, she said.

Keeping up with that need is a concern, she said. Donations to the group soared to $755,000 in 2022, which Kelley described as “rage donations” made after the U.S. Supreme Court ended half a century of guaranteeing the federal right to an abortion.

The anger didn’t last. Donations in 2023 declined to $272,000, she said.

“We’re going to have huge problems on our hands in a few weeks,” she said. “A lot of people who need an abortion are not going to be able to access one. That’s really scary and sad.”

Gray Areas Lead to Confusion

The is expecting that many women from Southeastern states will head its way.

Illinois offers abortions up until fetal viability — around 24 to 26 weeks. The state five years ago repealed its law requiring parents to be notified when their children seek an abortion.

About 3 in 10 abortions performed in Illinois two years ago — — involved out-of-state residents, up from fewer than a quarter the previous year, according to state records.

The Chicago nonprofit has prided itself on not turning away requests for help over the past five years, said Qudsiyyah Shariyf, a deputy director. It is adding staffers, including Spanish-language speakers, to cope with an anticipated uptick in calls for help from Southern states. She hopes Florida voters will make the crisis short-lived.  

“We’re estimating we’ll need an additional $100,000 a month to meet that influx of folks from Florida and the South,” she said. “We know it’s going to be a really hard eight months until something potentially changes.”

Losing access to abortion, especially among vulnerable groups like pregnant teenagers and women with pregnancy complications, could also increase cases of mental illness such as depression, anxiety, and even post-traumatic stress disorder, said , a licensed marriage and family therapist in Miami.

Kaminsky, who serves as board president of the , said the group has received calls from therapists seeking legal guidance about whether they can help a client who wants to travel for an abortion.

That’s especially true in states such as Alabama, Georgia, and Missouri that have passed laws granting “personhood” status to fetuses. Therapists in many states, including Florida, are required to report a client who intends to harm another individual.

“It’s creating all these gray areas that we didn’t have to deal with before,” Kaminsky said.

Deborah Dorbert of Lakeland, Florida, said that Florida's 15-week abortion limit put her health at risk and that she was forced to carry to term a baby with no chance of survival.

Her unborn child was diagnosed with in November 2022. An ultrasound taken at 23 weeks of pregnancy showed that the fetus had not developed enough amniotic fluid and that its kidneys were undeveloped.

Doctors told her that her child would not survive outside the womb and that there was a high risk of a stillbirth and, for her, preeclampsia, a pregnancy complication that can result in high blood pressure, organ failure, and death.

One option doctors suggested was a pre-term inducement, essentially an abortion, Dorbert said.

Dorbert and her husband were heartbroken. They decided an abortion was their safest option.

At Lakeland Regional Health, she said, she was told her surgery would have to be approved by the hospital administration and its lawyers since Florida had that year enacted its 15-week abortion restriction.

Florida’s abortion law includes an exemption if two physicians certify in writing that a fetus has a fatal fetal abnormality and has not reached viability. But a month elapsed before she got an answer in her case. Her doctor told her the hospital did not feel they could legally perform the procedure and that she would have to carry the baby to term, Dorbert said.

Lakeland Regional Health did not respond to repeated calls and emails seeking comment.

Dorbert’s gynecologist had mentioned to her that some women traveled for an abortion. But Dorbert said she could not afford the trip and was concerned she might break the law by going out of state.

At 37 weeks, doctors agreed to induce Dorbert. She checked into Lakeland Regional Hospital in March 2023 and, after a long and painful labor, gave birth to a boy named Milo.

“When he was born, he was blue; he didn’t open his eyes; he didn’t cry,” she said. “The only sound you heard was him gasping for air every so often.”

She and her husband took turns holding Milo. They read him a book about a mother polar bear who tells her cub she will always love them. They sang Bob Marley and The Wailers’ “Three Little Birds” to Milo with its chorus that “every little thing is gonna be alright.”

Milo died in his mother’s arms 93 minutes after being born.

One year later, Dorbert is still dealing with the anguish. The grief is still “heavy” some days, she said.

She and her husband have discussed trying for another child, but Florida’s abortion laws have made her wary of another pregnancy with complications.

“It makes you angry and frustrated. I could not get the health care I needed and that my doctors advised for me,” she said. "I know I can’t go through what I went through again.”

This article was produced through a partnership between Ä¢¹½Ó°Ôº Health News and the Tampa Bay Times.

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

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The share of high-strength oxycodone orders was well above normal for a chain of grocery store pharmacies, and the total number of pills sent to Publix stores was “significantly above their peers,” Teva’s head of federal compliance to his supervisors, according to court records in pending in Ohio against Publix and other companies.

“This is high-strength oxycodone ultimately going to Florida, a well-established hot spot for oxycodone abuse in the U.S.,” , Joseph Tomkiewicz, in the email explaining why he halted Teva-manufactured prescription opioids to Florida’s Publix pharmacies.

The volume of prescription opioids dispensed in Florida fell 56% from 2011 to 2019 as the pharmaceutical industry was hit by lawsuits for its role in the national opioid crisis, according to a Tampa Bay Times analysis of recently released by a federal court. But while national pharmacy chains like CVS and Walgreens were dispensing fewer of the highly addictive drugs, Publix’s sales were soaring.

The Lakeland-based grocer’s sales of oxycodone climbed from 26 million pills per year in 2011 to 43.5 million in 2019, the data shows. The increase in sales, which far outpaced the chain’s addition of stores in Florida, saw its market share rise to 14%, enough to overtake CVS to become Florida's second-largest dispenser of all opioid medications, behind only Walgreens, which dispensed 28% of opioids in the state in 2019. The analysis excludes drugs like methadone prescribed for addiction treatment. Opioid sales at Publix dipped slightly in 2018 and 2019, the last two years with available data.

Even as its market share grew, however, Publix was not among the 15 national manufacturers, distributors, and pharmacies that . That lawsuit claimed other pharmacies had flooded America with painkillers such as OxyContin, fueling debilitating addictions that strained communities’ first responders and medical providers.

The state’s lawsuit was a boon for Florida. While admitting to no wrongdoing, the companies agreed to settlement payments to the state, including $177 million from Teva, $440 million from CVS, and $620 million from Walgreens. The state didn’t sue Walmart but in 2022 negotiated a from the retail giant, which also denied any wrongdoing.

However, there is no mention of Publix’s role on touting the 10 opioid settlements reached during Ashley Moody’s tenure as attorney general.

That’s despite Publix being the third-biggest dispenser of opioids in the state, selling nearly twice the amount of the drugs as Walmart from 2006 to 2012, according to earlier DEA data , more than two years before Florida prosecutors reached settlements with other pharmacy chains.

Moody, a Republican, took over as the state’s top legal official in January 2019. Her office declined to specifically address why Florida has not included Publix in any of its legal actions over opioids.

“We are proud of the more than $3 billion recovered through the historic opioid litigation, and since the filing of the amended complaint, the Department of Legal Affairs has and will continue to take action when merited by the evidence — as we did in the more recent actions with and ,” said Moody’s communications director, Kylie Mason, in an email.

The grocery chain made $10.6 million in political donations in Florida from 2016 to 2022 when the state was preparing and pursuing its litigation, state election data shows. Most of the donations were for Republican committees and candidates, including $125,000 donated to the Friends of Ashley Moody political action committee.

In Florida, Walgreens made $637,000 in political donations, including $8,000 to Moody, over the same period. CVS made $208,500 in donations, none of which went to Moody.

Other local communities in Florida and beyond did sue Publix. The federal suit naming Publix that prompted the release of the federal data was filed by Georgia's Cobb County. It has been earmarked as a test case for dozens of other lawsuits brought by cities and counties in the Southeast. Those include more than 20 Florida communities, among them St. Petersburg and Pinellas and Pasco counties.

While Walgreens and other national companies paid billions to settle their lawsuits and agreed to stricter drug controls, Publix is still contesting the cases.

Those communities claim that the grocery chain failed to operate an “effective suspicious ordering monitoring program” and that when Publix did limit orders to its own pharmacies, those pharmacies could bypass the check by going to a third-party distributor such as AmerisourceBergen.

Publix also should have known that its pharmacies in Georgia, Florida, Alabama, Tennessee, and South Carolina, were filling multiple prescriptions written for the same patient by the same doctor or by multiple doctors, the federal lawsuit alleges. As part of the , other pharmacy chains were required to be more compliant with laws regulating opioids, including checks on suspicious orders and prescriptions from “blocked and potentially problematic” doctors.

“It’s a heck of a lot cheaper to distribute and dispense controlled substances without all these checks,” said Jayne Conroy, an attorney with New York law firm Simmons Hanly Conroy who is representing the Florida communities and has served as co-lead counsel in the national opioid litigation that has secured more than $50 billion in settlements and verdicts.

Publix did not respond to three emails and three phone calls to its communications office seeking comment.

In its responses to the lawsuits, it has repeatedly denied allegations of wrongdoing.

In seeking to get the Ohio case dismissed, Publix attorneys argued that it can’t be considered “a public nuisance” to legally distribute and dispense opioids. The judge in the case denied the company’s motion and another legal brief that sought to prevent the release of the more recent DEA data.

In November 2022, Publix sued more than a dozen of its insurers in federal court in Tampa, claiming they had not honored policies that would protect it from opioid litigation claims.

It also in 2023, saying the Georgia community’s lawsuit was “motivated by promises of a windfall.” The case is still pending.

“Publix takes great pride in its relationship with its valued customers and the communities it serves,” that lawsuit states. “These novel and unprecedented claims are baseless, false, and belied by Publix’s decades of service.”

DEA officials declined to comment on Publix’s opioid record. No enforcement actions against Publix are listed in the federal registry.

A Growing Player

Since its 1930 start as a food store in Winter Haven, Florida, Publix has grown into a massive company with more than and nearly 900 stores in Florida alone. Revered for its free cookies for kids, chicken tender subs, fresh produce, birthday cakes, and BOGO deals, the grocery chain has become one-stop shopping for customers.

And, increasingly, “Where Shopping Is a Pleasure” — Publix’s — includes powerful prescription drugs.

Publix was a smaller player in Florida’s opioid market before 2011, responsible for fewer than 5% of all opioid medications distributed to pharmacies across the state, according to the Times analysis of federal opioid data.

That year marked a turning point for opioid sales in Florida. As the scale of the opioid epidemic came to public attention, and litigation followed, most chain pharmacies began to back off their orders for pills, the data shows.

Many companies ultimately agreed to pay billions of dollars to settle lawsuits filed across the country by state and local governments. That included a $683 million settlement in May stating the pharmacy, which denied any wrongdoing, must pay for community treatment, education, and prevention programs, plus litigation costs.

In addition to hefty payouts, some settlement agreements required companies to adopt stricter controls to bring operations into fuller compliance with the Controlled Substances Act, a federal law that governs the manufacture, distribution, and use of drugs considered to have a high risk of being abused.

Distributors were required to adopt automated software that would flag suspicious orders from pharmacies such as quantities well above a store’s average. Pharmacy companies were required to conduct checks on doctors to ensure the prescribers are registered with the Drug Enforcement Administration. 

Those measures and others put the brakes on opioid distribution nationwide. Meanwhile, the distribution in Florida’s Publix stores went in the opposite direction: From 2011 to 2019, the grocery chain increased its dispensing of all opioid medication by 35%, according to the Times’ analysis of the data.

That growth far exceeded any increase in sales that would correspond to the grocer’s net addition of 146 pharmacies from 2011 to 2019.

As Publix’s distribution increased, so too did the number of orders that should have been flagged as suspicious, according to plaintiffs in multiple lawsuits. Drug distributor McKesson instructed its employees to investigate any pharmacy ordering more than 8,000 oxycodone pills in a single month as part of the company’s “Lifestyle Drug Monitoring Program,” according to .

Publix pharmacies’ orders surpassed that threshold almost 1,500 times in 2019, the Times analysis found, more than triple the number in 2011. The benchmark has been repeatedly used in opioid litigation as evidence of inadequate monitoring of drug distribution.

‘Red Flags’ Missed

As Tomkiewicz faced pressure from Teva management to fulfill Publix’s orders, he mined the data to back up his concerns, . During a heated phone call, one Teva executive stressed that Publix was an increasingly important player in the opioid distribution market, Tomkiewicz said , and an important client for the .

Tomkiewicz requested data from Publix’s 10 largest pharmacies by opioid sales, all located in Florida.

By law, Publix was required to keep tabs on the physicians whose prescriptions it filled. But it took Tomkiewicz just one day of searching the internet to find problems, according to submitted in the court records.

Among the top prescribers at two Publix locations in Melbourne was Thomas Velleff, according to . Public records and a newspaper report showed “significant anecdotal evidence of pill mill activity,” Tomkiewicz wrote. He said he found a 2010 article in the , in which a city employee claimed Velleff’s prior pain clinic in Palm City attracted “carloads” of patients, often with out-of-state license plates.

Complaints filed with the state Department of Health dating to 2010 allege that Velleff and his patients’ usage for signs of abuse. One 2017 complaint alleges that Velleff . The state Board of Medicine in December 2020. Velleff did not appear at his medical board hearing, according to the final order revoking his license. He did not respond to emails seeking comment.

A top prescriber at one Ocala store had been disciplined in 2011 for injecting herself with a sedative while leaving an . Other pharmacies repeatedly filled prescriptions from “cash-only” pain clinics or written by physicians located hundreds of miles away with no license to practice in Florida, Tomkiewicz wrote in the email. It is legal to do so, but drug diversion experts consider out-of-state prescriptions a red flag that should prompt additional checks for possible drug abuse.

Tomkiewicz had amassed a list of nine doctors among Publix’s top prescribers who made him wonder: “Why the hell do they still have a license and are ” according to his deposition.

Tomkiewicz also said in his deposition he was troubled by not just the volume of opioids Publix was selling, but that they were handing out a of 30-milligram instant-release oxycodone pills — another red flag for abuse. In an email to Teva’s director of compliance, he compared that with the Moffitt Cancer Center in Tampa, where cancer patients were mostly being prescribed 5 mg instant-release pills, .

As the strongest dose on the market, the 30 mg pills have limited use in retail pharmacies and are , Tomkiewicz wrote in the email. Stronger doses of oxycodone are available, but only in long-release capsules such as OxyContin, according to the .

Publix sold 4.8 million of the highly addictive high-dose pills in 2019 — roughly 1 in 10 of all oxycodone pills dispensed by the pharmacy chain that year, according to the Times analysis of the federal data.

Eventually, Tomkiewicz relented, he said in his deposition. As long as Publix promised not to send Teva products to nine locations that he’d picked out, he would let the shipment go ahead. Teva did not notify federal authorities, .

A Times review of court documents found no written record indicating that Publix responded to Tomkiewicz’s concerns at the time. An submitted in the lawsuit came to the same conclusion.

Tampa Bay Times staff writer Ian Hodgson previously worked for a research company, Cornerstone Research, that had a client relationship with Teva Pharmaceuticals. This article was produced in partnership with the Tampa Bay Times.

Methodology

For comparison and dosing purposes, it is to convert opioid medications to an equivalent dose of morphine. Every shipment of opioids in the federal database is reported as both the number of pills and its morphine milligram equivalent, or “MME.” This story uses that standard to calculate increases in the number of pills dispensed and compare the volume of pills prescribed by different pharmacy chains.

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

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His record as Florida’s governor suggests a presidency that would prioritize individual freedom over public health, but his push for such freedoms ends when it comes to abortion and treatment for gender dysphoria. In Florida, he has pushed restrictions on those medical services.

Critics contend those were the wrong priorities in a state where had no medical insurance as of 2022. Since then have lost the health insurance they had through Medicaid.

The DeSantis campaign did not return multiple requests for comment on the governor’s health policy campaign plans.

As he sets his sights on the White House, here’s a recap of his health care record:

Public Health

At campaign stops, DeSantis talks often of his handling of the covid-19 pandemic even as the issue has largely disappeared from the public’s radar.

DeSantis initially followed federal health guidance and ordered a statewide lockdown in April 2020. But the governor quickly changed course, beginning a phased reopening of Florida just one month later. Around then, Florida’s then-surgeon general, Scott Rivkees, was hustled out of a news conference and hardly seen for months after he said residents might have to socially distance themselves from others and wear masks until vaccines became available.

Florida was one of in August 2020, and DeSantis from enforcing mask mandates. He later and outlawed vaccine passports.

DeSantis did initially champion covid-19 vaccines, especially for Florida’s older adults. That changed in 2021, when DeSantis appointed Joseph Ladapo as his next surgeon general. A Harvard-trained doctor, Ladapo had gained prominence as a skeptic of the scientific consensus on how to treat and prevent the spread of the virus.

Subsequently, Florida was the covid-19 vaccine doses for children under 5 when those became available in 2022. At news conferences, DeSantis publicized covid-19 treatments such as monoclonal antibodies but didn’t urge residents to get vaccinated.

Later, DeSantis’ health department recommended against vaccines for young men and against people under 65 , guidance that contradicted that of the U.S. Centers for Disease Control and Prevention.

DeSantis as president would likely downplay the importance of the CDC, which is an advisory body, and instead might require states to invest more in public health infrastructure, said , a public health professor at the University of South Florida.

The pandemic exposed that Florida’s public health system had been underfunded and largely ignored by successive administrations, including DeSantis’, Wolfson said. Having led Florida through hurricanes Ian and Idalia, DeSantis may want a similar response to public health emergencies like covid-19, where states take the lead and the federal government’s role is to support them, he said.

Abortion

DeSantis has said he supports a “culture of life.” As governor, he’s signed the most anti-abortion modern-day legislation Florida has seen. But he has faced pushback from the anti-abortion crowd for his initial reluctance to endorse a federal ban and from other anti-abortion Republicans for signing a ban on most abortions after six weeks of pregnancy, which some have said is too extreme.

That bill, which DeSantis signed this year, has exceptions for rape, incest, and human trafficking up to 15 weeks into the pregnancy if the woman seeking an abortion has documentation proving her circumstances.

That bill has not taken effect, because of a pending court challenge over Florida’s current 15-week abortion ban, which DeSantis signed in 2022. That law does not have any exceptions for victims of rape or incest but does have exceptions for the health of the mother.

Opponents of Florida’s abortion restrictions say the threat of a felony arrest for violating the law makes it difficult for a doctor to provide an abortion they think is necessary.

After months of declining to directly answer whether he would support a nationwide abortion ban, DeSantis said during the second GOP presidential primary debate that he a 15-week federal abortion ban.

The issue remains a difficult one for Republicans. A recent successful ballot measure in Ohio suggests that preserving abortion rights remains an effective issue for Democrats to drive turnout.

With Florida’s ban held up in legal challenges, the state continues to be one of the biggest providers of abortions in the Southeast. About have been recorded by the Florida Agency for Health Care Administration so far this year. Almost 6,000 were for .

Medicaid

Even as states long opposed to Medicaid expansion such as South Dakota and North Carolina have recently reversed course, Florida remains in a group of 10 holdout states that refuse to expand the program as part of the Affordable Care Act.

The act provides extra federal funding to states that increase eligibility. In Florida’s case, doing so would help an estimated 514,000 residents gain health coverage, according to by the Urban Institute.

Florida has had one of the highest child uninsured rates for many years, higher than poorer states such as neighboring Alabama, another state that has refused to expand Medicaid, said , executive director at the Georgetown University Center for Children and Families.

Almost have lost Medicaid coverage since April, when states could remove recipients for the first time since the pandemic began. That includes at least 250,000 children. It’s unknown how many of those children are now covered through their parents’ insurance. But despite the state’s reassurance that kids who lose coverage would be referred to child health insurance programs like KidCare, Democratic state and federal lawmakers point to enrollment in the state program .

Florida is also the only state that has not taken advantage of that would enable the state to keep more people on Medicaid while it transitions back to normal Medicaid operation.

Wolfson said Florida’s position reflects DeSantis’ belief that the program has become “an expensive and overextended giveaway” that discourages people from working hard to better their lives.

“We’re not going to be like California and have massive numbers of people on government programs without work requirements,” DeSantis said during the second Republican debate when asked why Florida’s uninsured rate — 11.2% in 2022, according to — was higher than the national average, which was 8%.

DeSantis has, however, approved bills that expanded Medicaid coverage based on needs, an approach that may be more illustrative of his handling of the health insurance program should he end up in the White House.

In 2021, DeSantis signed a bill to extend postpartum Medicaid coverage to up to 12 months. This year, he approved legislation for Medicaid to cover glucose monitors and for family members who are 18 or older to be able to be trained and paid under Medicaid as home health aides for medically fragile child relatives.

DeSantis also signed a bill to make more lower-income families eligible for KidCare, a set of child health insurance programs.

Gender Dysphoria Care

Like other GOP-led states, Florida has restricted the rights of transgender minors to access treatments such as puberty blockers and hormone therapy.

Florida health officials in 2022 approved from accessing treatment for gender dysphoria. They then in 2023 prohibited minors from accessing that treatment even in clinical trials.

This past legislative session, Florida lawmakers passed a bill , which DeSantis signed into law. The decision runs counter to recommendations from major medical organizations. The legislation also requires that, for adults, gender dysphoria care, which the state calls “sex-reassignment prescriptions or procedures,” can be administered only by a physician.

In 2022, DeSantis’ administration published a report that created the that prohibited Medicaid from covering gender dysphoria treatments for both minors and adults. To create the report, the Florida health agency veered from its standard protocol and brought in consultants who had known views that ran counter to major medical organizations’ guidance.

A judge has since struck that Medicaid ban down, but lawyers are arguing in court that DeSantis’ administration has been willfully defying the order and has continued to implement the Medicaid ban.

Medical Freedom

Earlier this year, DeSantis declared Florida the “medical freedom” state as he signed into law protections for medical providers who turn away patients on “conscience” grounds.

The law provides similar protections for insurance companies.

Opponents of the legislation worry it will allow doctors to discriminate against LGBTQ+ people or other groups. The legislation does not allow someone to opt out of providing care because of “race, color, religion, sex, or national origin.”

Federal laws protect health care workers from having to provide abortions if doing so goes against their personal beliefs. Florida’s new law is much broader, allowing a medical professional to deny nearly any procedure if it goes against their conscience.

This article was produced in partnership with the Tampa Bay Times.

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).

Even though her friend immediately dressed the slight cut, her shin was red and sore when King awoke the next day. It must be a sunburn, she thought.

But three days later, the red and blistered area had grown. Her doctor took one look and sent King, 72, to the emergency room.

Doctors at HCA Florida Citrus Hospital in Inverness, Florida, rushed King into surgery after recognizing the infection as Vibrio vulnificus, a potentially fatal bacterium that kills healthy tissue around a wound. While King lay on the operating table, the surgeon told her husband she would likely die if they didn’t amputate.

Just four days after the scrape, King lost her leg then spent four days in intensive care.

“The flesh was gone; it was just bone,” she said of her leg.

Cases of V. vulnificus are rare. Between 150 and 200 are reported to the Centers for Disease Control and Prevention every year, with about 20% resulting in death. Most are in states along the Gulf of Mexico, but, in 2019, 7% were on the Pacific Coast. Florida averages about 37 cases and 10 deaths a year.

But a rise in cases nationally and the spread of the disease to states farther north — into coastal communities in states such as , , and — have heightened concerns about the bacterium, which can result in amputations or extensive removal of tissue even in those who survive its infections. And warmer coastal waters caused by climate change, combined with a growing population of older adults, may result in infections doubling by 2060, a warned earlier this year.

“Vibrio distributions are driven in large part by temperature,” said , an assistant professor at Florida Atlantic University. “The warmer waters are, the more favorable it is for them.”

The eastern United States has seen an eightfold increase in infections over a 30-year period through 2018 as the geographic range of infections shifted north by about 30 miles a year, according to the study, which was cited in a CDC last month.

The advisory was intended to make doctors more aware of the bacterium when treating infected wounds exposed to coastal waters. Infections can also arise from eating raw or undercooked seafood, particularly oysters, it warned. That can cause symptoms as common as diarrhea and as serious as bloodstream infections and severe blistered skin lesions.

New York and Connecticut this summer issued health warnings about the risk of infection as well. It’s not the first year either state has recorded cases.

“There’s very few cases but when they happen, they’re devastating,” said , a professor in the Department of Molecular Genetics and Microbiology at the University of Florida College of Medicine.

‘An Accident of Nature’

Vibrio has more than , including the bacterium that causes cholera, a disease that causes tens of thousands of deaths worldwide each year.

The V. vulnificus strain likes warm brackish waters close to shorelines where the salinity is not as high as in the open sea. Unlike some , it has no mechanism to spread between humans.

It’s found in oysters because the mollusks feed by filtering water, meaning the bacterium can become concentrated in oyster flesh. It can enter humans who swim in salty or brackish waters through the slightest cut in the skin. Infections are treated with antibiotics and, if needed, surgery.

“It’s almost an accident of nature,” Gulig said. “They have all these virulence factors that make them really destructive, but we’re not a part of this bug’s life cycle.”

Once inside the human body, the bacteria thrive.

Scientists don’t believe the bacteria eat flesh, despite how they’re often described. Rather, enzymes and toxins secreted by the bacterium as it multiplies break down the human tissue in the area below the skin, causing necrosis, or death of tissue cells.

The infection spreads like wildfire, Gulig said, making early detection critical.

“If you take a pen and mark where the edge of the redness is and then look at that two or four hours later, the redness would have moved,” Gulig said. “You can almost sit there and watch this spread.”

Researchers have conducted studies on the bacteria, but the small number of cases and deaths make it tough to secure funding, said Gulig. He said he switched his research focus to other areas because of the lack of money.

But growing interest in the bacteria has prompted talk about new research at his university’s .

Examining the bacteria’s genome sequence and comparing it with those of Vibrio strains that don’t attack human flesh could yield insights into potential drugs to interfere with that process, Gulig said.

Shock and Loss

Inside the operating room at HCA Florida Citrus, the only signs of King’s infection were on her shin. The surgeon opened that area and began cutting away a bright red mush of dead flesh.

Hoping to save as much of the leg as possible, the doctor first amputated below her knee.

But the bacteria had spread farther than doctors had hoped. A second amputation, this time 5 inches above the knee, had to be performed.

After surgery, King remained in critical care for four days with sepsis, a reaction to infection that can cause organs to fail.

Her son was there when she awakened. He was the one who told her she had lost her leg, but she was too woozy from medication to take it in.

It wasn’t until she was transferred to a rehab hospital in nearby Brooksville run by Encompass Health that the loss sank in.

A former radiation protection technician, King had always been self-reliant. The idea of needing a wheelchair, of being dependent on others — it felt like she had lost part of her identity.

One morning, she could just not stop crying. “It hit me like a ton of bricks,” she said.

Six different rehab staffers told her she needed to meet with the hospital’s consulting psychologist. She thought she didn’t need help, but she eventually gave in and met with Gerald Todoroff.

In four sessions with King, he said, he worked to redirect her perception of what happened. Amputation is not who you are but what you will learn to deal with, he told her. Your life can be as full as you wish.

“They were magic words that made me feel like a new person,” King said. “They went through me like music.”

Physical therapy moved her forward, too. She learned how to stand longer on her remaining leg, to use her wheelchair, and to maneuver in and out of a car.

Now, back in her Gulf Coast community of Homosassa, those skills have become routine. Her husband, Jim, a former oil company worker and carpenter, built an access ramp out of concrete and pressure-treated wood for their single-story home.

But she is determined to walk with the aid of a prosthetic leg. It’s the motivation for a one-hour regimen of physical therapy she does on her own every day in addition to twice-weekly sessions with a physical therapist.

Recovery still feels like a journey but one marked by progress. She has nicknamed her “stump” Peg. She’s now comfortable sharing before and after pictures of her leg.

And she’s made it her mission to talk about what happened so more people will learn about the danger.

“This is the most horrific thing that can happen to anybody,” she said. “But I’d sit back and think, ‘God put you here for a reason — you’ve got more things to do.’”

What to Know About ‘Flesh-Eating’ Bacterium Vibrio vulnificus

Infection Symptoms:

• Diarrhea, often accompanied by stomach cramping, nausea, vomiting, and fever.
• Wound infections cause redness, pain, swelling, warmth, discoloration, and discharge. They may spread to the rest of the body and cause fever. 
• Bloodstream infections cause fever, chills, dangerously low blood pressure, and blistering skin lesions.

To Protect Against Vibrio Infections:

• Stay out of saltwater or brackish water if you have a wound or a recent surgery, piercing, or tattoo.
• Cover wounds with a waterproof bandage if they could come into contact with seawater or raw or undercooked seafood and its juices.
• Wash wounds and cuts thoroughly with soap and water after contact with saltwater, brackish water, raw seafood, or its juices.

Who Is Most at Risk:

• Anyone can get a wound infection. People with liver disease, cancer, or diabetes, and those over 40 or with weakened immune systems, are more likely to get an infection and have severe complications.

Sources:

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And there was no paperwork showing that the boy’s biological mother or a judge had authorized the psychotropic medication, Keppra, as required by state law.

“I was caught between a rock and a hard spot,” she said. “You can’t just stop that cold turkey.”

The child’s medical records showed he had seizures only when he had a fever, suggesting he was not epileptic. The foster mom asked the boy’s neurologist if they could wean him off the drug.

He has not had a seizure since.

The account from the foster mother was confirmed by the boy’s biological mother, who said she was not asked nor would she have consented to put him on the anti-seizure drug. The Tampa Bay Times and Ä¢¹½Ó°Ôº Health News are not using their names to protect the identity of the boy, who is still in foster care.

The use of powerful psychotropic and opioid medications in Florida’s child welfare system is supposed to be strictly regulated and documented.

But a federal audit of of children prescribed those medications selected at random by the U.S. Department of Health and Human Services found lax record-keeping and multiple cases of child welfare workers failing to follow Florida regulations on psychotropic or opioid medication.

Federal audits in , , and also uncovered inadequate oversight of the use of psychotropic drugs among foster kids. In Maryland, the American Civil Liberties Union and other nonprofits filed a class-action lawsuit accusing the state of not maintaining medical records. The suit says as many as 34% of the state’s foster children are given psychotropic drugs but that most of them don’t have a documented psychiatric diagnosis.

Child advocates fear such examples reflect a national failure to closely monitor the use of drugs among a vulnerable population already more likely to be on medication than other children.

“We shouldn’t have to have a tragedy to make sure the system is paying attention,” said , deputy director of Florida’s Children First, a nonprofit that advocates for kids in foster care.

Medication Records Missing

More than 2,200 foster children in Florida — roughly 1 in 10 of the state’s foster care population — are given medication typically prescribed for mental health disorders such as schizophrenia, depression, bipolar disorder, and attention-deficit/hyperactivity disorder, .

That includes 73 children age 5 and younger. Among foster children 13 and older, the rate is almost 1 in 3, more than double the rate among similarly aged children .

But in close to half the cases, auditors found no records of the psychotropic medications prescribed in the case file in the state’s primary case management system.

Logs that record the frequency and dosage of — and any adverse reactions to — psychotropic medication were missing from 66% of case files reviewed, and authorization records were not found in more than one-third of the case files.

Documentation of the use of opioids was even more lax, with no record of what medication was prescribed in nearly every case reviewed.

The high turnover of case managers in foster care means accurate paperwork is critical, Rosenberg said. Foster children, especially teenagers, often move between different foster families and group homes, which can mean they may be treated by doctors who know little about their medical histories.

That raises the risk of overdoses or dangerous drug interactions, Rosenberg said.

The FDA in 2016 warned that the of opioids and psychotropics can result in “serious side effects, including slowed or difficult breathing and death.”

“Doctors need to have correct information to make the best decisions for children,” Rosenberg said.

‘Health and Safety May Have Been at Risk’

In response to the audit findings, the Florida Department of Children and Families is looking at more streamlined ways for records to be uploaded into the state’s child welfare system, said spokesperson Miguel Nevarez. It also plans to enhance its monitoring and is looking to use other sources of data to cross-check the information in case files.

In Florida’s privatized system, the Department of Children and Families contracts with local nonprofits to run the state’s foster care system in 20 distinct districts. The department has an oversight role.

“We will hold the lead agencies responsible for the work they are contracted to do and ensure that they adhere to Department policies,” Nevarez said in an email.

Children with mental disorders are often prescribed a combination of medications, including antidepressants, stimulants, antipsychotics, anti-convulsants, lithium, and sedative hypnotics. In foster care, the cost is covered by Medicaid in most cases.

Florida’s child welfare system has long required strict record-keeping for such drugs. Lawmakers added safeguards after a 7-year-old foster child named Gabriel Myers died by suicide in 2009. At the time of his death, Gabriel had been prescribed two psychotropic medications.

Physicians or psychiatric nurses prescribing medication must complete a medical report and attempt to obtain consent from the child’s parent or legal guardian. When parents cannot be reached or their parental rights have been terminated, the foster care agency must submit the medical report to a court for authorization.

Case managers are required to document the use of medication, including the prescription name, quantity, number of refills, and dosage, and record it in the state’s primary record system within three business days. Every time a child is given a pill or experiences side effects, it should be recorded on a medication log by the child’s caregiver, according to the Florida Administrative Code. Case managers are required to obtain the logs at each home visit and add them to the child’s case file.

But that was not happening consistently, the federal review found. One child who was prescribed stimulants and antidepressants had no record of them in their case file. Other case files had records of some prescribed drugs, but not all.

In another example, medication logs were missing for a child prescribed antipsychotic and anti-anxiety drugs. When asked by federal auditors to provide them using supporting paperwork, the foster care agency could not find any, the report said.

The state relies on these records to flag cases it may need to oversee for psychotropic medication use. When missing, those children’s cases were not monitored, the audit found.

Another concern for auditors was that the Department of Children and Families did not have access to all the state’s Medicaid data that federal auditors used to cross-check case files, meaning it had no way to ensure authorizations were on file.

Also, the training curriculum for child protective investigators and case managers did not specifically address the requirements for maintaining medication logs in the children’s case files, auditors found.

“The State agency could not ensure that children in foster care received the necessary monitoring and care. As a result, the children’s quality of care and health and safety may have been at risk,” the report states.

The Department of Children and Families is working to obtain Medicaid claims data for all children in foster care, Nevarez, the agency spokesperson, said.

The Challenge of Getting the Right Care

The review did not look at whether the use of psychotropic or opioid medication was justified. But the lack of oversight has brought renewed scrutiny to the higher rates of medication use in the child welfare system.

Marlene Bloom, a Tampa psychologist who has worked with foster children for 25 years, said it makes sense that a higher proportion of foster kids would need medication.The children of parents with mental health disorders are more likely to be in foster care and some disorders are genetic, she said.

But she also sees children on medication whose main issue is trauma, either from their home situation or from being removed from their families.

Among foster families, Bloom said, she doesn’t see as much resistance to giving kids medication as she does from the parents of her private clients. They also don’t push to get kids off the drugs as quickly as possible.

“In foster care, if it’s the difference between literally having no placement, or some medication that may not be necessary but does help you to maintain a placement, what’s the right thing to do?” she said.

Jenn Petion, CEO of , a nonprofit that serves as the lead foster care agency in Jacksonville and parts of Tampa Bay, said the additional paperwork required to get medication prescribed in the child welfare system can make it harder to give foster kids the same mental health care that is available to other children.

But for some families, the concern is not about lack of care — but about improper care. Dunedin resident Giselle Espinet said she believes her adopted daughter was overmedicated while in Florida’s foster care system. A former high school teacher, Espinet reached out to the foster care system four years ago hoping to adopt a teenager.

She was matched with Liliana, then 14, and attended two get-to-know-you meetings. But Espinet was not allowed to review Liliana’s disclosure file, including her medical history, until she agreed to move forward with the adoption.

Liliana regularly showed aggressive behaviors, which had led to her removal from some foster homes and schools.

She had been diagnosed with bipolar disorder and was taking 1,200 milligrams of lithium a day, the maximum recommended daily dose for children 12 and up, .

Even with the medication, Liliana was unhappy and struggling. Espinet paid $1,500 out of her own pocket for a neuropsychiatric evaluation.

It found signs of ADHD and mild post-traumatic stress disorder but no evidence of bipolar disorder, she said.

A new psychiatrist weaned Liliana off the drug. She still needs other medications but is back at school and pushing to graduate. She is happier and making friends, Espinet said.

“My child is a completely different person from the one I met four years ago,” she said. “For the first time, she feels like her brain isn’t wrapped up in rubber bands.”

This article was produced in partnership with the Tampa Bay Times.

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After the heartache of more than a dozen miscarriages, Anya Cook was 16 weeks along. She and husband Derick Cook spent a Sunday last December sharing the news with his parents and looking at cribs.

As they left a restaurant in Coral Springs, Florida, that evening, Cook’s water broke. Her husband rushed her to the nearest emergency room.

Cook, 36, still believed the baby they had nicknamed “Bunny” could be saved. Doctors told her she would miscarry in the next 24 hours, she said, and that the fetus was too premature to survive.

The early rupturing of her amniotic sac left Cook at risk of infection and complications including hemorrhaging. But her pregnancy was beyond Florida’s then-15-week restriction on abortion and an ultrasound showed the fetus still had a detectable heart rate, according to hospital records Cook shared with the Tampa Bay Times.

Though Florida’s law allowed abortions to protect the health of the mother, Cook said, a doctor told her he would be risking his license if he induced labor, essentially performing an abortion. He gave her two antibiotic injections to reduce the risk of infection and sent her home, she said.

“I told him, ‘You’re leaving me to die,’” she said.

Every state that bans or restricts abortions has an exception to protect the health of the mother. Allowing abortions in such cases — or in the case of rape or incest —  makes abortion legislation more palatable to a majority of the American public, who, , don’t support outright bans. When Florida lawmakers this year approved tightening the 15-week ban to a six-week limit, they added exceptions for rape, incest, and human trafficking to the existing exemptions to protect the health of the mother.

But recent history in other states suggests that few women will be able to take advantage of such exceptions if Florida’s new law, on hold while tied up by legal challenges, is upheld by the state Supreme Court. There is also concern that patients with pregnancy complications are being denied care.

In Alabama and Mississippi, which adopted stricter bans with some exceptions following the U.S. Supreme Court’s overturning of Roe v. Wade in June 2022, no abortions have been reported since July 2022, according to WeCount, a reporting effort organized by the abortion rights group . The project uses data from clinics, hospitals, and telemedicine providers and excludes from its tally cases in which women traveled to other states for abortions or obtained abortion pills.

In Texas, 13 women who had pregnancy complications sued the state’s medical board after being denied abortions, put their lives in jeopardy. 

Women’s health advocates fear Florida is headed in the same direction — and that more expectant mothers’ lives will be put at risk.

“Exceptions are a rhetorical trick, really,” said Laurie Bertram Roberts, executive director of the , a group that supports abortion rights. “They’re essentially a tool for Republican lawmakers to say, ‘There, those of you who worry that so-called good abortions won’t be available to you.”

State Sen. , a Republican who sponsored the bill for Florida’s six-week ban, said that her legislation has exceptions “to acknowledge some women experience unexpected pregnancy due to the heinous criminal acts committed by others, and to suggest the exceptions are window dressing is factually incorrect.”

Data Doesn’t Tell the Full Story

More than 82,000 abortions were performed in Florida last year, according to by the Florida Agency for Health Care Administration.

Those included 115 cases in which rape was cited as the reason for the abortion and seven that cited incest. No reported abortions were linked to human trafficking.

If Florida’s six-week ban moves forward, rape and incest victims would have to provide their doctor a copy of a restraining order, police report, medical record, court order, or other documentation to get an abortion after that window.

However, two-thirds of sexual assault victims do not report the crime, , meaning no police report would exist. An estimated 8 in 10 rapes are committed by , often leaving victims afraid of reprisals if they report the crime.

Florida has a long-established law allowing abortions when a fetus has fatal abnormalities. But no exceptions exist for serious genetic defects, deformities, or abnormalities, which were cited as the reason for 578 abortions in the state last year.

Roughly 60% were done in the second trimester, when tests like fetal echocardiograms or maternal serum screens . The result of those tests would arrive too late if Florida’s six-week ban is upheld.

It’s not clear how many women who had abortions last year in Florida would have had their health endangered if their pregnancies had continued.

Pregnancy and labor carry serious health risks such as hypertension, hemorrhaging, and blood clots. More than 1,200 women causes related to pregnancy or childbirth in the United States in 2021. In Florida in 2020, 21 pregnancy-related parental deaths occurred for every 100,000 live births — and the rate of death among pregnant Black expectant mothers was more than double.

A by the Texas Policy Evaluation Project at the University of Texas-Austin identified dozens of cases in 14 states, including Florida, where poor care due to abortion restrictions led to preventable complications and hospitalizations. Some of those patients nearly died. 

“Health care providers described feeling moral distress when they were unable to provide evidence-based care, and some reported considering moving their practices to a state where abortion remains legal,” the study states.

The American College of Obstetricians and Gynecologists in 2022 warned that doctors must be able to without “fear of prosecution, loss of license, or fines.”

Grall, the GOP state senator, said Florida has long-established laws to protect the life of the mother so there should be no confusion when an abortion is necessary.

“Florida should always be a state in which the life of the mother is protected and any doctor, hospital, or lawyers who seek to take a crystal-clear statute and try to muddy its interpretation to score political points should face the appropriate punishment,” she said.

A found that 61% of OB-GYNs who practice in states with abortion restrictions are concerned about the legal risk when deciding whether to perform an abortion.

“It doesn’t make any medical sense,” said Jennifer Griffin, a Tampa physician who provides abortions. “These politicians are not making policy based on science; they’re based on religion.”

‘I Went to a Really Dark Place’

Cook, the woman whose water broke 16 weeks into her pregnancy, barely slept that night, she said, after being refused treatment at Broward Health Coral Springs hospital.

The more she read online about her condition, the more convinced she became that she was going to die.

“I went to a really dark place,” she said.

Her miscarriage came when she was at a late-morning hair salon appointment. She rushed to the bathroom.

“I put my hands on my knees and I heard my daughter hit the toilet,” she said. Cook couldn’t bring herself to look down.

Her husband called 911. She told him she needed help to deliver the placenta she felt hanging from her womb.

He pulled some of the organ out with his bare hands, she said. There was a pop when the umbilical cord came away, Cook said.

Blood was gushing over the white porcelain toilet. A nurse who happened to be at the salon told Cook to squeeze her body as tightly as she could.

An ambulance rushed Cook to Memorial Hospital Miramar. Part of her placenta was still inside her. When doctors removed it, she began bleeding profusely, hospital records show. Doctors estimated she lost more than half a gallon of blood, an amount that can be fatal.

Cook ended up in intensive care. She needed four units of blood and was put on a ventilator, records show.

Doctors feared they would have to remove her uterus, which would mean she could never have a child, Cook said. Instead, they blocked some of the blood vessels and inserted a medical balloon to stem bleeding.

She stayed in the hospital for five days.

In May, Cook said, she was interviewed by officials from the Florida Agency for Health Care Administration and recounted her story about the limited care she received at Broward Health Coral Springs the night her water broke. She said they told her they are reviewing the hospital’s handling of her emergency. Spokesperson Bailey Smith said the agency cannot comment on ongoing investigations.

Jennifer Smith, Broward Health’s vice president for corporate communications and marketing, said in an email that the hospital’s handling of the case was appropriate. She said that the emergency physician contacted Cook’s OB-GYN, who recommended the antibiotic treatment. Cook was instructed to see her doctor that day or return to the emergency room if her condition worsened, Smith said.

“We empathize with Ms. Cook and the millions of women who annually suffer the unimaginable loss of miscarriage; however, we cannot speculate on whether Ms. Cook complied with the discharge instructions to see her private OB-GYN physician the same day of her discharge,” Smith said.

But Cook said she had already called her OB-GYN before she went to the hospital initially and it was after 2 a.m. when she was discharged. She miscarried around midday later that day.

“It’s absurd how they’re still trying to defend it,” she said.

Bunny was conceived through in vitro fertilization. That pregnancy was the furthest along Cook had ever been.

“To make it this far and lose her like that, it was really traumatic,” she said.

Cook has a stepson, but she isn’t ready to give up trying to have a biological child. She is still angry about her experience.

“I think about my niece and my future children,” said Cook, who is the oldest of six sisters. “I can’t imagine my sisters or any female family members having to go through this.”

This article was produced in partnership with the Tampa Bay Times.

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).

A special agent for the Florida Department of Environmental Protection, he was assigned to patrol 14 miles of Panhandle beaches on an all-terrain vehicle, alerting cleanup crews to new slicks from the BP Deepwater Horizon oil rig explosion.

His 16-hour shifts started at dawn. The air felt greasy; the ATV splashed up oil, he said, soaking his clothes, gun belt, hat, and boots.

“The smells were horrendous,” he recalled. “Like the ocean mixed with chemicals.”

About seeped into the Gulf of Mexico and 11 people died in the April 2010 disaster, the largest marine oil spill in history. Tens of thousands of workers were hired to clean sludge on beaches, mangroves, and dunes across Alabama, Mississippi, Louisiana, Texas, and the Florida Panhandle.

Boblitt said he wasn’t the same when he returned to his regular job after three months in the Panhandle. He struggled to concentrate. Knowledge gleaned from years of service eluded him. Physically demanding work caused him to shake.

Within two years, he said, he’d deteriorated so much he no longer trusted himself to handle airboats, personal watercraft and his firearm safely.

He took early retirement. He was 43.

More than a decade after the disaster, cleanup workers are still reporting cases of respiratory illnesses, skin disorders, dizziness, and other medical issues they say were caused by the spill. Their health struggles are documented in more than 5,000 lawsuits filed against BP in federal courts in Louisiana, Alabama, Mississippi, and Florida, with some workers reporting illnesses diagnosed as recently as 2020.

BP has so far set aside nearly $70 billion for the ecological disaster, including $11.6 billion to businesses affected by the spill, .

Payouts for cleanup workers’ medical claims make up a tiny portion of that restitution. According to a 2019 report from the court-appointed claims administrator, BP paid roughly $67 million to 22,833 workers to settle a class-action lawsuit, an average of about $3,000 each.

The petroleum giant also agreed in the 2012 settlement that cleanup workers could seek compensation for exposure symptoms that emerged later. But BP attorneys are aggressively contesting the new lawsuits — despite government-funded studies showing that these workers have higher-than-normal incidences of skin conditions, respiratory issues, and heart ailments.

BP officials declined to comment on the health claims filed against them. In multiple ongoing lawsuits, including the ongoing case filed by Boblitt against the oil giant, they maintain there’s no evidence that workers’ health problems were caused by the spill.

That burden of proof has become a very high bar for potential victims seeking compensation, according to plaintiffs’ attorneys. It has led some to stop accepting new cases. And on Jan. 24, a federal court effectively ended four cases filed by cleanup workers when it ruled that an expert hired by their attorneys had failed to prove their conjunctivitis and sinus problems were a direct result of the spill.

Allen Lindsay Jr., an attorney from the city of Milton in the Panhandle, has represented around 150 cleanup workers. He’s lost a third of those cases and is pessimistic about the remaining ones.

“I have to prove causation, that the poison on the beach is what poisoned our clients,” he said. “And we can’t do that.”

The legal battle has gotten so heated that attorneys at a Miami law firm have amassed a war chest of evidence — 130,000 samples of contaminated water, sand, sediment, wildlife, and tar balls — they believe will give them an edge in the courtroom.

‘Real Illnesses’

On the Beach

‘A War of Attrition’

Lindsay, the Panhandle attorney, has spent years trying to prove the spill made his clients sick.

It’s been a costly endeavor. Court filing fees are upward of $400 per case, and each lawsuit has to be submitted individually.

About two-thirds of cleanup workers surveyed for the Gulf Study reported household incomes below $50,000. Only 15% had a college degree.

“All these people have been denied justice because BP turned their back on them,” Lindsay said. “They needed these people to clean up their mess.”

Like Lindsay, other attorneys have stopped accepting BP cases as they face an opponent they perceive as having near-unlimited resources.

Houston-based lawyer Howard Nations said the cost of litigation is more than what his clients could hope to win in damages. BP, he said, has developed a “scorched-earth” policy: Defend every single case.

Larger firms have the resources for the drawn-out legal fight, but even some of those have dropped out.

“When you litigate against a corporate giant like this, the common narrative that you’re going to see is a war of attrition. And that’s exactly what BP has defaulted to in this litigation,” said Dylan Boigris, a partner at Downs Law Group in Miami, which represents 50 Florida cleanup workers.

In determining exposure, courts have been relying on water sample data BP collected during the spill. A key argument made by Boigris and his firm is that BP skewed the results to make it seem as if the oil on beaches wasn’t toxic.

“What they try to argue is that what arrived on the beach was ‘weathered’ oil and that it was effectively dead oil — that there’s nothing harmful and that it’s no different than a rock,” Boigris said.

And BP attorneys have convinced courts that those seeking damages must determine what level of exposure to crude oil is harmful, court records show. That would be like trying to prove exactly how many cigarettes caused somebody’s cancer, Boigris said.

His firm has gone to considerable expense to counter that.

In 2019, BP prepared to dispose of samples from the spill. Boigris and his team drove to Colorado with six refrigerated trucks to retrieve them.

Since then, the firm says, it has paid as much as $150,000 per year to store the samples in a South Florida warehouse. The law firm’s enlisted experts are studying the samples and “unraveling the perception that there was no harmful exposure,” Boigris said.

One late November morning, Boigris and his team met at the facility, where stacks of freezers keep samples as cold as minus 112 degrees Fahrenheit. Donning gloves, Boigris was shrouded in water vapor as he carefully pulled open the freezer.

The firm plans to have some samples analyzed by independent toxicologists and hopes to use the data as evidence.

It’s why Boigris views his firm as “the last hope” for any workers seeking justice.

“BP went out and hired the indigent, and the underrepresented, and they took advantage of those local populations,” he said. “They sent them out there to clean up their oil, and they’ve discarded them.”

Finding an Answer

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

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