ECOCIDE

Genocide in Gaza is a climate and environmental catastrophe

Islam Elhabil 

The Electronic Intifada 

21 November 2024

A Palestinian child collects garbage to sell in Nuseirat refugee camp, central Gaza Strip, on 14 November. Yousef ZaanounActiveStills

Israel’s onslaught since October 2023 has made the densely populated territory of Gaza – only 25 miles long and six miles wide – unlivable.

Despite the profound environmental impact and the implications for global climate stability, the destruction of Gaza’s environment, ecosystems and food production systems has not been answered with international action.

Independent experts have defined ecocide as “unlawful or wanton acts committed with knowledge that there is a substantial likelihood of severe and either widespread or long-term damage to the environment being caused by those acts.”

From the start, Israel was honest about its goal: the destruction of Gaza.

Israel’s indiscriminate attacks and use of weapons with wide-area effects are aimed at causing as much damage as possible. This has led not only to significant civilian casualties but the annihilation of entire ecosystems.

Israel has destroyed or damaged all five of Gaza’s wastewater treatment facilities, “contaminating beaches and coastal waters, soils and potentially the groundwater,” according to a UN environmental assessment published in June. Untreated sewage released into the Mediterranean Sea pollutes the marine environment and coastal habitats. It also will likely cause harm to Gaza’s fishing industry – fish being a key source of food and fishing a traditional vocation in the territory, where rates of food insecurity and unemployment are catastrophically high.

“Marine pollution can impair the nutrition and quality of waters, thus restricting the growth of fishes and thus impact fish production and catches,” according to the UN assessment.

“Pollution can also impact food safety, as fish in the inshore areas (which are currently the only areas Palestinians can fish) can become contaminated,” the UN adds.

The Wadi Gaza wetlands, an internationally important refuge for migratory birds and other wildlife where ecological restoration was underway before October 2023, have been damaged by military operations and pollution, threatening its biodiversity. Some 25 to 50 percent of Wadi Gaza is believed to have been destroyed as of June, “and with it the ecosystem services it provides,” the UN states.

Additionally, freshwater sources like wells and groundwater reservoirs have been contaminated, affecting people’s access to safe drinking water and harming essential ecosystems reliant on these resources.
Contaminated debris, decomposing bodies

Israel’s attacks have resulted in the accumulation of more than 42 million metric tons of debris throughout Gaza, much of it likely contaminated with asbestos, unexploded ordnance and other toxic pollutants. Israel’s severe restrictions on the import of fuel and a lack of proper equipment have also hindered the recovery of thousands of decomposing bodies underneath the rubble, exacerbating the humanitarian and environmental crisis.

The collapse of solid waste management systems due to Israeli destruction has also led to the formation of approximately 225 makeshift waste disposal sites across Gaza, some stretching for hundreds of meters, as reported by the Dutch organization PAX in July this year. UNRWA, the UN agency for Palestine refugees, reported in June that more than 330,000 tons of solid waste had accumulated in populated areas of Gaza – enough to fill more than 150 football fields, according to PAX. These sites have become breeding grounds for pests, rodents and diseases among Gaza’s displaced population.

Satellite imagery analyzed by the BBC shows that more than half of Gaza’s water and sanitation facilities have been damaged or destroyed. Most wastewater treatment and desalination plants have ceased operations entirely, leading to the discharge of untreated sewage into the sea, streets and camps sheltering internally displaced people. This poses a severe threat of groundwater contamination, compounding the crisis of waterborne diseases, especially among vulnerable populations including children, women and people with chronic illnesses.

The agricultural sector has also been heavily targeted.

As of March, nearly half of Gaza’s tree crops – including olive groves – had been destroyed, as have nearly one-third of Gaza’s greenhouses, according to a report in The Guardian based on satellite imagery. Ninety percent of greenhouses in northern Gaza “were destroyed in the early stages of the ground invasion,” according to the UK research group Forensic Architecture.

A study by Samer Abdelnour and Nicholas Roy estimates that some 80,000 tons of carbon emissions are expected during the rubble removal process in Gaza. It would take around 3.3 million trees an entire year to absorb this amount of carbon dioxide, based on the average absorption rate of a single mature tree, which is about 22 kilograms of carbon dioxide (roughly .024 tons) annually.

This is on top of the carbon emissions from the continuous flow of heavy weapons from the United States to Israel during the past year of ecocide. Another study conservatively estimates that “the climate cost of the first 60 days of Israel’s military response was equivalent to burning at least 150,000 tons of coal,” The Guardian reports – almost half of those carbon dioxide emissions resulting from US shipments of supplies to Israel.

A 2022 study estimating global military emissions found that militaries account for almost 5.5 percent of carbon dioxide emissions annually.

“If the global militaries were a country, they would have the world’s fourth largest footprint, one larger than [the] whole of Russia,” the study states. “Only the nations of China, the US, and India would have larger carbon footprints.”

Carbon emissions associated with Israel’s genocide in Gaza are contributing to climate change, extreme weather events, rising sea levels and harmful effects on global ecosystems and human health, including air pollution, respiratory diseases and disruptions to food and water supplies.

Despite constant warnings of a climate emergency, there has been very little coverage of the catastrophic and long-term environmental consequences of Israel’s ongoing genocide in Gaza, or other wars around the world.

Israel has increased the budget for its Environmental Protection Ministry to fund projects aimed at reducing the environmental impact on itself while it inflicts immense damage on Gaza and the broader region.
Words versus action

There is a massive gap between global environmental rhetoric and the utter failure to address the environmental harm of military conflicts and hold belligerent violators to account.

We cannot claim progress is being made towards sustainability through annual gatherings, climate movements and global peace efforts so long as blatant violations of environmental laws are taking place with zero repercussions.

Global frameworks addressing the challenges facing humanity must ensure that the law applies to everyone without exception. This is the only way that societies will take critical environmental issues like microplastics, water and soil pollution seriously, let alone the devastating impact of war on the environment.

Israel’s military actions in Gaza have likely breached several legally binding international environmental treaties it has committed to, including the Paris Agreement, the Convention on Biological Diversity and the Mediterranean Action Plan under the Barcelona Convention.

The use of heavy artillery and explosives in densely populated areas releases greenhouse gases and toxins, undermining emissions reduction goals under the Paris Agreement. The destruction of farmland, wetlands and marine areas harms biodiversity, contradicting the Convention on Biological Diversity’s objective to protect ecosystems.

The bombing of Gaza’s wastewater treatment plants – resulting in untreated sewage flowing into the Mediterranean, polluting marine environments – breaches the Barcelona Convention’s commitment to protect Mediterranean waters.

Additionally, hazardous debris and contaminants, including asbestos and unexploded ordnance, remain unmanaged – contradicting the Basel Convention’s principles on safe waste disposal.

That convention, which Israel has ratified, does include an exemption from liability for parties in the event of armed conflict. While this provision addresses uncontrollable circumstances, it may also hinder accountability for hazardous waste management in conflict zones. Supplementary frameworks or revisions are needed to address the unique environmental challenges posed by armed conflict – as is plainly evident in Gaza.

Israel has brazenly violated the fundamental principles of international humanitarian law, also known as the laws of war, with very little consequence. And it has also flagrantly flouted its environmental legal obligations, with severe consequences for both local and regional ecosystems and global efforts to curb climate change.

The ongoing genocide in Gaza epitomizes the utter failure of global institutions and the lie of the rules-based order. The ongoing ecocide amid international silence has weakened the credibility of global environmental organizations, highlighting the persistent inability to enforce international laws and halt ecological destruction.

If humanity cannot tackle these challenges in tiny Gaza, what hope is there for the planet as a whole?

Islam Elhabil is a Malaysia-based microplastics specialist, PhD researcher and engineer specializing in engineering solutions for pressing global environmental issues.

Johnson & Johnson risks UK lawsuit over talc cancer claim


By AFP
November 20, 2024

Johnson & Johnson removed its talcum-based powder products from North American markets in 2020

 - Copyright GETTY IMAGES NORTH AMERICA/AFP JUSTIN SULLIVAN

UK claimants announced Wednesday legal action against US pharmaceutical and cosmetics giant Johnson & Johnson, alleging that women diagnosed with cancers were exposed to asbestos in the company’s talcum powder.

J&J risks UK court action for the first time over the allegations, having faced a series of similar lawsuits in North America.

KP Law, the firm representing about 2,000 claimants, said “women who have been diagnosed with life-changing and life-limiting cancers were exposed to asbestos contained within the company’s talcum powder”.

In response Erik Haas, J&J’s worldwide vice president of litigation, said “Johnson & Johnson takes the issue of talc safety incredibly seriously and always has”.

Haas added that J&J’s own analysis found an absence of asbestos contamination in its products and said “independent science makes clear that talc is not associated with the risk of ovarian cancer nor mesothelioma”.

J&J has until the end of the year to respond to a letter sent on behalf of KP Law’s clients, following which documents will be filed in the UK’s High Court.

The law firm is representing predominantly women regarding the case, and says it has been contacted by thousands more, adding that some have died of their cancers.

Lawyers claim that the US-based corporation knew “as early as the 1970s that asbestos in its talc products was dangerous but failed to warn consumers and carried on producing and selling the products in the UK until as recently as 2022”.

J&J said that Kenvue, its former consumer-health division that it separated out in 2023, is responsible for “any alleged talc liability that arises outside the US or Canada”.

“Decades of testing by experts… demonstrates that the product is safe, does not contain asbestos, and does not cause cancer,” Kenvue said in a statement.



– Settled claims –



However, in September, J&J increased its offer to settle talc claims relating to ovarian cancer in the United States to around $8 billion to be paid over 25 years.

Earlier this year, the company agreed to pay $700 million to settle allegations it misled customers about the safety of its talcum-based powder products in North America.

The company did not admit wrongdoing in its settlement but withdrew the product from the North American market in 2020.

The World Health Organization’s cancer agency in July classified talc as “probably carcinogenic” for humans.

A summary of studies published in 2020 covering 250,000 women in the United States did not find a statistical link between the use of talc on the genitals and the risk of ovarian cancer.

FOR PROFIT HEALTHCARE U$A

How the nation's largest oxygen distributor became a multibillion-dollar Medicare scofflaw

Photo by Alexander Grey on Unsplash
man in blue hoodie wearing eyeglasses

Peter Elkind andProPublica

November 13, 2024

Reporting Highlights
Decades of Misbehavior: Lincare has repeatedly landed on Medicare’s equivalent of probation; the company has a dismal history of exploiting the government and ailing patients.
Too Big to Ban: Despite Lincare’s track record, Medicare, which provides most of the company’s revenues, has never sought to bar the company from the Medicare system.
Tolerating Wrongdoing: Faced with $60 billion a year in fraud, Medicare spends millions chasing companies but accepts penalties that are only a fraction of the profits made on misbehavior.

These highlights were written by the reporters and editors who worked on this story.

For Lincare, paying multimillion-dollar legal settlements is an integral part of doing business.

The company, the largest distributor of home oxygen equipment in the United States, admitted billing Medicare for ventilators it knew customers weren’t using (2024) and overcharging Medicare and thousands of elderly patients (2023). It settled allegations of violating a law against kickbacks (2018) and charging Medicare for patients who had died (2017). The company resolved lawsuits alleging a “nationwide scheme to pay physicians kickbacks to refer their patients to Lincare” (2006) and that it falsified claims that its customers needed oxygen (2001). (Lincare admitted wrongdoing in only the two most recent settlements.)

Such a litany of Medicare-related misconduct might be expected to provoke drastic action from the Department of Health and Human Services, which oversees the federal health insurance program that covers 1 in 6 Americans. Given that most of Lincare’s estimated $2.4 billion in annual revenues are paid by Medicare, HHS wields tremendous power over the company.

Sure enough, as part of the 2023 settlement, HHS placed Lincare on the agency’s equivalent of probation, a so-called corporate integrity agreement. The foreboding-sounding document includes a “death penalty” provision: Any “material breach” of the probation agreement, which runs for five years, “constitutes an independent basis for Lincare’s exclusion from participation in the Federal health care programs.” Such a ban could effectively kill Lincare’s business.

That sounds dire. Except that before that corporate integrity agreement was signed in 2023, Lincare was under the same form of probation, with the same death penalty provision, from 2018 to 2023, and violated its terms. From 2006 to 2011, Lincare was similarly on probation and also violated the terms, according to the government. And before that — well, you get the picture. Lincare has been on probation four times since 2001. And despite a pattern not only of fraud, but of breaking its probation agreements, Lincare has never been required to do more than pay settlements that amount to pennies relative to its profits.

This is not an aberration. While HHS routinely imposes the death penalty on small operations, it has never barred a national Medicare supplier like Lincare from continuing to do business with the government. Some companies, it seems, are too big to ban.

Lincare’s lengthy record of misbehavior isn’t a surprise to people in the medical equipment business. What is surprising is the federal government’s willingness to pull its punches with a company that has fleeced taxpayers and elderly customers again and again.

Federal officials have never pursued the company executives who oversee this behavior even though two of them, Chief Operating Officer Greg McCarthy and Chief Compliance Officer Jenna Pedersen, have worked at Lincare through all four of the company’s probationary periods. No one has faced criminal charges for activity the government’s own investigators deemed fraud.

Medicare has continued to pay Lincare billions even as many of the company’s customers revile it. Evaluations on customer-review websites are lacerating, and complaints to state attorneys general abound. On the Better Business Bureau’s website, 888 reviewers gave Lincare an average score of 1.3 out of 5. They cite dirty and broken equipment, charges that continue even after equipment has been returned, harassing sales and collection calls, and nightmarish customer service. As one person wrote in April, Lincare is “running a scam where they have guaranteed income” and “the customer can’t do a thing.”

HHS has always been reluctant to cut off big suppliers. Medicare’s first objective is to make sure nothing interrupts the flow of medications, devices and services to beneficiaries. And were HHS to seek to ban Lincare, the company would surely launch a long, costly legal war. But even if the cost of such combat reached many millions of dollars, it would still be a tiny fraction of the amount lost to fraud, which is yet another contributor to the soaring medical costs that bedevil the country. “This is taxpayer money,” said Jerry Martin, a former U.S. attorney who represented an ex-Lincare executive in a whistleblower suit against the company. “We need to pay people that don’t have four corporate-integrity agreements.”

Weak enforcement is not the only problem. Lincare is paid to rent oxygen equipment to patients, with HHS covering most of the monthly bills. But those rental fees often add up to many times what it would cost simply to buy the equipment. “If this were a rational country,” Bruce Vladeck, who ran Medicare from 1993 to 1997, told ProPublica, “the government would buy a million [oxygen] concentrators and pay Amazon or somebody to deliver them.”

In a seven-month investigation, ProPublica examined how Medicare’s largest provider of home medical equipment has managed to take advantage of its customers for a quarter of a century while fending off meaningful enforcement. ProPublica interviewed more than 60 current and former employees and executives, Medicare and Justice Department officials, patient advocates, and health care experts. ProPublica also reviewed dozens of court cases involving Lincare and thousands of pages of internal company documents, sales presentations and emails.

The investigation reveals a dismal picture of a company with a sales culture that depends on squeezing infirm and elderly patients and the government for every penny. Lincare employees are pressured to sell — whether a customer needs a product or not — on pain of losing their jobs.

And the company’s record of misbehavior and conflict extends far beyond its sales and billing practices. Lincare has paid $9.5 million in settlements for data breaches and mishandling patient and employee records. It has faced claims of violating wage rules, harassing customers with sales and collection calls, and tolerating racist comments to an African American employee. (Lincare lost the latter suit at trial and is appealing.) The company has repeatedly sparred in court with former executives, including a 2017 suit in which longtime executive Sharon Ford claimed that the company had cheated her out of a $1 million bonus. (A judge ruled in favor of Ford at trial before the case was overturned on appeal.) Ford testified that Lincare had earned an industry reputation as “The Evil Empire.” And when Lincare’s CEO, Crispin Teufel, resigned last year to become CEO of a rival company, Lincare sued him for breach of contract and misappropriating trade secrets. Teufel ultimately admitted to downloading confidential company records and was blocked from taking the new job. (Teufel did not respond to requests for comment. His replacement, Jeff Barnhard, took over as Lincare’s CEO in July 2023.)

Lincare declined multiple requests to make executives available for interviews. After ProPublica provided a lengthy document listing every assertion in this article, along with separate such letters to executives McCarthy and Pedersen, the company responded with a three-paragraph statement. It asserted that Lincare is “committed to delivering high-quality and clinically appropriate equipment, supplies, and services” but acknowledged “missteps in the past.” The company said its “new leadership” had “commenced a comprehensive review of our policies and procedures to help ensure we are complying fully with all state and federal regulations” and that “investments and enhancements we have made over the last several months will help prevent these issues from repeating in the future.” Lincare did not respond to follow-up questions requesting examples of the steps the company says it’s taking, including whether it has terminated any executives as part of this push.

When ProPublica asked a top Medicare enforcer why Lincare had eluded banishment, her answer suggested she views probation as a continuing ed class rather than a harsh punishment. “It’s like taking a college course,” said Tamara Forys, who is in charge of administrative and civil remedies for HHS’ Office of Inspector General. “At the end of the day, it’s really up to you to change your corporate culture and to study, to learn to pass the class … to embrace that and take those lessons learned and move them forward.” A spokesperson for the Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment on Lincare but said the agency “is committed to preventing fraud and protecting people with Medicare from falling victim to fraud.”

There’s little incentive to refrain from misbehaving in an environment that tolerates bad behavior, said Lewis Morris, who was chief counsel to HHS’ Office of Inspector General from 2002 to 2012. “As long as that [settlement] check is less than the amount you stole, it’s a good business proposition."

Indeed, Lincare has counted on the government’s tepid response, two former company executives told ProPublica. Top management, they said, responds to fraud warnings by conducting a cost-benefit analysis. “I’ve sat in meetings where they said, ‘We might have $5 to $10 million risk — if caught,’” said Owen Kirk Staggs, who ran one of Lincare’s businesses in 2017 and fell out with the company. “‘But we’ve made $50 million. So let’s go for it. The risk is worth the reward.’”

Libby, Montana, provides a glimpse of the way Lincare operates. Oxygen is an urgent need in this mountain town of 2,857. Libby suffers from the lingering effects of “the worst case of industrial poisoning of a whole community in American history,” in the words of the Environmental Protection Agency. An open-pit vermiculite mine, which operated from 1963 to 1990, coated the area — and residents’ lungs — with needle-like asbestos fibers. More than 2,000 Libby citizens have been diagnosed with respiratory diseases since then; some 700 have died.

Hundreds of ailing residents relied on Lincare for home concentrators, which provide nearly pure oxygen extracted from room air. Medicare and Medicare Advantage plans (which the government also funds) covered 80% of the monthly rental of about $135; patients paid the remaining 20%.

In 2020, Brandon Haugen noticed something suspicious in Lincare’s bills. Haugen was a customer service representative at the company’s local distribution site, one of 700 such locations around the country. (Lincare serves 1.8 million respiratory patients in 48 states.)

Lincare was allowed to charge patients and their insurers for a maximum of 36 months under federal rules. After that point, patients could use the equipment without further charge. Lincare, however, kept billing local patients and their Medicare Advantage plans far beyond 36 months — in some cases, for years. To Haugen, this looked like fraud.

Haugen conferred with center manager Ben Montgomery. The two, who had grown up in the area, had been buddies since seventh grade, after getting to know each other at summer Bible camp. Then 38, earnest and just beginning to gray out of their boyishness, the two men were concerned. The patients the men dealt with were their neighbors.

A regional Lincare manager assured them that charging beyond 36 months for Medicare Advantage patients “is the correct way to bill.” Skeptical, Montgomery raised the issue with Lincare’s headquarters in Clearwater, Florida. Lincare’s compliance director told him, according to Montgomery, that “it’s the patients’ problem to fix it if they want it to stop”; that was “just how it worked.” Further questions, sent to Lincare’s chief compliance officer, Pedersen, went nowhere. “It seemed pretty obvious they were well aware of this,” Montgomery told ProPublica. “For me, these were my customers that you were screwing over.”

Among them was Neil Bauer, now 80, who lives in a ramshackle house “out in the boondocks,” as he put it, 38 miles southeast of Libby. Bauer spent his career as a barber, head of investigations for the county sheriff’s department and a member of the local school board. He’s been on oxygen for more than a decade and quickly gets short of breath. “I can’t do stuff so much now,” he said. His wife is on oxygen, too. “We just have a sick family,” Bauer said.

Lincare had kept billing Bauer for his concentrator for seven years after it was supposed to stop. The monthly copays weren’t huge, but they added up to $2,325 that he shouldn’t have been charged over that period, a daunting sum for Bauer, who lives on a fixed income — and a hefty mark-up over the cost of the equipment, which can be purchased online for $799. For its part, Medicare Advantage paid Lincare $9,299 for Bauer’s concentrator during this period, along with another $5,760 for the months Lincare was legally permitted to bill. All told, the rental payments to Lincare, during authorized and unauthorized periods, were $16,547 for that one $799 piece of equipment. “We paid forever,” said Bauer. “Never was I told that we could have one without having to pay anything.”

Haugen and Montgomery studied billing records. Among the customers in their tiny office, Lincare was improperly charging at least 33 people and their Medicare plans. The two began to wonder how far this problem extended. An employee in Idaho confirmed the same practice was occurring there. “In my mind,” Montgomery said, “I went, ‘This is Libby, Montana. Multiply that by every center in the country. This is obviously a lot bigger deal.’”

Montgomery and Haugen had seen enough. On Jan. 18, 2021, they emailed a joint resignation letter to Lincare’s top management, recounting their concerns about billing that “likely affects thousands of patients company wide.” Citing the lack of response from corporate officials, they wrote, “we can only conclude that this is a known issue that is being covered up by Lincare.”

Haugen had 10 children. Montgomery had four. Neither man had another job lined up. “Had this not happened,” said Montgomery, who had been at the company for 13 years, “I would have seen myself retiring from Lincare.”

Instead, they became whistleblowers. They retained a law firm and sued Lincare in Spokane, Washington, the site of Lincare’s regional headquarters. After federal prosecutors decided to back the case, Lincare settled in August 2023. The company admitted to overbilling Medicare plans and patients across the country for years and paid $29 million to settle the matter, with $5.7 million of that going to Montgomery, Haugen and their lawyers. Dan Fruchter, the assistant U.S. attorney leading the government’s case, told ProPublica that the overbillings likely involved “tens of thousands” of patients.

Lincare agreed to its fourth stint of probation with HHS; the new corporate-integrity agreement took effect on the day after the previous one expired. The conduct Montgomery and Haugen flagged had gone on for years while the company was already on probation. But Lincare got the government lawyers to agree that nobody would try to impose the Medicare death penalty. Lincare asserted in the settlement that it had installed software (which it did only after learning of the government investigation) that will prevent billing beyond 36 months. Lincare promised to ensure “full and timely” compliance with the agreement and prevent future wrongdoing.

Medicare fraud, including in the “durable medical equipment” category that Lincare operates in, has long been an intractable problem. It cost the U.S. Treasury an estimated $60 billion in 2023 alone.

The government deploys large sums to try to stop it. HHS’ inspector general’s office has a $432 million budget and a staff of 1,600. Those resources are effectively extended by whistleblowers — most of the cases against Lincare have been such suits — who can receive a percentage of a civil settlement if they reveal wrongdoing, and by federal prosecutors, who can also bring cases or join those filed by whistleblowers. Last year HHS recovered $3.2 billion from fraudulent schemes.

But the agency’s enforcers have wielded their biggest deterrent almost entirely against small perpetrators. In 2023, they banned 2,112 small firms and individuals from Medicare reimbursement.

HHS hasn’t done the same with companies that operate on a national scale. Forys, the agency enforcer, said she worries that expelling a big provider from Medicare could leave customers in the lurch. In April, Inspector General Christi Grimm defended her office’s work in congressional testimony but also asserted that its resources are inadequate. A lack of staff keeps it from even investigating “between 300 and 400 viable criminal and civil health care cases” annually, she testified, as well as more than half the fraud referrals from Medicare’s outside audit contractors.

A different reason for going easy on big companies was suggested by Vladeck, the former Medicare chief. Seeking to bar a large supplier for repeatedly violating probation would require exhaustive documentation and years of litigation against squadrons of well-paid corporate lawyers. As a result, Vladeck said, “there’s a real incentive, from a bureaucratic point of view, to just slap their wrist, give them a kick and make them apologize. … It’s a cost of doing business.”

There are steps enforcers could take, but almost never do, that would make companies take notice, according to Jacob Elberg, a former federal prosecutor who is now a professor at Seton Hall Law School. (Among his publications is a 2021 law review article titled “Health Care Fraud Means Never Having to Say You’re Sorry.”) Elberg’s research shows that HHS and prosecutors tend to negotiate far smaller civil settlements than the law allows, and they rarely prosecute company executives. They also almost never take cases to trial. In short, enforcers have long signaled to companies that they’re looking for a smooth path to a cash payment rather than a stern punishment for a company and its leaders. “It is generally a safe assumption,” Elberg said, “that the result will be a civil settlement at an amount that is tolerable.”

For its part, Congress may soon be weighing a new law that would reshape how the oxygen industry is paid by Medicare. But rather than clamp down on corporations, the legislation seems poised to do the opposite. A new bill called the SOAR (Supplemental Oxygen Access Reform) Act would hand companies like Lincare hundreds of millions more, by raising reimbursement rates and eliminating competitive bidding among equipment providers. Advocates say the legislation will help patients by making some forms of oxygen more available and improving service. But along the way it will reward Lincare and its rivals.

Congress has a history of treating oxygen companies generously. For years, lawmakers set Medicare reimbursements for oxygen equipment at levels that even HHS, in 1997, characterized as “grossly excessive.” Over the succeeding decade and a half, Lincare took advantage, snatching up hundreds of small suppliers and becoming the industry’s largest player.

In 2006, under pressure to reduce costs, Congress approved steps to curb oxygen payments, including the introduction of competitive bidding and the 36-month cap on payments for equipment rentals. But even those strictures were watered down after the industry poured money into political contributions and lobbyists, who warned that cuts would harm elderly patients.

Lincare compensated by amping up strategies that generated profits, with little apparent regard for Medicare’s rules, which say it will reimburse costs for equipment only when there is evidence of “medical necessity.” The company aggressively courted doctors and incentivized sales, through bonuses the company paid for each new device “setup.” According to a 2016 commission schedule, reps could earn $40 for winning an order for a new sleep apnea machine, $100 for a new oxygen patient and $200 for a noninvasive ventilator. The entire staff of each Lincare center could receive a small bonus for signing up a high percentage of new patients for automatic monthly billing. Patients who refused auto-billing, a company document advised, should be warned they might face “collection activity” and service cutoffs. “Sales is our top priority!” declared a 2020 PowerPoint to train new hires.

Once it had a customer, Lincare would pitch them more costly products and services. One way Lincare did this was through a program called CareChecks. Promoted as a “patient monitoring” benefit, CareChecks were aimed, according to a company presentation, at generating “internal growth.” If a patient exhibited a persistent phlegmy cough, Lincare could persuade their doctor to prescribe a special vibrating vest to loosen chest mucus. Nebulizer patients might be candidates for home oxygen. Patients using apnea devices were potential candidates for ventilators. “We’d make patients think we were coming in clinically to assess them,” a former Lincare manager said, “when really it was to make money off of them.”

Selling replacement parts could also be lucrative. At Lincare call centers that sold items like hoses, masks and filters for CPAP machines (used to treat apnea), hundreds of commissioned agents in Nashville, Tennessee, and Tampa, Florida, were equipped with programs displaying what items each patient was eligible for under Medicare. By law, patients had to request replacement parts. But frequently, that wasn’t what happened, according to Staggs, who oversaw the CPAP business in 2017. He discovered that top salespeople, whose bonuses could total $8,000 a month, averaged just a few minutes on the phone per order. That wasn’t nearly enough time to identify what items, if any, customers actually needed. Staggs listened to recorded calls and found that, after reaching customers, agents often placed them on hold until they hung up, then ordered them every product that Medicare would cover.

At Lincare, results were closely tracked and widely shared in weekly emails displaying the best and worst performers in each region. Notes taken by one manager show supervisors’ performance demands during weekly conference calls: “Unacceptable to miss goal … stop the excuses … If this is not being done, wrong [center manager] in place … If you’re not getting O2 and not getting Care Checks — you shit the bed. Stop accepting mediocre, lazy responses ….”

“If we didn’t meet our quota, they were going to chop our heads,” said former Illinois sales rep Sandra Gauch, who worked for Lincare for 17 years before joining a whistleblower suit and quitting in 2022.

One salesperson was so fearful of missing her quota, according to Gauch, that she signed her mother up for a ventilator that she didn’t need. A company audit in 2018 found that only 10 of 56 ventilator patients at one center were using them consistently. Some patients hadn’t used their devices for years. Yet Lincare kept billing Medicare.

Only one thing mattered as much as maximizing new equipment rentals, according to former employees and company documents: minimizing customers’ attempts to end rentals. A call to retrieve breathing equipment meant that it was no longer wanted or being used, and Lincare was supposed to retrieve it and promptly stop billing Medicare and the patient. The person’s health might have improved. They might have gone into the hospital — or died. The reason didn’t matter; at Lincare, “pickups” were a black mark, deducted from employees’ performance scores, jeopardizing their bonuses and jobs.

As a result, employees said, such requests were dreaded, delayed and deterred. Clinical staff were sent to “reeducate” customers to keep using their devices. Patients were told they’d need to sign a form stating they were acting “against medical advice.”

Lincare managers made it clear that pickups should be discouraged. In a 2010 email, an Ohio center manager instructed subordinates: “As we have already discussed, absolutely no pick-ups/inactivation’s are to be do[ne] until I give you the green light. Even if they are deceased.” In 2018, an Illinois supervisor emailed her deputies that pickups were barred without her explicit approval: “Not even Death that I don’t approve first.”

In February 2022, Justin Linafelter, an area manager in Denver, responded to the latest corporate email celebrating monthly “Achievement Rankings” for oxygen sales by pointing out that almost all of the centers atop the rankings had at least 150 “pending pickups,” customers who weren’t using their equipment but whom the company appeared to still be billing. “Some of these centers are just ignoring pickups to make this list.”

That was only one of Linafelter’s concerns. In July of that year, he emailed headquarters, saying he no longer had “the resources to be successful at my job.” The customer service staff in Denver had been cut in half, Linafelter explained, and he’d been barred from hiring replacements. Denver’s remaining staff was “at a point of exhaustion,” threatening patient care.

The morning after Linafelter expressed concerns to Lincare in 2022, he was summoned to a conference call with the head of HR and fired, for what he was told was a “corporate restructuring.” Linafelter, who had worked at Lincare for nine years, said, “I got thrown away like a piece of trash.”

Other former employees offer similar accounts. In 2020, Jillian Watkins, a center manager in Huntington, West Virginia, repeatedly alerted supervisors that Lincare was improperly billing for equipment that patients weren’t using. Lincare blocked her from firing a subordinate who’d falsified documents supporting the charges, then fired Watkins, citing “inadequate direction and leadership.”

Then came a series of turns. Pedersen, the chief compliance officer, effectively confirmed Watkins’ assertions, belatedly alerting the government about $486,000 in improper billings by Lincare. But Pedersen blamed the billings on Watkins, writing to Medicare that the company had “terminated” her to “prevent [the problem] from recurring.” After Watkins sued, Pedersen admitted in a deposition that Watkins’ firing “had nothing to do with the overpayment.” In April 2024, a federal judge ruled that Watkins had presented “a prima facie case of retaliation.” The suit was privately settled in mediation.

Staggs, too, was ousted, he said, after he warned top Lincare executives about improper practices at the CPAP call centers. Staggs emailed a Lincare HR officer: “Patients are being shipped supplies that they never have ordered. … This is fraud and I have gotten zero support or attention to this matter when I raise the issue to my leadership.” Only months after starting, he was fired in November 2017. He later filed a whistleblower suit; Lincare denied wrongdoing. After the U.S. attorney’s office in Nashville declined to join the case in 2022, Staggs withdrew the action.

Staggs’ account of improper billings matches an industry pattern that appears to continue to this day. In a 2018 report, HHS’ inspector general estimated that Medicare had paid more than $631 million in improper claims for CPAP and other supplies over a two-year period. Another HHS analysis identified an additional $566 million in potential overpayments for apnea devices.

The agency’s oversight “was not sufficient to ensure that suppliers complied with Medicare requirements,” the 2018 report concluded. Six years later, HHS has not taken public action against Lincare relating to CPAPs.

Today, fraudulent billing among Medicare equipment providers remains a “major concern,” according to the inspector general. The agency says it continues to review the issue.


Doris Burke contributed research.

RIP
Contractor charged after Fort McMurray worker killed in fall through roof
CBC
Thu, October 24, 2024 

Charges have been laid after a worker sustained fatal injuries after falling through a roof on a Fort McMurray worksite in June 2023. ( Government of Alberta - image credit)


A contractor is facing workplace safety charges after a worker died in a fall in Fort McMurray last year.

The worker was removing construction material from a roof on June 8, 2023, when they fell through the roof to the floor below. The worker sustained fatal injuries.

Pacific Rim Industrial Insulations Ltd. has been charged with four counts under Alberta's Occupational Health and Safety Act.


The charges, which were laid on Oct. 10, include failing to ensure a worker was protected from falling when working at a height of three metres or more.

According to the charges, the worker was not equipped with an adequate restraint system and was not protected by guardrails.

It is alleged that the company had failed to develop a fall protection plan for its workers, as required by the OHS code.

According to the legislation, employers must ensure that employees are informed of all fall hazards at each work site. Employers must also enforce the use of fall protection systems when employees are at risk.

The charges have not been proven in court. Company officials have not responded to requests for comment on the case.

According to the company's website, the contractor specializes in insulation, cladding and asbestos abatement for sectors including the chemical, oil and natural gas industries.

Search of Manitoba landfill for remains of slain First Nations women on track: Kinew

Brittany Hobson
Wed, October 23, 2024 



WINNIPEG — The effort to find the remains of two slain First Nations women believed to be in a landfill is on track and excavation in the target area is set to start in early December, Manitoba Premier Wab Kinew said Wednesday.

"I hope that everybody in the province and across the country sees that Manitoba values and honours Indigenous women," Kinew told reporters as he stood at the Prairie Green Landfill north of Winnipeg.

Kinew also addressed the families of Morgan Harris and Marcedes Myran, who joined him at the site.


"I hope that as you see the progress that's been brought here today that it brings you some measure of healing," the premier said.

Preliminary excavation of a four-metre-deep top layer of material — above the area that searchers will initially focus on — is underway, said a government official.

The area is 10 metres deep, but the province said an assessment has been done to determine the amount of waste that needs to be moved.

A building is also being constructed for searchers, a power line to the building has been installed, road access has been built, and hiring interviews for searchers are in progress.

Forensic experts have been working with RCMP and the chief medical examiner's office to establish a protocol if remains are found.

Police believe the remains of Harris and Myran were sent to the privately run landfill in May 2022. Jeremy Skibicki admitted to killing Harris, Myran and two other Indigenous women and putting their remains in garbage bins.

The remains of Rebecca Contois were found in a garbage bin and in a different landfill. Those of an unidentified woman whom Indigenous grassroots community members have named Mashkode Bizhiki'ikwe, or Buffalo Woman, have not been located and police have not said where they are believed to be.

Skibicki was convicted of first-degree murder and sentenced earlier this year to life in prison with no parole eligibility for 25 years.

Several family members and supporters held bundles of tobacco wrapped in red, yellow and brown cloth as they flanked Kinew.

"I think it's important to acknowledge that there is a lot of work that needs to get done. But for our families, we're finally seeing that light at the end of the tunnel," said Cambria Harris, a daughter of Morgan Harris.

She said relatives planned to later lay down the tobacco ties at a healing lodge set up at the landfill — something they do every time they visit.

Betsy Kennedy, acting grand chief of the Assembly of Manitoba Chiefs, reiterated the importance of handling the search with the respect, care and diligence the families deserve. It's a sentiment former grand chief Cathy Merrick advocated for before her death last month.

Kinew also honoured Merrick during the event.

"This search of Prairie Green was something that she held very dear ... we dedicate these activities not only to the families that are gathered with us here today, but also to the late grand chief."

Police and the province's former Progressive Conservative government had rejected calls to search the landfill, partly because of asbestos and toxic material and as there's no guarantee the remains will be found.

The Tories took out election campaign ads before last year's vote that promoted their decision to "stand firm" against a search.

Kinew promised there would be a search if the NDP was elected. Earlier this year, the province committed $20 million to the search, matching a federal contribution.

"The search of the Prairie Green landfill was always feasible. It was always possible. It required political will," said Kinew.

The premier said the project has been designed to provide the highest environmental standards and protection for the area and ensure the health and safety of all workers.

"I hope we can bring your loved ones home," Kinew told the families.

"But the most important thing is we're going to try."

This report by The Canadian Press was first published on Oct. 23, 2024.

Brittany Hobson, The Canadian Press


Work to prepare for Prairie Green landfill search has started, province says

CBC
Wed, October 23, 2024 

Concrete slabs are in place at the Prairie Green landfill for the building where workers will search through materials for the remains of Morgan Harris and Marcedes Myran. (Travis Golby/CBC - image credit)


WARNING: This story contains disturbing details.

The province says it's made significant progress toward the search of a Winnipeg-area landfill for the remains of two First Nations women murdered by a serial killer.

Excavators have begun moving material away from an area of the landfill where the remains of Morgan Harris, 39, and Marcedes Myran, 26, are believed to be, said Amna Mackin, the provincial assistant deputy minister leading the operation.

An environmental assessment was completed earlier this year to determine the amount of waste that will need to be removed for the search to begin, Mackin said.

Work has also started on the building where the landfill materials will be searched through, and a hydro transmission line and access road to the site have been set up.

Next week, trailers for staff involved in the search are expected to arrive, Mackin said.

The women's remains are believed to have been taken to the Prairie Green landfill north of Winnipeg after Jeremy Skibicki killed them.

Left to right: Morgan Beatrice Harris, Marcedes Myran and Rebecca Contois. Winnipeg police said on Thursday, Dec. 1, 2022, they have charged Jeremy Skibicki with first-degree murder in the deaths of all three women, as well as a fourth, whom community members have named Mashkode Bizhiki'ikwe, or Buffalo Woman, because police do not know her identity.More

Left to right: Morgan Beatrice Harris, Marcedes Myran and Rebecca Contois. Jeremy Skibicki was found guilty of first-degree murder in the deaths of all three women, as well as a fourth, whom community members named Mashkode Bizhiki'ikwe, or Buffalo Woman, because police do not know her identity. (Submitted by Cambria Harris, Donna Bartlett and Darryl Contois)

Skibicki was convicted of first-degree murder on July 11 in the killing of three First Nations women — Harris, 39, Myran, 26, and Rebecca Contois, 24 — as well as an unidentified woman who has been given the name Mashkode Bizhiki'ikwe, or Buffalo Woman, by community leaders.

The search, which could continue into early 2026, will involve sifting through garbage removed from a total area of about 100 by 200 metres — or about four football fields — to a maximum depth of about 10 metres, the province previously said.

An aerial view of Prairie Green landfill near Winnipeg in June 2024.

An aerial view shows Prairie Green landfill near Winnipeg in June 2024. (Trevor Brine/CBC)

The provincial and federal governments each committed $20 million earlier this year to help fund the landfill search.

 

One Year of Israel’s War on Gaza’s Health System

Ana Vračar | 12 Oct 2024

After a year of unrelenting Israeli attacks, Gaza’s healthcare system lies in ruins. Yet, health workers continue their steadfast efforts to provide care.

Al Shifa Hospital after a two-week Israeli siege, April 2024.

After a year of relentless bombardment, Gaza’s healthcare system lies in ruins, and the warnings Palestinians have issued for decades are being confirmed: hospitals, clinics, and health workers are deliberate targets of Israeli Occupation Forces (IOF). What was once a systematic campaign against healthcare has escalated into an all-out assault, resulting in the decimation of most of the infrastructure. As the one-year anniversary of this ongoing genocide approached, Israeli forces continued their siege on northern Gaza, intensifying their attacks on health facilities.

Three hospitals still barely functioning in the area — including Al-Awda and Kamal Adwan — were just issued so-called “evacuation orders,” which, as pointed out by Medical Aid for Palestinians (MAP), are nothing short of forced removal orders. Kamal Adwan’s director, Hussam Abu Safiya, stressed the impossible position the hospital faced soon after the orders were issued. With critically injured children in their care, no means to safely evacuate them, and no other facility able to accept them, health staff are faced with the excruciating decision of either abandoning their patients or staying at the risk of their own lives.

“In between the constant bombardment occurring on the hospital and the surrounding buildings, the healthcare staff have become terrorized to a point where they are struggling to do their jobs,” Abu Safiya stated. Their situation is similar to that faced in other health facilities. Around the same time Abu Safiya recorded his statement, medics in Al-Awda were also issued forced removal orders—for the third time in a year—says Matilde De Cooman from Viva Salud, a Belgian organization partnering with the hospital.

The risks health workers face are all too real. Israeli forces have systematically besieged and destroyed healthcare infrastructure over the past 12 months, including Gaza’s largest hospitals, such as Al-Shifa. Under the pretext of searching for resistance fighters, the IOF raided operating rooms, destroyed medical equipment, and abducted patients and medical staff. In the aftermath of the attacks, civil defense teams discovered seven mass graves containing 520 bodies on hospital grounds.

Over 1,000 health workers have been killed since the genocide began, with hundreds more kidnapped and held in Israeli concentration camps. Those who have been released share harrowing accounts of torture: shackles, electric shocks, broken limbs, and sexual violence. Families of those still missing, like Dr. Ahmed Muhanna, the director of Al-Awda Hospital in northern Gaza, are not granted any official information about prisoners’ conditions. Dr. Muhanna was abducted in December 2023. Since then, no official word has emerged about his mental or physical condition, says De Cooman.

International campaigns to secure the release of Dr. Muhanna and other abducted health workers are ongoing, though disturbing reports of their treatment in Israeli camps have sparked both outrage and fear about what the future holds. Despite these developments, Gaza’s health workers remain resolute, refusing to abandon their patients. Their unwavering commitment, sumud (steadfastness), has been lauded by global health workers since the beginning of the genocide. Operating without pay or essential supplies due to the blockade, they have continued their work tirelessly since last October. “Even with Dr. Muhanna’s fate in mind, Al-Awda’s operating director, Mohammed Salha, never once considered abandoning the hospital,” says De Cooman. “As long as there is even one person left in the area, the hospital will remain open and stand by its people.”

The health suffering in Gaza extends far beyond the hospitals. With more than two million people pushed into poverty by the attacks and the aid blockade, food and clean water are scarce. Recent reports reveal that 35% of children and 40% of pregnant or breastfeeding women in Gaza are surviving on just one type of food. Malnutrition is rampant, and the World Health Organization (WHO) has documented cases of children starving to death as humanitarian aid convoys are blocked at Israeli-controlled checkpoints.

Hunger and disease go hand-in-hand, as the WHO continues to repeat. Gaza is witnessing a hard-to-imagine surge in infectious diseases—respiratory infections, skin diseases, Hepatitis A, and even polio, a virus that had been eradicated decades ago but resurfaced, paralyzing a 10-month-old child. The shortage of basic hygiene products, such as soap and clean water, only adds to the crisis.

The spread of diseases is anything but collateral damage: it is a calculated weapon in Israel’s strategy. As Jewish Voice for Peace remarked, in prisons, “skin diseases are a method of punishment. Prison authorities are allowing scabies to spread by restricting Palestinian inmates’ water supply and depriving them of clean clothes and medical care.”

On top of it all, Gaza’s whole environment is contaminated with asbestos dust raised by the constant bombardment. An estimated 800,000 tonnes of debris in Gaza could contain asbestos particles, as reported by Al Jazeera, raising the prospect of soaring cancer rates in the coming years.

“After a year, the occupying forces continue to practice an unprecedented genocide in modern history. What is particularly painful is the disgusting silence of the international community,” stated Hani Serag, Co-Chair of the People’s Health Movement. “We hope that activists across the world will continue expressing their solidarity to Palestinian people and refuse the barbaric practices of the occupying forces.”

Israeli crimes against healthcare are not confined to Gaza. In less than a month, Israeli forces have killed over 100 health workers in Lebanon and forced the closure of dozens of health centers. The destruction unfolding in Gaza serves as a blueprint for the invasion of Lebanon, raising the question: how long will the West look away while Israel continues its rampage?

People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscription to People’s Health Dispatch, click here.

Courtesy: Peoples Dispatch

What presidential campaign? 

The Electoral College puts most American voters on the sidelines

WHITE LANDOWNERS VETO POWER

CHRISTINE FERNANDO

Tue, October 8, 2024

WAUKEGAN, Ill. (AP) — On a table at the office of the Waukegan Township Democrats sits a box of postcards with Wisconsin addresses that were collected during a postcard-writing pizza party to help turn out voters there. Leaning against the table are homemade Harris-Walz signs.

“We know they’re handing these out everywhere in Wisconsin,” said Matt Muchowski, chair of the Democratic club. “Here in Waukegan, it’s been harder to get a hold of Harris yard signs, so we’re printing out our own.”

One reason they've been in short supply: Waukegan is in Illinois, which is not a presidential swing state. It just sits across the border from one.

Muchowski said this is emblematic of the limited attention cities outside of swing states receive from presidential campaigns. The United States' unique Electoral College system, which replaces the popular vote, puts disproportionate voting power in the hands of a relative few states that are evenly divided politically and ensures that the majority of campaign dollars — and attention from the presidential candidates — goes to those states.

The lack of attention leaves voters in much of the country feeling as if they and the issues they care about have been sidelined. It's a dividing line that is felt acutely in places such as Waukegan, one of Chicago’s farthest-flung suburbs.

The last time a presidential candidate set foot in the working class, majority Latino city was when former President Donald Trump landed at its airport in 2020. Trump walked off Air Force One, gave a single wave, and then immediately climbed into an SUV headed across the border to Kenosha, Wisconsin.

‘Lost in the national conversation’

In Racine, a Wisconsin city of a similar size just 50 miles north of Waukegan, Trump hosted a rally in June near a harbor overlooking Lake Michigan, where he gushed about the development along the lakeshore, spoke about revitalization efforts in Racine and the Milwaukee metropolitan area, and emphasized their voters’ importance in his attempt to return to the White House.

Just a month earlier, before he dropped out of the race, President Joe Biden lauded a new Microsoft center in Racine County during a campaign stop in the city. The city just south of Milwaukee has become a common stomping ground for presidential hopefuls as Wisconsin, one of just seven battleground states likely to determine this year’s presidential race, remains heavily targeted by the campaigns of Trump and Vice President Kamala Harris.

Cities such as Waukegan become “lost in the national conversation” during presidential elections, said Muchowski, who has lived in the area most of his life.

“It’s not so much the candidates as it is the anti-democratic Electoral College,” he said. “... It’s frustrating that certain voters’ votes count for more, and they discount and discredit the votes of more urban, more people of color voters.”

Campaigns visits to neighboring Wisconsin: 27

Illinois is a reliably Democratic state — it hasn't voted for a Republican presidential candidate since George H.W. Bush in 1988. That predictability is reflected in the presidential campaigns every four years.

Except for fundraisers, the Republican and Democratic presidential tickets have been to Illinois just twice this year — once for an appearance by Trump before a group representing Black journalists and once by Harris when she came to Chicago for her party’s national convention. By comparison, they had visited Wisconsin 27 times through Tuesday, including when Biden was the presumptive nominee.

This year's presidential battleground states — Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania and Wisconsin — represent 18% of the country's population but have dominated the attention of the Democratic and Republican presidential candidates and their running mates.

Through Tuesday, they have had just over 200 total campaign stops — three-quarters of which have been to those seven states, according to a database of campaign events that is based on Associated Press reporting. Pennsylvania alone has been visited 41 times, the most of any state.

But it's not just the state visits: The presidential campaigns are tailoring their appearances to specific counties they believe are crucial to their success. The AP's database shows their campaign events in the seven battleground states have been concentrated in counties with 22.7 million registered voters — just 10% of all voters registered nationally for this year's presidential election.

Electoral College, a system of 'neglect’

Many residents of Waukegan wish it also could get on the candidates' radar. They said they're proud of how multiculturalism has shaped their city, a place where almost 60% of residents are Latino and more than 16% are Black, according to 2020 U.S. Census data.

The working class community was largely built on factory jobs that once offered residents a comfortable, middle class life. But after companies abandoned the city’s lakefront, starting in the 1960s, tens of thousands of jobs disappeared.

Waukegan never fully recovered.

Its poverty and unemployment rates rise well above the state and national averages. Its school district is one of the worst-funded in the county, struggles with understaffing and has dismal graduation rates. And its lakeshore is a sagging reminder of the city's heyday: An asbestos manufacturing plant, a coal plant and a gypsum factory all sit silent beside public beaches. Beside them are a crisscrossed network of abandoned railroad tracks.

The industries brought with them another problem — a legacy of environmental damage. The city of around 86,000 residents has five federal Superfund sites. In 2019, the state’s pollution control board ruled that Waukegan’s coal plant violated environmental regulations and contaminated groundwater, and it was shuttered three years later.

The scene in Waukegan contrasts with Racine’s pristine lakefront marina, where luxury condos flank coffee shops, restaurants and hotels.

Thomas Maillard, the Democratic State Central Committeeman for Illinois' 10th Congressional District and a lifelong Lake County resident, said the contrast between the two cities is clear. In Waukegan, he said he worries about gun violence and access to well-paying jobs, affordable housing, child care and health care.

“The history of Waukegan, unfortunately, is the history of this country’s neglect of those Rust Belt communities, especially along the Great Lakes,” he said. “... People are struggling.”

Maillard pointed to the Electoral College system as a culprit, calling it “a system of potential neglect.”

‘You need to hear us’

Sam Cunningham, a former mayor of Waukegan, said people feel forgotten in the city that he’s called home since elementary school. It’s clear, he said, that the national agenda prioritizes some states over others.

“They’re probably thinking, ‘Why should we put money over here when we need it in these battleground states?’” he said. “I understand the logic, but understand how we feel. Do we feel slighted? Of course we do. It doesn’t mean it doesn’t hurt.”

Margaret Padilla Carrasco, who has lived in the Waukegan area her entire life, drove to Milwaukee in August to see Harris speak. If Harris were to visit Waukegan, Carrasco said she would take her to the deteriorating houses on the south side of the city, to assisted living facilities where senior citizens are struggling to pay their bills and to a homeless shelter near her home.

Her message to Harris, she said, is to not count on their votes. Saddled with job losses and a rising cost of living, people in Waukegan are frustrated, she said. While she still plans to vote for Harris, Carrasco hears of more and more Waukegan voters pulling away from the Democratic Party, which has long won the lion’s share of the city’s votes.

“If you don’t spend the time with us, then don’t expect us to vote for you,” said Carrasco, 65, who trains young Latinas in Waukegan to ride horses in traditional Mexican Charro style. “You need to hear us. You need to talk to us."

James Richard Wynn, a 35-year-old father of nine, said he feels doubly forgotten in Waukegan as a conservative in the predominantly Democratic city. He said he and the issues he cares most about — homeschooling, abortion restrictions, Second Amendment rights and government spending — often go ignored by presidential candidates.

“There is probably a mindset amongst a lot of conservatives, especially in Illinois, who think there’s no point in saying anything,” he said.

'A city of grit and imagination'

Despite limited political attention, several residents praised what they described as Waukegan's do-it-yourself spirit, which often translates into grassroots political organizing around issues such as housing and environmental justice.

On a sunny Tuesday recently, Pastor Julie Contreras, who helps support recent immigrants in the city, had a long to-do list. She was gathering community members to rebuild the roof for an undocumented couple whose house was damaged in a storm. Then she had to collect diaper donations for a woman who had just given birth.

This is the Waukegan most people don’t see, said Contreras, an advocate with the local nonprofit United Giving Hope. She chastised candidates for just dropping in to the city's airport before they head to Wisconsin without engaging with the voters there about their struggles.

“They’re missing out on a wonderful community right here,” she said.

Muchowski, of the Waukegan Township Democrats, said when the city feels ignored, its residents take care of each other. It's something they've gotten used to, he said.

“Waukegan, for a lot of people, is a city of grit and imagination,” Muchowski said. “I don’t know a lot of people who are like, ‘I want to move across the country to Waukegan.’ But the people that come here really see the potential.”

If only, he said, candidates would see the potential, too.

___

Associated Press multimedia journalist Kevin S. Vineys in Washington contributed to this report.

___

The Associated Press receives support from several private foundations to enhance its explanatory coverage of elections and democracy. See more about AP’s democracy initiative here. The AP is solely responsible for all content.

 Waukegan Township  in Waukegan, Ill., Monday, Sept. 16, 2024. (AP Photo/Nam Y. Huh)