When her son was a teenager, Connecticut mom Amy Wadsworth said, he was the type of kid parents rarely worry about.

He played sports, cared about his health and stayed away from drugs. In 2018, when he left West Hartford to start his freshman year at American University in Washington, D.C., she expected his biggest challenge would be adjusting to college life.

Instead, she said, he began using cannabis to cope with social anxiety and as a sleep aid.

Within months, Wadsworth’s son was calling home in the middle of the night, terrified and disoriented.

Over the next several years, his behavior became increasingly erratic, he had psychotic episodes and he was eventually diagnosed with severe cannabis use disorder. That’s when a person’s marijuana use becomes difficult to control and begins interfering with daily life.

Now 25, Wadsworth’s son has spent much of the past several years cycling through hospitals and treatment programs across the country.

“It’s definitely changed the trajectory of his life,” Wadsworth said. “It did nothing but harm him, literally harm every facet of his life — every facet, physical, mental, everything.”

States have spent the past several decades debating whether to legalize cannabis. Now, they are debating how intoxicating legal products should be.

A growing body of research suggests that frequent use of high-THC cannabis increases the risk of cannabis use disorder, psychosis and other mental health problems for users, particularly adolescents and young adults. In response, lawmakers in some states this year have moved to impose stricter potency caps, while others have scaled back or rejected such measures amid industry opposition and uncertainty over research findings.

While cannabis flower once commonly contained THC levels in the single digits, many products sold legally today contain 15% to 20% THC or more. Concentrates — such as waxes, oils and shatter — can exceed 80%.

About 15% of Americans ages 12 and older reported using marijuana in the past month in 2024, according to the Substance Abuse and Mental Health Services Administration. And about 3 in 10 people who use cannabis have cannabis use disorder, according to the federal Centers for Disease Control and Prevention.

Some public health researchers and addiction specialists argue that public perceptions of marijuana have not kept pace with the growing availability of high potency products. They say broader legalization efforts — including the federal government’s recent move to reclassify medical marijuana as a less restrictive drug under the Controlled Substances Act — may reinforce the belief that cannabis is harmless.

“Moving cannabis from Schedule I to Schedule III doesn’t help me save lives by decreasing the perception of that risk,” said Dr. Alta DeRoo, the chief medical officer of the Hazelden Betty Ford Foundation, one of the largest nonprofit treatment providers for addiction and mental health. DeRoo also is a board-certified addiction medicine physician and OB-GYN.

Some state efforts to impose potency limits have been stalled by resistance from the cannabis industry and questions about how far governments should go in regulating a legal product.

In Connecticut, lawmakers this year reinstated a 35% THC cap on flower just weeks after voting to eliminate it. Lawmakers from both sides of the aisle said they were concerned about the potential public health effects of increasingly potent marijuana products.

At the same time, the legislation moved forward with other cannabis market expansions. Lawmakers removed a 70% THC cap on concentrates, increased the amount of THC allowed in certain cannabis-infused beverages and expanded the market to include products such as topicals, tablets and capsules.

Proposals to cap THC potency have surfaced in statehouses across the country for years. This year, lawmakers in California, Georgia, Mississippi, Oklahoma, Oregon and South Dakota introduced similar measures, though most did not advance.

Georgia Republican Gov. Brian Kemp signed a law in May that removes the state’s previous 5% THC potency cap starting July 1. The new law will also add a 12,000 mg possession limit for registered medical cannabis patients and allow patients over 21 to vaporize medical marijuana.

‘A perennial debate’

Lawmakers across the country have proposed a range of measures aimed at limiting the potency of cannabis products.

In Washington state, Democratic state Rep. Lauren Davis has spent years trying to place guardrails on high-potency cannabis products. Since 2020, she has introduced at least five bills that would have capped THC levels in concentrates or imposed safeguards, including age restrictions, warning labels and a higher tax rate on products with elevated THC levels.

Most of those measures were thwarted by opposition from the cannabis industry, Davis told Stateline.

Industry groups and cannabis businesses argued that Washington’s existing regulations already protected consumers and kept cannabis away from minors. Opponents also warned that limiting high-THC products would drive consumers to the illicit market, hurting legal businesses and exposing users to unregulated, possibly contaminated products.

“(The industry) then went on to basically rain down all fire and brimstone and crush every bill that I’ve ever attempted in this area,” Davis said.

The only proposal to become law was a 2024 measure that requires retailers to warn customers about the association between high-potency THC products and psychotic disorders.

Washington state does not currently impose THC caps on flower or concentrates, but it does set limits on edibles and beverages.

Nearly all states have some form of medical-only or hybrid medical and recreational cannabis program, but just eight states, Connecticut, Mississippi, Montana, Nevada, New Mexico, Oregon, Rhode Island and Vermont, have potency caps on some products, including flower, according to the National Conference of State Legislatures. Potency limits on edibles are far more common.

“This is a perennial debate that comes up in Vermont and elsewhere around higher potency products,” said James Pepper, who chairs the Vermont Cannabis Control Board, the agency that regulates the state’s market.

“I feel like the concerns are certainly real,” he added.

In Oklahoma, a recent incident in which a 4-year-old boy was hospitalized and remained unconscious for more than a day after his parents said he ingested a 1,000 mg edible found at a playground has added to growing debate over high-potency cannabis products in the state.

“We know that some of our medical patients truly do need higher potency products, but do we really need a 2,000 milligram gummy available for anyone with a patient license to purchase in an Oklahoma dispensary?” said Adria Berry, the executive director of the Oklahoma Medical Marijuana Authority, which oversees the state’s medical market.

Oklahoma Republican Gov. Kevin Stitt also signed a measure into law last month that will take effect in November, adding stricter packaging and labeling requirements, including restrictions intended to prevent products from resembling candy or appealing to children.

While some industry experts acknowledge the potential harms, they say the focus should be on consumer education and clear information about potency and effects, rather than new restrictions.

An official with Trulieve, a cannabis company that operates dispensaries in eight states, told Stateline that its products are independently tested and that potency information is available for customers to review and ask questions about, including a product’s effects.

“We believe that that piece of information is critical for a consumer to make an educated decision on what type and what potency of product they are looking to consume,” said Lauren Niehaus, Trulieve’s executive director of government relations.

Some advocacy and trade groups, such as the National Cannabis Industry Association and the National Organization for the Reform of Marijuana Laws (NORML), argue that policymakers should steer consumers into tightly regulated legal markets rather than imposing blanket THC caps that could push some users back to illicit sellers. They say that accurate labeling, child-resistant packaging and public education campaigns are the best strategies to protect public health and prevent youth access.

“It’s undoubtedly safer and better for public health outcomes to regulate these products,” said Adam Rosenberg, who chairs the board of the National Cannabis Industry Association.

Paul Armentano, NORML’s deputy director, said potency caps oversimplify the risks of cannabis products and fail to account for how consumers actually use them. Consumers view ultra-potent products as a novelty, he said, and ultimately gravitate toward lower-potency options.

“When you look at state-tracked sales in legal states, cannabis flower or botanical cannabis still outsells every other product, and I would dare say it’s because that is the most moderate to low potency product available on the shelf, and that’s what most people want,” Armentano said.

Armentano also argued that some of the strongest calls for THC limits come from opponents of legalization, who see potency restrictions as a way to gradually roll back access to legal cannabis.

What the research says

A study published earlier this year in JAMA Health Forum found that adolescents who use cannabis, including products with higher potencies, had a significantly increased risk of developing psychotic and bipolar disorders, along with higher risks of depression and anxiety. The research followed about 463,000 adolescents in Northern California between ages 13 and 17 and tracked outcomes into early adulthood. The study did not, however examine whether the use of higher-potency products is more likely to cause psychotic and bipolar disorders.

But other research has linked frequent use of high-potency cannabis to a greater risk of psychosis and psychotic disorders, particularly among heavy users. Several studies have found a dose-response relationship, meaning the risk tends to rise as THC concentration and frequency of use increase. Experts caution, however, that many studies cannot definitively prove that cannabis causes psychosis and that individual risk varies widely.

Other research suggests the risk of developing psychosis may be higher for adolescents and young adults, whose brains are still developing, as well as people with existing mental health conditions or a family history of psychotic disorders.

“I’ve seen patients come through our facilities where they haven’t done any other drugs other than just high-potency marijuana, and their psychosis is remarkable,” said DeRoo, of the Hazelden Betty Ford Foundation. “They don’t have a grasp of reality. They come in seeing things, they come in believing things, alternate realities.”

John Puls, a psychotherapist and addiction specialist in Florida, has seen similar patterns in his practice at Full Life Comprehensive Care, particularly among adolescents and young adults using high-potency products.

He said families often don’t believe cannabis alone could be driving such dramatic changes. Beyond psychosis, he added, cannabis can chip away at more ordinary parts of life: Motivation drops, executive functioning suffers, patients miss appointments or forget obligations, and short‑term memory and relationships start to fray.

Some medical and industry experts say that cannabis can provide meaningful relief for some people, including those undergoing cancer treatment or who have chronic pain. But there is very little consensus on appropriate medical uses, dosing and long-term effects, particularly as products vary widely in potency.

“If there’s no standardized testing of products, or if there’s no enforcement of potency limits, then we might be putting people at more risk,” said Dr. Smita Das, an adult addiction psychiatrist and a clinical professor at Stanford University School of Medicine.

Stateline reporter Amanda Watford can be reached at awatford@stateline.org.

Vaccine hesitancy fed by misinformation is causing new surges of measles and whooping cough, while COVID-19 hotspots persist in some states and a new threat looms from an Ebola outbreak in central Africa.  

Nationally there have been 1,983 measles cases this year, nearly the 2,288 total for all of 2025, which in itself was the worst year since 1991, the federal Centers for Disease Control and Prevention reported Friday.  

Halfway through the year, 12 states and the District of Columbia already have more measles cases than they did for a full year in 2025. That’s true for South Carolina and Utah, where cases are already more than double last year, and also for states such as Florida, which has 139 cases so far compared with eight in 2025, and Virginia, which already has 63 compared with six in all of 2025.  

South Carolina, the state with the highest number of cases this year at 669, declared an end in April to an outbreak that was the nation’s largest in 35 years. The outbreak in the northwestern part of the state was centered in Spartanburg County, where religious exemptions to vaccination have spiked.  

The Utah outbreak, which began in the Short Creek area on the Utah/Arizona border, where vaccination rates are low, has generated 484 cases this year and is now slowing, said Dr. Andrew Pavia, a pediatrician and professor at the University of Utah, speaking at a May 26 briefing for the Infectious Diseases Society of America. 

Dozens of measles patients have been hospitalized with serious symptoms such as brain inflammation or pneumonia, he said, and one baby developed life-threatening congenital measles during pregnancy but survived, he said.

The national increases signal that the U.S. will certainly lose the measles elimination status it gained in 2000, Pavia said, in a determination due this fall. 

“Most state public health departments are stretched very, very thin, limiting their ability to contain measles. Anti-vaccine rhetoric has made this all the more difficult,” Pavia said. He referred to $11 billion in federal funding cuts to local public health last year that were delayed by a restraining order when states sued. The case is in settlement negotiations, according to court records. 

The Trump administration cited a “non-existent pandemic that Americans moved on from years ago” in the funding cuts, but COVID-19 is still causing more than 1,000 deaths a month and wastewater surveillance still shows hotspots in the Appalachian region and some other states, including Michigan.

Whooping cough is also on the rise with Ohio and Florida most affected. Deaths last year were at the highest level, 22, since 2010, according to the latest CDC WONDER provisional statistics.  

“The rising number of deaths from whooping cough, including among infants, is a reminder of the vital importance of vaccination,” said Dr. Joshua Sharfstein, a pediatrician and professor at Johns Hopkins Bloomberg School of Public Health in Baltimore who follows whooping cough trends. 

“Families who follow public health guidance on vaccination and other precautions can avoid a needless tragedy,” Sharfstein said. 

Louisiana was accused of unusual delays in reporting a whooping cough outbreak last year that claimed at least two lives. Shortly after the deaths were reported, the state ended promotion of vaccines and vaccination events. At least three babies died in Kentucky last year along with at least one in Oregon. 

Unvaccinated people are like fuel for the wildfire of disease outbreaks, said Pavia, of the University of Utah, in his remarks. 

“Until we can restore faith in vaccines and restore funding for our public health agencies and increase measles vaccine coverage, we have to anticipate that there will be many more outbreaks, and some of these may blow up into very large conflagrations,” Pavia said.

Meanwhile the Trump administration announced a new quarantine center in Kenya opening Friday, May 29, for Americans exposed to the Ebola virus in the Democratic Republic of the Congo. The move was criticized by the Infectious Diseases Society of America in a statement, saying the decision to send exposed Americans to Kenya “raises serious questions about resources, timing and the level of care Americans sent there will receive.”

On Ebola, a May 22 CDC directive prohibited United States entry of non-citizens who had been in the Democratic Republic of the Congo, or nearby Uganda or South Sudan, in the previous 21 days. The disease has killed 224 people in that region, and there are more than 900 suspected cases. 

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

More than 800 nurses at a Madison hospital owned by a national nonprofit group will vote in the coming weeks on whether to join a union.

The organizing campaign at St. Mary’s Hospital is one of the largest in recent memory in Wisconsin.

In a statement earlier this month, a spokesperson said the hospital’s parent organization, SSM Health, “respects the right of its employees” to freely choose union representation. Nurses and the Service Employees International Union say the hospital’s management has responded with stiff opposition.

Union supporters are planning a rally Thursday afternoon in front of the hospital, with U.S. Rep. Mark Pocan (D-Black Earth) among the featured speakers.

“There’s a national crisis facing both our healthcare system and the nursing workforce,” Pocan said in a statement issued Tuesday announcing the event. “St. Mary’s nurses are trying to address this crisis right here in our community by having a strong voice for better staffing and retention. SSM should respect their freedom to vote in a fair union election without any pressure campaign.”

The union election, supervised by the National Labor Relations Board, will be the largest such vote in recent memory in Wisconsin. A date for the election hasn’t yet been set, but it could be announced as early as this week.

It comes amid a rising interest in unions among healthcare workers — one that coincides with the growth of increasingly concentrated multistate healthcare networks, including nonprofit organizations.

“We’re seeing more union elections, we’re seeing more petitions for recognition of unions as well,” said Dr. Ahmed Ahmed, a research fellow at Brigham and Women’s Hospital in Boston and Harvard Medical School, in a panel discussion earlier this month conducted by Wisconsin Health News.

With mergers and consolidations, hospitals and health systems have grown larger and larger. Labor costs are their biggest expense, and in trying to trim those costs, they’re increasing caseloads and reducing the time patients have with their providers, Ahmed said. Healthcare workers are turning to unions in search of “one collective voice that is able to govern and be able to bargain for those things.”

Centralized decision-making

Supporters of the St. Mary’s union campaign say that concentration is one of the reasons they’re organizing. Centralized decision-making at the Missouri headquarters of the parent organization have felt to some like a corporate takeover.

“There have been a lot more directives from corporate headquarters in St. Louis,” said Josh Taylor, a nurse in the hospital’s inpatient behavioral health unit.

St. Mary’s was one of several hospitals and healthcare facilities established by nuns from Europe and sponsored by Roman Catholic congregations in the 19th century. The facilities were only loosely connected until 1986 when the corporate structure changed with the creation of SSM Health, according to the SSM Health website.

SSM Health had been sponsored by the Franciscan Sisters of Mary until 2013, when sponsorship shifted to a new corporate entity, SSM Health Ministries, while remaining part of the Roman Catholic church.

SSM Health is headquartered in St. Louis and operates in four states — Wisconsin, Illinois, Missouri and Oklahoma — where it runs 24 hospitals and more than 540 other facilities, including doctor’s offices, outpatient services, home care and hospice programs.

According to SSM’s annual financial statements, SSM Health had $12.7 billion in revenues in 2025 and ended the year with a balance of $484 million in net revenue over expenses.

In 2014 SSM Health began applying its name to all of the healthcare facilities in its network.  It also consolidated its business operations including human resources, finance, strategy and planning and marketing and communications.

With those changes, nurses who are supporting unionizing say that decision-making on day-to-day policies and practices has moved farther away.

“We watched our personalized policies for our hospital disappear,” said Lynette Willsey-Schmidt, a labor and delivery nurse who has worked at St. Mary’s for more than 11 years.

Employee councils called ineffective

Willsey-Schmidt said labor and delivery nurses along with the doctors in the department had developed a series of practices to reduce intervention during births where risks and complications were lower. Those practices were welcomed by patients, she said.

But as SSM Health took charge of policymaking, “we were told we can’t do that anymore,” Willsey-Schmidt said, because those policies didn’t exist elsewhere in the SSM Health system.

Taylor said that while employee councils are supposed to relay feedback from the floor to upper management, they haven’t been effective.

“I’ve been on the unit councils,” he said. “We have tried the normal routes to bring our concerns to the table. We are heard, but nothing is acted on.”

When employees have raised concerns, “We’re told, ‘This is how it is. This is how all the hospitals have to do it,’” Taylor said.

Morgan Espich, an inpatient medical and surgical nurse, said the hospital recently purchased and began requiring nurses to use a new brand of intravenous pumps, different from what they had been using. She and her coworkers had been happy with the previous models, Espich said, and no one explained the reason for the change. “We just had to get new ones that no one asked for,” she recalled.

In addition, the hospital staff has to keep some of the older IV pumps on hand, said Carrie Schrank, an intermediate care trauma nurse, to substitute for the new pumps when they malfunction.

Nurses contend staffing levels have left employees straining to cover all their responsibilities, while nurses have been told to improve productivity.

“Productivity should be about patients’ outcomes,” Willsey-Schmidt said.

Consultants who visited earlier this year recommended ways to reduce staffing, but Schrank said their recommendations didn’t address how acutely ill some patients are.

“The days we’re busy, we go home and wonder, did I do enough?” Espich said.

Hospital stance — respect or intimidation?

SSM Health released a statement earlier this month in response to the Wisconsin Examiner’s submission of specific questions about the union campaign as well as a request for an interview.

“At SSM Health, we work hard to cultivate a supportive and collaborative work environment where every employee is treated with respect and compassion,” said the statement, delivered by Kim Sveum, SSM Health regional director of communications.

“We value our high-quality patient-centered care and place of healing.  We strive to ensure that our team thrives so that they can do their best work in realizing our Mission to provide exceptional patient care.”

The statement concluded, “SSM Health respects the right of its employees to make a free and informed choice as to whether or not they wish to be represented by a union.”

Union organizers say that there have been extensive messages posted on employee bulletin boards disparaging unions and the SEIU and emphasizing employees’ right to decline to sign a union authorization card.

“They have been constantly intimidating staff,” Schrank said.

Employees typically attach their work badges to a retractable line coiled up in a holder called a badge reel that can be clipped to a lapel or pocket. When they made their campaign public, pro-union nurses began using a customized badge reel with an emblem, “St. Mary’s Nurses United.”

Supervisors have ordered employees to remove those badge reels. Espich and other nurses said they have been told that “this is soliciting” against hospital policy, and that nurses who don’t remove the badge reel would be sent home without pay for the day.

“With this union-busting, though, we’re all fired up even more,” Espich said.

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A group of more than 60 nonprofits, advocacy organizations and businesses wrote to two Wisconsin health systems Thursday, urging them to resume gender-affirming care for minors that they halted five months ago.

The hospital organizations — UW Health in Madison and Children’s Wisconsin in Wauwatosa — stopped providing hormone medication and puberty-blocking medication to minors with gender dysphoria following Trump administration actions targeting such healthcare.

Thursday’s letter, led by the LGBTQ+ rights groups Fair Wisconsin and GSAFE, cites a federal judge’s ruling in April that threw out the administration’s order blocking gender-affirming care.

“Gender-affirming care is legal in Wisconsin, but it is increasingly more and more difficult to access due to decisions made to pause the provision of this care at your institutions,” states the letter. “These decisions must be reversed and care restarted immediately.”

Thursday’s letter was the second this week to UW Health and Children’s Wisconsin. On Tuesday, more than 90 elected officials from around the state released a letter urging both hospitals to restore the suspended services, “reaffirm [their] commitment to evidence-based care, and rebuild trust with the transgender and gender diverse community.”

“The most important thing for people to understand is that the support for this care is so much broader and deeper than people realize,” Abigail Swetz, executive director of Fair Wisconsin, told the Wisconsin Examiner Thursday. “I hope the leadership of these hospitals are seeing that in this letter and the others that are coming through.”

She said local groups, Madison TRAC and Reproductive Justice Action Milwaukee, are organizing petitions in their communities as well for the general public to sign.

Both hospitals released statements Thursday that acknowledged the concerns of families and their children seeking gender-affirming healthcare, but cited legal risks of providing such care.

“We know this issue matters deeply to many in our community, especially the patients and families we serve,” Children’s Wisconsin said.

“Due to ongoing legal and regulatory uncertainty affecting organizations and providers across the country, we are not currently providing gender-affirming pharmacologic care,” it said. “We recognize the impact this has on patients and families.”

Children’s said it continued to provide related mental and behavioral healthcare.

UW Health said it paused gender-affirming medication therapy for minors “due to ongoing federal actions that threaten health systems that provide this care.”

“While we continue to believe this is evidence-based care, threats from those federal actions are not fully resolved,” UW Health said. “Therefore, the current risk is too great to resume this care. We recognize the challenges faced by impacted patients and families and remain committed to providing patient-centered care and supporting their health and well-being throughout this critical time.”

Gender-affirming care is a response to gender dysphoria, which the American Psychiatric Association has defined as  “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.”

Based on survey data collected by the federal Centers for Disease Control and Prevention between 2021 and 2023, the Williams Institute at the University of California at Los Angeles Law School estimated in an August 2025 report that 3% of adolescents ages 13 to 17 and 1% of adults 18 or older identify as transgender or nonbinary.

Swetz said that when health professionals provide gender-affirming healthcare, they do so because it is medically necessary.

“I think it is sometimes seen as something that is not essential, but it absolutely is medically necessary, because we know that when gender dysphoria is treated then the mental health of our trans youth just drastically improves,” she said.

Gender-affirming care is also provided based on what is appropriate for the person’s age, “and always, with the full consent of parents and guardians,” Swetz said.

For a child who hasn’t yet reached puberty, it entails counseling and other forms of behavioral therapy — not medication, she said. At the start of puberty, medication may be used to pause that process, along with hormone treatment, but it’s also “highly individualized,” she added.

“We’re talking about high quality care that is respectful and meets a trans youth exactly where they’re at, in the age appropriateness of the kind of care that will help move them forward in their lives and make it possible for them to live in a body that really feels like home,” Swetz said.

The two hospitals paused their use of gender-affirming care medication after a Dec. 18, 2025 declaration from Health and Human Services Secretary Robert F. Kennedy Jr. that threatened to withhold federal health dollars, such as Medicaid reimbursement, from providers offering gender-affirming healthcare for minors.

Wisconsin was one of 21 states and the District of Columbia that sued to block the federal rule. In late March, a federal judge in Oregon ruled for the states on summary judgment, and in April issued a written order that vacated Kennedy’s declaration.

The judge ruled that the declaration violated the Administrative Procedures Act; that Kennedy and HHS officials lacked the authority to override professional standards for gender-affirming care; and lacked the authority to exclude providers from federal programs for providing gender-affirming care that meets professional standards.

The order also includes an injunction forbidding “any materially similar policy which supersedes or purports to supersede the professionally recognized standards of care for gender-affirming care that exist” in the 21 states and D.C. that filed the lawsuit.

“They’re trying to make sure that the federal government can’t go around and just, like, do something in another name,” Swetz said. “And I think it’s important for people to know that Wisconsin specifically is one of the states.”

This report was updated to correct the organizers of local petitions in Madison and Milwaukee.

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Health officials from the U.S. cities hosting the 2026 FIFA World Cup say they are preparing to deal with infectious diseases, heat-related illness, and an array of other health threats when millions of fans, many of them from overseas, come to watch the games.

The World Cup is expected to draw between 5 million and 7 million soccer fans to the 11 U.S. host cities, which are Atlanta, Boston, Dallas, Houston, Kansas City, Los Angeles, Miami, New York City (in partnership with East Rutherford, New Jersey), Philadelphia, the San Francisco Bay Area and Seattle.

The newly formed Big Cities Health Coalition, a consortium of health officials from 36 of the nation’s largest health departments, says it has been formulating a strategy to mitigate any negative health impacts from such a large influx of people entering the country at once.

At a news briefing on Wednesday, health officials from Atlanta, Dallas, New York City, Philadelphia, and San Jose said they are preparing for disease monitoring and contact tracing during the weeks of soccer matches, which begin on June 11.

The officials said they aren’t concerned about the hantavirus, which is very rare. However, they are worried about the spread of measles after recent outbreaks around the country.

“Somebody might be here for a game in Atlanta and be exposed to something — let’s say measles, since that’s been so prevalent lately,” said Marcus Plescia, district health director at the Fulton County Board of Health, which includes the Atlanta region, “But by the time we realize that and start to look at who might be at risk, that fan might have traveled to Dallas to see their team playing there.”

“Something that happens here may actually have its impact somewhere else, and we’re going to have to think about how we handle that and hand off information.”

Alister Martin, commissioner of New York City’s health and mental hygiene department, said health officials also are concerned about extreme heat, alcohol and drug use, and sexually transmitted diseases.

“Relevant teams from disease control to mental health have been preparing to work in new capacities for months, and most recently, we tested our emergency capacity at our healthcare facilities,” Martin said.

At the briefing, the health officials said they are strapped for resources as a result of the expiration of COVID-19-era public health funding, and that host cities have gotten federal dollars for security and infrastructure needs but not for public health.

“In Atlanta, at least, there’s been some significant investment in infrastructure improvements, and those are very important things,” Plescia said. “We’ve not received a lot of direct funding for specific public health services.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

The U.S. Supreme Court on Monday extended a highly anticipated stay blocking an appellate court’s pause on telehealth abortion access until May 14.

The U.S. Food and Drug Administration’s approved medication-abortion regimen remains available via telehealth until then, following a week of uncertainty among abortion patients and providers.

“With this critical temporary administrative stay extended, we hope that some of the chaos and confusion inflicted on patients and providers last weekend will be abated,” said Evan Masingill, CEO of abortion-pill manufacturer GenBioPro, one of the defendants in the case, in a statement.

On May 4, the Supreme Court temporarily stayed the 5th Circuit Court of Appeals’ ruling to reinstate the FDA’s in-person dispensing requirement for mifepristone that the Biden administration officially lifted in 2023. Over the past week, several doctors groups submitted friend-of-the-court briefs arguing that cutting off access to mifepristone could harm many women seeking abortions and miscarriage management. Republican attorneys general from 23 states, meanwhile, urged the Supreme Court not to allow providers to send mifepristone through the mail. 

People in states with abortion bans or diminished abortion access continue to depend on abortion providers prescribing FDA’s approved mifepristone-misoprostol regimen through telemedicine and sending it to patients by mail.

According to new preliminary findings from the Society of Family Planning, telehealth abortion comprised 28% of all abortions at the end of 2025, an increase from 25% at the end of 2024.

Attorneys representing Louisiana have argued that in addition to undermining a state abortion ban, the federal rulemaking process allowing telehealth prescriptions of medication abortion was flawed.  

University of Michigan law professor Samuel Bagenstos, who served as general counsel of the U.S. Department of Health and Human Services at the time the Biden-era rule was implemented, said the policy was well considered and based on evidence. 

“The 2023 update was the result of an incredibly careful, deliberate, time-consuming, painstaking process to make sure that they were following what the evidence was,” Bagenstos said. If, the plaintiffs were to prevail, he added, ending telehealth access to mifepristone nationwide would have “really harmful effects on women across the country, as well as really destabilizing effects on the drug approval system.” 

Louisiana’s lawsuit against mifepristone has nationwide implications and could threaten residents in states with abortion access and so-called abortion shield laws, such as Maryland. 

Regardless of what happens in this case, abortion providers told Stateline they are determined to continue providing telehealth abortions, though potentially without mifepristone. Dr. Angel Foster, a telehealth provider in Massachusetts, a shield law state, said in the past week, about 100 patients have requested pills for future use, compared with 34 in the entire month of April. She said constantly changing rules around abortion access followed by sensational news headlines continue to create confusion for people seeking termination or miscarriage management.

“I live and breathe abortion at this point, and I find it can be hard to keep up with the ever-changing legal environment and the way that things are getting framed and phrased,” Foster said. “When you’re a patient and what you see are just the headlines, and you’ve got to figure out what it means for you, it’s really complicated.”

Editor’s note: This story has been updated to correct the number of Republican attorneys general who asked the Supreme Court to keep mifepristone from being prescribed via telehealth visits. It should be 23. 

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.

Advocates and opponents of abortion access say they’re wondering what happens next in a critical telehealth medication case that created chaos and confusion over the past week after an appeals court blocked nationwide access to the drug and, days later, U.S. Supreme Court Justice Samuel Alito issued a temporary stay.

Alito’s stay preserves telehealth access until May 11. But it’s unclear what happens next for patients and providers.

The Supreme Court on Monday temporarily blocked the 5th U.S. Circuit Court of Appeals’ Friday ruling to suspend a federal rule allowing telehealth prescriptions of the drug mifepristone while the lawsuit Louisiana v. U.S. Food and Drug Administration unfolds. Abortion providers are determined to continue providing the service, though potentially without mifepristone, the drug at the center for the case, which has had a high record of safety and efficacy since 2000.

Anti-abortion advocates have pushed to reverse the 2023 policy, enacted under former Democratic President Joe Biden, that allowed the FDA to drop its requirement that a patient see a provider in person before the medication can be prescribed. One similar national case already failed unanimously before the Supreme Court, but anti-abortion advocates are hoping this time around, with a more tailored approach, they will be successful.

Abortion-rights advocates say they’re prepared for whatever might happen in the courts, with contingency plans and a message that abortion will still be available even if the particular medication — mifepristone — is not.

Has the abortion pill been banned?

No. Mifepristone is still a legally approved FDA drug commonly used to terminate a pregnancy before 10 weeks’ gestation and is used off-label to treat miscarriages.

Is telehealth abortion still legal?

Yes, for now. Under the U.S. Supreme Court’s administrative stay that expires on May 11, it is still legal to obtain abortion medication through telemedicine under the FDA’s regulations. Mifepristone is commonly used with a second drug, misoprostol, in medication abortions. The case doesn’t include misoprostol.

Who would be affected if telehealth access is struck down?

According to the Society of Family Planning’s #WeCount report, 27% of all abortions in the first six months of 2025 were obtained through telehealth, adding up to more than 162,000 cases.

Mifepristone is also used for patients experiencing a miscarriage; those patients also would have to visit a provider in person.

The ruling would apply nationwide, meaning that health providers couldn’t prescribe mifepristone without an in-person visit with the patient, even in states with abortion access.

What are the arguments on each side in Louisiana v. FDA?

Louisiana says the Biden-era policy undermines a state law banning abortion, and that the federal rulemaking process allowing telehealth prescriptions was flawed.

The Food and Drug Administration says the state doesn’t have standing to sue, but also notes that it’s taking more time to review the drug’s safety.

Two mifepristone drugmakers, meanwhile, have intervened on the FDA’s side.

What could happen next?

The Supreme Court has many options available moving forward, but a few options are most likely, said Katie Keith, founding director of the Center for Health Policy and the Law at the Georgetown University Law Center. The justices could extend the stay when it expires May 11, or the court could make a longer-term ruling.

That could mean sending it back to the 5th U.S. Circuit Court of Appeals, with or without upholding the initial ruling blocking the 2023 provision while the appeals case proceeds. Or justices could decide to take up the case and bypass the rest of the 5th Circuit appeal.

If it did that, the manufacturer defendants Danco Laboratories and GenBioPro have asked for an expedited process with a decision by June. That seems unlikely, Keith said, but the court has conducted expedited cases related to abortion before, such as the Moyle v. United States case in 2024 related to the federal Emergency Medical Treatment and Labor Act.

What will providers do if they can’t use the combination of mifepristone and misoprostol?

Brittany Fonteno, president and CEO of the National Abortion Federation, said providers have been preparing since 2023 for the possibility of losing access to mifepristone. There have long been plans to switch to a misoprostol-only protocol, which is the main method of pregnancy termination across much of the world, she said.

“A lot of providers had created these policies and just needed to dust them off,” Fonteno said.

Dr. Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, which provides telehealth abortions to patients in all 50 states, said she and her team spent the weekend scrambling to contact patients waiting on medication abortion pills they had ordered before the ruling, and implementing a contingency plan that many abortion providers have been planning for since the lawsuits against mifepristone began in 2023.

That contingency involves pivoting from the FDA-approved mifepristone-misoprostol regimen to a misoprostol-only regimen.

Early Monday, Foster said her team was getting ready to ship misoprostol-only packages to patients at 2 p.m., but after the Supreme Court stayed the appeals court’s ruling on Monday morning, she said they were able to switch back to the mifepristone-misoprostol regimen.

Foster also said her organization was inundated with requests for pills that people could stockpile — people who didn’t need an abortion but were worried about losing access to the pills. Normally that’s a small fraction of the requests they receive, she said, but on Tuesday, they sent out more than had been sent in the entire month of April.

“Over the last two days, we’ve had a huge increase in the number of people from Louisiana requesting pills, especially pills for future use,” Foster said.

What are the pros and cons of the misoprostol-only regimen?

Dr. Maya Bass, a family physician in New Jersey who also provides abortions in Delaware, said misoprostol-only regimens are still safe and highly effective, but that the regimen has a lower efficacy rate than the combination of the two drugs and comes with potentially more side effects and risks.

Misoprostol-only regimens vary between 85% and 90% effective, while the combination is between 93% and 99% effective. The effective rates are lower as the gestational age increases.

The combination works well, Bass said, because mifepristone stops the hormone that allows the pregnancy to continue and signals to the body that the pregnancy is over. The misoprostol then helps soften the cervix and prompts the uterus to contract and expel the pregnancy tissue.

Without that hormonal signal, Bass said, a higher dose of misoprostol is needed to empty the uterus. The usual side effects of nausea, diarrhea, chills and sometimes fevers can be more severe because of the higher dosage. And it may lead to more people needing to seek in-person follow-up care to fully remove all of the pregnancy tissue, which can cause infection if it stays in the uterus.

“A lot of the people who are using telehealth for their medication abortion are not necessarily in places where they can safely access that care,” Bass said. “So it is concerning that we might be relying more on a regimen that means that many more people needing to seek care.”

What are the details of the legal arguments?

Louisiana officials, including Republican Attorney General Liz Murrill, argue that the state is harmed by the 2023 telehealth policy because it undermines a state law banning abortion at all stages of pregnancy, with few exceptions that don’t include rape or incest. The state also challenged the Food and Drug Administration’s process in deciding to eliminate the in-person dispensing requirement, saying it was based on flawed or nonexistent data.

The state also said the rule has resulted in $92,000 in Medicaid bills from two women who went to the emergency room because of complications related to mifepristone in 2025. And the state says the rule harmed the other plaintiff in the case, Louisiana resident Rosalie Markezich, who said her ex-boyfriend ordered the medication online and pressured her into taking it. That wouldn’t have been possible if the medication had to be dispensed through an in-person visit, the state argues.

“The priority of safety supersedes the priority of access, and that is what ultimately, I believe, needs to be looked at directly,” Sarah Zagorski, senior director of public relations at Americans United for Life, told Stateline on Wednesday. The anti-abortion organization submitted a brief supporting Louisiana’s case to the U.S. Supreme Court this week.

The FDA’s response has been to try to dismiss the claims in part on the grounds that Louisiana doesn’t have standing to sue, but agency officials have also said they are in the middle of conducting a safety review of mifepristone and need more time.

GenBioPro and Danco Laboratories, two of the manufacturers of mifepristone, intervened as defendants in the case, which can happen when the party that is sued may not be willing to fully defend the case for various reasons.

The two companies argue that Louisiana does not have proper standing to sue because the state does not prescribe or use mifepristone and is an “unregulated party” as it relates to the 2023 telehealth provision. They also noted that the FDA reviewed 15 studies evaluating medication abortion outcomes for more than 55,000 patients before approving the rule, “all of which supported the safety and effectiveness of dispensing mifepristone by mail, courier, or through pharmacies.”

How does this compare to the 2023 case Alliance for Hippocratic Medicine v. FDA?

Both lawsuits were designed to restrict access to mifepristone. The plaintiffs in the Alliance for Hippocratic Medicine case included a group of anti-abortion doctors who said they would be harmed by having to care for people who took mifepristone. They also argued that the FDA’s approval of the drug was improper.

The 5th U.S. Circuit Court of Appeals was involved in that case as well, and determined that the FDA should roll back its decision to ease restrictions on the drug, including the 2023 telehealth rule. But the U.S. Supreme Court unanimously decided in June 2024 that the Alliance plaintiffs didn’t have proper standing and sent it back to the lower court.

After that ruling, the attorneys general of Missouri, Idaho and Kansas stepped in as plaintiffs, and the case was transferred to Missouri’s U.S. district court, where it’s still pending.

The Louisiana case is more limited because it would strike down one provision of mifepristone regulation, noted Jenna Hudson, senior counsel at the Center for Reproductive Rights. The Alliance plaintiffs sought to revoke the drug’s approval altogether.

Stateline reporters Kelcie Moseley-Morris can be reached at kmoseley@stateline.org and Sofia Resnick can be reached at sresnick@stateline.org.  

The U.S. Supreme Court issued a temporary stay on an appeals court ruling from Friday that was blocking remote access to an abortion drug, restoring access until at least May 11.

The administrative stay, issued by Justice Samuel Alito, pauses Friday’s decision by the 5th Circuit Court of Appeals. That ruling blocked a 2023 rule adopted by the U.S. Food and Drug Administration allowing mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be prescribed without an in-person visit with a health care provider and also allowed it to be mailed to recipients in states with abortion bans.

“The administrative stay is temporary, and I am confident life and law will win in the end,” said Louisiana Republican Attorney General Liz Murrill in a statement. 

Thirteen states have near-total abortion bans, including Louisiana. Murrill sued the FDA in October, saying the rule undermines the state’s laws and causes financial harm because the state paid $92,000 in Medicaid bills for two women who needed emergency care in 2025 from complications related to mifepristone. 

In the years since the 2022 U.S. Supreme Court decision allowing states to regulate abortion access, telehealth prescriptions of abortion medication have become increasingly popular, with more than 27% of all abortions provided that way in 2025, according to data from the Society of Family Planning.

“While this is a positive short-term development, no one can rest easy when our ability to get this safe, effective medication for abortion and miscarriage care still hangs in the balance,” said Julia Kaye, senior staff attorney for the Reproductive Freedom Project at the American Civil Liberties Union, in a statement. “The Supreme Court needs to put an end to this baseless attack on our reproductive freedom, once and for all.”

The case could follow a similar pattern to one that played out in 2023, after U.S. District Court Judge Matthew Kacsmaryk of Texas issued a ruling that would have revoked access to the abortion drug mifepristone altogether. 

The U.S. Supreme Court intervened shortly after that ruling and kept mifepristone available while the case proceeded in the 5th Circuit appeals court, which eventually decided that more restrictions were warranted, but not pulling the drug’s approval. The Supreme Court officially took the case several months later, and unanimously ruled in June 2024 that the plaintiffs suing the FDA did not have standing, keeping access to mifepristone intact.

Responses from the attorneys in the latest case are expected to be filed with the Supreme Court by Thursday, according to Alito’s order.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

WASHINGTON — The State Department must spend the $600 million Congress approved for an international vaccine program, according to a letter sent Monday by a bipartisan group of U.S. senators.

The six senior members of the Appropriations Committee, three Republicans and three Democrats, called on Secretary of State Marco Rubio to fulfill the government’s “pledge” to GAVI, the Vaccine Alliance.

“GAVI plays a critical role in averting the spread of preventable diseases around the globe and helps protect public health in our country by stopping outbreaks before they reach our borders,” the senators wrote. “Congressional support for GAVI endures because of its proven success as a public-private partnership, immunizing more than 1.1 billion children – and in turn preventing 20.6 million deaths – since its inception in 2000.”

Senate Appropriations Committee Chairwoman Susan Collins, R-Maine; ranking member Patty Murray, D-Wash.; State-Foreign Operations Appropriations Subcommittee ranking member Brian Schatz, D-Hawaii; Sen. Mitch McConnell, R-Ky.; Sen. Lisa Murkowski, R-Alaska; and Sen. Jeanne Shaheen, D-N.H., all signed the letter.

South Carolina Republican Sen. Lindsey Graham, chairman of the State-Foreign Operations Appropriations Subcommittee, didn’t sign the letter. 

A State Department spokesperson wrote in an email the department doesn’t “comment on congressional correspondence.” 

Senators wrote in the letter that GAVI “supports U.S. industry and jobs, purchasing more than $12.5 billion in U.S.-manufactured goods and vaccines.”

“It is the world’s leading purchaser of U.S.-produced vaccines and hosts the U.S.-founded global vaccine stockpile,” the senators wrote. “Additionally, vaccines funded through GAVI are approved through the same standards as used by the Food and Drug Administration.”

This story was produced by Grist and co-published with States Newsroom. It is  part of the Grist series Vital Signs, exploring the ways climate change affects your health. This reporting initiative is made possible thanks to support from the Wellcome Trust.

Bailey Magers and Sunil Kumar cut strange figures on Pensacola Beach. Bags of disinfectant solution surrounded them on the white sand; their gloved hands juggled test tubes while layers of rubber and plastic shielded their skin from the elements. As the two organized their seawater samples on the popular Florida beach last August, an older woman wearing a swimsuit walked over to ask what they were doing.

“We’re just actively monitoring water quality,” they told her, but she pressed on.

“Are you looking for that flesh-eating bacteria?”

“We’re looking into it,” they replied, hoping not to frighten her. The woman turned back toward the ocean, her curiosity satisfied. As she walked away, Kumar noticed that she had scrapes and bruises on her body. A few minutes later, he watched her step into the waves. He shook off a chill and returned to the task at hand. 

Magers and Kumar study a bacteria called Vibrio, part of a lineage of ancient marine species that likely emerged sometime around the Paleozoic Era. Enormous, shallow seas flooded the massive, interconnected supercontinents that constituted the Earth’s landmass at the time, and complex marine ecosystems developed that thrived in these temperate, freshly-formed bodies of water. Researchers think there are more than 70 Vibrio species in the environment today, hundreds of millions of years later. The organisms float in warm, brackish water, attaching themselves to plankton and algae and accumulating in prolific water-filtering species like clams and oysters. 

A small number of Vibrio species can sicken and even kill. In worst-case scenarios, a person who has been exposed to the most dangerous of them — by swimming in brackish water with an open wound or ingesting a piece of raw shellfish that is contaminated with the tasteless and odorless toxin — may find themselves with only hours before the flesh on one or more extremities starts to bruise, swell, and decay. Without the quick aid of powerful antibiotics, septic shock can set in and lead to death. Anyone can get infected, though it is much more likely in people who have liver disease or are immunocompromised, elderly, or diabetic.

Climate change is making the world’s oceans, which have absorbed more than 90 percent of the excess heat trapped by greenhouse gas emissions, more hospitable to Vibrio. Research shows that temperature and salinity are the largest predictors of how widespread Vibrio bacteria are. As water temperatures rise, so does the concentration of Vibrio in seawater — boosting the risk of infection for beachgoers and shellfish consumers. The bacteria start getting active in water temperatures above 60 degrees Fahrenheit and multiply rapidly as coastal waters warm throughout the summer. In recent years, scientists have documented Vibrio expanding into places that were once too cold to support the bacteria, pushing as far north along the U.S. East Coast as Maine and appearing with more prevalence in temperate seas around the world. 

Vibriosis infections in general are the leading cause of shellfish-related illness in the U.S. They have increased “more than any other illness caused by a pathogen in the U.S. food supply” since the Centers for Disease Control and Prevention, or CDC, started keeping tabs on such illnesses in 1996, according to a 2019 analysis by the International Association for Food Protection. The report attributed the precipitous rise to a “perfect storm” of factors that include climate change, food handling practices, expanding globalization, a patchwork of regulatory oversight, and improved diagnosis. 

On their conspicuous expeditions to Pensacola and other Sunshine State beaches, Magers and Kumar are trying to understand where, and when, harmful Vibrio species are present across the state. The research they’re doing is part of an ongoing effort by a laboratory at the University of Florida to create a Vibrio early warning system for the eastern United States — a program that can alert public health departments to high Vibrio concentrations in any given area a month in advance. How many limbs would be saved, Magers wonders, if doctors and nurses could be warned ahead of time that their emergency rooms would soon see an uptick in these chronically underdiagnosed infections? 

The work serves more than one purpose: As Vibrio bacteria spread north into cooler waters, they serve as a first warning signal of changing marine conditions — giving researchers a heads-up that the familiar composition of marine species in their local waters may be starting to shift. In Europe’s Baltic Sea, for example, a spike in Vibrio infections in July 2014 closely mirrored a heatwave that rapidly warmed the shallow sea. The incident showed researchers that Vibrio spikes herald unusually warm marine conditions — and they have since been utilized as barometers for ocean heatwaves and sea-surface warming patterns, not just food safety.

“We see Vibrio as the indicator for climate change,” said Kyle Brumfield, a microbiologist at the University of Maryland who has been studying the bacteria for a decade. “We can use the presence of Vibrio and Vibrio cases as a proxy for water health in general.”

The CDC estimates that about 80,000 cases of vibriosis occur in the U.S. every year, resulting in about 100 deaths. Of those 80,000 cases, most are caused by a Vibrio called parahaemolyticus, which most commonly results in gastroenteritis, or food poisoning. The vast majority of the deaths, however, are caused by a type of Vibrio called vulnificus — the Latin word for “wound-making.”

Vulnificus is so potent it can squeeze through a pinhole-sized cut in the skin and lead to death in just 24 hours. In the last five years, the CDC registered 429 such vulnificus cases, plus 136 foodborne cases. But even though foodborne cases are less numerous, the patients that contract vulnificus by eating contaminated shellfish are more likely to die than those infected via open wounds. Thirteen percent of those nonfoodborne cases died, compared to 32 percent of people who got the infection from eating seafood. Most cases occur in the Gulf and Atlantic coastal regions.

As far as infectious diseases go, vulnificus is exceedingly rare: The CDC reports between 150 and 200 cases a year. The sexually-transmitted disease chlamydia, by comparison, one of the most common bacterial infections in the U.S., infects northward of 1.5 million Americans annually. But vulnificus’ astonishing speed and high fatality rate — 15 to 50 percent, depending on the health of the person exposed and the route of infection — makes it a unique public health threat, particularly as climate change grows its pathways of exposure. 

Vulnificus is not the kind of pathogen you’d want behaving erratically, but that’s exactly what it’s been doing since the late 2010s. Across the Eastern Seaboard, local and federal health officials have been reporting “unusual increases” in vulnificus prevalence — jagged spikes in infections that appear to correspond to extreme weather events like hurricanes and marine heatwaves.

In 2022 and 2024, years when the brackish water that Vibrio bacteria thrive in was pushed inland by major hurricanes, Florida’s public health department reported 17 and 19 deaths, respectively, linked to vulnificus exposure via open wounds. North Carolina, New York, and Connecticut also saw small clusters of infections during a record-breaking heatwave in the summer of 2023. “As coastal water temperatures increase,” the CDC warned in its investigation of those outbreaks, “V. vulnificus infections are expected to become more common.”

A 2023 study that analyzed a 30-year database of confirmed vulnificus infections from outdoor recreation along the U.S. Gulf and Atlantic coasts found the northern boundary of infections has moved north by a rate of 30 miles per year since 1998. The study noted that “V. vulnificus infections may expand their current range to encompass major population centers around New York,” and that annual case numbers may double as temperatures rise and America’s elderly population grows. 

“In the 1980s, Vibrio abundance would increase in the late spring and stay high through the summer and drop in the middle of October,” Brumfield, who conducts research on Vibrio in Maryland, said. “Now … we can pretty much find them almost year-round.”

Two ways to get infected

Just how worried we should be about the changing dynamics of Vibrio bacteria depends on who you ask and what you read. The gruesome and fast-acting nature of the vulnificus infection makes it enticing fodder for local and national news media, fueling a spree of terrifying reports every time a new severe infection or death surfaces. “Virginia dad wades in calf-high water, dies 2 weeks later of flesh-eating bacteria that ‘ravaged’ his legs,” read a recent headline in People magazine. “2 dead after eating oysters, contracting flesh-eating bacteria, officials say,” per a 2025 web story about two deaths linked to oyster consumption in Louisiana and Florida. Like many others in their mold, neither story mentions how rare the bacteria are. 

The press is bad news for some in the seafood industry, which does not welcome a national conversation about the rise in vibriosis cases, vulnificus in particular. Shellfish farmers and industry representatives that Grist spoke to in Florida and New York argued media attention on the safety of their products is unwarranted. “‘Flesh-eating bacteria,’” said Leslie Sturmer, a researcher who works for the University of Florida’s shellfish aquaculture extension program and consults with the shellfish industry on research and regulation — “the media loves it.”

Paul McCormick, an oyster farmer in Long Island who sells 750,000 oysters a year, thinks all press is bad press. “Even if the title of your article says ‘New York oysters are the safest oysters in the universe,’” he told me on the phone from his office in East Moriches in January, “you’ve already created a problem.”

In unrefrigerated oysters left out in warm conditions, Vibrio bacteria reproduce every 20 minutes. But in 2010, states began deploying strict protocols known as “Vibrio control plans,” which require harvesters to rapidly cool their catch onboard and then refrigerate it at a shellfish processing facility within a set number of hours. The measures have proven effective at stopping the growth of Vibrio in harvested shellfish and preventing disease.  

The fact that infections can happen in one of two ways — shellfish consumption and seawater exposure — makes it easy to shift blame and point fingers. Consumers have more control over how much exposure they have to Vibrio than they have with E. coli, for example. A person with a kidney condition can choose not to eat oysters on the half shell. E. Coli, often found in raw vegetables, is far tricker to avoid. Likewise, someone with an open wound can opt not to bathe in brackish waters if they are aware of the risks lurking in the surf.

For shellfish industry representatives, personal responsibility is the primary way to bring caseloads down. “The person is the risk,” said Sturmer. “Not the climate, not the water, not the bacteria.” Implicitly, this appears to be the government’s position as well: There is currently no numerical threshold at which state public health agencies will “shut down” a beach for outdoor recreation, though states will issue public advisories and, very rarely, close beaches if they happen to find high levels of Vibrio in the water.

But that perspective doesn’t account for the rapid marine changes brought on by climate change, the patchiness of vibriosis awareness, and the fact that Americans often make personal decisions that are at odds with their own health and safety.

The shellfishers Grist spoke to fully acknowledged the research underpinning Vibrio’s spread. McCormick studied environmental science in college, and Sturmer is running her own climate experiments in a laboratory in the fishing town of Cedar Key, Florida, putting different kinds of clams and oysters through heat stress tests to determine which species are best equipped to weather the decades ahead. Marine mollusks are uniquely threatened by rising ocean temperatures, ocean acidification, and sea level rise, issues that can lead to thin shells, low crop yields, and mass die-offs on farms. A detailed understanding of climate science, in other words, is good business for those who make their living fishing.

The problem, according to Sturmer, is that shellfishers have been unfairly singled out for a health issue that doesn’t affect most consumers and is more often contracted by ocean bathing rather than raw oyster consumption. While beaches stay open even when Vibrio bacteria are present in the water and lead to infections, a small number of foodborne vibriosis cases can trigger state closures of shellfish harvesting areas and product recalls. The National Centers for Coastal Ocean Science noted that these precautions “erode consumer confidence and likely decrease sales.” 

The panic that ensues after media reports of Vibrio infections has a similar effect: A 2024 study asked more than 350 shellfish consumers in Rhode Island — a state that relies heavily on its shellfish industry, particularly in summer months when people vacation along the coastline — to bid on entrees of raw oysters and clams. After showing study participants a real newspaper article about a 2015 Vibrio outbreak linked to an oyster farm in Massachusetts, the researchers reported that the news had a “significant negative impact” on participants’ willingness to bid on oysters. It had a depressive effect on clam sales, too.

“You should really be out there beating the drum on botulism or salmonella or E. Coli,” Sturmer told me on a recent visit to her lab in Cedar Key. “Why worry about [vulnificus] when the number of cases are so minimal?” Sturmer is quick to point out that even the term “flesh-eating bacteria” is a misnomer. She’s right, in a sense: The bacteria doesn’t “eat” tissue; it destroys it. But it’s hard to say whether someone who has survived a bout of necrotizing fasciitis, the medical term for what vulnificus does to the flesh, would care to dispute the difference.

Protecting consumers from being sickened by the deadly bacteria isn’t as simple as trusting people with underlying medical conditions not to eat shellfish. Americans consume 2.5 billion oysters every year, half of which are eaten raw. Vibrio infections, which most often resemble food poisoning, are still underreported and underrecognized, even among individuals who are most at risk of developing a severe infection. Vulnificus infections are also underreported, but much less so than other Vibrio-related infections because they often require a hospital or emergency room visit. 

“I’ve cared for many people with salmonella infections and water-borne infectious processes, but this is the one that is likely the most serious,” said Norman Beatty, an associate professor at the University of Florida College of Medicine who is also a practicing infectious disease doctor in Gainesville, and has seen limbs and lives lost to vulnificus. 

Identifying coastal areas most at risk

When it comes to preventing Vibrio infections, the work Magers and Kumar are doing could take some of the onus off of individual responsibility. The researchers are identifying which parts of the eastern U.S. coastline will be most risky for overall vibriosis infections, and vulnificus specifically, as waters warm. Alongside a group of microbiologists from the University of Maryland, including Brumfield, the scientists have developed a computer model that can predict how high the vibriosis risk will be in any given coastal county on the Gulf or East coasts a month in advance. The team trained their model by pairing the CDC’s count of Vibrio-related foodborne and waterborne illnesses from 1997 to 2019 with satellite data that measures the conditions that fuel Vibrio growth, such as water temperature and salinity. 

The system is far from perfect. When the model was first trained and evaluated, it was only 23 percent precise in pinpointing high-risk counties, meaning just one in four of the counties the program labeled as high-risk actually ended up seeing a vibriosis case in a given month. But it was very good at determining which counties were low-risk, capturing those regions with 99 percent precision. And it improved over time as the quality of the data they fed it got better. When they had the model do a test run on data collected by the Florida Department of Public Health from 2020 to 2024, 72 percent of total cases occurred in counties the tool flagged as high-risk for vibriosis. 

Perhaps most significantly, the model was especially adept at predicting high-risk counties ahead of Hurricanes Helene and Milton in 2024 — more than 80 percent of the vibriosis cases that occurred in Florida in the aftermath of those hurricanes were reported in counties the model had already flagged as high-risk. 

The tool is geared toward predicting water-borne infections, but it may also provide useful information to the shellfishing industry, though the system isn’t a replacement for the established protocols farmers already use — protocols that have proven to be effective, particularly in states that are aggressive about enforcing them. What the new tool could do, however, is supplement those Vibrio control plans, especially when an upcoming weather pattern deviates from the historical norm — something that has been happening a lot lately.

States currently use a rolling five-year average illness rate to calculate how many minutes or hours harvested shellfish can stay on a boat before moving into indoor refrigeration. In February, for example, Florida shellfishers have to get their oysters into refrigeration by 5 p.m. on the day of harvest. In July, they have no more than two hours, or they have to cool their catch in ice slurries on board. But these timetables don’t account for sudden temperature anomalies.

“It’s going to be 80 degrees this week in Alabama,” Andy DePaola, a Gulf Coast oyster farmer, told me in February. “Yet I can keep my oysters out for, like, 14 hours, because the rolling five-year average is 20 degrees less than that anomaly.” (DePaola is also a microbiologist who worked on Vibrio at the FDA for the better part of 40 years, and is the author of the 2019 analysis that diagnosed the “perfect storm” for Vibrio spread.)

But the shellfish industry doesn’t appear enthusiastic about the idea of assigning counties a risk category based on Vibrio prevalence. Vibrio researchers, by their own admission, haven’t done a good job of reaching out to shellfishers to find out how such a tool would work best for them. At an August meeting of the Delaware Bay Section of the ​​New Jersey Shellfisheries Council last year, the director of a shellfish research laboratory brought up the idea of using Vibrio predictive models to “determine optimal days to harvest to reduce the transfer of infection to humans.” A lengthy discussion ensued. The consensus, ultimately, was that the model was a bad idea, and could be “used against the industry.”

Not all shellfishers are dead set against the kind of work Magers and Kumar are doing. “If Vibrio is an indicator of global warming, then that’s just an unfortunate bad luck scene for us,” McCormick, the Long Island oysterman, said. But it’s hard for him to see what relevance that research has to an industry that already has its own methods of controlling Vibrio. “In my mind that exists in one realm and the safety of our oysters is a whole different thing.”

As we move deeper into the 21st century, however, those two realms will have more overlap. If countries keep up their current pace of greenhouse gas emissions, most coastal communities along the East Coast will be environmentally primed for vibriosis outbreaks during peak summer months by midcentury. It won’t be a question of if there will be more vibriosis cases — it will be a matter of how to manage them. That’s the scenario Magers and Kumar are preparing for.

“In 30, 40, 100 years, these models won’t even matter because the risk is so high,” said Magers, the lead author of the predictive modeling study. “When it gets to that point, it would probably be a different kind of modeling strategy where we’d be modeling case numbers instead of infection risk.” 

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Know the facts about Vibrio, a bacteria found in coastal waters and raw oysters

Stay informed about your risk level as you enjoy fresh shellfish and beach trips this summer. 

By Lyndsey Gilpin

This story was produced by Grist and co-published with States Newsroom.

What is Vibrio? 

Vibrio is a type of bacteria that has been around for hundreds of millions of years; researchers have identified more than 70 species. These species are mostly harmless, but some can cause infection. The bacteria thrive in warm, brackish (slightly salty) water such as estuaries and bays, attaching themselves to plankton and algae and accumulating in prolific water-filtering species like clams and oysters. Serious infections typically happen either through exposure to an open wound in saltwater or, more rarely, ingestion of raw shellfish that contain the bacteria. 

The concentration of Vibrio in coastal waterways is higher from May through October, when temperatures are warmer. Most U.S. cases are in the Gulf and Atlantic coastal regions. Vibrio is tasteless and odorless. The Centers for Disease Control and Prevention, or CDC, estimates that about 80,000 cases of vibriosis (an infection caused by the Vibrio bacteria) occur in the U.S. every year, resulting in about 100 deaths. Florida has the highest number of cases, with about 20 percent reported from the Indian River Lagoon region, a popular recreation destination on the Atlantic Coast. 

What happens if you come into contact with Vibrio?

Most people are not at risk of developing illness, or they may have only mild symptoms. However, those with compromised immune systems can develop life-threatening infections. 

The majority of the 80,000 annual U.S. cases are caused by a Vibrio called parahaemolyticus, which most often infects people via the raw seafood they eat and usually leads to gastroenteritis, or food poisoning. The symptoms may include nausea, vomiting, diarrhea, stomach cramps, fever and chills, weakness, fatigue, and headache. 

A different type of Vibrio, vulnificus, is much less common, but can cause severe illness. The infected wound may be red, swollen, and painful, or you may develop mild gastrointestinal issues such as watery diarrhea, stomach cramps, or vomiting. Symptoms typically appear within 12 to 24 hours and can last up to seven days. Healthy people tend to fight off the infection on their own. But if flesh on one or more extremities to bruise, swell, and decay, or symptoms of sepsis occur, it is a medical emergency. Vulnificus can squeeze through a pinhole-sized cut in the skin and lead to death in just 24 hours. This severe infection is rare, but it has a 15 to 50 percent fatality rate; the vast majority of the 100 annual deaths are from this strain. A severe vulnificus infection is much more likely in people who have liver disease or are immunocompromised, elderly, or diabetic.

How concerned should I be — and how do I stay safe? 

You don’t necessarily need to avoid oyster bars or cancel your beach trip, but you should know how to stay informed and take precautions. Here are a few ways to do so:

• Be aware that there are many fearmongering headlines about flesh-eating bacteria, despite vulnificus being one of the rarest forms of Vibrio exposure. Vibrio doesn’t attack random healthy flesh — there must be exposure through an open wound (a break in the skin) or it must be ingested, most often through raw shellfish. People who get sick often have underlying health conditions. 
• If you don’t feel well after eating raw seafood or swimming in brackish water, don’t wait — go to the doctor. Some medical professionals, particularly those in areas where the bacteria hasn’t historically infected people, don’t know what vibriosis is. Advocate for yourself — ask for a test. 
• If you have liver disease, your risk is much higher than the general population’s. Keep an eye out for public health advisories from state and local health officials and avoid swimming in ocean water with an open wound or consuming raw shellfish in warm months. Note that ocean temperatures, especially along the lower Atlantic and Gulf Coasts, have been elevated outside the typical seasonal range in some recent years.
• Be aware when eating raw shellfish, particularly raw oysters. It’s best to be confident that the shellfish was refrigerated and stored in compliance with government standards. The vast majority of foodborne Vibrio cases lead to food poisoning. (Food poisoning from bacteria is always a risk when eating uncooked shellfish and many other foods like salads or deli meat.)

How is climate change affecting Vibrio?

Climate change is making the world’s oceans, which have absorbed more than 90 percent of the excess heat trapped by greenhouse gas emissions, more hospitable to Vibrio. The bacteria start getting active in temperatures above 60 degrees Fahrenheit and multiply rapidly as waters warm throughout the summer. Vibrio is expanding into places that were once too cold to support it, farther north on the U.S. East coast and in other temperate seas around the world. As it spreads, it serves as a first warning signal of changing marine conditions.

What’s being done to address Vibrio?

There’s a lot of research happening to better understand the risks these bacteria pose under changing environmental conditions: A group of microbiologists at the University of Maryland, alongside other scientists, have developed a computer model that can predict how high the risk of vibriosis will be in any given coastal county in the eastern U.S. a month in advance. The team trained its model, which is still under development, by pairing the CDC’s count of Vibrio-related foodborne and waterborne illnesses from 1997 to 2019 with satellite data that measures the conditions that fuel Vibrio growth, such as water temperature and salinity. It’s far from perfect, but it’s improving. And it was especially adept at predicting high-risk counties ahead of hurricanes Helene and Milton in 2024 — more than 80 percent of the vibriosis cases that occurred in Florida in the aftermath of those hurricanes were reported in counties the model had already flagged as high-risk. 

This report was updated at 1:35 p.m. 4/23/2026.

Employees of two Wisconsin clinics operated by Rogers Behavioral Health voted by large majorities in favor of union representation Wednesday after more than two months in which the mental health nonprofit had campaigned heavily against the union.

In West Allis, employees voted 53-4 in favor of joining the National Union of Healthcare Workers. In Madison, the vote to join the union was 26-4. The votes were supervised by National Labor Relations Board officials at both clinics.

Employees at the two clinics “are ready to negotiate contracts that would provide better pay, protections to ensure safe staffing levels and more time to care for individual patients, as Rogers workers secured in California after joining NUHW,” the union stated in a press release Thursday.

The union represents Rogers employees at three facilities in California, where contracts have been negotiated, and one in Philadelphia, Pennsylvania, where contract negotiations are underway. “While contract negotiations are still ongoing in Philadelphia, the contracts Rogers agreed to for workers based in the Bay Area, Los Angeles and San Diego are among the best in the industry,”  the union statement said. “They include strong raises, limits on caseloads, and guarantees that no jobs will be lost to new technologies, including artificial intelligence.”

Rogers, based in Oconomowoc, said in a statement released Thursday, “We acknowledge the union election outcomes in Madison and West Allis Lincoln Center. We are evaluating our next steps in support of our system of care. We are committed to our patients, our people, and the integrated care that has made Rogers a trusted provider across Wisconsin since 1907.”

The union said in its press release that during the West Allis election Wednesday, Rogers management “prohibited NUHW’s representative from entering the facility and then suspended a worker who had agreed to serve as the union’s observer.”

Federal labor law procedures call for representatives from management as well as the union to observe the vote count. The absence of a union observer “could have resulted in the ballots being impounded and not immediately counted,” the union press release stated.

A second Rogers employee volunteered to serve as the union observer for the count “over the objections of Rogers’ representatives,” the NUHW stated, adding that Rogers did not attempt to stop ballots from being counted at the Madison clinic.

The workers involved were among three employees fired shortly after workers announced their petition for a union. The union has filed unfair labor practice charges over the terminations, claiming that the three were fired in retaliation for their support for unionization, which is illegal under federal law.

Rogers has declined to explain the firings, citing employment confidentiality, but said that it has not violated any laws.

Rogers Behavioral Health issued a follow-up statement Thursday about the voting conflict in West Allis. According to the statement, “individuals who are no longer employeed by Rogers had illegally entered the facility,” and Rogers contacted local police.

The next step will be for the National Labor Relations Board to certify the results. But a federal lawsuit challenging the agency is still pending. In addition, Rogers said in public statements as well as in communications to the workers before the vote that the company would not begin bargaining with the union until all its appeals have been exhausted. 

The nonprofit campaigned actively against unionization, telling employees that a union would not have been in the interests of the staff, the patients or the organization. In a final letter distributed on Monday, Rogers urged employees to vote no and made statements that the organization had made mistakes and wanted to be given another chance to improve relationships with the staff without a union.

Union supporters welcomed the outcome of Wednesday’s votes.

“We are thrilled with the overwhelming victory,” said Stephani Lohman, a nurse practitioner who was among those active in the union organizing campaign and was one of the three fired employees. “Over the last few weeks Rogers has shown us exactly why we need a union by running an aggressive anti-worker campaign, trying everything in their toolbox to intimidate and demoralize us, but it failed spectacularly because it was so cruel and wicked that it drove everyone to support the union.”

According to union supporters, the union campaign began late last year after changes at Rogers that included clinicians being reclassified from salaried to hourly, which resulted in schedule changes that increased patient volumes for staff members and reduced individual patient care. The organization increased caseload caps, “forcing caregivers to be responsible for far more patients than previously,” the NUHW said in its statement.

This report has been updated with additional information and comments Thursday from both the National Union of Healthcare Workers and from Rogers Behavioral Health. 

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A federal judge in Milwaukee rejected a bid from Rogers Behavioral Health Tuesday to block a pair of union elections scheduled for Wednesday at Rogers mental health clinics in West Allis and Madison.

The decision sets the stage for votes to go forward at both clinics. About 35 employees at Rogers’ Madison clinic and about 68 at the West Allis clinic will vote Wednesday on whether to be represented by the National Union of Healthcare Workers.

Rogers, based in Oconomowoc, had argued that the union election should cover all 13 Rogers facilities in Wisconsin — not just the two where employees had actively organized. But in a direction of election issued April 14, the NLRB regional director whose jurisdiction includes Wisconsin said those two clinics alone were each appropriate bargaining units.

On Monday, Rogers lawyers filed a lawsuit to block both elections. U.S. District Judge Lynn Adelman denied the mental health nonprofit’s petition for a temporary restraining order Tuesday after an online hearing that ran a little more than 40 minutes.

“I don’t think that they’ve established unconstitutional irreparable harm,” Adelman said of Rogers’ lawyers.

The Rogers lawsuit echoed a recent line of legal challenges that have sought to unravel the National Labor Relations Board — the 91-year-old agency created under President Franklin Delano Roosevelt as part of his administration’s New Deal to secure rights for workers and help the U.S. recover from the Great Depression.

One of Rogers’ lawyers, Aron Karabel, argued that the members of the NLRB itself as well as the regional director who issued the union election order are unconstitutional because they aren’t subject to dismissal by the president, violating the separation of powers in the U.S. Constitution.

Similar arguments have been made by other businesses, including Amazon and SpaceX, but the U.S. Supreme Court has not endorsed the claim.

Karabel’s colleague, Hannah Fitzgerald, argued that under Wisconsin law, the NLRB regional director had engaged in “tortious interference” with existing employment contracts for some of the Rogers employees who would be included in the union election bargaining unit. For that reason as well as other reasons, the election could cause “irreparable harm” to Rogers, Fitzgerald asserted.

Representing the NLRB, lawyer Craig Ewasiuk said that a Supreme Court ruling 82 years ago established that individual contracts “may not be availed of or to defeat or delay the procedures prescribed by the National Labor Relations Act” to further collective bargaining.

“The Supreme Court has spoken unambiguously on this question, and you simply can’t bring tortious interference acts against the NLRB for running elections,” Ewasiuk said.

Karabel argued that Rogers’ case was not about collective bargaining — which would prevent the federal court from acting until after final action by the NLRB — and for that reason, the court was an immediately appropriate venue.

The NLRB lawyer rejected that argument. ‘’The employer is essentially trying to stop the board’s proceedings from resolving this underlying labor dispute,” Ewasiuk said.

Staunch resistance to the union

Rogers Behavioral Health has mental health clinics and hospitals in 10 states. Employees are already represented by the National Union of Healthcare Workers at four clinics — three in California and one in Philadelphia, Pa. — and at three of those, the union was recognized voluntarily.

But in its home state of Wisconsin, Rogers has taken a much different posture.

Three employees were fired shortly after the union campaigns went public, according to the union, and the NUHW has filed unfair labor practice charges claiming the firings were illegal retaliation for union support.

Rogers has declined to discuss the firings as confidential personnel decisions but has stated they were not in violation of any laws.

From when employees first notified Rogers management of their desire for union representation, however, Rogers has posted notices and issued statements declaring that the mental health nonprofit doesn’t want  union representation for the West Allis and Madison employees.

“Many of your colleagues, your leaders, and I strongly believe that this union is not in the best interests of you, your family or our patients,” said one notice, stating it was from clinic leaders but without a name attached, that was shared with the Wisconsin Examiner. “We believe you should vote no and allow our team the opportunity for positive and direct collaborations.”

In March, Rogers’ executive director of marketing and communications, Maureen Remmel, responded to a question from the Examiner about the difference between Rogers’ responses at its California and Pennsylvania clinics and its handling of the union campaigns in Wisconsin

“While we work in good faith with the NUHW in California and Pennsylvania, our integrated system in Wisconsin is different,” Remmel said in an email message  March 17. “A direct relationship with our Wisconsin team members best serves employees, patients, and the company.”

At an NLRB hearing in February to establish the appropriate bargaining units for the Wisconsin clinics, Rogers’ lawyer argued that flexibility across multiple facilities was important and necessitated allowing all 13 Wisconsin locations to vote on union membership.

A statement attributed to the organization as a whole that Remmel sent April 16, after the election order was issued, asserted, “A union is not right for Rogers Behavioral Health in Wisconsin because it jeopardizes our ability to work together to solve problems quickly and flexibly.”

Jennifer Hadsall, the NLRB regional director, wrote in her analysis that there was little evidence of “functional integration” across the system to overcome the presumption that the two facilities where employees had organized were by themselves appropriate bargaining units.

Hadsall also rejected Rogers’ argument that certain employees were supervisors and therefore not eligible to be part of their facility’s bargaining unit.

Professional consultants

Starting in early February, Rogers has hired consultants to assist in managing its response to the union campaigns, according to LaborLab, a nonprofit based in Helena, Montana. LaborLab monitors the industry of consultants who advise and assist employers in responding to union drives.

Under the federal Labor-Management Reporting and Disclosure Act, employers and the consultants they hire to persuade employees “directly or indirectly” about unionizing must regularly file reports with the federal government. Employers file LM-10 reports and consultants file LM-20 reports as well as LM-21 annual financial reports.

While advocates for greater disclosure complain that those reports are often late or incomplete, they offer some information about those businesses.

LaborLab has identified three consultants working for Rogers since early February, when pro-union employees in Madison and West Allis petitioned for voluntary recognition. Two were identified through their LM-20 reports and one was named by union supporters during a radio interview with WORT-FM, the listener-sponsored community radio station in Madison.

LaborLab has estimated the consultants’ fees total about $50,000 a week, or more than $325,000 through April 1. Those don’t include the cost of attorneys representing the business on legal matters connected with the union campaign or “internal costs” that LaborLab’s calculations impute to employees assigned to directly address the union organizing effort.

“It’s hard to be precise because there are a lot of variables in these campaigns,” said Teke Wiggin, LaborLab’s strategic coordinator. “But we think that workers should have some general sense of how much is being invested in these campaigns.”

Wiggin said in an interview that some consultants interact only with corporate managers and executives, while others hold meetings with employees themselves, an action that requires disclosure in federal reports.

“They take arguments that have been crafted by industrial psychologists to sow as much fear and doubt about the value of unionization as possible,” Wiggin said.

In a letter sent to Rogers Feb. 25, 20 local and state elected officials criticized the organization for having “hired union busters” and urged the organization’s CEO to “immediately stop wasting patient care dollars on union busters paid to try to intimidate workers from organizing.”

Rogers did not respond to a question from the Examiner about its use of consultants in the organizing campaign.

In a response to the elected officials that was signed by “Rogers Behavioral Health,” the organization said it has “retained consultants to better understand and address the concerns shared by our employees and to raise awareness about their rights and the election process.”

Messages to employees

In a media statement April 16 after the election was scheduled, Rogers reiterated the organization’s position that a union was not the right choice for its employees and its intention to appeal the regional director’s finding after the election.

The day before, Rogers management emailed employees with a similar message, stating, “We are disappointed and disagree with this decision and are appealing to the full NLRB in Washington, D.C.”

The final line of the message was, “Regardless of the election outcome, bargaining will not start with the union until all appeals have been exhausted.”

The Wisconsin Examiner was provided screenshots of the message.

Employees involved in the union campaigns said that shortly after it landed in their inboxes, that message was remotely deleted, possibly because it was recalled.

On Monday, Rogers distributed another letter at both the West Allis and Madison locations that took up about a page and a half.

“We want to be direct with you today: change is coming to Rogers,” states the letter, photos of which were shared with the Examiner. “You will see it. We are working on it. That is why we are asking you to vote no on Wednesday and allow leadership 12 months to demonstrate to you, your colleagues, patients and families our commitment to making Rogers better than ever.”

Under federal labor law, if a majority of employees vote against a union in a representation election, the employees must wait at least 12 months before seeking a union again.

The members of Rogers’ leadership team “have heard you,” the letter states. “We know that there are things we can do and must do better.”

The letter’s final paragraphs reiterated both the vow to improve relations and a plea to vote against the union.

“The leadership team is committed to doing better. Today we are asking you to please give us 12 months. Vote ‘no’ in the upcoming election and give us a chance to show our commitment in action. If we do not come through for you, the law gives you the right to hold another election. Rogers will honor your choice in that election.

“Please vote ‘no’ on April 22. Vote to hold Rogers leadership accountable.”

Federal court records show Rogers filed its lawsuit to block the vote the same day that employees received that letter.

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Employees of two Wisconsin mental health clinics, both part of a national mental health nonprofit based in Oconomowoc, will vote next week on whether to join a union after what has become a highly contested campaign.

Almost two months after a four-day National Labor Relations Board hearing, the NLRB’s Minneapolis-based regional director this week ordered the elections at the clinics, operated by Rogers Behavioral Health in West Allis and Madison.

In the April 14 order, Regional Director Jennifer A. Hadsall rejected Rogers’ position that the election should include all 13 Wisconsin Rogers locations. Hadsall instead directed elections at the West Allis and Madison clinics, where a majority of employees had signed up with the National Union of Healthcare Workers, according to the union.

Union supporters at the Wisconsin clinics have said they decided to seek union representation in response to increased caseloads, changes in how employee productivity was measured and a reduction in individual time that therapists and other providers could spend with patients.

“All of the changes were about increasing the number of patients that were coming into the building,” Stephani Lohman, a nurse practitioner, told the Wisconsin Examiner earlier this year. “It did not seem to have a cohesive plan and no plan would be communicated.”

The NUHW is based in California. After employees at a Rogers clinic in Walnut Creek, California, organized in 2023 and elected the union to represent them in 2023, they negotiated their first contract in 2024.

Employees at two other California clinics and at a clinic in Philadelphia also joined the union, which those three clinics voluntarily recognized.

Union supporters at the West Allis and Madison clinics each sought voluntary recognition of the union after organizing over the past year.

In Wisconsin, however, Rogers declined voluntary recognition, and the employees then filed petitions with the NLRB for union elections.

Lohman worked at the West Allis clinic, known as Lincoln Center, and was among those active in organizing the union. She said she and two other employees were fired after submitting the petition to be recognized. The union has filed unfair labor practice charges claiming that the three firings were in retaliation for union organizing, which is against the law.

In response to an inquiry in March about the firings, Maureen Remmel, Rogers’ executive director for marketing and communications, told the Wisconsin Examiner via email, “We do not comment on confidential personnel matters and have acted in compliance with applicable law.”

Hadsall held a hearing that took place Feb. 23 through Feb. 27 at the NLRB’s office in Milwaukee, where Rogers’ lawyers argued for a bargaining unit of 1,383 employees encompassing all Rogers locations in Wisconsin — three hospitals in the Milwaukee area and 10 outpatient clinics around the state.

Rogers had “a heavy burden” to overcome the presumption that a single facility is an appropriate bargaining unit, Hadsall wrote in her order this week, and she found that management had  failed to do so.

The evidence in how Rogers is organized and supervises its employees was insufficient to overcome a general presumption in U.S. labor law — that a union bargaining unit representing a single health care facility in a larger network or organization is considered appropriate.

Evidence in the case showed that neither of the two clinics had “lost their separate identity such that a single-facility union would be inappropriate,” Hadsall wrote.

Union elections for about 68 employees at the West Allis Lincoln Center clinic and about 35 at the Madison clinic are scheduled for Wednesday, April 22.

For employees at both clinics who have been seeking union representation, the decision was welcome news.

“I’m thrilled and beyond thrilled,” said Erin Quinlan, a behavioral health specialist at the Madison clinic. “It really just vindicated how firm our stance is and how confident we feel about organizing a union and doing so for the Madison clinic.”

Lohman said she and other West Allis employees who have been seeking union representation were pleased as well.

“I’ve just been feeling really overjoyed,” Lohman said Thursday. She and the other fired employees will be able to vote in the West Allis union election, she said.

Rogers Behavioral Health has announced the organization will appeal the order to the full NLRB in Washington, but that will not forestall next week’s voting.

“We are disappointed with the NLRB regional office’s decision to allow separate bargaining units given that Rogers Behavioral Health operates as one unified system across Wisconsin,”  Rogers said in a statement, which Remmel delivered via email. The statement asserted that patients “can move seamlessly between different levels of care, supported by providers who collaborate across locations.”

In her order, however, Hadsall found that there was not sufficient evidence of “functional integration” across the system to overcome the presumption that a single facility is appropriate for a bargaining unit.

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WASHINGTON — Health and Human Services Secretary Robert F. Kennedy, Jr. testified before Congress on Thursday that he’s not pleased with how spending cuts to programs that help lower-income Americans afford food will affect his efforts to bolster healthy eating habits. 

“Am I happy about the cuts? No, I’m not happy about the cuts,” Kennedy said during a lengthy hearing in front of the House Ways and Means Committee, one of several congressional panels he’ll testify before in the days ahead. 

Kennedy added that President Donald Trump and White House budget director Russ Vought also didn’t truly want to propose funding cuts to the Special Supplemental Nutrition Program for Women, Infants, and Children, often called WIC, and the Supplemental Nutrition Assistance Program, or SNAP. 

“Nobody wants to make the cuts. Russ Vought doesn’t want to make the cuts. President Trump doesn’t,” he said. “But we got a $39 trillion debt.”

Wisconsin Democratic Rep. Gwen Moore, who asked the questions, then referenced comments Kennedy made earlier in the hearing about Froot Loops, when he said it “isn’t even a food. It’s just poison.”

Moore noted the cereal is “a lot cheaper than good, healthy food.”

Froot Loops includes a corn flour blend, sugar, wheat flour, whole grain oat flour, modified food starch and other ingredients. 

Trump advocates reductions for HHS

The Trump administration’s budget request for the fiscal year set to begin on Oct. 1 proposes Congress increase defense spending by more than half a trillion dollars, accounting for a 43% boost, and that lawmakers cut domestic spending by 10%. 

It suggested Congress reduce spending at HHS by $15.8 billion, or 12.5%, to $111.1 billion, though lawmakers largely rejected proposed spending cuts to the department during last year’s government funding process. 

Vought testified earlier this week that the administration expects to ask Congress for additional defense spending for the war in Iran, though he said he couldn’t give lawmakers a ballpark estimate for how much that will add to the current request for $1.5 trillion in defense funding. 

Lawmakers questioned Kennedy about dozens of other issues throughout the hearing, including how he’s spoken about vaccines since being confirmed HHS secretary, the rise in measles cases throughout the country and comments Kennedy and Trump made about the possible causes of autism. 

Utah Republican Rep. Blake Moore, after sharing that his 10-year-old is on the autism spectrum, said he was “underwhelmed” by what the administration has released so far about possible causes. 

He also said that his wife was hurt by claims from Trump and Kennedy that women who take Tylenol when pregnant could increase the risk their children are later diagnosed with autism. 

“We don’t even know if she took Tylenol during her pregnancy, but that was a hurtful moment for her,” Blake Moore said. “And I just want to encourage the administration and your team to keep at it. And I think there’s more we can do here with low expectations.”

Medical experts say that decades of research shows autism is the result of a combination of genetic and environmental factors.  

Measles death

California Democratic Rep. Linda T. Sánchez questioned Kennedy about comments he made during his Senate confirmation hearing on vaccines, arguing that he hasn’t stuck to the commitments he made during that process. 

She then asked him if the measles vaccine could have prevented a boy from dying of the disease in Texas. 

“It’s possible, certainly,” Kennedy said. 

But, he repeatedly declined to answer a question from Sánchez about whether Trump approved the Centers for Disease Control and Prevention’s decision to remove a messaging campaign to encourage vaccination, even as she asked it several times. 

Sánchez then displayed a poster showing a photograph of Kennedy and Kid Rock to illustrate her discontent with his work so far as HHS Secretary. 

“Now, one thing that I find incredible is that you suspended this pro-vaccine messaging campaign. But somehow you’re spending taxpayer dollars to drink milk shirtless in a hot tub with Kid Rock,” she said. “And somehow you think that’s a better public health message than informing the public about the importance of vaccines.”

Day care, Medicaid, Black maternal health

Illinois Democratic Rep. Danny K. Davis pressed Kennedy about whether he agrees with a statement Trump made earlier this month when the president said, “We can’t take care of day care. It’s not possible for us to take care of day care. Medicaid, Medicare, all of these individual things. They can do it on a state basis. You can’t do it on a federal. We have to take care of one thing, military protection.” 

Kennedy responded that he was “told to make a 12% cut across our department” because the national debt, which has accumulated over decades, has reached $39 trillion. 

“We’re now having to tighten our belt,” Kennedy said. 

Davis also questioned Kennedy on funding and initiatives to reduce Black maternal mortality, saying “the Trump administration is undermining Black maternal health from all sides.”

“The GOP slashed over a trillion dollars from Medicaid, which pays for over 40% of births in the United States. President Trump just proposed cutting maternal and child health programs by over $800 million,” he said. “DOGE canceled funds for several research projects that could save countless Black mothers, like the Morehouse School of Medicine research on improving the health of Black pregnant and postpartum women.”

Kennedy responded by arguing that he and others in the Trump administration are “doing more to advance maternal health than any other administration in history.”

“There was tremendous duplication in the departments. We had 42 different maternal health services in our department,” Kennedy said. “And we cut some of those and consolidated them. Right now, we are investing huge amounts of money in maternal health.”