AUTHOR NAME
Nowhere to Run
Every day we’re struck by terrible headlines concerning the refugee crisis in Europe: Austria finds 71 migrants dead in a truck. Hungarian police officers fire teargas at migrants. 50 refugees die in a ship’s hold off the coast of Libya. News like this has become almost commonplace. With the Syrian Civil War raging, ISIS displacing millions in Iraq, Ukraine and Russia at loggerheads, and multiple states in Africa mired in poverty, the number of migrants will surely increase in the months to come. To better understand what is at stake, we’ve compiled some of the best reports from the U.S. and Europe.
The Global Refugee Crisis, Region by Region
The New York Times, August 2015
Why do people leave their country? Why has the United Nations called this migration crisis the worst since World War II? Take a look at the hot spots illuminated by clarifying graphics.
Life on Hold – The struggle of Syrian refugees in Lebanon
Al Jazeera, March 2015
Europeans may feel that they are taking on the biggest influx of refugees, but most Syrians fleeing from war never make it to Europe. While the European Union currently hosts about 350,000 Syrian refugees, Lebanon – a country of 4.5 million – has received nearly 1.5 million. The refugees wait in camps and abandoned buildings. For them, as well as for the country that shelters them, life has changed unalterably.
Why is EU struggling with migrants and asylum?
BBC, August 2015
Another year, another record: Germany is expecting more than 800,000 refugees to arrive by the end of this year, 4 times more than the last. Where do they come from, which routes do they take, and what has caused migrant numbers to rise?
Scenes from a tragedy: just another week in Europe’s migrant crisis - in pictures
The Guardian, August 2015
Refugees arriving on a beach full of tourists in Greece. A fence set up to seal the border in Hungary. Migrants running after trains and trucks to get from France to England. Flight has many faces – some of them shown in these impressive photographs.
On Island of Lesbos, a Microcosm of Greece’s Other Crisis: Migrants
The New York Times, August 2015
The Greek isles are a new hotspot in Europe’s migrant crisis. More than 150,000 refugees have already arrived this year. The islands of Lesbos, Kos or Chios, which are close to the coast of Turkey, can hardly cope with the influx.
Migrants Wait With Hope and Resignation at French Camp Called “The Jungle”
Time, August 2015
The Jungle is in France, more precisely in Calais. It’s a tent city built out of dark and dirty makeshift shelters for more than 3,000 migrants on their way to England. The future they’re longing for is just a 30-minute train ride away, but police officers and barbed wire make the transit almost impossible. Some migrants have risked uncertain crossing, jumping on trucks, hanging on trains, swimming across open water.
Den ganzen Weg nur Todesangst — The Whole Way Scared to Death
Bavaria’s Public Broadcasting Service, January 2015
Muhanad is a Syrian father with two daughters. After studying finance and marketing, he worked in the textile industry in Halab, a city known for its textile mills, until his house was bombed. Muhanad and his family decided to escape from the war – first together to Turkey, and then Muhanad on his own to Germany, a perilous odyssey.
Fortress Europe
Sveriges Radio, 2014/2015
The Swedish Radio has collected stories of Syrian refugees on their way to Europe – Muhanad’s escape is one of the featured episodes. Hatem, another refugee, left Syria for Turkey, then to Indonesia and back, before embarking on a four-month long journey across Greece, Slovenia, France, and Belgium to arrive finally in the United Kingdom.
Mastermind: The evil genius behind the migrant crisis
Newsweek, June 2015
Dead migrants left behind in a truck – the driver is gone. A captain flees from the broken boat on the Mediterranean, leaving the refugees to fend for themselves. Smugglers are too often refugees’ only hope – and their doom.
Is the Ugly German Back? Flames of Hate Haunt a Nation
Spiegel Online International, July 2015
Germany is the EU country that has taken the most asylum seekers. Some Germans feel overwhelmed by the high number – anti-refugee protests online and in the streets, as well as attacks on refugee hostels, are on the rise. But others are standing up against hate.
Germans Open Their Homes To Refugee Roommates
NPR, March 2015
A German couple launched the website “Refugees Welcome” to place asylum-seekers in homes with room to spare.
This Silent Protest Song to Benefit Refugees Just Topped the Charts in Austria
Vice News, August 2015
The Austrian artist Raoul Haspel released a track last month titled "Schweigeminute (Traiskirchen).” It is a minute of silence that serves as an unconventionally inaudible protest song against the treatment of refugees in Europe.
Munich police swamped with refugee donations
The Local, September 2015
Just this week, more than 2,000 refugees arrived at the main train station in Munich. Police, aid organizations, and ordinary citizens came to help, offering food, water, diapers and teddy bears, all to say #refugeeswelcome.
‘Dark Money’ Debate: Two Views on Whether the Term is Fair Game
As the rules around campaign finance have changed, so has our vocabulary. Yet while the term “dark money” has gone mainstream – referring to dollars flowing in from nonprofit groups that are not required to disclose their donors – there is disagreement over whether the phrase is too loaded to be used by journalists. Organizations branded with the label claim that it unfairly suggests sinister intentions. Groups advocating for more disclosure in campaign finance, however, insist it is appropriate shorthand.
This week, ProPublica reporter Robert Faturechi speaks with leaders from both sides of the debate. First up: Brad Smith, former chairman of the Federal Election Commission (FEC), who remains a powerful voice in calling for less federal regulation of money in politics. He’s followed by Larry Noble, formerly the top lawyer for the FEC and now with the Campaign Legal Center, which supports strong enforcement of campaign finance laws. Both sides make a case for the merits or drawbacks of the phrase “dark money” and take their best shot at recommending alternatives they’d like to see.
Photo: Men walk outside the New York Stock Exchange on Wall Street. (Jeff Hutchens/Getty)
Highlights from their conversations:
- Smith says reporters should avoid using the language because “it’s not intended to be a neutral term; it’s intended to create an atmosphere of alarm in the listener that makes it harder for the listener to evaluate objectively what’s going on.” (8:45)
- A zero-tolerance policy against any political spending without public disclosure can come with high costs, says Smith, including the loss of privacy, harassment for voicing one’s political views, and a chilling effect on the advancement of new ideas. (12:10)
- Noble says “dark money” is fair, as it represents “the opposite of sunlight.” In several Supreme Court cases on campaign spending, including Citizens United, justices have emphasized the importance of disclosure and transparency. (20:32)
- Disclosure matters for voters, says Noble, because “you can often tell more about a candidate…by who’s supporting them than you can by what they say.” He argues that only with disclosure can the public know to whom candidates are beholden. (23:56)
Listen to this podcast on iTunes, SoundCloud or Stitcher. For more on Faturechi’s reporting on campaign finance, read his latest, Could Scott Walker’s Legal Victory Expand PAC Superpowers?
Activists Pursue Private Abortion Details Using Public Records Laws
This story was co-published with the Washington Post.
A few years back, Jonathan Bloedow filed a series of requests under Washington state’s Public Records Act asking for details on pregnancies terminated at abortion clinics around the state.
For every abortion, he wanted information on the woman’s age and race, where she lived, how long she had been pregnant and how past pregnancies had ended. He also wanted to know about any complications, but he didn’t ask for names. This is all information that Washington’s health department, as those in other states, collects to track vital statistics.
Help Us Investigate
What has been your experience with patient privacy? Do you think your medical information was shared by your doctor or health-care provider? Do you think it was involved in a breach? Tell us your story.
Bloedow, 43, isn’t a public health researcher, a traditional journalist or a clinic owner. He’s an anti-abortion activist who had previously sued Planned Parenthood, accusing the group of overcharging the government for contraception.
“There are stories in the data that bring home the reality of what these people do,” Bloedow, a software engineer, said in an email. “Any good investigator knows that when you’re dealing with hard-core criminals, if you ‘keep crawling through their garbage’ some evidence of criminality and corruption will turn up.”
The health department had already given him data for one provider, he said, and was on the verge of turning over more information when Planned Parenthood and other clinics sued, arguing that releasing the records would violate health department rules and privacy laws.
The legal skirmish, and others like it nationwide, reveal a quiet evolution in the nation’s abortion battle. Increasingly, abortion opponents are pursuing personal and medical information on women undergoing abortions and the doctors who perform them. They often file complaints with authorities based on what they learn.
Abortion opponents insist their tactics are generally not aimed at identifying women who have abortions but to uncover incidents involving patients who may have been harmed by poor care or underage girls who may have been sexually abused. They say they are trying to prevent situations such as the one involving Philadelphia abortion doctor Kermit Gosnell, who was convicted in 2013 of murdering three babies after botched abortions and of involuntary manslaughter in the death of a woman.
“This is about saving the lives of women,” said Cheryl Sullenger, senior policy adviser for the anti-abortion group Operation Rescue, which is based in Wichita, Kansas. “A lot of people don’t understand that. It’s a systemic problem within the abortion industry today for abortion providers to cut corners on patient care.”
But those who support abortion rights say the ultimate aim of these activists is to reduce abortions by intimidating women and their doctors — using the loss of privacy as a weapon. They say their opponents are amassing a wealth of details that could be used to identify patients — turning women, and their doctors, into pariahs or even targets. In a New Mexico case, a woman’s initials and where she lived became public as part of an investigation triggered by a complaint from activists.
“I don’t think there’s any margin for error here,” said Laura Einstein, chief legal counsel of Planned Parenthood of the Great Northwest and the Hawaiian Islands, which challenged Bloedow’s request. “These women came to a private health center to have a private health procedure, and that’s just not anybody’s business.”
In recent years, abortion opponents have become experts at accessing public records such as recordings of 911 calls, autopsy reports and documents from state health departments and medical boards, then publishing the information on their websites.
Some activists have dug through clinics’ trash to find privacy violations by abortion providers — such as patient records tossed in dumpsters — and used them to file complaints with regulators.
The fight has landed in courts nationwide as the two sides tussle over which information about abortions should be public and which should remain confidential under privacy laws.
In St. Louis, for example, an Operation Rescue staff member is suing the city’s fire department for 911 call logs and recordings from a Planned Parenthood clinic. The city says releasing the requested information would violate a federal patient privacy law.
In Louisiana, a critic of abortion sued the state last year to get data on abortions performed on minors, their ages and the ages of the listed biological fathers, as well as any complications that occurred. The state said the records were exempt from disclosure, and a judge agreed.
In Bloedow’s case, a Washington court sided with the clinics and prohibited the release of the records he sought. In May, a state appeals court upheld that injunction.
“The public has no legitimate interest in the health care or pregnancy history of any individual woman or where any particular abortion was performed,” the appeals court ruled.
A Tussle Over Privacy
At its core, the Supreme Court’s 1973 decision in Roe v. Wade rested on the right to privacy. The court determined that this right — guaranteed under the due process clause of the 14th Amendment — extended to a woman’s decision to have an abortion.
With the 1996 passage of the Health Insurance Portability and Accountability Act, known as HIPAA, additional federal privacy protections took hold for patients.
When Planned Parenthood officials were recently caught on video discussing the sale of donated fetal tissue, the organization invoked the potential violations of patient privacy to protest the surreptitious filming.
Still, the extent of the privacy guaranteed to those who seek abortions has been tested repeatedly.
In 2003, after Congress passed the Partial-Birth Abortion Ban, abortion providers sued to challenge its constitutionality. The Justice Department, as part of its defense of the law, sought patient records from a Chicago hospital, where a doctor was one of the plaintiffs’ expert witnesses.
Though patients’ names would have been redacted, a federal appeals court denied the request, citing privacy concerns.
“Imagine if nude pictures of a woman, uploaded to the Internet without her consent though without identifying her by name, were downloaded in a foreign country by people who will never meet her,” the court wrote. “She would still feel that her privacy had been invaded. The revelation of the intimate details contained in the record of a late-term abortion may inflict a similar wound.”
Around the same time, at least two state attorneys general, both abortion opponents, pressed for similar patient records. The attorney general of Kansas succeeded in part, while his counterpart in Indiana failed.
Digging For Dirt
More recently, it has been activists like Sullenger and Bloedow seeking information about abortion providers and their patients.
Coast to coast, they appear to be drawing from an unofficial playbook: Some wait outside clinics, tracking or taking photos of patients’ and staffers’ license plates and ambulances, if called.
They not only mine public records but also collect information leaked by sympathetic health care workers — for example, emergency-room doctors and ambulance drivers — who are required to keep patient information confidential under HIPAA. The law, however, doesn’t apply to advocacy groups.
Sullenger acknowledges receiving private patient information and said it helps to confirm when patients have suffered complications or died. In most cases, she said, the group does not name patients or publish photographs of them.
(Sullenger served two years in federal prison for conspiring to bomb a California abortion clinic in the 1980s. Today, the Operation Rescue website says, she denounces violence.)
The leaked information is used by activists to bolster complaints they submit to health agencies against abortion providers, sometimes without patients’ knowledge. Operation Rescue estimates that it has 100 complaints currently pending in different states.
Sullenger said it shouldn’t be left solely to patients to bring such matters forward. “If someone else sees that there may be an issue, we have a public duty to report things like that.”
Sometimes, complaints have brought violations to light.
In Indiana, the group Right to Life obtained thousands of pregnancy termination reports from the state health department. The records are nearly identical to those requested by Bloedow in Washington, but Indiana granted the request, redacting only a few fields.
After analyzing the data, the group filed a litany of complaints with the state, alleging that doctors were violating abortion record-keeping laws, including failure to report abortions involving minors in a timely manner. Four physicians now face disciplinary proceedings.
Such cases can be pursued without violating the privacy of patients, said Cathie Humbarger, vice president of policy enforcement for Indiana Right to Life. “We’re not aware of one situation where someone identified a patient by looking at a termination of pregnancy report after it was released by the state,” Humbarger said in an email sent through a spokeswoman.
One Indiana doctor, who has acknowledged making an “honest mistake” involving paperwork, faces a misdemeanor criminal charge.
His attorneys have argued that he did not knowingly violate the law and unsuccessfully sought to have the medical board case dismissed before a hearing.
But there have been other instances in which anti-abortion groups have filed unfounded complaints, said Janet Crepps, a senior counsel for the Center for Reproductive Rights. The resulting investigations caused additional details about the patients to be made public, she said.
Operation Rescue and another group filed complaints with New Mexico’s medical board against a doctor who works at an Albuquerque clinic after a patient experienced a complication and was taken to a hospital, and they obtained a recording of the 911 call.
Though the board ultimately exonerated the doctor, many details about the patient — her age and her mental state, in addition to her initials and where she lived — came out in a transcript of a hearing.
“The woman clearly did not want her privacy violated,” said Vicki Saporta, chief executive of the National Abortion Federation, a professional association for abortion providers. “She didn’t want to talk to anybody.”
After a Death, All Bets Are Off
Anti-abortion groups typically tread carefully when it comes to living patients.
Operation Rescue’s website in March published a photograph of a woman being wheeled out of a St. Louis clinic on a stretcher but put a black bar over her eyes to obscure her identity.
When a patient dies, however, it can be a different story.
In 2013, a different abortion opponent wrote on her blog that an “impeccable informant” told her the identity of a kindergarten teacher who had died after a late-term abortion at a clinic in Germantown, Maryland. Groups including Operation Rescue quickly got the word out, using the woman’s name and photos from social-media sites.
The doctor who performed the abortion, LeRoy Carhart, has been a target for protesters because he does late-term abortions that most other practitioners won’t. Though abortion opponents blame him for the woman’s death, the Maryland medical board found no deficiencies in his care for her.
Saporta said the woman’s family did not authorize the release of her identity.
Sullenger said she sympathized with the family’s loss but not its demand for privacy. “Look, once a person dies, they don’t have any privacy anymore,” she said. “I think they should have been more concerned about it happening to another person.”
Contacted recently, the woman’s mother declined to comment.
‘All They Cared About Was Judging Me’
For some patients, the grief they already feel with the end of a pregnancy is compounded by the loss of privacy.
Alicia, who spoke on the condition that only her first name be used, had an abortion in November 2013 after her OB/GYN told her and her husband that the fetus had a severe form of spina bifida, a debilitating birth defect.
During the procedure, she began bleeding heavily from a tear in her uterus. The clinic, located in Bellevue, south of Omaha, summoned an ambulance, which took Alicia to the hospital.
Someone protesting outside the clinic took a photo of the ambulance, and Operation Rescue’s website reported the incident, though it did not know Alicia’s identity.
Within weeks, the Nebraska health department subpoenaed Alicia’s records from the clinic. Alicia had not complained, but the agency had received a tip, she later learned.
“All this happened because I was in the clinic having a legal abortion,” she said. “All they cared about was judging me ... and building evidence for their case.”
Alicia said while the complication was scary at the time, it had been explained to her in advance as a possibility. She said she didn’t blame her doctor, Carhart, who practices in Nebraska as well as in Maryland.
In an interview, Carhart said that several of his patients have had their privacy violated.
After subpoenaing Alicia’s records, Nebraska’s health department disciplined a nurse at Carhart’s clinic for a pattern of negligence and unprofessional conduct involving a dozen patients, including Alicia.
Alicia said she asked state officials to identify who had filed the complaint that provided her name to state officials. To her amazement, she was told that information was confidential.
Marla Augustine, a health department spokeswoman, said in an email that patients are not notified if their records are examined “to protect the process from being contaminated.” For instance, a patient so notified could tip off a health provider about the existence of an investigation. That said, Augustine added: “The confidentiality of a patient’s medical records is very important to us, and a paramount consideration.”
Her explanation provides little comfort to Alicia.
“I don’t understand why whoever did this gets to be anonymous while I was the one who was supposed to not have my information leaked,” she said. “Why does that person get more rights than me?”
Has your medical privacy been compromised? Help ProPublica investigate by filling out a short questionnaire. You can also read other stories in our Policing Patient Privacy series.
How Yelp is Evolving in the Era of Big Data
Yelp may be best known for its restaurant and nightclub reviews, but the site’s seeds were actually planted when CEO Jeremy Stoppelman had trouble finding recommendations for a local doctor. Health providers now account for a rapidly growing six percent of Yelp’s reviewed businesses. Thanks to a new partnership with ProPublica, the site’s star ratings system is being supplemented with objective healthcare data.
ProPublica is helping Yelp to identify health metrics – including average wait times for emergency rooms and fines paid by nursing homes – to add to its provider pages. They are now available on nearly 26,000 pages, and more are coming soon. As part of the partnership, Yelp also is allowing ProPublica unprecedented access to its 1.3 million health reviews to help with our reporting.
This week, Stoppelman joins ProPublica senior reporter Charles Ornstein to discuss the debate over online reviews of health providers and Yelp’s increasing use of data across the site.
(Illustration: Emily Martinez/ProPublica)
Highlights from their conversation:
- Despite claims to the contrary by some displeased doctors, patients seem qualified to evaluate medical services. Stoppelman points to emerging academic research showing “a correlation between the ratings of a medical establishment and other sources of information that are perceived as quite objective.” Patients also provide insights on the full experience, not just the actual medical care delivered. (5:05)
- Yelp is poised to become a “one-stop shop,” integrating data across several review categories. Along with new information on its health provider pages, some of Yelp’s restaurant pages now feature health inspection scores. While Stoppelman says consumer opinions are important, other sources of information make Yelp “that much more powerful of a tool.” (7:55)
- The federal government has the green light to join the Yelp masses. The site already has thousands of reviews of federal agencies, but for years those agencies were not authorized to reply. A new partnership between Yelp and the federal government has changed this, allowing government organizations to claim their own pages and start interacting with the public. (13:20)
Listen to this podcast on iTunes, SoundCloud or Stitcher. For more on ProPublica’s partnership with Yelp, read Ornstein’s story, ‘Stay Far, Far Away’ and Other Things Gleaned From Yelp Health Reviews.
