25 March 23
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AT THE VERY LEAST, YOU CAN BE SURE HE'LL DELIVER HIS SPEECH IN ALL-CAPS.
The FBI and NYPD are investigating a letter containing a death threat and white powder that was mailed to Manhattan District Attorney Alvin Bragg, whose office is investigating former President Donald Trump, law-enforcement sources told NBC News. The letter was addressed to Bragg and said, "ALVIN: I AM GOING TO KILL YOU!!!!!!!!!!!!!” the sources said. It contained a small amount of white powder.
Tell me again that it’s worth leaving the former president* out there, unindicted and running wild. Tell me that his wankfest in Waco on the 30th anniversary of the Branch Davidian episode shouldn’t be shut down by local authorities, up to and including Gov. Greg Abbott. Tell me any of this makes any sense at all.
On Friday, the Republican majority in the House—which would’ve been bigger if the party weren’t insane and if Kevin McCarthy weren’t such a freaking dolt—passed a bill that already has a drawer reserved for it in the Senate morgue, and that most of the country thinks is a waste of time. Basically, it empowers every nuisance who ever showed up at a school board meeting to yell about whatever they heard on the radio that afternoon. From the NBC News:
The Parents Bill of Rights Act would require public school districts to publicly post information about curricula for students, including providing parents with a list of books and reading materials available in school libraries. The congressional action comes as some elected Republicans in states across the country have been intensifying a push to ban some books or pressed for limits on teaching about issues related to racial equality, sexual orientation and gender identity in schools. Under the measure, schools would be required to offer at least two in-person parent-teacher meetings annually, and school boards would be required to hear feedback from parents about students' educations.
These are the people who want to destroy the Department of Education because education should always remain "a local matter" (never mind that an amendment to the bill that would've done precisely that was defeated). Anyone who’s ever covered local government knows who this bill empowers: the ones who spout their ignorance at a volume that goes up to 11.
If there were not a Democratic Senate and a Democratic president with a freshly used veto stamp, we might be well on the way to raising three generations of snake-handling dumbasses.
Weekly WWOZ Pick To Click: “Funkwrench Blues” (A Face In The Crowd): Yeah, I pretty much still love New Orleans.
Weekly Visit To The Pathé Archives: Here, from 1950, King George VI and the future Queen Mum with their daughter (who is a couple of years away from being very, very famous) visit Shakespeare’s birthplace and the tourist trap that has sprung up around it. Strong hat game from the lady royals and a cameo from Anthony Quayle. This was, unbelievably, the first time a British monarch ever visited the place. I hope the cheap bastids at least hit the gift shop—or shoppe, as it were. History is so cool.
Discovery Corner: Over in the UAE, they have found…pearls before time. From (and I am not making this up) TimeOut Dubai:
The dig took place on Al Sinniyah Island, which was populated between the 6th and mid-8th centuries AD, where an ancient Christian monastery (Sinniyah Monastery) was found last year. Previously thought to have been a village for monks, this new discovery has proven that the homes belonged to a community of pearl divers and merchants. “This is a discovery of major significance for the history of Umm Al Quwain, the United Arab Emirates and the Arabian Gulf,” said the Umm Al Quwain Department of Tourism and Archaeology.
Pearlers lived pretty well, it seems.
Coming in different sizes, some of the homes had one room, others had two and others had multiple rooms, illustrating differences in wealth between the divers and the pearl merchants. Along with finding evidence of the pearl-diving settlement, a number of artefacts were found during the excavation. A pearl diving weight, dating back 1,300 years, was found at the site as well as a number of pearls, discarded oyster shells and pots.
Tip for the Umm Al Quwain Department of Tourism and Archaeology: Don’t invite the British nobility, they don’t spend a damn. Hey! Look what we found!
By now, it’s a national story that the principal of the Tallahassee Classical School fired an art teacher because a parent of a Very Important Child complained that the VIC saw a picture of Michelangelo’s David, which the parent considered pornographic because, you know, cock and balls.
We can all agree that this buckethead of a parent is not nearly as smart as the statue that so offended them—and likely not as good company, either. But the excuses being offered for this nonsense portend nothing good.
Read Slate’s interview with Barney Bishop III, the guy who chairs the school’s board (Tallahassee Classical is a charter school, so the principal and the teachers had little or no job security. They were all “at will” employees, another fine feature of any lightly regulated charter school system). Halfway through, he gets huffy because reporter Dan Kois has a cellphone number with a questionable area code.
Kois: I tend to think of a classical education as being the mode in the 17th, 18th century, where you study the Greeks and Romans, and Western civilization is central. A tutor or teacher is the expert, and that teacher drives the curriculum. You’re describing something where it seems the parents drive the curriculum. How does your classical education differ from the classical education as I think of it?
Bishop: What kind of question is that, Dan? I don’t know how they taught in the 17th, 18th century, and neither do you. You live in New York?
Kois: Virginia.
Bishop: You’ve got a 212 number. That’s New York.
Kois: I lived in New York when I got the cellphone, many years ago. Now I live in Virginia.
Bishop: Well, we’re Florida, OK? Parents will decide. Parents are the ones who are going to drive the education system here in Florida. The governor said that, and we’re with the governor. Parents don’t decide what is taught. But parents know what that curriculum is. And parents are entitled to know anytime their child is being taught a controversial topic and picture.
As the son of someone who spent 35 years in public education, I conclude from this that Barney Bishop III has no more business being in charge of a school than he does dancing with the Bolshoi. But he’d already established that earlier in the interview.
Bishop: Look, we’re not a public school. We’re a public charter. Parents, after they saw all the crap that’s being taught in public schools during COVID, decided of their own that they didn’t want their children to be taught that. Here we teach the Hillsdale Curriculum, focusing on civic and moral values. We teach a traditional, Western civilization, liberal classical education. And if there’s controversial topics or subjects, we tell parents in advance. We’re going to be sensitive to everybody at the school.
Oh, lord, the Hillsdale Curriculum again. Since the voters of Florida inflicted Ronald DeSantis on themselves as governor, that bunco scheme has been central to his campaign against public education in the state. From the Miami Herald:
The college’s influence has been seen in the state’s rejection of math textbooks over what DeSantis called “indoctrinating concepts,” the state’s push to renew the importance of civics education in public schools, and the rapid growth of Hillsdale’s network of affiliated public charter schools in Florida. Hillsdale also has had sway over the Republican-led Legislature. In 2019, lawmakers approved a law that allowed the college and three other groups to help the state revise its civics standards. Three years later, those guidelines are part of a DeSantis-led civics initiative that has concerned several educators about an infusion of Christianity and conservative ideologies[…]A Herald/Times review of nearly 6,000 pages of textbook examination showed only three of the 125 reviewers found objectionable content. Two of the three were affiliated with Hillsdale College. One was Jonah Apel, a sophomore student majoring in political science, and the other was Jordan Adams, a civics education specialist at the college. Apel is listed as the secretary of the Hillsdale College Republicans, a group whose mission includes connecting students to the “political arena” and “changing the United States in accordance with truth, liberty and human flourishing.” Adams is tied to Hillsdale’s 1776 curriculum, a history and civics-based education program that covers American history, government and civics to provide the “knowledge and understanding of American history and of the American republic as governed by the Constitution and morally grounded in the Declaration of Independence.”
I will go way out on the limb and say that Michelangelo and his nekkid statues have more to teach us about Western civilization than Barney Bishop III ever will.
Hey, Smithsonian. Is it a good day for dinosaur news? It’s always a good day for dinosaur news!
Ancient relatives of today’s swamp-dwelling reptiles were more diverse than dinosaurs and came in an even greater array of shapes and sizes, with dinosaurs largely on the ecological sidelines. When intense volcanic outpourings caused global climates to rapidly swing between hot and cold, however, fuzzy and warm-blooded dinosaurs were better able to cope. Crocodiles and other forms of ancient reptiles were hit much harder.
The Triassic began 252 million years ago as life was recovering from the worst mass extinction of all time, also caused by the aftereffects of incredible volcanic eruptions. Protomammals were decimated by the catastrophe, but reptiles of all sorts quickly evolved to open new niches in the water, on land and in the air. Dinosaurs were certainly among this saurian surfeit, but they weren’t necessarily trendsetters. The earliest dinosaurs date back to around 243 million years ago, but the animals were pretty small and not especially diverse. Only after the end-Triassic mass extinction, in the Jurassic, did dinosaurs start to truly flourish—before that, the world saw a very different cast of ruling reptiles.
Do we rejoice in the knowledge that there were dinos before dinos? You betcha, we do! And look at these dudes. One looks like the love child of a T. Rex and a crocodile. Another one is all armored up, complete with a big old hook thingie in the center of its back. And check out Triopticus, which apparently pioneered the domed head among prehistoric animals.
Dome-headed animals only evolve every so often.
Tragic, that is.
The pachycephalosaurs of the Late Cretaceous are the most famous—they’re well known for their thick, spiky headgear that continues to confound paleontologists. But those dinosaurs were not the first to wear the fashion. A very different animal, Triopticus, evolved a similar dome-headed profile back in the Late Triassic. Thus far, paleontologists have only uncovered part of the animal’s skull. The few clues gleaned from this specimen indicate Triopticus was an archosauriform, or part of the broader group that included dinosaurs, crocodiles and their evolutionary relatives. Despite such a distant relationship to the pachycephalosaurs, however, Triopticus independently evolved a very similar noggin, all the way down to spike-like protuberances around the dome. With any luck, researchers will someday find the rest of the animal.
On that day, I shall rejoice, because there were dinos before dinos, and they handed down the sacred obligation to live then to make us happy now.
I’ll be back on Monday to ignore any news about the former president* until there is some actual news to which I can pay attention. Be well and play nice, ya bastids. Stay above the snake-line. Wear the damn masks. Take the damn shots, especially the boosters. And spare a moment for the people of Ukraine, the people of the earthquake zone in Syria and Turkey, and for the people in the path of this week’s tornado in Los Angeles.
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New York County District Attorney Alvin Bragg. (photo: Seth Wenig/AP)
The NYPD is investigating a message sent to the Manhattan district attorney as Donald Trump has demonized him
Bragg is currently investigating a hush-money payment to Stormy Daniels prior to the 2016 election, and a grand jury is reportedly poised to indict Trump on charges relating to the payment.
According to law enforcement sources who spoke to NBC News, the letter — which contained a small amount of white powder and the message “ALVIN: I AM GOING TO KILL YOU!!!!!!!!!!!!!” — was discovered Friday. No injuries were reported and an evacuation was not carried out.
The letter “was immediately contained and [the] NYPD Emergency Service Unit and the NYC Department of Environmental Protection determined there was no dangerous substance,” said the DA’s office in a statement to NBC.
According to ABC News, Bragg sent an email to staffers Friday afternoon indicating that the powder was not hazardous. Bragg thanked staffers for their “strength and professionalism” in the face of “distressing disruptions,” including threatening emails and calls.
The FBI and NYPD are both involved in the investigation.
Trump has launched an all-out assault against Bragg and his investigation. In an early morning Truth Social post on Friday, Trump warned of “death and destruction,” should he be charged by Bragg. He scoffed at the calls for peaceful protests on Thursday.
Rolling Stone reported later on Thursday that Trump is already planning to retaliate against Bragg should he win back the White House in 2024. “The [former] president has asked people to draw up a plan for how to deal with Alvin Bragg and how the Department of Justice could respond to Bragg’s ‘illegal’ investigation of the president,” one source said.
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Russian president Vladimir Putin. (photo: Mikhail Metzel/Sputnik/AP)
ALSO SEE: With Victory in Ukraine Out of Reach,
Putin Is Stepping Up His War on Domestic Enemies
In practice, the situation is more complex — with some ICC member states condemning the arrest warrant, and others having set a precedent of flouting the court’s orders.
Already, the ICC’s arrest warrant, which accuses Putin, along with his children’s rights commissioner, of illegally deporting Ukrainian children to Russia, may be weighing on the Kremlin’s travel plans.
Kremlin spokesman, Dmitry Peskov, told reporters on Friday that “no decision has yet been made” on whether Putin will travel to Durban, South Africa, in August for a planned summit with Cyril Ramaphosa, the country’s president, as well as the leaders of Brazil, India and China.
Johannesburg, which historically has enjoyed a close relationship with Moscow, is reportedly seeking legal advice on the matter. A spokesman for Ramaphosa, Vincent Magwenya, told reporters: “We as the government are cognizant of our legal obligation. However, between now and the summit we will remain engaged with various relevant stakeholders.”
South Africa, however, already has a checkered history with the ICC, and was condemned by the international court as well as a South African court for not arresting Sudanese leader Omar Hassan al-Bashir in 2015 even though he had been charged with genocide. The South African government allowed al-Bashir to leave the country, where he had attended an African Union, by private plane, defying court orders.
On several occasions in recent years, South Africa has also voiced its intention to withdraw from the ICC.
Putin is already isolated on the international stage because of his war in Ukraine, and he has not traveled to what the Kremlin deems “unfriendly countries” since the start of the invasion February 2022. It is highly unlikely that he would travel to any of the 123 ICC member states in the near future.
Peskov has called the warrant “outrageous and unacceptable” but also “null and void” as far as Moscow is concerned because Russia is not a party to the International Criminal Court.
But other countries have applauded the court’s decision.
This week, German Justice Minister Marco Buschmann said that his country would arrest Putin. “Germany will be obliged to arrest President Putin if he enters German territory and hand him over to the International Criminal Court,” Buschmann told Die Zeit, a national newspaper.
The French Foreign Ministry tweeted: “No one responsible for crimes committed by Russia in Ukraine, regardless of their status, should escape justice.” And Britain’s foreign secretary, James Cleverly tweeted last week that, “those responsible for horrific war crimes in Ukraine must be brought to justice. Cleverly said that Britain “welcomed” the step taken by the ICC.
In addition to the summit in Durban, Putin might normally be expected to attend the Group of 20 leaders’ summit, scheduled for September in New Delhi. India is not an ICC member state so the trip may be possible, but Putin did not attend last year’s G-20 meeting in Bali, Indonesia, amid speculation that some leaders might leave rather than sit with him.
Putin has often attended the annual Asia-Pacific Economic Cooperation summit, but this year the meeting will take place in November in San Francisco. While the United States is not a ICC member state, Putin is under U.S. sanctions and President Biden has spoken out in favor of the arrest warrant, saying “it’s justified.”
Putin is expected to visit China later this year after the country’s president, Xi Jinping, invited him to Beijing during a three-day state visit to Moscow this week. China is not a party to the ICC.
Putin can also safely visit some ex-Soviet countries, including Belarus, Kazakhstan and Uzbekistan. And he can travel to Iran, which has emerged a key ally, supplying the Russian army with self-detonating Shahed drones.
The ICC does not have its own police force and must rely on individual nations to enforce its arrest warrants.
Former Russian president Dmitry Medvedev, who is now the deputy head of Russia’s security council, has said that arresting Putin would be “a declaration of war.” Medvedev threatened to bomb any country who did so.
Hungary, which is a member of the ICC, said on Thursday that it would not arrest Putin. Hungarian Prime Minister Viktor Orban has maintained good ties with Putin and has called on Ukraine to negotiate an end to the war.
Serbia, an ICC member and close ally of Russia, has also condemned the warrant.
South Africa is not the only country that has ignored its ICC obligations in the past. At least nine member countries — including Jordan, Nigeria, Kenya and Uganda — allowed al-Bashir to travel on their territory without being detained, despite two arrest warrants.
There have also been some surprising reactions to the warrant against Putin. Armenia’s Constitutional Court issued a ruling on Friday indicating that the country must act on the arrest warrant. Armenia, traditionally a close Russian ally and a member of the Collective Security Treaty Organization — an alliance of former Soviet states — signed the ICC treaty, known as the Rome Statute, in 1998 but never ratified it because of a previous Constitutional Court ruling.
Austria’s justice minister, Alma Zadic, issued a statement voicing commitment to the ICC. “Austria will continue to do everything possible to bring justice to the people of Ukraine,” Zadic said in the statement. “This also includes our continued support for the International Criminal Court in this case.”
And Brazil’s foreign minister, Mauro Vieira, told national media this week that Brazil had no official position on the warrant, but acknowledged that Brazil is obligated to respect ICC decisions.
Of the 52 people indicted by the ICC, 16 arrest warrants have been implemented, either through arrest or, in some cases, individuals surrendering voluntarily. Another 15 defendants, including Putin, remain at large.
The vast majority of countries that have carried out arrests in the past were African states and members of the ICC. France and Belgium have also arrested several individuals.
But, according to a spokesman for the ICC, there have also been cases of countries that are not signatories assisting the court, including by carrying out arrests and extraditions. Not all of the information on these cases has been made public, the spokesman said.
The ICC itself is a controversial body and several countries have withdrawn from it in recent years, including Burundi and the Philippines. Often, withdrawals occurred in line with prosecutions or mounting international pressure. Russia, for instance, withdrew from the ICC in 2016.
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Immigrants in an ICE detention center. (photo: Jose Cabezas/AFP)
The Social Justice Legal Foundation is representing seven currently and formerly incarcerated individuals of the immigration detention facility in Adelanto, Calif. Attorneys for the company claim that while Adelanto had used the chemical, HDQ Neutral, for at least 10 years, staff at the facility increased the spraying of the product at the height of the COVID-19 pandemic in the U.S.
The attorneys for SJLF allege that due to the detainees' months-long, near-constant exposure to this chemical from February 2020 to April 2021, they suffered symptoms like persistent cough, throat and nasal irritation, skin irritation, rashes and headaches.
Plaintiffs say they found blood in their mouths and saliva, suffered from debilitating headaches, felt dizzy and lightheaded, and now deal with long-term chronic health issues as a result of their exposure to the chemical.
A spokesman for GEO Group Inc. said the company strongly rejects the allegations "that GEO uses any harmful chemicals as cleaning products in our ICE Processing Centers."
The spokesman said, "In all our ICE Processing Centers, GEO uses cleaning products that are regulated by the EPA and are always used in accordance with the manufacturer's guidelines, as well as all applicable sanitation standards set by federal government's Performance-Based National Detention Standards."
But in 2021, the EPA issued a warning against GEO Group for the "use of a registered pesticide in a manner inconsistent with its labeling" after an inspection spurred by detainees' complaints about illness after exposure to HDQ Neutral.
What's allegedly happening in Adelanto is part of a pattern of conduct by GEO, Social Justice Legal Foundation Executive Director Shubhra Shivpuri told NPR.
GEO Group Inc. has faced several lawsuits by inmates and families of prisoners over the years due to alleged conditions at its prisons and immigration detention facilities. The U.S. Immigration and Customs Enforcement is GEO's biggest source of customer revenue streams.
GEO Group Inc.'s Adelanto facility has also been subject to scathing criticism by federal government watchdogs. Reports have emerged that detainees' health and safety were at risk while at Adelanto and that solitary confinement was used for long periods of time in violation of ICE's own standards, among other problems. Despite these prior problems, ICE renewed and expanded a contract to keep the Adelanto facility open.
GEO Group's spokesman said allegations such as the ones presented by SJLF are part of "a long-standing, politically motived, and radical campaign to attack ICE's contractors, abolish ICE, and end federal immigration detention by proxy."
Staff at Adelanto sprayed HDQ Neutral "indiscriminately"
The Environmental Protection Agency considers HDQ Neutral corrosive and a chemical that can cause irreversible eye damage and skin burns. The manufacturer, Spartan Chemical, warns users not to inhale or ingest it, or get it on eyes, skin or clothing.
Staff began using HDQ Neutral "to a startling degree" in February 2020, according to the lawsuit.
The "chemical spraying was a near-constant and invasive presence at Adelanto. GEO staff sprayed HDQ Neutral every 15 to 30 minutes from vats strapped to their backs and from smaller spray bottles. GEO staff sprayed this chemical into the air and onto all surfaces, including food contact surfaces, telephones, rails, door handles, bathrooms, showers, and sinks," the lawsuit continues.
"GEO staff sprayed when people were eating, and the chemical mist would fall on their food. GEO staff sprayed at night, on or around the bunk beds and cells where people slept. And on at least one occasion, GEO staff sprayed individuals as a disciplinary measure," the complaint alleges.
GEO ignored repeated complaints from detainees of their symptoms from the sprays, "denying and misrepresenting the use and effects of the toxic chemical to people detained and regulators alike," the SJLF alleges.
The company's spokesman maintains the cleaning products used are safe "and widely used throughout the country in many different settings, including hospitals, nursing homes, youth centers, and colleges and universities."
The SJLF wants the lawsuit to be certified to become a class action so that other individuals detained at the Adelanto ICE Processing Center who are believed to have been harmed by the use of the chemical can receive damages, medical expenses, and attorneys fees, among other awards.
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Nick van Terheyden. (photo: Jared Soares/ProPublica)
Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin D deficiency can lead to osteoporosis.
A blood test in the fall of 2021 confirmed the doctor’s diagnosis, and van Terheyden expected his company’s insurance plan, managed by Cigna, to cover the cost of the bloodwork. Instead, Cigna sent van Terheyden a letter explaining that it would not pay for the $350 test because it was not “medically necessary.”
The letter was signed by one of Cigna’s medical directors, a doctor employed by the company to review insurance claims.
Something about the denial letter did not sit well with van Terheyden, a 58-year-old Maryland resident. “This was a clinical decision being second-guessed by someone with no knowledge of me,” said van Terheyden, a physician himself and a specialist who had worked in emergency care in the United Kingdom.
The vague wording made van Terheyden suspect that Dr. Cheryl Dopke, the medical director who signed it, had not taken much care with his case.
Van Terheyden was right to be suspicious. His claim was just one of roughly 60,000 that Dopke denied in a single month last year, according to internal Cigna records reviewed by ProPublica and The Capitol Forum.
The rejection of van Terheyden’s claim was typical for Cigna, one of the country’s largest insurers. The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for 18 million people.
Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.
But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
Not all claims are processed through this review system. For those that are, it is unclear how many are approved and how many are funneled to doctors for automatic denial.
Insurance experts questioned Cigna’s review system.
Patients expect insurers to treat them fairly and meaningfully review each claim, said Dave Jones, California’s former insurance commissioner. Under California regulations, insurers must consider patient claims using a “thorough, fair and objective investigation.”
“It’s hard to imagine that spending only seconds to review medical records complies with the California law,” said Jones. “At a minimum, I believe it warrants an investigation.”
Within Cigna, some executives questioned whether rendering such speedy denials satisfied the law, according to one former executive who spoke on condition of anonymity because he still works with insurers.
“We thought it might fall into a legal gray zone,” said the former Cigna official, who helped conceive the program. “We sent the idea to legal, and they sent it back saying it was OK.”
Cigna adopted its review system more than a decade ago, but insurance executives say similar systems have existed in various forms throughout the industry.
In a written response, Cigna said the reporting by ProPublica and The Capitol Forum was “biased and incomplete.”
Cigna said its review system was created to “accelerate payment of claims for certain routine screenings,” Cigna wrote. “This allows us to automatically approve claims when they are submitted with correct diagnosis codes.”
When asked if its review process, known as PXDX, lets Cigna doctors reject claims without examining them, the company said that description was “incorrect.” It repeatedly declined to answer further questions or provide additional details. (ProPublica employees’ health insurance is provided by Cigna.)
Former Cigna doctors confirmed that the review system was used to quickly reject claims. An internal corporate spreadsheet, viewed by the news organizations, lists names of Cigna’s medical directors and the number of cases each handled in a column headlined “PxDx.” The former doctors said the figures represent total denials. Cigna did not respond to detailed questions about the numbers.
Cigna's explanation that its review system was designed to approve claims didn’t make sense to one former company executive. “They were paying all these claims before. Then they weren’t,” said Ron Howrigon, who now runs a company that helps private doctors in disputes with insurance companies. “You’re talking about a system built to deny claims.”
Cigna emphasized that its system does not prevent a patient from receiving care — it only decides when the insurer won’t pay. “Reviews occur after the service has been provided to the patient and does not result in any denials of care,” the statement said.
"Our company is committed to improving health outcomes, driving value for our clients and customers, and supporting our team of highly-skilled Medical Directors,” the company said.
PXDX
Cigna’s review system was developed more than a decade ago by a former pediatrician.
After leaving his practice, Dr. Alan Muney spent the next several decades advising insurers and private equity firms on how to wring savings out of health plans.
In 2010, Muney was managing health insurance for companies owned by Blackstone, the private equity firm, when Cigna tapped him to help spot savings in its operation, he said.
Insurers have wide authority to reject claims for care, but processing those denials can cost a few hundred dollars each, former executives said. Typically, claims are entered into the insurance system, screened by a nurse and reviewed by a medical director.
For lower-dollar claims, it was cheaper for Cigna to simply pay the bill, Muney said.
“They don’t want to spend money to review a whole bunch of stuff that costs more to review than it does to just pay for it,” Muney said.
Muney and his team had solved the problem once before. At UnitedHealthcare, where Muney was an executive, he said his group built a similar system to let its doctors quickly deny claims in bulk.
In response to questions, UnitedHealthcare said it uses technology that allows it to make “fast, efficient and streamlined coverage decisions based on members benefit plans and clinical criteria in compliance with state and federal laws.” The company did not directly address whether it uses a system similar to Cigna.
At Cigna, Muney and his team created a list of tests and procedures approved for use with certain illnesses. The system would automatically turn down payment for a treatment that didn’t match one of the conditions on the list. Denials were then sent to medical directors, who would reject these claims with no review of the patient file.
Cigna eventually designated the list “PXDX” — corporate shorthand for procedure-to-diagnosis. The list saved money in two ways. It allowed Cigna to begin turning down claims that it had once paid. And it made it cheaper to turn down claims, because the company’s doctors never had to open a file or conduct any in-depth review. They simply denied the claims in bulk with an electronic signature.
“The PXDX stuff is not reviewed by a doc or nurse or anything like that,” Muney said.
The review system was designed to prevent claims for care that Cigna considered unneeded or even harmful to the patient, Muney said. The policy simply allowed Cigna to cheaply identify claims that it had a right to deny.
Muney said that it would be an “administrative hassle” to require company doctors to manually review each claim rejection. And it would mean hiring many more medical directors.
“That adds administrative expense to medicine,” he said. “It’s not efficient.”
But two former Cigna doctors, who did not want to be identified by name for fear of breaking confidentiality agreements with Cigna, said the system was unfair to patients. They said the claims automatically routed for denial lacked such basic information as race and gender.
“It was very frustrating,” one doctor said.
Some state regulators questioned Cigna’s PXDX system.
In Maryland, where van Terheyden lives, state insurance officials said the PXDX system as described by a reporter raises “some red flags.”
The state’s law regulating group health plans purchased by employers requires that insurance company doctors be objective and flexible when they sit down to evaluate each case.
If Cigna medical directors are “truly rubber-stamping the output of the matching software without any additional review, it would be difficult for the medical director to comply with these requirements,” the Maryland Insurance Administration wrote in response to questions.
Medicare and Medicaid have a system that automatically prevents improper payment of claims that are wrongly coded. It does not reject payment on medical grounds.
Within the world of private insurance, Muney is certain that the PXDX formula has boosted the corporate bottom line. “It has undoubtedly saved billions of dollars,” he said.
Insurers benefit from the savings, but everyone stands to gain when health care costs are lowered and unneeded care is denied, he said.
Speedy Reviews
Cigna carefully tracks how many patient claims its medical directors handle each month. Twelve times a year, medical directors receive a scorecard in the form of a spreadsheet that shows just how fast they have cleared PXDX cases.
Dopke, the doctor who turned down van Terheyden, rejected 121,000 claims in the first two months of 2022, according to the scorecard.
Dr. Richard Capek, another Cigna medical director, handled more than 80,000 instant denials in the same time span, the spreadsheet showed.
Dr. Paul Rossi has been a medical director at Cigna for over 30 years. Early last year, the physician denied more than 63,000 PXDX claims in two months.
Rossi, Dopke and Capek did not respond to attempts to contact them.
Howrigon, the former Cigna executive, said that although he was not involved in developing PXDX, he can understand the economics behind it.
“Put yourself in the shoes of the insurer,” Howrigon said. “Why not just deny them all and see which ones come back on appeal? From a cost perspective, it makes sense.”
Cigna knows that many patients will pay such bills rather than deal with the hassle of appealing a rejection, according to Howrigon and other former employees of the company. The PXDX list is focused on tests and treatments that typically cost a few hundred dollars each, said former Cigna employees.
“Insurers are very good at knowing when they can deny a claim and patients will grumble but still write a check,” Howrigon said.
Muney and other former Cigna executives emphasized that the PXDX system does leave room for the patient and their doctor to appeal a medical director’s decision to deny a claim.
But Cigna does not expect many appeals. In one corporate document, Cigna estimated that only 5% of people would appeal a denial resulting from a PXDX review.
“A Negative Customer Experience”
In 2014, Cigna considered adding a new procedure to the PXDX list to be flagged for automatic denials.
Autonomic nervous system testing can help tell if an ailing patient is suffering from nerve damage caused by diabetes or a variety of autoimmune diseases. It’s not a very involved procedure — taking about an hour — and it costs a few hundred dollars per test.
The test is versatile and noninvasive, requiring no needles. The patient goes through a handful of checks of heart rate, sweat response, equilibrium and other basic body functions.
At the time, Cigna was paying for every claim for the nerve test without bothering to look at the patient file, according to a corporate presentation. Cigna officials were weighing the cost and benefits of adding the procedure to the list. “What is happening now?” the presentation asked. “Pay for all conditions without review.”
By adding the nerve test to the PXDX list, Cigna officials estimated, the insurer would turn down more than 17,800 claims a year that it had once covered. It would pay for the test for certain conditions, but deny payment for others.
These denials would “create a negative customer experience” and a “potential for increased out of pocket costs," the company presentation acknowledged.
But they would save roughly $2.4 million a year in medical costs, the presentation said.
Cigna added the test to the list.
“It’s Not Good Medicine”
By the time van Terheyden received his first denial notice from Cigna early last year, he had some answers about his diagnosis. The blood test that Cigna had deemed “not medically necessary” had confirmed a vitamin D deficiency. His doctor had been right, and recommended supplements to boost van Terheyden’s vitamin level.
Still, van Terheyden kept pushing his appeal with Cigna in a process that grew more baffling. First, a different Cigna doctor reviewed the case and stood by the original denial. The blood test was unnecessary, Cigna insisted, because van Terheyden had never before been found to lack sufficient vitamin D.
“Records did not show you had a previously documented Vitamin D deficiency,” stated a denial letter issued by Cigna in April. How was van Terheyden supposed to document a vitamin D deficiency without a test? The letter was signed by a Cigna medical director named Barry Brenner.
Brenner did not respond to requests for comment.
Then, as allowed by his plan, van Terheyden took Cigna’s rejection to an external review by an independent reviewer.
In late June — seven months after the blood test — an outside doctor not working for Cigna reviewed van Terheyden’s medical record and determined the test was justified.
The blood test in question “confirms the diagnosis of Vit-D deficiency,” read the report from MCMC, a company that provides independent medical reviews. Cigna eventually paid van Terheyden’s bill. “This patient is at risk of bone fracture without proper supplementations,” MCMC’s reviewer wrote. “Testing was medically necessary and appropriate.”
Van Terheyden had known nothing about the vagaries of the PXDX denial system before he received the $350 bill. But he did sense that very few patients pushed as hard as he had done in his appeals.
As a physician, van Terheyden said, he’s dumbfounded by the company’s policies.
“It’s not good medicine. It’s not caring for patients. You end up asking yourself: Why would they do this if their ultimate goal is to care for the patient?” he said.
“Intellectually, I can understand it. As a physician, I can’t. To me, it feels wrong.”
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Former president Jair Bolsonaro. (photo: Al Drago/Bloomberg)
New President Luiz Inácio Lula da Silva has busied himself with budgetary questions, the central bank, and a gaffe here and there. And election loser Jair Bolsonaro, whose supporters assaulted the Presidential Palace, the Supreme Court and Congress after his defeat, has been uncharacteristically quiet from his seclusion thousands of miles away in Kissimmee, Fla.
But now Bolsonaro, who rose to power by exploiting a succession of culture war battles and spent his four years as president deepening those divisions, says he’ll return soon to the country he polarized like few politicians before. His reappearance carries grave risks not only for Bolsonaro, who is facing multiple criminal inquiries and the possibility of arrest on a wide range of alleged wrongdoing, but also for Brazil, whose barely salved political wounds Bolsonaro’s inflammatory politicking could reopen.
“Bolsonaro’s return will swell the belligerence and polarization in society that is already polarized,” said political scientist David Magalhães, coordinator of Brazil’s independent Observatory of the Extreme Right. “He’s not coming back to talk about high interest rates and the central bank. He will go the ideological path.”
Injecting more uncertainty into the coming months will be the outcomes of the bevy of inquiries that have put increasing pressure on Bolsonaro and his associates. Investigators are probing, among other things, whether the former president spread fake news about the country’s electoral system or if he instigated the mob that attacked government institutions on Jan. 8.
If Bolsonaro is ultimately arrested — which as of now seems unlikely — or disqualified from running for office, the fallout could once more plunge the country into political turbulence.
“There will be protests,” said Dener Souza, 49, a staunch bolsonarista. “The people will rise up. We’ll fight against the persecution of Bolsonaro.”
There was a time when politics here were calmer. But in the past decade, as the economy stagnated and leading politicians were tarred by corruption scandals, the earliest skirmishes of the new culture war broke out — and its greatest warrior was Bolsonaro. He reframed politics as an existential clash between a persecuted right and a corrupt left, between what he called the “cidadão de bem” — the good citizen — and the criminals and minority groups trampling on their rights.
He said a good criminal was a dead criminal. He said he’d rather have a dead son than a gay son. He defined Brazil simply: “A Christian, conservative country.”
“Bolsonaro was able to Americanize Brazilian politics,” said Guilherme Casarões, a political scientist at the Getúlio Vargas Foundation, a degree-granting university. “He basically shifted the whole discussion in Brazil to something that Brazilians weren’t used to talking about on a political level.”
But the positions he took are often so extreme — and his manner of speaking so crass — that his emergence as a major national political figure polarized the country. As president and a candidate for reelection, he exploited those divisions, demonizing political opponents, undermining confidence in the country’s electoral systems, refusing to recognize Lula as the rightful victor — and pushing the sides still farther apart.
Now Bolsonaro wants back in to Brazilian politics. He frequently discusses his return with advisers. But it has been repeatedly delayed, by the legal jeopardy he faces in Brazil — and his own diminished spirits.
“He’s become reclusive, very saddened and shaken,” said one close Bolsonaro adviser, speaking on the condition of anonymity to offer a candid assessment. “He’s a strong man, strong emotionally, but he has been very impacted by everything that has happened.”
He has often voiced concerns over his legal liability in Brazil. Legal advisers have been telling him since January that the risk of his arrest would be low. Senior Brazilian judicial officials told The Washington Post in January that there was insufficient evidence to order his arrest. It’s unclear whether anything has happened since to change that thinking, but Bolsonaro has been reluctant to test it.
“A prison order can come out of nowhere,” he told the Wall Street Journal in February.
He has said he was planning to return to Brazil in late March. But earlier return plans have been scuttled, and this one could be, too.
“Bolsonaro is not a normal person, like you and me,” said a political ally in frequent communication with him, also speaking on the condition of anonymity. “He is not a normal politician who follows common behavior. He hides his game; he is unpredictable.”
Some former supporters say they have lost faith in their erstwhile leader. They think his decision to skip town days before his term ended, snubbing Lula’s inauguration to begin his self-imposed exile in Florida, where he has been seen eating fast food and shopping at Publix, was a mistake.
“A leader doesn’t abandon their allies,” said Claudinei Junior, 36, a bolsonarista in rural São Paulo state.
But Bolsonaro’s political party, the Liberal Party, is bullish on his appeal. It has announced plans for a tour of Brazil’s northeast, a largely impoverished region that rejected him in his two presidential runs. He’s slated to lead motorcycle rallies throughout the region as he attempts to take command of the opposition before the 2024 municipal elections.
Party leaders point to loyal bolsonaristas such as Esmeralda Silveira Soares as proof that people will rejoice at his return. The 75-year-old Salvador woman says Lula stole the election. She’s eagerly awaiting Bolsonaro’s return, she said, and hopes he’ll resume his political quest.
“Lula is a thief,” Soares said. “He got everything with money robbed from our country. I see communism in the government’s behavior, in that truth has become lies and lies have become truth. They’re preparing a vaccine to kill the people.”
Political observers expressed concern over how Bolsonaro could further exploit such widespread and entrenched political enmity.
“The presence of Bolsonaro is terrible for our democracy,” said Jairo Pimentel, a political scientist with the Brasília consultancy firm Ponteio Politica. “He treats his adversaries as enemies rather than adversaries.”
Rep. Lauren Boebert, R-CO, speaks during a press conference at the Capitol in Washington, D.C., March 10, 2023. (photo: J. Scott Applewhite/AP)
Republicans used conspiracy theories and unsound science in a hearing proposing to end protections for wolves and grizzlies.
“Since we’re talking about the Endangered Species Act, I’m just wondering if my colleagues on the other side would put babies on the endangered species list,” Boebert said, as she flipped through a series of graphic images. “These babies were born in Washington, D.C., full-term. I don’t know, maybe that’s a way we can save some children here in the United States.”
Boebert did not elaborate on the connection she saw between a law passed to protect imperiled wildlife and the viability of the human species, the most widespread mammal on the planet. Nevertheless, the tone for the day was set.
Boebert was on hand Thursday to discuss her “Trust the Science Act,” a proposal for the nationwide removal of federal protections for wolves, before the House Natural Resources Subcommittee on Water, Wildlife, and Fisheries. The subcommittee, chaired by Rep. Cliff Bentz, R-Ore., also heard from fellow GOP Reps. Matt Rosendale of Montana, and Harriet Hageman of Wyoming, who have both introduced legislation to remove grizzly bears from the endangered species list in their states.
“This is the first hearing that we will hold on the ESA but certainly not the last,” Bentz said of the landmark environmental law.
The Republican bills would capitalize on a precedent their Democratic counterparts set more than a decade ago: legislatively removing animals from the endangered species list, then barring those removals from judicial review, rather than following the scientific process required by the Endangered Species Act. The proposals are part of wider movement of Republican lawmakers — backed by supporters in the firearms and trophy hunting industry — to liberalize hunting of the West’s most iconic predators.
Steve Guertin, a deputy director at the U.S. Fish and Wildlife Service, the agency responsible for enforcing the Endangered Species Act, testified that the proposals “would supersede ongoing scientific analysis being conducted by the service regarding the status of wolf and grizzly bear populations right now.” The agency opposed the measures, Guertin told the lawmakers. “While each of these bills is unique,” he said, “they share the common thread of circumventing the scientific processes currently underway.”
California Rep. Jared Huffman, one of the few Democrats who participated in the hearing, described the day’s agenda as “a hot mess of extreme anti-science, anti-tribe, anti-wildlife bills.”
“The sheer hubris of these bills is impressive,” Huffman said. “The idea that we as members of Congress sitting here in Washington are more qualified than scientists and experts at the top of their field to make delisting decisions for the Endangered Species Act, and then to lock those in by insulating them from judicial review — that is incredibly extreme.”
While many environmentalists would agree, the move was not without precedent. In 2011, Montana Sen. Jon Tester, the lone Democrat in the state’s congressional delegation, attached a rider to a must-pass budget bill that reversed a federal judge’s decision returning wolves to the Endangered Species List and prohibited judicial review. The judge blasted the move as blatantly unconstitutional. Wolf hunting and trapping in the Northern Rockies has been legal ever since.
In the past two years, Republicans in Montana and Idaho passed a series of laws to slash their wolf populations — in Idaho by as much as 90 percent — through the use of bait and snares, aerial hunting, night hunting with thermal goggles, and more. In Montana, Republican Gov. Greg Gianforte abolished wolf hunting quotas altogether on Yellowstone National Park’s northern border in 2021, leading to the deadliest season the park has ever recorded, with nearly a fifth of its wolves eliminated. As Huffman noted, “Some of these states want to ‘manage’ wolves and grizzlies like Buffalo Bill managed bison.”
Boebert’s proposal would turn wolf management over to the states in the rest of the country, while Rosendale’s and Hageman’s bills would add grizzly bears to the mix as well.
Entering its 50th year of existence, the Endangered Species Act has saved 99 percent of the species afforded its protections and remains one of the most popular laws in the country.
Despite the high popularity, anti-government Republicans have long cast the law as one of the worst things to ever happen to the West. “For far too long, the Endangered Species Act has been weaponized by extremists, extremist environmentalists, to restrict common sense multiple use activities that they disagree with,” Boebert testified.
In 2020, voters in Boebert’s home state passed a historic measure mandating the reintroduction of wolves, which had disappeared from Colorado thanks to a government eradication campaign in the 1940s. The vote was extraordinarily close, with 50.9 percent of voters supporting reintroduction and 49.1 voting against. Supporters were largely based in urban centers on the eastern side of the Rocky Mountains, while the opposition was concentrated where the wolf reintroduction will happen, in Boebert’s district on the western slope.
Despite its name, Boebert’s promotion of the “Trust the Science Act” puts the politics of predator management front and center. “Its [sic] far past time that we removed leftist politics from listing decisions,” she said in unveiling the proposal last year. The bill received enthusiastic support from Safari Club International, a lobbying giant of the trophy hunting community, and the National Rifle Association.
Hageman and Rosendale sounded a similar tone in calling for delisting grizzly bears. “There’s a small handful of members on this committee that actually have grizzly bears in their districts,” Rosendale told his colleagues. “Yet, these bureaucrats and some members of this committee insist on telling Montanans how they should go about their everyday lives by keeping the species listed without ever feeling the impact of this decision.”
In advancing their proposals, the authors of the anti-predator bills often misrepresented basic facts related to wildlife biology and management.
Boebert read a statistic that “from 2002 to present day, approximately 500 people have been attacked by wolves with nearly 30 of these attacks resulting in human deaths.” Though she did not cite a source, Boebert seemed to be drawing from a recent Norwegian Institute for Nature Research report. She neglected to mention that only two of the cases were reported in the U.S. and only one was fatal.
As the report itself noted: “Considering that there are close to 60,000 wolves in North America and 15,000 in Europe, all sharing space with hundreds of millions of people, it is apparent that the risks associated with a wolf attack are above zero, but far too low to calculate.”
Hageman, for her part, repeatedly used the term “Canadian gray wolf” when discussing wolves residing in the Northern Rockies and described them as “non-native.”
The so-called non-native Canadian gray wolf is a feature of a conspiracy theory in which the wolves that were reintroduced to the U.S. in the 1990s were part of a super-large strain of extra ferocious predators deployed by the federal government to destroy the Western way of life. It is not true. The wolves that were reintroduced to Yellowstone National Park and central Idaho in 1995 were members of the same species — canis lupus — that the federal government exterminated over the preceding century.
Rosendale, meanwhile, focused on the “150 confirmed or probable” claims of grizzly bears eating livestock in Montana and the “hundreds of thousands of dollars lost.” Rosendale left out some key context. According to the Montana Department of Livestock, grizzly bears were responsible for killing 143 of Montana’s more than 2.7 million sheep and cattle in 2022, contributing to a loss of .0052 percent of the state’s livestock. The state paid ranchers $234,378.37 to compensate for those losses.
Rosendale also said Montana’s pivot to heavy-handed wolf hunting was “because the gray wolf population is about 10 times the target population” and “it continues to grow.” The “target population,” as Rosendale framed it, does not exist. In the early 2000s, Montana needed at least 150 wolves to obtain and retain state management authorities under the Endangered Species Act. The number was a minimum, not a target to maintain in perpetuity. As for the continued growth of Montana’s wolf population, biologists broadly agree that those numbers stabilized in recent years, and some of the region’s leading experts have raised concerns that the state may in fact be overestimating its totals.
The Republicans’ most challenging witness was Chris Servheen. For 35 years, Servheen led the U.S. government’s effort recover grizzly bears before retiring in 2016. Until recently, he was the most visible proponent of removing grizzly bears from the endangered species list. As detailed in an Intercept profile in January, the veteran biologist’s views changed with the anti-predator political pivot in the Northern Rockies.
As Servheen reiterated throughout his testimony, the Endangered Species Act is about more than numbers. States must have regulations in place that will ensure continued recovery before assuming management authority over a listed species.
“The adequacy of regulatory mechanisms is just as important as the numbers of animals,” Servheen said, and in the Northern Rockies “the lack of adequate regulatory mechanisms is due to political interference.” He added: “It doesn’t take a lot of imagination to realize that if grizzly bears were delisted by congressional action and turned over to state management, the legislatures and the governors would do the same thing to grizzly bears that they are currently doing to wolves.”
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