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Fast Food Workers Fight for a Raise, a Union, and Dignity at First National Convention

Fast Food Workers Fight for a Raise, a Union, and Dignity at First National Convention

By Alice Speri

July 30, 2014 | 10:55 am

“More than 1,300 workers from all over the US traveled to the outskirts of Chicago over the weekend for what organizers said was the first nationwide fast food workers convention. This gathering in Elmhurst, Illinois was held on the heels of a snowballing movement that has quickly grown from a spontaneous New York City walkout in November 2012 to one of the most significant American labor organizing efforts in recent years.

They came from California and Connecticut, from Kansas City, Little Rock, and more than 50 cities across the country. Most arrived after long, grueling road journeys, some on yellow school buses, and many brought their children along.

Most of the workers were young, but others were in their 40s and 50s, “career” fast food workers, who have spent decades in the industry. They were overwhelmingly black and Hispanic, but not only. Some were part-time students, a few had college degrees, and many held two or three different fast food jobs at the same time.

All photos by Alice Speri.

They came carrying banners from regional chapters and wearing shirts saying “Can’t survive on $7.25” and “We are worth more.” And they brought two demands: pay of $15 an hour and the right to form a union.

“Look around,” Mya Hill, an organizer from Detroit, told a roaring room packed with fired-up workers on Friday night, as the two-day event kicked off. “This is what a union looks like.”

First Victories
With most of them making the $7.25 federal minimum wage or just a few dimes more, fast food employees have become one of the most outspoken groups of low-wage workers in the country. While some politicians — including President Obama — have begun debating raising the minimum wage across the board to $10.10, the fast food workers’ bolder demand for $15 has quickly become the rallying cry for a movement that is promising to spread across industries.

“It’s time to stop paying us poverty wages, people are sick of it, everyone in this room is sick of it. We can’t live like this, it’s time for a change,” Shantel Walker, 32, a Brooklyn fast food worker for more than 15 years, told VICE News. “We work for multibillion dollar people. A little dollar, two, three, is nothing to them. They throw away money every day. When someone doesn’t eat their food, they throw it away. That’s basically our money in the garbage can.”

Shantel Walker, a fast food worker from Brooklyn said: ‘It’s time to stop paying us poverty wages, people are sick of it, everyone in this room is sick of it.’

Critics have slammed the $15 an hour demand as utopian, entitled, and economically senseless. But as Americans have started to awaken to the widening inequality in the country, the call for a fair wage has begun to gather traction. “We’re all people,” Walker added. “We have rights.”

Representatives for several fast food chains, including Burger King, Taco Bell, and Wendy’s, did not respond to requests for comment from VICE News on the convention and the workers’ demands.

A spokesperson for McDonald’s did not respond to interview requests or address questions on the impact of the fast food movement and whether its executives are taking the workers’ calls into consideration, but did release a statement.

“McDonald’s and our independent owner-operators share a concern and commitment to the well-being and fair treatment of all people who work in McDonald’s restaurants. McDonald’s and our independent franchisees believe that any minimum wage increase should be implemented over time so that the impact on small and medium business owners is manageable,” spokeswoman Heidi Barker Sa Shekhem said.

“Additionally, we believe that any increase needs to be considered in a broad context, one that considers, for example, the impact of the Affordable Care Act and its definition of ‘full time’ employment, as well as the treatment, from a tax perspective, of investments made by businesses owners.”

But despite some skepticism, the fast food workers’ movement has already reaped some important victories.

In June, Seattle’s city council voted to raise the minimum wage to $15 — a move that is also being debated in San Francisco, Los Angeles, and Chicago. So far, more than 6.7 million workers have seen their wages increase since the fast food workers’ movement started.

And in a decision with potentially massive consequences, the general counsel of the National Labor Relations Board ruled on Tuesday that McDonald’s is the “joint employer” for workers at its franchised stores — meaning the corporation will no longer be able to brush off workers’ complaints (and lawsuits) by putting all the blame on its franchisees. It could also be held responsible for unfair labor practices at its thousands of restaurants, including threatening to or firing workers for organizing.

“Like other fast-food franchisors, McDonald’s is trying to have it both ways when it comes to its relationship with employees working in stores bearing its name,” labor law scholar Michael Fischl said in a statement following the decision. “On the one hand, in order to protect its ‘brand,’ the Mother Ship micromanages virtually every aspect of day-to-day operations, from food preparation to customer service, and everything in between. On the other hand, in order to circumvent the rights of its employees under the National Labor Relations Act, it proclaims that it is ‘shocked, shocked’ that anyone would think it actually exerts such extensive control over its franchised stores,” Fischl continued.

“The General Counsel’s determination to treat McDonald’s as a ‘joint employer’ suggests that going forward the NLRB will be paying more attention to what franchisors are doing than to what they are saying they do.”

Predictably, the ruling outraged critics of organized labor, with Angelo Amador, vice president of labor and workforce policy for the National Restaurant Association, telling the New York Times that the decision “overturns 30 years of established law regarding the franchise model in the United States.”

Tuesday’s ruling came after the Chicago convention, but workers there were already celebrating their first big successes.

“What you are doing right now is the most important workers’ movement in America today,” congressman Keith Ellison — and co-chair of the Congressional Progressive Caucus — told workers on Saturday. “Millions of people across the country are looking at what you’re doing here in Chicago.”

Mary Kay Henry

Mary Kay Henry, president of the Service Employees International Union, also praised the workers. The union, which represents its members from a variety of service sectors, backed the convention and offered financial and organizational support — leading some critics to dismiss the event as an attempt to boost union membership.

“The people in this room tonight have changed our country,” Henry told Friday’s boisterous crowd. “When this movement started 21 months ago with the first strike in New York, people thought $15 an hour was a fantasy. They laughed at you. But now, because of your courage and your hard work, it will become a reality.”

Yet despite the wins, fast food employees face an uphill battle.

“It’s going to take a long time. You’re going back to your workplace after this and it’s not gonna happen overnight,” Justin Jones, a 23-year-old organizer from Orlando, told a group of workers in a breakout session. “This is gonna be a fight, it’s gonna be hard.”

“I’m pretty sure they’re gonna make it as tough on us as they can,” he told VICE News later, adding that he has already been turned away from many restaurants — including the world’s largest McDonald’s, in Orlando — for speaking with staff.

But the convention, Jones hopes, will boost workers’ morale and show them they are not in the fight alone.

“We wanted workers to come together and be motivated so when they go back to their cities they can share stories and be like, ‘Hey, this is a real big thing, they’re not playing,'” he said. “It’s a movement and it’s not going anywhere. These guys are serious, they’re for real.”

Birth of a Union
Just 21 months ago, most of the workers who packed into the convention center had no idea they could even protest cuts to their hours and late paychecks without getting fired.

Darrell Roper, 51, who works at a Burger King on Manhattan’s Upper East Side, did some research of his own after an organizer approached him outside the store two years ago. He was surprised to learn that he had a right to organize with other workers, as long as it was not on the clock.

“Most people don’t know that, that’s what it is. They’re weary because they don’t have any information,” he told VICE News, adding that he now talks to other workers — and has come under scrutiny from his managers for doing so. “What I learned gave me the heart and the audacity to want to participate, knowing that my employer can’t hold that against me.”

Darrell Roper

That sense of newly discovered empowerment was palpable across the convention hall, where many said they would have never dreamed to find themselves just months ago.

“When I first heard about it, I’m not gonna lie, I was kind of skeptical. I was thinking, ‘I’m gonna lose my job, I’m gonna get in trouble,’” Douglesha Nicholson, a 23-year-old Pizza Hut worker from Kansas City, told VICE News. But after the first strike, she was sold.

“It was a big rush of adrenaline, going out and being able to yell without the risk of being fired. Just to let you know ‘Hey, I’m here, this is what I’m demanding, this is what I want,’” Nicholsonsaid. “We’re here to educate other fast food workers who may be skeptical about it, to let them know that we have their back.”

Sitting at a table with workers from Detroit, Brooklyn, and Wisconsin, Nicholson and her partner Marcus Stove, 24, who works at Wendy’s and whatever other odd jobs he is able to find, they compared wages and managers. Nicholson and Stove have four children together — “four and a half,” he joked, as they are expecting their fifth in September — and have long searched for but have never been able to find anything better than their fast food jobs.

“I can’t feed five kids on $7.25,” Stove said. “I’m here for the $15. I’m here to get that money.”

“We all have children,” Nicholson, whose oldest son is seven and wants to be a Pizza Hut driver when he grows up, told the other workers at the table. “I’m here because we are human beings.”

Douglesha Nicholson and Marcus Stove

At other tables, workers from different cities also compared paychecks and traded stories of payments that came weeks late, frying burns, and customers throwing shakes at them through drive-through windows. For the workers, including many leaving their hometowns for the first time, it was a powerful experience.

“Especially in the South, a lot of people are not used to this, they don’t really have knowledge of what a union is, there aren’t a lot of strikes going on,” said Jones, the Orlando organizer. “Here, you are seeing strangers, from other states, races, and belief systems, who have the same issues as you, and it gives you common ground. It’s not just you, it’s other states that all have the same issues. It’s unifying. It’s pretty awesome.”

That was precisely the point of the convention, workers and organizers said: To unite workers and capitalize on the momentum of a movement that has already staged some of the most widespread strikes in recent history, turning the “Fight for $15” chant from a utopian slogan into a reality for some.

But the workers who gathered here also adopted a resolution at the end of the convention that pledged further action — including more strikes, sit-ins, and even soup kitchens outside their stores — “to make sure everyone knows their employees don’t make enough to eat,” one worker suggested.

And many of these employees want a union as much as a raise.

“Right now, people who are working in fast food, their rights are being trampled. The union is not just for job security, it’s to protect your rights,” Roper said. “Without a union, I can’t negotiate with management. It’s their way or no way.”

History of the Movement
The sometimes rowdy convention was heavy on hope and civil rights rhetoric, as workers discussed civil disobedience and watched videos of early workers’ movements. Speaker after speaker reminded those in the room that they were “making history.”

“I’m inspired by what you are doing,” Reverend William Barber II, head of the North CarolinaNAACP, told the workers at the beginning of a long sermon. “You are in a fight to change America and you need to stay in that fight.” At its national convention, last week, the civil rights group voted unanimously to endorse the Fight for $15 campaign.

In fact, this movement has already made history.

It was born almost by accident in New York City, when a couple of hundred workers — “overworked and underpaid” as some of them said — walked off their jobs in November 2012. After that, dozens of people gathered at a Brooklyn Wendy’s to support a young woman who had been fired for protesting. In a domino effect, the strikes started to follow across the country — with a massive, 150-city walk-out in May this year.

Also in May, 101 McDonald’s workers were arrested at a rally outside the company’s corporate headquarters in Oak Brook, Illinois. Many of them were at the Chicago convention, where they got a standing ovation, pledged to do it again, and asked for others to follow.

“I tell you, if every one of us in this room goes to jail for civil disobedience, these corporations are gonna have to listen to us,” one of them told the crowd.

“They’re afraid of this movement, they want to keep their workers subjected,” said Roper. “They don’t want the whole store walking out, but there’s gonna come a time when corporate is gonna have to deal with us, they’re gonna have to give in.”

The workers plan to directly take on the executives of the corporations they work for — an effort that will likely be boosted by Tuesday’s ruling.

“If a CEO gets paid 1,000 more times than the average worker, I believe they can pay you a living wage. If the industry can make billions and billions and billions, I believe they can pay you a living wage,” said Barber.

In her speech, Henry listed the total compensation of fast food CEOs — coming to around 1,200 times the minimum wage that workers make.

“I think these CEOs should come into the store, to see how the stores are actually run,” Kristina Bradley, 25, told VICE News. Bradley was fired from a Pittsburgh Chick-fil-A after joining protests, she said.

“My paycheck says $300. My monthly bus pass costs $146. My rent is $450. If I’m making $300, where is my money?” she asked. “They say there’s welfare out there, you should go get food stamps. You think we want to live off the government? Are you serious? We are working.”

Follow Alice Speri on Twitter: @alicesperi

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Vaccine Deniers Were Just Dealt A Blow In Court

“A federal judge has ruled in favor of a New York City policy that allows schools to ban unvaccinated kids from attending classes when another child has come down with a vaccine preventable illness, the New York Times reports. The lawsuit consolidated separate challenges from three families who claimed their religious freedom was violated when their kids were banned from school for up to a month at a time during disease outbreaks…”

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June 25, 2014 · 6:42 pm

Dear Millennials, We’re Sorry

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June 9, 2014 · 6:06 pm

Hospital Charges Surge for Common Ailments, Data Shows

“…Charges for chest pain, for instance, rose 10 percent to an average of $18,505 in 2012, from $16,815 in 2011. Average hospital charges for digestive disorders climbed 8.5 percent to nearly $22,000, from $20,278 in 2011.

In 2012, hospitals charged more for every one of 98 common ailments that could be compared to the previous year. For all but seven, the increase in charges exceeded the nation’s 2 percent inflation rate for that year, according to The Times’s analysis…”

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June 3, 2014 · 7:08 pm

Free Time Is an American Dream Deferred – NYTimes.com

http://www.nytimes.com/roomfordebate/2014/03/09/rethinking-the-40-hour-work-week/free-time-is-an-american-dream-deferred

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I Do Not Want My Daughter to Be ‘Nice’

July 31, 2013, 9:31 am
By CATHERINE NEWMAN

“My 10-year-old daughter, Birdy, is not nice, not exactly. She is deeply kind, profoundly compassionate and, probably, the most ethical person I know — but she will not smile at you unless either she is genuinely glad to see you or you’re telling her a joke that has something scatological for a punch line.

This makes her different from me. Sure, I spent the first half of the ’90s wearing a thrifted suede jacket that I had accessorized with a neon-green sticker across the back, expressing a somewhat negative attitude regarding the patriarchy (let’s just say it’s unprintable here). But even then, I smiled at everyone. Because I wanted everyone to like me. Everyone!

I am a radical, card-carrying feminist, and still I put out smiles indiscriminately, hoping to please not only friends and family but also my son’s orthodontist, the barista who rolls his eyes while I fumble apologetically through my wallet, and the ex-boyfriend who cheated on me. If I had all that energy back — all the hours and neurochemicals and facial musculature I have expended in my wanton pursuit of likedness — I could propel myself to Mars and back. Or, at the very least, write the book “Mars and Back: Gendered Constraints and Wasted Smiling.”

But it is not one thing or another, of course. My mostly pleasant way might get me more freelance work. And friendliness tends to put people at ease — loved ones, neighbors, waitresses — which is a good thing. Plus, smiling probably makes me feel happier, according to all those studies about self-fulfilling emotional prophesies. I know that our sweet-hearted son, who is 13, has always had the experience of niceness being its own reward. What can I do to help? he asks. Please, take mine, he insists, and smiles, and everyone says, “Oh, aren’t you nice!” and “What a lovely young man!” (Or sometimes, because he kind of looks like a girl, “What a lovely young lady!”) But, if I can speak frankly here, you really don’t worry about boys being too nice, do you? He still has the power and privilege of masculinity on his side, so, as far as I’m concerned, the nicer the better.

Birdy is polite in a “Can you please help me find my rain boots?” and “Thank you, I’d love another deviled egg” kind of way. But when strangers talk to her, she is like, “Whatever.” She looks away, scowling. She does not smile or encourage.

I bite my tongue so that I won’t hiss at her to be nice. I tell you this confessionally. Because do I think it is a good idea for girls to engage with zealously leering men, like the creepy guy in the hardware store who is telling her how pretty she is? I do not. “Say thank you to the nice man who wolf-whistled!” “Smile at the frat boy who’s date-raping you!” I want my daughter to be tough, to say no, to waste exactly zero of her God-given energy on the sexual, emotional and psychological demands of lame men — of lame anybodies. I don’t want her to accommodate and please. I don’t want her to wear her good nature like a gemstone, her body like an ornament.

And, currently, she is not in danger. She is decisive and no-nonsense, preferring short hair and soft pants with elastic waistbands. Dresses get in her way, and don’t even get her started on jeans, the snugly revealing allure of which completely mystifies her. She’s the kind of person who donates money to the Animal Welfare Institute and attends assiduously to all the materials they send her, including their dully depressing annual reports, which she keeps in a special folder. Gender stereotypes, among other injustices, infuriate her. “This is so stupid!” she sighs at Target, about the pink rows of dolls and the blue rows of Lego. “Why don’t they just put a penis or a vagina on every toy so you can be completely sure you’re getting the right one?”

She is tender, fierce and passionate — the kind of person who can stroke our pussycat with gentle fingers while she growls at you, her eyebrows a menacing shelf, about bedtime and her plans to avoid it. Even as a 2-year-old, she had the determined wrath and gait of a murderous zombie gnome — and my husband and I grimaced at each other, afraid, over her small and darkly glowering head. She will lift knife and fork, sighing, only if I scold her about eating with all 10 fingers like a caveman, and I have mixed feelings about that.

“She’s very moral,” a friend said recently, and it was not a compliment. She is the kid who can be a pain the neck at a play date, insisting on the rigors of turn-taking, of fair-sharing, of tidying up before the guests vamoose and leave her with an afternoon of mess to deal with. That said, though, she’s got your back. She is a patron saint of babies and animals, of the excluded or teased. “That’s not right,” she’s not afraid to say. “Stop it.”

She is a beautiful kid, but she is also sure and determined in a way that is not exactly pretty. Which is fine, because God help me if that girl ends up smiling through her entire life as if she is waitressing or pole-dancing or apologizing for some vague but enormous infraction, like the very fact of her own existence.

I picture her at the prom in stripy cotton pajamas, eating potato chips with both hands. I picture her slapping a patriarch-damning sticker on her jacket. I picture her running the country, saving the world, being exactly the kind of good bad girl that she knows herself to be. And I think: You go. I think: Fly! I think: Take me with you.


 

Catherine Newman, the author of Waiting for Birdy, writes atwww.benandbirdy.blogspot.com.”

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August 8, 2013 · 9:54 pm

The Decline and Fall of the English Major

By VERLYN KLINKENBORG
Published: June 22, 2013

 

“In the past few years, I’ve taught nonfiction writing to undergraduates and graduate students at Harvard, Yale, Bard, Pomona, Sarah Lawrence and Columbia’s Graduate School of Journalism. Each semester I hope, and fear, that I will have nothing to teach my students because they already know how to write. And each semester I discover, again, that they don’t.

They can assemble strings of jargon and generate clots of ventriloquistic syntax. They can meta-metastasize any thematic or ideological notion they happen upon. And they get good grades for doing just that. But as for writing clearly, simply, with attention and openness to their own thoughts and emotions and the world around them — no.

That kind of writing — clear, direct, humane — and the reading on which it is based are the very root of the humanities, a set of disciplines that is ultimately an attempt to examine and comprehend the cultural, social and historical activity of our species through the medium of language.

The teaching of the humanities has fallen on hard times. So says a new report on the state of the humanities by the American Academy of Arts and Sciences, and so says the experience of nearly everyone who teaches at a college or university. Undergraduates will tell you that they’re under pressure — from their parents, from the burden of debt they incur, from society at large — to choose majors they believe will lead as directly as possible to good jobs. Too often, that means skipping the humanities.

In other words, there is a new and narrowing vocational emphasis in the way students and their parents think about what to study in college. As the American Academy report notes, this is the consequence of a number of things, including an overall decline in the experience of literacy, the kind of thing you absorbed, for instance, if your parents read aloud to you as a child. The result is that the number of students graduating in the humanities has fallen sharply. At Pomona College (my alma mater) this spring, 16 students graduated with an English major out of a student body of 1,560, a terribly small number.

In 1991, 165 students graduated from Yale with a B.A. in English literature. By 2012, that number was 62. In 1991, the top two majors at Yale were history and English. In 2013, they were economics and political science. At Pomona this year, they were economics and mathematics.

Parents have always worried when their children become English majors. What is an English major good for? In a way, the best answer has always been, wait and see — an answer that satisfies no one. And yet it is a real answer, one that reflects the versatility of thought and language that comes from studying literature. Former English majors turn up almost anywhere, in almost any career, and they nearly always bring with them a rich sense of the possibilities of language, literary and otherwise.

The canon — the books and writers we agree are worth studying — used to seem like a given, an unspoken consensus of sorts. But the canon has always been shifting, and it is now vastly more inclusive than it was 40 years ago. That’s a good thing. What’s less clear now is what we study the canon for and why we choose the tools we employ in doing so.

A technical narrowness, the kind of specialization and theoretical emphasis you might find in a graduate course, has crept into the undergraduate curriculum. That narrowness sometimes reflects the tight focus of a professor’s research, but it can also reflect a persistent doubt about the humanistic enterprise. It often leaves undergraduates wondering, as I know from my conversations with them, just what they’ve been studying and why.

STUDYING the humanities should be like standing among colleagues and students on the open deck of a ship moving along the endless coastline of human experience. Instead, now it feels as though people have retreated to tiny cabins in the bowels of the ship, from which they peep out on a small fragment of what may be a coastline or a fog bank or the back of a spouting whale.

There is a certain literal-mindedness in the recent shift away from the humanities. It suggests a number of things. One, the rush to make education pay off presupposes that only the most immediately applicable skills are worth acquiring (though that doesn’t explain the current popularity of political science). Two, the humanities often do a bad job of explaining why the humanities matter. And three, the humanities often do a bad job of teaching the humanities. You don’t have to choose only one of these explanations. All three apply.

What many undergraduates do not know — and what so many of their professors have been unable to tell them — is how valuable the most fundamental gift of the humanities will turn out to be. That gift is clear thinking, clear writing and a lifelong engagement with literature.

Maybe it takes some living to find out this truth. Whenever I teach older students, whether they’re undergraduates, graduate students or junior faculty, I find a vivid, pressing sense of how much they need the skill they didn’t acquire earlier in life. They don’t call that skill the humanities. They don’t call it literature. They call it writing — the ability to distribute their thinking in the kinds of sentences that have a merit, even a literary merit, of their own.

Writing well used to be a fundamental principle of the humanities, as essential as the knowledge of mathematics and statistics in the sciences. But writing well isn’t merely a utilitarian skill. It is about developing a rational grace and energy in your conversation with the world around you.

No one has found a way to put a dollar sign on this kind of literacy, and I doubt anyone ever will. But everyone who possesses it — no matter how or when it was acquired — knows that it is a rare and precious inheritance.”

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American Way of Birth, Costliest in the World

Josh Haner/The New York Times

“I feel like I’m in a used-car lot.” Renée Martin, who, with her husband, is paying for her maternity care out of pocket.

By  | Published: June 30, 2013

“Throughout this article, readers have shared their experiences by responding to questions about their perspective on pregnancy care. Comments are now closed, but you may explore the responses received.

Elisabeth Rosenthal, reporter

LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.

At a prenatal class in March, she was told about epiduralanesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”

Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Midway through her pregnancy, she fought for a deep discount on a $935 bill for anultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute thesingle biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

“It’s not primarily that we get a different bundle of services when we have a baby,” said Gerard Anderson, an economist at the Johns Hopkins School of Public Health who studies international health costs. “It’s that we pay individually for each service and pay more for the services we receive.”

Those payment incentives for providers also mean that American women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans, said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health who studies the cost of women’s health care.

Financially, they suffer the consequences. In 2011, 62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage, like Ms. Martin. But even many women with coverage are feeling the pinch as insurers demand higher co-payments and deductibles and exclude many pregnancy-related services.

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

Women with insurance pay out of pocket an average of $3,400, according to a survey by Childbirth Connection, one of the groups behind the maternity costs report. Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.

Only in America

In most other developed countries, comprehensive maternity care is free or cheap for all, considered vital to ensuring the health of future generations.

Ireland, for example, guarantees free maternity care at public hospitals, though women can opt for private deliveries for a fee. The average price spent on a normal vaginal delivery tops out at about $4,000 in Switzerland, France and the Netherlands, where charges are limited through a combination of regulation and price setting; mothers pay little of that cost.

The chasm in price is true even though new mothers in France and elsewhere often remain in the hospital for nearly a week to heal and learn to breast-feed, while American women tend to be discharged a day or two after birth, since insurers do not pay costs for anything that is not considered medically necessary.

Only in the United States is pregnancy generally billed item by item, a practice that has spiraled in the past decade, doctors say. No item is too small. Charges that 20 years ago were lumped together and covered under the general hospital fee are now broken out, leading to more bills and inflated costs. There are separate fees for the delivery room, the birthing tub and each night in a semiprivate hospital room, typically thousands of dollars. Even removing the placenta can be coded as a separate charge.

Each new test is a new source of revenue, from the hundreds of dollars billed for the simple blood typing required before each delivery to the $20 or so for the splash of gentian violet used as a disinfectant on the umbilical cord (Walgreens’ price per bottle: $2.59). Obstetricians, who used to do routine tests like ultrasounds in their office as part of their flat fee, now charge for the service or farm out such testing to radiologists, whose rates are far higher.

Add up the bills, and the total is startling. “We’ve created incentives that encourage more expensive care, rather than care that is good for the mother,” said Maureen Corry, the executive director of Childbirth Connection.

In almost all other developed countries, hospitals and doctors receive a flat fee for the care of an expectant mother, and while there are guidelines, women have a broad array of choices. “There are no bills, and a hospital doesn’t get paid for doing specific things,” said Charlotte Overgaard, an assistant professor of public health at Aalborg University in Denmark. “If a woman wants acupuncture, an epidural or birth in water, that’s what she’ll get.”

Despite its lavish spending, the United States has one of the highest rates of both infant and maternal death among industrialized nations, although the fact that poor and uninsured women and those whose insurance does not cover childbirth have trouble getting or paying for prenatal care contributes to those figures.

Some social factors drive up the expenses. Mothers are now older than ever before, and therefore more likely to require or request more expensive prenatal testing. And obstetricians face the highest malpractice risks among physicians and pay hundreds of thousands of dollars a year for insurance, fostering a “more is safer” attitude.

But less than 25 percent of America’s high payments for pregnancy typically go to obstetricians, and they often charge a flat fee for their nine months of care, no matter how many visits are needed, said Dr. Robert Palmer, the chairman of the committee for health economics and coding at the American College of Obstetricians and Gynecologists. That fee can range from a high of more than $8,000 for a vaginal delivery in Manhattan to under $4,000 in Denver, according to Fair Health, which collects health care data.

Rather it is the piecemeal way Americans pay for this life event that encourages overtreatment and overspending, said Dr. Kozhimannil, the Minnesota professor. Recent studies have found that more than 30 percent of American women have Caesarean sections or have labor induced with drugs — far higher numbers than those of other developed countries and far above rates that the American College of Obstetricians and Gynecologists considers necessary.

During the course of her relatively uneventful pregnancy, Ms. Martin was charged one by one for lab tests, scans and emergency room visits that were not included in the doctor’s or the hospital’s fee. During her seventh month, she described one week’s experience: “I have high glucose, and I tried to take a three-hour test yesterday and threw up all over the lab. So I’m probably going to get charged for that. And my platelets are low, so I’m going to have to see a hematologist. So I’m going to get charged for that.”

She sighed and put her head in her hands. “Welcome to my world,” she said.

Extras Add Up

Though Ms. Martin has yet to receive her final bills, other couples describe being blindsided by enormous expenses. After discovering that their insurance did not cover pregnancy when the first ultrasound bill was denied last year, Chris Sullivan and his wife, both freelance translators in Pennsylvania, bought a $4,000 pregnancy package from Delaware County Memorial Hospital; a few hospitals around the country are starting to offer such packages to those patients paying themselves.

The couple knew that price did not cover extras like amniocentesis, a test for genetic defects, or an epidural during labor. So when the obstetrician suggested an additional fetal heart scan to check for abnormalities, they were careful to ask about price and got an estimate of $265. Performed by a specialist from the Children’s Hospital of Philadelphia, it took 30 minutes and showed no problems — but generated a bill of $2,775.

“All of a sudden I have a bill that’s as much as I make in a month, and is more than 10 times what I’d been quoted,” Mr. Sullivan said. “I don’t know how I could have been a better consumer, I asked for a quote. Then I get this six-part bill.” After months of disputing the large discrepancy between the estimate and the bill, the hospital honored the estimate.

Christopher Gregory/The New York Times

“Most insurance companies wouldn’t blink at my bill, but it was absurd.” Dr. Marguerite Duane, who questioned line items on her hospital bill.

Mr. Sullivan noted that the couple ended up paying $750 for an epidural, a procedure that has a list price of about $100 in his wife’s native Germany.

Even women with the best insurance can still encounter high prices. After her daughter was born five years ago, Dr. Marguerite Duane, 42, was flabbergasted by the line items on the bills, many for blood tests she said were unnecessary and medicines she never received. She and her husband, Dr. Kenneth Lin, both associate professors of family medicine at Georgetown Medical School, had delivered babies in their early years of practice.

So when she became pregnant again in 2011, she decided to be more assertive about holding down costs. After a routine ultrasound scan at 20 weeks showed a healthy baby, she refused to go back for weekly follow-up scans that the radiologist suggested during the last months of her pregnancy even though medical guidelines do not recommend them. When in the hospital for the delivery of her son Ellis in February, she kept a list of every medicine and every item she received.

Though she delivered Ellis with a midwife 12 minutes after arriving at the hospital and was home the next day, the hospital bill alone was more than $6,000, and her insurance co-payment was about $1,500. Her first two pregnancies, both more than five years ago, were fully covered by federal government insurance because her husband worked for the Agency for Health Care Research and Quality.

“Most insurance companies wouldn’t blink at my bill, but it was absurd — it was the least medical delivery in history,” said Dr. Duane, who is taking a break from practice to stay home with her children. “There were no meds. I had no anesthesia. He was never in the nursery. I even brought my own heating pad. I tried to get an explanation, but there were items like ‘maternity supplies.’ What was that? A diaper?”

Ms. Martin is similarly well positioned to be an expert consumer of health care. She administered the health plan for a large art gallery she managed in Los Angeles before marrying and moving to Vermont in 2011 to enroll in a year of pre-med classes at the University of Vermont. She has a scholarship this fall for a master’s degree program at Vanderbilt University’s Center for Medicine, Health and Society, and then she plans to go on to medical school. Her father-in-law is a pediatrician.

RENÉE MARTIN’S PREGNANCY COSTS

prenatal

She and her husband, who works for a small music licensing company that does not provide insurance, hoped to start their family during the year they were covered by university insurance in Vermont, she said, but “nature didn’t cooperate.”

Then they moved to the New Hampshire summer resort of Laconia, her husband’s hometown, for a year before she started the grind of medical training. But in New Hampshire, they discovered, health insurance they could buy on the individual market did not cover maternity care without the purchase of an additional “pregnancy rider” for $800 a month. With their limited finances and unsuccessful efforts at conceiving, it seemed an unwise, if not impossible, investment.

Soon after buying insurance coverage without the rider for $450 a month, Ms. Martin discovered she was pregnant. Her elation was quickly undercut by worry.

“We’re not poor. We pay our bills. We have medical insurance. We’re not looking for a handout,” Ms. Martin said, noting that her husband makes too much money for her to qualify for Medicaid or other subsidized programs for low-income women. “The hospital is doing what it can. Our doctors are taking wonderful care of us. But the economics of this system are a mess.”

Not knowing whether the pregnancy would fall at the $4,000 or $45,000 end of the range the hospital cited, the couple had a hard time budgeting their finances or imagining their future. The hospital promised a 30 percent discount on its final bill. “I’m trying not to be stressed, but it’s really stressful,” Ms. Martin said as her due date approached.

Package Deals

With costs spiraling, some hospitals are starting to offer all-inclusive rates for pregnancy. Maricopa Medical Center, a public hospital in Phoenix, began offering uninsured patients a comprehensive package two years ago. “Making women choose during labor whether you want to pay $1,000 for an epidural, that didn’t seem right,” said Dr. Dean Coonrod, the hospital’s chief of obstetrics and gynecology.

The hospital charges $3,850 for a vaginal delivery, with or without an epidural, and $5,600 for a planned C-section — prices that include standard hospital, doctors’ and testing fees. To set the price, the hospital — which breaks even on maternity care and whose doctors are on salaries — calculated the average payment it gets from all insurers. While Dr. Coonrod said the hospital might lose a bit of money, he saw other benefits in a market where everyone will have insurance in just a few years: mothers tend to feel allegiance to the place they give birth to their babies and might seek other care at Maricopa in the future.

Laura Segall for The New York Times

“Making women choose during labor whether you want to pay $1,000 for an epidural, that didn’t seem right.” Dr. Dean Coonrod, chief of obstetrics and gynecology at Maricopa Medical Center in Phoenix

The Catalyst for Payment Reform, a California policy group, has proposed that all hospitals should offer such bundled prices and that rates should be the same, no matter the type of delivery. It suggests that $8,000 might be a reasonable starting point. But that may be hard to imagine in markets like New York City, where $8,000 is less than many private doctors charge for their fees alone.

One factor that has helped keep costs down in other developed countries is the extensive use of midwives, who perform the bulk of prenatal examinations and even simple deliveries; obstetricians are regarded as specialists who step in only when there is risk or need. Sixty-eight percent of births are attended by a midwife in Britain and 45 percent in the Netherlands, compared with 8 percent in the United States. In Germany, midwives were paid less than $325 for an 11-hour delivery and about $30 for an office visit in 2011.

Dr. Palmer of the American College of Obstetricians and Gynecologists acknowledged the preference for what he called “medicalized” deliveries in the United States, with IVs, anesthesia and a proliferation of costly ultrasounds. He said the organization was working to define standards for the scans.

To control costs in the United States, patients may also have to alter their expectations, including the presence of an obstetrician at every prenatal visit and delivery. “It’s amazing how much patients buy into our tendency to do a lot of tests,” said Eugene Declercq, a professor at Boston University who studies international variations in pregnancy. “We’ve met the problem, and it’s us.”

Starting next year, insurance policies will be required under the Affordable Care Act to include maternity coverage, so no woman should be left paying entirely on her own, like Ms. Martin. But the law is not explicit about what services must be included in that coverage. “Exactly what that means is the crux of the issue,” Dr. Kozhimannil said.

If the high costs of maternity care are not reined in, it could break the bank for many states, which bear the brunt of Medicaid payouts. Medicaid, the federal-state government health insurance program for the poor, pays for more than 40 percent of all births nationally, including more than half of those in Louisiana and Texas. But even Medicaid, whose payments are regarded as so low that many doctors refuse to take patients covered under the program, paid an average of $9,131 for vaginal births and $13,590 for Caesarean deliveries in 2011.

Insured women are still getting the recommended prenatal care, despite rising out-of-pocket costs, according to a recent study. But that does not mean they are not feeling the strain, said Dr. Kozhimannil, the study’s lead author. The average amount of savings among pregnant women in the study was $3,000 to $5,000. “People will find ways to scrape by for medical care for their new baby, but are young mothers taking care of themselves? And what happens when they need to start buying diapers?” she asked. “Something’s got to give.”

Ms. Martin, who busied herself making toys as her due date neared, could not stop fretting about the potential cost of a complicated delivery. “I know that a C-section could ruin us financially,” she said.

On May 25, she had a healthy daughter, Isla Daisy, born by vaginal delivery. Mother and daughter went home two days later.

She and her husband are both overjoyed and tired. And, she said, they are “dreading” the bills, which she estimates will be over $32,000 before negotiations begin. Her labor was induced, which required intense monitoring, and she also had an epidural.

“We’re bracing for it,” she said.

This article has been revised to reflect the following correction:

Correction: July 2, 2013

An article on Monday about the high cost of maternity and newborn care in the United States misstated the number of years ago that Dr. Marguerite Duane’s daughter was born. It was five years ago, not seven. The article also misidentified which of Dr. Duane’s sons was born in February. He is Ellis — not Isaac, who is her older son.

A version of this article appeared in print on July 1, 2013, on page A1 of the New York edition with the headline: American Way of Birth, Costliest in the World.”

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July 11, 2013 · 3:20 pm

Beyond the Finish Line

Jeff Bauman waited at the finish line of the 2013 Boston Marathon to cheer for his girlfriend. In one flash, his life changed. Josh Haner/The New York Times

By TIM ROHAN
JULY 7, 2013
 
“BOSTON — Jeff Bauman stared straight ahead, his eyes wary and unconvinced, as his doctor told him the next procedure would be easy and painless. He sat in his wheelchair at Boston Medical Center, and Dr. Jeffrey Kalish, his primary surgeon, explained how a resident would remove the sutures from his legs.

Most of Bauman’s legs were gone. He had been waiting for his girlfriend near the finish line of the Boston Marathon on April 15 when the first of two bombs detonated and blew them off. An iconic sporting event had turned into a scene of chilling devastation, and a photograph of Bauman in the aftermath, his legs gruesomely lost, later became a searing symbol of the attacks.

The day of the bombings, Bauman had had an emergency, through-knee amputation that lasted about two hours. A surgeon had sifted through layers of skin, tissue and muscle, preserving what was healthy, cutting what was dirty and sick. He had removed what was left of Bauman’s lower legs at the knee joints.

Two days later, Kalish had performed a formal amputation at about four inches above the knee. He had measured the legs and cut each layer — skin, tissue, muscle and bone — farther up in the thigh, like a staircase. Then he washed out the legs for 10 minutes, tucked the muscle, and stitched the tissue.

 

Bauman as the sutures were being removed from his amputated legs by a resident, right, at Boston Medical Center. Josh Haner/The New York Times

 

Bauman’s legs had been reduced to stumps, sewn shut across each base. Now, as Kalish spoke, Bauman pulled his left leg toward his chest and eyed the sutures.

“We literally just yank and cut,” Kalish said. Bauman looked away. “Compared to everything you’ve been through, this is going to be a breeze. How about that?”

Kalish left the room, Bauman climbed onto a table, and the resident started on his left leg. There were 25 sutures to remove from his left and 24 from his right. The resident worked slowly, pulling and cutting, leaving the especially deep ones for Kalish to do. Bauman did not care to watch. He lay back, rested on his elbows and glanced out the window at the darkening sky and an American flag at half-staff. It had been one month since the bombings.

The resident moved on to his right leg, and on the third suture, as she pulled and cut, he cried out and grimaced and closed his eyes.

“O.K. — pain? O.K.,” she said. “We’ll just — we’ll go from the other side.”

She paused and watched his face twist.

“Do you need a break?” she asked.

“No,” he said as the pain left his face and he opened his eyes. “That one hurt.”

She did what she could with the right leg, and then went and retrieved Kalish. There were 10 deep ones left for him to do. He started with the left leg, and a few minutes later, Bauman whimpered again, softer now. He tried to hold back.

After this, there would be no more procedures. There was nothing more his doctors could do. His legs would be this way for the rest of his life. Learning to walk again, and whatever happened after that, was up to him.

Kalish said nothing and kept working. Bauman was crying now.

“Sorry,” Kalish said, without looking up. “Almost done.”

Five minutes later, he was finished, and Bauman’s legs were bleeding.

“You did it,” Kalish said. “I hope that wasn’t so awful.”

With his lower legs blown off in the Boston Marathon bomb blasts, 27-year-old Jeff Bauman began a long and painful journey back. Josh Haner/The New York Times

 

A Backpack and a Bang

Early on the morning of April 15, Bauman drove his girlfriend, Erin Hurley, to a meeting point for her charity running team.

“You better win,” he said as she got out of the car. She laughed.

Bauman then napped at Hurley’s apartment in Brighton, and at about 1:15 p.m. drove with her roommates, Remy Lawler and Michele Mahoney, to a marathon checkpoint in Newton. Bauman spotted Hurley there, and she ran over. The four of them group-hugged, and then Hurley took off. The plan was to meet her again at the finish line.

Bauman, Lawler and Mahoney took a cab to Boylston Street and waded through the crowd, looking for a good spot. Spectators were five and six deep. Lawler and Mahoney wormed their way closer to the street, and Bauman stayed near the back.

He was looking for Hurley when a man behind him, about five feet to his right, caught his eye. The man was wearing a dark, heavy coat, sunglasses, a backpack and a baseball cap low and tight on his head. He looked strange. Why was he dressed so warmly on a sunny day? He looked serious, too. And why was he standing so far back? Bauman looked away. He scanned for Hurley again, and then looked back over his right shoulder. The man was gone, but his backpack was there on the sidewalk.

Then Bauman saw a flash and heard a bang. Suddenly, he was lying on the sidewalk, dazed and a bit numb. He smelled sulfur. Or was it burning metal? What a firework, he thought. He sat up and saw bodies strewn and a lot of blood. Mahoney was a few feet away. She tried to scoot toward him, but her left leg would not budge. She looked at Bauman, then at his legs, and then back at him. He looked down, then back at her, horrified.

Bauman grabbed what was left of his legs, lay back down and was writhing there when Allan Panter found him. Panter, an emergency room physician from Gainesville, Ga., had been in the crowd, too, but was unharmed. He pulled Bauman from the pile of bodies and placed the loose tissue back into his leg. Bauman screamed.

Panter tied a makeshift tourniquet around his right leg, placed a jacket on him and left Bauman so he could tend to the woman sprawled nearby whose eyes were open and empty.

I’m going to die, Bauman thought, lying there alone.

Medical responders and a bystander, Carlos Arredondo (in the cowboy hat), rush Bauman from the scene in what became a symbolic image of the Boston Marathon carnage. Charles Krupa/Associated Press

 

He had sat up again when a man in a cowboy hat named Carlos Arredondo came bounding toward him. Arredondo had watched the chaos unfold from across the street. He called for help, and a woman came with a wheelchair. He nudged Panter, and they lifted Bauman into the chair, and off Bauman went, Arredondo running by his side.

Then the tourniquet on Bauman’s right leg caught in the wheel and came undone. Arredondo tried holding the tourniquet together, but an emergency medical technician caught up to them and grabbed Bauman’s right leg, applying pressure to slow the bleeding, while Bauman held his left leg up with his hands.

They made it to the medical tent, and Bauman was loaded into an ambulance headed for Boston Medical. A woman sat behind him and leaned over his face. He looked up at her and realized she was trying to talk to him. His eyes widened, and he said, “I can’t hear.”

She spoke louder. “Where were you on Boylston Street?” she asked.

“Up the street a little, by the grandstand,” he said. He was calm. She asked what he was doing there, and he told her about Hurley. She asked how old he was, and he said 27. She asked where he was from, and he said, Chelmsford, Massachusetts.

The questions were mostly to keep him engaged and conscious. They arrived at the hospital just as the pain started to set in.

What Was Left of Him

Bauman lay asleep in a bed at Spaulding Rehabilitation Hospital in Boston as the sun peeked over the buildings across the harbor. Light filled the room, and when it came across his face, he stirred. His face was long and thin and forlorn with deep lines under his eyes and eyelashes singed so short they looked like eyeliner. He hardly slept anymore. The pain from his injuries kept him up at night, and this morning sun did not help.

It had been two weeks since the bombings, and the burns on his back were still healing. Much of the skin was bright red and a few patches were raw, and it stung if he rolled or shifted or turned the wrong way. The bedsheets also bothered his sutures. So at night, he tried to lie still, but his legs would spasm. The pain pulsated down his thighs. Sometimes, it felt as if someone were beating on his knees. Most mornings, he woke up sore.

On this morning, Hurley fetched his clothes and his toothbrush and climbed into bed with him. She had spent the night on the couch at the foot of the bed, as she spent most nights now. After a while, she kissed him goodbye and left for a run.

Waking up at Spaulding Rehabilitation Hospital. Bauman found it difficult to get any sleep, because of the pain. Josh Haner/The New York Times

 

Bauman pulled his wheelchair alongside the bed and took the two-and-a-half-foot wooden plank from the chair’s back pouch. He laid the plank from the bed to the chair, and, pushing down on it, he lifted himself slowly and scooted across into the chair. This was his new means of moving around.

Now, for a fleeting moment, he was alone.

His mind wandered. He thought of the marathon, that day. He had accepted what had happened, perhaps as much as anyone could, but he was reminded whenever he saw his legs. He could not stand to see them. He was getting better about it, but he still got shaky. And they were always so sore. Sitting there, he held them and tried to rub away the pain.

Carlyn Wells, his physical therapist, arrived for his 8 a.m. session, and they went down to the rehabilitation gym. He started his stretches, lying on his left side and lifting his right leg sideways into the air. He did this 12 times, his leg wobbling more with each lift. Then he flipped onto his right side and did the same with his left leg.

“Can you hear me well?” Wells asked. He had not answered her last question.

Bauman stopped and sat up. He rubbed his face.

“It’s hard to hear in this room,” he said. “It’s so big.”

His right eardrum was destroyed in the blast, and his left one had a sizable hole in it. He had told people it felt as if someone were holding something over his ears, only to let up every now and then. His ear doctor said he was missing about 20 decibels of hearing and that the holes were unlikely to close on their own. He recommended surgery, but Bauman refused. He had had three operations since the bombings and had decided that was his limit.

 

“You want me to talk louder?” Wells asked.

“Yes, please,” he said.

“Will it bother you if the others turn music on?” she asked.

“The sound, it ricochets off the walls,” he said, looking up. “It, like, echoes.” He paused and looked back at her. “I hear it more than once. I won’t be able to hear.”

He finished stretching, and then worked with leg weights and a medicine ball. After 45 minutes, he was done, and Wells left him alone again in his room. He climbed back into bed and watched television. He tried to nap, but doctors and nurses kept popping in, and his thighs were sore. So he just lay there, resting. The room was starting to smell distinctly like him. He showered only a few times a week because it was such a challenge.

Later that morning, his mother, Patty, arrived. She worked as a waitress, but was given time off to attend to him. She nervously paced around the room, tidying things and reading unopened mail. She was always fretting over him, it seemed, cringing whenever he moved. Then he had to calm her down.

In the afternoon, he had occupational therapy, and his mother left. Then he climbed back into bed, rubbed his legs, picked at his eyelashes, and watched TV. More people visited. Some days, amputees from support groups came, showing off their prostheses. Sometimes, Chris Carter, the hospital psychologist, stopped in to chat.

Each Tuesday afternoon, Carter led a discussion with the marathon victims. When it was his turn, Bauman said he was optimistic, he had goals, he was trying to move on, and it could have been worse. He called the bombers cowards and clowns. He rarely thought of them, only when someone asked. He was more concerned with himself now.

His father had closely followed the manhunt. He came to see Bauman each night after work. This was by design. Bauman’s mother and father had separated when he was a toddler, and they generally did not get along. So by day and night, Bauman had two sets of relatives competing for his attention. Then his friends brought food, or he played the guitar, or Hurley came over, and he felt better.

Josh Haner/The New York Times

Carlyn Wells, Bauman’s physical therapist at Spaulding, measured his range of hip and leg motion, above left. At right, sharing a joke with his girlfriend, Erin Hurley, whose first marathon he had gone to see. Josh Haner/The New York Times

 

At some point, though, they had all stared at him. They expected him to be broken, angry and sad. He joked about his legs. He was trying to move on. But there was no escaping all these people, all their pity and all their questions. Then his legs were always so sore.

He never asked any of his visitors to leave, but he was a private person, and here he was confined to this bed or his wheelchair. He felt as if he were on display — hurt, tired and vulnerable for all to see. He hated the hospital for that. But he kept this all to himself.

One night, just as his patience waned, Hurley arrived; seeing her was the best part of his day now. They had been together for about a year. He had decided he wanted to marry her, buy a house with her, start a new life with her. But he sensed her guilt. She said she loved him more now. She was more affectionate. They had figured out how to be intimate in his hospital bed. She just had to be careful of his legs.

Now she kissed him and sat in the large chair next to his bed. He was lying there, his left hand behind his head. She was playing with her hair, twirling an end with her finger. She asked about his day. He wanted to talk about hers instead. She asked if she should renew the lease on her apartment. He hesitated. He tried to dissuade her, but when she resisted and made a case to keep the apartment, he suggested they buy a house together.

“It’s a lot of work buying a house, you know,” she said, looking down. She felt his eyes watching her. “You have to like — I don’t know. It’s a lot of work. It might be too much for you right now. And me, too.”

She let go of her hair and scratched her nose. His eyes glossed over.

“Eventually, though,” she said softly.

Painkillers and New Legs

Bauman was discharged from the rehabilitation center about four weeks after the bombings. He went back home to live with his mother in Chelmsford, and during the day, most days, it was just the two of them. Sometimes, his cousin came over to play video games. Otherwise, Bauman passed the time lying in bed until Hurley came over after work. He slept easier at home. There was not much else he could do.

Sitting in his wheelchair for a long time strained his legs. On the few occasions he did go out, he packed a zipper bag with his medication. He regularly took 1,200 milligrams of gabapentin for the phantom leg pain, 1,000 milligrams of Tylenol and 5 milligrams of oxycodone. And if the pain was still unbearable, he took more oxycodone.

At home, he packed three tablets of the painkiller oxycodone in a baggie before going to a restaurant for his father’s 53rd birthday. Josh Haner/The New York Times

 

He packed a baggie of painkillers the day he had his sutures removed and then again a few days later for a friend’s bachelor party. It was an all-day affair at a local gun club. He had never fired a shotgun and was a bit apprehensive about it. But he learned how, and the others wheeled him out between rounds to shoot by himself, all eyes on him. He was a sideshow again. Maybe that would change when he could walk.

A few days after that, Bauman had his first appointment with the prosthetist, Paul Martino, of United Prosthetics in Dorchester. Bauman sat on the edge of a bench in a patient room and listened intently as Martino explained how his new legs would work.

To put them on, Martino said, Bauman would roll a gel liner, which resembled a skintight sock, onto his thigh, then slide his thigh into a carbon-fiber socket. He would strap the liner to the socket, and the socket would be connected to the rest of the leg.

Ottobock manufactured the legs, Martino said. It was a German company that he had trusted for years. Its Genium knees had microprocessors, he said, that would be programmed to follow Bauman’s gait, to swing as he stepped, move as he moved.

Bauman nodded and rubbed his thighs. He was trying to retain it all.

He did not know what it would be like, walking on the prosthetic legs, but he hoped he would like it. He figured he would be restricted. He had made a running mental list of all the things he thought he could no longer do. He could not fly a plane, he thought, or work construction. He could not play hockey, as he used to in his father’s backyard, or play sports in general. He was not sure he could ever wear pants again.

The purpose of this first visit was to make casts of Bauman’s thighs to create the sockets. So first, he rolled on the gel liner; it felt strange and tight on his thighs. Then Martino put a plastic bag over it and a mesh netting over that. He took measurements, and then marked the netting and applied the plaster by dipping strips in water and setting them on.

Martino had come recommended by a doctor at Spaulding, and Bauman trusted him. He was lying on his back, watching Martino work, when Martino’s assistant asked where he worked before the injury. He told her he had worked at Costco. He had started there, in the delicatessen, about two and a half years ago, while he was taking college classes. And when he left college without a degree, he had committed himself to his Costco shifts.

 

Above left, casts of his thighs were made to build the sockets for his prosthetic legs. Then Bauman had a chance to examine one for the first time. Josh Haner/The New York Times

 

The assistant said she wanted to make sure his prosthetic legs would not prevent him from doing anything he was doing before. He thought for a moment and said: “I just want to get to the places I can’t get in the wheelchair, you know? I want to stand up.”

When Martino finished casting both thighs, he wiped down the bench, and the assistant showed Bauman an Ottobock leg. It felt solid and surprisingly heavy.

“Can you put pants on right over this?” he asked, and they assured him he could. He nodded. He was satisfied. On his way out, his mother noticed a photograph on the wall.

“Look, Jeffy!” she said. “An all-amputee hockey team!”

Face of the Tragedy

Another week passed, and Bauman started going out more in his wheelchair. His legs would still get sore, but by now, he was familiar with the pain and was bored at home. He and Hurley went out to eat, and inevitably, someone recognized him. He rarely paid for a meal anymore. Chefs and managers offered him gifts. They had seen the marathon-day photograph, published around the world, of Arredondo wheeling him away, his legs shredded.

Bauman could not bear to see the photo now. But it resonated with people in Boston. It was shown on the scoreboard at Fenway Park when the Red Sox had Bauman and Arredondo throw out ceremonial first pitches together. The crowd roared as they took the field. One man asked Bauman for an autograph. “You’re an inspiration,” the man said.

Bauman and Carlos Arredondo, the bystander who had helped him, were introduced at Fenway Park on May 28 before throwing the ceremonial first pitch for a Boston Red Sox game. Josh Haner/The New York Times

 

Bauman had recently asked his mother why people so adored him. They respected his bravery, she had said, and he was the face of the tragedy, of those who survived.

The day after the Red Sox game, Bauman and Hurley were invited to attend James Taylor’s rehearsal as he prepared to perform at a concert to benefit the marathon victims. After the set, Taylor sat with them.

“So, you’re a guitar player, I hear,” he said, tapping Bauman’s forearm.

“Yeah, I can play a couple of chords,” Bauman said. His ears were still ringing from the music, but he did not mention this, or how he played the guitar for only five minutes at a time now, his ears frustrated him so.

They chatted about Bauman’s first pitch at Fenway, about his rehabilitation, and the future. Bauman had to learn to walk first, and after that, he did not know what to expect. Taylor was asking questions Bauman had to ask himself.

Taylor asked about Costco and whether Bauman would return to work there. Bauman said yes, he would, once he was strong enough. But he had worried about having to stand all day. He had thought, maybe instead, he could do something that helped people.

Then Taylor asked about his health insurance at Costco and if it was covering his expenses, and Bauman said yes. But he did not know entirely. He had not seen a bill from Boston Medical or Spaulding. His new legs cost about $100,000 each, but he expected them to be covered by his insurance and a foundation called Wiggle Your Toes.

“You probably get a lot of donations, too, huh?” Taylor said.

“Yeah, I get a lot of donations,” Bauman said. “It’s a lot. I’m getting money all the time.”

Hanging out with friends, who were wearing bracelets with the words “Bauman Strong” on one side and “April 15, 2013” on the other. Josh Haner/The New York Times

 

An online fund-raiser for him had reached nearly $800,000, and he would soon receive a $2.2 million check from the One Fund, which was established to benefit the marathon victims.

But he feared his money and fame would run out. He retained a lawyer and two financial advisers. He put his money in a trust fund. He would trade it all, though, just to have his legs back.

But he tried not to think like that.

“Yeah, I guess I’m going to need it,” Bauman told Taylor. “I guess this stuff’s expensive.”

“You should sit back and let people do what they can,” Taylor said, “because it makes people feel good — like they’re doing something.”

Bauman nodded and stared at the ground.

The First Steps

The day after the concert, Bauman was going to try to walk. His prosthetic legs had been made, and now the thigh sockets needed to be fitted. At his last appointment at United Prosthetics, he had taken a few short steps, but Martino had held his hips. Martino wanted him to walk on his own now, to see how everything felt and if any more adjustments were necessary.

Bauman’s mother, his girlfriend and a few others gathered to watch in a hallway narrow enough that Bauman could reach the railings on each wall. He was in his wheelchair as he rolled the gel liners onto his thighs. He held his left thigh and squeezed it.

Martino held the legs in place as Bauman pulled on the sockets. He strapped the liners to the sockets as Martino adjusted the knees and set the feet on the ground, with their black, size-10 ½ sneakers. Bauman scooted forward in the chair, grabbed the railings and pushed himself up. Martino had a hold of him and helped him stand all the way up.

Hurley was behind him, and she, like the others, watched quietly. Bauman pursed his lips as he balanced using the railings and straightened himself over the legs. The chair was pulled out from behind him, and Martino crouched down to examine the sockets.

The first time Bauman had stood, the top had pinched his skin and the bottom had hurt the ends of his thighs. But Martino had corrected the sockets, and everything felt fine now. Bauman’s legs were sore, as they always were, but the pain no longer deterred him.

He seemed at ease with his torso leaning forward and supported mostly by his hands on the railings, as Martino worked. Then Bauman let up on the railings, stood up straighter, and felt the pressure on his thighs, the ground firm underneath him. He felt in control.

“All right, you O.K. to stand on that?” Martino said. “I’m going to run for a wrench.”

Martino left the room, and Bauman arced his neck back toward Hurley.

“How you doing, honey?” she asked.

“Good,” he said. He was completely upright now. He looked sturdy.

He turned forward and watched himself in the mirror at the end of the hallway. He lifted his hands off the railings, wobbled a bit and put his hands back. Hurley had not seen him do it. He did it again, lifting his hands higher now, and grinning.

At a final fitting for his prosthetic legs, Bauman walked on his own for the first time since the day of the marathon. Josh Haner/The New York Times

 

“No!” Hurley said. “Be careful!”

She wrapped her arms around him and kissed the back of his neck.

“Be careful,” she said softly. “You’re making me nervous.”

She leaned against the wall, keeping hold of his midsection.

She looked down at his legs. “Does it hurt?” she whispered.

“No,” he said. “I feel tremendously balanced.”

Martino returned, and Hurley moved away and left Bauman standing there by himself. Martino examined the legs, then stepped back and asked Bauman to walk.

Bauman leaned on the railings, hunched over, and swung his left foot ahead, barely off the ground. His face strained.

He took five steps, each a bit more cautious than the last.

 

Josh Haner contributed reporting from Boston.

A version of this article appeared in print on July 8, 2013, on page D1 of the New York edition with the headline: Beyond the Finish Line.”

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July 9, 2013 · 5:08 pm

The F.B.I. Deemed Agents Faultless in 150 Shootings

Gerardo Mora/Getty Images

An apartment complex in Orlando, Fla., where Ibragim Todashev was killed by an F.B.I. agent last month.

 

By  and 
Published: June 18, 2013

“WASHINGTON — After contradictory stories emerged about anF.B.I. agent’s killing last month of a Chechen man in Orlando, Fla., who was being questioned over ties to the Boston Marathonbombing suspects, the bureau reassured the public that it would clear up the murky episode.

“The F.B.I. takes very seriously any shooting incidents involving our agents, and as such we have an effective, time-tested process for addressing them internally,” a bureau spokesman said.

But if such internal investigations are time-tested, their outcomes are also predictable: from 1993 to early 2011, F.B.I. agents fatally shot about 70 “subjects” and wounded about 80 others — and every one of those episodes was deemed justified, according to interviews and internal F.B.I. records obtained by The New York Times through a Freedom of Information Act lawsuit.

The last two years have followed the same pattern: an F.B.I. spokesman said that since 2011, there had been no findings of improper intentional shootings.

In most of the shootings, the F.B.I.’s internal investigation was the only official inquiry. In the Orlando case, for example, there have been conflicting accounts about basic facts like whether the Chechen man, Ibragim Todashev, attacked an agent with a knifewas unarmedor was brandishing a metal pole. But Orlando homicide detectives are not independently investigating what happened.

“We had nothing to do with it,” said Sgt. Jim Young, an Orlando police spokesman. “It’s a federal matter, and we’re deferring everything to the F.B.I.”

Occasionally, the F.B.I. does discipline an agent. Out of 289 deliberate shootings covered by the documents, many of which left no one wounded, five were deemed to be “bad shoots,” in agents’ parlance — encounters that did not comply with the bureau’s policy, which allows deadly force if agents fear that their lives or those of fellow agents are in danger. A typical punishment involved adding letters of censure to agents’ files. But in none of the five cases did a bullet hit anyone.

Critics say the fact that for at least two decades no agent has been disciplined for any instance of deliberately shooting someone raises questions about the credibility of the bureau’s internal investigations. Samuel Walker, a professor of criminal justice at the University of Nebraska Omaha who studies internal law enforcement investigations, called the bureau’s conclusions about cases of improper shootings “suspiciously low.”

Current and former F.B.I. officials defended the bureau’s handling of shootings, arguing that the scant findings of improper behavior were attributable to several factors. Agents tend to be older, more experienced and better trained than city police officers. And they generally are involved only in planned operations and tend to go in with “overwhelming presence,” minimizing the chaos that can lead to shooting the wrong people, said Tim Murphy, a former deputy director of the F.B.I. who conducted some investigations of shootings over his 23-year career.

The F.B.I.’s shootings range from episodes so obscure that they attract no news media attention to high-profile cases like the 2009 killing of an imam in a Detroit-area warehouse that is the subject of a lawsuit alleging a cover-up, and a 2002 shooting in Maryland in which the bureau paid $1.3 million to a victim and yet, the records show, deemed the shooting to have been justified.

With rare exceptions — like suicides — whenever an agent fires his weapon outside of training, a team of agents from the F.B.I.’s Inspection Division, sometimes with a liaison from the local police, compiles a report reconstructing what happened. This “shooting incident review team” interviews witnesses and studies medical, ballistics and autopsy reports, eventually producing a narrative. Such reports typically do not include whether an agent had been involved in any previous shootings, because they focus only on the episode in question, officials said.

That narrative, along with binders of supporting information, is then submitted to a “shooting incident review group” — a panel of high-level F.B.I. officials in Washington. The panel produces its own narrative as part of a report saying whether the shooting complied with bureau policy — and recommends what discipline to mete out if it did not — along with any broader observations about “lessons learned” to change training or procedures.

F.B.I. officials stressed that their shooting reviews were carried out under the oversight of both the Justice Department’s inspector general and the Civil Rights Division, and that local prosecutors have the authority to bring charges.

The 2,200 pages of records obtained by The Times include an internal F.B.I. study that compiled shooting episode statistics over a 17-year period, as well as a collection of individual narratives of intentional shootings from 1993 to early 2011. Gunfire was exchanged in 58 such episodes; 9 law enforcement officials died, and 38 were wounded.

The five “bad shoots” included cases in which an agent fired a warning shot after feeling threatened by a group of men, an agent fired at a weapon lying on the ground to disable it during an arrest, and two agents fired their weapons while chasing fugitives but hit no one. In another case, an agent fired at a safe during a demonstration, and ricocheting material caused minor cuts in a crowd of onlookers.

Four of the cases were in the mid-1990s, and the fifth was in 2003.

In many cases, the accuracy of the F.B.I. narrative is difficult to evaluate because no independent alternative report has been produced. As part of the reporting for this article, the F.B.I. voluntarily made available a list of shootings since 2007 that gave rise to lawsuits, but it was rare for any such case to have led to a full report by an independent authority.

Occasionally, however, there were alternative reviews. One, involving a March 2002 episode in which an agent shot an innocent Maryland man in the head after mistaking him for a bank robbery suspect, offers a case study in how the nuances of an F.B.I. official narrative can come under scrutiny.

In that episode, agents thought that the suspect would be riding in a car driven by his sister and wearing a white baseball cap. An innocent man, Joseph Schultz, then 20, happened to cross their path, wearing a white cap and being driven by his girlfriend. Moments after F.B.I. agents carrying rifles pulled their car over and surrounded it, Agent Christopher Braga shot Mr. Schultz in the jaw. He later underwent facial reconstruction surgery, and in 2007 the bureau paid $1.3 million to settle a lawsuit.

The internal review, however, deemed it a good shoot. In the F.B.I.’s narrative, Agent Braga says that he shouted “show me your hands,” but that Mr. Schultz instead reached toward his waist, so Agent Braga fired “to eliminate the threat.” While one member of the review group said that “after reading the materials provided, he could not visualize the presence of ‘imminent danger’ to law enforcement officers,” the rest of the group voted to find the shooting justified, citing the “totality of the circumstances surrounding the incident,” including that it involved a “high-risk stop.”

But an Anne Arundel County police detective prepared an independent report about the episode, and a lawyer for Mr. Schultz, Arnold Weiner, conducted a further investigation for the lawsuit. Both raised several subtle but important differences.

For example, the F.B.I. narrative describes a lengthy chase of Mr. Schultz’s car after agents turned on their siren at an intersection, bolstering an impression that it was reasonable for Agent Braga to fear that Mr. Schultz was a dangerous fugitive. The narrative spends a full page describing this moment in great detail, saying that the car “rapidly accelerated” and that one agent shouted for it to stop “over and over again.” It cites another agent as estimating that the car stopped “approximately 100 yards” from the intersection.

By contrast, the police report describes this moment in a short, skeptical paragraph. Noting that agents said they had thought the car was fleeing, it points out that the car “was, however, in a merge lane and would need to accelerate to enter traffic.” Moreover, a crash reconstruction specialist hired for the lawsuit estimated that the car had reached a maximum speed of 12 miles per hour, and an F.B.I. sketch, obtained in the lawsuit, put broken glass from a car window 142 feet 8 inches from the intersection.

The F.B.I. narrative does not cite Mr. Schultz’s statement and omits that a crucial fact was disputed: how Mr. Schultz had moved in the car. In a 2003 sworn statement, Agent Braga said that Mr. Schultz “turned to his left, towards the middle of the car, and reached down.” But Mr. Schultz insisted that he had instead reached toward the car door on his right because he had been listening to another agent who was simultaneously shouting “open the door.”

A former F.B.I. agent, hired to write a report analyzing the episode for the plaintiffs, concluded that “no reasonable F.B.I. agent in Braga’s position would reasonably have believed that deadly force was justified.” He also noted pointedly that Agent Braga had been involved in a previous shooting episode in 2000 that he portrayed as questionable, although it had been found to be justified by the F.B.I.’s internal review process.

Asked to comment on the case, a lawyer for Agent Braga, Andrew White, noted last week that a grand jury had declined to indict his client in the shooting.

In some cases, alternative official accounts for several other shootings dovetailed with internal F.B.I. narratives.

One involved the October 2009 death of Luqman Ameen Abdullah, a prayer leader at a Detroit-area mosque who was suspected of conspiring to sell stolen goods and was shot during a raid on a warehouse. The F.B.I. report says that Mr. Abdullah got down on the ground but kept his hands hidden, so a dog was unleashed to pull his arms into view. He then pulled out a gun and shot the dog, the report says, and he was in turn shot by four agents.

The Michigan chapter of the Council on American-Islamic Relations filed a lawsuit against the F.B.I. The group was concerned in part because the handgun had no recoverable fingerprints and because of facial injuries to Mr. Abdullah. It also contends that the dog may have been shot instead by the F.B.I. agents and the gun thrown down in a cover-up.

A report by the Michigan attorney general’s office, however, detailed an array of evidence that it says “corroborates the statements of the agents as to the sequence of events,” including that bullet fragments in the dog’s corpse were consistent with the handgun, not the rifles used by the F.B.I. agents. Such an independent account of an F.B.I. shooting is rare. After the recent killing of Mr. Todashev in Orlando, both the Florida chapter of the same group and his father have called for investigators outside the F.B.I. to scrutinize the episode.

James J. Wedick, who spent 34 years at the bureau, said the F.B.I. should change its procedures for its own good.

“At the least, it is a perception issue, and over the years the bureau has had a deaf ear to it,” he said. “But if you have a shooting that has a few more complicated factors and an ethnic issue, the bureau’s image goes down the toilet if it doesn’t investigate itself properly.”

 

A version of this article appeared in print on June 19, 2013, on page A1 of the New York edition with the headline: The F.B.I. Deemed Agents Faultless In 150 Shootings.”

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June 20, 2013 · 5:46 pm