Debby made landfall as a Category 1 hurricane on the Big Bend coast of Florida early Monday, first hitting the small community of Steinhatchee. It damaged homes and businesses, sent floodwaters rising, caused sweeping power outages across the state and Georgia and led to several fatalities. Debby was downgraded to a tropical storm midday Monday.

But experts say the worst is yet to come as the storm system is expected to stall over the Southeast region.

How much rain is expected?

Forecasters say the system could pummel the Southeast with widespread areas of up to 20 inches (51 centimeters) of rain and some totaling up to 30 inches (76 centimeters).

That would be a record-setting rainfall, shattering the record from a tropical system in 2018’s Hurricane Florence. More than 23 inches (58 centimeters) of rain was recorded in South Carolina after that storm hit the Carolinas.

Although Debby was classified as a Category 1, “It really is worthy of a Category 3 or 4 rating, if you want to talk about rainfall impacts,” said Jeff Masters, founder of Weather Underground, now with Yale Climate Connections. “That’s going to cause a lot of damage.”

What areas are at risk?

Northern Florida as well as low-lying areas including Savannah, Georgia, and Hilton Head Island and Charleston, South Carolina, are expected to see the most severe flooding. North Carolina could also be impacted.

Officials in Savannah warned the area could see a month’s worth of rain in four days if the system stalls. There were also flooding concerns for Tybee Island, Georgia’s largest public beach 18 miles (28.97 kilometers) east of Savannah. On top of any torrential downpours that Debby dishes out, the island could get even wetter from 2 to 4 feet of storm surge, according to the National Hurricane Center.

“We don’t know how much rain is going to fall. But we have to prepare for the worst,” Hilton Head Island Mayor Alan Perry said on a video posted to Facebook. “If that happens, we will see an event we have never seen on Hilton Head before.”

Meanwhile, Charleston County Interim Emergency Director Ben Webster called Debby a “historic and potentially unprecedented event” three times in a 90-second briefing Monday morning.

Few places in South Carolina are as susceptible to flooding as Charleston. Much of the city and surrounding areas founded in 1670 were built on land created by using fill dirt and other debris. Rising sea levels cause a number of minor flooding events even without a storm and like many coastal cities, Charleston can’t drain well.

The city doesn’t expect a massive amount of flooding from the ocean, but the storm is still dangerous. Heavy rain can back up into the city, also causing flooding.

What’s causing this storm to stall?

Some hurricanes make landfall and move quickly, experts say, while others slow substantially.

“Really what happened, and why the storm has stalled, is because there’s basically high pressure areas to the west of the storm and to the northeast, and that’s kind of pinned the storm,” said Phil Klotzbach, senior research scientist at Colorado State University’s Department of Atmospheric Science. “With a hurricane you always have wind problems, but when you have a storm moving at 3 to 5 miles an hour, it’s going to be over any specific location for a very long period of time, so flash flooding and just tremendous rainfall totals are going to be very likely.”

Experts say the warming atmosphere plays a role in the severity of storm surges such as Debby.

Warming water in the northeast Gulf of Mexico is increasing Hurricane Debby’s heavy rains, as more moisture evaporates from the waters, Masters said. Some research says climate change can impact the forward motion of hurricanes, he added, making them go slower.

“It’s something we’ve been seeing more of lately,” Masters said.

How long could this last?

The worst of the rain is expected during the first half of the week, but it could last through Saturday, forecasters said.

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The Florida-based airline said Tuesday the top ticket will be a “Go Big” package that includes priority check-in, a roomier seat, snacks and drinks, a checked bag, a carry-on bag and free WiFi.

CEO Ted Christie said the changes are “taking low-fare travel to new heights.” They also indicate the deep trouble with Spirit’s longtime business model.

The airline with bright yellow planes hasn’t made a full-year profit since 2019 — it has lost nearly $2.4 billion since — leading industry analysts to mull whether a bankruptcy filing could be in Spirit’s future.

Full-service carriers Delta and United account for an outsized share of the U.S. airline industry’s profit, and they are doing it by focusing on premium flyers while also selling bare-bones “basic economy” fares that compete with Spirit, Frontier and Allegiant for travelers on tight budgets.

The budget carriers have suffered more than the giants from a glut of flights within the United States, which has led to price-cutting. Delta, United and American have a booming business right now in long-haul international flights that can offset weak pricing power at home. Spirit does not.

The budget carriers are trying to adapt. Frontier Airlines — which, like Spirit, has been losing money for more than four years — matched a pandemic-era move by the bigger airlines and dropped flight-change and cancellation fees for many customers this spring. Spirit quickly copied the move.

Spirit has other problems, including a looming debt payment of more than $1 billion and a shortage of planes because some of its jets are grounded for inspections and repairs of Pratt & Whitney engines. Spirit expects compensation of up to $200 million from the engine maker, but its condition is dire enough that Spirit announced in April it would furlough some pilots and delay delivery of new jets.

TD Cowen analysts downgraded Spirit shares to “Sell” this month and said if Spirit can’t renegotiate its debt or return leased planes to lessors, a pre-packaged bankruptcy filing is possible.

Spirit’s announcement Tuesday targets travelers who might not consider a budget airline.

It said customers will be able to book any of the four new ticket bundles starting Aug. 16. That means they won’t be available during the height of summer-vacation travel but will be in use over the busy Labor Day holiday.

“We listened to our guests and are excited to deliver what they want: choices for an elevated experience that are affordable and provide unparalleled value,” Christie said in a statement issued by Spirit.

Spirit shares gained 5% in afternoon trading but are down more than 80% this year.

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Sophisticated overseas criminals are stealing tens of billions of dollars from Americans every year, a crime wave projected to get worse as the U.S. population ages and technology like AI makes it easier than ever to perpetrate fraud and get away with it.

Internet and telephone scams have grown “exponentially,” overwhelming police and prosecutors who catch and convict relatively few of the perpetrators, said Kathy Stokes, director of fraud prevention at AARP’s Fraud Watch Network.

Victims rarely get their money back, including older people who have lost life savings to romance scams, grandparent scams, technical support fraud and other common grifts.

“We are at a crisis level in fraud in society,” Stokes said. “So many people have joined the fray because it is pretty easy to be a criminal. They don’t have to follow any rules. And you can make a lot of money, and then there’s very little chance that you’re going to get caught.”

A recent case from Ohio, in which an 81-year-old man was targeted by a scammer and allegedly responded with violence, illustrates the law enforcement challenge.

Police say the man fatally shot an Uber driver after wrongly assuming she was in on a plot to extract $12,000 in supposed bond money for a relative. The driver fell victim to the same scammer, dispatched to the home midway between Dayton and Columbus to pick up a package for delivery, according to authorities.

Homeowner William Brock was charged with murder in the fatal March 25 shooting of Lo-Letha Hall, but the scammer who threatened Brock over the phone and set the tragic chain of events in motion remains on the loose more than three months later.

Brock pleaded not guilty, saying he was in fear for his life.

Advantage scammers
Online and telephone rackets have become so commonplace that law enforcement agencies and adult protective services don’t have the resources to keep up.

“It’s a little bit like drinking from a fire hose,” said Brady Finta, a former FBI agent who supervised elder fraud investigations. “There’s just so much of it, logistically and reasonably, it’s almost impossible to overcome right now.”

Grifts also can be difficult to investigate, particularly ones that originate overseas, with stolen funds quickly converted into hard-to-track cryptocurrency or siphoned into foreign bank accounts.

Some police departments don’t take financial scams as seriously as other crime and victims wind up discouraged and demoralized, according to Paul Greenwood, who spent 22 years prosecuting elder financial abuse cases in San Diego.

“There’s a lot of law enforcement who think that because a victim sends money voluntarily through gift cards or through wire transfers, or for buying crypto, that they’re actually engaging in a consensual transaction,” said Greenwood, who travels the country teaching police how to spot fraud. “And that is a big mistake because it’s not. It’s not consensual. They’ve been defrauded.”

Federal prosecutors typically don’t get involved unless the fraud reaches a certain dollar amount, Greenwood said.

The U.S. Justice Department says it does not impose a blanket monetary threshold for federal prosecution of elder financial abuse. But it confirmed that some of the 93 U.S. attorneys’ offices nationwide may set their own thresholds, giving priority to cases in which there are more victims or greater financial impact. Federal prosecutors file hundreds of elder fraud and abuse cases annually.

The Federal Trade Commission says the “vast majority” of frauds go unreported. Often, victims are reluctant to come forward.

A 74-year-old woman recently charged with robbing a credit union north of Cincinnati was the victim of an online scam, according to her family. Authorities say they believe the woman was preyed on by a scammer, yet there is no record she made a formal police report.

“These people are very good at what they do, and they’re very good at deceiving people and prying money out of them,” said Fairview Township, Ohio, police Sgt. Brandon McCroskey, who investigated the robbery. “I’ve seen people almost want to fist fight the police and bank tellers because they … believe in their mind that they need to get this money out.”

A devastating scheme
Older people hold more wealth as a group and present a ripe target for scammers. The impact can be devastating since many of these victims are past their working years and don’t have much time to recoup losses.

Elder fraud complaints to the FBI’s Internet Crime Complaint Center rose by 14% last year, with losses increasing by 11% to $3.4 billion, according to a recent FBI report.

Other estimates put the annual loss much higher.

A 2023 AARP study calculated that Americans over 60 lose $28.3 billion each year to fraud. The Federal Trade Commission, seeking to account for unreported losses, estimated fraudsters stole a staggering $137 billion in 2022, including $48 billion from older adults. The authors of that study acknowledged a “considerable degree of uncertainty.”

In San Diego, 80-year-old William Bortz said criminals stole his family’s nest egg of almost $700,000 in an elaborate scheme involving a nonexistent Amazon order, a fake “refund processing center” in Hong Kong, doctored bank statements and an instruction that Bortz needed to “synchronize bank accounts” in order to get his money back.

Bortz’s scammer was relentless and persuasive, harassing him with dozens of phone calls and, at one point, taking control of his computer.

Even though he was the victim of a crime, Bortz struggles with self-blame.

“I understand now why so much elder abuse fraud is never reported. Because when you look back at it, you think, ‘How could I have been so stupid?’” said Bortz, who retired after a career in banking, financial services and real estate.

His daughter, Ave Williams, said local police and the FBI were diligent in trying to track down the overseas scammer and recover the money, but ran into multiple dead ends. The family blames Bortz’s bank, which Williams said ignored multiple red flags and facilitated several large wire transfers by her father over the course of eight days. The bank denied wrongdoing and the family’s lawsuit against it was dismissed.

“The scammers are getting better,” Williams said. ”We need our law enforcement to be given the tools they need, and we need our banks to get better because they are the first line of defense.”

The Justice Department contends industry needs to do more, saying the U.S. can’t prosecute its way out the problem.

“Private industry — including the tech, retail, banking, fintech, and telecommunications sectors — must make it harder for fraudsters to defraud victims and harder to launder victim proceeds,” the agency said in a statement to The Associated Press.

A way forward
Banking industry officials told a Senate subcommittee in May they are investing heavily in new technologies to stop fraud, “and some hold great promise.” The American Bankers Association says it’s working on a program to coordinate real-time communication among banks to better flag suspicious activity and reduce the flow of stolen funds.

But industry officials said the banks cannot singlehandedly prevent fraud. They said the U.S. needs an overarching national strategy to combat scammers, calling the federal government’s current efforts disjointed and uncoordinated.

Law enforcement agencies and industry need to join forces to fight fraud more quickly and efficiently, said Finta, the former FBI agent, who launched a nonprofit called the National Elder Fraud Coordination Center to cultivate better cooperation between law enforcement and major corporations like Walmart, Amazon and Google.

“There’s very, very smart people and there’s very powerful, wealthy companies that want this to stop,” he said. “So we do have the ability, I think, to make a greater impact and to help out our brothers and sisters in law enforcement that are struggling with this tsunami of fraud.”

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Already fighting voter concerns about his age, Biden, 81, was halting and seemed to lose his train of thought, sparking quick concerns among Democrats about the man they hope will keep former President Donald Trump from returning to office. For his part, Trump made repeated false claims and provocative statements. But Trump seemed smoother and more vigorous than Biden, who is only three years older than the Republican ex-president.

The debate covered a wide range of topics and included a former president — Trump — not backing down from his vows to prosecute members of Congress and even the man he was debating. But the overarching theme was the difference between the candidates’ performance.

Here are some takeaways from the face-off.

Style v. Substance
Presidential debates are often scored on style and impression more than substance. Trump was confident and composed, even as he steamrolled facts on abortion and immigration with false assertions, conspicuous exaggerations and empty superlatives. Biden was often halting, his voice raspy, even when he had the facts on his side. He had difficulty finishing his arguments and marshalling his attacks.

Trump’s supporters have seemed unconcerned about his relationship with the truth, and his performance and delivery helped him. Biden’s supporters consistently express concern about the president’s age and capacity and he did little to reassure them.

One of the first glimpses viewers got of Biden was when he lost his train of thought while making his case on tax rates and the number of billionaires in America — trailing off and looking down at his lectern before mumbling briefly and saying “we finally beat Medicare.” When he tried to finish his point, he was cut off because of the time limits.

At other times, Biden made some puzzling non sequiturs that seemed to undercut what the campaign has said are his strong points, including the economy and abortion rights. As Biden critiqued Trump’s economic record, the president suddenly pivoted to Afghanistan and how Trump “didn’t do anything about that” — although the botched withdrawal of Afghanistan is widely considered one of the lowest points of Biden’s presidency.

Later, as Biden singled out state restrictions on abortion, he confusingly pivoted to immigration and referred to a “young woman who was just murdered” by an immigrant. It was unclear what point he was trying to make.

Jan. 6 and Trump’s revenge
Trump was cruising through the opening of the debate when he suddenly stumbled over the question of how he would reassure voters that he would respect his oath of office after the Jan. 6, 2021, attack on the U.S. Capitol.

He continued to engage in denialism about the attack and refused to denounced those who attacked police and stormed the building by breaking doors and windows. He suggested that those charged will somehow be found one day to be innocent.

More than 1,400 people have been charged with federal offenses stemming from the riot. Of those, more than 850 people have pleaded guilty to crimes, including seditious conspiracy and assaulting police officers. About 200 others have been convicted at trial.

Trump tried to avoid addressing the issue. He defended the people who stormed the Capitol, blaming Biden for prosecuting them. “What they’ve done to some people who are so innocent, you ought to be ashamed of yourself,” Trump told Biden.

Trump warned that the members of the congressional committee that investigated Jan. 6 could face criminal charges, as could Biden himself.

Biden shot back: “The only person on this stage who’s a convicted felon is the man I’m looking at.”

Trump didn’t back down from his vow to seek vengeance. Coupled with his refusal to condemn the Jan. 6 attackers, it made for a stark moment.

Asked if he would accept the results of the election, Trump said, “if it’s a fair and legal and good election, absolutely,” which notably is not an unqualified yes.

Low road
In what may well be a first in a presidential campaign, Trump called the president, Biden, a “criminal” and said he could well be prosecuted after he leaves office. Biden then brought Trump’s recent criminal trial in New York in which prosecutors presented evidence that Trump had sex with a porn actor. “I didn’t have sex with a porn star,” Trump said.

Trump’s vow on abortion
Abortion is an issue Democrats think could help deliver a victory in November. Trump in 2016 campaigned on overturning Roe v. Wade, and as president appointed three Supreme Court justices who provided the deciding votes revoking the 49-year right to the procedure. In response to a question from the moderators, Trump vowed not to go further if he returns to the White House, where his administration would have the authority to outlaw the abortion pill mifepristone, which is widely used.

Overturning Roe is one of Trump’s greatest political vulnerabilities, but on Thursday the former president contended everyone was happy with what he did.

“As far as abortion’s concerned it’s back to the states,” Trump said, contending the Founding Fathers would have been happy with the end of Roe. “Everybody wanted it brought back.”

That’s not true. Polls have shown significant opposition to overturning Roe and voters have punished Republicans in recent elections for it. “The idea that the founders wanted the politicians to be the ones making the decisions about women’s health is ridiculous,” Biden shot back.

In a unanimous decision this month, the Supreme Court preserved access to mifepristone, a pill that was used in nearly two-thirds of all abortions in the U.S. last year.

Until Thursday, Trump had not detailed his position on access to the medication, but during the debate he indicated he supported the justices’ decision, saying: “I will not block it.”

But when it was his turn to speak, Biden stumbled through his explanation of Roe, which he said “had three trimesters” — a lost opportunity for the Democrat to make a strong rhetorical case on an issue vital for his party.

“The first time is between a woman and a doctor,” Biden continued. “Second time is between a doctor and an extreme situation. A third time is between the doctor, I mean, between the women and the state.”

Border skirmish
In recent months, Biden has tried to reverse his poor public standing over his handling of immigration, first by endorsing a bipartisan Senate proposal with some of the toughest border restrictions in recent memory and then, after that legislation collapsed, taking executive action to clamp down on migrants seeking asylum at the southern border.

But as Biden tried to tout the progress he’s made, particularly the 40% drop in illegal border crossings since his border directive was implemented this month, Trump invoked his trademark dark and catastrophic rhetoric to paint a portrait of a chaotic border under Biden’s watch.

For example, Trump argued that the migrants arriving at the U.S. border are coming from “mental institutions” and “insane asylums” — a frequent refrain of his at rallies for which he has offered no evidence. He also claimed the U.S.-Mexico border is the “most dangerous place anywhere in the world” and cited examples of immigrants in the U.S. illegally who had committed violent crimes.

Though some immigrants do commit horrific crimes, a 2020 study published by the National Academy of Sciences found “considerably lower felony arrest rates” among people in the United States illegally than among legal immigrants or native-born. But Trump often benefits from his certitude.

It’s the economy, and Trump said Biden is stupid
The debate began with Biden defending his record on the economy, saying he inherited an economy that was “in a freefall” as it was battered by the pandemic and that his administration put it back together again.

But after Biden touted his administration’s accomplishments — such as lowering the cost of insulin and the creation of millions of new jobs — Trump boasted that he oversaw the “greatest economy in the history of our country” and defended his record on the pandemic.

Biden retorted: “He’s the only one who thinks that.” But Trump responding by attacking him on inflation, arguing that he inherited low rates of inflation when he came into office in January 2021 yet prices “blew up under his leadership.”

Suckers and losers
Biden — whose deceased son, Beau, served in Iraq — had one of his most forceful moments when he went on the attack against Trump’s reported comments in 2018 that he declined to visit a U.S. military cemetery in France because veterans buried there were “suckers” and “losers.”

It was an argument that Biden, then the Democratic challenger, made against Trump in their first 2020 debate and one that the incumbent president has regularly used against Trump, framing him as a commander in chief who nonetheless disparages veterans. “My son was not a loser, was not a sucker,” Biden said. “You’re the sucker. You’re the loser.”

Trump responded that the publication that initially reported this comments, The Atlantic, “was a third-rate magazine” and had made up the quotes. But undercutting Trump’s retort is the fact that his former chief of staff, John Kelly, confirmed those private remarks in a statement last fall.

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Most violations involved pinning people facedown in ways that could restrict their breathing or stunning them repeatedly with Tasers, an Associated Press investigation found.

Some officers had little choice but to break policing best practices — safety guidelines that are recommended by government agencies, law enforcement groups and training experts — to save a life or protect someone.

Many other violations were harder to explain. Officers at times prematurely resorted to weapons or physical holds during routine calls or misread a person’s confusion as defiance in medical emergencies, setting off a string of mistakes. In other cases, they kept applying force even after they had people handcuffed and controlled.

For its investigation, AP catalogued 1,036 deaths over a decade’s time after officers had used force not involving their guns. In about half, medical officials ruled that law enforcement caused or contributed to the deaths, but they usually didn’t mention whether policing best practices were followed.

Counting violations of best practices also was difficult when departments didn’t document important details or withheld their files. But based on a review of tens of thousands of pages of police and court records, as well as hundreds of hours of body-camera video footage, AP found:

— Officers breached the guidelines in three or more ways in roughly 440 deaths, or about 45% of the time. In others, a single mistake sometimes fueled life-threatening injuries.

— Many who died were on drugs or alcohol, or had underlying medical conditions, making them more vulnerable to misapplied force, just as best practices forewarned.

— In about 30% of the deaths where police went outside the guidelines multiple times, the officers or bystanders were facing imminent or potential danger. Safety practices may excuse officers under those circumstances.

Because of how policing is set up in the United States, there are no national rules for how officers apply force. Best practices provide some direction but aren’t mandatory. In the end, individual departments or states set their own policies and training.

Directives from the federal government would help establish consistent use-of-force standards, said Alex del Carmen, a longtime criminologist who has monitored court-ordered reforms at troubled departments and works at Tarleton State University.

While national policing organizations offer guidelines, they don’t always trickle down to officers, and, he added, they “do not take the place of the federal government, who should have taken the lead many years ago in providing direction and clarity.”

The reasons why officers didn’t follow the guidelines varied, AP found. Some testified that they weren’t taught them. In other departments, policies weren’t up to date.

A few times, officers specifically credited their training with helping avoid mistakes. One Ohio deputy, for example, holstered his Taser after he was told a 60-year-old man wanted on a warrant had heart trouble.

Tyler Owen, a former officer, believes nearly all police do get it right. Most encounters don’t involve force, he said, and the solution for avoiding trouble is almost always straightforward: Comply with police.

“By continuing to resist and continuing to fight law enforcement, you are putting yourself at risk,” said Owen, now spokesperson for the Texas Municipal Police Association, the state’s largest law enforcement group.

When officers deal with people who are volatile or can’t comprehend commands, they sometimes need to use force outside best practices — even if that means “doing violent things to go home to their families,” he said.

AP’s investigation, done in collaboration with the Howard Centers for Investigative Journalism and FRONTLINE (PBS), covered 2012 through 2021. While violations spanned many types of “less-lethal force,” the most prevalent happened in the four areas below.

PINNING FACEDOWN
WHAT THE GUIDELINES SAY: Police have been on notice since the 1990s about the risks of pinning someone on their chest in what is known as prone position. The concern started with positional asphyxia — when the chest can’t expand, starving the body of oxygen. But more recently, researchers have warned that compressing the chest also can stress the heart and cause cardiac arrest.

The key is getting someone off their stomach quickly. A 1995 Justice Department bulletin advised doing so “as soon as the suspect is handcuffed” and warned of a “vicious cycle” in which putting weight on a person’s back can further restrict breathing, causing them to struggle more violently to create room for their lungs. That federal guidance came amid increasing concern about prone restraint, including from a national group of police chiefs in 1993.

The DOJ also has warned that prone restraint can be more dangerous to a broad category of people police often confront — those on drugs or alcohol. Also vulnerable are people who are obese, who have cardiac or respiratory problems, or who have already been shocked with stun guns. By 2001, the DOJ advised departments to develop policies addressing positional asphyxia.

WHAT AP FOUND: Officers restrained someone facedown in at least 740 of the 1,036 deaths — usually with one, or sometimes more, using their bodyweight. In about half of the prone restraint cases, police didn’t turn over the person as soon as they were handcuffed or did so only after they had stopped responding.

Where video was available or police reports noted the duration of restraint, a few people were kept on their chests after handcuffing for less than 60 seconds. More often, the pinning continued for minutes while officers bound the suspect’s ankles together or waited for them to stop struggling.

A video obtained by AP showed a police officer in Ava, Missouri, handcuffing a man having a drug relapse and restraining him in a prone position for roughly eight minutes. The officer warned he wouldn’t ease up until the man stopped kicking. Once still, the officer asked the man, “Are you going to be calm now?” He didn’t answer. Another two minutes passed before the officer realized the man didn’t seem to be breathing. A federal judge who reviewed the video ruled in the officer’s favor in a civil lawsuit, saying the law didn’t require police to stop prone restraint once a person quit struggling. That legal interpretation, however, was out of step with federal courts in other regions, which provide broad direction on use of force.

About 240 of the prone restraint cases involved people suspected of using drugs or alcohol. For 11 minutes, officers in Gulfport, Mississippi, held down a 53-year-old man who was causing a disturbance outside a beachside restaurant. Police first shocked him with a Taser and then an officer straddled his back as he was pinned. Previously unreported dashcam video obtained by AP showed him struggling to shift his hips and shoulders, yelling “I can’t breathe.” He eventually became motionless with the officer still on top. The officer told investigators he’d been trained not to put someone on their chest and that his weight was on his knees, insisting — contrary to what the video showed — that he had turned the suspect sideways the entire time. A grand jury declined to charge the officers after the death was ruled accidental from drug use.

At least 180 people pinned to the ground were obese. Knox County deputies in Tennessee realized they needed to reposition a handcuffed man who was facedown in the dirt. “Roll him on his side so he can breathe. He’s got a big belly,” one said. But when the 280-pound man pulled his leg away, officers hog-tied him by crossing his legs, cuffing his ankles and strapping his hands and feet together behind his back. For more than three minutes, close to a dozen deputies stood by as he rolled on his stomach. One pressed a knee and hand into his upper back, forcing him to be still. A minute later, they saw his life was in danger when an officer kneeled next to his motionless body and asked his date of birth. His death was blamed on fentanyl and methamphetamines. The district attorney called the actions of deputies lawful and closed the case, but the family reached an undisclosed settlement with the county in a wrongful death lawsuit.

TOO MUCH TASER
WHAT THE GUIDELINES SAY: When stun guns began gaining popularity among police two decades ago, there were no specific limits for how many times, or how long, someone could be shocked. That changed as deaths and lawsuits against the leading brand of the weapon, Taser, increased.

Axon Enterprise Inc., the maker of Tasers, has long said that in volatile situations, Tasers are a safer alternative to shooting suspects or smashing their head with a baton. Tasers fire small darts that are connected to the weapon with wires, delivering electricity from a close distance that briefly locks up muscles. Officers can also drive Tasers into the body, painfully jolting someone to gain compliance.

The company has insisted that factors like drug intoxication or hidden cardiac problems are really to blame for deaths, not the electricity. But some research began finding repeated shocks can create cardiac and respiratory risks.

In 2011, the Police Executive Research Forum, a national law enforcement policy group, issued guidelines saying officers should be taught that multiple uses may increase the risk of death. The guidelines warned against simultaneous shocks from more than one device and recommended capping the electricity at 15 seconds — or three blasts of the standard 5-second cycle.

By 2013, Axon in its training manual warned to “avoid prolonged and repeated exposures” and cited the concerns from law enforcement and medical groups about going beyond 15 seconds.

Safety recommendations, including from Axon, also say officers should pause between pulling the Taser trigger to evaluate the person before delivering another shock. When multiple shocks aren’t effective, officers should consider other options.

WHAT AP FOUND: Despite the warnings, officers fired their stun guns more than three times or for more than a combined 15 seconds in at least 180 of the 538 deadly encounters involving the weapons.

Three Roswell, New Mexico, officers shocked a 34-year-old man as many as 15 times after they said he was wielding a police-style baton and throwing handfuls of rocks. Some of the darts hit his head and chest. After an initial shot to the chest, the man dropped the baton, yet the stunning continued. A federal judge didn’t find fault with the overall number of Taser shots but did say the final few when the man was on the ground and incapacitated went too far because he was no longer a threat.

In Colorado, one of two officers who fired their Tasers a combined eight times at a man resisting handcuffing testified in a lawsuit that he was not trained about the danger of shocking someone more than three times. The deputy chief of the Colorado Springs Police Department at the time testified that its policy allowed officers to keep delivering electricity until the person’s behavior changed. The department determined the officers did nothing wrong, but the lawsuit alleging poor training of police is ongoing.

One of three officers in South Boston, Virginia, who shocked a man rolling on a hospital sidewalk said a suspect’s actions — not Taser guidelines — dictate what to do. The officers fired their Tasers a combined 20 times, even after handcuffing the man. “There are eight pages of warnings, and basically if I read and abided by every single warning, I would not tase anyone,” the officer said in response to a civil lawsuit later settled out of court. Federal prosecutors said they didn’t see enough evidence to pursue civil right charges against the three officers.

Some cases went far beyond the guidelines issued by Axon and policing experts. Officers fired their stun guns 10 or more times in at least 29 encounters AP identified. In a rare occurrence, two police officers in Wilson, Oklahoma, were convicted of murder after shocking a man 53 times in 2019 — just under four minutes total of firing the Tasers — even though he never tried to attack either officer. A state investigator said the man was naked in a ditch and shocked numerous times because he apparently didn’t follow orders to roll onto his stomach and put his hands behind his back.

SHOCKING THE VULNERABLE
WHAT THE GUIDELINES SAY: Axon and law enforcement organizations have warned police departments for well over a decade that the elderly and people having a mental health or medical crisis are among those at higher risk for sudden death from electrical shocks. Officers also have long been told that people on elevated surfaces or running could have a catastrophic fall when their muscles lock up.

In 2009, Axon first recommended that police aim Taser darts at the back or abdomen instead of the chest whenever possible. While the company said this would increase the weapon’s “effectiveness and avoid the remote potential risk of cardiac effect,” it said the main reason for the change was to defend against lawsuits, according to a company memo explaining the changes.

Many police agencies have adopted at least some of these recommendations, while still giving officers leeway when people pose an immediate danger and the need to control them outweighs the risks.

WHAT AP FOUND: The vulnerable groups most often subjected to shocks were suspected of using illicit drugs or showing signs of bizarre or aggressive behavior, paranoia, or unexpected strength.

Others were vulnerable in different ways. At least 10 people who died after stuns were 65 or older, including a veteran with dementia who had threatened to stab an officer with a pen at a Minnesota nursing home. The 79-year-old fell and broke his hip after the electrified darts connected. He died two months later from complications related to the fall. None of the officers faced an investigation, according to the Stillwater Police Department.

Officers shocked at least 50 people who were fleeing or susceptible to a fall. A federal court in Georgia said a DeKalb County police officer shouldn’t have fired his Taser at an unarmed passenger who inexplicably ran from a traffic stop and then climbed onto an 8-foot wall. The court said the man had neither committed a crime nor made threatening gestures, yet the officer fired his Taser without giving a warning. The man fell, broke his neck and died.

In some cases, officers opted to use a Taser even when a gun might have been justified. Among the more than 100 people shocked by police in the chest, head, neck or genitals was a Michigan man who was sexually assaulting his girlfriend in front of her two children. Hearing him yelling “I’m going to kill her,” one officer fired his Taser to stop the attack. Another shocked the suspect from 5 feet away as he was refusing to turn onto his stomach. That blast near his heart proved to be fatal, a medical examiner said. While the Rockwood Police Department’s policy warned against targeting the chest, the officer said in a deposition that wasn’t where he was aiming and the man was a moving target. He told a state investigator using the Taser was safer than “going hands on” with the man or using his firearm. A prosecutor and a federal court sided with the officers, citing the safety threat.

FORCE AFTER CUFFING
WHAT THE GUIDELINES SAY: For the most part, federal courts have agreed that punching, using Tasers or holding someone facedown is excessive when they’re handcuffed and not resisting or ignoring an officer’s orders.

These federal court decisions have led many departments to adopt policies that allow force against handcuffed people in just a few instances. One model policy, developed by nearly a dozen law enforcement groups in 2017, called for using force against people in restraints only when they would otherwise flee or injure someone.

WHAT AP FOUND: Police failed to promptly turn over at least 360 people after they were handcuffed or controlled — about half of all cases involving prone restraint. Many of the officers also continued to use their bodyweight, hands or knees to apply pressure.

A federal appeals court said officers in Richmond, Virginia, went too far after they handcuffed and pinned a man who refused mental health treatment. After he became motionless, the officers still didn’t let up, the court said. The court didn’t fault the officers’ decision to detain the man, but said he couldn’t have posed a threat once he was outnumbered and handcuffed.

In more than 30 cases, police used Tasers in drive-stun mode or fired darts at someone who was already handcuffed or who had stopped resisting. Police officers in Hazelwood, Missouri, shocked a handcuffed man as many as 13 times and hit him repeatedly with a baton. The man was driving erratically on his way home to celebrate his wedding anniversary and appeared intoxicated. Prosecutors decided police did nothing wrong because he was aggressively resisting. A federal judge, who also sided with the police, said it was clear he fought for eight minutes, and that it took three officers and multiple Taser blasts and baton strikes to subdue him.

In a Delaware case, a federal judge wouldn’t give a state trooper immunity from an excessive force claim after he fired his Taser at a man who appeared to be secured and no longer resisting. The trooper, a certified Taser instructor, initially took steps to avoid a deadly outcome when he came across the man, who had a gun behind his back. Thinking the man might be mentally ill, the trooper holstered his gun and shocked him, causing him to fall and drop his firearm. The trooper rapidly fired again because he thought the man was rolling over and reaching for the gun. But the third jolt of electricity was unjustified, the judge said, because it came 15 seconds later and after officers had secured the man. An expert hired by the family said the final blast hit the man’s chest, something the trooper should have known to avoid.

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Holbrook Mohr in Jackson, Mississippi, and Kristin M. Hall in Nashville, Tennessee, contributed to this report. Mary Dalrymple and Sean Mussenden of the Howard Center for Investigative Journalism at the University of Maryland also contributed.

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Crump said in a statement released Wednesday that Okaloosa County Sheriff’s deputies responding to a disturbance call at the apartment complex in Fort Walton Beach burst into the wrong unit and fatally shot Senior Airman Roger Fortson when they saw he was armed with a gun. Fortson was home alone and on a Facetime call with a friend when deputies arrived at his door, Crump said.

Fortson was based at the Special Operations Wing at Hurlburt Field.

According to Crump, the woman, whom the attorney didn’t identify, said Fortson heard a knock at the door. He asked who was there but didn’t get a response. A few minutes later, Fortson heard a louder knock but didn’t see anyone when he looked through the peephole, Crump said, citing the woman’s account.

The woman said Fortson was concerned and went to retrieve his gun, which Crump said was legally owned.

As Fortson walked back through his living room, deputies burst through the door, saw that Fortson was armed and shot him six times, according to Crump’s statement. The woman said Fortson was on the ground, saying, “I can’t breathe,” after he was shot, Crump said.

Fortson died at a hospital, officials said. The deputy involved in the shooting was placed on administrative leave pending an investigation.

The woman said Fortson wasn’t causing a disturbance during their Facetime call and believes that the deputies must have had the wrong apartment, Crump’s statement said.

“The circumstances surrounding Roger’s death raise serious questions that demand immediate answers from authorities, especially considering the alarming witness statement that the police entered the wrong apartment,” Crump said.

“We are calling for transparency in the investigation into Roger’s death and the immediate release of body cam video to the family,” Crump said. “His family and the public deserve to know what occurred in the moments leading up to this tragedy.”

Crump is a nationally known attorney based in Tallahassee, Florida. He has been involved in multiple high-profile law enforcement shooting cases involving Black people, including those of Ahmaud Arbery, Trayvon Martin, Tyre Nichols, George Floyd and Breonna Taylor, who was also killed in her home during a no-knock police raid that targeted her ex-boyfriend in 2020.

On Wednesday, when he released a statement about Fortson’s death, Crump was in Ohio for the funeral of Frank Tyson, a 53-year-old who died in police custody on April 18.

The Okaloosa County Sheriff’s Office didn’t immediately respond to an email or voicemail from The Associated Press seeking comment about Crump’s statements. But Sheriff Eric Aden posted a statement on Facebook on Wednesday afternoon expressing sadness about the shooting.

“At this time, we humbly ask for our community’s patience as we work to understand the facts that resulted in this tragic event,” Aden said.

The sheriff’s office said in a statement last week that a deputy responding to a call of a disturbance in progress at the apartment complex reacted in self-defense after encountering an armed man. The office did not offer details on what kind of disturbance deputies were responding to or who called them.

The sheriff’s office also declined to immediately identify the responding deputies or their races. Officials said earlier this week that the Florida Department of Law Enforcement and the local State Attorney’s Office will investigate the shooting.

FDLE spokeswoman Gretl Plessinger told The Associated Press on Wednesday that it is highly unlikely the agency will have any further comment until the investigation is complete.

Fortson was assigned to the 4th Special Operations Squadron as a special missions aviator, where one of his roles as a member of the squadron’s AC-130J Ghostrider aircrew was to load the gunship’s 30mm and 105mm cannons during missions.

Fortson’s death draws striking similarities to other Black people killed in recent years by police in their homes, in circumstances that involved officers responding to the wrong address or responding to service calls with wanton uses of deadly force.

In 2018, a white former Dallas police offer fatally shot Botham Jean, an unarmed Black man, after mistaking his apartment for her own. Amber Guyger, the former officer, was found guilty of murder the following year and was sentenced to 10 years in prison.

In 2019, a white former Fort Worth, Texas, officer fatally shot Atatiana Jefferson through a rear window of her home after responding to a nonemergency call reporting that Jefferson’s front door was open. Aaron Dean, the former officer, was found guilty of manslaughter in 2022 and was sentenced to nearly 12 years in prison.

Crump has represented families in both cases as part of his ongoing effort to force accountability for the killings of Black people at the hands of police.

“What I’m trying to do, as much as I can, even sometimes singlehandedly, is increase the value of Black life,” Crump told The Associated Press in 2021 following the conviction a former Minneapolis officer in the murder of George Floyd.

In November 2023, an Okaloosa County Sheriff’s deputy mistook the sound of an acorn hitting his patrol vehicle for a gunshot and fired multiple times at the SUV where a handcuffed Black man was sitting in the backseat. Sheriff’s officials said the man, who was being questioned about stealing his girlfriend’s car, was not injured. He was taken into custody, but released without being charged. The officer who initiated the shooting resigned.

Fort Walton Beach is between Panama City Beach and Pensacola in the Florida Panhandle.

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Once or twice a year, she visits her two adult children in different states. She’s planning multiple other trips, including to a science fiction convention in Scotland and a Disney cruise soon after that, along with a trip next year to neolithic sites in Great Britain.

“I really have more money to spend now than when I was working,” said Harris, 64, an engineer who worked 29 years for the federal government and lives in Albuquerque, New Mexico.

Back then, she and her now-ex-husband were paying for their children’s college educations and piling money into savings accounts. Now, she’s splurging a bit and, for the first time, is willing to pay for first-class plane tickets. She plans to fly business class to Scotland and has arranged for a higher-level suite on the cruise.

“I suddenly realized, with my dad getting old and my mom dying, it’s like, ‘No, you can’t take it with you,’ ” she said. “I could become incapacitated to the point where I couldn’t enjoy something like going to Scotland or going on a cruise. So I better do it, right?”

Older Americans like Harris are fueling a sustained boost to the U.S. economy. Benefiting from outsize gains in the stock and housing markets over the past several years, they are accounting for a larger share of consumer spending — the principal driver of economic growth — than ever before.

And much of their spending is going toward higher-priced services like travel, health care and entertainment, putting further upward pressure on those prices — and on inflation. Such spending is relatively immune to the Federal Reserve’s push to slow growth and tame inflation through higher borrowing rates, because it rarely requires borrowing.

Affluent older Americans, if they own government bonds, may even be benefiting from the Fed’s rate hikes. Those hikes have led to higher bond yields, generating more income for those who own such bonds.

The so-called “wealth effect,” whereby rising home and stock values give people confidence to increase their spending, is a big reason why the economy has defied expectations of a sharp slowdown. Its unexpected strength, which is contributing to stickier inflation, has forced a shift in the Fed’s plans.

As recently as March, the Fed’s policymakers had projected that they would cut their benchmark rate three times this year. Since then, though, inflation measures have remained uncomfortably high, partly a consequence of brisk consumer spending. Chair Jerome Powell made clear recently that the Fed isn’t confident enough that inflation is sustainably easing to cut rates.

When the Fed meets this week, it is sure to keep its benchmark rate unchanged at a 23-year high, the result of 11 rate hikes. The Fed’s hikes have forced up borrowing costs across the economy — for everything from home and auto loans to credit cards and business loans.

Even as the Fed has jacked up borrowing costs, stock and home values have kept rising, enlarging the net worth of affluent households. Consider that household wealth grew by an average of 5.5% a year in the decade after the 2008-2009 Great Recession but that since 2018, it’s accelerated to nearly 9%.

Stock prices, as measured by the S&P 500 index, are about 72% higher than they were five years ago. Home values soared 58% from the end of 2018 through 2023, according to the Federal Reserve.

All told, Americans’ wealth has ballooned from $98 trillion at the end of 2018 to $147 trillion five years later. Adjusting for inflation, the gains are less dramatic, but still substantial.

“People have had significant wealth gains in stocks, significant wealth gains in fixed income, significant wealth gains in home prices, significant wealth gains even in crypto,” said Torsten Slok, chief economist at the Apollo Group, an asset manager. “All that adds up to still a very significant tailwind.”

The gains are hardly universal. The wealthiest one-tenth of Americans own two-thirds of all household wealth. Still, wealth for the median household — the midpoint between the richest and poorest — rose 37% from 2019 to 2022, the sharpest rise on record since the 1980s according to the Fed, to $193,000.

Wealth is also disproportionately held by older Americans. People ages 55 and over now own nearly three-quarters of all household wealth, up from 68% in 2010, according to the Fed. In percentage terms since the pandemic, household net worth has also surged for younger households. But because younger adults started from a much lower level, their gains haven’t been anywhere near enough to keep pace with older Americans.

“The baby boomers are the richest retiring generation we’ve ever had,” said Edward Yardeni, president of Yardeni Research. “Not everybody is well-off, but we’ve never had a retiring generation with this much wealth. That’s one of the major reasons why the economy is strong.”

That said, many older Americans face significant financial challenges. One-quarter of Americans over age 50 have no retirement savings, according to a survey by the AARP.

Even so, as the huge baby boom generation has aged and, on average, has accumulated more assets, they have accounted for a rising share of consumer spending. Americans ages 65 or over supplied nearly 22% of consumer spending in 2022, the most recent year for which data is available. That’s the highest such figure on records dating to 1989, up from about 16% in 2010.

One result of the Fed’s higher rates has been a kind of bifurcated economy, by age. Older, wealthier Americans who already own homes and cars have been much less affected by the Fed’s rate hikes. By contrast, younger Americans are enduring a combination of expensive home prices and high mortgage rates, making it much harder to buy a first home.

Harris, for one, sees this divide in her own family: Her home and car are paid off, and higher interest rates have had little effect on her finances. She recently visited a home in her neighborhood that she was surprised to see priced at $500,000. She bought hers, which she thinks could fetch a higher price, for $162,000 in 1991.

Her 25-year-old daughter, Ruby, had a vastly different experience during a recent visit to an open house near her boyfriend’s apartment in the Boston area. An older two-bedroom apartment was on sale for $800,000; it sold within a week.

Ruby considers herself fortunate to have a well-paying job as a materials engineer. But that apartment price still seemed astronomical. She loves the area, especially for its walkability, but doubts she’ll ever be able to afford a house there.

“In the long term, it probably won’t be affordable to stay here,” she said. “Whereas the Midwest is more affordable but won’t have the neighborhoods that I like.”

Economists calculate that while the wealth effect generally has a relatively modest effect on spending, it may be larger now. That’s because retirement-age Americans, who are more likely to spend out of their wealth, constitute a larger proportion of the nation: Americans ages 65 and over make up about 17% of the population, up from 13% in 2010. And people with stock holdings can now easily access their account balances online, increasing their awareness of increases in their net worth.

Research by Michael Brown, an economist at Visa and others has also found that significant stock market wealth typically boosts spending on discretionary items such as restaurants, travel and entertainment — sectors of the economy where spending is surging and inflation remains elevated.

The Conference Board, a business research group, asks Americans in its monthly survey of consumer confidence whether they plan an overseas vacation in the next six months. Slok noted that more than one in five households say they are — a record-high proportion on records dating to 1967.

The cruise provider Royal Caribbean just reported blowout earnings and strong demand, “leading to higher pricing for all our key products,” CEO Jason Liberty told investors. “Customer sentiment remains very positive, bolstered by resilient labor markets, wage growth, stabilizing inflation and record-high household net worth.”

Last week, the Fed’s preferred inflation gauge, excluding volatile food and energy costs, rose 2.8% from a year earlier, a sign that inflation remains sticky. Solid consumer spending, particularly on services, was one key factor. In one measure of services inflation that the Fed watches closely, prices climbed 3.5% from a year earlier, far higher than is consistent with its 2% inflation target.

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Demetrio Jackson was desperate for medical help when the paramedics arrived.

The 43-year-old was surrounded by police who arrested him after responding to a trespassing call in a Wisconsin parking lot. Officers had shocked him with a Taser and pinned him as he pleaded that he couldn’t breathe. Now he sat on the ground with hands cuffed behind his back and took in oxygen through a mask.

Then, officers moved Jackson to his side so a medic could inject him with a potent knockout drug.

“It’s just going to calm you down,” an officer assured Jackson. Within minutes, Jackson’s heart stopped. He never regained consciousness and died two weeks later.

Jackson’s 2021 death illustrates an often-hidden way fatal U.S. police encounters end: not with the firing of an officer’s gun but with the silent use of a medical syringe.

The practice of giving sedatives to people detained by police has spread quietly across the nation over the last 15 years, built on questionable science and backed by police-aligned experts, an investigation led by The Associated Press has found. Based on thousands of pages of law enforcement and medical records and videos of dozens of incidents, the investigation shows how a strategy intended to reduce violence and save lives has resulted in some avoidable deaths.

At least 94 people died after they were given sedatives and restrained by police from 2012 through 2021, according to findings by the AP in collaboration with FRONTLINE (PBS) and the Howard Centers for Investigative Journalism. That’s nearly 10% of the more than 1,000 deaths identified during the investigation of people subdued by police in ways that are not supposed to be fatal. About half of the 94 who died were Black, including Jackson.

Behind the racial disparity is a disputed medical condition called excited delirium, which fueled the rise of sedation outside hospitals. Critics say its purported symptoms, including “superhuman strength” and high pain tolerance, play into racist stereotypes about Black people and lead to biased decisions about who needs sedation.

The use of sedatives in half these incidents has never been reported, as scrutiny typically focuses on the actions of police, not medics. Elijah McClain’s 2019 death in Aurora, Colorado, was a rare exception: Two paramedics were convicted of giving McClain an overdose of ketamine, the same drug given to Jackson. One was sentenced last month to five years in prison and the second faces sentencing Friday.

It was impossible to determine the role sedatives may have played in each of the 94 deaths, which often involved the use of other potentially dangerous force on people who had taken drugs or consumed alcohol. Medical experts told the AP their impact could be negligible in people who were already dying; the final straw that triggered heart or breathing failure in the medically distressed; or the main cause of death when given in the wrong circumstances or mishandled.

While sedatives were mentioned as a cause or contributing factor in a dozen official death rulings, authorities often didn’t even investigate whether injections were appropriate. Medical officials have traditionally viewed them as mostly benign treatments. Now some say they may be playing a bigger role than previously understood and deserve more scrutiny.

Time and time again, the AP found, agitated people who were held by police facedown, often handcuffed and with officers pushing on their backs, struggled to breathe and tried to get free. Citing combativeness, paramedics administered sedatives, further slowing their breathing. Cardiac and respiratory arrest often occurred within minutes.

Paramedics drugged some people who were not a threat to themselves or others, violating treatment guidelines. Medics often didn’t know whether other drugs or alcohol were in people’s systems, although some combinations cause serious side effects.

Police officers sometimes improperly encouraged paramedics to give shots to suspects they were detaining.

Responders occasionally joked about the medications’ power to knock their subjects out. “Night, night” is heard on videos before deaths in California, Tennessee and Florida.

Emergency medical workers, “if they aren’t careful, can simply become an extension of the police’s handcuffs, of their weapons, of their nightsticks,” said Claire Zagorski, a paramedic and an addiction researcher at the University of Texas at Austin.

Supporters say sedatives enable rapid treatment for drug-related behavioral emergencies and psychotic episodes, protect front-line responders from violence and are safely administered thousands of times annually to get people with life-threatening conditions to hospitals. Critics say forced sedation should be strictly limited or banned, arguing the medications, given without consent, are too risky to be administered during police encounters.

Ohio State University professor Dr. Mark DeBard was an important early proponent of sedation, believing it could be used in rare cases when officers encountered extremely agitated people who needed rapid medical treatment. Today, he said he’s frustrated officers still sometimes use excessive force instead of treating those incidents as medical emergencies. He’s also surprised paramedics have given unnecessary injections by overdiagnosing excited delirium.

Others say the premise was flawed, with sedatives and police restraint creating a dangerous mix. The deaths have left a trail of grieving relatives from coast to coast.

“They’re running around on the streets administering these heavy-duty medications that could be lethal,” said Honey Gutzalenko, a nurse whose husband died after he was injected with midazolam in 2021 while restrained by police near San Francisco. “It’s just not right.”

‘I’M BEGGING YOU TO STOP’
Jackson was standing on a truck outside a radio station on the border of the small Wisconsin cities of Eau Claire and Altoona. An employee called 911 before dawn on Oct. 8, 2021, hoping officers could shoo away a stranger who “doesn’t seem to be a threat, but not normal either.”

Police video and hundreds of pages of law enforcement and medical records show how the incident escalated.

An Altoona police officer met Jackson in the parking lot. Jackson appeared uneasy and paranoid, looking around and talking softly. He had taken methamphetamine, which a psychiatrist said he used to self-medicate for schizophrenia. He’d been in and out of jail and living on the streets, with frequent visits to the emergency room seeking a place to rest.

The officer, joined by a second Altoona officer and a sheriff’s deputy, told him he could leave if he gave his name. Jackson refused.

Police identified him through his tattoos, learning he was on probation for meth possession. They noticed the truck had minor damage and decided to arrest him.

Jackson took off running. The officers chased Jackson, who stopped seconds later and staggered toward the first officer. Body-camera video shows she fired her Taser, its darts striking Jackson in the stomach and thigh. He screamed after the electrical shock and collapsed.

When officers couldn’t handcuff Jackson, she fired additional darts, striking Jackson in the back as he lay on the ground. Officers from the Eau Claire Police Department forced Jackson onto his stomach to be handcuffed and restrained him in what’s known as the prone position.

“I’m begging you to stop,” Jackson said. “I can’t breathe.”

After a couple of minutes, officers moved him to his side and then sat him up, trying to improve his breathing.

An officer wondered aloud whether Jackson had “excited delirium” and asked a colleague if paramedics were “going to stand around and do nothing.” He voiced approval when one arrived with ketamine, adding Jackson would not like it “when he gets poked.”

The Eau Claire Fire Department’s excited delirium protocol advises, “Rapid sedation is the key to de-escalation!!!!!” The medic measured 400 milligrams after estimating the 6-foot-tall Jackson weighed 175 pounds, enough to immobilize someone within minutes. He injected the medicine into Jackson’s buttocks.

Five medical experts who reviewed the case for AP said Jackson’s behavior did not appear to be dangerous enough to justify the intervention.

“I don’t believe he was a candidate for ketamine,” said Connecticut paramedic Peter Canning, who said he supports sedating truly violent patients because they stop fighting and are sleeping by the time they get to the hospital.

Minutes later, Jackson stopped breathing on the way to Sacred Heart Hospital. He’d suffered cardiac arrest and, after he was resuscitated, had no brain function.

Jackson’s mother, Rita Gowens, collapsed while shopping at an Indiana Walmart when she learned her oldest son was hospitalized and not expected to survive.

Gowens rushed to the hospital 500 miles away, where she was told he’d been injected with ketamine. She searched online and was stunned to read it’s used to tranquilize horses.

Gowens spoke to Jackson, held his hand and hoped for a miracle. She eventually agreed to remove him from a ventilator after his condition didn’t improve, singing into his ear as he took his final breaths: “You’ve never lost a battle, and I know, I know, you never will.”

She still has nightmares about how police and medics treated her son, whom she recalls as a happy boy with chunky cheeks that inspired the nickname “Meatball.” There are few days when she doesn’t ask, “Why did they give him an animal tranquilizer?”

KETAMINE MOVES TO THE STREETS
The practice of using ketamine to subdue people outside hospitals began in 2004 when a disturbed man scaled a fence, cut himself with a broken bottle and paced along a narrow strip of concrete on a Minneapolis highway bridge.

The man was in danger of falling into traffic below when officers reached through the fence and grabbed him.

Dr. John Hick, who worked with first responders, heard the emergency radio chatter while driving and rushed to the scene with an idea. Hick gave the man two shots of ketamine, started an IV and kept him breathing with an air mask.

The man stopped struggling, and responders lowered him to safety.

Paramedics had occasionally used other sedatives to calm combative people since the 1980s. Hick and his Hennepin County Medical Center colleague Dr. Jeffrey Ho believed ketamine worked faster and had fewer side effects, showing promise to avert fatal police encounters.

Ho was a leading researcher on Taser safety and an expert witness for the company in wrongful death lawsuits. In a 2007 deposition in one such case, he argued for a potentially “life-saving tactic” of having sedative injections quickly follow Taser shocks, saying the combination could shorten struggles that, if prolonged, might end in death.

Some doctors at his public hospital in Minneapolis were using “something called ketamine, which is an analog to LSD,” he said. “It’s sort of an animal tranquilizer.”

The drug became more common outside the hospital in 2008 when Hennepin County paramedics were given permission to use it.

An American College of Emergency Physicians panel that included Ho said in 2009 that ketamine had shown “excellent results and safety” while acknowledging no research proved it would save lives.

In time, its use became standard from Las Vegas to Columbus, Ohio, to Palm Beach County, Florida. The earliest death involving ketamine documented in AP’s investigation came in 2015, when 34-year-old Juan Carrizales was injected after struggling with police in the Dallas suburb of Garland, Texas.

Shortly after ketamine became authorized for such use in Arizona in 2017, deputies who were restraining David Cutler facedown in handcuffs in the scorching desert asked a paramedic to sedate him.

The medic testified he was surprised when Cutler stopped breathing, although the dose was larger than recommended for someone weighing 132 pounds. He said he had been trained that ketamine didn’t impact respiration. Cutler’s death was ruled an accident due to heat exposure and LSD — though that was disputed by experts hired by Cutler’s family, who said heat stroke along with ketamine caused his death.

In Minneapolis, an oversight agency found the use of ketamine during police calls rose dramatically from 2012 through 2017 and body-camera video showed instances of officers appearing to pressure paramedics to use ketamine and joking about its power. The department told officers they could never “suggest or demand” the use of sedation.

Facing criticism, Hennepin Healthcare halted a study examining the effectiveness of ketamine on agitated patients. The Food and Drug Administration later found the research failed to protect vulnerable, intoxicated people who had not given consent.

By 2021, the American College of Emergency Physicians warned ketamine impacted breathing and the heart more than previously believed.

“Ketamine is not as benign as we might have hoped it to be,” a co-author of the new position, Dr. Jeffrey Goodloe, said on the group’s podcast in 2022.

He said the practice of giving large doses of ketamine, sometimes too much for smaller patients, had spread nationwide as agencies copied each other’s protocols with little independent review.

But the AP’s findings show risks of sedation go beyond ketamine, which was used in at least 19 cases.

Roughly half of the 94 deaths documented by the AP came after the use of midazolam, which has long been known to heighten the risk of respiratory depression. Many came during police encounters in California, where ketamine is not widely used. Midazolam, a common pre-surgery drug known by the brand name Versed, is also part of a three-drug cocktail used in some states to execute prisoners.

Other cases involved a range of other drugs, including the antipsychotic medications haloperidol and ziprasidone, which can cause irregular heartbeats.

The need for monitoring side effects is often laid out for paramedics in written guidelines, many of which are based on the disputed belief that excited delirium can cause sudden death.

THE HISTORY OF ‘EXCITED DELIRIUM’
The theory of excited delirium was troubling from the start.

In the 1980s, with cocaine use soaring, Dr. Charles Wetli, a Miami forensic pathologist, coined the term to explain a handful of deaths of violent cocaine users, many of whom had been restrained by police. Wetli, who died in 2020, also blamed excited delirium for the mysterious deaths of more than a dozen Black women. He said cocaine and sexual activity triggered the fatal condition.

The women’s deaths eventually were attributed to a serial killer. Wetli’s theory survived. And over time, symptoms described by Wetli and others — “superhuman strength,” animal-like noises and high pain tolerance — became disproportionately assigned to Black people. The terms spread to police and emergency medical services to describe certain agitated people — and explain sudden deaths.

By the mid-2000s, police were encountering more drug users and mentally ill people as stimulant use increased and psychiatric hospitals closed. Departments adopted Tasers as a less-lethal alternative to firearms, but there was a problem — hundreds died after being jolted.

Supporters of Wetli’s research, including the medical examiner in Miami-Dade County, ruled again and again that excited delirium was the cause of these deaths, not the effects of the weapons and other physical force. Executives at Taser’s manufacturer agreed, promoting excited delirium to medical examiners around the country and retaining experts who explained the concept to juries in wrongful death lawsuits.

In 2006, a grand jury that investigated Taser-related deaths in Miami-Dade recommended an untested treatment that it said could save people before they died from excited delirium: squirting midazolam up their noses to cause “almost immediate sedation.” Its report acknowledged they “may experience difficulty in breathing.” Miami-Dade paramedics adopted this treatment.

But key medical groups didn’t recognize excited delirium, and activists were calling for limits on Taser use. What happened next would help promote sedation alongside Tasers as tools to gain control.

In 2008, the biggest names in excited delirium research gathered at a Las Vegas hotel for a three-day meeting organized by a group with ties to Taser’s manufacturer.

“A lot of talk took place on chemical sedation because the cops didn’t know what to do with these people,” recalled John Peters, president of the Institute for the Prevention of In-Custody Deaths, which sponsored the meeting. “Jeff Ho had done some work up in Minnesota. He said, ‘Look. I’ve been using ketamine. It knocks them out quicker.’”

The timing was fortuitous: The American College of Emergency Physicians would soon form a task force to study excited delirium and how police and medics should respond.

The 19-member panel included Ho, who became Taser’s medical director under an arrangement in which the company paid part of his hospital salary; Dr. Donald Dawes, a Taser research consultant; and University of Miami researcher Deborah Mash, who testified for Taser about several deaths she blamed on excited delirium. At least two other panelists were routinely retained by officers and their departments as expert witnesses.

The panel’s 2009 paper disclosed none of these relationships. It found excited delirium was real, could result in death regardless of whether someone was shocked with a Taser and called for “aggressive chemical sedation” to treat the symptoms.

DeBard, the Ohio doctor who chaired the panel, told AP he recruited relevant experts to join and that disclosure of conflicts wasn’t required by the ER doctors group then. He said Taser didn’t influence the outcome, which reflected the panel’s consensus. Mash said she had no conflict because Taser didn’t fund her research. Dawes declined an interview request. Ho didn’t return messages.

Taser rebranded itself in 2017 as Axon. A spokesperson for the company declined interview requests and did not respond to written questions.

Dr. Brooks Walsh, an emergency physician in Connecticut who was not on the panel, said the 2009 paper reinforced racial bias as it formalized “loaded terms” used to describe excited delirium, influencing how the diagnosis would be applied.

Ho and other Taser- and police-aligned experts joined a federally sponsored panel in 2011 that built on the work, recommending four actions on a checklist for officers and paramedics: Identify excited delirium symptoms; control (with a Taser if necessary); sedate; and transport to a hospital.

No test measures for excited delirium, so paramedics faced a judgment call: Which patients were so agitated, strong, impervious to pain and dangerous that they needed to be sedated?

DeBard said the symptoms were based on medical observations, not race. “If you’ve got somebody that’s delirious, irrational, aggressive, hyperactive, running around naked, I mean, it’s really pretty easy” to recognize, he said.

Yet, over time, prominent medical groups and some experts pointed to overuse of sedation during police encounters and a disproportionate impact on Black people. Even supporters of the practice have acknowledged that the wrong patients at times have been injected.

The deaths of Black men in police custody, including the 2020 killing of George Floyd, put pressure on the medical community to re-examine excited delirium. The ER doctors group in 2023 withdrew approval of the 2009 paper and said excited delirium shouldn’t be used in court testimony. Some doctors called that decision political and note the group still recognizes a similar condition — hyperactive delirium with severe agitation — that can be treated with sedation. But today no major medical association legitimizes excited delirium.

‘CONVENIENT FOR LAW ENFORCEMENT’
In more than a dozen cases reviewed by AP, police asked for or suggested the use of sedatives, calling into question whether medics were working for law enforcement or in patients’ interests. Officers often suggested their detainees had excited delirium.

University of California, Berkeley, law and bioethics professor Osagie Obasogie, who has studied excited delirium and sedation, said officers should be banned from influencing medical care.

“We need to be sure that folks are treated in a way that meets their medical needs and not simply given a chemical restraint because it’s convenient for law enforcement,” he said.

Officers are told not to dictate medical treatment but “some knuckleheads” have done otherwise, said Peters, whose group hosted the 2008 Las Vegas meeting that focused on excited delirium.

Paramedics say they make medical decisions independently from police, following guidelines that call for sedating people who may be dangerous. But in several cases AP found, people were injected though they had calmed down or even passed out after struggles with police.

Ivan Gutzalenko, a 47-year-old father, was struggling to breathe as two officers restrained him in Richmond, California. Gutzalenko told the officers they were hurting him, and bucked to try to get one off his back.

A paramedic viewed Gutzalenko’s action as aggression, and went to his ambulance to get a 5-milligram dose of midazolam. When he returned three minutes later, Gutzalenko lay motionless. “He’s faking like he’s unconscious,” an officer said.

The medic plunged the needle into his bicep. Gutzalenko’s heart stopped. He was declared dead at a hospital. A pathologist testified that midazolam was given to “quiet him down” during an episode of excited delirium but did not contribute to the death, which he blamed on prone restraint and meth use.

His wife said Gutzalenko, a former critical care nurse, would never have consented to receive midazolam that day.

“I know from being a registered nurse since 2004, you don’t administer a sedative to someone who is clearly already in respiratory distress,” she said, adding that his death has been devastating to their two teenage children.

Dr. Gail Van Norman, a University of Washington professor of anesthesiology and pain medicine, said it’s dangerous for officers to put pressure on the backs and necks of detainees before and after they’re injected with sedatives.

“It’s a recipe for disaster, because you may have created a situation in which you are impeding a person’s ability to get oxygen,” she said.

The AP investigation found half who died following sedation had been shocked with a Taser and the majority had been restrained facedown.

Their blood acid levels may already have been spiking from drugs, adrenaline and pain while oxygen levels may have been plummeting — life-threatening conditions called acidosis and hypoxia.

Sedatives can dull the instinct to compensate by breathing quickly and heavily to blow off carbon dioxide, essential for the heart to beat, said Dr. Christopher Stephens, a UTHealth Houston anesthesiologist and former paramedic.

Under sedation, he said, the body doesn’t respond as efficiently to the buildup of carbon dioxide. “Your brain doesn’t care as much about it,” Stephens said. “And they can go into respiratory and cardiac arrest.”

Paramedics usually have no idea whether their patients have alcohol, opioids or other depressants in their bodies that increase sedatives’ effects on breathing.

More than a dozen who died had been drinking, including Jerica LaCour, 29, a Colorado Springs, Colorado, mother of five young children.

She was stressed about family finances, husband Anthony LaCour recalled, when deputies found her trespassing at a trucking company.

“Guess who gets ketamine?” paramedic Jason Poulson of AMR, the nation’s largest ambulance company, said as LaCour was restrained on a gurney, according to body-camera footage.

An EMT said in a report that she told Poulson that LaCour had calmed and didn’t need ketamine, and later warned that LaCour was no longer breathing. In a disciplinary agreement with state regulators, Poulson admitted he was unsuccessful in protecting LaCour’s airway despite multiple attempts, mishandled the syringe and failed to document the ketamine use properly. His state certification was put on probation.

AMR and Poulson deny responsibility for LaCour’s death in her family’s pending lawsuit, arguing LaCour was experiencing excited delirium and ketamine was appropriate.

AFTER DEATH, SEDATION GOES UNQUESTIONED
When people died, the use of sedation often went unacknowledged publicly and unquestioned by investigators.

After Jackson’s death in Wisconsin, police press releases said nothing about ketamine. State police redacted mention of the drug from investigation records and blurred video of the prone restraint and injection, saying his family’s privacy outweighed the public interest in disclosure.

The fire department, which declined comment, blacked out the information in its incident report. But when AP uploaded the document, redactions disappeared, revealing Jackson was given 400 milligrams of ketamine.

An autopsy concluded Jackson died from complications caused by meth. The report said Jackson’s ketamine dose was 100 milligrams, a quarter of what the fire department report said.

Two longtime forensic pathologists who reviewed the case for AP said meth use wasn’t the only factor. Dr. Joye Carter said she believed the police altercation and ketamine caused the death, saying the sedative can cause heart problems when given to a meth user.

Dr. Victor Weedn said the level of meth in Jackson’s blood was high but generally not lethal. He said Jackson likely died from high blood acid levels, with police restraint and possibly ketamine contributing.

The autopsy was performed in Ramsey County, Minnesota. A county spokesperson defended the findings from a now-retired medical examiner, saying the discrepancy on the ketamine dose wasn’t significant.

Citing the autopsy’s finding that meth was the cause, Eau Claire County District Attorney Peter Rindal ruled Jackson’s case was not an “officer-involved death” under Wisconsin law and closed the investigation.

In nearly 90% of the deaths examined by AP, coroners and medical examiners did not list sedation as a cause or contributing factor. Some autopsy reports failed to document that the deceased had been sedated.

The most common ruling was an accidental death in which other drugs, often meth or cocaine, were causes or contributing factors. More than a quarter were at least partially attributed to excited delirium.

Medical examiners view sedatives as safe treatments to control patients and wouldn’t question their use unless there was a grievous error, said Dr. James Gill, the chief medical examiner of Connecticut and past president of the National Association of Medical Examiners.

“Generally we’re going to default then back to what’s the underlying disease or injury that started this chain of events,” Gill said.

He said sedatives rarely cause deaths by themselves but additional studies could look at whether they play a role in fatal police struggles where many factors are involved.

Even when autopsies implicated sedatives, investigations didn’t always follow.

In LaCour’s case, the coroner found she died from “respiratory arrest associated with acute alcohol and ketamine intoxication.” The district attorney’s office said it had no record of reviewing her death.

Nine miles from LaCour’s injection, a paramedic injected 26-year-old Hunter Barr with ketamine as officers held him facedown in the dirt outside his Colorado Springs home in September 2020.

Retired postal worker Mark Barr had called 911 for help controlling his son, who he said wasn’t violent but was having a bad reaction to LSD. He watched as a medic gave two injections just minutes apart. He said he couldn’t figure out why the second injection was necessary, saying his son was subdued. Hunter Barr became unconscious on the way to a hospital and died within hours.

The coroner ruled Barr died from the effects of ketamine. The Colorado Springs Police Department closed the case as “non-criminal” and the DA’s office again had no review.

When deaths were investigated, inquiries usually focused on whether police used excessive force. In audio and video reviewed by AP, investigators seemed uninterested in how sedation may have contributed.

“I’m not trying to get in the weeds with a whole bunch of that,” an investigator told a paramedic explaining the ketamine injection he gave 18-year-old Giovani Berne before Berne’s heart stopped in Palm Bay, Florida, in 2016.

Berne’s sister, Christina, said the family didn’t know he had been given ketamine until contacted by AP years later, but “we knew something bad happened in the ambulance.” A medical examiner ruled that Berne died of excited delirium.

The death of McClain, 23, in Colorado is the only one that resulted in charges against paramedics. Prosecutors argued Aurora paramedics Jeremy Cooper and Peter Cichuniec didn’t assess McClain, gave him too much ketamine for someone his size and didn’t monitor him afterward.

Their convictions shook the EMS field, whose leaders say treatment mistakes shouldn’t be criminalized. Defense attorneys argued the paramedics followed their training on excited delirium and ketamine. A judge gave Cichuniec five years in prison while Cooper is scheduled to be sentenced Friday.

Civil liability is also rare, in part because deaths have multiple causes and some courts have ruled that unwilling injections aren’t excessive force even when they cause harm. That hasn’t stopped families from trying: A number of wrongful death lawsuits involving sedation are pending.

Lawmakers in Colorado banned excited delirium as a justification for using ketamine and put other restrictions on the drug, but changes in the law elsewhere have been few.

Paramedic reformers are working to address the failures that increase the risk of sedatives contributing to deaths.

Paramedic Eric Jaeger helped rewrite New Hampshire’s protocols and, at a fire station in Hooksett, recently used Jackson’s death as a training scenario after evaluating the case for AP. He questioned whether sedation was necessary. He said medics failed to thoroughly evaluate Jackson and should have had monitoring equipment ready before any injection.

He said he had been aware of a handful of deaths but the number found by AP “dramatically increases” the scope.

“If we don’t change the training, change the protocols, change the leadership to make the system safer,” Jaeger said, “then we all bear responsibility for future deaths.”

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Slemp expected to return to work after having her son in August. But then she and her husband started looking for child care – and doing the math. The best option would cost about $2,000 a month, with a long wait list, and even the least expensive option would cost around $1,600, still eating up most of Slemp’s salary. Her husband earns about $35 an hour at a hose distribution company. Between them, they earned too much to qualify for government help.

“I really didn’t want to quit my job,” says Slemp, 33, who lives in a Seattle suburb. But, she says, she felt like she had no choice.

The dilemma is common in the United States, where high-quality child care programs are prohibitively expensive, government assistance is limited, and daycare openings are sometimes hard to find at all. In 2022, more than 1 in 10 young children had a parent who had to quit, turn down or drastically change a job in the previous year because of child care problems. And that burden falls most on mothers, who shoulder more child-rearing responsibilities and are far more likely to leave a job to care for kids.

Even so, women’s participation in the workforce has recovered from the pandemic, reaching historic highs in December 2023. But that masks a lingering crisis among women like Slemp who lack a college degree: The gap in employment rates between mothers who have a four-year degree and those who don’t has only grown.

For mothers without college degrees, a day without work is often a day without pay. They are less likely to have paid leave. And when they face an interruption in child care arrangements, an adult in the family is far more likely to take unpaid time off or to be forced to leave a job altogether, according to an analysis of Census survey data by The Associated Press in partnership with the Education Reporting Collaborative.

In interviews, mothers across the country shared how the seemingly endless search for child care, and its expense, left them feeling defeated. It pushed them off career tracks, robbed them of a sense of purpose, and put them in financial distress.

Women like Slemp challenge the image of the stay-at-home mom as an affluent woman with a high-earning partner, said Jessica Calarco, a sociologist at the University of Wisconsin-Madison.

“The stay-at-home moms in this country are disproportionately mothers who’ve been pushed out of the workforce because they don’t make enough to make it work financially to pay for child care,” Calarco said.

Her own research indicates three-quarters of stay-at-home moms live in households with incomes less than $50,000, and half have household incomes of less than $25,000.

Still, the high cost of child care has upended the careers of even those with college degrees.

When Jane Roberts gave birth in November, she and her husband, both teachers, quickly realized sending baby Dennis to day care was out of the question. It was too costly, and they worried about finding a quality provider in their hometown of Pocatello, Idaho.

The school district has no paid medical or parental leave, so Roberts exhausted her sick leave and personal days to stay home with Dennis. In March, she returned to work and husband Mike took leave. By the end of the school year, they’ll have missed out on a combined nine weeks of pay. To make ends meet, they’ve borrowed money against Jane’s life insurance policy.

In the fall, Roberts won’t return to teaching. The decision was wrenching. “I’ve devoted my entire adult life to this profession,” she said.

For low- and middle-income women who do find child care, the expense can become overwhelming. The Department of Health and Human Services has defined “affordable” child care as an arrangement that costs no more than 7% of a household budget. But a Labor Department study found fewer than 50 American counties where a family earning the median household income could obtain child care at an “ affordable ” price.

There’s also a connection between the cost of child care and the number of mothers working: a 10% increase in the median price of child care was associated with a 1% drop in the maternal workforce, the Labor Department found.

In Birmingham, Alabama, single mother Adriane Burnett takes home about $2,800 a month as a customer service representative for a manufacturing company. She spends more than a third of that on care for her 3-year-old.

In October, that child aged out of a program that qualified the family of three for child care subsidies. So she took on more work, delivering food for DoorDash and Uber Eats. To make the deliveries possible, her 14-year-old has to babysit.

Even so, Burnett had to file for bankruptcy and forfeit her car because she was behind on payments. She is borrowing her father’s car to continue her delivery gigs. The financial stress and guilt over missing time with her kids have affected her health, Burnett said. She has had panic attacks and has fainted at work.

“My kids need me,” Burnett said, “but I also have to work.”

Even for parents who can afford child care, searching for it — and paying for it — consumes reams of time and energy.

When Daizha Rioland was five months pregnant with her first child, she posted in a Facebook group for Dallas moms that she was looking for child care. Several warned she was already behind if she wasn’t on any wait lists. Rioland, who has a bachelor’s degree and works in communications for a nonprofit, wanted a racially diverse program with a strong curriculum.

While her daughter remained on wait lists, Rioland’s parents stepped in to care for her. Finally, her daughter reached the top of a waiting list — at 18 months old. The tuition was so high she could only attend part-time. Rioland got her second daughter on waiting lists long before she was born, and she now attends a center Rioland trusts.

“I’ve grown up in Dallas. I see what happens when you’re not afforded the luxury of high-quality education,” said Rioland, who is Black. “For my daughters, that’s not going to be the case.”

Slemp still sometimes wonders how she ended up staying at home with her son – time she cherishes but also finds disorienting. She thought she was doing well. After stints at a water park and a call center, her state job seemed like a step toward financial stability. How could it be so hard to maintain her career, when everything seemed to be going right?

“Our country is doing nothing to try to help fill that gap,” Slemp said. As a parent, “we’re supposed to keep the population going, and they’re not giving us a chance to provide for our kids to be able to do that.”

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Reaching the United States was a harrowing ordeal. Silva, 25, her husband and their then-7-year-old daughter braved the treacherous jungles of Panama’s Darien Gap, traveled the length of Mexico, crossed the Rio Grande and then turned themselves in to the U.S. Border Patrol in Brownsville, Texas. Seeking asylum, they received a work permit last year and found jobs in Rock Hill, South Carolina.

“My plan is to help my family that much need the money and to grow economically here,” Silva said.

Her story amounts to far more than one family’s arduous quest for a better life. The millions of jobs that Silva and other new immigrant arrivals have been filling in the United States appear to solve a riddle that has confounded economists for at least a year:

How has the economy managed to prosper, adding hundreds of thousands of jobs, month after month, at a time when the Federal Reserve has aggressively raised interest rates to fight inflation — normally a recipe for a recession?

Increasingly, the answer appears to be immigrants — whether living in the United States legally or not. The influx of foreign-born adults vastly raised the supply of available workers after a U.S. labor shortage had left many companies unable to fill jobs.

More workers filling more jobs and spending more money has helped drive economic growth and create still-more job openings. The availability of immigrant workers eased the pressure on companies to sharply raise wages and to then pass on their higher labor costs to their customers via higher prices that feed inflation. Though U.S. inflation remains elevated, it has plummeted from its levels of two years ago.

“There’s been something of a mystery — how are we continuing to get such extraordinary strong job growth with inflation still continuing to come down?’’ said Heidi Shierholz, president of the Economic Policy Institute and a former chief economist at the Labor Department. “The immigration numbers being higher than what we had thought — that really does pretty much solve that puzzle.’’

While helping fuel economic growth, immigrants also lie at the heart of an incendiary election-year debate over the control of the nation’s Southern border. In his bid to return to the White House, Donald Trump has attacked migrants in often-degrading terms, characterizing them as dangerous criminals who are “poisoning the blood” of America and frequently invoking falsehoods about migration. Trump has vowed to finish building a border wall and to launch the “largest domestic deportation operation in American history.” Whether he or President Joe Biden wins the election could determine whether the influx of immigrants, and their key role in propelling the economy, will endure.

The boom in immigration caught almost everyone by surprise. In 2019, the Congressional Budget Office had estimated that net immigration — arrivals minus departures — would equal about 1 million in 2023. The actual number, the CBO said in a January update, was more than triple that estimate: 3.3 million.

Thousands of employers desperately needed the new arrivals. The economy — and consumer spending — had roared back from the pandemic recession. Companies were struggling to hire enough workers to keep up with customer orders.

The problem was compounded by demographic changes: The number of native-born Americans in their prime working years — ages 25 to 54 — was dropping because so many of them had aged out of that category and were nearing or entering retirement. This group’s numbers have shrunk by 770,000 since February 2020, just before COVID-19 slammed the economy.

Filling the gap has been a wave of immigrants. Over the past four years, the number of prime-age workers who either have a job or are looking for one has surged by 2.8 million. And nearly all those new labor force entrants — 2.7 million, or 96% of them — were born outside the United States. Immigrants last year accounted for a record 18.6% of the labor force, according to the Economic Policy Institute’s analysis of government data.

And employers welcomed the help.

Consider Jan Gautam, CEO of the lodging company Interessant Hotels & Resort Management in Orlando, Florida, who said he can’t find American-born workers to take jobs cleaning rooms and doing laundry in his 44 hotels. Of Interessant’s 3,500 workers, he said, 85% are immigrants.

“Without employees, you are broken,” said Gautam, himself an immigrant from India who started working in restaurants as a dishwasher and now owns his own company.

“If you want boost the economy,” he said, “it definitely needs to have more immigrants coming out to this country.”

Or consider the workforce of the Flood Brothers farm in Maine’s “dairy capital’’ of Clinton. Foreign-born workers make up fully half the farm’s staff of nearly 50, feeding the cows, tending crops and helping collect the milk — 18,000 gallons each day.

“We cannot do it without them,” said Jenni Tilton-Flood, a partner in the operation.

For every unemployed person in Maine, after all, there are two job openings, on average.

“We would not have an economy, in Maine or in the U.S. if we did not have highly skilled labor that comes from outside of this country,” Tilton-Flood said in a phone interview with The Associated Press from her farm.

“Without immigrants — both new asylum-seekers as well as our long-term immigrant contributors — we would not be able to do the work that we do,” she said. “Every single thing that affects the American economy is driven by and will only be saved by accepting immigrant labor.”

A study by Wendy Edelberg and Tara Watson, economists at the Brookings Institution’s Hamilton Project, has concluded that over the past two years, new immigrants raised the economy’s supply of workers and allowed the United States to generate jobs without overheating and accelerating inflation.

In the past, economists typically estimated that America’s employers could add no more than 60,000 to 100,000 jobs a month without overheating the economy and igniting inflation. But when Edelberg and Watson included the immigration surge in their calculations, they found that monthly job growth could be roughly twice as high this year — 160,000 to 200,000 — without exerting upward pressure on inflation.

“There are significantly more people working in the country,” Fed Chair Jerome Powell said last week in a speech at Stanford University. Largely because of the immigrant influx, Powell said, “it’s a bigger economy but not a tighter one. Really an unexpected and an unusual thing.’’

Trump has repeatedly attacked Biden’s immigration policy over the surge in migrants at the Southern border. Only about 27% of the 3.3 million foreigners who entered the United States last year did so through as “lawful permanent residents’’ or on temporary visas, according to Edelberg and Watson’s analysis. The rest — 2.4 million — either came illegally, overstayed their visas, are awaiting immigration court proceedings or are on a parole program that lets them stay temporarily and sometimes work in the country.

“So there you have it,’’ Douglas Holtz-Eakin, a former CBO director who is president of the conservative American Action Forum, wrote in February. “The way to solve an inflation crisis is to endure an immigration crisis.”

Many economists suggest that immigrants benefit the U.S. economy in several ways. They take generally undesirable, low-paying but essential jobs that most U.S.-born Americans won’t, like caring for children, the sick and the elderly. And they can boost the country’s innovation and productivity because they are more likely to start their own businesses and obtain patents.

Ernie Tedeschi, a visiting fellow at Georgetown University’s Psaros Center and a former Biden economic adviser, calculates that the burst of immigration has accounted for about a fifth of the economy’s growth over the past four years.

Critics counter that a surge in immigration can force down pay, particularly for low-income workers, a category that often includes immigrants who have lived in the United States longer. Last month, in the most recent economic report of the president, Biden’s advisers acknowledged that “immigration may place downward pressure on the wages of some low-paid workers” but added that most studies show that the impact on the wages of the U.S.-born is “small.”

Even Edelberg notes that an unexpected wave of immigrants, like the recent one, can overwhelm state and local governments and saddle them with burdensome costs. A more orderly immigration system, she said, would help.

The recent surge “is a somewhat disruptive way of increasing immigration in the United States,” Edelberg said. “I don’t think anybody would have sat down and said: ‘Let’s create optimal immigration policy,’ and this is what they would come up with.”

Holtz-Eakin argued that an immigration cutoff of the kind Trump has vowed to impose, if elected, would result in “much, much slower labor force growth and a return to the sharp tradeoff’’ between containing inflation and maintaining economic growth that the United States has so far managed to avoid.

For now, millions of job vacancies are being filled by immigrants like Mariel Marrero. A political opponent of Venezuela’s authoritarian President Nicolás Maduro, Marrero, 32, fled her homeland in 2016 after receiving death threats. She lived in Panama and El Salvador before crossing the U.S. border and applying for asylum.

Her case pending, she received authorization to work in the United States last July. Marrero, who used to work in the archives of the Venezuelan Congress in Caracas, found work selling telephones and then as a sales clerk at a convenience store owned by Venezuelan immigrants.

At first, she lived for free at the house of an uncle. But now she earns enough to pay rent on a two-bedroom house she shares with three other Venezuelans in Doral, Florida, a Miami suburb with a large Venezuelan community. After rent, food, electricity and gasoline, she has enough left over to send $200 a month to her family in Venezuela.

“One hundred percent — this country gives you opportunities,’’ she said.

Marrero has her own American dream:

“I imagine having my own company, my house, helping my family in a more comfortable way.”

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