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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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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Sen. Bernie Sanders, the far-left independent from Vermont, this week introduced a bill that would shorten to 32 hours the amount of time many Americans can work each week before they’re owed overtime.

Given advances in automation, robotics and artificial intelligence, Sanders says U.S. companies can afford to give employees more time off without cutting their pay and benefits.

Critics say a mandated shorter week would force many companies to hire additional workers or lose productivity.

Here’s what to know about the issue:

What would Sanders’ proposal do?
The bill Sanders introduced Wednesday in the Senate would reduce the standard workweek from 40 hours to 32 hours. Employers would be prohibited from reducing their workers’ pay and benefits to match their lost hours.

That means people who currently work Monday through Friday, eight hours per day, would get to add an extra day to their weekend. Workers eligible for overtime would get paid extra for exceeding 32 hours in a week.

Sanders says the worktime reductions would be phased in over four years. He held a hearing on the proposal Thursday in the Senate Health, Education, Labor and Pensions Committee, of which Sanders is the chairman.

How would a shorter workweek affect employees and productivity?
One recent study of British companies that agreed to adopt a 32-hour workweek concluded that employees came to work less stressed and more focused while revenues remained steady or increased.

In 2022, a team of university researchers and the nonprofit 4 Day Week Global enlisted 61 companies to reduce working hours for six months without cutting wages. Afterward, 71% of the 2,900 workers said they were less burned out and nearly half reported being more satisfied with their jobs.

Meanwhile, 24 of the participating companies reported revenue growth of more than 34% over the prior six months. Nearly two dozen others saw a smaller increase.

“The majority of employees register an increase in their productivity over the trial. They are more energized, focused and capable,” Juliet Shor, a Boston College sociology professor and a lead researcher on the UK study, told Sanders’ Senate committee.

Critics say a 32-hour workweek might work for companies where employees spend most of their time at computers or in meetings, but could be disastrous for production at manufacturing plants that need hands-on workers to keep assembly lines running.

“These are concepts that have consequences,” Roger King, of the HR Policy Association, which represents corporate human resource officers, told the Senate committee. “It just doesn’t work in many industries.”

What’s the response in Washington?
With considerable opposition from Republicans, and potentially some Democrats, don’t expect Sanders’ proposal to get very far in the Senate. A companion bill by Democratic Rep. Mark Takano of California is likely doomed in the GOP-controlled House.

GOP Sen. Bill Cassidy of Louisiana said paying workers the same wages for fewer hours would force employers to pass the cost of hiring more workers along to consumers.

“It would threaten millions of small businesses operating on a razor-thin margin because they’re unable to find enough workers,” said Cassidy, the ranking Republican on the committee. “Now they’ve got the same workers, but only for three-quarters of the time. And they have to hire more.”

Sanders has used his platform as the committee’s chairman to showcase legislation aimed at holding big corporations more accountable to workers. He blamed greedy executives for pocketing extra profits as technology has boosted worker productivity.

“Do we continue the trend that technology only benefits the people on top, or do we demand that these transformational changes benefit working people?” Sanders said. “And one of the benefits must be a lower workweek, a 32-hour workweek.”

How did we decide a 40-hour workweek was the standard?
The Fair Labor Standards Act, signed into law by President Franklin D. Roosevelt in 1938, restricted child labor and imposed other workplace protections that included limiting the workweek to 44 hours. The law was amended two years later to make it a 40-hour week.

The landmark law followed a century of labor-union efforts seeking protections for the many overworked people in the U.S., said Tejasvi Nagaraja, a labor historian at Cornell University’s School of Industry and Labor Relations.

“The issue of time was always as important, or more important, than money for labor unions and labor advocates,” Nagaraja said.

In the 1830s, coal miners and textile workers began pushing back against workdays of up to 14 hours. After the Civil War, the abolition of slavery caused those in the U.S. to take a fresh look at workers’ rights. Unions rallied around the slogan: “Eight hours for work, eight hours for rest, eight hours for what you will.”

The federal government took tentative steps toward limiting working time. In 1869, President Ulysses S. Grant ordered an eight-hour workday for government employees. In 1916, Congress mandated the same for railroad workers.

Other reforms came from private industry. In 1926, Henry Ford adopted a 40-hour week for his automobile assembly workers more than a decade before Congress mandated it.

Ford wrote: “It is high time to rid ourselves of the notion that leisure for workmen is either lost time or a class privilege.”

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The changes have made it so anyone following you on the platform formerly known as Twitter can call and see your Internet Protocol address by default.

An IP address lists where your phone or computer lives on the internet — it’s how you get messages and load websites. An exposed IP address can make you more vulnerable to dangers from spam to ID theft to revealing your location.

It poses perhaps the most serious risk to people like human-rights activists who create online accounts under pseudonyms to avoid persecution.

If you want to avoid random calls from people you may not know or want to hide your IP address from the X community, here are the mobile app settings you need to change:

Head to your direct message settings
Navigate to the X app on your phone. Click on your profile picture in the upper-left corner, navigate to “Settings and Support,” then hit “Settings and privacy.”

Touch the “Privacy and safety” menu and then scroll to the “Direct messages” subcategory.

How to limit who can see your IP address
If you want to use X’s new audio and video call functions but limit the exposure of your IP address, scroll down and toggle on the “Enhanced call privacy” option. It’s toggled off by default.

X says this setting will help you avoid revealing your IP address to your contact during a call.

In this same menu, you also have a number of choices to limit who can call you, including an option that allows only people in your address book to reach out.

How to turn off audio and video calls entirely
In the “Direct messages” menu, toggle off the “Enable audio and video calling” option. This will collapse the previous options and prevent anyone on X from calling you.

Limiting IP address visibility and turning off the calls entirely is only available in the settings if you are using the mobile app version of the former Twitter. For now, at least, there does not appear to be an option to turn off the feature using the web version of X. A representative for X did not immediately return a message for comment on Monday.

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Fed up with prices that remain about 19%, on average, above where they were before the pandemic, consumers are fighting back. In grocery stores, they’re shifting away from name brands to store-brand items, switching to discount stores or simply buying fewer items like snacks or gourmet foods.

More Americans are buying used cars, too, rather than new, forcing some dealers to provide discounts on new cars again. But the growing consumer pushback to what critics condemn as price-gouging has been most evident with food as well as with consumer goods like paper towels and napkins.

In recent months, consumer resistance has led large food companies to respond by sharply slowing their price increases from the peaks of the past three years. This doesn’t mean grocery prices will fall back to their levels of a few years ago, though with some items, including eggs, apples and milk, prices are below their peaks. But the milder increases in food prices should help further cool overall inflation, which is down sharply from a peak of 9.1% in 2022 to 3.1%.

Public frustration with prices has become a central issue in President Joe Biden’s bid for re-election. Polls show that despite the dramatic decline in inflation, many consumers are unhappy that prices remain so much higher than they were before inflation began accelerating in 2021.

Biden has echoed the criticism of many left-leaning economists that corporations jacked up their prices more than was needed to cover their own higher costs, allowing themselves to boost their profits. The White House has also attacked “shrinkflation,” whereby a company, rather than raising the price of a product, instead shrinks the amount inside the package. In a video released on Super Bowl Sunday, Biden denounced shrinkflation as a “rip-off.”

Consumer pushback against high prices suggests to many economists that inflation should further ease. That would make this bout of inflation markedly different from the debilitating price spikes of the 1970s and early 1980s, which took longer to defeat. When high inflation persists, consumers often develop an inflationary psychology: Ever-rising prices lead them to accelerate their purchases before costs rise further, a trend that can itself perpetuate inflation.

“That was the fear — that everybody would tolerate higher prices,” said Gregory Daco, chief economist at EY, a consulting firm, who notes that it hasn’t happened. “I don’t think we’ve moved into a high inflation regime.”

Instead, this time many consumers have reacted like Stuart Dryden, a commercial underwriter at a bank who lives in Arlington, Virginia. On a recent trip to his regular grocery store, Dryden, 37, pointed out big price disparities between Kraft Heinz-branded products and their store-label competitors, which he now favors.

Dryden, for example, loves cream cheese and bagels. A 12-ounce tub of Kraft’s Philadelphia cream cheese costs $6.69. The store brand, he noted, is just $3.19.

A 24-pack of Kraft single cheese slices is $7.69; the store label, $2.99. And a 32-ounce Heinz ketchup bottle is $6.29, while the alternative is just $1.69. Similar gaps existed with mac-and-cheese and shredded cheese products.

“Just those five products together already cost nearly $30,” Dryden said. The alternatives were less than half that, he calculated, at about $13.

“I’ve been trying private-label options, and the quality is the same and it’s almost a no-brainer to switch from the products I used to buy a ton of to just the private label,” Dryden said.

Alex Abraham, a spokesman for Kraft Heinz, said that its costs rose 3% in the final three months of last year but that the company raised its own prices only 1%.

“We are doing everything possible to find efficiencies in our factories and other parts of our business to offset and mitigate further price increases,” Abraham said.

Last week, Kraft Heinz said sales fell in the final three months of last year as more consumers traded down to cheaper brands.

Dryden has taken other steps to save money: A year ago, he moved into a new apartment after his previous landlord jacked up his rent by about 50%. His former apartment had been next to a relatively pricey grocery store, Whole Foods. Now, he shops at a nearby Amazon Fresh and has started visiting the discount grocer Aldi every couple of weeks.

Samuel Rines, an investment strategist at Corbu, says that PepsiCo, Kimberly-Clark, Procter & Gamble and many other consumer food and packaged goods companies exploited the rise in input costs stemming from supply-chain disruptions and Russia’s invasion of Ukraine to dramatically raise their prices — and increase their profits — in 2021 and 2022.

A contributing factor was that millions of Americans enjoyed solid wage gains and received stimulus checks and other government aid, making it easier for them to pay the higher prices.

Still, some decried the phenomenon as “greedflation.” And in a March 2023 research paper, the economist Isabella Weber at the University of Massachusetts, Amherst, referred to it as “seller’s inflation.”

Yet beginning late last year, many of the same companies discovered that the strategy was no longer working. Most consumers have now long since spent the savings they built up during the pandemic.

Lower-income consumers, in particular, are running up credit card debt and falling behind on their payments. Americans overall are spending more cautiously. Daco notes that overall sales during the holiday shopping season were up just 4% — and most of it reflected higher prices rather than consumers actually buying more things.

As an example, Rines points to Unilever, which makes, among other items, Hellman’s mayonnaise, Ben & Jerry’s ice cream and Dove soaps. Unilever jacked up its prices 13.3% on average across its brands in 2022. Its sales volume fell 3.6% that year. In response, it raised prices just 2.8% last year; sales rose 1.8%.

“We’re beginning to see the consumer no longer willing to take the higher pricing,” Rines said. “So companies were beginning to get a little bit more skeptical of their ability to just have price be the driver of their revenues. They had to have those volumes come back, and the consumer wasn’t reacting in a way that they were pleased with.”

Unilever itself recently attributed poor sales performance in Europe to “share losses to private labels.”

Other businesses have noticed, too. After their sales fell in the final three months of last year, PepsiCo executives signaled that this year they would rein in price increases and focus more on boosting sales.

“In 2024, we see … normalization of the cost, normalization of inflation,” CEO Ramon Laguarta said. “So we see everything trending back to our long-term” pricing trends.

Jeffrey Harmening, CEO of General Mills, which makes Cheerios, Chex Cereal, Progresso soups and dozens of other brands, has acknowledged that his customers are increasingly seeking bargains.

And McDonald’s executives have said that consumers with incomes below $45,000 are visiting less and spending less when they do visit and say the company plans to highlight its lower-priced items.

“Consumers are more wary — and weary — of pricing, and we’re going to continue to be consumer-led in our pricing decisions,” Ian Borden, the company’s chief financial officer, told investors.

Officials at the Federal Reserve, the nation’s primary inflation-fighting institution, have cited consumers’ growing reluctance to pay high prices as a key reason why they expect inflation to fall steadily back to their 2% annual target.

“Firms are telling us that price sensitivity is very much higher now,” Mary Daly, president of the Federal Reserve Bank of San Francisco and a member of the Fed’s interest-rate setting committee, said last week. “Consumers don’t want to purchase unless they’re seeing a 10% discount. … This is a serious improvement in the role that consumers play in bridling inflation.”

Surveys by the Fed’s regional banks have found that companies across all industries expect to impose smaller price increases this year. The New York Fed says companies in its region plan to raise prices an average of about 3% this year, down from about 5% in 2023 and as much as 7% to 9% in 2022.

Such trends suggest that companies were well on their way to slowing their price hikes before Biden’s most recent attacks on price gouging.

Claudia Sahm, founder of SAHM Consulting and a former Fed economist, said, “consumers are more powerful than President Biden.”

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But when the 91-year-old got his first virtual reality experience recently, he was stunned. Sitting in a conference room at John Knox Village, a suburban Fort Lauderdale, Florida, retirement community, Patrick sat up straight as his eyes and ears experienced what it would be like to be in a Navy fighter jet flying off the Florida coast.

“Oh my God, that’s beautiful,” he blurted before the VR program brought the jet in for a landing on an aircraft carrier.

John Knox Village was one of 17 senior communities around the country that participated in a recently published Stanford University study that found that large majorities of 245 participants between 65 and 103 years old enjoyed virtual reality, improving both their emotions and their interactions with staff.

The study is part of a larger effort to adapt VR so it can be beneficial to seniors’ health and emotional well-being and help lessen the impact dementia has on some of them.

During the testing, seniors picked from seven-minute virtual experiences such as parachuting, riding in a tank, watching stage performances, playing with puppies and kittens or visiting places like Paris or Egypt. The participants wore headsets that gave them 360-degree views and sounds, making it seem like they had been all but dropped into the actual experience.

“It brought back memories of my travels and … brought back memories of my experience growing up on a farm,” said Terry Colli, a former public relations director at the Canadian Embassy in Washington, D.C., of his 2022 experience. Colli, 76, liked swiveling in a chair to get a panoramic view. “That was kind of amazing.”

Anne Selby, a 79-year-old retired counselor and artist, found VR “stimulated virtually every area of my brain, all of the senses.”

“I particularly enjoyed the ones dealing with pets because I have a cat and I’ve had pets most of my life,” she said.

Stanford’s peer-reviewed study, working with the company Mynd Immersive, found that almost 80% of seniors reported having a more positive attitude after their VR session and almost 60% said they felt less isolated socially. The enjoyment lessened somewhat for older respondents whose sight and hearing had deteriorated. Those who found VR less enjoyable were also more likely to dislike technology in general.

In addition, almost 75% of caregivers said residents’ moods improved after using VR. More than 80% of residents and almost 95% caregivers said talking about their VR experience enhanced their relationships with each other.

“For the majority of our respondents, it was their first time using virtual reality. They enjoyed it. They were likely to recommend it to others, and they looked forward to doing it again,” said Ryan Moore, a Stanford doctoral candidate who helped lead the research.

“We are proving VR to be a tool that really does help with the well-being of our elders,” said Chris Brickler, Mynd’s CEO and co-founder. The Texas-based company is one of a handful that specializes in virtual reality for seniors. “It is far different than a two-dimensional television or an iPad.”

Separate from the study, John Knox Village uses virtual reality in its unit that houses seniors who have Alzheimer’s disease and other dementia. It helps spur memories that lead to conversations with caregivers.

“It is like they come back to life when they tell their story.” said Hana Salem, the facility’s meaningful life coordinator. She said that with others who don’t talk much perk up when given a VR experience putting them in nature.

“They’ll start laughing and saying, ‘Ooh, I’m going to catch the butterflies,’ ” Salem said. Catching butterflies is also part of a game Mynd developed that helps seniors enhance their mobility and flexibility as they stand and reach for objects.

“It’s more fun for these seniors to come in and catch butterflies and work on shoulder rehab than it is to go pick up a weight,” Brickler said.

Brickler said his company’s systems will soon attach to Google Earth, so seniors can virtually visit neighborhoods where they lived, schools they attended and places they have visited, sparking further conversations with caregivers.

Such virtual visits “can bring back a tremendous amount of joy, a tremendous amount of memories. And when the therapist or the other caregiver can work with that older adult and talk through things we see, we definitely see that it provides an uplift,” Brickler said.

The company has worked on the biggest complaints seniors in the study had about VR — the headsets were too heavy, the heat they generated made their foreheads sweat and sometimes the experience created nausea, he said. The new headsets weigh about six ounces (189 grams) instead of a pound (454 grams), they have a built-in fan for cooling, and the videos aren’t as jumpy.

The findings that seniors in their 80s and 90s enjoy VR less than those in their 70s might lead to changes for them such as requiring less neck rotation to see all of the scenery and making the visuals bigger, Moore said.

On a recent afternoon at John Knox, a handful of seniors who live independently took turns again using virtual reality. Pete Audet experienced what it would be like to fly in a wingsuit, soaring over show-capped mountains before landing in a field.

“Oooh, running stop!” exclaimed Audet, a 76-year-old retired information technology worker. He thinks other seniors “will really enjoy it. But they just need to learn how to use it.”

His wife, Karen, “played” with puppies and was so entranced by her virtual walk around Paris that she didn’t hear questions being asked of her.

“I was there. But I was here!” said Karen Audet, an 82-year-old retired elementary school teacher.

Farrell, the retired Army computer expert, said he hopes to live to 100 because he believes the next five years will see momentous change in VR. Still a technology enthusiast, he believes the cost of systems will drop dramatically and become part of everyday living, even for seniors.

“It is not going to be as elementary as it is now. It is going to be very realistic and very responsive,” he said. “It will probably be connected to your brain.”

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Woods introduced his lifestyle brand Sun Day Red on Monday evening the day after the Super Bowl and during the middle of Hollywood’s awards season. He’s transitioning to the next phase of his career with TaylorMade Golf after he parted ways with Nike after 27 years.

Some in the fashion community believe Woods can survive without sporting Nike’s popular swoosh on chest. He’ll now have logo of a tiger with 15 stripes, signifying his 15 championship titles, along with apparel that includes cashmere hoodies, sleek sweaters and footwear with his brand’s name etched on them.

“I thought it was very refreshing to see him kick off this new chapter,” said Allen Onyia, co-founder of UpscaleHype, a social media account that chronicles stylish celebrity wardrobes. “The brand has a lot of potential, with Tiger being the face of it, and the machine pushing it. I have nothing but positive thoughts.”

Onyia said Woods made a good move by branching out into a market beyond the golfing realm — especially after the golfer made his own imprint in the sport over the years with his signature cap, sleek red polo and trousers.

“The key thing that they’re trying to do is separate it from just becoming a performance brand,” he said. “They’re tapping into the lifestyle market, adopting different fabrics, textures and showing how it can still be functional. They’re tapping into premium quality, but not losing the performance aspect as well. I’m excited to see the marriage of the two.”

Woods, 48, felt now is the right time to make the transition during the twilight stage of his career because he’s no longer a “kid anymore.” He’s worn red on Sundays throughout his career after his Thai-born mother, Kultida, suggested that the color instilled power in him.

“Releasing his new collection two days after the Chinese Lunar New Year speaks volumes to me about how Tiger and his team are embracing this new move positively post Nike,” said Angela Watts, the founder of Atlanta Fashion Week. Woods’ mother once referred to her ancestry as Thai, Chinese and Dutch.

Watts said the premium materials reflect a commitment to both style and functionality, catering to the demands of modern athletes and fashion enthusiasts.

“His collection showcases thoughtful details such as subtle logo placement,” she said. “The bold hue exudes confidence and power, while the impeccable tailoring ensures a sharp, polished look.”

TaylorMade plans to first launch online the apparel line for men on May 1 in the United States and Canada. The website has already gone live with the hopes of expanding into other markets across the globe. The company wants to add lines for women and children.

Woods already had a deal with TaylorMade for clubs and with Bridgestone for the golf ball.

“The biggest challenge we have is being able to build enough of this incredible product to service the amount of demand we anticipate with this,” said TaylorMade CEO David Abeles. “But we’re going to do that. And like anything we’ve done historically, we’ll continue to ensure quality is priority No. 1, design is cutting edge and ultimately this meets the playing needs of Tiger and the lifestyle needs of everybody that wears the brand.”

Watts said Woods timing is nearly perfect. His announcement comes a few days before he takes his 2024 debut in the Genesis Invitational at Riviera, a signature event on the PGA Tour. It also came between the Masters and the PGA Championship.

“If the goal is to capture the attention of a broader audience and leverage the media buzz surrounding these major events, the timing is favorable,” Watts said. “His collection has smart designs and undeniable versatility. The collection is sure to resonate with fans of both golf and fashion.”

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