Rates rose slightly less last year, with an average increase of about 4%. Marylanders, however, will continue to have some of the most affordable individual market rates in the country in 2025, the insurance administration said in a news release Thursday.

A new insurance carrier — Wellpoint Maryland — also was approved by the insurance administration to sell 10 plans both on and off the Affordable Care Act individual marketplace, bringing the total number of carriers to five. Regardless of where Marylanders live in the state, they will have the choice of at least four insurance carriers for next year, the release said.

The rates approved by the insurance administration are about 0.5% lower on average than originally requested by insurance carriers, saving state residents an estimated $6.4 million in premium costs, the administration said.

Next year’s rate increase was driven by an overall increase in the cost of claims, according to the insurance administration, which is charged with regulating the state’s $42 billion insurance industry. On average, the costs of prescription drugs rose 10.2%, physician costs rose 8.5% and hospital costs rose 4.3%.

In Maryland, federal and state subsidies that encourage younger and healthier residents to purchase insurance help keep costs low for everyone, the insurance administration said. About 80% of people who purchase their individual market plan on Maryland Health Connection — the state’s health insurance exchange — receive some reductions in premium costs through federal tax credits.

The state’s reinsurance program — a fund through which insurers are reimbursed for a portion of the costs from patients who require the most expensive care — also helps stabilize the market and keep rates low, the administration said. The approved 2025 rates are about 17% lower than they were in 2018, before the program began. The state’s waiver from the U.S. Centers for Medicare and Medicaid, which allows the reinsurance program to exist, is approved through 2028.

“The success of the Reinsurance program continues to be evident,” Acting Maryland Insurance Commissioner Joy Hatchette said in Thursday’s release. “Maryland premiums will continue to be amongst the lowest and most affordable in the nation.”

About 271,000 Marylanders will be affected by the approved rates next year, though overall costs and how much rates increased vary between plans.

A 40-year-old living in the Baltimore metro region, for example, could pay anywhere from $41 per month more for the lowest cost silver plan than they paid last year — if they’re covered by CareFirst’s PPO plan — or $40 less, if they’re covered by Optimum Choice. Costs for the silver HMO plan from CareFirst, the No. 1 choice plan on the exchange from its dominant insurer, increased by $20 a month for the same person.

In Thursday’s news release, Hatchette advised Marylanders to work closely with health insurance agents and advisers when reviewing plans to make sure they take advantage of any opportunities to offset the costs of their premiums.

The insurance administration also approved an average rate increase of 0.3% for dental plans in the individual market, where about 96,000 Marylanders purchase insurance.

About 227,000 Marylanders are enrolled in small group market plans, which are geared toward businesses with 50 or fewer employees. Rates for these plans will increase by an average of 4.5%. More than 225 plans will be offered in the small group market this year.

The study, published last week in the Journal of the Air and Waste Management Association, focused on the prevalence of black carbon in Curtis Bay and other pollution hot spots in the region. Black carbon is a sootlike air pollutant emitted from gas and diesel engines, coal-fired power plants and other fossil fuel burners that — according to the U.S. Environmental Protection Agency — is tied to asthma and other respiratory problems, heart attacks, low birth rates and lung cancer.

Researchers at the University of Maryland and the National Oceanic Atmospheric Administration designed a pollutant measurement tool that could be attached to the roof of a standard Chevrolet Suburban. Between March and May of 2022 and January and June of 2023, the mobile lab — nicknamed “NOAA’s ARC” — was deployed in the region spanning Baltimore and Washington, D.C., for a total of 64 days.

They found that black carbon tended to be the most concentrated in Baltimore along major highways (Interstates 95, 895 and 695), in the congested downtown area and near Curtis Bay, a community near the Patapsco River’s Curtis Bay.

“You would expect a lot of black carbon and other pollutants where you have an eight-lane highway and heavy truck traffic,” said Russell Dickerson, an atmospheric and oceanic science professor at the University of Maryland. “The residential area was a bit of a surprise.”

Dickerson was lead author on the study, which was published online Aug. 26. Other authors included researchers from NOAA’s Air Resources Laboratory, the Johns Hopkins Bloomberg School of Public Health, the Maryland Department of the Environment and the South Baltimore Community Land Trust.

The study adds to other research recently published about air pollution in Curtis Bay. In December, a collection of researchers from Hopkins, the University of Maryland, the state environment department and community organizations released a report that captured the toll of coal dust in the community.

Much of the coal dust is believed to be from the adjacent CSX Curtis Bay Coal Piers, which load coal brought in by train mostly from Appalachia for export overseas. CSX has taken issue with the aspects of the report, but the state recently issued a draft of a new air quality permit for the facility that requires it to take further steps to reduce coal dust.

Coal dust can be a source of black carbon in the environment, Dickerson said. While he and his teammates certainly found levels of coal dust in Curtis Bay — “Full stop, it’s there,” he said — their instrument was designed to measure the smaller pollutant particles emitted from gas and diesel engines, not the larger, more coarse ones found in coal dust.

In the published study, researchers cited advocacy efforts by Curtis Bay residents as a motivator for measuring black carbon and other pollutants in the neighborhood. The Community of Curtis Bay Association and other community-action groups want to route diesel truck traffic away from the neighborhood’s residential and small-business corridor and to end subsidies for incinerators and landfills, among other objectives listed in the study.

Angie Shaneyfelt, a Curtis Bay Association board member, has been involved in regional advocacy efforts since 2021, when an explosion at the CSX facility rattled the surrounding neighborhoods.

She acknowledged that she doesn’t read every study that comes out about pollution in the area, since they tend to be filled with scientific jargon. But she doesn’t have to be a scientist to know that there’s something wrong with the air in the neighborhood where she’s lived for 16 years.

She has wiped chunks of coal dust from the filter in her window air conditioning unit and keeps her windows shut year-round. Her 11-year-old twins have seasonal asthma — a condition she also was diagnosed with about two years ago. And her husband struggles with a perpetual cough.

“The air feels heavy,” she said. “Whether that’s the coal, whether that’s the carbon particles from the trucks, I don’t know. It’s just in the air. And you can feel it.”

The constant noise from truck traffic on Pennington Avenue — about a block away from Shaneyfelt’s home — feels like another type of pollution Curtis Bay residents have to live with, she said. When she goes to work at Hon’s Honey, a beauty shop on the busy road, she listens all day to the sound of trucks slowing for red lights, then accelerating.

Curtis Bay is likely just one of many communities around the country experiencing a black carbon pollution problem, Dickerson said. But it also presents the opportunity to create a model for mitigating the negative effects caused by truck traffic in residential neighborhoods.

In the long term, Dickerson said, heavy-duty, diesel-burning trucks need to be replaced with electric vehicles. Earlier this year, the Biden-Harris administration outlined a plan to boost the number of zero-emission commercial vehicles on the road and increasing access to electric vehicle recharging and hydrogen refueling along the country’s freight corridors and at truck depots.

But actions also can be taken in the shorter term, such as monitoring roads to identify heavy emitters, diverting heavy-duty trucks from residential neighborhoods, and adding more trees and green space. Additionally, Dickerson said, researchers found the concentration of black carbon on Pennington Avenue to be three times higher on average than on Curtis Avenue, which runs parallel a block away and is closer to the coal piers.

They suspect that’s because Pennington has three stop lights, causing a stop-and-go traffic pattern. Better timing of the lights on that stretch of road would lead to smoother traffic flow — and fewer emissions generated from trucks accelerating after slowing to a stop, Dickerson said.

David Jones, another Curtis Bay Association board member, works in road safety. Living on Curtis Avenue alongside the truck traffic feels “beyond dangerous,” he said. Beyond the pollution problem, he’s worried that one day a tractor-trailer will crash through his front window.

He wishes only local trucks were allowed to drive through Curtis Bay. Now, he said, commercial vehicles from all kinds of industries use roads in the neighborhood. Traffic has only worsened in the area since the Francis Scott Key Bridge collapsed in March, Jones said.

Jones has lived in Curtis Bay off and on since he was a kid, he said. It’s where he got his first apartment when he was 16. It’s always felt “off the beaten path,” which makes problems faced by the community feel easy for politicians and officials to ignore, he said. Roadway congestion is no exception.

Like a lot of problems in Curtis Bay, “it’s never gotten better,” Jones said. “It’s gotten worse.”

For weeks, she hoped the hard knot in her left breast would go away on its own – that it was just a strange side effect of her menstrual cycle. But when her mother felt it and looked concerned, Adamson started worrying, too.

She knew she needed a mammogram, but it was 2012, and she was working at a temp agency that didn’t give her health insurance. So Adamson, 46 at the time, dialed the Baltimore City Cancer Program – an organization run by the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center that had helped her get a free pap smear earlier that year.

Days later, she found herself in tears on an examination table as a doctor told her the lump appeared abnormal. She’d soon be diagnosed with Stage 3 breast cancer — a disease that would require intensive chemotherapy and for Adamson to stop working while she recovered.

But the day after her mammogram, when she visited the West Baltimore office for the Baltimore City Cancer Program, a community outreach worker made her a promise.

“I’m here for you,” Loretta Setzer told Adamson. “We’re gonna do everything. I know you don’t have no insurance. Don’t worry yourself, because you got enough going on. You don’t need to stress yourself anymore.”

The cancer prevention program has been making — and keeping — similar promises to uninsured and otherwise disadvantaged people in Baltimore for more than two decades.

Since 2001, the program has provided free screenings to nearly 40,000 city residents and found 152 cases of breast cancer, along with a handful of cervical, oral and colorectal cancers. And 93% of people who were diagnosed through the program are alive today — a statistic that Rhonda Silva, a registered nurse and division administrator for the program, said “speaks volumes for all that we’ve done.”

While the program used to focus on caring for people without health insurance, that changed after the Affordable Care Act boosted the number of insured people in Baltimore. Now, the program also serves those who are underinsured — people who have insurance, but struggle to afford out-of-pocket health care costs. It targets breast, cervical and colorectal cancers when educating community members and providing free screenings, transportation to appointments, support groups, patient navigation and other services.

The program gets most of its funding — about $1.2 million a year — from the Cigarette Restitution Fund. Similar to the money now flowing into the state and city from lawsuits against opioid companies, money in the Cigarette Restitution Fund is from a massive 1998 settlement between most of the country’s attorneys general and the tobacco industry’s biggest players.

In the program’s early stages, many of the people it served were Black women who didn’t have insurance, Silva said. Since the passage of the Affordable Care Act, though, the patient population has shifted to include a higher percentage of Hispanic and Latino people, some of whom have concerns around their immigration status and don’t have insurance.

Research shows that both groups are less likely to get regular screenings for breast, cervical and colorectal cancer, and more likely to be diagnosed late — something that can worsen a patient’s outcome, said Dr. Shana Ntiri, the program’s medical director. She pointed to the program’s high survivorship as proof it’s possible to shrink disparities in cancer screening.

“When thinking about the patient population we serve, you hear a lot of stereotypes, to be frank. Like, ‘Oh, these folks will never do this and never do that,’” she said. “That’s not true. When people have information, when they have access, when they have guidance, they’ll absolutely do what they need to do in order to optimize their health. But you have to give them true opportunity.”

Community outreach is among the most important services the program provides — and in that area, Loretta Setzer, the community outreach worker who spoke with Adamson after her mammogram, is a local celebrity. She even has a nickname among her coworkers: the Pied Piper of Baltimore.

Setzer, who has been an outreach worker with the program since its start, passes out informational flyers every time she rides the bus. She said she can tell when someone is lying to her when she asks for the last time they got a cancer screening.

At 78 years old, Setzer knows how to get people to trust her. And she’s not afraid to crack jokes to lighten the mood.

“If you don’t want to do your own self-examination,” she’ll tell women, “let your boyfriend examine your breasts.”

Veronica Duran, one of the program’s three outreach workers who speak Spanish, laughed as she described Setzer’s persistence in getting someone to agree to a screening. Sometimes, Duran said, if Setzer sits beside someone on the bus or runs into a construction worker in her neighborhood who speaks Spanish, she’ll give Duran a call and ask her to translate.

Language barriers supply an additional challenge for non-native English speakers who are diagnosed with cancer, Duran said. Even though hospitals provide interpreters, it can be hard for non-native English speakers to keep up with the information overload that often happens at doctor’s appointments. Duran encourages her patients to carry a notebook and write down any questions that come to mind throughout their day.

“There’s no little question, no big question, no dumb question, no smart questions,” she tells patients. “Every single little question or thought that you have matters, and you need to get an answer.”

In 2014, two years after Adamson’s first breast cancer diagnosis, the cancer came back. She couldn’t see her oncologist at the Greenebaum Cancer Center any longer, since he didn’t accept her insurance, but one of her “survivor sisters” from the cancer program’s support group helped her find a new doctor at Mercy Medical Center.

Ten years later, Adamson takes a chemotherapy oral medication and gets regular screenings to moderate the cancer’s growth. But she likes to focus on the positives — the fact she can watch her eldest granddaughter, Treasure, play basketball in high school and see her youngest granddaughter, Peace, smile.

She said she thanks God every day for the doctors who treat her, the researchers searching for a cure — and for the Baltimore City Cancer Program.

“I feel like if it wasn’t for them,” she said, “I wouldn’t be here today.”

Already, the city has received more than $240 million through settlements with drug companies — most recently a $152.5 million deal with the drug distributor Cardinal Health and previously smaller deals with CVS and Allergan — and officials say they expect to receive hundreds of millions of dollars more by the time ongoing litigation is resolved.

The trial in the city’s lawsuit — which argues drugmakers and distributors flooded Baltimore with millions of opioid prescriptions, while downplaying the drugs’ addictiveness — is set to start Sept. 16.

On Thursday, Scott announced that $20 million from the settlement funds already won will go to the Baltimore City Health Department to strengthen its efforts to mitigate Baltimore’s overdose crisis.

Among other programs, that funding will benefit the SPOT Mobile Clinic, a public-private partnership between the health department and Johns Hopkins University School of Medicine that provides buprenorphine treatment for opioid use disorder, among other low-barrier-to-access health care services.

“We have an unprecedented opportunity today to serve the people of this city,” said Bobby Harris, medical director of mobile clinical services for the city health department, at Thursday’s news conference. “We look forward to working together to lift up the city’s narrative in becoming a leader in addressing the opioid syndemic [the epidemic and the factors contributing to it] through tireless work, dedication and urgency in serving our people who so rightfully deserve to be well.”

As a part of the settlements, $42 million had already been promised to several organizations and service providers working to address the crisis, including Baltimore Safe Haven, Charm City Connection and the peer navigators program at the Enoch Pratt Free Library.

Baltimore chose to go its own way about two years ago, opting out of a massive global settlement with several major opioid companies that the state of Maryland and most local jurisdictions decided to join. So far, Scott and other city officials have said that decision has paid off — if the city had joined the global settlement, it would have gotten about $7 million over the course of seven years.

“Every community has been inflicted with the pain of the opioid overdose epidemic, but here in Baltimore, we have been disproportionately impacted — particularly due to the actions of reckless bad actors in big pharma,” Scott said in a news release Thursday morning.

“We made the decision to see our litigation against these companies through until the very end, foregoing the global settlements that were offered along the way, because we knew how impacted our community has been and how important it was to see adequate financial accountability from these companies. But it isn’t enough to win the funds — we need to put them to work.”

Moving forward, Scott said, community engagement through town halls, focus groups and an online survey will be a key part of the city’s process for determining how to use the settlement funds.

He announced an executive order Thursday that fleshed out the process for managing the money. The order established an opioid restitution fund where the settlement dollars will be deposited and listed guidelines for how the dollars may be distributed — including for substance use prevention, treatment, recovery and harm reduction programs, and services mitigating other harms caused by the opioid epidemic.

To steer more specific decision making on how the money should be spent, the city plans to create a Restitution Advisory Board that will include city employees, such as the health commissioner and fire chief, as well as non-city employees like a peer recovery specialist, licensed social worker and at least four Baltimoreans with lived experience with substance use.

Board members will review grant applications and make funding recommendations that will be reviewed by the mayor’s overdose cabinet and get final approval from the mayor, city officials said in a briefing Wednesday night. Non-city employee board members will receive $15,000 per year for their participation.

Scott’s executive order also created two new positions in his office: an executive director of overdose response, who will coordinate the city’s response to the epidemic, and an opioid restitution program manager, who will support the advisory board, among other duties.

The order also established a trust — which officials at Wednesday’s briefing compared to a large university’s endowment — to sustain the money for at least 15 years. Interest earned will be used only for substance use mitigation and won’t be returned to the city’s general fund, unless otherwise approved by the Board of Estimates.

The city also intends to publish several documents to better ensure the funds are appropriately used to address the opioid crisis, including an overdose reduction strategy and a substance use community needs assessment, as well as plans for community engagement and transparency.

It plans to launch a dashboard providing information on programs receiving funds and submit an annual report to the mayor and city council about the funded programs. The Mayor’s Office of Recovery Programs will manage funding availability notices and monitor the performance of organizations that received grant money.

Sara Whaley, a senior practice associate for the Johns Hopkins Bloomberg School of Public Health, advised the city while it crafted the executive order announced Thursday. Whaley, the lead author for a list of best practices for how jurisdictions should use opioid litigation funds, is considered a national expert on the subject.

“This order is based on best practices from around the country,” she said in Thursday’s news release, “and lays a foundation to ensure funds will have the greatest impact by protecting the dollars and ensuring their longevity, thinking holistically about the role of restitution funds as part of a broad overdose response, and rooting decision-making in the expertise of a diverse set of voices.”

The gift — donated by Ellen Weis Platz Wasserman, a founding member of the LifeBridge Health board whose grandfather established a grocery store that became Weis Markets — is the largest from an individual in LifeBridge’s history. It represents an “exclamation point” to her legacy of philanthropy in Baltimore, Sharon Boston, a spokeswoman for LifeBridge, said in an email.

Wasserman, who turned 101 in March, has given nearly $24 million to the health system over the course of 36 years, with many of the gifts focused on teaching clinicians and providing support for vulnerable children.

LifeBridge, which runs several Baltimore-area hospitals and more than 100 other sites in Maryland, announced the donation in a news release Tuesday. The Regional Medical Campus is a two-year-old partnership between the health system and The George Washington University School of Medicine and Health Sciences in Washington, D.C., that allows students at the medical school to complete their clinical rotations at Sinai.

“We are so grateful to Ellen Wasserman for this transformational gift to invest in the education of future physicians, who we hope will go on to practice in our communities,” Lifebridge President and CEO Neil Meltzer said in Tuesday’s release. “With her many years of support to Sinai Hospital, our patients and our communities, this gift is part of Ellen’s legacy and a way to take on health disparities and make a positive difference in the health of people, particularly those who may be at increased health risks due to social or economic challenges.”

Students at the Regional Medical Center complete their first two years of medical classroom coursework at George Washington’s campus before coming to Baltimore for their final two years of medical school. At Sinai, the students help care for many patients who come from underserved communities, where economic and social disparities can harm their health.

Fifteen students are currently training at Sinai in the program’s second full year. There will be 60 students — 30 third-year and 30 fourth-year — when the program reaches capacity, LifeBridge said in the release. Students who benefit from Wasserman’s donation will receive annual tuition scholarships of $10,000 and be known as Wasserman Scholars.

“The [Regional Medical Center] students are a remarkable and enthusiastic group of students, and we are so thankful for Mrs. Wasserman’s gift that will support our students in this special learning environment and community-focused program,” said Dr. Scott Krugman, pediatrician and senior associate dean for the Regional Medical Campus, in the release. “The current RMC students have shared how much they value the individualized, hands-on education and training they are receiving at Sinai, as well as connections they are able to build with their patients and our greater community.”

During the students’ first year at Sinai, they rotate through all medical specialties offered at the hospital, from family and internal medicine to pediatrics, psychiatry, obstetrics and gynecology, neurology and surgery. They can take electives like population health, value-based care and technology, and digital health during their second year.

While Wasserman’s endowment will ensure ongoing scholarship support for students at the Regional Medical Center, the program previously has received support from the Herman & Walter Samuelson Foundation, the Kahlert Foundation, Louis and Phyllis Friendman, the Blavatt Family, the Israelson Family Foundation and Dr. Stanley Friedler.

“Ellen Wasserman is a caring and compassionate woman who always asks about our patients and how we can help people in our communities,” said Julie Cox, chief philanthropy officer for LifeBridge, in Tuesday’s release. “We are so appreciative for her leadership and support to LifeBridge Health over more than a quarter century.”

Each year, more than 160 medical residents work and train at Sinai Hospital, including those from the Johns Hopkins University School of Medicine and the University of Maryland School of Medicine, as well as The George Washington University School of Medicine and Health Sciences and other schools.

In addition to Sinai, LifeBridge operates Levindale Hebrew Geriatric Center and Hospital, Grace Medical Center in Southwest Baltimore, Northwest Hospital in Randallstown and Carroll Hospital in Westminster.

“There’s a picture that somebody took of us in an office building,” said Joel Klein, the system’s senior vice president and chief information officer, “where it was this combo of PC techs, project managers and people like me who don’t normally get into the guts of computers.”

The outage, which temporarily paralyzed operations at hospitals, 911 call centers, airlines and businesses globally — costing companies an estimated loss of more than $1 billion in revenue — began just after midnight on July 19. After initial fears of a massive ransomware attack were dispelled, word spread quickly that the fix would require IT workers to manually delete the faulty file from each affected computer.

At the University of Maryland Medical System — where nearly two-thirds of the laptops, workstations and servers across 50 sites were rendered useless by the CrowdStrike update — this was a herculean task that required thousands of man-hours to correct.

“Our team members are consistently focused on delivering high quality, world-class patient-centered care across the System,” Dr. Mohan Suntha, president and CEO of the University of Maryland Medical System, said in a statement. “I am incredibly proud of the way that our organization was able to respond to and navigate the challenges associated with CrowdStrike, throughout the day, over the weekend and into early the following week.”

Here’s a timeline of how one of the most hectic stretches in IT history played out for one of Maryland’s largest hospital systems, assembled from interviews and information provided by a system spokesperson.

July 19, 12:09 a.m.

The first device in the medical system received the corrupted update file from CrowdStrike. Over the next hour and a half, nearly 20,000 of approximately 33,800 devices across the system received the file and became unusable. Individual troubleshooting didn’t work. Phone calls and tickets streamed into the IT help desk to report the problem.

1 a.m.

Klein got a phone call, alerting him of the outage. Soon, Kristie Snedeker, vice president of Shock Trauma, and Adam Canterbery, senior manager for end-user computing, also were woken up and jumped on calls to begin understanding what was happening.

2 a.m.

All hospitals and sites across the medical system were directed to begin “downtime procedures” — non-technological protocols that replace procedures that require computers or other technology to complete.

Computers are intertwined with nearly every facet of health care delivery. They allow doctors and nurses to almost immediately access a patient’s entire medical history, including what prescriptions they’re taking and any allergies they have, and quickly send orders to labs and pharmacies. But even though technology makes health care safer and more efficient, Klein said, patients can be treated without it.

“You can still go take out somebody’s appendix. You can still do CPR. You can still provide lifesaving care,” Klein said. “It’s just a lot slower, a lot more cumbersome, and the handwriting is worse.”

In some ways, it’s a return to how hospitals worked in the 1980s — when Klein worked in emergency medicine and when doctors and nurses had to ask patients for a list of their medications and track their symptoms on paper charts, instead of computers.

In the early hours of July 19, hospital officials had to figure out the extent of the disruption. Would nurses be able to clock in and out? MRI and CT machines might be working, but were they able to push their results to the platform where a radiologist could read them? How about security cameras — were they functioning correctly?

These are questions that are hard to answer when it’s 3 a.m. and everyone is asleep, Snedeker said. As she drove to Shock Trauma in downtown Baltimore, she called the hospital’s department heads.

“This is what is happening,” she told them. “I need you to wake up and I need you to get an idea of how things are working in your space and then I need you to report in about 20 minutes.”

3 a.m.

Canterbery and his co-workers identified a way to break through the computers’ blue screens of death and delete the file causing the problem — but the process was a doozy. It involved entering a 48-digit key to get past the encryption software on each device. The key for each device across the system is unique and can be accessed only through a secure server.

Two hours later, Canterbery had drafted a step-by-step process IT workers could follow to manually unlock each device. He distributed the document to technical teams across the system to begin the remediation effort. Computers and workstations critical to patient care — such as those in the operating rooms, trauma resuscitation unit and post-anesthesia care unit — were prioritized.

6:30 a.m.

Kayla Zellous, a licensed practical nurse on the orthopedic floor at the University of Maryland Baltimore Washington Medical Center, got a call from her supervisor, asking whether she could work that day, even though she was scheduled to be off.

“Today is going to be a little bit different,” her supervisor told her when she arrived at work.

The prospect of a day with little access to computers was initially intimidating, Zellous said. The 27-year-old has been a nurse for only two years. While some of her co-workers remembered the days of paper charting, that was new for her. Computers in four of the patient rooms where she was assigned to work that day were functional, but she couldn’t use them to order labs or communicate with the pharmacy.

Later that morning, Zellous and her co-workers pulled all of the computers on the floor into the hallway so they would be easier to access for the IT workers running around to unlock them. By 4 p.m., most of the unit’s computers had been rebooted and were ready for use, she said.

“It was a difficult time, but I definitely have a humor about myself. I don’t let myself or the people around me get down,” Zellous said. “I really built up the morale that day, because I could tell a lot of people were like, ‘What do we do?’”

9 p.m.

Word of another strategy to unlock computers affected by the CrowdStrike update got around to the medical system. The new process was simpler and faster — but required a USB flash drive for each computer.

Canterbery and his co-workers tested the new method and wrote up new instructions for unlocking computers. Then, Canterbery went on Amazon to make an overnight order of flash drives, which arrived at his front door at 4 a.m. the next day. He later bought an additional 100 drives from Micro Center.

“I think in total, I spent a little over $500 on flash drives, not counting what we had already,” Canterbery said.

Saturday and Sunday – July 20 and 21

At around 7 a.m. the next day, the first shift of IT workers arrived at hospitals and outpatient centers across the system and got to work.

The time it took to unlock each computer varied. Some took just a few minutes, but others required workers to suit up in personal protective gear and enter a patient’s room, then use a key to unlock a cabinet to access the device.

Even though IT staff members were required to work only one shift, Canterbery said, many worked through the second shift, all the way to 10 p.m. More than 200 other employees who weren’t scheduled to work volunteered their time to help with the remediation effort. On Monday, July 22, technical teams set up kiosks in the system’s hospitals and outpatient centers to unlock any stragglers.

Moving forward, some system hospitals held meetings to talk about the response and what could have been done differently. It might be helpful for the medical system to review its emergency IT playbook on a more regular basis, Canterbery said, and possibly expand it to include more scenarios.

By the time the weekend ended, Canterbery was about ready to collapse, he said with a laugh. Between Friday morning and Sunday evening, he had walked nearly 50,000 steps — or more than 24 miles. The weekend was grueling, but it also had some bright spots.

Most of the time, Canterbery said, IT workers just hear from people when things go wrong. But on July 19, they were the heroes. Nurses and other clinical staff members were excited when they saw them arriving on their units. They thanked them, and some offered food and drinks to the workers.

“It was nice,” Canterbery said.

By not seeking bids from other companies, as the suit alleges, the University of Maryland Medical System edged Capitol Radiology out of the process, argued the company — based about 50 yards away from the medical system’s Laurel campus — in a lawsuit filed July 31 in Prince George’s County Circuit Court.

Dr. Doriann Thomas has owned and operated Capitol Radiology for about 20 years. She purchased the facility from Radiologix, a Dallas-based imaging services company that later was acquired by RadNet, the Los Angeles company selected by the medical system.

According to the lawsuit, which also named RadNet as a defendant, Capitol Radiology is the only Black-owned radiology facility in Maryland. In excluding Capitol Radiology from the bidding process, the lawsuit argues, the University of Maryland Medical System and RadNet violated state equal protection laws and the medical system violated a state law that requires the board of directors to operate the system without race or sex discrimination.

“UMMS knew that locating an outpatient radiology facility on the Laurel campus would have a substantially adverse effect on the black- and female-owned Capitol Radiology,” the lawsuit argues. “On information and belief, it excluded Capitol Radiology from bidding on the joint venture opportunity precisely because it was black- and female-owned, and therefore likely to prevail under State bidding rules.”

The University of Maryland Medical System and RadNet had not yet filed responses to the lawsuit as of Monday. When reached by phone, Brian Moffett, a lawyer from the Baltimore-based firm Miles and Stockbridge, which is representing RadNet in the suit, declined to comment on the pending litigation.

UM Capital Region Health — the network that operates the Laurel medical campus at question in the lawsuit — also declined to comment in a statement from spokeswoman Jania Matthews. The statement described the network as a “mission-driven organization focused on providing high-quality, safe and compassionate care to Prince George’s County residents.”

“In general, expanding and enhancing access to care and increasing health care options for the community, giving individuals choice and flexibility, is part of our strategic approach and among our top priorities,” the statement said.

The University of Maryland Medical System acquired Dimensions Healthcare — the company that ran the late Laurel Regional Hospital — in 2017. The system followed through on Dimensions’ plans to convert the former hospital to an outpatient care site, and later broke ground on a $70 million project to build an entirely new health center.

In an August 2022 news release about that year’s second-quarter financial results, RadNet announced it would partner with Dimension to build two new outpatient imaging centers — one in Largo and one in Laurel. At the time, the company said it expected to start seeing patients at the centers in the second or third quarter of 2023.

In a separate filing with the Prince George’s Circuit Court, Capitol Radiology asked a judge to issue an order that would temporarily prevent RadNet from operating on the Laurel health campus. But Judge William Snoddy denied the motion Aug. 9, writing that the company had failed to convince him that granting the order would be in the public interest and that it would suffer “irreparable harm” if the order were not granted.

Snoddy also said Capitol Radiology failed to convince him that its case is likely to succeed “on the merits” — a rule in civil procedure that requires someone seeking a preliminary injunction to show they have a good chance of winning their case.

Capitol Radiology is demanding a jury trial, where it hopes to gain compensatory and punitive damages, as well as injunctive relief preventing RadNet from offering outpatient radiology services on the Laurel campus, according to the lawsuit.

In the lawsuit, Capitol Radiology draws a line between the RadNet and the University of Maryland Medical System’s joint venture and the history of self-dealing and corruption in the board responsible for overseeing the medical system.

In 2019, The Baltimore Sun reported that a third of the board’s 30 members — including former Baltimore Mayor Catherine Pugh — had entered into deals with the medical system worth more than $115 million in total, many of which were not competitively bid.

“The UMMS-RadNet joint venture was the product of this very Board of Directors,” the lawsuit said.

Capitol Radiology also accused the University of Maryland Medical System of other unfair business practices, such as partnering with RadNet to obtain patient referrals and excluding Capitol Radiology from the bidding process because it didn’t have a preexisting relationship with the medical system

“This form of cronyism is anathema to the public bidding process because it results in the selection of companies based on pre-existing relationships rather than merit,” the lawsuit argues. “It also serves to perpetuate discrimination by freezing out previously excluded groups.”

There is no public need for the University of Maryland Medical System to open an outpatient radiology center in Laurel, the lawsuit said. For nearly 20 years, Capitol Radiology has served hundreds of thousands of patients in the surrounding communities and performed more than 170,000 Medicare and Medicaid procedures. It sees patients seven days per week, the lawsuit said.

The company fears the medical system’s joint venture with RadNet will harm its business — something that also would harm the surrounding communities, the lawsuit argues. Black physicians are significantly underrepresented in the radiology workforce, according to research quoted in the suit.

“Within the professional environment, expanding diversity is crucial for both radiologists and patients alike,” the lawsuit said. “Increased diversity in the professional workforce has been tied to performance improvement and innovative practices and has also been associated with professional efforts to expand access and challenge racial barriers to care. Improving diversity within the medical workforce has thus been associated with improved patient care.”

Perched on a stool, Dr. Thomas Hyde held an electric dental drill — the instrument he and his colleagues have found works the best for delicately extracting tissue samples. Another researcher handed him a dull pink slice of someone’s brain about the size and shape of a chicken cutlet.

He used the drill to remove a tiny piece of the caudate nucleus — a seashell-shaped structure deep in the brain that plays a critical role in many higher neurological functions.

Floors below, in the basement of the shiny office tower owned by the Johns Hopkins University, thousands more brains — more than 4,300 in total — are stored at temperatures 80 degrees below freezing. Without question, it is the largest collection in the world of postmortem brains devoted to the study of neuropsychiatric disorders.

This is the Lieber Institute for Brain Development, a nonprofit research organization affiliated with the Johns Hopkins University School of Medicine. It was founded in 2010 by the parents of children with schizophrenia. Through intense study of how the genes a person inherits from their ancestors determine the way their brain is built — and how that architecture may later degrade — scientists hope to develop new treatments and therapies for people living with these disorders.

But there’s a major weakness in the data available to study genetic disorders: Even though people of European descent make up less than 16% of the world’s population, they constitute 81% of large-scale genomic databases.

In recent years, the Lieber Institute has been trying to diversify its research and brain collection to better understand why people with African ancestry are far more likely than people of European descent to experience serious mental health problems, develop Alzheimer’s disease and die by suicide before turning 13 — and less likely to develop Parkinson’s disease and other neurological disorders.

In 2019, the institute joined with Morgan State University and African American community leaders in Baltimore to create the African Ancestry Neuroscience Research Initiative. Through this partnership, officials and experts hope to grow the pipeline of Black neuroscientists and allow community members to help shape what questions researchers explore and how they interpret their findings.

The Lieber Institute receives donated brains from medical examiners in four sites around the country, including in Baltimore, where the legacy of Henrietta Lacks — a Black woman from Turner Station, whose cells were taken from her without her consent by a doctor at the Johns Hopkins Hospital — continues to loom large.

“To be perfectly frank, we needed help,” said Dr. Danny Weinberger, CEO and director of the Lieber Institute. “We couldn’t be a group of white nerd scientists — no, seriously — saying, ‘We’re going to do all this stuff to help the Black community.’

“We wanted to bring the community in before we did anything.”

Now, Weinberger said, the Lieber Institute has 900 brains in its collection from people with African ancestry. Scientists recently used 425 of these brains to study the link between genetic ancestry and the prevalence of neurological and psychiatric diseases in people of African and European descent. The study, the first to explore how African ancestry influences gene function in the human brain, was the cover article in June’s edition of Nature.

In the study, researchers found evidence that genetic ancestry is partially responsible for the increased prevalence of Alzheimer’s and stroke in African Americans and the decreased prevalence of Parkinson’s. But they didn’t find evidence that ancestry is responsible for the disparity in psychiatric disorders and behavioral traits — meaning these differences may be driven by environmental factors, like less quality education and housing, unsafe neighborhoods, worse access to food and other effects of systemic racism.

African Americans, in general, have mixed ancestry — they might have anywhere from 0 to 60% European ancestry. Lieber scientists identified more than 2,500 genes in the brains of African Americans with significant differences in expression related to their proportion of African versus European ancestry. They were then able to figure out how much a person’s ancestral variation predicted corresponding variation in gene abundance.

“Genes for common medical illnesses — like heart disease, stroke, diabetes, asthma, schizophrenia, depression, anxiety disorder, bipolar disorder — these genes are not fate genes,” Weinberger said. “It’s not like Huntington’s disease or cystic fibrosis, where if you get the gene, you’ve got the disease. These are genes that change the probability. They move you a little bit in one direction or another.”

The article, published by lead author and Lieber scientist Kynon Benjamin, was paired with a commentary written by Duke University researcher Kafui Dzirasa, his former doctoral student Gwenaëlle E. Thomas and longtime Baltimore community organizer the Rev. Dr. Alvin Hathaway.

Hathaway and the researchers, who were key in raising more than $3 million for the project from the state of Maryland and philanthropic sources, including the Chan Zuckerberg Initiative, stressed the importance of involving marginalized community members in studies about them.

“Science is a human enterprise,” the article began. “It matters who asks the questions. It matters who interprets the results. It matters who tells the stories.”

Before becoming pastor at Union Baptist Church, Hathaway served as assistant pastor at Pennsylvania Avenue AME Zion Church, where he became friends with a worshiper named Maggie Quille. When she was a child, her uncle was involved in the Tuskegee syphilis experiment — an infamously unethical study that did not get the informed consent of participants and did not offer those with syphilis the readily available treatment for the disease.

Quille, who died in 2012, used to receive a monthly check in the mail from the government for her uncle’s participation in the study. Hathaway would drive her to the bank to cash it, and she’d tell him stories about growing up in Alabama. Despite her uncle’s experience with the medical system, she became a nurse.

“She helped me to understand that yes, you can have tragic experiences,” Hathaway said, “but what do you do to contribute? What do you do to make change? Get involved?”

He has the sense that trust is slowly building between research institutions and the Black community in Baltimore, he said. Over the years, he’s watched as hospitals like Hopkins and those in the University of Maryland Medical System seem to have become more sensitized to the concerns of people of color and work to improve their patient experience.

Each of the brains in the institute’s collection was donated by the deceased person’s family following a rigorous consent process often conducted within a few hours of their loved one’s death. Hyde, the institute’s chief medical officer, has made thousands of phone calls to grieving family members in the past 14 years.

He has noticed that people of African descent are just as likely to agree to donate their loved one’s brain as people of European descent. Instead, he said, cultural, personal and religious reasons are more likely to dissuade someone.

The calls can be hard to make. In each one, he spends upward of 20 minutes with grieving family members, who are often reeling from an unexpected death of a loved one by suicide or overdose. He explains what the Lieber Institute is and what scientists are trying to discover, and answers any questions they have.

“They understand that we’re very oriented toward finding new treatments and new targets for treatment for these disabling disorders,” Hyde said. “And for a lot of families, that makes a tragic, unexpected, sudden loss a little bit less painful.”

Priscilla Agnew-Hines remembers the phone call she got from the Lieber Institute after her beloved son, Larry Agnew, died from an overdose at age 41. She agreed almost immediately to donate his brain to the institute.

For years, Agnew-Hines had wondered what triggers a person to develop a substance use disorder. In 2014, she became a recovery coach to help those struggling with addiction. She’s grateful that her son — a talented drummer and athlete, who would bring home children from around the neighborhood in the summer to share popsicles with them — will be able to help researchers figure out the root cause of addiction after his death.

“I’m going to be the voice that helps other families that lost their sons due to this,” she said. “I don’t want families to continue to struggle. I don’t want them to have to hide.”

The study published in May is just the “tip of the iceberg” of what Lieber scientists want to achieve, Weinberger said. Down the road, Hathaway hopes the institute can establish partnerships with other historically Black colleges in the area, like Coppin State University in West Baltimore.

And Dzirasa expects researchers will dive even deeper into the brain’s genomic architecture in future studies.

In the commentary that accompanied the published study, Dzirasa, Hathaway and Thomas described Lieber’s efforts as a “down payment” on addressing the historical harm caused by exclusionary practices in science.

“Science continues to move forward,” the last paragraph of the piece read. “But this time, we will not be left behind. These are our questions. This is our story.”

Her friends often text her posts written by people who think they were the target of a trafficking scheme because they found a zip tie or a pair of sunglasses on their car in a parking lot.

McAree, a forensic nurse at Towson’s Greater Baltimore Medical Center and human trafficking liaison for the hospital’s Sexual Assault Forensic Examination, Domestic Violence and Child Protection Program, has mixed feelings about these sorts of posts.

“Any awareness is good about, you know, human trafficking is happening here,” she said. “However, it actually harms victims, because when we think human trafficking should look this certain way or fit in this little box that’s preconceived, we’re going to miss actual signs that we could look for or actual red flags for true victims.”

“The truth is that human trafficking, it is happening all around us. It’s happening to so many different populations of people,” she continued. “Sometimes they say it’s ‘hidden in plain sight,’ because it’s not what we’re going to see in the movies.”

Educating community members, from teachers and court-appointed special advocates to naval officers and school resource officers, about what human trafficking is and what it’s not is a vital role that GBMC’s Anti-Human Trafficking Initiative plays in Baltimore County and elsewhere in the state, McAree said.

After getting a $50,000 boost from the federal government, McAree and her colleagues hope to expand the reach and impact of the program. The U.S. Department of Health and Human Services selected the local initiative late last month as one of 18 winners across the country of its Innovation Challenge to prevent human trafficking among women and girls.

Human trafficking — the use of force, fraud or coercion to compel a person into labor or to participate in commercial sex against their will — often involves extensive grooming and victimizes vulnerable people, like those who are addicted to drug or alcohol, have mental health problems, are recent migrants, or are children who have run away from home.

Trafficking can take the form of an organization — like in the case earlier this summer, where a Baltimore woman is accused of forcing women to perform sex work in exchange for drugs in hotels across the state — but it doesn’t have to, McAree said. It can also look like a boyfriend using emotional abuse or threats to force his girlfriend to perform sex work to buy drugs or pay the bills. And since people under 18 are not able to consent to commercial sex work under federal law, all instances of children engaging in sex work are considered trafficking.

Because of how complicated situations involving human trafficking can be, it’s not an easy problem to quantify. But researchers agree that the majority of victims and survivors are women and girls. According to the National Human Trafficking Hotline, which is run by Polaris, a nonprofit that advocates for survivors and provides financial support to them, about 84% of people in trafficking scenarios are female.

That can be at least partially explained by the fact women are more likely to experience sexual assault, intimate partner violence and other types of abuse — a risk factor that can make them more vulnerable to trafficking. Black women and girls and LGBTQ people are also especially vulnerable, McAree said.

The Department of Health and Human Services launched the Innovation Challenge to identify and reward programs that have proved to be effective at preventing human trafficking and improving health outcomes related to trafficking, according to a news release from GBMC.

“Concentrating on human trafficking among women and girls requires a multifaceted approach that combines prevention, education, and support,” Dr. Dorothy Fink — deputy assistant secretary for women’s health and director of the Office on Women’s Health — said in the release. “We commend the challenge winners for their dedication and demonstrated success in addressing this critical need.”

Last year, McAree and her colleagues trained more than 9,000 people on a variety of topics related to human trafficking. Beyond outreach, McAree said, GBMC’s SAFE program provides free care to survivors and victims of all ages, including trauma-informed forensic and medical exams, peer recovery support, advocacy and education.

The program works with community service providers and has a close partnership with the Baltimore County Police Department, victim service agencies and the local state attorney’s office. However, even though nurses are legally required to call the police if they suspect child abuse or neglect, they need an adult survivor’s explicit consent before they involve law enforcement.

Last year, Lt. Gov. Aruna Miller praised the SAFE program after a visit to the hospital.

“Anyone that’s going through this horrific trauma in their life should be able to come to a place like this, where they’re received with comfort and warmth and understanding and patience,” Miller said in the GBMC news release, “and I think that’s the first step toward healing.”

McAree and her colleagues have a lot of plans to expand the hospital’s anti-human trafficking initiative, now that they have an extra $50,000 — an amount that might increase by $100,000 under phase two of the contest, if they’ve successfully grown their program by next summer.

They hope to add in-house mental health support for survivors, allowing them to bypass long wait times. They also hope to grow support for sheltering resources they offer to survivors and provide more advanced training to law enforcement agencies GBMC partners with and hospital employees.

They also want to replicate the SAFE program’s anti-human trafficking initiative in other hospitals and health centers across Maryland, McAree said. She wants there to be a similar program in every jurisdiction around the country. Even though SAFE won the extra money through a contest, McAree said she and her colleagues aren’t in competition with other health care providers.

“We want every single program to be tied for number one,” she said.

“It’s tragic,” said Dr. Janet O’Mahony, an internal medicine doctor who practices out of Mercy Hospital in downtown Baltimore. “But he’s also not our typical poster child for hypertensive cardiomyopathy. I guess it is a wake-up call for those of us who aren’t professional athletes — to pay attention to our lifestyle and doctor’s visits.”

People are more at risk of high blood pressure as they get older and their blood vessels stiffen, O’Mahony said. Though people should start getting their blood pressure checked when they’re young, O’Mahony often tells her patients that 40 is a great age to talk with their doctors about their levels and make sure they’re healthy.

Jones had just turned 40 before he died.

Since hypertension typically doesn’t come along with symptoms, it often goes undetected until someone gets their blood pressure checked by their doctor. O’Mahony noted that she was not Jones’ doctor and has not reviewed his medical records — or his family’s medical history — but she said she’d presume the professional athlete had plenty of access to doctors throughout his football career and even after he retired.

She’d also guess he got plenty of exercise and had access to plenty of healthy food — two factors that are key to managing hypertension and reducing the chances of further health problems, she said.

But even though NFL athletes might seem bulletproof, said Dr. Scott Jerome, a sports cardiologist at the University of Maryland Medical Center and an assistant professor of medicine at the University of Maryland School of Medicine, they also can be vulnerable to heart disease, especially if they don’t maintain a healthy diet or stay at a high weight after retiring.

“Athletics doesn’t protect you from heart disease,” Jerome said. “People say, ‘Well, I’m going to eat bad, then I’m going to run and run off all of that bad stuff, and then I’m all healthy.’”

It doesn’t work like that, Jerome said.

For anyone, regardless of physical activity, eating a diet that’s high in salt can increase their blood pressure. Think of your body like a house, he said. If the pressure in your water pipes is too high, a pipe — or your blood vessel — might burst. But too much pressure is also bad for the house’s infrastructure overtime, Jerome said. Hypertension can put people at risk for kidney damage, retinal disease and cerebrovascular disease.

And just like how your biceps might get bigger if you lift progressively heavier weights, your heart muscle can thicken from pushing blood through your body at a high pressure, making it harder for the organ to do its job, Jerome said.

People with diabetes, who smoke or drink alcohol, or who have high cholesterol are at a higher risk of developing hypertensive heart disease.

There is also a big racial disparity in those most likely to develop high blood pressure or experience complications from hypertension, like heart failure, a stroke or a heart attack. Black men have a 70% higher risk of heart failure compared with white men, and Black women have a 50% higher risk compared with white women.

While some research suggests that people with African ancestry may carry a gene that makes them more salt-sensitive, experts say structural racism and social determinants of health are big reasons for the gap. Black Americans are more likely to live in a food desert, where it’s hard to buy healthy groceries for their family, and are more likely to experience the stress of poverty and not have access to health services. Some studies suggest that experiencing daily discrimination and racism can have a cumulative effect on a person’s blood pressure.

There’s also some evidence that football players are more likely to have hypertension compared with other athletes, said Dr. Jaideep Patel, a cardiologist at Johns Hopkins Hospital and director of preventive cardiology at the Greater Baltimore Medical Center in Towson.

“This may be explained in part by increased risk of concussions, higher body mass index, higher use of supplements and pain medications, and sleep apnea seen among pro football players,” he said in an email.

Some research shows that offensive and defensive linemen — typically the largest athletes on a team — are most at risk for high blood pressure. A 1994 study from the CDC found that retired NFL players experienced a lower mortality rate compared with the general population, but retired linemen had a 52% greater risk of dying from heart disease.

The 6-foot, 3-inch Jones was a lean 192 pounds when he played as a wide receiver for the Ravens. He was working as wide receiver coach at Alabama State University when he died July 14 at his home in New Orleans.