A case against drug distributors over the flood of pills that ravaged West Virginia is back in court. Here’s what to know.
A case against major drug distributors over the flood of painkiller pills that devastated West Virginia is back in court. This time, the case is before the state Supreme Court, which is considering whether the overdose crisis qualifies under West Virginia law as a “public nuisance.”
Public nuisance is a legal term for something that endangers public health and safety. A person or company responsible can be sued and forced to remedy a public nuisance.
In drug distributors’ arguments, they say that it is not applicable to shipments of a lawful product.
How did we get here?
Counties and cities across West Virginia filed lawsuits against drug distributors, manufacturers and pharmacies, saying they fueled the opioid epidemic resulting in thousands of lost lives, grieving families and overwhelmed law enforcement and treatment providers.
But Cabell County and Huntington have been fightingone case on their own.
Opioid litigation cases across the county were consolidated in a court overseeing multi-district cases in the Northern District of Ohio.
U.S. District Judge Dan Polster selected the lawsuit filed by Cabell County and Huntington to serve as a “bellwether” case, meaning it could indicate how similar cases might fare. He sent the case back to federal court in West Virginia.
Those municipalities alleged drug distributors AmeriSource Bergen Drug Corp., Cardinal Health, Inc. and McKesson Corp. caused a public nuisance by knowingly shipping an excessive amount of pills to the area, resulting in more than 700 deaths from opioid overdoses in Cabell County between 2015 and 2020.
They said to abate the crisis — abatement means remedying a public nuisance — companies should pay them $2.5 billion dollars, which a Johns Hopkins researcher estimated it would take to support their recovery.
Cabell County and Huntington lost their case when in 2022, U.S. District Judge David Faber ruled in favor of the companies, agreeing with their argument that public nuisances don’t include lawful product distribution.
Soon after, more than 100 cities and counties settled with the same companies for $400 million, to be dispersed throughout the state.
This meant while they received money, companies didn’t have to admit liability.
Cabell County and Huntington appealed, and they presented their case to the 4th U.S. Circuit Court of Appeals in Richmond, Va., last year.
A three-judge panel there decided that the West Virginia Supreme Court should determine if state law considered drug distribution as something that would be found to be a public nuisance.
Why is the Supreme Court’s decision important?
Huntington and Cabell County say prescription drug distributions are different from other product distributions as federal law requires companies to monitor and report large prescription requests, because these drugs have potential for misuse.
Companies say applying the law would result in a flood of new nuisance cases. In oral arguments last week, an attorney for the companies, Steve Ruby, argued it could result in cases over everything from foods associated with obesity to gun deaths.
Ruby said companies and Faber agreed that distributors were only responding to prescription orders written by licensed doctors and sent to pharmacies.
David Frederick, a lawyer for the communities, said Faber was “led into error by the distributors who wanted to shunt the blame to everybody else.”
If the city and county prevail, the case would be sent back to the 4th Circuit. A ruling there in favor of defendants would end the case. Judges there could also rule in favor of the communities, which could mean defendants could appeal to the U.S. Supreme Court, or they could send the case back to Faber.
Even if Huntington and Cabell County lose, they would still be eligible for funds from the West Virginia First Foundation. That’s because that organization is distributing $1 billion from settlements with multiple entities, including pharmacies and manufacturers, and Cabell County and Huntington are only excluded from the $400 million other municipalities received in settlements with distributors.
Companies also say the communities can’t prove they caused the opioid crisis, so they shouldn’t have to pay to remedy its impacts.
Locked up: West Virginia still sends kids with physical or emotional disabilities to group homes and treatment centers at a rate three times the national average, according to the most recent data available.
Undiagnosed: After the federal government began investigating West Virginia’s treatment of foster kids with disabilities, the state started screening a much smaller percentage of kids for these conditions, data shows.
Failed solutions: The state has touted new programs to help send fewer kids to these facilities, but those kids still aren’t getting sufficient mental health care.
By the time Sadie Kendall turned 18 and aged out of West Virginia’s foster care system, she had lived in more than two dozen places. There was her mother’s house in Mineral County, where she lived until the state took her away after discovering her mom’s substance abuse. There were foster homes, and a revolving door of parents who ultimately couldn’t or didn’t want to keep her. There was shelter after shelter, short-term spots where Sadie waited for something better.
And there were the treatment centers, a series of in-patient hospitals the state started sending her to when she was only eight. The first one — Southwood in Pittsburgh — is fuzzy in her memory. She knows there were other kids, some of whom were scary to her. She remembers being restrained, and nurses giving her shots in the butt. And she can still taste the psychiatric medications. She was too young to swallow pills, so nurses fed them to her crushed up in peanut butter. They made her sleep all day.
“I was sedated most of the time, pretty much,” Sadie, now 27, recalled.
It didn’t help. There were outbursts, tantrums and repeated attempts to run away. Sadie missed her mom and was confused about why they weren’t all together. Time and time again, West Virginia sent her to short-term homes where she struggled to get adequate mental health care and form permanent relationships.
“I think I just had a lot of trauma in my life, and I just needed somebody to care for me how you’re supposed to care for a child,” she said.
Listen to Sadie Kendall discuss her experience.
By the time Sadie turned 18 and left the state’s care in 2015, the U.S. Department of Justice had concluded West Virginia was over-relying on these types of group facilities and treatment centers. This “systemic failure,” officials wrote in their findings, violated kids’ rights under the Americans with Disabilities Act and “places children with mental health conditions who currently live in the community at risk of unnecessary institutionalization.” In 2019, West Virginia and the DOJ agreed to a plan to fix the issues. But several months later, there hadn’t been enough action for the state to avoid a lawsuit over the issue.
And even now, more than five years later, West Virginia is still failing to meet the mental health needs of kids like Sadie, a Mountain State Spotlight investigation has found.
Undoubtedly, there are some foster kids who need in-patient mental health care and benefit from short-term intensive treatment. But in a system where by definition almost every child in it has either experienced trauma or neglect, West Virginia officials have fallen short of helping kids get access to therapy while they live with families in communities.
Despite early gains reducing the overall number of kids in group homes and institutions, kids with any kind of physical or mental disability were still institutionalized at a rate more than three times the national average as recently as 2022, according to an analysis of the data West Virginia submits to the federal government. The state’s Department of Human Services still doesn’t have an adequate number of social workers to investigate child abuse cases and help find homes for foster kids; this in turn means untenable case loads that leave kids in care and foster families without adequate mental health care and necessary supports.
And though the state has trumpeted increased enrollment in a new program to help kids access mental health care in their communities, in practice it has fallen short of giving biological, adoptive and foster parents and kids the support they need to keep kids safe and healthy at home.
Over the last two months, Mountain State Spotlight has shared findings of our reporting with state human services officials. A spokesperson initially responded, referring us to previous agency press releases. We then sent the agency a long list of our questions, but received no response.
For kids like Sadie, hard to place because of behavioral issues, it may seem like there are few good options. But sending vulnerable children to residential facilities, including group homes, shelters and in-patient treatment centers, can end up doing more harm than good, according to warnings from years of research.
“Sending children to live together among other children who have behavior problems, we have good evidence, makes them worse,” said Mary Dozier, the Amy E. du Pont Chair in Child Development at the University of Delaware.
That’s what happened to Sadie, who spent her early adulthood struggling to piece together a life after her years in state custody.
“It never got better,” Sadie said. “It was always just the same shit over and over again.”
Kids still being institutionalized
The system’s problems are deep, entrenched, and intertwined. But there are two points that can’t be ignored: mental health care is hard to access for many West Virginians, and there is a dire need for quality care among foster kids.
Most kids enter the foster care system because they are either abused or neglected, both of which can cause lasting mental health problems. Nearly half of the West Virginia kids who spent time in foster care from 2012-2022, were there at least in part because of a parent’s substance use. One-third of all foster kids were neglected, nearly one-fifth were exhibiting some sort of behavioral problem and one in six were physically or sexually abused.
And of course, all of them had experienced the trauma of being taken away from their families. While the goal of the state’s foster care system is to reunify kids with their biological parents, that’s not always possible. In those cases, West Virginia is their guardian on paper, tasked with making sure their needs are met and that they’re able to eventually leave the system as productive adults.
But all this is happening in a state where access to mental health care is a struggle. Only six of West Virginia’s 55 counties exceed the very low target adopted by the World Health Organization of one psychiatrist per 10,000 people. Thirty-five counties have no psychiatrist or addiction medicine specialist. None of the state’s public school districts met the recommended ratio of one psychologist for every 500 kids during the 2023-24 school year.
The result has been the state sending many kids with mental health needs to in-patient hospitals and residential facilities. In 2014, the rate of kids living in these kinds of residential treatment facilities was so high, it kicked off the DOJ investigation that concluded West Virginia had built its entire child welfare mental health system around these segregated facilities.
“The system is killing a lot of children who remain alive but who have just been so devastated by the circumstances that they encounter that they’re effectively destroyed.”
marcia lowry, executive director, a better childhood
It’s a system that Orion Flynn knows well. He was only 10 when he spent his first long-term stint in a psychiatric hospital. At that point, he had been through a lot in his short life — taken away from his parents as his mother struggled with substance use and his father repeatedly robbed the bank down the street.
This led to behavioral issues. Orion says he “was a child who didn’t know what was going on, throwing a tantrum, yelling, slamming a door, that sort of thing,” he recalled. “And it would sometimes get me sent to actual in-patient psychiatric hospitals.”
Orion Flynn has aged out of the state’s custody, but as a foster child, he spent time in several different in-patient treatment centers. Photo courtesy Orion Flynn.
That first hospitalization at Charleston’s Highland Hospital lasted a year. Orion is 19 now, and still remembers the types of restraints the hospital used on him.
There was the four-point restraint, a system of wrist and ankle cuffs that held the ten-year-old child to the bed for up to four hours. Then, there was the papoose board, immobilizing Orion on the floor when he acted out.
A spokesperson for Highland Hospital noted that the facility has changed ownership since Orion was hospitalized there, but that it uses these kinds of interventions for patients’ safety and in accordance with “the latest least restrictive psychiatric intervention guidelines” and to “prioritize de-escalation.”
But for Orion, it was an experience that didn’t seem to help any of the mental health issues he was experiencing. “When I left, I think I was on 12, maybe 13 different medications, and I received mediocre therapy at best,” he said.
Listen to Orion Flynn discuss the year he spent in an in-patient psychiatric hospital as a child.
West Virginia officials have spent the last decade arguing that they’re making progress on fixing the issue. In 2015, in the wake of the DOJ investigation, then-Cabinet Secretary Karen Bowling wrote in a press release that she had already been working for two years to “turn these statistics around.”
But four years later, in 2019, disturbed by the ongoing high rates of kids in institutions, a group of foster kids sued the state, seeking more independent oversight of the system.
“Basically what's happening is the system is killing a lot of children who remain alive but who have just been so devastated by the circumstances that they encounter that they’re effectively destroyed,” said Marcia Lowry. She is a lawyer and the executive director of A Better Childhood, a nonprofit advocacy group that is representing the foster children in the lawsuit against West Virginia. Her group has successfully sued other states over similar issues, forcing reforms to their foster care systems.
“They are just destroyed, and they continue to walk around, but when they get to be 18, there's no way that they can effectively contribute to society. Some of them survive, lots of them don't, but they're all damaged,” she said.
In response to the suit, agency officials once again argued they were in the process of making major improvements, and shrugged it off as the work of outside lawyers.
“The issues they raise are generally those the Department has already publicly reported to the Legislature and is working to resolve with the input of the Department of Justice, our local stakeholders, the West Virginia Judicial Branch, and the West Virginia Legislature,” former Cabinet Secretary Bill Crouch said in a press release. “For an out-of-state group to sue the State of West Virginia to take over our child welfare system is offensive to the many federal, state, and community partners who have worked tirelessly to transform and improve our system.”
It’s true that since the DOJ first issued its findings, West Virginia has made some progress.
In the years immediately following, West Virginia cut the overall percentage of kids going to group homes and institutions by half. There’s also been an effort to keep more kids closer to home, rather than sending them to out-of-state group homes and institutions, which a 2021 Mountain State Spotlight investigation found left some kids in unsafe situations.
But while the state improved, the majority of those gains weren’t for the kids who needed it most.
Progress getting kids with disabilities out of group homes and institutions was much, much slower, according to a first-of-its-kind Mountain State Spotlight analysis of the data states submit to the federal government. In September 2022, West Virginia was still putting half of the kids with any sort of disability — physical or mental — in these types of places. That was three times the national average for similar kids with disabilities for that year.
The West Virginia Department of Human Services wouldn’t provide any more recent data about whether that has changed. But it does post monthly reports about where foster kids are living on a dedicated website. That separate state data doesn’t indicate disability status, but it does show that since the time period when the federal data ended, the state has sent even more foster kids — and a larger percentage of kids in care — to residential treatment facilities.
Quality mental health treatment for a short period of time can help kids with some conditions. But the class action lawsuit alleges kids are being left to “languish” in these kinds of settings, where they experience additional trauma. And even in the best case scenarios, workers in these group centers, no matter how caring, are still coming and going. These situations rob kids of the key ability to form attachments, which can have life-long implications.
“If there's no primary persons who are pretty much reliably there, they're not able to form that kind of attachment, which will impact them throughout their lives,” said Carole Shauffer, the senior director of strategic initiatives at the Youth Law Center.
State’s solutions to these problems are falling short
As West Virginia grapples with trying to find appropriate homes for the increasing number of foster kids in its care, it’s under a mandate from an agreement with the federal government to offer more alternatives to in-patient psychiatric care.
The goal is to give kids more options for mental health care in their communities, whether that’s living with their biological parents, with adoptive parents or in a foster family.
It’s hard to say how many foster kids could benefit, because the data shows West Virginia hasn’t determined whether a large percentage of foster kids have a disability or not.
Starting in 2016, there was a sharp jump among West Virginia foster kids who “had not yet” been diagnosed with any kind of mental or physical disability. In 2015, only 6% of kids had this undiagnosed status. The next year, as the DOJ continued to closely examine how West Virginia treated kids with diagnosed disabilities, 26% of kids were undiagnosed. Some remained that way for years, and West Virginia’s foster care agency didn’t respond to questions about why that might be.
But people familiar with the system weren’t surprised.
“There’s a lot of things they’re supposed to do that don’t get done,” said Layne Diehl, a Martinsburg attorney who is frequently appointed to represent foster kids’ interests in court. She said often she’s had issues even tracking down kids’ basic medical records for their foster parents.
“The way that that abuse and neglect system works, a lot of times I feel like the focus gets placed on putting resources around the parents and the kids oftentimes get left out,” she said. “You have parents who have to complete an improvement period and so they need to get a psychological evaluation, but the child’s not necessarily getting the services they need.”
And while kids entering foster care are required to be scheduled for an initial medical exam within the first several days, there’s no similar requirement for a mental health screening.
“There were times they needed a psychological that they didn't get it until they were court-ordered,” said former Child Protective Service worker Kathie Giboney, who worked for four years in the district that covers Pleasants, Doddridge and Ritchie counties.
“At some point, it breaks your heart when the system screws a child so badly you know they’re never going to be fixed.”
stacy jacques, adoptive and foster parent
Over the past 12 years, the state has rolled out program after program designed to help kids access mental health care in their communities. The list of programs has been a moving target as they change names and services over time; Safe at Home morphed into West Virginia Wraparound, for instance, and the state’s services now include a veritable alphabet soup of acronymic programs: ACT, CCBHCs, FSCs, CSED.
The idea is simple: if you provide whatever mental health services a West Virginian might need in their own community, you may be able to avoid having to send them somewhere else for residential psychiatric treatment.
For the last several years, the state has offered a special program for kids on Medicaid with serious mental health needs. It’s not just for foster kids or adoptive kids, but there is a large overlap between the two groups.
Stacy Jacques’ son was one of the first kids to get into this program, back in 2020. Jacques adopted him from the foster care system and he had been struggling with significant mental health issues — so significant that they had posed a safety threat to Jacques and her other children and necessitated him living with another family for a while.
Jacques said this Medicaid program is the only solution the state has offered her son. “And it’s just not enough,” she said.
Stacy Jacques with her son in 2007 on their first day together; she fostered him from infancy then eventually adopted him. Photo courtesy Stacy Jacques.
West Virginia has touted the program’s increased enrollment as a sign of its success. In a December press release, the Department of Human Services reported that nearly 4,000 children have enrolled in the program, and provider numbers have doubled since 2020 to meet the growing demand.
But while the program has grown exponentially — between 2020 and 2023, the number of kids approved on the first try grew six-fold — the providers haven’t kept up. There are just 26 providers now, up from 22 in 2021.
The state’s own reports have highlighted the program’s shortcomings.
Since 2022, the expert hired by West Virginia to assess whether it’s complying with the state’s agreement with the DOJ has warned that the number of hours of therapy each kid is getting through the program is too low. Even when there were fewer kids enrolled in the program, the report found they were getting less than nine hours a month of services. In a recent report — from March 2024, which analyzed 2023 data — kids were only getting 10 hours a month, and half of that was staff time for administrative tasks.
When Jacques signed her son up, she says the program promised 2-4 hours of in-home services a day. But that didn’t last for long.
“Now we’re lucky to get half an hour every week.”
She said they’ve had some amazing providers through the program, but there have been major gaps and inconsistencies. She’s been waiting four years to get access to family therapy through the program, but has been told there are no therapists available in Cabell, Kanawha or Putnam counties. Once, her son didn’t have a therapist for a year because of a lack of providers. Once, during a crisis on a Friday night, she tried to access the emergency support that’s supposed to be part of the program. The coordinator who answered the phone said she was at a party and would call back on Monday.
“With other families that I’ve known, most have given up,” Jacques said of the program.
Stacy Jacques and her son at “foster parent day” at the West Virginia Legislature in 2019, advocating for more adoption resources. Photo courtesy Stacy Jacques.
Now, after five years enrolled, she said assessments of her son still indicate he has severe needs, despite all that she’s done to keep him at home and improve his life.
“But the hand he was dealt before he even came to me has made it impossible to achieve those goals,” she said. “At some point it breaks your heart when the system screws a child so badly you know they’re never going to be fixed.”
Around the state, others have reported problems too. Giboney said while she saw kids get into the programs, they ended up being plagued by the same staffing shortages that are an issue among state CPS workers. “They had a worker that would come once in a while but then the worker had to either drop them, or they just didn’t have a worker because the worker quit,” she said.
And in Martinsburg, Diehl said though the concepts behind many of the state’s programs are excellent, “the bureaucracy around it is absolutely maddening.”
She’s worked to get kids approved for the Medicaid program, but then their caseworker left the agency. Then, she has encountered the same sort of turnover among the mental health providers and the facilities. After months of calls trying to find someone else with a record of the approval, she’d reach someone only to learn the services were withdrawn because they weren’t used.
“Right about the time you feel like you’ve got everybody on the same page, there’s a ball that’s dropped over in the corner somewhere. And everybody’s scrambling trying to find that,” she said. “It can be very, very frustrating.”
The cycle
As West Virginia enters its second decade of trying to fix the problems in its foster care system, thousands of children have entered adulthood having spent time in group homes and institutions. In the cases of both Orion Flynn and Sadie Kendall, they were released from the state’s custody with lasting trauma, ill-prepared to thrive on their own.
Carole Shauffer of the Youth Law Center says that moving kids from one abusive or neglectful home to another goes against the goals of the system. “I think once the state intervenes, it has an obligation to intervene in such a way as to provide you with high quality care that will enable you to thrive and become a healthy adult,” she said.
Sadie Kendall cooking dinner on a recent evening for her daughter. She loves to cook, and hopes to do it professionally someday. Photo by Duncan Slade / Mountain State Spotlight
It can be a vicious cycle, where it’s easy for former foster kids to see their own children taken away and put into the same system that defined their childhoods.
That’s what happened to Sadie. After she aged out of the system, she struggled to get back on track. She was sometimes homeless and worked low-wage jobs at Walmart and a local hotel. She moved in with her boyfriend to a house that she said was so bad, it should have been condemned. And she had two children.
“I didn’t have anything. I took care of my kids, I took care of them very well. But it wasn’t enough for the state,” she said.
After Sadie was arrested on a series of misdemeanor charges including disorderly conduct, obstructing, public intoxication, refusal to fingerprint and battery on an officer, the state intervened.
“They took them and that was it. That was it.”
To regain custody of her children, Sadie was told she could enroll in a series of parenting classes and report for regular drug tests. But she didn’t have reliable transportation to get there, and was trying to keep a job. The state had created a set of hurdles she just couldn’t clear.
“I kind of gave up,” she said sadly.
At that point, it’s easy to see how for Sadie, the cycle might have continued. She signed away her parental rights, and her children were eventually adopted by a foster family. For many, that would be the end of the story. It wasn’t for Sadie.
She made more mistakes, trusting the wrong people and struggling with drug addiction.
“At this point, what do I have left to lose?” she said.
Then, she had another child. And she was determined not to repeat the mistakes she made with her older children.
Today, her daughter Zariyah is four years old. And despite Sadie’s best intentions, she’s continued to struggle to retain custody. Last year, she made a huge error in judgment when she gave an acquaintance a ride home. She got pulled over, and he had drugs on him. The state took Zariyah away. For a minute, it seemed the cycle would repeat itself again.
But this time, Sadie knew what to do. She fought.
“They think it’s how it used to be and it’s not. I’m going to show them that I’m not just a statistic,’” she said. She hired a lawyer, she drove herself to the drug tests, she attended the classes. And several months later, she got Zariyah back.
Now Sadie is trying again to be the mother she always wanted to be. She works part-time as a bartender; when she’s not at work, she describes her life as “Mommy mode 24/7.” She loves to cook and started culinary school this month in hopes of eventually doing it professionally.
Sadie Kendall holds her daughter, Zariyah, who is four years old. Photo by Duncan Slade / Mountain State Spotlight
Though Sadie’s life has stabilized, she continues to bear the scars of her time in foster care. She struggles with deciding who to trust. She won’t touch prescription medication, even if she needs it. And she feels like West Virginia’s system repeatedly set her up for failure.
“They were convinced I wasn’t going to make it,” she said. “I’m going to prove them wrong.”
Mountain State Spotlight is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on the collaborative include The Carter Center and newsrooms in select states across the country.
The data used in these stories, [Dataset 176, 187, 192, 200, 215, 225, 235, 239, 255 and 274, Adoption and Foster Care Analysis and Reporting System (AFCARS), Foster Care File 2012-2021], were obtained from the National Data Archive on Child Abuse and Neglect and have been used in accordance with its Terms of Use Agreement license. The Administration on Children, Youth and Families, the Children’s Bureau, the original dataset collection personnel or funding source, NDACAN, Duke University, Cornell University, and their agents or employees bear no responsibility for the analyses or interpretations presented here.
Appalachian Tennessee Abortion Providers Are Still Fighting to Provide Care
When Jules Edwards was a teenager, they say being able to access an abortion was life-saving health care.
“I was somebody who had an abortion as a teenager and didn’t tell my family and got support through a family friend,” Edwards said recently. “And that saved my life and gave me my future.”
Now, as executive director of Abortion Care Tennessee (ACT) and Mountain Access Brigade (MAB), independent organizations funding Appalachians who need to seek abortion care out of state, Edwards spends every day fighting to provide that same life-saving care for others.
It’s increasingly difficult. Edwards says they’ve been threatened and doxxed doing this work. Their home state of Tennessee enacted a trigger ban when the U.S. Supreme Court first overturned Roe v. Wade; abortion remains banned across the state, as well as in the bordering states of Kentucky, Missouri, Arkansas, Mississippi and Alabama. Tennessee’s abortion laws are so strict that the state is currently entangled in two court cases over them.
With the government enacting ever-tightening bans across Southern Appalachia, nationwide organizations like Planned Parenthood are no longer able to provide life-saving abortion care in Tennessee, and have faced intense operational threats. It’s left to grassroots organizations in Appalachia — usually founded, funded and run entirely by and for their communities — to continue fighting to provide care and helping each other when no one else will or can, despite funding challenges, tightening restrictions and risks of persecution.
Edwards’s organizations, ACT and MAB, are among the grassroots funds filling a reproductive health gap by operating statewide to service Tennesseans going out of state for abortion care. Among community work and educational measures, ACT funds procedural costs for Tennesseans traveling for abortion access, and MAB is an abortion fund and doula collective.
The ulterior motive of the state’s injunctions against abortion, Edwards said, is taking away the ability of young people to have power and autonomy, as well as to “make it impossible for the Planned Parenthoods, the abortion funds, or support groups to do their jobs.” Both abortion providers in Appalachia — and individuals who need abortions in the region — are left grappling with a landscape that’s nearly impossible to navigate.
Organizers work through an ‘access crisis’
Tennessee was sued over its abortion law, a ban with virtually non-existent exemptions, in a case led by the Center for Reproductive Rights and three Tennessee women, Katy Dulong, Allie Phillips and Nicole Blackmon,who faced near-deadly barriers in accessing abortions for life-threatening pregnancies and/or fetuses that were virtually non-viable. In a temporary injunction in late October 2024, judges ruled that doctors in Tennessee who provide abortions to patients facing certain medical conditions can do so without facing disciplinary action. As of December 2024, the case is still active.
Meanwhile, back in September 2024, a judge temporarily blocked enforcement of Tennessee’s ban criminalizing any non-parent from helping a minor to obtain an abortion, according to reporting from Tennessee Lookout. For organizations like ACT and MAB, bans not only impact them providing aid, including to minors, but also complicate elements of their work.
Before Roe’s overturn, “Tennessee was actually a safe haven for abortion in the South,” Edwards said, noting Tennessee’s central location to other Southern states and previously higher number of abortion clinics. As of 2012, more than one in four abortions in Tennessee were being obtained by someone traveling from out of state, an outcome of the 2000 Tennessee Supreme Court decision that struck down abortion restrictions.
“We received quite an influx of out-of-state patients,” Edwards said. “So when Tennessee lost abortion access, it sent the entire South into an access crisis.” Doing this work in the South, Edwards said, “feels like a microcosm of the fascism that we’re facing on a national level.”
‘The need is significant’
That “access crisis,” driven by Tennnesee’s trigger ban, was compounded by violent blowback against providers. For MAB and ACT, the uptick in work kicked off before Roe’s overturn when, on New Years Eve of 2021, Knoxville’s Planned Parenthood clinic was destroyed. Mark Reno, a Jan. 6 insurrectionist and member of a Catholic Orthodox militant group, allegedly arsoned the $2 million yet-to-be-opened facility, but died in jail before he could be convicted. The year before, he had allegedly fired shots at the same clinic.
The day of the arson, Noé Monárrez, an East Tennessee Community Health Educator who has worked at the Knoxville Planned Parenthood since June of 2021, recalled opening their phone and scrolling through Twitter. Monárrez immediately saw that a Planned Parenthood was on fire – and realized where it was.
“I had an inkling that somebody had burned it down, because it is Knoxville, it is East Tennessee, that’s just one of those things you have to expect potentially,” Monárrez said.
“The day it burned, I remember the first thing I thought was, ‘Did that person have my address? Did they find me online?’ said Tory Mills, who was Director of Community Engagement at Planned Parenthood for 11 years. Mills recalled fear that she — along with her friends and colleagues — were in danger.
“That’s what that building being burned down was [for], was to scare people, to scare them away from getting care [and] from doing this work,” said Mills, now a member of Knoxville Abortion Justice Alliance (KAJA), a community organization advocating for stigmatization and education around reproductive care.
For a year after the arson, Knoxville, the third largest city in the state, was left without a Planned Parenthood. After that, Knoxville’s Planned Parenthood had a brief tenure of offering limited services out of a bus until the provider went on maternity leave. Even when the mobile unit was offering services, many community members didn’t know; Planned Parenthood was reluctant to advertise given the violence and threats they’d previously faced, and struggled with zoning issues, according to Monárrez.
Because it was still a functional clinic, the bus had to be in a location zoned for health care. It couldn’t remain on the site of the previous Planned Parenthood due to construction starting, and had to be moved overnight due to safety concerns.
“At the time, we also didn’t publish [the location of the bus] anywhere publicly except social media and maybe [the Planned Parenthood] website,” Monárrez said. “We tried to keep the announcement of it very quiet just because of safety and security reasons.”
In anticipation of Roe’s overturn, the mobile health unit’s offerings were kept fairly simple. They focused primarily on basic birth control services, pregnancy testing and limited UTI treatment, with the hope of being able to offer ultrasounds, gender-affirming care and more extensive STI/UTI testing and treatment in time.
“[For many of the patients,] the only times they were seeing any kind of medical care was when they were coming into Planned Parenthood,” Monárrez said.
The Dobbs decision left the entire state without abortion care. Now, the Knoxville Planned Parenthood facility has been rebuilt with tightened security measures and reopened in November 2024. But it still legally can’t offer abortion care within the state, though it will help navigate patients to the closest clinic that offers the services they need. The Knoxville Planned Parenthood also has an internal patient navigation assistance fund, which can be applied to travel costs such as flights and hotels as well as procedure costs, and partners with abortion assistance mutual aid funds such as MAB, according to Monárrez.
In Appalachia, the stigma against abortion, as well as systemic barriers like lack of access to transportation and failure to expand Medicaid, directly impact community members. There are gaps in the narrative around what attacks on Planned Parenthood mean and how they impact people, particularly how they potentially leave “the everyday person who needs an abortion feeling terrified for their life,” according to Edwards. Whereas Planned Parenthood is a national organization, most local abortion organizations — the ones stepping in to fill health care gaps and save lives — are funded by the community and often lack capital.
Multiple organizers with MAB and KAJA previously worked for Planned Parenthood, and noted the importance of the organizing work they learned there; Planned Parenthood is the first stepping stone for many people, some said. But Planned Parenthood doesn’t share the same funding burden with the funds, some organizers said.
One MAB member mentioned that the fund’s anonymous support line sometimes has to be closed for a week or so out of a month due to lack of funding. In late September, the fund posted a message to Instagram: the support line was closed because they’d spent double their weekly budget the week prior, supporting appointments.
The need is significant. A study from The Guttmacher Institute detailed that more than 10,000 Tennesseans crossed state lines to access an abortion in the last year. While Tennessee is already classified as a “maternity care desert,” experts have stated that maternal and infant mortality rates could rise in states with abortion restrictions, according to reporting from The Tennessee Lookout.Because Tennessee is out of Title X compliance due to a policy of refusing to allow clinics to share information on elective abortions, the state is also ineligible for vital federal Title X funding.
Mills also noted that many abortion funds and national organizations deem the climate in Appalachia too difficult to navigate and too hostile, and simply give up on providing care here. “This country as a whole has painted Appalachia as a throwaway place,” said Mills.
The organizers in Tennessee see this as another social justice battle that Appalachia is being thrown to the frontline of. “And now we’re experiencing that around abortion,” Edwards said, noting that many of the most brilliant social justice activists come from the South, particularly Appalachia.
The lack of resources, rights, wealth and more that Appalachians often face is discussed and widely known – but rarely are Appalachians celebrated for the “grittiness, resourcefulness and tenacity” they show in the face of oppression and injustice, Edwards said, pointing out that Appalachians rarely fail to rise up and provide for each other.
People in Tennessee and East Tennessee will always need abortion, Mills said, and regardless of what entities or organizations hold the work, there will always be workers ensuring people get the care they need.
“Even as tired as I am 20 years into this fight, I will never leave this region,” Mills said. “I will never leave Appalachia, and I will never let the bastards win.”
Contact Mountain Access Brigade’s Support Line at 855888MAB8.
Kacie Faith Kress is an investigative journalist, with an MS in Journalism from Northwestern University’s Medill School, specializing in Social Justice & Solutions Journalism. Born and raised in East Tennessee, she now lives in Chicago.
How President-elect Trump’s proposed tariffs could further squeeze West Virginians’ wallets
President-elect Donald Trump has repeatedly threatened tariffs on imports from foreign countries to pressure them to curb illegal immigration and the flow of illicit drugs.
When he takes office in January, he’s said he plans to sign executive orders implementing a 25% tax on all imports from Canada and Mexico and an additional 10% tax on Chinese imports.
In his first term, Trump also used the threat of tariffs to negotiate with countries including Mexico. And started an ongoing trade war with China.
West Virginians across the state have said they are struggling with the rising cost of living. Donald Trump won West Virginia with 70% of the vote. Economists say his proposed tariffs would make prices worse.
Experts said stronger tariffs could raise the prices of groceries and technology. The state’s largest trade partners would be hit and could retaliate, furthering the effects on West Virginia’s economy.
Here’s what to know about how Trump’s proposed tariffs could affect West Virginians.
What is a tariff?
A tariff is simply a tax imposed on the import of a foreign-manufactured good that domestic companies pay. However, companies usually offset the costs by raising prices, which consumers then pay.
For example, most bananas at American grocery stores are imported from Central and South American countries because they grow best in tropical climates.
So, when there’s a tariff on bananas, the company bringing them into the country has to pay the extra tax when they arrive. The extra tax gets passed on and shows up on grocery bills.
Tariffs are not a new economic tool and historically they’ve been used to generate revenue when countries were developing. But now, those taxes are primarily used as leverage for trade agreements or to protect domestic manufacturers from foreign competition.
Recently, the U.S. has imposed several tariffs on countries, including China, with the Biden Administration substantially increasing taxes on electric vehicles, steel, aluminum and lithium-ion batteries.
Christina Fattore, a professor of political science at West Virginia University who specializes in international trade relations, said tariffs can start trade wars between countries when retaliation occurs or an “eye for an eye” scenario where consumers lose out in both countries.
“Tariffs are supposed to strengthen domestic industry, but if that domestic industry doesn’t exist, you’re stuck paying it,” she said.
Where does West Virginia import from and export to?
In 2023, West Virginia exported $5.7 billion of goods to other countries. Canada, China, Japan, the Netherlands and Belgium are the largest recipients. The state’s top exports were coal and petroleum gas, vehicle parts, synthetic rubber and chemicals.
“Canada consistently ranks as the state’s top trade partner, accounting for nearly 40% of West Virginia’s exports, particularly in coal, chemicals, and machinery,” said Andy Malinoski, spokesperson for the state Department of Economic Development.
That same year, the state imported $4.8 billion of products from Canada, Japan, Germany, China, and Mexico. Imports included steel and aluminum for vehicles and aircraft, electronics and industrial chemicals.
Tariffs by the U.S. would increase the price of imported goods. If other countries retaliate with their own tariffs on U.S.-made items, industries that export to foreign markets would be impacted.
How will proposed tariffs on imports impact prices in West Virginia? Who pays tariffs?
Trump said in a recent interview that he couldn’t guarantee that his proposed tariffs would not impact consumer prices, and many economists agree that tariffs drive up prices.
“I am really concerned about consumer prices — prices are going to go through the roof,” Fattore said. “Countries will retaliate with tariff taxes on their own.”
Grocery store items like fruits and vegetables would increase in price because the U.S. relies on other countries for produce. In 2022, Mexico alone supplied 51% of fresh fruits and 69% of vegetables that Americans buy.
Gasoline prices could also increase from Canadian tariffs as the U.S. imports crude oil from the country. Some analysts have predicted gas prices could go up by 30 cents or more.
Meanwhile, the price of new and used cars will likely increase as Canada and Mexico remain top suppliers of auto parts and imports to the U.S. American companies like Ford, Tesla and General Motors have factories in Mexico and about 76% of vehicles manufactured in the country are exported to the U.S.
Fattore said when global steel and aluminum tariffs were put in place in 2018, the prices of aluminum cans became more expensive, impacting canned goods, soda and beer. She said technology imports also suffered as Chinese tariffs hurt American businesses during the 2018-2019 trade war.
“If you’re thinking about buying a new car, getting a new phone or buying a computer, I would do that before Christmas or before Trump comes into office,” she said.
How could a trade war affect West Virginia’s jobs?
A new trade war could hit American workers just as hard. Trump’s proposed tariffs could lead to the loss of over 344,000 jobs, according to a report from the Tax Foundation, a nonpartisan think tank. Those projections do not account for any future retaliatory tariffs from other countries.
Fattore said tariffs can usually backfire and harm the job market as other countries retaliate with their own taxes on imported goods.
“I wouldn’t expect more American jobs to come out of tariffs,” she said. “When Trump put tariffs on steel and aluminum, companies like Harley-Davidson actually exported jobs overseas so they could avoid paying import fees.”
Canada is West Virginia’s largest trade partner and tariffs would hurt manufacturers, especially car manufacturers who ship parts back and forth between the border, she said.
In 1994, President Bill Clinton signed the North American Free Trade Agreement, opening the door for freer trade between Canada, Mexico and the U.S. But it disproportionately impacted American manufacturers and pushed thousands of jobs to other countries, hurting places dependent on manufacturing.
In West Virginia, places where steel jobs were significant like Weirton, lost thousands of jobs.
In 2020, the Trump Administration reached a new trade deal with Canada and Mexico to replace NAFTA.
The free trade agreement provided new provisions highlighting digital trade, requiring that 75% of automotive parts be made in North America and allowing the American government to conduct independent reviews of working conditions in Mexican factories.
However, the new proposed tariffs would effectively squash the 2020 deal on free trade between the three countries as it will need to be renegotiated. The U.S. has 14 free trade agreements with 20 countries, including Canada and Mexico. These agreements eliminate or reduce tariffs and other trade barriers to protect domestic investors.
As Starlink faces federal scrutiny, the internet company has become a lifeline in West Virginia — for those who can afford it
Two years ago, the DSL internet at Aeriell Turner’s home in rural Raleigh County grew increasingly unreliable as she began to rely on her phone’s mobile hotspot for work.
“The lines where I live are notoriously bad,” she said.
Aeriell Turner, a resident of Raleigh County who uses Starlink to work for home for an out-of-state insurance agency. Courtesy photo
But then, Turner, an insurance agent who works remotely, switched to Starlink.
Now, as she turns on her computer at the beginning of each work day, a sleek white router softly blinks in her living room reminding her that her internet troubles are far behind.
She now answers video calls and interacts with her clients without interrupted service.
“A good internet connection is a literal lifeline,” she said.
For West Virginians like Turner, Starlink promises a solution to their desperate need for fast and reliable internet access. Residents say they’ve turned to the company, despite the high price tag, while they wait for faster, more reliable internet from traditional providers.
However, federal regulators concluded that the company couldn’t meet promised speeds and rejected its application for nearly $900 million in subsidies in 2022.
Now, as West Virginians continue to search for answers, Starlink could soon be in line for more of the flood of federal dollars to expand broadband.
The company’s owner, Elon Musk, is not only the richest person in the world, but he spent $200 million to help Donald Trump get back to the White House. And Trump has already said he plans to appoint a Musk ally to run the Federal Communications Commission.
SpaceX, which owns Starlink, did not respond to a request for comment.
State officials are in the midst of a $1.2 billion push to bring high-speed internet to every corner of West Virginia by 2029. However, the roll-out has been hindered by disputes between utility companies and internet service providers on the ground.
Starlink hasn’t released exact numbers for how many customers they have in West Virginia. The company is not required to share that information, said Del. Daniel Linville, chair of the House Infrastructure and Technology Committee.
But, the number of subscribers is increasing monthly in the state, he said.
Kensey Bergdorf-Smith, director of the West Virginia Science and Technology Policy Initiative, said despite its growing popularity, satellite internet still has challenges compared to other broadband options.
A dish must be properly positioned and be free of interference like trees and bad weather for the strongest service, she said.
“The concern with satellite internet is that it’s not super reliable,” she said. “It doesn’t always reach the speeds that it needs to, and it’s also pretty pricey compared to standard broadband options.”
Starlink was denied millions in federal subsidies
In 2022, Starlink’s long-form application for a $885 million contract from the FCC through its Rural Digital Opportunity Fund was denied. The fund was created to expand broadband to rural communities and the subsidies would have been released over 10 years.
The company was to deploy internet service to over 600,000 homes and businesses across 35 states with speeds of at least 100 megabits per second download and 20 megabits per second download upload.
Those speeds are defined as the bare minimum to qualify as broadband following new standards passed by the FCC earlier this year.
Federal officials determined the company would be unable to provide high-speed internet to the amount of homes it had proposed. The FCC affirmed that decision last year.
“The agency also has a responsibility to be a good steward of limited public funds meant to expand access to rural broadband, not fund applicants that fail to meet basic program requirements,” FCC Chairwoman Jessica Rosenworcel said in a press release.
Brendan Carr, the senior Republican on the FCC, dissented from the agency’s ruling writing that the decision follows the Biden administration’s pattern of “regulatory harassment” against Elon Musk.
This week, President-elect Donald Trump named Carr as the new chairman of the commission. As chairman, Carr could exert influence over decisions with the potential to send hundreds of millions of dollars in federal subsidies to Starlink.
Starlink service is expanding from space, while internet providers hit snags on the ground
From outer space to deep inside a holler, high-speed internet can reach homes without traditional infrastructure like poles and cables using satellites that bounce signals as long as there is a clear view of the sky.
The company offers residential plans for $120 a month with unlimited data and charges a $349 upfront cost for hardware like the router and mountable disk.
In a 2023 survey of over 2,000 West Virginians by state broadband officials, 15% said they use satellite internet and generally paid more than people using other providers.
Alex Cain, owner of Country Roads Satellites in Clarksburg, said that his team travels across the state installing Starlink mounts on homes, and most customers have resorted to satellite service because they’ve had unreliable, slow internet connections.
“When Starlink came out, it was kind of a game changer just because the speeds are 20 times faster,” he said. “We’ve been doing five to six installs a week.”
Starlink’s satellites circle the planet in a much lower orbit than older satellite internet providers. That means Starlink satellites should be faster than competitors.
Elizabeth Stewart, a resident of Pocahontas County, who uses Starlink to work from home after switching from a traditional broadband provider. Courtesy photo
Outside of Durbin on the northern end of Pocahontas County, Elizabeth Stewart lives with her husband in a wooded area and uses Starlink to work from home.
They’ve put their dish in a clearing where there isn’t interference from trees in the yard. She said she’s been a customer for three years despite other providers offering cheaper plans and doesn’t mind paying the higher cost.
“You have to shell out about 500 bucks to get the service and a lot of people can’t afford to do that,” she said. “But, online is my life, and it’s how I’m able to work from home.”
Today is Election Day. Here’s how votes are tallied and secured in West Virginia.
When West Virginians go to the polls today to cast ballots for their next U.S. Senator, Governor, state delegate, or county sheriff, their votes will be counted and protected, despite any fraud claims.
Four years ago, then-President Donald Trump falsely alleged that the election had been stolen from him. The turmoil that followed led to a violent insurrection in which his supporters tried to stop Congress from certifying Joe Biden’s victory.
This year, Trump has said that if he loses the election, it will only be because he was cheated out of victory. Therefore, things could get increasingly confusing, so here’s what you need to know if you’re watching events unfold at home.
Haven’t voted yet?
If you haven’t voted today, there’s still time.
Today, several key races will be on the ballot. The state will have new leadership come January between the governor’s race and local delegate races in each district.
Mountain State Spotlight has a comprehensive voter guide with information about each candidate running in your district and our previous coverage talking with voters from all 55 counties.
How can I find out who won?
After polling locations close and results come in, we’ll have live election results on our website provided by the Associated Press.
The Associated Press has a team of experts who research historic voting trends and election laws. As votes are tallied, they project winners when the losing candidate can no longer come back and win.
Voter turnout has historically been much lower in West Virginia than in other states for the past three presidential elections. But, in early voting, several county clerks said they had record-breaking turnout on the first day.
How votes in West Virginia are counted
On the night of Election Day, ballots cast and tallied are reported as unofficial votes. After polls close, official results will not be known until a few days or weeks later.
Five days after the election, excluding weekends and holidays, county election officials conduct the canvass process in which mail-in, early voting, absentee and election-day ballots are counted together. During this process, officials also review voting machines and other materials involving vote collection.
After the canvass process is completed officials declare the results and wait 48 hours, during which candidates can request a recount. Then, the results are certified except in places where votes must be recounted.
Within ten days after the results are certified, candidates can contest the election through the courts.
If the results are not contested, then those are sent to the secretary of state and governor within 30 days to be reviewed. The deadline for results to be transmitted is December 5.
To learn more about how election officials canvass votes in West Virginia, you can find the state canvassing and recount manual on the Secretary of State’s Office website. Or view the West Virginia Election Calendar.
To learn more about election laws, you can read the elections and officers portion of the state constitution.
County clerks conduct the actual counting of votes at the local level, as laid out in state law.
“The process is established in a manner to make elections the safest and most transparent for gaining the public’s confidence,” wrote Diana Cromley, Mason County clerk and president of the West Virginia Association of Counties, in a recent op-ed.
County clerks are responsible for making sure that everyone who votes is eligible to vote and has access to vote, Cromley wrote. They also assist with the canvassing process after Election Day.
Is voter fraud an issue?
In 2020, former President Donald Trump claimed that the presidential election had been stolen, despite numerous court rulings indicating otherwise. These claims have been echoed by West Virginia politicians, even the state’s top election officer, Secretary of State Mac Warner.
The truth is that incidents of voter fraud are almost nonexistent, voter impersonation is very rare and many instances of alleged fraud are errors by election administrators, according to the nonpartisan Brennan Center for Justice.
Human errors can still happen. In Mingo County, a state Senate candidate was mistakenly left off of nearly 700 ballots during early voting.
Several studies have also been conducted which have shown election fraud is incredibly rare. It is illegal in every state for noncitizens to vote in federal elections, holding a penalty of up to a year of federal prison and a fine.
“Citizens can vote in 2024 with confidence,” wrote Michael Waldman, the center’s president and CEO. “Despite the noise and lies and melodrama, voting will likely be uneventful for the vast majority of Americans.”
Mountain State Spotlight talked to voters in all 55 West Virginia counties. Here’s what we learned.
Back in July, we asked incumbent state Del. Marty Gearheart if he had anything to add to his answers to questions about community redevelopment, the high costs of medical insurance and homelessness.
“It seems to me you address a lot of issues that are far afield for what I address and my party addresses,” Gearheart said. “I would prefer to talk about lessening the tax burden on all West Virginians.”
That answer convinced me of the importance of the approach Mountain State Spotlight has taken over the last year as we’ve covered the 2024 primary and general elections.
Reporter Henry Culvyhouse spent a couple of days in Gearheart’s district, asking Mercer County residents what they wanted candidates for public office to be talking about as they asked for votes. The result was a nuanced profile of Bluefield and Princeton. These are communities that have taken some tough shots. But folks there were working hard to come back and wanted a little more help from the state to get there.
Overlook view of Bluefield area is seen. Photo by Henry Culvyhouse / Mountain State Spotlight
And Henry’s questions for Del. Gearheart were drawn from his discussions with those residents — the delegate’s constituents — asked in a respectful way aimed at getting answers voters could use to make informed decisions.
It seems important that a state delegate (and perhaps his party) are addressing different issues than what that delegate’s constituents want to hear about. But in the runup to the 2024 election, there is a fair amount of that going on in West Virginia and across the country.
Over the last six months, Mountain State Spotlight staff crisscrossed the state, talking to more than 500 West Virginians across visits to all 55 counties. We hosted events in six communities, from Wheeling to Welch. And our reporters took trips to every corner of the state, visiting our cities, towns and hills and hollows.
This all started with our belief that elections should be more about West Virginians and their communities, and less about horse race polls or attack ads. Using The Citizens Agenda, we set out to help our neighbors take back the political process.
We began with a simple question: What do you want to hear candidates talking about as they ask for your vote?
Everywhere we went, there were common refrains from voters: We need more substance abuse treatment and recovery programs. We need clean and reliable water. Our roads need to be fixed or upgraded. Our community needs more jobs, better schools, affordable child care, and a more responsive government.
Our reporters found a lot of West Virginians who were digging in, trying to make their part of the state better. Most didn’t mind doing that hard work, but many also said they would like to see the state do more to help.
We also heard that lawmakers focus too much on issues that can tend to divide West Virginians, and not enough on things that can bring us all together.
About a dozen West Virginians attended Mountain State Spotlight’s election community discussion in Welch. Photo by Tre Spencer / Mountain State Spotlight
For example, in McDowell County, we heard a desire to focus less on what the Rev. Brad Davis called “culture war issues” and more on the ingredients for building a post-coal economy, like access to food, water and health care.
In other places, like Logan County, we found plenty of examples of West Virginians who don’t really trust politics anymore. Others are just sick and tired of empty promises.
We read a lot about young people leaving, but often it’s just old people lamenting this trend. Our reporters actually talked to some young people – in Lincoln County and in Wetzel and Tyler counties – to lift up those voices.
As we heard more and more from voters, we started putting their questions to the candidates. When we started this work, we worried about what to do when none of the candidates would talk to us.
After all, our organization is still only four years old. A lot of politicians don’t feel the need to talk to the press, let alone to a Charleston-based outlet they and their constituents have never even heard of.
West Virginia Gov. Jim Justice speaks to state lawmakers, officials and guests during his 2024 State of the State address in the House of Delegates chamber. Photo by Will Price/WV Legislative Photography.
At the same time, the response to our outreach to more than 200 candidates wasn’t what it should have been. Only about a quarter of candidates answered the questions we developed from reader input.
This was our first election doing this as a major newsroom project, so it’s been a learning process. One thing readers asked us for that we promise to get better at next time is comparing what incumbents are saying with what they are doing when they come to Charleston. As we finish our campaign coverage, some major stories about the races for governor and senator seek to provide a bit more of that.
National media has tried to say that people in places like our beloved West Virginia vote against our own interests.
And we did certainly find examples of powerful politicians in West Virginia who are campaigning on protecting gun rights, outlawing abortion and continuing the extractive economy, while their constituents wanted to hear a lot more about making substance abuse disorder treatment more easily available.
Maybe there’s a powerful disconnect here. Maybe there’s something more cynical going on. Either way, more information is a path forward for our state.
Mountain State Spotlight’s bold and ambitious mission is to help West Virginians make our state a better place by delivering sustained outrage journalism that holds the powerful accountable and lifts up voices that aren’t always heard.
As we’ve visited your community and so many others, one thing we’ve learned is that we have our work cut out for us.
For tens of thousands of West Virginians who need clean water, a $1 billion investment is a drop in the bucket
ROCKPORT — Kim Sargent keeps an eye on the weather. It’s how she decides when to do her laundry as most of the water that flows through Sargent’s home comes from the rainwater she collects.
“If it doesn’t rain, and you’ve done laundry, then you’re taking a chance on running out of water,” she said.
She hauled city water to her Wood County home for over 20 years before she started collecting the rain. Before that, she relied on a private well, but it sank after three years. When drillers told her there was no guarantee that she’d have water if they cleaned her well out or drilled a new one, Sargent opted to forgo the well.
“You might hit water, you might not. You’re still out the money,” Sargent said.
Since the drought in West Virginia began, Sargent has relied on her neighbors to haul water to a cistern at her house.
Kim Sargent set up the roof of her chicken coop to collect rain water into a rain barrel. Photo by F. Brian Ferguson / Mountain State Spotlight
Over the last six months, Mountain State Spotlight reporters traveled across the state to ask West Virginians what they wanted to hear candidates talk about as they sought their votes.
Everywhere, we heard about the water.
Across the Northern Panhandle, residents buy bottled water because their aging systems spit out discolored or smelly city water. In Putnam, Ritchie and Webster counties, folks haul hundreds of gallons of water to their homes as they wait for nearby systems to extend lines to their communities. And during a community listening session in Welch, an attendee brought in a 16-ounce plastic bottle filled with water from Wyoming County that was brown with floating particles.
“It’s tough on folks,” said Rev. Brad Davis.
When Davis learned that communities in McDowell County didn’t have reliable drinking water because of aging systems and had to buy or haul water to their homes, he began coordinating weekly water distribution events in the county. Water concerns are severe in the coalfields as many communities have remained under boil water advisories for years waiting for their systems to be repaired.
“Having to rely on buying bottled water all the time is an economic hardship on folks who are already economically burdened,” Davis said.
Tens of thousands of West Virginia residents rely on systems that state officials classified as “marginal or failing” in a 2023 report to the U.S. Environmental Protection Agency. These systems “pose a constant threat of disruption to their customers’ drinking water supply,” and they are a threat to “customers’ health and welfare and are an impediment to economic development,” according to the state Department of Health.
Since 2002, the number of failing systems has decreased by 84% according to data from the report. Some failing or marginal systems have merged with more viable systems and others have made improvements.
West Virginia has expanded access to drinking water and made progress in the maintenance of already existing water systems.
The growth of state funding for these projects has been spurred on by “historic” investments in water and sewer infrastructure by the federal government. Through the Biden administration’s Infrastructure Investment and Jobs Act and American Rescue Plan Act, West Virginia has seen significant boosts of funding specifically for water-related projects since 2021. U.S. Reps. Alex Mooney and Carol Miller voted against both pieces of legislation, and U.S. Rep. David McKinley and Senator Shelley Moore Capito voted against the American Rescue Plan Act.
Millions of dollars for a billions of dollars problem
Once all the money from those two pieces of legislation is allocated, the state is projected to receive almost $1 billion for water and sewer projects, according to the Pew Charitable Trusts.
“We are miles and miles ahead of where we were,” said Amy Swann, who sits on the board of the state’s Water Development Authority. She added that over the years the state has also established agencies and policies that have helped make the process to improve water and sewer infrastructure more effective.
But the need is still much larger than the resources available.
Bill Sweeney, left, and his son Michael Sweeney unload water at Michael’s home in Rockport. They retrieved the water from the Rockport Volunteer Fire Department. Photo by F. Brian Ferguson / Mountain State Spotlight
Earlier this year, Gov. Jim Justice announced that the state had invested about $736 million in water and sewer projects between 2017 and 2024. During the September special session, the Legislature earmarked another $225 million for water and sewer projects, bringing the state’s total spending on these projects to $961 million in seven years.
But the state’s water and sewer needs would cost between $16 and $20 billion according to the 2023 Needs Assessment by the central funding authority for infrastructure projects throughout the state.
It would cost about $1 billion to fix and update water systems for just the communities that have already requested funds. Another $1.3 billion could provide sewer system improvements.
It would cost $2.1 billion to connect West Virginians who don’t already have it to public water infrastructure, and nearly $12 billion for city sewer infrastructure access for everyone.
And those costs don’t account for routine system upgrades and maintenance, which could be $4 billion more.
As with West Virginia’s other infrastructure issues, including roads and broadband, there “aren’t any solutions that could be implemented overnight,” said Del. Evan Hansen, D-Monogalia. Hansen runs Downstream Strategies, an environmental and economic development consulting firm.
“But funding goes a long way if the state is able to dedicate sufficient funds to address these issues, and then they can be addressed with proper planning,” Hansen said.
“We’re not going to reach everybody immediately. It’s going to take years of a lot of money coming in,” said Marie Prezioso, executive director of the state Water Development Authority.
Craig Hart, the Republican candidate for the Senate’s 6th District, teaches agriculture at Tug Valley High School in Mingo County. He spoke about how the lack of water impacts his students’ learning.
“My students regularly go without showers or home cooked food due to not having water. My students refer to mid-week as “No Water Wednesday” and the end of the week as “No Power Friday.”
Hart said the coalfields built the state and the state has turned its back on them.
“Who wants to invest in a community that lacks basic utilities? Even our tourists demand reliable water, power and emergency services,” he said.
‘Give these people some money so they can have clean water’
Meanwhile, state lawmakers have passed roughly the same budget amount year to year since 2021 while continuing to approve and celebrate historic tax cuts. Since 2023, state lawmakers have passed two tax cuts for residents, totaling more than 23%, and a policy that triggers another cut in years with a significant surplus.
As a result of keeping West Virginia’s budget the same and not increasing spending year to year, the state has a surplus this year — something lawmakers have repeatedly touted this election cycle.
Meanwhile, residents of the southern coalfields have spent months raising awareness of their dire water situation through online petitions, social media posts and campaigns through state and local advocacy groups and various news articles.
130 customers in the McDowell Public Service District need about $6.1 million to repair the water system in Anawalt and extend lines to serve another 60 in Leckie. They are still waiting on funding.
“That’s less than 1% of the budget surplus that the state claims that it has,” Davis said. “Give these people some money so they can have clean water.”
Kim Sargent and “Gemma Dawn” sit near the cistern at her home in Wood County. Photo by F. Brian Ferguson / Mountain State Spotlight
Back in Wood County, Sargent thinks about the people at the base of the ridge she lives on, how they can wash their cars or keep green and lively gardens — things she’d like to do but can’t because she’s always conserving her water.
“I should be allowed to have water,” Sargent said. “I’m not far from town, and it’s all the way around me, and I don’t have water.”
Wages, housing and health care are top priorities for voters in Mineral, Hampshire and Morgan counties
KEYSER — Inside S & H Variety, a thrift store right off Main Street, Vanessa Broadwater, a longtime Mineral County resident, emerged through the narrow aisle lined with racks of clothes, cabinets of dainty china and packed bookshelves.
As she walked, Broadwater reflected on the loss of Luke Paper Mill in 2019. She said the mill was one of the few major and well-paying employers in the county. But even before it closed, many residents in the region relied on finding well-paying jobs out of state.
Keyser, with a population of a little less than 5,000 people, is the county seat of Mineral County. Photo by Sarah Elbeshbishi / Mountain State Spotlight
“There’s just no opportunities,” said Broadwater, a West Virginia native. “There’s just nothing here for the younger kids.”
All but one of her five children stayed in the county. However, Broadwater knows some of her grandchildren are looking forward to leaving.
“The youngest can’t wait to turn 18, so she can get out,” she said.
For many residents across Mineral, Hampshire and Morgan counties, leaving has been their only option to find well-paying jobs. Those who’ve stayed have opted for long commutes to Maryland, Virginia and Washington D.C. for livable wages.
Mountain State Spotlight visited all three counties this month, asking residents about the biggest challenges their communities face. They frequently spoke about the need for more well-paying jobs and affordable housing. Residents also said they’d like to see increased access to basic services, including broadband and health care.
Across town from the thrift store, on the edge of the quad at Potomac State College of West Virginia, computer science student Josh See lamented that he’ll likely have to move away from West Virginia for work.
Computer science student Josh See sits at a table on the edge of the quad at Potomac State College of West Virginia in Keyser, W.Va. Photo by Sarah Elbeshbishi / Mountain State Spotlight
“I think my options are pretty limited with staying here,” said See. “If I have to move, I’d have to move. I wouldn’t like it, but I wouldn’t be opposed to it as long as there’s a decently paying job, and I can live comfortably.”
Teacher salaries aren’t competitive
The need for higher wages has affected school systems in all three counties, as schools struggle to find teachers.
In the banquet hall at the Country Inn of Berkeley Springs, members of the Berkeley Springs Rotary Club discussed Morgan County’s inability to retain or hire qualified teachers, largely because they can earn more in neighboring states.
Members of the Berkeley Springs Rotary Club are concerned about teachers’ salaries in Morgan County. Photo by Sarah Elbeshbishi / Mountain State Spotlight
“It’s just a 15-minute drive to Maryland and an hour to Virginia, and that’s where we lose a lot of ours,” said Allison Maconaughey, the current president of the club and a mom of two.
The average teacher salary in West Virginia is about $53K, about 10K less than in Virginia and 27K, less than in Maryland, according to the National Education Association. West Virginia ranks 51st in average teacher salary nationwide.
As a result, students have lost teachers mid-way through the school year, and teachers who stay often have to work “double duty” or fill in for subjects that they’re not necessarily prepared for, Maconaughey said.
Some residents said it isn’t only work they are seeking outside their counties, but other resources, including recreational activities and healthcare services.
Beside the Liberty Gas Station off U.S. Route 50 near Romney in Hampshire County, January Dillinger and her daughter, Lilly, carried boxes of produce to a white building with a red roof, awning and door. Inside the Barefoot Farmer produce store, Dillinger, a county native, said the options for kids and younger residents are scarce.
Hampshire County native January Dillinger and her daughter, Lilly, stand amid the produce stalls out in front of the Barefoot Farmer produce store off U.S. Route 50 near Romney. Photo by Sarah Elbeshbishi / Mountain State Spotlight
The other night, the county’s youth football program was relegated to practice on the baseball field because it’s the only field with lights. And there aren’t enough gyms in the area to accommodate the number of people wanting to play basketball, Dillinger said.
“I can’t take my kids on a bike ride because there isn’t anywhere safe to do it,” she said.
Because of the few options in the county, the mom of three often travels outside the state to find activities to do with her kids.
“If you want to do something in this area, you almost guarantee that you’re going to travel to Cumberland, or you’re going to travel to Winchester [Virginia] or beyond to be able to do that,” Dillinger said.
Hampshire County native Melanie Chaer also blames the lack of activities for costing the community its younger residents.
“There’s no recreation here for them to do anything,” she said.
Limited resources for mental health and addiction
Aside from recreation, Dillinger said that many people, especially seniors in Hampshire County, travel outside the county for specialty medical services given the limited options. This past summer Dillinger’s mom spent two months in Winchester after being diagnosed with sepsis because of an infection in her hand.
Residents in the three counties spoke about the insufficient number of medical professionals, including general practitioners, therapists and gynecologists. They said they often have a months-long waitlist, prompting people to seek health services elsewhere.
Those in Morgan County often travel to Hagerstown, Winchester or Martinsburg for healthcare services, Maconaughey said.
And those seeking mental health providers are looking at a “six to eight week wait to get an initial evaluation, if not longer,” said Audrey Morris, director of Morgan County Family Support Center.
Mineral County resident Alante Coleman spoke about how difficult it was to find a mental health counselor when she moved back to the county from South Carolina earlier this year. When Coleman finally found a provider, it was a three-month wait for an appointment. The delay meant she lost her sense of control over her situation.
“I was on [top of] the mental health. I was on the medications. And then I got here,” she said.
Resident Alante Coleman sits on the stoop of the Mineral County Family Resource Network office building in Keyser, W.Va. Photo by Sarah Elbeshbishi / Mountain State Spotlight
Along with an increased need for general medical and mental health services, there’s also a need for more addiction treatment and recovery resources in the counties.
“We need a lot more when it comes to drug rehabilitation. Places for people to go,” said AJay Root, administrator for the Mineral County Health Department. He added that the closest treatment center is about an hour and a half away in Morgantown.
Community resource providers in Mineral County also said they want to see investments in programs that prevent addiction and mental health crises, so they aren’t always in triage mode. But because of the limited resources, they often have to wait until situations become urgent. Even then, there’s no guarantee any help will be available.
There’s been several instances of residents in critical condition unable to access services or treatment because of insufficient resources in the community, said Dayla Harvey, executive director of the Mineral County Family Resource Network.
Limited housing options
A few miles away, in downtown Keyser, as Broadwater opens a jewelry display for a customer, she reflects on the available housing in the community.
“The quality of the housing is just horrible. And young people just don’t have any options,” she said. One of her granddaughters just moved out of her new rental apartment because the paint on the walls was peeling, exposing her to old layers of lead-based paint.
Broadwater said the number of available rental units in the county is already slim, and there are even fewer that are safe and affordable. And while the county has income-based housing, it’s not nearly enough to accommodate the number of people who need it.
“Mineral County has options. However, they’re limited,” Harvey said. “The need is greater than what we can provide.”
The income-based housing in Hampshire and Morgan counties is also not enough to meet the needs of the community. And as tourism grows in the region, especially in Morgan County, the available housing is even more scarce as it’s often picked up and turned into AirBnBs or second homes.
Along with the limited supply of housing, affordable options are a growing challenge for residents in Hampshire and Morgan counties as well. As the population has grown and people with higher incomes have moved into the region, the cost of housing has greatly increased and priced out local communities
Terri Beard, a Morgan resident, thinks it’s sad that the area can’t offer more to reward people who choose to stay. She said it’s discouraging that the state’s teachers go to school, get their degrees and can only afford low income housing.
Tourism is booming in Pocahontas County. It’s causing problems for some locals
MARLINTON — Tourism is rapidly growing in Pocahontas County, where the headwaters of eight rivers flow and miles of trails attract hikers and bikers. But, while many locals embrace the influx of visitors, it has created some challenges.
From Hillsboro to Bartow, residents said they need a solution to the lack of affordable housing in the area, additional resources for county public schools and more grocery stores or places to shop.
In Marlinton, the county seat, business owners and longtime residents say they’ve seen a daily uptick of visitors since the pandemic brought people from urban areas to the state.
“We’re just average-joe people living in a tourist town,” said Anne Walker, owner of the Handmade WV Market.
Anne Walker teaches her 15-year-old daughter Sherry how to work the cash register at the Handmade WV Market in Marlinton, W.Va. Photo by Tre Spencer / Mountain State Spotlight
In the back of her store, displays house colorful artwork, patterned quilts and tie-dyed shirts from local artisans. Near the entrance, handmade beaded bracelets and jewelry sit adjacent to fresh vegetables and jars of jam.
Walker said business has been steady since the market opened three years ago, but that changes with tourism seasons. Most tourists visiting are stragglers from Snowshoe Mountain Resort or bikers on the 77-mile Greenbrier River Trail.
Next door at Greenbrier Bikes, owner Scott Geyette sees bike riders from all over the country who come to town for biking gear or repairs at his shop.
With new bikes lining both corners of the shop, Geyette said that since moving to the area in 2011, he’s seen the town transform. Many new businesses opened following the pandemic.
“We’re trying to be a destination for people to come and spend their tourism dollars,” he said. “And it’s working.”
Greenbrier Bikes owner Scott Geyette helps two customers purchase bikes in Marlinton, W.Va. Photo by Tre Spencer / Mountain State Spotlight
Nicknamed “Nature’s Mountain Playground,” Pocahontas County boasts activities including riding the Cass Scenic Railroad, skiing at Snowshoe Mountain Resort and hiking at Watoga State Park or the Cranberry Glades.
However, like in nearby counties, the strong tourism investment has led to a housing shortage and rising prices for residents.
Housing prices, available inventory remain an issue for many
Back at the market, Walker assisted her next customer and said finding housing has been a big issue for people in the area.
She said local landlords are turning rental properties into Airbnbs as demand has grown, further limiting supply for long-term rentals.
“The price of land has gone up, while the availability of housing has gone down since the pandemic,” she said. “Rural areas have become a sanctuary, and we’ve become a sanctuary for people living in the cities.”
Her customer, Marty Giddings, who is a real estate broker from Slaty Fork, added that the housing market atop Snowshoe Mountain has affected other markets across the county. She said she most recently closed on a $1.8 million listing there.
“Housing is incredibly difficult because of Snowshoe,” she said. “Landlords can get residual income from the resort through rentals. So, locals end up not being able to afford to buy something because the prices are crazy.”
20 minutes south in Hillsboro, at the Hillsboro Public House, visitors are enjoying a menu of salads, burgers and desserts. The pandemic-born eatery had three years of extensive renovations but was opened last year.
Owner Terrell McSweeney Burns moved to the area in the late 1990s and owns rental properties and businesses in town.
She said she’s struggled to find skilled labor like culinary chefs and the housing market has hindered her search.
Owner Terrell McSweeny Burns sorts menus while a family enjoys lunch at the Hillsboro Public House in Hillsboro, W.Va. Photo by Tre Spencer / Mountain State Spotlight
“I could recruit from further away if I had housing to offer people, but I can’t,” she said. “I’m limited because there’s not enough housing here.”
Last year, Pocahontas County was designated as a Build WV zone, which is a state initiative to build more affordable housing. Developers can apply, and projects that are approved receive a sales tax exemption on building materials and property tax credits.
McSweeney Burns said she’s struggled with making rent prices of her properties affordable while also receiving returns on investments and figuring out how to develop land she owns.
“This tax credit thing they passed is a great start,” she said. “But, it’s not even close to trying to figure out the economics of someone like me actually developing properties.”
County public schools need more funding, resources for students
With a population of a little more than 7,800, the county only has one high school but several elementary schools.
As a mom of two teenage kids, McSweeney Burns said there need to be more resources for the school system and more pay for teachers.
“We don’t even have a scoreboard on our baseball field for the high school,” she said. “If we could invest more in the schools so that the kids felt more support and had real sports programs and real music programs, that would be great.”
In March, high school students walked out of classes in protest of proposed budget cuts that would’ve eliminated multiple teaching positions.
The county Board of Education voted to save a position in April but cited rising costs and decreased federal and state funding as reasons for the cuts.
On the northern end of the county, Dunmore resident Teresa Lambert works as a culinary arts teacher at the high school and runs the Mountain State Cakes Bakery.
She said the school system could use more supportive programs for struggling students as more than half of them do not live with their parents.
“It’s sad because we have lots of students who could do a lot of wonderful things, but when you have that kind of home life, that’s your focus,” she said.
More grocery stores, places to shop in the county
Residents also said they’d like more local places to shop or pick up household supplies and groceries instead of driving out of the county.
Up north in Cass, the scenic railroad gift shop features a range of items for thousands of visitors riding the train every year. From branded baseball caps to toy train whistles and playing cards, new souvenirs are stocked daily.
The Cass Scenic Railroad State Park in Cass, W.Va. Photo by Tre Spencer / Mountain State Spotlight
Amanda Bennett, who works as the receptionist for tickets, said she lives in Bartow but doesn’t mind making the 25-minute commute for work as she makes an even longer one just to pick up a loaf of bread.
“It’s not very crowded here, and it’s peaceful, but the worst part is going to buy groceries,” she said. “I have to go almost an hour away to Elkins.”
Inside the Cass Scenic Railroad Gift Shop where Amanda Bennett works at the front ticket desk in Cass, W.Va. Photo by Tre Spencer / Mountain State Spotlight
Even in Marlinton, resident and local craftmaker Cheryl Cane said she loves where she lives and how close-knit the community is but wishes she didn’t have to travel so far for her essentials. It would be nice to have some of the stores in the cities, she said.
“We have one grocery store, one dollar store and one pharmacy.”
Cheryl Cane hangs a hand-woven quilt at the Pocahontas County Artisan Co-op in Marlinton, W.Va. Photo by Tre Spencer / Mountain State Spotlight