The effort, part of Baltimore’s more than $100 million gun violence prevention plan, relies on staffers like Fitzgerald to build trust with people at risk of such violence and offer them resources like housing or food. Researchers believe these programs reduce gun deaths.

Yet one morning in 2019, Fitzgerald said, his oldest son, Deshawn McCoy, then 26, was shot just outside of the neighborhood he patrolled at the time. Fitzgerald said McCoy was a “really beautiful soul,” who fixed dirt bikes at a local garage. McCoy became the city’s , one of 348 that year, among the city’s deadliest. He left behind three daughters.

“This is our zone,” said Fitzgerald, pointing toward McElderry Park. “My son got cooked over here.”

For years, violence intervention was the work of loosely organized, underfunded groups. Then gun violence spiked during the covid pandemic and the Biden administration and Congress poured in money to better integrate such programs within cities. It appeared to help: In Baltimore and beyond, gun violence has plummeted.

The number of homicides in the city dropped 41%, from more than 300 a year in 2021 to 201 in 2024, according to the U.S. attorney’s office in Maryland.

“Gun violence is a sticky, hard problem to solve,” said Daniel Webster, a researcher at the Johns Hopkins Center for Gun Violence Solutions in Baltimore. “We’re getting it right finally.”

Now President Donald Trump’s administration has gutted funding for that work.

Webster said it could take years to untangle what led to the city’s gun violence drop. Among the factors, he said: the pandemic’s end, investments in violence intervention, improvements that have given police more legitimacy in neighborhoods, targeted prosecutions, and an aggressive effort to remove untraceable ghost guns.

“You need all of these systems working well to have systemic reductions in gun violence,” he said.

The Trump administration has slashed funding for and research, cutting about $500 million in grants to organizations that support public safety.

At the same time, Trump has loosened gun laws the Bureau of Alcohol, Tobacco, Firearms and Explosives, which oversees gun dealers. He has also sent federal troops into the Democratic-led cities of Chicago; Los Angeles; Memphis, Tennessee; Portland, Oregon; and Washington, D.C.

Webster said cities are still benefiting from pandemic-era efforts to address gun deaths. But given the Trump policy changes, if violence escalates, city leaders could have a hard time keeping it from spiraling out of control.

Trying Something Different

Safe Streets is among the promising violence prevention programs that could lose funding. Staffers in the city’s most violent neighborhoods operate like community health workers.

During the pandemic, the Biden administration provided billions of dollars to local governments through the American Rescue Plan Act. Biden urged them to deploy money to community violence intervention programs, which have been shown to by as much as 60%. His administration to spend Medicaid dollars on such programs. The goal: Stop gun deaths.

Few cities seized the opportunity.

Analyzing federal data, professors Philip Rocco of Marquette University and Amanda Kass of DePaul University found local governments used the ARPA money for 132,451 projects. Yet only 231, less than 0.2%, involved community violence intervention, they said.

In Baltimore, then-newly elected mayor Brandon Scott was ready for the federal influx.

Baltimore’s homicide rate had been high since 2015, when a 25-year-old Black man named Freddie Gray died in police custody. Protests erupted and fractures between residents and police deepened. Baltimore ended the year with 342 homicides, the first time since 1999 that more than 300 were recorded in the city.

“We got really good at our jobs” in the years after Gray’s death, said James Gannon, trauma program manager at Sinai Hospital of Baltimore.

Gun deaths tracked what public health researcher Lawrence T. Brown called the : racially segregated areas that fanned out across Baltimore’s eastern and western neighborhoods around a wealthy central strip. People who faced years of forced displacement and disinvestment , which fueled the cycle.

Every year from 2015 to 2022, the city recorded at least 300 homicides.

“We had to try something different,” said Stefanie Mavronis, director of the Mayor’s Office of Neighborhood Safety and Engagement. Scott created the agency weeks after he was sworn into office in 2020, later with $50 million in ARPA money and $20 million annually from the city’s budget.

Containing an Outbreak

The office’s budget — $22 million in fiscal year 2026 — is a fraction of the city’s .

Still, the money allowed Baltimore’s leaders to scale up a new approach: addressing gun violence the way public health officials might handle an infectious disease outbreak, Mavronis said.

City staffers identified the small subset of people most at risk of being shot or becoming the next shooter through crime data and referrals from social service workers, hospitals, and violence intervention staff, she said. Mavronis said that gangs, friends willing to engage in violence for each other, and retaliation had been driving gun deaths in the city.

“This never-ending cycle of violence and loss and trauma,” Mavronis said, “comes from that.”

The city convened hospital presidents to connect gunshot victims and their friends and family to counseling, crisis support, and city services.

It offered people help finding therapy, a job, or emergency relocation — and threatened arrest and prosecution if they retaliated.

“We decided that we were no longer going to subscribe to the belief that one thing, one agency, one part of government, one program was going to help cure Baltimore of this disease of gun violence that has had a stranglehold on this city for the entirety of my life,” Scott said.

The Coming Cliff

Baltimore is on pace this year to post its fewest gun deaths since Richard Nixon was president.

“Some of it is the national zeitgeist of the moment,” said Adam Rosenberg, executive director of Center for Hope at LifeBridge Health, which operates Safe Streets sites and the Violence Response Team at Sinai Hospital. He credits mainly the infusion of funding that allowed more resources and hands-on engagement with high-risk communities.

“We typically talk about how poverty affects homicides, but it works in reverse too,” Webster said. “People don’t invest in homes and businesses or, frankly, in people, where people get shot regularly.”

Fitzgerald, who grew up in East Baltimore, said he started working for Safe Streets in 2010 for the paycheck.

He’s been on both sides of gun violence, he said, as someone hit more than a dozen times in shootings — first when he was 12. At 13, Fitzgerald said, he shot a cousin in the leg. Over years, he was in and out of the criminal justice system, including for charges of attempted murder, which helped him understand the people he now works with every day, he said.

No college “can certify you in my experiences in violence,” he said. “That’s what allows me to identify and detect potentially violent situations.”

Today, Fitzgerald, 49, believes that teaching kids trauma coping mechanisms can drive culture change and stop shootings.

“Our kids see more death than soldiers,” he said.

But federal funding is drying up. Anthony Smith, executive director of , which supports local leaders on gun violence reduction, estimates that about 65 groups have lost funding this year. And Trump’s signature legislation slashes nearly $1 trillion in anticipated federal Medicaid spending over the next decade.

Center for Hope lost $1.2 million from federal cuts.

“It’s like a car racing along, and you see the cliff coming,” Rosenberg said. “I don’t know if the resources are there anymore, but the need certainly is.”

Rosenberg said that, because of their experiences, staffers such as Fitzgerald are “incredible messengers” for people involved in gun violence, and he noted that they are thoroughly vetted.

Fitzgerald put it this way: “I’m trying to save my kids, the community. The people we’re trying to save is our friends and our family, and ourselves.”

Â鶹ŮÓÅ Health News senior correspondent Fred Clasen-Kelly contributed to this report.

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“When you get shot,” he said, “you stop thinking about the future.”

He is anchored by his wife and child and faith. He once wanted to work as a forklift driver but has built a stable career in information technology. He finds camaraderie with other gunshot survivors and in advocacy.

Still, trauma remains lodged in his daily life. As gun violence surged in the shadows of the covid pandemic, it shook Harris’ fragile sense of security. He moved his family out of Philadelphia to a leafy suburb in Delaware. But a nagging fear of crime persists.

Now he is thinking about buying a gun.

Harris is one of tens of thousands of Americans killed or injured each year by gun violence, a public health crisis that escalated in the pandemic and churns a into a hospital emergency room every half hour.

Over the past two decades, the firearm industry has and stepped up sales campaigns through social media influencers, conference presentations, . An industry trade group acknowledged that its traditional customer was “” and in recent years began targeting and who are disproportionately victimized by gun violence.

The Trump administration has moved to reduce federal oversight of gun businesses, announced by the Bureau of Alcohol, Tobacco, Firearms and Explosives as “marked by transparency, accountability, and partnership with the firearms industry.”

The pain of gun violence crosses political, cultural, and geographic divides — but no group has suffered as much as Black people, such as Harris. They were nearly 14 times as likely to die by gun homicide than white people in 2021, , citing federal data. Black men and boys are 6% of the population but of homicide victims.

Washington has offered little relief: Guns remain one of few consumer products the federal government for health and safety.

“The politics of guns in the U.S. are so out of whack with proper priorities that should focus on health and safety and most fundamental rights to live,” said attorney Jon Lowy, founder of , who helped represent Mexico in an unsuccessful lawsuit against Smith & Wesson and other gunmakers that reached the Supreme Court. “The U.S. allows and enables gun industry practices that would be totally unacceptable anywhere else in the world.”

Â鶹ŮÓÅ Health News undertook an examination of gun violence during the pandemic, a period when firearm deaths reached an all-time high. Reporters reviewed academic research, congressional reports, and hospital data and interviewed dozens of gun violence and public health experts, gun owners, and victims or their relatives.

The examination found that while public officials imposed restrictions intended to prevent covid’s spread, politicians and regulators helped fuel gun sales — and another public health crisis.

As state and local governments schools, advised residents to stay home, and closed gyms, theaters, malls, and other businesses to stop covid’s spread, President Donald Trump kept gun stores open, critical to the functioning of society.

White House spokesperson Kush Desai did not respond to interview requests or answer questions about the Trump administration’s efforts to reduce regulation of the firearm industry.

During the pandemic, the federal government gave firearm businesses and groups more than $150 million in financial assistance through the Paycheck Protection Program, even as some businesses reported brisk sales, according to from Everytown for Gun Safety, an advocacy group.

Federal officials said the program would keep people employed, but millions of dollars went to firearm companies that did not say whether it would save any jobs, the report said.

About bought a gun during the first two years of the pandemic, including millions of first-time buyers, according to survey data from NORC at the University of Chicago.

Harris is keenly aware of what drives the demand.

“Guns aren’t going away unless we get to the root of people’s fears,” he said.

most Americans who own a gun feel it makes them safer. But public health data suggests that owning a gun of homicide and triples chances of suicide in a home.

“There’s no evidence that guns provide an increase in protection,” said Kelly Drane, research director for the . “We have been told a fundamental lie.”

Record Deaths

Less than a year into the pandemic, 20-year-old Jacquez Anlage was shot dead in a Jacksonville, Florida, apartment. Five years later, the killing remains unsolved.

His mother, Crystal Anlage, said she fell to her knees and wailed in grief on her lawn when police delivered the news.

She said Jacquez overcame years in the foster care system — living in 36 homes — before she and her husband, Matt, adopted him at age 16.

Jacquez Anlage had just moved into his own apartment when he was shot. He loved animals and wanted to become a veterinary technician. He was kind and loving, Crystal Anlage said, with the 6-foot-4, 215-pound physique of the football and basketball player he’d been.

“He was just getting to a point in life where he felt safe,” Crystal Anlage said.

Gun violence researchers say parents like Crystal Anlage carry trauma that destroys their sense of security.

Anlage said she endures post-traumatic stress disorder and anxiety. She is terrified of guns and fireworks.

But she has made something meaningful of her son’s killing: She co-founded the Jacksonville Survivors Foundation, which works to raise awareness about the impact of homicide and to support grieving parents.

“Jacquez’s death can’t be in vain,” she said. “I want his legacy to be love.”

His legacy and that of other young men killed by guns is muted by firearm manufacturers’ powerful message of fear.

During the pandemic, gun marketers told Americans they needed firearms to defend themselves against criminals, protesters, unreliable cops, and , filed by gun control advocacy groups with the Federal Trade Commission.

In a since-deleted June 18, 2020, from Lone Wolf Arms, an Idaho-based manufacturer, a protester is depicted being confronted by police officers in riot gear between the words “Defund Police? Defend Yourself,” the petition shows. The caption says, “10% to 25% off demo guns and complete pistols.”

Impact Arms, an online gun seller, on Instagram on Aug. 3, 2020, showing a person putting a rifle in a backpack, the document says. “The world is pretty crazy right now,” the caption reads. “Not a bad idea to pack something more efficient than a handgun.”

The National Rifle Association in 2020 posted on YouTube a of a Black woman holding a rifle and telling viewers they need a gun in the pandemic. “You might be stockpiling up on food right now to get through this current crisis,” she said, “but if you aren’t preparing to defend your property when everything goes wrong, you’re really just stockpiling for somebody else.”

The messaging worked. Background checks for firearm sales soared 60% from , the year the federal government declared a public health emergency.

The same year, more than , the highest number up till then. In 2021, was broken again.

Weapons sold at the beginning of the pandemic were more likely to wind up at crime scenes within a year than in any previous period, according to by Democrats on Congress’ Joint Economic Committee, citing ATF data.

Gun manufacturers “used disturbing sales tactics” following mass shootings in Buffalo, New York, and Uvalde, Texas, “while failing to take even basic steps to monitor the violence and destruction their products have unleashed,” according to a released by congressional Democrats in July 2022 following a House Oversight and Reform Committee investigation of industry practices and profits.

The firearm industry has marketed “to white supremacist and extremist organizations for years, playing on fears of government repression against gun owners and fomenting racial tensions,” the House investigation said. “The increase in racially motivated violence has also led to rising rates of gun ownership among Black Americans, allowing the industry to profit from both white supremacists and their targets.”

In 2024, then-President Joe Biden’s Department of the Interior provided a to the National Shooting Sports Foundation, a leading , to help companies market guns to Black Americans.

The Federal Trade Commission is responsible for protecting consumers from deceptive and unfair business practices and has the power to take enforcement action. It issued warnings to companies that made unsubstantiated claims their products could prevent or treat covid, for instance.

But when families of gun violence victims, lawmakers, and advocacy groups in 2022, during Biden’s term, how firearms were marketed to children, people of color, and groups that espouse white supremacy, officials did not announce any public action.

This summer, the National Shooting Sports Foundation pressed its and derided “a coordinated ‘lawfare’ campaign” that it said gun control groups have waged against “constitutionally-protected firearm advertising.”

FTC spokesperson Mitchell Katz declined to comment, saying in an email that the agency does not acknowledge or deny the existence of investigations.

Serena Viswanathan, who retired as an FTC associate director in June, told Â鶹ŮÓÅ Health News that the agency lost at least a quarter of the staff in its advertising practices division after Trump came into office in January.

Gun companies Smith & Wesson, Lone Wolf Arms, and Impact Arms did not respond to requests for comment. Neither did the National Shooting Sports Foundation or the NRA.

In an August 2022 , Smith & Wesson President and CEO Mark Smith said gun manufacturers were being wrongly blamed by some politicians for the pandemic surge in violence, saying cities experiencing violent crime had “promoted irresponsible, soft-on-crime policies that often treat criminals as victims and victims as criminals.”

He added, “Some now seek to prohibit firearm manufacturers and supporters of the 2nd Amendment from advertising products in a manner designed to remind law-abiding citizens that they have a Constitutional right to bear arms in defense of themselves and their families.”

Guns and Race

In 2015, the National Shooting Sports Foundation gathered supporters at a conference in Savannah, Georgia, and urged the firearm industry to diversify its customer base, according to a and reports from and the .

Competitive shooter Chris Cheng gave a presentation called “Diversity: The Next Big Opportunity.” Screenshots from the conference include slides purporting to show “demographics,” “psychographics,” and “technographics” of Black and Hispanic shooters.

The slides described Black shooters as “expressive and confident socially, in a crowd” and “less likely to be married and to be a college grad.” They said Hispanic shooters were “much more trusting of advertising and celebrities.”

Nick Suplina, senior vice president for law and policy at Everytown for Gun Safety, said industry marketing shifted in the latter half of the 20th century as the popularity of hunting declined. The new sales pitch: guns for personal safety.

“They said, ‘We need to break into new markets,’” Suplina said. “They identified women and people of color. They didn’t have a lot of success until the pandemic, the Black Lives Matter movement, and the death of George Floyd. The marketing says, ‘You deserve the Second Amendment too.’ They are selling the product as an antidote to fear and anxiety.”

Gun manufacturers were harshly criticized in the Oversight Committee’s 2022 investigation for marketing products to people of color, as gun violence remains a leading cause of death for young Black and Latino men.

At the same time, some companies also promoted assault rifles to white supremacist groups who believe a race war is imminent, the investigation found. One company sold an AK-47-style rifle called the “Big Igloo Aloha,” a reference to an anti-government movement, it said.

Still, Philip Smith wants more Black people to get guns for protection.

Smith said he was working as a human resources consultant a decade ago when he got the idea to form the , which helped the National Shooting Sports Foundation compile its report on communicating with Black consumers.

Smith encourages Black people to buy firearms for self-defense and get proper training on how to use them.

After 10 years, Smith said, his group has about 45,000 members nationwide. Single members pay $39 a year and couples $59, which gives them access to discounts from the organization’s corporate partners, including gunmakers, and raffles for gun giveaways, according to its website.

The police killing of Michael Brown in Ferguson, Missouri, and the shooting death of Florida teenager Trayvon Martin helped spark early interest from doctors, lawyers, and others in joining the group, he said. But interest took off during the pandemic, he said, even among Democrats who had resisted the idea of owning a gun.

“Hundreds of people called me and said, ‘I don’t agree with anything you’re saying, but what kind of gun should I buy,’” Smith recalled.

Smith, describing himself as “quiet, nerdy, and Afrocentric,” said criticism of guns misses the point.

“My ancestors bled for us to have this right,” he said. “Are there some racist white people? Yes. But we should buy guns because there is a need. No one is forcing us to buy guns.”

‘American Amnesia’

During the pandemic, gun violence took its greatest toll on racially segregated neighborhoods in places such as Philadelphia, where roughly residents live in poverty.

A says a one-year period in the pandemic saw more than 2,300 shootings, or about six a day. Many of the cases haven’t been solved by police.

City officials cited the boom in gun sales in the report: Fewer than 400,000 sales took place in Pennsylvania in 2000, but in 2020 it was more than 1 million.

Gun sales since the pandemic ended, but the harm they’ve caused persists.

At a conference last year inside the Eagles’ football stadium, victims of firearm violence or their relatives joined activists to share accounts of near-death experiences and the grief of losing loved ones.

Paintings flanked the stage and the meeting space to commemorate people who had been fatally shot, nearly all young people of color, under messages such as “You are loved and missed forever” and “Those we love never leave.”

Marion Wilson, a community activist, said he believes the nation has forgotten the suffering Philadelphia and other cities endured during the pandemic.

“We suffer from the disease of American amnesia,” he said.

Harris was on his way home from a job at Burlington Coat Factory nearly two decades ago when robbers followed him from a bus stop and demanded money. He said he had none and was shot.

Harris had spent his early life fixing cars with his grandfather, when he wasn’t at school or attending church. He remembers lying in a hospital bed, overcome with a sense of helplessness.

“I had to learn to feed myself again,” he said. “I was like a baby. I had to learn to sit up so I could use a wheelchair. The only way I got through it was my faith in God.”

Harris endured years of rehabilitation and counseling for PTSD. As someone in a wheelchair, he said, he sometimes fears for his safety — and a gun may be one of the few ways to protect himself and his family.

“I’m mulling it over,” Harris said. “I’m afraid of my trauma hurting someone else. That’s the only reason I haven’t gotten one yet.”

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“Get him off the table,” the doctor recalled telling the surgical team at SSM Health Saint Louis University Hospital as the team cleaned Black’s chest and abdomen. “This is my patient. Get him off the table.”

At first, no one recognized Zohny Zohny in his surgical mask. Then he told the surgical team he was the neurosurgeon assigned to Black’s case. Stunned by his orders, the team members pushed back, Zohny said, explaining that they had consent from the family to remove Black’s organs.  

“I don’t care if we have consent,” Zohny recalled telling them. “I haven’t spoken to the family, and I don’t agree with this. Get him off the table.”

Black, his 22-year-old patient, had arrived at the hospital after getting shot in the head on March 24, 2019. A week later, he was taken to surgery to have his organs removed for donation — even though his heart was beating and he hadn’t been declared brain-dead, Zohny said.

Black’s sister Molly Watts said the family had doubts after agreeing to donate Black’s organs but felt unheard until the 34-year-old doctor, in his first year as a neurosurgeon, intervened.

Today, Black, now 28, is a musician and the father of three children. He still needs regular physical therapy for lingering health issues from the gun injury. And Black said he is haunted by what he remembers from those days while he was lying in a medically induced coma.

“I heard my mama yelling,” he recalled. “Everybody was there yelling my name, crying, playing my favorite songs, sending prayers up.”

He said he had tried to show everyone in his hospital room that he heard them. He recalled knocking on the side of the bed, blinking his eyes, trying to show that he was fighting for his life.

Organ transplants save a growing number of lives in the U.S. every year, with performed in 2024, according to the Organ Procurement and Transplantation Network, which oversees the nation’s transplant system. And awaiting donations that never come.

But organ donation has also faced , including reports of patients showing alertness before planned organ harvesting. The results of a into a Kentucky organ donation nonprofit, first disclosed by in June, found that during a four-year period, medical providers had planned to harvest the organs of 73 patients despite signs of neurological activity. Those procedures ultimately didn’t take place, but federal officials to overhaul the nation’s organ donation system.

“Our findings show that hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. “The entire system must be fixed to ensure that every potential donor’s life is treated with the sanctity it deserves.”

Even before this latest investigation, Black’s case showed Zohny that the organ donation system needed to improve. He was initially hesitant to talk to Â鶹ŮÓÅ Health News when contacted in July about Black. But Zohny said his patient’s story had stuck with him for years, highlighting that while organ donation must continue, little is understood about human consciousness. And determining when someone is dead is the critical but confusing question at play.

“There was no bad guy in this. It was a bad setup. There’s a problem in the system,” he said. “We need to look at the policies and make some adjustments to them to make sure that we’re doing organ donation for the right person at the right time in the right place, with the right specialists involved.”

LJ Punch, a former trauma surgeon who was not involved with the case but reviewed Black’s medical records for Â鶹ŮÓÅ Health News, questioned whether Black’s injury — from gunfire — possibly contributed to how he was treated. Young Black men like Larry Black are in the United States, and . His experience exemplifies “the general neglect” of Black men’s bodies, Punch said.

“That’s what comes up for me,” Punch said. “Structurally, not individually. Not any one doctor, not any one nurse, not any one team. It’s a structural reality.”

The hospital declined to comment on the details of Black’s case. SSM Health’s Kim Henrichsen, president of Saint Louis University Hospital and St. Mary’s Hospital-St. Louis, said the hospital system approaches “all situations involving critical illness or end-of-life care with deep compassion and respect.”

Mid-America Transplant, the federally designated organ procurement organization serving the St. Louis region, does not comment on individual donor cases, according to , executive vice president for organ procurement. She did tell Â鶹ŮÓÅ Health News that her organization has walked away from cases when patients’ conditions change — though not as late as when they are in the operating room for harvesting.

“Let me be clear about that. It happens way before then,” she said. “It definitely happens multiple times a year where we get consent. The family has made the decision, we approach, we get consent, it’s all appropriate, and then a day or so later they improve and we’re like, ‘Whoa.’”

But Speir said the recent media stories about the nation’s donation system are prompting a lot of questions about a process that also does a lot of good.

“We’re losing public trust right now,” Speir said of the industry. “And we’re going to have to regain that.”

Blink Twice for a Chance at Life

It was a Sunday afternoon when gunshots rang out in downtown St. Louis. Black had been on his way to his sister’s apartment.

“I didn’t know I was shot at first,” Black said, sitting in his living room six years later. “I literally ran like a block or two away.”

He collapsed moments later, he said, crawling to the back door of a woman’s home, where he asked for help. He said he asked the woman to give him two large towels, one covered in rubbing alcohol and another soaked with hydrogen peroxide. He wrapped those towels around the back of his head.

When his sister Macquel Payne found him, he was lying on the ground near the leasing office of her apartment complex, a crowd gathered around him.

Before an ambulance took him to the hospital, Black told his sister not to worry about him.

“I’m hearing Larry say, ‘I’m good, sis,’” Payne recalled. “‘I’m OK.’”

Black said he went in and out of consciousness on the way to the hospital and once he was there.

“I got to hitting my hand on the side of the ICU bed,” Black said. “They was like: ‘That’s just the reaction, the side effects of the medicine. Ask him some questions.’”

Payne said she asked her brother to blink twice if he could remember his first pet, a dog named “Little Black” that looked like the Chihuahua from the Taco Bell commercials.

Black said he remembers blinking twice. His sisters remember the same.

Payne asked him another question. This time she wanted to know whether her brother recognized their family. Black said he blinked twice when he saw his mom and sister standing nearby.  

Black said his sister then asked him “the main question” that everyone needed him to answer.

“She’s like, ‘If you want them to pull a plug, if you tired and you giving up, blink once,’” Black recalled. “‘If you still got some fight in you, blink more than once.’”

Black said he started blinking and hit the bed to let his family know that he was still with them.

The sisters said hospital staffers told them the movements were involuntary.

‘Not Right Now’

In a waiting room steps away from the hospital’s intensive care unit, a woman carrying brochures explained to Payne and the rest of the family that Black had identified himself as a possible organ donor on his ID.

The woman wanted to know whether the family wished to move forward with the process if Black died, Payne said.

“I remember my mom saying, ‘Not right now,’” Black’s sister recalled. “‘It’s kind of too soon.’”

Payne said the woman persisted.

“She was like, ‘Well, can I at least leave you some brochures or something?’” Payne recalled. “Then my mom got a little agitated because it felt like she was being, like, pushy.”

The family was already acquainted with the organ donation process. In 2007, Black’s teenage brother Miguel Payne drowned at a local lake. His organs were donated, Macquel Payne said, noting the family was told that his body parts and tissues helped multiple people.

“I believe in saving lives,” Payne said. “But don’t be pushy about it.”

Mid-America Transplant handles the organ transplant process for 84 counties in parts of Illinois, Arkansas, and Missouri, including St. Louis. Like the Kentucky organization, it is one of 55 federally designated nonprofits that facilitate organ donations throughout the country.

The nonprofit has never pressured a family into organ donation, Speir said. Registering to be an organ donor is legally binding, she said, but Mid-America has walked away from cases when families didn’t want to move forward.

She said her staff tries to dispel myths about organ donation and alleviate concerns. “We want to have the families leave with a positive experience,” Speir said.

Despite the family’s initial ambivalence, they ultimately consented to moving forward with donating Black’s organs. Watts said members of her brother’s care team had told the family that her brother was at “the end of the road.”

The family was told to prepare for Black’s “last walk of life,” Payne said. Also known as an honor or hero’s walk, the tradition honors the life of an organ donor before the harvesting process begins.

At the time, Payne said, she thought her brother still had a fighting chance. She asked the hospital staffers to take another look at him before he was wheeled down the hall.

“I’m like, ‘My brother’s in there tapping on the bed,’” Payne said. “They said, ‘That’s just his nerves.’ But I’m like, ‘No, something’s not right.’ It’s like he was too alert. He was letting us know: ‘Please don’t let them do this to me. I’m here. I can fight this.’ They were saying that’s what the medicine will do, it affects his nerves.”

After the family had agreed to move forward with the organ donation process, the two sisters said, an especially helpful member of Black’s medical team no longer treated them the same way. She became standoffish, they said.

“You could tell the dynamics had changed,” Watts said.

‘#¸é±õ±Ê²Ñ²âµþ°ù´Ç³Ù³ó±ð°ù’

The family put on blue jumpers for the walk of life. “We just walked around the floor, and everybody was, like, acknowledging him,” Payne said. “We just thought this was the end.”

A friend Black went to high school with filmed part of the ritual. In a , Black is seen being wheeled on a stretcher down a hallway in the hospital. His eyes are half-open. People are crying.

False rumors then started to swirl outside the hospital.

Brianna Floyd said she went into shock when she heard that her friend was dead. She knew that Black had been shot in the head. But a few days earlier, that he was in stable condition.

Floyd checked Facebook to see whether the news of his death was true. Her timeline was flooded with farewell posts for Black, so she decided to write one, too.

“I Love You So Much Brother,” . “#RIPMyBrother. Never Thought I Would Say That.”

Black’s father rushed to the hospital when he heard a rumor that his son was being wheeled to the morgue.

“‘He’s gone,’” Lawrence Black Sr. recalled being told. “‘He’s going to the freezer now.’”

Black Sr. said he refused to believe that his son was dead. The thought was devastating. He had already experienced that kind of loss to gun violence.

“You wake up and nothing’s the same,” Black Sr. said. “The spirit is lingering for about a week, and you can feel it, you know?”

Overwhelmed with emotion, he prayed for his son to live.

‘I Can’t Kill Your Son’

Zohny, the neurosurgeon, said he heard an announcement about a “hero’s walk” over a loudspeaker in the hospital. He wasn’t familiar with the term, so he asked about it. Medical residents in the hospital explained and told Zohny that the walk was possibly for his patient Larry Black.

“No, that can’t be my patient,” Zohny said he told them. “I didn’t agree.”

That’s when Zohny called the ICU to check on Black’s status. A person who answered the phone told him that Black was being wheeled to an operating room, he said.

“This is my first year,” Zohny said. “Your first year out as a neurosurgeon is the riskiest time for you. Any mistakes, anything small, basically derails your career. So the moment this happened, my legs went weak and I was very nervous because, at the end of the day, your job as a doctor is to be perfect.”

Â鶹ŮÓÅ Health News, Zohny, and Punch all reviewed the medical files given to Black from his hospitalization. It’s not clear from the records what led to that moment.

“In every case, the patient must be declared legally dead by the hospital’s medical team before organ procurement begins. This is not negotiable,” Mid-America Transplant’s CEO and president, Kevin Lee, wrote in on the nonprofit’s website, responding to the news and federal comments about the investigation centered in Kentucky. “Mid-America Transplant strictly follows all laws, regulations, and hospital protocols throughout the process.”

He said in a statement to Â鶹ŮÓÅ Health News that a person can be pronounced dead in two ways. A person is legally dead if their heart stops beating and they stop breathing, which is when donation after cardiac death can occur. A person can also become an organ donor if their brain, including the brain stem, has irreversibly ceased functioning, which is when brain death donation can occur.

“Every hospital has their own process in declaring both types of death,” Speir said in a statement. “Mid-America Transplant ensures hospitals follow their policies.”

But Black didn’t fall into either category, Zohny said. And, he said, Black hadn’t had what is known as a brain death exam.

Zohny said he immediately informed his chairman about the situation, then started running to the operating room. Black’s family was waiting in the hallway, unaware of the drama happening behind a set of closed silver doors.

Then Zohny emerged, pulling Black’s family into an empty operating room that was nearby.

“I remember he told my mama, ‘I can’t kill your son,’” Payne recalled. “She said, ‘Excuse me?’”

Zohny put an image of Black’s brain on a screen. Then he circled the part of his brain that was damaged. He explained that Black’s gunshot wound was something that he could possibly recover from, though he might need therapy. He asked the family whether they were willing to give Black more time to heal from the injury, instead of withdrawing care.

“In my opinion, no family would ever consent to organ donation unless they were given an impression that their family member had a very poor prognosis,” Zohny said. “I never had a conversation with the family about the prognosis, because it was too early to have that discussion.”

Zohny knew that he was taking a professional risk when he ran into the operating room.

“The worst-case scenario for me is that I lose my job,” he recalled thinking. “Worst-case scenario for him, he wrongfully loses his life.”

Later, Zohny said, a hospital worker who transported Black from the ICU to the operating room told Zohny that something had seemed off.

 “I remember him looking at me and saying, ‘I’m so glad you stopped that,’” Zohny recalled. “And I said, ‘Why?’ And he said: ‘I don’t know. His eyes were open the whole time, and I just felt like he was looking at me. His eyes didn’t move, but it felt like he was looking at me.’”

‘Back From the Dead’

After Zohny’s intervention, Black was wheeled back to the ICU. Zohny said the medical team held back all medications that caused his sedation.

Black woke up two days later, Zohny said, and started speaking. Within a week, the neurosurgeon said, he was standing.

“I had to learn how to walk, how to spell, read,” Black said. “I had to learn my name again, my Social, birthday, everything.”

Zohny continued to care for Black during what remained of his 21 days in the hospital. During a follow-up appointment, he posed for a photo with Black and his older sister, Watts. Next to Zohny, Black is standing up, a brace on his leg.

“It’s a miracle that despite flawed policy we were able to save his life,” Zohny said. “It was an absolute miracle.”

Zohny, who was working as a fellow and assistant professor at the time, left Saint Louis University Hospital for another job later that year when his fellowship ended. He said Black’s story made him question what we know about consciousness.

He’s now working on a new method that quantifies consciousness. Zohny said it could possibly be used to help measure consciousness from brain signals, such as with an electroencephalogram, or EEG, a test that measures electrical activity in the brain. Zohny said his method still needs rigorous validation, so he recently started a medical research company called Zeta Analytica, separate from his work at the West Virginia University , which he’ll begin in October.

“We don’t understand the brain to the level that we should, especially with all of the technology we have now,” Zohny said.

Today, Black is trying to move forward. He said he has seizures if the bullet fragments in his head move around too much. He said he easily overheats because of the injury.

He doesn’t blame his family for their decision. But he questions the organ transplantation process. “It’s like they choose people’s destiny for them just because they have an organ donor ribbon on their ID,” Black said. “And that’s not cool.”

To help him process everything that happened to him in 2019, he makes music under the name BeamNavyLooney. “I am back from the dead,” he recently wrote in a song about his experience.

Earlier this year, Black celebrated the birth of another son, who was sleeping peacefully at home as Black recounted his story.

“He doesn’t really cry,” Black said. “He just makes noises.”

Black sat with a firearm within reach. He said he keeps the gun close to protect his family. It’s still hard for him to sleep at night. Nightmares about what happened — both on the street and in the hospital — keep him awake.

He said he no longer wants to be on the organ donor registry.

This project was supported by a fellowship from the Association of Health Care Journalists, with funding from The Joyce Foundation.

This <a target="_blank" href="/news/organ-donation-transplant-harvesting-still-alive-missouri-st-louis/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

She found Forbes face down in the street in August 2023, two weeks before he had planned to move away from the empty storefronts, boarded-up houses, and poverty that make this one of the most troubled places in the nation.

Naketra Guy thought about how her son overcame losing his father at age 4 and was the glue of the family. She called him “humble” and “respectful,” a leader in the community and on the football field, where he shined.

Yet he could not outrun the grim statistics of his hometown. Bogalusa posts some of the worst health outcomes and poverty in Louisiana, a state that routinely ranks among the worst nationally in both. And Bogalusa has endured another indicator of poor public health: high levels of gun violence.

Since the beginning of the covid-19 pandemic, gun violence has shattered any sense of peace or progress here. Louisiana suffers the nation’s second-highest firearm — and Bogalusa, a predominantly Black community with 10,000 residents, has seen dozens of shootings and a violent crime rate approaching twice the national average.

A nearby team refused to play football at Bogalusa High School in fall 2022, .

Bogalusa’s mayor, Tyrin Truong, was elected in 2022 at age 23 on his promises to fix entrenched challenges: few youth programs and good jobs, and perpetual crime and blight.

“I ran for mayor because I got sick of seeing our city painted as mini-New Orleans,” he said, “due to the high levels of youth gun violence.”

In January, the Louisiana State Police , accusing him of soliciting a prostitute and participating in a drug trafficking ring that allegedly used illicit proceeds to buy firearms. He has . “I still haven’t been formally arraigned,” he told Â鶹ŮÓÅ Health News in late July, “and I haven’t been charged with anything.”

Every year tens of thousands of Americans — — are killed by gun violence on the scale of a public health epidemic.

Many thousands more are left to recover from severe injuries, crushing medical debt, and the mental health toll of losing loved ones.

Most headlines focus on America’s urban centers, but the numbers also reflect the growth of gun violence in places like Bogalusa, a pinprick of a town 75 miles north of New Orleans. In 2020, the gun violence death rate for rural communities than in large metropolitan areas, according to Johns Hopkins University.

Firearms are the No. 1 killer of children in the U.S., and no group suffers more than . More Black boys and men ages 15 to 24 in 2023 than from the next 15 leading causes of deaths combined. Though overall U.S. homicides after the pandemic ended, adolescent gun deaths climbed even higher in the years after, according to , an associate professor in the School of Public Health at Boston University.

“It has all the markers of an epidemic. It is a major driver of death and disability,” Jay said. “Gun violence does not get the attention it deserves. It is underrecognized because it disproportionately impacts Black and brown people.”

Rather than bolstering efforts to save lives, federal, state, and local government officials have undermined them. Â鶹ŮÓÅ Health News undertook an examination of gun violence since the pandemic, a period when firearm death rates surged. Reporters reviewed government reports and academic research and interviewed dozens of health policy experts, activists, and victims or their relatives. They reviewed corporate earnings reports from gun manufacturers and to politicians.

In polling published in 2023 by Â鶹ŮÓÅ, said they or a family member had been impacted by gun violence such as by seeing a shooting or being threatened, injured, or killed with a gun.

American politicians and regulators have put in place laws and practices that have helped enrich firearm and ammunition manufacturers — which tout — even as already damaged by white flight, systemic disinvestment, and other forms of racial discrimination.

President Donald Trump championed gun rights on the campaign trail and has from the National Rifle Association, , “No one will lay a finger on your firearms.” His administration has rolled back efforts under President Joe Biden to address the rise in gun violence.

Emboldened in his second term, Trump to in schools, weaken federal oversight of the gun industry, override state and local gun laws, permit sales , and cut funding for violence intervention.

Trump to review all Biden administration actions that “purport to promote safety but may have impinged on the Second Amendment rights of law-abiding citizens.”

The Biden administration said “” during the pandemic took its greatest toll on racially segregated and high-poverty neighborhoods.

Black youths in four major cities were as white ones to experience a firearm assault, research showed. Gun suicides reached an all-time high, and for the first time the firearm suicide rate among older Black teens surpassed that of older white teens.

In Bogalusa, the pandemic gun violence spread fear. Among the victims killed were a 15-year-old attending a birthday party and a 24-year-old nationally known musician. Thirteen people were injured at a memorial for a man who himself had been shot. Residents said neighbors stopped sitting in their yards because of stray bullets.

Researchers say communities like Bogalusa endure a collective trauma that shatters their sense of safety. Two years after , his mother says that when she leaves home her surviving children worry that she, too, might get shot.

Repercussions from the surge will last years, researchers said: Exposure to shootings increases risk for post-traumatic stress disorder, anxiety, suicide, depression, substance abuse, and poor school performance for survivors and those who live near them.

“We saw gun violence exposure go up for every group of children except white children, in the cities we studied,” Jay said. “Limits on government funding into gun violence research may stop us from ever knowing exactly why.”

Politics of Pain

The year before Forbes died in Bogalusa, Biden signed into law the Bipartisan Safer Communities Act, considered the in decades.

In a matter of months, Trump has systematically dismantled key provisions.

Efforts to regulate guns have long proven ineffective against the power of political and business interests that fill the streets with weapons. In 2020, the number of guns manufactured annually in the U.S. hit 11.3 million, more than double a decade earlier, according to . In 2022, the United States had nearly 78,000 , more than its combined number of McDonald’s, Burger King, Wendy’s, and Subway locations, according to Everytown for Gun Safety, an advocacy group.

The Biden administration it would attempt to reduce gun violence by adopting a “zero tolerance” policy toward firearm dealers who committed violations such as failing to run a required background check or selling to someone prohibited from buying a gun.

The federal Bureau of Alcohol, Tobacco, Firearms and Explosives, or ATF, which licenses gun dealers, has the authority to enforce laws meant to prevent illegal gun sales. In issuing an executive order, the Trump administration , under Biden, the agency targeted “mom-and-pop shop small businesses who made innocent paperwork errors.”

From October 2010 to February 2022, the agency conducted more than 111,000 inspections, recommending revocation of a dealer’s license only 589 times, about 0.5% of cases, an inspector general’s report said. Even when it cited serious violations, the ATF rarely shut dealers down.

ATF leaders that recommendations for license revocations increased after Biden’s zero-tolerance policy was implemented. In April, the Trump administration .

Surgeon General Vivek Murthy last year declared firearm violence a public health crisis. Within weeks of Trump’s inauguration, the advisory. Of the 15 leading U.S. causes of death, firearm injuries received less research funding from the National Institutes of Health for each person who died than all but poisoning and falls, according to in 2024 by Brady, an anti-gun violence organization. that funding, too.

Trump’s Department of Justice abruptly cut 373 grants in April for projects worth about $820 million, with a large share from gun violence intervention.

“We are going to lose a generation of community violence prevention folks,” said Volkan Topalli, a gun violence researcher at Georgia State University. “People are going to die, I’m sorry to say, but that is the bleak truth of this.”

Asked about its policies, the White House did not address questions about public health considerations around gun violence.

“Illegal violence of any sort is a crime issue, and President Trump has been clear since Day One that he is committed to Making America Safe Again by empowering law enforcement to uphold law and order,” White House spokesperson Kush Desai said.

Trump administration officials “want safer streets and less violence,” Topalli said. “They are hurting their cause.”

Garen Wintemute, an emergency medicine professor who directs the violence prevention program at the University of California-Davis, was among the first in the nation to consider guns and violence as a public health issue. He said race plays a significant role in perceptions about gun violence.

“People look at the demographic risk for firearm homicide and depending on the demographics of the people in the audience, I can see the transformation in their faces,” Wintemute said. “It’s like they’re saying, ‘Not my people, not my problem.’”

Eroding Gun Restrictions

Trump’s incursions against public health efforts to contain gun violence are backed by lobbying power.

Firearm industry advocacy groups made millions of dollars in political donations in recent years, mostly to conservative causes and Republican candidates. That includes $1.4 million to Trump, , which tracks campaign finance data.

The assassination of civil rights icon the Rev. Martin Luther King Jr. helped lead to the passage of the federal , which imposed stricter licensing rules and outlawed the sale of firearms and ammunition to felons.

While it remains the law of the land, over time, federal and state government actions have significantly weakened its protections.

Most states now concealed weapons without a permit or background check, even though the practice can increase the risk of firearm homicides.

In Louisiana, Democratic former Gov. John Bel Edwards, in office from 2016 to 2024, that would have allowed people to carry concealed firearms without a permit.

Elected in 2023, Republican Gov. Jeff Landry to allow any person over age 18 to conceal-carry without a permit.

The Trump administration has created his executive order to end most gun regulations and which would allow more people with criminal convictions, including for domestic abuse, to own guns.

Figures vary, but some researchers estimate as many as 500 million guns circulate in the U.S. Sales reached during the pandemic and publicly traded firearm and ammunition companies saw .

Donald Trump Jr. this summer of GrabAGun, an online gun retailer that went public in July under the stock ticker PEW. In a , the company, which markets guns to people ages 18 to 44, cited “ organizations that oppose sales of firearms and ammunition” as threats to its sales growth.

Dave Workman, a gun rights advocate with the , said firearms are not to blame for the surge in pandemic shootings.

“Bad guys are going to do what bad guys are going to do regardless of the law,” Workman said. “Taking away gun rights is not going to reduce crime.”

David Yamane, a Wake Forest University sociology professor and national authority on guns, said the U.S. firearm debate is complex and the industry is often “painted with too broad a brush.”

Most guns will never be used to kill anyone, he said. Americans tend to buy more guns during times of unrest, Yamane added: “It’s part of the American tradition. Guns are seen as a legitimate tool for defending yourself.”

‘A Low Level of Hope’

Once called “,” Bogalusa has become a grim symbol of deindustrialization.

Bogalusa emerged as Black people formed their own communities in the time of Jim Crow racial segregation at the turn of the 20th century.

Racism concentrated Black people in neighborhoods that , reflected in high rates of cancer, asthma, chronic stress, preterm births, pregnancy-related complications — and, over recent decades, .

Thousands flocked to Bogalusa after the Great Southern Lumber Company built one of the world’s biggest sawmills, establishing Bogalusa as a company town. Racial tensions .

Members of the local gained national attention in the 1960s for protecting civil rights organizers from the Ku Klux Klan, that burned houses and churches, terrorizing and killing Black people.

As the mill changed hands over the decades, Bogalusa’s fortunes slid. In the mid-20th century, the population surpassed 20,000, but it is now about half that.

International Paper, based in Tennessee, runs the mill as a containerboard factory, employing about 650 people. In 2021, the state announced incentives for the company that included a $500,000 tax break, saying the move would help bring “prosperity.”

Businesses remain boarded up along the main drag. Houses still bear damage from Hurricane Katrina, and many streets are eerily quiet.

Nearly 1 in 3 people in Bogalusa live in poverty — 2½ times the national average.

Bogalusa’s violent gun crime rate people in 2022, higher than Louisiana’s and 1.7 times the national one, according to the nonprofit Equal Justice USA, citing FBI Uniform Crime Reporting data.

In many rural towns across the South, “there is a level of desperation that is more apparent” than in other parts of the U.S., said , a of social justice and public policy.

“They don’t have the same infrastructure to have robust social services. People are like, ‘What are my life chances?’” Shaefer said. “People feel like there is nothing that can be done. There is a low level of hope.”

Missed Opportunities

Mayor Truong lamented the violence in Bogalusa after Forbes was killed, , “When are we as a community going to come together and decide enough is enough?”

The federal government had offered one path forward.

The Biden administration provided billions of dollars to local governments through the American Rescue Plan Act during the pandemic. Biden urged them to deploy money to community violence intervention programs, shown to by as much as 60%.

A handful of cities seized the opportunity, but most did not. Bogalusa has received since 2021. None appears to have gone toward violence prevention.

The Louisiana legislative auditor, Michael Waguespack, found that Bogalusa used nearly $500,000 for employee bonuses, which his report said may have violated state law. In some cases, says, payments were not tied to work performed.

Bogalusa officials did not respond to a public records request from Â鶹ŮÓÅ Health News seeking detailed information about its ARPA money.

Former Mayor Wendy O’Quin-Perrette, who served from 2015 through early 2023, told Waguespack that the city used ARPA money to improve streets and pay the bonuses. “We would not have done it without being sure it was allowed,” she said.

O’Quin-Perrette did not respond to requests for comment.

In a to Waguespack, O’Quin-Perrette’s successor, Truong, wrote that Bogalusa officials didn’t know how the federal money was spent. When he took office, Truong alleged, officials discovered “tens of thousands of dollars of checks and cash” stashed “in various drawers and on desks” in city offices.

Truong defended his stewardship of ARPA funds, saying that about $1 million remained when he assumed office but that the money was needed for more urgent sewer infrastructure repairs. “I wish we could have invested more, invested any money in gun violence prevention efforts,” he said.

In an interview, Truong said the city has been “intentional” about bringing down gun violence, including through a summer jobs program. He pointed to statistics that show homicides decreased from nine in 2022 to two in 2024. “If you keep them busy, they won’t have time to do anything else,” he said.

Asked about his January arrest, Truong said he has political enemies.

“I’m the only Democrat in a very red part of the state, and, you know, I’ve made a lot of changes at City Hall, and that ticks people off,” Truong told Â鶹ŮÓÅ Health News. He said that he ended long-standing city contracts with local businesspeople. “When you’re shaking up power structures, you become a target.”

Josie Alexander, for , said city officials missed an opportunity when they didn’t use ARPA funds for gun violence prevention. “The sad thing is people here can now see that money was coming in,” she said. “But it just wasn’t used the way it needed to be.”

‘Too Much Trouble Here’

Truong said the city is still reeling from the . He said he was at Bogalusa High School’s homecoming football game in 2022 when one teen shot another. Shots rang out, Truong said, and he grabbed his 3-month-old son and “laid in the bleachers.”

“It’s not a foreign topic to hardly anybody in town, whether you’ve heard the gunshots in the distance, whether you have attended a funeral of somebody who passed due to gun violence,” he said. Many still grapple with trauma.

In December 2022, Khlilia Daniels said, she hosted a birthday party for her teenage niece, praying no one would bring a gun.

The hosts checked guests for weapons, she said.

Yet gunfire erupted, Daniels said. Three teens were shot, including , who died, according to police.

“When someone you know is killed, you never forget,” said Daniels, 32, who held Taylor until emergency responders arrived.

Tajdryn Forbes was planning his future when he , likely because of a dispute that started on social media over lyrics in a rap song, Guy said.

In a in January, Bogalusa police said they had arrested someone in connection with Forbes’ killing. Authorities had the arrest of a teen in connection with the homicide.

Forbes had been a high school football standout, like his late father, Charles Forbes Jr., who played semipro. When Forbes scored a touchdown, he would look to the sky to honor his dad.

The school praised Forbes for his senior baseball season in : “This young man makes a difference on our campus and on the field with his strong character.”

When hopes for a college football scholarship did not pan out, Forbes worked as a deckhand for a marine transportation company. He saved money, looking forward to moving to Slidell, a suburb of New Orleans.

“He would always say, ‘There’s too much trouble here’” in Bogalusa, Guy recalled.

This <a target="_blank" href="/public-health/bogalusa-louisiana-gun-violence-firearm-industry-black-communities-discrimination/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Céline Gounder, Â鶹ŮÓÅ Health News’ editor-at-large for public health, discussed Centers for Disease Control and Prevention employees’ reaction to a deadly shooting at the agency’s Atlanta office on CBS News 24/7’s “The Daily Report” on Aug. 11.

Â鶹ŮÓÅ Health News Southern correspondent Sam Whitehead discussed how President Donald Trump’s recent megabill is unlikely to insulate Medicaid expansion holdout states from health cuts on WUGA’s “The Georgia Health Report” on Aug. 8.

• Read Whitehead’s “.”

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Â鶹ŮÓÅ Health News senior correspondent Phil Galewitz discussed Medicaid and Supplemental Nutrition Assistance Program cuts on “CBS Morning News” on June 26.

• Read Galewitz and Stephanie Armour’s ““

Â鶹ŮÓÅ Health News senior correspondent Arthur Allen discussed the first Centers for Disease Control and Prevention vaccine advisory panel meeting under Health and Human Services Secretary Robert F. Kennedy Jr. on “CBS News 24/7” on June 25.

Â鶹ŮÓÅ Health News chief Washington correspondent Julie Rovner discussed abortion and the three-year anniversary of the Supreme Court’s Dobbs decision on “CBS Evening News Plus” on June 24.

Céline Gounder, Â鶹ŮÓÅ Health News’ editor-at-large for public health, discussed the new Purdue Pharma opioid settlement and Medicaid cuts on “CBS Evening News Plus” on June 20 and June 16, respectively. On June 20, Gounder also discussed trials for a new HIV prevention drug on “CBS News 24/7.”

Â鶹ŮÓÅ Health News senior correspondent Renuka Rayasam discussed covid vaccine recommendations and gun violence prevention on WUGA’s “The Georgia Health Report” on June 20 and June 13, respectively.

• Read Jackie Fortiér’s ““
• Read Bram Sable-Smith’s ““

Â鶹ŮÓÅ Health News senior correspondent Aneri Pattani discussed the dramatic decrease in drug overdose deaths on WAMU’s “1A” on June 17.

• Read Pattani’s coverage of opioid settlements in “”

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In Oakland, California, a hospital-based program to prevent retaliatory gun violence lost a $2 million grant just as the traditionally approach. Another $2 million award was pulled from a Detroit program that offers to young people in violent neighborhoods. And in St. Louis, a clinic treating the physical and emotional injuries of gunshot victims also lost a $2 million award.

They are among 373 grants that the U.S. Department of Justice abruptly terminated in April. The largest share of the nixed awards were designated for community-based violence intervention — programs that range from conflict mediation and de-escalation to hospital-based initiatives that seek to prevent retaliation from people who experience violent injuries.

Gun violence is among America’s most deadly public health crises, medical experts say.

Among programs whose grants were terminated were those for protecting children, victims’ assistance, hate-crime prevention, and law enforcement and prosecution, according to by the Council on Criminal Justice, a nonpartisan think tank. The grants totaled $820 million when awarded, but some of that money has been spent.

“Not only are these funds being pulled away from worthy investments that will save lives,” said , founding director of the Violence Reduction Center at the University of Maryland, “but the way that this was done — by pulling authorized funding without warning — is going to create a lasting legacy of mistrust.”

The Justice Department “is focused on prosecuting criminals, getting illegal drugs off the streets, and protecting all Americans from violent crime,” according to a statement provided by agency spokesperson Natalie Baldassarre. “Discretionary funds that are not aligned with the administration’s priorities are subject to review and reallocation, including funding for clinics that engage in race-based selectivity.”

The Council on Criminal Justice found that descriptions of 31% of them included references to “diversity,” “equity,” “race,” “racial,” “racism,” or “gender.”

Baldassarre’s statement said the department is committed to working with organizations “to hear any appeal, and to restore funding as appropriate.” Indeed, it restored seven of the terminated grants for victims’ services after in April.

But the cuts have already prompted at other organizations around the country. Five groups on May 21 to restore the grants in their entirety.

Joseph Griffin, executive director of the Oakland nonprofit Youth Alive, which pioneered hospital-based violence intervention in the 1990s, said his organization had spent only about $60,000 of its $2 million grant before it was axed. The grant was primarily to support the intervention program and was awarded for a three-year period but lasted just seven months. The money would have helped pay to intervene with about 30 survivors of gun violence to prevent retaliatory violence. He’s trying to find a way to continue the work, without overtaxing his team.

“We will not abandon a survivor of violence at the hospital bedside in the same way that the federal government is abandoning our field,” he said.

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The cuts are also hitting St. Louis, often dogged by being labeled one of the most in America. The city created an with under former President Joe Biden, and various groups received Justice Department grants, too.

Locals say the efforts have helped: The 33% drop in the city’s homicide rate from 2019 to 2024 was the among 29 major cities examined by the Council on Criminal Justice.

“I don’t think there’s any doubt that there’s some positive impact from the work that’s happening,” said University of Missouri-St. Louis criminologist , who received a grant from the Justice Department to assess the work of the city’s new Office of Violence Prevention. That research grant remains in place.

But the Justice Department in St. Louis, including $2 million for Power4STL. The nonprofit operates the Bullet Related Injury Clinic, dubbed the BRIC, which provides free treatment for physical and mental injuries caused by bullets.

The BRIC had about $1.3 million left on its grant when the award was terminated in April. LJ Punch, a former trauma surgeon who founded the clinic in 2020, said it was intended to fund a mobile clinic, expand mental health services, evaluate the clinic’s programs, and pay for a patient advisory board. The BRIC won’t abandon those initiatives, Punch said, but will likely need to move slower.

Keisha Blanchard joined the BRIC’s advisory board after her experience as a patient at the clinic following a January 2024 gun injury. Someone fired a bullet into her back from the rear window of a Chevy Impala while Blanchard was out for a lunchtime stroll with a friend from her neighborhood walking group. The shooting was random, Blanchard said, but people always assume she did something to provoke it. “It’s so much shame that comes behind that,” she said.

The 42-year-old said the shooting and her initial medical treatment left her feeling angry and unseen. Her family wasn’t allowed to be with her at the hospital since the police didn’t know who shot her or why. When she asked about taking the bullet out, she was told that the common medical practice is to leave it in. “We’re not in the business of removing bullets,” she recalled being told. At a follow-up appointment, she said, she watched her primary care doctor google what to do for a gunshot wound.

“Nobody cares what’s going to happen to me after this,” Blanchard recalled thinking.

Before she was referred to the BRIC, she said, she was treated as though she should be happy just to be alive. But a part of her died in the shooting, she said. Her joyful, carefree attitude gave way to hypervigilance. She stopped taking walks. She uprooted herself, moving to a neighborhood 20 miles away.

The bullet stayed lodged inside her, forcing her to carry a constant reminder of the violence that shattered her sense of safety, until Punch removed it from her back in November. Blanchard said the removal made her feel “reborn.”

It’s a familiar experience among shooting survivors, according to Punch.

“People talk about the distress about having bullets still inside their bodies, and how every waking conscious moment brings them back to the fact that that’s still inside,” Punch said. “But they’re told repeatedly inside conventional care settings that there’s nothing that needs to be done.”

The Justice Department grant to the BRIC had been an acknowledgment, Punch said, that healing has a role in public safety by quelling retaliatory violence.

“The unhealed trauma in the body of someone who’s gotten the message that they are not safe can rapidly turn into an act of violence when that person is threatened again,” Punch said.

Community gun violence, even in large cities, is concentrated among who are often both victims and perpetrators, according to researchers. Violence reduction initiatives are frequently tailored to those networks.

Jennifer Lorentz heads the Diversion Unit in the office of the St. Louis Circuit Attorney, the city’s chief prosecutor. The unit offers mostly young, nonviolent offenders an opportunity to avoid prosecution by completing a program to address the issues that initially led to their arrest. About 80% of the participants have experienced gun violence and are referred to the BRIC, Lorentz said, calling the clinic critical to her program’s success.

“We’re getting them these resources, and we’re changing the trajectory of their lives,” Lorentz said. “Helping people is part of public safety.”

Punch said the BRIC staffers were encouraged during the Justice Department application process to emphasize their reach into St. Louis’ Black community, which is disproportionately affected by gun violence. He suspects that emphasis is why its grant was terminated.

Punch likened the grant terminations to only partially treating tuberculosis, which allows the highly infectious disease to become resistant to medicine.

“If you partially extend a helping hand to somebody, and then you rip it away right when they start to trust you, you assure they will never trust you again,” he said. “If your intention is to prevent violence, you don’t do that.”

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She saw people running from Exclusive Barbershop next door. She heard a voice telling a 911 operator that someone had been shot in the head. Her hands shook as she ventured outside. Then she saw 20-year-old Elijah Clunie slumped in a barber’s chair, haircut unfinished.

In the chaos, a 7-year-old boy stood in shock, eyes bulging at Clunie’s body. Sowers-Hassell asked the boy to come with her and sheltered him at the salon until his father arrived. “He kept going, ‘I can’t breathe. I can’t breathe,’” she said, and he later told her he never wanted to get his hair cut again.

Barbershops and salons are regarded in the Black community as safe, sacred spaces, where men and women gather to laugh, debate, and see their unofficial therapists: the barbers and stylists. When those refuges are violated by gun violence, an unspoken bond is broken.

Clunie’s killing cost Dorchester more than his own young life. Shootings send ripples of trauma through communities that can carry across generations. A found that exposure to gun killings was linked to higher levels of depression, suicidal ideation, and other mental health difficulties. Children and young adults were the most susceptible, and Black youth were disproportionately affected.

When economists calculate the societal costs of gun violence, “what they find is that much bigger than hospital treatment or criminal justice response or anything, is the fear and trauma and how it affects individuals and businesses,” said Daniel Webster, a professor and distinguished scholar with the Johns Hopkins Center for Gun Violence Solutions.

Four Corners — home largely to African American, Caribbean, and Puerto Rican families — is not a destination neighborhood. A historic Methodist church is one of the few attractions. There aren’t any major supermarkets, fine dining restaurants, or hospitals. Of the businesses that do exist, many cover their doors and windows in plexiglass and metal bars.

“We talk about these food deserts of good, healthy food; the truth of the matter is, it’s a desert for everything,” Webster said. “Businesses generally don’t want to be there.”

The owner of Salvaged Roots, Shanita Clarke, said she intended her salon to stand out as an oasis in the community.

Clarke was planning to take her then-13-year-old son to the salon to get his hair done when she got a phone call about the shooting. She rushed to work to check on her stylists. Clarke, her staff, and clients spent the next three hours waiting while officers collected evidence. In the weeks that followed, calls came in to push back appointments. Clarke said she could sense her clients’ anxiety and understood it. Even though she wasn’t in the shop when Clunie was shot, she experienced the incident vicariously through the sound of gunshots captured on the salon’s security footage and accounts from her employees.

A from the commonwealth of Massachusetts alleges the suspect in Clunie’s killing, Diamond Jose Brito, entered Exclusive Barbershop wearing all black clothing and a ski mask. Brito walked to the back of the shop, where Clunie was seated, and asked his barber how long the wait was for a haircut. About 45 minutes later, the statement alleges, Brito returned, walked to Clunie’s chair, shot him in the back of the head with a small silver revolver, then shot another victim multiple times.

Brito, of Canton, Massachusetts, was in October and is being held without bail. He to all the charges against him, including murder.

“Mr. Brito maintains his innocence and we are looking forward to presenting his defense at trial,” Brito’s attorney, David Leon, said in a statement to Â鶹ŮÓÅ Health News.

Boston City Councilor Brian Worrell’s office is around the corner from Salvaged Roots and Exclusive Barbershop. The neighborhood requires investment and initiatives by elected officials and policymakers, he said. Residents have to feel that homeownership and stable careers are possible.

“That can’t be some far-off thinking,” said Worrell, who represents District 4, which includes that part of Dorchester. “They have to be able to see it, and it has to show up in their lives, in a real, tangible way.”

Clunie had been a student at TechBoston Academy and a basketball player who was named player of the game after a big win his senior year, in 2022. But in a uploaded to the presentation site Prezi in June of that year, a user presumed to be Clunie wrote: “When I first moved to the Dorchester area I thought I was going to die,” noting “the killings on the news” every day.

Moments after the shooting, an unknown person walked into the barbershop and recorded a graphic video of Clunie’s body, which was then uploaded to social media platforms. It spread on Facebook and X, leading users to find Clunie’s personal accounts, on which some commenters made light of his death. He would have turned 21 the Saturday following his killing.

Worrell called the video especially inappropriate and callous. But apathy in the face of violence, he said, isn’t hard to imagine in a community suffering food and housing insecurity, struggling schools, and a persistent lack of opportunity.

Clarke said she’s torn on how to move forward. Loud noises and being alone trigger anxiety, and she now sometimes locks the salon doors once clients are in for their appointments. She’s felt anger and isolation, she said.

Recovering from the trauma of witnessing gun violence is often more difficult for onlookers when they still live and work where the shootings happened.

“We want to address the mental health trauma from gun violence, but let’s not kid ourselves,” Webster said. “If we don’t actually address gun violence, we’re swimming against a really strong tide.”

Since she opened her salon almost six years ago, Clarke has been active in community efforts to make the neighborhood safer, attending civic association and neighborhood meetings and speaking with police and local politicians.

Clarke believes efforts to clean up moved more drug users into Dorchester. Salvaged Roots is next to a commuter rail station, which Clarke said attracts transients who set up camps and leave behind trash and sometimes drug paraphernalia. Only a week before Clunie’s killing, there was a across the street from the salon.

In 2024, there were about 20 shootings in the police district that includes Four Corners, five of them fatal. Most of the victims were Black men, according to a Â鶹ŮÓÅ Health News analysis of data.

Though gun violence overall is at a record low in Boston and the city has in investigative resources — including , management, and oversight — a disproportionate amount occurs in Boston’s historically Black communities.

Since Clarke opened Salvaged Roots, she feels Four Corners has gotten both better and worse. “If other businesses leave, then where do people that live in the community — where are the nice places that they get to go to?” she asked.

Residents of neighborhoods with frequent gun violence and crime can mistakenly be perceived as being desensitized, but “we can never accept the violence as normal,” Boston City Council President Ruthzee Louijeune said. She’s volunteered and worked in Four Corners and said tackling the violence takes a multipronged approach, including getting guns off the street and providing access to affordable housing, secure jobs, and good health care.

In communities of color, she said, intergenerational trauma from racism and poverty must also be addressed.

In Dorchester, Louijeune said, a high number of residents resort to visiting emergency rooms for mental health issues. The neighborhood needs more access to health care, she said, especially for young people. Across Boston, Black residents were nearly twice as likely to go to the ER for mental health care than white residents, according to the Boston Public Health Commission’s .

Months later, attention and curiosity over the shooting had died down, but the trauma remained. Sowers-Hassell continues to work at Salvaged Roots, and though the city sent a trauma team to meet with the stylists after the shooting, she still has flashbacks. She said the influx of resources was helpful and that Four Corners has been a little quieter. But she’s skeptical the reprieve will last.

“Everybody talks a good game,” she said, “but when it’s time to get something done, what’s going to happen?”

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She rushed to check on him at a hospital run by Denver Health, the city’s safety-net system, but she was unable to get information from emergency room workers, who complained that she was creating a disturbance.

“I was distraught and outside, crying, and Jerry came out of the front doors,” she said.

Jerry Morgan is a familiar face from Green’s Denver neighborhood. He had rushed to the hospital after his pager alerted him to the shooting. As a violence prevention professional with the , or AIM, Morgan supports gun-violence patients and their families at the hospital — as he did the day Green’s brother was shot.

“It made the situation of that traumatic experience so much better. After that, I was, like, I want to do this work,” Green said.

Today, Green works with Morgan as the program manager for AIM, a hospital-linked violence intervention program launched in 2010 as a partnership between Denver Health and the nonprofit . It since has expanded to include Children’s Hospital Colorado and the University of Colorado Hospital.

AIM is one of dozens of hospital-linked violence intervention programs around the country. The programs aim to uncover the social and economic factors that contributed to someone ending up in the ER with a bullet wound: inadequate housing, job loss, or feeling unsafe in one’s neighborhood, for example.

Such programs that take a public health approach to stopping gun violence have had success — one in San Francisco reported a over six years. But President Donald Trump’s executive orders calling for the review of the Biden administration’s gun policies and trillions of dollars in federal grants and loans have created uncertainty around the programs’ long-term federal funding. Some organizers believe their programs will be just fine, but others are looking to shore up alternative funding sources.

“We’ve been worried about, if a domino does fall, how is it going to impact us? There’s a lot of unknowns,” said John Torres, associate director for Youth Alive, an Oakland, California-based nonprofit.

Federal data shows that gun violence became a leading cause of death among children and young adults at the start of this decade and was tied to more than 48,000 deaths among people of all ages in 2022. New York-based pediatric trauma surgeon Chethan Sathya, a National Institutes of Health-funded firearms injury prevention researcher, believes those statistics show that gun violence can’t be ignored as a health care issue. “It’s killing so many people,” Sathya said.

Research shows that a violent injury puts someone at heightened risk for future ones, and the risk of death goes up significantly by the third violent injury, according to a 2006 study published in The Journal of Trauma: Injury, Infection and Critical Care.

Benjamin Li, an emergency medicine physician at Denver Health and the health system’s AIM medical director, said the ER is an ideal setting to intervene in gun violence by working to reverse-engineer what led to a patient’s injuries.

“If you are just seeing the person, patching them up, and then sending them right back into the exact same circumstances, we know it’s going to lead to them being hurt again,” Li said. “It’s critical we address the social determinants of health and then try to change the equation.”

That might mean providing alternative solutions to gunshot victims who might otherwise seek retaliation, said Paris Davis, the intervention programs director for Youth Alive.

“If that’s helping them relocate out of the area, if that’s allowing them to gain housing, if that’s shifting that energy into education or job or, you know, family therapy, whatever the needs are for that particular case and individual, that is what we provide,” Davis said.

AIM outreach workers meet gunshot wound victims at their hospital bedsides to have what Morgan, AIM’s lead outreach worker, calls a tough, nonjudgmental conversation on how the patients ended up there.

AIM uses that information to help patients access the resources they need to navigate their biggest challenges after they’re discharged, Morgan said. Those challenges can include returning to school or work, or finding housing. AIM outreach workers might also attend court proceedings and assist with transportation to health care appointments.

“We try to help in whatever capacity we can, but it’s interdependent on whatever the client needs,” Morgan said.

Since 2010, AIM has grown from three full-time outreach workers to nine, and this year opened the in Denver’s Five Points neighborhood. The community-based clinic provides wound-care kits; physical therapy; and behavioral, mental and occupational health care. In the coming months, it plans to add bullet removal to its services. It’s part of a growing movement of community-based clinics , including the Bullet Related Injury Clinic in St. Louis.

Ginny McCarthy, an assistant professor in the Department of Surgery at the University of Colorado, described REACH as an extension of the hospital-based work, providing holistic treatment in a single location and building trust between health care providers and communities of color that have historically experienced .

, created in 1994 and run by Youth Alive in Oakland, is cited as the nation’s first hospital-linked violence intervention program and has since inspired others. The , a national network initiated by Youth ALIVE to advance public health solutions to gun violence, counted among its membership as of January.

The alliance’s executive director, , compared medicine’s role in addressing gun violence to that of preventing an infectious disease, like cholera. “That disease spreads if you don’t have good sanitation in places where people aggregate,” she said.

Dreier, who also serves as executive director of the , said medicine identifies and tracks patterns that lead to the spread of a disease or, in this case, the spread of violence.

“That is what health care can do really well to shift society. When we deploy this, we get better outcomes for everybody,” Dreier said.

The alliance, of which AIM is a member, offers technical assistance and training for hospital-linked violence intervention programs and to make their services eligible for traditional insurance reimbursement.

In 2021, President Joe Biden issued an that opened the door for states to use Medicaid for violence prevention. Several states, including , , and , have for hospital-linked violence intervention programs.

Last summer, then-U.S. Surgeon General Vivek Murthy , and the earmarked $1.4 billion in funding for a wide array of violence-prevention programs through next year.

But in early February, Trump issued an instructing the U.S. attorney general to conduct a 30-day review of a number of Biden’s policies on gun violence. The White House Office of Gun Violence Prevention now , and recent moves to freeze federal grants created uncertainty among the gun-violence prevention programs that receive federal funding.

AIM receives 30% of its funding from its operating agreement with Denver’s , according to Li. The rest is from grants, including Victims of Crime Act funding, through the Department of Justice. As of mid-February, Trump’s executive orders had not affected AIM’s current funding.

Some who work with the hospital-linked violence prevention programs in Colorado are hoping a in the state, expected to generate about $39 million annually and support victim services, could be a new source of funding. But the tax’s revenues aren’t expected to fully flow until 2026, and it’s not clear how that money will be allocated.

Trauma surgeon and public health researcher Catherine Velopulos, who is the AIM medical director at the University of Colorado hospital in Aurora, said any interruption in federal funding, even for a few months, would be “very difficult for us.” But Velopulos said she was reassured by the bipartisan support for the kind of work AIM does.

“People want to oversimplify the problem and just say, ‘If we get rid of guns, it’s all going to stop,’ or ‘It doesn’t matter what we do, because they’re going to get guns, anyway,’” she said. “What we really have to address is why people feel so scared that they have to arm themselves.”

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The effort, part of Baltimore’s more than $100 million gun violence prevention plan, relies on staffers like Fitzgerald to build trust with people at risk of such violence and offer them resources like housing or food. Researchers believe these programs reduce gun deaths.

Yet one morning in 2019, Fitzgerald said, his oldest son, Deshawn McCoy, then 26, was shot just outside of the neighborhood he patrolled at the time. Fitzgerald said McCoy was a “really beautiful soul,” who fixed dirt bikes at a local garage. McCoy became the city’s , one of 348 that year, among the city’s deadliest. He left behind three daughters.

“This is our zone,” said Fitzgerald, pointing toward McElderry Park. “My son got cooked over here.”

For years, violence intervention was the work of loosely organized, underfunded groups. Then gun violence spiked during the covid pandemic and the Biden administration and Congress poured in money to better integrate such programs within cities. It appeared to help: In Baltimore and beyond, gun violence has plummeted.

The number of homicides in the city dropped 41%, from more than 300 a year in 2021 to 201 in 2024, according to the U.S. attorney’s office in Maryland.

“Gun violence is a sticky, hard problem to solve,” said Daniel Webster, a researcher at the Johns Hopkins Center for Gun Violence Solutions in Baltimore. “We’re getting it right finally.”

Now President Donald Trump’s administration has gutted funding for that work.

Webster said it could take years to untangle what led to the city’s gun violence drop. Among the factors, he said: the pandemic’s end, investments in violence intervention, improvements that have given police more legitimacy in neighborhoods, targeted prosecutions, and an aggressive effort to remove untraceable ghost guns.

“You need all of these systems working well to have systemic reductions in gun violence,” he said.

The Trump administration has slashed funding for and research, cutting about $500 million in grants to organizations that support public safety.

At the same time, Trump has loosened gun laws the Bureau of Alcohol, Tobacco, Firearms and Explosives, which oversees gun dealers. He has also sent federal troops into the Democratic-led cities of Chicago; Los Angeles; Memphis, Tennessee; Portland, Oregon; and Washington, D.C.

Webster said cities are still benefiting from pandemic-era efforts to address gun deaths. But given the Trump policy changes, if violence escalates, city leaders could have a hard time keeping it from spiraling out of control.

Trying Something Different

Safe Streets is among the promising violence prevention programs that could lose funding. Staffers in the city’s most violent neighborhoods operate like community health workers.

During the pandemic, the Biden administration provided billions of dollars to local governments through the American Rescue Plan Act. Biden urged them to deploy money to community violence intervention programs, which have been shown to by as much as 60%. His administration to spend Medicaid dollars on such programs. The goal: Stop gun deaths.

Few cities seized the opportunity.

Analyzing federal data, professors Philip Rocco of Marquette University and Amanda Kass of DePaul University found local governments used the ARPA money for 132,451 projects. Yet only 231, less than 0.2%, involved community violence intervention, they said.

In Baltimore, then-newly elected mayor Brandon Scott was ready for the federal influx.

Baltimore’s homicide rate had been high since 2015, when a 25-year-old Black man named Freddie Gray died in police custody. Protests erupted and fractures between residents and police deepened. Baltimore ended the year with 342 homicides, the first time since 1999 that more than 300 were recorded in the city.

“We got really good at our jobs” in the years after Gray’s death, said James Gannon, trauma program manager at Sinai Hospital of Baltimore.

Gun deaths tracked what public health researcher Lawrence T. Brown called the : racially segregated areas that fanned out across Baltimore’s eastern and western neighborhoods around a wealthy central strip. People who faced years of forced displacement and disinvestment , which fueled the cycle.

Every year from 2015 to 2022, the city recorded at least 300 homicides.

“We had to try something different,” said Stefanie Mavronis, director of the Mayor’s Office of Neighborhood Safety and Engagement. Scott created the agency weeks after he was sworn into office in 2020, later with $50 million in ARPA money and $20 million annually from the city’s budget.

Containing an Outbreak

The office’s budget — $22 million in fiscal year 2026 — is a fraction of the city’s .

Still, the money allowed Baltimore’s leaders to scale up a new approach: addressing gun violence the way public health officials might handle an infectious disease outbreak, Mavronis said.

City staffers identified the small subset of people most at risk of being shot or becoming the next shooter through crime data and referrals from social service workers, hospitals, and violence intervention staff, she said. Mavronis said that gangs, friends willing to engage in violence for each other, and retaliation had been driving gun deaths in the city.

“This never-ending cycle of violence and loss and trauma,” Mavronis said, “comes from that.”

The city convened hospital presidents to connect gunshot victims and their friends and family to counseling, crisis support, and city services.

It offered people help finding therapy, a job, or emergency relocation — and threatened arrest and prosecution if they retaliated.

“We decided that we were no longer going to subscribe to the belief that one thing, one agency, one part of government, one program was going to help cure Baltimore of this disease of gun violence that has had a stranglehold on this city for the entirety of my life,” Scott said.

The Coming Cliff

Baltimore is on pace this year to post its fewest gun deaths since Richard Nixon was president.

“Some of it is the national zeitgeist of the moment,” said Adam Rosenberg, executive director of Center for Hope at LifeBridge Health, which operates Safe Streets sites and the Violence Response Team at Sinai Hospital. He credits mainly the infusion of funding that allowed more resources and hands-on engagement with high-risk communities.

“We typically talk about how poverty affects homicides, but it works in reverse too,” Webster said. “People don’t invest in homes and businesses or, frankly, in people, where people get shot regularly.”

Fitzgerald, who grew up in East Baltimore, said he started working for Safe Streets in 2010 for the paycheck.

He’s been on both sides of gun violence, he said, as someone hit more than a dozen times in shootings — first when he was 12. At 13, Fitzgerald said, he shot a cousin in the leg. Over years, he was in and out of the criminal justice system, including for charges of attempted murder, which helped him understand the people he now works with every day, he said.

No college “can certify you in my experiences in violence,” he said. “That’s what allows me to identify and detect potentially violent situations.”

Today, Fitzgerald, 49, believes that teaching kids trauma coping mechanisms can drive culture change and stop shootings.

“Our kids see more death than soldiers,” he said.

But federal funding is drying up. Anthony Smith, executive director of , which supports local leaders on gun violence reduction, estimates that about 65 groups have lost funding this year. And Trump’s signature legislation slashes nearly $1 trillion in anticipated federal Medicaid spending over the next decade.

Center for Hope lost $1.2 million from federal cuts.

“It’s like a car racing along, and you see the cliff coming,” Rosenberg said. “I don’t know if the resources are there anymore, but the need certainly is.”

Rosenberg said that, because of their experiences, staffers such as Fitzgerald are “incredible messengers” for people involved in gun violence, and he noted that they are thoroughly vetted.

Fitzgerald put it this way: “I’m trying to save my kids, the community. The people we’re trying to save is our friends and our family, and ourselves.”

Â鶹ŮÓÅ Health News senior correspondent Fred Clasen-Kelly contributed to this report.

If you or someone you know have experienced the pain of a gunshot wound, and are willing to talk about the medical experience, please fill out our form .

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“When you get shot,” he said, “you stop thinking about the future.”

He is anchored by his wife and child and faith. He once wanted to work as a forklift driver but has built a stable career in information technology. He finds camaraderie with other gunshot survivors and in advocacy.

Still, trauma remains lodged in his daily life. As gun violence surged in the shadows of the covid pandemic, it shook Harris’ fragile sense of security. He moved his family out of Philadelphia to a leafy suburb in Delaware. But a nagging fear of crime persists.

Now he is thinking about buying a gun.

Harris is one of tens of thousands of Americans killed or injured each year by gun violence, a public health crisis that escalated in the pandemic and churns a into a hospital emergency room every half hour.

Over the past two decades, the firearm industry has and stepped up sales campaigns through social media influencers, conference presentations, . An industry trade group acknowledged that its traditional customer was “” and in recent years began targeting and who are disproportionately victimized by gun violence.

The Trump administration has moved to reduce federal oversight of gun businesses, announced by the Bureau of Alcohol, Tobacco, Firearms and Explosives as “marked by transparency, accountability, and partnership with the firearms industry.”

The pain of gun violence crosses political, cultural, and geographic divides — but no group has suffered as much as Black people, such as Harris. They were nearly 14 times as likely to die by gun homicide than white people in 2021, , citing federal data. Black men and boys are 6% of the population but of homicide victims.

Washington has offered little relief: Guns remain one of few consumer products the federal government for health and safety.

“The politics of guns in the U.S. are so out of whack with proper priorities that should focus on health and safety and most fundamental rights to live,” said attorney Jon Lowy, founder of , who helped represent Mexico in an unsuccessful lawsuit against Smith & Wesson and other gunmakers that reached the Supreme Court. “The U.S. allows and enables gun industry practices that would be totally unacceptable anywhere else in the world.”

Â鶹ŮÓÅ Health News undertook an examination of gun violence during the pandemic, a period when firearm deaths reached an all-time high. Reporters reviewed academic research, congressional reports, and hospital data and interviewed dozens of gun violence and public health experts, gun owners, and victims or their relatives.

The examination found that while public officials imposed restrictions intended to prevent covid’s spread, politicians and regulators helped fuel gun sales — and another public health crisis.

As state and local governments schools, advised residents to stay home, and closed gyms, theaters, malls, and other businesses to stop covid’s spread, President Donald Trump kept gun stores open, critical to the functioning of society.

White House spokesperson Kush Desai did not respond to interview requests or answer questions about the Trump administration’s efforts to reduce regulation of the firearm industry.

During the pandemic, the federal government gave firearm businesses and groups more than $150 million in financial assistance through the Paycheck Protection Program, even as some businesses reported brisk sales, according to from Everytown for Gun Safety, an advocacy group.

Federal officials said the program would keep people employed, but millions of dollars went to firearm companies that did not say whether it would save any jobs, the report said.

About bought a gun during the first two years of the pandemic, including millions of first-time buyers, according to survey data from NORC at the University of Chicago.

Harris is keenly aware of what drives the demand.

“Guns aren’t going away unless we get to the root of people’s fears,” he said.

most Americans who own a gun feel it makes them safer. But public health data suggests that owning a gun of homicide and triples chances of suicide in a home.

“There’s no evidence that guns provide an increase in protection,” said Kelly Drane, research director for the . “We have been told a fundamental lie.”

Record Deaths

Less than a year into the pandemic, 20-year-old Jacquez Anlage was shot dead in a Jacksonville, Florida, apartment. Five years later, the killing remains unsolved.

His mother, Crystal Anlage, said she fell to her knees and wailed in grief on her lawn when police delivered the news.

She said Jacquez overcame years in the foster care system — living in 36 homes — before she and her husband, Matt, adopted him at age 16.

Jacquez Anlage had just moved into his own apartment when he was shot. He loved animals and wanted to become a veterinary technician. He was kind and loving, Crystal Anlage said, with the 6-foot-4, 215-pound physique of the football and basketball player he’d been.

“He was just getting to a point in life where he felt safe,” Crystal Anlage said.

Gun violence researchers say parents like Crystal Anlage carry trauma that destroys their sense of security.

Anlage said she endures post-traumatic stress disorder and anxiety. She is terrified of guns and fireworks.

But she has made something meaningful of her son’s killing: She co-founded the Jacksonville Survivors Foundation, which works to raise awareness about the impact of homicide and to support grieving parents.

“Jacquez’s death can’t be in vain,” she said. “I want his legacy to be love.”

His legacy and that of other young men killed by guns is muted by firearm manufacturers’ powerful message of fear.

During the pandemic, gun marketers told Americans they needed firearms to defend themselves against criminals, protesters, unreliable cops, and , filed by gun control advocacy groups with the Federal Trade Commission.

In a since-deleted June 18, 2020, from Lone Wolf Arms, an Idaho-based manufacturer, a protester is depicted being confronted by police officers in riot gear between the words “Defund Police? Defend Yourself,” the petition shows. The caption says, “10% to 25% off demo guns and complete pistols.”

Impact Arms, an online gun seller, on Instagram on Aug. 3, 2020, showing a person putting a rifle in a backpack, the document says. “The world is pretty crazy right now,” the caption reads. “Not a bad idea to pack something more efficient than a handgun.”

The National Rifle Association in 2020 posted on YouTube a of a Black woman holding a rifle and telling viewers they need a gun in the pandemic. “You might be stockpiling up on food right now to get through this current crisis,” she said, “but if you aren’t preparing to defend your property when everything goes wrong, you’re really just stockpiling for somebody else.”

The messaging worked. Background checks for firearm sales soared 60% from , the year the federal government declared a public health emergency.

The same year, more than , the highest number up till then. In 2021, was broken again.

Weapons sold at the beginning of the pandemic were more likely to wind up at crime scenes within a year than in any previous period, according to by Democrats on Congress’ Joint Economic Committee, citing ATF data.

Gun manufacturers “used disturbing sales tactics” following mass shootings in Buffalo, New York, and Uvalde, Texas, “while failing to take even basic steps to monitor the violence and destruction their products have unleashed,” according to a released by congressional Democrats in July 2022 following a House Oversight and Reform Committee investigation of industry practices and profits.

The firearm industry has marketed “to white supremacist and extremist organizations for years, playing on fears of government repression against gun owners and fomenting racial tensions,” the House investigation said. “The increase in racially motivated violence has also led to rising rates of gun ownership among Black Americans, allowing the industry to profit from both white supremacists and their targets.”

In 2024, then-President Joe Biden’s Department of the Interior provided a to the National Shooting Sports Foundation, a leading , to help companies market guns to Black Americans.

The Federal Trade Commission is responsible for protecting consumers from deceptive and unfair business practices and has the power to take enforcement action. It issued warnings to companies that made unsubstantiated claims their products could prevent or treat covid, for instance.

But when families of gun violence victims, lawmakers, and advocacy groups in 2022, during Biden’s term, how firearms were marketed to children, people of color, and groups that espouse white supremacy, officials did not announce any public action.

This summer, the National Shooting Sports Foundation pressed its and derided “a coordinated ‘lawfare’ campaign” that it said gun control groups have waged against “constitutionally-protected firearm advertising.”

FTC spokesperson Mitchell Katz declined to comment, saying in an email that the agency does not acknowledge or deny the existence of investigations.

Serena Viswanathan, who retired as an FTC associate director in June, told Â鶹ŮÓÅ Health News that the agency lost at least a quarter of the staff in its advertising practices division after Trump came into office in January.

Gun companies Smith & Wesson, Lone Wolf Arms, and Impact Arms did not respond to requests for comment. Neither did the National Shooting Sports Foundation or the NRA.

In an August 2022 , Smith & Wesson President and CEO Mark Smith said gun manufacturers were being wrongly blamed by some politicians for the pandemic surge in violence, saying cities experiencing violent crime had “promoted irresponsible, soft-on-crime policies that often treat criminals as victims and victims as criminals.”

He added, “Some now seek to prohibit firearm manufacturers and supporters of the 2nd Amendment from advertising products in a manner designed to remind law-abiding citizens that they have a Constitutional right to bear arms in defense of themselves and their families.”

Guns and Race

In 2015, the National Shooting Sports Foundation gathered supporters at a conference in Savannah, Georgia, and urged the firearm industry to diversify its customer base, according to a and reports from and the .

Competitive shooter Chris Cheng gave a presentation called “Diversity: The Next Big Opportunity.” Screenshots from the conference include slides purporting to show “demographics,” “psychographics,” and “technographics” of Black and Hispanic shooters.

The slides described Black shooters as “expressive and confident socially, in a crowd” and “less likely to be married and to be a college grad.” They said Hispanic shooters were “much more trusting of advertising and celebrities.”

Nick Suplina, senior vice president for law and policy at Everytown for Gun Safety, said industry marketing shifted in the latter half of the 20th century as the popularity of hunting declined. The new sales pitch: guns for personal safety.

“They said, ‘We need to break into new markets,’” Suplina said. “They identified women and people of color. They didn’t have a lot of success until the pandemic, the Black Lives Matter movement, and the death of George Floyd. The marketing says, ‘You deserve the Second Amendment too.’ They are selling the product as an antidote to fear and anxiety.”

Gun manufacturers were harshly criticized in the Oversight Committee’s 2022 investigation for marketing products to people of color, as gun violence remains a leading cause of death for young Black and Latino men.

At the same time, some companies also promoted assault rifles to white supremacist groups who believe a race war is imminent, the investigation found. One company sold an AK-47-style rifle called the “Big Igloo Aloha,” a reference to an anti-government movement, it said.

Still, Philip Smith wants more Black people to get guns for protection.

Smith said he was working as a human resources consultant a decade ago when he got the idea to form the , which helped the National Shooting Sports Foundation compile its report on communicating with Black consumers.

Smith encourages Black people to buy firearms for self-defense and get proper training on how to use them.

After 10 years, Smith said, his group has about 45,000 members nationwide. Single members pay $39 a year and couples $59, which gives them access to discounts from the organization’s corporate partners, including gunmakers, and raffles for gun giveaways, according to its website.

The police killing of Michael Brown in Ferguson, Missouri, and the shooting death of Florida teenager Trayvon Martin helped spark early interest from doctors, lawyers, and others in joining the group, he said. But interest took off during the pandemic, he said, even among Democrats who had resisted the idea of owning a gun.

“Hundreds of people called me and said, ‘I don’t agree with anything you’re saying, but what kind of gun should I buy,’” Smith recalled.

Smith, describing himself as “quiet, nerdy, and Afrocentric,” said criticism of guns misses the point.

“My ancestors bled for us to have this right,” he said. “Are there some racist white people? Yes. But we should buy guns because there is a need. No one is forcing us to buy guns.”

‘American Amnesia’

During the pandemic, gun violence took its greatest toll on racially segregated neighborhoods in places such as Philadelphia, where roughly residents live in poverty.

A says a one-year period in the pandemic saw more than 2,300 shootings, or about six a day. Many of the cases haven’t been solved by police.

City officials cited the boom in gun sales in the report: Fewer than 400,000 sales took place in Pennsylvania in 2000, but in 2020 it was more than 1 million.

Gun sales since the pandemic ended, but the harm they’ve caused persists.

At a conference last year inside the Eagles’ football stadium, victims of firearm violence or their relatives joined activists to share accounts of near-death experiences and the grief of losing loved ones.

Paintings flanked the stage and the meeting space to commemorate people who had been fatally shot, nearly all young people of color, under messages such as “You are loved and missed forever” and “Those we love never leave.”

Marion Wilson, a community activist, said he believes the nation has forgotten the suffering Philadelphia and other cities endured during the pandemic.

“We suffer from the disease of American amnesia,” he said.

Harris was on his way home from a job at Burlington Coat Factory nearly two decades ago when robbers followed him from a bus stop and demanded money. He said he had none and was shot.

Harris had spent his early life fixing cars with his grandfather, when he wasn’t at school or attending church. He remembers lying in a hospital bed, overcome with a sense of helplessness.

“I had to learn to feed myself again,” he said. “I was like a baby. I had to learn to sit up so I could use a wheelchair. The only way I got through it was my faith in God.”

Harris endured years of rehabilitation and counseling for PTSD. As someone in a wheelchair, he said, he sometimes fears for his safety — and a gun may be one of the few ways to protect himself and his family.

“I’m mulling it over,” Harris said. “I’m afraid of my trauma hurting someone else. That’s the only reason I haven’t gotten one yet.”

If you or someone you know has experienced the pain of a gunshot wound, and are willing to talk about the medical experience, please fill out our form .

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Â鶹ŮÓÅ Health News and The Trace are teaming up to take a deep look at how insurance status affects treatment for gunshot wounds. We’re looking for survivors, their friends and family, or family members of people who suffered complications or died from gunshot wounds after leaving the hospital. We want to hear about medical treatment, insurance coverage, and experiences after discharge from the hospital.

If you or someone you know has experienced the pain of a gunshot wound and you’re willing to talk about the medical experience, please fill out below. We’ll be in touch as soon as possible.

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“Get him off the table,” the doctor recalled telling the surgical team at SSM Health Saint Louis University Hospital as the team cleaned Black’s chest and abdomen. “This is my patient. Get him off the table.”

At first, no one recognized Zohny Zohny in his surgical mask. Then he told the surgical team he was the neurosurgeon assigned to Black’s case. Stunned by his orders, the team members pushed back, Zohny said, explaining that they had consent from the family to remove Black’s organs.  

“I don’t care if we have consent,” Zohny recalled telling them. “I haven’t spoken to the family, and I don’t agree with this. Get him off the table.”

Black, his 22-year-old patient, had arrived at the hospital after getting shot in the head on March 24, 2019. A week later, he was taken to surgery to have his organs removed for donation — even though his heart was beating and he hadn’t been declared brain-dead, Zohny said.

Black’s sister Molly Watts said the family had doubts after agreeing to donate Black’s organs but felt unheard until the 34-year-old doctor, in his first year as a neurosurgeon, intervened.

Today, Black, now 28, is a musician and the father of three children. He still needs regular physical therapy for lingering health issues from the gun injury. And Black said he is haunted by what he remembers from those days while he was lying in a medically induced coma.

“I heard my mama yelling,” he recalled. “Everybody was there yelling my name, crying, playing my favorite songs, sending prayers up.”

He said he had tried to show everyone in his hospital room that he heard them. He recalled knocking on the side of the bed, blinking his eyes, trying to show that he was fighting for his life.

Organ transplants save a growing number of lives in the U.S. every year, with performed in 2024, according to the Organ Procurement and Transplantation Network, which oversees the nation’s transplant system. And awaiting donations that never come.

But organ donation has also faced , including reports of patients showing alertness before planned organ harvesting. The results of a into a Kentucky organ donation nonprofit, first disclosed by in June, found that during a four-year period, medical providers had planned to harvest the organs of 73 patients despite signs of neurological activity. Those procedures ultimately didn’t take place, but federal officials to overhaul the nation’s organ donation system.

“Our findings show that hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. “The entire system must be fixed to ensure that every potential donor’s life is treated with the sanctity it deserves.”

Even before this latest investigation, Black’s case showed Zohny that the organ donation system needed to improve. He was initially hesitant to talk to Â鶹ŮÓÅ Health News when contacted in July about Black. But Zohny said his patient’s story had stuck with him for years, highlighting that while organ donation must continue, little is understood about human consciousness. And determining when someone is dead is the critical but confusing question at play.

“There was no bad guy in this. It was a bad setup. There’s a problem in the system,” he said. “We need to look at the policies and make some adjustments to them to make sure that we’re doing organ donation for the right person at the right time in the right place, with the right specialists involved.”

LJ Punch, a former trauma surgeon who was not involved with the case but reviewed Black’s medical records for Â鶹ŮÓÅ Health News, questioned whether Black’s injury — from gunfire — possibly contributed to how he was treated. Young Black men like Larry Black are in the United States, and . His experience exemplifies “the general neglect” of Black men’s bodies, Punch said.

“That’s what comes up for me,” Punch said. “Structurally, not individually. Not any one doctor, not any one nurse, not any one team. It’s a structural reality.”

The hospital declined to comment on the details of Black’s case. SSM Health’s Kim Henrichsen, president of Saint Louis University Hospital and St. Mary’s Hospital-St. Louis, said the hospital system approaches “all situations involving critical illness or end-of-life care with deep compassion and respect.”

Mid-America Transplant, the federally designated organ procurement organization serving the St. Louis region, does not comment on individual donor cases, according to , executive vice president for organ procurement. She did tell Â鶹ŮÓÅ Health News that her organization has walked away from cases when patients’ conditions change — though not as late as when they are in the operating room for harvesting.

“Let me be clear about that. It happens way before then,” she said. “It definitely happens multiple times a year where we get consent. The family has made the decision, we approach, we get consent, it’s all appropriate, and then a day or so later they improve and we’re like, ‘Whoa.’”

But Speir said the recent media stories about the nation’s donation system are prompting a lot of questions about a process that also does a lot of good.

“We’re losing public trust right now,” Speir said of the industry. “And we’re going to have to regain that.”

Blink Twice for a Chance at Life

It was a Sunday afternoon when gunshots rang out in downtown St. Louis. Black had been on his way to his sister’s apartment.

“I didn’t know I was shot at first,” Black said, sitting in his living room six years later. “I literally ran like a block or two away.”

He collapsed moments later, he said, crawling to the back door of a woman’s home, where he asked for help. He said he asked the woman to give him two large towels, one covered in rubbing alcohol and another soaked with hydrogen peroxide. He wrapped those towels around the back of his head.

When his sister Macquel Payne found him, he was lying on the ground near the leasing office of her apartment complex, a crowd gathered around him.

Before an ambulance took him to the hospital, Black told his sister not to worry about him.

“I’m hearing Larry say, ‘I’m good, sis,’” Payne recalled. “‘I’m OK.’”

Black said he went in and out of consciousness on the way to the hospital and once he was there.

“I got to hitting my hand on the side of the ICU bed,” Black said. “They was like: ‘That’s just the reaction, the side effects of the medicine. Ask him some questions.’”

Payne said she asked her brother to blink twice if he could remember his first pet, a dog named “Little Black” that looked like the Chihuahua from the Taco Bell commercials.

Black said he remembers blinking twice. His sisters remember the same.

Payne asked him another question. This time she wanted to know whether her brother recognized their family. Black said he blinked twice when he saw his mom and sister standing nearby.  

Black said his sister then asked him “the main question” that everyone needed him to answer.

“She’s like, ‘If you want them to pull a plug, if you tired and you giving up, blink once,’” Black recalled. “‘If you still got some fight in you, blink more than once.’”

Black said he started blinking and hit the bed to let his family know that he was still with them.

The sisters said hospital staffers told them the movements were involuntary.

‘Not Right Now’

In a waiting room steps away from the hospital’s intensive care unit, a woman carrying brochures explained to Payne and the rest of the family that Black had identified himself as a possible organ donor on his ID.

The woman wanted to know whether the family wished to move forward with the process if Black died, Payne said.

“I remember my mom saying, ‘Not right now,’” Black’s sister recalled. “‘It’s kind of too soon.’”

Payne said the woman persisted.

“She was like, ‘Well, can I at least leave you some brochures or something?’” Payne recalled. “Then my mom got a little agitated because it felt like she was being, like, pushy.”

The family was already acquainted with the organ donation process. In 2007, Black’s teenage brother Miguel Payne drowned at a local lake. His organs were donated, Macquel Payne said, noting the family was told that his body parts and tissues helped multiple people.

“I believe in saving lives,” Payne said. “But don’t be pushy about it.”

Mid-America Transplant handles the organ transplant process for 84 counties in parts of Illinois, Arkansas, and Missouri, including St. Louis. Like the Kentucky organization, it is one of 55 federally designated nonprofits that facilitate organ donations throughout the country.

The nonprofit has never pressured a family into organ donation, Speir said. Registering to be an organ donor is legally binding, she said, but Mid-America has walked away from cases when families didn’t want to move forward.

She said her staff tries to dispel myths about organ donation and alleviate concerns. “We want to have the families leave with a positive experience,” Speir said.

Despite the family’s initial ambivalence, they ultimately consented to moving forward with donating Black’s organs. Watts said members of her brother’s care team had told the family that her brother was at “the end of the road.”

The family was told to prepare for Black’s “last walk of life,” Payne said. Also known as an honor or hero’s walk, the tradition honors the life of an organ donor before the harvesting process begins.

At the time, Payne said, she thought her brother still had a fighting chance. She asked the hospital staffers to take another look at him before he was wheeled down the hall.

“I’m like, ‘My brother’s in there tapping on the bed,’” Payne said. “They said, ‘That’s just his nerves.’ But I’m like, ‘No, something’s not right.’ It’s like he was too alert. He was letting us know: ‘Please don’t let them do this to me. I’m here. I can fight this.’ They were saying that’s what the medicine will do, it affects his nerves.”

After the family had agreed to move forward with the organ donation process, the two sisters said, an especially helpful member of Black’s medical team no longer treated them the same way. She became standoffish, they said.

“You could tell the dynamics had changed,” Watts said.

‘#¸é±õ±Ê²Ñ²âµþ°ù´Ç³Ù³ó±ð°ù’

The family put on blue jumpers for the walk of life. “We just walked around the floor, and everybody was, like, acknowledging him,” Payne said. “We just thought this was the end.”

A friend Black went to high school with filmed part of the ritual. In a , Black is seen being wheeled on a stretcher down a hallway in the hospital. His eyes are half-open. People are crying.

False rumors then started to swirl outside the hospital.

Brianna Floyd said she went into shock when she heard that her friend was dead. She knew that Black had been shot in the head. But a few days earlier, that he was in stable condition.

Floyd checked Facebook to see whether the news of his death was true. Her timeline was flooded with farewell posts for Black, so she decided to write one, too.

“I Love You So Much Brother,” . “#RIPMyBrother. Never Thought I Would Say That.”

Black’s father rushed to the hospital when he heard a rumor that his son was being wheeled to the morgue.

“‘He’s gone,’” Lawrence Black Sr. recalled being told. “‘He’s going to the freezer now.’”

Black Sr. said he refused to believe that his son was dead. The thought was devastating. He had already experienced that kind of loss to gun violence.

“You wake up and nothing’s the same,” Black Sr. said. “The spirit is lingering for about a week, and you can feel it, you know?”

Overwhelmed with emotion, he prayed for his son to live.

‘I Can’t Kill Your Son’

Zohny, the neurosurgeon, said he heard an announcement about a “hero’s walk” over a loudspeaker in the hospital. He wasn’t familiar with the term, so he asked about it. Medical residents in the hospital explained and told Zohny that the walk was possibly for his patient Larry Black.

“No, that can’t be my patient,” Zohny said he told them. “I didn’t agree.”

That’s when Zohny called the ICU to check on Black’s status. A person who answered the phone told him that Black was being wheeled to an operating room, he said.

“This is my first year,” Zohny said. “Your first year out as a neurosurgeon is the riskiest time for you. Any mistakes, anything small, basically derails your career. So the moment this happened, my legs went weak and I was very nervous because, at the end of the day, your job as a doctor is to be perfect.”

Â鶹ŮÓÅ Health News, Zohny, and Punch all reviewed the medical files given to Black from his hospitalization. It’s not clear from the records what led to that moment.

“In every case, the patient must be declared legally dead by the hospital’s medical team before organ procurement begins. This is not negotiable,” Mid-America Transplant’s CEO and president, Kevin Lee, wrote in on the nonprofit’s website, responding to the news and federal comments about the investigation centered in Kentucky. “Mid-America Transplant strictly follows all laws, regulations, and hospital protocols throughout the process.”

He said in a statement to Â鶹ŮÓÅ Health News that a person can be pronounced dead in two ways. A person is legally dead if their heart stops beating and they stop breathing, which is when donation after cardiac death can occur. A person can also become an organ donor if their brain, including the brain stem, has irreversibly ceased functioning, which is when brain death donation can occur.

“Every hospital has their own process in declaring both types of death,” Speir said in a statement. “Mid-America Transplant ensures hospitals follow their policies.”

But Black didn’t fall into either category, Zohny said. And, he said, Black hadn’t had what is known as a brain death exam.

Zohny said he immediately informed his chairman about the situation, then started running to the operating room. Black’s family was waiting in the hallway, unaware of the drama happening behind a set of closed silver doors.

Then Zohny emerged, pulling Black’s family into an empty operating room that was nearby.

“I remember he told my mama, ‘I can’t kill your son,’” Payne recalled. “She said, ‘Excuse me?’”

Zohny put an image of Black’s brain on a screen. Then he circled the part of his brain that was damaged. He explained that Black’s gunshot wound was something that he could possibly recover from, though he might need therapy. He asked the family whether they were willing to give Black more time to heal from the injury, instead of withdrawing care.

“In my opinion, no family would ever consent to organ donation unless they were given an impression that their family member had a very poor prognosis,” Zohny said. “I never had a conversation with the family about the prognosis, because it was too early to have that discussion.”

Zohny knew that he was taking a professional risk when he ran into the operating room.

“The worst-case scenario for me is that I lose my job,” he recalled thinking. “Worst-case scenario for him, he wrongfully loses his life.”

Later, Zohny said, a hospital worker who transported Black from the ICU to the operating room told Zohny that something had seemed off.

 “I remember him looking at me and saying, ‘I’m so glad you stopped that,’” Zohny recalled. “And I said, ‘Why?’ And he said: ‘I don’t know. His eyes were open the whole time, and I just felt like he was looking at me. His eyes didn’t move, but it felt like he was looking at me.’”

‘Back From the Dead’

After Zohny’s intervention, Black was wheeled back to the ICU. Zohny said the medical team held back all medications that caused his sedation.

Black woke up two days later, Zohny said, and started speaking. Within a week, the neurosurgeon said, he was standing.

“I had to learn how to walk, how to spell, read,” Black said. “I had to learn my name again, my Social, birthday, everything.”

Zohny continued to care for Black during what remained of his 21 days in the hospital. During a follow-up appointment, he posed for a photo with Black and his older sister, Watts. Next to Zohny, Black is standing up, a brace on his leg.

“It’s a miracle that despite flawed policy we were able to save his life,” Zohny said. “It was an absolute miracle.”

Zohny, who was working as a fellow and assistant professor at the time, left Saint Louis University Hospital for another job later that year when his fellowship ended. He said Black’s story made him question what we know about consciousness.

He’s now working on a new method that quantifies consciousness. Zohny said it could possibly be used to help measure consciousness from brain signals, such as with an electroencephalogram, or EEG, a test that measures electrical activity in the brain. Zohny said his method still needs rigorous validation, so he recently started a medical research company called Zeta Analytica, separate from his work at the West Virginia University , which he’ll begin in October.

“We don’t understand the brain to the level that we should, especially with all of the technology we have now,” Zohny said.

Today, Black is trying to move forward. He said he has seizures if the bullet fragments in his head move around too much. He said he easily overheats because of the injury.

He doesn’t blame his family for their decision. But he questions the organ transplantation process. “It’s like they choose people’s destiny for them just because they have an organ donor ribbon on their ID,” Black said. “And that’s not cool.”

To help him process everything that happened to him in 2019, he makes music under the name BeamNavyLooney. “I am back from the dead,” he recently wrote in a song about his experience.

Earlier this year, Black celebrated the birth of another son, who was sleeping peacefully at home as Black recounted his story.

“He doesn’t really cry,” Black said. “He just makes noises.”

Black sat with a firearm within reach. He said he keeps the gun close to protect his family. It’s still hard for him to sleep at night. Nightmares about what happened — both on the street and in the hospital — keep him awake.

He said he no longer wants to be on the organ donor registry.

This project was supported by a fellowship from the Association of Health Care Journalists, with funding from The Joyce Foundation.

This <a target="_blank" href="/news/organ-donation-transplant-harvesting-still-alive-missouri-st-louis/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

She found Forbes face down in the street in August 2023, two weeks before he had planned to move away from the empty storefronts, boarded-up houses, and poverty that make this one of the most troubled places in the nation.

Naketra Guy thought about how her son overcame losing his father at age 4 and was the glue of the family. She called him “humble” and “respectful,” a leader in the community and on the football field, where he shined.

Yet he could not outrun the grim statistics of his hometown. Bogalusa posts some of the worst health outcomes and poverty in Louisiana, a state that routinely ranks among the worst nationally in both. And Bogalusa has endured another indicator of poor public health: high levels of gun violence.

Since the beginning of the covid-19 pandemic, gun violence has shattered any sense of peace or progress here. Louisiana suffers the nation’s second-highest firearm — and Bogalusa, a predominantly Black community with 10,000 residents, has seen dozens of shootings and a violent crime rate approaching twice the national average.

A nearby team refused to play football at Bogalusa High School in fall 2022, .

Bogalusa’s mayor, Tyrin Truong, was elected in 2022 at age 23 on his promises to fix entrenched challenges: few youth programs and good jobs, and perpetual crime and blight.

“I ran for mayor because I got sick of seeing our city painted as mini-New Orleans,” he said, “due to the high levels of youth gun violence.”

In January, the Louisiana State Police , accusing him of soliciting a prostitute and participating in a drug trafficking ring that allegedly used illicit proceeds to buy firearms. He has . “I still haven’t been formally arraigned,” he told Â鶹ŮÓÅ Health News in late July, “and I haven’t been charged with anything.”

Every year tens of thousands of Americans — — are killed by gun violence on the scale of a public health epidemic.

Many thousands more are left to recover from severe injuries, crushing medical debt, and the mental health toll of losing loved ones.

Most headlines focus on America’s urban centers, but the numbers also reflect the growth of gun violence in places like Bogalusa, a pinprick of a town 75 miles north of New Orleans. In 2020, the gun violence death rate for rural communities than in large metropolitan areas, according to Johns Hopkins University.

Firearms are the No. 1 killer of children in the U.S., and no group suffers more than . More Black boys and men ages 15 to 24 in 2023 than from the next 15 leading causes of deaths combined. Though overall U.S. homicides after the pandemic ended, adolescent gun deaths climbed even higher in the years after, according to , an associate professor in the School of Public Health at Boston University.

“It has all the markers of an epidemic. It is a major driver of death and disability,” Jay said. “Gun violence does not get the attention it deserves. It is underrecognized because it disproportionately impacts Black and brown people.”

Rather than bolstering efforts to save lives, federal, state, and local government officials have undermined them. Â鶹ŮÓÅ Health News undertook an examination of gun violence since the pandemic, a period when firearm death rates surged. Reporters reviewed government reports and academic research and interviewed dozens of health policy experts, activists, and victims or their relatives. They reviewed corporate earnings reports from gun manufacturers and to politicians.

In polling published in 2023 by Â鶹ŮÓÅ, said they or a family member had been impacted by gun violence such as by seeing a shooting or being threatened, injured, or killed with a gun.

American politicians and regulators have put in place laws and practices that have helped enrich firearm and ammunition manufacturers — which tout — even as already damaged by white flight, systemic disinvestment, and other forms of racial discrimination.

President Donald Trump championed gun rights on the campaign trail and has from the National Rifle Association, , “No one will lay a finger on your firearms.” His administration has rolled back efforts under President Joe Biden to address the rise in gun violence.

Emboldened in his second term, Trump to in schools, weaken federal oversight of the gun industry, override state and local gun laws, permit sales , and cut funding for violence intervention.

Trump to review all Biden administration actions that “purport to promote safety but may have impinged on the Second Amendment rights of law-abiding citizens.”

The Biden administration said “” during the pandemic took its greatest toll on racially segregated and high-poverty neighborhoods.

Black youths in four major cities were as white ones to experience a firearm assault, research showed. Gun suicides reached an all-time high, and for the first time the firearm suicide rate among older Black teens surpassed that of older white teens.

In Bogalusa, the pandemic gun violence spread fear. Among the victims killed were a 15-year-old attending a birthday party and a 24-year-old nationally known musician. Thirteen people were injured at a memorial for a man who himself had been shot. Residents said neighbors stopped sitting in their yards because of stray bullets.

Researchers say communities like Bogalusa endure a collective trauma that shatters their sense of safety. Two years after , his mother says that when she leaves home her surviving children worry that she, too, might get shot.

Repercussions from the surge will last years, researchers said: Exposure to shootings increases risk for post-traumatic stress disorder, anxiety, suicide, depression, substance abuse, and poor school performance for survivors and those who live near them.

“We saw gun violence exposure go up for every group of children except white children, in the cities we studied,” Jay said. “Limits on government funding into gun violence research may stop us from ever knowing exactly why.”

Politics of Pain

The year before Forbes died in Bogalusa, Biden signed into law the Bipartisan Safer Communities Act, considered the in decades.

In a matter of months, Trump has systematically dismantled key provisions.

Efforts to regulate guns have long proven ineffective against the power of political and business interests that fill the streets with weapons. In 2020, the number of guns manufactured annually in the U.S. hit 11.3 million, more than double a decade earlier, according to . In 2022, the United States had nearly 78,000 , more than its combined number of McDonald’s, Burger King, Wendy’s, and Subway locations, according to Everytown for Gun Safety, an advocacy group.

The Biden administration it would attempt to reduce gun violence by adopting a “zero tolerance” policy toward firearm dealers who committed violations such as failing to run a required background check or selling to someone prohibited from buying a gun.

The federal Bureau of Alcohol, Tobacco, Firearms and Explosives, or ATF, which licenses gun dealers, has the authority to enforce laws meant to prevent illegal gun sales. In issuing an executive order, the Trump administration , under Biden, the agency targeted “mom-and-pop shop small businesses who made innocent paperwork errors.”

From October 2010 to February 2022, the agency conducted more than 111,000 inspections, recommending revocation of a dealer’s license only 589 times, about 0.5% of cases, an inspector general’s report said. Even when it cited serious violations, the ATF rarely shut dealers down.

ATF leaders that recommendations for license revocations increased after Biden’s zero-tolerance policy was implemented. In April, the Trump administration .

Surgeon General Vivek Murthy last year declared firearm violence a public health crisis. Within weeks of Trump’s inauguration, the advisory. Of the 15 leading U.S. causes of death, firearm injuries received less research funding from the National Institutes of Health for each person who died than all but poisoning and falls, according to in 2024 by Brady, an anti-gun violence organization. that funding, too.

Trump’s Department of Justice abruptly cut 373 grants in April for projects worth about $820 million, with a large share from gun violence intervention.

“We are going to lose a generation of community violence prevention folks,” said Volkan Topalli, a gun violence researcher at Georgia State University. “People are going to die, I’m sorry to say, but that is the bleak truth of this.”

Asked about its policies, the White House did not address questions about public health considerations around gun violence.

“Illegal violence of any sort is a crime issue, and President Trump has been clear since Day One that he is committed to Making America Safe Again by empowering law enforcement to uphold law and order,” White House spokesperson Kush Desai said.

Trump administration officials “want safer streets and less violence,” Topalli said. “They are hurting their cause.”

Garen Wintemute, an emergency medicine professor who directs the violence prevention program at the University of California-Davis, was among the first in the nation to consider guns and violence as a public health issue. He said race plays a significant role in perceptions about gun violence.

“People look at the demographic risk for firearm homicide and depending on the demographics of the people in the audience, I can see the transformation in their faces,” Wintemute said. “It’s like they’re saying, ‘Not my people, not my problem.’”

Eroding Gun Restrictions

Trump’s incursions against public health efforts to contain gun violence are backed by lobbying power.

Firearm industry advocacy groups made millions of dollars in political donations in recent years, mostly to conservative causes and Republican candidates. That includes $1.4 million to Trump, , which tracks campaign finance data.

The assassination of civil rights icon the Rev. Martin Luther King Jr. helped lead to the passage of the federal , which imposed stricter licensing rules and outlawed the sale of firearms and ammunition to felons.

While it remains the law of the land, over time, federal and state government actions have significantly weakened its protections.

Most states now concealed weapons without a permit or background check, even though the practice can increase the risk of firearm homicides.

In Louisiana, Democratic former Gov. John Bel Edwards, in office from 2016 to 2024, that would have allowed people to carry concealed firearms without a permit.

Elected in 2023, Republican Gov. Jeff Landry to allow any person over age 18 to conceal-carry without a permit.

The Trump administration has created his executive order to end most gun regulations and which would allow more people with criminal convictions, including for domestic abuse, to own guns.

Figures vary, but some researchers estimate as many as 500 million guns circulate in the U.S. Sales reached during the pandemic and publicly traded firearm and ammunition companies saw .

Donald Trump Jr. this summer of GrabAGun, an online gun retailer that went public in July under the stock ticker PEW. In a , the company, which markets guns to people ages 18 to 44, cited “ organizations that oppose sales of firearms and ammunition” as threats to its sales growth.

Dave Workman, a gun rights advocate with the , said firearms are not to blame for the surge in pandemic shootings.

“Bad guys are going to do what bad guys are going to do regardless of the law,” Workman said. “Taking away gun rights is not going to reduce crime.”

David Yamane, a Wake Forest University sociology professor and national authority on guns, said the U.S. firearm debate is complex and the industry is often “painted with too broad a brush.”

Most guns will never be used to kill anyone, he said. Americans tend to buy more guns during times of unrest, Yamane added: “It’s part of the American tradition. Guns are seen as a legitimate tool for defending yourself.”

‘A Low Level of Hope’

Once called “,” Bogalusa has become a grim symbol of deindustrialization.

Bogalusa emerged as Black people formed their own communities in the time of Jim Crow racial segregation at the turn of the 20th century.

Racism concentrated Black people in neighborhoods that , reflected in high rates of cancer, asthma, chronic stress, preterm births, pregnancy-related complications — and, over recent decades, .

Thousands flocked to Bogalusa after the Great Southern Lumber Company built one of the world’s biggest sawmills, establishing Bogalusa as a company town. Racial tensions .

Members of the local gained national attention in the 1960s for protecting civil rights organizers from the Ku Klux Klan, that burned houses and churches, terrorizing and killing Black people.

As the mill changed hands over the decades, Bogalusa’s fortunes slid. In the mid-20th century, the population surpassed 20,000, but it is now about half that.

International Paper, based in Tennessee, runs the mill as a containerboard factory, employing about 650 people. In 2021, the state announced incentives for the company that included a $500,000 tax break, saying the move would help bring “prosperity.”

Businesses remain boarded up along the main drag. Houses still bear damage from Hurricane Katrina, and many streets are eerily quiet.

Nearly 1 in 3 people in Bogalusa live in poverty — 2½ times the national average.

Bogalusa’s violent gun crime rate people in 2022, higher than Louisiana’s and 1.7 times the national one, according to the nonprofit Equal Justice USA, citing FBI Uniform Crime Reporting data.

In many rural towns across the South, “there is a level of desperation that is more apparent” than in other parts of the U.S., said , a of social justice and public policy.

“They don’t have the same infrastructure to have robust social services. People are like, ‘What are my life chances?’” Shaefer said. “People feel like there is nothing that can be done. There is a low level of hope.”

Missed Opportunities

Mayor Truong lamented the violence in Bogalusa after Forbes was killed, , “When are we as a community going to come together and decide enough is enough?”

The federal government had offered one path forward.

The Biden administration provided billions of dollars to local governments through the American Rescue Plan Act during the pandemic. Biden urged them to deploy money to community violence intervention programs, shown to by as much as 60%.

A handful of cities seized the opportunity, but most did not. Bogalusa has received since 2021. None appears to have gone toward violence prevention.

The Louisiana legislative auditor, Michael Waguespack, found that Bogalusa used nearly $500,000 for employee bonuses, which his report said may have violated state law. In some cases, says, payments were not tied to work performed.

Bogalusa officials did not respond to a public records request from Â鶹ŮÓÅ Health News seeking detailed information about its ARPA money.

Former Mayor Wendy O’Quin-Perrette, who served from 2015 through early 2023, told Waguespack that the city used ARPA money to improve streets and pay the bonuses. “We would not have done it without being sure it was allowed,” she said.

O’Quin-Perrette did not respond to requests for comment.

In a to Waguespack, O’Quin-Perrette’s successor, Truong, wrote that Bogalusa officials didn’t know how the federal money was spent. When he took office, Truong alleged, officials discovered “tens of thousands of dollars of checks and cash” stashed “in various drawers and on desks” in city offices.

Truong defended his stewardship of ARPA funds, saying that about $1 million remained when he assumed office but that the money was needed for more urgent sewer infrastructure repairs. “I wish we could have invested more, invested any money in gun violence prevention efforts,” he said.

In an interview, Truong said the city has been “intentional” about bringing down gun violence, including through a summer jobs program. He pointed to statistics that show homicides decreased from nine in 2022 to two in 2024. “If you keep them busy, they won’t have time to do anything else,” he said.

Asked about his January arrest, Truong said he has political enemies.

“I’m the only Democrat in a very red part of the state, and, you know, I’ve made a lot of changes at City Hall, and that ticks people off,” Truong told Â鶹ŮÓÅ Health News. He said that he ended long-standing city contracts with local businesspeople. “When you’re shaking up power structures, you become a target.”

Josie Alexander, for , said city officials missed an opportunity when they didn’t use ARPA funds for gun violence prevention. “The sad thing is people here can now see that money was coming in,” she said. “But it just wasn’t used the way it needed to be.”

‘Too Much Trouble Here’

Truong said the city is still reeling from the . He said he was at Bogalusa High School’s homecoming football game in 2022 when one teen shot another. Shots rang out, Truong said, and he grabbed his 3-month-old son and “laid in the bleachers.”

“It’s not a foreign topic to hardly anybody in town, whether you’ve heard the gunshots in the distance, whether you have attended a funeral of somebody who passed due to gun violence,” he said. Many still grapple with trauma.

In December 2022, Khlilia Daniels said, she hosted a birthday party for her teenage niece, praying no one would bring a gun.

The hosts checked guests for weapons, she said.

Yet gunfire erupted, Daniels said. Three teens were shot, including , who died, according to police.

“When someone you know is killed, you never forget,” said Daniels, 32, who held Taylor until emergency responders arrived.

Tajdryn Forbes was planning his future when he , likely because of a dispute that started on social media over lyrics in a rap song, Guy said.

In a in January, Bogalusa police said they had arrested someone in connection with Forbes’ killing. Authorities had the arrest of a teen in connection with the homicide.

Forbes had been a high school football standout, like his late father, Charles Forbes Jr., who played semipro. When Forbes scored a touchdown, he would look to the sky to honor his dad.

The school praised Forbes for his senior baseball season in : “This young man makes a difference on our campus and on the field with his strong character.”

When hopes for a college football scholarship did not pan out, Forbes worked as a deckhand for a marine transportation company. He saved money, looking forward to moving to Slidell, a suburb of New Orleans.

“He would always say, ‘There’s too much trouble here’” in Bogalusa, Guy recalled.

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In Oakland, California, a hospital-based program to prevent retaliatory gun violence lost a $2 million grant just as the traditionally approach. Another $2 million award was pulled from a Detroit program that offers to young people in violent neighborhoods. And in St. Louis, a clinic treating the physical and emotional injuries of gunshot victims also lost a $2 million award.

They are among 373 grants that the U.S. Department of Justice abruptly terminated in April. The largest share of the nixed awards were designated for community-based violence intervention — programs that range from conflict mediation and de-escalation to hospital-based initiatives that seek to prevent retaliation from people who experience violent injuries.

Gun violence is among America’s most deadly public health crises, medical experts say.

Among programs whose grants were terminated were those for protecting children, victims’ assistance, hate-crime prevention, and law enforcement and prosecution, according to by the Council on Criminal Justice, a nonpartisan think tank. The grants totaled $820 million when awarded, but some of that money has been spent.

“Not only are these funds being pulled away from worthy investments that will save lives,” said , founding director of the Violence Reduction Center at the University of Maryland, “but the way that this was done — by pulling authorized funding without warning — is going to create a lasting legacy of mistrust.”

The Justice Department “is focused on prosecuting criminals, getting illegal drugs off the streets, and protecting all Americans from violent crime,” according to a statement provided by agency spokesperson Natalie Baldassarre. “Discretionary funds that are not aligned with the administration’s priorities are subject to review and reallocation, including funding for clinics that engage in race-based selectivity.”

The Council on Criminal Justice found that descriptions of 31% of them included references to “diversity,” “equity,” “race,” “racial,” “racism,” or “gender.”

Baldassarre’s statement said the department is committed to working with organizations “to hear any appeal, and to restore funding as appropriate.” Indeed, it restored seven of the terminated grants for victims’ services after in April.

But the cuts have already prompted at other organizations around the country. Five groups on May 21 to restore the grants in their entirety.

Joseph Griffin, executive director of the Oakland nonprofit Youth Alive, which pioneered hospital-based violence intervention in the 1990s, said his organization had spent only about $60,000 of its $2 million grant before it was axed. The grant was primarily to support the intervention program and was awarded for a three-year period but lasted just seven months. The money would have helped pay to intervene with about 30 survivors of gun violence to prevent retaliatory violence. He’s trying to find a way to continue the work, without overtaxing his team.

“We will not abandon a survivor of violence at the hospital bedside in the same way that the federal government is abandoning our field,” he said.

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The cuts are also hitting St. Louis, often dogged by being labeled one of the most in America. The city created an with under former President Joe Biden, and various groups received Justice Department grants, too.

Locals say the efforts have helped: The 33% drop in the city’s homicide rate from 2019 to 2024 was the among 29 major cities examined by the Council on Criminal Justice.

“I don’t think there’s any doubt that there’s some positive impact from the work that’s happening,” said University of Missouri-St. Louis criminologist , who received a grant from the Justice Department to assess the work of the city’s new Office of Violence Prevention. That research grant remains in place.

But the Justice Department in St. Louis, including $2 million for Power4STL. The nonprofit operates the Bullet Related Injury Clinic, dubbed the BRIC, which provides free treatment for physical and mental injuries caused by bullets.

The BRIC had about $1.3 million left on its grant when the award was terminated in April. LJ Punch, a former trauma surgeon who founded the clinic in 2020, said it was intended to fund a mobile clinic, expand mental health services, evaluate the clinic’s programs, and pay for a patient advisory board. The BRIC won’t abandon those initiatives, Punch said, but will likely need to move slower.

Keisha Blanchard joined the BRIC’s advisory board after her experience as a patient at the clinic following a January 2024 gun injury. Someone fired a bullet into her back from the rear window of a Chevy Impala while Blanchard was out for a lunchtime stroll with a friend from her neighborhood walking group. The shooting was random, Blanchard said, but people always assume she did something to provoke it. “It’s so much shame that comes behind that,” she said.

The 42-year-old said the shooting and her initial medical treatment left her feeling angry and unseen. Her family wasn’t allowed to be with her at the hospital since the police didn’t know who shot her or why. When she asked about taking the bullet out, she was told that the common medical practice is to leave it in. “We’re not in the business of removing bullets,” she recalled being told. At a follow-up appointment, she said, she watched her primary care doctor google what to do for a gunshot wound.

“Nobody cares what’s going to happen to me after this,” Blanchard recalled thinking.

Before she was referred to the BRIC, she said, she was treated as though she should be happy just to be alive. But a part of her died in the shooting, she said. Her joyful, carefree attitude gave way to hypervigilance. She stopped taking walks. She uprooted herself, moving to a neighborhood 20 miles away.

The bullet stayed lodged inside her, forcing her to carry a constant reminder of the violence that shattered her sense of safety, until Punch removed it from her back in November. Blanchard said the removal made her feel “reborn.”

It’s a familiar experience among shooting survivors, according to Punch.

“People talk about the distress about having bullets still inside their bodies, and how every waking conscious moment brings them back to the fact that that’s still inside,” Punch said. “But they’re told repeatedly inside conventional care settings that there’s nothing that needs to be done.”

The Justice Department grant to the BRIC had been an acknowledgment, Punch said, that healing has a role in public safety by quelling retaliatory violence.

“The unhealed trauma in the body of someone who’s gotten the message that they are not safe can rapidly turn into an act of violence when that person is threatened again,” Punch said.

Community gun violence, even in large cities, is concentrated among who are often both victims and perpetrators, according to researchers. Violence reduction initiatives are frequently tailored to those networks.

Jennifer Lorentz heads the Diversion Unit in the office of the St. Louis Circuit Attorney, the city’s chief prosecutor. The unit offers mostly young, nonviolent offenders an opportunity to avoid prosecution by completing a program to address the issues that initially led to their arrest. About 80% of the participants have experienced gun violence and are referred to the BRIC, Lorentz said, calling the clinic critical to her program’s success.

“We’re getting them these resources, and we’re changing the trajectory of their lives,” Lorentz said. “Helping people is part of public safety.”

Punch said the BRIC staffers were encouraged during the Justice Department application process to emphasize their reach into St. Louis’ Black community, which is disproportionately affected by gun violence. He suspects that emphasis is why its grant was terminated.

Punch likened the grant terminations to only partially treating tuberculosis, which allows the highly infectious disease to become resistant to medicine.

“If you partially extend a helping hand to somebody, and then you rip it away right when they start to trust you, you assure they will never trust you again,” he said. “If your intention is to prevent violence, you don’t do that.”

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She saw people running from Exclusive Barbershop next door. She heard a voice telling a 911 operator that someone had been shot in the head. Her hands shook as she ventured outside. Then she saw 20-year-old Elijah Clunie slumped in a barber’s chair, haircut unfinished.

In the chaos, a 7-year-old boy stood in shock, eyes bulging at Clunie’s body. Sowers-Hassell asked the boy to come with her and sheltered him at the salon until his father arrived. “He kept going, ‘I can’t breathe. I can’t breathe,’” she said, and he later told her he never wanted to get his hair cut again.

Barbershops and salons are regarded in the Black community as safe, sacred spaces, where men and women gather to laugh, debate, and see their unofficial therapists: the barbers and stylists. When those refuges are violated by gun violence, an unspoken bond is broken.

Clunie’s killing cost Dorchester more than his own young life. Shootings send ripples of trauma through communities that can carry across generations. A found that exposure to gun killings was linked to higher levels of depression, suicidal ideation, and other mental health difficulties. Children and young adults were the most susceptible, and Black youth were disproportionately affected.

When economists calculate the societal costs of gun violence, “what they find is that much bigger than hospital treatment or criminal justice response or anything, is the fear and trauma and how it affects individuals and businesses,” said Daniel Webster, a professor and distinguished scholar with the Johns Hopkins Center for Gun Violence Solutions.

Four Corners — home largely to African American, Caribbean, and Puerto Rican families — is not a destination neighborhood. A historic Methodist church is one of the few attractions. There aren’t any major supermarkets, fine dining restaurants, or hospitals. Of the businesses that do exist, many cover their doors and windows in plexiglass and metal bars.

“We talk about these food deserts of good, healthy food; the truth of the matter is, it’s a desert for everything,” Webster said. “Businesses generally don’t want to be there.”

The owner of Salvaged Roots, Shanita Clarke, said she intended her salon to stand out as an oasis in the community.

Clarke was planning to take her then-13-year-old son to the salon to get his hair done when she got a phone call about the shooting. She rushed to work to check on her stylists. Clarke, her staff, and clients spent the next three hours waiting while officers collected evidence. In the weeks that followed, calls came in to push back appointments. Clarke said she could sense her clients’ anxiety and understood it. Even though she wasn’t in the shop when Clunie was shot, she experienced the incident vicariously through the sound of gunshots captured on the salon’s security footage and accounts from her employees.

A from the commonwealth of Massachusetts alleges the suspect in Clunie’s killing, Diamond Jose Brito, entered Exclusive Barbershop wearing all black clothing and a ski mask. Brito walked to the back of the shop, where Clunie was seated, and asked his barber how long the wait was for a haircut. About 45 minutes later, the statement alleges, Brito returned, walked to Clunie’s chair, shot him in the back of the head with a small silver revolver, then shot another victim multiple times.

Brito, of Canton, Massachusetts, was in October and is being held without bail. He to all the charges against him, including murder.

“Mr. Brito maintains his innocence and we are looking forward to presenting his defense at trial,” Brito’s attorney, David Leon, said in a statement to Â鶹ŮÓÅ Health News.

Boston City Councilor Brian Worrell’s office is around the corner from Salvaged Roots and Exclusive Barbershop. The neighborhood requires investment and initiatives by elected officials and policymakers, he said. Residents have to feel that homeownership and stable careers are possible.

“That can’t be some far-off thinking,” said Worrell, who represents District 4, which includes that part of Dorchester. “They have to be able to see it, and it has to show up in their lives, in a real, tangible way.”

Clunie had been a student at TechBoston Academy and a basketball player who was named player of the game after a big win his senior year, in 2022. But in a uploaded to the presentation site Prezi in June of that year, a user presumed to be Clunie wrote: “When I first moved to the Dorchester area I thought I was going to die,” noting “the killings on the news” every day.

Moments after the shooting, an unknown person walked into the barbershop and recorded a graphic video of Clunie’s body, which was then uploaded to social media platforms. It spread on Facebook and X, leading users to find Clunie’s personal accounts, on which some commenters made light of his death. He would have turned 21 the Saturday following his killing.

Worrell called the video especially inappropriate and callous. But apathy in the face of violence, he said, isn’t hard to imagine in a community suffering food and housing insecurity, struggling schools, and a persistent lack of opportunity.

Clarke said she’s torn on how to move forward. Loud noises and being alone trigger anxiety, and she now sometimes locks the salon doors once clients are in for their appointments. She’s felt anger and isolation, she said.

Recovering from the trauma of witnessing gun violence is often more difficult for onlookers when they still live and work where the shootings happened.

“We want to address the mental health trauma from gun violence, but let’s not kid ourselves,” Webster said. “If we don’t actually address gun violence, we’re swimming against a really strong tide.”

Since she opened her salon almost six years ago, Clarke has been active in community efforts to make the neighborhood safer, attending civic association and neighborhood meetings and speaking with police and local politicians.

Clarke believes efforts to clean up moved more drug users into Dorchester. Salvaged Roots is next to a commuter rail station, which Clarke said attracts transients who set up camps and leave behind trash and sometimes drug paraphernalia. Only a week before Clunie’s killing, there was a across the street from the salon.

In 2024, there were about 20 shootings in the police district that includes Four Corners, five of them fatal. Most of the victims were Black men, according to a Â鶹ŮÓÅ Health News analysis of data.

Though gun violence overall is at a record low in Boston and the city has in investigative resources — including , management, and oversight — a disproportionate amount occurs in Boston’s historically Black communities.

Since Clarke opened Salvaged Roots, she feels Four Corners has gotten both better and worse. “If other businesses leave, then where do people that live in the community — where are the nice places that they get to go to?” she asked.

Residents of neighborhoods with frequent gun violence and crime can mistakenly be perceived as being desensitized, but “we can never accept the violence as normal,” Boston City Council President Ruthzee Louijeune said. She’s volunteered and worked in Four Corners and said tackling the violence takes a multipronged approach, including getting guns off the street and providing access to affordable housing, secure jobs, and good health care.

In communities of color, she said, intergenerational trauma from racism and poverty must also be addressed.

In Dorchester, Louijeune said, a high number of residents resort to visiting emergency rooms for mental health issues. The neighborhood needs more access to health care, she said, especially for young people. Across Boston, Black residents were nearly twice as likely to go to the ER for mental health care than white residents, according to the Boston Public Health Commission’s .

Months later, attention and curiosity over the shooting had died down, but the trauma remained. Sowers-Hassell continues to work at Salvaged Roots, and though the city sent a trauma team to meet with the stylists after the shooting, she still has flashbacks. She said the influx of resources was helpful and that Four Corners has been a little quieter. But she’s skeptical the reprieve will last.

“Everybody talks a good game,” she said, “but when it’s time to get something done, what’s going to happen?”

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She rushed to check on him at a hospital run by Denver Health, the city’s safety-net system, but she was unable to get information from emergency room workers, who complained that she was creating a disturbance.

“I was distraught and outside, crying, and Jerry came out of the front doors,” she said.

Jerry Morgan is a familiar face from Green’s Denver neighborhood. He had rushed to the hospital after his pager alerted him to the shooting. As a violence prevention professional with the , or AIM, Morgan supports gun-violence patients and their families at the hospital — as he did the day Green’s brother was shot.

“It made the situation of that traumatic experience so much better. After that, I was, like, I want to do this work,” Green said.

Today, Green works with Morgan as the program manager for AIM, a hospital-linked violence intervention program launched in 2010 as a partnership between Denver Health and the nonprofit . It since has expanded to include Children’s Hospital Colorado and the University of Colorado Hospital.

AIM is one of dozens of hospital-linked violence intervention programs around the country. The programs aim to uncover the social and economic factors that contributed to someone ending up in the ER with a bullet wound: inadequate housing, job loss, or feeling unsafe in one’s neighborhood, for example.

Such programs that take a public health approach to stopping gun violence have had success — one in San Francisco reported a over six years. But President Donald Trump’s executive orders calling for the review of the Biden administration’s gun policies and trillions of dollars in federal grants and loans have created uncertainty around the programs’ long-term federal funding. Some organizers believe their programs will be just fine, but others are looking to shore up alternative funding sources.

“We’ve been worried about, if a domino does fall, how is it going to impact us? There’s a lot of unknowns,” said John Torres, associate director for Youth Alive, an Oakland, California-based nonprofit.

Federal data shows that gun violence became a leading cause of death among children and young adults at the start of this decade and was tied to more than 48,000 deaths among people of all ages in 2022. New York-based pediatric trauma surgeon Chethan Sathya, a National Institutes of Health-funded firearms injury prevention researcher, believes those statistics show that gun violence can’t be ignored as a health care issue. “It’s killing so many people,” Sathya said.

Research shows that a violent injury puts someone at heightened risk for future ones, and the risk of death goes up significantly by the third violent injury, according to a 2006 study published in The Journal of Trauma: Injury, Infection and Critical Care.

Benjamin Li, an emergency medicine physician at Denver Health and the health system’s AIM medical director, said the ER is an ideal setting to intervene in gun violence by working to reverse-engineer what led to a patient’s injuries.

“If you are just seeing the person, patching them up, and then sending them right back into the exact same circumstances, we know it’s going to lead to them being hurt again,” Li said. “It’s critical we address the social determinants of health and then try to change the equation.”

That might mean providing alternative solutions to gunshot victims who might otherwise seek retaliation, said Paris Davis, the intervention programs director for Youth Alive.

“If that’s helping them relocate out of the area, if that’s allowing them to gain housing, if that’s shifting that energy into education or job or, you know, family therapy, whatever the needs are for that particular case and individual, that is what we provide,” Davis said.

AIM outreach workers meet gunshot wound victims at their hospital bedsides to have what Morgan, AIM’s lead outreach worker, calls a tough, nonjudgmental conversation on how the patients ended up there.

AIM uses that information to help patients access the resources they need to navigate their biggest challenges after they’re discharged, Morgan said. Those challenges can include returning to school or work, or finding housing. AIM outreach workers might also attend court proceedings and assist with transportation to health care appointments.

“We try to help in whatever capacity we can, but it’s interdependent on whatever the client needs,” Morgan said.

Since 2010, AIM has grown from three full-time outreach workers to nine, and this year opened the in Denver’s Five Points neighborhood. The community-based clinic provides wound-care kits; physical therapy; and behavioral, mental and occupational health care. In the coming months, it plans to add bullet removal to its services. It’s part of a growing movement of community-based clinics , including the Bullet Related Injury Clinic in St. Louis.

Ginny McCarthy, an assistant professor in the Department of Surgery at the University of Colorado, described REACH as an extension of the hospital-based work, providing holistic treatment in a single location and building trust between health care providers and communities of color that have historically experienced .

, created in 1994 and run by Youth Alive in Oakland, is cited as the nation’s first hospital-linked violence intervention program and has since inspired others. The , a national network initiated by Youth ALIVE to advance public health solutions to gun violence, counted among its membership as of January.

The alliance’s executive director, , compared medicine’s role in addressing gun violence to that of preventing an infectious disease, like cholera. “That disease spreads if you don’t have good sanitation in places where people aggregate,” she said.

Dreier, who also serves as executive director of the , said medicine identifies and tracks patterns that lead to the spread of a disease or, in this case, the spread of violence.

“That is what health care can do really well to shift society. When we deploy this, we get better outcomes for everybody,” Dreier said.

The alliance, of which AIM is a member, offers technical assistance and training for hospital-linked violence intervention programs and to make their services eligible for traditional insurance reimbursement.

In 2021, President Joe Biden issued an that opened the door for states to use Medicaid for violence prevention. Several states, including , , and , have for hospital-linked violence intervention programs.

Last summer, then-U.S. Surgeon General Vivek Murthy , and the earmarked $1.4 billion in funding for a wide array of violence-prevention programs through next year.

But in early February, Trump issued an instructing the U.S. attorney general to conduct a 30-day review of a number of Biden’s policies on gun violence. The White House Office of Gun Violence Prevention now , and recent moves to freeze federal grants created uncertainty among the gun-violence prevention programs that receive federal funding.

AIM receives 30% of its funding from its operating agreement with Denver’s , according to Li. The rest is from grants, including Victims of Crime Act funding, through the Department of Justice. As of mid-February, Trump’s executive orders had not affected AIM’s current funding.

Some who work with the hospital-linked violence prevention programs in Colorado are hoping a in the state, expected to generate about $39 million annually and support victim services, could be a new source of funding. But the tax’s revenues aren’t expected to fully flow until 2026, and it’s not clear how that money will be allocated.

Trauma surgeon and public health researcher Catherine Velopulos, who is the AIM medical director at the University of Colorado hospital in Aurora, said any interruption in federal funding, even for a few months, would be “very difficult for us.” But Velopulos said she was reassured by the bipartisan support for the kind of work AIM does.

“People want to oversimplify the problem and just say, ‘If we get rid of guns, it’s all going to stop,’ or ‘It doesn’t matter what we do, because they’re going to get guns, anyway,’” she said. “What we really have to address is why people feel so scared that they have to arm themselves.”

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