Are you planning a vacation to Spain, Italy, France, Greece, or another country along the Mediterranean?
If so, you should know about a parasite that puts travelers at risk of a rare disease, called “visceral leishmaniasis,” that can be deadly when untreated. The parasite — leishmania — is transmitted by a bite from an infected sandfly. It can lie dormant in the body for years, then latercause severe illness, including persistent high fever.
A 34-year-old South Jersey resident, Louis-Hunter Kean, died from it in late 2023 after doctors at two South Jersey medical systems and later at Penn Medicine missed the diagnosis. His symptoms developed about a year after he vacationed in Tuscany, where parasitic disease experts now believe he was infected.
“Leishmania in the U.S. is underappreciated,” said Joshua A. Lieberman, assistant director of the molecular microbiology clinical laboratory at University of Washington in Seattle. “We want to get the word out that there’s a lot more of it than we think.”
Parasitic disease experts say most American doctors don’t know enough about leishmania. Here’s what you should know about leishmania:
Visceral leishmaniasis is caused by the most deadly species. At risk are travelers to Southern Europe, Brazil, East Africa, India, and military personnel who were deployed to Afghanistan and Iraq. Its primary symptom is fever, along with an enlarged liver and spleen, weight loss, and a low blood cell count. Each year, an estimated 50,000 to 90,000 new cases are reported globally, according to the World Health Organization (WHO).
The majority of healthy people who get infected never experience symptoms or sickness. However, the parasite can cause severe illness in small children, senior citizens, and people who are malnourished or immunocompromised. It can activate decades after exposure.
Cutaneous leishmaniasis is the most common and less dangerous form of the disease. This species is present in the countries that also have visceral leishmaniasis, as well as in Israel, Mexico, Central and South America — and in a few U.S. states, including Texas, Oklahoma, and Arizona. More than 80 cases have been reported in the U.S. since 2017, though experts believe that’s an undercount, according to a recent study published in the digital journal JMIR Dermatology.
People with active cases first see small, red bumps on the skin that can develop into skin ulcers, which may ooze or scab. These symptoms typically appear within weeks or months after exposure, but ulcers can surface years later. Worldwide, an estimated 600,000 to 1 million cases occur each year, according to the WHO.
“If you’re traipsing through the rain forest in Central America, you’re at huge risk,” said leishmania expert David L. Sacks, an immunologist and senior investigator with the National Institutes of Health (NIH). “We see patients all the time at the NIH hospital who have the cutaneous form from traveling.”
Mucosal leishmaniasis is most commonly found in parts of the Amazon basin, specifically Bolivia, Peru, and Brazil. Symptoms usually start as a skin sore, which can advance to the nose, mouth, or throat and cause severe facial disfigurement. It can be life-threatening.
Can leishmaniasis be treated?
All three typesare treatable with antiparasitic and antifungal medications.
Some forms of cutaneous leishmaniasis will heal on their own.
More than 90% of patients with visceral leishmaniasis will die without treatment. An estimated 20,000 to 50,000 people die from it each year, according to research published in the academic journal Tropical Diseases, Travel Medicine and Vaccines.
How prevalent is leishmaniasis in the U.S.?
An exact number of cases is unknown. The federal government does not require doctors to report the disease to the Centers for Disease Control and Prevention. Texas is the only state that requires medical providers to report cases to the state health department.
How can you protect yourself against leishmaniasis?
There are no vaccines or drugs for prevention, but people can take steps to protect themselves when visiting areas where the parasite is circulating.
Sandflies are most active from dusk until dawn, so consider staying indoors during that time. Wear long-sleeved shirts and long pants, and socks that cover ankles. Apply insect repellent, preferably with DEET, to clothing and exposed skin. Sandflies can slip through window and door screens, so it’s best to stay in accommodations with air-conditioning or sleep under insecticide-treated bed nets.
People who are immunocompromised may want toavoid travel to regions with leishmania.
Also, if you experience symptoms, especially a high fever that won’t go away, provide your doctor with a thorough travel history, going back decades.
Each night, Louis-Hunter Kean spiked a fever as high as 104.5. He would sweat through bedsheets and shiver uncontrollably. By morning, his fever wouldease but his body stillached; even his jaw hurt.
He had been sick like this for months. Doctors near his South Jersey home couldn’t figure out why a previously healthy 34-year-old was suffering high fevers plus a swollen liver and spleen. In early 2023, they referred Kean to Penn Medicine.
Louis-Hunter Kean visiting a winery in the Tuscany region of Italy in September 2021. He first spiked a mysterious and persistent fever about a year later in August 2022.
“These doctors are very sharp, and there are a lot of teams working on it,” Kean texted a friend after being admitted to the Hospital of the University of Pennsylvania (HUP) in West Philadelphia.
Was it an infection? An autoimmune disease? A blood cancer? Over the next six months, at least 34 HUP doctors — rheumatologists, hematologist-oncologists, gastroenterologists, infectious disease and internal medicine specialists — searched for an answer.
Kean was hospitalized at HUP five times during a six-month period in 2023. His electronic medical chart grew to thousands of pages.
Along the way, doctors missed critical clues, such as failing to obtain Kean’s complete travel history. They recommended a pair of key tests, but didn’t follow up to make sure they got done, medical records provided to The Inquirer by his family show.
Doctors involved in Kean’s care, including at Penn, prescribed treatments that made him sicker, said four infectious disease experts not involved in his care during interviews with a reporter, who shared details about his treatment. Penn doctors continued to do so even as his condition worsened.
Louis-Hunter Kean receives a kiss from bride Ashley Greyson at the October 2021 wedding of his close friend, Joshua Green. Green and Kean graduated from Haddonfield High School in 2007.
“No one was paying attention to what the doctor before them did or said,” Kean’s mother, Lois Kean, said.
“They did not put all the pieces together,” she said. “It was helter-skelter.”
Kean’s family is now suing Penn’s health system for medical malpractice in Common Pleas Court in Philadelphia. The complaint identifies nearly three dozen Penn doctors, accusing them of misdiagnoses and harmful treatments. These physicians are not individually named as defendants.
In court filings, Penn says its doctors did not act recklessly or with disregard for Kean’s well-being, and his case is not indicative of any systemic failures within its flagship hospital. A Penn spokesperson declined further comment on behalf of both the hospital and the individual doctors involved in Kean’s care, citing the pending lawsuit.
The puzzle of Kean’s diagnosis finally came together in November 2023 after a Penn doctor, early in his career, sought help from the National Institutes of Health (NIH).
An NIH doctor recommended a test that identified the cause: a parasite prevalent in countries bordering the Mediterranean Sea. Kean likely got infected while vacationing in Italy, four parasitic disease experts told The Inquirer.
The infection, which is treatable when caught early, is so rare in the U.S. that most doctors here have never seen a case, the experts said.
By the time Penn doctors figured it out, Kean’s organs were failing.
Louis-Hunter Kean and his then-girlfriend Zara Gaudioso at a friend’s wedding in Tuscany in September 2021. Kean and Gaudioso got engaged in early 2023. Gaudioso was smitten by Kean’s good looks and sense of humor.While vacationing in Italy in September 2021, Louis-Hunter Kean and his friends hiked in the foothills of the Apennine Mountains and visited Gran Sasso and Monti della Laga National Park.
A missed clue
When a patient has an ongoing and unexplained fever, an infectious disease doctor will routinely start by takinga thorough travel history to screen for possible illnesses picked up abroad.
A medical student took Kean’s travel history during his initial workup at HUP in June 2023. An infectious disease specialist reviewed the student’s notes and added a Cooper University Hospital doctor’s earlier notes into Kean’s electronic medical chart at Penn.
Those records show Kean had traveled to Turks and Caicos with his fiancée in May 2022. The next month, he took a work trip out West, including to California, where he visited farms, but didn’t interact with livestock.
This was not unusual for Kean, who worked with fruits and vegetables imported from around the world at his family’s produce distribution center on Essington Avenue in Southwest Philadelphia.
Kean’s fiancée, Zara Gaudioso, said she repeatedly told doctors about another trip: In September 2021, about a year before his fevers began, they traveled to Italy for a friend’s wedding in Tuscany.
The couple hiked remote foothills, danced all night in a courtyard, dined by candlelight surrounded by a sunflower farm, and slept in rustic villas with the windows flung open.
“We told everybody,” Gaudioso said. “A lot of Americans go to Italy — it’s not like a third-world country, so I could see how it could just go in one ear and out the other.”
But notes in Kean’s medical record from the Penn infectious disease specialist don’t mention Italy. Neither do the ones the specialist copied over from Kean’s infectious disease doctor at Cooper.
Kean “does not have known risk factors” for exposure to pathogens, the Penn specialist concluded, except possibly from farm animals or bird and bat droppings.
Still, the specialist listed various diseases that cause unexplained fever: Tick-borne diseases. Fungal infections. Tuberculosis. Bacteria from drinking unpasteurized milk.
The possible culprits included a parasitic disease, called visceral leishmaniasis, transmitted by a bite from an infected sandfly. It can lie dormant for a lifetime — or, in rare cases, activate long after exposure, so it’s important for doctors to take extensive past travel histories, parasitic experts say.
The parasite is widely circulating in Southern European countries, including Spain, Greece, Portugal, and Italy.
“Mostly, people living there are the ones who get it. But it’s just a lottery sandwich, and there’s no reason that travelers can’t get it,” said Michael Libman, a top parasitic disease expert and former director of a tropical medicine center at McGill University in Canada.
But few cases become severe. Hospitals in Italy reported only 2,509 cases of active infection between 2011 and 2016, affecting fewer than one in 100,000 people. Infections requiring hospital care in Italy began to decline after 2012, according a 2023 European study by the Public Library of Science (PLOS) journal Neglected Tropical Diseases.
Caught early, visceral leishmaniasis is treatable. Without treatment, more than 90% of patients will die.
In addition to fever, other telltale symptoms are swelling of the liver and spleen and low blood cell counts. Kean had all of those.
A missed test
The infectious disease specialist requested a test to examine tissue biopsied from Kean’s liver, which was damaged and enlarged. Lab results showed that immune cells there had formed unusual clusters — another sign that his body might be fighting off an infection.
In her notes, the specialist identified “visceral leish” as a possible diagnosis, which repeated — via copy and paste — seven times in his medical record. Her request to “please send biopsy for broad-range PCR” repeated five times.
That is a diagnostic (polymerase chain reaction) test that looks for the genetic fingerprint of a range of pathogens.
The test comes in different versions: One looks broadly for bacteria. The other is for fungi. The broad fungal test candetect leishmania, even though it’s not a fungus. However, it’s not always sensitive enough to identify the parasite and can produce a false negative, experts said.
The specialist’s chart note doesn’t specify which type she wanted done.
It’s not clear if anyone asked. The test wasn’t done.
Louis-Hunter Kean (right, with wine glass and tambourine) leads a wedding procession through the small stone village of Santo Stefano di Sessanio in Italy’s Abruzzo region in September 2021.
She did not order a low-cost rapid blood test that screens specifically for leishmaniasis by detecting antibodies made by the immune system after fighting it. She also didn’t order a leishmania-PCR, which is highly targeted to detect the exact species of the parasite.
Nor did the medical record show that the specialist followed up on the results of the broader test she requested, even though she saw Kean on nine of the 13 days of his first hospitalization at HUP in June 2023.
Penn has a policy that a lead doctor on the patient’s case is responsible for making sure that recommended tests get done. The specialist was called in as a consultant on Kean’s case. During that June hospitalization alone, his medical chart grew to 997 pages.
Patient safety experts have warned for years that electronic medical record systems — designed for billing and not for care — can become so unwieldy that doctors miss important details, especially with multiple specialists involved, or repeat initial errors.
A seemingly innocuous step in charting — copying and pasting previous entries and layering on new ones— can add to the danger, patient safety experts say.
That’s how the specialist’s mention of “visceral leish” and her test recommendation got repeated in Kean’s chart.
Marcus Schabacker, president of ECRI, a nonprofit patient-safety organization based in Plymouth Meeting, said “copy and paste” in electronic medical records puts patients at risk of harm.
“The reality is if you are reading something over and over again, which seems to be the same, you’re just not reading it anymore. You say, ‘Oh, yeah, I read that, let’s go on,’” said Schabacker, speaking generally about electronic medical record systems and not specifically about Kean’s case.
Louis-Hunter Kean plays guitar in his younger years. He loved music and shared eclectic playlists with his friends.
When treatments harm
Penn doctors believed Kean had a rare,life-threatening disorder, known as hemophagocytic lymphohistiocytosis (HLH), in which the immune system attacks the body. Instead of fighting infections, defective immune cells start to destroy healthy blood cells.
In most adults, the constellation of symptoms diagnosed as HLH gets triggered when an underlying disease sends the body’s immune system into overdrive. Triggers include a blood cancer like lymphoma, an autoimmune disease like lupus, or an infection.
Penn doctors across three specialties — hematology-oncology, rheumatology, and infectious disease — were searching for the cause within their specialties.
“His picture is extremely puzzling,” one doctor wrote in Kean’s chart. “We are awaiting liver biopsy results. I remain concerned about a possible infectious cause.”
As HUP doctors awaited test results, they treated Kean’s HLH symptoms with high doses of steroids and immunosuppressants to calm his immune system and reduce inflammation.
The treatments, however, made Kean highly vulnerable to further infection.And defenseless against another possible trigger of HLH: visceral leishmaniasis.
At the time, a Penn rheumatologist involved in Kean’s care before his first hospitalization warned about steroids “causing harm” to Kean if it turned out he had an infection. He wrote, “please ensure all studies requested by” infectious disease are done, medical records show.
Steroid treatments would allow the parasites to proliferate unchecked, experts said.
“It’s unfortunately exactly the wrong treatment for parasitic disease,” said Libman, the leishmania disease expert at McGill University.
As Kean grew sicker, he was readmitted to HUP for a third time in September 2023. He texted a friend: “I’m on more medications than I’ve ever been on and my condition is worse than it’s ever been.”
A sampling of Louis-Hunter Kean’s electronic medical records, which ballooned to thousands of pages over five HUP hospitalizations within six months in 2023.
Handoffs between doctors
No single doctor seemed to be in charge of Kean’s care, his family said. And the number of specialists involved worried them.
“Everyone just kept being like, ‘We don’t know. Go see this specialist. Go see that specialist,’” Kean’s sister, Priscilla Zinsky, said.
By fall 2023, rheumatologists hadn’t found a trigger of Kean’s symptoms within their specialty. They turned to doctors specializing in blood cancer.
During the handoff, three doctors noted that they didn’t see the results of the test requested by the infectious disease specialist back in June. They still thought it was possible that Kean had an infection, records show.
“An additional consideration to rule out infectious cause would be blood-based Karius testing (though this would be fraught with false positives),” wrote that doctor, who was still training as a hematologist-oncologist.
A supervising physician reviewed the Sept. 8, 2023, note and signed off on it. The medical records don’t show any follow-up with infectious disease doctors, and the test wasn’t done at the time.
In the coming days, blood cancer specialists struggled to find a link between Kean’s symptoms and an underlying disease.
They thought he might have a rare form of leukemia, but tests weren’t definitive, Kean texted friends.
Untreated HLH symptoms can lead to rapid organ failure, so doctors often start patients on treatment while trying to figure out the underlying cause, said Gaurav Goyal, a leading national expert on HLH, noting that it can take days to get test results.
“You have to walk and chew the gum. You have to calm the inflammation so the patient doesn’t die immediately, and at the same time, try to figure out what’s causing it by sending tests and biopsies,” said Goyal, a hematologist-oncologist at the University of Alabama at Birmingham.
Medical records show that Penn doctors feared Kean was at “significant risk” of “irreversible organ failure.”
They suggested a more aggressive treatment: a type of chemotherapy used to treat HLH that would destroy Kean’s malfunctioning immune cells.
In his medical record, a doctor noted that beginning treatment without a clear diagnosis was “not ideal,” but doctors thought it was his best option.
Four parasitic disease experts told The Inquirer that chemotherapy, along with steroids and immunosuppressants, can be fatal to patients with visceral leishmaniasis.
“If that goes on long enough, then they kill the patient because the parasite goes out of control,” Libman said, explaining that ramping up the HLH treatments weakens the immune system. “The parasite has a holiday.”
A sample of text messages from Louis-Hunter Kean to friends during separate HUP hospitalizations over a six-month period in 2023.
Chemo as last resort
Kean banked his sperm, because chemo infusions can cause infertility. He told friends he trusted his Penn team and hoped to make a full recovery.
“Started chemo last night. It really feels like finally there is a light at the end of the tunnel,” he texted a friend on Oct. 7, 2023.
“I’m gonna get to marry my best friend, and I think I’m going to be able to have children,” Kean wrote in another text to a different friend.
Kean spent nearly all of October at HUP getting chemo infusions. He rated his pain as a nine out of 10. His joints throbbed. He couldn’t get out of bed. He started blacking out.
Doctors added a full dose of steroids on top of the IV chemo infusion. By the end of the month, Kean told a friend he feared he was dying.
A year had passed since Kean first spiked a fever. He no longer could see himself returning to his former life — one filled with daily exercise, helping run his family’s produce store, nights out with friends at concerts and bars, and vacations overseas.
Lethargic and weak, he could barely feed himself. His sister tried to spoon-feed him yogurt in his hospital bed.
He started texting reflections on his life to friends and family, saying his illness had given him a “polished lens” through which he could see clearly. He wrote that their love felt “like a physical thing, like it’s a weighted blanket.”
“I’ve lived an extremely privileged life. I don’t think it’s possible for me to feel bad for myself,” he said in a text. “And I don’t want anyone else to either.”
Louis-Hunter Kean enjoying dinner out with his sister, Jessica Kean, in Manhattan in 2014. Friends and family described him as a “foodie” and health food advocate prior to the onset of his illness in August 2022.
Puzzle solved
One doctor involved in Kean’s care had seen him at Penn’s rheumatology clinic in early June 2023, just before his first HUP hospitalization. The doctor, a rheumatology fellow,urged him to go to HUP’s emergency department, so he could be admitted for a medical workup.
The fellowremained closely involved in Kean’s care, medical records show. Also in his 30s, this doctor shared Kean’s interests in music, fashion, and the city’s restaurant scene, according to Kean’s family.
“They had a rapport,” Kean’s father, Ted Kean, said. “Louis thought a lot of him, and he seemed to think a lot of my son.”
By early November 2023, the rheumatology fellow was extremely concerned, medical records show.
The chemo infusions weren’t helping. Kean still was running a fever of 103. The fellow wrote in his chart that he was worried Kean needed a bone-marrow transplant to replace his failing immune system.
And doctors still didn’t know the root of his symptoms.
The fellowcontacted the NIH, medical notes show.
An NIH doctor recommended a test to check for rare pathogens, including parasites that cause visceral leishmaniasis,according to family members present when the testing was discussed.
The NIH-recommended Karius test was the same one suggested two months earlier by the Penn hematologist-oncologist in training, but with no follow-up.
File of sign on front of Hospital of the University of Pennsylvania (HUP) taken on Tuesday, March 19, 2024.
On Nov. 16, the fellow got the results. He went to Kean’s bedside.
After five HUP hospitalizations over six months, a single test had revealed the cause of his illness: visceral leishmaniasis.
Kean cried with relief and hugged the fellow, joined by his mother and sister.
“‘You saved my life,’” Kean’s sister, Jessica Kean, recalled her brother telling the doctor. “‘Finally, we know what this is, and we can treat it.’”
Kean’s medical chart was updated to note that he traveled to “Italy in the past,” also noting he had visited Nicaragua and Mexico. A HUP infectious disease doctor consulted with the Centers for Disease Control and Prevention on antiparasitic medications.
Meanwhile, Kean’s nose wouldn’t stop bleeding. He felt light-headed and dizzy, with high fever. Even on morphine for his pain, his joints ached.
“I’ve been struggling, buddy,” he texted a friend on Nov. 20. “This might be the worst I’ve ever been.”
By Nov. 22, he stopped responding to text messages. He began hallucinating and babbling incoherently, family members recalled. “Things went downhill very, very quickly, like shockingly quickly,” his sister, Priscilla Zinsky, said.
When she returned on Thanksgiving morning, he was convulsing, thrashing his head and arms. “It was horrifying to see,” Zinsky said.
Her brother had suffered brain bleeds that caused a stroke. His organs were failing. He had a fungal infection with black mold growing throughout his right lung, medical records show.
Kean was put on life support, with a doctor noting the still-preliminary diagnosis: “Very medically ill with leishmaniasis.”
“Prognosis is poor,” read the note in his Nov. 29, 2023, medical records.
A few hours later, Kean’s family took him off life support. He died that day.
“All of his organs were destroyed,” said Kean’s mother, Lois Kean. “Even if he had lived, he had zero quality of life.”
Portraits of Lois and Ted Kean’s four children decorate a wall at their home in Haddonfield. Their son, Louis-Hunter, died after contracting visceral leishmaniasis, a parasitic infection he likely picked up in Italy. When caught early, it’s treatable with medication. It’s deadly without treatment.
It’s not clear why the parasites began to attack Kean a year after his return from Italy. Healthy people rarely develop severe disease from exposure to the deadly form of the parasite circulating outside the U.S., experts said.
Most people infected by a sandfly “are probably harboring small amounts of the parasite” in their organs, according to Naomi E. Aronson, a leishmania expert and director of infectious diseases at the Uniformed Services University of the Health Sciences in Bethesda, Md.
“Most of the time, you don’t have any problem from it,” Aronson said.
Children under age 5, seniors, and people who are malnourished or immunodeficient are most susceptible to visceral leishmaniasis. Aronson said she worries about people who might harbor the parasite without problems for years, and then become immunocompromised.
Libman, the parasitic expert from McGill, said he’s seen six to 10 patients die from visceral leishmaniasis because doctors unfamiliar with the disease mistakenly increased immunosuppressants to treat HLH during his 40 years specializing in parasite disease.
“That’s a classic error,” he said.
Kean’s case “should be a real clarion call” for infectious disease specialists and other doctors in the U.S., said Joshua A. Lieberman, an infectious disease pathologist and clinical microbiologist who pioneered the leishmania-PCR test at the Washington state lab.
“If you’re worried about an unexplained [fever], you have to take a travel history that goes back pretty far and think about Southern Europe, Iraq, Afghanistan, India, and maybe even Brazil,” Lieberman said.
In the wake of Kean’s death, his family was told that Penn doctors held a meeting to analyze his case so they could learn from it.
An infectious disease doctor called Zinsky, Kean’s sister, to let her know about the postmortem review and shared that doctors discussed that Kean had likely picked up the parasite in Tuscany.
“Why didn’t you guys have this meeting,” she asked, ”while he was alive?”
Editor’s note: This story has been updated to clarify that ECRI President Marcus Schabacker was not speaking specifically on Kean’s case.
Every day, sometimes several times a day, the 7-year-old girl wants to talk about the mother she lost in the Northeast Philadelphia plane crash.
“She’s missing her all the time and she’ll ask me, `Do you think I look like my mom? Do you think I dress like my mom? Do you see my bag? This is my mom’s bag,’” said 35-year-old Shantell Fletcher, the girl’s godmother.
It has been a year since a medical jet crashed on Cottman Avenue near the Roosevelt Mall, killing all six people onboard. The explosion cast a plume of plane shrapnel and fire over the neighborhood. At least 16 homes were severely damaged and about two dozen people were injured that night.
The girl’s mother, Dominique Goods Burke, and her fiance, Steven Dreuitt Jr., along with Dreuitt’s 10-year-old son, Ramesses Dreuitt Vazquez, were driving on Cottman Avenue on Jan. 31, 2025, just after 6 p.m. when the plane slammed into the ground at more than 278 mph, within feet of their car.
Flames instantly engulfed the vehicle. Dreuitt, 37, trapped in the car with his legs crushed beneath the steering wheel, died at the scene, but Goods Burke and Ramesses escaped with severe burns.
A floral photo of Dominique Goods Burke is carried out after the funeral service as family, friends and community members gather outside at Tindley Temple UM Church in Philadelphia, Pa., on Thursday, May 8, 2025. Dominique passed away at Jefferson hospital on April 27 due to the critical burns from the Roosevelt Mall Learjet crash along Cottman Avenue.
Goods Burke, 34, died of her injuries in April at Thomas Jefferson University Hospital, leaving behind her daughter and her 16-year-old son, Dominick Goods. (The family asked The Inquirer to withhold her daughter’s name to protect her privacy.)
On Saturday evening, Mayor Cherelle L. Parker and other city officials planned to place a wreath at the crash site. About 100 people gathered inside Engine 71 Fire Station on Cottman, the station closest to the crash site.
The plane’s impact had left a bomb-like crater in a driveway apron between a Raising Cane’s restaurant and a Dunkin’ Donuts. The 8-foot-deep hole has since been filled in and paved over, but the loss and devastation are irreparable.
“I don’t know how we made it through a year. It feels fresh, raw. Sometimes it’s hard to breathe,” said Fletcher, who was Goods Burke’s first cousin and best friend. “Losing her, I’ve felt alone and empty. I miss laughing with her. I miss joking with her. I miss celebrating life with her.”
Fletcher is helping to raise Goods Burke’s daughter and her son, Dominick, an 11th grader at Imhotep Institute Charter High School in East Germantown. Dominick’s father was Dreuitt, so he lost both parents.
“My godson doesn’t have his mother or his father. My goddaughter doesn’t have her mamma,” Fletcher said. “Other than them coming back, nothing could ever give us a reprieve from the pain.”
Ramesses Dreuitt Vazquez, 10, spent months in a Boston hospital recovering from burns to more than 90% of his body when the car he was riding in caught fire in the Jan. 31, 2025 plane crash in Northeast Philadelphia.
“I have my moments of still struggling. It’s been really tough,” said Dreuitt’s 61-year-old mother, Alberta “Amira” Brown, whose grandchildren are Ramesses and Dominick. “The life that we once had, we can never get it back.”
An irreplaceable booming voice
Dreuitt worked as a kitchen manager and team leader at the Philadelphia Catering Co. in South Philadelphia for more than seven years. Co-owner Tim Kelly said it was Dreuitt’s job to call staffers to lunch, which the company served to its 45 employees each day at noon.
“Steve would always call lunch, which basically was him just yelling, ‘LUNCH,’ three times loudly,” Kelly said. “His deep booming voice. Many of the guys here have tried to replicate it, but to no avail.”
“Time does help. It softens the blow,” Kelly said. “It was very difficult for a long time for a lot of us, but we’re at the point where we can remember him with a little less sadness and we can smile a bit.”
Goods Burke, whom loved ones affectionately called “Pooda” and colleagues called “Dom,” worked at High Point Cafe as a day bakery manager for years.
Cafe founder Meg Hagele said the staff treats her former work space, dubbed “Dom’s table,” with a shrine-like reverence. Seeing Goods Burke’s handwriting on recipes, scribbles in margins, stirs memories of her vibrancy and creativity.
“She’s very present with us still,” Hagele said. “This accident was just a shock to the entire city, but to be touched so personally by it is just freakish and profound.”
NTSB investigation continues
The National Transportation Safety Board is still investigating the crash’s cause. The plane — a medical transport Learjet 55 owned by Jet Rescue Air Ambulance, headquartered in Mexico City — had taken off at 6:07 p.m. from Northeast Philadelphia Airport. It climbed to 1,640 feet before nosediving just three miles away around 6:08 p.m.
NTSB investigators recovered the cockpit voice recorder at the scene, but after repairing it and playing it back, they found the device “had likely not been recording audio for several years,” according to a preliminary report released in March.
Brown, of Mount Airy, said she got a letter from the NTSB a few weeks ago saying investigators were making progress.
“That’s hope right there,” Brown said in a recent interview. ”It will help to know exactly what happened to make that plane come down. Does it change anything? No.”
Alberta “Amira” Brown remembers her son, Steven Dreuitt Jr., who died in the Jan. 31, 2025, plane crash in Northeast Philadelphia. In November, Brown attended a memorial service at Oxford Presbyterian Church in North Philadelphia.
The cremated remains of the six Mexican nationals who died aboard the plane were returned to loved ones in Mexico City last spring. Among the passengers were 11-year-old Valentina Guzmán Murillo and her 31-year-old mother, Lizeth Murillo Osuna. They were returning home after Valentinahad spent four months undergoing treatment for a spinal condition at Shriners Children’s Philadelphia.
Also killed were the pilot, Alan Montoya Perales, 46; his copilot, Josue de Jesus Juarez Juarez, 43; a Jet Rescue doctor, Raul Meza Arredonda, 41; and paramedic Rodrigo Lopez Padilla, 41.
Philadelphia Fire Commissioner Jeffrey Thompson (from left) Mayor Cherelle L. Parker, and Police Commissioner Kevin J. Bethel ring a ceremonial bell at the one-year anniversary memorial observance of the Northeast Philly plane crash Saturday, Jan. 31, 2026, at Engine 71 Fire Station on Cottman Avenue in Philadelphia.
In the moments after the crash, hundreds of firefighters and rescue workers swarmed the area to put out homes and cars on fire from the jet fuel or burning pieces of aircraft that struck them.
Philadelphia Fire Commissioner Jeffrey Thompson, a 36-year veteran of the city’s fire department, said the plane crash “was without a doubt the biggest thing that I’ve ever responded to.”
In an interview on Thursday, Thompson recalled rushing to the scene from his Fishtown home, filled with dread and adrenaline.
“I remember it was dark. It was cold, and it was raining — it was like something out of a disaster movie,” Thompson said. “As I got closer, I could just see a sea of lights.”
He arrived to find multiple homes and cars on fire. Pools of jet fuel everywhere. And so many pieces of debris that he initially had no idea of the plane’s size. He said he and other first responders will never forget seeing body parts strewn among the wreckage.
“This still affects all of us. Just to see that is so unnatural,” Thompson said. “And the work that they did that night — that’s indelibly etched in their memories.”
More than 150 firefighters scoured “blocks and blocks” of homes, entering each one and every room, to make sure everyone was accounted for. He said he is amazed how multiple agencies worked together to bring “order to chaos.”
“That just gives me goose bumps,” Thompson said. He added, “This is actually therapeutic — me talking to you has been therapeutic because there was a lot there that night and I don’t often talk about this.”
Miracles, luck, and skill
As tragic as that night was, Thompson said, there was some miraculousness, including the fact that the plane struck a patch of empty pavement between two busy restaurants.
“Sometimes in this life, there’s luck,” Thompson said. “It was rush hour. You had a shopping mall and a densely populated neighborhood. It could have been infinitely worse.”
Lashawn ‘Lala’ Hamiel, Andre “Tre” Howard III, and his family cheer on the Eagles during Super Bowl LIX.
Andre Howard Jr. had just picked up his three kids — then ages 4,7, and 10 — from aftercare at Soans Christian Academy. They headed to Dunkin’ for strawberry doughnuts. As they were leaving the parking lot in Howard’s car, the plane exploded a few feet away. A plane part crashed through the car’s window. Howard’s 10-year-old son, Andre “Tre” Howard III, used his body to shield his 4-year-old sister and a piece of metal struck his head.
Tareq Yaseen, a neurosurgeon at Jefferson Torresdale Hospital, was having dinner with his family, including his kids, ages 10 and 6, at Dave & Buster’s at Franklin Mall when he rushed back to the hospital to perform emergency surgery on Tre.
The boy had two gashes in the right side of his head, and his skull had been shattered into more than 20 pieces, Yaseen recalled.
“My son is the exact age as Tre, which made things very personal and emotional to me,” Yaseen said. “He’s gonna die. He was basically losing consciousness and going in a bad direction.”
“I felt for a moment that I would not be able to help him,” Yaseen said. “I was very scared that I’m gonna fail. There’s too much on the line and it’s a little boy.”
Yaseen said he worked fast to relieve the pressure on Tre’s brain and remove bits of broken skull. The surgery was a success. More than 60 relatives and friends in the hospital waiting room hugged and thanked him, Yaseen recalled.
“It’s a moment that would happen in the movies,” Yaseen said. “I was very lucky to take part in saving his life.”
Tre was transferred to the Children’s Hospital of Philadelphia, where he made a near-full recovery. He celebrated his 11th birthday in December.
“With time, he’ll grow up and forget about it. God gave us a gift to forget, which is great,” Yaseen said. “But I will never forget.”
Jefferson neurosurgeon Tareq Yaseen poses for a photo with Andre “Tre” Howard III and his mother, Lashawn “Lala” Hamiel at Jefferson Torresdale Hospital.
A memorial
At the memorial Saturday, Mayor Parker read aloud the names of all eight who perished that night.
“To all the families who continue to carry this grief everyday, that until you’ve walked a mile in their shoes, you can’t begin to understand what it’s like,” Parker said. “It is important for us to affirm that they know that Philadelphia stands with you today and we will always.”
She asked the victims’ family members in attendance to stand and be recognized, including Brown, her grandson, Dominick, and Lisa Goods, the aunt of Goods Burke.
The mayor said she plans to keep close tabs on Dominick.
“Now he knows he belongs to me — don’t try to take him from me,” Parker said as she looked at Dominick seated in the front row.
Parker also recognized first responders for their “extraordinary bravery and selflessness.”
“In a moment of unimaginable tragedy, you all ran towards danger to protect others.”
Alberta “Amira” Brown (center), the grandmother of 10-year-old Ramesses Dreuitt Vazquez, who was severely burned after a plane crashed into his North Philadelphia neighborhood last year at the one year anniversary memorial observance of the Northeast Philly plane crash Saturday, Jan. 31, 2026, at Engine 71 Fire Station on Cottman Ave., in Philadelphia
Escalating President Donald Trump’s fight against transgender rights, a top official at the Department of Health and Human Services on Thursday asked the department’s inspector general to investigate two Philadelphia-area children’s hospitals over their gender-affirming carefor transgender children.
Children’s Hospital of Philadelphia (CHOP) and Nemours Children’s Health in Wilmington are among a dozen hospitals that HHS general counsel Mike Stuart said in posts on X he had referred to the agency’s Office of the Inspector General (OIG) in recent days.
A CHOP spokesperson declined to comment on Friday,and Nemours did not respond to a request for comment.
Both hospitals treat children and teens with gender dysphoria — a medical condition in which a person’s body does not match their gender identity. Doctors can prescribe hormone therapy and puberty blockers to treat the condition, although Nemours has already limited its use of these treatments in response to threats from the Trump administration.
The administration hastargeted CHOP and other hospitals that treat transgender youth with subpoenas demanding patients’ medical records, including their dates of birth, Social Security numbers, and addresses, as well as every communication by doctors — emails, voicemails, and encrypted text messages — dating back to January 2020.
CHOP filed legal action in response, asking a federal judge in Philadelphia to block the parts of the subpoena that sought detailed medical records of patients. In November, the judge ruled in CHOP’s favor.
The Trump administration appealed the decision Friday. It has argued that it needs the records as part of its investigation into possible healthcare fraud or potential misconduct by the hospitals.
Stuart said in a Thursday post on X that the administration is investigating hospitals in order to safeguard children from “sex-rejecting procedures,” adding: “There is no greater priority than protecting our children.”
Corinne Goodwin, executive director of the Eastern Pennsylvania Trans Equity Project, called Stuart’s post part of the Trump administration’s ongoing efforts to intimidate doctors and hospitals that provide gender-affirming care to those under 19.
“This action by the Department of Health and Human Services is yet another attempt to intimidate healthcare providers and to harm young people who simply want access to proven healthcare that helps them to live happy and productive lives,” said Goodwin, whose nonprofit organization provides services to transgender people in 42 counties, including Montgomery, Bucks, and Delaware.
The administration has said it recognizes only two genders, limited research into LGBTQ+ health, and phased out gender-affirming care at the Department of Veterans Affairs.
Directly targeting children’s hospitals, HHS Secretary Robert F. Kennedy Jr. issued a declaration in December rejecting gender-affirming procedures for minors, including puberty blockers, hormone therapy, and surgeries.
The American Academy of Pediatrics and other major medical associations, citing research, widely accept such care as safe, effective, and medically necessary for the patients’ mental health.
HHS’s OIG declined Friday to confirm or deny the existence of an investigation.
Last month, the U.S. Senate confirmed Thomas “March” Bell to serve as inspector general over HHS. During his confirmation hearing, Bell submitted written testimony saying, “If confirmed as inspector general, I will examine, evaluate, audit, and investigate to support the initiatives of President Trump and Secretary Kennedy.”
An ongoing legal battle
CHOP runs one of the nation’s largest clinics providing medical care and mental health support for transgender and nonbinary children and teens and their families. Each year, hundreds of new families seek care at CHOP’s Gender and Sexuality Development Program, created in 2014.
Nemours’ Gender Wellness Clinic, launched in 2018, provided hormone therapy and puberty blockers, as well as mental health support, to transgender patients in Delaware, and Nemours is the only hospital in the state that provides gender-affirming care for children.
Starting last July, its clinic began accepting only new patients who need behavioral healthcare. Existing patients receiving hormones or puberty blockers at the clinic were allowed to continue their treatment, the hospital said at the time.
On Thursday, Stuart wrote on X that CHOP and Nemours “appear to continue to operate outside recognized standards of healthcare and entirely outside @SecKennedy’s declaration that sex-rejecting procedures for children and adolescents are neither safe nor effective.”
Kennedy’s Decemberdeclaration says that these procedures “do not meet professionally recognized standards of health care.” Doctors who perform such procedures could be barred from participating in federally funded healthcare programs like Medicaid and Medicare, he said.
The lawsuit says that Kennedy has no authority to define “a national standard of care,” and that any substantive changes to Medicare rules are legally required to be subjected to a decision-making process that includes 60 days of public comment.
Officials at the Centers for Medicaid and Medicare Services have started that process, announcing alongside Kennedy’s declaration that they are proposing a rule that would bar hospitals from Medicaid and Medicare if they offer gender-affirming care to children under 19. They also proposed that Medicaid should not cover gender-affirming care for minors.
But those rules have not yet been instituted, and the lawsuit alleges that Kennedy’s declaration is skirting the law by immediately imposing restrictions on gender-affirming care in hospitals.
The Public Interest Law Center, a Philadelphia-based nonprofit that advocates for the civil, social, and economic rights of marginalized communities, is representing five parents of transgender children in legal motions seeking to protect their medical records.
Mimi McKenzie, PILC’s legal director, said the federal judge in Philadelphia was “very clear and on firm ground” when he ruled in November that the DOJ had no authority to issue the sweeping subpoena and that it violated the privacy rights of children.
She noted that six other courts around the country have similarly ruled that DOJ “has no right to rifle through children’s medical records.”
“Gender-affirming care is legal in Pennsylvania and endorsed by every leading medical association,” McKenzie said. “This is just another tactic in their ongoing attack against providers and patients.”
Passional Boutique & Sexploratorium displays mannequins in leather handcuffs, vibrators, and posters of women in lingerie in its storefront windows along one of Philadelphia’s main shopping drags.
But the adult store — a South Street staple of fetish and fantasy fashion and sex toys for about two decades — is now under scrutiny by President Donald Trump’s administration for selling an undergarment tucked away on the shop’s second floor: breast binders.
On Dec. 16, the U.S. Food and Drug Administration sent a warning letter to Passional stating it was illegally selling breast binders. Most purchasers are trans men — individuals who are assigned female at birth but identify as male.
The FDA classifies breast binders, which compress chest tissue, as a medical device. Businesses that distribute them in the United States must be registered with the FDA or face fines and other enforcement action.
Passional’s operations manager, Ashly Booth, said it’s “a paperwork issue” that pertains to the overseas manufacturer, not to the Center City retailer. Passional will continue to sell those breast binders in its store but not online, she said.
An employee at Passional Boutique displays a breast binder for sale at the South Street store. Breast binders are garments that compress chest tissue.
The FDA’s warning sparked outrage within the region’s transgender community.
Naiymah Sanchez, 42, who described herself as “a proud woman of transgender experience,” said she believes the Trump administration wants to ban gender-affirming care for everyone, not just children and teens.
Breast binders can help treat gender dysphoria, a medical condition in which a person’s body does not match their gender identity.
“This is an adult store, so now you’re attempting to restrict our access — adult access — to the things we need so that we can exist‚” said Sanchez, a senior organizer for the ACLU’s Pennsylvania chapter. “They are trying to double down on making it illegal to be trans in the United States.”
Protecting ‘children’?
Passional was one of only 12 businesses across the nation and overseas, including companies in Singapore and the Netherlands, that received a warning letter. All 12 companies sell, distribute, or manufacturer breast binders to buyers in the United States, primarily through online sales. They included Seattle-based Tomboyx, which uses the tagline “Be Exactly Who You Were Born to Be — No Apologies,” and Manhattan-based For Them, a queer and trans-owned company.
The language in each FDA letter was largely boilerplate.
During a Dec. 18 news conference, FDA Commissioner Martin Makary said the 12 companies were illegally marketing breast binders for children as treatment of gender dysphoria.
“Pushing transgender ideology in children is predatory, it’s wrong, and it needs to stop,” Makary said.
However, none of the violation letters specifically mention children or marketing of breast binders to minors. The FDA declined to comment Friday, referring a reporter to the letter sent to Passional.
Passional employees said they do not market breast binders to minors. Customers must be 18 or older to shop there. A teen may enter and try on a breast binder, but only when accompanied by a parent or guardian, they said.
Makary’s comments were part of a Trump administration announcement of proposed rules to cut off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children. The administration wants to restrict the use of puberty blockers, hormone therapy, and surgical interventions for transgender people under the age of 18.
“It’s based on a medical dogma, sadly, that the normal, sometimes stressful experiences of boys and girls growing up is a pathology that requires medical intervention,” Makary said.
Several states have prohibited gender-affirming care for minors, but it remains legal in Pennsylvania, New Jersey, and Delaware. The American Academy of Pediatrics and other major medical associations, citing research, widely accept such care as safe, effective, and medically necessary for the patients’ mental health.
“These binders are not benign,” he said. “Long-term usage has been associated with pain and compromised lung functions.”
‘A paperwork issue’
Passional carries a line of breast binders distributed by UNTAG, originally Trans-Missie B.V., a company based in the Netherlands. UNTAG says on its website that “chest binding plays a vital role in reducing gender dysphoria” and it offers “kids binders.” Passional does not sell child sizes.
“We offer a selection of domestic and imported binders from sizes XS through 3XL,” Passional’s website says. “Whether you are binding for gender identity, cosplay, drag performance or nonsurgical body sculpting, we offer a range of styles and price points to help you achieve your desired expression.”
Under FDA regulations, manufacturers and distributors of Class 1 — generally meaning low risk — medical devices must register annually with the government. The regulation is designed to help the FDA track devices and quickly respond to safety concerns or recalls.
The FDA defines medical devices, including breast binders, as “intended for use in the diagnosis of disease or other conditions or in the cure, mitigation, treatment, or prevention of disease, or to affect the structure or any function of the body.”
The FDA issued warning letters to both Passional and the Dutch company. The letters say separate government reviews of Passional and UNTAG’s websites found “various breast binders for sale” with claims to help “reduce gender dysphoria” in violation of the Federal Food, Drug, and Cosmetic Act.
The letters gave each 15 business days to respond and provide corrective measures.
In an email to The Inquirer on Wednesday, UNTAG, based in Amsterdam, replied that it would keep a reporter informed of any next steps.
Booth, Passional’s operations manager, said the regulations do not apply to in-store retail sales. However, Passional will stop selling UNTAG breast binders on its website, she said.
“One specific producer of the binders that we have here in Passional now did not register themselves as a medical device company,” Booth said. “It was more of a paperwork issue on the side of the manufacturer.”
Passional, she added, would not pull breast binders from its brick-and-mortar store “for the simple fact that there is a need for them.”
Teens need parental consent
Passional customers must be 18 or older to enter the store. Employee Aizlyn Kraus said she will ask for identification if a patron looks under age.
However, teens who want to get fitted for a breast binder and possibly purchase one may come in, but they must be accompanied by a parent or guardian. In those cases, Passional temporarily closes the store so the teen can quickly get upstairs, where there’s a dressing room. Typically, parents call or email ahead of time to set up an appointment, according to Kraus and Booth.
“We can get them up there without them seeing anything they don’t need to see, without them knowing anything they don’t need to know, and they walk out with something that helps them in their lives,” Kraus said.
Kraus, who is transgender and identifies as a woman, said “dysphoria affects everyone differently. Some people know at a really early age and when they begin to go through puberty, it’s really distressing. There are so many trans kids who either think about self-harm or engage in self-harm. It’s disheartening.”
In the last six months, “two or three parents” have come in separately with their teens to try on breast binders, Booth said.
Kraus said Passional does not market or advertise breast binders to minors, and the majority of purchasers are adults. Passional employees are trained how to properly fit people in breast binders, making sure they are not too tight and advising customers not to wear them for longer than eight hours a day.
Kraus, 33, said breast binders offer an alternative to top surgery. “It’s a whole lot cheaper and easier to do, rather than just jump right into surgery,” Kraus said.
Passional, known for its queer and trans inclusivity, sells many items to help people “feel better about their body,” including waist-tightening corsets, penis “extenders,” and “tucking” or “gaff” undergarments to minimize penile bulge — all forms of gender-affirming care, Kraus said.
Kraus added that some men with gynecomastia, or an enlargement of breast tissue in males due to hormone imbalance, will buy breast binders.
‘It’s just insane’
Prior to undergoing top surgery, 34-year-old Simon Parsons wore a breast binder for a flattened appearance, likening it to Spanx body-sculpting wear.
Parsons, who identifies as a nonbinary transgender Philadelphian, said: “This is going to create a chilling effect for anyone who needs a breast binder. It’s all just to open the door to eventually say, ‘Trans people are not allowed to exist.’”
Parsons said after breast-removal surgery, the hospital provided a chest compression vest to reduce swelling, but it looked nothing like the ones sold by Passional. It had a padded front zipper and Velcro shoulder straps for easy release.
Passional’s breast binders look like sports bras or nylon crop tops.
Parsons and others described the FDA action as a government overreach at best and erosion of civil rights at worst.
“It’s just insane,” said Corie Bosman, 34, of Bensalem.
Bosman, who is nonbinary transgender and whose stage name is “Mister Right,” has worn breast binders while performing as a drag king. Bosman was the 2025 winner of Mr. Philly Drag King, or Mr. PDK, a pageant-style competition organized by the Philly Dyke March.
Corie Bosman, whose stage name is “Mister Right,” was the 2025 winner of the Mr. Philly Drag King (Mr. PDK) pageant competition, organized by Philly Dyke March. Bosman uses breast binders or special “trans tape” for chest flattening.
Bosman and Parsons, who had purchased their breast binders online, said they are concerned that transgender people, especially minors, will resort to potentially harmful practices, like binding their chests with duct tape, if the Trump administration restricts access to breast binders.
“It opens up the window for people to hurt themselves by just trying to be themselves,” Bosman said.
The 10-year-old boy who was severely burned in the Northeast Philadelphia plane crashwas headed home on Tuesday after spending nearly a year in the hospital, his grandmother, Alberta “Amira” Brown said.
“It’s the best thing ever that he’ll be home for the holidays,” Brown said in the morning as the boy prepared to leaveWeisman Children’s rehabilitation hospital in South Jersey. “He is truly happy to be coming home.”
Ramesses Vazquez Viana, then 9, suffered burns to 90% of his body on Jan. 31 whena Learjet medical transport crashed on Cottman Avenue near the Roosevelt Mall, killing allsix people on board.
Ramesses had been riding in a car with his father, Steven Dreuitt Jr., and Dreuitt’s fiancée, Dominique Goods Burke. Dreuitt, 37, died in the blaze. Goods Burke, 34, died in April from her injuries after spending nearly three months at Thomas Jefferson University Hospital.
A bystander saw Ramesses after he escaped from the car; the boy’s back was on fire, and his shirt was burned away.
Police took Ramesses to St. Christopher’s Hospital for Children, and he was later airlifted to Shriners Children’s hospital in Boston. He underwent more than 40 surgeries, including multiple skin grafts. He spent months in physical therapy relearning how to get out of bed, walk and climb stairs, according family interviews with CBS News.
His classmates from Smedley Elementary School in the Philadelphia’s Frankford neighborhood cheered him on from afar, writing him cards and sending videos.
Ramesses celebrated his 10th birthday in October at the Boston hospital.
A few weeks ago, Ramesses was moved closer to his Philadelphia home to Weisman Children’s in Marlton, N.J.
During a phone interview with The Inquirer, Brown said her grandson “has a long road ahead of him” and would need additional surgeries.
During a visit with him Saturday, he kicked a soccer ball around with her.
Brown confirmed a CBS report that Ramesses was being released from Weisman sometime Tuesday, but declined to provide specifics.
Brown said her grandson has chilling memoriesfrom that night: He was in the car’s backseat texting with Brown at about 6 p.m. when the plane exploded in a giant fireball, and he heard loud booms.
As flames engulfed the car, Ramesses tried to help his father, who couldn’t move his legs. The child heard his father yell to get out, and that he loved him. Ramesses told his father he loved him back. He could hear Goods Burke screaming.
Steven Dreuitt Jr. and Goods Burke shared a teenage son, Dominick Goods, who is now a junior at Imhotep Institute Charter High School. Brown said her older grandson is “really struggling” with his parents’ deaths.
The sixpassengers killedon the medical transport jet were Mexican nationals. They included the pilot and copilot, two medical personnel, an 11-year-old girl, and her mother. The girl was headed home to Mexico after undergoing treatment for a spinal condition at Shriners Children’s Philadelphia.
Investigators with the National Transportation Safety Board haven’t yet determined why the plane crashed. A preliminary report, released earlier this year, found the cockpit voice recorder “had likely not been recording audio for several years.” No distress calls were made by the pilot or copilot.
A second woman is accusingPhiladelphia doctor John Smyth Michel, the medical director and owner of Excel Medical Center, of sexual abuse. She said Michel touched her inappropriately when she worked for him several years ago, according to a recent court filing by the Philadelphia District Attorney’s Office.
Prosecutors charged Michel with felony rape and sexual assault earlier this yearafter a female patient said he raped her during an October 2024 office visit.
Michel, 55,of Jenkintown, told police and state medical licensing authorities that he had sex with the 39-year-old patient, but he claimed it was consensual, criminal and state licensing records show.
The new accusations involve a former female employee who worked for Michel as a medical assistant from 2015 to 2019 at his East Mount Airy office on Stenton Avenue and at another location in Germantown on Chelten Avenue.
She recently told law enforcement authorities that beginning in 2018 Michel touched her breasts over her clothing on multiple occasions while she was working in the office. He additionally groped her vagina over her clothing before she quit in 2019.
The accusations have not resulted in new charges at this time, but the investigation remains ongoing, according to Marisa Palmer, a spokesperson for the DA’s office.
Prosecutors are seeking to introduce the groping accusations as evidence to bolster its sexual assault case against Michel, given there were no witnesses to the alleged rape.
“The incidents reveal a common plan, scheme or design on the part of the defendant to engage in unlawful and similar nonconsensual sexual conduct with vulnerable women in his medical offices,” Assistant District Attorney Eamon Kenny wrote in a Nov. 24 court motion.
The judge presiding over the criminal case must decide whether to grant Kenny’s motion and put the 34-year-old former employee’s accusations before jurors at trial.
The Inquirer does not identify alleged victims of sexual assaultwithout their permission.
Michel did not return phone calls and emails from The Inquirer this week. His criminal defense lawyer, Andrew Gay Jr., declined to comment Wednesday.
Michel founded Excel Medical Center, whichgrew to more than a dozen medical clinics located throughout the city, with about 20,000 patients and 200 employees.
Last month, Excel’s general manager wrote a letter to patients informing them the practice “will be ceasing operations” as of Dec. 1. “We truly value the trust you have placed in us for your care,” the manager stated in the Nov. 11 letter obtained by The Inquirer.
A woman who answered the phone at Excel’s main location in West Mount Airy on Thursday said the practice was not taking any new patients in preparation of closing. She said the practice might resume operations and accept new patients after the new year. Michel’s lawyer declined to comment when asked about the practice’s status.
The criminal case, which is pending in Common Pleas Court, involves a then-38-year-old patient.
According to police and court records, she accused Michel of kissing her during a May 2024 exam at his East Mount Airy location.
She told him “no,” left the office, and did not report the kissing incident.
About five months later, she went to an appointment at Michel’s North Philadelphia office on West Diamond Street. During the Oct. 14, 2024, visit, she says Michel raped her with such force that her head banged twice against the exam room wall.
The exterior of Excel Medical Center at 2124 Diamond Street in Philadelphia.
In early November 2024, she told her husband what had happened and subsequently filed a police report. Michel was arrested and charged about three months later.
Michel’s trial was initially slated for Dec. 9, but during a hearing on Monday, a judge postponed it until Feb. 17 after the DA’s office asked for more time to investigate, court records show.
Michel’s suspension nears end
In June, the State Board of Osteopathic Medicine, which regulates and oversees licensure of osteopathic doctors like Michel, disciplined him for having sex with a patient — a violation of state regulations.
He apologized to the board in a letter, saying, “I fully acknowledge that I crossed a professional boundary” and is “profoundly contrite.”
The board suspended his medical license for six months, followed by 18 months of supervised probation, and fined him $4,000. Michel’s suspension is set to end on Dec. 11.
If convicted in the criminal case, Michel could permanently lose his medical license.
In an e-mailed statement on Thursday, the Pennsylvania Department of State, which oversees professional licensing boards, said its prosecution division “continues to closely monitor Dr. Michel’s criminal charges and review his compliance with the terms of the consent agreement.”
Abuse in office hallways
The accusations outlined in Kenny’s motion include new details of sexual misconduct. The former employee said Michel approached her from behind to “grab her breast over her shirt.”
She was stunned and “hated the feeling,” but she feared losing her job so she didn’t say anything to him.
Once, he simultaneously “cupped” her breast and vagina over her clothes with his hands. She turned around and screamed at him to stop touching her, according to the motion. He replied, “`You know you want it and you know you like it,’” she recounted.
She said she couldn’t quit because she needed the income and told her co-workers about the abuse. Those colleagues helped her “avoid him” while at work. She also told her husband, though she persuaded him not to confront Michel.
She resigned in 2019 after landing a new job. They had no contact until this year when he texted her.
When she asked why he wanted to talk to her after so much time had passed, Michel texted nevermind, the former medical assistant told prosecutors. She then wrote back, “explaining how she felt about his abuse all these years later, that the thoughts of it still traumatized her.”
Inquirer staff writer Chris Palmer contributed to this article.
A federal judge in Philadelphia has blocked President Donald Trump’s administration from obtaining the private medical records of youth who sought gender-affirming care at Children’s Hospital of Philadelphia.
The decision, issued Friday by U.S. District Court Judge Mark A. Kearney, was a victory for patients’ privacy rights and for CHOP, which had waged a legal battle to limit the scope of a sweeping federal subpoena that sought the names, dates of birth, Social Security numbers, addresses, and parent/guardian information of patients who had been prescribed puberty blockers or hormone therapy.
In a 54-page opinion, Kearney found that the medical records sought by the U.S. Department of Justice were “beyond the authority granted by Congress” under the Food, Drug and Cosmetic Act, and that “the heightened privacy interests of children and their families substantially outweighs the Department’s need to know” such confidential and sensitive information.
Neither CHOP nor the DOJ responded to a request for comment late Friday.
In addition to protecting the identities of patients, Kearney also denied the part of the DOJ subpoena seeking documents related to how doctors make decisions in prescribing medications that help patients to have a body that matches their gender identity, including details such as “clinical indications, diagnoses, or assessments.” Kearney also blocked federal investigators from obtaining documents related to “informed consent, patient intake, and parent or guardian authorization for minor patients.”
CHOP runs one of the nation’s largest clinics providing medical care and mental health support for transgender and gender-nonbinary children and teens and their families. Each year, hundreds of new families seek care at CHOP’s Gender and Sexuality Development Program, created in 2014.
Along with CHOP, five parents of transgender children also filed a motion asking the federal court to intervene on their behalf. Kearney’s ruling rendered that motion moot since it sought similar legal relief as CHOP. The motion was filed by the Public Interest Law Center, a Philadelphia-based nonprofit that advocates for the civil, social, and economic rights of marginalized communities.
Mimi McKenzie, the center’s legal director, said the judge’s ruling was “a complete rebuke” to the DOJ and an affirmation that the federal government has “no authority to root through” private medical records.
“The court recognized that the Department of Justice is using its subpoena power not as a tool for legitimate inquiry, but as a tool for intrusion, and it’s not allowing that,“ McKenzie said late Friday. ”This is an important victory. Under this court’s ruling their privacy is protected, their medical records are not going to be turned over, and this court is just not going to condone this type of government overreach.”
The CHOP case against the DOJ has become part of a broader legal battle playing out across the country. As part of an investigation into possible healthcare fraud or potential misconduct, the DOJ had issued subpoenas to CHOP and at least 19 other hospitals nationally that treat transgender youth. In September, a federal judge in Boston blocked the Trump administration’s attempt to subpoena medical records of patients who received gender-affirming care at Boston Children’s Hospital, ruling it was “motivated only by bad faith.” The DOJ has appealed the Boston ruling.
The Trump administration has said doctors who prescribe to children and teens medications commonly used for gender-affirming care, such as puberty blockers and hormones, are engaging in chemical mutilation, likening it to child abuse. Teenagers are not mature enough to make such major decisions, the administration hasargued.
The American Academy of Pediatrics and other major medical associations, citing research, widely accept such use of these medications assafe, effective, and medically necessary for the patients’mental health.
In his ruling, Kearney said the DOJ subpoena was part of the Trump administration’s strategy to end gender-affirming care for minors. Kearney noted a “charged political environment” in which the federal government views “their medical treatment to [be] a radicalized warped ideology.” He concluded that the state and not the federal government has the authority to regulate medical care, and gender-affirming care for minors is legal in Pennsylvania.
The Children’s Hospital of Philadelphia called new evidence presented by President Donald Trump’s administration weak and untrustworthy in a blistering legal response to federal efforts to investigate its doctors providing gender-affirming care.
CHOP’s response, filed late Monday in federal court in Philadelphia, came in defense of accusations by the U.S. Department of Justice that it’s investigating “fraudulent billing practices“ at the hospital.Federal officials say they’re looking into whether CHOP doctors were fudging or lying about diagnoses to get private and public health insurance companies to cover off-label drug prescriptions used to treat patients with gender dysphoria — a medical condition in which a person’s body does not match their gender identity.
In its filing, CHOP lawyers called the DOJ’s allegations “unreliable,” and urged U.S. District Court Judge Mark A. Kearney to disregard claims that are “threadbare, of dubious origin, and so heavily qualified and caveated as to offer the court no meaningful information.”
CHOP and the DOJ are locked in a legal battle over a sweeping federal subpoena sent to the hospital in June. The subpoena seeks patient names, Social Security numbers, addresses, diagnoses, and treatment notes, in addition to doctor emails and encrypted text messages.
In July, CHOP filed a motion to limit the scope of the subpoena to protect patient privacy. Judge Kearney is now weighing CHOP’s motion.
In the latest filing, CHOP’s lawyers argued the DOJ’s “new evidence” against the hospital was unfairly “shoehorned” into a separate but related case filed last month by a group of CHOP patients and their families who also want Kearney to block the release of private medical records to the DOJ.
“That new evidence should not be considered because it is not before the Court in this case and is unreliable in any event,” CHOP lawyers wrote in the filing. “The government (still) cannot establish that its need for extraordinarily sensitive and personal patient information outweighs the highest-order privacy interests on the other side of the ledger.”
The DOJ did not immediately respond Tuesday to a request for comment.
Feds seek patient information from CHOP
In April, U.S. Attorney General Pam Bondi issued a memo, entitled “Preventing the Mutilation of American Children,” in which she tasked the DOJ with enforcing measures targeting gender-affirming care for youth.
About two months later, the DOJ sent subpoenas to CHOP and at least 19 other hospitals nationally that are under scrutiny for treating transgender youth. The subpoenas sparked legal opposition playing out in federal courts in Pennsylvania and across the nation.
The DOJ’skey focus is how doctors are prescribing puberty blockers and hormones “off-label,” meaning for a condition not specifically approved by the U.S. Food and Drug Administration.
Once a drug is approved by the FDA, it is legal for doctors to prescribe it to treat other conditions that could benefit from the medication. Off-label prescribing is a common and widely accepted medical practice, especially in pediatrics.
Gender-affirming care for children and adolescents has been deemed medically appropriate by the American Academy of Pediatrics and other major medical and mental health organizations. Research shows young people with gender dysphoria suffer higher rates of suicide, self-harm, depression, and anxiety.
CHOP’s Gender and Sexuality Development Program, created in 2014, is one of the nation’s largest such clinics and provides medical care and mental health support to hundreds of new families each year.
CHOP’s legal fight for patient privacy
Late last month, families and patients joined in CHOP’s fight against the federal subpoena by filing a separate motion to protect their privacy rights. That motion was filed on behalf of five parents with transgender children and one adult who received care at CHOP.
In response to that case, the DOJ filed a “Declaration,” or sworn statement, from Lisa Hsiao, acting director of the DOJ’s Enforcement and Affirmative Litigation Branch, formerly known as the Consumer Protection Branch. In it, Hsiao said the government has new evidence “particular to CHOP that raises concern that federal healthcare offenses may be occurring there.”
Hsiao said the government analyzed CHOP’sinsurance claims and found that between 2017 and 2024, CHOP providers diagnosed 250 minors with central precocious puberty at age 10 or older, “including numerous teenagers aged 14 to 18.”
“This is well beyond the age at which children are typically diagnosed with precocious puberty,” Hsiao stated. The government, she said, suspects doctors are improperly using the precocious puberty diagnosis to get insurance coverage for treatment of gender dysphoria.
In Monday’s court filing, CHOP lawyers accused the DOJ of attempting to “shoehorn its new evidence into CHOP’s case” through the other case.
CHOP also argued Hsiao’s declaration provides nothing to support its contentions surrounding precocious puberty diagnosis.
“Moreover, the government fails to contextualize the findings of its rudimentary analysis, offering no comparator for the use of the code for precocious puberty at peer hospitals, let alone hospitals that, like CHOP, have providers who specialize in treating endocrine disorders,” CHOP lawyers wrote.
The source of “the data set is entirely unknown,” CHOP’s lawyers noted, addingthe declaration never says how many patients were treated for gender dysphoria during that time frame.
The CHOP lawyers also criticized Hsiao for writing in her sworn declaration that the government was aware of a lawsuit filed against CHOP that alleges doctors hastily prescribed puberty blockers and hormones to a minor who later regretted it.
Hsiao later refiled the declaration to remove any reference to a lawsuit after learning that it hadn’t been filed.
CHOP lawyers wrote they believe the lawsuit reference came from a news article about a former CHOP patient. The article said the patient “was suing the hospital.” However, CHOP was unaware of any such lawsuit.
“The similarities between the report and the allegations in the Hsiao Declaration — including the reference to a lawsuit — raise suspicions that, in looking to justify its investigative interest in CHOP, the government simply searched the internet for stories fitting its narrative and presented the one it found as fact without adequately scrutinizing its veracity.”
