One fateful decision. Years of neglect.
Five once-average schools remade into the worst in Florida.

Failure factories

In just eight years, Pinellas County School Board members turned five schools in the county’s black neighborhoods into some of the worst in Florida.

First they abandoned integration, leaving the schools overwhelmingly poor and black.

Then they broke promises of more money and resources.

Then — as black children started failing at outrageous rates, as overstressed teachers walked off the job, as middle class families fled en masse — the board stood by and did nothing.

Today thousands of children are paying the price, a Tampa Bay Times investigation has found.

They are trapped at Campbell Park, Fairmount Park, Lakewood, Maximo and Melrose — five neighborhood elementary schools that the board has transformed into failure factories.

Every year, they turn out a staggering number of children who don’t know the basics.

Eight in 10 fail reading, according to state standardized test scores. Nine in 10 fail math.

Ranked by the state Department of Education, Melrose is the worst elementary school in Florida. Fairmount Park is No. 2. Maximo is No. 10. Lakewood is No. 12. Campbell Park is No. 15.

All of the schools operate within six square miles in one of Florida’s most affluent counties.

All of them were much better off a decade ago.

Times reporters spent a year reviewing tens of thousands of pages of district documents, analyzing millions of computer records and interviewing parents of more than 100 current and former students. Then they crisscrossed the state to see how other school districts compared.

Among the findings:

■ Ninety-five percent of black students tested at the schools are failing reading or math, making the black neighborhoods in southern Pinellas County the most concentrated site of academic failure in all of Florida.

■ Teacher turnover is a chronic problem, leaving some children to cycle through a dozen instructors in a single year. In 2014, more than half of the teachers in these schools asked for a transfer out. At least three walked off the job without notice.

■ All of this is a recent phenomenon. By December 2007, when the board ended integration, black students at the schools had posted gains on standardized tests in three of the four previous years. None of the schools was ranked lower than a C. Today, all the schools have F ratings.

■ After reshaping the schools, the district funded four of them erratically. Some years they got less money per student than other schools, including those in more affluent parts of the county. In 2009, the year after resegregation, at least 50 elementary schools got more money per student than Campbell Park.

■ Other districts with higher passing rates are doing far more to aid black students, including creating special offices to target minority achievement, tracking black students’ progress in real time and offering big bonuses to attract quality teachers to high-minority schools. Pinellas does none of those things.

The problems don’t end in the five south St. Petersburg schools. Overall, black children in Pinellas County are failing at higher rates than black children in virtually any other school district in Florida.

In 2014, they were a third more likely to fail math than black children in Miami-Dade, Broward, Orange and Palm Beach counties. They were 23 percent more likely to fail math than black children in Hillsborough.

Fifty-seven of 67 school districts in Florida recorded better reading scores, putting Pinellas in the same league as the poorest, most rural counties in the state.

In an interview with the Times, Superintendent Mike Grego acknowledged the school district’s role in creating problems at the schools.

“You can’t undo the past. You have to take the district from where it’s at,” Grego said. “I’m going on record saying we’re going to fix this. And we’re going to educate our students as if each one of them was our own kid.”

Pinellas County Schools Superintendent Mike Grego

Hired in 2012, Grego has launched reforms to aid students in the five schools. They include adding extended learning programs, extra summer instruction and bringing in counselors and social workers to connect families with outside services — initiatives that were proposed in the past but never started or were discontinued.

Pinellas County’s black students haven’t been struggling in secret. School Board members have heard repeatedly from parents and teachers at south St. Petersburg schools who begged for relief. State education officials have stepped in to monitor four of the five schools because of their low test scores.

Yet, when contacted by the Times, board members distorted facts, pleaded ignorance or said they needed more information before they could act.

Linda Lerner, who voted for the plan that resegregated the district in 2007, blamed the schools’ problems on “the cycle of poverty,” not on actions by the School Board.

“This is a nationwide thing, not just us. You hear school districts everywhere talking about this,” said Peggy O’Shea, who also voted for the plan in 2007. “It’s an issue that’s everywhere, unfortunately.”

“We only talk about it in black schools,” she added, “but we resegregated white schools as well.”

“We’ve looked at just about everything we can and put things in place,” said Carol Cook, who also voted for resegregation in 2007. “I think we’re on the right track.”

“Mindblowing,” said Terry Krassner, who joined the board in 2010 and who said virtually the same thing about struggling black students four years ago. “I think we need to figure out what we don’t know.”

Black parents and community leaders hold up such sentiments as proof of a disconnect. They say they are not convinced real changes are coming.

Goliath Davis, a former police chief and deputy mayor of St. Petersburg, speaks to Pinellas County School District officials.

“We keep making the same mistakes over and over and over,” said Goliath Davis, a former police chief and deputy mayor of St. Petersburg. “What happens to all these kids? What do they do? Every time we fail one, the criminal justice system is a winner. And you’d rather pay to keep them incarcerated than try to straighten out the system?”

A prayer for safety

Lawanda Bodden with her sons, Cayton, 10, and Chance, 14.

A prayer for safety

Cayton Bodden wakes up afraid to go to school.

When his mother knocks at his bedroom door, the 10-year-old hides under the covers. “No, no, no,” he groans softly.

At the breakfast table, he picks at his oatmeal, staring down in silence. He spends several minutes putting on his socks.

The more time he can put between himself and Fairmount Park Elementary, the better.

Waiting for him at the school up the road are all the things he has learned to dread: the endless shouting, the sudden brawls, the rookie teachers who can’t control their classrooms.

Just before he starts the walk to school his mother reaches down and takes his hand. She closes her eyes and prays to God to protect him from harm.

This is what it’s like to go to school in Pinellas County’s black neighborhoods.

Cayton Bodden, 10, slowly eats his oatmeal before leaving home for Fairmount Park Elementary.

Cayton started as a fourth grader at Fairmount Park in August 2014.

Barely 4-foot-8 in his sneakers and lugging a green camouflage backpack, Cayton spends his school days wary of what might happen next. Once, in March, as he was lining up in class, a boy slapped the back of his head and kicked him hard in the calf.

The following Monday, he came home with a teacher’s note: the same boy had slapped him again, said his mother, Lawanda Bodden.

The bullying took its toll. In his first weeks at Fairmount Park, Cayton made Bs and Cs.

But as the year progressed, his grades plummeted.

Soon he was bringing home all Fs.

Lawanda Bodden has watched her son fail with a mounting sense of desperation.

Though the family lives about a block from Douglas L. Jamerson Jr. Elementary, one of the best magnet schools in the area, Cayton can’t get into the program. At least 60 children are ahead of him on the wait list.

“I felt like I’m setting up my child for failure. I have no control over what education I can give my child,” said Bodden, a 43-year-old single mother who works for a Tampa engineering firm. “Unless I made enough money to send him to a private school or stay at home and teach him, this is the only option I have.”

“It’s really like a parent being put in a maze,” she said. “And we have no way out of it.”

Pinellas in perspective

At Dillard Elementary School in Broward County, girls and boys learn in separate classrooms with an emphasis on fun, hands-on lessons. They might learn about fractions, for instance, by hula-hooping or playing football.

Pinellas in perspective

There are places in Florida where deep generational poverty, runaway crime and rampant drug use make educating children an extremely difficult task.

Pinellas County doesn’t fit that description.

In St. Petersburg, the crime rate is 12 percent lower than in Orlando, 15 percent lower than in Daytona Beach and 21 percent lower than in Panama City.

The poverty rate among blacks in Pinellas is 32 percent, compared to 33 percent in Escambia County, 35 percent in Alachua County and 36 percent in Volusia County.

Yet the black neighborhoods in Pinellas are home to schools that are doing far worse than schools in any of those places.

At West Jacksonville Elementary — in a neighborhood so violent it’s nicknamed Lil’ Baghdad — black students are passing reading at twice the rate as at Fairmount Park.

In Palm Beach County, at Belle Glade Elementary — in one of Florida’s poorest places — black children are passing reading at three times the rate as at Melrose.

It isn’t just that Pinellas is trailing a few extraordinary schools that are beating long odds.

There were 1,664 regular elementary schools tested in Florida in 2014. Students at 1,650 of those schools passed reading at higher rates than children in Pinellas County’s five most segregated schools.

Poverty doesn’t explain Pinellas’ problems. One hundred eighty-four elementary schools are as poor or poorer than Pinellas’ worst schools. All but seven outperformed the Pinellas schools in reading and math.

Darren Reismeier teaching fourth grade science at Andrew A. Robinson Elementary in Duval County.Monica Herndon | Times

The rate of failure in the five elementary schools is unlike anything that occurs elsewhere in Florida.

In 2014, 964 black children were tested in reading and math at the five schools; 912 failed one or both subjects.

No other large school district in Florida has problems on the scale of Pinellas’, but all of them are doing more to raise their black children’s passing rate.

Broward County created a computer system that assigns a “risk level” to every student based on whether the child has been arrested, suspended, failed a class or referred for social services. Teachers use it to keep tabs on their classes in real time.

Duval County is raising $50 million to attract better teachers to the district’s lowest performing schools, offering bonuses of as much as $20,000 apiece.

Orange County created an office to focus solely on minority students. The team runs teacher training, tracks discipline data and oversees remedial programs in reading and algebra.

Palm Beach County trains principals and district administrators to be mindful of ways schools might unintentionally discriminate against black children.

Pinellas does none of those things.

“They won’t even consider what other school boards have done,” said the Rev. Manuel Sykes, pastor of Bethel Community Baptist Church in St. Petersburg. “They refuse to accept that there are people who are doing things better.”

Racial divide

Students in an assembly at Melrose Elementary School.

Racial divide

Among Florida’s most populous counties, Pinellas is the least diverse.

Blacks make up only about 10 percent of the population. A majority live in a roughly 12-square-mile area south of Central Avenue in St. Petersburg.

They didn’t get there by accident.

Beginning in the 1930s, city leaders drew up plans for a “colored zone” on the city’s south side and made it impossible, through permitting and housing discrimination, for blacks to live or own businesses outside its borders. Blacks who tried to move out of the zone were met with death threats.

In the 1970s, city and county leaders routed Interstate 275 through the heart of St. Petersburg’s black community. Whole blocks were razed and thousands of families were resettled farther south of Central Avenue, where the county’s most segregated schools stand today.

But by then, black families were fighting back in court, targeting the segregated school system.

In 1964, 10 years after the U.S. Supreme Court outlawed racial segregation, a black parent named Leon Bradley asked the school district to place his son in an all-white school.

When the district refused, the Clearwater police officer sued in federal court. The case kicked off an era of strict federal monitoring, during which a judge, not the School Board, had the final say over district decisions.

The School Board fought efforts to integrate for the next seven years.

Then, in 1971, they voted to desegregate countywide.

They adopted rules that barred any school from being more than 30 percent black.

They bused students across the county to meet the quota.

They installed new magnet programs to encourage voluntary integration.

Though the efforts were working — black students were posting steady gains on standardized tests — many parents bridled at the tools of integration. They complained about the inconvenience and the high cost of busing and special programs.

Public opposition steadily built until 2007, when the School Board got out from under federal monitoring. The chance to do away with busing finally was at hand.

Everything was about to change.

A fateful decision

Kindergartner Tyree Parker sits at the front doors of Maximo Elementary as he waits for school to open.

A fateful decision

On Dec. 18, 2007, the School Board met to consider a new plan.

It called for a “neighborhood schools” system that kept students close to home.

It was de-facto segregation.

Children in white neighborhoods would go to mostly white schools. Children in black neighborhoods would go to schools that were almost entirely black.

Fifty years of research has shown that such decisions set districts back, said Gary Orfield, co-director of the Civil Rights Project at UCLA and a leading expert on school segregation.

“It produces schools that teachers don’t want to teach in and that are branded as failures by our state and national governments,” Orfield said. “When you go to neighborhood schools, whites and Asians get schools that function well and blacks and Latinos get schools that are impoverished and fail.

“This isn’t a secret.”

Giving up on racially balanced schools wasn’t the School Board’s only option.

They could have integrated schools by requiring a balance of children based on socio-economic status, as other counties were doing.

They could have carefully constructed magnet schools and special programs to attract more white children to schools in black neighborhoods.

Instead, they were ready to plow ahead, to scrap the most important parts of what they had done to guarantee black children got an equal education.

Some School Board members, both then and now, said they heard from black parents who wanted neighborhood schools as badly as white parents did.

But at meetings leading up to the vote, scores of parents, teachers and community leaders lined up to warn against the decision. Resegregating the schools would concentrate the county’s poorest, most challenging students into a handful of south St. Petersburg schools. Teachers would be overwhelmed. Students would stop learning.

“You will have white- and black- middle-class flight,” the board’s sole black member, Mary Brown, said ahead of the vote. “And three to four years down the road, if this isn’t working, it is too late to go back to it then. Because once people leave those areas, they are not coming back.”

Even Clayton Wilcox, the then-superintendent and a champion of dropping the integration plan, admitted at the time that he doubted that schools with so many impoverished students could succeed. “In my darkest moments,” he told the Times, “I don’t see how it can be done.”

Five of seven board members voted for the plan anyway.

Three of them — Carol Cook, Peggy O’Shea and Linda Lerner — still sit on the board today.

Before and after

In 2007, Maximo Elementary was a C school. Today it’s rated F and is listed by the state as the 10th worst elementary school in Florida.

Before and after

On the day of the vote, the five neighborhood elementary schools in south St. Petersburg were relatively diverse. None was more than 63 percent black.

Fairmount Park had an A in Florida’s statewide ranking system. More than half the students in the school were reading at grade level. Fifty-nine percent were proficient in math.

Campbell Park and Lakewood each were B schools that year. Maximo and Melrose had Cs.

But the effects of giving up on integration were immediate.

In less than a year, schools on St. Petersburg’s north side became whiter, and the neighborhood schools to the south began drawing primarily from the city’s blighted avenues and subsidized housing complexes.

Before, the area’s most disadvantaged children, including the relatively few with serious behavior problems, were spread among a large area, mixed in with more affluent classmates and given access to several schools’ worth of teachers and counselors. Now they were all concentrated in a handful of schools.

The new system left Fairmount Park, along with the other neighborhood elementary schools, utterly transformed.

Housed at Fifth Avenue South and 41st Street S, the one-time A school is now the second-worst in Florida.

In the mornings, unsupervised boys and girls pack the drop-off area. Giggling and shoving often give way to fist fights and wrestling, parents say. It’s so volatile that Moe Thurton won’t let his 10-year-old son J’Len walk to school.

“It’s fights every day. I’m getting out of my car and physically breaking kids up from fighting,” Thurton, 43, said in March. “I broke up two fights last week.”

Inside the school, students roam the campus at will, said Scott Ryan, a special-needs teacher who resigned in 2013 rather than work another full year at the school. “I would go in and teachers would be talking,” Ryan said, “and the kids are telling the teachers to shut up.”

It isn’t a matter of a few parents and teachers complaining. In a first-of-its-kind analysis, the Times reviewed district discipline data and found that the five schools are awash in disruptive behavior and violence.

Fairmount Park recorded at least 661 referrals for violence and disruption in 2013-14 compared to 198 in 2009-10 — a 230 percent increase.

Even after behavior problems spiked, district officials ignored calls from the teachers union for smaller class sizes and later start times.

They failed to deliver on promises to assign students extra social workers and counselors.

“Teachers were saying, 'I don’t have the resources and training that I need,’” recalled Kim Black, former president of the Pinellas Classroom Teachers Association. “It was a terrible snowball.”

‘We will burn out’

Children raise their hands at Fairmount Park Elementary.

‘We will burn out’

Elyse Mermelstein started as a first-grade teacher at Lakewood Elementary nine weeks into the fall of 2013, but she already was the third teacher to run the class, her principal told her.

The other teachers had quit.

“The kids were horribly behind,” Mermelstein, 43, said in an interview with the Times.

A certified teacher of elementary school children and non-native English speakers, she said her Lakewood students could barely read. “They should have been reading books with paragraphs. They should have been comprehending.

“They had so many teachers, it added to the problem.”

Eight weeks after taking the job, she resigned, too.

She said administrators left her on her own to handle behavior problems and encouraged her to teach at too slow a pace. She said both she and the principal agreed it wasn’t working out.

Mermelstein said that as she packed up her things on Dec. 20, just before winter break, she heard crying coming from the classroom next door.

It was another first-grade instructor, who was halfway through her first year as a teacher.

She, too, walked out that day and never came back, Mermelstein said.

Keeping teachers at these five elementary schools in south St. Petersburg has been a difficult task, records show.

In 2014, 52 percent of the schools’ instructors requested transfers out.

Fourteen quit in the middle of the year. At least three of them simply walked off the job without giving notice, opting to risk action against their state teaching certificate rather than stay a moment longer.

That year, Fairmount Park alone lost three fifth-grade teachers, two first-grade teachers, two language teachers and a dropout prevention specialist. That amounted to more than 10 percent of the teachers typically on staff.

The teachers who remain at the schools are among the least experienced in the county, according to a Times analysis of state Department of Education records.

Last year, they had about 7 years of teaching experience on average. Teachers at other elementary schools in the district had about 13 years.

The outlook of teachers at the schools has gone from measured optimism to desperation.

In survey comments gathered by the district in 2008, one elementary school teacher wrote: “The majority of our faculty and staff are happy to be at Campbell Park Elementary. We work well together and complement strengths and weaknesses.”

By 2014, their feedback had turned bleak: “I can’t believe that the county has allowed the destruction of a good south county school. Confront the real issues head on for the children. Campbell Park needs help NOW!”

Another Campbell Park teacher wrote of students: “They don’t care about anything or anyone! They trash the building and their neighborhood. Need to teach these children a trade!”

At Maximo, an instructor wrote: “How long can a teacher survive in such a broken system and how much can a human endure? Until the resources match the need, the district will continue to chew up our teachers and spit them out. We will burn out, leave the school and leave the profession.”

Slow to act

Pinellas County School Board member Rene Flowers is pictured on the televisions in a 2014 Pinellas County School Board meeting.

Slow to act

School Board members promised things wouldn’t turn out this way.

Before they voted in 2007, all of them acknowledged what had to be done to keep south St. Petersburg schools on equal footing. The schools would need more money, staff and after-school programs.

“And we’re going to be held accountable by our constituents, the community, to follow through on that,” board member Linda Lerner said at the time. “And it may mean taking some resources from some other schools. That’s never easy. I believe we understood that when we put that commitment into the plan.”

But a Times analysis of school operating expenses shows the vote didn’t trigger a flood of new resources to the south St. Petersburg schools.

Pinellas County School Board member Linda Lerner

Instead, the district gave some of them less state and local tax money than other Pinellas elementary schools. Then it took federal money that was supposed to pay for extra staff and teaching time and used it to make up the difference.

That’s what happened at Maximo in 2011, according to district budget documents.

The school got about $5,600 per pupil in state and local tax dollars. On average, other elementary schools in the county got about $6,300.

The district supplemented Maximo’s budget with nearly $700,000 in Title I money and other federal funds, bringing the school’s per pupil funding to about $6,600 — $300 more than the district average.

But that still left Maximo behind more than a dozen schools in the district. And it left the school with less than half of the extra money it would have gotten if the district had given it the same local funding as most other schools.

Grego boosted funding for the schools in 2014, aggressively targeting them for the first time since they were resegregated.

Help would have come sooner if district leaders had followed through on promises. Instead, they announced one program after another, only to abandon each one in short order.

Turnover made things worse. Pinellas County went through four superintendents in five years.

Four months after the vote, Clayton Wilcox — the superintendent who designed the district’s plan to end integration — announced he was quitting to take a job with Scholastic Corp.

He was replaced by Julie Janssen, who launched her own programs to stop the test-score freefall at schools in south St. Petersburg.

Starting in 2008, Janssen championed a plan designed to prevent experienced teachers from leaving the schools. It would offer teachers a free master’s degree if they completed rigorous on-the-job training and stayed at their school for at least five years.

She later commissioned a study to find out why Pinellas County’s black children were trailing their peers in other counties across Florida.

Then the School Board fired her in 2011.

One of the first actions taken by John Stewart, the interim superintendent who replaced her, was to cancel the study. He also discontinued the teacher master’s program.

“If we kept all the things that we promised going, we wouldn’t be seeing the results that we’re seeing,” Janssen, who now goes by her maiden name, Mastry, told the Times in June. “We thought through it. It was the perfect scenario. It was like getting your soldiers better equipment, better pay. And then they took it all away. How can you do that? That’s criminal.”

Since the board hired Mike Grego as superintendent in 2012, at least one additional measure has fallen through the cracks.

In a 2013 turnaround plan filed with the state, the district pledged to recruit its most effective teachers to work at struggling schools.

The district analyzed state test scores and identified about 600 teachers whose students showed the biggest improvement year over year.

More than two years later, district officials have done nothing with the list.

In spite of past setbacks, Grego told the Times the district is back on track.

In 2014, he expanded a program to add classroom aides, mental health therapists and “navigators” to connect families with services outside the school district.

He also has brought in TNTP, a nonprofit group that provides extra training for teachers and administrators in struggling schools.

District officials said there are early signs of improvement. They said fewer teachers quit the schools last year and internal testing suggests students are making academic gains.

“We will close this gap,” Grego told the Times. “I can tell you that, sure as I’m sitting here.”

It’s not the parents

Loneiyce Washington looks back at her grandson, Tyree Parker, as she drives him to Maximo Elementary.

It’s not the parents

When people have complained about black students’ poor grades over the years, district leaders and teachers have blamed parents, and the students themselves.

Facing a lawsuit over black student performance in 2005, Wilcox said black parents and children needed to take more responsibility.

The district sets the table for them, he said, “But at some level you’ve got to lift your arm and lift your fork and go for the nourishment.”

In reality, there’s nothing measurable about the county’s black population that explains why students are doing so poorly.

A Times analysis of statewide kindergarten readiness data shows that new students in Pinellas County’s most segregated schools show up no less prepared than students in scores of other struggling, high-poverty schools.

It’s only after a few years in Pinellas classrooms that they’re falling behind their peers statewide.

Ranked by social indicators that researchers use to predict how children will fare in school, Pinellas is a typical Florida county.

The median household income for black families falls squarely in the middle of all Florida counties. So do the rates of poverty, reliance on food stamps and unemployment. Children here are no more likely to live with an unmarried mother or father.

Many parents interviewed by the Times felt trapped in neighborhood schools or forced to take extraordinary steps to enroll their children elsewhere.

Stephanie Ruth drove her daughter Shenyah 35 minutes every morning from south St. Petersburg to Madeira Beach Fundamental K-8, where Shenyah was one of only a handful of black children enrolled. “We were willing to make the sacrifice,” Ruth said. “Whatever it took to make sure she got a good education.”

Kimberly Anderson homeschools her children to avoid sending them to Campbell Park. “Public school,” she said, “was just never an option.”

Zakevia Peterson prays every night that she can get her daughter transferred from Fairmount Park into a nearby magnet school.

And then there are cases like Loneiyce Washington’s.

Washington, 61, moved from Georgia to Florida with her grandson, Tyree Parker, last year. They settled in south St. Petersburg because it was the only place she could afford to live, she said.

Collecting disability checks and unable to work, she enrolled Tyree at Maximo Elementary and expected the boy would soon be at the head of his class. He could read. His preschool teachers in Georgia had singled out his ability to judge shapes, identify numbers and do simple math.

But soon after he started, the sweet-tempered 6-year-old fell victim to bullies, Washington said. They slapped him and kicked him. Pushed him down in the bathroom and tore his pants. Grabbed his Teenage Mutant Ninja Turtles hat and ripped it. Kicked him and called him “rathead” and “snaggletooth.”

Kindergartner Tyree Parker waits for his grandmother, Loneiyce Washington, to pick him up from Maximo Elementary.

As the bullying got worse, his progress in school all but halted. On a report card in the fall, his teacher wrote that he couldn’t compare groups of objects or write numbers.

Every day that Tyree came home sore from a fresh slap or kick, Washington got a little more desperate. She said she called the school, sent faxes to the district headquarters, even hounded the principal and the area superintendent until they agreed to meet with her.

“Place yourself in my place,” Washington told them, according to a recording of the meeting. “I have to pray over this baby every day that he leaves my house to come in here, do you understand?”

Still, Washington said, the boy’s situation never improved. With no money and dim prospects for getting him into a better school, she said she felt trapped.

In May, it finally became too much. She packed her things into a storage unit, left her house in south St. Petersburg and crammed with Tyree into her 27-year-old daughter’s apartment in Pinellas Park.

The new address meant she could enroll him at Marjorie Kinnan Rawlings Elementary School. Almost immediately, she said, Tyree started doing better.

Though her living arrangement is tenuous, Washington said she’s glad to be away from south St. Petersburg schools.

She said she feels sorry for the children left behind there.

“I’m going to worry about them for the rest of my life,” she said.

Data reporter Nathaniel Lash, computer-assisted reporting specialist Connie Humburg, data director Adam Playford and news researcher Caryn Baird contributed to this report. Page design by Martin Frobisher.

This article was written while Times reporter Michael LaForgia was participating in the National Health Journalism Fellowship, a program of the University of Southern California’s Annenberg School of Journalism.