FORT LAUDERDALE, Fla. — Jury selection in the groundbreaking trial of a former sheriff’s deputy charged with failing to confront the killer of 14 students and three staff members at a Florida high school five years ago got off to a speedy start Wednesday, with the preliminary round concluding in just one day.

Circuit Judge Martin Fein had tentatively scheduled three days of preliminary jury selection, seeking 50 candidates whose schedules and employment would allow possibly two months of service at the trial of former Broward County Deputy Scot Peterson.

But by the end of Wednesday, the judge ended the process after finding 55 finalists out of 300 prospects interviewed.

Those 55 will be brought back Monday for questioning by prosecutors and Peterson’s attorney about their knowledge of the 2018 shooting at Marjory Stoneman High School in Parkland, and whether they can be fair in judging Peterson’s alleged refusal to confront shooter Nikolas Cruz at the scene.

Six jurors and four alternates will be chosen. Florida is one of six states that allow six-member juries for trials other than capital murder. The others are Arizona, Connecticut, Indiana, Massachusetts and Utah. All other states use 12-member juries in felony trials.

If all goes according to plan, opening statements would be given the middle of next week.

While Fein tried to dissuade additional comments Wednesday, two prospective jurors demanded to speak to him outside of the presence of the others. One said he already knew he couldn’t be fair because he considers Peterson “a coward.” Another said his boss’s daughter was one of the 17 wounded in the shooting. Both were dismissed.

Peterson, 60, is charged with seven counts of felony child neglect involving four students killed and three wounded on the top floor of a three-story classroom building. He becomes the first U.S. law enforcement officer prosecuted for his alleged actions and inaction during a school shooting. Texas authorities are still considering charges for the officers who failed last year to confront the gunman at an Uvalde elementary school who killed 19 children and two teachers.

On Feb. 14, 2018, Peterson approached the building with his gun drawn 73 seconds before Cruz reached the third floor, but instead of entering, he backed away as gunfire sounded. He has said he thought the shots were coming from outside the building, perhaps from a sniper. His attorney Mark Eiglarsh says he will call 22 witnesses who also thought the shots came from outside.

Eiglarsh also argues that under Florida law, Peterson had no legal obligation to enter the building and confront Cruz.

Peterson is also charged with three counts of misdemeanor culpable negligence for the adults shot on the third floor, including a teacher and an adult student who died. He also faces a perjury charge for allegedly lying to investigators. He could get nearly a century in prison if convicted on the child neglect counts and lose his $104,000 annual pension.

Prosecutors did not charge Peterson in connection with the 11 killed and 13 wounded on the first floor before he arrived at the building. No one was shot on the second floor.

Peterson retired shortly after the shooting and was fired retroactively.

Cruz pleaded guilty in 2021 to the killings. In a penalty trial last year, his jury couldn’t unanimously agree on whether he deserved the death penalty. The 24-year-old former Stoneman Douglas student was then sentenced to life in prison.

In Uvalde, a report by lawmakers put nearly 400 officers at Robb Elementary School shortly after the shooting began from an array of federal, state and local agencies, many of them heavily armed.

They waited more than an hour to confront and kill the 18-year-old gunman. At least five officers were put under investigation after the shooting and were either fired or resigned, although a full accounting is unclear.

The head of the Texas Department of Public Safety, Col. Steve McCraw largely blamed Uvalde’s school police chief, who was later fired by trustees.

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Associated Press reporter Acacia Coronado in Austin, Texas, contributed to this report.

WASHINGTON — Hard-fought to the end, the debt ceiling and budget cuts package is heading toward a crucial U.S. House vote as President Joe Biden and Speaker Kevin McCarthy assemble a coalition of centrist Democrats and Republicans to push it to passage over fierce blowback from conservatives and some progressive dissent.

Biden is sending top White House officials to meet early Wednesday at the Capitol to shore up support ahead of voting. McCarthy is working furiously to sell skeptical fellow Republicans, even fending off challenges to his leadership, in the rush to avert a potentially disastrous U.S. default.

Despite deep disappointment from right-flank Republicans that the compromise falls short of the spending cuts they demanded, McCarthy insisted he would have the votes needed to ensure approval.

“We’re going to pass the bill,” McCarthy said as he exited a lengthy Tuesday night meeting at the Capitol.

Quick approval by the House and later in the week the Senate would ensure government checks will continue to go out to Social Security recipients, veterans and others and would prevent financial upheaval at home and abroad. Next Monday is when the Treasury has said the U.S. would run short of money to pay its debts, risking an economically dangerous default.

The package leaves few lawmakers fully satisfied, but Biden and McCarthy are counting on pulling majority support from the political center, a rarity in divided Washington, testing the leadership of the Democratic president and the Republican speaker.

Overall, the 99-page bill restricts spending for the next two years, suspends the debt ceiling into January 2025 and changes policies, including new work requirements for older Americans receiving food aid and greenlighting an Appalachian natural gas line that many Democrats oppose.

For more than two hours late Tuesday as aides wheeled in pizza at the Capitol, McCarthy walked Republicans through the details, fielded questions and encouraged them not to lose sight of the bill’s budget savings.

The speaker faced a sometimes tough crowd. Leaders of the hard-right House Freedom Caucus spent the day lambasting the compromise as falling well short of the spending cuts they demand, and they vowed to try to halt passage by Congress.

“This deal fails, fails completely,” Rep. Scott Perry, R-Pa., the chairman of the Freedom Caucus, said earlier in the day, flanked by others outside the Capitol. “We will do everything in our power to stop it.”

A much larger conservative faction, the Republican Study Committee, declined to take a position. Even rank-and-file centrist conservatives were unsure, leaving McCarthy desperately hunting for votes.

Rep. Nancy Mace, R-S.C., said after the “healthy debate” late into the night she was still a no.

Ominously, the conservatives warned of potentially trying to oust McCarthy over the compromise.

“There’s going to be a reckoning,” said Rep. Chip Roy of Texas.

Biden was speaking directly to lawmakers, making more than 100 one-on-one calls, the White House said.

The nonpartisan Congressional Budget Office said the spending restrictions in the package would reduce deficits by $1.5 trillion over the decade, a top goal for the Republicans trying to curb the debt load.

McCarthy told lawmakers that number was higher if the two-year spending caps were extended, which is no guarantee.

But in a surprise that could further erode Republican support, the GOP’s drive to impose work requirements on older Americans receiving food stamps ends up boosting spending by $2.1 billion over the time period. That’s because the final deal exempted veterans and homeless people, expanding the food stamp rolls by 78,000 people monthly, the CBO said.

House Democratic leader Hakeem Jeffries said it was up to McCarthy to turn out votes from some two-thirds of the Republican majority, a high bar the speaker may not be able to reach. In the 435-member House, 218 votes are needed for passage.

Still, Jeffries said the Democrats would do their part to avoid failure.

“It is my expectation that House Republicans would keep their promise and deliver at least 150 votes as it relates to an agreement that they themselves negotiated,” Jeffries said. “Democrats will make sure that the country does not default.”

Liberal Democrats decried the new work requirements for older Americans, those age 50-54, in the food aid program. And some Democratic lawmakers were leading an effort to remove the surprise provision for the Mountain Valley Pipeline natural gas project. The energy development is important to Sen. Joe Manchin, D-W.Va., but many others oppose it as unhelpful in fighting climate change.

The top Democrat on the House Natural Resources Committee, Rep. Raul Grijalva of Arizona, said including the pipeline provision was “disturbing and profoundly disappointing.”

Rep. Pramila Jayapal, D-Wash., chair of the Congressional Progressive Caucus, had this warning for McCarthy: “He got us here, and it’s on him to deliver the votes.”

Wall Street was taking a wait-and-see approach. Stock prices were mixed in Tuesday’s trading. U.S. markets had been closed when the deal was struck over the weekend.

The House aims to hold procedural votes Wednesday afternoon with final action expected in the evening. It would then send the bill to the Senate, where Democratic Majority Leader Chuck Schumer and Senate Republican leader McConnell are working for passage by week’s end.

Schumer called the bill a “sensible compromise.” McConnell said McCarthy “deserves our thanks.”

Senators, who have remained largely on the sidelines during much of the negotiations between the president and the House speaker, began inserting themselves more forcefully into the debate.

Some senators are insisting on amendments to reshape the package from both the left and the right flanks. But making any changes to the package at this stage seemed unlikely with so little time to spare before Monday’s deadline.

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Associated Press writers Farnoush Amiri, Mary Clare Jalonick and Seung Min Kim contributed to this report.

PITTSBURGH — Robert Bowers carried out the deadliest antisemitic attack in U.S. history when he killed 11 people and injured seven others by storming a Pittsburgh synagogue and shooting everyone he could find. On that, everyone agrees.

Even though Bowers’ defense conceded the point Tuesday at the outset of his federal trial, they hope to spare the suburban truck driver from a possible death sentence over the Oct. 27, 2018, attack at the Tree of Life synagogue.

His lead lawyer, Judy Clarke, said during opening statements that Bowers “shot every person he saw” that day in the building, which was being shared by members of three congregations, Dor Hadash, New Light and the Tree of Life. But she questioned whether Bowers had acted out of hatred or an irrational belief that he needed to kill Jews to save others from the genocide he claimed they were enabling by helping immigrants come to the U.S.

“He had what to us is this unthinkable, nonsensical, irrational thought: that by killing Jews, he would attain his goal,” Clarke said. “There is no making sense of this senseless act. Mr. Bowers caused extraordinary harm to many, many people.”

Prosecutors, who rejected the 50-year-old Bowers’ offer to plead guilty in exchange for taking the death penalty off the table, opened their case by describing for jurors the terror he sowed as he moved through the synagogue, opening fire indiscriminately.

“The depths of the defendant’s malice and hate can only be proven in the broken bodies” of the victims and “his hateful words,” Assistant U.S. Attorney Soo C. Song told the 12 jurors and six alternates hearing the case.

As Song spoke, some of the survivors in the somber courtroom dabbed tears. Bowers, seated at the defense table, showed no reaction.

Prosecutors have said Bowers made incriminating statements to investigators and left an online trail of antisemitic statements that they say shows the attack was motivated by religious hatred. Police shot Bowers three times before he surrendered.

After opening statements, prosecutors began presenting their case by playing an initial 911 call from Bernice Simon, who reported “we’re being attacked!” at the synagogue and that her husband, Sylvan Simon, had been shot.

Shannon Basa-Sabol, the dispatcher who took that call, testified that she advised Bernice Simon to find the wound and stanch the bleeding. Then the dispatcher heard additional gunfire and screaming as Bernice, too, was shot. Neither of the Simons survived.

“Bernice, are you still with me?” Basa-Sabol asked in the recording, There was no answer.

Song also described in detail how worshippers from three congregations arrived that Sabbath to pray and socialize in what should have been a safe place.

She described how Tree of Life members Cecil and David Rosenthal showed up early as usual to help greet and set up for worship — brothers who were fully integrated into their congregation despite their intellectual disabilities. She also told how the oldest victim, 97-year-old Rose Mallinger, typically offered a weekly prayer for peace at Tree of Life, while another victim, Jerry Rabinowitz of Congregation Dor Hadash, was a medical doctor who was killed after running toward the sound of gunshots seeking to help.

But she said the story of that day is not just of atrocity, but of survival and of police heroics in confronting and stopping Bowers. “Life survived and emerged from the Tree of Life synagogue,” Song said.

Bowers, who is from the Pittsburgh suburb of Baldwin, also injured seven people, including five police officers who responded to the scene, investigators said.

In a filing earlier this year, prosecutors said Bowers “harbored deep, murderous animosity towards all Jewish people.” They said he also expressed hatred for HIAS, founded as the Hebrew Immigrant Aid Society, a nonprofit humanitarian group that helps refugees and asylum seekers.

Prosecutors wrote in a court filing that Bowers had nearly 400 followers on his Gab social media account “to whom he promoted his antisemitic views and calls to violence against Jews.”

In the long run-up to the trial, Bowers’ lawyers did little to cast doubt on whether he was the gunman and instead focused on trying to save his life. As an indication that the trial’s guilt-or-innocence phase would be almost a foregone conclusion, they spent little time during jury selection asking how potential jurors would reach a verdict.

Instead, they focused on the penalty phase and how jurors would decide whether to impose the death penalty in a case of a man charged with hate-motivated killings in a house of worship. The defense lawyers, who recently said Bowers has schizophrenia and brain impairments, probed whether potential jurors could consider factors such as mental illness or a difficult childhood.

The families of those killed are divided over whether the government should pursue the death penalty, but most have voiced support for it.

The three congregations have spoken out against antisemitism and other forms of bigotry since the attack. The Tree of Life congregation also is working with partners on plans to overhaul its current structure, which still stands but has been closed since the shootings, by creating a complex that would house a sanctuary, museum, memorial and center for fighting antisemitism.

The death penalty trial, which is being presided over by Judge Robert Colville, is proceeding three years after now-President Joe Biden said during his 2020 campaign that he would work to end capital punishment at the federal level and in states that still use it. His attorney general, Merrick Garland, has temporarily paused executions to review policies and procedures, but federal prosecutors continue to vigorously work to uphold death sentences that have been issued and, in some cases, to pursue new death sentences at trial.

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Associated Press reporter Michael Rubinkam in northeastern Pennsylvania contributed to this report.

While cancer drugs have been most publicized recently, experts in pharmacy say they often find themselves scrambling to find common generic medications such as antibiotics and fear having to resort to rationing.

They say only a national effort to bring generic drug manufacturing back from overseas, among other steps, will help relieve the problem, which mostly affects injectable drugs, including chemotherapy and cardiac medications.

“It is not just cancer, said Dr. Peter Yu, physician-in-chief of the Hartford HealthCare Cancer Institute in Hartford, Connecticut. “It’s pediatrics, it’s infectious diseases, it’s rheumatology.”

Yu said the American Society of Clinical Oncology looked into the problem when he was president in 2014-15. “In part what we learned is it wasn’t just oncology; it really is a health economics issue about how drugs are paid for and manufactured and distributed in the United States and the world,” he said.

“We are experiencing it ourselves across Hartford HealthCare,” Yu said. “We treat hundreds of patients a day with chemotherapy. We tried to keep a several weeks’ supply of our chemotherapy drugs on hand and we’ve been down to as low as a two-day supply, which makes us extremely nervous.”

Yu said health care systems rely on a few large distributors, “big names like Cardinal Health, American BioSource and McKesson, and they’re unable to tell us when they can deliver supplies. We call every day and they say, we’re not sure we can distribute your order.”

He said Hartford HealthCare has been able to shift supplies among its seven hospitals to avoid a total shortage, but “there’s very little margin for error here, or very limited.”

‘A spike in shortages’

“What we’re seeing now is a spike in shortages,” said Eric Arlia, vice president for pharmacy services at Hartford HealthCare.” We’ve gone through these waves on and off over the last five years. We seem to be going through another period where there’s going to be more than the typical number of drug shortages that we’re dealing with.”

Arlia said the business office and pharmacy buyers for the health care system are holding weekly meetings because of the seriousness of the issue.

“The team is tracking 46 drugs in short supply as of this week,” Arlia said last week. “Not all at the same level of criticality, but 46 of them that they’re talking about and talking about mitigation strategies, whether that be trying to buy it from a different company or looking at different dosage forms.”

Other options are looking at therapeutically equivalent medications and switching patients to another drug if necessary. But that isn’t always the best treatment, especially if a patient has been on one medication for a while.

The two main cancer chemotherapy drugs, cisplatin and carboplatin, have been among those in short supply, but Arlia said methylprednisolone, used to treat asthma, arthritis and allergies, is “our No. 1 shortage product at the moment.”

“It’s an anti-inflammatory — probably one of the biggest issues is people with breathing issues to help them breathe better, but it has other uses too,” Arlia said.

However, “the good news with that one is sometimes people can take oral if they’re able to and then there’s a couple other drugs … in the same therapeutic class with similar effects,” he said.

Manufacturing in China and India

According to a U.S. Department of Homeland Security report, drug shortages increased 30% between 2021 and 2022. There was a five-year high of 295 drug shortages at the end of 2022, according to the report.

A major concern is that 90% to 95% of the chemicals that make up acute-care injectable drugs, known as the active pharmaceutical ingredient, are manufactured in India and China, according to the report. The Food and Drug Administration does not have the same level of oversight of those countries, and officials worry about geopolitical threats disrupting supply.

“The drugs are being manufactured overseas and not just the drugs but also the active ingredients” and the inactive ingredients, said C. Michael White, chairman of the Department of Pharmacy Practice at the University of Connecticut School of Pharmacy.

“India makes most of the finished pharmaceutical products,” he said. “So that’s the actual tablet or the capsule. China makes a lot of the active ingredients.” And that won’t change anytime soon.

“One of the things that’s actually scary from a national security standpoint is that the United States doesn’t have any capacity to be able to have the fermenting plants that they would need to have to make penicillin and cephalosporin antibiotics,” White said. “They’ve all shut down and they’ve all moved overseas, and most of them are now in China.”

That could cause a major problem if China were to attack Taiwan, for example, he said. 

“You can’t just build a manufacturing plant for pharmaceuticals,” White said. “It takes years in order to be able to construct it. And that’s one of the things I think we found with COVID, is that we’re always behind the eight ball because we didn’t have the capacity to be able to manufacture it here, so we were beholden to the normal supply chains, which were all being interrupted.” 

A contamination scandal

A major shortage occurred when Ranbaxy USA, based in India, was found to have contaminated drugs and was shut down.

“The FDA did not have any funding in order to be able to go overseas and do any of the inspections of those foreign manufacturing plants,” White said. The companies were put on the honor system, “where you would send them reports of the stuff that you were doing, but they would never visit you.”

After a whistleblower notified the FDA that Ranbaxy was falsifying reports, the FDA began scheduling inspections, but the foreign companies knew when inspectors were coming so that would take plants offline to bring them up to standards. That in itself causes shortages, White said.

Another issue is the age of equipment. “They were beating us on price because they were dealing with equipment that was much much older and then prone to breakdowns and whatnot, but because it was less expensive to be able to use that equipment they ended up dominating the market, putting other people out of business,” White said. “But then when the equipment breaks, then you have a drug shortage.”

However, the quality of foreign-made drugs is higher now than it had been, he said.

“The FDA is behind on inspecting them, and sometimes when they get to them, if they have violations, they can shut them down and then it just has a trickle effect,” Arlia said.

“Obviously, if companies either in the U.S. or in another part of the world can’t get the raw materials needed to make a medication, there’s going to be a shortage.”

Looming threat of rationing

Dr. Daniel Petrylak, an oncologist and professor of urology at the Yale Cancer Center in New Haven, Connecticut, said a notice went out two months ago about a shortage of cisplatin, also known as cisplatinum.

“Unfortunately, for tumors such as testes cancer, there are no alternatives,” Petrylak said. “Cisplatinum is the backbone of treatment for these patients. Same thing with bladder cancer for those patients that can receive cisplatinum.”

He said there was a clinical trial comparing cisplatin and carboplatin in testes cancer patients “because the concept was that (carboplatin) was a less toxic drug, but unfortunately it was found that there was a higher relapse rate in those patients who received carboplatinum versus those patients who received cisplatinum.”

If there is a shortage, decisions about who will get the drug are difficult to make, Petrylak said.

“I’m not trying to say that it’s any less important to treat somebody who is older but most of the testes patients are in their 20s and 30s, and they have long lives ahead of them,” he said. “And this is a pretty much curable disease in most patients. In fact, in a good-risk patient, 90% of those patients are cured.”

Older men have a higher relapse rate, which requires more treatment and could lead to side effects. “So there’s not only a quantity-of-life issue but a quality-of-life issue,” Petrylak said. “Those are important factors, but I view this as a national health emergency. No question.”

Lisa Holle, clinical professor of pharmacy practice at the UConn School of Pharmacy and an oncology pharmacist, also sees rationing as a possibility. 

A consideration is, “What is the reason they’re getting the chemotherapy?” she said. “Is it because we know we could cure this patient of their cancer and they can be free from their disease? … But in some instances, we can’t cure the cancer because it’s such an advanced stage of cancer and we’re giving the chemotherapy to try to keep the cancer at bay for as long as we can.”

In that ethical situation, “we might think about the patients who are curable versus those who are not,” Holle said. “And of course we do not ever want to be in that situation because we think it’s really important to also keep some of these cancers at bay, but those are sort of ethical dilemmas I think that one gets faced with when there’s a limited supply of a life-saving drug.”

Another alternative is for the FDA to allow importing of unapproved foreign drugs on an emergency basis, Holle said.

“Back in 2012, 2013, there was a drug that was in short supply, and the FDA allowed an emergency use of an internationally manufactured version of the drugs,” she said. “It required the FDA to be able to approve this drug temporarily so that we could import it into the United States and use it for patients because there was no alternative to that drug for that type of cancer.”

‘Inconsistent availability’

Dr. Pragna Kapadia, assistant professor in hematology and medical oncology at UConn Health, said the health care system has avoided shortages of cisplatin, docetaxel and carboplatin, three common chemotherapy drugs, so far.

“Fortunately, we have not had any issues that have directly impacted a patient, meaning we haven’t had to change a treatment course or substituted therapeutic drugs because of a shortage,” she said. 

“We previously had tried to keep a one-month supply of most of our medications on hand,” Kapadia said. “There are certain chemotherapy drugs as of late it’s just not available. So we have more of maybe a two- to three-week supply on hand and it’s just inconsistent availability.”

This causes pharmacists to have to be creative, she said. 

“So there may be certain vial sizes that are available and certain concentrations that are available, but then it’s up to us, our pharmacists, to compound the medication to make it what we need it to be, because it’s not available in the form that we need it to be,” she said.

She said UConn Health has not had to resort to rationing of drugs.

“I will say, I’ve been at UConn for five years, and there was a point where … they said, we have X number of doses of this drug and so be mindful of that as you talk to patients about starting them on a treatment regimen that includes that drug,” Kapadia said.

Doctors don’t want to alter a treatment plan because “that is only going to potentially be harmful to the patient, she said. 

UConn Health uses a group purchasing organization, Vizient, which helps mitigate shortages. Kapadia said that is more available to large health care systems, whereas smaller hospitals may not have access.

“You never want to be that patient who has to hear, I can’t treat you with what is felt to be our best standard of care because the drug isn’t available,” Kapadia said “You never want to have to have that conversation with a patient.”

She said she hasn’t had to do that recently, “but it’s something that we worry about, and I do think that smaller institutions who don’t have these large purchasing groups, or they don’t have a large volume that they’re purchasing, I think they are at a higher risk of not having enough drugs.”

Cardiovascular drug issues

In cardiovascular medicine, the biggest shortages are in lidocaine, adenosine and dofetilide, White said.

Lidocaine is an anesthetic that also treats arrhythmias. A shortage can lead to delayed procedures, White said.

A lack of adenosine, used for people in arrhythmia, “acutely causes a break so people will go back into a regular heart rhythm.” A lack of it can put patients at risk because the substitute, calcium channel blockers, stay in the system for several hours.

“The adenosine gives you the advantage that you can come in and you could break the person out of that arrhythmia, put them back into a regular heart rhythm,” White said. “And then you only have to do that intensive monitoring for a few minutes.”

If channel blockers must be used, “you may have more low blood pressure and you’ve got to monitor the patient and be concerned for a longer period of time,” he said. Adenosine is also used in stress tests.

Dofetilide is used daily to prevent atrial fibrillation. The problem with the substitute, sotalol, is that dofetilide must be out of the system before the new drug is used, putting the patient at risk for several days, White said. Both drugs require a three-day hospital stay when they are introduced.

“You can’t just on the same day take somebody off dofetilide and put them on sotalol,” White said. “You have to wait until all of the dofetilide is out of the body. And then you have to bring them into the hospital for another three days to put them on sotalol.”

When dofetilide is available again, doctors are faced with a conundrum. “Do you keep them on the sotalol, or do you take them off, give them several days without any antiarrhythmic therapy, and then have to put them back on the dofetilide?” White said.

No one keeps reserves

To Arlia, “the other big issue is that nobody keeps any reserve supplies in the supply chain anymore.”

Companies used to keep inventory reserves, but economics has eliminated that, he said.

“What happens now is, if there’s even a relatively minor disruption, it just hits everybody very fast, because there’s just very little reserves in the system.” He said there are programs where “if you’ll commit to buying a certain product, they’ll guarantee that they’ll hold 90 or 120 days’ supply in a warehouse for you. And we did that with a few drugs.”

Arlia said he would “happily commit to buying one brand of a generic, commit to it for a year or a couple of years at a certain price if I know they’re going to hold stock for me. … Because ultimately, I think you end up spending more money when you have a shortage and you’re changing things around. And of course, it’s bad for patient care.”

For Arlia, the lack of reserves is a critical issue. “I think there just needs to be more of a national focused effort on this,” he said.

“As a country, to me it’s a vulnerability that we don’t have reserve supply of critical pharmaceuticals. And nobody’s going to do it out of the goodness of their heart. Somebody needs to be incentivized, really, to hold more supply than they need to for their general business.”

“You may have everything that you need, but then you don’t have the vial or you don’t have the ampule, or you don’t have one of the really important ingredients but you have all the others,” disrupting the manufacturing process, White said.

Kapadia sees another cause. “If you look across the board at the different medications that have been affected, I think some of it is still a ripple effect from COVID, workforce issues and supply chain issues,” she said. “Even though we feel that the pandemic is behind us, those things I think are still playing a role.”

The problem with generics

The low prices of generics have their own issues, according to Yu. As long as a manufacturer has a patent, the price may be high.

“When that patent drops, you get the entry of generic manufacturers that can now produce that drug … but the price begins to drop, and it drops pretty quickly,” Yu said. “So within a year’s time, the price may fall by 97% or more. So it fairly rapidly reaches a level where that generic manufacturer is no longer so interested in making that drug. … Manufacturers may shift to another generic drug where they have a higher margin.” 

White said manufacturers’ move to overseas added to the problem.

Generic drug manufacturing “shifted overseas with the understanding that prices would continue to go down, which they have for generic drugs,” he said. “And that created a lot of pressure on the system so that only the ones that have the cheapest price were the ones that we’re going to be getting a majority of the sale.”

Insurance companies reimburse based on the lowest-priced drug, so there is little incentive to spend money to increase automation or maintain equipment, White said. And companies have consolidated so there may be just two making one drug.

White said of the shortages that “at most points, it’s a severe inconvenience. … Periodically it becomes dangerous when some of the drugs that are in shortage are more vital-type drugs, like the cancer drugs.

“But we have this extreme vulnerability and the extreme vulnerability could really be devastating to the United States if all of the manufacturing was taken away,” he said.

UConn working on problem

White said one faculty member is working on “a new manufacturing-type process that is much, much more efficient and doesn’t use a lot of worker time in order to be able to set up and be able to create.”

“The U.S. had allocated money. I think there’s like a billion dollars or whatever into research specifically on bringing manufacturing back to the United States. … And UConn is is part of a consortium of major universities in the country, called NIfTI (Neuroimaging Informatics Technology Initiative) that have been working on ways to be able to support bringing manufacturing back to the United States and be able to do it in an efficient manner.” 

Yu said Congress passed a law requiring manufacturers to notify the FDA if they anticipate a drug shortage within six months.

“Often they don’t know six months in advance if there’s going to be a problem,” Yu said. “And just notifying people that there’s a problem doesn’t solve the problem. It’s not a very satisfying answer.

“I think we need Congress to put sharper focus on this,” Yu said. “I think we need to think about this as a consumer protection issue as well as a public health issue.”

Yu called the health care system “very fragmented and nonsensical in many ways. We have some parts of the health system that are highly regulated, and then some parts like drug manufacturing and production that have a lot less regulation behind pricing and distribution.”

Ed Stannard can be reached at estannard@courant.com.

DES MOINES, Iowa — A woman was rescued more than a day after a six-story apartment building partially collapsed in Davenport, Iowa, and after city officials ordered that it be demolished, saying there were no known people left inside and it was in “imminent danger” of coming down. Protesters urged a delay, concerned that people could still be trapped.

Protesters carried signs Tuesday morning near the building site, saying “Find Them First” and “Who is in the Rubble?” Some used a megaphone to shout out names of building residents.

City officials said rescue crews escorted 12 people from the building shortly after a middle section collapsed at about 5 p.m. Sunday, and rescued several others, including one person who was taken to safety overnight Sunday. No fatalities have been reported.

By Monday morning, Fire Chief Michael Carlsten told reporters: “No known individuals are trapped in that facility.” Authorities said they would soon shift from a rescue operation to a recovery operation.

The city then issued a statement saying that the owner had been served with an order for demolition that was expected to begin Tuesday morning. That prompted many people to turn to Facebook, naming loved ones who were unaccounted for, and expressing concern that the building was being demolished too quickly.

On Tuesday morning, the city issued a new statement, saying it has been “continually evaluating the timing of the demolition.” The statement said demolition “is a multi-phase process that includes permitting and staging of equipment that will begin today. The timing of the physical demolition of the property is still be evaluated. The building remains structurally insecure and in imminent danger of collapse.”

The woman was rescued at about 8 p.m. Monday after calling her family for help, according to multiple news reports. A bystander’s video showed someone waving from a fourth-floor window to a fire department ladder truck below. A city statement late Monday said an injured woman had been extricated, but it wasn’t immediately clear if this was the same person referred to in news reports. Authorities did not immediately respond to a message seeking comment.

When firefighters initially arrived Sunday, they immediately took action, saving lives at great risk to their personal safety, city officials said.

“There was a lot of screams, a lot of cries, a lot of people saying ‘Help!’ when the building came down,” Tadd Mashovec, a resident of the building, told KCCI-TV. “But that did not last, and two or three minutes, and then the whole area was silent.”

Carlsten said the back of the complex had separated from the rest of the building, and authorities found a gas leak.

It wasn’t clear what immediately caused the collapse, which left a gaping hole in the center of what was once the Davenport Hotel, a building listed in the National Register of Historic Places in 1983. Built in 1907, the brick over steel and concrete structure had been renovated into a mixed-use building with residential and commercial spaces.

Work was being done on the building’s exterior at the time of the collapse, said Rich Oswald, the city’s director of development and neighborhood services. Reports of falling bricks were part of that work, and the building’s owner had a permit for the project, Oswald said.

Gov. Kim Reynolds issued a disaster proclamation for Scott County, activating the Iowa Individual Assistance Grant Program and the Disaster Case Management Program for the residents left homeless. The property owner was served Monday with a demolition order, and residents were prevented from going back inside to remove their belongings, due to the building’s unstable condition.

Authorities confirmed that multiple residents had complained of unmet maintenance problems. Quad-City Times reported nearly 20 permits were filed in 2022, mainly for plumbing or electrical issues, according to the county assessor’s office.

The collapse didn’t surprise Schlaan Murray, a former resident, who told The Associated Press that his one-year stay there was “a nightmare.”

Murray, 46, moved into his apartment in February 2022 and almost immediately began having issues — the heat and air conditioner didn’t work, and there were plumbing problems in the bathroom. Multiple calls to the management company rarely got a response, and when a maintenance person did stop by, they never completely fixed the problems, he said.

“They would come in and put some caulk on it,” he said. “But it needed more than that. They didn’t fix stuff, they just patched it up.”

He questions how the building passed inspections.

“It was horrible,” Murray said, adding that he felt the conditions were so bad that he didn’t want to bring his children to his apartment.

Murray said he moved out a month before his lease was up in March, and still hasn’t received his security deposit. Despite deplorable conditions, many residents were like him, he said, struggling to come up with the first and last month’s rent, plus security deposit, required to move elsewhere.

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Associated Press contributors include Freida Frisaro in Fort Lauderdale, Florida, Trisha Ahmed in Minneapolis, Kathy McCormack in Concord, New Hampshire, and Beatrice Dupuy in New York City.

WASHINGTON — President Joe Biden says he “feels good” about the debt ceiling and budget deal negotiated with House Speaker Kevin McCarthy as the White House and congressional leaders work to ensure its passage this week in time to lift the nation’s borrowing limit and prevent a disastrous U.S. default.

Biden spent part of the Memorial Day holiday working the phones, calling lawmakers in both parties, as the president does his part to deliver the votes. A number of hard right conservatives are criticizing the deal as falling short of the deep spending cuts they wanted, while liberals decry policy changes such as new work requirements for older Americans in the food aid program.

A key test will come Tuesday afternoon when the House Rules Committee is scheduled to consider the package and vote on sending it to the full House for a vote expected Wednesday.

“I feel very good about it,” Biden told reporters Monday as he left Washington for his home in Delaware.

“I’ve spoken to a number of the members,” he said, among them Senate Republican leader Mitch McConnell, a past partner in big bipartisan deals who largely sat this one out.

“I spoke to a whole bunch of people, and it feels good,” Biden said.

To those progressive Democrats raising concerns about the package, the president had a simple message: “Talk to me.”

As lawmakers size up the 99-page bill, few are expected to be fully satisfied with the final product. But Biden, a Democrat, and McCarthy, a Republican, are counting on pulling majority support from the political center, a rarity in divided Washington, to join in voting to prevent a catastrophic federal default.

Wall Street will open early Tuesday morning delivering its own assessment, as the U.S. financial markets that had been closed when the deal was struck over the weekend show their reaction to the outcome.

McCarthy acknowledged the hard-fought compromise with Biden will not be “100% of what everybody wants” as he leads a slim House majority powered by hard-right conservatives.

Facing potential blowback from his conservative ranks, the Republican speaker will have to rely on upwards of half the House Democrats and half the House Republicans to push the debt ceiling package to passage.

Overall, the package is a tradeoff that would impose some spending reductions for the next two years along with a suspension of the debt limit into January 2025, pushing the volatile political issue past the next presidential election. Raising the debt limit, now $31 trillion, would allow Treasury to continue borrowing to pay the nation’s already incurred bills.

Additionally, policy issues are raising the most objections from lawmakers.

Liberal lawmakers fought hard but were unable to stop new work requirements for people 50 to 54 who receive government food assistance and are otherwise able-bodied without dependents. The Republicans demanded the bolstered work requirements as part of the deal, but some say the changes to the food stamp program are not enough.

The Republicans were also pushing to beef up work requirements for health care and other aid; Biden refused to go along on those.

Questions are also being raised about an unexpected provision that essentially gives congressional approval to the Mountain Valley Pipeline, a natural gas project important to Sen. Joe Manchin, D-W.Va., that many Democrats and others oppose.

At the same time, conservative Republicans including those from the House Freedom Caucus say the budget slashing does not go nearly far enough to have their support.

“No one claiming to be a conservative could justify a YES vote,” tweeted Rep. Bob Good, R-Va.

This “deal” is insanity,” said Rep. Ralph Norman, R-S.C. “Not gonna vote to bankrupt our country.”

All told the package would hold spending essentially flat for the coming year, while allowing increases for military and veterans accounts. It would cap growth at 1% for 2025.

The House Rules Committee has three members from the influential Freedom Caucus who may very well try to block the package from advancing, forcing McCarthy to rely on the Democrats on the panel to ensure the bill can be sent to the House floor.

The House aims to vote Wednesday and send the bill to the Senate, where Majority Leader Chuck Schumer along with McConnell are working for a quick passage by week’s end.

Senators, who have remained largely on the sidelines during much of the negotiations between the president and the House speaker, began inserting themselves more forcefully into the debate.

Some senators are insisting on amendments to reshape the package from both the left and right flanks. That could require time-consuming debates that delay final approval of the deal.

Democratic Sen. Tim Kaine of Virginia is “extremely disappointed” by the provision greenlighting the controversial Mountain Valley Pipeline, his office said in a statement. He plans to file an amendment to remove the provision from the package.

Republican Sen. Lindsey Graham of South Carolina complained that the military spending increases are not enough. “I will use all powers available to me in the Senate to have amendment votes to undo this catastrophe for defense,” he tweeted.

But making any changes to the package at this stage seems highly unlikely with so little time to spare. Congress and the White House are racing to meet the Monday deadline now less than a week away. That’s when Treasury Secretary Janet Yellen has said the U.S. would run short of cash and face an unprecedented debt default without action.

A default would almost certainly crush the U.S. economy and spill over around the globe, as the world’s reliance on the stability of the American dollar and the country’s leadership fall into question.

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Associated Press writers Darlene Superville, Mary Clare Jalonick and Farnoush Amiri contributed to this report.

The 17-year-old suffered a traumatic brain injury when he was shot while trying to pick up his younger brothers in April, the Kansas City Star reported.

Yarl walked with family, friends and other brain injury survivors Monday at Going the Distance for Brain Injury, a yearly Memorial Day race at Loose Park in Kansas City, Missouri.

“It takes a community. It takes a family. It takes a support group, all of that,” Yarl’s mother, Cleo Nagbe, said ahead of the race, adding: “Let’s raise more awareness to stop the things that cause brain injuries and should not be causing them, especially gun violence.”

As many as 1,000 people raced through the park, including many in neon green T-shirts who registered to be part of “Team Ralph,” said Robin Abramowitz, executive director of the Brain Injury Association of Kansas and Greater Kansas City.

“It’s important for Ralph to see that he is not alone,” Yarl’s aunt, Faith Spoonmore, said. She added that Yarl has debilitating migraines and issues with balance. He is also struggling with his emotions, mood changes and the trauma of the shooting.

Andrew Lester, an 84-year-old white man, is accused of shooting Yarl. The teen had confused Lester’s address with a home about a block away where he was supposed to pick up his siblings.

The shooting drew worldwide attention and prompted rallies and protests in the Kansas City area, with critics saying Lester was given preferential treatment when police released him just two hours after he was arrested.

WASHINGTON — An Army veteran who stormed the U.S. Capitol in a military-style formation with fellow members of the Oath Keepers was sentenced Friday to more than eight years in prison, a day after the far-right extremist group’s founder received an 18-year prison term in the Jan. 6, 2021 attack.

Jessica Watkins, of Woodstock, Ohio, was acquitted of the seditious conspiracy charge that Oath Keepers founder Stewart Rhodes was found guilty of in November, but jurors convicted her of obstruction and conspiracy to impede Congress’ certification of President Joe Biden’s victory.

She is the third member of the antigovernment group to receive her punishment this week in one of the most serious cases the Justice Department has brought in the riot. Rhodes’ 18 year-term is the longest sentence that has been handed down so far in the hundreds of Capitol riot cases.

U.S. District Judge Amit Mehta said that while Watkins was not a top leader, like Rhodes, she was more than “just foot soldier,” noting that at least three others charged in the riot wouldn’t have been there if she hadn’t recruited them to join. He sentenced her to 8 1/2 years behind bars.

“Your role that day was more aggressive, more assaultive, more purposeful than perhaps others,” he told her.

Watkins tearfully apologized for her actions before the judge handed down her sentence. She condemned the violence by rioters who assaulted police, but said she knows her presence at the Capitol “probably inspired those people to a degree.” She described herself as “just another idiot running around the Capitol” on Jan. 6.

“And today you’re going to hold this idiot responsible,” she told the judge.

During the nearly two-month trial in Washington’s federal court, lawyers for Watkins and the other Oath Keepers argued there was no plan to attack the Capitol. On the witness stand, Watkins testified she never intended to interfere with the certification and never heard any commands for her and other Oath Keepers to enter the building.

Evidence shown to jurors showed Watkins after the 2020 election messaging with people who expressed interest in joining her Ohio militia group about “military-style basic” training. She told one recruit: “I need you fighting fit” by the inauguration, which was Jan. 20, 2021.

On Jan. 6, Watkins and other Oath Keepers wearing helmets and other paramilitary gear were seen shouldering their way through the crowd and up the Capitol stairs in military-style “stack” formation. She communicated with others during the riot over a channel called “Stop the Steal J6″ on the walkie-talkie app Zello, declaring “we are in the main dome right now.”

Another Oath Keeper and fellow Army veteran — Kenneth Harrelson — will be sentenced later Friday. One of their other co-defendants, Florida chapter leader Kelly Meggs, was sentenced Thursday to 12 years behind bars for seditious conspiracy and other charges.

Rhodes, 58, of Granbury, Texas, was the first Jan. 6 defendant convicted of seditious conspiracy to receive his punishment for what prosecutors said was a weekslong plot to forcibly block the transfer of power from former President Donald Trump to Biden. Four other Oath Keepers convicted of the sedition charge during a second trial in January will be sentenced next week.

During his sentencing Thursday, Rhodes defiantly claimed to be a “political prisoner,” criticized prosecutors and the Biden administration and tried to play down his actions on Jan. 6. The judge described Rhodes as a continued threat to the United States who clearly “wants democracy in this country to devolve into violence.”

The Oath Keepers’ sentences this week could serve as a guide for prosecutors in a separate Jan. 6 case against leaders of the Proud Boys extremist group. Earlier this month, a different jury convicted former Proud Boys national chairman Enrique Tarrio and three other group leaders of seditious conspiracy for what prosecutors said was another plot to keep Trump in the White House.

Before Thursday, the longest sentence in the more than 1,000 Capitol riot cases was 14 years and two months for a man with a long criminal record who attacked police officers with pepper spray and a chair as he stormed the Capitol. Just over 500 of the defendants have been sentenced, with more than half receiving prison time.

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Richer reported from Boston.

WASHINGTON — Days from a deadline, President Joe Biden and House Speaker Kevin McCarthy are narrowing in on a two-year budget deal aiming to curb federal deficits in exchange for lifting the nation’s debt ceiling and staving off an economically devastating government default.

The Democratic president and Republican speaker hope to strike a budget compromise this weekend. With Republicans driving for steep cuts, the two sides have been unable to agree to spending levels for 2024 and 2025. Any deal would need to be a political compromise, with support from both Democrats and Republicans to pass the divided Congress.

But the budget flow isn’t the only hang-up.

A person familiar with the talks said the two sides are “dug in” on whether or not to agree to Republican demands to impose stiffer work requirements on people who receive government food stamps, cash assistance and health care aid, some of the most vulnerable Americans.

Yet both Biden and McCarthy expressed optimism heading into the weekend that the gulf between their positions could be bridged. A two-year deal would raise the debt limit for that time, past the 2024 presidential election.

“We knew this would not be easy,” McCarthy, R-Calif., said as he left the Capitol for the evening Thursday.

McCarthy said, “It’s hard, but we’re working and we’re going to continue to work until we get this done.”

House Republicans have pushed the issue to the brink, displaying risky political bravado in leaving town for the Memorial Day holiday. The U.S. could face an unprecedented default as soon as June 1, hurling the global economy into chaos.

In remarks at the White House, Biden said, “It’s about competing versions of America.”

“The only way to move forward is with a bipartisan agreement,” Biden said Thursday. “And I believe we’ll come to an agreement that allows us to move forward and protects the hardworking Americans of this country.”

Lawmakers are tentatively not expected back at work until Tuesday, just two days from the early June deadline when Treasury Secretary Janet Yellen has said the U.S. could start running out of cash to pay its bills and face a federal default.

Biden will also be away this weekend, departing Friday for the presidential retreat at Camp David, Maryland, and Sunday for his home in Wilmington, Delaware. The Senate is on recess and will return after Memorial Day.

Meanwhile, Fitch Ratings agency placed the United States’ AAA credit on “ratings watch negative,” warning of a possible downgrade.

Weeks of negotiations between Republicans and the White House have failed to produce a deal — in part because the Biden administration resisted negotiating with McCarthy over the debt limit, arguing that the country’s full faith and credit should not be used as leverage to extract other partisan priorities.

The White House has offered to freeze next year’s 2024 spending at current levels and restrict 2025 spending, but the Republican leader says that’s not enough.

“We have to spend less than we spent last year. That is the starting point,” said McCarthy.

One idea is to set those topline budget numbers but then add a “snap-back” provision that enforces the cuts if Congress is unable during its annual appropriations process to meet the new goals.

On work requirements for the aid recipients, the White House is particularly resisting measures that would drive Americans into poverty or take their health care, said the person familiar with the talks, who was granted anonymity to describe behind-closed-door discussions.

On the Republican demand to rescind money for the Internal Revenue Service, it’s still an “open issue” whether the sides will compromise by allowing the funding to be pushed back into other domestic programs, the person said.

Pressure is bearing down on McCarthy from the House’s right flank not to give in to any deal, even if it means blowing past the June 1 deadline.

“Let’s hold the line,” said Rep. Chip Roy, R-Texas, a Freedom Caucus member.

McCarthy said Donald Trump, the former president who is again running for office, told him, “Make sure you get a good agreement.”

Failure to raise the nation’s debt ceiling, now at $31 trillion, to pay America’s already incurred bills would risk a potentially chaotic federal default. Anxious retirees and social service groups are among those already making default contingency plans.

Even if negotiators strike a deal in coming days, McCarthy has promised lawmakers he will abide by the rule to post any bill for 72 hours before voting — now likely Tuesday or even Wednesday. The Democratic-held Senate has vowed to move quickly to send the package to Biden’s desk, right before next Thursday’s possible deadline.

In one potential development, Republicans may be easing their demand to boost defense spending, instead offering to keep it at levels the Biden administration proposed, according to another person familiar with the talks.

The teams are also eyeing a proposal to boost energy transmission line development from Sen. John Hickenlooper, D-Colo., that would facilitate the buildout of an interregional power grid, according to a person familiar with that draft. Those two people were also granted anonymity to discuss the private negotiations.

The White House has continued to argue that deficits can be reduced by ending tax breaks for wealthier households and some corporations, but McCarthy said he told the president as early as their February meeting that raising revenue from tax hikes was off the table.

While Biden has ruled out, for now, invoking the 14th Amendment to raise the debt limit on his own, Democrats in the House announced they have all signed on to a legislative “discharge” process that would force a debt ceiling vote. But they need five Republicans to break with their party and tip the majority to set the plan forward.

They are all but certain to claw back some $30 billion in unspent COVID-19 funds now that the pandemic emergency has officially been lifted.

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Associated Press writers Chris Megerian, Josh Boak, Zeke Miller and Mary Clare Jalonick contributed to this report.

WASHINGTON — The Supreme Court on Thursday sharply limited the federal government’s authority to police water pollution into certain wetlands, the second decision in as many years in which a conservative majority narrowed the reach of environmental regulations.

The outcome could threaten efforts to control flooding on the Mississippi River and protect the Chesapeake Bay, among many projects, wrote Justice Brett Kavanaugh, breaking with the other five conservatives. Environmental advocates said the decision would strip protections from tens of millions of acres of wetlands.

The justices boosted property rights over concerns about clean water in a ruling in favor of an Idaho couple who sought to build a house near Priest Lake in the state’s panhandle. Chantell and Michael Sackett objected when federal officials identified a soggy portion of the property as a wetlands that required them to get a permit before filling it with rocks and soil.

By a 5-4 vote, the court said in an opinion by Justice Samuel Alito that wetlands can only be regulated under the Clean Water Act if they have a “continuous surface connection” to larger, regulated bodies of water. There is no such connection on the Sacketts’ property.

President Joe Biden said the court’s decision defies science and undermines a law that has been used for a half-century to make American waters cleaner.

“The Supreme Court’s disappointing decision in Sackett v. EPA will take our country backwards. It puts our Nation’s wetlands – and the rivers, streams, lakes, and ponds connected to them – at risk of pollution and destruction, jeopardizing the sources of clean water that millions of American families, farmers, and businesses rely on,” Biden said in a statement.

The court jettisoned the 17-year-old opinion by their former colleague, Anthony Kennedy, allowing regulation of what can be discharged into wetlands that could affect the health of the larger waterways.

Kennedy’s opinion covering wetlands that have a “significant nexus” to larger bodies of water had been the standard for evaluating whether permits were required for discharges under the 1972 landmark environmental law. Opponents had objected that the standard was vague and unworkable.

Reacting to the decision, Manish Bapna, the chief executive of the Natural Resources Defense Council, called on Congress to amend the Clean Water Act to restore wetlands protections and on states to strengthen their own laws.

“The Supreme Court ripped the heart out of the law we depend on to protect American waters and wetlands. The majority chose to protect polluters at the expense of healthy wetlands and waterways. This decision will cause incalculable harm. Communities across the country will pay the price,” Bapna said in a statement.

The outcome almost certainly will affect ongoing court battles over new water regulations, including for wetlands, that the Biden administration put in place in December. Two federal judges have temporarily blocked those rules from being enforced in 26 states.

Congress voted in March to overturn the administration’s new water rule and, even though President Joe Biden vetoed the measure, the prospect of legislative action to restore wetlands protections anytime soon is remote.

The head of the Environmental Protection Agency, Michael S. Regan, credited the Clean Water Act with leading to “transformational progress” in cleaning up the nation’s waterways. “I am disappointed by today’s Supreme Court decision that erodes longstanding clean water protections,” Regan said in a statement.

Damien Schiff, who represented the Sacketts at the Supreme Court, said the decision appropriately narrowed the reach of the law. “Courts now have a clear measuring stick for fairness and consistency by federal regulators. Today’s ruling is a profound win for property rights and the constitutional separation of powers,” Schiff said in a statement issued by the property rights-focused Pacific Legal Foundation.

In Thursday’s ruling, all nine justices agreed that the wetlands on the Sacketts’ property are not covered by the act.

But only five justices joined in the opinion that imposed a new test for evaluating when wetlands are covered by the Clean Water Act. Chief Justice John Roberts, Justice Clarence Thomas and Alito would have adopted the narrower standard in 2006, in the last big wetlands case at the Supreme Court. They were joined Thursday by Justices Neil Gorsuch and Amy Coney Barrett.

Kavanaugh and the court’s three liberal justices charged that their colleagues had rewritten that law.

Kavanaugh wrote that the court’s “new and overly narrow test may leave long-regulated and long-accepted-to-be regulable wetlands suddenly beyond the scope of the agencies’ regulatory authority.”

Justice Elena Kagan wrote that the majority’s rewriting of the act was “an effort to cabin the anti-pollution actions Congress thought appropriate.” Kagan referenced last year’s decision limiting the regulation of greenhouse gas emissions under the Clean Air Act.

In both cases, she noted, the court had appointed “itself as the national decision-maker on environmental policy.” Kagan was joined in what she wrote by her liberal colleagues Sonia Sotomayor and Ketanji Brown Jackson.

The Sacketts paid $23,000 for a 0.63-acre lot near Priest Lake in 2005 and started building a three-bedroom home two years later.

They had filled part of the property, described in an appellate ruling as a “soggy residential lot,” with rocks and soil in preparation for construction, when officials with the EPA showed up and ordered a halt in the work.

They also won an earlier round in their legal fight at the Supreme Court.

The federal appeals court in San Francisco upheld the EPA’s determination in 2021, finding that part of the property, 300 feet from the lake and 30 feet from an unnamed waterway that flows into the lake, was wetlands.

The Sacketts’ own consultant had similarly advised them years ago that their property contained wetlands.