“Pain and Profit,” a 16-month Dallas Morning News investigation into mismanaged health care in Texas by reporters J. David McSwane and Andrew Chavez is the winner of the 2018 Worth Bingham Prize for Investigative Journalism.

Using extensive public records and leaked state data, McSwane and Chavez discovered that health care companies in the state made billions of dollars while denying or stalling crucial taxpayer-funded medications and treatments to thousands of sick children and disabled Texans. Those actions caused significant and needless suffering.

The reporters also found that top health officials and lawmakers were aware of the problems yet kept them hidden from the public. The state rarely penalized the companies involved, and patients who were denied crucial services almost always lost appeals.

The series began with a tip regarding D’ashon Morris—a young foster child who had been denied around-the-clock nursing care and suffered brain damage—along with complaints from dozens of parents who said private Medicaid contractors were endangering their sick and disabled children.

Investigating the leads was challenging since medical records are confidential and foster children’s records in Texas are sealed under state law, but McSwane and Chavez persevered, filing more than 170 public records requests that produced 70,000 pages of records.

To do their reporting, McSwane and Chavez reviewed thousands of spreadsheets, met with reluctant sources and accepted leaked files through encrypted apps. Chavez analyzed 20 years of lobbying data to tell the story of the revolving door of regulators-turned-lobbyists and a ballooning health care industry lobby with close ties to the governor.

Just days after The Dallas Morning News began publishing the eight-part “Pain and Profit” series, state lawmakers launched official inquiries, and Texas health officials publicly acknowledged that the program needed to be fixed. Although the Texas legislature only meets every other year, top lawmakers reached a rare out-of-session agreement to spend $7 million more a year to hire nearly 100 new regulators, including nurses, to check on patients in their homes. The state’s child welfare agency also now tracks when the 30,000 foster children in Texas are denied medical treatment.

Some two dozen bills were introduced to address problems exposed in the series and there is broad bipartisan support for reforms, including instituting a third-party review by medical staff when patients are denied treatments and devices.

Bingham Prize judges noted the swift and significant impact of the reporting, the excellent writing and the sensitive approach to the vulnerable patients profiled in the series. They additionally were struck by the injustice of the offenses and the time taken to identify victims who otherwise would have remained hidden, voiceless and sacrificed for profit.

Bingham judge Denise-Marie Ordway said: “The effort and skill that went into this series are truly impressive. With powerful storytelling and rich detail, the team was able to clearly demonstrate and explain the failures and coverups they found within a complex system involving government and private companies. I’m not ashamed to say I wept in anger and despair as I read about the challenges families and individuals faced to get the care they needed to live or, quite literally, to breathe.”

In addition to McSwane and Chavez, the team members who produced the series are: Tom Fox, photographer/videographer; Leslie Eaton, editor; Frank Christlieb and Clay Morton, copy editors; Irwin Thompson, photo editor; and John Hancock, interactives editor.

Four finalists for the Bingham Prize were recognized this year.

• “Denied Justice” reported by Brandon Stahl, Jennifer Bjorhus, MaryJo Webster and Hannah Covington in Minnesota’s Star Tribune
• “Toxic City: Sick Schools” by Barbara Laker, Wendy Ruderman, Dylan Purcell, Jessica Griffin and Garland Potts in The Philadelphia Inquirer
• “Trump Engaged in Suspect Tax Schemes as He Reaped Riches From his Father” by David Barstow, Susanne Craig and Russ Buettner in The New York Times
• The “Beach House Sheriff,” series reported by Connor Sheets for the Alabama Media Group

Bingham judge Stuart Watson said: “At a time when journalists are under attack, it is particularly encouraging to witness work of such breadth and depth. As judges and working journalists ourselves, most of us were torn between multiple entries, each quite deserving of the prize. I’m inspired by all the entries and you can see by the list of finalists just how difficult a call it was. Should my hopes flag for the future of a free, vibrant and independent media, I need only look to work like this for motivation to press on. I’m humbled and honored by these contemporaries.”

The $20,000 Bingham Prize will be presented on May 1, 2019, at the Nieman Foundation for Journalism at Harvard University in Cambridge, Mass.

The seven journalists who judged the Bingham submissions received this year are:

Maryclaire Dale, legal affairs reporter for The Associated Press and a 2018 Nieman Fellow; Tyler Dukes, an investigative reporter at WRAL News in Raleigh, N.C., and a 2017 Nieman Fellow; Carol Marbin Miller, a senior investigative reporter at The Miami Herald and winner of the Bingham Prize in 2017 for “Fight Club” and in 2014 for “Innocents Lost”; Nneka Nwosu Faison, managing editor of WCVB-TV’s “Chronicle” program and a 2018 Nieman Fellow; Denise-Marie Ordway, managing editor of Journalist’s Resource at Harvard University’s Shorenstein Center for Media, Politics and Public Policy and a 2015 Nieman Fellow; Michael Petrou, historian, journalist and 2018 Nieman Fellow, currently a fellow-in-residence and adjunct professor at Carleton University; and Stuart Watson, an investigative reporter based in Charlotte, N.C., and a 2008 Nieman Fellow.

The Worth Bingham Prize honors investigative reporting of stories of national significance where the public interest is being ill-served. Worth Bingham, who died at the age of 34, achieved prominence as an investigative journalist and was vice president and assistant to the publisher for the Louisville Courier-Journal. He was a 1954 Harvard University graduate. His family and friends created the annual prize in his memory in 1967.

The Nieman Foundation for Journalism at Harvard educates leaders in journalism and elevates the standards of the profession through special programs that convene scholars and experts in all fields. More than 1,600 journalists from 97 countries have been awarded Nieman Fellowships since 1938. The foundation’s other initiatives include Nieman Reports, a quarterly print and online magazine that covers thought leadership in journalism; Nieman Lab, a website that reports on the future of news, innovation and best practices in the digital media age; and Nieman Storyboard, a website that showcases exceptional narrative journalism and explores the future of nonfiction storytelling.