On a recent Friday morning, Alyssa Laxamana arrived at a laboratory on the UC Davis campus to continue California’s race against bird flu.

A note from her supervisor had alerted Laxamana that about 130 samples of cow milk and other dairy products were en route — a large but manageable workload. She got to work preparing the buffer solutions and other supplies she would need to test the samples for H5N1 influenza, the virus that causes the flu spreading through California’s cattle and poultry farms.

Laxamana’s plans, however, quickly went out the window. More samples kept popping up in a digital queue as another lab worker logged unexpected shipments. Around noon she had to draw a line. She calculated she could get through about 270 samples that day. The rest would have to wait.

“I can only do so much,” Laxamana recalled saying to herself.

Laxamana works in the biotechnology department of the California Animal Health and Food Safety Laboratory, the first line of defense in the state’s effort to track and prevent the spread of the H5N1 virus.

Far from working at full capacity, however, the Davis lab has been roiled over the past year by workplace tensions. Understaffing and poor management, Laxamana and other current and former employees say, have left lab employees overworked and struggling to keep pace with testing demands, while creating an environment where mistakes are more likely. An exodus of most of the staff this year left Laxamana and a co-worker for a period as the only two people testing for the virus on a daily basis.

The stakes for the lab are high: It is the only lab in the state with the authority to confirm bird flu cases. Although there is no evidence that the alleged workplace problems have contributed to an outbreak, processing tests quickly gives farmers a jump on quarantining or culling infected animals.

“Any potential delay in testing could result in greater spread,” said Richard Webby, a virologist at St. Jude Children’s Research Hospital in Tennessee, who specializes in influenza in birds and other animals.

The problems come amid a rising tide of bird flu cases at poultry and dairy farms and an increasing threat to humans. Last week the Davis lab confirmed the virus had been found in a retail sample of raw milk from a Fresno-based dairy, which health officials warn may have been sold in stores in Los Angeles County. And, so far, about 30 people in the state — the vast majority of them dairy workers — are known to have been infected.

Bill Kisliuk, a spokesperson for UC Davis, denied that workplace issues have left the lab ill-equipped to handle bird flu testing. He said the facility has “maintained the supervision, staffing and resources necessary to provide timely and vital health and safety information to those asking us to perform tests throughout the current outbreak of avian flu.”

After The Times inquired about staffing levels and other workplace issues, the Governor’s Office of Emergency Services inspected the lab in October, while UC Davis officials hired more staff and got help from a lab in Wisconsin, according to current staff. UC Davis officials declined to confirm the moves.

The spokesperson for the California Department of Food and Agriculture, which jointly operates the lab, deferred questions to UC Davis, saying, “CAHFS lab has done tremendous work under demanding circumstances.”

The virus is taking a rising toll on the state’s dairy and poultry industries. Since September, outbreaks at turkey farms, chicken broilers, egg-laying facilities and other producers around the state have affected more than 6 million birds, according to USDA data. And while the virus is less lethal in cows than birds, dead cows and calves have piled up along roadsides in Tulare County, with farmers and veterinarians reporting mortality rates far higher than expected. Also worrisome for a state that produces 20% of the country’s milk is the steep drop-off in milk production farmers have reported among cows that recover from the flu.

Discontent over staffing, pay and other alleged workplace issues has pervaded the lab over the past two years, emails and other communications reviewed by The Times show.

In May 2023, employees in the biotechnology section sent a petition to the lab’s managers demanding they address the staff’s concerns. After getting no reply, they sent another note viewed by The Times in November, accusing managers of refusing “time and again” to make improvements. Their workload, they added, had “measurably increased” since the temporary closure of the another CAHFS lab in Tulare earlier that year due to flooding.

“We operate with the mindset that the next outbreak is always around the corner, and we need proper training opportunities and competitive salary to remain adequately staffed for that eventuality,” they wrote.

Several lab staff quit their jobs in the first half of 2024, leaving behind what they described as a relatively inexperienced, skeletal crew.

Helen Kado-Fong, a supervisor who had worked in the biotechnology department for about 12 years decided to retire early in May. She said she had become fed up with what she described as an attitude of indifference or hostility toward efforts by her and others in the lab to raise concerns.

In an email she sent a few months before she left to the dean of UC Davis veterinary school and CAHFS director, Kado-Fong warned the “high turnover and disengagement of technical staff is weakening the ability of the CAHFS laboratory to fulfill its mission.”

Another to quit was Kayla Dollar, a lab assistant in the department for about two years, who said she left in June after being rejected for a promotion to a lab technician. Dollar said she was told she didn’t get the job because she didn’t have sufficient experience. Dollar said she was perplexed by the explanation because her supervisor Kado-Fong had been trying to get the OK to have Dollar receive training to prepare her for the technician role.

“I was hitting a wall at every turn,” Dollar said.

Dollar was hired at a UC Davis veterinary genetics lab in June as a biotechnologist, the same position she had been rejected from at CAHFS.

And Jasmine Burke quit her post as one of the lab’s technicians in July, she said, after being threatened with discipline for raising concerns about long work hours and rushed testing procedures. She and others said that as the lab rushed to meet 24-hour turnaround times for bird flu testing, other types of tests became backlogged, and she and other staff failed at times to keep up with routine lab maintenance, such as recalibrating machines and ensuring refrigerators holding samples and chemical solutions were set at the correct temperature.

“Every attempt to communicate concerns here goes nowhere,” she wrote to the university’s human resources department, according to an email viewed by The Times. Burke now works as a barista at a coffee shop.

Kisliuk, the UC Davis spokesperson, declined to respond to questions about specific incidents involving employees. “When a staff member reports concerns about workplace safety or conditions, we review the matter and take the appropriate steps,” he wrote in an emailed statement.

By July, five employees had departed, leaving behind only Laxamana and colleague Victoria Ontiveros, who have worked in the lab for two years or less.

Late one afternoon on a day in September, Ontiveros recalled how she changed into scrubs and donned two sets of surgical gloves, goggles, an N95 mask, a lab coat and a hairnet — the required gear for entering the Biosafety Level 3 lab, or BSL-3, where samples suspected of containing the virus are tested. Only approved staff can enter the facility through a locked door that requires an iris scan to open.

California officials have blocked Raw Milk dairy in Fresno from distributing its raw dairy products.

(Tomas Ovalle / For The Times)

Ontiveros had already done several long shifts in the BSL-3 that week, which with normal staffing would have been divided among multiple people, she said. Now, she was preparing to test cow milk samples that had arrived at the lab around 2 p.m. Typically, samples received after noon were tested the following day, but she said her supervisors had insisted these needed to be turned around quickly as infections spread.

She said she worked for hours, painstakingly pipetting drops of the samples into tiny glass wells as part of the testing process, which extracts genetic material in order to detect the presence of the virus. Then, late in the evening, she realized she had programmed one of the machines analyzing the samples incorrectly. Ontiveros felt a sharp pang of despair. All her work, and the hours Laxamana had spent earlier in the day mixing a chemical solution to wash the samples, had been wasted.

It was around 9 p.m. when she emerged from the lab. She had started her workday around 8 a.m. The tests would have to be redone the next day.

“We are stretched so thin that mistakes can happen,” Ontiveros said. “I was so tired and mentally drained.”

At the time, Ontiveros said she was handling the testing of cow milk largely on her own, although another worker was sometimes sent up from the Tulare lab to help on weekends. While Laxamana had the required security clearance, she hadn’t yet completed the necessary training.

“There’s this huge pressure on me and and responsibility to show up to work every day because I have no backup,” Ontiveros said.

Later in September, Laxamana described being put straight to work as the number of cattle milk samples was ramping up. She said she was asked to run 44 samples without ever having completed a practice run. The only hands-on training she had had was twice shadowing the testing process. As Laxamana worked, Ontiveros stood nearby, supervising.

Already nervous, Laxamana said she was distracted by a walkie-talkie that crackled with voices as she tried to work. Colleagues in the main lab were peppering her with questions about what to do about another batch of tests that appeared to have failed. Holding a pipette carefully in one hand, Laxamana talked through the radio to troubleshoot the problem.

At times this year understaffing has led to quality control missteps, current and former workers said.

Laxamana described coming to work one morning in October and realizing results of tests she had run the day before had not been analyzed properly by lab staff. She said a manager assured Laxamana the errors would be corrected, but when she checked later that day the results had not been changed.

She said she stopped a case coordinator from releasing the incorrect results to farmers, which would have resulted in the culling of birds.

Earlier this year, a poultry sample got misplaced and went untested for three weeks, Laxamana said. She attributed the mistake to being overworked, saying, “There were only two people handling the workload, and things were missed in all of that chaos.”

Kisliuk, the UC Davis spokesperson, declined to answer questions about specific incidents described where workers made mistakes or where managers made mistakes. “We have multiple levels of quality assurance and extensive training of staff,” he said.

In late summer the lab hired a supervisor and others to join the lab. The move created additional work for Laxamana and Ontiveros, who said they were required to juggle their own work while also helping with training the new arrivals.

In recent weeks the supervisor and another new hire took over testing of high-risk poultry samples, but Laxamana and Ontiveros said staffing shortages remain.

Still, Laxamana doesn’t think about leaving.

“There are things that I can do to help prevent a disaster,” she said.“I could not bear to leave the lab in the condition that it is right now.”

A line of immigrant workers formed outside an office building in Koreatown on a recent Friday afternoon.

They followed makeshift signs to a small courtyard, where scores of volunteer lawyers, translators and other staff helped them apply for a little-known federal program that offers an unusual — and probably fleeting — reprieve from deportation.

Under the Deferred Action for Labor Enforcement program, people in the U.S. illegally who work at companies under investigation for workplace violations can receive permission to work in the country for four years. The program, which was started during the Biden administration, is intended to encourage undocumented workers to cooperate with investigations into safety violations, employment abuses and other issues without fear that their immigration status will be used against them.

Earlier registration clinics like the three-day push that the Koreatown Immigrant Workers Alliance began Nov. 8 drew little interest. But President-elect Donald Trump’s promise to deport millions of people when he returns to office has reignited fears among the millions of people living and working in the U.S. illegally. More than 500 workers turned up at the KIWA event, several hundred more than initially expected, as information about the government program and the registration clinic spread by word of mouth.

With applications averaging 60 days to be processed, the workers found themselves in a race against the clock to try to secure four years of protections before Trump takes office Jan. 20. With time running out, aid groups are ending their registration efforts. Hundreds of workers from California traveled to Las Vegas over the weekend, where Arriba, an organization that helped run the Koreatown event, held a final registration clinic.

Although Trump is widely expected to do away with the program, immigrant labor advocates said they don’t expect that officials in the new administration will rescind work permits that already have been granted.

Bliss Requa-Trautz, executive director of Arriba, a Las Vegas-based advocacy group, said she warns workers of the risks that come with applying to the deferred action program: Although applications are meant to be confidential, applying nonetheless makes authorities aware that a worker is in the country illegally, giving rise to the possibility that they could be targeted for deportation afterward.

“Once you’re in the system you’re visible to the agencies, whereas otherwise folks might be flying under the radar,” said Alexandra Suh, executive director of the Koreatown worker center. “It’s a certain level of visibility that comes with a risk.”

Regardless, for many workers who take odd jobs under the table or use a false Social Security number to work, a temporary job permit can mean better pay and a temporary reprieve from the fear of being deported.

A man who said he immigrated to the United States from Chihuahua, Mexico, more than 20 years ago sat in a white plastic chair waiting his turn to meet with an attorney at the Koreatown registration drive. He learned about the clinic from some of his friends whom he used to work with at Bella+Canvas, a local apparel manufacturer and wholesaler. The company has worked with BaronHR, a staffing company that has come under scrutiny from federal agencies for alleged abuses of workers it recruits for warehouses, factories and distribution center jobs in California and elsewhere.

“I am sure my life is going to change,” said the man, who asked to be identified by only his first name, Hector. “I’m going to be able to take more work to help my family.”

During the Obama administration, authorities began granting relief to workers involved in some labor cases and the program was formalized under Biden at the beginning of 2023. As of the end of October, more than 7,700 workers had been granted protections under the program for assistance in more than 50 investigations by state and federal agencies, according to the Department of Homeland Security. Over the summer, the length of the protection was expanded to four years from two.

An investigation of a chemical leak that killed six workers at a Georgia poultry plant in 2021 served as an early test case of how granting protections to workers could help bolster the collection of evidence and testimony, said Jessie Hahn, senior counsel for labor and employment policy at the National Immigration Law Center. Immigrant workers had initially hesitated to come forward because they feared retaliation by the plant’s owner, including a call to local police or Immigration and Customs Enforcement, she said.

“One thing to understand is that this program does not have a humanitarian purpose. It has a law enforcement purpose,” Hahn said. “The government is trying to facilitate investigations.”

Hahn said her organization has partnered with the United Farm Workers union to help farmworkers employed by major farms and labor brokers under investigation by California’s workplace safety agency enroll in the program.

Daniel Lopez, a spokesperson for California’s Department of Industrial Relations, said state labor agencies — including the Labor Commissioner’s office and the Division of Occupational Safety and Health — have submitted about 150 requests to the Department of Homeland Security requesting protections for workers employed by companies under investigation. Each request can cover multiple workers.

Attorney Yvonne Medrano of Los Angeles-based Bet Tzedek Legal Services, a nonprofit legal advocacy group, said the loss of the program would not only affect workers but also would create an uneven playing field for employers that follow the rules since it will become difficult to punish bad actors that are flouting minimum wage laws and other regulations.

“We want workers to speak out against bad employers because it benefits everybody,” she said.

To apply, a person must show a letter issued by a government agency naming the worker’s employer as the subject of an investigation and specifying the period covered by the inquiry. A worker admitted into the program is not required to cooperate with the investigation.

A worker who asked to be identified by only his first initial, “A,” because of fear of being identified as being in the country illegally, decided the day of the clinic to drive from Santa Fe Springs with his parents to the Koreatown clinic. He was among many workers at the clinic employed by BaronHR. Until the firm collapsed this year, workers whom the firm employed were often underpaid and working in unsafe conditions, according to a New York Times report published Sunday.

The 30-year-old, who immigrated to the United States from El Salvador with his family when he was 10, had been reluctant to apply to DALE over fears of reprisals if he spoke out about the staffing agency, which also employed his parents. And after so many years living in the country illegally, he also didn’t trust that the program really offered the possibility of working in the country legally.

“Growing up undocumented you grow skeptical, with a nonstop defense mechanism. Even though I’ve seen co-workers get permits, I haven’t accepted it,” A. said. “I’m protecting myself by not letting myself care too much.”

Around 5 p.m., as the light disappeared and the air grew chilly, Jovita Bautista, 50, stayed at her post at the check-in desk outside KIWA, where she had been stationed since 8 a.m. Bautista had applied for her work permit in early August, and received it weeks later.

She said she has been able to secure better-paying work, leaving behind her minimum-wage staffing agency job. She now does the same work, but because she is directly employed by the Intuit Dome in Inglewood, she is paid $22 per hour, she said.

Bautista said she admires Trump for what she describes as his business acumen, and said she owns three of his books. But she fears his impending presidency, because she worries about her siblings who are in the country without authorization.

“I like Donald Trump, but not as president.”

President-elect Donald Trump’s choice to run the sprawling government agency that administers Medicare, Medicaid, and the Affordable Care Act marketplace — celebrity doctor Mehmet Oz — recently held broad investments in healthcare, tech and food companies that would pose significant conflicts of interest.

Oz’s holdings, some shared with family, included a stake in UnitedHealth Group worth as much as $600,000, as well as shares of pharmaceutical firms and tech companies with business in the healthcare sector, such as Amazon. Collectively, Oz’s investments total tens of millions of dollars, according to financial disclosures he filed during his failed 2022 run for a Pennsylvania U.S. Senate seat.

Trump said Tuesday he would nominate Oz as administrator of the Centers for Medicare & Medicaid Services. The agency’s scope is huge: CMS oversees coverage for more than 160 million Americans, nearly half the population. Medicare alone accounts for approximately $1 trillion in annual spending, with more than 67 million enrollees.

UnitedHealth Group is one of the largest healthcare companies in the nation and arguably the most important business partner of the Centers for Medicare & Medicaid Services, through which it is the leading provider of commercial health plans available to Medicare beneficiaries.

UnitedHealth also offers managed-care plans under Medicaid, the joint state-federal program for low-income people, and sells plans on government-run marketplaces set up via the Affordable Care Act. Oz also had smaller stakes in CVS Health, which now includes the insurer Aetna, and in the insurer Cigna.

It’s not clear if Oz, a heart surgeon by training, still holds investments in healthcare companies, or if he would divest his shares or otherwise seek to mitigate conflicts of interest should he be confirmed by the Senate. Reached by phone on Wednesday, he said he was in a Zoom meeting and declined to comment.

An assistant did not reply to an email message with detailed questions.

“It’s obvious that over the years he’s cultivated an interest in the pharmaceutical industry and the insurance industry,” said Peter Lurie, president of the Center for Science in the Public Interest, a watchdog group. “That raises a question of whether he can be trusted to act on behalf of the American people.” (The publisher of KFF Health News, David Rousseau, is on the Center for Science in the Public Interest board.)

Oz used his TikTok page on multiple occasions in November to praise Trump and Robert F. Kennedy Jr., including their efforts to take on the “illness-industrial complex,” and he slammed “so-called experts like the big medical societies” for dishing out what he called bad nutritional advice. Oz’s positions on health policy have been chameleonic; in 2010, he cut an ad urging Californians to sign up for insurance under President Obama’s Affordable Care Act, telling viewers they had a “historic opportunity.”

Oz’s 2022 financial disclosures show that the television star invested a substantial part of his wealth in healthcare and food firms. Were he confirmed to run CMS, his job would involve interacting with giants of the industry that have contributed to his wealth.

Given the breadth of his investments, it would be difficult for Oz to recuse himself from matters affecting his assets, if he still holds them. “He could spend his time in a rocking chair” if that happened, Lurie said.

In the past, nominees for government positions with similar potential conflicts of interest have chosen to sell the assets or otherwise divest themselves. For instance, Treasury Secretary Janet Yellen and Atty. Gen. Merrick Garland agreed to divest their holdings in relevant, publicly traded companies when they joined the Biden administration.

Trump, however, declined in his first term to relinquish control of his own companies and other assets while in office, and he isn’t expected to do so in his second term. He has not publicly indicated concern about his subordinates’ financial holdings.

The Centers for Medicare & Medicaid Services’ main job is to administer Medicare. About half of new enrollees now choose Medicare Advantage, in which commercial insurers provide their health coverage, instead of the traditional, government-run program, according to an analysis from KFF, a health information nonprofit that includes KFF Health
News.

Proponents of Medicare Advantage say the private plans offer more compelling services than the government and better manage the costs of care. Critics note that Medicare Advantage plans have a long history of costing taxpayers more than the traditional program.

UnitedHealth, CVS and Cigna are all substantial players in the Medicare Advantage market. It’s not always a good relationship with the government. The Department of Justice filed a 2017 complaint against UnitedHealth alleging the company used false information to inflate charges to the government. The case is ongoing.

Oz is an enthusiastic proponent of Medicare Advantage. In 2020, he proposed offering Medicare Advantage to all; during his Senate run, he offered a more general pledge to expand those plans. After Trump announced Oz’s nomination for the Centers for Medicare & Medicaid Services, Jeffrey Singer, a senior fellow at the libertarian-leaning Cato Institute, said he was “uncertain about Dr. Oz’s familiarity with healthcare financing and economics.”

Singer said Oz’s Medicare Advantage proposal could require large new taxes — perhaps a 20% payroll tax — to implement.

Oz has gotten a mixed reception from elsewhere in Washington. Pennsylvania Sen. John Fetterman, the Democrat who defeated Oz in 2022, signaled he’d potentially support his appointment to the Centers for Medicare & Medicaid Services. “If Dr. Oz is about protecting and preserving Medicare and Medicaid, I’m voting for the dude,” he said on the social platform X.

Oz’s investments in companies doing business with the federal government don’t end with big insurers.

He and his family also hold hospital stocks, according to his 2022 disclosure, as well as a stake in Amazon worth as much as nearly $2.4 million. (Candidates for federal office are required to disclose a broad range of values for their holdings, not a specific figure.)

Amazon operates an internet pharmacy, and the company announced in June that its subscription service is available to Medicare enrollees. It also owns a primary care service, One Medical, that accepts Medicare and “select” Medicare Advantage plans.

Oz was also directly invested in several large pharmaceutical companies and, through investments in venture capital funds, indirectly invested in other biotech and vaccine firms. Big Pharma has been a frequent target of criticism and sometimes conspiracy theories from Trump and his allies. Kennedy, whom Trump has said he’ll nominate to be Health and Human Services secretary, is a longtime anti-vaccine activist.

During the Biden administration, Congress gave Medicare authority to negotiate with drug companies over their prices. CMS initially selected 10 drugs. Those drugs collectively accounted for $50.5 billion in spending between June 1, 2022, and May 31, 2023, under Medicare’s Part D prescription drug benefit.

At least four of those 10 medications are manufactured by companies in which Oz held stock, worth as much as about $50,000.

Oz may gain or lose financially from other Trump administration proposals.

For example, as of 2022, Oz held investments worth as much as $6 million in fertility treatment providers. To counter fears that politicians who oppose abortion would ban in vitro fertilization, Trump floated during his campaign making in vitro fertilization treatment free. It’s unclear whether the government would pay for the services.

In his TikTok videos from earlier in November, Oz echoed attacks on the food industry by Kennedy and other figures in his “Make America Healthy Again” movement. They blame processed foods and underregulation of the industry for the poor health of many Americans, concerns shared by many Democrats and more mainstream experts.

But in 2022, Oz owned stakes worth as much as $80,000 in Domino’s Pizza, Pepsi and US Foods, as well as more substantial investments in other parts of the food chain, including cattle; Oz reported investments worth as much as $5.5 million in a farm and livestock, as well as a stake in a dairy-free milk startup. He was also indirectly invested in the restaurant chain Epic Burger.

One of his largest investments was in the Pennsylvania-based convenience store chain Wawa, which sells fast food and all manner of ultra-processed snacks. Oz and his wife reported a stake in the company, beloved by many Pennsylvanians, worth as much as $30 million.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.