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Trust in COVID-19 Information Sources and Incident Persistent Symptoms in the CONSTANCES Cohort at Pandemic Onset

The following is a summary of “Trust in sources of information on COVID-19 at the beginning of the pandemic’s first wave and incident persistent symptoms in the population-based CONSTANCES cohort: A prospective study,” published in the June 2023 issue of the Psychosomatic Research by Matta et al.

This study aims to investigate the relationship between trust in various sources of information about COVID-19 at the onset of the pandemic and the incidence of persistent symptoms. This prospective investigation utilized data from the SAPRIS and SAPRIS-Sérologie cohorts within the French CONSTANCE cohort. From April 6 to May 4, 2020, the credibility of various information sources was evaluated. In December 2020 and January 2021, self-reports of persisting symptoms that manifested subsequently were collected. The psychological burden associated with somatic symptom disorder B was measured using the bodily symptom disorder B criteria scale (SSD-12). 

Adjustments were made for gender, age, education, income, self-assessed health, SARS-CoV-2 serology assays, and self-reported COVID-19 in the analyses. Among 20,985 participants [mean age (SD), 49.0 years (12.7); 50.2% female], those with greater trust in government/journalists at baseline reported fewer incident persistent symptoms at follow-up (estimate (SE) for one IQR increase: 0.21 (0.03), P<0.001). The odds ratio (95% CI) for one IQR increase in trust in government/journalists and medical doctors/scientists was 0.87 (0.82–0.91) and 0.91 (0.85–0.99), respectively. 

Among the 3,372 participants (16.1%) who reported at least one symptom, greater trust in government/journalists and medical doctors/scientists predicted lower SSD-12 scores (0.39 (0.17), P = 0.02 and 0.85 (0.24), P<0.001, respectively). In contrast, greater trust in social media predicted higher scores in those with less confidence in government/journalists (0.90 (0.34), P = 0.008). These associations were independent of surrogate markers of SARS-CoV-2 infection. Regardless of infection with SARS-CoV-2, trust in information sources on COVID-19 may be associated with incident persistent symptoms and psychological burden.


Doctors who put lives at risk with covid misinformation rarely punished

The Washington Post


July 26, 2023 at 6:00 a.m. EDT

(Video: Illustrations by Laura Padilla Castellanos/The Washington Post; Documents obtained by The Washington Post; iStock)

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A Wisconsin doctor in 2021 prescribed ivermectin, typically used to treat parasitic infections, to two covid-19 patients who later died of the disease. He was fined less than $4,000 — and was free to continue practicing.

A Massachusetts doctor has continued practicing without restriction despite being under investigation for more than a year over allegations of “disseminating misinformation” and prescribing unapproved covid treatments, including ivermectin, to a patient who died in 2022, according to medical board records.

And in Idaho, a pathologist who falsely promoted the effectiveness of ivermectin over coronavirus vaccines on social media has not been disciplined despite complaints from fellow physicians that his “dangerous and troubling” statements and actions “significantly threatened the public health.”

Across the country, doctors who jeopardized patients’ lives by pushing medical misinformation during the pandemic and its aftermath have faced few repercussions, according to a Washington Post analysis of disciplinary records from medical boards in all 50 states.

State medical boards charged with protecting the American public often failed to stop doctors who went against medical consensus and prescribed unapproved treatments for covid or misled patients about vaccines and masks, the Post investigation found.

At least 20 doctors nationally were penalized for complaints related to covid misinformation between January 2020 and June 2023, according to board documents, which The Post obtained by filing requests with state medical boards and reviewing public records. Five of those doctors lost their medical licenses — one had his revoked, while four surrendered theirs. Discipline is typically connected to patient care, not just what doctors say.

It is impossible to know how many doctors were spreading misinformation because most states do not monitor or divulge those complaints. But The Post’s requests to the boards yielded at least 480 covid-misinformation-related complaints in the last three years — meaning only a tiny fraction of those led to disciplinary action.

The Post investigation, which included a review of more than 2,500 medical board documents, lawsuits and news stories as well as interviews with more than 130 current and former medical board staffers, physicians, patients, health officials and experts, is the most comprehensive national accounting of the consequences for doctors spreading medical misinformation related to the pandemic.

Many of the complaints relate to doctors promoting ivermectin or hydroxychloroquine, which have been disproved as effective covid treatments and are not recommended by the Centers for Disease Control and Prevention or authorized by the Food and Drug Administration for covid. Health authorities caution that these treatments, which President Donald Trump and his allies frequently touted when he was in office, not only can have dangerous side effects but also may delay patients from seeking proper medical care.

The political polarization fueled by the pandemic spawned a torrent of medical misinformation and exposed the nation’s fragmented system of monitoring the more than 1 million physicians licensed in the United States. State medical boards — the professional licensing agencies composed mostly of doctors — are supposed to investigate complaints and discipline physicians who endanger public health.

But they are barely able to keep up with the more mundane task of issuing licenses, doctors say, let alone monitor social media, where many of the false claims proliferate. Critics say the system is not up to the task of overseeing the medical industry, and was particularly unable amid the explosion of misinformation that accompanied the pandemic.

“We allow the profession to police themselves. And when they fail to do that, even in the most egregious cases, what they are abetting is the erosion of trust and respect for doctors,” said Wendy Parmet, director of Northeastern University’s Center for Health Policy and Law, who has written about the harms of covid misinformation.

No organization monitors how many physicians have been penalized for spreading covid misinformation.

In addition to the doctors who have been disciplined, board documents show that as of June, at least 12 are under investigation for actions linked to the spread of misinformation, a costly and opaque legal process that can drag on for years. State medical boards flagged at least three other doctors on their websites, signaling that they had done something that regulators disagreed with but that didn’t warrant discipline.

Some of the doctors cited in the misinformation-related complaints have defended their actions by saying they adhered to covid-treatment guidelines recommended by organizations that promote alternative therapies — guidelines rejected by major medical societies and government agencies. They said patients died of covid — not because of misinformation or the therapies they provided.

Doctors don’t normally face discipline for promoting treatments that go against medical consensus because state boards are loath to tread on physicians’ medical judgment and First Amendment rights, according to doctors and members of medical boards. Physicians commonly prescribe drugs for conditions other than those they were approved for, a practice known as “off-label” use that boards do not want to curtail.

“State boards can only do limited things,” said Humayun Chaudhry, president of the Federation of State Medical Boards, a nonprofit that represents the licensing agencies. “The most common refrain I hear from state licensing boards is they would like to have more resources — meaning more individuals who can investigate complaints, more attorneys, more people who can process these complaints sooner — to do their job better.”

Instead, the opposite is happening: The boards face new efforts, largely by Republican state legislators and attorneys general, to rein in their authority in ways that are “potentially dangerous and harmful to patient care,” Chaudhry said.

Florida legislators passed a law in May that effectively prevents professional boards from punishing doctors accused of spreading covid misinformation online.

Six other states have limited the power of medical boards to discipline physicians for prescribing ivermectin or hydroxychloroquine.

Ryan Stanton, an emergency room doctor in Lexington, Ky., said he has struggled to treat patients who took as gospel the ineffective treatments some doctors tout on social and right-wing media. One couple in their 60s with covid symptoms wanted only ivermectin in 2021, he recalled. He instead recommended approved treatments, such as steroids, monoclonal antibodies and the antiviral Remdesivir. The couple refused, ending up on respirators and dying of covid days later, he said.

“We can’t have physicians out there using their medical degrees to profess their own beliefs that are just wildly outside the accepted practice of medicine,” Stanton said. “Millions of people latched on to them tightly.”

Death by misinformation

Some doctors who provided patients with ivermectin have said they were following treatment protocols recommended by the Front Line Covid-19 Critical Care Alliance, a group of doctors promoting ivermectin as a covid panacea.

In Wisconsin, Edward Hagen prescribed ivermectin to a covid patient in his 50s during a virtual visit in October 2021, after the FDA and CDC had warned against prescribing the drug for covid. The patient, identified only as “G.N.,” died four days later of “probable COVID-19 infection,” according to state disciplinary records.

Hagen prescribed ivermectin to another patient, identified as “J.R.” in state records, who died of covid complications in 2022.

Hagen told The Post he could not force people to go to the hospital when they became sicker. “They didn’t pass away from ivermectin,” he said. “They passed away from covid.”

The Wisconsin medical board reprimanded Hagen in February 2023 for “failing to conform to the standard of minimally competent medical practice which creates an unacceptable risk of harm to a patient or the public,” according to the records. The board suspended his medical license, but the suspension was immediately set aside because Hagen had agreed to complete nine hours of education and pay $3,943 to cover the costs of the board investigation.

Hagen said he would still prescribe ivermectin today because he believes in its effectiveness, despite multiple scientific studies disputing that claim.

“It’s not uncommon to use things off-label,” he said. “It’s not illegal to use things off-label.”

Hagen stressed that he told patients he followed treatment guidelines promoted by the Front Line Covid-19 Critical Care Alliance. Unlike doctors, the alliance does not answer to state medical boards, which license only individuals.

Massachusetts physician John Diggs is under investigation for prescribing ivermectin and hydroxychloroquine to a patient with covid symptoms who died in 2022 after being intubated, according to state medical board documents and the board’s executive director. The board alleged that Diggs prescribed the medications despite “clear evidence for the lack of any clinical benefit of hydroxychloroquine” and the fact that “ivermectin has been proven ineffective.”

The medical board accused Diggs of providing treatment to two patients that fell “below the standard of care.” It also accused him of “disseminating misinformation” on a Worcester, Mass., radio program in December 2020 when he promoted unproven coronavirus treatments touted by the alliance. At least two physicians lodged complaints in 2021 accusing him of “physician misconduct related to egregious COVID-19 misinformation and medical care well outside of the standard of care” and alleging “significant risk of patient harm,” board records show.

“We fear that other patients may be at risk because of similar actions and ask the Board to investigate and act decisively,” wrote the physicians, whose identities were redacted by the board.

But Diggs’s patients would not know about the complaints, let alone that he has been under investigation since 2022, even if they knew to check the state database for disciplinary action. The Massachusetts medical board, like those in many states, discloses only final outcomes on its website — not complaints against doctors under investigation.

The Post obtained the information after asking the state medical board for records pertaining to all covid misinformation investigations.

Diggs declined to comment after consulting with his lawyer, who did not respond to questions about the case.

In documents detailing his response to board charges, Diggs denied disseminating misinformation on the radio program but admitted to prescribing ivermectin and hydroxychloroquine and advocating for treatment of covid based on “studies from recognized medical professional organizations.” His lawyer, in the documents, accused the board of violating Diggs’s free-speech rights by “attempting to inhibit the expression of his medical opinions.”

Paul Marik, co-founder and chief scientific officer of the Front Line Covid-19 Critical Care Alliance, declined to comment on Hagen’s or Diggs’s cases.

“We are not familiar with the case in Wisconsin or the investigation in Massachusetts and unable to comment on any specifics of either,” Marik said in a statement. He pointed to the “scientific and clinical evidence” cited by the alliance in its treatment protocol. Major scientific studies have disproved the effectiveness of ivermectin in treating covid.

Public trust in science and the expertise and authority of government health officials eroded during the pandemic as basic tools to prevent disease became politicized, allowing falsehoods about the virus to fill the void, said Richard Baron, chief executive of the American Board of Internal Medicine. The decline in trust is especially apparent among Republicans, according to polling by KFF, a nonprofit focused on national health issues, and Pew Research Center.

Much of the mistrust can be traced to confusing guidance about masks released by the CDC throughout the pandemic, according to clinicians and health officials. Politicization of the pandemic further undermined public confidence. Trump frequently promoted the benefits of unproven treatments from the White House podium despite the lack of evidence that they worked for covid. Doctors who espoused such treatments were given platforms on Fox News and invited by Republican legislators to testify in statehouses. A Fox News spokeswoman declined to comment.

U.S. Surgeon General Vivek H. Murthy and FDA Commissioner Robert M. Califf have singled out misinformation as an urgent threat to public health given the lives that could have been saved by coronavirus vaccines and antivirals. Califf frequently refers to misinformation as a leading cause of preventable death.

“In many people we lost the ideological battle, and they died completely unnecessarily,” Califf said during an appearance at the Aspen Ideas Festival in June.

A widow and a lawsuit

In Nevada, Jelena Hatfield and her husband, Jeremy Parker, did not believe what federal health officials said about the safety or effectiveness of the coronavirus vaccines and refused to get a shot.

Instead, Hatfield said the couple sought what Trump had touted early in the pandemic as an alternative way to protect themselves: hydroxychloroquine. After Trump’s repeated promotion, the FDA issued an emergency-use authorization in March 2020 allowing the antimalarial drug to be used to treat covid. By early June of that year, however, virtually every published study reported that the medication was not effective in reducing death or illness, and the FDA revoked its authorization because of reports of serious side effects, including heart problems.

But a year later, Medina Culver, a family medicine physician in Henderson, Nev., prescribed hydroxychloroquine to Parker as a preventive treatment during a telehealth visit, Hatfield said. She said that Parker had connected with Culver through America’s Frontline Doctors, which shot to prominence in 2020 by challenging pandemic health guidance, and that the doctor never performed a physical exam of her husband.

In January 2022, Parker began having cold-like symptoms, assumed he had contracted covid and, unbeknown to his wife or Culver, took the medication that he had stashed away. The 52-year-old construction worker died within days, Hatfield said.

An autopsy uncovered a small abnormality in Parker’s heart, but the coroner’s office told Hatfield it wasn’t serious enough to kill him, she said. Her husband’s death certificate reads: “Sudden Death In The Setting Of Therapeutic Use Of Hydroxychloroquine.”

Hatfield and the couple’s three children — 9, 15 and 17 — filed a wrongful-death lawsuit in February 2023 against America’s Frontline Doctors and Culver. Hatfield blames the doctors’ group for promoting the disproven covid treatment and Culver for prescribing hydroxychloroquine without examining her husband in person or taking into account his history of high blood pressure, a condition that can lead to heart disease.

On June 12, a state judge denied separate motions by Culver and America’s Frontline Doctors to dismiss the lawsuit. Culver has denied causing Parker’s death. Judge Barry L. Breslow wrote that the evidence was sufficient for the lawsuit to proceed, including a physician expert who said that, “to a reasonable degree of medical probability, Mr. Parker’s ingestion of hydroxychloroquine caused his death.”

Culver did not respond to requests for comment. One of her lawyers, in an email, declined to comment because of “on-going litigation.”

Jose Jimenez, an attorney for America’s Frontline Doctors, in an email to The Post, claimed the safety and efficacy of hydroxychloroquine for covid, citing “389 studies.” Jimenez said the questions asked by The Post show an “egregiously incorrect premise and conclusion based on a random lawsuit in Nevada that attempts a random and erroneous connection” to the doctors’ group.

Culver has not been disciplined, according to state records. In Nevada, as in most states, the medical board disciplinary process is usually triggered only when someone files a complaint, action that Hatfield said she is still considering against Culver. Hatfield said she chose to first file a lawsuit — one way to hold physician groups such as America’s Frontline Doctors accountable for spreading medical misinformation — because she is seeking financial compensation after losing the family’s sole breadwinner. State medical boards do not provide wrongful-death compensation.

“How many families are out there like me, and they still have that hydroxychloroquine in their cabinet waiting for a rainy day,” Hatfield said, “and then that actually be the thing that kills them?”

Neutered medical boards

Following the rise in online covid misinformation, the Federation of State Medical Boards warned in July 2021 that doctors who engaged in the spread of misinformation risked losing their medical licenses.

Two-thirds of state medical boards reported increased complaints “related to licensee dissemination of false or misleading information,” according to a 2021 federation survey of the boards.

But the amplification of medical misinformation on social media “has not been accompanied by any increase in accountability for those who disseminate the misinformation and disinformation,” the federation noted in a 2022 report.

As of June, medical boards in at least 14 states had taken disciplinary action against one or more physicians for misinformation-related causes, The Post’s analysis shows. Nine of those states have Democratic governors, leaving more-conservative swaths of the country unprotected given that board members are usually appointed by the governor, subjecting them to political head winds.

Polls show that Americans who trust conservative news sources are more likely to believe covid misinformation. Many GOP leaders have framed the right of physicians to prescribe unapproved covid treatments as part of the larger battle over “medical freedom.”

And state medical boards face growing barriers to holding doctors accountable.

In the last two years, Missouri, North Dakota and Tennessee have passed laws that would protect doctors from disciplinary actions for prescribing ivermectin, according to The Post’s review of more than 80 bills, including those identified by the Federation of State Medical Boards, the Association of State and Territorial Health Officials and the Center for Public Health Law Research at Temple University.

Republican state Sen. Rick Brattin, who added the provision to the Missouri bill on professional licensing, told The Post that much of what doctors do in their day-to-day practice is either “off-label” or “not based on definitive randomized controlled clinical trials.”

“This is how medicine is practiced,” Brattin said in an email. The fact that some in the medical establishment want to punish doctors for doing what they believe is in the best interest of their patients shows “ideological bias and a desire to suppress dissent from the prevailing orthodoxy,” he said.

In addition, attorneys general in six states — Indiana, Kansas, Nebraska, Oklahoma, Tennessee and South Carolina — have issued opinions saying doctors can prescribe ivermectin and hydroxychloroquine, with four of them determining doctors cannot be disciplined for off-label prescription to treat covid.

Medical boards’ ability to determine unprofessional conduct and mete out discipline varies widely by state, with boards typically requiring punishment for misinformation to be linked to patient harm — not merely espousing treatments debunked by science.

In Maine, the medical board temporarily suspended the license of Meryl Nass, an internal medicine doctor, in January 2022 as it launched an investigation of complaints against her. The board alleged that Nass spread “misinformation” about covid online, including scientifically disproven claims that coronavirus vaccines increase the risk of miscarriage and that drugs such as ivermectin and hydroxychloroquine are effective in killing the virus, according to the suspension order.

The board also cited complaints from two clinicians that Nass had prescribed ivermectin and hydroxychloroquine to patients without examining them, including one who was later hospitalized and a 28-year-old woman who was six months pregnant, according to board documents and interviews. The board said Nass also admitted to regulators that she had lied to a pharmacist about why she had prescribed hydroxychloroquine to another patient.

Renata Moise, a certified nurse-midwife in Ellsworth, Maine, said she alerted the board that one of her pregnant patients was taking hydroxychloroquine prescribed by Nass. The woman had contracted covid amid the 2021 omicron surge overwhelming hospitals, and Moise feared she would get sicker without proper care.

“It was this feeling of helplessness, a feeling of horror,” Moise recalled. She said most pregnant women in the rural Maine counties she serves hold inaccurate beliefs about coronavirus vaccines, illness and treatment.

In an email to the board, a copy of which she shared with The Post, Moise wrote: “When Dr. Nass promotes, prescribes, or advises treatments for Covid-19 which are not among the approved or recommended treatments, it hampers our ability here … to promote the public health factors necessary for controlling the pandemic.”

But ahead of Nass’s first hearing in October 2022, the board withdrew its misinformation allegations for reasons it would not disclose, leaving multiple charges related to patient care, competency, record-keeping and honesty. Nass, in an interview, called misinformation a “fake crime.” Board officials declined to comment on a pending case.

Nass told The Post she prescribed ivermectin and hydroxychloroquine because she believes in their effectiveness in combating covid. She said two of the patients mentioned in the complaints against her eventually got better and plan to testify in her behalf.

She said she believes the covid-misinformation charges were part of the board’s strategy to pressure her to give up her medical license. Nass said she has never had a malpractice case filed against her. Despite racking up what she said is nearly half a million dollars in legal expenses, she vows not to back down.

“They wanted me to be a poster child to scare other doctors, to stop them from telling their patients what they felt was the truth about hydroxychloroquine, ivermectin, the covid vaccines,” Nass said. “I have not pledged allegiance to the FDA, CDC or [National Institutes of Health] guidelines. Medicine is not one-size-fits-all.”

The board has held five hearings on Nass’s case, with the next scheduled for Friday. Her license suspension will continue until the disciplinary process concludes.

Inconsistent, infrequent discipline

When they are handed out, punishments differ drastically by state — even for the same physician accused of misconduct.

Ryan Cole, an Idaho pathologist also licensed in Washington state, has publicly disparaged the coronavirus vaccines as “needle rape” and falsely claimed that ivermectin decreases the chances of severe illness from covid by up to 90 percent, according to allegations in Washington board documents.

The Washington medical board accused Cole of spreading “medical disinformation” by making 19 “false and misleading” statements that “generate mistrust in the medical profession and in public health, and have a wide-spread negative impact on the health and well-being of our communities.” The board accused him in January of multiple instances of unprofessional conduct. His Washington license remains active, pending a September disciplinary hearing.

In a March response to the medical board, Cole, through his lawyer, denied allegations of unprofessional conduct and causing injury or “unreasonable risk of patient harm” to those he treated with ivermectin. The filing says no patients have lodged complaints against him. Cole said any attempt to impose sanctions violated his First Amendment rights and accused the board of “viewpoint discrimination.”

In Idaho, fellow physicians in the state medical association took the rare step of filing a complaint against Cole with the state medical board in October 2021. Many of Cole’s public statements are “profoundly wrong, unsupported by medical research and collected knowledge, and dangerous if followed by patients or members of the public,” according to the complaint, first reported by local media and obtained by The Post. Cole’s prescribing of ivermectin “likely has violated” a doctor’s ethical obligation to “first do no harm,” the complaint said.

But the Idaho medical board has not launched an investigation against him in his home state, Cole said in an interview last year with a prominent anti-vaccine doctor.

Idaho medical board spokesman Bob McLaughlin would not confirm whether Cole is under investigation. Only formal discipline, such as a reprimand or license restriction, is public, McLaughlin said — not information about complaints or the existence or closing of an investigation. Cole’s Idaho medical license remains active, board records show.

Neither Cole, who the Federation of State Medical Boards says is licensed in at least half a dozen states, nor his lawyer responded to requests for comment.

It is extremely rare for physicians to receive the harshest punishment: losing their license to practice.

The Post found just one doctor whose medical license has been revoked for spreading covid misinformation or misleading patients.

Oregon’s state medical board revoked the license of Steven LaTulippe, a family medicine doctor, in September 2021 and fined him $10,000 for refusing to follow covid guidelines in his office and endangering public health and patient safety. The board also cited what it characterized as his professional negligence in treating chronic opioid patients, an accusation he disputed during the board hearing.

At the height of the pandemic, before vaccines were available, LaTulippe and his staff did not wear masks. Patients said they were told to take off their masks when they entered his clinic in Dallas, Ore. Wearing a mask was dangerous, he told them erroneously, because it could contribute to strokes, carbon dioxide poisoning and collapsed lungs, according to disciplinary records and interviews with patients.

Margret Murphy, 60, a longtime patient, said LaTulippe told her in spring 2020 that wearing a mask could be causing her high blood pressure. She found another doctor who changed her medications, and she said her blood pressure went down.

Kathy Ellis-Kelemen brought her 95-year-old mother in for an annual physical that same spring. LaTulippe’s wife, who worked in the office, asked them to remove their masks, saying it would build up carbon dioxide and make her mother faint.

Ellis-Kelemen said LaTulippe did not wear a mask when he examined her mother. She was so worried about the risk of infection that they left.

“I called a few doctor friends. One said, ‘If you don’t report him, nothing will happen, and he’ll just keep doing this,’” Ellis-Kelemen said. She decided to file a complaint only after LaTulippe’s office called to schedule a follow-up appointment and informed her the staff was still not wearing masks.

During his March 2021 board hearing, LaTulippe testified that there was “a tremendous amount of fearmongering with the masks and a lot of confusion about who do I believe.” He cited his affiliation with America’s Frontline Doctors to set his views apart from those of mainstream medicine. The board concluded that LaTulippe had engaged in “unprofessional and dishonorable” conduct in refusing to mask and providing information about masks that was “counter to basic principles of epidemiology and physiology.”

LaTulippe sued the board, but the Oregon Court of Appeals this spring upheld the board’s revocation of his license.

Reached by phone, LaTulippe said he was not going to address any questions about his case. “I am appealing to the Oregon Supreme Court,” he said.

Alice Crites and Nate Jones contributed to this report.


The Washington Post asked medical boards in 50 states to identify physicians who had been disciplined or were under investigation for covid-19 misinformation or disinformation, including doctors who misled patients about vaccines, masks or pandemic treatments since January 2020. Thirty-six boards responded between January and March 2023 with records. For states that provided incomplete information or refused to release documents, The Post examined records on the board websites to find additional doctors. Reporters also examined public records for osteopathic boards in states with separate regulating agencies.

The Post also requested data related to the number of covid misinformation complaints filed since 2020, which most states said they were unable to provide. Only 13 states said they had such complaints and provided a number, but did not release details. The numbers for disciplinary actions, pending investigations and complaints should be considered minimums.

In addition to data provided by the boards, The Post reviewed news releases and disciplinary files for each state that were updated between March and June 2023 to find additional physicians who had been disciplined.

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