Jassmine McBride was struggling to breathe.

But as she sat in her doctor’s office near Flint, Michigan last July, tethered to an oxygen tank, McBride just wanted to tell everyone about her upcoming 30th birthday party.

She rattled off the details: her uncle would fire up the barbecue, and kids would play games. There would be music and dancing. And everyone was invited — even her doctors. “Bring your grandchildren if you have them,” she said. “Just let them have fun, get some food and have a water balloon fight.”

For McBride, this birthday wasn’t just a milestone. It was a celebration of survival. She was one of 90 people in the Flint area that the state said were sickened during a 2014-15 outbreak of Legionnaires’ disease, a sometimes fatal form of pneumonia caused by waterborne bacteria. The source of the outbreak hasn’t been definitively proven, but numerous scientists have linked it to improperly treated water the city pulled from the Flint River and used as its drinking water supply.

Six months after that momentous birthday, McBride was back in the emergency room, again short of breath. She went into cardiac arrest and lost consciousness. Eight days later, on Feb. 12, 2019, Jassmine McBride died.

While neither Flint’s drinking water crisis nor Legionnaires’ disease is named on McBride’s death certificate, her physician, friends and family say it is impossible to ignore the links between her declining health and the city’s fateful switch to the Flint River, which happened five years ago today: April 25, 2014.

Dr. Marcus Zervos, an infectious disease specialist at Detroit’s Henry Ford Hospital who treated McBride in the final months of her life said, “The immediate cause of death was cardiac arrest, but she suffered from complications of Legionnaires’ disease from 2014, which were kidney failure, heart failure, respiratory failure.”

“She was the story of Flint,” he added.

Over the past two years, FRONTLINE has been investigating the extent and toll of the Legionnaires’ outbreak in Flint — which, despite being one of the largest in U.S. history, has been eclipsed by outrage over high lead levels in the water and the resulting public health crisis.

Officially, the Michigan Department of Health and Human Services (MDHHS) has said that 12 people died from Legionnaires’ during the outbreak.

But Legionnaires’ shaped many more lives in Flint in painful and indelible ways. A FRONTLINE analysis found that of the 78 Legionnaires’ patients who initially survived their diagnosis, at least 20 have died in the weeks, months and years since leaving the hospital. That higher tally is based on county health department records, court documents, news reports and interviews with family members.

The state’s death toll from the outbreak included only individuals who died while hospitalized with Legionnaires’ disease or from any cause within 30 days after leaving the hospital — a standard public health methodology. In a statement, MDHHS said it did not track patients beyond that because of the difficulty in determining the role Legionnaires’ may have played in a death. The department could not confirm FRONTLINE’s figures, but said: “Legionnaires’ disease frequently impacts people with comorbid conditions, such as cancer, diabetes and heart disease, which put people at increased risk of mortality over time.” The department said that 84 percent of cases in the outbreak had another significant health problem.

Most of the deaths FRONTLINE uncovered were officially attributed to kidney, heart and lung diseases, which infectious disease specialists say are commonly linked to Legionnaires’. Of the 20 additional deaths FRONTLINE has identified, at least eight people died less than a year after leaving the hospital. The families of 11 patients told FRONTLINE or said in court filings that Legionnaires’ left their loved one so debilitated that they never fully recovered.

This was the case with Jassmine McBride. Records from her last hospital stay list six different complications, including the cardiac arrest that ultimately killed her. Autopsy results are still pending.

Dr. Amesh Adalja, an infectious disease expert at Johns Hopkins University Center for Health Security who reviewed McBride’s medical records — which FRONTLINE obtained with her family’s permission — said he believed Legionnaires’ disease was a factor in McBride’s death. “Her prior critical illness made this outcome more likely, hastened it, and had some role in her demise — though was not the specific, final cause of death,” he said.

Much of the debate about Legionnaires’ disease in Flint has been about its source: whether legionella bacteria, which cause the disease, spread through the water supply during the 18 months that the city drew from the Flint River in 2014 and 2015.

In the wake of the outbreak, the state of Michigan appointed a group of scientists to answer that question. The 23-member team included statisticians, epidemiologists, engineers and infectious disease experts, including Dr. Zervos. Members of the team ultimately published two papers in the peer-reviewed academic journals Proceedings of the National Academy of Sciences and mBio. The PNAS paper concluded that 80 percent of the Legionnaires’ cases could be attributed to the change in water supply, and the mBio paper found that many other cases had likely gone undetected.

The state health department disputed the team’s conclusions, releasing a public statement calling them “inaccurate” and “incomplete.” The state maintained that the Legionnaires’ cases could not be definitively linked to the water, in part because the necessary samples and patient laboratory tests weren’t collected during the outbreak. The state has since relied on its own findings and case data, which attribute the epidemic to a single source: McLaren Flint hospital.

Dr. Brooke Decker, who heads infection control and prevention at the Veterans Affairs hospital in Pittsburgh, said in an interview with FRONTLINE that it was unlikely that a hospital could be the source of an outbreak. “Legionella does not just appear in a hospital,” she said. “It had to come from somewhere. It likely came in from the source of water that’s supplying the hospital, that may be the municipal water source.”

McLaren Flint hospital was drawing on Flint water at the time. The hospital denies that it is the source of the outbreak. “It’s been five years since the water change was made and our community is still experiencing the consequences,” Chad Grant, the hospital’s chief executive, told FRONTLINE in a statement. He added: “It’s clear our community continues to have a very serious problem on its hands. It’s unclear what our state is doing about it.”

The Legionnaires’ outbreak has formed the basis for several of the criminal charges filed against 15 state and city officials in the wake of the water crisis. A special prosecutor appointed by the state filed involuntary manslaughter charges against two of the state’s top health officials — former director Nick Lyon and Dr. Eden Wells, the former chief medical executive — arguing that some of the Legionnaires’ deaths might have been prevented had they acted more quickly. Last year, a Michigan district court determined in two rulings that the cases against both officials should proceed to a jury trial.

Their attorneys have appealed, and like the state say the municipal water could not be definitively linked to the outbreak. Lyon’s attorney, John Bursch, has said there is no merit to the charges, and that his client did nothing wrong. A final decision in Lyon’s case is expected in the coming weeks. Wells’ attorneys are waiting to argue their appeal before a judge, and have also maintained their client’s innocence. In the meantime, Wells has been hired for a newly created advisory physician role at MDHHS, where she advises the administration on public health issues.

Seven other defendants have struck plea deals; six cases are still pending. Earlier this month, a federal judge also allowed former governor Rick Snyder to be named as a defendant in a class-action lawsuit, which alleges that he misled the public about the safety of using the river water. Through an attorney, Snyder declined to comment on any issues related to the water crisis, citing the pending litigation. Snyder has also expressed his “full faith and confidence” in both Wells and Lyon .

Back in 2014, Jassmine McBride nearly died from Legionnaires’ disease. She spent three months shuttling between the hospital and a rehabilitation facility, and ultimately emerged with a weakened heart and damaged lungs and kidneys. The 26-year-old known for her quick wit suddenly struggled to find words to speak. She couldn’t walk or even eat by herself.

Jassmine McBride was diagnosed with Legionnaires’ disease during the Flint water crisis. (Abby Ellis/FRONTLINE)

“Before the Legionnaires’, I was able to do things on my own,” she told FRONTLINE in one of several interviews conducted over the past year. She had to relearn to walk, talk and eat. “It was just like being reborn all over again.”

By the time her 30th birthday party arrived last year, McBride had finally recovered enough to celebrate. Family and friends turned out in droves. The sun was bright, and the smell of grilled hot dogs filled the air. Guests chatted in the shade of a large tree, while kids raced around and played games. There was music, dancing and, to McBride’s delight, a performance by her cousin’s dance team, the Fli City Glamourettes. Momentarily free of her oxygen tank, McBride even managed to show off a few moves of her own. It was one of the last times she would be gathered together with so many people she loved.

McBride was born and raised in Flint amid a supportive crowd of family and friends. She was diagnosed with diabetes as a toddler, but it barely slowed her down. If things got quiet, it was usually a sign that she’d gotten into something. As a kid, she shaved off her eyebrows, which McBride herself attributed to having been a “very curious” child.

A photo of Jassmine McBride as a young girl. (Courtesy of Jassmine McBride)

As a teen, McBride channeled her energy into dance, taking to the field during halftime at football games with the marching band as a drum majorette.

Her struggle with diabetes inspired her to pursue a career as a pediatric nurse. She wanted, she said in an interview, “to be able to help the children better themselves with their health, so they can go for their dreams.”

In August 2014, McBride was living with her mom on Flint’s north side, a predominantly African-American enclave, and working as a nurses’ aide at an assisted living facility just outside of Flint. In her spare time, she went to church and spent time with friends and family. She recalled that her mother, Jacqueline McBride, had heard rumors that the water wasn’t safe to drink. “She was like, ‘Jassmine, don’t drink the water, I don’t know if it’s true or not,’” she said. “Me, still I was just drinking water, drinking water. Bathing in it, brushing my teeth. I thought it was OK.”

Then, she fell ill. McBride went to the emergency room with a cough, chills and a fever. Within days, she was hooked up to a ventilator in the intensive care unit and diagnosed with Legionnaires’ disease.

Jacqueline arrived at the hospital to find her daughter surrounded by a tangle of tubes and machines. “She’s asking me, ‘Mama’ … just trying to breathe. Struggling to breathe. ‘Mama, can you just take [the oxygen mask] off just for a minute?’” she recalled. “And she was just crying, she was crying because she was scared.”

Jassmine McBride with her mother, Jacqueline. (Courtesy of Jassmine McBride)

McBride, like many other Flint residents, was particularly susceptible to Legionnaires’ disease. The disease takes the greatest toll on those who have a weakened immune system, including those suffering from chronic illness such as diabetes. It’s also more prevalent among African Americans.

Flint’s population is 54 percent African American. The city also has a higher prevalence of chronic illnesses like diabetes, kidney disease and chronic obstructive pulmonary disease than almost any of the country’s largest cities, according to the U.S. Centers for Disease Control and Prevention.

Despite the risks, local and state health officials did not warn the public or issue a widespread alert to the medical community until the Legionnaires’ outbreak had subsided in 2016.

Emails and court documents show officials at both the Genesee County Health Department and the Michigan Department of Health and Human Services were aware of the uptick in Legionnaires’ cases in the summer of 2014. About eight months later, in February 2015, the county health department, at the suggestion of the state, sent clinical guidance on legionella to about 15 staff members at three area hospitals and a clinic.

In January 2016 — about 18 months after the first diagnosis — Gov. Snyder finally held a press conference to announce that there had been an outbreak of Legionnaires’ disease. He said at the time he had just learned of the outbreak.

State officials have said there was not enough information about the source of the outbreak to warn the public earlier. In a prior statement to FRONTLINE, MDHHS spokeswoman Angela Minicuci said there is no legal requirement to notify the public when starting an outbreak investigation. “Certainly our investigation into the outbreak was occurring regardless of whether or not a public notice went out,” she said.

By the time McBride fell ill in August 2014, there were already more than a dozen infections in the Flint area, according to a county health department document.

Once she left the hospital that December, McBride needed regular dialysis treatment, and it became even harder to control her diabetes. She still relied on a portable oxygen tank. Breathing issues, erratic blood sugar or sudden problems with her kidneys could all send her back to the emergency room.

Infectious disease specialists say people treated for critical illnesses like Legionnaires’ often experience chronic health complications in the months and years that follow. Dr. Adalja, who is also an expert in intensive care and emergency medicine, said McBride was especially susceptible to such complications given her diabetes.

“We know that those people, after they leave the [intensive care unit] are going to have chronic health problems because of the severity of the pneumonia they had,” Adalja said. “It’s going to be a long road to recovery.”

It also increases the risk of death, he said.

McBride’s struggles were more than physical. Traumatized by her months in the hospital, she found herself hyperventilating and having panic attacks, worried she might fall seriously ill again. “I was scared,” she said. “I didn’t even feel — I hate to say it — but safe.”

Experts say people treated for critical illnesses like Legionnaires’ often experience chronic health complications in the months and years that follow. (Abby Ellis/FRONTLINE)

Her medical needs made it impossible to work, so she scraped together a living from monthly disability payments. She abandoned her dream of nursing, enrolling instead in an online medical billing program.

Her friends in Flint moved on, many started their own families. “I [used to] get asked to do a lot of things like, ‘You want to go here? You want to do this?’ And now it’s like I have nobody. Nobody really calls,” she said. “I guess they don’t want to deal with somebody who has to lug oxygen.”

McBride cycled in and out of depression, she said. Anxiety crept up on her at night. She worried she might stop breathing in her sleep.

Then, last year, McBride found a reason to hope. Doctors were helping to treat some of the health problems that kept her from being eligible for a kidney transplant, which she desperately needed. McBride said the new health care regimen was “doing miracles” for her body.

“Lord willing,” McBride declared in September, “I will be getting put on the transplant list.”

She died before becoming eligible for a new kidney.

Jassmine McBride in her prom dress. (Courtesy of Jassmine McBride)

On a Sunday evening at the end of February, McBride’s family and friends packed the pews of the Jackson Memorial Temple for an emotional homegoing, or funeral service, in Flint. McBride lay in a baby blue casket surrounded by flowers.

The church band kept up a steady beat as the mourners, many of them wearing shirts emblazoned with McBride’s name and picture, filed past to say goodbye. A cousin read a poem she’d written titled “Sassy Jassy,” a nod to McBride’s cheeky sense of humor, but the verses quickly turned to all McBride had endured.

“If she could get up right now she would say/

‘I’m not suffering anymore from diabetes/

I’m not suffering anymore from Legionnaires’ disease.

…Thank God I’m free!’”

When the service was over, pallbearers danced McBride’s casket out of the church.

Since the funeral, Jacqueline McBride has struggled not just with grief, but with her feelings toward the city and state officials she blames for her daughter’s death. She hopes the pending criminal trials will bring some accountability.

“She was angry and she forgave them, because of the love in her heart,” Jacqueline said, and added: “She just wants justice to be served. And that’s what I want.”

— Marcia Robiou and Rahima Nasa contributed reporting.