Baltimore has been deeply challenged pretty much since, forever.
And boy, self published books are more lucrative than they used to be. At least for some people.
(From The Baltimore Sun)
UMMS paid Pugh $500,000 for copies of the books while she served on its board. UMMS paid $100,000 in each of five transactions in 2012, 2013, 2015, 2017 and 2018 to purchase 20,000 copies of her self-published books at $5 per book. Pugh was among nine members of the 30-person UMMS board that had contracts or other business deals with the medical system.