Inspections at Michigan Mammogram Facilities Turn Up Violations at 60 Sites. - Knight Ridder/Tribune Business News

By Patricia Anstett, Detroit Free Press Knight Ridder/Tribune Business News

Jun. 17--Sixty Michigan mammogram facilities had violations in the past 15 months, according to the third annual Free Press analysis of disciplinary records compiled by the Michigan Department of Consumer and Industry Services.

Most of the problems were minor and corrected within two months, sometimes the same day or week. Minor problems include the failure of staff to complete continuing medical education classes and not performing daily ...uality checks on machines.

But, in a rare action, the state told Northland Radiology to stop performing mammograms at its site at 15521 W. Seven Mile in Detroit because its X ray pictures were so poor.

Northland Radiology stopped performing mammograms at the facility because it was only performing about five mammograms a week, said Anita Craig, mammographer coordinator.

The state inspections are usually announced ahead of time.

Most Michigan mammography facilities have had no violations since 2000.

Many of the 60 facilities also had previous violations dating to 2000. All are in compliance except Northland Radiology's Southfield facility, which hopes to be in compliance soon.

Here are others: Oakland County Northland Radiology, 20905 Greenfield, Southfield Providence Hospital, 16001 W. Nine Mile, Southfield Birmingham Technology, 511 Pierce, Birmingham Drs. James C. MacKenzie and John R. Joseph, 1777 Axtell, Troy Advance Radiological Center PC, 23077 Greenfield, Suite 487, Southfield Wayne County Bon Secours Cottage Diagnostic Center, 21400 Eleven Mile, St. Clair Shores Henry Ford Hospital, 2799 W. Grand Blvd., Detroit DMC Health Centers, 10201 E.

Jefferson, Detroit Universal Imaging, 8560 Silvery Lane, Suite 100, Dearborn Heights Midwest Health Center, 5050 Schaefer, Dearborn Macomb County St. John North Shores Hospital, 26755 Ballard, Harrison Twp. Bi-County Community Hospital, 13355 E. Ten Mile, Warren Romeo Plank Diagnostic Center, 46591 Romeo Plank, Suite 135, Macomb Out-state St. Joseph Mercy Livingston Hospital, 620 Byron Road, Howell McLaren Women's Imaging, 1314 S. Linden, Flint Gratiot Community Hospital, 300 Warwick, Alma Iron County Community Hospitals Inc., 1400 W. Ice Lake Road, Iron River Oaklawn Hospital, 200 N. Madison, Marshall Ontonagon Memorial Hospital, 601 S. Seventh, Ontonagon Marlette Community Hospital, 2770 Main, Marlette St. Mary's Spectrum Health Mobile Mammography Service, Grand Rapids Borgess Medical Center, 1521 Gull Road, Kalamazoo

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Shared medical appointments offer chronic care forums - Managed Healthcare Executive

Specialists fit in more care management time

THE NEED TO improve the accessibility and efficiency of healthcare has more providers adopting the emerging shared medical appointment (SMA) model.

While primarily thought of as an efficiency measure, there is mounting evidence that group visits also can improve the quality of patient care, particularly for those with chronic conditions such as diabetes and asthma, and, by doing so, lower healthcare costs.

A shared medical appointment is a physicianto-patient visit in the presence of other patients who benefit by hearing about the experiences of similar patients. During a typical 90-minute SMA, patients discuss their concerns in a forum and listen to strangers share their health concerns. Virtually everything-diagnoses, prescriptions, medical histories, treatment - is discussed in the group setting. An SMA is not a support group or psychiatry session, though it often does incorporate patient education. In addition to the physician and patients, SMAs usually are attended by one or more nurses or other clinical staff, who might act as facilitators.

'We are able to see two to three times more patients,' says Zeev Neuwirth, MD, chief of clinical effectiveness & innovation at Harvard Vanguard Medical Associates, a division of Atrius Healthcare, with 700 physicians in Greater Boston. 'It is a higher-cost activity, but you are able to see more patients.'

A backlog of patients and a phone ringing off the hook are among the reasons Holly Thacker, MD, director for the Center of Specialized Women's Health at the Cleveland Clinic, held her first SMA in July 2002. To reduce the appointment backlog, she scheduled several patients in a conference room and found it allowed her to educate everyone at the same time and address more common concerns.

Dr. Thacker says her first available individual appointment is typically eight months out, but she can see a patient within the week with an SMA.

'I can see a whole afternoon of patients in 90 minutes,' she says. 'IfI can do four hours of work in two hours time, then I can do other things, like writing and research activities.'

Dr. Thacker is likely on the leading edge of the trend.

In a survey by the American Academy of Family Physicians (AAFP), 8.4% of practices reported using SMAs in 2008, up from 5.7% percent in 2005. Among the institutions using group visits are: Kaiser Permanente Medical Centers at Santa Clara and San Jose, California; Borgess- Promed in Kalamazoo, Michigan; Sutter Medical Foundation in Sacramento, California; Parkland Health & Hospital System in Dallas; University of Virginia Health System; WellSpan Health in York, Pennsylvania, and the Cleveland Clinic.

A PricewaterhouseCoopers report on healthcare access in July 2009 cited SMAs as one way to ease the shortage of primary care physicians.

REIMBURSEMENT DOESN'T CHANGE

SMA visits are billed the same way as typical patient visits, based on the level of care delivered, and are documented in the patient's chart according to Current Procedural Terminology (CPT) criteria.

The Centers for Medicare & Medicaid Services (CMS) has not published official payment or coding rules for group visits for Medicare, says Cindy Hughes, billing and compliance specialist for the AAFP.

'Reimbursement is based on evaluation and management services provided to the individual patient - provided there is documentation to support it,' says Hughes, adding that payers reimburse SMAs at the same level as an individual office visit.

That's been the experience for Edward Noffsinger. The former director of clinical access improvement at Palo Alto Medical Foundation for the Kaiser Permanente Medical Centers has spread the mission of SMAs worldwide, helping implement group visits for more than 400 physicians and practices.

'Billing and compliance officers tell me the only thing different between my model for the group visit and an individual office visit is that it is happening in a group room rather than an exam room. But that is irrelevant in terms of CPT coding because what counts is the level of care delivered and documented,' he says. 'It doesn't matter if happens in a group room, an exam room, or the 'doc in the box' at your local Costco.'

Physicians are delivering the same care, if not more care, Noffsinger says. Although it is a group setting, it offers similar care value.

Time spent counseling is an exception, he says. He recommends physicians not bill for counseling time to avoid double-dipping.

SMAs have the potential for billing abuse, says Patrick Hurd, a healthcare attorney in Norfolk, Virginia.

'I caution providers not to 'game the system' by up-coding or billing at a level that neither the length of the office visits nor the nature of the services provided support,' he says.

He has spoken with CMS, and officials are concerned that doctors will be tempted to file fraudulent claims. Providing SMA service once with 10 patients could not be billed and additional 10 times for counseling.

'We just consider that overhead expense of the program,' he says.

In April 2009, Michigan insurer PriorityHealth added a separate reimbursement category for SMAs as part of its initiative to support primary care providers in becoming patient-centered medical homes.

The insurer sees SMAs as one way to increase the productivity and efficiency of the healthcare team and improve patient access. Additionally, PriorityHealth reimburses SMAs as a way to encourage quality through education and care management.

SMAs do save insurers money, says Kimberly Moreland, vice president at Rising Medical Solutions, a healthcare consulting firm in Chicago.

'Based on the requirements for an office visit code and the required time it takes for each component, it is very unlikely an SMA visit could ever qualify for even a mid-level visit,' she says. 'If the provider can see more patients, the medical community saves money due to the lower level of coding used for an SMA. This could be a win-win option for some medical treatments,' she says.

QUALITY AND QUANTITY

Though the initial appeal of SMAs was attributed largely to their potential to allow more patients to receive care in timely manner, studies continue to suggest they can deliver improved outcomes and lower costs.

A study of Hispanic patients with diabetes at a Dallas clinic found that those who attended SMAs were more successful in adhering to American Diabetes Assn. guidelines than those who had traditional visits.

A 2006 review of research on SMAs, published in the Journal ofthe American Board of Family Medicine, concluded 'there is sufficient data to support the effectiveness of group visits in improving patient and physician satisfaction, quality of care, quality of life, and in decreasing emergency department and speciahst visits.'

The improvement in outcomes has been attributed to patients having more time with their physicians as well as the group pressure on members to follow care directives.

PROTOCOLS FOR PRIVACY

Any practice offering group visits must ensure federal and local privacy rules are followed, however. Patients should always have the choice to opt out of group visits.

The AAFP recommends patients sign a confidentiality form and HIPAA disclosure form prior to the SMA.

At the Cleveland Clinic, SMA patients sign a waiver before the appointment, agreeing not to disclose other patients' personal information. Patients are referred to only by first names during the visit. HIPAA does not prevent patients from voluntarily discussing their personal health information with each other.

'HIPAA really doesn't apply to other patients, and there isn't a private right of action, 'says John Meyers, an attorney specializing in healthcare law in Beverly Hills, Calif.

'The challenge and liability lies within how the provider can ensure patients from the group remain compliant to their signed confidentiality agreement, and what recourse, if any, do they have should they become aware of a non-compliant patient,' says Moreland, of Rising Medical Solutions. 'That is a legal argument with possible exposure.'

Hurd cautions that healthcare providers should create protocols for protecting personal information in shared appointments, because that is the sole right of the patient.

Meyers says the best way to ensure HIPAA regulations are met is through consent and acknowledgement by the patient prior to the SMA, rather than a confidentiality agreement, which could be hard to enforce.

SMAs are not a good fit for all provider types, however. If group visits are not set up and run correctly, costs can increase.

Beginner mistakes often result in failure of the entire SMA program, says Noffsinger. One ofthe most common problems is starting an SMA with a smaller, homogenous patient population. He recommends SMAs incorporate a diverse group of patients to achieve critical mass.

'If only 15% of a panel is diabetic, physicians are going to have a hard time filling their groups,' according to Noffsinger.

Maintaining high patient volume is key to sustaining the program.

SMAs with fewer patients are less efficient and can be more costly than routine care, according to Dr. Thacker. She overbooks her appointments to account for no-shows in order to keep her SMA patient volume high.

'To eliminate billing/reimbursements concerns, SMAs would need to help reduce medical costs, not increase them,' says Moreland.

The AAFP believes small practices and physicians who don't practice full time are not good candidates for the SMA model.

But SMAs are an effective way to mitigate the shortage of primary care physicians, Noffsinger says.

'If you triple your productivity, physicians are doing 4.5 hours of work in 1.5 hours,' he says. 'That is a net gain of three hours of physician time.'

IT'S LIKE GAINING A DOCTOR

For every 12 scheduled SMAs, the result can be up to 36 hours of physician time saved. Essentially, the equivalent of a full-time physician is created from efficient use of current physicians' time without an increase in overhead expenses, Noffsinger says.

'The only thing the doctor is left to do is what the doctor can uniquely do, which is what they went to medical school for,' he says. 'They don't have to do the charting, they don't have to ferret out the reason for the visit. They just deliver high-quality, high-value medical care to each and every person in that room.'

SMAs can go beyond primary care. The opportunity for patients to learn from each other's experiences is one reason Neuwirth has spearheaded the launch of SMAs for Vanguard across a wide range of medical specialties, including pediatrics, dermatology, neurology and cardiology.

'If you add up the number of hours a day it takes for a primary care physician to practice medicine [according to best practices], it takes 18 hours a day. And it is just not doable,' says Neuwirth. 'We have some physicians that you cannot get a general appointment with for several months - at least you couldn't until they started offering shared medical appointments.'

With 18 SMAs a year, the savings could be more than $6 million within seven years, says Noffsinger.

'The physician is able to see three times as many patients in a 90-minute period because they are delegating non-medical tasks.'

[Sidebar]

MHE EXECUTIVE VIEW

* CMS has not published official rules for SMAs.

* Payers reimburse SMAs at the level of a typical office visit.

* Studies suggest the group settings save money.

[Sidebar]

MHE EXECUTIVE VIEW

* Patient privacy can be reasonably well maintained in shared appointments.

* Offer consent forms or confidentiality agreements.

* High volume is key to sustaining the model.

* Small practices are not suited for SMAs.

[Author Affiliation]

MICHIGAN INFANT MORTALITY AT ALL-TIME LOW - US Fed News Service, Including US State News

Gov. Jennifer M. Granholm, D-Mich., issued the following press release:

Governor Jennifer M. Granholm today announced that infant mortality rates - especially among the state's African American population - are now the lowest in Michigan history thanks to a concerted effort on the part of state and local entities to combat the problem. While the decrease in the overall infant death rate - 7.4 deaths per 1,000 births in 2006, down from 7.9 in 2005 is impressive, the drop in African American live births was staggering - from 17.9 in 2005 to 14.8 in 2006, Granholm said. 'Our continued investments in health care are making a critical difference in the lives of our most vulnerable citizens,' Granholm said. 'If we continue to make these investments, we can ensure that this progress is sustainable.' In July 2005, Granholm unveiled a blueprint to prevent unintended pregnancies, which included Talk Early, Talk Often - a program designed to offer parents a resource for talking with their middle school-age children about abstinence and sexuality issues, and Plan First, an initiative designed to increase access to family planning services. Today, more than 30,000 women are enrolled in Plan First. Further, Granholm has continued to promote the state's effort to promote safe sleep, encouraging partnerships between state agencies who are responsible for putting important safe sleep information into the hands of young families and the Nurse Family Partnership, which is primarily responsible 'All of these activities in concert at both the state and local levels are directly responsible for the significant drop in infant mortality rates from 2006,' said Janet Olszewski, director of the Michigan Department of Community Health. 'We are proud of the work we have done together to begin to curb the rates, but we need to redouble our investments to make further reductions reality.' Olszewski said continued investment in state programs that save the lives of infants is vital to ensuring that Michigan's number remains on a downward trend. Since 2003, the governor has worked tirelessly to fund infant mortality reduction coalitions in Berrien, Genesee, Ingham, Kalamazoo, Kent, Macomb, Oakland, Saginaw, Washtenaw, and Wayne counties, and in the city of Detroit that collaborate on educating residents about preventing infant mortality. These coalitions developed case management projects to improve birth outcomes for women who have experienced a fetal death, a low birth weight infant, or a premature infant. Additionally, the state's Nurse-Family Partnership (NFP) - a program initiated by Granholm in 2004 in which nurses visit low-income women in their homes during their first pregnancies through the first two years of their children's lives - has been critical to the rate reduction. Today, the NFP is available in Benton Harbor, Detroit, Grand Rapids, and Pontiac. According to national Medicaid research, it is estimated that each public dollar spent to provide family planning services saves an estimated $3 that would otherwise be spent in Medicaid costs for pregnancy-related care and medical care for newborns. 'Unintended pregnancy and infant mortality are issues that affect public health, our economy, and our society,' said Dr. Gregory Holzman, Michigan's chief medical executive. 'We must convince health care providers, members of the Legislature, and the general public that investment in state and local programs that reduce our state's infant mortality rate are absolutely necessary for our continued shared success.' Holzman said the infant mortality statistics will officially be unveiled at a Mapping the Future public health conference sponsored by Michigan State University and the Kalamazoo Center for Medical Studies in Kalamazoo on Monday. 'These results clearly indicate that even in the midst of difficult budget times, programs initiated by our state and local communities in support of pregnant women are working,' said Dr. Arthur James, chief of Borgess Medical Center and associate professor at Michigan State University. 'However, even with this substantial improvement, black babies in Michigan died at more than 2.7 times the rate of white babies during the first year of life in 2006. We've made progress, but we still have a lot of work to do.'Contact: James McCurtis, 517/241-2112.

HOUSE REPUBLICANS KEEP UP FIGHT TO STOP GOVERNMENT ENCROACHMENT ON RELIGIOUS LIBERTY. - States News Service

WASHINGTON -- The following information was released by the office of Ohio Rep. John Boehner:

House Republicans are keeping pressure on the Obama administration to reverse its unconstitutional mandate that 'would force some Americans to violate their religious beliefs' - the most egregious government encroachment on Americans' First Amendment rights in 220 years, Congressman Boehner said yesterday. Here's more from CNS News:

''I think it's important for us to win this issue,' Boehner said at a Capitol press briefing. 'The government, our government, for 220 years has respected the religious views of the American people. And for all of this time there's been an exception for those churches and other groups to protect the religious beliefs that they believe in.' 'And that's being violated here,' he said.

'The House Speaker also said it is 'an important part of my job' to stand up for the Constitution. 'I believe that standing up for the Constitution, standing up for people's protection under the law and under the Constitution to practice their faith as they like, this is an important part of my job,' he said. 'I'm trying to find a way, frankly, to get a bipartisan agreement to solve this problem.''

Speaking at a Heritage Foundation forum titled 'Women Speak Out: Obamacare Tramples Religious Liberty' held earlier this week, Rep. Ann Marie Buerkle (R-NY) explained how the ObamaCare mandate is just the latest consequence of the government takeover of healthcare and further indication of the disastrous implications it will have for Americans' Constitutionally-enshrined liberties:

'The very essence of the health care law-the very essence of it-is that the government will tell you what your health care is going to be. So it is absolutely a logical sequence that we now have the government stepping in and saying, 'Okay, we're going to pick your conscience issues.''* This rule is nothing more than a continuation of what we've seen. It is just the government way overstepping its bounds.'* You have the rights. You shouldn't be going to them for permission.'* We need to get government back to its proper role.'

At an Energy and Commerce Subcommittee on Health hearing yesterday, committee chairman Fred Upton (R-MI) also pressed the Obama administration on its fine-on-faith mandate. From the Energy and Commerce Committee:

'Energy and Commerce Committee Chairman Fred Upton (R-MI) highlighted a CRS memo that outlines possible penalties for religious employers that fail to comply with the HHS' mandate to cover drugs or services that violate their religious or moral convictions. 'In my state there's a hospital, Borgess Hospital, it is a part of the Ascension Hospital, and they employ 31,000 people. According to this CRS memo, Ascension is likely to be subject to fines over $1 billion.' Upton questioned how HHS would accommodate self-insured employers, such as Borgess Hospital, that the White House's 'accommodation' fails to protect. Secretary Sebelius provided no details regarding how these employers' conscience would be protected. Burgess responded, 'it bothers me that there will be a fine for faith.''

Abuse, murder in troubled Toledo: Notre Dame sister joins ranks of those accusing priest of sexual abuse; another cleric faces trial for 1980 killing of Mercy nun.(NATION) - National Catholic Reporter

Like Catholics everywhere, the faithful in Toledo, Ohio, have become somewhat inured to persistent media reports about priests sexually abusing children. But a Nov. 9 story in Toledo's daffy newspaper, The Blade, raised a few eyebrows. The headline read 'Nun 'called' to support reforms of abuse laws: Sister said she was assaulted by priest.'

Ann-Marie Borgess, 42, a longtime Sister of Notre Dame, voluntarily entered the spotlight with the claim that she was repeatedly abused as a girl by Chet Warren, a former priest of the Oblates of St. Francis de Sales. Borgess said she's now coming forward to support a bill pending in the Ohio legislature that would dramatically expand the statute of limitations for civil suits related to sexual abuse. The legislation, Senate Bill 17, would lengthen filing limitations from two to 20 years after the alleged victim turns 18 and it would establish a controversial 'look back' period of one year that would allow suits to be filed on abuse claims as old as 35 years. The bill received recent support from Auxiliary Bishop Thomas Gumbleton of Detroit (NCR, Jan. 20).

The latter provision has drawn intense objections from the Catholic Conference of Ohio, overseen by the state's bishops, which claims the look back period is unconstitutional and could encourage frivolous lawsuits that threaten the church's welfare.

In speaking up, Borgess is at odds with Toledo Bishop Leonard Blair. While it may be unusual for a nun from a conservative order to publicly buck her bishop on such a contentious issue, Borgess does so with the support of her provincial superior, Sr. Anne Mary Molyet. The superior effects diplomacy in saying her 'position is that I support Sr. Ann-Marie Borgess' decision to speak out.' She said neither she nor the community wishes to take a public position on the bill. By her own admission, Molyet faces a thorny political problem, so it is striking that she supports Borgess at all. That support comes with her endorsement of Borgess as 'a very courageous, wonderful religious woman' who is 'deeply prayerful and discerning.' Molyet said, 'It was the needs of children that brought [the Sisters of Notre Dame] into being.... [There's] a prophetic role to stand with the suffering, especially children.'

Hornet's nest

If the sisters' defiance seems unusual even in the context of the larger abuse scandal, it's hardly the most sensational turn in the events that have traumatized this midsize diocese over the last few years. Toledo has been a hornet's nest shaken by a vigorous daily newspaper and an active chapter of the Survivors Network of those Abused by Priests, known as SNAP. The city is, in fact, the birthplace of Barbara Blaine, SNAP's founder, who was abused as a girl in a local parish. A 2004 Oscar-nominated documentary was made about a Toledo abuse survivor. Reports of cooperation between the diocese and police to hush information about clerical abuse have surfaced. Most disturbing, perhaps, is the possibility of a ring of ritualistic abusers within the diocese. In one case, at least, it's clear the diocese initially withheld evidence in the investigation of a priest who will soon go to trial for the alleged murder of a nun.

The man accused of murder is Fr. Gerald Robinson, a diocesan priest who is scheduled to stand trial in April for the 1980 murder of the 71-year-old Catholic nun. Mercy Sr. Margaret Ann Pahl was strangled to death, stabbed up to 32 times and covered with an altar cloth in what many believe to be a Satanic/ritualistic killing. The murder took place in a Catholic hospital chapel on Holy Saturday 1980.

At the time, Robinson, the chaplain, was a prime suspect who took two lie detector tests and performed poorly on one. The cold case was reopened in December 2003 after events of byzantine complexity that eventually resulted in Robinson's arrest and indictment in spring 2004.

Then there's the story of Toledo firefighter Tony Comes, whose anguish is detailed in the 2005 Oscar-nominated documentary 'Twist of Faith.' The film takes a heartbreaking look at how Comes, now in his 30s, tries to cope with the abuse he suffered at the hands of former priest Dennis Gray in high school. On the verge of losing his marriage, health and sanity, Comes reluctantly entered into a $55,000 settlement with the diocese. One of the movie's most poignant scenes is when Comes returns to his new home only to discover that Gray, his former abuser, is living just four houses away. Comes takes his young daughter into his lap and tells her, with tears streaming down his face, what happened to him. Then he tells her never to go near Gray--even if she's bleeding badly and he claims to want to help her.

Comes said the movie touches people because the tragedy is universal: 'You could take me out of that movie and plug in just about any clerical abuse victim.'

There was always someone

According to retired Toledo police detective John Connors, Gray's abuse was known to the diocese in the 1980s. In addition to his work with the police department, Connors volunteered many years investigating clerical abuse for the diocese. Around 1986, he said he received a call from Fr. John 'Archie' Thomas, who was then superintendent of Catholic schools. Thomas was concerned that Gray was raping boys from Central Catholic High School and wanted to know what to do. Connors told Thomas to keep Gray away from kids. That was it--no report was ever filed.

According to a July 31 investigation by The Blade, this kind of cooperation between the diocese and law enforcement was the norm for many decades. 'I can tell you that there was always somebody [the diocese] could go to in the police department,' retired detective John Connors said. 'And I can tell you that, at one time, I was that man.' To date, 10 alleged Gray victims have settled lawsuits with the diocese. Even so, Auxiliary Bishop Robert Donnelly gave Gray a positive recommendation before he left the priesthood to work as a probation officer, a youth camp counselor and until a 2002 news expose, dean of students at a Toledo high school. Gray was never criminally charged. Donnelly remains auxiliary bishop.

There are three people arguably most responsible for uncovering Toledo's extraordinary abuse scandals. All three identify the others as having done the most for change. They are Barbara Blaine and Claudia Vercellotti, both of SNAP, and reporter Michael Sallah, formerly of The Blade. Blaine is the founder and president of SNAP. The role the group has played in the clerical abuse crisis is well known. What's less known about Blaine is that she was raised in Toledo, where her activism was prompted. Starting just before the 8th grade, Blaine says, she was abused by Chet Warren, the same priest implicated by Borgess and several others. Blaine first confronted Warren's religious order with her allegations 21 years ago in 1985; Warren was finally removed from ministry in 1992. Her intimate knowledge of the diocese continues to make her an effective advocate for change, but Blaine has often been at odds with the Toledo church. Shortly after the clerical scandals swept the nation in 2002, the former director of communications for the diocese, Fr. Thomas Quinn, now deceased, reportedly told a Blade writer he wanted to 'plant bombs' around Blaine at a speaking engagement. The diocese apologized for Quinn's remark shortly after that.

Claudia Vercellotti is Toledo's volunteer co-coordinator for SNAP. She helped start the Toledo chapter, the first in Ohio. Vercellotti has a background in criminal justice, social work and sociological research. She studied law until her involvement with SNAP overwhelmed her other interests. These pursuits strengthened her for SNAP, Vercellotti said, but she also claims '[SNAP] is the toughest advocacy I've ever done.' In early September, Vercellotti's advocacy got that much tougher when her apartment building burned down, destroying her personal belongings and all the records she kept for SNAP. According to Toledo fife officials, the severity of the blaze made its cause indeterminate.

Along with reporters Mitch Weiss and Joe Mahr, Sallah authored an expose about a rogue combat unit in Vietnam that earned The Blade the 2004 Pulitzer Prize for investigative journalism. Just prior to his work on the Vietnam story, however, Sallah was the driving force behind The Blade's comprehensive series about the Toledo diocese that appeared in December 2002. The series, called 'Shame, Sin, Secrets,' was a six-month undertaking responsible for exposing dozens of perpetrators and the diocese's decades-old pattern of covering the crimes. Early this year Sallah led two more large investigations involving the diocese. The first piece, cowritten with Weiss, was prompted by the Gerald Robinson saga. It explored questions about Satanic/ritualistic happenings within the diocese's religious community. The second piece, published in July, detailed how the diocese colluded with local law enforcement to whitewash sex abuse stretching back five decades. Sallah edited the series, written by his partners Weiss and Mahr. 'Without Mike Sallah,' said SNAP's Vercellotti, 'the diocese would still be saying 'There's no systemic problem here in Toledo.''

For several reasons, the Toledo diocese strikes some as troubled. This goes back to the negative exposure it's earned through repeated missteps, high profile legal cases like Robinson's and what some see as a longtime aversion to transparency.

Bizarre letter surfaces

Diocesan officials are saying little about clerical sexual abuse these days and next to nothing regarding the Robinson affair. The diocese repeatedly cites the judge's gag order as a reason for the silence. Still, victim advocates like Vercellotti think the diocese's motivation to keep quiet might have a lot to do with the criticism it has received regarding its handling of Robinson's case. 'They did everything they could to keep Robinson from coming under scrutiny,' said Vercellotti.

According to the case's lead prosecutor, Dean Mandros, the murder of Pahl was reopened by the cold case squad when they came into possession of a bizarre letter wherein a woman alleges graphic acts of Satanic/ritualistic abuse and murder perpetrated by a number of Toledo priests. One of the names contained in the letter was Robinson. The alleged victim first presented the letter June 11, 2003, to the diocesan board that reviews sexual abuse claims. Contents of the letter have been printed in The Blade and elsewhere. The handwritten letter claimed the woman was abused for years as a child in horrific ways, sexually and otherwise, by a satanic cult.

This 'Jane Doe' letter also names former priest Chet Warren, Barbara Blaine's abuser. On behalf of Warren, the diocese and the Oblates of St. Francis DeSales have paid Blaine and others monetary settlements. Blaine said she can't recall any ritualistic abuse from Warren, but both she and Vercellotti claim to know at least five alleged victims of Warren who identify such abuse. In fact, said the SNAP leaders, some of the alleged victims identify similar patterns, places and abusers as detailed in the Jane Doe letter, even though the victims would have no way of knowing one another. 'With some of the things they talk about,' said Vercellotti, 'it's like they're reading each other's marl.' In a Feb. 20, 2005, story Sallah and Weiss wrote for The Blade, the writers say four women told Toledo police about being ritually abused by clerics. Only one woman, Teresa Bombrys, was identified in the article by name. Bombrys also alleges abuse at the hands of Warren, for which she received a legal settlement.

Jane Doe's letter was presented to the diocesan review board on June 11, 2003. Robert Cooley, a licensed psychologist and review board member, took the position that there was a legal obligation to turn over this new information to the local prosecutor. However, Cooley was rebuffed in letters dated June 12 and June 27 from Tom Pletz, a diocesan attorney. Later that summer, Cooley was fired from the review board. Fr. Michael Billian, diocesan chancellor, was quoted as saying Cooley was dismissed for confidentiality issues.

Pletz's June 12 letter took the position that Cooley and the diocese didn't have a legal obligation to turn over the new allegations, in part because the woman's case file had been given to authorities in 2002. Pletz wrote, 'I can report that this person's diocesan rifle was reviewed by the Lucas County prosecutor's office last year. Its contents thus have already been reported to the proper legal authorities.' The lawyer also wrote that counselors--whether or not they are review board members--didn't have a legal responsibility to inform authorities about suspected child sexual abuse once the individual in question is older than 18. Jane Doe was beyond that age limit.

'Should have blazed a trail'

Pletz's letter said nothing about Jane Doe's murder allegations, a point that gets an angry reaction from Vercellotti: 'The diocese should have blazed a trail over to the prosecutor's office with that letter in hand on June 11 the second they got it. That letter went beyond new sex abuse allegations, beyond satanic abuse allegations--it contained murder allegations. I'd say that's something you should tell prosecutors.'

Assistant prosecutor John Weglian, chief of the special victims division, said he recalls some information from the woman's case being turned over (as Pletz's letter states) prior to June 11, 2003, but cannot recall precisely what it contained. Weglian is unequivocal, however, in stating he never saw the infamous Jane Doe letter until December 2003, when detective Steve Forrester from the police department's cold case squad approached him.

Forrester said he first received the letter on Dec. 3 from the Ohio attorney general's office and showed it to Weglian shortly thereafter. The letter piqued Forrester's interest in seeing the Robinson investigation reopened later that month. 'I knew Robinson was [the police's] prime suspect from 1980,' said Forrester.

The Ohio attorney general got the letter, said Vercellotti, because she took it to them with Jane Doe's permission in September. She did so, she said, because she believed it was clear the diocese intended to keep the explosive letter away from secular authorities after their attorney sent the two letters to Cooley. 'The letters they sent Cooley were meant to shut him up, plain and simple,' she said.

Retired detective John Connors was brought in to work on an internal investigation of Jane Doe's allegations for the diocese. Strangely, said Connors, it was at least a month after they got the letter--some time in July 2003--that he and another retired detective were asked to do the internal investigation. 'Even then,' said Connors, 'I thought that was a long time to wait.'

Pletz, the lawyer who advised the diocese on the Jane Doe letter, won't comment on his role in the affair. First, he claimed not to remember the woman's letter, despite the deluge of publicity surrounding the Robinson case. Pletz also cited the gag order in the Robinson trial and said he wouldn't comment even if he could recall the statement and his own subsequent advisory letters to the diocese. 'Whatever letters I wrote--if those are somehow public--I'm just going to let them speak for themselves,' said Pletz. The contents of the letters Pletz sent to the diocese showed up in news reports shortly after Robinson was arrested in April 2004.

At the time Jane Doe came forward with her letter in June 2003, the diocese was waiting for another bishop to be appointed in the wake of Bishop James R. Hoffman's death. Leonard Blair wouldn't be appointed to the role until December 2003, so the hierarchy consisted of Chancellor Fr. Michael Billian and Auxiliary Bishop Robert Donnelly. The chancellor is normally responsible for the day-to-day operations and, of the hierarchy, only Billian was 'carbon copied' on Pletz's letters. Billian did not return phone calls requesting comments for this article. Spokeswoman Sally Oberski said the diocese would not speak about the Robinson affair, so NCR was unable to ask about Donnelly's role in the matter.

Earlier, in August 2002, Hoffman signed a legal agreement with the Lucas County prosecutor's office that dictated how the diocese would deal with allegations of sexual abuse. Julia Bates, Lucas County prosecutor, claims the diocese had a legal obligation to turn over Jane Doe's letter in light of the special agreement it had with her office. 'That letter, I think, falls within the purview of the agreement and they should have forwarded that letter to this office,' said Bates.

There are also questions about how the diocese behaved after December 2003 when Lucas county prosecutors finally got the Jane Doe letter and reopened the Robinson investigation. Authorities asked the diocese to voluntarily turn over the records it had on Gerald Robinson but received only three pages. 'When we asked them if that was it,' said Detective Forrester, 'they told us yes.' Then, on Sept. 15, 2004, authorities returned with a warrant, and the diocese gave them more than 100 documents bearing Robinson's name. Another warrant was executed two days later, but Forrester said he can't discuss the documents seized in that search.

'Could refute good image'

Robinson's trial, scheduled for mid-April, almost two years after his arrest, promises to be a media circus. He has entered a not guilty plea. One of his attorneys, Alan Konop, declined to comment on the case, citing the gag order.

Speculation about the trial increased in November when Borgess, the nun who recently came forward to support the victim protection legislation, was identified on a list of potential witnesses for the prosecution. On Nov. 10, The Blade carried this headline: 'Prosecutor might quiz nun in priest's trial: Sister could be called to refute good image.' Neither the prosecutor's office, Robinson's attorneys, nor Borgess would comment to NCR about her potential role in the trial. No comment about this matter was cited by The Blade, either, but the prospect of Borgess testifying against Robinson adds another element of intrigue to the already sensational proceeding. The Blade has reported that Warren is on the prosecution's list of possible witnesses.

It was reported Jan. 7 that Blair had named a new chancellor to replace Billian. The significance of this isn't clear, but Oberski claimed the personnel change has nothing to do with Billian's role in the Robinson case. She said she couldn't comment on the case and cited the gag order after being told that Lucas county prosecutors say no one from the diocese ever gave them the Jane Doe letter prior to reopening the murder case. According to a diocesan news release, Billian will retain his administrative functions as episcopal vicar and moderator of the curia.

Meanwhile, Borgess is standing with Tony Comes, Claudia Vercellotti and Barbara Blaine in their effort to see Senate Bill 17 passed into law. Blair now presides over the diocese with Donnelly. Blair and Ohio's other bishops oppose SB 17, based primarily on the controversial provision that would open discovery for abuse claims up to 35 years old.

This comes as no surprise to Blaine. 'Aiding discovery of abuse is not something for which the Toledo diocese, or the church as a whole, deserves much praise,' she said.

Contracts Update.(contracts that health care information technology companies have signed with provider and payer organizations)(The University of Chicago Hospitals) - Health Data Management

The Contracts Update Department features announcements of recent contracts that health care information technology companies have signed with provider and payer organizations. Please send contract announcement news releases via e-mail to Senior Editor Beckie Kelly at rebecca.kelly-schuerenbergthomsonmedia.com.

Abbott Laboratories

Web-based data management system

Premier Inc., San Diego

Agfa

Picture archiving and communication system and computed radiography system

Adventist Health System, Winter Park, Fla.

Amicas Inc.

Picture archiving and communications system

The University of Chicago Hospitals

Bsquare

I.T. services

University of Washington Medicine, Seattle

Concuity Inc.

Revenue cycle management system

Swedish Medical Center, Seattle

Datawatch Corp.

Enterprise reporting system

Good Shepherd Health System, Longview, Texas

Eastman Kodak Co.

Picture archiving and communication system

National Institutes of Health Clinical Center, Bethesda, Md.

Eclipsys Corp.

Clinical information system

Calgary Health Region, Alberta, Canada

Memorial Sloan-Kettering Cancer Center, New York

Electronic Data Systems

I.T. management and operations

Blue Cross Blue Shield of Massachusetts Inc., Boston

Ensure Technologies

Security software

Community Health Partners, Lorain, Ohio

Sumner Regional Medical Center, Gallatin, Tenn.

Gold Standard Multimedia

PDA-based drug information software

Florida's Agency for Health Care

Administration, Jacksonville

ibex Healthdata Systems

Emergency department information system

Mount Clemens (Mich.) General Hospital

Info-X

Claims management system

Physician Practice Services, Northvale, N.J.

InstantDX LLC

Electronic prescription software

Lifespan, Providence, R.I.

Interactive Payer Network

Electronic data interchange connectivity and clearinghouse services

Compensation Programs of Ohio, Austintown

Enterprise Group Planning Inc., Cleveland

Kryptiq Corp.

Secure messaging application

Austin (Texas) Diagnostic Clinic

LanVision Systems Inc.

Web-based electronic medical records system

Pattie A. Clay Regional Medical Center, Richmond, Ky.

MC Strategies

Web-based management training services

MedAssets HSCA, St. Louis

Med3000 and Misys Healthcare Systems

Practice management, electronic medical records and data warehouse applications

Miller Orthopaedic Clinic, Charlotte, N.C.

Med-Data Management Inc.

Charge management and reporting system

Catholic Health Initiatives, Denver

Mediware Information Systems Inc.

Computerized physician order entry system

Jewish Hospital, Louisville, Ky.

MercuryMD

Mobile software

Carolinas HealthCare System, Research

Triangle Park, N.C.

Misys Healthcare Systems

Integrated practice management and electronic medical records systems

Advanced Women's Health Center, Spring Hill, Fla.

DeFuentes & Real, M.D., PA, Kissimmee, Fla.

Issaquah (Wash.) Medical Group

Low Country Health Care System, Fairfax, S.C.

Rivers Edge Family Medicine, Charlottesville, Va.

Marcos J. Valdez M.D., PA, McAllen, Texas

Wythe Medical Associates, Wytheville, Va.

Radiology and mammography information systems

Barton HealthCare System, South Lake Tahoe, Calif.

Netsmart Technologies Inc.

Practice management and electronic medical records software

The Nevada Division of Children and Family Services, Las Vegas

Opus Healthcare Solutions Inc.

Web-based clinical documentation system

Spring Valley Hospital Medical Center, Las Vegas

Pegasystems Inc.

Customer service software

Blue Cross and Blue Shield of Rhode Island, Providence

Plexis Healthcare Systems Inc.

Claims processing software

Arrowhead Administrators, San Bernadino, Calif.

Precyse Solutions

Web-based medical transcription services

Beebe Medical Center, Lewes, Del.

Premier Healthcare Informatics

Clinical benchmarking system

Henry Ford Health System, Detroit

ProxyMed Inc.

HIPAA-compliant transaction services

Harvard Pilgrim Health Care, Wellesley, Mass.

Redwood Software Inc.

Automated reports management software

Sentara Healthcare, Norfolk, Va.

RelayHealth Corp.

Web-based physician-patient communications service

Newton-Wellesley Primary Care, Newton, Mass.

Quality Care Solutions Inc.

Managed care application

Molina Healthcare Inc., Long Beach, Calif.

Sentillion Inc.

Single-sign-on application

Children's Hospital and Medical Center, Cincinnati

Valley Medical Center, Renton, Wash.

Siemens Medical Solutions

Medical imaging technologies and information systems

The University of Michigan Health System, Ann Arbor

Picture archiving and communication system and network storage technology

Wyoming Valley Health Care System, Kingston, Pa.

Symantec Corp.

Intrusion protection, firewall and anti-virus technologies

Magee Rehabilitation Hospital, Philadelphia

Tumbleweed

E-mail firewall and encryption application

Blue Cross and Blue Shield of North Carolina, Durham

Ultra-Scan Corp.

Biometrics technology

Catholic Health System, Buffalo, N.Y.

Verilet Inc.

Web portal technology

Scott & White Health Plan, Temple, Texas

Visicu Inc.

Electronic intensive care unit technology

Borgess Medical Center, Kalamazoo, Mich.

Kaleida Health, Buffalo, N.Y.

Websense Inc.

Security software

Sharp HealthCare, San Diego

Zix Corp.

Secure e-mail services

Cedars-Sinai Medical Center, Los Angeles