MEDICINE WEB SITE Background Every attempt is
made to provide accurate and well written material.
Your contributions, suggestions, additional
information and advice sent to the web address at
the foot of the page are welcome. Where possible
they will be included in revised pages. The intention is
to show the general thrust of corporate practices
as well as the nature and extent of any allegations
made. Material contained here represents my views
based on my study of the operation of the health
care marketplace and the material available to me.
It should not be assumed to represent the views of
any other individual or organisation. Content All
TO CORPORATE MEDICINE WEB PAGES
The many extracts on these pages are from copyright material. They are owned by the reference given or its owner. They are reproduced here for educational purposes and to stimulate public debate about the provision of health and aged care. I consider this to be "fair use" in the common interest. They should not be reproduced for commercial purposes.
This page examines some of the problems in developing a site of this nature. It summarises the thrust of the arguments on the web site and stresses the importance of the issues at stake. It is intended as an introduction to pages which the reader may come upon through web searches without having previously examined the rest of the web site.
LINKS CORPORATE MEDICINE WEB SITE
Every attempt is made to provide accurate and well written material. Your contributions, suggestions, additional information and advice sent to the web address at the foot of the page are welcome. Where possible they will be included in revised pages.
The intention is to show the general thrust of corporate practices as well as the nature and extent of any allegations made. Material contained here represents my views based on my study of the operation of the health care marketplace and the material available to me. It should not be assumed to represent the views of any other individual or organisation.
INTRODUCTION TO CORPORATE MEDICINE WEB PAGES
Web pages in isolation
Suggestions have been made that some of the
pages on this web site are defamatory. I believe that this is because
those inexperienced with the World Wide Web read pages in isolation
when they find them by doing web searches. They fail to understand
that a web page is only one page out of many on a site. It is simply
not possible to repeat the argument and set the context on each of
the over 400 pages on this web site. Many pages are already too long.
This web page
Pages are part of a book and web pages are
part of a web site. They are not isolated entities. I appreciate that
it has sometimes been difficult for new readers to find the
arguments, which are spread out over many pages. This page addresses
that issue and links to sections that explore the issues in greater
depth. It summarises the main arguments made on the site with links
to pages that explore the issues in greater depth.
Any opinions, assertions or conclusions
reached are based on the information publicly available to me and
represent my best assessment of the situation. They are intended to
tie the many pages to the thesis of the web site. The comments are
supported by extracts or references in almost all instances. Comments
are made in order to provide context, summarise and ensure
continuity. In contentious areas I try to keep this to a minimum to
allow the material to speak for itself.
A Dysfunctional System
I try to avoid making assertions about
companies and individuals that are not implicit in material quoted so
leaving readers to draw their own conclusions. I am primarily
concerned with a system rather than individuals. Individuals and
companies are part of that system and are the vehicles through which
it is expressed. They are selected for and moulded by the system.
They are the vehicles through which the system operates. I cannot
deal with the failures in the system without giving these individuals
and companies close attention and examining their characters.
While I do my best to be objective I am not
infallible. The information is presented through the prism of my
studies and my understandings. There are other ways of
conceptualising what has happened in health and aged care. I have
criticised some of these. The unrealistic response of Australian
politicians to the failures in aged care at Riverside
and to the 2006 rape
scandal is a good examples of
perspective's I criticise. The failure of a majority of US citizens
to confront the limitations of markets is another.
My comments can be challenged and the
extracts may need amplification or refutation. I correct any errors
when they are pointed out to me. I am willing to include alternate
and conflicting points of view. I welcome input from those involved
in one way or another and if that information is verifiable or
printable then I will include it.
Views from the other side
This web page is written from one side of what I describe as a massive divide in perceptions and I am strongly critical of the other side of that divide. I cannot fairly put their point of view, as I cannot see it. What the web site and the public needs is a properly constructed argument which promotes the market system of health and aged care and which confronts the criticisms and the mass of material about corporate misbehaviour on these web pages. I invite any market advocate to write something I can add to individual web pages or include as a page to which I can link. I do not believe that they can mount a credible argument in everyday language to confront the criticisms I have made on this web site.
The Health and aged care section of this web site is a critical analysis of the marketisation of health and aged care. A simple framework is developed in order to understand the findings and the failures in the market system when it is applied to health and aged care. I believe that this provides important insights. The intention is not to target individuals but expose the failures in the application of a market system to health and aged care. The controlling forces in the marketplace are the financiers, the share market, the companies, the entrepreneurs and the managers they appoint. This web site shifts the focus from the hospitals and nursing homes to the marketplace owners and managers - the people who are ultimately responsible for what happens.
These people seek to profit from the sick, the frail and the vulnerable. They provide services in the sector in order to do so. It is therefore inevitable that they and their conduct be critically examined when examining market processes. Some incorrectly see this as a personal attack.
What I am suggesting is that persons and groups who may be highly credible and successful operators in the marketplace may nevertheless be dysfunctional in health and aged care. Delightful people they may be; philanthropic and often good and generous friends. I argue that they pose a threat to the well being of citizens when their operations shift to health and aged care. This is not because they are malign but because they operate within a very different and incompatible framework of understanding to that required in health and aged care.
This web site confronts the market with its actions. It has its origins in whistle blowing. It is not designed specifically to assist the elderly and their families find a specific hospital or nursing home but they can learn more about the owner's track record. It argues that if this is a marketplace then the customers, already disempowered by their condition, have the right to all of the information available about the owners and the facilities they operate. They can then decide if they are the sort of people who can be trusted to care for them or their loved ones. Government no longer provides adequate protection.
However this is no longer the main purpose of this web site. The intention is to argue and illustrate the failures in the health and aged care market system. The pages advance concepts that enable us to understand this in non-judgemental terms and so design something more suitable. Abstract arguments have little impact. They need to be brought into sharp focus by real life situations and consequences.
The background to the arguments on this web
site can also be accessed from the web page "Coming
to Grips with Health Care". It very
briefly outlines the issues and links to other pages. This web page
summarises and also links to some of them.
This web site argues strongly that there is a discordance between the way health and aged care are perceived in the marketplace on the one hand and the way carers and the community see it on the other. The ideas are so contradictory that they cannot be effectively reconciled. Individuals seeking to build their lives and become successful in this environment have to accommodate to this conflict. Those unable to do so fail, go elsewhere or lie low.
Those who build successful lives in this
environment generally accomplish this by a number of well-documented
psychological strategies that enable them to avoid confronting the
conflicts. In a published paper "Belief
versus Reality in Reforming Health Care"
(pdf file) I explore these issues.
An Eye for the Main Chance
Australian author David Malouf praises the
characteristics that make for a good entrepreneur as "An eye for the
main chance and the weakness of others". He attributes Australia's
entrepreneurial growth to these convict inherited attributes. I have
no argument with this and in fact these people may make major
contributions and perform well in the wider marketplace. The argument
is that they are poorly suited to provide care for the vulnerable
sick and the frail elderly when this is done within a market context.
The consequence of their doing so is all too often disastrous.
Being focused or being closed minded
These people are often supremely self-confidant, have enormous energy and are intolerant of other points of view. They are very focused. They can be very effective, are often charismatic and are great doers. Some have made major contributions in advancing health care when they have worked within, been controlled by and adopted professional and community value systems. They have a burning drive to achieve.
When they adopt contradictory patterns of thinking they fail to confront these contradictions and become problems. I suspect that a number of doctors have adopted contradictory market thinking, achieving status and recognition among businessmen rather than professional colleagues.
These potential problems in many of our
personalities are magnified in the competitive health and aged care
marketplace where the motivation and focus of ambitious individuals
is directed away from care towards profits. Their adaptive strategies
make those of us with these characteristics dysfunctional.
We are all more or less like this
While there are wide differences I argue that we all have these characteristics in greater or lesser degree. The extent to which we behave in an open or reflective manner as contrasted with a closed minded manner is strongly influenced by the context in which we live our lives. The strong competitive internal pressures some of us have to succeed in whatever situation we find ourselves pushes us away from reflection. Reflection entails questioning and doubt. Doubt and success can sometimes be poor bedfellows.
What happens is well illustrated by the development of fascism in Germany and apartheid in South Africa. Illogical patterns of thought and behaviours can become pervasive and legitimate within the cultures of a country or of a company (eg Tenet Healthcare). As members of that culture we feel isolated and uncomfortable when we step outside its prescriptions and look in at it critically. Few of us do. These cultures can be very resistant to change can resist outside pressure and logical argument. They may re-offend repeatedly.
On a web page titled "Introduction to Sociopathy" I have explored the ideas of "open" and "closed" minded personalities as a continuum along which we move as we pass through more or less stressful situations. It explores the success and consequences of closed mindedness in a health/aged care context that is dominated by marketplace thinking.
I argue that the context (in this case marketplace) selects for the sort of people and the sort of groups who will succeed there. The people and groups selected by the marketplace are poorly suited to health care and as a consequence the system becomes dysfunctional. Because health and aged care pose the greatest conflicts for the marketplace, the people from the extreme closed-minded end of this spectrum are most likely to flourish. They do so at the expense of those who have a more suitable reflective and empathic personality. The latter will be beset by doubts. They will be unable to identify with the market's prescriptions for care.
Another page "Understanding the Corporatisation of Health Care" explores these issues further and examines the wider cultural implications.
A consequence of all this is that we have a massive divide between corporate thinking and the rest of us. I explore this on a page titled " THE GREAT DIVIDE IN PERCEPTIONS about the CORPORATE MARKETPLACE"
Other web pages explore some of these issues.
These include " A
CLASH OF WORLDS" and "
Health and aged care are probably the best illustration of the way the market fails when people are vulnerable. Profits can be increased dramatically by exploiting this vulnerability. When one group does so others must follow. Those who fail to do so will usually go under.
These situations are opportunities for people with an eye for the main chance and the weakness of others. Individuals with focused or closed minded personalities and cultures that enable them to look past logical conflicts flourish. They develop patterns of thinking and rationalisations that enable them to do so. Pressures to success drive them to exploit the vulnerability of others in order to meet market objectives without confronting the appropriateness of their actions.
There are many other examples. I have used the recent Wall Street frauds and particularly Citigroup's involvement in these to illustrate the wider problem and in particular the adverse role played by bankers and financiers in the health care market.
Market pressures are powerful and a failure to heed them results in economic failure. Regulatory effort to control dysfunctional conduct consequently fails. This has been shown over and over again in health and aged care.
The web site argues that business practices, which are widely accepted as legitimate and desirable in the marketplace, are severely dysfunctional in health and aged care when they are employed there. The web site therefore devotes considerable attention to the way in which the market operates. It examines the impact of business practices on vulnerable people outside the health and aged care context. The social dynamics are similar. There are for example 13 pages devoted to Citigroup and other Wall Street financiers.
For all these reasons I also look at available information about the other businesses of health and aged care operators. If there is material that throws light on the nature of the marketplace, on personalities and on business practices I include it. Management seldom change their business thinking and practices when they move from commodities to health. Probity and social consciousness are not confined to domain or context when they are expressed.
The eminent economist Uwe Reinhardt describing the market in health in the USA called it "brutal and inhumane". Other analysts trying to explain why health care in the USA is so dysfunctional have indicated that "its just business".
In the later part of a rather inappropriately titled background paper prepared for a visit to Canada I explored the impact of current marketplace theories on community thinking and culture. I expressed concern about the impact on our understanding of society and democracy. I argue that as with fascism, communism, various forms of socialism and even apartheid, ideas which have validity in a limited context have been generalised and turned into an ideology which is seen to be universally applicable. In our complex world this is unbalanced and dysfunctional.
The ideology which now pervades the
marketplace and capitalist society has shifted the focus of our
thinking away from our responsibility for the rights and well being
of others to our personal right to exploit the situations in which we
find ourselves for our own benefit. The English philosopher Botolo
touches on some of these issues in his television series "Status
Anxiety". He uses US society to illustrate the problem. The
marketisation of health and aged care is a good example of what can
Citizens no longer protected
One of the consequences of this marketisation of all of society is that older concepts and legal restraints, that worked to protect citizens and shield areas of activity that are vulnerable to self-interest, have been disregarded and devalued. This is because they restrict the rights of some. Instead the system relies on ineffective and costly monitoring, detection and penalties - closing the gate after the horse has bolted.
A process of liberalisation is advocated
globally. This essentially means the removal of these protective
restrictions on marketplace activity. The market is believed to be
self-correcting, an obvious fallacy as is so clearly shown in health
and aged care. When it does correct it leaves an unacceptable trail
of suffering. Large corporations receive lenient treatment and are
not put out of business when they offend. Prison sentences are rare.
and aged care in
the USA and Australia)
in health and aged care is increasingly considered obsolete,
anti-competitive or restrictive. The protective values embodied in
professionalism have suffered. Both the protections provided by
professional ethics and the cooperation inherent in professionalism
are seen as obsolete and anti-competitive. They no longer have
credibility as competition in the marketplace is supposed to do this
better. Professionals are part of this community and consequently are
less restrained by professional values. They have become more
Most worrying of all is the atrophy of the concept of probity. It suffers from a lack of enforcement and a failure of legislators to legislate and give statutory authorities the legal resources to cope with a marketplace.
Probity is a key concept adopted from the British. Probity requires that the providers of services be the sort of people who can be trusted to place services to vulnerable citizens ahead of their own personal and financial interests. Trustworthiness rather than "buyer beware" protected the vulnerable. Corporate directors and managers have a primary fiduciary duty to put shareholders financial interests first. When there is a conflict between these interests, as occurs continuously in the health and aged care marketplace, they must put shareholders profits ahead of care. I argue that as a consequence market listed corporations cannot meet probity requirements.
In the early 1990s even the poorly enforced probity requirements in Australia became a stumbling block for health care multinationals. They had been welcomed into Australia by market focused governments. Tenet Healthcare (then called NME), Columbia/HCA, Sun Healthcare and Citigroup all had to confront our hospital probity requirements. None now own hospitals in Australia. I like to think that I played some part in this.
In 1996/7 the federal government "liberalised" aged care and abolished the probity requirements replacing them with accreditation processes, processes that had already failed in the USA.
As a direct consequence members of Citigroup, the giant financiers involved in recurrent Wall Street scandals now own and control Australia's largest nursing home company and there are no effective restrictions on their activities. They had been restricted when they bought hospitals.
Government regulators granting approval to
nursing home operators no longer have the power to assess the probity
of nursing home owners. In a recent letter to me dated
20th February 2007 the Department of Health and Aging
admitted that they had no powers in regard to the purchase of the
giant Australian aged care multinational DCA by a Citigroup
consortium. Citigroup has recent convictions and has paid fines for
defrauding and exploiting those it had a responsibility to serve. It
has or is expected to pay in the region of US $10 billion to
recompense those it helped Worldcom and Enron defraud. The government
body, which approves nursing home providers, had no power to
intervene in this sale.
Accreditation and Probity
In the USA Accreditation and oversight processes have failed repeatedly in spite of multiple attempts to restructure them. They have served citizens poorly.
Australia's accreditation agency aids and abets the concealment of an operator's probity. It removes older poor inspection results from its web site as soon as a new inspection is carried out. It does not keep a publicly available record of past inspection results and the track record of owners. It tracks nursing home processes rather than corporate behaviour. It does not record and chart patterns of failure across the industry. This may encourage homes to correct problems in process rapidly. It denies consumers their right to information in the marketplace.
Citizens are denied the right to examine an owner's probity and act accordingly. We are all concerned about the sort of people we plan to trust to care for our failing mothers and fathers. The agency charged with monitoring the marketplace actively subverts our right to examine company track records and the track records of their owners.
Even more incredible, a company was supported by the minister for aging when it alleged that another web site was defamatory. The owner of the web site had placed adverse reports not on the accreditation web site onto its own site.
This web site attempts to bring available material together so that citizens can assess it. Market advocates claim that poor operators will be pushed out of business. If we must have a marketplace then we should try to make it work so that poor operators are pushed out and that citizens contribute to this. They are entitled to all the available information.
Response to issues raised on the web site welcomed
This web site is a discussion about health and aged care. If my selections are not properly representative I welcome correction and if anyone involved wishes to comment on the material I will include that.
I am particularly eager for someone from the market sector to respond to the arguments on this web site. I am on the wrong side of the divide and cannot put their point of view in regard to the matters raised. Critical contributions addressing the arguments are welcomed.
Allegations of misconduct and dysfunction
The health and aged care market sector is the subject of extensive allegations of fraud and the misuse of vulnerable people for profit.
It can no longer be seriously disputed that
Most have been denied and then resolved by massive settlements without admitting guilt. It is clear that these events are red flags and are not exceptions. They are representative of a wide and pervasive problem in the provision of health and aged care in a profit driven marketplace. Credible investigators have now addressed this issue and identified marketplace health care as the key problem.
Health care fraud has become a major issue in
health and aged care. In the USA it takes a major slice out of the
health care budget. The largest frauds, totalling billions in some
instances, are perpetrated by the most
successful health care companies. The
majority of them are exposed by whistle blowers. The true incidence
in Australia is not known because there is insufficient legislative
protection for whistleblowers. Successful whistle blowers are not
rewarded for their efforts. Instead they are likely to be attacked
and sued for defamation.
Denials and Aggressive Responses
With rare exception allegations and concerns about corporate misconduct are strenuously denied. This denial continues in the face of massive fraud and patient care settlements. These settlements are often confidential or made without admitting liability. While most allegations are denied, the information available is more than sufficient to show that there is a major problem in the provision of care primarily for profit. The exception is the US $4 billion HealthSouth fraud where the fraud is admitted but responsibility is disputed.
It is clear that many of the people who make these denials are genuine when they make the denials. They really believe that they were justified in taking the actions they did and that their critics are in some way malicious or mistaken. What they do is often legitimate within the framework of understanding that the market uses. Within any other framework of understanding these practices may be totally unacceptable. It is hardly surprising that companies re-offend.
The reasons why one group of people are unable to see and understand that something is wrong and harmful, when to others it is very clear, is one of the matters discussed on this site.
Corporate market proponents have no doubts about their position. Yet rather than discussing the issues and addressing the arguments made by their critics they attack the messenger and resort to threats and litigation. They rarely acknowledge their failings and seldom confront the concerns about their operations with evidence or argument. Instead they retreat into marketplace justifications.
I have argued that this is a consequence of
the psychological structure of those who succeed in the marketplace
and particularly in health and aged care. The competitive market in
health selects for people who are adept at finding ways of avoiding
conflicting evidence and opinion. It does not select for people who
are good and concerned citizens - although they may believe that they
are. (eg. Sun
Including denials in the material
These web pages bring large amounts of publicly available information together in the form of short extracts from published material. If it were to include all denials and explanations then it would not only considerably increase the size of the pages but would use more copyright material than I am comfortable with.
I have interpreted the "fair use" provisions fairly liberally and I trust that the copyright owners will appreciate the importance of the issues and the need to bring this material to the public's attention in one place so that its impact is not dissipated by fragmentation. I try to reproduce only what I feel is essential to make the points and support my thesis in a balanced way.
Documenting each denial does not alter the
arguments on these pages. I have therefore been selective in quoting
them. I have done so when there were serious issues that are in doubt
or in order to illustrate the analysis of marketplace responses.
Where the sources of information are credible or authoritative and
there seems little doubt that there is at least some substance to the
matters then denials have been omitted. The reader should assume that
all allegations made are disputed and that there will seldom be a
final public resolution of most of the matters published.
I stress again that this web site is not about whether a particular practice is legal or not but whether it is functional for the community or not. The practice of paying kickbacks for doctors is illegal and creates an outcry. Entering into joint ventures that similarly align the doctor's interests with the corporation is usually legal and is advocated by the marketplace. Turning doctors into company shareholders is a favoured strategy to align their interests with the company rather than their patients. The consequences are similar.
Even more damaging is the offering of massive incentives to directors, managers and even hospital administrators when they successfully squeeze more profit from the funds available to provide care to the sick and aging. Not only is it legal but it is normal business practice and considered essential for marketplace success. It lies at the heart of the problems in the USA and potential problems in Australia.
Litigation in the marketplace is ruthless in the pursuit of business advantage. David Malouf's positive assessment of the successful entrepreneur is of someone with "an eye for the main chance and the weakness of others". This leads them to take advantage of every opportunity. The unwary can get hurt. Legal niceties rather than trustworthiness and social conscience determine the courts decisions.
This web site challenges the appropriateness of people, who operate in the acquisitive and legalistic market environment, becoming providers of health and aged care. The modes of operation are contradictory and incompatible. The law does not recognise this.
The law does not keep pace with the community's needs and the context within which we live. It follows political ideology. Health is consequently subjected to legal interpretations that relate to marketplace activity and economic rationalist ideology. Activities that are severely dysfunctional can be sanctioned. Investigations and critical discussion can run foul of draconian litigation laws even when matters of vital interest to the community are illustrated by examples, as they must be to make the argument.
Arguing that something is legal, has been sanctioned in law, or is defamatory is not a response to the arguments, even though we must ultimately live by the law. It may need to be changed and if so must be criticised.
Corporations all too often confuse the words "legal" and "acceptable". On the one hand they stretch the law to the limits in their pursuit of profits and on the other they use it aggressively to protect their commercial interests and suppress dissent. Milton Freedman the prize-winning economist asserts that they have a fiduciary responsibility to do all this in the interests of their shareholders. Health and aged care sit very uncomfortably within this context.
In a civil society, where a community functions effectively, acceptable conduct is to take up the issues, discuss and dispute them. Legal action may be resorted to when the response is not reasonable or fair but should be uncommon in an interacting community of sensible and reflective citizens.
The problems inherent in marketplace health and aged care are being recognised by investigative analysts in the USA. The business and political communities in the USA and Australia are still in denial and make every effort to avoid the issues.
The issues are not trivial. The lives and well being of large numbers of citizens are at stake. Ultimately the business and political communities will have to face reality and come to terms with the problems that have been created. I have suggested ways in which they can understand their shortcomings by gaining insights which do not hold them personally responsible and which enable them to become active in reforming the system.
The sensibilities of health and aged care entrepreneurs whose noses are out of joint when available information about their past history is brought together and exposed to critical scrutiny cannot be allowed to derail that process. It is too important. They have every right to respond to the reports about them and to criticise. I would be delighted if they would do so and urge them to take the opportunity to do so by emailing me at the address at the foot of this page. This will help to bring on the debate we must have and the sooner the better. Attempting to prevent that may be legally possible. I suggest that would be a disservice to society and would ultimately reflect on their credibility.
As a society we criticise the absence of readily available historical information about doctors like Dr Patel (called Dr Death because of the number of his patients who died in Bundaberg, Australia). At the same time we allow legal processes to stifle the ready availability of the past history of health and aged care corporations and their owners. The US experience suggests that the number of people who die or are harmed is even greater.
The USA is a prime example of the failure of the market in illness and decrepitude. This is now widely acknowledged. It not only increases costs, but also provides inferior care and ruthlessly misuses citizens in order to generate profits. It is analysed on this web site in order to identify the risks for Australia and confront similar changes in this country at an early stage. Australian politicians hotly dispute suggestions that we are going the same way as the USA. At the same time they pursue the same policies and promote the practices and thinking which lie at the root of the US failures. They have welcomed (possibly even invited) and smoothed the path for US multinationals seeking to operate in health and aged care in Australia. They have continued to do so in the face of overwhelming evidence that the US system is dysfunctional and that these companies could not possibly meet any reasonable definition of probity.
It is certainly true that we in Australia have not descended to the levels of dysfunction seen in the USA. Examination of the conduct of US companies provides valuable insights for us as we travel the same path. There are ample indications of a tendency to go this way. The process has been restrained but not yet aborted. Doctors have largely refused to enter into financial contracts and arrangements with insurers and hospitals. They have retained their independence and so continue to exert economic leverage for the benefits of patients as well as themselves. This is particularly well illustrated by their response to Mayne Health's dysfunctional business practices.
Doctors exert little if any economic leverage in aged care. It is not surprising therefore that, although there are differences from the USA in some of the patterns, dysfunctional practices have occurred and become progressively more confronting. The agencies responsible for keeping the market in check have failed and been heavily criticised. The situation has progressed from understaffing and neglect (eg Riverside) to such demoralisation of staff that 90 year olds have been raped and other nurses have not done anything about it.
As in the USA claims have been made that these are isolated and exceptional instances but no evidence has been supplied to justify this. It is far more likely that these instances are red flags pointing to a pervasive problem in the provision of aged care, a problem consequent on applying competitive market principles to aged care.
If citizens are to be protected in this marketplace then it is essential that any deviations from acceptable conduct be strongly and publicly criticised and that trends or patterns of behaviour that can be seen to be dysfunctional be brought to every one's attention. This site tries to do so by bringing material together. By making publicly available information more readily available, the site empowers the community and individuals when they deal with the marketplace and when they make political decisions.
The material on this web site is all publicly available and extracts are reproduced as "fair use" in order to support the arguments.
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This page created Mar 2007 by Michael Wynne
Additions June 2007