Johnl: Steve -- You mentioned that UPMC is the second-largest private employer in the state, behind Wal-Mart. What is the source for that? I figured that Wal-Mart was a large employer, but over 40,000 employees (UPMC's figure) seems like a lot.

Steve Levin: It is a lot. But the number is likely to grow larger as UPMC continues to expand. The numbers for employment come from UPMC.

Jodiejodie: What does Mr. Romoff feel about the Catherine Loughfner case from '98? As that was the time of the "Empire Building," which involved NOT hiring minorities, especially African Americans.

Steve Levin: I did not ask Mr. Romoff specifically about that case. It was well publicized at the time, however. I did ask Esther Bush, head of the Pittsburgh Urban League, about it during the course of my interviews. She was adamant that while UPMC had improved somewhat in its hiring of minorities, there was still a long way to go. BTW, at any one time, UPMC has dozens of ongoing lawsuits it must contend with, everything from workers' comp cases to firings.

Patricia: After writing this series and interviewing everyone for this series, do you agree with Jeffrey Romoff's decisions?

Steve Levin: There's no question that Mr. Romoff (and Dr. Thomas Detre) have been very, very successful at what they do. Far be it from me to say whether or not I agree with their decisions. That's not my field. It's hard to argue with success, right? That said, many people would argue with the means used to achieve said end.

Jodiejodie: Does Mr. Romoff feel that there are any problems in the hiring policy at UPMC?

Steve Levin: As I said earlier, I spoke with Esther Bush about this. I'll have to let her comments suffice.

Well-tanned: Mr. Levin: Several questions: 1) Do you work for UPMC or the Post-Gazette? 2) Were you paid to write the article? 3) What was the purpose of your article? 4) Advertising by UPMC appeared juxtaposed with your articles, raising questions about objectivity; 5) What is the Jewish code of business to which you referred in one article?

Steve Levin: Always a jokester in the crowd.

MedSchoolFaculty: What about the medical school and residency training programs? These are critical components of the public trust which gives UPMC its nonprofit status. Is the omission of these from the discussion the reason they are not as successful as the "business" side of UPMC?

Steve Levin: In a project such as this, it is not possible to cover every aspect of a huge organization. I dealt with the residence program as it pertained to Mr. Romoff's tenure at the hospital. The series was essentially a profile of Mr. Romoff. UPMC served as background and foundation in telling Mr. Romoff's story. Quite honestly, I don't know whether the med school and residency training programs today are successful or not.

Gasbone: Is Mr. Romoff participating or "listening" as we speak?

Steve Levin: I seriously doubt neither.

Floppydisk: The article has the flavor of a public-relations attempt to smooth the perceptions that people have of Mr. Romoff. Can you asnwer why this article was written and who paid for it?

Steve Levin: You're certainly entitled to your opinion, although I can't figure out how you arrived at it.

Pennyless: I'm African American; I've seen a lot of things in my 10-year tenure with UPMC. Actually, I'm shocked at what I've seen. I've trained many Caucasians who continue to rise above me in title/pay. Is Mr. Romoff aware of the absolute unfairness to African Americans? The Catherine Loughner case was a raindrop to a river of the issues with their hiring.

Steve Levin: I'm always looking for new stories. If you feel that there is blatant racism ongoing at UPMC, I urge you to give me a call so that we can talk about it in a more appropriate forum.

Johnl: Steve -- Do you have any read on the rationale for UPMC's decision to voluntarily comply with Sarbanes-Oxley? I mean the behind-the-scenes rationale, as opposed to the publicly stated rationale that it's just good business practice. Are they trying to get ahead of federal attempts to more closely regulate nonprofit health care institutions (e.g., the Grassley hearings)?

Steve Levin: From what I was able to find out, that was UPMC's reason. Mr. Romoff was chagrined about Enron and other fiascos and wanted to be ahead of the curve on Sarbanes-Oxley.

Danny: What are the changes you can expect once Mr. Romoff leaves UPMC, and who do you think may be his likely sucessor?

Steve Levin: Changes? Who knew managed care would become what it has become, that suburban hospitals would merge with urban ones to create huge networks, that a health system would create its own insurance arm? I have no idea what's in store for the medical industry, but the reason UPMC has been so successful is that Mr. Romoff and Dr. Detre were excellent tea-leaf readers and weren't caught by surprise that often by the industry's vagaries. As far as a successor, the fifth day of the series in today's Post-Gazette names Elizabeth Concordia as the most likely successor.

Floppydisk: It appears "success" has been defined as going after money at the expense of elevating the academic standing across the board, exhibted by the departure of quite a number of well-known and respected researchers. Why is that "success"?

Steve Levin: There are unintended consequences to every action. Nobody would call it a success to lose quality minds like Fung, Griffith, Reyes, Trump and others. It happened, and UPMC obviously believes it can continue forward without them.

Oldguy: Where is John Paul now, and what was the reason behind his leaving?

Steve Levin: John Paul is in Pittsburgh. I don't know what he's doing now. He declined to talk to me for the series. There are lots of stories about why he left, but none I can share with you since they're not confirmed.

Oldguy: Is Mr. Romoff's health an issue (?successor)? He looks to have aged a lot in the photos published online.

Steve Levin: I think he looks pretty good for 60, and a lot better than he looked at 50.

Michael_G.: Although Mr. Romoff was not considered a people person in your article, it appeared that a person would always know where he stood with Mr. Romoff. Was he also considered honest and fair in his dealings with his employees?

Steve Levin: Obviously, I have no way to answer about how all his employees feel. People I spoke with did feel he was very honest, that he often struck deals and sealed them based only on a handshake, and that he was up front with his opinions. The truth is the medium everyone should deal in. The problem comes with the way it's delivered. Tact is not a strong point of Mr. Romoff.

Danny: Do you expect UPMC to fragment after Romoff?

Steve Levin: I don't believe it'll follow the same course as Alexander the Great's empire. A lot of it may depend on the direction the medical industry takes. For the foreseeable future, though, I would think UPMC would maintain its dominant role.

Middleman: What are your thourghts on why so many would not allow their names to be used in their interviews?

Steve Levin: Physicians were afraid for their jobs. Business leaders and the heads of other hospitals were concerned about having to live in the city with Mr. Romoff and Dr. Detre. Employees believed they'd be terminated. It gives you a sense of the power Mr. Romoff wields when the former heads of Fortune 500 companies and multi-billion dollar companies don't want their names used in a story.

Sasha: How much do you feel his personality led to the success of the health system?

Steve Levin: A company's culture often reflects that of its leader. People who have called or written me since the series began have spoken of the fear inherent throughout UPMC, about how people literally think they're being watched. I think Mr. Romoff has, for a long time, had his "eye on the prize" and has worked with incredible focus to steer the health system toward its current status. The resulting wake has capsized some people and damaged a lot of feelings. I would imagine, however, that you'd be hard pressed to find any head of a multi-billion dollar business who was lovey-dovey all the time.

Pennyless: I'm sure and very clear. How and when can I contact you?

Steve Levin: Contact me via e-mail: slevin@post-gazette.com.

Paul: While you were examining indicators of UPMC growth, did you look at the growth in government Disproportionate Share funds? If so, please share the results.

Steve Levin: I did not. I have to admit I don't know what government Disproportionate Share funds are.

Floppydisk: Mr Levin: I hardly see Mr. Well-tanned's questions as jokes. They go to credibility of the reporting and the objectivity of the article. Please respond.

Steve Levin: Please. If you're gonna ask about such obvious drivel, you've either got a bone to pick with media or too much time on your hands.

Paul: You mentioned the Jewish Healthcare Foundation was set up with money from the UPMC buyout. Did you examine and compare and account for the size and degree of independence of the foundations set up in the wake of UPMC buyouts?

Steve Levin: No. What do you believe that would show?

Johnl: UPMC has apparently stopped expanding locally (and is now looking further afield to places like Vegas); for years there were rumors about them acquiring a Westmoreland County hospital, for instance, but now that those hospitals have merged to form Excela, that seems unlikely. At the same time, UPMC is investing in financially well-performing outlying assets (UPMC Northwest, for instance), while divesting itself of underperforming ones (UPMC Beaver Valley and UPMC Lee, for example). Does this mark a change in management style? Is UPMC interested in acquiring any more community hospitals, or do they consider community hospitals a risky financial sinkhole these days?

Steve Levin: Very good questions. I wish I'd had you as a consultant for this story. I don't have the answers for you but I think they would make for an interesting story. I'll pass your questions along to the appropriate reporter.

Rockfordrock: Since Romoff has been in Pittsburgh for over 25 years now, and made his fortune here, does he consider himself a "Pittsburgher"?

Steve Levin: He said he realized he was a Pittsburgher when his first daughter was born in Pittsburgh. As I recall, he said he couldn't believe it at the time that a daughter of his would not be born in the Northeast. He told me he likes Pittsburgh, particularly the large number of options for the arts.

Pgh_Exec: In researching this article on Mr. Romoff, it would have been prudent of you to review available information on the personality profile of Sherif Abdelhak, the deposed former head of AHERF. What distinguishes Mr. Romoff and his hugely successful UPMC empire from Mr. Abdelhak and his monumental collapse of the AHERF organization?

Steve Levin: Aside from the number of marriages each had, the fact that AHERF is gone and UPMC is still here.

Rockfordrock: Did you say Romoff came from Yale?

Steve Levin: Sort of. He came from New Haven. He earned a master's degree from Yale. Dr. Detre was employed by Yale when he arrived in Pittsburgh.

Rockfordrock: How did the "Yale Mafia" manage to take over Pitt's health care system, Steve?

Steve Levin: I'll have to recommend you read the first day of the series that ran Sunday, Dec. 25. Dr. Detre brought his "posse" in and essentially said, "There's a new sheriff in town." In this case, it was a new head of Western Psychiatric Institute and Clinic.

Slr: As an organization, it's apparent that UPMC has been financially successful -- and that it is focused on this. But do we have any evidence that it and Mr. Romoff have improved the health of Western Pennsylvanians? We still have a vastly underdeveloped primary health care system, with 10 percent uninsured, and great discrepencies in the health by social class and race/ethnicity, with certain communities carrying the burden of illness. Our public health care system is being stripped bare of resources. Besides research, what is the largest corporation doing to address these issues? Does Mr. Romoff see a role for UPMC in promoting health and addressing these issues? They did not come up in the series.

Steve Levin: Well, Mr. Romoff lost 80 pounds ... Seriously, there are so many problems in today's health care system. You mention several of them. I do not know what UPMC's plan for the future is.

Well-tanned: One at a time: Did you receive an honorarium from anyone other than the Post-Gazette?

Steve Levin: My dentist sent me a New Year's card.

Drawohe: You seem like you are in awe of this man; how can you profess objectivity?

Steve Levin: I am in awe of no one, Mr. Drawohe, except for the inventor of Strat-o-Matic.

Educated00: What is the status of the UPMC - Las Vegas project?

Steve Levin: I'm not sure right now, but I can send your question on to the reporter who has written about that topic. Or you can contact him directly: Christopher Snowbeck.

Robodoc: Paul makes a good point, worthy of a separate article, namely, that while there is no doubt that the Jewish Healthcare Foundation has contributed significantly to the care of underserved populations, it is also the case that some of the projects they have sponsored could be accused of having a strong pro-UPMC bias. It would be worthwhile to examine exactly how independent is JHCF.

Steve Levin: That's why these forums are good. I agree.

Unhappy: The series was so accurate, and you pulled no punches. Aren't you afraid of consequences?

Steve Levin: Consequences? The Post-Gazette has no connection with UPMC. That said, I'm changing my PPO to Allegheny General.

Floppydisk: How did Mr. Romoff become president of UPMC even though the advisory board disapproved of him by a large margin?

Steve Levin: Because the senate faculty is only advisory. It's interesting, though, that he got the job without a job search. I think that shows the power at that time of Dr. Detre.

Floppydisk: Mr. Middleman makes a very good point. Your answer about Mr. Romoff is that he has power. I believe this is more aptly termed "intimidation," and I have to ask, Why?

Steve Levin: Power often intimidates, yes?

Rockfordrock: Steve, you mentioned in one part Romoff was married (the last time) by a Sicilian cardinal; did he convert to Catholicism? Btw, this story could be made into a TV mini-series, LOL.

Steve Levin: As far as I know he has not converted, but he does order calamari more often when he goes out. LOL

Well-tanned: Serious question: How large is UPMC's advertising budget with the PG? Does it influence your writing and capacity to be objective?

Steve Levin: I don't work in the advertising department. Neither does anyone in the news operation. The two departments are completely separate.

Pgh_Exec: Paul O'Neil has been an outspoken critic of UPMC and was essentially removed from its board of directors. Was there any attempt to obtain his "insider" comments or opinions on Mr. Romoff?

Steve Levin: He declined to talk to me for the series.

educated00: Do you have any information on the UPMC-DOD partnership with the IMETTS program?

Steve Levin: I don't, but if you do I'd like to talk to you. Please send me an e-mail at the Post-Gazette: slevin@post-gazette.com.

Observer: Steve: Bill Lieberman is quoted in Wednesday's article tesifying how "Jeff and John got their direction from the board," yet he makes tens of thousands of dollars from people selling AFLAC under his contract with UPMC. He gets about 30 percent of every policy sold to UPMC employees. How can he be an independent board member? They control whether or not he gets that money. And he, like Romoff, runs the operation with an iron fist even to the point of running out other vendors of employee-optional benefits like myself. I worked two years to procure an employee-optional benefit on legal services and was "iced out" by Lieberman's folk even though our legal plan offered more for less money. How many other "independent" board members have other such conflicts?

Steve Levin: Wow. Great question. I'll have to ask Mr. Lieberman about that.

Count_Conjecture: Who made the first contact in initiating this series?

Steve Levin: My editors asked me to undertake the project.

DS: Does Mr. Romoff see Medicare as a payor or pain in the rear? Does he see the new Medicare Part D benefit as a "cash cow" for the Health Plan?

Steve Levin: I'm sorry, but I don't know the answer to that.

Dr._X: Do you think that there were others behind Detre? There was a "power" behind the "power"?

Steve Levin: Not behind Dr. Detre.

Robodoc: By the way, a few years ago Ann McFeatters wrote an op-ed piece that appeared in the PG asking why Bill Clinton did the things that he did (to undercut the success of his presidency). I responded with a remark made by my former department chairman at the University of Pittsburgh School of Medicine (who shall remain nameless) who said, "Dumb psychopaths become criminals; smart psychopaths become deans, department chairmen and [health system] presidents." He wasn't joking.

Steve Levin: Hilarious.

Strzlo: How long did this entire series take to put together?

Steve Levin: I spent 16 months working off and on on the project. During that time I also worked on more than 100 other stories, too.