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13 questions still unanswered in the Larry Nassar scandal


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After months of deflecting questions about its response to the Larry Nassar controversy, attorneys for Michigan State University provided detailed responses to 30 questions posed by state lawmakers as part of an inquiry by the state House.

Those questions and answers were released Thursday as part of the House’s report of its findings, which criticized MSU for enabling Nassar, a former MSU sports-medicine doctor who molested patients for years.

Read the House report and MSU response

The House inquiry fills some the public gaps in information about the case, but there are still questions that remain unanswered.

MSU failed to protect patients, students, House inquiry finds

Below are the most-pressing questions still out there.

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The Michigan State University Sports Medicine building in East Lansing, where Dr. Larry Nassar was employed and practiced medicine until September 2016

1. Why did Nassar’s colleagues vouch for him?

At the heart of the scandal are Nassar’s intravaginal treatments, which he performed on girls and young women throughout his two-decade medical career.

In MSU Police interviews, Nassar’s colleagues said they didn’t know if he was doing intravaginal treatments, even as they offered assurances that Nassar was known for his cutting-edge methods in the pelvic area and his treatments were within the realm of osteopathic manipulation therapy.

A big reason Nassar continued for as long as he did: Colleagues trumpeted his reputation, even though they did not appear to know his exact treatments. And many patients didn’t questioning the legitimacy of Nassar’s treatments because of that reputation.

It was a disastrous disconnect, and enabled Nassar to go undetected for years.

When colleagues did hear descriptions of Nassar’s treatments at Nassar’s sentencing hearing, they were horrified.

“If he had told me that he was doing intravaginal procedures on 14-year-olds, no way I could I justify that,”   said Dr. Steve  Karageanes, a one-time Nassar friend and former president of the American Osteopathic Academy of Sports Medicine.

While osteopathic manipulation can involve the genital region, it’s often done over clothing, Karageanes said, and penetration of the vagina is a “very last resort,” particularly for women who are not sexually active or haven’t had children.

What he heard from victims at Nassar’s sentencing hearing “is not like any OMT (osteopathic manipulative treatment) that I’ve ever heard about,”  Karageanes said. “My mind was spinning.”

Nassar’s ‘perfected excuse’: He was a doctor 

Genitals a ‘no-fly zone,’ Nassar once said in training materials

Amanda Thomashow, the one who filed the MSU Title IX report in 2014 speaks about her voice not being heard during the second day of Nassar’s sentencing in Lansing, Mich. on Wednesday, Jan. 17, 2018. (Joel Bissell | MLive.com)

2. Why did MSU Police and the MSU Title IX office reach different conclusions on a 2014 complaint?

In 2014, Amanda Thomashow filed a Title IX and a police report with MSU alleging she was molested by Nassar during an appointment at MSU’s Sports Medicine Clinic.

The Title IX investigator exonerated Nassar, saying Thomashow failed to understand the “nuanced difference” between medical treatment and sexual assault.

In the House inquiry, state lawmakers questioned why Nassar was exonerated in the 2014 Title IX investigation, but found guilty of sexual misconduct in a 2016 Title IX complaint filed by Rachael Denhollander, the first woman to go public with allegations against Nassar.

An even better question: Why did Kristine Moore, the 2014 Title IX investigator, reach a different conclusion than MSU Police in the same case?

While Moore cleared Nassar, MSU Police forwarded the case to the Ingham County Prosecutor’s Office with a recommendation for a charge of fourth-degree criminal sexual conduct, which includes misconduct by a medical professional and is a misdemeanor that carries up to a two-year prison sentence.

The prosecutor’s office dismissed the case, saying  in a memo it appeared Nassar was “actually” doing a “very innovative and helpful manipulation of a ligament located in the butt cheek and lateral to the vaginal opening.”

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3. Why didn’t MSU tell USA Gymnastics, Twistars and Holt High School about the 2014 complaint?

After Thomashow filed her complaint, Nassar was put on leave at the MSU Sports Medicine Clinic.

But while MSU took that precautionary approach, Nassar continued to serve as team doctor at Holt High School, the Twisters gymnastics center in Dimondale and the monthly training camp in Texas operated by USA Gymnastics for elite gymnasts.

Had those organizations been given a heads-up in spring 2014, they may have discovered then that athletes in each of those organizations were being molested by Nassar.

And it’s not like others at MSU were unaware of Nassar’s activities outside of the Sports Medicine Clinic: Nassar himself mentioned it during his May 2014 interview with MSU police and the Title IX investigator.

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Excerpt from MSU police report on Thomashow’s 2014 complaint.

4. Why wasn’t an outside doctor consulted in the 2014 investigation?

One criticism of the 2014 investigation  is that the medical experts consulted about Nassar’s treatment of Thomashow were his friends and colleagues at MSU.

It remains unclear why an outside opinion wasn’t sought, even though an Ingham County assistant prosecutor made that recommendation, according to MSU Police documents.

The House inquiry noted the bias of the three doctors who vouched for Nassar. One was a doctor mentored by Nassar and hand-picked by him to offer support. The House inquiry report noted that another doctor said “she ‘would never say that (Nassar) would have any intent in an exam other than purely professional.’ “

From the House inquiry report: “If she was not willing to ever say that, no matter what the evidence against Nassar was, then why would MSU rely on, or even ask for, her opinion?”

Former MSU volleyball player Jennifer Rood Bedfoord talks about self-blame during Nassar sentencing hearing in Ingham County.

5. Why were several red flags ignored or minimized in the 2014 investigation?

Thomashow told investigators in 2014 that Nassar massaged her breasts and her vaginal region during her office visit — treatments that the Title IX investigator and the prosecutor’s office deemed legitimate, even “innovative and very helpful.”

But it wasn’t just what Nassar did, but how he did that made Thomashow view it as abuse: He didn’t offer an explanation or get consent for those treatments; he didn’t use gloves, even though he was massaging her vaginal area, and he did it without another medical professional in the room to chaperone.

Both the Title IX and prosecutor’s office flagged those actions, but only to the extent that Nassar needed to change those things going forward to head off future complaints.

Notably, his actions were not seen as indications of sexual misconduct — even though Nassar’s colleagues told MSU Police that they themselves would never perform skin-to-skin treatments in the vaginal region without gloves, informed consent and a chaperone in the case of a male doctor.

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6. Who signed off on Nassar returning to work in 2014?

The state House inquiry revealed  the 2014 Title IX report was sent to William Strampel, then dean of the College of Osteopathic Medicine; Terry Curry, associate provost and associate vice president for academic human resources,, and Theresa Kelly, Office of General Counsel, “and possibly to Paulette Granberry-Russell,” who headed MSU’s Title IX office.

Still unknown: Whether Strampel made a unilateral decision in allowing Nassar to return to work in 2014 while still under police investigation, or whether others at MSU weighed in.

That question is even more intriguing since Strampel is now facing criminal charges of “willful neglect of duty” for his supervision of Nassar, and one of those charges involves allowing Nassar to return to work prematurely.

Olympian Aly Raisman was among the athletes molested by Nassar while he was under investigation. This video shows Raisman speaking at Nassar’s sentencing hearing in Ingham County. (Joel Bissell / MLive)

7. Who knew Nassar was seeing patients after MSU Police recommended criminal charges?

In July 2015, Michigan State University Police forwarded the Nassar case to the prosecutor’s office and recommended that he be charged with fourth-degree criminal sexual conduct. Five months later, in December, the prosecutor’s office dismissed the case.

Question: Considering MSU’s own police department was recommending criminal charges against an MSU doctor, why was Nassar allowed to see patients during that time? What was the change of command that would allow that to happen? Could a similar situation still happen at MSU today?

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8. Why did it take until 2017 for MSU to implement new health-care protocols?

In her final Title IX report on Thomashow complaints, Moore recommended that MSU’s Sports Medicine Clinic address its lack of policies on informed consent, having a chaperone in the room and using gloves during a “sensitive procedure.”

When Nassar returned to work in the summer of 2015, he agreed  in writing to follow those standards. But Strampel, his boss, did not implement any system to enforce the protocols. Even more significantly, Strampel did not  establish new policies for the clinic as a whole.

That didn’t happen until spring 2017, three years after the issues were first raised by Thomashow’s complaint and more than six months after Nassar was fired for failing to failing to follow those directives.

Why did it take so long when Strampel himself said such protocols were “common sense medical guidelines”?

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9. Why wasn’t more attention paid earlier to Nassar’s issues on Facebook?

Multiple colleagues of Nassar — Dr. Douglas Dietzel, director of the Sports Medicine Clinic; Dr, Michael Shingles, the clinic’s financial manager; Dr. Jeffrey Kovan, a physician at the clinic;  Michael Straus, a physician’s assistant at the clinic, and athletic trainer Destiny Teachnor-Houk — told MSU police they were aware that Nassar had been “kicked off” Facebook at some point for his interactions with teenage girls.

Yet none of them saw that as a red flag, even after Thomashow filed her complaint in 2014.

After the allegations against Nassar became public in fall 2016, a woman called MSU Police to say that she deliberately did not send her gymnast daughter to Nassar because she was disturbed by Nassar’s Instragram account, which mainly involved interactions with his teenage patients,

The woman took her daughter to Kovan instead, and mentioned her concerns about Nassar’s behavior on social media, according to the woman’s interview with police.

Kovan told her that Nassar’s Facebook page was shut down because it was deemed “potentially problematic” and Nassar had to provide multiple letters of recommendations to get his page reopened, the woman told police.

Yet “the conversations with Dr. Kovan concluded with Dr. Kovan reiterating that he didn’t think there was anything to worry about with Nassar,” said a report of the interview.

What the woman didn’t know and Kovan did at that point: The year before, Kovan was the first MSU staffer contacted by Thomashow to report her complaint.

Larissa Boyce talks about being sexually assaulted in 1997 by Larry Nassar and Michigan State University doing nothing during the fourth day of Nassar’s sentencing in Lansing Mich., on Friday, Jan. 19, 2018. (Joel Bissell | MLive.com)

10. Has MSU investigated to determine who knew about Nassar’s treatments?

In its response to questions from the state House inquiry panel, MSU insisted that it had never received a formal complaint about Nassar before the 2014 complaint by Thomashow.

However, numerous Nassar victims have said they raised concerns about Nassar’s behavior to MSU staff members, most notably members of the MSU Athletic Department, where Nassar served as team doctor to the gymnastics and rowing teams, and also saw other athletes sent to the Sports Medicine Clinic.

According to Nassar victims who filed lawsuits:

  • Two gymnasts told MSU gymnastics Coach Kathie Klages in 1997 about Nassar’s intravaginal treatments.
  • An MSU cross country runner told a coach and trainers in 1999.
  • Softball player Tiffany Thomas Lopez says she told trainers, including Teachnor-Houk, in 1999 and 2000.
  • In 2003, volleyball player Jennifer Rood Bedford said Nassar was known as the “crotch doc” among her teammates and she told a trainer that Nassar’s treatments made her uncomfortable.
  • In 2004,  a  12-year-old Nassar family friend told Dr. William Stollak, a MSU clinical psychologist, that she was molested by Nassar.

MSU Police documents indicate they  have received additional reports in recent weeks that MSU staff were allegedly alerted to concerns about Nassar. Those reports came in after Nassar was already sentenced. Among the examples in the police documents, which were heavily redacted:

  • An MSU athlete said an MSU intern trainer was present when she was given an intravaginal treatment by Nassar.
  • Another MSU athlete said she had an intravaginal treatment from Nassar in 2000 with a trainer in the room, and said Nassar was known among her teammates as “Dr. Nasty.”
  • An MSU athlete said several of her teammates told two MSU clinical psychiatrists that they felt sexually abused by Nassar.
  • An MSU employee said she took her stepdaughter to Nassar in 2015, and when he put his bare hand on her genitals, she jumped up and asked what he was doing. The woman told police that there was a female medical professional in the room who gave the mother “a blank stare.” The woman said she also didn’t get a response when she reported the incident to three women at the Sports Medicine Clinic reception desk.

A victim statement from Olympian McKayla Maroney is read at Nassar’s sentencing hearing. Maroney is one of the athletes whose concerns about Nassar led to an FBI investigation in 2015. (Joel Bissell / MLive)

11. Why didn’t USA Gymnastics contact MSU about its concerns about Nassar?

This question isn’t for MSU, but rather USA Gymnastics, where Nassar volunteered as doctor for the U.S. national team.

In June 2015, Maggie Nichols — a member of the U.S national gymnastics team — was overheard by a coach talking to teammate Aly Raisman about Nassar’s intravaginal treatments.

USAG conducted an in-house investigation, and Olympian McKayla Maroney told them that Nassar had sexually assaulted her during the 2011 world championships in addition to the suspicious treatments.

The USAG quietly cut ties with Nassar and notified the FBI in July 2015. However, the USAG did not notify MSU — which was still investigating Nassar for the Thomashow’s 2014 complaint. Had MSU known of the USAG complaints, it’s likely Nassar’s career — and abuse of patients — would have been stopped sooner.

Speaking at Nassar’s sentencing hearing, Gina Nichols — mother of elite gymnast Maggie Nichols — questioned why the investigation of Nassar took so long. Maggie Nichols is one of the athletes whose complaints about Nassar led to the end of his relationship with USA Gymnastics. (Joel Bissell / MLive)

12. Why didn’t the FBI alert Michigan State of its investigation?

One of the most perplexing questions of the controversy: Why didn’t the FBI tell Michigan State in 2015 that Nassar was under investigation for sexual misconduct?

USAG filed a report with the FBI in July 2015, and the case ended up in the FBI’s Detroit office.

But the FBI did not contact MSU, and Michigan State officials have said they were not aware of the FBI investigation until September 2016, the month Nassar was fired.

Nassar saw patients for 2 years while under criminal investigation

James White, an Okemos attorney representing some the Nassar victims, has said that many people are perplexed by the FBI’s seeming inaction for months.

“Without knowing exactly what USAG reported, I want to be fair,” White said. “Did USAG share enough information about Dr. Nassar? Did the FBI make the leap that he was still working at Michigan State? I don’t know that.”

The FBI has not responded to MLive requests for comment.

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Michigan State University President Lou Anna Simon talks to Danial Munford of MSU Police Department on the second day of Larry Nassar’s sentencing at the Ingham County Circuit Court in Lansing on Wednesday, Jan. 17, 2018. (Neil Blake | MLive.com)

13. What did the MSU president and provost know and when did they know it?

Another perplexing question: What did Lou Anna K. Simon, who resigned as MSU president Jan. 24, and Provost June Pierce Youatt know about the 2014 Nassar investigation?

An MSU spokesman said in January that Simon “was made aware that a complaint involving an unnamed physician has been filed with our Title IX office at the time and the MSUPD. As there was no policy violation found, I do not believe there was any further briefing.”

That doesn’t exactly answer the question, since the MSU Police Department did recommend criminal charges.

In short: Were Simon and Youatt involved in the decision to allow Nassar to see patients before the police investigation was completed? Did they know that Nassar continued to see patients even after its police department recommended criminal charges?