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Jeffrey D. Allred, Deseret News
H. David Burton, chairman of the University of Utah board of trustees, and U. President David W. Pershing leave a board meeting in Salt Lake City on Tuesday, April 25, 2017.

SALT LAKE CITY — A tumultuous week at the University of Utah in which Huntsman Cancer Institute Director and CEO Mary Beckerle was fired and quickly reinstated exposes a rift within the hospital system that is at the heart of negotiations over its future.

Discussions about the governance of the Huntsman Cancer Institute within the larger University of Utah Health organization is one of the top issues of debate in ongoing negotiations between the Huntsman family, the institute and the university, according to multiple sources familiar with the negotiations.

The strong backlash over Beckerle’s firing, and the reversal of U. President David Pershing and Dr. Vivian Lee's decision, also raises questions about who really is in charge of the university and the health care system, and whether Pershing and Lee can be effective leaders after the stunning about-face.

On Tuesday, 13 department chairs from a variety of specialties from pediatrics to neurosurgery issued an open letter proclaiming their "full and unwavering support" of Lee, the senior vice president of health sciences at University of Utah Health.

That comes after Lee was the focus of protests and criticism calling into question her management style after she and Pershing fired Beckerle on April 17.

Resolving those issues is now task No. 1 for the university. Among the questions to answer:

  • How will the university move forward after an unusually public and ugly rift?
  • How much influence does the Huntsman family and Jon Huntsman Sr. wield in negotiations over the university’s direction and future?
  • And what motivated Pershing and Lee to dismiss Beckerle from her role in the first place?
"Without knowing (why Beckerle was fired) it's very hard to know how to move forward," said Alana Welm, a cancer researcher and associate professor in the department of oncological sciences who advocated for Beckerle's reinstatement. "Bringing whatever issues there are forward and having a really reasonable discussion is the best way forward at this point."

Integration or independence?

Although university administrators shied away from specifics in talking about their plans for moving forward, Pershing's actions Tuesday hinted at shifts in how the Huntsman Cancer Institute would be managed.

In addition to rehiring Beckerle, Pershing announced that he would pull the Huntsman Cancer Institute out from under the purview of Lee.

That means that going forward, Beckerle and the institute will report directly to the university president — an unprecedented move that makes the Huntsman Cancer Institute the only clinical service and research line at the university with this setup, according to Chris Nelson, spokesman for the University of Utah.

The arrangement is part of the debate over how independently Huntsman Cancer Institute can and should operate from the rest of the University of Utah health system.

Some have praised the cancer center’s semi-autonomous culture as critical to its success, allowing it to be nimble and have more control over its finances.

But critics have said it hampers the growth of the university health care system as a whole because departments and institutes aren't allowed to pool resources.

Dr. Ed Clark, a professor and chairman of the department of pediatrics at the University of Utah, said a smoothly integrated health care system allows divisions that generate far less revenue — such as infectious diseases — to be supported by those that generate far more — such as cancer and cardiology.

In other systems that have had an independent cardiology center or an autonomous neurology institute, "they don't work," Clark said.

"The highest-performing health care systems in the country, whether it's Kaiser Permanente or Mayo Clinic or Geisenger, have created that single system approach."

But Welm said the direct line between the Huntsman Cancer Institute and Pershing would preserve the institute’s unique culture and allow it to stay focused.

“What’s unique about the Huntsman Cancer Institute is it’s really one of the only cancer centers that is truly conceptualized and designed by patients,” Welm said. “So you get that perspective and that focus that isn’t just about academic research and the bottom line. It’s about the mission.”

Nelson said on Tuesday that the university looked forward to "moving forward and negotiating a new memorandum of understanding" that would lay out the operations, financing and fundraising of the Huntsman Cancer Institute in relation to the wider University of Utah health organization.

Lee and Huntsman did not respond to multiple requests for comment.

Colleagues defend Lee

While some faculty members have called for Lee's firing, there are no plans to let her go, with Nelson stating Tuesday that Pershing "stands behind Dr. Lee in her role as senior vice president.”

Lee and Pershing faced immediate backlash for their decision to fire Beckerle on April 17.

Under Lee's direction, University of Utah Health Care earned the top spot in a national ranking of academic health care systems last year and was featured in the New York Times for an innovative program to measure the cost of care at the hospital system.

But some faculty members and researchers with the U. said that frustration against Lee has been building for years following a string of releases of high-profile department chairs and deans without explanation.

The 13 department heads who expressed support for Lee in their petition criticized what they called "mis-characterizations" of her over the past several days and said that Lee "challenges us to think beyond the good, to the excellent."

“Our entire University of Utah Health community has thrived under her leadership and her positive impact extends to both a national and international stage," the statement read.

Clark, who was one of the department chairs that supported Lee, called her an "extraordinarily talented woman who has been leading us now for nearly six years."

"This is a transformative moment in American health care... Hard decisions have to be made," he said. "And not everybody agrees with those decisions."

Contributing: Ben Lockhart