Jeffrey D. Allred, Deseret News
The Huntsman Cancer Institute in Salt Lake City on Tuesday, April 25, 2017. Peter Huntsman, the CEO of the Huntsman Cancer Foundation, confirmed Tuesday that his family will continue to seek more autonomy for the Huntsman Cancer Institute in ongoing negotiations with the University of Utah.

SALT LAKE CITY — Peter Huntsman, the CEO of the Huntsman Cancer Foundation, confirmed Tuesday that his family will continue to seek more autonomy for the Huntsman Cancer Institute in ongoing negotiations with the University of Utah.

Among other things, Huntsman said, the foundation will continue to ask for Huntsman Cancer Institute CEO Mary Beckerle to have authority over finances and hiring at the institute, independent of the approval of academic departments at the U.

The negotiations between the Huntsmans and the university came to light on Monday when the Deseret News published a draft of a memorandum of understanding that Huntsman and his father, Jon Huntsman, Sr., had proposed to the university.

"My mind is exactly where it was when I signed (the memorandum)," Huntsman said on Tuesday. “It’s not about the Huntsmans controlling anything. I don’t want to run Huntsman Cancer Institute. … The people that are giving huge sums of money ought to have accountability. We ought to be able to expect openness and transparency.”

Negotiations are still ongoing despite a turbulent two weeks in which Beckerle was dismissed from her role as director and CEO of the cancer institute before being re-hired.

Days later, the senior vice president of health sciences at the U., Dr. Vivian Lee, stepped down amid criticism of her handling of Beckerle's dismissal. On Monday, University of Utah President David Pershing, who had made the decision to dismiss Beckerle along with Lee, announced his upcoming retirement.

Through a public records request, the Deseret News on Tuesday obtained 50 pages of old memorandums of understanding finalized by the Huntsmans, the Huntsman Cancer Institute and the university, stretching back to the first "support agreement" signed in 1995 to the most recent signed in 2014.

The documents show the Huntsman Cancer Institute gradually negotiating more and more autonomy over its operations and management.

In the 1995 agreement, the Huntsman Cancer Foundation and the university agreed that cancer investigators at the institute may be appointed as faculty subject to “university policies and procedures and university approval."

In 2001, as construction broke on the new cancer hospital, a new agreement stated that the hospital was being created “for the purposes of more fully integrating the university's clinical and research cancer programs.”

The parties also agreed that the hospital would function under the leadership of the senior vice president for health sciences, the role that would later be held by Lee.

Six years later, a new memorandum of understanding was renegotiated.

The 2007 memorandum specifically spelled out that the executive director of the cancer hospital would report to the CEO of University of Utah Hospitals and Clinics on operations and finances — a position now held in interim by Gordon Crabtree, who reports to Lee.

But on issues related to the clinical or research programs, the hospital director would report to the director of the Huntsman Cancer Institute — at that time, Beckerle.

The most recent finalized memorandum of understanding, signed in 2014, added a clause that any appointments of department chairs "and other major decisions" be made in consultation with the Huntsman Cancer Foundation "to the extent they affect Huntsman Cancer Institute and its operations."

The foundation is a nonprofit that exists solely to support the Huntsman Cancer Institute.

The document also states that the Huntsman Cancer Foundation has primary responsibility for contacting donors and that the U. "shall not independently contact such donors for additional contributions to cancer programs."

Tensions between cancer centers and their affiliated academic institutions are not unique to Utah, according to Dr. Vinay Prasad, a senior scholar at the Center for Health Care Ethics and oncologist with Oregon Health and Sciences University.

Some cancer institutions, like Fred Hutchinson Cancer Research Center in Seattle, are freestanding centers with no umbrella organization. Others, like the University of Pittsburgh Cancer Institute, are completely integrated with the academic institution with which they are affiliated.

“Since the beginning of time there has been a battle in academic medicine between the specialties that are extremely lucrative and the specialties that are not as lucrative," Prasad said.

Departments that make less money, like infectious disease, tend to have a “we’re all in the same ship” mindset, according to Prasad.

More lucrative departments, like cancer, are incentivized to carve out their own territory and fight to maintain control over the revenue they generate.

But that bumps up against an increasing national trend among health systems to integrate different specialties, much like the Cleveland Clinic in Ohio, to pool resources across departments and make coordinating visits easier for patients.

“There’s this huge tension between who should have control over these academic purses, which are very large, and how the money should be distributed,” Prasad said.

The behind-the-scenes negotiations between Huntsman Cancer Foundation and the U. were met with a variety of perspectives from faculty.

Trudy Oliver, an assistant professor of oncological sciences and a cancer researcher at the Huntsman Cancer Institute, said she wants the cancer center to have a high degree of independence from the rest of the university health care system.

"I came here because of the semi-autonomous nature of Huntsman Cancer Institute,” Oliver said. "It makes us nimble. We can be innovative and make decisions without a lot of bureaucracy."

But U. Professor Emeritus L. Jackson Newell, who studies universities and administration philosophy, said he had reservations about donors who seek to take away the authority of academic departments in appointing faculty.

"That's a violation of fundamental principles of faculty," Newell said. "It goes against everything that major universities believe."

Huntsman said the negotiations have nothing to do with Lee, Beckerle, or Pershing, and more to do with making sure the institute focuses only on cancer. Beckerle now reports directly to Pershing — a change made after she was reinstated.

He said he would not want the Huntsman Cancer Institute to become completely freestanding, but added, "It’s quite compelling, the number of organizations that come back saying you’ve got to be autonomous — focus on cancer, don’t get lost in the weeds with pediatrics or gynaecology or anything else.”

He said faculty members who have raised concerns about the influence of the Huntsman family in the cancer institute and beyond are asking "good questions."

“If Huntsman Cancer Institute has been a negative institution, if it’s brought ill will to the community, if it’s brought bad results to the university, if it’s embarrassed people … they probably ought to stop doing business with the Huntsman family,” he said.

“But it looks like we’re doing a pretty good job.”