The Kansas University School of Medicine represents a sizable investment for the state of Kansas. Millions upon millions of dollars have been appropriated for this facility, and its graduates have played a significant role in the Kansas health care system.

With this level of fiscal support and the long history of the medical school, doesn’t it seem reasonable that state legislators would be aware of any plans for a substantial change in the medical school or a repositioning of its alliances and associations in greater Kansas City?

Apparently some in Kansas City and at the medical center have been working behind the scenes to try to pull off a merger or operating agreement between the medical center and St. Luke’s Hospital in Kansas City, Mo. – leaving KU Med Center out in the cold.

Several months ago, Kansas legislators learned of a possible association or affiliation between the KU Medical Center and two hospitals on the Missouri side of the state line – St. Luke’s and Children’s Mercy – and voiced their concern about what was being planned behind their backs. Publicly, the story dropped from the front pages, but some at the KU medical school and St. Luke’s didn’t let the matter rest. The St. Luke’s people realize the importance of a working association with a top-flight medical school, and KU has the only such facility in greater Kansas City.

It is believed there are two factors driving what is going on at the KU School of Medicine: One, they want money, far more money than they are getting today; and two, some of the folks at the medical center do not like KU Med, which is doing great business and growing, but, in the eyes of medical center people, is not sending enough money across the street to the medical school. There’s no love lost between the leadership of these two medical facilities.

It almost looks as if medical school people have decided to put themselves up for bid. Who can offer the medical school the most attractive fiscal offer: KU Med or St. Luke’s and Children’s Mercy? Also, with this financial payoff would come the availability of medical school interns for either the KU hospital or St. Luke’s.

For years, medical school people have thought they were being shortchanged by their KU hospital cousins. Several years ago, the hospital became a separate operation, free of state control, with no direct connection with the medical center and its medical school. Under the leadership of Irene Cumming, the hospital started to grow and prosper. In fact, it has shown tremendous growth under her vision and guidance. She is smart, tough and goal-oriented.

There is a long history of turf wars, egos and jealousy within the medical school/hospital complex, and there still are deep scars among some professional and non-professional leaders at St. Luke’s, who think KU “stole” or “bought” a large group of cardiologists who moved from St. Luke’s to KU Hospital. The fact is it wasn’t a case of KU “stealing,” but rather a matter of the group that left St. Luke’s not liking the idea that another cardiology group at St. Luke’s was given oversight and direction of its group. The doctors didn’t think they were second-class doctors and took advantage of KU’s plans to jump start their heart program.

Several state legislators were upset – very upset – several months ago when they first learned of the plan for some kind of association between the KU medical school and St. Luke’s and Children’s Mercy.

Also, they didn’t like the idea that KU School of Medicine people were giving the KU Hospital and Cumming the cold shoulder. She has been on the outside and wasn’t invited to be part of a Nov. 4 strategy session.

Meetings and discussions between St. Luke’s people and KU medical school representatives have continued, and it looks as if they may be trying to craft some kind of agreement before some state legislators gather on Dec. 11 to learn more about the secret negotiations.

The latest development is a proposal, calling for the School of Medicine to receive about $400 million new dollars over the next 10 years from KU Med in exchange for the medical school agreeing to an exclusive relationship with KU Med.

This $400 million does not include what already has been pledged to the school in the way of funding for faculty salaries, committed research and education contributions or federal dollars for fiscal year 2007. This hunk of dollars totals about $30 million.

For this additional contribution, KU Med would get some favorable relationships with the medical school and a so-called “master affiliation agreement.”

It is not known whether St. Luke’s and any other Kansas City, Mo., hospitals will offer to top the $400 million offer or whether they will try to negotiate some other deal with the medical school.

A paper has been prepared listing the specific dollars to be given to the medical school along with an outline of “three driving reasons KUH (KU Hospital) must maintain a unique primary partnership with KUSOM (KU School of Medicine) for adult acute care.”

One wonders whether this leaves open a financial opportunity for St. Luke’s to carve out, or be given a relationship with the School of Medicine for medical services outside “adult acute care” such as pediatrics or non-acute care.

KU Med is providing millions of dollars – some say close to $100 million a year – worth of care to indigent patients. If they are going to pay the medical school $400 million, will the hospital be able to continue this level of care?

It seems Kansas legislators should have been brought into the picture long ago rather than KU officials trying to put this, or some similar deal, together without seeking input or approval from lawmakers.

There already is enough conflict within the medical school/hospital complex. Various departments believe they are being neglected, placed on the back burner and almost forgotten while KU leaders make cancer programs the primary, almost the sole, focus of the school, to the detriment of the entire institution.

Someone in a powerful position needs to demand that the medical school shape up. Nothing should be done without the approval of state legislators. What is the fiscal condition of the medical school? Is it operating in the red? If so, by how much? Where is the Kansas Board of Regents in such a situation? Have the regents given their approval to what is going on or are they blind to current affairs at the Kansas City, Kan., campus? Has the chancellor, with a foot in both the hospital and medical school operations, approved of the negotiations with St. Luke’s and the $400 million that is being sought by the medical school? Has he engineered the $400 million action?

It’s far past time for state legislators to find out what is going on. Kansas taxpayers have a huge stake in this matter.