The infighting and empire-building continues at the Kansas University Medical School.

In a letter this week, addressed to “Dear Colleagues,” Barbara Atkinson, the medical center’s executive vice chancellor, acknowledges the ongoing efforts of the medical center, which includes the KU School of Medicine, to acquire additional fiscal support.

She assumes, although it is questionable, that all her colleagues knew of a $400 million offer by the KU Hospital – a separate operation not a part of the medical center – to provide additional funding for the medical center. She says this is nice and thanks the KU Hospital for its offer, but the tone of her letter makes it clear she does not like some of the strings attached to the hospital’s proposal.

She also makes it clear she is opposed to an exclusive relationship with KU Hospital and thinks it would be good for the medical school to have a working association with St. Luke’s Hospital in Kansas City, Mo. She says this is for the benefit of the Greater Kansas City area and that Kansas City, Mo., leaders have been very helpful in trying to work out a sound relationship for the KU medical school, which would be good for all parties.

It’s no secret Atkinson does not get along well with Irene Cumming, who has done an exceptional job in building up the KU Hospital as its president and chief executive officer. There is no question that St. Luke’s wants an association with the KU Medical Center for various reasons, some of which deal with providing staffing for their hospital, some that involve strengthening their fiscal structure and position in the market, some that involve image and some that actually center on what they think would be good for the overall medical research. Atkinson calls this a “healthy clinical competition among peers.”

Now, it is a contest between the KU Hospital and Missouri’s St. Luke’s Hospital to see who will offer the best deal dollarwise and who will allow Atkinson the most freedom to elevate the position of the medical school and, in the process, raise her image and role as queen of the Kansas City medical scene.

One big question remains: When will Atkinson and other university leaders seek the advice and consent of Kansas legislators? The medical school is a state facility and it would be reasonable to think state legislators would have a voice in the operation of the school. What about the Kansas Board of Regents? Have they been informed of what is going on, or are they supposed to be a rubber stamp for whatever someone at KU might want? What is the role of the governor in this tug of war?

There has been a great deal of behind-the-scenes or secret planning and negotiating by Kansas City, Mo., leaders and Atkinson, and maybe Chancellor Hemenway, to arrive at the current proposals, which tend to favor St. Luke’s, perhaps at the expense of KU Hospital. Shouldn’t Kansas lawmakers and members of the Board of Regents have been a part of the discussions?