Tucked within the University Medical Center of El Paso’s (UMC) non-voter approved bond request is a request for a cancer center. According to UMC’s June 27 presentation to the county commissioners, they are requesting $78.9 million for a cancer center from the $345.7 million on non-voter approved bonds pending before county commissioners. The question is, where is the feasibility study or supporting financial research needed for voters to understand how their 22% investment will be sustainable over the long term? UMC is holding public meetings explaining how they intend to use the bond monies and why it is important to El Paso voters. However, there is no information about how almost $80 million of the request will be an investment that will be sustainable over the long term. Thus, are voters expected to fund the cancer center well into the future with additional tax monies?

The PDF presentation provided to county commissioners on June 27, 2022, uses eight slides of the 42 slides to explain the cancer center proposal. The first two slides discuss the incidents of cancer in the nation and in El Paso. Interestingly, the incidents of cancer since 2010 have remained “relatively flat” in El Paso, “while statewide incidence has declined,” as well. Likewise, incidents of cancer in Hudspeth County are “considerably lower.” [1] These are UMC’s own words.

Although the incidence of cancer are not growing, UMC argues that this “might indicate disparities in detecting cancers in the local population.” [2] However, UMC provides no explanation at how they determined that incidences of cancer that are “flat” or “considerably lower” are an indication of a lack of detection.

The UMC presentation goes on to state that El Paso “is one of the largest metropolitan areas that does not have a comprehensive cancer center within a two-hour drive.” [3] UMC adds that cancer cases at UMC have been growing since 2013. [4]

UMC goes on to argue that spending almost $80 million would be a “growth opportunity” for UMC. The hospital assumes that it treats 32% of the cancer patients in the county currently. How that assumption is arrived at is not explained. Nonetheless, UMC says that if it can take another 8% of the cancer patients from other hospitals, the 40% of patient share would generate 1,561 patients in five years. According to UMC’s own analysis, the expected 40% share of cancer patients, assuming their “population growth and aging” assumptions are correct, would provide UMC an additional 352 cancer patients over five years, or about 5 new patients a month. [5]

Although UMC writes that the “threshold to support radiation oncology is about 250 patients per year,” it does not explain how it plans to sustain the cancer center after they build it. The “Capacity for Care” website created by UMC to explain their bond request, also does not provide sustainability details for its proposed cancer center.

A Branding Opportunity?

One of UMC’s slides makes the point that “El Paso is one of the largest metropolitan areas that does not have a comprehensive cancer center within a two-hour drive.” The slide adds that “while NCI designation is not an immediate goal,” it should “be a long-term objective” for UMC. [6]

An NCI-Designated Cancer Center is a designation created under the National Cancer Act of 1971. According to the National Cancer Institute, there are 71 NCI-Designated cancer centers in America. They are in 36 states and in the District of Columbia. Most are part of university medical centers. The National Cancer Institute, a government agency, states that cancer centers “develop and translate scientific knowledge from promising laboratory discoveries into new treatments for cancer.” [7]

Cancer centers are not focused on treatment, but instead on research.

In a 2019 editorial, David Rubenson argued that the NCI label “has evolved into a nationwide branding exercise, mostly signifying grant-writing endurance and adherence to metrics that skew scientific priorities.” Rubenson goes on to write that “university leaders, fundraisers, hospital executives, and politicians use the designation to promote unrelated objectives.” (emphasis mine) [8]

Rubenson spent 15 years working as an administrator for NCI-designated cancer centers, according to his profile. He wrote that “university hospital executives see” the NCI-designation as an “effective, even if somewhat deceptive, advertising” (emphasis mine) for hospitals. Rubenson adds that “politicians see it [the designation] as a symbol for their region and a way to ‘attract thousands of jobs and billions of dollars’,” for their communities. [9]

Veronica Escobar (D-TX) recently wrote in an El Paso Times guest column arguing among other things, that the cancer center would create jobs.

Without an explanation of how UMC plans to sustain the cancer center after it builds it suggests that formal research into how it will be sustained after the infrastructure is created does not exist. Will the jobs it creates be sustained by 300 new patients or will El Paso taxpayers be asked to fund new positions to keep the cancer center sustainable?

Additionally, a 2017 National Library of Medicine peer-reviewed medical journal research paper found that cancer center advertising between January 2005 and December 2014 have “substantially increased” further supporting that health officials see cancer centers as revenue streams for their health centers. [10] But the question remains, who is UMC looking at to fund the new revenue streams?

UMC’s plan for the cancer center states that although the NCI designation is not an immediate goal, it is nonetheless a long-term objective. However, the UMC presentation does not explain how the cancer center will be financially sustained over the long term. To find if a feasibility study for a UMC cancer center exists, we researched where the idea for a cancer center originated from.

Where Did The Cancer Canter Plan Originate?

El Paso News reviewed the UMC Board of Manager agenda and minutes to determine when the planning for a cancer center began. We used optical character recognition (OCR) to search for the term “cancer” in the scanned UMC board agendas and minutes between January 10, 2017 and July 21, 2022. We also used the same technique for the Planning & Development Committee documents. We wanted to know when discussion about a cancer center began at UMC. We chose the search word “cancer” because any discussion of a cancer center likely required a mention of the word “cancer”. It should be noted that many of UMC’s Board of Managers meeting minutes are not available online. However, because the discussion of a cancer center likely required board action, we assumed that an agenda item for such a discussion would be on the agendas.

In our search we found discussion of a cancer laboratory services contract agreement but nothing about a cancer center. We also found instances of “cancer awareness month” discussions.

It is possible that discussions about the cancer center could have been had as part of strategy sessions or budget planning that would not have used the term “cancer” on the agenda. This is impossible to know because the UMC’s website is inconsistent in posting the minutes of their meetings.

However, considering that the cancer center accounts for about 22% of the total non-voter approved bond request by UMC and because it involves investing in building up new capacity, we assumed that the Board of Managers would have held a separate discussion on how that investment would become sustainable over the long term. To do so, the Board of Managers would have looked at a feasibility study or a marketing plan and discussed them before embarking on asking El Paso taxpayers to fund about $80 million in a cancer center. We found no such discussion in the records available to us.

This forces the question, do the UMC Board of Managers understand how the $80 million on non-voter approved tax money will be used and whether that investment will be sustainable for the community?

The Woody Hunt Enigma

Our research into the UMC cancer center did not find any discussion among the UMC Board of Managers about such a center and its financial model. Yesterday we filed a Texas Public Information Act request with UMC asking for any financial documents or feasibility studies for the proposed cancer center. We will report on our findings once we receive a response to our open records request.

But the question remains, if the UMC Board of Managers did not look at feasibility studies or financial models for a cancer center, then where did the idea to fund a cancer center with $80 million come from?

As far as El Paso News has been able to discover, the cancer center originated in early 2020, although it was briefly mentioned in 2019.

The first mention of a possible cancer center based on some type of collaboration seems to have originated from a text message sent by Ted Houghton that was forwarded to Cindy Stout on May 20, 2019. Houghton’s text message referred to a Scripps webpage about cancer care with M.D. Anderson. [11]

But UMC building a cancer center seems to have begun in early 2020.

On January 23, 2020, Cindy Stout, CEO of the El Paso Children’s Hospital, asked UMC’s CEO, Jacob Cintron if he had “heard of high profile community individuals bringing a cancer center here on the MCA campus?” [12] The MCA campus is likely the Medical Center of the Americas. Cintron responded that UMC have “been the ones talking about bringing it.” Cintron added that “while MD Anderson is one option, the Mayo Clinic seems more interested.” [13] This seems to be first official UMC discussion of the cancer center.

An email sharing a survey link to an unknown number of recipients on September 22, 2020, gives us the first indication of who is behind the idea of the cancer center at UMC and what the plans are for it. Amy Hayes was retained as a consultant by the Paso del Norte Community Foundation “to lead an initiative for El Paso to create a vision and project plan for community collaboration, coordination and implementation of cancer services.” Hayes wrote to the unknown recipients that “an informal group of community leaders including Woody Hunt,” and others like Tracy Yellen and Emma Schwartz had asked that they respond to the survey. Hayes asked the recipients to respond to the 20 questions in her survey as “the first stage of vision gathering” for the cancer center. [14]

In addition, on March 5, 2019, Cindy Stout had written to Jacob Cintron that there are three items that attract “lots of funding” from philanthropic groups. They are “cardiac, cancer, and children’s care.” [15] Could the cancer center be a means to increase philanthropic income?

But the first time that building a cancer center and adding a burn program publicly appears for the first time is in an application for an award submitted by UMC. On August 10, 2020, UMC submitted an application to be considered for the Texas Award For Performance Excellence for 2020. In their application, UMC submitted “build and operationalize comprehensive additional programs (cancer center, burn program, pediatric cardiology)” as one of its “growth” milestones. [16] This is the only known reference to a plan to create a cancer center at UMC that we have found that is not part of the certificates of obligations request.

The question remains, publicly UMC has asked taxpayers to fund capacity by buying equipment and beds for a cancer center, but we can find no reference to how they will fund staffing for it.

What Does A Cancer Center Cost?

A cancer center is a cost intensive item that requires significant financial resources to develop. Although UMC is asking for $80 million to increase its cancer patient load by about 350 new patients over five years, it adds that it is “a long-term objective” for UMC to seek an NCI designation. To get a better understanding of what the financial implications are for a UMC cancer center, we consulted the financial statements for The University of Texas M.D. Anderson Cancer Center.

The UT Austin M.D. Anderson Cancer Center has budgeted $4.9 million in total income for 2022, with $4.6 million as income from patient services. UT-Austin M.D. Anderson planned on spending about the same amount in operating expenses. [17] Likewise, the Dana-Farber Cancer Institute in Boston had revenues of $2.2 million, 69% of which was derived from patient services in 2019. The Institute spent $2.2 million, with 57% of it in patient services. [18]

UMC is asking El Paso voters for $80 million for a cancer center but has not indicated whether it will pursue NCI designation with those funds, or will it be asking for more funding in the future? Moreover, the approximately $80 million is not broken down into how the hospital plans to use it other than to add 36 exam rooms and medical equipment. The budget published by UMC makes no mention of doctors, nurses or other medical staff for the cancer center leaving the question open on how they plan to fund those positions once the cancer center is ready to begin accepting patients. [19] UMC will need between $2 and $4 million annually to operate the proposed UMC cancer center. Where will that money come from remains unknown.

When UMC offers that its non-voter approved request will only cost the taxpayers $5.00 a month but does not include a feasibility study or other information as to what the operating costs will be over the long term and how it expects to fund them leaves open the question of what will happen once the new services are brought online. Will the taxpayers be asked for more funding? Moreover, did the UMC Board of Managers look at any study about what the true cost to the taxpayers will be?

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Footnotes:

1. UMC Powerpoint Presentation presented to El Paso county commissioners on June 27, 2022, “Capital Needs – Update,” June 2022, 27.
2. UMC Powerpoint Presentation presented to El Paso county commissioners on June 27, 2022, “Capital Needs – Update,” June 2022, 27.
3. UMC Powerpoint Presentation presented to El Paso county commissioners on June 27, 2022, “Capital Needs – Update,” June 2022, 28.
4. UMC Powerpoint Presentation presented to El Paso county commissioners on June 27, 2022, “Capital Needs – Update,” June 2022, 29.
5. UMC Powerpoint Presentation presented to El Paso county commissioners on June 27, 2022, “Capital Needs – Update,” June 2022, 30.
6. UMC Powerpoint Presentation presented to El Paso county commissioners on June 27, 2022, “Capital Needs – Update,” June 2022, 28.
7. “NCI-Designated Cancer Centers,” National Cancer Institute, last update June 24, 2019, https://www.cancer.gov/research/infrastructure/cancer-centers.
8. David Rubenson, “Opinion: Are 71 NCI-Designated Cancer Centers Too Many?,” TheScientist, August 29, 2019, https://www.the-scientist.com/news-opinion/opinion–are-71-nci-designated-cancer-centers-too-many–66370.
9. Rubenson, “Opinion: Are 71 NCI-Designated.”
10. Vater LB, Donahue JM, Park SY, Schenker Y, “Trends in Cancer-Center Spending on Advertising in the United States, 2005 to 2014,” JAMA Intern Med., (February 1, 2017), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969207/.
11. Text message from Ted Houghton forwarded to Cindy Stout, May 20, 2019, received from a Texas Public Information Act Request.
12. Text message from Cindy Stout to Jacob Cintron, January 23, 2020, received from a Texas Public Information Act Request.
13. Text message from Cindy Stout to Jacob Cintron, January 23, 2020, received from a Texas Public Information Act Request.
14. Amy C. Hay, email with link to survey sent to unknown recipients asking the recipients to participate in a survey for a cancer center, September 22, 2020. Copy received via a Texas Public Information Act Request.
15. Text message from Cindy Stout to Jacob Cintron, March 5, 2019, received from a Texas Public Information Act Request.
16. El Paso County Hospital District Texas Award For Performance Excellence 2020 Award Level Application Package, August 10, 2020, 7.
17. The University of Texas M.D. Anderson Cancer Center Operating Budget Fiscal Year Ending August 31, 2022, Adopted August 19, 2021, C.1-C.3.
18. 2022Facts, Dana-Farber Cancer Institute, 2021.
19. UMC Powerpoint Presentation presented to El Paso county commissioners on June 27, 2022, “Capital Needs – Update,” June 2022, 37.

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