The ad ran in The Chronicle of Higher Education in April 2020.
Framed in horned-frog purple, an all-caps headline promised a “new kind of med school.” The logo for Texas Christian University was stamped in the bottom right corner.
Dr. Charles Taylor, provost at The University of North Texas Health Science Center, was confused. He sent an email to Dr. Stuart Flynn, the dean of what was then the TCU and UNTHSC School of Medicine. Why wasn’t the Health Science Center brand included?
A spokesperson from the medical school responded within the hour. Taylor had seen only part of the ad, she wrote. The other half included the full name of the school, and the two parts toggled back and forth online. Flynn responded, too. He didn’t know about the ad, but apologized for it. “This is not what we need right now,” he wrote.
When the advertising snafu took place, the celebrated public-private partnership had already done what it set out to do: Establish an M.D. school in Fort Worth. In 2019, the school of medicine welcomed its inaugural class of medical students. Not long before that, the school received the preliminary accreditation required to legitimize its program.
But beyond the public’s gaze, cracks had formed, both within the partnership and its narrative. The ad was merely a consequence of a slow disintegration already in progress, according to more than 1,000 pages of documents and emails the Fort Worth Report received through records requests to the Health Science Center. As a private university, TCU is not as bound by Texas’ open records law as the publicly funded Health Science Center.
The documents reveal years of disagreements over joint governance, a model depicted in the medical school’s founding documents as a “unique equal collaboration” between the two institutions. As frictions rose, the Health Science Center worked to maintain its authority while TCU made decisions that buoyed its own, including the purchase of property in Fort Worth’s medical district five years before the partnership ended in January 2022.
Flynn, along with TCU Provost Teresa Abi-Nader Dahlberg and TCU Chancellor Victor J. Boschini, Jr. declined to be interviewed, but a TCU spokesperson answered questions through email. Taylor and UNT System Chancellor Dr. Michael R. Williams also declined to be interviewed, but Health Science Center spokesperson Eric Griffey answered questions through email.
Chapter One: A Meeting of the Minds
Williams, then the president of the Health Science Center, and Boschini had known each other less than a day when Williams pitched Boschini his vision for a collaborative new medical school.
The two leaders met for breakfast at the Worthington Hotel in March 2015, an introduction spurred by a mutual acquaintance in Fort Worth. Williams’ proposal took place that morning.
Seven years ago, Fort Worth was the largest city in Texas without an allopathic medical school, which is a program that produces doctors of medicine, or M.D.s. The Health Science Center had more than 40 years of experience training physicians through its osteopathic medicine program, which produces physicians with D.O. degrees. Still, the school wanted an allopathic program, too.
The desire was stymied by state legislation from the early 1990s that prohibited the Health Science Center from offering M.D. degrees.
Then-state Sen. Mike Moncrief, who would later become Fort Worth’s mayor, agreed to pen the bill at the request of the Health Science Center, he told the Report. Historic tension between the D.O. and M.D. communities made the possibility of two programs under one roof unwise, he said. But, he added, times have changed.
After Williams took the helm in 2012, the Health Science Center worked to overturn the legislation but didn’t immediately succeed. Williams brought with him an unusual background that blended both flavors of medical education: He’d earned a D.O. and an M.D. His vision for a partnership with TCU served as a marriage between both paths.
What do the letters stand for?
D.O. — doctor of osteopathic medicine. The Texas College of Osteopathic Medicine at the Health Science Center produces physicians with D.O.s.
M.D. — doctor of medicine, also called an allopathic doctor. The TCU School of Medicine produces physicians with M.D.s.
TCU also wanted to expand its graduate offerings. The university had considered a law school and a medical school, Boschini told TCU360 in 2012.
A partnership would be cost-effective, according to 2019 reporting from Business Officer Magazine. Back then, the Texas Higher Education Coordinating Board estimated six-year startup costs for medical schools to be $160 million.
Because TCU and the Health Science Center could combine resources, including facilities and faculty, the medical school projected a six-year startup cost of $140 million, then-Health Science Center financial official Greg Anderson told the magazine. Anderson is now the deputy chancellor for finance and operations for the UNT System.
On its own, the Health Science Center could provide decades of expertise, as well as facilities like anatomy labs and a medical library that serves several states. But as a publicly funded institution, the school would need the 1993 legislation overturned and permission from the Texas Higher Education Coordinating Board to establish a new program. Since then, the Health Science Center has received both permissions. In 2017 and 2018, respectively, the Legislature and coordinating board both approved the Health Science Center for an M.D. school.
Before then, though, privately funded TCU could directly approach the accrediting body for allopathic medical programs in the U.S., the Liaison Committee on Medical Education.
Approval from the Liaison Committee signifies a medical school is equipped to train — and receive certain federal funds for — a new generation of physicians. And, it serves as a golden ticket for students. Students who graduate from an accredited medical school are eligible to apply to residency programs and sit for their medical licensing exams.
Chapter Two: Accreditation
Before the school of medicine received preliminary accreditation in October 2018, the accrediting body required it to meet a laundry list of benchmarks, among them development of the curriculum, selection of a dean and a formal description of the school’s governance model. In other words, the committee needed to know who was in charge.
When Boschini and Williams first envisioned the medical school, they committed to work toward shared governance. Early documents that shaped the school’s founding brim with references to equal partnership.
For example, both documents include this line: “The Institutions are committed to the fullest possible joint development and operation of the Medical School in Fort Worth …”
By September 2017, nearly two years before the school welcomed its first class, the messaging shifted. An updated agreement removed references to a “unique equal collaboration,” opting instead to laud a “unique collaboration.” The section on governance was concise:
“The School of Medicine will be governed by the Board of Trustees of TCU. The Board of Trustees of TCU have delegated the management of the School of Medicine to the Chancellor of TCU who has in turn delegated authority to the Provost of TCU.”
The document justified the shift: A single governing authority is a model accepted by accrediting bodies like the Liaison Committee. Moreover, the decision could be temporary. When describing TCU’s power to govern, the document qualifies the university’s authority with the word “initially.”
The setup made sense, because TCU’s path to accreditation included fewer obstacles than the Health Science Center’s, the latter’s spokesperson Eric Griffey wrote in an interview over email.
“Regardless,” Griffey wrote, “all parties repeatedly agreed, in alignment with the signed documents, it would ultimately be joint governance, joint accreditation, jointly named diploma.”
But the decision would not be temporary. In three years, Dahlberg would tell Taylor that the TCU board of trustees would retain sole control of the medical school.
In October 2021, just months shy of the separation announcement, Boschini would reference this decision in a certified letter to Williams: “No accreditor has ever given us a greenlight to joint governance, or recommended that joint governance was the right approach to awarding a joint degree. In fact, both you and I were present in several meetings where the accreditors specifically told us joint governance would be impossible if we desired accreditation.”
But the Liaison Committee doesn’t dictate whether a governance model should be solo or shared, Dr. Veronica Catanese, co-secretary for the Liaison Committee, told the Report. Catanese is also the senior director of accreditation services at the Association of American Medical Colleges.
In her tenure with the accrediting body, she’s seen all kinds of shared governance models, “so many variations on a theme,” she said. “But there’s nothing at all unusual (about shared governance) or in any way threatening or a problem for accreditation.”
Nor, she said, is it uncommon for a school’s governance model to shift during and after the accreditation process. “From the accreditors’ perspective, they just want to know that the program is strong and that the students are secure,” she said.
Chapter Three: The Medical District
This past February, the newly christened TCU School of Medicine announced the location of its new campus: a roughly five-acre plot of concrete slabs and grass at the corner of West Rosedale and South Henderson in Fort Worth’s medical district.
The news came six weeks after the formal ending of the TCU and Health Science Center partnership. However, ownership for the majority of the land, which comprises dozens of smaller properties, hasn’t changed hands since September 2017, when TCU purchased the land under a different name. Later, Williams would refer to the purchase as a breach of trust.
“TCU acquires land in Fort Worth as part of its long-term strategy, including for use as possible expansion,” the TCU spokesperson wrote to the Report. “TCU had not determined how or when it would use the site when it acquired that first parcel.”
TCU is listed as the owner for dozens of its properties, according to the Tarrant Appraisal District. But between August 2017 and June 2018, a limited liability company called Dashrose purchased properties between Dashwood and Rosedale streets. As of June, Dashrose, LLC is still listed as the primary owner.
The agent of the company, which formed in August 2017, is William M. Kerr Jr., an Austin-based partner with Kelly Hart & Hallman. Kerr’s colleague, Dee Kelly, Jr., sits on the TCU board of trustees. Furthermore, at the time, the law firm served as TCU’s legal counsel for the school of medicine, the TCU spokesperson wrote.
In August 2017, the school of medicine was still in its seedling stages. TCU and the Health Science Center had hired Flynn as founding dean the year before. The school was more than a year away from receiving preliminary accreditation from the Liaison Committee.
The properties would sit quietly until April 2019, when members of the real estate community in Fort Worth alerted leaders at the Health Science Center that TCU had purchased land in the medical district with an alias name, Griffey wrote. When those leaders asked TCU about the purchase, TCU didn’t confirm or deny its involvement, he added.
In an email to the Report, a TCU spokesperson wrote that TCU informed the Health Science Center of the initial land purchase.
“From the beginning and as the most recent agreement with UNTHSC reflects, both institutions agreed that the School of Medicine would eventually expand into its own building and space,” the spokesperson wrote. “The medical district was always a strong contender as a location for the (school of medicine’s) permanent home.”
Chapter Four: Pandemic
“Dear Michael,” Boschini began a November 2020 email to Williams. “First, it has been way too long – are you having lunches again – are you comfortable doing that?”
He’d emailed to make sure Williams knew about a decision the TCU board of trustees had made as early as August: TCU would retain “ultimate governance” over the school of medicine.
The decision stemmed from a discussion among the board of trustees about the “ensuing economic impact” of the COVID-19 pandemic, according to a September 2020 email from Dahlberg to Taylor. “TCU cannot have unlimited financial exposure for the (school of medicine) without retaining control,” she wrote.
TCU invested over $30 million each year in the medical school, according to her email. The Health Science Center, by contrast, provided the medical school with more than $5 million per year in in-kind support like facilities.
The partnership, she added, would stay intact. “We are open to lots of options,” she wrote. Still, TCU would need to stay on top.
The next day, Williams wrote an email to Boschini. He asked Boschini if he were willing to re-engage PricewaterhouseCoopers, whom they’d hired to help the school navigate the accreditation process and the creation of a joint governance model. Earlier that year, the pandemic had forced the leaders to pause their regular meetings with the firm.
Time was short, Williams wrote, to prepare for the next milestone in the accreditation process: an upcoming site visit by the Liaison Committee in February 2021.
“It is my concern that we are not fully appreciating the risk of failure,” Williams wrote. “We need to approach this with urgency.”
Boschini wasn’t convinced of the need to re-engage PricewaterhouseCoopers. After all, he would later write, the medical school’s Dean Flynn had navigated the accreditation process at The University of Arizona College of Medicine in Phoenix.
The next week’s emails reflect a gridlock among the school’s leaders: Williams wanted to prioritize preparation for the February site visit, and he wanted to re-engage PricewaterhouseCoopers to make that happen. In an email to Taylor, Dahlberg put her foot down: “Prior to making that decision (about PricewaterhouseCoopers), we need confirmation regarding the need for the TCU Board to remain the governing board, even when we offer a joint degree.”
Then, in mid-November, without prior review from leaders at the Health Science Center, TCU submitted the data collection instrument — a prerequisite document for the upcoming site visit — to the Liaison Committee.
Chapter Five: The End
The last full year of the partnership began with a worried letter from Williams to Boschini, delivered by courier and dated Jan. 19, 2021.
Williams outlined the school’s successes — preliminary accreditation by the Liaison Committee, engagement with a consulting firm to solidify joint governance plans, approval of a pilot process that would allow students to receive credit from both schools.
Still, he wrote, he’d been caught off guard by Dahlberg’s email in September 2020, requesting that TCU retain sole governance of the medical school. Also, he’d learned that TCU submitted the data collection instrument to the accrediting board without prior review from anyone at the Health Science Center.
TCU was responsible for taking “all steps necessary” for accreditation of the medical school, according to the 2017 agreement.
Williams and his colleagues had reviewed the submission and found it fraught with errors of omission and misleading information, he wrote. Along with the letter, he included a 14-page outline of those alleged errors in TCU’s submission.
For example, the document suggests Dahlberg’s September 2020 email, in which she requested that TCU retain ultimate governance over the medical school, reflects a “change in governance” the accrediting body should know about.
Toward the end of his letter, Williams included a warning: “As a partner of the TCU-UNTHSC School of Medicine, we have a good faith requirement to report these material omissions and misstatements to the LCME if TCU does not.”
Boschini responded by email. “In general,” he wrote, “all of the concerns you raised have been discussed at length and none of them were resolved in a way that would be harmful to either school.”
Months passed, and as winter faded into spring, Dahlberg and Taylor worked to craft a document that would reaffirm the medical school’s vision statement, one that centered the development of a “joint allopathic medical school.”
The two provosts sent drafts back and forth in late April 2021, but the institutions couldn’t agree on a final version, Griffey wrote. In a May 2021 letter to Williams, however, Boschini wrote that, “As of April 28, we were under the impression that our provosts had reached agreement on the content of that draft document.”
The document was slated to be signed May 9, 2021. It never was.
Instead, just days before, Williams handed a letter to Boschini at an in-person meeting. In the letter, he requested to end the collaboration between the Health Science Center and TCU.
The letter detailed breaches of trust between the institutions, including the purchase of land in the medical district without the Health Science Center’s knowledge. Williams proposed a path that would allow “TCU to move forward with its (School of Medicine).”
That parting wouldn’t take place for months. Within a week, Boschini rejected Williams’ proposal. He didn’t agree with Williams’ portrayal of the collaboration, he wrote in a letter of his own: “TCU has provided the support it promised (and then some).”
TCU managed and administered “all funds held for the benefit” of the school, according to the 2017 document that governed the institutions’ partnership through its dissolution. TCU also designated $50 million to the medical school’s endowment fund.
Boschini referenced Dahlberg’s language from her September 2020 email to Taylor: “TCU cannot have unlimited financial exposure for the (school of medicine) without retaining control.” Boschini noted that Dahlberg’s email also emphasized TCU’s ongoing commitment to the partnership.
Then, on June 1, 2021, Dahlberg emailed Taylor a memo with official letterhead: Someone had filed a complaint with the Liaison Committee against TCU, alleging that the data collection instrument omitted “relevant material information” about the governance model of the medical school.
“Based on the excerpts included with LCME’s letter,” she wrote, “it seems clear that the complaint came from UNTHSC.”
The Fort Worth Report asked the Health Science Center directly if it submitted the complaint. “HSC provided information to the LCME when prompted,” Griffey wrote in response, “which is a standard practice for all its programs and the associated accrediting bodies.”
As summer faded into fall and fall faded into winter, correspondence between the leaders focused on separation. The schools released a joint press release on Jan. 12, 2022, announcing that the partnership had come to an end.
Chapter Six: The Beginning
The third floor of the Interdisciplinary Research & Education Building on the Health Science Center campus reflected a school in transition on June 15.
The glossy silver signs directing people to the TCU and UNTHSC School of Medicine remained intact, and TCU medical students roamed the hallways. Still, cardboard boxes lined office doors, and someone had taped a reminder to the wall: Be packed, moved and ready to check out by June 10.
Since the announcement, the Health Science Center’s relationship with TCU has been primarily that of landlord and tenant. The same services and space the medical students received under the original partnership, they’ve still received under the separation, Griffey wrote. This time, however, TCU pays for them.
TCU planned to transfer medical students to a temporary site by the beginning of the next school year, which begins in July, Flynn told the Report at the unveiling of the new campus location. The campus, which has yet to break ground, should be ready to house an incoming class of medical students in July 2024.
The medical school received a record number of applicants for the upcoming school year, the TCU spokesperson wrote — more than 8,000 people who vied for 60 spots.
“We are extraordinarily proud of what has been achieved on behalf of our community with this transformative medical school,” Boschini wrote in a statement to the Report.
“I deeply value the opportunity I had to work closely with Dr. Williams and his team on this founding collaboration, which is achieving its goal of training talented future physicians, ultimately resulting in better health care for our area.”
The medical school will receive its full accreditation decision from the Liaison Committee in 2023.
As for the Health Science Center, the institution will have 60,000 square feet of free space, originally planned for research, when the school of medicine takes its leave. In the meantime, expansion will take other forms. The campus’ newly renovated Regional Simulation Center opens June 23.
“HSC is more committed than ever to fulfilling its purpose: Transform lives to improve the lives of others,” Griffey wrote.
In November 2021, Williams was appointed chancellor of the UNT System. He will “always remain open” to partnerships public and private that benefit the region, Griffey wrote. He added that “no current formal partnerships between HSC and TCU exist or are currently planned.”
The Fort Worth Report also asked TCU if the university and Health Science Center were partnering on any other projects.
“Various TCU schools and programs partner and collaborate with HSC on many initiatives that leverage collective expertise for the benefit of our community,” the TCU spokesperson wrote.
“We continue to have a strong relationship with our colleagues at HSC.”
The differences in their answers tell another story.
Alexis Allison is the health reporter at the Fort Worth Report. Contact her by email or via Twitter. Allison’s position is supported by a grant from Texas Health Resources. Also, Marianne Auld, a managing partner of Kelly Hart & Hallman, is on the Fort Worth Report’s board of directors. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.