When Texas voters approved the creation of the $3 billion Cancer Prevention and Research Institute of Texas in 2007, state officials said they hoped it would help Texas become an epicenter of cancer research, accelerate the development of lifesaving treatments and expand prevention programs.
But a series of improprieties at the institute, known as Cprit, has endangered the state's mission, and a moratorium placed on Cprit grants while leaders work to reform the institute has left Texas' cancer community hanging in the balance.
"The individuals who are facing this disease are too important to allow this to derail such a monumental effort," said Doug Ulman, president and chief executive of the Livestrong Foundation, which is part of a coalition of national cancer prevention and survivorship groups that is urging state lawmakers to restructure Cprit, not demolish it. "The cancer community is frustrated, both by the sort of hiccups and missteps, but also by the belief by some that that means everything is bad."
The moratorium placed on Cprit grants in December has halted the distribution of $182.6 million — including $71.8 million to bring additional research teams to Texas and $16.2 million for cancer prevention services. As a result, Texas universities are scrambling to hold on to renowned cancer researchers who were promised millions of dollars to move their labs to Texas. And advocacy groups fear they will be forced to dismantle cancer prevention programs.
"All of the momentum that we've worked for in the last two to three years will just be lost if those funds abruptly go away," said Leticia Goodrich, executive director of the Amarillo Area Breast Health Coalition, which has increased the number of cancer screenings provided to impoverished women by 400 percent with a Cprit grant that expires in June. "It gives us no time to build our program towards becoming self-sustaining."
Since 2010, Cprit has awarded nearly 500 grants totaling $836 million. With that financing, Texas' higher-education institutions have recruited 44 prominent cancer researchers, and 184,000 Texans have been screened for cancer — including 38,000 people who had never received cancer screenings before, according to the institute's figures.
But three of those grants — totaling $56 million — were approved without proper peer review, according to a state audit released in January. And the Travis County district attorney's office is conducting an investigation to determine whether the actions of former Cprit employees were criminal.
The most problematic grant identified by auditors was the institute's largest and most visionary: $25 million to establish a statewide clinical trial network, known as CTNeT, designed to expand access to cancer services and accelerate testing of new cancer treatments. An audit found that three high-ranking Cprit employees were members of CTNeT's board of directors, and that the company received $6.8 million in advance payments not permitted under its contract.
CTNeT closed in January, and the state is trying to recover $1.3 million that was spent on prohibited expenses like employee bonuses and office furniture.
Such statewide clinical trials are "exactly what needs to happen," said Mr. Ulman, of the Livestrong Foundation, who expressed disappointment that rural Texans would continue to have limited access to cancer treatments because of CTNeT's failure. "We would encourage the leadership to think about how to accomplish that goal in a different manner."
State Representative Sarah Davis, a breast cancer survivor, represents a Houston district with four higher education institutions that have collectively been awarded more than $300 million in Cprit grants. Ms. Davis, a Republican, said lawmakers agreed that there were some major problems at Cprit, but she said she had concerns that the moratorium "further erodes the stature and credibility of Cprit" by scaring scientists and researchers away from Texas.
A researcher recruited with a Cprit grant to one of the institutions in Ms. Davis's district backed out because of the moratorium, she said, while another "had a whole research team move to Texas — and they're just waiting in limbo."
Dr. Adam Kuspa, the senior vice president of research at Baylor College of Medicine in Houston, said Cprit grants have been critical in attracting scientists to Texas and developing infrastructure for biotechnology labs, both of which provide long-term benefits to the state's economy.
Baylor, for example, has recruited seven nationally recognized cancer researchers with Cprit grants, but three of those grants are on hold because of the moratorium, Dr. Kuspa said.
"They chose to come here because we were able to offer them a substantial kick-start to their career through the Cprit award," Dr. Kuspa said. The prospect of being able to apply for additional Cprit grants for research was also enticing, he said, "so there's a little bit of angst around whether that will be available to them going forward."
If the moratorium is not lifted, Baylor will have to divert money from other projects to keep its financial promises to the new recruits, Dr. Kuspa said, which could slow the institute's overall research progress.
The Legislature's initial budget proposal for the 2014-15 biennium reduces Cprit's financing from $300 million to $10 million — the bare minimum to meet existing obligations. But lawmakers are considering measures to reform the institute, and some are optimistic that financing could be restored before the end of the legislative session.
"What I'm hearing from the members is, 'Mend it, don't end it,' " said Wayne Roberts, the associate vice president of public policy at the University of Texas Health Science Center in Houston, who was appointed as Cprit's interim executive director in December.
Cprit's rescue team — which also includes a fiscal consultant, Billy Hamilton, the state's former chief revenue estimator, and a chief scientific officer, Margaret L. Kripke, the former executive vice president of the M. D. Anderson Cancer Center in Houston — is reviewing past grant applications and carrying out recommendations from state auditors while awaiting further direction from the Legislature.
Mr. Roberts said he would not recommend lifting the moratorium or requesting additional financing from the Legislature until Cprit had "made inroads in regaining their trust."
The institute's grant review processes "are only as good as the people implementing them," he said, "and if they don't follow them, things go off track."
baaronson@texastribune.org
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