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But Colloton thrived in a very different period than our own. Looking back, it now seems unfathomable that, at the same time he was directing University Hospitals, Colloton was allowed to be on the board of directors of Wellmark, the state health insurance giant and the hospital's biggest customer. It's equally unbelievable that there wasn't more public outcry against such obvious conflict of interest until 2003, when then-Gov. Tom Vilsack appointed John Forsyth, Wellmark's president and CEO, to the Iowa state Board of Regents -- the board that has the final word in state universities' educational, research and medical mission. And even worse, the board elected Forsyth president.

The ensuing UI/Wellmark contract dispute of 2004 and 2005 led to the resignation of Forsyth and two other regents, the eventual installation of Michael Gartner as regent president, the resignation of former UI President David Skorton, last year's failed presidential search and the ongoing concern about the direction of the university's educational and medical missions. We can't move forward effectively with either the UI presidential search or the proposed changes to University Hospitals until we sort out some of the complicated, interconnected relations that brought us to the present -- and until everyone involved pledges not to let them happen again.

A recently obtained letter from Colloton to Regent Bob Downer gives us a glimpse into the behind-the-scenes confrontations in the UI/Wellmark dispute ("Letters touch on allegations of blame," Jan. 30). The letter, dated Jan. 6, 2005, was sent immediately following the university notifying Wellmark that it intended to terminate its multi-million dollar contract with the insurance company. The complicated business relations between any hospital and large insurer were complicated further by Forsyth's role as regents president. Downer, who was president pro tem, had to act as regents president on all issues related to Wellmark.

In the Jan. 6 letter -- dictated to a university-provided secretary, printed on University Hospitals letterhead and signed over the title "Director Emeritus" -- Colloton told Downer that the move was "an ill-conceived and counter-productive strategy." Colloton had no official decision-making authority at the hospital, but when reading the letter, it's hard to view it merely as a former director offering his "personal analysis" of the contract dispute. Instead, the letter shows that Colloton was lobbying the regent acting as president on behalf of Wellmark, the health insurance giant that paid Colloton $144,000 a year as its head director. Colloton comes across as a Wellmark fox in the university's henhouse.

Perhaps we have unrealistic expectations of Colloton based on his track record of successfully preparing University Hospitals to thrive in the 21st century. But in the 21st century, we immediately become suspicious of anyone acting with such profound conflicts of interest or such monopolistic results. Someone -- including us -- should have said something long ago about the inappropriateness of such dual positions. Everyone -- including us -- should be doing everything possible to ensure that such conflicts are a thing of the past.

We celebrate the Colloton era, but it's not a time we want to return to. As patients have become more knowledgeable about the clinical practice of medicine, so the public has become more interested in the business of medicine. It's time for all high-level health policy decisions in Iowa to move beyond the backrooms of a few well-positioned good old boys and to come out into the open where the rest of us can see what is going on.