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Susan Hammerle says she "thanks heaven" for Primary Children's Medical Center every day.

She believes the specialized care her daughter Nichole receives there has spared the 13-year-old girl's life and has changed her attitude from despair to courageous acceptance and optimism.When Susan and Fritz Hammerle were told that Nichole had a rare form of bone cancer, a friend comforted them - promising that angels would be with them during this ordeal.

The couple believes that the doctors and nurses at Primary hospital are those angels.

"We didn't think our hearts could take any more pain. Those at Primary pulled us through with their positive attitude. These people have given Nichole excellent medical care with the best technology available. They give Nichole the spirit of heart to believe and to fight," the mother said.

The hospital the Hammerles talk about with such gratitude is the subject of an investigation by the U.S. Justice Department. Other institutions - the University of Utah and its hospital - have been named as targets of the antitrust investigation.

Why should the Hammerles or other Utahns care about antitrust?

To the Hammerles, the word "antitrust" means nothing. On its face, it certainly doesn't inspire intrigue or even mild interest to most Utahns. Simply put, antitrust means illegal collusion to restrain or control fair competition. Yet the controversy attached to this seemingly dull word is threatening the reputations and futures of Primary Children's Medical Center and its parent company, Intermountain Health Care Inc., and the University of Utah and its hospital.

If criminal indictments are delivered against these institutions or individual physicians affiliated with them, their ability to attract first-rate physicians and teaching faculty will be devastated, says U. President Arthur K. Smith. The quality of health care available to Utahns will be severely diminished. Already, the investigation has cost taxpayers millions.

Reporting accurately on antitrust is tricky because the U.S. Justice Department has not disclosed exactly what it's investigating. But from the information the Justice Department is seeking through subpoenas, investigators are looking at possible antitrust violations surrounding the creation of a for-profit group called Pediatric Faculty Physicians with 90 doctors from University Hospital and IHC's Primary Children's Medical Center. The university is in the process of dissolving the PFP group.

Questions are being asked regarding Primary Children's Medical Center's cooperative relationship with the University of Utah. The university agreed to lease Primary the ground near the U.'s medical school at $1 yearly rate so physicians can teach at the medical school and treat Primary Children's and University Hospital patients. This arrangement is not unique. Throughout the nation, 52 other pediatric hospitals have affiliation agreements with universities.

"If there is something we are doing in our arrangement with Primary Children's hospital that violates antitrust laws, then the implication for other medical schools throughout the country is staggering," said Smith.

More broadly, the investigation raises questions about how antitrust applies to the complex and expensive business of health care.

This investigation is the test case for the country to answer perplexing questions about the future of health care in America. The critical bottom line is: How can hospitals cooperate with each other to share expensive equipment and staff without unfairly limiting competition that keeps prices in check? In the absence of competition among hospitals, should government regulation enforce a ceiling on costs?

From the Hammerles' perspective, the arrangement between the U. and Primary provides what concerned parents want most - the very best in medical care. Unlike comparative shopping for a car, people don't look at sticker price at competing hospitals to determine which is the best buy. When health is at stake, finding a bargain is rarely the driving force. And because insurance companies generally pick up the tab, comparison is difficult. A customer normally doesn't even know the cost until after the surgery or hospital stay.

The Hammerles believe the physicians who have helped Nichole are attracted to Primary because there are several children - drawn from the Intermountain area - with specialized diseases to treat. Nichole is not "an experiment" for them.

Because Nichole's cancer was discovered only a month after the Hammerles had changed insurance companies, their bills for treatment - so far amounting to $100,000 - have been denied based on a "pre-existing condition" claim. They are appealing that decision.

Meanwhile, the Layton couple has cashed a certificate of deposit to pay what they can. "It's incredible how bad luck in timing with your insurance can totally upset your world. We worry about the cost and want to pay what we can."

The hospital is working with them to reduce financial worries. They do not get nagging calls from accountants.

"We've compared the cost of Nichole's room and chemo treatments to another hospital we were in, and Primary's rates are less. But most importantly is the attitude here. Our doctors have assured us that if things don't work out with our insurance, the hospital will help us somehow. It's a non-profit hospital. No child gets turned away."