The San Juan Hospital District Commission approved on June 18 a letter of intent that clears the way for the district and PeaceHealth to explore in more depth the feasibility of a new integrated medical center on San Juan Island.

In our June 25 editorial, we recommended the commission approve the letter of intent and explore with more depth the unanswered questions regarding the medical center. But we also urged the commission to keep the process open. That’s why we’re disturbed by the fact that the commission adopted the letter of intent without public discussion. Specifically, the commission adopted the letter first, then opened it up to public discussion after the decision was made.

According to the letter of intent, PeaceHealth will “prepare and circulate in a timely manner” a draft agreement. If the draft agreement is approved, the district will help raise $10 million in philanthropy toward the cost of building the new medical center; and will contribute property tax revenue toward the cost of building the medical center and for uncompensated and charity care.

If the draft agreement is approved, the hospital district will work with PeaceHealth to investigate the purchase and financing of a medical center site; and will work with PeaceHealth to secure a certificate of need from the Department of Health.

The letter of intent states that the hospital district and PeaceHealth “agree that the breach of this Letter of Intent would cause irreparable and immediate harm to the other that could not be remedied by monetary damages” and each can seek court intervention to prevent what they believe to be a breach.

While the letter of intent is supposedly “non-binding,” it is a commitment — a commitment by a public commission that is elected by and responsible to the voters of San Juan Island. It is only right, then, that public discussion should have preceded the commission’s vote to approve the letter of intent.

Public should have say in the final decision to proceed

This part of last week’s editorial deserves repeating.

A lot of questions need to be answered about the feasibility of an integrated medical center on San Juan Island.

This much we know: The proposed medical center will provide many services for which islanders must travel off-island; it would provide 24-hour inpatient care, which the current medical center does not. Reimbursement rate for Medicare would be improved; the current medical center is classified as a medical clinic, and is reimbursed as such.

PeaceHealth would run the medical center and would be responsible for all operating costs; the existing hospital district’s tax revenue would be freed up to pay for EMS services and for a bond for hospital construction. Proponents say the medical center would be profitable in five years and that there would be no increase in property taxes.

Here’s what we don’t know:

• What authority will our elected hospital district commission have over the medical center’s operations?

The current plan states that the medical center would be overseen by a board delegated by PeaceHealth. It also states taxpayers would contribute $12.8 million toward the medical center’s construction costs.

With islanders putting the provision of their care into the hands of another organization, how do our elected representatives ensure that islanders’ interests are protected? How do our elected representatives ensure that islanders have a voice in the quality of care?

• The medical center’s construction costs would be funded this way: $12.8 million from a taxpayer-supported bond; $10 million raised by the San Juan Community Hospital Committee, the lead proponent; and $7 million from PeaceHealth.

If for some unforeseen reason the agreement falls apart someday, who owns what? How would the existing hospital district resume providing medical services? Would taxpayers have to buy out PeaceHealth?

We see the need for an integrated medical center on the island. But these questions must be answered first and the non-binding letter of intent before the commission today should be approved so those questions and others can be answered.

The hospital district was created by taxpayers to provide medical services on the island. Yet the commission has the authority to, without public vote, approve the project as well as a $12.8 million bond guaranteed by our property taxes. The commission, which is directly responsible to taxpayers, has the authority to assign our medical care to another organization which may or may not be directly responsible to taxpayers. Right now, if we are not pleased with financial management or quality of care, we can elect new commissioners. Under the new process, we would call a board member delegated by PeaceHealth.

PeaceHealth has a good track record. But our assignment of rights, our financial commitment, our trust of future medical care warrants a public say in the final decision to proceed.