A lot of questions need to be answered about the feasibility of an integrated medical center on San Juan Island. We encourage the San Juan Hospital District Commission, which oversees Inter Island Medical Center and San Juan EMS, to approve the letter of intent that will allow a study that will answer those questions.

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.

Our recommendations: Approve the non-binding letter of intent. Explore with more depth the unanswered questions. And put this project on the ballot for public vote.