Several governors and legislatures have attempted, but no one has come as close to realizing the decades-old vision of building a new Guam Memorial Hospital as Governor Lou Leon Guerrero and the 38th Guam Legislature. And it isn’t just a hospital that is on the brink of development. If Ms. Leon Guerrero succeeds – if senators help to realize what she calls the “community’s vision” of a medical campus in Mangilao, the island will be building an entirely new city complete with unprecedented regional access to an array of medical and health services, improved and sustainable infrastructure, affordable housing, and residents teeming with economic development opportunity.
And if all is on track – despite the attorney general’s campaign to stop the development of the medical campus in the identified lots along the back road to Andersen Air Force Base (Route 15, Mangilao) – the first fruits of the development will begin this month. A new hospital could open in five years; and, with it, the possible realization of universal access to health coverage.
In a 40-minute one-on-one interview with Troy Torres of Kandit News that was recorded in late January, Ms. Leon Guerrero:
- Laid out the process, in chronological order from utilities development through ribbon cutting of medical campus
- Explained her vision for Mangilao, the medical campus, health access, and economic development
- Revealed that utilities-laying contracts could be in place as early as this month
- Detailed how the military can pay for major road expansion; GovGuam likely will build new access roads for swifter commute to the new GMH
- Expressed confidence that GovGuam can afford the debt service
- Gave a pricetag: About $800 million
- Discussed how she anticipates a bond for financing of part of the project will be about $400 million, though the amount can be lower depending on federal sources
- Revealed that federal grantors have green lighted the use of about $400 million out of the recently awarded $500 million CDBG-DR grant for hospital development
- Said she is far more hopeful about the success of her vision with the new Republican-led legislature in place
- Asks for senators to ratify the Mangilao location to end all questions about that debate
- Explained that though senators previously provided authorization for bond financing of up to $35 million in annual debt service (bond repayment), she may need to update the authorization depending on what type of financing scheme the administration settles on
- Said she needs senators’ help to reform procurement law for this program
- Said she is confident, despite the possibility of the Trump tax cuts, that the GovGuam budget can handle this development
- Wants doctors and other stakeholders to be actively involved in the design process
- Revealed potential for partnerships with major medical education and university campuses, along with allowing qualified foreign specialists to practice alongside local doctors
- Explained how the medical campus will get us closer to an overall goal of universal access to healthcare
- Agreed with senators that GMH needs an annual subsidy. She commits to work with senators to identify revenue to keep the current facility operational until the new hospital comes online
- Called out medical providers who have unreasonably obstructed the development of the new hospital as having special interest
- Asked the people of Guam to support this vision.
Here is the full transcript of this interview (which may contain minor errors):
TROY TORRES: Governor Leon Guerrero, thank you so much for your time this morning.
GOVERNOR LOU LEON GUERRERO: Thank you for the opportunity.
TORRES: Thank you. God bless you. Let’s get started. We are at a point where a location has been set and funds have been obligated for various projects related to the location for the new medical campus. When will work start on the funded infrastructure projects for the medical campus, your power, water, waste water?
GOVERNOR: Right. So as you know, I had set aside ARP monies specifically to be able to quickly do the preparatory work for construction. I am very aware that there’s all these things that need to be done, infrastructure, utilities, environmental studies, getting an A&E, doing the design, and so forth. So with the money that we have set aside, this gives us a quick movement to start with GPA and GPA has laid out where the station is going to be, where the utilities underneath are going to be and they’re actually, we are very excited that they are going to start as soon as we can. I would like to have had it started two years ago, but it’s not. And so there’s a lot of urgency in this because we have to spend these monies by December 2026. And I’m very confident that GPA has been very, very supportive. GWA has been very, very supportive. We are looking at getting a construction manager or a project manager, and I think those things are looking really very good. So I expect, I would expect by the middle of February or the end of February to start laying those, at least getting the contract going and getting it effectuated so we can continue to do the work.
TORRES: What about the roads expansion? When will that start and about how much might that cost?
GOVERNOR: We’re working very hard with DPW and also with the military because that is considered a DAR, and so a defense access road. And they have in their plans to expand that. So we’re trying to coordinate it so it works simultaneously with or right after with the layout of the utilities and, man, I’m expecting maybe I would say by the end of this year maybe, yeah.
TORRES: That’s pretty quick.
GOVERNOR: Yeah because they are aware already and I know DPW has already, you know, done some preliminary work, but not only that, that whole land space there where the road is, is 60 feet. So we don’t really have to work with any other land owners or any other property owners. That’s already dedicated there. So that part’s going to go by, I think, real quickly.
TORRES: Oh, I see. So the government of Guam already owns the pavement?
GOVERNOR: Yeah.
TORRES: Okay. What about other plans to build new roads to more efficiently connect communities?
GOVERNOR: Yeah, well of course we want to have as many accesses as we can. And you know, if you’ve seen where it is, right? If you look at it straight on to the left, if you go to the left you’ll have Radio Barrigada over there. You know, it goes right into some housing areas there. And there’s already an easement that goes there. So that’s just something that we would have to expand and work with.
TORRES: Okay, so there’s the possibility of another access?
GOVERNOR: Even with the original medical action plan document, there was already another access that way.
TORRES: What federal, military, and non-GovGuam funding sources are you seeking to defray the cost of building, furnishing, and staffing the new hospital?
GOVERNOR: Every federal sources that I can get, right? So we’ve been talking to, of course, the Department of Defense. We’ve been talking to HUD. We made a big presentation just I think in October, September, October last year to Region 9 so that they can be up to speed with the hospital and also with the military buildup and how significant and important this is to the overall health care system of our island because I’ve always been out there advocating and espousing that you cannot have national security if you do not have human health security. And the Department of Defense has accepted that and they’re on, I know Indo-PACOM now is on moving with working with other foreign countries to be able to provide health care resources should the need arise here in Guam. So I think that position statement has been heard very loudly in Pentagon and we’re working to see what we can do. If we can get it into the next NDAA and of course I’m looking at, based on the Army Corps of Engineers assessment of about seven hundred and forty three million dollars, but you know with time and inflation and so forth I’m looking at eight hundred million dollars but we are – that’s the number that we are – throwing out both with senators and and House of Representatives that have come to Guam on a CODEL. And also when we go back there and meet with our White House and congressional stakeholders.
TORRES: So considering that price tag and considering the potential for outside source investment whether it’s federal, military or non just non-government, what is the guesstimated price tag that you have for a bond to pay for the rest of it?
GOVERNOR: Oh, I’m going to say about maybe between 400 and 500 million. And I just want to say at this point that last year we went on an investment briefing investors, and we threw out the hospital. And they’re ready to come to the table to provide the investment and the capital needed to make that happen. We already have the legislature had already approved a financing piece of legislation of about $35 million debt service a year. So, you know, we would have to either look at really what the much more accurate estimate is and then if we need to go back to the legislature for amendments to it, we’ll certainly do that. I think 35 million seems to be a reasonable amount and just with the private financing and equity, they’re there, they’re ready.
TORRES: I was going to ask, do you need to go back to the legislature for anything else related to a bond financing?
GOVERNOR: We probably would want to come back because I think in this piece of legislation it was a lease to own, but we want to have, you know, as many opportunities and options in financing, right? So I think that’s one thing that we are looking at. And of course if we can go back to the legislature for more ratification maybe or more support through policy and mandate of building the hospital in Mangilao that would also be very helpful.
TORRES: Do you feel better about this vision of yours coming to fruition with this new legislature in place?
GOVERNOR: I do. I feel better because for one very, very important hurdle that we have to do is find the property. And I think once we found the property, it’s a lot more opportunities for planning in investment and financing in knocking on doors and saying we’ve got a location now, we just need to help on the funding. So it makes it, that one hurdle makes, opens a wide variety of doors and opportunities. And you know, it would really be very helpful if the legislature would ratify that now the hospital will be built in Mangilao and moving forward with support in whatever policies that we need to do to build it. And I just want to say that this hospital building is a vision of the whole community. Everywhere that I go, people are supporting it. And they’re supporting and giving their commitment in helping build it. And I’m sure you hear the same thing. Governor, we need a new hospital. Governor, we don’t really care where it’s going to be built. Governor, once we decide a location on the hospital, let’s move fast. And Governor, I hope the legislature will support you on this. And so the reason I say it’s a little more hopeful for me is because there are now new senators in there, I think five new senators, who I feel will have a fresh perspective. And I know that they believe that that there has to be a new hospital for our people. Everybody that goes to the hospital, they don’t complain about the talent there. They don’t complain about the doctors or the nurses. They complain about the facility, and it’s an old facility. It’s a facility that’s lived its purpose, and we’re trying to put Band-Aid solutions there to just help it along for about three, four, five more years until we complete the hospital. But I really believe that the people of Guam deserve, they deserve a new facility so that then our employees will feel so much high morale to work in an environment that they can do their work. An environment that they have the equipment, an environment that they don’t have to stop and, you know, mop up the floor because it’s leaking from rain, right? An environment that’s clean and safe for them. And not only that, not just for our people here, but for the whole region, you know, and we can help our brothers and sisters in the other islands deliver to them the kind of health care that they also deserve as human beings, period. And so this vision is not my only vision, it’s the community’s vision. And I really am asking that our senators get on board. I’m asking that all the naysayers that have now, you know, the debate is over as to where the location is going to be, to get on board and support all of us, the community, so we can have a really good hospital. The need for a new hospital has been going on for the last 20, 25 years, right? So it’s time, I think, that we all unite on this vision and on this project because our administration can’t do it alone. Our administration needs the help of the legislature, needs the help of the AG, it needs the help of the judiciary, it needs the help of all of government and all of our community as a whole.
TORRES: Considering pending uncertainties with the finances of the government of Guam. I’m not talking about your administration’s handling of it, I’m talking about the possibility of Trump tax cuts, the possibility that the legislature might, over your objections, lower the BPT from 5% to 4%. Are you, considering those possibilities, are you confident that the government’s finances will be able to absorb the up to $35 million annual debt service?
GOVERNOR: It would probably be a bit of a struggle and it would probably mean that we would have to look at all our services and we’d have to look at what our revenues are going to be in light of all those cuts. I just want to say that rolling the BPT back by 1% will remove close to $80-$100 million of revenues to our island. This means it’ll impact our government services. Tax cuts that President Trump is going to do is also going to decrease revenue. I don’t know by how much, I don’t know what his tax cuts going to be, but I know that in the last Jobs Act that had the cuts, they were losing about $60 to $70 million. That’s why they had to increase the BPT by 1% to make up of all that. they were losing about $60 to $70 million. That’s why they had to increase the PPT by 1% to make up of all that. And I know Shawn Gumataotao is spearheading the rollback of 1%. I did speak to him personally and asked him to please make sure he considers all angles of the analysis. How much are we to be losing? What are your sources of revenues to replace those lost revenues? What does that mean to impact of government services? What does that mean in our ability to continue recruiting our public safety, our nurses, our teachers, so we can provide the care, the services that our people deserve? There’s a lot of things that need to be considered in light of all this. And the other point I wanted to make, Troy, is 90% of our businesses do not pay 5%. They pay 3%. And there’s quite a number of small businesses that don’t make $50,000 a year that don’t pay any taxes. The revenue source of this increase of the BPT. So really the strain isn’t on our business communities, the strain is more on our contractors and construction people. And that’s where we’re going to be losing that money. And so if we’re going to remove that, how are we going to replace 80 to 100 million dollars that is needed to run our government the way it should be run. So a 35 million debt service, of course we’re going to make it because that’s the first thing we do. You know this. In a budget, we receive the budget, we look at all our revenues, we carve out those revenues for the debt service and whatever’s left there is for government operations. And that’s why I say we’ll have to look very closely on what government services we’re going to have to cut back, what human resources we won’t be able to recruit.
TORRES: The public has an understanding that the first steps of this hospital development are the infrastructure laying and the roads expansion, but can you explain to our audience what comes next and then how do we get to a ribbon cuttings?
GOVERNOR: So the most important thing here is to get A&E, the design, right, because the architectural and engineering design. Because from those plans and designs we can have a better understanding of what the cost will be. And I want to assure the public that we will have stakeholders be part of that architectural and engineering design. We’re going to meet with the doctors. We have to. It would be, I think, a great error if we don’t include them because they’re going to be the users of the hospital. So we’re going to ask a radiologist, we’re going to ask the laboratory people, the pharmacist, so they can give us input on their workflow, right? Because you design it based on the workflow and how effective is that? Where are you gonna put the nurses station? Are you gonna centralize it? Are you gonna decentralize it? What’s the most effective way of the workflow so that you’re taking care of all the patients in a view, right, that you can see? So yes, they’re very important, very, very essential part of feedback and input into the architectural and engineer design. So with the laying of the utilities, architectural and engineering design, and then of course hiring a construction manager to oversee it, very very crucial also. And then we’re going to try to work it so we don’t have to have as many change orders because you know in construction change orders are very costly and we’ll try to get within the budget but we’ll have a better idea when we do the A&E. Okay and then after the A&E all the procurement happens for the bonds, the financing and then the actual construction. We go out into the financing or even, you know, I’m very hopeful that we’ll have as little as possible in the equity market so our debt service is less. My goal really is to have it funded by the federal government. How possible is that? I’m shooting for the moon here because if you don’t, you’re not going to be able to say, ‘Hey I did everything I can.’ Already HUD is giving us $502 million for housing and recovery and so forth. They did say that hospital is eligible. We’re working up our action plan so we can get a major portion of that for the hospital. I’m looking if we can get $400 million, $450 million for that. And then of course I also am working with our delegate to ask to do a stand-alone bill to put in like $400 million. In the last Congress, I know that Congressional Delegate Kilili was working also very hard with his Democrat caucus and he had an omnibus bill that gave Guam $350 million for a hospital and also American Samoa. So you know we can work all the delegates there to ask Congress to you know appropriate 400- 450 million dollars for a hospital. So and also of course DOD and you know I’m looking to DOD to get and put money in. I’m looking at the veterans. So I’m using every opportunity that I can. HHS is another one that we’re looking at. Yeah.
TORRES: This is going to be the single largest, by cost, development of the government of Guam in its history and you know maybe you want to get ahead of the problem. I don’t know what are your thoughts on- are you going to be asking senators to do anything about procurement so that you don’t have, for example, frivolous protests that hold this thing up?
GOVERNOR: Well, you know, they have given exceptions to, I think, GPA, where even if they do protest, see, most areas in procurement, if they protest, but it’s already awarded and the protests continue on with the award, right? And then whatever happens with the protests happens, right? But that’s something I think that if we could be part of that procurement, where we go up, you’re absolutely right, protests has always been one of the biggest delays in any kind of construction. We saw that with Simon Sanchez, right? And so absolutely that would be something that the legislature could help in the urgency of building the hospital.
TORRES: What message do you have for those senators and doctors who have pushed back on you? Have been your greatest critics about building the hospital elsewhere?
GOVERNOR: I would say to them, now that the location has been identified and there’s a progress made towards the hospital based on where the location is, to garner their support. I think, like I said earlier, we need to look at this as a whole community endeavor. And certainly, and certainly you know the legislature, the senators can can be part of this great project I think that’s going to be so beneficial not just to our people for health care but the surrounding areas. Already when we were talking with GPA they were talking about how they can they’ll bring in underground distribution from Barrigada, from Mangilao and so that we’re hardening recovery right? That’s going to be beneficial for them. GWA is going to bring down sewer and wastewater and that’s going to be beneficial for all the residents there. Not only that, the properties that are vacant there, these landowners now, right, can develop them because now there is major major utilities that’s going to be available in the surrounding areas.
TORRES: Aren’t there also a lot of Chamorro land trust lots there?
GOVERNOR: Yes, yes. Ancestral lands also there. I mean ancestral lands can be used for development. You know we are of course hurting for housing. Why can’t ancestral lands in – actually that property that I wanted in the in the beginning, Adacao or Eda Agaga, that’s prime because that’s crown land, no owners there, and so that’s a good source for government to use for development of affordable homes. And if you bring down the infrastructure, main infrastructure, the utilities, that’s going to be a plus in terms of moving it further along. The other thing I wanted to say is I know the critics about access, and how quick can you get there. I’ll tell you, the north will come quicker to this hospital than they have to fight the traffic in Tamuning going down to Tamuning.
TORRES: That’s the truth, I live in Yigo.
GOVERNOR: Yeah, we have the access roads where the road from the church right to Route 15. And then also the Latte Heights one from that road to Route 15. I timed this. From Yigo down to where it is, it’s only 10 minutes. And this is going at like 35, 40 miles an hour.
TORRES: Yeah, no, you’re absolutely right. I personally know this to be true. It’s really something trying to get into Tamuning.
GOVERNOR: I have done my research. I have roamed those areas there and timed it. I’ll tell you this I know that Akimoto is a big naysayer and so is Dr. Nguyen right? But to their clinic is only three minutes three minutes to their clinic so I I don’t understand the the pushback on that one. But I just want to say let’s all take a deep breath and just look at this for the public interest.
TORRES: Do you welcome them to the table?
GOVERNOR: Absolutely.
TORRES: Governor you answered the the next three questions I had. So what is- when you envision this medical campus and where it’s at and you just talked about affordable housing opportunities, the ability for current residents or those who have properties there to do something with it because of the power and water infrastructure. What else? What is this greater vision that you have of that entire area once this medical campus is set up?
GOVERNOR: So this is my greater vision. I don’t know if you’ve ever gone to like Los Angeles, right? Or Stanford. And when you drive in to the hospital, right? Everything is there, right? You have your oncology centers there, you have your women’s center there, you have your pediatric center there, you have your cardiac, pulmonary, all these clinics in one place. So it’s convenience for our people. If you had GBHWC there, Public Health there, Veterans there, and now you know Dr. Shieh wants a women’s center, I say build it in Mangilao because like I have said you can share resources there, right? So it’s a medical campus. And the beauty of this too, Troy, is we can entice specialists. We can work with universities to bring in their residents to be part of this medical campus in their clinical experience and their residency, which then introduces them to Guam and they may want to stay.
TORRES: So this is how you’re going to get specialists? I was wondering about that.
GOVERNOR: Yes. Okay. And I’ll tell you this, I’ve been talking with USC and USC is very interested, very interested. I’ll tell you about that later. But very interested to partner with us.
TORRES: Very interesting. Thank you for letting us know that. It was one of the major questions that I had about access to care.
GOVERNOR: I’ve spoken to Good Samaritan. I’ve spoken to a network of hospitals there. Believe me, because I’ve been in healthcare for so long and I know this, I know what we need to bring. You know, we’re trying to work with the medical, the Guam but only work in the hospital. They’ve done this in California and they’ve done this in other states so we’re researching that with the Guam medical examiners.
TORRES: Governor, what type of information and data has your administration been able to gather about the future of the public’s health? You know, your incidences of cancer, heart disease, all that stuff.
GOVERNOR: I really believe the future of our public health is going to be good. I think we have, you know, the community has acknowledged the importance of prevention, right? You have seen people now walking, running, bicycling. Schools are teaching about nutrition, diet, exercise, we’re working very hard to prevent, you know, drug addiction, those kinds of services, we have both services, preventive services, because we feel drug addiction is really a medical issue. And so if you can catch it in the very beginning, then that’s where the key is. That’s the key to the future of our health. And I think it’s, I’m very hopeful it’s going to be very positive. You know, of course, diabetes continues to be the major, major incidence of health disease here. And also the non-communicable diseases, cancer, diabetes, kidney issues, all of that. And to me, prevention is very, very, very key to this. And so we’re working with public health, you know, with all areas in the schools and so forth to promote and encourage them. And I’ve seen this, you know. I’m 74 years old and I was born in Guam, grew up in Guam and you know even in our school at the time there’s no such thing as PE. We just went to school and went home. But at the time also we didn’t have computers and game stuff that we stayed home and in the couch, right? We were all outside running, playing and so forth. And one of the things with the pandemic is this, that people started going outside because they’re allowed to go outside to the park and I’ll tell you bicycles were being bought. The Hornet couldn’t get them fast enough, right? And so those are all positive things I believe and I think if if our leaders and of course you know our legislatures promote that and continue to pass policies that will promote that, that’s going to be very, very beneficial for our island.
TORRES: Well, how will this new medical campus assist that improvement of the public’s health? And even more than that, is it possible that this, how can this medical campus get us closer to universal access to coverage?
GOVERNOR: Oh my gosh, just being there in one site, right? And of course, Public Health is going to be there. There- like, Public Health is the main driver of public health in our island, right? And so our resources in this medical campus will stretch out to the community and do more community outreach, maybe do more screening, more prevention, more education, more health education, nutritional education, and push it out in the community. We’ll just have so many resources in this one area.
TORRES What’s the plan, Governor, for GMH, the current GMH operations and survivability until the new hospital comes online? In what, three to five years?
GOVERNOR: Well, hopefully. You know, that’s, I think, a very aggressive time frame, but we’re going to try to make it work as fast as we can. Right now, you know, of course, operationally wise, they’re trying to really just stand up the facility there. You know, they’re working hard with their very basic needs of good ventilation, non-leaking floors and windows, all of that. They’re working very closely to bring specialists and hospitalists in to provide for the services. Operationally wise they’re looking at probably outsourcing some of the administrative, you know like maybe the recovery, the revenue recovery portion, things like that and how to expand their capacity and their ability to collect.
TORRES: The Republicans, when they did a walkthrough of GMH it appeared that their top priority when it comes to medical care at least policy from the legislature is to get GMH some sort of subsidy uh… first an infusion of capital so that they can make whatever critical repairs and also perhaps a subsidy until the new hospital is built. Is this something that you’re willing to work with these senators on?
GOVERNOR: I’m very supportive of this. Just looking at their finances, right? They collect like 30 to 40 percent. That cannot stand. They need to be getting at least 50 to 60 percent. And if they can have subsidy infusion to get to that level, they’ll be able to, you know. And so I also know that at one point the hospital was being subsidized regularly by the tune of $30 to $40 million. And this was back in the 70s, the 80s, and so forth. And then they stopped because it was felt at that time that they’re charging, and so they felt that their revenue source was enough. But over the years, you could tell it isn’t enough. And I would say a subsidy of about $40 to $50 million a year would really beef up and further solidify their ability to provide the necessary supplies, equipment, resources, doctors and so forth to continue their work there as caregivers in acute care hospitals.
TORRES: My final question, Governor, before I ask you to give your message to the people of Guam is what do you want our audience to know about the pushback and even the vitriol that you’ve received because of your vision?
GOVERNOR: I just want to say it’s very unfortunate because I really think the pushback from some of their local doctors is on their self-interest. And I’ve said this publicly and I’m being very candid and very open because as I see it, really, the main fight is to protect their own self-interest agenda. And to me, that’s uncalled for in a medical professional capacity. You become doctors and nurses because of your compassion and your passion to help those that are sick, those that are vulnerable, to come to a state of healing and recovery so that they can go back to their families and their loved ones and be productive members of the community, right? To be healthy again. Self-interest agenda has no place in that medical profession, in health care. I remain focused and I remain very firm in knowing that what I am doing, what we are doing is the right thing for our people. The only interest here in my agenda is the public’s interest and the ability for our and be treated in a modern hospital because healing is not just medical medicine and all that, it’s also the family. And when you take somebody who is sick out of their familial environment and send them to a strange place that at times they don’t even know who their doctor is, that’s very stressful. And that doesn’t do anything to help them heal. Family surroundings, family healing is, I would say, 80% of a person’s health. And so this way, we can stay here, be with our families, and still get the medical that we need.
TORRES: Finally, Governor, I’m going to step away from the shot so you can look straight into your camera and talk directly to our audience. What are your final thoughts on your vision?
GOVERNOR: I know it’s been a long, long journey, and the journey continues on in the fight to get a quality hospital for our people… also means continued and sustained quality health care personnel, human resources, equipment, supplies, and so forth, because you, the people of Guam, we, the people of Guam, deserve that kind of health care delivery. You know, when we’re not healthy and we’re sick, we cannot take care of our family. The least we can do as a government and as an administration is to provide and remove that stressful situation of being able to get the proper medical care with the facility and with the specialists and the resources that we need so that you can stay home and be treated in your familiar surroundings. So I ask the community of Guam to get on board, and I ask the community of Guam to support this hospital, because administration, government cannot do it alone. We need all your help, all your support, and let’s be united for the good of our families and our public here. We are about serving the community and healthcare is one of the most essential, basic needs for the lives of our people to continue on providing for their families and their family friends. So, please stay tuned. There will be lots of information out there. Be involved. We welcome any comments that you may have to help improve the situation, but let’s be together on this journey for the good of – improve the situation, but let’s be together on this journey for the good of – our people. Si Yu’us ma’ase.
