In a 3-2 vote by fellow commissioners, Dr. Paul Joos was replaced Monday night by Dr. Tamara Sleeter as president of the Public Hospital District No. 1 commission.

It didn’t become publicly clear until later in the meeting why three commissioners wanted to hold new elections – Joos was elected the 2016 president just a month earlier.

At the crux of the matter is the strategic alliance between UW Medicine and the hospital district that oversees the operations of Valley Medical Center. For years, the alliance has sharply divided the commission.

Joos testified on Jan. 18 in Olympia before a Senate committee chaired by Sen. Pam Roach in support of three bills related to the governance of the hospital district and the strategic alliance.

To Sleeter and commissioners Barbara Drennen and Lawton Montgomery, Joos wasn’t clear in his comments whether he was testifying on behalf of himself or the entire commission.

Joos introduced himself as an ophthalmologist and eye surgeon and later explained that he had served as commission president for three years starting in 2012 and was elected again in January.

“It implied that you were there representing the board, although it didn’t flat out say that you were or weren’t,” Sleeter said. “I think that is probably the point that irritated people.”

“You would have been much better if you had said, ‘I am not representing the board’,” she said.

Joos told commissioners he was the only one who “bothered” to testify on the bills. He said he wasn’t representing the entire commission in his testimony.

Joos was also questioned about his testimony in Olympia at a recent Board of Trustees meeting.

Also testifying alongside Joos was Anthony Hemstad, who was one of two sitting commissioners who voted against the strategic alliance in May 2011. Former commissioner Dr. Aaron Heide also voted against the alliance.

Sleeter and Drennen, who weren’t on the board when the alliance was approved, both expressed support for the alliance. Sleeter practiced obstetrics in Renton for decades before retiring and Drennen is a co-founder of the Pediatric Interim Care Center.

Montgomery, who won election to replace Heide on commission, said commissioners should concentrate on their elected roles and not lobby in Olympia. He spoke in favor of writing a letter to the Senate committee explaining the board’s position, whether or not it was misrepresented.

“This board is neutral on it and we have no bearing on it. Let that process just continue on its own down there,” he said. “Let us set the record straight that we are not there to campaign.”

The board later decided to write such a letter.

Drennen called for a new election at the beginning of the meeting but first wanted each commission to voice a short biography. “I’d like to know who I am electing,” she said.

But Joos ruled her out of order, saying that the bylaws call for an election of officers in January, unless there’s a resignation. He told the board he wasn’t resigning.

“So we’ve already had elections so I have to call your motion out of order,” said Joos and went ahead with introductions. But Drennen wanted to hear first from the board’s attorney, Matthew Harrington, whether Joos’ analysis was correct.

Harrington said he reviewed statutes governing hospital commission elections and the commission’s own bylaws. And he had talked with Joos about the matter.

The statutes provide for two things: a commission is to elect officers and all decisions by the commission are made by majority vote, he said.

“That is the extent to which the law tells us what this board can or cannot do on this subject,” he said.

In his view, the board has the power to remove a president, he said. “I think the power to appoint contemplates the power to remove,” he said.

“So do we follow the bylaws or do we follow the majority vote?” Joos asked.

Based on the statutes and the bylaws, “I think you are doing both,” Harrington answered. The bylaws don’t restrict the commission from taking the action on the table, he indicated.

The commissioners then spoke about their individual backgrounds.

Montgomery then nominated Sleeter for president, seconded by Drennen. No one else was nominated. The vote was 3-2, with Joos and newly elected commissioner Dr. Chris Monson voting no.

Montgomery was the sole nominee for vice president. Drennen was elected secretary, after Monson declined the nomination by Drennen.

Joos then read a statement. For the first time in months, the meeting was being recorded. He called on the commission to adopt a resolution supporting the three bills in Roach’s committee.

The bills:

• require that voters in the hospital district ratify the strategic alliance

• requires voters to approve any contract in which a certain percentage of hospital district activities is contracted to another entity

• regulates the core legislative powers of elected commissioners of a public hospital district.

The first two bills were re-introduced in this year’s legislative session after failing to win approval in last year’s session. The third bill is new this session.

The deadline for the three bills to leave Roach’s committee is today (Friday).

Joos pointed out that three commissioners – Sleeter, Montgomery and Monson – all ran on platforms that if elected, they would return control of the hospital district to the elected board of commissioners. Under the strategic alliance, a 13-member Board of Trustees, comprised of the five commissioners and eight appointed trustees, oversees hospital operations.

All three easily won their elections; Monson beat long-time commissioner Carolyn Parnell in 2015.

Drennen did not make that promise in her campaign in 2013.

Joos indicated in his election in 2011 that he didn’t make that promise either, but he had concerns about the implementation of the strategic alliance. He said he supports the bills in the state Legislature because that “is clearly the will of the people.”

“Clearly the people of the district oppose the governance structure of the UW/Valley alliance and they voted for challengers who said they would fight to return control to the elected commissioners,” he said, saying the three “have a moral and ethical obligation” to support such legislation.

“The question is, will the three of you who campaigned to return control of Valley to elected commissioners live up to your campaign promises or betray the voters who believed you, trusted you and gave you their votes,” Joos asked.

Turnout in hospital elections in November was the lowest in recent years.

In 2015, 30.37 percent or 47,359 voters of the district’s 155,959 registered voters cast a ballot. Based on total number of registered voters, 15.7 percent voted for Monson and 13.2 percent voted for Montgomery.

In the 2013 election, 17.7 percent of the district’s 153,230 registered voters voted for Sleeter and 15 percent voted for Drennen. The turnout in 2013 in the hospital district was 39.29 percent.

In 2011 22.9 percent of the district’s 139,404 registered voters voted for Joos. The turnout was 47.88 percent. Joos defeated Mary Alice Heuschel, the Renton School District superintendent at the time.

In response to Joos, Drennen said she felt “Valley and the U should be very honored to affiliate with one another.”

Montgomery made his comment about commissioners doing their elected jobs and not lobbying in Olympia. And Monson said he’s “happy” to be associated with the UW but he doesn’t think it’s “appropriate” for appointed trustees to overrule elected commissioners.

Sleeter spoke of what she’s learned about the alliance since her election. “To undo everything that’s been done for this hospital would be disastrous,” she said.

“It’s time to move on,” she said.

She pointed out in an interview that the hospital district and UW Medicine spent about half-million dollars for the courts to decide that the strategic alliance is legal.