Valley Medical Center commissioners voted 3-2 Monday night to approve what is called an “historic” strategic alliance with UW Medicine.

The split vote was expected, reflecting a division in the board of Public Hospital District No. 1 that has held firm since members began formally reviewing the alliance in January.

Voting for the alliance were Don Jacobson, Carolyn Parnell and board President Sue Bowman. Voting against the agreement were Anthony Hemstad and  Aaron Heide.

Hemstad and Heide expressed support for an alliance with UW Medicine.

But Heide made the distinction that he was voting against the contract to create the alliance, which he said the commission only had 72 hours to review. He called the process “flawed.”

Hemstad said the commissioners needed a “deal that’s not giving away the store.” The agreement, he said, “guts the authority of future elected commissions.”

But Bowman, Parnell and Jacobson said the alliance is really about patient care and patient safety for the residents of the hospital district.

“That’s the bottom line,” Bowman said. Anything else, she said, is a “red herring.”

Jacobson in his remarks said the alliance “has the potential to enhance everything we are doing.”

The 3-2 vote was greeted with loud applause and a standing ovation from the  large crowd at the commissioner meeting. Audience members who spoke, including community members, politicians, nurses and doctors, expressed almost unanimous support for the alliance.

Before the vote, Valley Medical CEO Rich Roodman reviewed the timeline for the alliance approved Monday night, starting in November 2009 at a retreat where health-care reform was discussed. During the next several months, he sought community input about the idea and discussed possible alliances with about a dozen possible suitors.

“My contribution to this was simply an idea,” Roodman said.

The alliance will enhance medical services and bring new ones to the residents of the hospital district, who would continue to own the hospital.

The strategic alliance is not a merger of the two medical institutions. However, Valley Medical will become part of UW Medicine, which also includes Harborview Hospital and the University of Washington Medical Center.

Valley’s commissioners heard from UW Medicine executives during their four-month review of the alliance.

UW Medicine CEO Paul Ramsey in January told commissioners the two medical institutions share a common mission – to improve the health of the public.

UW Medicine operates the largest medical schools by geography in the nation, if not the world, Ramsey said. It brings care, teaching and research to five states, in a variety of partnerships.

Heide and Hemstad left the meeting after the alliance vote, even though the commission still had business to do. Roodman wondered whether it was to make a cameo on a KING TV report on executive pay at Valley Medical.

The medical center’s general counsel, David Smith, said their departure was “disappointing.” Their departure, he said, “is reflective of what’s going on here.”

Smith was part of the legal team, led by chief negotiator George Beal, that worked out the agreement with UW Medicine.

“I challenge anyone to find a better deal,” Smith said.

“This is about patient care,” he said. “That’s what it has always been about.

In order to become effective on July 1, the agreement must be approved by the UW Medicine Board and the University of Washington Regents.