Valley Medical Center’s commissioners came with their game faces on Tuesday night to ask tough questions about a strategic alliance between the medical center and UW Medicine.

Only a handful of really probing questions were asked Monday night as the commissioners’ chief negotiator, attorney George Beal, walked them through in detail the sections in the agreement at the beginning of their review.

Beal and hospital administrators had primed the question pump by providing them with more than 200 questions they could ask.

Now, more than ever before, the commissioners need to put on full display their acumen for overseeing this $1 billion enterprise, Public Hospital District No. 1.

Commissioners have much more work to do before a final vote on the alliance. What they saw this week was only a draft agreement. The final version will go before them later this month.

Absent from Tuesday’s meeting were the tensions – at least obvious ones – that have marked the interactions between Commissioner Anthony Hemstad and the three commissioners who make up the board majority, Carolyn Parnell, Sue Bowman and Don Jacobson, and even one of the district’s attorneys, David Smith.

In fact Valley CEO Rich Roodman took a pass on his chance to speak, saying, tellingly so, that the meeting had been civil and he didn’t have anything to say. Our guess is that he was prepared to say SOMETHING.

Frankly, the dysfunction on the board has existed for years; it seems like small-town politics where the debate turns personal and real issues are obscured. The board needs to rebuild its credibility with the community by acting civily and professionally.

And commissioners simply need to show up. Dr. Aaron Heide missed part of Monday’s meeting and didn’t attend Tuesday’s. To be fair, he warned in advance he couldn’t attend these critical meetings because of his medical practice. But there are other doctors who attend board meetings regularly and they have other doctors covering their patients.

While commissioners may feel comfortable in their understanding of the agreement’s details, that understanding is only part of what they need to accomplish before voting on the agreement. There are long-term implications for the hospital, its patients and the hospital district that are just as important, if not more so than individual details.

Beal wisely counseled that in any negotiation, you win some and you lose some. You compromise. The commissioners’ job is to decide whether the positives –  and there are many – outweigh the negatives –  and there are some – in deciding whether to approve the strategic alliance.

Part of that balancing act is to air concerns about what happens if this long-term agreement, up to 45 years, simply doesn’t pan out financially or fails to deliver on enhanced medical services. Valley Medical could become so integrated with UW Medicine that it no longer has all the necessary business operations to go it alone. Of course, there are guidelines in the agreement about how to end the relationship.

No one can predict the future nor anticipate every possible pothole. But at least raise issues that seem far off now, think about them and leave behind for future commissioners through thoughtful discussion some guidance about how to exit with grace.

District resident and Renton businessman Jim Sullivan warned against “what-iffing” the agreement to death.

That’s true. Still, the commissioners should enter this agreement with confidence, knowing they’ve fully vetted the proposal. In turn, they will instill confidence in the public that the strategic alliance is the right move.