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  • By Dr. Vincent Akimoto

Cain and Abel? My Brother’s Keeper

For 40 years, two men with Texas-size egos perpetrated medicine’s most famous feud. The bad blood involved two of the world’s greatest heart surgeons, Dr. Michael E. DeBakey and Dr. Denton A. Cooley. As partners, they pioneered life-saving heart operations at Baylor College of Medicine and Methodist Hospital in Houston in the 1950s,

Guam Memorial Hospital

In 1966, Dr. DeBakey became the first to successfully implant a partial artificial heart — a left ventricular assist device — in a patient. In 1968, DeBakey’s protégé Dr. Cooley performed the first successful heart transplant in the United States.

Then in 1969, Cooley, without approval from Dr. DeBakey, obtained an experimental artificial heart from his former partner’s lab and became the world’s first doctor to implant a completely robotic heart in a patient. Thus began four decades of rivalry, creative isolation and duplication of resources such that Dr. Cooley called the short distance between their operating rooms “a demilitarized zone.”

The competition between DeBakey and Cooley created a situation where wealthy donors, referring physicians, and even patients had to choose sides. People were confused, bad feelings boiled and redundancy of services and unnecessary costs were incurred simply because of the stubborn, self-absorbed brilliance of two medical superstars.

The reality is that competition, whether healthy or not, is an inevitable part of the human condition, manifesting early even between the first sons of Adam and Eve. The dark, detrimental side of competition is when the activity is defined by mutually exclusive goal attainment, more simply put as “my success requires your failure” or even your death.


This dark reality appears to define the current relationship between the Guam Memorial Hospital and the Guam Regional Medical Center.

GMH is our island’s original and still only public civilian hospital and it is mandated to provide safe, competent medical care to all patients regardless of their ability to pay. Despite humongous taxpayer subsidies in excess of $30 million annually, GMH has been unable to consistently maintain competent hospital operations and has been repeatedly threatened with the loss of federal Medicare funding due to a multitude of administrative and operational failures. GMH has been deemed unsafe for patient care by the Joint Commission and lost national hospital accreditation more than three years ago.

GRMC is Guam’s still shiny new $400 million private hospital which meets or exceeds Joint Commission American hospital standards for patient safety and competent care. GRMC has received generous exemptions from paying local corporate taxes and it has recently benefited from lucrative legislation which is disruptive of fair market forces. GRMC is treated as a golden child by Medicare which bestows generous reimbursements for GRMC hospital billings, while GMH’s hospital billings are treated like the unfavorable vegetarian offerings of Cain.

GRMC is now Guam‘s primary acute care facility for the rich and the poor. Since they opened their doors more than three years ago, GRMC has seen its patient visits rapidly grow, particularly among the indigent and uninsured population. In 2017, GRMC saw a little over 48,000 patients while GMH treated just over 37,000 patients, rich and poor. Rich patients are likely enchanted by GRMC’s handsome hospital campus and GMH loses vital revenue on curb appeal alone.

GMH was supposed to improve with the coming of GRMC. GovGuam was supposed to recognize the public’s mandate for competent, efficient hospital care as manifested by successful private hospital management. Instead they have refused to downsize, continue to make reckless and nonproductive operational excuses, and repeatedly betray the trust of the community by extorting vicious taxes under the guise of saving GMH.


GMH is dying. Every year, under the current strategy of prioritizing GovGuam jobs over safe patient care, GMH will continue to bleed money — lots of it. Despite caring for less poor patients and collecting less money from rich patients, GMH delusionally employs 430 more warm bodies than GRMC.

While GRMC trims employees in the face of harsh financial realities, GMH cruelly demands a $200 million budget to preposterously feed 1,304 employees who will care for fewer and fewer patients because there will be no room for patients in the hospital parking lot and the rest of them will die from the shortages of blood, oxygen and critical medicines that have perpetually ruined GMH.

Despite pessimistic politicians who think only off-island hospital management solutions can save GMH, GRMC is a successful, ever-improving company run competently by home-grown hospital experts who used to labor futilely in the political swamp of the government of Guam.

GMH must be set free from payroll politics. GMH must be allowed to downsize its administrative employee payroll burden in order to hire necessary nursing and direct patient care personnel.

Small business owners and independent blue-collar laborers, who form the majority of uninsured GMH patients, must be liberated from mean-spirited taxes on food and medicine that fund bloated, corrupt local government that then perfidiously demands allowance to import cheap Mexican workers.

In spite of the discomfort of it all, we must be each other’s keeper. GovGuam must no longer greedily sulk while “your brother's blood cries out to me from the soil.” We all must now clearly and frequently exclaim to our politicians that they must set local small business people free from the mean-spirited tax for the privilege of doing business on Guam.

Let GRMC be for GRMC and let GMH be for Guam and not just for self-serving GovGuam employees.

Dr. Vince Akimoto practices Family Medicine at the American Medical Clinic. Send feedback to

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