Letter to the Editor: GMH has structural problems

By PeterJohn Camacho

I have had the privilege, and the responsibility, of serving as chief executive officer of the Guam Memorial Hospital at different times under each of the last Republican governors.

First, during the administration of Gov. Felix Camacho, and second, under  Gov. Eddie Calvo. Today, I continue to serve as deputy director of Public Health and Social Services.

Though she is of a different party, I am honored to serve under Gov. Lou Leon Guerrero. What unites every governor I’ve worked with, regardless of party, is a genuine desire to finally fix GMH. What also unites them, unfortunately, is the frustration of confronting the same stubborn reality: structural problems that no governor, no matter how talented or well-intentioned, can resolve with quick or politically popular fixes. 

It is tempting to say the problem is bad management, that every governor or administrator or administration has failed at the dollars and cents. But that is not true. GMH has been accredited, certified, celebrated and recognized in the past and continues today. But the truth is, systemic problems unseen by most always bring us back to the same place. 

According to a March 2025 report by the healthcare finance policy organization, the Center for Healthcare Quality and Payment Reform, about 768 rural hospitals in the U.S. are at risk of closing, with 315 at “immediate risk” of closing within three years, citing ongoing financial challenges like reimbursement rates for services as the problem. Texas, Oklahoma, Kansas, and Mississippi were identified as the states with the most (more than 20) at-risk hospitals. The problem? It’s more expensive to provide acute care for patients in rural communities. 

These are the same reasons we struggle with here: inadequate federal and insurer reimbursements, rising staff costs, and an aging,  sicker population of uninsured that costs more and more to treat. If mainland hospitals with more resources can’t make the math work, one can understand the challenge for Guam’s only public hospital.

During my years at GMH, we experienced firsthand concerns about meeting payroll, pharmaceutical vendors stopping supply chains due to non-payment of invoices, employees being uncertain about their benefits, and facility structural concerns. New boards, new administrators, even new governors all came to the same conclusion eventually–GMH’s problems are extremely challenging. These require a modern, up-to-code facility,  strong leadership, and consistent funding. 

Even in a good year, GMH begins in a $20 million to $40 million hole, before even paying for a single capital need. That deficit cannot be blamed away.  Blame will not pay for medicine, keep the lights on, or save a life. Even as we continue to operate the current hospital as best we can, those structural and systemic challenges also continue. 

During Gov. Calvo’s administration, he also proposed projects to address GMH’s structural challenges that would have improved facilities, not all of them, but it was a starting point, notwithstanding the consideration that GMH has outgrown its current landlocked footprint. 

Enter Gov. Leon Guerrero, who called for a new hospital six years ago. Imagine where we’d be today if we had rallied around that call. However, we were faced with the Covid-19 pandemic that gripped our attention and demanded a response.

Then Typhoon Mawar passed over Guam, further demanding attention and a response that further delayed efforts to address GMH. 

With the right tools and united vision, I believe we can fix GMH, but this is not going to be easy. Imagine the logistics that would be required in that endeavor, keeping current operations going at existing levels while fixing those pressing issues. We cannot fail our community.

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