Questions and answers took up about two-thirds of Monday night's 90-minute public meeting about SSM Health's proposed sale of the St. Mary's Hospitals in Jefferson City and Mexico to MU Health Care.
During that time, SSM Heath chief financial officer Chris Zimmer and MU Health's chief executive officer Jonathan Curtright fielded questions or statements about the proposal from 16 people.
The proposed sale was first announced last summer and in which both men have agreed has not, yet, been finalized.
Zimmer acknowledged a couple of times SSM Health didn't handle the announcement well.
A lady who identified herself as Rebecca noted: "I was at the hospital, with my mom, when the nurses found out" about the proposed sale from the local news reports.
"That's atrocious," Rebecca added, with someone else in the audience crying, "Shame on you!"
Zimmer, who's been with SSM Health for 15 years said, "I couldn't agree more with your statement.
"That has never happened, in my experience and SSM's experience, (but) it did happen, and you're not exaggerating.
"It was unfair to the employees (and) patients."
Dr. Tom Robbins - a St. Mary's physician since 1985 - raised the same issue earlier in the evening, wondering why medical staff and other employees, as well as the Jefferson City community, were not notified about SSM's plans even to search for a buyer when it issued a request for proposals.
"I find it very disturbing that you chose to do this without the input of the medical staff, (employees) and the community," Robbins said.
Zimmer answered: "You're right, there wasn't public discussion in advance.
"There had been a lot of previous discussions about the situation within the community - what needs were being met and what weren't, and those kinds of things."
Zimmer said SSM Health officials considered the RFP as part of "an information gathering process," then announced it publicly "at the point of (our) choosing to work exclusively with MU Health."
And that announcement, itself, was "out of the ordinary," Zimmer said, because, "typically, the announcement is made at the point of definitive agreement - we're not at that point, yet."
Zimmer said SSM Health's St. Louis-based leadership established six criteria deemed important to the final transaction: keeping jobs, and care, local; providing charity care and meeting unmet needs of the community; safety and quality; recruitment and development of medical specialists in the community; long-term sustainability of the integrated model; and "ensuring the professional future of our employees."
He said avoiding a monopoly wasn't one of those criteria.
Zimmer also said St. Mary's "RFP did go to a broad group. No one else met these six criteria the way MU Health did."
Robbins said officials with both hospitals shouldn't assume that all in the Jefferson City area "are enthusiastic about this whole merger. I think that is not the case."
Curtright said one of the problems with the current situation is that St. Mary's and Capital Region Medical Center are "small community hospitals" with a combined average daily occupancy of about 135 beds, while the two hospitals have a combined 300 beds available.
With only 45 percent occupancy, he said, the current situation isn't "sustainable" in the long run.
However, with the proposed sale, he said: "We think that one plus one will equal three, because we're going to have a bigger population of covered lives."
Also, Curtright said, one of MU Health's goals is keeping jobs, current pay and benefits at both St. Mary's and which, ultimately, would be merged under "one community board."
"If you look at the total number of open jobs at MU Health and Capital Region," he said, "it's 700 open positions we're actively trying to fill."
He acknowledged many of those 700 jobs may be entry-level positions, and he promised to provide a more detailed breakdown later this week.
Dr. David Flood, who lives and works in Jefferson City, said he chose to come to the area "because MU Health recruited me. I believe the system does work."
Curtright said a number of decisions have not been made - including mergers of the existing staff at St. Mary's and Capital Region, or the future of St. Mary's Home Health Service (that neither MU nor Capital Region provide) - since MU and SSM are still in the "due diligence" phase and haven't decided if the proposed sale will happen.
However, Curtright and Zimmer said the sale appears to be the best alternative for the Mid-Missouri community.
Curtright also said he doesn't know whether lawmakers will have to approve the sale, although he said regulatory approval will be needed.
He added, although MU Health is part of the University of Missouri system and owned by MU's Board of Curators, no taxpayer money would be involved in the proposed sale.
"We are 100 percent self-supported," he explained.
Several people noted national studies - including one from Yale University - have shown reducing competition in the health care business actually makes health care costs go up.
A man who identified himself as Justin, and a life-long Jefferson City resident, said: "This whole thing frightens me. Literally every piece of research contradicts that you'll be able to maintain costs the way they are.
"Consolidation does not improve access - actually, the two don't even go together."
He added: "I don't think many people realize that the state has the authority to block any new competition trying to enter the market. So, this is a generational decision, and it needs plenty of time to be thought-through."
MU Health plans a similar public meeting from 8-9 a.m. Wednesday at Presser Hall in Mexico, and another evening meeting 5:30-7 p.m. Monday at the Special Olympics center off Christy Drive, just north of the U.S. 54/Missouri 179/Route B interchange in Jefferson City.