Jan. 18—BEMIDJI — From impassioned testimonies of care received to ardent opposition to the monopolization of Minnesota's health care systems, a public forum on the proposed Sanford-Fairview merger drew in a crowd with mixed opinions Tuesday evening.

One of four public hearings hosted by the Minnesota Attorney General's Office across the state as a part of its investigation into the proposed merger between Sanford Health and Fairview Health Systems, the Bemidji meeting saw incredible local interest in the importance of the topic.

"There is no doubt that this is a significant and important matter," Attorney General Keith Ellison said to the crowd of about 200 gathered in Bemidji State University's Beaux Arts Ballroom. "This is a very, very impactful issue. We want to make sure that the people who may support, or the people who may have misgivings about the proposal, have their say."

Sanford Health, based in Sioux Falls, S.D., is one of the country's largest rural health care providers and operates 47 medical centers and 224 clinics, including a significant presence in the Bemidji area.

Fairview, a Minneapolis-based health care provider, operates 11 hospitals, including M Health Fairview University Medical Center. This hospital represents a partnership between Fairview, the University of Minnesota and University of Minnesota Physicians, and has become a key part of the ongoing debate over the merger.

Recently, the University of Minnesota announced its interest in re-purchasing ownership of its hospital from Fairview as a condition of the merger, to avoid having the authority operating its facility being based out of state.

The two health systems

announced their intent to merge in November,

having previously explored the option in 2013 before plans fell through following public concern. Their most recent proposal is under review by the Attorney General's Office regarding its relation to anti-trust laws and Minnesota's charitable assets.

"Mergers do have effects when they occur," Ellison said. "It's important to understand that historically there have been effects on employees, consumers seeing higher prices and services go down. That does not mean it will happen here, but we want to explore it."

Bill Gassen, president and CEO of Sanford Health, spoke after Ellison and shared Sanford's reasons for pursuing the merger along with assurances behind the proposal's motivations.

"The reason for this merger is simple: it's about strengthening the care for our patients," Gassen said. "Fairview's expertise combined with Sanford's virtual care infrastructure will provide patients in rural areas like Bemidji with seamless access to specialists and cutting-edge medicine."

James Hereford, president and CEO at Fairview, also shared his organization's thought process.

"I've been transparent about the financial challenges we face," Hereford said. "The ongoing challenges demand that we do things differently. Together we can strengthen our financial footing and improve the experience for both patients and providers in a way that neither Fairview or Sanford can do alone."

While some in the audience agreed with these statements and expressed support for the merger, others shared their strong opposition, citing concerns about consolidation, increasing monopolies and decreasing care.

"The solution to the challenges in health care is not further consolidation," said Ann Schwagerl, vice president of the Minnesota Farmers Union, who spoke on behalf of the organization in opposition to the merger. "Rural Minnesota already has one of the most consolidated hospital markets in the country, and this merger would give one company control over a fifth of our state's hospitals."

Darrell Seki Sr., tribal chairman of Red Lake Nation, noted that he feels Sanford already holds a monopoly on health care in northern Minnesota and his concerns about his tribal members' access to services.

"Sanford has taken over virtually the entire care delivery system in northern Minnesota, and Sanford is the only option locally for our tribal members outside of Indian Health Services," Seki shared. "The reduction of health care options is bound to lower the quality of care for patients."

Higher costs were also a concern that many commenters brought up, including Joe Gould, a recently elected Beltrami County Commissioner.

"I'm most concerned that this would become a monopoly and costs for health care services would increase when they're already too high," Gould shared. "They are indeed a business entity and do operate under a business model concerned about revenues. We should not let Sanford move forward with this merger."

Jeanne Forman, a member of the Minnesota Nurses Association, shared comments from two Bemidji nurses who opposed the merger and cited concerns over union rights and monopoly but wished to remain anonymous to avoid retaliation for speaking up against their employer.

"Sanford needs to take care of the staff and patients they have now before merging with another entity," one nurse wrote. "When Sanford freely chooses to take care of their current employees and this community, only then should they have the audacity to propose a merger such as this. Patients should be before profits."

Not all Sanford employees who spoke at the hearing felt this way, however, and others saw the merger as a positive, both for practitioners and patients.

For David Carter, who has worked in desk services at Sanford Bemidji for eight years, the merger means potential for growth.

"We do really care about the people, each person that walks in the door is important," Carter said. "You'll never hear Sanford Health say 'We've done enough,' they always strive to do better and to do more. That's what I believe this merger is about."

Dr. Johnna Nynas, an OB-GYN at Sanford Bemidji, expressed optimism that a merger with Fairview Health could help recruit young physicians into rural medicine, especially if its connections with the University of Minnesota remain.

"I see this merger as an opportunity to help mentor and train the next generation of physicians, and show them a career in rural medicine is a viable career path for them, and so rewarding," Nynas said.

Others who had worked at North Country Hospital before it became the Sanford Bemidji Medical Center in 2011, shared the difficulty they faced in recruiting medical professionals before Sanford took over and how they saw the potential merger with Fairview as a similar opportunity that could also improve access to specialists in the Twin Cities.

"I feel the proposed merger between Sanford and Fairview would be a positive force for recruiting top-tier clinicians to our state," shared Sylvia Wilgen, who had been on the board of North Country Hospital during its decision to merge with Sanford.

David Hengel, executive director of Greater Bemidji, also compared the current merger question to that of North Country Health Services and expressed his support.

"Just over a decade ago our community felt the same concerns (about merging)," Hengel said. "At the time Sanford made commitments to the Bemidji area, commitments that they've far exceeded. They've expanded services, not only here in Bemidji but also in smaller communities throughout north-central Minnesota."

After listening to around 30 public comments, Ellison reiterated the importance of public feedback and encouraged those in the audience who did not have the chance to speak to submit comments to his office in other formats.

"We want to hear from you," Ellison said. "This is going to be a big deal, and we're trying to get it right."

He also explained that from his office's perspective, the question is not on the character of Sanford and Fairview as institutions, but on whether the merger would benefit Minnesotans.

"We are looking it from the standpoint, not of whether Sanford is a great institution," Ellison said. "What we're trying to think about is whether the merger is going to benefit Minnesota or not."

Ellison also acknowledged that the timeframe for the investigation was short and that his office could make a decision on the merger as soon as March 31.

"We can't guarantee you're going to agree with us, but at least we hope that you'll agree that we did our best," Ellison said.

Ellison's office will be holding

two more public forums on the merger,

in Worthington on Jan. 25, and Grand Rapids on Jan. 31.

Online comments on the proposal can be submitted via a form on the

Attorney General's website

or by phone at

(800) 657-3787

for Greater Minnesota or

(651) 296-3353

for the Metro area.