Monday’s on-site oversight hearing of the Guam Memorial Hospital Authority started with a walk through the hospital, taking stock of completed and ongoing capital improvement projects.

From freshly painted walls to new equipment.

“What a difference several months make in terms of what we saw here from the last time we were here for an oversight hearing,” said Senator Shawn Gumataotao.

And that progress is backed by numbers with 44 projects completed and more than 50 still underway.

But the tour also highlighted areas still in need of repair. Basic operations like patient records are fragmented.

GMH interim CEO and Administrator Dr. Joleen Aguon says a new electronic health record system could cost $25 million, but right now there’s no funding in place.

“If one goes down, you can’t register patients and if the other one goes down, you can’t document patients. You can’t see prior notes. It’s just awful,” said Aguon.

And GMH Chief Engineer Zaldy Tugade warned the hospital is still relying on aging and outdated systems, like in their electrical distribution system.

“These are already obsolete. Nobody carries this item. so we have to make do with what we can,” said Tugade.

And while a full replacement of the electrical distribution system is now in the works, the hearing revealed it could take up to 18 months to complete.

Wrapping up the tour, lawmakers and hospital leadership turned to a recent oxygen supply shortage that highlighted just how fragile operations can be.

In March, Guam’s only oxygen supplier experienced a disruption.

Associate Hospital Administrator of Operations, Jesse Quenga said, “If we made no changes, we had enough oxygen supply to last us about 5 days.”

“We did ask around and we inquired with our facility partners, namely GRMC and naval hospital if they had any relief that they could provide, but they were in a situation similar to the hospital,” added Quenga.

Without action, patient care could have been at risk.

“We would have had two days of no oxygen. It would have been detrimental to our patients,” said Quenga.

Staff quickly reduced usage, stretching supply and avoiding a crisis.

In the aftermath, the hospital is now pushing for its own on-site oxygen plant to create a backup and prevent a similar situation from happening again.

Financially, GMHA is also trying to update how employees get paid as much of the billing process is manual.

By outsourcing and modernizing its revenue system, hospital leaders estimate they could bring in about $12 million more each year.

GMHA has also received millions in support, including $40 million used mostly to pay down debt.

However, another $20 million promised for operations has yet to be released from the Department of Administration and the Bureau of Budget Management and Research.

“I’m not sure if they recognize that as a legal obligation, but we have not received any of that funding yet,” said GMH Chief Financial Officer, Yuka Hechanova.

The GMHA warns that without that critical funding, the bills could start to pile up again.

Still, there are bright spots.

Hospital officials say their nurse-to-patient ratios meet national standards and retention is strong with a 92.9% retention rate.

Lawmakers were pleased to see real momentum.

For lawmakers, the takeaway is clear: Progress is in motion, but critical systems, from infrastructure to technology, are still playing catch-up.

And until those gaps are closed the hospital remains in a delicate balance between improvement and risk.