Natividad Medical Center on Tuesday received the final go-ahead from elected officials to begin building Monterey County’s first official trauma center during a meeting that grew testy over a letter sent to supervisors by Salinas Valley Memorial Healthcare System proposing a delay in choosing the trauma site while an affiliation between the two hospitals is considered.

Harry Weis, chief executive officer of NMC, made a number of trips up to the podium to answer questions about the safety-net hospital’s fiscal health as the Monterey County Board of Supervisors deliberated on the matter. At this point in NMC’s fiscal year, which ends June 30, Weis acknowledged the medical center is projected to run between $8 million and $9 million in the red. Currently, the hospital is showing about a $4 million loss.

That, Weis said, is because of heavy investments in equipment and other upgrades to prepare for the launch of the Level II trauma center. He said he plans to fill close to 70 new positions. Those new hires will staff everything from the trauma bay and intensive care unit to medical-surgical and laboratory jobs. The trauma center is slated to open no later than January 2015.

“We will need these additional teams of people ready 24/7 when the trauma center opens,” Weis said after the meeting.

In terms of revenue for NMC, an independent consultant, Bishop and Associates, concluded that a trauma center at NMC would be profitable by millions of dollars.

A letter to the Board of Supervisors from Salinas Valley Memorial Healthcare System suggesting a partnership was interpreted by some audience members as a ploy to delay authorizing NMC to move forward with the trauma center. Weis, who declined to criticize SVMH throughout the meeting, said the letter suggested a type of joint powers authority between the two hospitals, and contained an “implicit request to delay the trauma center action.”

The letter, dated Jan. 23, outlined a partnership in which NMC’s assets would be transferred to the new joint powers authority, Narvaez said. In 2012, SVMH rejected a proposal by the county to affiliate with Natividad at a time when SVMH’s board of directors had put the healthcare system on the market in hopes of finding a buyer. Natividad ended up as the only suitor at that time.

Supporters of NMC came out in full force, defending the hospital and chastising SVMH for its proposal.

At times, speakers became testy with the board. Narvaez told supervisors that if they did anything other than approve the implementation plan for the trauma center, it “would be a failure in your (supervisors’) leadership to put the interests of our community first.”

Another speaker, Manuel Sapien, called on Supervisor Fernando Armenta to have the courtesy to look speakers in the eye when they are at the podium.

Armenta fired back — and later apologized for his tone — that the reason he was looking down was because he had already made seven pages of notes.

“I spent 14 years with Natividad Medical Center and if anyone has any questions about my loyalty to that hospital, and to SVMH and to healthcare in this county, I will hold you up for days talking about it,” he said.

In the end, supervisors voted unanimously, with Supervisor Dave Potter absent, to direct NMC to begin implementation of its trauma center plan. Weis estimates full accreditation will come in January 2015.

He said after the meeting that date is the drop-dead deadline, but he has an internal deadline of opening sooner than that.