Why is an election required for the Tri-City/Sharp partnership to move forward? Can't Tri-City Healthcare District and Sharp HealthCare establish a partnership on their own?

Measure H requires voter authorization for this simple reason: in 1997, the State Legislature passed legislation requiring local voter approval for transactions like this involving the lease and transfer of 50% or more of the assets of a public entity (in this case, Tri-City Healthcare District).  Note that pending voter approval of Measure H, Tri-City Medical Center will still be a community hospital, dedicated to serving North County residents and their communities.