The new fiscal year is approaching, and with it a deadline for deciding who should operate emergency medical services within the county. But not everyone agrees on the best path forward.
Resident Scott Jones and McDonough District Hospital board member Noel Oliver at the MDH Monday night meeting both expressed concern that the public isn't being included in a very important decision: Who should operate emergency medical services in the county?
The hospital in March announced that it is considering outsourcing its ambulance service to a private transport company, and is actively considering three different companies. Within about three weeks of the announcement, a group of county EMS professionals approached the McDonough County board's human resources and planning committee to request the county adopt local ambulance service instead, paid for in part through a public safety sales tax.
During public comment at Monday night's meeting, Jones said he was a lifelong county resident, and had previously worked in the hospital for 16 years. He then went on to say he wanted to "clear the air a little bit and get some facts out."
He recalled the founding of the hospital in the late 1950s through referendum and emphasized that the hospital is a public institution, rather than a for-profit corporation or a not-for-profit corporation. Emphasizing that the board had ultimate control over decisions, he said, "MDH management is answerable to you... The management is required to provide accurate information to the general public through you and through other avenues."
He then spoke about his concerns related to the March announcement about outsourcing its ambulance services. "The concern is that McDonough County residents are gonna pay the ambulance bill regardless, whether it's through you folks doing the tax, or through our fees."
The hospital is currently in the process of cutting as much as $3.8 million from its budget by the end of the calendar year. Emergency medical services at the hospital are creating a yearly $200,000 operational deficit that needs to be cut, according to MDH CEO Kenny Boyd.
Jones spoke on the issue of the deficit, saying that there was a "huge difference" depending on whether the county addressed it through taxation or through privatization. "If it's addressed through taxation, all that money stays within the organization and McDonough County," he said. "... But if you privatize it, obviously that money stays within your organization to a point, other than the...profit that the private company takes out of the institution. Probably — I can't say this for sure — the majority of that money will leave the county, never to return."
He also expressed concern that once the decision was made, there was no going back. "Once the ambulance service is gone, it's gone. I'm pragmatic enough to know – I think most of the people in McDonough County know that once it's privatized, it'll never come back."
He also raised the question of whether a stipend or subsidy would be required to maintain the ambulance service in the future. "I know that there are private (entities) that would not require this stipend or subsidization — at this point. But the one thing I learned a long time ago, you never hold ... later boards accountable for decisions of the current board. So that's not saying that down the (road), that this board will come to McDonough County voters and ask them to subsidize or pay a stipend for a private corporation (to maintain) profitability. That is really a hard thing to swallow: The (possibility) that people in McDonough County will be subsidizing private profit."
"The relationship between MDH and citizens of McDonough County is based on trust. Once that is lost, it will be very, very difficult to get it back," he said. "... The only other organization that really brings the county together – other than county government – is McDonough District Hospital. That is part of that intimate fabric that holds us together as a community. That's one of the things, having lived here all my life, to see how the county is becoming more fractured. That to me is not a good harbinger of things to come. I think we need — citizens need to do everything we possibly can to keep McDonough County together."
He asked the board to give county residents a chance to voice their opinion in a public forum to help resolve the funding issues the hospital is facing and to help bolster the relationship between the hospital and the public.
Board member Noel Oliver also expressed concerns about the way the EMS decision was being handled. He said it seemed as if Boyd was going to provide his selection, but there wouldn't be community or board involvement.
Boyd disagreed, responding that he was going to be presenting to the board his recommendation for solving the EMS issue. He then outlined the related process, which includes monthly updates to the board, presenting the board with feedback from the senior team and Macomb Fire Chief J.R. Hyde.
Part of the process includes presentation to the board by representatives from the EMS group wanting to adopt a county-operated ambulance service, and an opportunity by the board to respond, he said.
Boyd confirmed that the county board was aware of the request to form a county ambulance service, and added, "The county has made it fairly clear they don't want anything to do with it."
Oliver said he had attended the county meeting, and got the same message, adding, "As I told (Scott Schwerer), if he was wanting MDH to continue to offer the service, we need to subsidize it. That is an option...for them to subsidize, and they've declined to do that. That doesn't mean that it automatically goes to privatization of the EMS system."
Board Chair Kent Slater brought up the question of a referendum brought up by Jones, saying that county residents could seek to support the ambulance service with a tax referendum, rather than relying solely on the county chair's statement.
Boyd said that this was one of the options the hospital was looking at, in addition to the proposed county EMS association.
Oliver asked if the hospital was still evaluating the option to maintain the services, which he emphasized have been provided for over 40 years.
"When we get all of the information and it comes back to the table, is that completely off the table? The answer's no," Boyd said. "When all the information comes back to us and we have the data, the question is, can we provide the same level or better service at reduced impact on the organization. That's something we have to look at, because if not, we have to figure out where that other money comes from."
Boyd said that having all the necessary information from the interested parties would drive the recommendation he made to the board.
"Recommend a company, recommend a tax referendum. Now is a tax referendum on the top of my list? No, because I don't know many people that think spend more money, tax more money is an option where if you can provide the same quality service to residents at no financial impact on them, is that a better option than getting the tax and not find a way to do it."
Oliver raised a question about the $200,000 deficit figure given by Boyd. "Is this the first year we've had to eat that?... What's changed?"
Boyd said the change occurred when the hospital no longer had the staff to keep up with non-emergency transfers, which he described as the "bread-and-butter inside of the ambulance delivery service. We've not been able to overcome that."
More discussion on the issue covered similar ground. Near the end of the meeting, Dr. Richard Iverson raised two major concerns brought up two board meetings ago: ensuring MDH was delivering appropriate services in an appropriate fashion and whether the hospital would be able to continue to exist in the future.
"I think this discussion is necessary to evaluate both pieces. I appreciate your input...this is a discussion we needed to have. The reason we're having this discussion at all is to fulfill those two responsibilities that I feel we have as a board. And I don't have an answer to that."
Oliver agreed with Iverson, and said, "The fact is, we don't know the answer yet. And my fear is, that it's already decided. Everything I see is that it's already decided. I've already been told that five 'yes' votes are assured, so I don't even need to bother (voting) at all. That's a decision that's already been made, and that's what upsets me, I guess... Let's at least take some time and think about this. At the last county board meeting, I left with the feeling this was going to be done on 20 June for our next fiscal budget. That's what you said: that his goal was to do this, make a decision...for this next fiscal year. That's rushing to me."
Boyd responded, "That's four months worth of evaluation."
"We all agree that we don't know the answers yet," Oliver said.
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