The Demopolis City Council’s decision not to include the Tombigbee EMS ambulance service in its 2008-09 budget was just the final step in the service’s request to be subsidized not only by the City of Demopolis, but also the City of Linden and Marengo County, each of which had also not provided any funds for the service.

It was just a formality, actually, as it was an “all-or-none” agreement, with each entity’s requested subsidy determined as a proportion based on the number of calls answered in each area over the last three years.

“The way it was originally proposed was we went to the three governments, and this was an ‘all-or-none’ concept,” said Arthur Evans, the chief financial officer of the hospital. “That was the difficulty, was that it had to be an ‘all-or-none’ concept, where they each equally and jointly shared in the responsibility to help assist the ambulance service.”

Now, the ambulance service — originally taken over by the hospital from the City of Demopolis in 1977 — may be done away with or, more likely, sold to a for-profit ambulance service.

“Over the last three years, we have averaged operating at a loss of $261,000 per year,” said Mike Marshall, the chief executive officer of the hospital. “That, along with the increasing pressure that we are getting from Medicare and Medicaid for reimbursement, we have gotten to the point where we can’t afford to operate without some subsidy, not only from the City of Demopolis, but from the City of Linden and the county.

“The way we came up with how much to ask from each entity was we took the data from the last three years, including the runs made and the ZIP code to which they went and then allocated out what we felt we would need to operate and continue to upgrade, proportional to the amount of business we did in those entities.”

The hospital sent that information to the three entities — Demopolis, Linden and the Marengo County Commission — and all three denied the request for subsidies.

“The decision, now, that our board is going to have to make is: Do we keep operating it or not?” Marshall said. “The options are to keep operating at a loss, shut it down with appropriate notice to everybody or see if we can’t find another company to come in and take over the service, and it would be up to them to decide which geographic areas they would cover, where they would be located and if they would need any help to do it or not.

“My personal opinion is that you’re not going to be able to get anybody because everybody else is a for-profit entity. My personal belief is that whoever comes in would want help from the communities, just like we did. So, if you’re going to provide help, why not keep the money local instead of it going to an out-of-town or out-of-state company? It just doesn’t make sense to me.”

Marshall said that another option could be found in redrawing an agreement that would serve just the City of Demopolis. One concern addressed at Thursday’s Demopolis City Council meeting was that Demopolis would be the only community providing a subsidy for an ambulance service that would still serve the county. Marshall added that the hospital board would have to make the decision.

“Really, all options are on the table,” Evans said. “The board will ultimately decide what’s best, and I’m sure they will decide what is best for the citizens of Marengo County. There are ambulance services in other counties: NorthStar in Sumter County, and one in Clarke County. They already have people who are responding to areas that touch our medical service area.

“The city would be better off with us having and continuing to operate an ambulance service in this area. We are going to be more conscious of the people and the citizens of this area. If you bring in somebody else, a for-profit, they will come in and say up front, ‘We’ll do it, but you’ll have to subsidize this much,’ or they will come in and take it for a while, and when everybody gets used to it, they’ll say, ‘We’re out of here in 90 days unless you come up with some money.’ Then, they would hold all of us hostage to the situation, and the decision’s not going to be really any different than it is right now: Do we want an ambulance service, or do we not?

“We would like to have a win-win with the local governments to keep some local control over it,” Evans said. “Unfortunately, this is not a core business function for the hospital. We have to provide the other services for the medical community that we serve. We are not mandated to have an ambulance service. It is draining the institution of monies that are needed more from a hospital setting that we’re spending on the ambulance setting. It’s a matter of our board saying, ‘What are our options?’ The solvency of this institution is first and foremost. We are facing the same challenges that all hospitals are facing.”

The hospital board certainly has a lot to consider at its next meeting, considering the future of an ambulance service that it has had for 31 years. The next meeting of the Bryan W. Whitfield Memorial Hospital board is scheduled for Thursday, Sept. 25, at 5:30 p.m.