County's Ambulance Service Hangs in the Balance
On March 19, McDonough District Hospital notified Lifeguard that the county hospital is terminating the ambulance service's contract effective May 3. The Community News Brief (CNB) learned of this decision late Thursday afternoon and immediately reached out to hospital administration for more information.
In an email response to CNB March 26, CEO Bill Murdock, stated, 'Confirming the date of the Lifeguard contract cancellation is May 3, 2026.'
There were 2,780 ambulance transfers in calendar year 2025.
The CNB sent an email to Lifeguard's media relations department Friday afternoon to inquire about the termination and its future in Macomb. Global Medical Response, Lifeguard's parent company, told The Community News Brief in an email that Lifeguard Ambulance has proudly served McDonough County and its residents since 2018, and their focus remains ensuring the community receives timely, lifesaving emergency care when they need it most.
'We are concerned by the recent notice regarding the termination of our contract with McDonough District Hospital (MDH). The termination date of May 3 is quickly approaching, which does not leave much time for all parties to renegotiate our contract,' Lifeguard media relations stated in the email. 'However, Lifeguard remains committed to continuing to provide high-quality EMS services in McDonough County until such time a new agreement is reached between Lifeguard and the appropriate party.
The Community News Brief sat down with Murdock March 27 to learn more about the decision to end the contract, which would put the county without critical emergency medical transportation services. In January, a new five-year contract with Lifeguard went into effect, which was negotiated by Chief Nursing Officer Wayne Laramie, would cost the hospital $600,000/year, from its current $180,000/year as Macomb Fire Department personnel are no longer sub-contracted as Lifeguard employees. The contract will cost MDH $3.1 million over the course of five years, which Murdock says is not sustainable as the hospital does not receive 'a penny of reimbursement for this service.'
'We negotiated this, so the cost is on us. The county was not involved, and they weren't asked to be involved in the negotiations. We asked the city and county for money after the fact, but they turned us down,' Murdock said. 'The county has never paid for an ambulance service; it has been a hospital expense.'
The Brief asked Murdock if the county could negotiate a contract without first notifying the hospital, Murdock noted they could because 'they (the county) would be paying for it instead of us.' The CNB also asked if the decision to terminate the contract is holding the city and county hostage, Murdock said, yes, to a certain degree, but due to the hospital's precarious fiscal situation, they had to look at what the CEO calls 'non-core services,' of which the hospital considers to be an ambulance service.
'Our continuum of care is contained within these four walls of our hospital,' he added. 'We were backed into a corner to provide this service, so we entered into the contract as we didn't want this service to not be available. At the same time, the city and county were asking us to add another unit, so we negotiated the best deal we could with Lifeguard. The longer we let this contract go, the more we're going to have to pay, so we decided to terminate the contract now rather than later.'
Global Medical Response (GMR) clarified that Lifeguard responded to the request of the hospital for enhanced services and to address the removal of support from other entities. To meet MDH’s requested level of service, Lifeguard hired more EMTs and paramedics and increased Advanced Life Support coverage by over 80 additional hours each week, GMR added.
County Board Chair Eric Blakeley told the Brief Friday afternoon that the latest announcement from MDH is, in his opinion, 'irresponsible' for county and local residents, especially on such short notice. He added that negotiations, implementation and full control of the ambulance contract has always been handled by the hospital.
'MDH is a district hospital, not a county hospital, and as such, operates as its own business entity and is not connected to county government,' Blakeley pointed out. 'If the current contract, which was 100 percent hospital negotiated, was not workable, why did the hospital sign the contract and move forward, knowing full well they could not fulfill the financial obligations of the contract?'
In addition to the emergency services stoppage, the hospital is eliminating other non-core services, including its sleep lab for an estimated $100,000 in savings, as well as others that Murdock could not share publicly at this time. He did share that those other non-core services that will be cut will save the hospital 'upwards of over $1 million.'
Who Ya Gonna Call?
If a renegotiated contract with Lifeguard, which is still a possibility, Murdock said, doesn't come to fruition, there is also a new vendor that recently appeared and is providing MDH with a proposal in the coming weeks. When asked about the liability to the hospital and fallout from this decision if nothing is in place by May 3, Murdock pointed out they have no liability until a patient comes through their doors.
'We will still have AirEvac available and we will provide excellent service within our four walls, but we will not go any further if someone needs to be transferred if we do not have an ambulance service in place,' he stated. 'We're hopeful we can resolve this by May 3, but there's still a lot up in the air.'
As for returning to an in-house service, which was in place until former CEO Kenny Boyd eliminated that service in 2017, that could cost the hospital anywhere from $3-4 million annually. The contractual service with Lifeguard began in 2018.
'We have no appetite to bring that back in-house,' he said. 'We'd still be operating at a loss.'
While the county and the city are not in the business of providing these highly specific and regulated ambulatory services, Blakeley said that he has already reached out to other health care providers to discuss a short-term solution should the hospital cut its ambulance services on May 3.
'Our county residents deserve high quality ambulatory and ER services and options.
Canceling services and then saying, 'Oh well, it's someone else's problem' is not the correct way to address this,' Blakeley added. 'Other out of county medical providers are eager to help our county in the event of a breach of service, if we reach that point.
'And it's interesting to note that while our hospital is cutting services, numerous other medical providers around our county are willing, and are expanding and adding more services,' he said. 'Furthermore, if we contract with a private service in the short-term, patients will be able to choose where to go, and that might not be MDH, which will have further financial implications for the hospital.
While I hope to resolve this in the coming weeks, I want our residents to know that we will make sure they have ambulatory and ER services, though it might look a little different in the interim. As someone with deep roots in this community and skin in the game, I will always work to achieve the best options the good citizens of McDonough County deserve.'
County Board Chair Blakeley added should the county hire a private vendor to provide ambulatory services in the interim, if necessary, the services would be fee-based.
That is, when an ambulance is dispatched by the county's 9-1-1 center, the patient will be invoiced by the ambulance contractor for the services. The county will not run the services, rather, they will serve as the host for the private contractor.
GMR added as external circumstances or funding sources change, Lifeguard adapts and evolves to meet the needs of its partners and the community. They stressed the company remains willing and ready to work collaboratively with MDH to identify a sustainable solution that keeps ambulances in service and protects patient care.
“We’re proud of our legacy in the county, providing reliable care for our neighbors and friends, partnering with police and fire, and supporting local schools through training and trauma-bag programs. Our team includes employees with deep roots in McDonough County, such as members who serve on the 911 Board and as deputy coroner, and who support fire, rescue and dispatch,” GMR concluded. “We look forward to continuing that legacy of partnership and care with McDonough District Hospital.”
Show Me the Money
The hospital’s debt-service ratio is not meeting its covenant, which means they must have an improvement plan in place; hence canceling the fairly new Lifeguard contract, closing the sleep lab and eliminating other non-core services. Another factor in the hospital's budget being in the red, operating at a deficit of about $6 million annually, is the hospital is waiting on $30 million in payment from federal and state services (Medicaid and Medicare), along with insurance payments and private pay, and with the passage of the federal government's bill that cut into social service and Affordable Care Act programs, the wait is getting longer.
MDH also remains committed to continuing to provide free and reduced cost care each year, which totals $5 million annually, Murdock stressed. Without cutting what it considers non-core services, the free and reduced cost care for those in dire need will also be reduced. In addition, the hospital is seeking a waiver from the federal government to receive a critical access hospital (CAH) designation, which could provide a subsidy for an ambulance service. MDH has been unable to secure the CAH designation as the federal guidelines require that critical access care hospitals not be within 35 miles of another CAH. Currently Carthage's Memorial Hospital and Rushville's Culbertson Memorial Hospital, both about 27 miles from the MDH campus, are CAH-designated hospitals. To be designated as a CAH by the Centers for Medicare & Medicaid Services (CMS), eligible hospitals must meet the following conditions: have 25 or fewer acute care inpatient beds; be located more than 35 miles from another hospital; maintain an annual average length of stay of 96 hours or less for acute care patients; and provide 24/7 emergency care services.
Another question raised about expenses during the Lifeguard interview included the cost of the new MDH Community Pharmacy, which was a pet project pushed by former CEO Brian Dietz. The former embattled CEO was forced to resign in February 2024 after numerous allegations surfaced regarding Dietz purportedly making racist remarks in meetings, spent recklessly, threatened employees' job security and launched smear campaigns against those who spoke out against him.
'Expenditures made in the past are impacting us now. I'd love to have those funds back,' Murdock, who had previously served as the CFO, said. 'I own that, but we can't do anything about that now.'
The cost of building the MDH Community Pharmacy was approximately $8 million, which was funded by a donation that represented close to 40 percent of the cost of the project. The remainder of the construction costs have been funded from MDH operations. Currently the pharmacy is operating at a loss, Murdock shared; however, its finances are improving 'every day' and because it has only been open 14 months, he'd like to give it a little more time. The cost to operate the pharmacy is $174,510 /monthly (or $2.09 million annually), which includes salaries and benefits for eight employees (four pharmacists and four pharmacy techs) and expenses (primarily drug costs). The pharmacy building depreciation is $58,830/month.
The hospital's overall annual personnel expenditures are $60 million for 550 employees. This doesn't include contractual employees, such as ER doctors, he added.
When asked why MDH doesn't consider merging with a larger hospital so the burden is no longer on the small, independent rural hospital, Murdock stressed MDH wishes to stay independent for 'a long time.'
'The trend now is to look into partnerships, which we have; however, we want to remain in the community as an independent hospital and to keep the services we have here,' Murdock added. 'But even if we merged with a larger hospital, they probably wouldn't offer an ambulance service either.
And if we do go down that road with a merger, that's up to our bond holders.'
Another option would be a tax levy; however, MDH administration noted that is a last resort option to pay for the additional expenses.
The History of McDonough County Ambulance Services On June 5, 1970, the county board voted unanimously to fulfill the need for a county ambulance service, and 'file with the proper state and federal agencies for financial assistance on this matter, with the purpose in mind of providing a full ambulance services for all residents of said County' and that the ambulance service be provided to the county by McDonough District Hospital, 'who shall administer and service said operation on a contract basis with McDonough County, the hospital to perform and maintain said service at actual cost without profit.'
Under Illinois' 1973 Public Act 78-456, non-home rule counties were authorized to provide emergency ambulance service to or from points within or without the county; or to combine with other units of government for the purpose of providing ambulance service. Before the county provides the operation of an ambulance service, an ordinance must be passed by a majority of the county board. Once passed, the Board may provide or operate an ambulance service, or contract with a private person, hospital, corporation or another governmental unit for the operation of ambulance service or subsidize the service.
A new ordinance was passed in 1981 that required the county to purchase a new ambulance for the hospital. Murdock said the county has breached that ordinance as it has never purchased an ambulance, nor contributed funding for an ambulance service.
