The decision last week by Owensboro Health to exit a backup ambulance service agreement it has maintained with the city of Owensboro and Daviess Fiscal Court for more than 40 years could have legal ramifications that serve to embitter the already strained relationship local government has with this region's largest health care institution.

According to County Attorney Claud Porter, whatever legal next-steps the city and county decide to take, Owensboro Health's letter of intent to exit that interlocal agreement was interpreted by some as "adversarial." Plans, he said, to engage the health care organization in a "friendly lawsuit" that would produce a judge's declaratory judgment on the status of that contract have been stalled by the sudden development.

"Right now, 'friendly' is not the way I would characterize this anymore," Porter told the Messenger-Inquirer on Tuesday. "I think this is adversarial in the sense that they have informed us that they will contest anything that we ask a court to do."

A law firm representing Owensboro Health sent the city and county that letter notifying them of its intent to abandon the 1978 annual backup agreement last week. The agreement, which the newspaper has since obtained under Kentucky open records laws, is set to expire on Sept. 18.

When that ambulance service agreement first came up, the city, county and what was then the Owensboro-Daviess County Hospital were not considering a backup service scenario, but rather the community's primary, long-term emergency medical transport service. Local government had been trying to convince the hospital to take over service from a private company — Owensboro-Daviess County Ambulance Service Inc. — and, in fact, was briefly successful two years prior, during the summer of 1976. But shockingly, after providing the service for just 63 hours and responding to a mere 14 calls in July, the hospital board voted to disband the system, forcing the certificate of need back into private hands.

So, the '78 agreement outlined a strict set of considerations all three parties would take up; the city and county would provide what was then a public hospital four, fully-equipped ambulances and the hospital agreed to run them 24 hours a day, seven days a week. Government would provide the capital and health experts would provide the medical service.

That was, by in large, the status of the hospital-city-county ambulance service arrangement in Daviess County until 1998 when Yellow Ambulance took over the service. Since then, and at least as recently as 2008, Owensboro Health has still agreed to sign back-up agreements with the city and county that would be triggered only if their primary contractor were to fail to meet its end of the deal.

In its letter last week, Owensboro Health insisted that the 2008 agreement is no longer in effect, and by exiting one from 1978, there is a real possibility, officials have said, that there would be no "plan B" in Owensboro and Daviess County, come mid-September.

"It makes it -- and I’m sure this is what they’re trying to do -- much more difficult now," Porter said, "and we have to find alternative methods to secure a backup agreement or emergency ambulance service at all if something were to happen to our current provider. We don’t want anything to happen to our current provider, but if there is an interruption in service, we have to have some way of providing that service. So, we are in a different position now, and we’re trying to figure that out."

Although the '78 agreement was initially relied on for primary service, the county, at least, seems to believe that it may have bound Owensboro Health to backup service as well. Now, Porter said, a judge might rule that Owensboro Health can't exit the agreement without Daviess County and the city of Owensboro weighing in as well.

Conversations between the city and the county are ongoing, says Judge-Executive Al Mattingly, but, in the meantime, he still wants Owensboro Health to clarify what it wants both local governments to do.

Last week, the regional health care provider sent the Messenger-Inquirer the following statement in response to its first report that the '78 agreement might end:

"Owensboro Health remains completely committed to engaging in any opportunities for positive dialogue about the future health care needs of our community and region." Owensboro Health remains completely committed to engaging in any opportunities for positive dialogue about the future health care needs of our community and region."

Mattingly encouraged Owensboro Health to engage the city and county in that conversation, but he insisted that it take place in a public setting.

"The hospital continues to say that they’re interested in having a conversation about the health of this community," he said. "I call on them to initiate that conversation, but I think that conversation needs to be in a public setting. The public needs to know what it is that the hospital is concerned about. I can tell you what Daviess County and the city of Owensboro (are) probably concerned about, and that’s ambulance services and who is going to provide the backup now."

Austin Ramsey, 270-691-7302,, Twitter: @austinrramsey

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