Emergency airlift plans grounded by politics

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Posted on Sun, Dec. 23, 2007

Emergency airlift plans grounded by politics

BY DANNY ROBBINS

STAR-TELEGRAM STAFF WRITER

• Air ambulances vie for lucrative deals

For much of the past year, Somervell County Judge Walter Maynard was

courted by two of the area's air ambulance services, sometimes none

too subtly.

A company plane flew him to Air Evac Lifeteam's headquarters in West

Plains, Mo., where he toured the facilities, had lunch and chatted

with Chief Executive Officer Colin .

Jim Swartz, the CEO of Grand Prairie-based CareFlite, came to

Maynard's office, where he forcefully noted his service's ties to the

community as well as the fact that Air Evac's billing practices were

the subject of a federal investigation.

Why were these people so interested in the highest elected official

in Texas' second-smallest county? Because they need the approval of

Maynard and other county judges to tap into a key source of revenue:

selling memberships.

The quest to sell memberships among some of the state's air ambulance

providers has become a highly politicized process, involving hardball

tactics and the stroking of politicians. It has also focused

attention on a service some believe offers limited value in life-or-

death situations.

" It's a mess, and I'm not sure at all it's good for the citizen, "

said Mike Ford, a Somervell County commissioner.

Membership programs, in which consumers pay an annual fee as a hedge

against the high cost of helicopter transport, have become more

prevalent among Texas' air ambulance providers as Air Evac, the

company that pioneered them, has sought to increase its presence in

the state.

Air Evac, which operates primarily in rural areas, opened its first

Texas base in 2003 and now has 18 in the state, including four in

counties surrounding Dallas-Fort Worth.

The company's expansion into the Metroplex led CareFlite, the area's

longtime nonprofit provider, to start its own membership program this

year.

As competition between the two providers has heated up, county judges

have found themselves in the middle.

The reason is a state law, enacted 18 years ago with ground ambulance

services in mind, requiring any EMS provider seeking to sell

memberships to obtain written authorization from the chief elected

official in the jurisdiction in which it plans to sell them.

The influx of air medical membership programs has raised concerns for

many of the county officials who must approve them, as well as for

the Governor's EMS and Trauma Advisory Council, a group that makes

recommendations to the State Health Services Department.

At the council's request, the department has asked the Federal

Aviation Administration whether such programs should be considered

part of airline rates. If the FAA answers yes, it means the programs

will be exempt from state regulation, said Veal, an EMS

compliance manager for the department.

Many of the county officials interviewed for this report said they

would welcome any ruling that takes them out of the process.

" It's a stretch to put county government in the middle of how that

ought to operate, " County Judge Mark Riley said.

How the programs work

Most air medical membership programs work the same way: They charge

an annual fee based on the size of the household. If a member

requires helicopter transport, the bill is limited to the amount

covered by insurance. The value to the consumer is avoiding potential

out-of-pocket costs of several thousand dollars.

But critics contend that the programs offer minimal benefit because

such transport is rarely needed and a membership only counts for the

service that sold it.

In emergency situations, it's particularly dicey that you will be

transported by the service to which you subscribe. Paramedics at an

accident scene usually follow their department guidelines, which

often require calling the closest available helicopter, without

regard to memberships.

" Even if it were readily apparent that somebody had a membership, I'm

not sure that ethically you would want to make a financial decision

about which unit to send, " said Griswell, the medical director

for MedStar, the ground ambulance service operating in Fort Worth.

CareFlite launched its membership program after Swartz, who became

the service's CEO in 2005, unsuccessfully lobbied the state in 2006

to have such programs classified as insurance, a move that would have

effectively eliminated them.

In a presentation to the Governor's EMS and Trauma Advisory Council,

Swartz contended that membership agreements " distort the delivery

model " for EMS.

Asked recently about the about-face, he said: " I would characterize

it as not giving any competitor of ours an unfair advantage. "

The CareFlite-Air Evac battle to sell memberships has been

particularly contentious in the counties south and west of Fort

Worth, an area both services can reach from multiple bases: CareFlite

in Granbury and Denton and at Methodist Hospital near downtown

Fort Worth; Air Evac in Glen Rose, Decatur and Mineral Wells.

Some counties have decided to stay out of the competition.

In Erath County, neither service has received permission to sell

memberships because officials are wary of the consequences.

" We don't want to be in a position where you, as a member, are

sitting there going, 'I'm with [a particular service] and that's who

I want,' " County Judge Tab said.

County commissioners gave approval to both, although

reluctantly, according to Riley. " I don't think it's fair for me to

tell a resident of County that they can't buy a membership if

they choose to do so, " he said.

Somervell County's vote

But other counties have jumped into the fight, in some instances

taking sides and leaving hard feelings.

Somervell County commissioners voted in July to approve Air Evac and

not CareFlite, largely because Air Evac has a base in Glen Rose, the

county seat, according to Maynard.

" You would think that Air Evac would be the first one on the scene,

and if [residents] had CareFlite memberships, we'd have some unhappy

citizens, " he said recently.

The decision angered Swartz, who contends that CareFlite wasn't given

a chance to make its case.

" What did we do in 28 years of saving lives in that county to deserve

such treatment? " he said.

Swartz went to Glen Rose to visit Maynard and Ford a month before the

commissioners' vote because he believed that CareFlite was being

deliberately kept off the agenda.

" I was very firm that I didn't consider that fair, " he said.

He also told the officials about the federal investigation involving

Air Evac. The reference was to published reports in May describing

how FBI agents seized records at the company's headquarters as part

of what the company called an investigation into " billing and

healthcare compliance " matters.

Although CareFlite ultimately got on the agenda, Swartz wrote a

letter to Maynard the day after the vote complaining that CareFlite

wasn't allowed to make a full presentation.

" What is your plan for handling complaints from citizens that are

transported by CareFlite while holding Air Evac memberships? " he

wrote. " Will you tell them why you led the campaign to prohibit

CareFlite from offering memberships in Somervell County? "

In the letter, he again mentioned the investigation of Air Evac and

included a story from The New York Times describing it.

Ford said his vote against CareFlite was due in part to Swartz's

aggressiveness.

" The way he chose to approach this whole thing was, from my

perspective, less than I would expect ethically, " he said.

Maynard's trip to Air Evac's headquarters in Missouri occurred late

last year, just after Air Evac began operating in Glen Rose.

He said he was impressed by what he saw, but that the trip, which

included others from the county, did not have a bearing on his vote.

" None of this had anything to do with the membership program, " he

said. " It was strictly [Air Evac] showing us they could support our

community with a helicopter. "

The trip was part of a program in which Air Evac flies EMS and

hospital officials to its headquarters for a day so they can get

a " comfort level " with the company, located in a remote area of the

Ozarks, said Seth Myers, the company's vice president for operations.

Although accepting such trips doesn't violate state law, some

officials said it raises questions for them.

" If I felt it necessary to go look at their facility, I'd ask the

Commissioners Court to budget that money and steer clear of any

suggestion that the company had influenced the decision, " said Riley,

the County judge.

Hood County's choice

In Hood County, commissioners approved CareFlite last December and

have yet to consider Air Evac, which hasn't sought a spot on their

agenda.

The county's EMS personnel prefer CareFlite, which moved into

Granbury, the county seat, in 2006, said County Judge Andy Rash.

But Air Evac will be put to a vote if the company seeks it, he said.

Rash himself required CareFlite's transportation in April, when he

suffered a heart attack and was flown from Granbury to Fort Worth.

He acknowledged that he was billed as a member, even though he had

not purchased a membership. The benefit allowed him to save

approximately $5,500.

Giving a county judge such a break could be considered an illegal

gift to a public servant under state law. Rash conceded that it

could be a problem but pointed out that he never sought special

treatment.

CareFlite simply didn't bill him for the portion he owed, he said.

Swartz said he was unaware of how Rash's bill was handled.

" Memberships are not retroactive, " he said. " But I can't tell you

[what happened]. We have 35,000 patients a year here. "

County's agenda

County commissioners gave CareFlite permission to sell

memberships last December. A request to put Air Evac on the

commissioners' October agenda was denied by County Judge Harmon.

Discussing his reasoning recently, Harmon said he was acting to

protect the interests of CareFlite, which has been contracted by the

county to provide it with ground ambulance service since 2003.

" Our relationship with CareFlite is so good, I'm not going to do

anything that would jeopardize it, " he said.

Harmon subsequently complained to Air Evac that Casey Peacock, the

company membership coordinator who sought the spot on the

commissioners' agenda, threatened to " smear " him as a result of the

decision.

Peacock, who has since been fired, denied using such language,

although he acknowledged telling Harmon that the public might find

his reasoning interesting.

Peacock said he doesn't know whether his firing was related to his

dealings with Harmon or his sales numbers, which were lagging. Either

way, he said, he's glad to be out of the business.

" It has nothing to do with what's a good service, what's a bad

service, how long you've been here, " he said. " It has to do with who

you know and whose back you're going to scratch. "

Companies woo county officials

Air Evac Lifeteam and CareFlite have sought approval to sell

memberships in rural counties near Fort Worth.

Somervell County

1 Air Evac Lifeteam, which has a helicopter based in Glen Rose,

received the commissioners' approval to sell memberships in July.

CareFlite was also considered at the meeting and denied the ability

to sell. County Judge Walter Maynard was part of a contingent from

the county that visited Air Evac's headquarters in West Plains, Mo.,

at the company's expense a few months after the Glen Rose base was

opened in 2006.

Hood County

2 CareFlite, which has a helicopter in Granbury, received permission

from commissioners to sell memberships last December. Air Evac

Lifeteam has yet to seek a vote on its program. CareFlite gave County

Judge Andy Rash a price break associated with membership -- worth

several thousand dollars -- when he suffered a heart attack in April

and was flown to Fort Worth, even though he was not a member at the

time.

County

3 CareFlite, the county's ground ambulance provider since 2003, was

approved by commissioners to sell memberships last December. County

Judge Harmon refused a request to put Air Evac Lifeteam on the

commissioners' agenda for a similar vote in September.

Erath County

4 No service has been approved to sell memberships in the county

because of County Judge Tab 's opposition to the concept.

was part of another group that visited the Air Evac Lifeteam

headquarters in Missouri at the company's expense.