A Gap in Coverage

Critics of GoldStar ambulance service say it's late to emergencies, cares for profits over patients, and doctors its books. But without it, there's nothing.

Yet one commitment the company hasn't honored is its duty to the tax man. The Internal Revenue Service issued liens on the company in the past ten months totaling $1.3 million for delinquent payroll taxes. The company also owes Jefferson County $18,000 in back taxes on its two jets, one of which the county seized in April. GoldStar filed for Chapter 11 bankruptcy protection the same month, claiming to clients that the move was only a reorganization and wouldn't affect operations.

Even so, GoldStar recently pulled its ambulances out of Corpus Christi, Jasper, Woodville and Center, stopped working in San Augustine, Sabine and Brown counties, and is in the process of ending operations in Galveston County, where this March it helped transport victims of the BP refinery explosion in Texas City.

Some medical officials are hoping GoldStar will survive, at least in the short term. The company's partial collapse has already left a gap in ambulance coverage in many regions of the state that won't be easy to fill, say EMS providers. Only AMR and the Houston Fire Department field more ambulances in Texas than GoldStar, which has a fleet more than twice the size of the city-based service in Dallas. "There's no one to put in their place overnight," says Sean Fitzgerald, owner of Southeast Texas EMS, who is scrambling to fill GoldStar's shoes in Jasper. "When there's a void, that's when you start hearing the horror stories about increased response times."

Ralph Crall, CEO of GoldStar EMS, has spun the 
company into an increasingly complex corporate web.
Daniel Kramer
Ralph Crall, CEO of GoldStar EMS, has spun the company into an increasingly complex corporate web.
Cindi Nicklas, a Shepherd Volunteer Fire Department 
first responder, says she has seen GoldStar botch 
responses to several accidents, including her own.
Daniel Kramer
Cindi Nicklas, a Shepherd Volunteer Fire Department first responder, says she has seen GoldStar botch responses to several accidents, including her own.

On the other hand, GoldStar's rapid expansion hasn't necessarily benefited public safety -- a fact that highlights major problems in Texas with the growth and regulation of private ambulance companies.

Since 2003, 11 complaints have been lodged against GoldStar with the state's Bureau of Emergency Management. By comparison, the slightly larger Houston Fire Department prompted only two complaints in the same period. Based on incidents per ambulance, GoldStar has the worst recent record of any major EMS company in the state, according to state records. And yet lawsuits and the accounts of former employees suggest that the official numbers tell only part of the story.

Many former GoldStar workers interviewed for this story requested anonymity, fearing reprisals from the company, interference with an FBI investigation and difficulty finding a job with other ambulance operators, which some former employees say engage in similar practices.

One former GoldStar worker with knowledge of a state investigation of the company says GoldStar has even exerted sway to convince state regulators to whitewash its official safety record. Officials with the Bureau of Emergency Management discovered in 2000 that one GoldStar paramedic had responded to more than 100 ambulance calls without a valid paramedic's license, the former worker says. Each call was a separate violation punishable by a $1,000 fine, which meant GoldStar faced more than $100,000 in penalties and revocation of its EMS license, he says.

Instead of closing shop, however, GoldStar turned to Gene Weatherall, who had retired less than a year earlier from his position as the bureau's chief. GoldStar representatives dropped in with Weatherall for an unannounced visit to the office of Cathy Perkins, his former subordinate and the new acting bureau chief, Perkins says. The meeting violated the state's revolving-door policy, which prohibits former regulators from representing the companies they policed for at least two years after retiring.

Perkins discussed the infractions with GoldStar and Weatherall, she says, and the penalty was ultimately drastically reduced, adds the former employee. According to state records, GoldStar was levied a $5,000 fine and put on six months' probation. Partially backing up the former employee's account of the violations, the records indicate that GoldStar had broken a rule requiring that at least one EMT and one EMT-I aboard all ambulances have "active status certification."

According to the former employee, GoldStar and Weatherall also negotiated to have the roughly 100 infractions appear as a single violation, instead of 100 of them, in the back of Texas EMS Magazine, which health officials read to keep tabs on the performance of ambulance companies. The entry in the September/October issue of the magazine, obtained by the Press, gives no indication whether the citation was for multiple violations.

Perkins acknowledges that Weatherall, who recently passed away, may have violated the revolving-door policy by representing GoldStar in the meeting. She says it wasn't her job at the time to interpret the statute. She can't recall any additional details of the case, she says, but added in an e-mail that condensing numerous violations into one is not an unusual practice at the health department.

"In cases like this, the department often uses its discretion and assesses one administrative penalty for the aggregated conduct that supports the violations," she wrote. "This simplifies the process (i.e. one final order vs. 100; 1 penalty vs. 100, etc.)."

Perkins also says the discussion with Weatherall and GoldStar was preliminary and any arrangements were later subject to the department's approval.

"They just showed up," she says. "They surprised us, let's put it that way."

GoldStar attorney Ed Rothberg said he was unfamiliar with the incident, but added that any account from a former employee was problematic. "I have heard all sorts of goofy allegations that bear no relation to reality," he said.

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