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But, he adds, "others have very selfish business plans." The more aggressive companies sometimes out-compete their nonprofit competitors using dubious cost-cutting measures, he says. For example, nonprofit, hospital-based programs tend to be more willing to invest in new aircraft, high-tech gear and pilot training programs, while "you ask [some for-profit organizations] to do these types of things and it cuts into their bottom line," he says. "They can't charge for it, so therefore it's not attractive to them."
GoldStar appears willing in some respects to adhere to lower standards. The company's helicopters and Learjets are all more than 18 years old, available records show. None of them are certified under the voluntary industry standards devised by the Commission on Accreditation of Medical Transport Systems, which cover roughly a third of the nation's medical helicopter fleet and are stricter and more thorough in numerous respects than the rules and licensing requirements enforced by the state. For example, the CAMTS standards require pilots to have at least 1,500 hours of training, mechanics to have at least two years of rotorcraft experience, and medical personnel to have access to uninterrupted rest at the EMS station after they complete their duties during a 24-hour shift. It's unknown at what level GoldStar operates.
Still, the company seems determined to respond to as many calls as possible. The financial incentives are clear: GoldStar charges roughly $900 for a 13-mile ride to a hospital and up to $10,000 for a chopper flight, patients say. But critics say the company's desire for profits is delaying response times. GoldStar is reluctant to ask other EMS companies to handle calls when its own choppers are occupied, they say. The result, says Hopkins, was GoldStar's dawdling response to his accident on U.S. 59.
Authorities disagree on the degree to which GoldStar is to blame for the incident and similar contentious responses in San Jacinto County, which have been increasingly common, first responders say. Gene Clark, the head of the San Jacinto County Emergency Services District, says dispatchers can call whichever EMS company can send a chopper to an accident scene most quickly. But the San Jacinto County Sheriff's Department says its dispatchers must first call GoldStar, and GoldStar is responsible for promptly supplying its own chopper or calling another company.
At a minimum, GoldStar's approach to patient care has been proprietary. Responding to the county's recent head-on collision, Hopkins and Roy Pippin Jr., the chief of the Shepherd Volunteer Fire Department, were following the GoldStar ambulance that was carrying the injured driver to the chopper's landing zone. Pippin learned of the broken tail rotor at the LZ and immediately called a GoldStar competitor, who told him that the company had two choppers on the ground in Conroe and could have one on the scene in seven minutes, Hopkins says.
But it was too late: GoldStar's ground ambulance had ushered the patient down the road. "They are just out there to make money and make their paycheck," Hopkins says. "They don't care about the lives of other people."
Local emergency officials say that coordinating with GoldStar would be easier if its ambulances would tune in to the same radio frequency they use. Nicklas points out that the arrangement allows GoldStar to communicate secretively. The company has yet to explain why it can't fix the problem. "It may be a technical issue," Nicklas says, "or it may be that they are just flat not going to do it."
The business of making money from car accidents and heart attacks in southeast Texas has been an unstable and somewhat seamy venture for years. The formerly dominant player in the region, AMR, was plagued by many of GoldStar's same problems.
For example, AMR took a similarly creative approach to ambulance reports, says Kuehner, who worked for AMR in the '90s. "They'd make you fix your reports if you wrote something that kind of arose speculation as to the need for an ambulance," he says, adding that AMR later codified the policies on a handout.
An AMR spokesperson describes the allegations as inaccurate. "We ask [paramedics] to be very thorough about all of the information that they have seen," says Cynthia Wentworth.
After expanding rapidly over much of the decade, AMR faced growing criticism from across the country in the late '90s for lagging response times and substandard patient care. Laidlaw, AMR's parent company, lost a tax ruling in 1998 and was ordered to pay more than $140 million, including a hefty interest fee. AMR fired hundreds of workers that year and drastically scaled back its operations in southeast Texas.
Into the void stepped Boever and Crall. They connected with Larry Cauthen, a Baird-based financial backer, raised capital from other minority-stake shareholders and shadowed AMR's former stomping grounds with GoldStar ambulances. "Boom! Overnight they were in the top 10 percent of the largest ambulance companies in the state of Texas," says Sean Fitzgerald, the EMS company owner. "And from there they just went to Houston, to Allison, down to Corpus Christi. Everywhere."
Cauthen, Crall and Boever along the way spun the company into an increasingly complex corporate web. In early 2000, they created LRJ Enterprises Ltd -- using the initials for Larry, Ralph and Jason -- and appointed three individually controlled limited liability corporations as the partners. LRJ acquired GoldStar and earned at least some of its funds from leasing GoldStar's ambulances and office space back to the company, says a former employee; bankruptcy filings list LRJ among GoldStar's top 20 creditors.