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.

On a frigid Sunday evening, Daniel Hopkins and his girlfriend pasture his sorrel quarter horse, crank the heater in his Astro van and set off with a load of five children for his house in Shepherd. Hopkins is rolling down the blacktop and crossing the divided lanes of U.S. 59, a fast stretch of dark, rural freeway, when he fails to see a packed Grand Marquis speeding south.

The car smashes into the van and sends it spinning. Rolling over in a whirl of shattering windows, the van grinds 20 feet across the pavement, trailing sparks, glass and screams. The impact sends Melissa Brame off the front seat into her boyfriend.

Scrambling for their children through the machine's mangled belly, Hopkins and Brame find his seven-year-old son, Bradley, crying and bleeding from a crescent-shaped gash atop his head. The young father worms through the van's broken rear window while Brame unbuckles the other children and notices that her three-year-old son, Chevy, is missing.

Daniel Hopkins and Melissa Brame say they waited 
nearly an hour before a GoldStar helicopter arrived at 
the scene of their recent auto accident to transport her 
son Chevy to the hospital.
Daniel Kramer
Daniel Hopkins and Melissa Brame say they waited nearly an hour before a GoldStar helicopter arrived at the scene of their recent auto accident to transport her son Chevy to the hospital.
With 91 ambulances, two helicopters and two 
Learjets, GoldStar EMS is the largest private 
ambulance company in southeast Texas. But now it's 
shrinking.
Daniel Kramer
With 91 ambulances, two helicopters and two Learjets, GoldStar EMS is the largest private ambulance company in southeast Texas. But now it's shrinking.
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.

A woman in an approaching car spots the boy on the freeway lying in a pool of blood and wailing. Hurled 20 feet from the van, his body is scored with road rash, his head gashed with puncture wounds.

Shepherd Volunteer Fire Department first responder Cindi Nicklas, No. 1606 on the emergency band radio, speeds to the wreck within minutes and cradles the writhing boy in her hands, shouting immediately for a medevac. "Get me a bird and get me a bird now," she says to a deputy constable. "I don't care what color it is, I don't give a shit who it is, but get me a bird. This child has got to go."

The deputy radios a dispatcher who calls GoldStar EMS, an ambulance company that holds exclusive contracts with many Houston-area counties. GoldStar's local chopper is based nearby, eight minutes away in Lufkin. Its ground ambulance is based even closer: two miles away at a station in Shepherd.

But 15 painful minutes pass and the road is black, the sky empty.

Nicklas barks to the deputy: "Got an ETA on that bird?" Ten minutes pass, then 20, and there's no word from dispatch. Chevy bleeds into bandages. The deputy dials on his cell phone straight to GoldStar's corporate headquarters in Port Arthur, yelling, cajoling, begging for a helicopter.

No matter. Chevy waits alongside the freeway for 55 minutes before two GoldStar ambulances arrive with medics, Nicklas says. And only then does GoldStar radio its chopper. The cops are already calling the response a "cluster" -- cop-speak for clusterfuck -- and the chaos gets only more obscene. The pugnacious medics squabble over how to treat the patients and where to land the chopper. Hopkins, bruised and dazed from the accident, breaks them up. "You take care of my kids and then y'all can take care of whatever some other time," the 25-year-old construction worker tells them. "I will not stand by and listen to this."

Chevy is flown to Memorial Hermann Hospital, but most of the children are across the highway huddling in an extended-cab pickup. The ambulance drivers refuse to cross the road to inspect them. They make young Bradley, who most likely has been hit in the head by a tool box, walk back across the freeway, dodging cars. Only then do they strap him onto a wooden board to immobilize his spine. For this alone, GoldStar will bill his father $200. "This was like a three-ring circus," Nicklas says. "The worst possible things that could happen were happening right in front of me."

But the biggest outrage came later that month in a public meeting packed with hopping-mad county officials, Nicklas says, when a company spokeswoman claimed the ambulances had arrived in a mere 20 minutes. "I called her a damn liar to her face," says Nicklas, herself a volunteer firefighter.

It was far from the first time doubts had been cast on the honesty of GoldStar, whose administrators failed to return repeated calls from the Houston Press for this story. Under investigation for Medicare fraud by the FBI, the company has repeatedly doctored ambulance logs, ignored the safety complaints of its own employees, and maximized profits and growth at the expense of the injured, say first responders and former workers.

And yet GoldStar still carries patients in Houston. In fact, it is the largest private EMS company in southeast Texas.


In 1998, Jason Boever, a onetime aspirant to medical school, and Ralph Crall, a transplant from California, bought two ambulances and founded GoldStar in Beaumont. They had worked public relations for American Medical Response, the largest ambulance company in the nation, and they put the experience to use. GoldStar grew fast, perhaps too fast.

A family of six companies, GoldStar now operates two helicopters, two Learjets and 91 ambulances, 16 of them based in Houston, according to state officials. A GoldStar attorney said the company is even larger: It consists of seven subsidiaries that operate 190 vehicles, most of them ambulances.

What is clear is that GoldStar has expanded to serve Texas cities ranging from Corpus Christi to Galveston and Beaumont to Jasper, offering affordable rates and a squeaky-clean image. "Our values reflect our commitment to exemplify the 'service before self-interest philosophy' at every level of our organization," says a mission statement on its high-tech Web site, "to treat everyone we meet -- including each other -- with compassion, dignity and respect, to deal fairly and honestly, and to honor all of our commitments."

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."

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.

Officially, the state has slapped GoldStar with three administrative penalties. The other two infractions came in 1999 for failure to notify the state of a change in ownership and "violation of a provider requirement." Among the state's ten largest EMS companies, only the Dallas Fire Department received as many administrative penalties in the same period. Brett Hart, the state's EMS complaints coordinator, says he cannot offer further information on GoldStar's penalties because the relevant documents exceeded the state's "retention schedule" and were destroyed.


Prompted by allegations of Medicare fraud, the FBI raided GoldStar's offices this April, according to former employees who say they tipped off the agency. A spokesperson for the U.S. Attorney's Office in Beaumont confirmed that the FBI searched the company's offices in seven Texas cities, but declined to comment on the investigation.

Five former employees contacted by the Press claim or allege GoldStar used a variety of techniques to bill Medicare for services not normally covered by the program.

One tactic involved pressuring paramedics to omit or change information in logs of ambulance trips, known as run reports, former workers say. The reports are used by the Medicare system to verify that the trips qualify for reimbursement with federal funds.

"There were people transported that didn't need to be transported," says Richard Kuehner, a paramedic who worked for GoldStar for eight months in the late '90s, "and they tried to encourage you not to document it in a way that would arouse any kind of suspicion.

"Like you couldn't say, 'The person walked to the stretcher, the person was ambulatory from the stretcher,' " he explains. "You had to say that you moved the patient to the stretcher. Things like that. Nothing that would indicate that this person probably doesn't need an ambulance for transport."

Pressure to fudge the reports bordered on the ridiculous, says Kenneth Lowder, who worked for GoldStar from 1998 to 2000. "There would be patients sitting ready to go in an electric wheelchair," he says. "But they would want us to write it a certain way so it would be paid."

Rothberg, the GoldStar attorney, said the company never engaged in Medicare fraud and described the allegations as "utter nonsense." He said that competitors or disgruntled former workers may have lied to the FBI in an attempt to put GoldStar out of business.

What nobody disputes is that GoldStar's profits in the late '90s were substantial. In a grant application submitted to the Port Arthur Economic Development Corporation, GoldStar pegs its 1999 revenue at $10.5 million and its net income at more than $4.3 million.

Mom-and-pop ambulance operators say they saw the company's flare-up coming. "For the seasoned people in the business, it just hasn't been a surprise," says the owner of a local EMS company who asked not to be identified. "I'm calling it our own little local Enron. I mean, seriously."


GoldStar obviously isn't headquartered in a gleaming, 40-story office building, but in some respects, the company may come tumbling down from even greater heights.

One test of GoldStar's stability took place in April, when a young man passed an 18-wheeler at high speed on a rural blacktop in San Jacinto County and crashed head-on into a woman in an oncoming car, sending it hurtling into a bank of trees. Her ribs were smashed. First responders dispatched Angel Flight, GoldStar's helicopter service, but the chopper's tail rotor broke mid-flight and the machine had to make an emergency landing in a nearby pasture.

San Jacinto County Constable Lou Rogers, who responded to the scene, was livid. "It was totally, unbelievably unacceptable what happened," he told GoldStar representatives at a public meeting. "When I call for a [helicopter], I want that son of a gun in the air on its way, and I want it here."

Breakdowns aboard responding medical helicopters, though rare, aren't unheard of, say veteran air medics. Yet GoldStar's safety record is plagued by more than the occasional bone of contention.

Last year a GoldStar pilot received a warning notice from the FAA for violating a safety reporting requirement, agency records show. The pilot was cited for breaking a rule that required him to record "each mechanical irregularity" that comes to his attention during a flight and to determine the status of the irregularity before the next flight.

In April, Thomas Gene Elder, a former GoldStar flight nurse and manager, sued the company, alleging that he had been fired after he reported "a potentially serious safety concern." Court documents do not elaborate on the issue, and Elder's attorney declined to comment on the case. As of press time, GoldStar had not submitted a response to the complaint.

On another occasion, GoldStar had to return to the launchpad on an emergency run when its personnel discovered they didn't have enough oxygen to supply the patient throughout the entire trip.

Profit-oriented EMS companies such as GoldStar own an increasing portion of the roughly 700 medical helicopters operating in the United States, and not all of them exploit their patients, says Ron Walter, president of the International Association of Flight Paramedics. They sometimes will base choppers in sparsely populated areas that nonprofit companies can't afford to service, filling an important role. "Some have very good business plans," he says.

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.

LRJ has in turn diversified its portfolio into far-flung holdings. The company owns condos in Port Arthur and also operates under the assumed business name of Texas Boat Docks, which offers "low maintenance, heavy framed aluminum swim docks, boat docks and gangways," the company Web site says, that will "hold up to the roughest of conditions…"

Crall also keeps business running smoothly by consulting with a fourth business partner: God.

Pastor Ralph Crall is the leader of Fellowship of Grace church, a Baptist congregation with a flashy Web site and a weathered salmon-pink corrugated-metal sanctuary in Nederland, nestled between a goat pasture and a community of shotgun shacks and dirt streets a few miles outside Beaumont. One of Crall's recent sermons was titled "Building Character."

At a minimum, God seems to have blessed Crall with a divine capacity for unctuous public relations. Before pitching GoldStar's services or defending the company's decisions, Crall has at times led his audience in prayer, say two former employees.


GoldStar's celestial connections may help keep money in the fold, but they have done little to keep emergency workers faithful.

The problems begin for some emergency personnel as soon as they pick up the phone. Constable Rogers, for example, requested a helicopter for County Commissioner Joe Johnson, who was having a heart attack, but the GoldStar dispatcher cut him off. "She hung up on me," he says. "And he's lying on the couch, dying."

The chopper didn't show up for another half-hour, he says.

Assuming a GoldStar ambulance promptly arrives to pick up a patient, there's no guarantee that it will swiftly shuttle him to the hospital. Alexandra Marcotte, a first responder with the Pumpkin Evergreen Volunteer Fire Department, jumped out of bed early one morning in March and secured a landing zone for a GoldStar helicopter. A medic at the scene told her GoldStar was flying the patient to the Conroe hospital because the company's ground ambulance driver didn't know how to get there, she says.

A different GoldStar driver who picked up a patient a month later asked Marcotte for directions to the same hospital, delaying his departure by ten minutes.

The delay might have been preferable to the foul-up two weeks later, when Marcotte responded to the head-on collision involving the woman with smashed ribs. After the chopper malfunctioned, the ambulance transporting the woman took a wrong turn on its way to Conroe and ended up going on a 15-minute diversion through New Waverly, Marcotte says.

"They do not know where they are going," she told San Jacinto County commissioners at a recent meeting, "and I am concerned that is going to cost somebody their life or cause a serious injury."

A GoldStar spokesperson at the meeting explained that drivers need time to learn their way around because they are rotated to different counties.


The regimen of almost any paramedic is tough: 24-hour shifts, long drives and patients ranging from drunks to hypochondriacs. But working at GoldStar was worse, say veteran paramedics. The job meant being worn to the bone.

Kuehner, the former GoldStar paramedic, described a typical shift in Beaumont. He showed up at 7 a.m. and spent the whole day on his feet ferrying nonemergency patients -- such as people receiving kidney dialysis -- between different hospitals. This is a lucrative business, and it makes up a huge part of GoldStar's bread and butter, especially in Houston, where the company's ambulances focus exclusively on transfers, unless the fire department is short-staffed.

With the evening arrived the drunks, car wrecks and kitchen accidents. Kuehner ran emergencies into the night and stumbled back into the station in the early morning, where he tried to catch up on paperwork. But he wasn't done. At around 3 a.m. -- a few hours before his shift ended -- GoldStar sent him out again on a long transfer call to Houston. "You are dead on your feet," he says. "Your partner is trying to drive an ambulance and falling asleep. It's not a real safe situation."

The predicament was the product of GoldStar's greed, he says.

Kuehner says GoldStar's ambulances spent an unusual amount of time on profitable nonemergency transfer calls, wearing out medics and making them unavailable for emergency calls, which they are obligated to fill in Beaumont and other cities based on contracts with authorities. "We were not in standby mode in case of emergencies," he says. "We were doing the transfer stuff about 75 percent of the time."

The practice is common among for-profit ambulance companies and theoretically allows them to offer lower rates in bids for municipal contracts, but Kuehner adds that GoldStar pushed it to the extreme. "I think they were the worst at it," he says. "They really tried to get away with it."

GoldStar also squeezed employees for profits in other ways.

Before 2002, GoldStar used a pay system known in the industry as Chinese overtime. Employees sued GoldStar, claiming they had received $200 for a 24-hour shift, even though many worked several shifts amounting to more than 70 hours a week. Seven GoldStar employees filed suit in U.S. District Court in Beaumont that year and settled the case out of court. Workers said the deal included the right to overtime pay.

Many paramedics who work for companies such as GoldStar don't stick around for long. Kuehner, for example, now makes twice as much money working aboard an offshore seismic ship. Others go on to work for government providers, such as the Houston Fire Department, which on average offer better pay and benefits.

GoldStar exploits poorly educated workers, says the owner of a rival company, who asked not to be named. "The small town, small mentality, big heart, they take advantage of that," he says.


Critics in San Jacinto County are pointing to GoldStar's record in an effort to get authorities to drop the company for a different EMS provider. But making a switch isn't easy.

Part of GoldStar's allure is its ability to offer what looks like a great value to rural counties that are low on cash and manpower. In San Jacinto County, GoldStar charges the Emergency Services District $380,000 a year to provide the equivalent of 2.5 ambulances -- more than twice what the county could man on its own, officials say.

One supporter of the deal is County Commissioner Johnson, the same lawmaker who almost died when GoldStar allegedly failed to dispatch a helicopter promptly to respond to his heart attack. Johnson defends the company's reliance on transfers to supplement its income and believes GoldStar's medics are top-notch. "They are doing a hell of a job," he says. "It's just their [response] times, sometimes."

Clark, the graying head of the emergency services district, has heard "all kinds of accusations going around" about GoldStar but also knows the county has been burned by other suppliers. The county's prior contractor ended the arrangement two years ago after it failed to make enough money. It had replaced a public service in Shepherd that imploded because of unpaid taxes. Prior to that, a volunteer-run system had run out of volunteers.

"I do the best I can with what I have to work with," Clark says. "But if you need a straight out answer, am I satisfied? I'm satisfied that we're getting a service for what we are paying for."

Still, some volunteer firefighters believe a public ambulance service deserves another chance. Nicklas, who is trained as an EMT, says Shepherd's nonprofit service folded because of bad management and could easily exceed GoldStar's coverage and service under new direction.

Of course, given the widespread controversy surrounding GoldStar, the debate in San Jacinto County could climb the ladder to the Bureau of Emergency Management, which could strip the company's EMS license. The bureau has never pursued such a nuclear option against an EMS company, arguing that it would disrupt patient care and create more problems than it solves. Yet the option is considered more seriously for repeat offenders.

Ultimately, the state has limited experience conducting confrontational investigations. In a recent interview, Perkins was unsure whether her agency had the power to subpoena witnesses. She initially stated that the agency didn't have such power, then responded a week later through an employee that she had been wrong -- the agency could subpoena them.


If anybody in San Jacinto County knows what it means to depend on GoldStar, it's probably Nicklas, who sits behind a desk in the one-room office shack of the Shepherd Volunteer Fire Department. A calendar full of accident photos hangs on the wall near a scented candle and a sign that says, "You just can't fix stupid." Nicklas curtly fields calls and works other days alongside GoldStar paramedics as a first responder. But she also knows GoldStar in more personal ways, and it's a relationship that began roughly.

Driving a year ago in her Ford Ranger extended-cab pickup down a two-lane road, Nicklas encountered a dog lying in the middle of the street and swerved -- nothing unusual, she explains. "The dog stays in the road every day. We had an understanding: He just laid there; I went around him." That much went smoothly. But her tire caught on the sharp edge of the pavement as she hooked back onto the road, flipping her truck upside down and sending it skidding across the blacktop.

The wrecker drivers arrived first. Nicklas says she directed them -- from the inverted swing of her seat belt -- to switch on the radio in her pickup and say: " '1606 was in an MVA, is hanging upside down, and it was a 1050 major,' because I did have injuries."

The distress call brought a GoldStar paramedic who parted the crowd and brashly set out to free Nicklas from her dangling captivity. Another EMT offered a cervical collar to place around Nicklas's neck. The paramedic waved it off, Nicklas says. Police and firemen on the scene volunteered to help her remove Nicklas, who is short and stocky. The paramedic declined. Nicklas volunteered this advice: "Don't pop the seat belt; that's the only thing holding me in here."

The paramedic popped it.

Nicklas screamed and landed on her head, wrenching her neck and smashing her back on the truck's door frame.

A doctor at Cleveland Regional Medical Center diagnosed her with a concussion and back injuries, including multiple herniated and broken discs. Surgeons later installed two metal rods and six screws and nuts into her back, fusing them together with a cadaver bone. She still suffers major muscle spasms.

Nicklas later submitted a formal complaint against GoldStar to the Bureau of Emergency Management. She said GoldStar's failure to outfit her with a C-collar, a C-spine device and a Kendrick Extrication Device violated the bureau's rules. An investigation of the complaint is pending.

Nicklas's battle with GoldStar quickly escalated. The company accused her of lying, even though she had witnesses. Company medics gave her cold glares at accident scenes. And yet Nicklas kept pressuring Gene Clark and the Emergency Services District. She stood up at a meeting in February and demanded someone take the company to task. "They can just skate by and get away with anything," she said. "Poor patient care, the response times are horrible, they don't know where they are, they don't know what they're doing. But as long as you're happy, they can continue this.

"Who is going to have to die before somebody does something around here?" she said, and she sat back down.

Two days later, her husband, Lonnie Nicklas, the chief of the Shepherd Volunteer Fire Department, had a heart attack. The GoldStar ambulance based in Shepherd was in Coldspring, ten miles away, probably covering for another ambulance doing a transfer, but nobody knows outside of GoldStar. If it had been on standby in Shepherd, it would have arrived in five minutes. Instead it arrived in 12, not fast enough to revive Lonnie Nicklas.

Cindi Nicklas doesn't know if subtracting seven minutes would have meant that her husband would now be sitting at the adjacent desk. "God only knows that," she says, trying not to cry. "But it sure would have made me feel a whole hell of a lot better."

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