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The Honolulu Advertiser
Posted on: Saturday, April 8, 2006

Flying ambulance service back in air

By Christie Wilson
Advertiser Neighbor Island Editor

Hawaii Air Ambulance returned one of its planes to the skies yesterday and could have as many as three planes flying missions next week following a crash March 8 that killed three crew members, an official said.

The company has been leasing a second plane since the start of the month, leaving it one aircraft short of the number it was using before the crash. Chief flight nurse and program director Anita Lucas-Legg yesterday said the company hopes to have a third plane, one of its Cessnas, in service by the end of next week.

The Coast Guard will continue airlifting patients in need of critical care from the Neighbor Islands to O'ahu until full service by Hawaii Air Ambulance resumes, said state Department of Health Director Chiyome Fukino in a letter yesterday to physicians and hospitals.

Meanwhile, the company's voluntary grounding of its fleet of four Cessna 414As a month ago opened the door to other companies eyeing the state's tightly controlled air ambulance market. Four companies filed applications in the past 10 days seeking approval from the State Health Planning and Development Agency for an emergency certificate of need to provide interisland aeromedical service, and one more is planning to start without it.


Even though HAA could be headed back to full service, the applications for emergency certificates of need still will be considered, said DOH spokeswoman Janice Okubo. As they are reviewed one by one, SHPDA officials will decide whether emergency conditions exist, she said.

SHPDA has 10 days to review the applications once they have been submitted in final form.

The applicants include:

  • Big Island Air, a Kona-based air-tour company that has provided backup service to Hawaii Air Ambulance from the Big Island and Maui.

  • O'ahu-based Pacific Medical Assets, which said in its application that it "routinely performs services in remote, austere and hostile environments" on behalf of its clients, which include the U.S. military and foreign governments.

  • ACI Pacific LLC, which is doing business as Emergency Airlift and is looking at establishing a Hawai'i operation as part of a larger strategy to provide medical transport throughout the Pacific and Asia, according to CEO Terry Habeck.

  • AirMed Hawaii LLC, which filed its application last week and submitted a revised application yesterday in response to SHPDA requests for additional information. AirMed Hawaii is a subsidiary of AirMed International, based in Birmingham, Ala.

    Because Hawai'i is a small market, state law requires major medical facilities and services to obtain certificates of need to protect existing care. The concern is that competition could weaken providers of essential healthcare services and possibly leave Hawai'i without the services altogether if they are unable to remain in business.

    HAA is the only company holding a certificate of need for aeromedical services, and there were no challenges to the company's position until the crash on Maui on March 8. HAA has been providing fixed-wing aeromedical services for 27 years, carrying more than 37,500 patients during that time.


    Lucas-Legg said that even as the sole provider, HAA has broken even or made a slim profit in only two or three of the last 10 years, in part due to insufficient health insurance reimbursements. She said the company averages 200 flights a month.

    "Having more than one company would make everyone fail," she said.

    The only other business in recent years to win state approval as an air ambulance provider was Mercy Air, which received a certificate of need in 1993 for helicopter service because the Maui-based program did not attempt to compete head-to-head with HAA, said healthcare consultant William Bryant, who helped Mercy with its certificate of need application.

    But Mercy quit in 1997 because of low volume and higher costs associated with helicopter operations, said Bryant, who works for Sierra Health Group in Dallas. He said he doubts much has changed to make it more feasible for additional air ambulance companies.

    "The medical community wants an air ambulance there when they want one in short order, but they may not fully understand the facts of what is sustainable," he said.

    AirMed Hawaii's local representative, Sandy Apter, said "There's room for two companies, especially with the increase in patients every year ... You don't need a rocket scientist to tell you that."

    Arguing against the emergency applications is state Rep. Joshua Green, D-6th (N. Kona, Keauhou, Kailua), who said they are premature and should be denied. Green is an emergency-room physician at the Pahala and Kohala hospitals on the Big Island and vice chairman of the House Committee on Health.


    In a letter Sunday to SHPDA administrator David Sakamoto, Green said SHPDA rules require that in order for emergency applications to be considered, there must be a substantial injury to public health or a "clear and present danger of such injury."

    With the Coast Guard and HAA providing some level of service, that has not occurred, Green said.

    "No doubt, HAA's temporary grounding of its planes is worrisome and unfortunate. However, now is not the time to panic or overreact," he said in his letter.

    Dr. Linda Rosen, acting chief of the DOH's Emergency Medical Services Branch, has said the situation has not caused any "negative" patient outcomes.

    Green told The Advertiser yesterday that he is uncomfortable with the sudden interest by companies wanting to provide air ambulance services, and said the applications should be closely scrutinized.

    "If there is this massive problem, then why weren't there five or eight applications before this? It makes me nervous to see people swoop in that way," he said.

    Green said he works at the state's two most remote hospitals, and "I haven't felt that my patients were taking too long to get transferred. ... I'm quite confident in the ability of Hawaii Air Ambulance to get my patients to safety. They've done it before."

    He said the state should welcome regular certificate-of-need applications from potential providers, and that health leaders should hold discussions several times a year to assess the adequacy of aeromedical services.

    None of the companies applying for an emergency certificate of need has said whether it would file for a regular certificate of need.

    Staff writer Curtis Lum contributed to this report.

    Reach Christie Wilson at cwilson@honoluluadvertiser.com.