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Lawmakers in Annapolis are beginning to debate the idea of seeking reimbursement from insurance companies when Maryland State Police fly critically injured patients from accident scenes, a proposal that is meeting resistance from at least one legislator from Frederick County.

Del. Galen R. Clagett (D-Dist. 3A) of Frederick said such an idea would be unfair, in part because not all insurance companies cover such an expense, which can run up to $10,000 in the private industry.

As chair of subcommittee on Public Safety and Administration, he said he will not support any such change because it will ratchet up insurance rates for residents using the medical evacuation service, or Medevac.

"To be fair, everyone should get a free ride," Clagett said. "The idea is to give the best possible care at the best possible rate."

But the idea is floating around as a way to help shore up a tight budget. The Maryland State Police Aviation division runs the Medevac program, and has a budget for fiscal 2010 of $19 million with projections calling for increases up to $22 million by 2014.

Along with increases, however, the state estimates a revenue shortfall of nearly $28 million in its overall medical emergency services budget. Most of the money for the Medevac program comes from a $13.50 annual fee paid through vehicle registration.

Sen. E.J. Pipkin (R-Dist. 36) of Stevensville, who supports the idea, said the money has to come from somewhere. "It's really a concern," he said. "Looking for a way of reimbursing besides using our EMS funds makes sense."

But before the state can seek reimbursement from insurance companies or any lawmaker can put the idea in the form of a bill, the Medevac program must become certified by the Federal Aviation Administration.

"This certification has been part of the discussion for the last several years," Pipkin said.

While Maryland has received accolades for its program, which has flown the critically injured at no charge for 40 years — averaging 5,000 trips per year since 1998 —Medevac's reputation has taken a beating in recent years.

A crash on a foggy night on Sept. 27, 2008, killed four. The accident, largely attributed to personnel, training and equipment failures, occurred on the heels of a scathing audit of the program in August 2008.

Pete Peterson, a former Medevac pilot, filed a lawsuit against the Maryland State Police in October 2009, citing wrongful termination under the air carrier whistleblower law.

Peterson wrote a letter to the Department of Transportation's Inspector General about the State Police's lack of regulatory compliance and other safety concerns just weeks before the September 2008 crash. After his letter became public, he was fired.

As a result of the audit and the fatal crash, numerous safety recommendations were made by the House Emergency Medical Services System Workgroup in 2009, including receiving FAA certification.

Aviation Commander A.J. McAndrew sent a letter to lawmakers last summer stating that his division has started the process, and estimated it would take a year to complete.

But to obtain FAA certification, the State Police has to spend money for equipment upgrades, and add 30 flight paramedics at the cost of $1.7 million, among other requirements.

Sen. John Astle (D-Dist. 30) of Annapolis, who called for substantial changes in the program, said that is not happening. "I know for a fact that of the money allocated last year, no checks are being written. ... How will [the State Police] make the changes required by the audit, the National Transportation Safety Board and the FAA?" Astle said.

Clagett and Pipkin remain hopeful that the recommendations made last year are taking place. "This legislature has dealt with the issue in a very lengthy and intense discussion last year," Pipkin said. "Policy for the near-term has been set."

Pipkin, however, is still trying to balance what he sees as inequities in the system by submitting SB634. The bill, making its third appearance in the Senate, would compensate residents who are charged by private air companies for emergency transport.

In a multiple injury accident, one patient may be flown by Medevac and another by private air transport, resulting in a bill for the patient. If the patient is uninsured or is not covered for the service, he has to pay out of pocket.

About 15 to 20 such incidents take place each year, Pipkin said. SB634 is capped at $150,000. Previous bills have failed, Pipkin said, because some lawmakers view it as a step toward privatizing the air ambulance service. A hearing on the bill is scheduled for March 3.

E-mail Katherine Heerbrandt at kheerbrandt@gazette.net.