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CHARLOTTE, N.C. --While fishing in a boat on Lake Wylie June 15, the reel fell out of Charlie Pridmore s hand. He crumpled to one side.

I had a strange feeling come over my body like a little stroke of electricity, he said.
He was having a stroke.

Weeks later, when he got the bill for the air ambulance that flew him from Piedmont Medical Center in Rock Hill to the Medical University of South Carolina in Charleston for treatment, he says he thought he was going to have another stroke.

The total: $58,477.

The details of Pridmore s flight from Piedmont Medical to MUSC raise questions about whether the intense competition for patients and their health care dollars infects the decision of where patients are treated and whether they are flown to that treatment.

Piedmont EMS drove Pridmore from the Commodore Yacht Club to the closest accredited stroke center, Piedmont Medical Center. Pridmore says Piedmont treated him with so-called clot busting drugs to dissolve the clots that caused his stroke. But Pridmore says a specialist from MUSC talked to him by way of a video link and strongly recommended he fly to Charleston in case of complications.

They had the doctor on the web cam, said Pridmore. I could see her. She was looking at me.

MUSC advertises its stroke network in a television ad.

Telemedicine provides big city stroke care to patients throughout rural South Carolina, it says.

Pridmore says the doctor in Charleston told him that he could develop what he calls a brain bleed and could die if a specially trained neurosurgeon was not on standby to install a stint.

She said, I'm the only doctor. I don t remember if she said in the state or in this part of the country - that is certified to do that so I would highly recommend that you get here, Pridmore recalled.

Hearing he could die, Pridmore says he did not argue with the doctor. But representatives of both Presbyterian and Carolinas Medical Center in Charlotte tell the I-Team they had specialists who were skilled, certified and available that day to treat complications from a stroke and install a stint if necessary.

Piedmont promotes itself as an accredited stroke center but that afternoon the hospital called in a chopper to fly Mr. Pridmore to MUSC in Charleston. But hospital staff did not call the closest air ambulance.

Pridmore says his wife was told, We called one out of Conway.

And she says, Conway?! Conway, South Carolina was a 140-mile flight away almost to Myrtle Beach on the coast. Pridmore says it took well over an hour for the flight to arrive and then more time to refuel before leaving for Charleston.

CMC Spokesman Kevin McCarthy says a Med Center Air chopper was available at the time in Concord, a 20 minute flight away. Pridmore says his wife tried to persuade the staff at Piedmont to consider another air ambulance.

They said we don t do it that way, said Pridmore.

A ground ambulance could have driven Charlie Pridmore to CMC or Presbyterian in a fraction of the hours it took to fly him to Charleston.

I could have gotten much closer and probably better care if I had gone to Charlotte, said Pridmore.

Weeks later, his wife opened the bill of $58,477. His insurance company wrote that the flight was not medically justified billing the Pridmores for the full amount. The Pridmores have since secured a letter from an MUSC neurologist saying his case was an emergency. They can appeal the amount with their insurer.

People take advantage of you in a life or death situation, Pridmore said, and I think we were taken advantage of.

Piedmont Public Relations Manger Katie Norwood said the hospital would not comment on Pridmore s case unless he signed a privacy release form and presented it in person to the hospital along with a photo ID. But Norwood released a written response saying:

In instances in which a patient s condition necessitates transfer to a facility that offers a higher-level of service, the decision regarding the method and location of transfer depends on many factors, including the severity of the patient s symptoms, the patient s treatment needs, the availability of needed services at other facilities, local weather conditions, and patient and family request. The patient and his or her family are consulted throughout the decision-making process.

You can read the full statement here.

State EMS offices in North and South Carolina issue protocols for air ambulances which pick up patients in the field. But EMS directors say most air ambulance flights are from one hospital to another. And in those cases they say the protocol is left to the individual hospital.

They used their choice not mine, said Pridmore.

There s also no cap on what an air ambulance company can charge a private pay patient. And the per-mile costs can vary wildly. Omni Transport, which flew Pridmore, charged $249 per loaded mile for each of the 173 miles it flew him to Charleston pls a $15,400 liftoff fee.

Air Methods, one of the nation s largest air ambulance companies which has since acquired Omni, charges about $160 per loaded mile and caps its cost at no more than $32,000 no matter how far it flies.

As far as Pridmore and his $58,000 bill, Air Methods vice-president Craig Yale said, I can assure you we re aware of the case and are working with the family to minimize the problem.

Pridmore is by no means an isolated case.

Air ambulances are profitable and as a result have proliferated their number more than doubling in the U.S. over the last ten years, leaving some patients to wrestle with their insurance companies over thousands, even tens of thousands of dollars in bills.

I said, What am I supposed to do? Sell my house that I ve worked 40 years to pay for in order to pay a $58,000 helicopter bill, said Pridmore.

The fierce competition over patients in York County, South Carolina, where Pridmore had his stroke, is also well documented. At the same time he had the stroke, CMC, Presbyterian and Piedmont were all competing for the right to build a new hospital in Fort Mill.

And last year the I-Team reported how Piedmont issued a memo to its EMS ambulance staff instructing them to tell, not ask, patients in the ambulance, I will be taking you to Piedmont Medical Center.

The I-Team reviewed ambulance transportation statistics from York County government that showed most patients in non-profit Fort Mill Rescue Squad ambulances were transported to Charlotte hospitals, while most Fort Mill patients picked up by for-profit Piedmont EMS ambulances were transported to Piedmont Medical Center.

Piedmont CEO Charlie Miller told the I-Team last year that Piedmont ambulances would not take patients to CMC s freestanding emergency room at Steele Creek even if it were the closest ER because it s not a hospital. Miller changed the policy after the I-Team s report.

Pridmore says he mercifully never developed a brain bleed and as a result never needed a stint at MUSC. He is going through physical therapy and has recovered some of the use of his left side.

They say I m a walking miracle, he said. But he hasn t yet made it back to Lake Wylie to keep on fishing.

As to the bigger question of air ambulance dispatch protocols and whether future upstate South Carolina patients will travel 25 miles to Charlotte or 175 miles to Charleston, SC EMS Director Jennifer Paddock said, Air medical transport is largely unregulated nationwide; that s something we need to look at.

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