After it was disclosed that Baltimore ambulance company owner Willie Runyon, his daughter and his company gave $95,000 to Gov. Parris N. Glendening's legal defense fund, the governor said the gift created no ethical conflict because Mr. Runyon did no direct business with the state.
But Mr. Runyon's flagship company, American Ambulance and Oxygen Service Inc., does in fact have significant interaction with state government.
His ambulances are licensed, regulated and inspected by state officials. He does business with the University of Maryland Medical System, whose board is appointed by the governor. And he has collected millions of dollars in state Medicaid payments over the years.
More broadly, decisions made in Annapolis in the next few years could have sweeping impact on the entire health care industry, including ambulance-service providers, in a time of dramatic change.
Some of his rivals have spent the week trying to figure out just what Mr. Runyon wants out of his generous contributions to Mr. Glendening. Mr. Runyon, 71, professes that there is nothing except to help the new Democratic governor.
"I've always supported Democrats, and he needed the money," Mr. Runyon said. "The Republicans are trying to cut everything."
With 18 ambulances, American is one of the state's largest ambulance providers in a highly competitive field. Relatives own other ambulance companies in the area.
Housed in a modest building on East North Avenue, American has contracts with a variety of hospitals and nursing homes, including Maryland General Hospital, Blue Cross and Blue Shield of Maryland, and Manor Care nursing homes.
Like all private ambulance companies, American's fleet has been licensed and inspected by the Maryland Institute for Emergency Medical Services System -- a state agency -- since 1992. A separate state board licenses and certifies ambulance personnel.
In addition, American Ambulance has an exclusive, no-bid contract to provide basic ambulance service for patients at the University of Maryland Medical System. The medical system is a private, nonprofit corporation, but it has close ties to state
government and receives significant state budget assistance.
"We're very happy with their service, and they reach the largest geographic area," Jill Bloom, a spokeswoman for the medical system, said of American.
Under the arrangement, the hospital last year paid American less than $5,000 -- payments to cover transportation for uninsured patients, Ms. Bloom said. But the arrangement gives American the right to transport many more patients who are covered by Medicare or private insurers.
The contract is not bid, Ms. Bloom said, because it involves such a small amount of the medical system's money.
American Ambulance also has been negotiating with University of Maryland officials to have the hospital sponsor the company as it applies to the state for certification to provide "advanced life support" rather than "basic life support" in some of its ambulances. State regulations require that a hospital provide training and other support to an ambulance company seeking advanced life support certification.
Unlike many ambulance companies in the area, Mr. Runyon's company has not moved until now to seek such certification -- a step that would allow it to capture a growing piece of the market. American officials have been discussing an affiliation with the University of Maryland for several weeks, Ms. Bloom said.
Over the years, Mr. Runyon's most lucrative connection to the state has been the reimbursement he received for transporting patients covered by Medicaid, the government health insurance program for the poor and disabled.
In 1994, the state paid American Ambulance about $442,000. So far this year, the company has collected $46,000.
Observers have speculated that Mr. Runyon would like the state spend more on ambulance transportation for Medicaid patients. But Mr. Runyon says he's not interested in competing for Medicaid business and did not bid on the new transportation contracts in July.
Mr. Runyon's company makes even more each year from Medicare, the federal insurance program for the elderly. The Sun reported yesterday that Mr. Runyon's ambulance business is under federal investigation for possible irregularities in billings to Medicare. Mr. Runyon has denied any wrongdoing.
Last weekend, after initially declining, Mr. Glendening released the names of 40 contributors who had given $173,000 to help defray his legal fees combating the challenge to the election results by his Republican challenger, Ellen R. Sauerbrey.
The list showed that Mr. Runyon, his daughter and his ambulance company together donated $95,000 to the effort. Mr. Runyon has, in addition, given more than $23,000 to Mr. Glendening's campaign fund and his inaugural activities.
The size of the contributions may have startled even veteran political players, but Mr. Runyon has contributed generously to politicians for decades. He also has made it a practice to hire influential people.
In the 1970s, for example, his advisers included Gary Mandel, son of former governor Marvin Mandel, and Maurice R. Wyatt, Mr. Mandel's one-time patronage chief.
In the mid-'70s, it was disclosed that Mr. Runyon also had close ties with two of the three members of the Baltimore fire board at a time when the board was approving policy changes that brought significant new business to Mr. Runyon's companies.
In 1991, he hired state Sen. Larry Young, a Baltimore Democrat and now the chairman of a key subcommittee that handles health issues. Mr. Young's job at American is to handle public and community relations.
"You pick talent," Mr. Runyon said of his employees. "Larry Young, I picked him for public relations. . . . If I got a problem with a nursing home, he'll go over and smooth things over. He's a very diplomatic guy."
Mr. Runyon also tried unsuccessfully last year to hire former state health secretary Nelson J. Sabatini for an unspecified post. Recently, he signed on as his medical director Dr. James D'Orta, a close friend of former Gov. William Donald Schaefer and the man who headed the commission that reconfigured the state's emergency service network two years ago.