Could Maryland's State Police charge a fee for medevac helicopter transfers between hospitals without losing legal immunity?

Plain-English summary

The chairman of the Maryland Executive Helicopter Advisory Committee (MEHAC) asked the Attorney General about a budget bill proviso that pushed the State Police and MEHAC to develop a "third party reimbursement schedule" for State Police helicopter medevac flights that moved patients from one hospital to another (as opposed to accident-scene rescues). He asked whether the State Police could charge such fees without a statute expressly authorizing them, and what charging a fee would do to the legal immunity of everyone involved, from the helicopter crew to the physicians at the sending and receiving hospitals to the Maryland Tort Claims Act immunity of State employees generally.

The opinion concluded that, though the question was "not at all free from doubt," the State Police could charge the fees under the law as it then existed. The Medevac program itself had never been created by a specific statute; it rested on the State Police's general duty under Article 88B to "safeguard the lives and safety of all persons within the State." The opinion found that the General Assembly had effectively consented to fee-charging over the years, through budget language, joint resolutions asking MEHAC to review the program's costs, and a 1973 legislative committee memo that had already floated third-party reimbursement as a funding source. Even so, the opinion recommended that the legislature pass an explicit statute covering the Medevac program's operational details, including fees, rather than leaving it to rest on inference from budget provisos and old committee memos.

On immunity, the opinion drew a sharp line. Maryland's Good Samaritan statutes (then Courts Article §§5-309 and 5-310) only protected people who provided emergency assistance "without fee or other compensation." So if the State Police charged a transfer fee, the State Police personnel involved in that flight would lose Good Samaritan immunity, while hospital or Shock Trauma Center staff would keep theirs unless their own employers separately charged a fee for their part in the transfer. Separately, the broader Maryland Tort Claims Act immunity for State personnel (then Courts Article §5-399.2(b)) did not turn on whether a fee was charged, so State employees would keep that immunity regardless. Finally, the opinion warned that charging a fee would likely convert the flights from general aviation operations (14 C.F.R. Part 91) into "air taxi" operations regulated under the far more detailed requirements of 14 C.F.R. Part 135, based on the position of FAA staff the office had consulted.

Currency note

This opinion was issued in 1991. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current Maryland Good Samaritan and Tort Claims Act provisions (now recodified from the Courts Article sections cited here) and current FAA air-taxi regulations before relying on any specific rule described here.

Common questions

Did Maryland need a new law before the State Police could charge for medevac helicopter transfers?
The opinion concluded that under the law as it stood in 1991, express statutory authorization was not strictly necessary because the General Assembly had already shown enough "consent" through the budget process and joint resolutions, though the office recommended the legislature enact a specific statute anyway.

Would charging a medevac transfer fee have affected the helicopter crew's legal immunity?
Yes, according to the opinion. Maryland's Good Samaritan statutes at the time only protected people who provided emergency assistance without a fee, so State Police personnel involved in a fee-charged transfer would have lost that immunity, though the separate Maryland Tort Claims Act immunity for State employees would have remained unaffected.

Would a transfer fee have changed which federal aviation rules applied to the State Police helicopters?
The opinion reported that FAA staff had indicated charging a fee would likely move the flights from general operating rules under 14 C.F.R. Part 91 to the stricter "air taxi" requirements of 14 C.F.R. Part 135.

Background and statutory framework

The Maryland State Police Aviation Division had used helicopters since 1970 to move patients from accident scenes to hospitals, and had also used them for inter-hospital transfers to trauma and specialty centers. The Medevac program was never created by its own statute; it operated under the State Police's general duty in Article 88B, §3 to "safeguard the lives and safety of all persons within the State" and its authority under Article 88B, §13 to perform duties assigned by the General Assembly. The only specific statutory mention of the program appeared in §13-103(c)(1) and (d) of the Education Article, which gave the Maryland Institute for Emergency Medical Services Systems responsibility to coordinate a statewide emergency medical system and to require helicopters transporting patients between hospitals to notify the state communications center.

Chapter 3 of the Laws of Maryland 1991, the fiscal year 1992 budget bill, included a proviso conditioning Special Operations Bureau funding on the State Police and MEHAC first developing and submitting a third-party reimbursement fee schedule to the legislature's budget committees. The opinion treated this as an ordinary budget-power condition that presupposed, rather than granted, authority to charge fees, citing Bayne v. Secretary of State on the limits of using budget bills to "legislate in the budget."

On the fee-authority question, the opinion started from Article 14 of the Declaration of Rights, which requires legislative consent for any "aid, charge, tax, burthen, or fees." It distinguished fees that are a kind of monopoly rent for services only a public officer can provide, such as a notary's fee under Article 36, §23, which need explicit statutory authorization, from fees for government services that are also available commercially, such as ambulance transport, where authority to provide the service may itself imply authority to charge a commercially reasonable fee (citing Ace Ambulance Services, Inc. v. City of Augusta). The opinion found the Medevac program's history, including a 1973 Senate Finance Committee memo on possible revenue sources and 1987 joint resolutions asking MEHAC to review program costs (Joint Resolution Nos. 20 and 24), sufficient evidence of legislative "consent" to fee-charging even without an explicit fee statute.

On immunity, the opinion worked through Maryland's Good Samaritan provisions, CJ §5-309 (covering licensed medical providers and trained emergency personnel, including "[i]n transit" and dispatch-communications assistance) and CJ §5-310 (covering government and nonprofit personnel providing support to the emergency medical system), both of which conditioned immunity on providing assistance "without fee." Citing Tatum v. Gigliotti, the opinion concluded that charging a fee would remove Good Samaritan immunity for the fee-charging organization's own personnel, but not for other participants (like hospital staff) whose own employers charged no fee. It then noted that the separate Maryland Tort Claims Act immunity in CJ §5-399.2(b) was not linked to fees at all, so State personnel would keep that protection regardless.

Finally, on federal aviation law, the opinion explained that the FAA's general operating rules in 14 C.F.R. Part 91 applied to all aircraft, while the more detailed "air taxi" rules of 14 C.F.R. Part 135 (citing §135.1(a)(1) and (a)(3), and §298.21(c)(1)(iv) classifying air ambulance service as air taxi operation) applied to aircraft carrying persons "for compensation or hire." Based on conversations with FAA staff in Washington and the New York regional office, reflecting what was said to be at least the view of the Regional Counsel, the opinion concluded Part 135 would likely apply once a fee was charged, even for a small share of the Aviation Division's overall flights.

Citations and references

Statutes:

• Article 14 of the Declaration of Rights, requiring legislative consent for any fee or charge
• Article 15, §1 of the Constitution, using "fees" in the same monopoly-rent sense
• Article 36, §23 of the Maryland Code, the notary fee statute cited as an example of explicit fee authorization
• Article 88B, §3 of the Maryland Code, the State Police's general duty to safeguard lives and safety
• Article 88B, §13, authorizing other duties assigned by the General Assembly
• Article 88B, §15(a), the Superintendent's rulemaking authority
• §13-103(c)(1) and (d) of the Education Article, the Institute for Emergency Medical Services Systems' coordination duties
• CJ §5-309(a)(2), (a)(3)(ii) and (iii), and (b)(1) and (2), Maryland's Good Samaritan immunity provision
• CJ §5-310, immunity for support personnel to the emergency medical system
• CJ §5-399.2(b), the Maryland Tort Claims Act immunity provision
• 49 U.S.C. §1348(a) and (c), FAA authority to regulate navigable airspace and air traffic
• 14 C.F.R. Part 91 and §91.1(a), general operating and flight rules for all aircraft
• 14 C.F.R. Part 135, Subpart C, and §135.1(a)(1) and (a)(3), air taxi operator requirements
• 14 C.F.R. §298.21(c)(1)(iv), classifying air ambulance service as an air taxi operation
• Chapter 3 of the Laws of Maryland 1991, the FY1992 budget bill proviso on Medevac fees
• Joint Resolution Nos. 20 and 24 (1987 Session), reconstituting MEHAC and asking it to review Medevac costs

Cases:

• Bayne v. Secretary of State, 283 Md. 560, 574, 392 A.2d 560 (1978), on the limits of "legislating in the budget"
• State Roads Comm'n v. Postal Tel. Cable Co., 123 Md. 73, 91 A. 147 (1914), noting no case had applied Article 14 to fees
• Bradford v. Jones, 1 Md. 351 (1851), on the "fees" concept in Article 15
• Ace Ambulance Services, Inc. v. City of Augusta, 337 A.2d 661 (Me. 1975), on authority to charge for a service also available commercially
• Tatum v. Gigliotti, 80 Md. App. 559, 568, 565 A.2d 354 (1989), on fees defeating Good Samaritan immunity

Source

• Landing page: https://oag.maryland.gov/resources-info/Pages/attorney-general%E2%80%99s-opinions.aspx
• Original PDF: https://oag.maryland.gov/resources-info/Documents/pdfs/Opinions/1991/Volume76_1991.pdf (this opinion appears at printed pages 95-104 of the bound annual volume; Maryland's site does not publish a standalone PDF of this opinion)

Original opinion text

Best-effort transcription from a scanned PDF. Minor errors may remain — the linked PDF is authoritative.

CONSTITUTIONAL LAW

Fees — Torts - Immunity - Aviation - Authority to Charge
Fees For Medevac Inter-Hospital Transfers - Effect of
Fees on Immunity and Federal Aviation Regulation

                          July 26, 1991

The Honorable Melvin A. Steinberg
Chairman, Maryland Executive
Helicopter Advisory Committee

 The Maryland Executive Helicopter Advisory Committee

("MEHAC") has requested our opinion on several issues related to the
possible imposition of fees for the transfer by State Police helicopter of
certain patients from one hospital to another. Specifically, these
questions are as follows:

1. May the State Police charge these fees without legislation

expressly authorizing them?

 2. Would those involved in the transfer of the patient (including

the crew of the helicopter, the medical personnel at the sending and the
receiving hospital, and physicians at the Shock Trauma Center) lose
immunity under the Good Samaritan law if these fees were charged?

3. What effect would the charging of fees have on the immunity

granted State personnel under the Maryland Tort Claims Act?

 4. Would the charging of the fees lead to the imposition of more

stringent federal aviation regulations on the operation of the State Police
helicopters used for inter-hospital transfers?

For the reasons stated below, we conclude as follows:

 1. Although the question is not at all free from doubt, in our view

the State Police may charge fees under current law for inter-hospital
transfers. However, we recommend consideration of legislation that
would grant explicit authority over the operational details of the
Medevac program, including fees.

 2. If the State Police charged a fee for the transfer of a patient

from one hospital to another, the State Police employees involved in the
transfer would no longer have immunity under §5-309 of the Courts
Article. The imposition of a fee by the State Police, however, would
not affect the immunity of persons employed by the hospitals involved
or the Shock Trauma Center. The question of their immunity under this
statute would depend on whether they or their employers charged a fee
for their role in the transfer of the patient.

3. The charging of a fee would not affect any State employee's
   immunity under the Maryland Tort Claims Act.

   4. The charging of the fee would likely change the status under
      federal aviation regulations of the State Police helicopters used for inter-
      hospital transfers.

                               I
      
                         Background
      

   As we understand it, since 1970 the Aviation Division of the
   Maryland State Police has been using its helicopters to transport patients
   from the scene of accidents to hospitals. In some instances, State Police
   helicopters are also used to transport patients from small hospitals to
   trauma and specialty referral centers.

   The system works as follows: When a physician at a hospital
   believes that a patient ought to be transported by helicopter to another
   facility, the physician calls the central communications and dispatch
   center at the Maryland Institute for Emergency Medical Services
   Systems. A physician at the Shock Trauma Center and the physician at
   the hospital then discuss the patient's condition and the need for a State
   Police helicopter to transport the patient to a higher level of care. The
   physician at Shock Trauma makes the final decision about the need for
   the transfer. If the transfer is approved, the Shock Trauma physician
   then decides whether a medical specialist, usually from the sending
   hospital, must accompany the patient.

   In Chapter 3 of the Laws of Maryland 1991, the budget bill for
   fiscal year 1992, the General Assembly added a condition intended to
   require the State Police and MEHAC to develop a fee schedule for inter-
   hospital transfers. The appropriation to the Special Operations Bureau
   of the State Police, Item 35.06.01.03, contains the following proviso:

       [F]unds may not be expended for performing
       nonemergency MEDEVAC inter-hospital transfers
       until:
   
            (1) The State Police and the Maryland Executive
       Helicopter Advisory Committee (MEHAC) has
       developed and submitted to the budget committees, a
       third party reimbursement schedule to recover costs of
       inter-hospital transfers except those directly related to
       accident scene transports, and,
   
           (2) the budget committees have reviewed and
       commented upon the schedule or 45 days have elapsed
       from the date the report is received by the
       committees.1
   

   This language is framed as a traditional budget condition: it uses
   the power of the purse to push the exercise of agency discretion in a
   desired direction. In other words, the budget bill proviso presupposes
   that the State Police and MEHAC have the authority to adopt the fee
   schedule and does not itself purport to grant that authority.2

   The fee schedule to be developed is for "third party reimbursement."
   The intention, presumably, is that fees be charged to patients for
   services that would be covered under typical health insurance policies.

                                    II
   
                     Authority to Charge Fees
   

   A State agency may not charge a fee for its services without
   legislative approval. This fundamental principle is stated in Article 14
   of the Declaration of Rights, which provides "[t]hat no aid, charge, tax,
   burthen, or fees ought to be rated or levied, under any pretense, without
   the consent of the Legislature."

   1
      An additional budget condition, relating to "the transport by helicopter
   

   or fixed wing aircraft of State personnel" is not at issue in this opinion.
   2
   Thus, we need not here consider the extent to which use of the budget bill
   as a vehicle for grants of authority to agencies would be impermissible "legislating
   in the budget." See Bayne v. Secretary of State, 283 Md. 560, 574, 392 A.2d 560
   (1978). See also 63 Opinions of the Attorney General 60 (1978).

   Thus, "consent" for a fee, as for a tax, is always required.3 Indeed,
   for many fees legislative consent must be manifested explicitly in a
   statute: "Fees cannot be taken by an officer for the performance of
   duties imposed by law, except where authority to collect fees is
   expressly provided by law." 4 McQuillan Municipal Corporations
   §12.189, at 76 (1985). In Article 14 of the Declaration of Rights, the
   term "fees" was most likely intended to denote this kind of monopoly
   rent - a fee that a citizen must pay to receive a service that only a public
   officer can provide (and that often serves as the officer's means of
   compensation). The term is used in this sense in Article 15, §1 of the
   Constitution. See also Bradford v. Jones, 1 Md. 351 (1851).

   A person needing an acknowledgement by a notary public, for
   instance, cannot obtain the needed service from a private source. If the
   person is to be charged for something that can only be provided by a
   public officer, Article 14 requires that the General Assembly explicitly
   authorize the charge (as it has done with respect to notaries in Article
   36, §23 of the Maryland Code).

   However, we cannot say that express statutory authorization for a
   fee is always essential under Article 14. Depending on the nature of the
   activity for which a fee is to be charged and the evidence of legislative
   approval of the fee, "consent" that is implicit in a statutory scheme might
   be sufficient.

   This opinion request does not require us to try to resolve
   comprehensively the difficult problem of applying Article 14, without
   judicial guidance, to the variety of fees charged by the agencies of a
   modem government.4 It may be that, if a State agency is authorized by
   statute to provide goods or services of a kind that are available at a price
   in the marketplace, the authority to engage in the activity should
   ordinarily be viewed as authority to impose commercially reasonable
   charges. See Ace Ambulance Services, Inc. v. City of Augusta, 337
   A.2d 661 (Me. 1975) (statute authorizing city to "provid[e] for a public

   3
     As a treatise-writer put it, "in neither nation nor state, would the levy of
   

   taxes, without the consent of the legislature, be valid even without this article."
   Niles, Maryland Constitutional Law 24 (1915).
   4
   Article 14 was adopted without debate at the convention that prepared
   Maryland's first constitution, of 1776. Other state constitutions contain
   comparable provisions but without reference to "fees." We are aware of no case
   applying Article 14 to fees. See State Roads Comm'n v. Postal Tel. Cable Co.,
   123 Md. 73, 91 A. 147 (1914) (issue raised but not reached by Court).

... ambulance service" viewed as authority to charge for the service).5
To respond to your inquiry, however, we need only consider the limited
question whether fees for inter-hospital transfers enjoy legislative
"consent," taking into account the unique circumstances of the Medevac
program.

 The program itself does not derive from an explicit statutory source.

Rather, the Medevac services of the State Police have been undertaken
pursuant to that agency's general duty to "safeguard the lives and safety
of all persons within the State ...." Article 88B, §3 of the Maryland
Code. See also Article 88B, §13 (State Police "shall perform such other
duties as may be assigned from time to time by the General Assembly").
The only express statutory recognition of the program is in a provision
governing the Maryland Institute for Emergency Medical Services
Systems, which has overall responsibility to "[c]oordinate a statewide
system of emergency medical services" and specific responsibility to
"adopt rules and regulations that assure that helicopters transporting
patients between hospitals or to or from specialty centers notify the
systems communication center of the State emergency medical
communications system." §13-103(c)(1) and (d) of the Education
Article.

 Over the years, the primary instruments for legislative control over

the Medevac program have been nonstatutory: the budget process and
joint resolutions.6

 In each year's budget, the General Assembly appropriates funds to

the component of the State Police that is responsible for the Medevac
mission. In addition, since 1981 the budget book has detailed the
number of Medevac missions and flight hours.

Moreover, as early as 1973, soon after Governor Mandel acted by

executive order to coordinate emergency medical services, the Senate
Finance Committee expressed concern over the funding of the program.
See 1973 Reports of the Fiscal Committees to the Maryland Legislative
Council 245. A memorandum to the committee from the Division of

    5
       A person needing to go from one hospital to another is not seeking a

service that only the State Police could provide. While there might be significant
disadvantages in doing so, the patient could obtain transport service from a private
air ambulance.
6
In addition, the General Assembly has in the past formed a Special Joint
Committee on the Med-Evac Program. See 1991-1992 Maryland Manual at 58.

Budget Review discussed "[p]ossible sources of revenue," including third
party payors. Id. at 250.

 In 1987, the General Assembly adopted identical joint resolutions

requesting that the Governor reconstitute the advisory body overseeing
the use of Medevac helicopters. Among other points, the General
Assembly asked that the new Maryland Executive Helicopter Advisory
Committee "revie[w] and develo[p] recommendations for improvement
of delivery of Med-Evac services in the State, addressing such issues as
deployment of helicopters ... and the optimum utilization of the
Maryland State Police helicopter fleet." Joint Resolution Nos. 20 and
24 (1987 Session). The joint resolutions also requested "[m]onitoring
the progress of budget requests and expenditures ...." Thus, through
these resolutions, the General Assembly expressed both its approval of
the role of the State Police Aviation Division in providing emergency
medical services and its concern about the costs associated with that
program.

 In short, all aspects of the Medevac program have been developed

administratively, in reliance on the broad language in Article 88B, §§3
and 13.7 The General Assembly, choosing not to enact a statute
addressing the Medevac program itself, unquestionably has acted on the
belief that these broad grants of authority are sufficient to enable the
State Police (with MEHAC's involvement) to decide the operational
details of the program.

 The issue of fees is another such operational detail, one with a

specific record of legislative awareness. As we noted above, at an early
point in the program's history, a Senate Finance Committee document
indicated that third party reimbursement might be a part of the
program's funding. This possibility would not have been raised if the
statute allowing for the program - no different now than then - had been
thought not to allow for the steps needed to obtain such reimbursement.
The proviso in the current budget bill simply seeks to compel the State
Police and MEHAC to take those steps.

 Thus, we conclude that the General Assembly has sufficiently

manifested its "consent" to the proposed fees. However, we recommend
that the General Assembly consider enacting a statute that provides a
more specific underpinning for the entire Medevac program, including
any fees that might be charged.

    7
       The Superintendent of the State Police "shall have the power to make any

rules necessary to promote the effective and efficient performance ..." of the State
Police. Article 88B, § 15(a).

                                  III

                    Effect of Fees on Immunity

A. Good Samaritan Law

 Under §5-309 of the Courts Article ("CJ" Article), certain "special

personnel" are granted "Good Samaritan" immunity for their role in the
provision of emergency medical care. These "special personnel" include
individuals licensed to provide medical care and trained members of law
enforcement agencies. CJ §5-309(b)(1) and (2).8

 This immunity applies not only to "assistance or medical care"

provided at the scene of an emergency but also "[i]n transit to a medical
facility" and "[t]hrough communications with personnel providing
emergency assistance." CJ §5-309(a)(3)(ii) and (iii). However, the
immunity is available only if "[t]he assistance or medical care is
provided without fee or other compensation." CJ §5-309(a)(2).

Similarly, CJ §5-310 provides immunity for certain individuals who

support the emergency medical services system:

            An individual is not civilly liable for any act or
        omission while providing support to the emergency
        medical system by giving care, equipment, facilities,
        or consultation, if:

            (1) The individual is a member or employee of
        any federal, State, county, or city government,
        hospital, emergency medical service council, or
        agency that operates as a nonprofit group;

    8
        CJ §5-309(b) specifies, in pertinent part, that statutory immunity is

available to:
(1) An individual who is licensed by this State to provide
medical care; [and]
(2) A member of any state, county, municipal, or
volunteer fire department, ambulance and rescue squad or law
enforcement agency if the member:
(i) Has completed an American Red Cross course in
advanced first aid and has a current card showing that status;
(ii) Has completed an equivalent of an American Red
Cross course in advanced first aid, as determined by the
Secretary of Health and Mental Hygiene; or
(iii) Is certified by this State as an emergency medical
technician, or cardiac rescue technician ....

         (2) The act or omission is not one of gross
     negligence; and

         (3) The service is provided without fee to the
     emergency victim.

 As we read these statutes, the charging of a fee makes Good

Samaritan immunity unavailable to the employees of an organization that
charges the fee. See Tatum v. Gigliotti, 80 Md. App. 559, 568, 565
A.2d 354 (1989), aff'd 321 Md. 623, 583 A.2d 10 Opinions of the
Attorney General 175, 177 (1979). Thus, if the State Police charged a
fee for the transfer of a patient to a medical facility, the State Police
personnel involved in the transfer would not be able to assert immunity
under CJ §§5-309 and 5-310. However, the immunity would remain
available to employees of other organizations dealing with the patient,
including the hospitals involved and the Shock Trauma Center, if those
organizations did not themselves charge a fee for services related to the
transfer of the patient.

B. Maryland Tort Claims Act

 Under CJ §5-399.2(b), "State personnel are immune from suit in

courts of the State and from liability and tort for a tortious act or
omission that is within the scope of the public duties of the State
personnel and is made without malice or gross negligence, and for which
the State or its units have waived immunity ...." This grant of immunity
is not linked to the matter of fees. Hence, if the State Police charged
fees for certain helicopter transfers, the State Police personnel involved
in the transfers would continue to be able to assert immunity under this
provision.

                               IV

                Federal Aviation Regulations

 Under federal law, the Federal Aviation Administration is given

broad authority to regulate the "use of navigable air space" and "to
prescribe air traffic rules and regulations ..." 49 U.S.C. §1348(a) and
(c). In 14 C.F.R. Part 91, the FAA has set out rules that govern the
operation of all aircraft within the United States. See 14 C.F.R.
§91.1(a). These general operating and flight rules now apply to State
Police helicopter operations.

Much more detailed regulations, set out in 14 C.F.R. Part 135,

govern the operation of certain commercial aviation activities. These
regulations go well beyond the generally applicable requirements of 14
C.F.R. Part 91 by, for example, setting out detailed requirements for
aircraft equipment. See 14 C.F.R. Part 135, Subpart C.

 The Part 135 regulations are applicable to "air taxi operators." 14

C.F.R. §135.1(a)(1). An air ambulance service is a type of air taxi
operation. See 14 C.F.R. §298.21(c)(1)(iv). More generally, Part 135
applies to an operator providing "carriage in air commerce of persons ...
for compensation or hire as a commercial operator ...." 14 C.F.R.
§135.1(a)(3).

 According to FAA staff in both Washington and the regional office

in New York, Part 135 would become applicable to State Police
helicopter operations in a service for which a fee is charged. In the
FAA staff's view, the charging of compensation, even if the service in
question represented only a small proportion of the Aviation Division's
overall operations, would subject the aircraft and personnel engaged in
that "carriage ... for compensation" to Part 135 regulations.

 We cannot say that the FAA staff's construction of the regulation

is wrong. Although we have not been able to obtain the views of the
FAA's counsel, the staff's position is said to reflect the legal opinion of
at least the Regional Counsel.9

                                  V

                             Conclusion

In summary, it is our opinion that:

 1. Although the question is not at all free from doubt, in our view

the State Police may charge fees under current law for inter-hospital
transfers. However, we recommend consideration of legislation that
would grant explicit authority over the operational details of the
Medevac program, including fees.

 2. If the State Police charged a fee for the transfer of a patient

from one hospital to another, the State Police employees involved in the
transfer would no longer have immunity under §5-309 of the Courts
Article. The imposition of a fee by the State Police, however, would
not affect the immunity of persons employed by the hospitals involved

    9
       The State Police could seek a formal opinion from the FAA's counsel's

office, but we cannot obtain an estimate of the time that a response would take.

or the Shock Trauma Center. The question of their immunity under this
statute would depend on whether they or their employers charged a fee
for their role in the transfer of the patient.

3. The charging of a fee would not affect any State employee's
   immunity under the Maryland Tort Claims Act.

   4. The charging of the fee would likely change the status under
      federal aviation regulations of the State Police helicopters used for inter-
      hospital transfers.

                                          J. Joseph Curran, Jr.
                                          Attorney General
      
                                          Jack Schwartz
                                          Chief Counsel
                                          Opinions and Advice