The state Department of Health yesterday cleared AirMed Hawaii to begin air ambulance service.

State officials inspected the company's Hawker 800 jet at Honolulu airport and met with AirMed Hawaii Vice President Sandy Apter before giving the go-ahead late in the day. "We're ready to go," said Apter.

She said the jet was awaiting its first missions last night. The company will use it for interisland patient transport until a twin-propeller Beechcraft King Air C-90 arrives in about two weeks. The Hawker will remain available until a backup King Air arrives two weeks later, Apter said.

AirMed Hawaii was granted an emergency certificate of need last week from the State Health Planning and Development Agency, which determined that additional aeromedical services were needed after Hawaii Air Ambulance voluntarily grounded its fleet of four Cessnas following a March 8 crash on Maui that killed three crew members.

Hawaii Air Ambulance, which has been in service for 27 years, has since returned one of its Cessna 414As to the air and also is using a leased airplane while its other three Cessnas undergo inspection.

Department of Health spokeswoman Janice Okubo said it is up to hospitals and physicians to decide which company to call for patient transports.

Even if Hawaii Air Ambulance returns to full service, AirMed Hawaii got permission to operate for at least two years in order to recoup its costs. AirMed Hawaii is a subsidiary of AirMed International, based in Birmingham, Ala.

Hawaii Air Ambulance has enjoyed state protection from competition because of fears that the relatively small Hawai'i market could not support additional companies, and that competition would drive providers out of business, leaving the state without aeromedical services.

Hawaii Air Ambulance Chairman and Chief Executive Officer Andrew Kluger said in a statement that he disagrees with SHPDA's decision to grant emergency approval to AirMed Hawaii, saying it will not benefit the state's emergency medical system in the long run. Kluger pointed to the experience of Mercy Air, which briefly operated a Maui-based helicopter ambulance in the 1990s before quitting for financial reasons.

Kluger said his company flies patients regardless of their ability to pay, and that Hawaii Air Ambulance loses money on about a quarter of its transports. He said there is "a delicate mix between paying and nonpaying clients," and that "this delicate mix is at the heart of whether Hawai'i can indeed support two air ambulance companies."

Apter, who headed Hawaii Air Ambulance before leaving the company in 2003, said the need for aeromedical transport has increased since the days of Mercy Air.

Reach Christie Wilson at cwilson@honoluluadvertiser.com.