Two homeless men in Fresno have called for an ambulance an average of nearly twice a day for more than a year, racking up hundreds of thousands of dollars in costs and even more when they get to a hospital.

They are Fresno County's highest-volume ambulance users -- "frequent fliers" as they are called in the business -- and their 1,363 combined trips made up 1.34% of all American Ambulance calls in the county last year.

"I call all the time," Cesar Arana, 41, said while sitting on a bus-stop bench downtown. "I have a major problem with my liver."

Lonzel McPeters, 51, has seizures and says he grows concerned when he senses one coming on.

"I'd be having seizures on a regular basis," said McPeters, wearing a neck brace to stabilize a broken C-7 vertebrae after a January seizure. "I call when I feel like I'm having seizures."

Because the men don't pay for the rides, the bulk of the costs is passed on to others in the form of higher insurance rates. Taxpayers pick up part of the tab through Medi-Cal and other government programs.

Some in the industry say the two are abusing the system, using it as a free taxi service. But the men, who are friends, say they're just trying to get to a hospital for treatment of their chronic illnesses.

Calling 911 when there is no emergency is a crime and there is no law saying the men must be brought to a hospital, but ambulance officials err on the side of caution. They fear liability lawsuits such as a 1979 case in which a sick man called for an ambulance, was not picked up and died.

"We do not refuse any service," said Dan Lynch, Fresno County's emergency medical services director. "If they want to go to the hospital, we will take them. It's easier to take them than to take the time to talk them out of it."

Calling in sick

In 2011, Arana called an ambulance 710 times and McPeters 653 times. In the first 41 days of 2012, they have combined for 136 calls.

Sometimes the men call an ambulance, are brought to a hospital and walk away if they have to wait too long. Then they'll call 911 for a return ride later.

Lynch's office has sent notices to the men, demanding they stop abusing the 911 system. After sending one such notice to Arana last year, Lynch said, his office got an angry phone call from Arana.

In a taped phone conversation with Lynch's office, Arana is heard saying he didn't abuse the system and threatened to call his lawyer.

"If I want to go to the hospital and call the ambulance, I will," he said. "You cannot deny me to call the ambulance."

Said Lynch: "It's defiant; it's like laughing in my face."

Arana, who worked as a chef until five years ago, said he is not trying to be defiant but trying to follow medical directions for treating his alcohol problem.

"I am trying to make sure I am doing the right thing," he said of his frequent hospital visits.

But Lynch worries that while paramedics are treating Arana or McPeters, another call might come in with a life-threatening emergency and a second ambulance will be too far away to get there in time.

In a typical ambulance call, paramedics will give patients a physical exam and check their mental state, medical history and vital signs, said Todd Valeri, American Ambulance's general manager. They'll also ask about any medications patients are taking and allergies or reactions they have with certain drugs.

After the exam, paramedics will treat, release or transport the patient.

"If the patient still wants to be transported, we will transport," Valeri said.