HomeMy WebLinkAbout1999-446ORDINANCE NO yL- V LA
AN ORDINANCE AUTHORIZING THE CITY MANAGER TO EXECUTE A PROFESSIONAL
SERVICES AGREEMENT WITH BAYLOR MEDICAL CENTER AT GRAPEVINE AND DR
JOHN ANSOHN TO PROVIDE MEDICAL CONTROL SERVICES FOR THE CITY OF
DENTON FIRE DEPARTMENT AS SET FORTH IN THE CONTRACT, PROVIDING FOR THE
EXPENDITURE OF FUNDS THEREFORE, AND PROVIDING AN EFFECTIVE DATE (RFSP
2414 — PROFESSIONAL SERVICES CONTRACT FOR MEDICAL CONTROL SERVICES
AWARDED TO BAYLOR MEDICAL CENTER AT GRAPEVINE AND DR JOHN ANSOHN
IN THE AMOUNT OF $62,750)
THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS
SECTION I That the City Manager is hereby authorized to enter into a professional service
contract with Baylor Medical Center at Grapevine and Dr John Ansohn for the Medical Centrol
Services, a copy of which is attached hereto and incorporated by reference herein
SECTION II That the City Manager is authorized to expend funds as required by the
attached contract
SECTION III That this ordinance shall become effective immediately upon its passage and
approval
PASSED AND APPROVED this the day of ,1999
JAC M LER, MAYOR
ATTEST
JENNIFER WALTERS, C,ITY SECRETAR�Y�, y
BY
APPROVED AS TO LEGAL FORM
HERBE{tT L PROUTY, CITY ATTORN Y
BYt
PSA 2414 t CONTRACTUAL FOR PROFESSIONAL SERVICES ORDINANCE
PROFESSIONAL SERVICES AGREEMENT
FOR MEDICAL CONTROL SERVICES
STATE OF TEXAS §
COUNTY OF DENTON §
THIS AGREEMENT is made and entered into as of the �_ day of
DZCennkAr, 19C _, by and between the City of Denton, Texas, a Texas mumcipal
corporation, with its principal office at 215 East McKinney Street, Denton, Denton County,
Texas 76201, hereinafter called "CITY" and BAYLOR MEDICAL CENTER AT GRAPEVINE,
a Texas non-profit corporation located at 1650 West College Street, Grapevine, Texas 76015,
hereinafter called "BAYLOR," acting herein, by and through their duly authorized
representatives
WITNESSETH, that in consideration of the covenants and agreements herein contained,
the parties hereto do mutually agree as follows
ARTICLE I
EMPLOYMENT
The CITY hereby contracts with BAYLOR, as an independent contractor, and that
BAYLOR hereby agrees to perform the services herein in connection with the Project as stated
in the sections to follow, with diligence and in accordance with the highest professional
standards customarily obtained for such services in the State of Texas The professional services
set out herein are in connection with the following described project
Providing medical control services for the City of Denton Fire Department
ARTICLE 2
SCOPE OF SERVICES
The BAYLOR shall perform the following services in a professional manner
A BAYLOR shall perform all those services as necessary and as described in the CITY's
RFSP #2414, which is attached hereto and made a part hereof as Exhibit "A" and as
described in Baylor's Response to RFSP #2414, which is attached hereto and made a part
hereof as Exhibit `B" as if written word for word, to include but not limited to the
following
1 Off-line EMS Medical director services as required by the Texas State Board of
Medical Examiners' EMS regulations for medical directors, 22 Tex Admin Code
§§ 197 1-1976 6,
2 On-line medical control, as defined by Department regulations, 24 hours a day for
seven (7) days a week,
3 Formulation and review of EMS protocols,
4 Monthly scheduled meetings to discuss the operation of Emergency Service and
Baylor's responsibilities under this Agreement,
5 Establish guidelines and monitor quality assurance,
6 Coordinate sufficient continuing education to meet Department requirements as
set forth at 25 Tex Admm Code § 157 38,
7 By independent contract, Baylor will provide an EMS Medical Director (the
"Director"), as defined by 22 Tex Admm Code § 197 2 who fulfills the
obligations and requirements of Chapter 197, Tex Admm Code, pertaining to
EMS medical directors The agreement between Baylor and the Director to
provide the EMS Medical Director services is attached hereto as Exhibit "D" and
incorporated herein by reference,
8 Baylor will sponsor up to three (3) EMS Examiners and three (3) EMS Instructors
from Emergency Service, and
9 Baylor will provide two (3) specialty -type courses (BTLS, ACLS, and pediatric
course) for the CITY during the term of this Agreement The classes will be held
at Denton Fire Department in Denton, Texas The scheduling of these courses
will be mutually agreed upon by CITY and BAYLOR
No more than thirty eight (38) students may be enrolled in ACLS course
No more than thirty eight (38) students may be enrolled in pediatric course
No more than twenty six (26) students may be enrolled in BTLS course
B If there is any conflict between the terms of this Agreement and the exhibits attached to
this Agreement, the terms and conditions of this Agreement will control over the terms
and conditions of the attached exhibits
ARTICLE 3
PERIOD OF SERVICE
This Agreement shall become effective upon January 1, 2000 after proper execution by
the parties, and shall remain in force for a period of one (1) year This Agreement may be
renewed for additional one (1) year terms upon the giving of pnor written notice by the CITY
before the anniversary date This Agreement may be sooner terminated in accordance with the
provisions hereof
ARTICLE 4
COMPENSATION
A COMPENSATION TERMS
In consideration for BAYLOR's provision of medical control services under this
Agreement, CITY will pay to BAYLOR the fee set forth in Exhibit "C" The fee shall be
paid to Baylor in quarterly installments, consisting of four equal installments as
determined in Exhibit "C", with the first installment due on or before the tenth (10`h) day
after the Commencement Date, with each following installment due on or before the first
day of each (3rd) month following CITY shall pay all fee installments to Baylor at the
address set forth in Article 10 hereof Any fee refunds shall only be made on a prorated
Pnve 2
basis and in the event of termination of the Agreement After the expiration of the first
term of the Agreement and upon their mutual agreement, the parties may modify the
compensation to be paid Baylor by executing a new Exhibit "C" to the Agreement If
any new compensation is beyond the City Manager `s authority then the change in
compensation shall go before the city council as an amendment to this agreement
ARTICLE 5
INDEPENDENT CONTRACTOR
BAYLOR shall provide services to CITY as an independent contractor, not as an
employee of the CITY BAYLOR shall not have or claim any right ansing from employee
status Nothing in this Agreement shall be interpreted or construed so as to make BAYLOR an
employee, agent, or borrowed servant of the CITY Nothing in this Agreement shall be
interpreted or construed so as to make the employees of the CITY the servants, agents, or
employees of BAYLOR CITY and the employees of the CITY shall not be eligible for the
employment benefits, including health and unemployment insurance, and worker's compensation
coverage, which are provided to employees of BAYLOR The parties agree and acknowledge
that the Director is an independent contractor physician, and nothing in this Agreement shall be
interpreted or construed so as to make the Director an employee, servant or agent of BAYLOR
or the CITY CITY and BAYLOR acknowledge and understand that nothing in this Agreement
requires, and shall not be construed to require (directly or indirectly, explicitly or implicitly
CITY's use of BAYLOR or any other facility or service related to BAYLOR, or the admission or
referral of any persons or patients treated by CITY to BAYLOR or other facilities related to
BAYLOR
ARTICLE 6
INDEMNITY AGREEMENT
BAYLOR shall indemnify and save and hold harmless the CITY and its officers, agents,
and employees from and against any and all liability, claims, demands, damages, losses, and
expenses, including, but not limited to court costs and reasonable attorney fees incurred by the
CITY, and including, without limitation, damages for bodily and personal injury, death and
property damage, resulting from the negligent acts or omissions of BAYLOR or its officers,
shareholders, agents, or employees in the execution, operation, or performance of this
Agreement
To the extent permitted by law, CITY agrees and is bound to hold harmless and
indemnify BAYLOR against any and all claims for damages, costs, and expenses to persons or
property that may anse out of, or be occasioned by this contract or any of its activities or from
any act or omission of the CITY, its employees, representatives and agents, provided, however,
that it is not the intention or purpose to create liability against the CITY unless such liability is
imposed by law
Nothing in this Agreement shall be construed to create a liability to any person who is not
a party to this Agreement, and nothing herein shall waive any of the parties' defenses, both at
law or equity, to any claim, cause of action, or litigation filed by anyone not a party to this
pipe I
Agreement, including the defense of governmental immunity, which defenses are hereby
expressly reserved
ARTICLE 7
INSURANCE
During the performance of the services under this Agreement, BAYLOR shall maintain
the following insurance either as a self insured entity or with an insurance company licensed to
do business in the State of Texas by the State Insurance Commission or any successor agency
that has a rating with Best Rate Carriers of at least an A- or above
A Professional Liability Insurance with limits of not less than $1,000,000 annual aggregate
ARTICLE 8
ARBITRATION AND ALTERNATE DISPUTE RESOLUTION
The parties may agree to settle any disputes under this Agreement by submitting the
dispute to arbitration or other means of alternate dispute resolution, such as mediation No
arbitration or alternate dispute resolution ansmg out of or relating to this Agreement, involving
one party's disagreement, may include the other party to the disagreement without the other's
approval
ARTICLE 9
TERMINATION OF AGREEMENT
A Notwithstanding any other provision of this Agreement, either party may terminate by
giving thirty (30) days' advance written notice to the other party
B This Agreement may be terminated in whole or in part in the event of either party
substantially failing to fulfill its obligations under this Agreement No such termination
will be affected unless the other party is given (1) written notice (delivered by certified
mail, return receipt requested) of intent to terminate and setting forth the reasons
specifying the non-performance, and not less than thirty (30) calendar days to cure the
failure, and (2) an opportunity for consultation with the terminating party prior to
termination
C This Agreement shall terminate automatically upon either party's loss of licensure or
certification, or upon the effective date of any change in statute, ordinance, rule or
regulation or action of governmental authority prohibiting this arrangement or the
services contemplated hereunder
ARTICLE 10
NOTICES
All notices, communications, and reports required or permitted under this Agreement
shall be personally delivered or mailed to the respective parties by depositing same in the United
States mail to the address shown below, certified mail, return receipt requested, unless otherwise
specified herein Mailed notices shall be deemed communicated as of three (3) days' mailing
To BAYLOR
Baylor Medical Center of Grapevine
Attention Leigh Anne Bednch
EMS Education Coordinator
1650 W College St
Grapevine, Texas 76051
To CITY
City of Denton
Ross Chadwick, Fire Chief
212 West Sycamore
Denton, Texas 76201
All notices shall be deemed effective upon receipt by the party to whom such notice is
given, or within three (3) days' mailing
ARTICLE 11
ENTIRE AGREEMENT
This Agreement, consisting of 8 pages and four (4) exhibits, constitutes the complete and
final expression of the agreement of the parties, and is intended as a complete and exclusive
statement of the terms of their agreements, and supersedes all prior contemporaneous offers,
promises, representations, negotiations, discussions, communications, and agreements which
may have been made in connection with the subject matter hereof
ARTICLE 12
SEVERABILITY
If any provision of this Agreement is found or deemed by a court of competent
jurisdiction to be invalid or unenforceable, it shall be considered severable from the remainder of
this Agreement and shall not cause the remainder to be invalid or unenforceable In such event,
the parties shall reform this Agreement to replace such stricken provision with a valid and
enforceable provision which comes as close as possible to expressing the intention of the stricken
provision
ARTICLE 13
COMPLIANCE WITH LAWS
BAYLOR shall comply with all federal, state, and local laws, rules, regulations, and
ordinances applicable to the work covered hereunder as they may now read or hereinafter be
amended
P"we 5
ARTICLE 14
DISCRIMINATION PROHIBITED
In performing the services required hereunder, BAYLOR shall not discriminate against
any person on the basis of race, color, religion, sex, national origin or ancestry, age, or physical
handicap
ARTICLE 15
PERSONNEL
A The BAYLOR represents that it has or will secure, at its own expense, all personnel
required to perform all the services required under this Agreement Such personnel shall
not be employees or officers of, or have any contractual relations with the CITY
BAYLOR shall inform the CITY of any conflict of interest or potential conflict of
interest that may anse during the term of this Agreement
B Except for the services provided by the Director, services required hereunder will be
performed by BAYLOR or under its supervision All personnel engaged in work shall be
qualified, and shall be authorized and permitted under state and local laws to perform
such services
ARTICLE 16
ASSIGNABILITY
This Agreement shall apply to, and be binding upon, the parties and their respective
successors and permitted assigns The parties shall not assign any interest in this Agreement,
and shall not transfer any interest in this Agreement (whether by assignment, novation, or
otherwise) without the prior written consent of the other party Any assignment attempted
without such consent shall be void
ARTICLE 17
MODIFICATION
No waiver or modification of this Agreement or of any covenant, condition, or limitation
herein contained shall be valid unless in writing and duly executed by the party to be charged
therewith, and no evidence of any waiver or modification shall be offered or received in evidence
in any proceeding ansmg between the parties hereto out of or affecting this Agreement, or the
rights or obligations of the parties hereunder, and unless such waiver or modification is in
writing and duly executed, and the parties further agree that the provisions of this section will not
be waived unless as set forth herein
ARTICLE 18
MISCELLANEOUS
A The following exhibits are attached to and made apart of this Agreement (list exhibits)
Pgov r
I Exhibit "A" City's Request for Sealed Proposal
2 Exhibt "B" Baylor's Response to Request for Sealed Proposal
3 Exhibit "C" Compensation Exhibit
4 Exhibit "D" Baylor's Agreement with physician
B Venue of any suit or cause of action under this Agreement shall lie exclusively in Denton
County, Texas This Agreement shall be construed in accordance with the laws of the
State of Texas
C Force Maleure Neither party shall be in violation of this Agreement if either party is, or
if either party reasonably determines that it is, prevented from pei forming its obligations
for any reason beyond its control, including without limitation, flood, storm, strikes, acts
of God or the public enemy
D The captions of this Agreement are for informational purposes only, and shall not in any
way affect the substantive terms or conditions of this Agreement
IN WITNESS HEREOF, the City of Denton, Texas has caused this Agreement to be
executed by its duly authorized City Manager, and BAYLOIt�ias executed this A Bement
through its duly authorized undersigned officer on this the p day of. /
20�
CITY OF DENTON, TEXAS
;, m &, /,,/a, 7
'K4INAEL W J TY MANAGER
ATTEST
JENNIFER WALTERS, CITY SECRETARY
APPROVED AS TO LEGAL FORM
HERBERT L PROUTY, CITY ATTORNEY
BY �l
PwP7
WITNESS
BY
BAYLOR MEDICAL CENTER
AT GRAPEVINE
MARK OH OD Executive Director
Page 8
EXHIBIT "A"
CITY OF DENTON
RFSP # 2414
PROFESSIONAL SERVICES
CONTRACT FOR MEDICAL
CONTROL SERVICES
BID OPENING DATE: SEPTEMBER 23,1999
NOTICE TO VENDORS
Proposals will be received by the City of Denton, Texas at the office of the Purchasing Agent prior
to 2 00 p in., SEPTEMBER 23,1999 for the following
RSFP # 2414 - PROFESSIONAL SERVICES CONTRACT FOR MEDICAL
CONTROL SERVICES
Qualified prospective suppliers my obtain copies of the proposal with information at the office of
the Purchasing Agent, located at 901-B Texas Street, Denton, Texas 76201 in the Service Center
complex
The City of Denton, Texas reserves the right to reject or accept any proposal and award to the most
advantageous proposal received
No officer or employee of the City of Denton shall have a financial interest, direct or indirect in any
contract with the City of Denton
Minority and small business vendors are encouraged to submit proposals
CITY OF DENTON, TEXAS
(940)349-7100
TOM D SHAW, C P M
PURCHASING AGENT
This advertisement to run: SEPTEMBER 8 AND SEPTEMBER 15 1999
PFSP 2414-STANDARD AD
REQUEST FOR PROPOSAL
The City of Denton is accepting Request for Proposals for a Professional Services
Contract for medical control services for the Denton Fire Department per the enclosed
requirements Two (2) copies of the proposal must be submitted by September 23, 1999
in a sealed envelope with the following information marked plainly on the front
RFSP # 2414
CITY OF DENTON
901E TEXAS STREET
DENTON, TX 76201
Questions regarding the attached specifications may be directed to Greg Taylor, EMS
Program Manager, at 940/349-8132
Requirements
The requirements of the Medical Control provider fall into three categories as described
below
I. On -Line Medical Direction
A On-line services shall be provided as required by the Texas State Board of
Medical Examiners' EMS regulations for medical directors in 22 TAC, §197
B On-line service via phone with two dedicated lines and fax/modem compatible
with Life -Pak 12s will be provided 24-hours, 7 days per week
C A relationship with a local Denton hospital for on-line medical control is
preferred
D Assistance will be provided in disasters and MCIs with destination control and
bed availability
E Permanent audio recordings will be maintained of all on-line medical
direction and copies provided to DFD upon request
II Off -Line Medical Direction
A Medical Control services shall be provided as required by the Texas State
Board of Medical Examiners' EMS regulations for medical directors, 22 TAC
§ 197
B The Medical Director will be a board certified Emergency Medicine physician
located in Denton, Dallas, Tarrant, or Collin counties
C Protocols and SOPs will address basic and advanced life support procedures
D Continuous protocol development and review will be provided
E Quality Assurance guidelines will be established according to a systematic
plan and will include the following
I Written and skills evaluations will be conducted at least annually as part of
a system to ascertain individual and system -wide proficiency and to satisfy
TDH recertification requirements
2 CQI summaries will be generated by the Medical Control provider and
reported to the DFD EMS Program Manager on a monthly basis or as
requested
3 Field evaluations will be conducted by experienced nurse/paramedics and
paramedic instructors Results will be reviewed with the EMS Program
Manager and written summaries provided
4 Patient chart and system audits will be conducted monthly for the purpose
of complying with quality control provisions in accordance with the Texas
Department of Health
III. Continuing Education
A The Medical Control provider will conduct both basic and advanced
continuing education in accordance with the Texas Department of Health
guidelines each contract year to employees of DFD Continuing education
classes will be offered at DFD fire stations at a date and time mutually
agreeable to the City and the provider
B Continuing education courses will be scheduled for each of the three shifts to
accommodate one-half of each sluft per course, once per month on -site
C A multi -discipline approach to CE instruction will be used and should be
enhanced by video instruction, quality improvement reviews, and computer -
based training
D Skills and protocol review will be incorporated into continuing education
curriculum
E. Provider will offer initial and recertification courses for DFD paramedics and
emergency medical technicians including a TDH approved pediatric course,
ACLS, and BTLS courses
F A written remediation plan will define procedures for DFD employees who
fail to meet minimum requirements of the evaluation tools used by the
Provider and Texas Department of Health
IV Contents of Proposal
Proposals offered for consideration under this RFP will contain the following
A Curriculum Vitae on medical director, program manager, and course
instructors
B Statement of services to be performed
C Current client base, size of total population served, and a client history
encompassing the last five years
D Length of time in business
E. Softwarethardware, computer configuration requirements in order to
implement program
F Samples of CE evaluation tools, CQI reports, and other forms used in the
administration of the medical control program
G A division of duties between the Medical Director and the DFD EMS Program
Manager will be clearly defined
H Outline of quality assurance program
I Implementation plan for integrating City of Denton Fire Department into
Provider's present system
J References
K Documentation of certifications and licenses
L A certificate of insurance or a statement from an agent/broker indicating that
medical malpractice coverage exists must be included Coverage limits,
policy term and name of agent/broker handling coverage must be included on
the documentation
V Terms
In consideration of services rendered, such services shall receive compensation on
a contractual basis, with payment disbursed in quarterly amounts as specified in
the Contract subject to contractual limitations The Medical Director and the
Medical Control Provider are responsible for providing their own insurance
including, but not limited to, medical malpractice insurance, and all other licenses
and certificates necessary to carry out the job requirements The City shall
provide no additional compensation or reimbursement for such expenses The
Contract period will be for one year, with an option to renew the Contract
annually for additional one-year terms upon agreement of the parties Any such
renewal shall be subject to the written approval of the City of Denton Fire
Department
VI Consideration of Proposals
Proposals shall be opened so as to not disclose the contents The City of Denton
Fire Department may enter into negotiations with as many Proposers as have
submitted feasible proposals in order to arrive at the best possible contract
Applicants may receive an invitation to appear before a panel of City of Denton
Fire Department personnel for an interview
The City of Denton Fire Department reserves the right to accept any proposal
deemed most advantageous to the City, to reject all proposals, and to negotiate the
specific terms of the contract with any selected proposer
VII. Projected Time Table
The projected date for a Medical Control Provider to be contracted is November
1, 1999 Services would commence immediately upon execution of the contract
VIII Indemnity or Hold Harmless Statement
Medical Control Provider agrees to defend, mdemmfy and hold the City harmless
for any loss sustained by the City as a result of a claim or suit by a third party
claimant to the extent that such a loss is the result of negligence, bad faith, or
default of Medical Control Provider The Medical Control Provider further agrees
to perform the services with that standardof professional care, skill and diligence
normally provided in the performance of like or similar services
CITY OF DENTON, TEXAS F/RE DO
DEMOGRAPHICS OF THE DENTON FIRE
DEPARTMENT'S EMERGENCY MEDICAL
SERVICE
The Denton Fire Department operates the emergency ambulance service for the city of
Denton and our neighboring communities in central and northwest Denton County We
have provided this Advanced Life Support ambulance service since 1978 We serve a
population of over 125,000 in our response area
Today, we operate six (6) Mobile Intensive Care Units, three (3) frontline and (3) reserve
These units are staffed by firefighter/paramedics When needed, the reserve MICUs are
manned from the crews of on -duty engine companies Due to our increasing call volume
a fourth, frontline MICU will be added in early 2000
Over 70% of all the 8,000 plus calls that the Fire Department receives each year are for
medical responses Within our city we have an average response time of 5 09 minutes
The average response time in the county is 1152 minutes To get help to the county
residents sooner, the volunteer fire departments serve as first responders in their
communities and are an integral part of our EMS delivery system
When a 911 call is received a coordinated response begins The 911 dispatchers are
trained in providing pre -arrival instructions in First Aid and CPR until the responding
units get to the scene On every medical call both a fire engine and ambulance are
dispatched All of Denton's fire engines are manned by firefighter/paramedics and are
fully equipped to provide Advanced Life Support If the engine arrives before the MICU
they will begin treatment to stabilize the patient The care of the patient is then continued
by the firefighter/paramedics assigned to the MICU
We are fortunate in Denton to have two fine hospitals Both hospitals have Fire
Department radios as well as dedicated phone lines for EMS use The decision of which
hospital to use is left to the patient If the patient has a preference, then we will transport
to that local hospital If the patient doesn't have a preference, is unable to tell us, or the
patient's condition warrants, then the patient is transported to the closest hospital that can
care for the patient's injuries or illness
217 WEST McKINNEY STREET DENTON, TEXAS 76201
OFFICE (940) 349.8110 FAX (940) 349-8109
Page 2, Demographics of the Denton Fire Department Emergency Medical Service
The Denton Fire Department is dedicated to providing our customers with the very best
EMS system possible We made a decision several years ago to have all of our personnel
cross -trained as paramedics Out of the 100 persons in operations over 70% are currently
paramedics With the projected growth of our city, the Department is planning on adding
approximately 40 firefighters and at least one new station within the next three years All
of these new recruits will receive both firefighter and paramedic training
Recognizing that our citizens are always the first care givers on a scene, the City is
current implementing a Public Access AED program We have begun placing Automatic
Defibrillators in the City facilities The first unit will be placed in the Senior Center The
program calls for an additional 15-20 AEDs, as funding becomes available
BAYLOR MEDI:Al
i Gdaul in Cann ui i0 H
4TER AT GRAPENINE
W din Jk 1, Hwdrh C m w v
September 22, 1999
Tom Shaw, CPM
City of Denton
901B Texas Street
Denton, Texas76201
Dear Mr. Shaw
EXHIBIT "B"
di
� LJ, : LT"�- L UNTEP. a (
Paul
MPA, NRE'N4T-P
,nh' n,,,
e �'il sir il. _r i J
Enclosed are the ingredients that were requested by your city for RFSP #2414
have described our services that are offered and hope that you find this bid
acceptable
We can provide the requested services for an annual fee of $52,750.75
Items that are not included in this price are ACLS ($100 per person), BTLS ($125
per person), and pediatric course fees (price unknown at this time) These prices
would be determined on the number of providers that Denton FD would be
sending to these type of classes. These fees are reported for budgeting
purposes. ACLS is a system requirement and all paramedics would be required to
obtain this certification
A start up fee of $950.00 would be required to purchase the necessary
protocol books and to teach the initial three New Paramedic Orientation courses
As DFD added new paramedics (after the initial three courses), DFD would need
to budget $100 per paramedic. Again, this fee is reported for budgeting
purposes Attendance at a New Paramedic Orientation course is required for all
paramedics
I cannot think of any additional fees except for initial training courses for
paramedics, intermediates, and basics These fees would not be paid to Baylor
because DFD would send these students to other institutions. Baylor does not
teach these courses because of upcoming national and state requirements There
are many excellent schools in the area that can do this in accordance with the
upcoming state and federal changes.
If I can assist you in any way, please contact me at (817) 329-2815
Sincerely,
Paul L Rosenberger, MPA, NREMT-P
EMS Coordinator
l,n(t., T., i W,I
Mera (81-) 4�1 1 ",
Baylor Medical Centel at Grapevine
EMS Medical Control
Curriculum Vitae
For EMS Medical Director, EMS
Coordinator, and Instructor Staff
C--
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MEDICAL SCHOOL University of North Texas Health Science Center,
Texas College of Osteopathic Medicine, Forth Worth,
Texas, Graduated Cum Laude in May 1985
Student Memberships Student Government, National
Osteopathic Honor Society, Class Officer, Texas
Osteopathic Association, Texas Medical Association,
American Osteopathic Association, American
Academy of Family Practitioners
INTERNSHIP Northeast Community Hospital, Bedford, Texas
Graduated July, 1986 Rotating
LICENSING EXAMS American Osteopathic Boards Part I March 1983, Part Il
March 1985, Federal Licensing Exam (FLEX) June 1985,
Texas Medical Jurisprudence June 1985
BOARD CERTIFICATION December 28, 1992 American College of Osteopathic
Family Physicians, American Osteopathic Board of Family
Physicians
LICENSE State of Texas December 3, 1986, Texas License #H013
DEA #BA0534342
SOCIETY MEMBERSHIPS Tarrant County Medical Society, Texas Medical
Association, Texas Osteopathic Medical Association,
American Osteopathic Association, American
Academy of Family Practitioners, American College
Of Osteopathic Family Practitioners, American College
Of Sports Medicine, American Osteopathic Academy of
Sports Medicine, Association of Military Osteopathic
Physicians and Osteopathic Physician and Surgeons,
American College of Emergency Physicians
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Certifications State of Texas Paramedic
State of Texas EMS Coordinator
State of Texas EMS Examiner
Advanced Cardiac Life Support Instructor
Advanced Cardiac Life Support Provider
Basic Cardiac Life Support Instructor
Basic Cardiac Life Support Provider
Basic Trauma Life Support Instru or
Basic Trauma Life Support Provider
Nationally Registered Emergency Medical Technician - Paramedic
Prehospital Pediatric Provider Course
Prehospital Pediatric Provider Course Instructor
Lugeue Bates Jr.
4502 Dorchester CL
Grapevine TX 76051
EmDIoyment Htstory
1986-present City of Grapevine
Job Duties Firefighter/ParamediefField Training Officer for the Fire Department
1996-Present Baylor Medical Center of Grapevine
Job Duties EMS Instructor
1996-Present Tarrant County Junior College
Job Duties EMS Instructor
Certifications
Texas Commission of Fire Protection as Firefighter
Texas Commission of Fire Protection as intermediate Instructor
Texas Department of Health as Emergency Medical Technician/Paramedic
Texas Department of Health as Emergency Medical Services Skills Examiner
Texas Department of Health as Emergency Medical Services Instructor
American Heart Association as Advanced Cardiac Life Support Provider/Instructor
American Heart Association as Basic Cardiac Life Support PCOvider/Instructor
Basic Trauma Life Support international as BTLS Provider/Instructor
�,
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volume Responsible for county wide EMS, transfers, and assisting in public awareness of EMS
Sole BTLS certified medic in Okmulgee EMS Sole medic in Okmulgee EMS pursuing Paramed c
certification
1/92-7/93 Security Concepts of Tulsa, Tulsa, OK
Owner
Responsible for sales, termtory development, inventory, and presentation of home, personal, ara
auto security systems
Currently covering a to -state area
87-5/92 Windsor Consultants Inc., Houston, TX
Data Processing Consultant
Responsible for client development, and recruiting of qualified individuals for clients Responsible
for salary negotiation, reference verifications, and salary surveys Responsible for general
recruitment on regional and national basis Knowledgeable in salary and compensation, EEOC
practices, and technical practices
86-12/86 Magnacon, Houston, TX
Consultant
Responsible for client development and recruitment of individuals for contract placement
Responsible for hourly rate negotiation and candidate compensation
85-6/86 Builders Square #1010, Houston, TX
Inventory Control Supervisor
Responsible for 7-8 MM dollar inventory Responsible for entry of purchase orders and recenting
orders into systems Supervised 1 to 2 employees during tenure
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Experience (cont ):
Six Flags Over Texas, Inc.
f mergenet .kiedical Technician May 1991-December 1991 Duties included
providing First Aid to the guests of Six Flags Over Texas
Palk �ervic&s, April 1986-May 1991 Duties included managing a crew of eight
personnel and ensuring the cleanliness of the park
Education
Tarrant County Junior College, Fort Worth, Texas
Graduated December 1996 with an Associates Degree of Applied Science in Fire
Protection Technology
Texas A&M University, College Station, Texas
August 1989-May 1991 Studied courses m Aeronautical Engineering
Tnmty High School, Euless, Texas
Graduated with Honors in June 1989
Certifications
Texas Intermediate Firefighter
Texas Intermediate Fire Instructor
TDH EMT-P
ACLS Provider
ACLS Instructor -expired January 1998
PHTLS Provider -expired October 1997
PPPC Provider
TDH EMS Instructor
TDH Skill Examiner
Awards:
Valedictorian, Metrocrest Medical Services, Inc Paramedic Class #10
Outstanding Scholastic Freshman, Infantry Band, Texas A&M University
Eagle Scout
References:
Geo Randy Corbin, Fire Cluef
Lewisville Fire Department
188 North Valley Parkway
Lewisville, Texas 75067
972 219 3580
Steven Palmer
5932 Cimarron Trail
Ft. Worth, Texas 76148
(817)581-0889
Obiective
To use my education and years of fire and emergency medical experience in an administrative
training capacity
Experience
Keller Fire Department - 137 Taylor Street, Keller, Texas 76248
July 1988 - Present
Job Title Lieutenant
Duties include EMS Officer for the department with responsibility for mamtamg the
department's EMS training records, ordering EMS supplies, mamtamg protocols, ensuring
compliance with the CQI standards, preparing the EMS budget, writing the specifications
for EMS equipment and vehicles, and ensuring the department complies with all Texas
Department of Health Rules, Supervision of daily activities for station, flow testing
hydrants, conducting fire inspections of businesses, computer upgrades and maintenance,
conducting personnel evaluations, supervising fire training, assist in budget preparation,
- - conduct new hire interviews, coordinate CPR for the all city departments
Baylor Medical Center Grapevine - 1650 West College Street, Grapevine, Texas 76051
December 1995 - Present
Job Title EMS Instructor /Examiner/ EMS Web Master
Duties include Instructing EMTs and Paramedics in continuing education, Advanced
Cardiac Life Support, Basic Trauma Life Support, CPR, and EMT schools
Developing, updating, and overseeing the EMS web page
Medical Education Systems - P 0 Box 820702, North Richland Hills, Texas 76182
July 1996 - Present
Job Title Owner
Duties include Coordinate EMT curriculum, coordinate instructors, order equipment and
supplies, instruct classes, and ensure program quality
Education
Tarrant County College - Associate Degree in Emergency Medical Technology
(estimated completion December 1998)
f
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c
�7 TEXAS DEPARTMENT OF HEALTH
Ka CerttJla that
Ll L STEVEN B PALMER
meets the regtaremenu ja certy7catton as
Imtructor
Expires 00112000
WOIhmIt Archer OT.MA. GeroWwtW4chief
Pa camel M 14483 Expiry 08/31/2000
Document 6383d
STEVEN BRADLEY PALMER
6832 CIMARRON TR
FORT WORTH TX 76148
Report ehangee In ad&= or employment to
Tam Departmant of Heelth
Burau oCEmetgenq Management
1100 Wen49th
Austin, TX 7SlS6-3I"
Robert W. Potter
4941 Colonial Park Dr
Haltom City, Texas 76117
817-577-4265
SUMMARY
I haN a dedicated the last 12 years of my life to the service of the citizens of the State of
Texas, first as a police officer, and then as a fire fighter I have been involved in the medical
care of people since 1991 as an EMT, and then progressing to a Paramedic and finally as a
Registered Nurse My goal is to protect and service those around me
WORK HISTORY
1996-Current Fire Fighter/ Paramedic Richland Hills Fire Department
Provide Fire and EMS service to a city of approximately 8,5oo people Duties include Fire
Suppression, Emergency Medical Services via MICU, and Fire/Arson Investigations
1996-Current Emergency Room RN, North Hills Hospital
Provide care to patients of all ages with either medical problems or trauma injuries in an
emergency department that has on average over 2200 patients a month
1996-1999 Emergency Room RN/Trauma Coordinator, DFWMedical Center
Provide care in the emergency room setting, as well as began the development of the Trauma
Center program for the hospital
1987-1996 Public Safety Corporalll, DFIVAirport
Cross trained in Police, Fire and EMS Performed general Police and EMS duties m the
Patrol/Rescue Division and Fire Suppression duties in the Aircraft/Fire/Rescue Division
111111000111
1992-1995 Associates Degree in Nursm& Tarrant County Jumor College
LICENSES s OERTIROATES
• Certified Police Officer, 1987
• Certified Fin Fighter, 1988
• Registered Nurse, 1995
• Emergency Medical Techmcian-Paramedic, 1994
• Licensed Paramedic, 1999
• Trauma Nurse Con Course, 1997
• Pediatrics Advanced Life Support, 1996
• Emergency Nurse Pediatric Course, 1998
• Rescue Systems One, Rescue Course, 1997
• Hazardous Materials Technician, 1998
• Swift Water Rescue Technician 1, 1993
• Swift Water Rescue Technician 2, 1994
• Advanced Peace Officer, 1997
• Basic Pohce Officer Instructor, 1995
• Fire & Arson Investigator Basic, 1997
• Fire Commission Instructor Intermediate, 1997
• Te+uas Dept of Health Instructor & Examiner 1999
• Special Weapons and Tactics School, 1992
aaytoi ivieaicai i-enter at urapevine
EMS Medical Control
Statement of services to be
performed
Baylor Medical Center currently offers EMS Medical Control Services to ten fire -
based EMS services in North Tarrant and South Denton Counties Our services
can be grouped into four basic categories. The categories are on/off-line medical
direction, continuing education, CQI standards, and written protocols All are
offered to ensure the highest level of consistency in the clinical care arena
On-line medical direction, in most cases, is offered by Baylor Medical Center at
Grapevine through our emergency department (ED) The ED is staffed twenty-
four hours per day and seven days a week with a staff of nurses and physicians
These health care professionals are trained to answer our dedicated EMS
phones. We contract with EmCare to provide physician services and to perform
the EMS on-line consultation and direction duties. The ED has double physician
coverage from noon to midnight, this will reduce the chance of a doctor being
tied up with a critical patient and needing to talk to EMS at the same time
Other on-line medical direction sites are allowed when the requesting facility
signs a contract and fulfills its commitments to become a site. Currently, Harris
Methodist Hospital HEB has obtained this status Medical Center of Lewisville is in
the process of obtaining this status. Denton Community has expressed its
interest, if Baylor is awarded the bid.
Three dedicated phone lines, a fax, and a Physio-Control twelve lead receiving
station is located in an EMS work area This area also contains a recording device
for conversations between Baylor and the EMS service Disaster assistance is
available by activating the Baylor Emergency Response Team. Destination control
and bed iavailability can be offered as best as possible when a disaster strikes
Off-line medical control direction is another area offered. Baylor contracts directly
with Dr John Ansohn for his role as the EMS Medical Director Dr Ansohn works
for EmCare and Metroplex Emergency Physician Association (MEPA) While
working for EmCare his services are provided at Baylor -Grapevine. When working
for MEPA, his services are provided to Denton Community Hospital. By reviewing
Dr Ansdhn's resume, you will see that he climbed the ladder to obtain his role as
a physician. As a result, he Is very paramedic friendly and, most importantly, a
strong believer In the role that EMS plays In the continuum of care
tsayior i�,Ieaicai (.enter at uiapevine
EMS Medical Control
2FSP 1-2,14;J^r:a FD
Baylor traditionally offers CQI standards only These standards are developed by
the EMS CQI Sub -Committee and approved by the EMS Medical Control
Committee. The standards are implemented by the fire department by utilizing a
CQI Officer and Field Training Officers Remediation and quality improvement
recommendations are usually developed by the agency (CQI Officer) and
approved by the EMS Medical Director
The RFP submitted by Denton actually requests that medical control provide
skills examination (once per year), chart audits, field evaluations, and CQI
summaries These services are traditionally conducted by the agency and
subject to inspection by the EMS Medical Director These services are included
(with Baylor performing these duties) in the final quote
Baylor will provide an EMS Instructor eight hours per week (three weeks per
month) who will come to Denton and conduct chart audits, field evaluations, and
CQI summaries during this time The instructor will make every attempt from the
EMS Coordinator employed by the FD to obtain the charts, obtain who is to be
evaluated, and submit monthly summaries Skill evaluation/instruction can be
offered during this time Skill testing will be offered on a testing case -by -case
basis and is not part of the bid. Our current fees for TDH skills testing are, EMT -
Basic $100 per person, EMT -Intermediate $130 per person, and EMT -Paramedic
$150 per person In the past, the system (Baylor and fire departments) conduct
two EMS Skills testing dates to fulfill TDH criteria Admission is free for testing
candidates when the fire department submits a TDH Examiner
EMS Protocols are developed and written by the EMS Protocol Sub -Committee
and approved by EMS Medical Control Our existing protocols are researched and
based in national standards. In the skills section, skill levels are identified for
EMT -Basics, EMT -Intermediates, and EMT -Paramedics The chapters of the
protocol book are Introduction, Cardiac, Medical, Pediatric, Trauma, Medication
Reference, Skills Reference, and Medical Control Policies and Procedures An
original protocol book is supplied to the fire department and the agency will be
allowed to make as many copies needed A protocol book will be supplied to
each paramedic during orientation courses Updates and revisions are
communicated through the agency's EMS Coordinator
bayior rieaicai renter at urapevine
EMS Medical Control
Length of time in business
The EMS Medical program was developed in 1993 as a joint endeavor between
Baylor -Grapevine and the Cities of Colleyville, Flower Mound, Grapevine, Keller,
Southlake, and Trophy Club
The hospital property, in Grapevine, was bought by the Baylor Health Care
System In 1981 from a group of local physicians and became Baylor Medical
Center at Grapevine In 1903, Texas Baptist Memorial Sanitarium was developed
and renamed Baylor Hospital in 1921 The health care system has operated in
North Texas since 1903
The system enjoys the strength, wealth of knowledge, and expertise that can
come from being part a historically world renowned health care system
bayior iweoicat center at c,rapevine
EMS Medical Control
Samples of CE evaluation tools, CQI
reports, and other forms used in
the administration of the medical
control program.
Enclosed are copies of the CE Verification Form, CE Registration, Participant
Evaluation Tool (student critique of Instruction) Enclosed In the attached CQI
Plan are the forms used in the CQI process
Date
Course Title
Content Area
EMS CE REGISTRATION
Course Location
Course Approval Number 100145
Instructor Name and ID Number
Shift
Awarded
Lesson ID Number
Coordinator Paul Rosenbereer Medical Control Use
Only
student Name De artment 1D Number Pass / Fail
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Continuous Quality Improvement
Plan
c
Baylor Medical Center at Grapevine EMS Medical Control
Introduction:
Baylor Medical Center at Grapevine currently provides medical control to several public based EMS providers r
Northeast Tarrant and Southern Denton Counties EMS medical control is provided to the cities of Colleyville
Euless, Flower Mound, Grapevine, Keller, Lewisville, Richland Hills, Roanoke, Southlake, and Trophy Club
The combined population for these nine cities is over 268,110 people Nineteen fully dedicated ambulances and
numerous Paramedic Engine Companies (PEC) provide high quality emergency medical services
The goal of the medical control system is to aid in the enhancement of emergency medical service and to provice
access to medical control and educational opportunities to agencies participating in the system This goal is
accomplished by Baylor Medical Center at Grapevine providing continuing education, continuous quality
improvement (CQI), protocols, and on/off line medical contrdl
CQI is a comprehensive program that reviews all aspects of EMS care and has multiple participants The CQI
program is composed of a data base, in -field evaluations, a patient follow-up process, patient satisfaction
surveys, new paramedic orientation courses, chart evaluations, incident investigation process, testing standards,
and on-line medical control patient report review
The CQI process relies on several different participants to make it effective Field Training Officers (FTO), CQI
Officers, and the EMS Coordinator and Medical Director are essential to system review and improvement FTOs
are selected by the agency and approved by medical control The qualifications that a FTO has are that he/she is a
paramedic in good standing with their respective agency and has completed a FTO course that is hosted by
Baylor It is recommended that a FTO is a ranking officer and is certified by the Texas Department of Health as
an Instructor and Examiner, or is certified by the Texas Commission on Fire Protection as a Basic Fire Instructor
or higher FTOs are responsible for conducting chart review, and conducting in -field evaluations
The CQI Officer should be a ranking officer within the agency or has been delegated the authority to implement
to CQI the process When this person is not a ranking officer, Medical Control will communicate directly to the
agency's EMS Coordinator for various issues FTOs are directly accountable to the CQI Officer The CQI
Officer is selected by the agency and approved by Medical Control The qualifications that a CQI Officer
possesses are that he/she is a paramedic in good standing with their agency and has completed a FTO course that
has been hoste&by Baylor It is highly recommended that the CQI Officer is a ranking Officer within the agency
It is recommended that the CQI Officer is certified by the Texas Department of Health as an Instructor and
Examiner or is certified by the Texas Commission on Fire Protection as a Basic Fire Instructor or higher CQI
Officers are responsible for all of the FTO roles and compilation, review, forwarding of the data base
requirements, chart evaluation, and adaunistering the patient satisfaction survey
The EMS Coordinator is employed by Baylor Medical Center at Grapevine EMS Medical Control The EMS
Coordinator is accountable to the EMS Medical Director The qualifications that the EMS Coordinator possess
is that he/she possess is certified by Texas Department of Health as an Instructor and Examiner It is preferred
that the EMS Coordinator also possesses the Coordinator certification The EMS Coordinator is responsible for
oversight of the entire EMS medical control program
"Responding to the Call of Excellence"
Baylor Medical Center at Grapevine EMS Medical Control
Organizational Chart:
"Responding to the Call of Excellence" 4
Baylor Medical Center at Grapevine EMS Medical Control
- In -Field Evaluation:
A Field Training Officer (new employees) or the iridividuars ranking officer (current employees) will conduct in-
field evaluation on each paramedic A field training officer or appropriate officer will evaluate each primary
paramedic annually New paramedics in the system will have an evaluation at the sic -month anniversary date and
at the one-year anniversary date These m-field evaluations should be incorporated or utilized when conducting
an annual performance review for the EMS provider
The paramedic must obtain a score of "Meets Expectations" or higher and satisfy all absolutes on the evaluation
When an improvement opportunity is identified, the CQI Officer and the EMS Coordinator will develop a plan of
action
The in -field evaluation form will evaluate the following components of EMS duties
I Paramedic preparedness
Il Interaction with other public service entities
III Patient and family rapport
IV Skill technique
V Protocol application and implementation
VI Interaction with on-line medical control staff
VII Interaction at the receiving facility
"Responding to the Call of Excellence"
Overall Rating Score
FTO/CQI Officer Signature
EMS Provider Signature
FTO/CQI Officer should make comments in the appropriate areas EMS Providers should make
comments in the area below
III Patient and family rapport
4 = Interactions are always professional and friendly No valid complaints from family
or patient
3 = Interactions are consistently professional and friendly Very few valid complaints
from family or patient
2 = Interactions are usually professional and friendly May require intervention,
complaints are considered mild in offense
1 = Interactions lack courtesy and professionalism. Intervention required
0 = Commits an offense that is grossly offensive to patient or family
(SA) X (W) 15% =
Rating Justification
IV Skills technique
4 = Follows all skills criteria and exlubits proficiency according to established
guidelines in the Procedure Chapter of the protocol book
i
3 = Follows all skills criteria and exhibits a moderate level of proficiency according to
established guidelines in the Procedure Chapter of the protocol boo
2 = Adheres to most of the established guidelines in the Procedure Chapter of the
protocol book but exhibits a minimal level of proficiency
1 = Performs skills but in a manner or fashion that is inappropriate
0 = Does not know skills criteria as established in the Procedure Chapter of the
protocol book Not proficient in skills usage
(SA) X (W) 25% _
Rating Justification
vII Interaction at the receiving facility
4 = Interactions are always professional and friendly Patient reports are concise and
the appropriate information is relayed
3 = Interactions are consistently professional and friendly Patient reports are concise
and the appropriate information is relayed
2 = Interactions are usually professional and friendly Patient reports are not always
concise and/or the appropriate patient information is not relayed
1 = Interactions occasionally lack professionalism or friendliness Patient reports are
not always concise and/or the appropriate patient information is not relayed
0 = Patient reports are not concise and/or patient information is not relayed
Rating Justification
r
(SA) X (W) 5% _
Baylor Medical Center at Grapevine EMS Medical Control
Patient Satisfaction Surveys:
Patient Satisfaction Surveys will be mailed out by the agency on at least twenty- percent of all EMS responses
When an improvement opportunity is identified, the CQI Officer and the EMS Coordinator will be responsible
for developing a plan of action
"Responding to the Call of Excellence"
'Your City Logo
P 0 Box 123
Beautiful City USA 12345
-------------------------DETACH HERE --------------
CITY OF BEAUTIFUL
CUSTOMER SERVICE SATISFACTION SURVEY
Recently you had an occasion to contact the Beautiful City Fire/EMS
Department with a request regarding
PLEASE GRADE US!
HOW SATISFIED WERE YOU
Were the Fire/EMS personnel fair and non-discriminatDry7
Were the Fire/EMS personnel friendly and caring?
Were our FireJEMS personnel knowledgeable?
Were our MrelEMS persarmel courtemWhelOU responding to YOW Asa?
Were you sadsfled with ttie quality of service we provided'
Were you sadOed whh the FreJEMS personnel over all perfonnance7
p
B
C
D
F
p
g
C
D
F
A
g
C
D
F
p
B
C
D
F
p
g
C
D
F
Yes
No
ADDITIONAL COMMENTS OR SUGGESTIONS YOU MIGHT HAVE AND WISH TO SHARE
New Paramedic Orientation
Day 1
0800-0900
Why 12 Lead ECG
0900-1100
Cardiac Anatomy & Electrophysiology
1100-1200
Lead Placement
1200-1300
Lunch
1300-1500
Characteristics of a Normal 12 Lead ECG
1500-1700
Characteristics of an Abnormal 12 Lead ECG
Day 2:
0800-1200
Protocol Review
a
Introduction Chapter
b
Cardiac Chapter
c
Trauma Chapter
d
Medical Chapter
e
Pediatric Chapter
1200-1300
Lunch
1300-1400
Protocol Review
f
Procedures Chapter
g
Drug Information Chapter
1400-1600
Skills Instruction and Testing
a.
Implantable Access Systems
b
Intraosseous
c
Percutaneous Airway
d
Pleural Decompression
1600-1700
Written Examinations
ISM
Agency
Certification Level
New Paramedic Orientation Course
Course Completion Checklist
Agency I D #
Protocol Handbook
ram
Review
Skill Sheet
Implantable Access
Systems
Skill Sheet
Intraosseous Infusion
Skill Sheet
Cncothyrotomy
Skill Sheet
Pleural
Decompression
Written Examination
BCLS and ACLS are system requirements If you do not possess these certifications,
please notify your agencies EMS Coordinator
Baylor Medical Center at Grapevine
EMS Medical Control Program
Introsseous Infusion Skill Sheet
Candidates Name:
Agency
Yes
No
I Description of action to be undertaken
Locates site (Antenor aspect of the tibia 1-3 cm below the tibial tuberosity)
Preps area with aseptic technique, outward direction
Directs I0 needle inferiorly to avoid the eptphyseal plate
Verbalizes successful cannulatton (Must verbalize at least one of the following Lack of
resistance after needle passes through the bony center, needle stands upright without suppo--
ability to aspirate bone marrow, or free flow of the infusion without significant subcutaneo s
infiltration)
Attaches I, fluid
Secures needle with protecti-ve dressing
Satisfies the above criteria
Comments
Medical Control Use Only"
Signature of Examiner -
Date
Baylor Medical Center at Grapevine
EMS Medical Control
Pleural Decompression Skill Sheet
Candidate Name:
Agency
Yes
No
Description of action to be taken
Identifies the need for pleural decompression (Must verbalize two of the following signs or
symptoms dyspnea, diminished breath sounds, hypotension, or distended neck vems)
Locates the second or third mtercoastal space in the mid -clavicular line
Preps area with aseptic technique, outward technique
Inserts the needle over the nb into the pleural space
Withdraws the needle from the catheter and attaches the one-way flutter valve
Secures pleural decompression device
Continuously monitors the breath sounds, respiratory rate and effort
Satisfies the above criteria
** Medical Control Use Only**
Signature of Examiner:
Date-
" Chart Evaluation:
x-
Baylor Medical Center at Grapevine EMS Medical Control
The agency's CQI officer will oversee chart evaluation The agency will review a mimmum of thirty charts per
month (with available call volume) Each agency will review at least fifty percent of the following categories of
calls ALS calls, aeromedical support, CPR, pharmacological agent administration (excluding oxygen, and IV
therapy), and completion of a patient refusal form
Selected sections of the protocol book have a corresponding CQI Appropriateness of Care Standard that will be
utilized to evaluate improvement opportunities On the back of these sheets are comment sections for the EMS
provider and the CQI officer or FTO Providers will respond to questions by the CQI Officer or FTO in a timel%
fashion
The goal for chart evaluation is to have ninety- percent compliance to the appropriate standard that applies to a
given medical condition and satisfy all absolute requirements The provider will be required to treat and
document a patient report with compliance to the CQI standard and protocol Deviations from the standard
should be explained on the patient care report
At the end of each month, the CQI Officer will submit a copy the Quality Management report to Medical
Control All charts are subject to inspection to Medical Control When an improvement opportunity is identified,
the CQI Officer and the EMS Coordinator will develop a plan of action
"Responding to the Call of Excellence" 10
Please complete the information below for each chart that does not meet the CQI standards
r
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Improvement Action Codes I = Discussed with Individual, 2 = Referred to Supervisor, 3 =
Referred to Medical Control, 4 = Departmental policy changed, 5 = Protocol review/change,
and/or 6 = Other, please specify
FTO/CQI Officer Observations & Questions
-. EMS Provider Comments•
EMS Provider Signature Date
Baylor Medical Center at Grapevine EMS Medical Control
Provider Name
** Confidential Information **
Medication Administration Appropriateness of Care Standard
Chart Number
Standard'
Medication administration was in comphance with protocols or direct orders
Absolute-
***
Yes:
Na-,
Nh
given by Medical Control
Provides complete documentation of the following
***
route, time administered, dosage, and the person administering the
medication.
Provides complete documentation of the medicated IV drip Name of
***
solution, amount of medication in solution and rate
Assesses change in patient condition after treatment
I***
Documents allergies, when available
I***
Are the Absolutes Satisfied? Yes No
- - Score of Chart
Is the Score Greater Than 89%? Yes No
If any of the absolutes are not satisfied or the score is not equal to or greater than 90%, the chart does not meet
the CQI standards Please make comments on the back of this sheet EMS Providers are required to respond to
FTO/CQI Officer comments
FTO/CQI Officer Signature
Date
Baylor Medical Center at Grapevine EMS Medical Control
T
Provider Name
** Confidential Information **
Trauma Appropriateness of Care Standard
Chart Number
Provides chnicai cession.
*'*
Obtams history and chief compliant Provides time, mechanism of injury, and
loss of consciousness
Assesses respiratory status Rate, symptoms of distress, breath sounds, and
pulse oximeter
***
Provides appropriate airway control and oxygen therapy***
Assesses vital signs re- rt, transport, or as directed by protocol.
**+
Provides continuous cardiac monitoring with correct interpretation.
***
Assess neurological status
***
Provides full assessment of all body stems
***
Provides spinal yMobilization, wound dressing, and/or facture stabilization
***
Provides IV therapy Lists rate, route, size, site, fluid, and person initiating IV
with the number ofattempts
***
Performs advanced skills as indicated MAST, pleural decompression, or
other Lists the person initiatmg the skill
***
Assesses change m1patient condition after treatment
**'
Contacts Medical ontrol
Reassesses patient condition at receiving facility
Treats patient in compliance with protocol
***
Scene tune 10 minutes or less for major trauma
***
Are the Absolutes Satisfied? Yes No
Score of Chart
Is the Score Greater Than 89%9 Yes No
If any of the absolutes are not satisfied or the score is not equal to or greater than 90%, the chart does not meet
the CQI standards Please make comments on the back of this sheet EMS Providers are required to respond to
FTO/CQI Officer comments
FTO/CQI Officer Signature
Date
Baylor Medical Center at Grapevine EMS Medical
Provider Name
Date of Incident
Parties Involved
Description of Incident/Event*
Date Reviewed
Action Taken
** Confidential Information **
Adverse Incident/Sentmel Event/Chmcal Compliant
Appropriateness of Care Standard
Chart Number
Please attach any pertinent paperwork
Baylor Medical Center at Grapevine EMS Medical Control
Testing Standards:
TDH Evaluation Tool:
For the EMT or EMT -I to function within the medical control system, the EMT must obtain an overall score of
at least a seventy five percent The EMT-P must obtain an overall score of at least a seventy five percent and
achieve at least a seventy- percent in each subscale area
First Failure
If the provider fails the TDH Evaluation Tool, the EMS Medical Director will assign a probationary status and
the provider will be given the opportunity to self -study The provider will continue to function at their state
certified level
The EMT or EMT -I will be administered an evaluation tool, by Medical Control, which will cover the entire
course content of an EMT basic or EMT -I course, which ever is appropriate
The EMT-P will retest the specific subscale that the provider faded, up to three subscales If the individual fails
four or more subscales or the overall score is below seventy-five percent, the EMT-P will retest the entire course
content of an EMT-P course These tests will be administered by Medical Control
All testing will be completed within mnety days
Second Failure
If the provider fails the TDH Evaluation Tool and the Medical Control Examination, the provider will continue
their probationary status and study with a FTO The probationary provider must function under the FTO's direct
supervision and cannot be responsible for patient treatment at any time The provider may perform skills only
when supervised by the FTO If the FTO's supervision is not provided, the provider may only function at a level
below their certification A paramedic will function at the EMT level
The EMT and EMT -I will be administered another examination, by Medical Control, which will cover the entire
course content of an EMT or EMT -I course, whichever applies
The EMT-P wdl retest the specific subscale that the provider failed or the entire course content of an EMT-P
course, which ever applies according to the first failure criteria This test will be admimstered by Medical
Control
All testing will be completed mtlun ninety days of the EMS Medical Director receiving the test results from the
EMS Coordinator
"Responding to the Call of Excellence" 12
Baylor Medical Center at Grapevine EMS Medical Control
Second Failure*
If the provider fails initial Protocol Examination and the retest, the provider will continue their probationary
status and work and study with a FTO The probationary EMT-P must function under the FTO's direct
supervision and cannot be responsible for patient treatment at any time The EMT-P may perform skills only
when supervised by the FTO If the FTO supervision is not provided, the provider may only function at an EMT
level
The EMT-P will retest the specific section that the EMT-P failed Medical Control or the CQI Officer will
administer the retest All testing will be completed no sooner than fourteen days and no later than sixty days
Third Fa►lure-
If the EMT-P fails the initial protocol examination and two retests, the provider will receive a letter from the
EMS Medical Director that states that they are no longer eligible to provide any EMS care under the direction of
the EMS Medical Director's authority A fire fighter status will be the only recognized status If the EMT-P
wants to regain their EMS status, they must attend a New Paramedic Orientation Course After successful
completion of this course and the entire Protocol Examination, the EMT-P status will be reassigned A fire
fighter status will be assigned from the failure date of the retest to the date of successful completion of the New
Paramedic Orientation Course
Fourth Failure,
After failure of the initial Protocol Examination, two retests, and the New Paramedic Orientation Course, the
EMT-P will be considered a fire fighter only and subject to disciplinary actions established by their respective
agencies
"Responding to the Call of Excellence" 14
Baylor Medical Center at Grapevine EMS Medical Control
Physician Competencies:
On/Off line Medical Control Physicians will be required to complete an exercise that is intended to familiarize the
physician with medical control systems medications, procedures, and quality assurance plan The exercise is in a
question and answer format The physician will have two weeks to complete the exercise The exercise will be
administered by the respective medical director at each on-line medical control site and submitted to the EMS
Coordinator
"Responding to the Call of Excellence" 16
Your Name:
Date:
Please list the 28 drugs that are camed by the paramedics on each EMS vehicle This can
be found in the Introduction or Drug Information Chapters
2 List the type of Intravenous Solution and sizes that are carved by the paramedics in the
EMS vehicles This can be found in the Introduction Chapter
5 What does the term "Open" and "Closed" mean in the Transportation Guideline protocol?
In the event of an Adverse Incident/Sentinel Event/Clinical Complaint where can the
reporting form be found? (ER Departmental Policy)
7 This form should be completed and mailed to
Baylor Medical Center at Grapevine
EMS Education -Attention Paul Rosenberger
1650 West College Street
Grapevine, TX 76051
Comments or Suggestions
In consideration of the services provided in the attached Agreement, City of Denton
will pay to Baylor the fee of $62,750 00 per year for each term of the Agreement Cityof
Denton shall pay the fee to Baylor in quarterly installments of $15,687 50 per
installment
CONFIDENTIAL AND PROPRIETARY
PROPERTY OF BAYLOR HEALTH CARE SYSTEM
ALLPRiviLEGES CLAIMED
EXHIBIT "D"
MEDICAL DIRECTOR AGREEMENT
This Medical Director Agreement ("Agreement") is entered into effective as of the 1" day of November,
1999 ("Effeetwe Date"), by and between Baylor Medical Canter at Grapevine. ("HospttaP)> a Texas
nonprofit corporation, and John Ansohn, D O ("Physician")
RECITALS
Hospital operates an acute care general hospital located in Grapevine, Texas and requires certain
administrative services for medical direction and/or supervision of prehospital care by emergency medical
service ("EMS') personnel ("Medical Control"),
Hospital requires the services of a physician with specialized training and experience in emergency
medicine to provide part-time professional and administrative direction for EMS Medical Control, and
Physician possesses specialized training and experience in the area of Medical Control and is qualified to
provide such services, and
Hospital desires to engage Physician as part-time Medical Director for EMS Medical Control, and
Physician desires to accept such engagement with Hospital and in that capacity to provide services under
the terms and conditions of this Agreement
AGREEMENT
NOW, THEREFORE, in consideration of the foregoing premises, and the mutual covenants and
conditions contained herem, Hospital and Physician agree as follows
EMPLOYMENT
Hospital hereby employs Physician to serve as part-time Medical Director for EMS Medical
Control ("Medical Director") and Physician hereby accepts such employment, all subject to the
terms and conditions of this Agreement
2. TITLE.
Physician's title shall be Medical Director, EMS Medical Control
EMS MEDICAL CONTROL JOHN ANSORN, D O
®BAYLGR HEALTH CARE SYSTEM 1999 PAGE 1 OF 17
ot d FMB McAeal Dueetm A®—Aiedm)
CO"ID NTULANDPROPRIETARY
PROPME. Or ORWWRI11MC I erCAR. 9Tsrmvr
EXHIBIT "B"
MEDICAL DIRECTOR AGREEMENT
This Medical Director Agreement ("Agreement") :s entered into effective as of the V day of November,
1999 ("Effective Date"), by and between Baylor Medical Center at Grapevine ("Hospital"), a Texas
nonprofit corporation, and John Anschn, D O ("Physician")
RECITALS:
Hospital operates an acute care general hospital located in Grapevine, Texas and requires certain
administrative services for medical direction and/or supervision of prehospltal care by emergency medical
service ("EMS') personnel ("Medical Control"),
Hospital requires the services of a physician with specialized training and experience in emergency
medicine to provide part-time professional and administrative direction for EMS Medical Control, and
Physician possesses specialized trammg and experience in the area of Medical Control and is qualified to
provide such Services, and
Hospital desuas to engage Physician as part-time Medical Director for EMS Medical Control, and
Physician desires to accept such engagement with Hospital and in that capacity to provide services under
the terms and conditions of this Agreement
AGREEMENT:
NOW, THEREFORE, in consideration of the foreggmg_premises, and the mutual covenants and
conditions contained harem, Hospital and Physician agree as follows
I- Ei��1
Hospital hereby employs Physician to serve as part-time Medical Director for EMS Medical
Control ("Medical Director") and Physician hereby accepts such employment, all subject to the
terms and conditions of this Agreement
2. TTfLE.
Physician's title shall be Medical Director, EMS Medical Control
EMS MRoicAL CONTROL - JOaN ANsoaN, D.O
Vag
6&MB
CONFEDENTIAL AND PROPRIETARY
PROPERTY OF BIYLOR HEALTH CARE SYSTM
ALL PRiy ILEGES CLAWED
3 DUTIES OF PHYSICL4Y
3 l Services Physician shall perform the Services (defined below) pursuant to the terms and
conditions of this Agreement, and shall serve the Hospital faithfully and diligently, according to
the best of his/her abilities Phvslclan shall serve as the Medical Director for EMS Medical
Control and shall, in such role, have the following major areas of responsibility (a) assisting
Hospital in defining the scope and characteristics of Medical Control services provided in the pre -
hospital emergency care of patients, (b) providing trauung and consultation to EMS personnel as
required by all applicable state and federal statutes, rules and regulations and as requested by
Hospital; and (c) monitoring the delivery of Medical Control services in the pre -hospital care of
patients by EMS personnel In carrying out such responsibilities, Physician shall perform the
specific services set forth on Exhibit AA attached hereto and incorporated herein by reference (the
Services') The Services are administrative to nature and do not constitute the practice of
medicine
3 2 Hours Physician shall devote on average eleven (11) hours per week to the performance of
Services hereunder, with the enact dates and times to be coordinated by the Physician and the
Hospital in accordance with the needs of the Hospital, and subject to approved absences,
provided, hov ever, that Physician shall not provide and Hospital shall not be obligated to
compensate Phvstcian for more than five hundred seventv-sic (576) hours of Services per each
one (1) year term of this Agreement
3 3 Reports and Records Physician shall provide Hospital with written documentation of all
Services rendered hereunder Such documentation shall be submitted to Hospital on a periodic
basis as reasonably requested by Hospital The documentation shall be in the form, and contain
the information, as may be requested by Hospital from time to time to comply with applicable
federal and state laws, regulations and rules, and with the physician compensation allocation
requirements under the Medicare and Medicaid programs
34 Reporting Relatlonshios Physician shall report to (1) the Executive Director of Hospital with
respect to all administrative matters, and (it) the Chief of the Medical Staff at Hospital or such
committee of the Medical staff as the Chief of the Medical Staff mav, from time to time,
designate with respect to all clinical, medical staff policy and planning and professional matters
Physician also shall maintain effective liaison with the medical directors of all clinical
departments in the Hospital for clinical and professional matters related to, as appropriate, clinical
integration, quality improvement, patient care, research and teaching
ENIS NEEDICAL CONTROL JOHN X43OW. D O
ilir y199 PAGE 2 OF
YNal 0=wr pnohn�+
CO;F ENTIALA. xD PROPRIETARY
PROPERTY OP SMOR HEALTH CARE SYSTEM
4LL PRIM ILEGES CLAWED
REPRESENTATIONS, WARRANTIES AND CERTAIN COVENANTS OF PHYSICIAN
4 1 Licensure and Certification Phv sieian represents and warrants that he/she is, and during the term
of this Agreement shall remain duly licensed, registered and in good standing under the laws of
the State of Texas to engage in the unrestricted practice of medicine and to administer and
prescnbe controlled substances, and is possess the qualifications for Medical Director (off-line)
as set forth in the regulations of the Texas State Board of Medical Examiners, 22 TEX ADMIN
CODE § 197 1 et seq Phvstcian represents and warrants that lusher license to practice medicine
and certificate to prescnbe medications and controlled substances in the State of Texas or in any
other jurisdiction has never been denied, suspended, revoked, terminated, voluntarily relinquished
under threat of or subject to disciplinary action, probated, or restricted in any way Physician
further represents and warrants that he/she has not been subject to disciplinary or corrective
action by any hospital or licensing agency or to exclusion or debarment from either the Medicare
or Medicaid program Upon request, Physician shall provide to Hospital third -party
documentation to evidence the accuracy of the foregoing representations and warranties and,
upon request, shall authorize (in venting if requested) Hospital to obtain venfication directly from
third parties
42 Medic NIembershiD Phy sician represents and warrants that he/she has or will obtain prior
to the Effective Date, and during the term of this Agreement shall maintain, Hospital medical
staff membership and appropriate clinical pnvileges, in good standing However, this Agreement
is not, and shall not be construed as, any form of guarantee or assurance by Hospital that
Physician will obtain or retain medical staff membership or appropnate clinical privileges, since
such membership and privileges are governed solely by the bylaws of Hospital and the bylaws of
the medical staff at Hospital as amended from time to time
an -ants that he/she is, and dunng
43 Contterm o fthi Medical Education remaPhyin,
professionallyian ts and tra trained experienced in current EMS Offs
term of this Agreement shall remain, p
Line Medical Control, and agrees to take all actions necessary to maintain such training and
experience as mae be required by the Texas State Board of Medical Examiners and as necessary
to abide by the requirements of Phesician s medical board specialty, including, without
limitation, attendance, at professional conventions, post -graduate seminars, continuing medical
education seminars and conferences and functions of professional societies ("CME Activities")
less such
for in n the budget of the DepE Activities are at the artment t and/or approe cost and expense ved Physician advance by Executive Directorxpenses s accounted
44 Conflicts_ of 1_nterest Phvscian shall complete and execute a Baylor Health Care System
approved form of Conflicts of Interest Statement identifying all known and anticipated conflicts
Physician or any of his or her family members has with any entity affiliated with Baylor Health
complywithwith the Baylor iHealth Care System Conflicts of Interest es dunng the Term of this tan shall be sublet[ to and
Pol cy
EeIS MEDICAL COMMOL ioaN A,xsOHN, DO
YBAY" OR �A[yjji CARE $YSTEei 1999 PAGE 3 OF 17
d E\IS Had,al Du l Apn'Ra M VuoM AnN
CONFIDENTIAL A.w PROPRIETARY
PROPERTY OF BAYLOR HEALTH CARE SYSTL%t
ALL PRIVILHGES CLA WD
4 5 Disclosure Physician shall promptly (within three (3) days) notify Hospital in the event any
representation or warrant, by Physician set forth in this Agreement shall no longer be true,
correct or complete
46 Compliance with Hospital Policies Physician shall compl, with all applicable bylaws, rules and
regulations of the medical staff at Hospital, and the policies and procedures of Hospital, as are in
effect from time to time Phvstcian shall work cooperatively with the personnel of Hospital, and
in particular, those persons working in or on behalf of Hospital
47 Education Programs Physician shall participate in the EMS and Medical Control educational and
training programs conducted by Hospital, and shall perform such other teaching and training
functions within Hospital as Hospital reasonably requests Physician shall monitor developments
and improvements in the provision of medical services relating to Medical Control, and shall
work with Hospital in the implementation of developments in the service area
48 Ethics and Professional Standards Physician shall comply with the ethical and professional
standards of the American Medical Association, the Joint Commission on Accreditation of
Healthcare Organizations, the Health Care Financing Administration, the Texas Department of
Health, the Institutional Ethics Committee at Hospital and other relevant professional and
go,eming bodies Physician shall comply with the Bavlor Health Care System Code of Conduct,
Clinical Ethics Guidelines and Business Ethics Guidelines
49 Inc mng FLDanctal Obllgation. Expenses Physician ma, not incur an, financial obligation on
behalf of Hospital without the prior written approval of Hospital Phvsician will be responsible
for all expenses incurred in providing Services under this Agreement, unless such expenses are
approved in advance by Executive Director
4 10 Private Medical Practice Nothing contained herein shall prevent Physician from establishing and
maintaining a private medical practice Physician shall conduct his/her private medical practice
in a manner that permits fulfillment of his/her responsibilities under this Agreement Physician
in
shall d t determine, and e such may bills for ervices and colecttalldsuch charges, without payment ofmedical actice as he/she
anv part of the
proceeds thereof to Hospital
4 11 No Other Baylor Relationship Physician represents warrants to Hospital
that neither
or
Physician nor any family member of Physician has an agreement or arrangement
written) for the provision f or
rn or any of
its affiliated organizations, other sthan as services
forth Hospital, Baylor
rth on E bitB ttached hereto and incorporated
herein by reference and/or as established by this Agreement
PROFESSIONAL LIABILITY INSURANCE
E,IS,IEDICAL CONTROL JOHN ANSOaN, D O
_ av TR CA_ v SYQTE,i 191" PAGE OP 1L
MENS,NEmy Ovaroe AVv� (loM ANdm Nil)
COYrmE-4TtAL A.w PROPRIETARY
PROPERTY OF BAYLOR HEALTH CARE SYSTEM
ALL PRIVILEGES CLALNED
In the event Physician maintains a private medical practice, Physician, at his/her own cost and
expense, shall maintain, in full force and effect during the Term of this Agreement, professional
lability Insurance, issued by an insurer acceptable to Hospital, covering Physician against all
claims arising out of the performance of services constituting the practice of medicine
( Malpractice Insurance') Malpractice Insurance shall be in amounts of coverage no less than
the minimum required by Hospital to be a member of the medical staff dunng any year The
insurance policy shall require the tamer to provide Hospital with written notice of any
cancellation or reduction of Insurance coverage at least twenty (20) days in advance of such
cancellation or reduction On or before the Effective Date and thereafter upon request, Physician
shall promptly delivery to Hospital certificates of insurance evidencing such coverage
INDEMNIFICATION
Physician shall indemnify and hold harmless Hospital from and against any and all claims,
liabilities, damages and expenses, including without limitation reasonable attorneys' fees Incurred
by Hospital, Its officers, directors, employees or agents, ansing out of or related to the acts or
omissions (including the negligence) of Phvstclan in connection with Physician's practice of
medicine
7 OwNERSHIP OVACCESS TO BOOKS AND RECORDS
7 1 Government Access to Books and Records Physician shall comply with all applicable federal
and state laws governing the maintenance of documentation to venfy the cost of Services
rendered under this Agreement Until the expiration of four (4) years after the furnishing of
Services pursuant to this Agreement, Physician shall make available, upon wntten request of the
Secretary of the Department of Health and Human Services or the Comptroller General of the
United States, or any of their duly authonzed representatives, this Agreement, and books,
documents, and records of Physician that are necessary to certify the nature and extent of such
costs
72 Notice to Hospital If Physician receives a request or demand to disclose any books, documents
or records relevant to this Agreement for the purpose of an audit or investigation, Physician shall
immediately (within two (2) business days after receipt of such request or demand) notify
Hospital in writing of the nature scope of such request or
available to Hospital, upon wntten r qdemand Physician
request of Hospital, all such booksdocumentsor recordds e
73 Ownership of Rg r s All Hospital and Medical Control records shall be and remain the
property of Hospital
g FINANCIAL ARRANGEMENTS
ENS MEDICAL CONTROL Joan AYSoax, D O
mBAYLOR Fes.' Ta CA.Q* SYSTEM 1599 PAGE OF l7
d ENS Nadrtal Jv I AFt VO vxan ura„
CONIMEVTIAL A.w PROPRIETARY
PROPERTY OF BAYLOR HEALTH CARE SYSTEM
In consideration of the performance by Phystcian of the Services set forth in this Agreement,
upon submission of the reports and records required by this Agreement, and subject to the
limitations of tton 3 2, Hospital shall pay to Physician a salary at the rate set forth on Exhibi
Q attached hereto and incorporated by reference herein, provided, however, that Hospital shall
not be obligated to pay Physician any salary unless this Agreement and all of its terms and
conditions are approved b% the Executive Committee of the Baylor Health Care
System
Board of
Trustees on or before December 31, 1999 Physician shall not bill any patients
ty
pa -, ors for Services pro-,ided pursuant to thus Agreement
9 TER,rt AND TERSIINATION
9 L Term of Aareemert condition The original tern of thus Agreement shall be for a period of one
(1) year commencing on the Effective Date (the "Onginal Term'7, unless terminated earlier in
accordance with the provisions of thus Agreement This Agreement shall be automatically
extended for additional successive one (1) year terms (each, a "Renewal Term") under the same
terms and conditions unless the Agreement is otherwise terminated pursuant tten notice poor ts Article 8 o
either party elects not to so renew by giving the other parry rty' ( )days nnote a subject
the end of any term Notwithstanding anything herein to the contrary, this AgreementJ
to and shall be conditioned upon its approval by the Executive Committee of the Baylor Health
Care System Board of Trustees, and, in the event that such Executive Committee does not
approve of the Agreement on or before December 31, 1999, this Agreement shall be null and void
and of no effect whatsoever
92 Termination b Vlual Consent This Agreement may be terminated at any time by mutual
wntten agreement of the parties
93 Oononal Terminariopn runet Agreement
90 days nor written n a be either of the panes without cause
by giving the other arty y ( ) p
9 d Termini'ion for Breach Either party may terminate this Agreement immediately for breach of
any material term or condition of this Agreement by the other party ("Breaching Party") if such
breach is not corrected within ten (10) business days after wntten notice thereof is received by the
Breaching Parry The notice of breach under this Section shall specify with reasonable
particularity the nature and extent of the matenal breach for which complaint has been made
95 Termination by Hospital Hospital may terminate this Agreement, effective immediately upon
notice to Physician, in the event of
ion, withdrawal und
er threat of
linarN
a any ternution,
probation nlimitation ornreduct on n Physic an s staff pnvil gesp at Hospital or
any other hospital or health care facility, or
E-,IS NIEDICAL CONTROL - JOHN A,YSOMMi, D O
„ AY ay 71f Gti > SYSTEM 1999 PAGE 6 oP 17
d EMS �IedcJ Dueelar Apt, (oM ��—
CON11DENTIAL AND PROPRIETARY
PROPERTY OF BAYLOR HEALTH CARE S"T"
anv termination suspension probation, limitation, revocation or lapse of
Physician's (a) license to practice medicine in the State of Texas, (b) state or
federal authorization to administer or prescribe controlled substances, or
(c) qualification under the Medicare or Medicaid programs, or
charging or conviction of Physician by any federal or state agency or authority of
anv crime involving fraud, moral turpitude or Immoral conduct
96 M tters Relauna to Medical Staff tembershio and Due Proce Medical staff membership is a
condition to the performance of Services under this Agreement However, this Agreement is not,
and shall not be construed as, any form of guarantee or assurance by Hospital that Physician will
obtain or retain medical staff membership or clinical privileges, those matters are governed solely
by the bylaws, rules and regulations of the medical staff at Hospital as are in effect from time to
time The oarenei&al or rmintion of s Agreement shall
membersh prior clinical privil gesaof Ph siaiiian at Hospital, %&hch taffect
status shall be separatethe medical ly
goyemed by the bylavvs of the medical staff of Hospital, although the event causing the
termination under this Agreement may also be grounds for action under such bylaws Any due
process or other requirements of Hospital or its medical staff bylaws, rules or regulations shall not
apply to the termination of this Agreement
97 Leal omoliance If there is a change in anylaw, regulation or rule, state or federal, e in the
which
affects this Agreement or the activ ities of either party under this Agreement, or any g
judicial or administrative interpretation of any such law, regulation or rule or if any of the
prov isions of this Agreement are found to be in violation of the laves existing at the time of such
determination, and either party reasonably believes in good faith that the change, inteationstior its
on or
determination will have a substantial adverse effect on that p�Y's se
ss rights or obligations under this Agreement, then the party may, up written notice, require the
other party to enter into good faith negotiations to renegotiate the terms of this Agreement and to
take any action necessan to maintain compliance with such laws, rules or regulations If the
parties are unable to reach an agreement concerning the modification of this Agreement within
the earlier of forty-five (45) day s after the date of the notice seeking renegotiation or the effective
date of the change, or if the change or determination is effective immediately, then either party
may immediately terminate this Agreement by written notice to the other party
10 CONFIDENTLALLM
Phvscian acknowledges that in connection with this Agreement and the Services provided by
Physician under this Agreement, Phvstcian may be acquiring and making use oen
confidential information of Hospital which includes, but is not limited to, managementcPrtai
financial statements, internal memoranda, reports, patient information, and other materials or
records of a proprietan nature (` Confidential Information") Therefore, in order to protect the
Confidential Information, Phvstcran shall not use such Confidential Information except in
E\IW yiEDICAL CONTROL JOHN A79s;w1, D O
�' u YSTEy11999 PACE 7 OF �IS HWuil Dvrtwr kVt (JoM A � Mi)
CONPD)EVTUL AND PROPRIETARY
PROPERTY Of BAYLOR HEALTH CARS SYSTLM
ALL PRIVu,SOES CLAW&D
connection with the performance of Physician s duties pursuant to this Agreement, or divulge the
Confidential lnformation to an) third party, unless Hospital consents in writing to such use or
divulgence or disclosure is required by law Physician shall comply with the applicable federal
and state laws and regulations governing the confidentiality of all patient medical records and
peer review information In the event Physician receives a request or demand from a third parry
for the disclosure of Confidential Information, Physician shall promptly (within two (2) business
days after receipt of such request or demand) provide written notice to Hospital of such request or
demand, including a copy of any written document of such request or demand Upon termination
of this Agreement, Physician shall not take or retain, without prior written authonzation from
Hospital, any patient records, other patient clinical data or information, patient list, papers, fee
schedules, files, or other documents or copies thereof or other Confidential Information of any
kind belonging to Hospital pertaining to patients, business, sales, financial condition, or products
of Hospital Without limiting other possible remedies for the breach of this covenant, the parties
agree that injunctive or other equitable relief shall be available to enforce this covenant, such
relief to be w ithout the necessity of posting a bond, cash or otherwise
11 NOTICES
Notices or communications to be given under this Agreement shall be provided to the appropriate
party in writing either by personal delivery, overnight delivery service, confirmed telefacsimile or
registered or certified mail, postage prepaid, as follows
To Hospital
Baylor Medical Center at Grapevine
1650 W College St
Grapevine, Texas 76051
Fax (817) 481-2962
Attention Executive Director
w ith a copy to
BHCS Office of General Counsel
3600 Gaston Avenue
Suite 1157, L B 83
Dallas, Texas 75246
Fax (214) 820-1535
If to Physician
John Ansohn, D 0
ENiS NtED1cAL CQrfmoL JouN ANSOE1N D O
"BAILOR RE.U.TR CARE SYSTB,A11 PAC380I 17
d E�1$ �I�� (loM NecM MYl
CONFIDENTIAL A.ND PROPRRTARY
PROPERTY OF BAYLOR HEALTH CARE SYSTEM
Fax
or at such other addresses and to such other persons as either parry may from time to time
designate by notice given as herein provided Such notices or communications shall be deemed
to have been given upon receipt if by personal delivery, three (3) business days after deposit in
the United States mall if sent by regular, registered or certified mall, postage prepaid, one (1)
business day after delivery if by an overnight delivery service, or upon transmission confirmation
if by telefacsimde
12 GENERAL PROVISIONS.
12 1 Entire Agreement ° an *anon r onstruction This Agreement, any amendments or addenda
hereto, and any exhibits specifically mentioned herein constitute the entire agreement between the
parties regarding the subject matter hereof and supersede all poor or contemporaneous
discussions, representations, correspondence, offer letters, memoranda and agreements, whether
oral or written, pertaining thereto By executing this Agreement, the parties acknowledge that
they have been represented by independent counsel, and have had the opportunity to review and
consider its terms The language of this Agreement shall be construed as a whole according to its
fair and common meaning The various titles of the sections herein are used solely for
convenience and shall not be used for interpretation or construing any word, clause, paragraph, or
subparagraph of this Agreement
122 ! ounteroarts This Agreement may be executed in multiple counterparts, and each counterpart
shall be considered an original
123 Further Acts The parties each agree to cooperate fully with the other party to take such further
action and execute such other documents or instruments as necessary or appropriate to implement
this Agreement
124 Amendments Tlus Agreement may be amended only by a written instrument signed by Hospital
and Physician
125 ASSI£nment Physician may not assignor delegate the tights, duties and obligations of Physician
under this Agreement to any other person, group or professional association Hospital may not
assign or delegate the rights, duties or obligations of Hospital under this
hi Agr ementho"vto any that this
other
person or entity without poor written consent of Physician, p
rovd,Agreement may be assigned to any corporation or other entity succeeding to the business of
Hospital in connection with the merger, consolidation or transfer of all or substantially all of the
assets and business of Hospital or with a corporate reorganization involving Hospital This
Agreement may also be assigned to any subsidiary, parent corporation or other affiliate of
Hospital
ENiS MEDICAL CONTROL JOaN A.NsoliN, D O
CBf" OR wv TH C,L SYSTEM 1999 PAaE 9 OF 17
d EIS �IedKal 0va1m Apnt (IoM ANaM�
PROPERT\ OF BAYLOR HL%LTH CARE SYSTEM
126 No Third Party Beneficianes This Agreement shall be binding upon and inure to the benefit of
the parties hereto, their successors and permitted assigns Nothing in this Agreement is intended,
nor shall be deemed, to confer am benefits on any third party, including, without limitation any
patients of the Hospital, nor shall such person or entity have any right to seek, enforce or recover
am right or remedy with respect hereto
127 gepresentatlons and Warranties Phvstcian acknowledges that Hospital is relying on
representations and warranties contained in this Agreement in entering into this Agreement and
the transactions contemplated hereby
128 Severability If any term or provision of this Agreement is held illegal, invalid or unenforceable
to any extent, the remainder of this Agreement shall not be affected thereby and each term and
provision of this Agreement shall be valid and enforceable to the fullest extent permitted by law,
and in lieu of each such illegal, invalid or unenforceable provision the games shall use then best
efforts to add as a part of this Agreement a provision as similar in terms to such illegal, invalid or
unenforceable provision as may be legal, valid, and enforceable
129 Waiver Waiver by either party of a breach or violation of any provision of this Agreement shall
not operate as, or be construed to be, a waiver of any prior, concurrent or subsequent breach of
the same or similar provision None of the provisions of this Agreement shall be considered
waived by either party except when such waiver is given in writing
12 10 Governing Law. Venue This Agreement shall be construed and governed according to the laws
of the State of Texas, without giving effect to its conflict of laws provisions The parties hereto
expressly agree that this Agreement is executed and shall be performed in Tarrant County, Texas
and venue of all disputes, claims and lawsuits arising hereunder shall lie in Tarrant County,
Texas
12 11 Remedies The remedies provided to the parties by this Agreement are not exclusive or
exhaustive, but are cumulative of each other and in addition to any other remedies the parties may
have
against the
ther
ce any
tion or
12 12 AnOMMS Fees If either party covenant of this Agreement, the brings
vailin ationin addition t ootherto
elief awarded by acourt or
prevailing party, y
arbitrator, shall be entitled to recover from the other party Its court costs and reasonable
attorney's fees incurred in such action
12 U Confidentiality of Agreement Physician shall keep this Agreement and its contents confidential
and not disclose this Agreement or its contents to any third party other than his/her legal and
financial advisors, or otherwise as required by law, without the prior written consent of Hospital
ENIS NLEDICAL CONTROL JOHN AMOEI , D O
eBA LOR �,a, TH C SYSTE�r�---�- P Q le OP 17
0 ENS Ne Mc tAI tVW Anon °""�
PROPERTY Or DAYLoa HEALTH CARE SYSTLN
1214 Corporate Fichte of Medicine Nothing contained herein is intended to (a) constitute the use of
a medical license for the practice of medicine by anyone other than a licensed physician, (b) aid
Hospital or an-Y other corporation to practice medicine when in fact such corporation is not
in any
r act or
arrang arrangements ntice viola violaine, or (c) constitute or tion the Texas Medical PraccticetAct (TEXt REV CIV STAT ANN other
art
4495b)
12 15 FF id ML&UM Law and Texas Heap►+ &Safety Code The parties enter into this Agreement
with the intent of conducting their relationship in full compliance with applicable state, local, and
federal law including the Stark law, the Medicare and Medicaid Anti -Fraud and Abuse law and
the Texas Health & Safety Code Illegal Remuneration law Nownthstanding any unanticipated
effect of any of the provisions herein, neither party will intentionally conduct itself under the
tAn�Fof this r Anti -Fraud and Abuse law or Tement in a exas Health & Safety Code Illegal Remuner to constitute a violation of the erationnla provisand ns Medicaid
12 16 No Refeital Obliaatton Physician acknowledges and understands that this Agreement does not
require, and shall not be construed to require (directly or indirectly, explicitly or implicitly),
Phyr service related
ission or
refesiman's use of rral of anv patientsitrlor any othereated by Physician toacility oHosptal or othetrfac facilities elatedtoHospital
This ng
of
any other hospital or health care entity or from referreement does not prohibit Physician from ring pa patients to utliz g the seron the vices ocal ff any
other hospital or health care entity
[Signature Page Follows]
ENiS NiEDiCAL CONTROL JoHN k,4soHN, D O '
HENS Me " WuMmApnlfl AIYa1N
CorrvmerrrrAL A.YD PROPRnTAAY
PROPERTY OP BAYLoR HEALTH CARS SYSTEM
ALL PRIVEAGSS CLAMD
IN WITNESS WHEREOF, the parties hereto have duly executed this Agreement by their
respective duly authorized representatives as of the Effective Date first stated above
HOSPITAL
BAYLOR MEDICAL CENTER AT GRAPEVINE
a Texas nonprofit cor or�atio
Mark Hood
Executive Director
PHYSICIAN
JOHN AN&OHN, D O
Texas M cat License No 40 k3
EATS NIEDicAL CGlrraoL - Jomv A.`isomv, D O
�DBAYLOR aHALTB CARE SYSTTM 1999 PAGE 12 or 17
d ENSN D Ia Ap1tt( oTlu Anafin�
EXHIBIT A
ADMINISTRATIVE SERVICES
Provide off-line EMS Medical Director services as required by the regulations of the Texas State
Board of Medial Examiners for EMS medical directors, presently codified at 22 Tex Admm
Code § 197 1 et seq for those EMS systems ("The EMS Systems") listed below and as may be
added from time to time through contractual agreement with Hospital
a Colleyville Fire Department,
b Denton Fire Department,
c Euless Fire Department,
d. Flower Mound Fire Department,
e Grapevine Fire Department,
f Keller Fire Department,
g Lake Cores Fire Department,
h L waville Fire Department,
i Richland Hills Fire Department,
3 Roanoke Fire Department,
k Southlake Department of Public Safety,
L Trophy Club Emergency Medical Services
2 Facilitate Continuous Quality Improvement (CQI) activities at Hospital for the EMS Systems
3 Formulate and review emergency medical service protocols
4 Establish guidelines and monitor quality assurance for all Medical Control activities
5 Coordinate sufficient continuing education to meet Department of Health requirements as set
forth in 25 Tex Admm Code § 157 38
6 Provide trammg and education on EMS -related matters through Hospital to EMS Systems
7 Represent the Hospital on EMS -related issues before local, regional and state EMS and trauma
organizational boards and authorities
8 Provide and facilitate strategic planning for Hospital EMS Medical Control system
Attend and represent Hospital at medical control meetings and sub -committee meetings as
needed
EMS Me.DiCei. CorrrnoL -Joey ANSO@I, AO
am
PROPsatY Or BAYIAR HULTH CAR19 SYS76M
t0 Assist in enforcing the bylaws and the rules and regulations of the Hospital's medical staff as well
as any other Hospital, medical staff or patient care policies and procedures
1 l Perform other duties or special requests as may from time to time be reasonably requested by the
administration of Hospital or by the Hospital's Medical Board or as may be required by the
medical staffbylaws of Hospital
EAIS NRO[C.u. COM[ROL. JOHN p,NSORM, D O
Oa �., TH�C nw SY 1999 Pace N OP 17
d-EMS M
d�EMS Med�W Duaow Arv.•• ••••••• �—•
CONVID MIAL A W PROPRIETARY
PROPERTY Of BAYLOR HEALTH CARE SYSTEM
ALL PRIVILRCES CLAIMID
EXHIBIT B
OTHER BAYLOR RELATIONSHIPS
List all other contractual or financial relationships with Hospital, BHCS or affiliated entities
Contractual relationship with Baylor Medical Center at Grapevine for provision of Medical
Director services to Hospital Utilization Review and Quality Assurance Review programs
Employment relationship with Texas-EM I Medical Services, P A, contractor to Baylor Medical
Center at Grapevine for Emergency Department Coverage
EMS iIEDtCAL CoMot,- JOuN A.`7SOW4. D O
^B•YLOR� 28 CARE S'Y'sr6WM PAGE18DPrT
d MS Nadpai OU AOM O M AMdY1 MW
Co,,VFM9NTtAL AND PROPRIETARY
PROPERTY OF BAYLOR HEALTH CARE SYSTS:M
ALL PRIyn.IOIS CLALUID
EXHIBIT C
COMPENSATION
Fee shall be based upon the number of hours for which Physican provides Medical Director services, paid
at a rate of Seventy -Five and No/100 Dollars per hour ($75 00/hr) up to annual maximums of 576 work
hours and Forty -Three Thousand, Two Hundred and No/100 Dollars (S43,200 00) compensation per year
Physician's compensation fee shall be paid in monthly installments after receipt of Physician's reports
and documentation of services for the previous month Physician shall maintain and provide to Hospital a
monthly written record, in form and in detail reasonably satisfactory to Hospital, meeting the
requirements of this Agreement and documenting all tune devoted to Services under this Agreement
ErIS NUDICAL coNTROL - Jost ANWHN. D o
�YLOR RI.�t T8 CARE SYST'LM1I 1999 Pwo816 OP 17
MEIN N