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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-- r - 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 I � � �i�,���"�r�t �'�'i1�F����,'Lt�yF�'S 'tn t,'p'irvF�'r• OL iT•'4' k � i f t ,. Y'r 1 �CyC WP f,. t ,,• . A i r Q 4R; QQ;U iLhx` �otn I wm C) O t Q CN ij".U) 1�I 4 0. W I Q . r 4 IIm Q F-N Rr 1. ! p w rt • ttt^^^""SSS � I C [r, C tM1G 1-� t �%'' • " � ' *S P . 1(,`rI� ^^^^^^iiiiii""" , 41 I N ,bd ♦ 4 4 % I, s , ,''dT N .•' ti ' � I JI . kt �1L.Y,^ �r�� ' Zy'"`P•i',•.�• ti`i if'ti11p�i .S �t it b0 d 9ibi3nl'W-SZ-d3S 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 �, C] O U cv � Q 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 O J:', I blio IF a ^/ I� •�1 ��{a!Y W �ti 1 �f U e � W L 5 o � Q erg c o� _ b Q 4 u 0. L _ !' v l 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 wr 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