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1999-446AN 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 1N 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 ~nto a professional service contract with Baylor Medical Center at Grapewne and Dr John Ansohn for the Medical Centrol Services, a copy of which is attached hereto and incorporated by reference herein ~ That the City Manager is authorized to expend funds as reqmred by the attached contract SECTION III That this orchnance shall become effective immediately upon its passage and approval PASSED AND APPROVED thls the ~/g/-'-~ dayof d~d~_,1999 ATTEST JENNIFER WALTERS, CITY SECRETARY APPROVED AS TO LEGAL FORM HERBERT L PROUTY, CITY ATTORNEY PSA 2414 -~ 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 q day of ~..~~_, 19 C~C~ , by and between the City of Denton, Texas, a Texas mummpal corporation, with its pnnclpal office at 215 East McKmney 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 authonzed representatives WITNESSETH, that in consideration of the covenants and agreements herein contmned, the parties hereto do mutually agree as follows ARTICLE 1 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 ~n the sections to follow, with diligence and in accordance with the baghest professional standards customarily obtained for such services m 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 descnbed 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 Off-hne EMS Medical director services as required by the Texas State Board of Medical Examiners' EMS regulations for medical directors, 22 Tex Admm Code §§ 197 1-1976 6, On-hne medical control, as defined by Department regulations, 24 hours a day for seven (7) days a week, 3 4 5 6 Formulation and review of EMS protocols, Monthly scheduled meetangs to dascuss the operation of Emergency Servace and Baylor's responsthflmes under thas Agreement, Establash guadelanes and monator quahty assurance, Coordanate sufficient eontanuang educataon to meet Department requirements as set forth at 25 Tex Admm Code § 157 38, By independent contract, Baylor will provade an EMS Medacal Darector (the "Darector"), as defined by 22 Tex Admln Code § 197 2 who fulfills the oblagataons and requarements of Chapter 197, Tex Admm Code, pertmmng to EMS medmal dareetors The agreement between Baylor and the Darector to prowde the EMS Medaeal D~reetor serrates as attached hereto as Exh~bat "D" and aneorporated herean by reference, Baylor wall sponsor up to three (3) EMS Examiners and three (3) EMS Instructors from Emergency Servace, and Baylor wall provade two (3) spemalty-type courses (BTLS, ACLS, and pedaatnc course) for the CITY during the term of thas Agreement The classes wall be held at Denton Fare Department an Denton, Texas The scheduling of these courses wall be mutually agreed upon by CITY and BAYLOR No more than thirty eaght (38) students may be enrolled an ACLS course No more than thirty eaght (38) students may be enrolled an pedaatne course No more than twenty sax (26) students may be enrolled an BTLS course B If there as any conflact between the terms of thas Agreement and the exhab~ts attached to thas Agreement, the terms and cond~taons of thas Agreement will control over the terms and condataons of the attached exhabats ARTICLE 3 PERIOD OF SERVICE Th~s Agreement shall become effective upon January 1. 2000 afier proper executaon by the partaes, and shall remain an force for a period of one (1) year Thas Agreement may be renewed for add~taonal one (1) year terms upon the giving of prior written not,ce by the CITY before the anmversary date Thas Agreement may be sooner termanated m accordance wath the provaslons hereof ARTICLE 4 COMPENSATION A COMPENSATION TERMS In consaderataon for BAYLOR's provasaon of medacal control servaces under thas Agreement, CITY wall pay to BAYLOR the fee set forth an Exhab~t "C" The fee shall be prod to Baylor an quarterly anstallments, consastang of four equal anstallments as determined an Exhablt "C", wath the first installment due on or before the tenth (10th) day after the Commencement Date, wath each following ~nstallment due on or before the first day of each (3rd) month followang CITY shall pay all fee anatallments to Baylor at the address set forth an Article 10 hereof Any fee refunds shall only be made on a prorated Pm,e 2 basis and in the event of termination of the Agreement ARer the expiration of the first term of the Agreement and upon their mutual agreement, the parties may modify the compensation to be prod Baylor by executing a new Exhibit "C' to the Agreement If any new compensation ~s beyond the City Manager's authority then the change in compensation shall go before the city council as an amendment to thts agreement ARTICLE 5 INDEPENDENT CONTRACTOR BAYLOR shall prowde services to CITY as an independent contractor, not as an employee of the CITY BAYLOR shall not have or claim any right arising from employee status Nothing m this Agreement shall be interpreted or construed so as to make BAYLOR an employee, agent, or borrowed servant of the CITY Nothing In thru 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 ehgible for the employment benefits, including health and unemployment ~nsurance, and worker's compensation coverage, which are provided to employees of BAYLOR The part,es agree and acknowledge that the D~reetor is an independent contractor physm~an, and nothing in thts 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 ~n th~s Agreement reqmres, and shall not be construed to reqmre (directly or indirectly, exphcitly or lmphcitly 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 famlmes related to BAYLOR ARTICLE 6 INDEMNITY AGREEMENT BAYLOR shall tndemnify and save and hold harmless the CITY and its officers, agents, and employees from and agmnst any and all habfl~ty, claims, demands, damages, losses, and expenses, ~ncluding, but not hm~ted 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 neghgent acts or omissions of BAYLOR or its officers, shareholders, agents, or employees in the execution, operation, or performance of th~s Agreement To the extent permitted by law, CITY agrees and IS bound to hold harmless and ~ndemmfy BAYLOR against any and all claims for damages, costs, and expenses to persons or property that may arise out of, or be occasioned by th~s contract or any of its acttwt~es or from any act or omission of the CITY, its employees, representatives and agents, provided, however, that ~t ~s not the tntention or purpose to create hablhty against the CITY unless such habfllty ~s ~mposed by law Nothing in th~s Agreement shall be construed to create a habIhty to any person who is not a party to th~s Agreement, and nothing here~n shall wmve 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 Agreement, including the defense of governmental lmmumty, which defenses are hereby expressly reserved ARTICLE 7 INSURANCE Dunng the performance of the services under this Agreement, BAYLOR shall maintain the following insurance either as a self insured entity or w~th 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 Camers of at least an A- or above A Professional Liability Insurance with hmlts 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 dtspute to arbitration or other means of alternate dispute resolution, such as mediation No arbitration or alternate dispute resolution arising out of or relating to th~s Agreement, involving one party's d~sagmement, may include the other party to the d~sagreement without the other's approval ARTICLE 9 TERMINATION OF AGREEMENT A Notwithstanding any other provision of this Agreement, e~ther party may terminate by g~vmg thirty (30) days' advance wntten notice to the other party B Th~s Agreement may be terminated in whole or in part in the event of either party substantmlly failing to fulfill its obhgat~ons under this Agreement No such termination will be affected unless the other party is given (1) written notme (delivered by cemfied mall, return receipt requested) of ~ntent to terminate and setting forth the reasons spemfymg the non-performance, and not less than thirty (30) calendar days to cure the failure, and (2) an opportumty for consultation with the termmnatmg party prior to termination C This Agreement shall terminate automatmally upon either party's loss of hcensum or certification, or upon the effective date of any change m statute, ordinance, role or regulation or action of governmental authority prohibiting this arrangement or the services contemplated hereunder ARTICLE 10 NOTICES All notlces, communications, and reports reqmred or permitted under this Agreement shall be personally delivered or marled to the respective parties by depositing same ~n the United States marl to the address shown below, certffied marl, return receipt requested, unless otherwise specified herein Mmled notices shall be deemed commumcated as of three (3) days' maflmg To BAYLOR To CITY Baylor Medmal Center of Grapewne Attention Lelgh Anne Bednch EMS Education Coordinator 1650 W College St Grapewne, Texas 7605 l 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 not,ce ~s g~ven, or w~thln three (3) days' mailing ART ENTIRE AGREEMENT Th~s Agreement, consist~ng of 8 pages and four (4) exhibits, constitutes the complete and final expression of the agreement of the parties, and ~s intended as a complete and exclusive statement of the terms of their agreements, and supersedes all prior contemporaneous offers, promises, representatmns, negotmt~ons, d~scusslons, commumcat~ons, and agreements which may have been made ~n connection w~th the subject matter hereof ARTICLE 12 SEVERABILITY If any prov~slon of this Agreement ~s found or deemed by a court of competent junsdmt~on to be tnvahd or unenfomeable, ~t shall be considered severable from the remamnder of th~s Agreement and shall not cause the remainder to be ~nvahd or unenfomeable In such event, the pames shall reform this Agreement to replace such stricken provision with a valid and enforceable provision which comes as close as possible to expressing the mtent~on of the stricken provision ARTICLE 13. COMPLIANCE WITH LAWS BAYLOR shall comply w~th all federal, state, and local laws, rules, regulatmns, and ordinances apphcable to the work covered hereunder as they may now read or hereinafter be amended Pace ~ ARTICLE 14 DISCRIMINATION PROHIBITED In performing the services reqmred hereunder, BAYLOR shall not dmcnm~nate against any person on the bas~s of race, color, rehg~on, sex, national ongm or ancestry, age, or physical hand~cap ARTICLE 1 $ PERSONNEL A The BAYLOR represents that tt has or will secure, at its own expense, all personnel reqmred to perform all the services reqmred under th~s Agreement Such personnel shall not be employees or officers of, or have any contractual relations w~th the CITY BAYLOR shall mfonn the CITY of any conflict of ~nterest or potential conflmt of ~nterest that may arise dunng the term of th~s Agreement B Except for the servmes prowded by the D~rector, services reqmred hereunder will be performed by BAYLOR or under as supervision All personnel engaged ~n work shall be qualified, and shall be anthonzed and penmtted under state and local laws to perform such services ASSIGNABILITY Th~s Agreement shall apply to, and be b~ndmg upon, the part,es and their respective successors and permitted assigns The part, es shall not assign any interest ~n thru Agreement, and shall not transfer any interest m th~s Agreement (whether by assignment, novatmn, or otherwise) w~thout the pnor written consent of the other party Any asmgnment attempted without such consent shall be vmd ARTICLE 17 MODIFICATION No wmver or modfficatton ofth~s Agreement or of any covenant, condition, or hm~tat~on hereto contained shall be vahd unless ~n writing and duly executed by the party to be charged therewith, and no ewdence of any waiver or modfficat~on shall be offered or received m evidence ~n any proceeding arising between the parties hereto out of or affecttng this Agreement, or the rights or obhgat~ons of the partxes hereunder, and unless such waiver or modification ~s ~n writing and duly executed, and the part~es further agree that the pmws~ons of th~s section w~ll not be waived unless as set forth herein MISCELLANEOUS A The following exhibits are attached to and made a part of th~s Agreement (hst exh;blts) 1 Extub~t "A" C,ty's Request for Sealed Proposal 2 Extubt "B" Baylor's Response to Request for Sealed Proposal 3 Exhibit "C" Compensation Exh,ba 4 Exbab~t "D" Baylor's Agreement with phys,caan B Venue of any stat or cause of action under th~s Agreement shall lie exclustvely in Denton County, Texas This Agreement shall be construed in accordance with the laws of the State of Texas C Force MaJeure Ne,ther party shall be in violation ofth~s Agreement ~f either party is, or ~f e~ther party reasonably determ,nes that it m, prevented from pel fonmng ~ts obligations for any reason beyond its control, including without hm~tat~on, flood, storm, strikes, acts of God or the pubhe enemy D The captions of this Agreement are for informational purposes only, and shall not m any way affect the substantive terms or conditions ofth~s Agreement IN WITNESS HEREOF, the C~ty of Denton, Texas has caused th, s Agreement to be executed by its duly authorized City Manager, and BAYL~/3~as exeeuted,.thls Agreement througih its duly authorized undersigned officer on this the /4t~ day of 2000 CITY OF DENTON, TEXAS ~ANAGER ATTEST JENNIFER WALTERS, CITY SECRETARY APPROVED AS TO LEGAL FORM HERBERT L PROUTY, CITY ATTORNEY WITNESS BAYLOR MEDICAL CENTER AT GRAPEVINE BY 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 pnor to 2 00 pm,, SEPTEMBER 23. 1999 for the following RSFP # 2414 - PROFESSIONAL SERVICES CONTRACT FOR MEDICAL CONTROL SERVICES Qualtfied prospective suppliers my obtain cop~es of the pwposal w~th mformat~on at the office of the Purchasing Agent, located at 901-B Texas Street, Denton, Texas 76201 m the Service Center complex The C~ty of Denton, Texas reserves the nght 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 f'mancml interest, chrect or ~ndlrect m any contract w~th 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 Ttus advertisement to run: SEPTEMBER 8 A~ND SEPTEMBER 15. 1999 RFSP 2414-STANDARD AD REQUEST FOR PROPOSAL The City of Denton is accepting Request for Proposals for a Pwfesslonal Services Contract for medmal control services for the Denton Fire Department per the enclosed requirements Two (2) copies of the proposal must be submitted by September 23, 19o9 in a sealed envelope w~th the following information marked plainly on the front RFSP # 2414 CITY OF DENTON 90lB TEXAS STImuli' DENTON, TX 76201 Questions regarding the attached spec:flcations 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 sermces shall be provided as reqmred by the Texas State Board of Medical Examiners' EMS regulations for medical directors in 22 TAC, § 197 B On-hne service via phone with two dedicated lines and fax/modem compatible with Life-Pak 12s wdl 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 dest~nation control and bed availability E Permanent audio recordings will be maintained of all on-hne medical direction and copies provided to DFD upon request II Off-Line Medical Direction A Mechcal 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 Colhn 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 wdl be estabhshed according to a systematic plan and will Include the following Written and slolls evaluations will be conducted at least annually as part of a system to ascertain individual and system-wide proficiency and to satisfy TDH recertfficatlon requirements CQI summaries will be generated by the Medmal Control provider and reported to the DFD EMS Program Manager on a monthly basis or as requested Field evaluations will be conducted by expenenced nurse/paramedms and paramedic instructors Results will be reviewed voth the EMS Program Manager and written summanes provided 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 IlL Continuing Education A The Medical Control provider will conduct both basic and advanced continuing education in accordance with the Texas Department of Health gmdehnes each contract year to employees of DFD Continmng education classes will be offered at DFD fire stations at a date and time mutually agreeable to the City and the provider B Continmng education courses will be scheduled for each of the three shifts to accommodate one-half of each shif~ 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, quahty ~mprovement r~vlews, and computer- based trmnlng D Skills and protocol review yell be incorporated into continuing education curnculum E. Provider will offer initial and recertfficatlon courses for DFD paramedics and emergency medical technicians including a TDH approved pedmtnc course, ACLS, and BTLS courses F A written remediation plan will define procedures for DFD employees who fall 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 followtng A Cumculum Vitae on medical instructors B C D director, program manager, and course Statement of servxces to be performed Current client base, size of total population served, and a client history encompassing the last five years Length of time in business Software/hardware, computer configuration requirements m order to implement program Samples of CE evaluation tools, CQI reports, and other forms used in the administration of the medical control program A division of duties between the Medical Director and the DFD EMS Program Manager will be clearly defined Outline ofquahty assurance program Implementation plan for integrating City of Denton Fire Department into Provlder's present system References Documentation of certffications and licenses 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 Pmvlder are responsible for providing their own insurance including, but not limited to, medical malpractice insurance, and all other licenses and certfficates 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 C~ty of Denton Fire Department may enter into negotiations with as many Proposers as have submitted feasible proposals m order to amve 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 Prowder to be contracted IS November 1, 1999 Services would conunence muned~ately upon execution of the contract VIII Indemmty or Hold Harmless Statement Medical Control Provider agrees to defend, ~ndemmfy and hold the C~ty harmless for any loss sustained by the C~ty as a result ora clmm or stat by a third party claimant to the extent that such a loss ns the result ofneghgence, bad faith, or default of Medical Control Provider The Medical Control Prowder further agrees to perform the services w~th that standardof professional care, slnll and d~hgence normally prowded ~n the performance ofhke or s~mdar services CITY OF DENTON, TEXAS DEMOGRAPHICS OF THE DENTON FIRE DEPARTMENT'S EMERGENCY MEDICAL SERVICE The Denton Ftm Department operates the ~ ambulance servtce for the city of Denton and our netghbonng communities in central and northwest Denton County We have provided flus Advanced Life Support ambulance servtce since 1978 We serve a population of over 125,000 m our response area Today, we operate sxx (6) Mobile Intenmve Care Umts, three (3) fronthne and (3) reserve These units are staffed by firefighter/paramedms When needed, the reserve MICUs are manned from the crews of on-duty engine compames Due to our increasing call volume a fourth, fronthne MICU will be added m early 2000 Over 70% of all the 8,000 plus calls that the Ftre Department receives each year are for medical responses Wtth~n our cxty we have an average response ume of 5 09 mtnutes The average response time tn the county ts I 1 52 minutes To get help to the county residents sooner, the volunteer fire departments serve as first responders in their communines and are an integral pa~ of our EMS dehvery system When a 911 call is received a coordtnated response begtns The 911 dispatchers are trained m providing pre-amval tnstmct~ons ~n First Atd and CPR until the responding units get to the scene On every medtcal call both a fire engine and ambulance are dispatched All of Denton's fire engines are manned by firefighter/paramedics and are fully eqmpped to provxde Advanced Life Support If the engine amves before the MICU they will beg~n treatment to stabilize the pattent The care of the patient ts then continued by the firefighter/paramed;cs assigned to the MICU We are fortunate m Denton to have two fine hospttals Both hospttals have Ftre Department radios as well as dedicated phone hnes for EMS use The decxsion of which hospital to use Is left to the patient If the patient has a preference, then we will transport to that local hospttal If the pattent doesn't have a preference, is unable to tell us, or the pattent's condmon warrants, then the patient ts transported to the closest hospttal that can care for the patxent'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 Ftro Depaxtment ts dedicated to prowdmg our customers wtth the very best EMS system posstble We made a decision several years ago to have all of our personnel cross-tra~ned as paramedics Out oft. he 100 persons m operations over 70% are currently paramedics W~th the projected growth of our city, the Department ts planmng on adding approximately 40 firefighters and at least one new staUon wtthm the next three years All of these new recrmt$ wtll recetve both firefighter and paramedic tra~mng Recogmz~ng that our c~tizens are always the first care givers on a scene, the City is current implementing a Pubhc Access &ED program We have begun plactng Automatic Defibrillators m the Ctty facdmes The first umt wtll be placed tn the Semor Center The program calls for an addlttonal 15-20 AEDs, as funding becomes avmlable September 22, 1999 Tom Shaw, CPM Oty of Denton 9018 Texas Street Denton, Texas 76201 EXHIBIT "B" ~ F~4/('~xwd~r m~r Dear Mr. Shaw Enclosed are the ~ngredlents that were requested by your city for RFSP #2414 I have described our services that are offered and hope that you find th~s bid acceptable We can provide the requested services for an annual fee of $S2,750.75 :Items that are not included in this pdce are ACLS ($100 per person), BTI~ ($125 per person), and pedlatflc course fees (price unknown at th~s Ume) These prices would be determined on the number of prowders 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 obtmn this certification A start up fee of $950.00 would be requ,red to purchase the necessary protocol books and to teach the initial three New Paramedic Orientation courses As DFD added new paramedics (alter 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 ~s 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 ~n accordance w~th the upcoming state and federal changes. If I can asmst you in any way, please contact me at (817) 329-2815 Sincerely, Paul L Rosenberger, MPA, NREMT-P EMS Coordinator Bayior Meclical Cente~ at Grapewne EMS Medical Control Curriculum Vitae For EMS Medical Director, EMS Coordinator~ and Instructor Staff MEDICAL SCHOOL University of North Texas Health Science Center, Texas College of Osteopathic Medmme, Forth Worth, Texas, Graduated Cum Laude m May 1985 Student Memberships Student Government, National Osteopathic Honor Society, Class Officer, Texas Osteopathic Association, Texas Medical Association, American Osteopathic Association, American Academy ofFanuly Pracutmners INTERNSHIP Northeast Cornmumty Hospital, Bedford, Texas Graduated July, 1986 Rotating LICENSING EXAMS American Osteopathic Boards Part I March 1983, Part 11 March 1985, Federal Licensing Exam (FLEX) June 1985, Texas Medical Jurisprudence June 1985 BOARD CERTIFICATION LICENSE December 28, 1992 American College of Osteopatluc Family Physlmans, American Osteopathic Board of Family Phys~cians State of Texas December 3, 1986, Texas License #H013 DEA #BA0534342 SOCIETY MEMBERSHIPS Tan:ant County Medical Society, Texas Medical Association, Texas Osteopathic Medical Association, American Osteopathic Associntmn, American Academy of Farmly Practitioners, American College 0f Osteopathic Family Practitioners, American College Of Sports Medicine, American Osteopathic Academy of Sports Medlcme, Association of Military Osteopathic Phymcians and Osteopathic Physician and Surgeons, American College of Emergency Physicians Certifications State of Texas Paramedic State of Texas EMS Coordinator State of Texas EMS Examiner Advanced Cardiac L~fe Support Instructor Advanced Cardm¢ Life Support Prowder Basle Card~a¢ Life Support Instructor Basle Card~a¢ Life Support Provider Basic Trauma Life Support Instru or Bas~¢ Trauma Life Support Prowder Nationally Registered Emergency Medical Techmelan - Paramedze Prehosp~tal Pediatric Prowder Course Prehosp~tal Pedtatnc Provider Course Instructor Lugene Bates Jr. 4502 Dorchester Ct. Grapevine TX 760~1 19g6-Present C~ty of Grapevine Job Duues Fu-efighterfParamed~c/F~eld Tram,ng Officer for the Ftre Deparunent 1996-Present Baylor Medical Crater of Orapewne .lob DuU~ EMS Instructo~ 1996-Present Tarrant Cotmty Stmwt College Job Duties EMS Instructo~ Texas Commission of F~re Protection as Ftrefighter Texas Comm~sston of Fire ProtecUou as Intermedmte Instructor Texas Department of Health as Emergency Medical Techmc~apJParamed~c Texas Deperlment of Health as Emergency Med~ca! Ser~ces Skills Examiner Texas Department of Health as Emergency Medical Serwces lnslructor American Heart Assoctatwn as Advanced Card~ac Life Support Prowder/Instructor American Heart Aasoc~atwn as Bas~¢ Car&ac Life Support Prov~der/-mswactor Basic Trauma Life Support InternaUonal aa BTLS Prowdet/Ins~ructor rT~ ° ¥92-7/93 87-5/92 86-12/86 85-6/86 volume Responsible for county w~de EMS, transfers, and assisting tn pubhe awareness of EMS Sole BTLS certified medic ;n Okmulgee EMS Sole medm m Okmulgee EMS pursuing Paramed c certification Security Concepts of Tulsa, Tulsa, OK Owner R. espons~ble for sales, tel~ ritory development, inventory, and presentauon of home, personal, ara auto security systems Currently covering a tn-state area Windsor Consultants Inc., Houston, TX Dgta Processing Consultant Kesponslble for cheat development, and recruiting of quahfied mdiv~duals for chents Responsible for salary negoUatlon, reference verifications, and salary surveys Responsible for general recruitment on regional and national basis Knowledgeable in salary and compensation, EEOC prac~mes, and techmcal pracUces Magnacon, Houston, TX Consultant Responsible for cheat development and recrmtment of mdiwduals for contract placement Responstble for hourly rate negottataon and candidate compensation Builders Square #1010, Houston, TX Lnventorv Control Superxnsor Responsible for 7-8 MM dollar inventory Responsible for entry of purchase orders and receixang orders into systems Supennsed I to 2 employees dunng tenure Exoenence (cont): Six Flags Over Texas, Inc. Lmergenc: Medical fechmctan May 1991-December 1991 Duties included providing First Aid to the guests of S,x Flags Over Texas Pat/, ~ervwe% April 1986-May 1991 Duties included manag,ng a crew of eight personnel and ensunng the cleanliness of the park Education Tarrant County Jumor College, Fort Worth, Texas Graduated December 1996 w~th an Associates Degree of Apphed Science tn Fire Protection Technology Texas A&M Umvemty, College Station, Texas August 1989-May 1991 Studied courses m Aeronautical Engineering Tnmty I-hgh School, Euless, Texas Graduated v~th Honors in June 1989 Certlficat~ons Texas Intermediate Flrefighter 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 Skall Examiner Awards: Valedictonatt, Metrocrest Medical Semces, Inc Paramedic Class #10 Outstanding Scholastic Freshman, Infantry Band, Texas A&M Umversity Eagle Scout References: Gee Randy Corbm, Fire Chief Lew~svtlle F~re Department 188 North Valley Parkway Lev, nsville, Texas 75067 972 219 3580 Steven Palmer 5932 Cimarron Trail Ft. Worth, Texas 76148 (817)58 -0889 Oblecttve To use my education and years of fire and emergency medmal expenence tn an admm~straUve tratntng capac~y Experience Keller Fire Department - 137 Taylor Street, Keller, Texas 76248 July 1988 - Present Job Trtle Lieutenant Duties include EMS Officer for the department v~th responslbfl.,ty for mamtamg the department's EMS training records, ordenng EMS supplies, mamtatng protocols, easurmg compliance wrdh the CQI standards, prepamg the EMS budget, writing the specifications for EMS equipment and vehicles, and easunng the department comphes wr,.h all Texas Department of Health Rules, Superwsmn of daffy activities for stauon, flow testing hydrants, conducting fire mspecuons of businesses, computer upgrades and mam~nance, conducting personnel evaluations, super~nsmg fire training, assist m budget preparauoo, conduct new hire mterwews, coordinate CPR for the all c~ty departments Baylor Mechcal Ceater Grapevine - 1650 West College Street, Grapevine, Texas 76051 December 1995 - Present Job Trde EMS Inz'auetor/Exanuner/EMS Web Master DuUes include Instructing EMTs and Paramedics aa conttnutng education, Advanced Card, an Life Support, Basic Trauma Life Support, CPR, and EMT schools Developing, updating, and overseeing the EMS web page Me&cai EducaUon Systems - P O Box 820702, North R~chland Hills, Texas 76182 July 1996 - Present Job Trde Owuer DuUes include Coordinate EMT cumculum, coordinate tnstructors, order equipment and supphes, instruct classes, and ensure program qualrty Education Tarrant County College - Associate Degree m Emergency Me&cai Technology (estLmated completion December 1998) tn~eLf tht rtqutreme, nt~ for c~rtl, flcatlon Imt~ctor P. xptres 08/3112000 ~el iD 14483 F....-~b~ · rb'vEN BRADLEY PALMER 6932 CIMARRON TR FORT WORTH TX 76148 R~l~rt e~ tn =dtO'a= ~r t~lo~ntnt to Texas ~ ,,fHealth ii00 V/est 49th Attain. TX 75'?$0.3199 1996-Current 1996-Current 1996-1999 1987-1996 1992-1995 Robert W. Potter 4941 Colonial Park Dr Haitom C~ty, Texas 76117 817-577-4265 SUMMARY I ha~ e dcdiceted thc last 12 )cars of my life to tho service of the cmzens of the State of Texas, first as a pohce officer, and then as a fire fighter I have been involved in the medical care of pcaple since 1991 as an EM'T, and then progressing to a Paramedic and finally as a Registered Nurse My goal is to protect and service those around mc WORK BISTORY Fire Fighter/Paramedic Richland Hills Fire Department Provide Fire and EMS serwce to a city of apprommately 8,500 people Duucs tncludc Fire Suppression, Emergency Medical Se~,'aces ,aa MICU, and Fire/Arson Investtgauons Emergency Room RN, ~Vorth HHIs Hospttal Pre,ade care to paUents of all ages w~th rather mechcal problems or trauma injuries tn an emergency department that has on average over 2200 pauents a month Emergency Room RN/Trauma Coordinator, DFW Medtcal Center Provide care tn the emergency room semng, as well as began the development of the Trauma Center program for the hospital Pubhc Safety Corporal II, Dl~V Alrport Cross trained m Police, Fire and EMS Performed general Pohce and EMS duUes tn the Patrol/Rescue Dixnmon and Fire Suppression duues tn the Aireraft/Ftre/Rescue Dl'as~on wnuQATtON Assoclatcs D~gree in lq'urstng, Tarrant County Junior College UOERm & OIBllSR,qTIS · CetUfied Police Officer, 1987 Ce~ F~ Ft~ter, 1988 ~e~ N~, 1995 Em~gen~ M~ T~ct~-~c, 1994 L~ ~m~c, 1999 Tm~ N~ Co~ Co~, 1997 P~am~ ~ ~e Su~ 1996 Emer~n~ N~ P~a~c Co~, 1998 ~o Sy~ ~e, ~e Co~, 1997 H~ ~ten~s T~c~ 1998 S~ Water ~ T~cz~ 1, 1993 S~ Wat~ ~c T~ 2, 1994 A~ ~ ~r, 1997 Bamc Poh~ ~cer l~or, 1995 Fzre & ~n ~tor B~c, 1997 F~ Co~sslon ~or Inter.ate, 1997 Te~ ~ ofH~ ~or & EYnmmcr 1999 S~t~ W~ ~dTa~ Sch~l, 1992 i¥1e(]lcal ~.enter au ~fapevlne EMS MedIcal Control Statement of services to be performed Baylor Medical Center currently offers EMS Med,cal Control Services to ten fire- based EMS services In North Tarrant and South Denton Counties Our services can be grouped into four basic categofles. The categories are on/off-hne medical d~rection, continuing education, C(~! standards, and written protocols All are offered to ensure the highest level of consistency i~ the clinical care arena On-hne medical direction, in most cases, Is offered by Baylor Medical Center at Grapewne through our emergency department (ED) The ED ~s 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 w~th EmCare to prowde physician servIces and to perform the EMS on-line consultation and direction duties. The ED has double physioan coverage from noon to midnight; this will reduce the chance of a doctor being bed up w~th a critical patient and needing to talk to EMS at the same time Other on-line medical d~rection sites are allowed when the requesting faohty s~gns a contract and fulfills ~ts commitments to become a site. Currently, Harris MethodiSt Hospital HEB has obtained this status Medical Center of Lewlswlle is in the process of obtaining this status. Denton Community has expressed interest, if Baylor Is awarded the bid. Three dedicated phone lines, a fax, and a Phys,o-Control twelve lead receivIng station iS located In an EMS work area This area also contains a recording dewce for conversations between Baylor and the EMS service Disaster assistance ~s available by activating the Baylor Emergency Response Team. Destination control and bed ~ava~lablllty can be offered as best as possible when a disaster strikes Off-hne medical control direction Is another area offered. Baylor contracts diredJy w~th Dr .lohn Ansohn for his role as the EHS Medical Director Dr Ansohn works for EmCare and Metroplex Emergency Physldan Association (MEPA) Wh~le working for EmCare his services are provided at Baylor-Grapevine. When working for MEPA, h~s services are provided to Denton Commumty Hospital. By reviewing Dr Anscihn's resume, you w~ll see that he climbed the ladder to obtain h~s role as a physician. As a result, he is very paramedic friendly and, most ~mportantiy, a strong believer In the role that EMS plays In the continuum of care ~aylor ~lec]lcal center at ~apewne EMS Medical Control RF£P ~2~:14 ~Dem-~n FD~ Baylor trad~bonally offers CQT standards only These standards are developed by the EMS CQT Sub-Committee and approved by the EMS Medical Control Committee. The standards are implemented by the fire department by utilizing a CQ! Officer and F~eld Training Officers Remedlabon and quality improvement recommendations are usually developed by the agency (CQT Officer) and approved by the EMS Hedlcal D~rector The RFP submitted by Denton actually requests that medical control provide sk~lls examination (once per year), chart audits, field evaluations, and CQ! summaries These services are tradibonally conducted by the agency and subject to inspection by the EivlS Medical D~rector These services are included (with Baylor performing these duties) in the final quote Baylor w~ll prowde an EMS Tnstructor e~ght hours per week (three weeks per month) who w~ll come to Denton and conduct chart audits, field evaluations, and CQ! summanes dunng th~s time The ~nstructor w~ll make every attempt from the EMS Coordinator employed by the FD to obtain the charts, obtain who ~s to be evaluated, and submit monthly summanes Sk~ll evaluabon/~nstrucbon can be offered during this time Sk~ll testing will be offered on a testing case-by-case bas~s and ~s not part of the b~d. Our current fees for TDH sk~lls tesbng are, EHT- Basic $100 per person, EHT-Tntermedlate $130 per person, and EHT-Paramedlc $150 per person Tn the past, the system (Baylor and fire departments) conduct two EMS Skills testing dates to fulfill TDH cntena Admission ~s 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 ex~stmg protocols are researched and based in national standards. Tn the sk~lls secbon, sk~ll levels are identified for EHT-Bas~cs, EHT-Jntermedlates, and EHT-Paramed~cs The chapters of the protocol book are Tntroduction, Card~ac, Medical, Pediatric, Trauma, Med~cabon Reference, Skills Reference, and Hed~cal Control Pol~oes and Procedures An original protocol book Is supplied to the fire department and the agency w~ll be allowed to make as many copies needed A protocol book will be supphed to each paramedic dunng orientation courses Updates and rews~ons are commumcated through the agency's EMS Coordinator ~8ylor IVlea~c81 Lenter at brapev~ne EMS Ned~cal Control Length of time in business The EMS Medical program was developed In 1993 as a joint endeavor between Baylor-Grapevlne and the Cmttes 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 8aylor Medical Center at Grapevine Tn 1903, Texas Baptist Memorial Sanitanum was developed and renamed Baylor Hospital m 1921 The health care system has operated ~n North Texas since 1903 The system en]oys the strength, wealth of knowledge, and expertise that can come from being part a historically world renowned health care system uaylor ivlea~cal uen~er ac brapev~ne EMS Ned~cal Control Samples of CE evaluation tools, 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 CQ! Plan are the forms used ~n the CQ! process Date Course T~tle EMS CE REGISTRATION Course Locanon Shn~ Content Area Course Approval Number 100145 Instructor Name and ID Number Coordinator Paul Roserk,~rger Hours Awarded. Lesson ID Number Me&cal Control Use o~y Student Name Department ID Number Pass ~ Fad 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Continuous Quality Improvement Plan Baylor Medical Center at Grapewne £MS Medtcal Control Introduction: Baylor Medtcal Center at Grapewne currently pro~ades medtcal control to several public based EMS prowders Northeast Tm-rant and Southern Denton Counties EMS medical control ts provided to the ctttes of Colleyvtlle Euless, Flower Mound, G-rapevme, Keller, Lewisvflle, Richland I-hlls, Roanoke, Southlake, and Trophy Club The combined populatton for these Pane reties ts over 268,110 people Nmeteen fi~lly dedicated ambulances and numerous Paramedtc Engme Compames (PEC) prowde h~gh quahty emergency medtcal serwces The goal of the medical control system ts to md m the enhancement of emergency medtcal serwce and to prowae access to medtcal control and educational opportumttes to agenmes pammpatmg tn the system Th~s goal ~s accompltshed by Baylor Medtcal Center at C-rapevme prowdmg contmumg educatton, contmuous quaht7 ~-nprovement (CQI), protocols, and on/off lme medical contrdl CQI ts a comprehenstve pro,'am that rewews all aspects of EMS care and has multtple pammpants The CQI program is composed of a data base, tn-field evaluattons, a patient follow-up process, pattent satisfaction surveys, new paramedic onentatton courses, chart evaluattons, mctdent mvesttgat~on process, testmg standards, and on-hne medtcal control pattent report rewew The CQI process rehes on several dL~erent parttctpants to make tt effecttve Fteld Trapamg Officers ('FTO), Officers, and the EMS Coordtnator and Medical D~rector are essentml to system review and tmprovement FTOs are selected by the agency and approved by medtcal control The quahficattons that a FTO has are that he/she paramedm m good standmg w~th thew respecttve a~ency and has completed a FTO course that ts hosted by Baylor It ts recommended that a FTO ts a rankmg officer and ts cert~ed by the Texas Department of Health as an Instructor and Exarmner, or ~s certified by the Texas Comnusston on Fire Protectton as a Bastc Ftre Instructor or h~gher FTOs are responstble for conducting chart rewew, and conductmg m-field evaluations The CQI Officer should be a rankmg offcer wtthm the agency or has been delegated the authority to implement to CQI the process When tlus person ts not a ranlcpag officer, Medtcal Control will commumcate dtrectly to the agency's EMS Coordmator for various tssues FTOs are directly accountable to the CQI Officer The CQI Officer ts selected by the agency and approved by Medtcal Control The quahficattons that a CQI Officer possesses are that he/she ts a paramedm tn good standmg w~th thetr agency and has completed a FTO course that has been hosted,by Baylor It ts lughly recommended that the CQI Officer ts a ranYang Officer wth~n the agenc.~ It is recommended that the CQI Officer [s certified by the Texas Department of Health as an Instructor and Exarmner or ts certified by the Texas Commission on Ftre Protection as a Bastc Ftre Instructor or h~gher CQI Officers are responstble for all of the FTO roles and comptlatton, rewew, forwardtng of the data base reqmrements, chart evaluation, and adrmpasterin$ the pattent satlsfactton survey The EMS Coordmator ts employed by Baylor Medical Center at Grapevme EMS Medtcal Control The EMS Coordinator ~s accountable to the EMS Medtcal D~rector The quahficattons that the EMS Coordmator possess ts that he/she possess ~s certtfied by Texas Department of Health as an Instructor and Exarmner It is preferred that the EMS Coordmator also possesses the Coordmator cert~ficatmn The EMS Coordtnator Is responsible for oversight of the enttre EMS medtcal control pro,ram ((Responding to the Call of Excellence' 2 Baylor Medical Center at Grapewne EMS Medical Control Organizational C~hart: "Responding to the Call of Excellence" 4 Baylor Medical Center at Grapevine EMS Medical Control In. Field Evaluation: A Field Tra~mn$ Officer (new employees) or the mdl,adual's ran!OhS officer (current employees) vail conduct m- field evaluatwn on each paramedic A field training officer or appropriate officer vail evaluate each primary paramedic annually 1',lew paramedics m the system will have an evaluation at the s~x-month anniversary date and at the one-year anmversary date These m-field evaluations should be mcorporated or utd~zed when conducting an annual performance rewew for the EMS prowder The paramedic must obtain a score of "Meets Expectations" or higher and satisfy all absolutes on the evaluation When an improvement opportumty is identified, the CQI Officer and the EMS Coordinator will develop a plan of action The m-field evaluation form vail evaluate the follovang components of EMS duties I Paramedic preparedness H Interaction with other pubhc sennce enuties Patient and family rapport IV Shll techmque V Protocol apphcatmn and unplemantation VI Interaction vnth on-line medical control staff VII Interacuon at the receiving faahty "Responding to the Call of Excellence" Overall Rating Score FTO/CQI Officer Stgnature EMS Provader Stgnature FTO/CQI Officer should make comments ua the appropriate areas EMS Provaders should make comments in the area below III Patient and family rapport 4 = Interactions are always professional and friendly No vahd complaints fi.om fanuly or patient 3 = Interacttons are cons~ently professior~l and friendly Very few vahd cornplamts from farmly or patient 2 = Interactions are us,,.lty professional and friendly May reqmre intervention, complaints are considered todd m offense 1 = Interactions lack courtesy and profassmnabsn~ Intervention reqmred 0 = Commits an offense that ts grossly offensive to patient or ~hmdy (sA) x (w) 15% = Rating Justification IV Skfl[q techmque 4 = Follows all skulls criteria and exhibits proficiency according to estabEshed guidelines tn the Procedure Chapter of the protocol book 3 = Follows all skdl.q criteria and exhibits a moderate level of proficiency accordmg to estabbshed gudehnes m the Procedure Chapter of the protocol book 2 = Adheres to most of the estabhshed gmdelmes m the Procedure Chapter of the protocol book but exhtbits a nantmal level of proficiency 1 = Performs skdl-q but tn a manner or fastnon that ts inappropriate 0 -- Does not know skulls criteria as estabhshed in the Procedure Chapter of the protocol book Not pwficient tn skills usage Rating Justtfication (SA) X (W) 25% = Interaction at the receiwng facility 4 = Interactions are always professioml and lhendly Patient reports are conctse and the appropmt¢ mformatlen is relayed 3 = Interactions are consistently professional and ihendly Patient reports are concise and the appropriate reformation ~s relayed 2 -- Interactions are us~l!y professional and friendly Patient reports are not always concise and/or the appropriate patient reformation ~s not relayed 1 = Interactions occasionally lack professlonaEsm or fi~endhness Patient reports are not always concise and/or the appropriate patient re.formation is not relayed 0 = Patient reports are not concise and/or patient reformation is not relayed (SA) X (W) 5% = RatmgJustffi¢~lon Baylor Medical Center at Grapevine EMS Medical Control Patient Satisfaction Surveys: Patient Satisfaction Surveys wall be totaled out by the agency on at least twenty- percent ofa~l EMS responses When an unprovement opportumty ~s ~dent~fied, the CQI Officer and the EMS Coordinator wall be responsible for developing a plan ofactxon "Responding to the Call of Excellence" P O Box 123 Beautiful C~ty USA 12345 ......................... DETACH HERE CITY OF BEA~ CUSTOMER SERVICE SATISFACTION SURVEY Recently you had an occamon to contact the Beautiful Ctty Fmc/EMS Department wnh a request regarding PLEASE GRADE US! HOW SATISFIED WERE YOU Were the Fire/EMS personnel fair and non-dlscrimlnaton/? A B Were the Mre/EMS persorlnel frlerldty and caring'~ A B Were our fire/EMS personnel knowledgeable? A B . Were you satisfied with the quallL"y of service we pmvldecP A Were you satLefled with the Rre/EN$ personnel over all performance~ ¥¢s. C ,D , F C ,D F __ .C D __F __ C D__F__ C D F__ No ADDITIONAL COMMENTS OR SUOGESTIONS YOU MIGHT HAVE AND WISH TO SI[ARE New Paramedic Orientation Day 1' 0800-0900 0900-1100 1100-1200 1200-1300 1300-1500 1500-1700 Why 12 Lead ECG Cardiac Anatomy & Electrophystology Lead Placement Lunch Charactensucs ora Normal 12 Lead ECG Charactenstlcs of an Abnormal 12 Lead ECG Day 2: 0800-1200 1200-1300 1300-1400 1400-1600 Protocol Rewew a Introduction Chapter b Cardmc Chapter c Trauma Chapter d Medical Chapter e Pedmtnc Chapter Lunch Protocol Rewew f Procedures Chapter g Drug Information Chapter Skfl!s Instruction and Testing Implantabla Access Systems b Intraosseous c Percutaneous Au'way d Pleural Decompression 1600-1700 WnRen Exammatmns Name New Paramedic Orientation Course Course Completion Checkhst Agency Certification Level Agency I D # Slall Sheet Implantable Access Systems Skall Sheet Intraosseous Infusion Skill Sheet Cncothyrotomy Skall Sheet Pleural Decompression Written Examination BCLS and ACLS are system requirements If you do not possess these certifications, please notify your agencies EMS Coordinator Candidates Name: Baylor Medical Center at Grapevine EMS Medical Control Program lntrosseous Infusion Skill Sheet Agency of action to be undertaken Locates site (Anterior aspect of the tibia 1-3 cm below the tibial tuberosity) Preps area with aseptic technique, outward direction Directs I0 needle mfenorly to avoid the eplphyseal plate Verbalizes successful cannulatlon (Must verbal,ze at least one of the following Lack of resistance aider needle passes through the bony center, needle stands upright without suppo'- ability to aspirate bone marrow, or ~ree flow of the infusion wtthout significant subcutaneo',:s infiltration) Attaches ['v fluid Secures needle with protect,~e dressing Satisfies the above criteria Comments Signature of £xammer' Medical Control Use Only*~ Date Baylor Medical Center at Grapevine EMS Medical Control Pleural Decounpresslon $1oH Sheet Candidate Naune: Agency Yes No Description of action to be t~k~. Identifies the need for pleural decompression (Must verb~hTe two of the following s~gns or syraptoms dyspnea, dmamashed breath sounds, hypotensmn, or d~tended neck veins) Locates the second or tbard untercoastal space un the mad-clavicular line Preps area wath aseptic techmque, outward techraque Inserts the needle over the nb unto the pleural space W~thdraws the needle fi.om the catheter and attaches the one-way flutter valve Secures pleural decompression dewee Contunuously mountors the breath sounds, resp~ratou rate and effort Satisfies the above criterm ** Medical Control Use Only** S~gnature of Exaunmer: - Date' Baylor Medical Center at Grapevine EMS Medical Control Chart Evaluation: The agency's CQI officer will oversee chart evaluation The agency will review a mimmum of flurry charts per month (with available call volume) Each agency will rewew at least fifty percent of the following categories of calls ALS calls, aeromedical support, CPR, pharmacological agent admimstratmn (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 wll be Utdlzed to evaluate ~mprovement opportumues On the back of these sheets are comment sections for flae EMS prowder and the CQI officer or FTO Providers will respond to questions by the CQI Officer or FTO in a t~mel.x fastuon The goal for chart evaluation is to have mnety- percent compliance to the appropnate standard that apphes to a g~ven medical condition and satisfy all absolute requirements The provtder will be required to treat and document a patient report w~th comphanee 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 opportumty is idenufied, the CQI Officer and the EMS Coordinator will develop a plan of action "Responding to the Call of Excellence" 10 below for each chart that does not standards 2 3 4 5 8 9 10 11 12 13 14 15 16 17 18 19 20 Improvement Actmn Codes = D~scussed ,oath Individ-aL 2 = ~eferred to Super'asor, 3 = Referred to Medical ControL, = Departmemal pohcy ctmnged, 5 = Protocol rewew/change, and/or 6 = Other, please specify FTO/CQI Officer Observatmns 8; Quesuons EMS Prowder Comments' EMS Prowder Signature Date Baylor Mechcal Center at C-rapevme EMS Medical Control ** Confident,~d Information ** Medication A~tlon Approprmteness of Care Standard Provader Name Chart Number Mechcatlon admumtratlon was m comphance w~h protocols or direct orders *** given by Medical Control Provides complete documentauon of the following ** * route, t~me admmi.~tered, dosage, and the person aflmm~nterllag the med,cation. Prowdes complete documentation of the me&cared IV chap Name of solution, amount of me&cation m solution and rate Assesses change tn paUem condition after treatment Documents allergies, when available Are the Absolutes Satisfied9 Yes No - - Score of Chart Is the Score Greater Than 89%9 Yes No If any of the absolutes are not sattsfied or the score ts not equal to or greater than 90%, the chart does not meet the CQI standards Please make comments on the back oftl~s sheet EMS Prowders are reqmred to respond to FTO/CQI Officer comments FTO/CQI Officer Signature Date Baylor Mechcal Center at C-rapevme EMS Medical Control ** Confidentml Information ** Trauma Appropriateness of Care Standard ProviderName Chart Number Provides clinical __ Obtains lustory and chlefcomplumt Provzdes time, mechemsm of injury, and loss of consciousness Assesses resptratory status Rate, symptoms ofdistxess, breath sounds, and Provides a!~propnate itu-way control and oxygen therapy Assesses v~tal s~gns l~re-trsn~rt, transport, or as d~rected by protocol Provides continuous cardiac monitoring vath correct interpretation. Assess neurological slatu.s Provides full assessment of all body systems Provides stabd~Tatlon Provides IV therapy Lints rate, route, s~ze, s~te, fired, and person Imtmtmg IV vnth the number of attempts Performs advanced skills as mdlcated MAST, pleural decompression, or other Ltsts the person imtlatmg the skill Assesses change m patient conchtlon atter treatment Contacts Medical (~ontrol Resssesses patzent ~onditlon at recennng facility Treats patient m c~mphance vath protocol Scene time 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 ~s not equal to or greater than 90%, the chart does not meet the CQI standards Please make comments on the back oftlus sheet EMS Providers are reqmred to respond to FTO/CQI O~eer comments FTO/CQI Officer Sxgneture Date Pro~der Name Date of Inctdent Baylor Medical Center at C-rapevme EMS Medical ** Confidentnd Information ** Adverse Incident/Sentinel Event/Chracal Comphant Appropriateness of Care Standard Chart Number Pames Involved Description o f Incident/Event' Date Rewewed Action Taken 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 vathln 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 actueve at least a seventy- percent in each subscale area First Failure If the pro,ader fails the TDH Evaluation Tool, the EMS Medical Director wll assign a probat,onary status and the prowder vail be given the oppormmty to self-study The provider ~ continue to function at their s~ate cenlfied level The EMT or EMT-I vail be adrmmstered an evaluation tool, by Medical Control, which ~ cover the entire course content of an EMT basic or EMT-I course, which ever is appropriate The EMT-P vail retest the specific subscale that the prowder failed, up to three subscales If the lnchv~dual four or more subscales or the overall score is below seventy-five percent, the EM'r-P vail retest the entire course content of an EMT-P course These tests vail be adrmmstered by Medical Control All testing vail be completed vathin ninety days Second Failure If the provider fails the TDH Evaluation Tool and the Medical Control ExarmnaUon, the prowder ~ continue then' probationary status and study vath a FTC The probationary prowder must function under the FTO's d~rect supemsion and cannot be responsible for patient treatment at any time The provider may perform skills only when supervised by the FTC If the FTO's super~nslon is not provided, the prowder may only function at a level below their certification A paramedic vail function at the EMT level The EMT and EMT-I vail be admimstered another exarmnauon, by Medical Control, whch vall cover the entire course content of an EMT or EMT-I course, whichever applies The EMT-P will retest the specific subscale that the provider faded or the entn'e course content of an EMT-P course, which ever applies according to the first failure criteria This test ~ be adrmmstered by Medical Control All testing vall be completed vathin mnety days of the EMS Medical Director receiving the test results from the EMS Coordinator "Responding to the Call of Excellence" Baylor Medical Center at Grapevine EMS Medical Control Second Fadure' If the prowder fails xmtlal Protocol Exarmnat~on and the retest, the provtder will continue their probattonary status and work and study w~th a FTC The probauona~ EMT-P must function under the FI'O's dxrect supervision and cannot be responsible for patient treatment at any time The EMT-P may perform skalls only when super.ased by the FTC If the FTC supervmon is not prowded, the prowder may only function at an EMT level The EMT-P wll retest the specific section that the EMT-P failed Medical Control or the CQI Officer adrmmster the retest All testing vall be completed no sooner than fourteen days and no later than sixty days Third Failure' If the EMT-P fa~Is the lmtlal protocol exammauon and two retests, the prowder wdl receive a letter from the EMS Medical Director that states that they are no longer ellg~ble to prowde any EMS care under the direction of the EMS Medical Dtrector's authority A fire fighter status vall b~ the only recogmzed status If the EMT-P wants to regain thew EMS status, they must attend a New paramedic Orientation Course After successful completion oftlus course and the entire Protocol Exasmnntlon, the EMT-P status w~ll be reassigned A fire fighter status w~H be assigned from the failure date of the retest to the date of successful completion of the New Paramedic Onentatlon Course Fourth Fadure' After failure of the uutlal Protocol Exanunation, two retests, and the New Paramedtc Orientation Course, the EMT-P will be considered a fire fighter only and subject to disc~plmary actions estabhshed by their respective agencies "Responding to the Call of Excellence" 14 Baylor Medical Center at Grapevine EMS Medical Control Physician Competencles: On/Offhne Medical Control Phystctans will be reqtured to complete an exercise that ts tntended to famdianze the physician with medical control systems medicat~ons, procedures, and quahty assurance plan The exercise is m a question and answer format The physician w~ll have two weeks to complete the exercise The exercise vall be administered by the respectzve mechcal dtrector at each on-line medical control site and submitted to the EMS Coordinator "Responding to the Call of Excellence" Your Name: Date: Please list the 28 drags that are earned by the paramedics on each EMS vehtcle Th~s can be found m the Introduction or Drug Information Chapters 2 List the type of Intravenous Solution and sizes that are canned by the paramedics in the EMS vehicles Th~s can be ~'ound in the Introduction Chapter 5 What does the term "Open" and "Closed" mean in the Transportation Guideline protocol* 6 In the event of an Adverse IncldenffSentmel EvenffChmcal Complaint where can the reporting form be found* (ER. Departmental Pohcy) 7 Tbas form should be completed and mailed to Baylor Medical Center at Grapevine EMS Educauon-Attanuon Paul Rosenberger 1650 West College Street Grapemne, TX 76051 8 Commems or Suggestions In conslderaUon of the services provided m the attached Agreement, C~ty of Denton will pay to Baylor the fee of $62,750 00 per year for each term of the Agreement City of Denton shall pay the tee to Baylor ~n quarterly installments of $15,687 $0 per installment CONFIDENTIAL AND PROPRIETARY I~ROPERTY Off BAYLOR HEALTH CARE SYSTEM ALL PRIVILEC, E8 CLAIMED EXHIBIT 'D' MEDICAL DIRECTOR AGREEMENT This Medical Director Agreement ("Agreement") is entered into effective as of the 1s* day of November, 1999 ("Effe~ve i~at~'), by and bet'~ean-~.ylor Me~o~ Ce-!er at C. wapevm~ ("Hoslmal'), a Te~a~ nonprofit corporation, and John Anschn, D O ("Physician") RECITALS Hospital operates an acute care general hospital located m Grapevine, Texas and requires ce~am admimstrat~ve services for me&cai dlrec/aon and/or supervision of prchospital care by emergency medical service ("EMS'~ personnel ("Medical Control"), Hospital requires the sennces of a physician wgh speclahzed trammg and experience m emergency medlcme to provide part-time professional and admmlstrative direction for EMS Medical Control, and Physician poSsesses speclahzed training and experience in the area of Medical Control and is qualified to provide such services, and Hospital desires to engage Physician as pan*time Medical Director for EMS Me&cai Control, and Physic~an desires to accept such engagement w~th Hospital and m that capacity to provide services under the terms and conditions of this A~reement AGREEMENT NOW, THEREFORE, m consideration of the foregoing premises, and the mutual covenants and con&tlons contained hereto, Hospital and Physician agree as follows I EMPLOYMENT Hospgal hereby employs Phystctan to serve as part-Ume Me&cai D~rector for EMS Me&cai Control ("Me&cai Director") and Phys~aan hereby accepts such employment, all subject to the terms and conditions of tins Agreement 2. TITLE. Physic~an's t~le shall be Me&cai Director, EMS Me&cai Control EMS MEDICAL CONTROL JOHN A~SOHN, D O MEDICAL DIRECTOR AGREEMENT This Medical Dtrector Agreement (#Agreement~) ~s entered rote effective as of the 1~ day of November, 1999 ("Effective Dste~), by and between Baylor Medical Center at Grapevine ("Hoslgtsl'L a Texas nonprofit corporation, and l~dn Ansohn, D O ("Physician") I~E~ITALS: Hospital operates an acute care general hospital located m Grapevme, Texas and requires co,am admm~rative eer,flcee for medical directlGn and/or supeFvls~on of prehosplral cam by emer~0ncy medical semce ("EMS'~ personnel ("Mediesl Control"), Hospital req~lree the selv~ces of' a I~h~slcum vflth sileclahzed irs'hms_and exll~nence m emer~i~cy medtcme to provide pan-tone prot'ess~onal and admmlstrauve chrecuun for EMS Medtcal Control, and Phys~cian possesses slpcclahzed training_and OXl~Onanco m the area of Medical Coatsol and ~s quahfied to prowde such semces, and [dospKal destree to eniii~e Phl/slclan as Ilart-time Me(heal D~rector for EMS Medical Control, and Phystclan desires to accept such engagement with Hospital and m that capac~'y to pro3flda semces under the terms and,cund~tiuns ofth~s Agreement AGREEMENT: NOW, THEREFORE, m consideration of the foreg.omg_llremlses, and the mutual covenants and conditions contained hereto, Hospital end Phys~clan agree as follows Hospital hereby employs Ph!/sl(llan to SOlVe lis part-time Meihcal D~rector for EMS Medical Control ("Medicsl Director~) and Physician hereby accepts such employment, all subjeci to the terms and condmuns ofth~s Agl~ement 2. TITLE. Physician's t~le shall be Methcal Dlreaor, EMS Medical Control EMS MEDICAL CONTROL - JOHlq AIqSOH~, D.O ~ BAYLOit HEALTH CAR~ SYS?RM 199~ PAGE 1 OF I? 3 31 32 33 34 DUTIES OF PHYSICL~I Services Phxsician shall perform the Services (defined below) pursuant to the terms and cond,uons of this Agreement, and shall serve the Hospital faithfully and diligently, according to the best of his/her abilities Physician shall serve as the Medical Director for EMS Medical Control and shall, in such role, have the following major areas of responslbdit,, (a) assisting Hospital in defining the scope and characteristics of Me&cai Control services provided in the pre- hospital emergency care of patients, (b) providing trmmng and consultation to EMS personnel as required bm all applicable state and federal statutes, rules and regulations and as requested by Hospital; and (c) momtonng the delivery of Medical Control serwces m the pre-hospital care of pauents by EMS personnel In carting out such responslbfllues, Physician shall perform the specific services set forth on ~ attached hereto and incorporated hereto bv reference (the Services") The Services are administrative m nature and do not constitute the practice of medicine Hours Physician shall devote on average eleven (11) hours per week to the performance of Services hereunder, with the exact dates and times to be coordinated by the Physician and the Hospital in accordance ~th the needs of the Hospital, and subJeCt to approved absences, prowded, hox~ever, that Physician shall not prowde and Hospital shall not be obligated to compensate Phssician for more than five hundred seventy-six (576) hours of Services per each one (I) ~ear term of tins Agreement ~ Physician shall provide Hospital v, ith written documentation of all Services rendered hereunder Such documentation shall be submitted to Hospital on a periodic basis as reasonably requested b) Hospital The documentaUon shall be in the form, and contain the reformation, as ma~ be requested by Hospital from time to time to comply with apphcable federal and state laws, regulations and rules, and with the physician compensation allocataon requirements under the Medicare and Medicaid programs ~ Ph.~stclan shall report to (0 the Executive Director of Hospital with respect to all administrative matters, and (ii) the Chief of the Medical Staff at Hospital or such committee of~ the Medical staff as the Chief of the Medical Staff may, from time to Ume, designate with respect to all chmcal, medical staff policy and plamung and professional matters ?h)sl¢lan also shall maintain effective halson with the medical directors of all clinical departments In the Hospital for clinical and profasslnnal matters related to, as appropriate, chmcal integration, quality improvement, patient care, research and teaching 4 41 42 43 44 REPRESENTATIONS, WARRANTIES AND CERTAIN COVENA2qT$ OF PHYSICL~N Lmcnsurc ~d Ce~lficat~on Phx src~ represents ~d ~a~ ~at he/she is, ~d during ~c te~ of ~ls Agreement shall remain dun hcenscd, registered ~d m good st~dmg under ~c laws of ~c State of Tcx~ to engage m ~c unrcsmctcd practice of mcdimne ~d to a~m~stcr ~d prescribe controlled subs~ccs, ~d Is possess ~c quahficat~ons for Medical Director (off-hnc) ~ set fo~ m ~c r~gulat~ons of ~c Tcx~ State B~rd of Medical Exa~ncrs, 22 ~ ~ CODE { 197 I et seq Ph*slct~ reprosents ~d wa~ts ~at ~s~er license to practice medmme ~d ce~ficatc to prescribe medtcattons ~d controlled subst~ces m ~e State of Tex~ or m ~y other jurisdiction h~ never been dcmed, suspended, revoked, tcmmatcd, voluntarily rehnqmshed under ~reat of or subject to dtsc~phnau action, probated, or rcsmctcd m ~y way Phys~ct~ ~er represents ~d ~a~ts ~at h~shc ~ not been subject to &sc~ph~ or conecUvc action by ~ hosp~l or hcensmg ~cnc~ or to exclusion or deba~ent ~om e~er ~e Mc&care or Med~cmd progr~ Upon request, Ph~ssct~ shall prowdc to Hosptml ~srd-p~ documentation to cwdencc thc accurac~ of ~c foregoing reprcscnmUons ~d wa~txes ~ upon request, shall au~onze (m x~ntmg ff requested) Hospital to obmm verification ~rcctly ~om ~rd pames Medical St~ff Membershm Ph)s~c~ represents ~d wa~ts ~t he/she h~ or wd[ obtain prior to ~c ~ffect~ve Date, ~d dunng ~c te~ of ~s Agreement shall maintain, Hosptml mcdmal staff membership ~d appropriate chmcal pnvdeges, m good s~dmg However, ~s Agreement ~s not, ~d shall not be construed as, ~ fo~ of guar~tce or ~su~cc by Hospital ~t Ph~s~c~ ~xdl ob~n or rcmm medsc~ s~ff membership or appropriate chmcal privileges, since such membership ~d pnvdegcs ~c governed solely by thc bylaws of Hospital ~d ~e bylaws of · e medical smffat Hosptml as ~ended ~om t~mc to t~c ~ontmum~ Medmal Educatmn Ph)s~c~an represents ~d wa~ts ~at he/she ~s, ~d dunng ~c tc~ offs Agreement s~ll ~mam, professionally ~med ~d experienced m cunent EMS Off- Linc M~mal Control, ~d agrees to ~e all actions necessa~ to maintain such tra~ng ~d experience as max be reqmred b~ ~c Tcx~ State Bo~d of Mcdmal Ex~mers ~d ~ neccssa~ to ab~de bx ~c reqmremcn~ of Phxs~cz~ s mcdzcal board specmlty, including, wl~out hmt~tlO~ a~en~cc, at profcss~o~ convention, post-graduate seminars, contmmng med~l educatmn semi.rs ~d coherences ~d ~nctmns of profcss~o~ socset~es CCME Act~wt~es") CME Act~tses arc at ~e sole cost ~d expe~e of Phys~c~ ~lcss such expenses ~c accounted for m ~e budget of~e Dep~ent ~Wor approved m advice by Exccuttvc D~rector ~ Ph~smmn shall complete ~d execute a Ba~lor Health C~e System approved fo~ of Co~cts off ~tercst Statement idcnt~mg all ~own ~d ~ttc~patcd co~ic~ Physic~ or ~y of his or her f~fly members ~ ~th ~y ent~t) a~hated wxth Ballot Health C~e S)stem At ~1 times dunng ~e Te~ of~ls Agreement, Physm~ shall be subject to ~d comply wt~ ~c Baylor H~lth C~c Sy~em Co~lc~ of Interest Pohcv CO~I:~gNTIA~ AND ~ROFR.I~TARY '1 PROPERTY Of' BAyLOR HEALTH CARE SYST F,M ALL [~RIVILEGgS CLA~iED ~ Physician shall promptly (within three (3) da~s) notlS, Hospital m the event any representation or ~arrant~ by Physician set forth m this Agreement shall no longer be true, correct or complete Comp|tahoe ~lth Hosoltal Policies Physician shall compl~ with all applicable bylaws, rules and regulations of the me&cai staff at Hospital, and the policies and procedures of Hospital, as are in eft'cci from time to time Physician shall work cooperanve[y with the personnel of Hospital, and in particular, those persons working in or on behalf of Hospital ~[ILg~L~:l~ 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 developmants and improvements tn the provision of medical services relating to Medical Control, and shall ~ork with Hospital in the implementation of developments in the service area Etbacs and Professional Standards Physician shall comply with the etlucal 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~ermng bodias Physician shall comply with the Bavlor Health Care System Code °f C°nduct' Clinical Ethics Guidelines and Business Ethics Guidelines Lncummz Financial Obhlzatlon. Exoensas Physician mat not incur an~ financial obligation on behalf of Hospital without the prior written approval of Hospital Physician ~lll be responsible for all expenses incurred in providing Services under t.}us Agreement, unless such expenses are approved in advance by Executive Director ~ Nothing contained herein shall prevent Physician from establishing and maintaining a private medical practice Physician shall conduct his/her private medical practace in a manner that permits fulfillment of his/her responsibilities under tins Agreement Physician ma~ make such charges for services provided in Physician's private medical practice as he/she shall determine, and may bill and collect all such charges, vathout pa~Tnant of any part of the proceeds thereof to Hospital Nc) Other Bavlor Relatwnshio Physician represents and warrants to Hospital that neither Ph~ slclan nor any family member of Physician has an agreement or arrangement (whether oral Oo~ written) for the provision of items or services with Hospital, Baylor Health Care System or any its affiliated organizations, other than as set forth on ~ attached hereto and incorporated hereto by reference and/or as established by this Agreement PROFESSIONAL LIABILITY INSURANCE 6 7 71 72 73 8 In thc event Ph~slcma maintains a private medical practice, Physicmn, at lus/her own cost and expense, shall maintain, m full force and effect dunng the Term of this Agreement, professional habdity insurance, issued b~ aa insurer acceptable to Hospital, covering Physic~nn against all clmms arising out of the performance of services consUtutmg thc pracucc of medicine ( Malpractice Insurance ') MalpmcUce Insurance shall bcm amounts of coverage no less than thc mtmmum required b~ Hospital to be a member of thc medical staff dunng an~ year The insurance pohc~ shall require thc career to provide Hospital with written notice of an~ cancellanon or reduction of insurance coverage at least twenty (20) days in advance of such cancellaUon or reduction On or before the Effective Date and thereafter upon request, Physician shall promptl~ dchvery to Hospital certificates of insurance evidencing such coverage I NDEMi"ffFICATION Physician shall mdemm~ and hold harmless Hospital fi.om sad against any and all clmms, liabilities, damages and expenses, incluthng without lumtauon reasonable attorneys' fees incurred bv Hospital, its officers, threctors, employees or agents, arising out of or related to the acts or onnssions (mcluthng the negligence) of Physician in connection with Physician's pmcUcc of medicine OWNERSHIP OF/ACCESS TO BOOKS AND RECORDS GOvernment Access to Books and Records Physician shall comply with all applicable federal and state la~s governing the maintenance of documentation to verify thc cost of Services rendered under this Agreement Until the expiration of four (4) years after the fumislung of Services pursuant to flus Agreement, Physician shall make available, upon written 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 anthonzed representaUves, this Agreement, and books, documents, and records of Physician that are necessary to eertl~ the nature and extent of such COSTS Notice to Hosmtal If Ph>sicmn receives a request or demand to disclose any books, documems or records relevant to flus Agreement for the purpose of an autht or investigation, Physsciaa shall immediately (within two (2) business days after receipt of such request or demand) noufy Hospital in wnung of the nature and scope of such request or demand Physscian shall make available to Hospital, upon wnt~an request of Hospital, all such books, documents or records 0x~nershio of Records All Hospital and Ivlcdical Control records shall be and remain the property, of Hospital FINANCIAL A. RRANGE~NTS 9 91 92 93 94 95 In consideration of the performance by Phystclan of the Services sci forth m this Agreement, upon submiss,on of thc reports and records required by this Agreement, and subject to thc hmltat~ons of ~.LL0.R~, Hospital shall pay to Physician a salary at the rate set forth on ~ ~ attached hereto and incorporated by reference herein, provided, however, that Hospital shall not be obhgatcd to pa'~ Physician any salary unless this Agreement and all of tis terms and conditions arc approsed bs the Executive Committee of thc Baslor Health Care System Board of Trustees on or before December 3 l, 1999 Physician shall not bill an~ patients or tlurd-party pasors for Services pros idcd pursuant to tlus Agreement TI~RM AND TI~ILMINATION T~rm of A~reement. Condition ~e ong:~ t~ of ~s A~eement s~ll be for a period of one (1) yc~ co~encmg on ~c ~ffecttvc Date (~e "Original Term'3, ~lcss tc~t~tcd ~rhcr m accor~cc ~ath ~e provisions of ~s Ag~cmcnt ~s Agreement s~l be auto~Bcally extended for addttto~ successive one (1) ye~ ~s (~ch, a "Renewal Term") ~dcr ~c s~e te~s ~d conditions unless ~e A~rcement ts o~e~zse te~t~ted pursuit to ~s ~ or el~er p~ elects not w so renew by ~t~n8 ~ No~vtt~ng ~tng hereto to ~c contr~, ~s Agreement is subj~ · c end of ~) te .... ._ ~ ..... ~ i~ce of ~c Baylor H~th to ~d s~ll be con.ironed upon tis approvat oy C~e S)stem Bo~d of T~tees, ~d, m ~e event tMt such Executive Co~t~ee does not approve of~c ~re~ment on or before December 31, 1999, ~s Agreement shall be null ~d void ~d of no e~cct x~hatsoever Tc~matton bx Mu~al Consent ~ts Agreement ~Y bc tc~tcd at ~y ttmc by mum~ wnsen agreement of ~e pa~tes ~ ~s Agreement ~Y be to.hated by either of ~c pa~tcs ~vt~out cause by gxvmg thc other p~ mnety (90) ~ys' prior ~Ren noucc ~matc tMs Agreement tmmcdtatel) for breach of ~ ~tcn~ tc~ or conatuon et uxb...~___mc Y ...... a --*bm ten il0) business ~ys ~cr Breac~n~ Pa~ ~ notice of brach ~r ~s ~t~~ ~ble ~c~tnatton b~ ~0sDt~ ~ospl~ ~Y ~tnate ~ts Agreement, cffc~tvc i~cdtatcly upon notice to physician, m ~c event of a ~) te~atlon, suspc~wn, wl~awal under ~cat of ~sctpl~ a~ton, probation, [tint.lion or reduction m Physician s s~ privileges at ~ospt~ or ~y o~cr hospt~l or hcal~ care facthW, or .~R,,vcoa ax~.'m c,~u~ s~sax~ 1 .,999 p&og 6 or i_~ 96 97 b an~ termination suspension probation, [imitation, revocation or lapse of Physician's (a) license to practice medicine in the State of Texas, (b) state or federal authorization to acLmimster or prescribe controUed substances, or (c) quahRcauon under the Medicare or Medicaid programs, or c charging or con~ lction of Physician by any federal or state agency or authority of any crime lnvol~mg ~raud, moral turpitude or immoral conduct Matters R¢latmc, to Medical Staff .Membershio and Duc Process Ivlcdical staff membership is a condition to thc pert'ormancc of Services under this Agreement However, this Agreement is not, and shall not be construed as, any form of guarantee or assuranc~ by Hospital that Physician obtain or retain medical staff membership or cllmcal pn,nleges, those matters are governed solely b~ the b.~laws, roles and regulations of the medical staff at Hospital as are m effect from time to time The nonrenev~al or termination of this Agreement shall not affect the medical staff membership or clinical privileges of Ph.%sician at Hospital, ~h,ch status shall be separately gosemed b~ the bylax~s of the medical staff of Hosp,tal, 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 appl~ to the termination of this Agreement Leitat Comohance If there Is a change in an,v law, regulation or rule, state or federal, which affects this Agreement or the actl~ lties of either party under this Agreement, or any change in the judicial or admlmstrativ¢ interpretation of an~ such law, regulation or rule or if any of the pro~ lslons of this Agreement are found to be in violation of the laws ex. isling at the time of such determination, and either party reasonably believes in good faith that the change, lnterpretaUon or determination x~lll have a substantial adverse effect on that party's business operations or its rights or obligations under this Agreement, then the party may, upon whiten notice, require the other part~ to enter into good faith negotiations to renegottate the terms of this Agreement and to take an~ action necessar'~ 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 ca,her of fort'y-five (45) days a~er the date of the notice seeking renegotlation or the effective date of the change, or if the change or determination is effective immediately, then either party ma~ immediately termmata this Agreement by wntten notice to the other party 10 CONI~IDI~NTIALITY Ph~sician acknowledges that in connection with this Agreement and the Services provided by Phxsician under this Agreement, Phvslclan may be acquinng and making use of certain confidential information of Hospital which includes, but is not limited to, management reports, financial statements, internal memoranda, reports, patient information, and other materials or records of a propnetar', nature (' Confidential Information") Therefore, in order to protect the Confidential Information, physician shall not use such Confidential Information except in ~Ba¥1~oR ~LTII CARE SYSTEM 1999 pn~E 7 OF I~ CONi~DgNT~A.[. Avl} ~ROpRX~TARY [~ROelLRTY OY BAyLOR [-~A LTH CARE SYST LM ALL PRIV~---ee--st ~ CLAIblID connecUon v~,th the performance of Phystctans duttes pursuant to tlus Agreement, or chvulge the Confidential Information to an) thtrd party, unless Hosp,tal consents m writing to such use or dtvulgence or d~sclosure ~s requtred by law Physician shall comply w~th the apphcable federal and state laws and regulatzons govcmzn8 the confident,ahty of all paUent medical records and peer review m~ormat~on la the event Phystctan receives a request or demand fi.om a third party for the d~sclosure of Confidentml Informauon, Phys~cmn shall promptly (wzthm two (2) business days a~er receipt of such request or demand) provtde wnuen nouce to Hospital of such request or demand, including a copy of any written document of such request or demand Upon ternunaUon of th~s Agreement, Phystc~an shall not take or retain, without prior written authonzatton from Hospttal, any pauent records, other pattant chmcal dat~ or tnformauon, patient list, papers, fee schedules, files, or other documents or cop~es thereof or other Confidential lnformaUon of any kind belonging to HospitaJ pertsuung to l~tUents, business, sales, ~manctal con&tton, or products of Hospital Wtthout hmmng other possible remedtes for the breach of thts covenant, the pames agree that mjuncuve or other equitable rebel shall be avmlable to enforce this covenant, such rebel to be ~thout the necesstty of pc)sung a bond, cash or otherwise 11 NOTICES Nottccs or communicat~ons to be gtven under thts Agreement shall be provtded to the appropriate party m ~ntmg etther by personal dehvery, overmght dehvery service, confirmed telefacsimde or registered or cemfied mall, postage prepmd, as follows To Hospital Baylor Medical Center at Grapevine 1650 W College St Grapevine, Texas 7605 l Fax (817) 481-2962 AttenUon £xecutiv¢ Director s~tth a cop~ to BHCS Office of General Counsel 3600 Gaston Avenue Suite I157, LB 83 Dallas, Texas 75246 Fax (214) 820-1535 If to Physician John Ansohn, D 0 EM S % tED lCAL COtq't'ROL JoaW A,-~so~, D O ~'BA'~ LOR ~EALTT[ CARE SySTeM 1999 PAGE 8 OF 17 or at such other addresses and to such other persons as either part~ may fi.om time to time designate by notice given as herein provided Such notices or commumcations shall be deemed to have been given upon receipt if bm personal dehverv, three (3) business days after deposit in the United States mail if sent by regular, registered or certified mall, postage prepaid, one (1) business day after delivery if by an ovem,ght dehverv service, or upon transmassion confirmation if by telefacsimde 12 GENERAL PROVISIONS. 12 I Entire A~reement. Reoreseatation. Construction Tl~s Agreement, any amendments or addenda hereto, and an,, exhibits specifically mentioned herein constitute the entire agreement between the parties regard,ne the subject mat~er hereof and supersede all prior 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 opportumty 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 soleil, for convenience and shall not be used for interpretation or construing any ~ord, clause, paragraph, or subparagraph of this Agreement 12 2 ~ Tlus Agreement ma~, be executed in multiple counterparts, and each counterpart shall be considered an original 12 3 ~ 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 12 4 ~ Tlus Agreement mas be amended only by a written instrument signed by Hospital and Phvstman 12 5 ~ Physician may not assign or delegate the rights, duties and obhgntaons of Physicmn under flus Agreement to any other person, group or professional association Hospital may not assign or delegate the rights, duties or obligations of Hospital under this Agreement to any other person or entity without prior written consent of Phvsiman, provided, ho~sever, that ttus Agreement may be assigned to any corporation or other entity, succeeding to the business of Hospital in connection with the merger, consohdat~on or Wansfer of all or substantially all of the assets and business of Hospital or with a corporate reorganization involving Hospital Tlus Agreement may also be assigned to any subsid~ary, parent corporation or other affiliate of Hospital RM$ %I~DICa2. CONTROl. .IOI1~ A~'~OI~, D O ~AYLOR E[~ALTH (~AP~ S¥~T~,N~ 1..999 pXOl~ 9 OF 17 I CONtqDE~ITL~.L .A.~D ~1~.O PR~'TARY PROPgRT*~ OF BAyLoR HEA~TH CARE ~[.L t~R~VILEG~ CI.A~M ED ,, 12 6 NO Third Part~ Beneficiaries This Agreement shall be binding upon and inure to the benefit of the parties hereto, their successors and pernutted assigns Nothing m this Agreement ts intended, nor shall be deemed, to confer an~ benefits on any third party, including, without limitation any pauents of the Hospital, nor shall such person or entity have an:, right to seek, enforce or recover an~ right or remed.~ with respect hereto 127 Reorescntations and Warranties Physician acknowledges that Hospital is relying on representations and warranties contained tn this Agreement m entering into this Agreement and the transactions contemplated hereby 128 ~ If any term or prov~ston of this Agreement ts held illegal, mvahd or unenforceable to any extent, the remmnder 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 pernutted by law, and tn lieu of each such illegal, mvahd or unenforceable provision the parties shall use their best efforts to add as a part of this Agreement a provision as sumlar m terms to such dlegal, invalid or unenforceable provision as may be legal, vahd, 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 stmdar provision None of the provisions of this Agreement shall be considered x~atved by either party except x~hen such wmver ts g~ven tn x~'nting 1210 v L w V u This Agreement shall be construed and governed accordmg to the la~s of the State of Texas, ~,athout gtvmg effect to tls eonfilct of laws prov~sions The parUes hereto expressly agree that this Agreement ts executed and shall be performed m Tarrant County, Texas and venue of all disputes, claams and lawsmts arising hereunder shall lie tn Tan'ant County, Texas 12 Il Remedies The remedies prowded to the parties by this Agreement are not exclusive or exhaustive, but are cumulative of each other and tn adtht~on to any other remedies the parties may have 1212 Attorneys Fees If either party bnngs an acuon against the other to enforce any condttaon or covenant of this Agreement, the prevailing party, m addmon to other rebel awarded by a court or arbitrator, shall be entitled to recover from the other party its court costs and reasonable attorney's fees recurred tn such action 1213 C0nfidentiaht,, of Aitreement Physician shall keep th~s Agreement and its contents confidential and not chsclnse this Agreement or tls contents to any third partT other than his/her legal and financial advisors, or otherwise as reqmred by law, w~thout the prior written consent of Hospital 12 14 Corporate Practice of Medicine Nothing contained herein is intended to (a) consvtute the usc of a medical license for the practice of medicine by anyone other than a licensed physician, (b) md Hospital or an., other corporation to practice medicine when in fact such corporation ts not hcensed to practice medicine, or (c) constitute or result m any other ac~ or create any other arrangements in violation of the Texas Med~eal Practice Act ('lEx REV CFc STAT AblN ~ 4495b) 12 15 Fraud and Abuse Law and Texas H~lth & Safety Code The parUes enter rote this Agreement with the intent of conducting their relationship In f~ll comphance with applicable stat~, local, and federal law including tho Stark law, the Mc&care and Medicaid Anti-Fraud and Abuse law and the Texas Health & Safot~ Code Illegal Remunerauon law Notvathstandmg any unanfaclpated effect of any of tho prov~sions herein, neither party w~ll intentionally conduct itself under the , terms of tlus Agr~¢munt in a manner to constitute a wolat~on of the Medicare and Medic, md Anti-Fraud and Abuse law or Texas Health & Safety Code Illegal Remuneration law provisions 12 16 ~L~q~L~/~gl~l Physlcmn acknowledges and understands that this Agreement does not require, and shall not be construed to require (directly or m&rectly, explicitly or implicitly), Physician's use of Hospital or any other facility or sevace related to Hospital, or the admission or referral of any patients treated by Physlcmn to Hospital or other facilities related t~ Hospital Tlus Agreement does not prohibit Physician from obtaining memberslup on the medical staff of any other hospital or health tara entaty or from refemn$ patients to or utilizing the services of any other hospital or health care entlt2,. [Signature Page Follows] COeI~II~T~A,L A,%'O I~OI~R~TA~Y I~ROPERTY O1 BAYLOR H~ALTH CA~E SYSTLM A~L I)RIVI~EGES CLAIMED IN WITNESS WHEREOF, the pames hereto have duly executed th~s Agreement by their respective duly authorized representatives as of the Effective Date first stated above HOSPITAL BAYLOR MEDICAL CENTER AT GRAPEVINE Mark Hood E~¢¢UtlV¢ Dtrector PHYSICIAN EMS % EIEOICA~. CO~O~, - Jo~ A~sO~, D O ~BAYLOR IIFALT~ CAI~ S¥~q~4 1~99 PAGE 12 O~ 17 I CO~IDI~r~IAL ~ I~ROI~J~TA~Y I EXHIBIT A ADMINISTRATIVE SERVICES 2 3 4 5 6 7 Provide off-line EMS Me,heal D~rec~or services as reqmred by the regulaUons of the Texas State Board of Medrol Examiners for EMS ra~hcal &rectors, presently co&tiM at 22 T~x Admm Code § 197 1 et seq for those EMS systems (Wl~ne EMS Systems") listed below and as may be added from t~me to tm~e through contractual a~/eement with Hoep~tal a J k L Colle~lle F~re Department, Denton Fu~ De~artmant, Euless FLre Department, Flower Mound Fu~ Depnnm~ot, Grapevine F~e Department, Keller Ftre De~amnant, Lake CtUes F~e Department, La~et~x~kt F~ro Pochland Hdls Fire Department, Roanoke F~rz Department, Southlake Department of Pubh¢ Safety, Trophy Club Emerl~n¢~ M~hcal Serwces Facthtete Contmuons Quahty Improvement (CQI) acttvtt~es at Hospital for the EMS Systems Formulate and review emergency me&cai service protocols Estabhsh gmdelmes and momtor quahty assurance for all Medical Control acUvmes Coordinate suffioent contmumg education to meet Department of Health requirements as set forth tn 25 Tex Admtn Code § 157 38 Pro.de training.and educ~on on EMS-feinted matters through Ho~al to EMS Systen~ R~q~rssent the Hosp~al on EMS-related nsanes before local, regional and state EMS and trauma org~zauonal boards and authormes Prowde and fncfl~te strategtc planning for Hospttet EMS Medical Control system 9 Attend and represent Hospr, al at medical control meetings and sub-commntee meatmgs as needed CO~/~DE,%rTIAL A,ql) ~R. OPRI~TARY ~:)ROP~RTY Or BAYI,OR ~LTI-I CARI ALL ~,~I, ~O ~ C~En 10 11 Assist in enforcm$ the bylaws and the roles and regulations of thc Hospital's medical staff as well a~ any other Hospital, medical ~ or patient cate pohcses and procedures Perform other duties or special requests as may from tu~c to ume be reasonably requestcd by the adm~mstration of Hospital or by the Hospital's Mcchcal Board or as may be rcqmred by thc medical staff bylaws of Hospital EMS ~,LKDZCAL COFTTROL - JOH~ A,~OH~, O O ~BAYLOR HY. ALTH CA.q~ SYSTEM 1999 PAGE 14 OF 17 I Coffll'TD e.',(TIA l, ~"~D ~l?.O P~r, TARY "1 ~tOP~TY OF BAYL.OK [-[F~ LTH C.~i~ SYSTL~4 EXHIBIT B OTHER BAYLOR RELATIONSHIPS List all other contractual or financial relattonslups vath Hospital, BHCS or a/~hated entrees Contractual relationship with Baylor Medical Center at Grapewne for provision of Medical Director services to Hospital Utthzat~on Review and Quality Assurance Rewew programs 2 Employment relaraonship wgh Texas-EMI Me(hcal Scn~lces, P A, contractor to Baylor Me&cai Center at Grapevine for Emersency Dep~u b.L,ont CoverSSe EMS %IF. DICAL CONTROl, - JOIL~ A,~'SOHN, D O ~ BA~/.OR HF. ALTH CARE SYSTEM 1999 ~AGE IS OF 17 EXHIBIT C COMPENSATION Fee shall be based upon thc number of hours for which Physlcan provldes Mc&cai Director services, pard at a rote of Sev~nt~-Fiv¢ and No/100 Dollars per hour ($75 00/hr) up to annual ma.vamums of 576 work hours and Forty-Three Thousand, Two Hundred and No/100 Dollars ($43,200 00) compensation per year Physician's compensauon fee shall be prod in monthly installments after receipt of Physician's reports and documentatton of services for the previous month Physician shall mamtmn and provide to Hospaal a monthly wnttan record, m form and in detml reasonably sausfactory to Hospttal, meeting the requirements of this Agreement and documenting all tune devoted to Services under tlus Agreement