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HomeMy WebLinkAboutMINUTES - 09271994 - 1.48 51 � 1� TO: BOARD OF SUPERVISORS FROM: Mark Finucane, Health Services Director " Contra By: Elizabeth A. Spooner, Contracts Administrator Costa DATE: September 12, 1994 County SUBJECT: Approval of Unpaid Student Training Agreement #26-121-2 with Mount Saint Mary's College SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: Approve and authorize the Health Services Director or his designee (Frank Puglisi) to execute on behalf of the County, Unpaid Student Training Agreement #26-121-2 with Mount Saint Mary' s College, for the period from September 1, 1994 through August 31, 1997 , for provision of clinical experience for physical therapy students. II. FINANCIAL IMPACT: None. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: The purpose of this agreement is to provide physical therapy students with the opportunity to integrate academic knowledge with application skills and attitudes at progressively higher levels of performance requirements and responsibility. Supervised field work experience in physical therapy is considered to be an integral part of both the educational and professional preparation. As a teaching hospital, Merrithew can provide the requisite field education, while at the same time, taking advantage of the students ' services to patients. This agreement is prepared in the standard format approved by County Counsel ' s Office and has been executed by the Contractor. CONTINUED ON ATTACHMENT: YES SIGNATURE: ' 0--,-e�7.--� RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEN ATI OF BOARD•C MITTEE APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS UNANIMOUS (ABSENT T ) I HEREBY CERTIFY THAT THIS IS A TRUE AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD Contact: Frank Puglisi, Jr. (370-5100) OF SUPERVISORS ON THE DATE SHOWN. cc: Health Services (Contracts) ATTESTED SEP 2 7 1& Contractor -- Phil Batchelor, Clerk of the Board of Supentina ad Goduty AdminisUat g M382/7-68 BY Od DEPUTY "'Contrz C�s�a County '` �� Standard. Form UNPAID STUDENT. TRAINING AGREEMENT Number 26-121-2 1. Contract Identification. County Department: Health Services (Hospital and Clinics Division) Subject: Unpaid student training with Department, sponsored by Contractor 2. Parties. The County of Contra Costa, California (County) , for its Department named above, and the following named Contractor mutually agree and promise as follows: Contractor: MOUNT ST. MARY'S COLLEGE Capacity: Private Educational Institution Address: 12001 Chalon. Los Angeles, California 90049 3. Term. The eff e o this Agreement is September' l. 1994 and it terminates Au ust 3 1 . nless sooner terminated as provided herein. 4. Termination. Agreement may be terminated by either party, at its sole discretion, upon seven-da,- advance written notice thereof to the other, or canceled immediately by written mutual consent, subject to termination conditions (if any) set forth in the Program Plan attached hereto and incorporated herein by reference. 5. Program. By this Agreement County agrees to permit unpaid student training by persons (participants) sponsored by Contractor under the following conditions: a. Services provided under this Agreement are volunteer services, and participants obtain no employment rights with, or employment benefits from, the County, by virtue of this Agreement or service hereunder. Agreement, in the form attached hereto, is required of every participant. b. Upon approval by County's Board of Supervisors this Agreement shall be an authorized volunteer program. The County's volunteer policy and the County Administrator's rules and procedures for authorized volunteer programs attached hereto, are applicable with respect to this Agreement, and are incorporated herein by reference together with any amendments thereto, subject nevertheless to the terms of this Agreement. C. Other contract terms and conditions are expressed in the Program Plan attached hereto and incorporated herein by reference. 6. Independent Contractor Status. This A = ei nt is by and between two independent contractors and is not intended td�a s 1 not be construed to create the relationship of agent, servant, e 'u y ,e,. rtnrship, joint venture, or association. 7. Indemnification. Except fort� 'c ' vities of participants covered by the County's Volunteer policy, each party�Ad its employees, agents and officers shall be indemnified and held harmless against any and all claims, demands, or causes of action allegedly arising out of any act or omission arising as a result of the services provided in this agreement, of any officer, agent, or employee of the other party, or resulting from the conditions of any property owned or controlled by the other party. 8. Legal Authority. This Agreement is entered into under and subject to the following legal authority: California Government Code Sec. 26227. 9. Signatures. These signatures attest the parties' agreement hereto: COUNTY OF CONTRA COSTA, CALIFORNIA CONTRACTOR By By Designee Recommended by Department (Designate official capacity) By Designee (Form approved by County Counsel) Contra Costa County Standard Form UNPAID STUDENT TRAINING PARTICIPANT AGREEMENT The County of Contra Costa and the Participant named below agree as follows: 1. Participant will engage in training for a Contra Costa County Department pursuant to a contract between the County and a contractor sponsoring the participant. 2. Participant agrees that in connection with such training, participant is a volunteer, subject to the County's volunteer policy and regulations, and will obtain no employment rights or employment benefits from the County and waives any claim to any employment rights or benefits from Contra Costa County based upon participant's training services, whether or not authorized under such contract. 3. Participant further agrees: "I have read the Contra Costa County Policy Statement on Volunteer Programs. In return for the benefits provided by Contra Costa County in case of my illness, injury, death, or third party liability while providing, or resulting from acts or occurrences within the scope of my authorized volunteer services, and for my right to authorized expense reimbursement, I waive any claim on my behalf and on behalf of my heirs, representatives, and assigns against the County of Contra Costa or any of its agents, servants or employees for illness, injury, debts or other harm arising from my volunteer services, whether or not authorized. " 4. Participant has read and understands the Unpaid Student Training Agreement (identified below) between the County and participant's sponsoring contractor and agrees to and is bound by the terms of that contract. 5. County or participant may terminate this agreement upon three day's notice or without prior notice, for cause; or by mutual consent; otherwise this agreement terminates upon termination of the agreement between the County and participant's sponsoring contractor. 6. This agreement is made in consideration of the County accepting participant for training. 7. Neither the County nor any agent, officer, servant, or employee of the County shall undertake or incur any liability or other responsibility respecting the quantity, quality, kind, or value of the training of participant and no warranty, express or implied shall exist in that regard. 8. Entire Contract. This Agreement contains all the terms and conditions agreed upon by the parties. Except as expressly provided herein, no other understandings, oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any of the parties hereto. 9. Identification of Unpaid Student Training Agreement: Number 26-121-2 Contractor Mount St. Mary's College - Physical Therapy Department County Department Health Services - Hospital and Clinics Division CONTRA COSTA COUNTY PARTICIPANT (Printed Name) By (Designee) (Signature) PROGRAM PLAN FOR CLINICAL EXPERIENCE FOR PHYSICAL THERAPY Number 26-121-2 1. Purpose of the Program. Mount Saint Mary's College, Los Angeles, conducts an educational program in physical therapy for its students. The College desires to have students, enrolled in this program, receive clinical instruction from the County, and the County is willing to provide such instruction under the terms and conditions hereinafter set forth. Therefore, the parties will undertake a program whereby such instruction and experience will be provided in accordance with a plan mutually agreed to by the parties. 2 . Contractor' s Obligations. In participating in this program, Contractor shall: a. Designate students for participation in the clinical experience conducted pursuant to this Agreement. b. Suggest dates for the clinical experience periods, and cooperate with County's Department in establishing assignment schedules consisting of specific dates for the placement of a specific number of students with the County for training, which shall be established by mutual agreement of the respective representatives of the County and the Contractor. C. Assign for field instruction only those students who are prepared to a degree considered adequate by mutual agreement of the parties hereto; d. Make all necessary arrangements so that each student will: (1) Have completed all the necessary courses required by the Contractor as preparation for said clinical experience; (2) Agree to execute the County's Unpaid Student Training Participant Agreement upon referral to the training program; (3) Arrange for their own transportation to and from the Health Services Department and for maintenance and housing during field instruction; (4) Channel educational problems to the Contractor; Initials: Contractor County Dept. 1 PROGRAM PLAN FOR CLINICAL EXPERIENCE FOR PHYSICAL THERAPY Number 26-121-2 (5) Promptly report illnesses and absence from duty; and (6) Comply with regulations and standards of conduct governing professional physical therapists in the County Health Services Department. e. Furnish County with such evidence as County may require that each student assigned for training hereunder is physically fit. f. Verify, at request of County, that the Contractor has in full force and effect during the term of this Agreement, professional liability insurance for students designated for participation pursuant to this Agreement with a coverage of at least One Million Dollars ($1, 000, 000) for the activities of the student pursuant to this Agreement. 4. County' s Obligations. In participating in this program, County shall: a. Comply with all State statutes and regulations applicable to the training of physical therapists enrolled in the Contractor' s program; b. Accept for clinical experience those students assigned by the Contractor for such a period and in such numbers as may be mutually agreed; C. Provide the student with learning experiences needed to meet the objectives of the training program mutually agreed to by the parties in accordance with the plan referenced in Paragraph l. , above; and d. Have the right to terminate the participation of any student in the clinical experience for failure to follow the instructions of County, or for any other reason deemed adequate by County. In the event of such termination, County shall give prompt written notice to the Contractor. 5. Joint Obligations. County and Contractor shall jointly: a. Plan a student training program including course content and student assignment schedule so as to provide a sound and effective educational program; Initials: Contractor County Dept. 2 PROGRAM PLAN FOR CLINICAL EXPERIENCE FOR PHYSICAL THERAPY . Number 26-121-2 b. Review the program at the end of each training period in order to evaluate progress and recommend changes for the next consecutive training period; and C. Plan for periodic review of this Agreement. 6. Participants' _Obligations. Participants shall: a. Execute the County's Unpaid Student Training Participant Agreement upon referral to the training program; b. Abide by County policies and regulations; C. Conduct themselves in an appropriate professional manner consistent with responsibility; d. Observe and respect patient's rights, privacy and dignity; and e. Comply with applicable County, State and Federal regulations respecting disclosure of patients ' heath information and access to, and removal of, medical records and/or information contained therein. 7. University, County and Participant Agreement. Notwithstanding the authorization for reimbursement for actual and necessary expenses (including a flat mileage rate of $0. 15 per mile for use of personal vehicles) of authorized volunteer services set forth in the final paragraph of attached Contra Costa County Policy Statement on Volunteers, participant shall be entitled to no reimbursement by County for said expenses while engaged in the training program covered by this Agreement. Initials: Contractor County Dept. 3 Administrative Bulletin Contra Number 321 Costa Replaces Office of the County Administrator Date _ l 7 -26-7R Court y Section _porernnal SUBJECT: Rules and Procedures to be Followed by County Departments for Authorized Volunteer Programs I . GENERAL This bulletin provides the rules and procedures to be followed by County departments governing entrance , training, and supervising of volunteers under County authorized volunteer programs, including the policies and procedures for reimbursement of expenses; medical and permanent disability benefits ; and legal defense and indemnification against liability claims initiated by third parties . These regulations and procedures are promulgated in accordance with the policy adopted by the Board of Supervisors . II . RULES AND PROCEDURES County departments shall submit to the Office of the County Administrator a description of each volunteer program, the number of volunteers to be assigned, County staff requirements for coordination and County expenditures and funding involved. Such volunteer program definition, following review by the Office of the County Administrator, shall be forwarded to the Board of Supervisors for approval. After Board approval, rules and procedures , as follows, shall be adopted, and copies forwarded to the County Administrator: A. County departments sponsoring volunteer programs shall have a staff member assigned as a volunteer coordinator, who will be respon- sibile for the selection and acceptance of volunteers. Personnel matters regarding the volunteers will be referred to the volunteer coordinator. Volunteers will work directly with other staff members and will be under their supervision for each assignment. Each County department will forward to the County Administrator the name and telephone number of the employee (s) assigned as the volunteer coordinator. Volunteers will be provided with initial orientation and training by the 2 . volunteer coordinator. Where appropriate, confidentiality requirements shall be explained, reading materials assigned and discussion groups held on a regular basis with the volunteers. B. The volunteer coordinator will also be respon- sible for requiring volunteers to fill out, read and sign the application form, and if such volunteer is accepted, the volunteer coordinator will fill out the registration form (just below the application form) showing acceptance of the volunteer, date services commence and terminate , any remarks he may wish to include with respect to the capability of the volunteer and limitations as to tasks to be performed, and lastly the service authorized to be performed by the volunteer. If the volunteer is a minor, the parental consent form shall be completed and signed by the parent or legal guardian. Forms to be used by departments are attached. Departments may continue to use forms developed for volunteer programs which include information needed by the department in addition to that indicated on the attachments . Any obvious or suspected disabilities of a volunteer shall be discussed with the County Safety Officer. If reimbursement of actual and necessary expenses in performing volunteer services is contemplated, volunteer must sign Oath of Allegiance form in accordance with established department procedures when registering to perform authorized volunteer services with the County. The volunteer coordinator shall be responsible for mainte- nance of a log listing pertinent information with respect to all authorized volunteers , including date services commenced and terminated. Records are to be retained at least five years from the date of the last volunteer service for subsequent reference on claims which may be presented by either the volunteer or any third party allegedly injured. 3. If a volunteer is to use his personal vehicle in the course of authorized volunteer services, he will be required to fill out the "Volunteer Auto Insurance Declaration" form. Volunteers must check with their insurance agent or broker to make certain that liability insurance is extended under their policy while their vehicle is being used for volunteer activities . Auto insurance is required for all volunteers who will use their personal- automobile while performing authorized volunteer services with at least the following limits : $15 , 000 for injury to or death to one person $30 , 000 for injury to or death to two or more persons in one accident -$5 , 000 for property damage The volunteer must furnish a valid California motor vehicle operators license if he is to use a vehicle and the license number together with insurance policy number duly noted on the Auto Insur- ance Declaration (form attached) . A Certificate of Insurance or other evidence of insurance may be requested and placed on file . III . PROCEDURE IN CASE OF ACCIDENT OR INJURY When a volunzteer is injured while performing authorized volunteer services , the sup ervisor. shall arrange for medical care as necessary and appropriate in accordance with normal departmental operating procedures . The volunteer' s supervisor shall immediately thereafter complete the Supervisor' s Report of Occupational Injuries or Illness (Form AK-30) . The supervisor shall then forward the form to the volunteer cordinator who within 24 hours shall submit the report through department channels to the Safety Division of the Civil Service Office. The form shall indicate that the injured party is a volunteer. A copy of the report must be .forwarded to the Office of the County Administrator. All medical bills received by the volunteer not otherwise covered by health insurance, other insurance, or third party pay- ment shall be forwarded to the Office of the County Administrator. Such bills must be itemized and indicate the date of injury. County payments will be made jointly to the volunteer and to the medical provider. Any claims for permanent disability compensation shall be referred to the Office of the County Administrator for review and adjustment . Prior to final settlement and payment of any such claim, the volunteer shall execute an appropriate form releasing the County from any further liability and agreeing that such compensation shall be the sole and exclusive remedy with respect to the injury sustained. 1 4. When there is an accident resulting in third party personal injury or property damage, the appropriate accident report form Shall be completed by the supervisor and forwarded to the volunteer coordinator. The subsequent procedure to be followed shall be`• identical to that applicable as in accidents involving County employees . IV. LIABILITY .The County under its self-insurance program upon request shall defend and indemnify the volunteer against liability claims initi- ated by third parties arising from acts or omissions occuring within the . scope of authorized services , unless the volunteer acted or failed to act because of actual fraud, corruption, malice or gross negligence . However , the County shall provide automotive liability insur- ance protection as excess only of the limits under the volunteer' s personal automotive liability policy. Such Count7 insurance protection does not cover any damages to the vehicle o t e volun- tee=, including any deductibie provision w ich must be paJ. . Maintenance of such records as determined necessary to assure that adequate insurance protection is afforded shall be a respon- sibility of the department ' s volunteer coordinator. V. REIMBURSEMENT OF EXPENSES Volunteers are eligible to receive reimbursement from the County for certain actual and necessary expenses incurred in the performance of authorized volunteer services . In order to claim expenses , the volunteer must have signed the Oath of Allegiance before any County officer authorized to administer oaths and meet previously described insurance requirements . Volunteers are governed by general County reimbursement policies established for County employees with the exception of mileage which will be reimbursed at a flat rate of $0. 15 per mile . The County will not reimburse volunteers for child care expense mileage ram the volunteer' s residence to the County desi ate tacility or service location or damage to the volunteer s personal vehicle , includingan e--ructible provisions which are aid by t o volunteer. : The volunteer must provide nrorrnation to ttie vo unteer coot inator with respect to the automobile liability insurance coverage maintained prior to use of the personal vehicle for volunteer services and reimbursement of mileage claims . j 5. Volunteers are recognized as a valuable resource in perform- ing services which are not provided by the County. The Board of Supervisors has expressed its strong support of volunteer programs. These policies and procedures have been developed for the information and guidance of County staff and volunteers . Acting County Administrator n - - CONTRA COSTA COUNTY VOLUNTEER APPLICATION AND REGISTRATION FORM / I _ Name Age Social Security No . Home Address Home Phone Business Address Business Phone Driver ' s License No. , If Any Service Preference Acceptable Location Do you have a health problem we should be aware of in an emergency? Yes No (Describe - such as a history of back trouble , heart, epilepsy, diabetes , fainting, etc . ) Is there a medication you must take? Yes No Is there a medication to which you are allergic? Yes No If yes , medication is : Medical, Hospital or Other Insurance Person to Call in Emergency Address Phone No . Interviewed by I have been informed against and accept responsibility for any breach on my part respecting confidential information. I have read the Resolution adopted by the Contra Costa County Board of Supervisors on volunteer programs . In return for the Signature benefits provided. by Contra Costa County Date in case of my illness , injury; death, or third party liability while providing, or resulting from acts or occurrences within the scope of my authorized volunteer services, and for my right to authorized expense reimbursement, I waive any claim on my behalf and on behalf of my heirs, representatives, and assigns against the _ County of Contra Costa or any of its agents, servants or employees for illness , injury, debts or other harm arising from my volunteer services, • whether or not authorized . Signature CONTRA COSTA COUNTY VOLUNTEER SERVICES AUTO INSURANCE DECLARATION �. Date This is to certify that I, the undersigned, am in possession of a valid California Driver' s License , , Number My car Expiration Date (Make) (Model)a ear (License No. is insured with (Company) Po icy No . ) Expiration Date I further certify that I have minimum liability insurance coverage as follows : $15 , 000 for injury to, or death of, one person ; $30 , 000 for injury to, or death of, two or more persons in one accident; $5 , 000 for property damage. Signature CONTRA COSTA COUNTY PARENTAL CONSENT FORM VOLUNTEER PROGRAM Name of Minor: Address : Birthdate : Volunteer Activity : The above person, a minor , desires to perform volunteer services for the County in accordance with the attached application form. As parent/guardian of this minor, permission is hereby granted for him/her to participate in the volunteer program. My child does not have any physical or medical problems which would prohibit or limit participation in the volunteer program, except: In case of illness or emergency, please call: Telephone Number: I have reviewed the volunteer application and registration form and give my consent for to participate in the volunteer program subject to the terms and conditions expressed therein. Signed by Parent/Guardian: Date: I- Liz Cont-ra;- Costa, County StandArd Form 1/87 ` CONTRACT AMENDMENT AGREEMENT (Purchase of Services) Number 24-458-9 Fund/Org # 5967 Account # 2320 Other # 1. Identification of Contract to be Amended. Number: 24-458-7 (as amended by Contract Amendment Agreement #24-458-8) Effective Date: July 1, 1993 Department: Health Services - Health Division Subject: Mental Health Socializati and Vocational Services .for Conditional Release Prom (CONREP) Clients 2 . Parties. The County of Contra Costa, California (County) , for its Department named above, and the following named Contractor mutually agree and promise as follows: Contractor: MANY HANDS, INC. Capacity: Nonprofit California corporation Address: 1231 Loveridge Road, Pittsburg, California 94565 3 . Amendment Date. The effective date of this Contract Amendment Agreement is May 1, 1994 4 . Amendment Specifications. The Contract identified above is hereby amended"which are i set forth in the "Amendment Specifications" attached hereto orporated herein by reference. 5. Signatures. The® atures attest the parties' agreement hereto: COUNTY bFCONTRA COSTA CALIFORNIA ATTEST: Phil Batchelor, Clerk of BOARD OF SUPERVISORS the Board of Supervisors and County Administrator By Chairman/Designee Deputy CONTRACTOR By By (Designate business capacity A) (Designate business capacity B) Note to Contractor: For corporations(profit or nonprofit),the contract must be signed by two officers. Signature A must be that of the president or vice-president and Signature B must be that of the secretary or assistant secretary (Civil Code Section 1190 and Corporations Code Section 313). All signatures must be acknowledged as set forth on page two. Contra Costa County Standard Form 1/87 APPROVALS/ACKNOWLEDGEMENT Number 24-458-9 APPROVALS RECOMMENDED BY DEPARTMENT FORM APPROVED By By Designee APPROVED: COUNTY ADMINISTRATOR By ACKNOWLEDGEMENT State of California ACKNOWLEDGEMENT (By Corporation, Partnership, or Individual) County of The person(s) signing above for Contractor, personally known to me in the individual or business capacity(ies) stated, or proved to me on the basis of satisfactory evidence to be the stated individual or the representatives) of the partnership or corporation named above in the capacity(ies) stated, personally appeared before me today and acknowledged that he/she/they executed it, and acknowledged to me that the partnership named above executed it or acknowledged to me that the corporation named above executed it pursuant to its bylaws or a resolution of its board of directors. Dated: [Notarial Seal] Notary Public/Deputy County Clerk -2- AMENDMENT SPECIFICATIONS Number 24-458-9 In consideration for Contractor's willingness to provide additional vocational Client-Day units of service under the Contract identified herein, County agrees to increase the Contract Payment Limit. County and Contractor agree, therefore, to amend said Contract as set forth below while all other parts of the Contract remain unchanged and in full force and effect. 1. Payment Limit Increase. The Payment Limit set forth in Paragraph 1. (Payment Limit Increase) of Contract Amendment Agreement #24-458-8 is hereby increased by $9 , 367 , from $22 , 751, to a new total Payment Limit of $32,118. 2. Increased Service Units. The number of service units set forth in Paragraph 2 . (Modification of Payment Provisions) in Contract Amendment Agreement #24-458-8 is hereby increased by 175, from 425 units of service to a new total of 600 units of service. 3 . Increase of Automatic Contract Extension Payment Limit. The six-month Payment Limit set forth in Paragraph 3 . (Increase of Automatic Contract Extension Payment Limit) of Contract Amendment Agreement #24-458-8 is hereby increased by $4 , 683 , from $11, 376 to a new six-month Payment Limit of $16, 059 . Initials: Contractor County Dept.