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HomeMy WebLinkAboutMINUTES - 09211999 - C158-C162 ............................ r: TO: BOARD OF SUPERVISORS 5i' William "calker, M.D. , Health Services Director FROM- By: Ginger Marieiro, Contracts Administrator Contra Costa DATE: September 8, 1999 County SUBJECT: Approval of Amendment to Agreement 26-344 with the U. De-Dartlrent of Veterans Affairs SPECIFIC REQUEST(S)OR RECO&11MEN DAT€ON$S)&BACKGROUND AND JUSTIFICATION RECQ ENDED ACS ION: Approve and: a-uthorize the Health. Services Director, or his designee (Frank Buglisi, Jr. ) , to execute on behalf of the County, ' Amendment/Modification #4 to Agreement 426--344 (VA #V26-1P-6152) with the U.S . Department of Veterans Affairs Northern California Health Care System (VANCHCS) to extend the term of the agreement from July 31, 1999 through September 30, 1-1999 . FINANCIAL IMPACT: „he Agreement is funded in the Health Services Department ' s Enterprise 1 Budget . '.Yoder the tern: of the agreement, VANCE1CS is paid a fee for service in accordance W44-th the fee schedule which is incorporated in the Contract . The services provided for the County' s patients under this Contract are bissable to patients and third party payors . REASONS FOR R CO ATICNSfBAC€ GRO Or. May 25, 1999, the Board of Supervisors approved Amendment» Modification #3 (#V612P-6 .52) with the VANCHCS to extend the term of the agreement through July 31, 1999, to provide specialized ,Speech -Pathology services to County' s patients referred for treatment by Conga Costa Regional Medical Center physicians . Approval of this Amendment #26-344-4 , will allow Contractor to continue providing services at the Fates specified in the original agreement, through September 30, 1999 . The Contract documents have a'-ways been: prepared by the Veterans Admin istrat ion. CONTINUED ON ATTAC�I�IEN�, v5'GNATi3RE RECOMMENDATION OF COUNTY ADMINISTRATOR ®y RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER ACTION OF BOARD ON �� �'�^��-`�` c.Y'�s � � APPROVED AS RECOMMENDED CJ`I'HER VOTE OF SUPERVISORS 6 HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (AE3S Nj'L 4 AND CORRECT COPY OF AN ACTION TAKEN AYES NOES- AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: -- }ABSTAIN: of SUPERVISORS ON T€-1:E DATE SHOWN, ATTESTED 161a� PHIL BATCHELOR,CLERK OF THE BOARD OF Contact Person: Frank Put 11si (370-5100) SUPERVISORS AND COUNTY ADMINISTRATOR CC: Health Services(Contracts) Risk Management Auditor Controller ��� /��� �� �� DEPUTY TO, BOARD OF SUPERVISORS William Walker, M.D. , Health Services44 rector FROM. By: Ginger Marie'iro, Contracts Administrator � Contra Costa DATE, September S, 1999 County SUBJECT: Approval of Amendment. to Sharing Agreement #26-346 (Modificatio-n V6125- 6162) with the U.S. Department of Veterans Affairs SpI cIEIC REQUEST(S)OR RECO #P ENDAT#ON(S)&BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: Approve and authorize the Health Services Director, or his designee (Frank Pugli.si, Jr. ', , to execute on behalf of the County, Amendment/Modif?cation #1 (County #26-346-1) ,, Frith the Tj.S. Department of Veterans Affairs, Northern California Health Care System (VANCHCS) , to amend Contract 26-346, to extend the term of the agreement through July 31, 2000 . FINANCIAL IMP&C-T: This Contract is funded in the Health Services Department' s Enterprise' I Budget . Under the term of the agreement VAN`CHCS will continue to be paid a fee for each service in accordance with the attached fee> schedule, which is incorporated in the Contract . The services provided for the County' s patients under this Contract are billable to patients and third party payors . OTM For many years the County and U.S . Department of Veterans Affairs has maintained a mutual sharing agreement which has rade a-rai.lable to the County specialized medical services not otherwise available 'due to lack of resources, ecluiprent, and personnel . These services included' specialized labs ratory testing, radiology services, nuclear medicine' studies, CT scans, MRI ' s, dermatology, gastroenterology, urology, audiology and speech, and ophthalmology services. The County provided Emergency Room, treatment and inpatient care, including certain ancillary services, for VA-referred patients . On September 1, 1998, the Board of Supervisors approved. Sharing Agreement 26-346 with VANCHCS (under the auspices of the. VANCHCS Nuclear Regulatory Commission License) to provide a ' full range of Nuclear Medicine Services to County' s patients at the VA Outpatient Clinic in Martinez and/or the Contra Costa Regional Medical Center' s Nuclear Medicine Department . Approval of Modification #1 (County ##26-346-1) will, allow VANCHCS to', continue providing nuclear medicine services through July 31, 2000 . The Contract documents have always been prepared by the Veterans ' Adim-4 nistration. 1"a RECOMMENDATION OF COUNTY ADMINISTRA c'OR � � RECOMINIENDATION OF BOARD COMMITTEE �,L APPROVE OTHER Zw -- - z ACTION OF BOARD APPROVED AS RECON ENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRIM UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NQ S: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE HATE SHOWN. ATTESTED x_3~ 5 , sf PE#II. ATCI E C ,CLERK F THE�ARD OF k rank Pugl s i, u r. (313-51001 SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: CC: Health Services(Contracts) lfisk Management � � VNuclea,Medicine Services FEE SCHEDULE B, OPTION 1. 811199 -713110 m�w Services provided at Services provided at PROCEDURES VAOPC CCRMC CPT Est. Unit Est. Unit Item# Code Deetript€ens Oty, Fries Total Price Oty. Price Total Price 76475 Bone Densit?! 25 1,178 4,461 0, 2 I.f 78006 Thyroid S 1-131 155 310 168 337 3 78007 T1 yresld€ €-123 85 166 14,091 180 1,618 t 4 78f11 Thyroid Scars Ccr39s Flow— 154 0 0 167 0 5 78018:Cancer Survey 0 342 0 0 371 €3 6 780 s8 8 Thyrold Scan(MIBI) 0 342 0 0 371 0 7 78070 Parathyrtsld Scan 0 140 0 0 182 9 78122 RSC l a s 267. 8 289 0 9 :8195 Lymph Scan 2 277 554 0 301 0 1t, 782051 Hemangidrrsa Scan SF CT(w178202) 0 352 0 a 382 0 11 78295 L,ver/Sp€een Scan SPECT 0 352 0 IJ 382 0<, 12 78-2115 Liuer/Spiesrs Scan Planar —13 183 2,384 1 199 199 13 78220 HIDA 33 224 7,389 4 243 972 14 78223 HIDA wl EF 0 244 G, 0 265 0 IA 7825a Fsoph. Moblity 0 198 a 0 215 0 !6 78262 gastric R flax 0 264 0 287 0; 17 `8264 gastric Empty 21 264 5,553Eto 287 574 18 782.70 Schilling$,stage 1 03' 0 1 31 0 19 78271 Sal'€€€ings Stage€€and 111 0 98 0 El 107 0 20 78278 t3€Bleed 0 317 0 0 344 0` 21 76290,mackels 0 202 0--E €3 219 0 22 78305 Bone,Ltd': 0 244 0 0 26.5 0 23 783136 Scsrte,sJV.3 273 277 7x,661' 34 301 9;€31 24 78315.fnrs�s: Ltt1 +,'r�ls� 4 313 1,252 0 343 0 25 78315 Bone,1'" 8 wlFlow 0 313 0 0 34-01 0 26 78320 Bone Spect 4 373 1,491 47 404 1,617 27 78460 Persantine Myov'€lar ar* 0 249 0 0 270 0 2f 7$460 Treadmill Myov Planar' 0 249 0. 0 270` 03 20 78460 Dobutam'ne T1-201 Planar* 0 249 0 0 270 0 30 784130 24 rss TIp2E31 f�€arsar{Adst.j 0 179 0 0 194 0 L:::]-22 f 78461 P�Ianar,ersantine T1-201 0 394 - G 0 428 0 784 1 Planar Mycv€des# 0 324 0 €4 35278464 SPECT addit.TL-201 0 436 0 £3 473' 0 34 78 364 Treadmill Myov SPECT* 0 506 0 13 549 0. 35 78 644 Rest Myov SPECT* €3 506 0 €} 543 _ _76--W-84-64 ersantine Ivlyov PECTR 0 506 01 0 549 0 37 7e4 4X24 Isr TL-201 SPECT 0 436 0 0 473 0, 38 78465 Thallium Treadmill fest` 89 773 68,615 9 839 7,549 39 ; 78465 SPECT Rest T'L-201 � 0 703 0770 753, 0 46 78465 SPECT Dobutamine TL-2 31` 0 7731 0 0 839 0 41 78465 SPECT Persantine TL-201 --i-99 773 153,868 22 : 839 18,452 42 ` 78466 1PYP Myocardial Infarction Planar l 0 `182 a G; 0 137; 00j 43 78469 F'!P fs yuca5ai its€archon Scars � 0 330• 0 €3 388 .-. NIUC-98-TL-01.xis Revised{811/98} tvuciear-Medidne Services EEE SCHEDULE B. OPTION 1: 8/1699 -7131/0 Services provided at Services provided at PROCEDURES VAOPC CCRMC CPT , Est. Unit St. Unit Item# Cutts Description Qty, Price Total Price Qty, Price Total Price 44 a 78472}GWMS 5,, 349 1,744 1 378 3? 4711473 Exert€se^W€ S* 0 592 03 0 642 46 78478 Myocardial Perrcrsion Study ui0a<1 Motio £3 122 0 6 132 0 47 73461 'G71V MS w1'1 st Pass 0 334 0 0 362 0 48 78483 ExGy M w/IstPass* 0 5,21 0 0 621 0 49 785803 Lurg I'arfusior� 0 226 03 0 245 0 50 ' 78580'Lung Quantification 0 226 a3 245 03 51 78586 i u g VII 49 362 5 392 1,362 _5_2__T 7€3594 Lung Vent(addit.) fl 232 0 9 317 0 53 786036 Cerebral How and Scar: 242 0 i 0 262 03 54 ?863O cisternogram - -- A 3{35 0 03 331 0 w5 78656 CSF Leah study t3 2?9 0 Q 3033 0 r 56 7E57037 4ena1 Scai-Saseiine 25 293 7326 3 318 954 57 78707 Lasix Renal(Incl Lasix) €# 312 0 0 338 0 58 797139,Captopril Renal(in-Captopril) 6 312 0 0 338 0 59 788036 Octreoscan Ltd 2 view 6 -219 0 0 2'�7 03 603 7038€313 Can( cirt Ltd 2 views 0 219 9 0` 237 E3 61 78801 Ca-67 Ltd 0 2713 0 0 293 5 62 788032 Ga-67 16 342 5,472 0 2 # 371 742 63 892 CtctrW3sic-in WB t3 342 03 6 7`8 37 4 a4 78802#Oncoscint WB 13 351 f3 t4 371 0 65 78303 Gni-67 SPECT 0 ' 4039 {3 a 444 61 66 78803 Octreoscan SPECT 0 4039 0 0 444 03 67 : 73863 iOncoscint SPECT 13' 409 0 9 444 0 68 788035 in-1'1 WBC Ltd 0 223 0 ; 6 .242 0 69 78806 In-111 WBC WB 12 388 4,653 1 421 421 70 788O6 €n-191 WBC SPECT(addit) 0 388 0 0 429 0 71 73690 Hyperthyroid Therapy Initial 18 255 4,592 2 ' 277 72 790302 Ty—p;rthyroid Therapy Additional 01 136 0 9 148E4553 73 79030'Thyroid Therapy-; lation 0 275 0 0 298 74 79035 Thyroid Therapy Cancer i3 30.E 0l 329° 03 75 • 7910x0 P-32 Therapy 6 222 0 0 241 03 76 79401 Sr-89 Therapy 0 0 01 0 03 03 77 788913 Corrtpute.=Processing{c312 min', f3 00 €3 1 0C 78 i 78891 Computer Processing(>30 min) 0 0 0_7 0 03 rJ 79 199241 fsff€ceCorisi 10 #5 rnirnutes 2 62 124 80 99242 Office Consu#tatiari-30 minutes 2 96 192 €3 194 0 899243:C7ce Consu€taticrn-40 irnutes2 924 249 €3 135 13 PROCEWRES SUBTI �TAL —$377,904--- X45,346 Ci ITi ATIENT AND€NPA` iENT 4 Pi�03CED1�£PEs TOTAL $423,2501 *Imides 33c #6 930318 Revised(811198) Nuclear Mledicire Services FEE SCHEDULE . t�rTION 1: 811199 - 713V00 Eat. Unit Item# Ref# Description(CPT/HCPCS) Qty, Price "foetal Price 82 3 £7G1 7139953 A4641 Tc99m iv1A5-3 w 165 4,614 F84 935192 789957 A4641 T c99m� 21 x,112 5369133.789953A464 Tc99€n C36 21 783; 00004 78990 A4641 Tc99m C PA 13 2 53 86 00005 78990 A4641 Tc99m Choletec 37 52 1,966 87 030006 78990 A4641 i-123 200 uCi 94 83 7,842 8 5539177 7t399fl A4641 1-131(1-5 rni) 26 82 1,548 89 5353 798 78996 A4641 1-131(ea adds Ci) 2 3 15} 2t3fi 90 09{;69 78990 A4641 1N-111 DTPA(1v1) 0 515 G 91 91 0157 78990 A4641 IN-1 s 1 WBC(per labeling) 13 412 5,356 92 100011178990 A4641 Xenon(I G Citvi) 54 21 1,112 93 535751/2 78996 A4641 Ga67(6 mC!) 18 97 1,743 9400013 789957 A4641 Rubratope(1 lit) 3 155 464 98 0535314 76990 A4641 Ultratag(1 kt) � 71 E3 96 0535315 78990 A4641 Otreoscanldose 53 1,224 9 L4= i 97 +11, 1316 76990 A4641 Tc04(353 mCj) 0 10 53 9870£317 789953 A464, Bulk Tc04 6 24 57 99 957018 78990 A4641 reStascint 0 1,535 53 1€30 00019 18990A4641 Tc99m CEA 0 1,422 0 1€-1 5153€329 789-'4--0 A4642 t✓ncosccmt a 052 0 162 90621 789953 A9 532 Tc99m A95,02 88 t3 , l 1533 357622 78990 A9503 Tc99m MDP 397 32 9,803 1€34 ' €33023 7899:7 A95i75 TL-201 (3:d i) 319 55 17,414 1575 1353€)24 7899 5 A9t35353 a69 Chloride{4 n1C1) 6 2,936 5} m 106 00025 J01 50 Adenosine(per 6 mg) 6 26 0 167 69026 35326£3 Aminophy.line(to 2553 ung) 398 2 829 1536 53531327 J1245 Persantine(10 g) 221 21 4,641 109 00028 tarnine,(per 259 mg) 9 23 0 S 3 1 1 7 5305329 Cabutarnire Paoli g 67 9 111 535}53353 CCl{!lvlerphlne 6 65 389 11200031 789953 A4641 Chromium 511Ascorbiv Acid Q 3,9fl5 5) l GTS 3P S TOTAL $w9,853 MISCELLANEOUS isotope Charges for Equipment Calibration 113 at CCRMC(Estimated) 500 ETOTAL(from Page 6) 3419,577 OPTION YE R I -GRAND TOTAL ; ,(Outpat( nt,linpatientli otopes) $Z8 3 1533 NUC-98-TC-09.xis Revised(819198) { TO: BOARD OF'SUPERVISORS V m William Walker, M.D. , Health Services Director FROM By: Cinder Marieiro, Contracts Administrator Contra Caste DATE: September s, 1999 County SUBJECT: Approval- ciMcDonald, M.D. Approval- Contract 2S-967 with Thomas J. SPECIFIC REQUEST(S)OR R C83MMEAIBAT€ONIS)&BACFCGI:tGIIIAID AND JUSTIFICATION - RECOMMENDATION(S) - Approve ECf3 E ?ATIO ( ) rApprove and authorize the Health Services Director, or his designee', (Frank Puglisi, Jr. ) to execute on behalf of the County, Contract 26-967 with `.i:`horra.s J. McDonald, M.D. , (Specialty: Ophthalmology; for the period from, August 1, 1999 through July '?W, 2000, in the amount of $195, 000 . FISCAL IMPACT: Cost to the County depends upon utilization . As appropriate, patients and/or third party payors will be billed for services. BACKGROUND/REASON(S) FOR RECOMMENDATIONS : For a number of years the County has contracted with Medical and Dental Specialists to provide specialized professional, services which are not otherwise available in its hospital and clinics . Under Contract 26-967, Dr. Thomas J. McDonald will provide OL,hthalmology services for Contra Costa Regional Medica? Center and Contra Costa Health Centers through July 31, 2000 Cf3 € #A€3#EB 91 ATT C €tail NT: yZ — _ € NAS RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD Ct3lU€€U#ITTEE APPROVE —OTHER SIC A__1URF S): d ACTION OF BOARD ON- �e: 6_ 22 `f APPROVED AS RECOMMENDEDn / /`� � OTHER VOTE OF SUPERVISORS I,HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ASSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AAIB ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED" ? ✓d �;. PHIL BATCHELOR,CLERK OF THE.BOARD OF SUPERV€SOR>AAIB C € NTY ADMINISTRATOR Co�ItectPerscyrt: M�'xa.y:fs PI:aI?si (370-5100) CC: Health Services(Contracts) Risk Management Audkor Controller By Contractor DEPUTY TO: . 3t.«A(711 /S$ y +�yel i�{{''��yU�+�PivaiY.�4yd3b7B.6 M.D. , ��6��r3r g^� p�'�^y 6' ryCzyServices '._^f e� <>;•f'6'«�1'f�y�?+:( Director y,.p�^t¢..y-y YM.L l.va knq. Y�a1tCe.r, M.L. , Hea:s.t.h Ser V..�4r L..tom.. d.J,�3.i+4.4.Vr FROM- By. Cih.ger Marieiro, Contracts A:dmini.strator Contra Costa DATE, September 3, 1999 Count SUBJECT: Approval of Contract #26-965 with Thomas N. Paige, M.D. SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECCMATICN(S) Approve and authorize the Health Services Director, or -is desmgnee, (Frank Pugl si, Jr. ) to execute on behalf of the County, Contract 26-963 with. Thomas N. Paige, M.D. , (Specialty; Dermatology) for the period from October 1, 1999 through September 30, 2€00, to be painas follows . 33.33 per :vont h, for the provi si,on of Dermatology services ,including consultation, clinic coverage, training, and medical and/or surgical procedures, NOT TO EXCEED jjQP,£l€ 0 Cost to the County depends upon utilization. As appropriate, patients and/or third party payors will be billed for services. BACKGRCUND/REASO ( ) FOR RECOMMENDPd'I`IQNS a For a number of years the County has contracted with 'Medical and. Dental Specialists to, provide specialized professional services which are not otherwise available in its hospital and. clinics . Under Contract 26-968, Dr, "Phomas N. Paige wil. prC3�"'Ji'de Dermatology services for Contra Costa Regional Medical Center and Contra Cost Health Centers 'through September 30, 2000 . 7 l CI3 T� INUE .N ATTACHMENT: SIG A€ R L ' 3 RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE /OTHER SIG1 s1 ' ACTION OF BOARD ON APPROVED A5 RECOMMENDED OTHER VOTE OF SUPERVISORS a HEREBY CERTIFY THAT THIS IS A TRUE f UNANIMOUS (AS sEl T_Ie! ' l AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES. AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: . _ __ OF SUPERVISORS ON THE DATE SHOWN. ATTESTED PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person, Frank Pugh is,i, Jr. 370--510(7} CC: Health SepAc (Contracts) Risk Management Auditor Controller By— > ,� �� ,DEPUTY Contractor TO: BOARD OF SUPERVISORS WilliatT Walker, M.D. , Health Services Director FROM. By Ginger Marieiro, Contracts Administrator Contra Costa DATE. September- 8, 1999 County SUBJECT: Approval of Contract #26-910-10 with Violet S al l.horne, M.D. SPECIFIC REQUEST(S)OR R C&'?P,MENDATION(SI&BACKGROUND AND JUSTIFICATION RECON .TIC (S) : Approve and authorize the Health Services Director, or his designee, (Frank P glisi, Jr. ) to execute can behalf of the County, Contract 26- 910-10 with Violet Smallhorne, M.D. (Species a ty: Surgical services) , for she period from August 1, 1999 through July 31, 2002, to he paid in accordance with the attached Fee Schedule. FISCAL IMPACT: Cost to the County depends upon utilization. As appropriate, patients and/car third party payors will be billed for services . BACKGROUND/REASON(S) FOR RECO E ATION(S) c On January 1.9, 1999, the Board of Supervisors approved Contract #26- 910-9, with Violet Sma:llhorne, M.D. , for to provision of professional surgical services for Contra Costa Regional Medical. Center and Centra Costa Health: Centers through January 31, 2000 Due to a recent study by the Medical Group Management Association (MG': ) Physician Compensation Survey with regard to the salaries of ;medical and surgicalsub-specialist, the Department is currently re- negotiating Contract Payment Provisions for the medical and surgical. sub-specialist . County and Contractor have mutually agreed to terminate the existing services under Contract #26-910-9 and to substitute Contract #26-910-10 in its place . Approval of Contract 26-910-10 will reflect an increase in salary consistent with the MGMA Physician Compensation Survey, allowing Dr. Small ho ne to CCitltin e providing services through July 31, 2002 . CONTINUED ON ATTACHMENT: YESxx RECOMMENDATION OF COUNTY ADMINISTRATOR _ RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER ZA S ..:.__� ! ACTION OF BOARS 01•IY.��€'� ?�2� ='r' � / AP€'F2O'JcD:4S RECL?MRtlEhtDE{3 __,� OTHER VOTE of SUPERVISORS 4 13€Ar #€ I S {ABSENT I HEREBY CERTIFY THAT THIS IS ATRUE 3 AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: ANIS ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOIWN. PITA.�ATCHELbfl,CI rERK OF THE BOARD of S-UPERVISORS AND COUNTY ADMINISTRATOR ContactPerson: Frank P:z l is l', j r. (370-5100) CC: Health Services(Contracts) Risk Management �r Auditor Controller BY. `_ t z -s EPu I Contractor Page Board Order #26-910-10 Bee Schedule a. $13.115 . 00 payable upon execution of Contract; b. For consultation, training, medical and/or surgical procedures, Contractor shall be paid as follows: (1) $17, 083 .33 per month, for the period from August 1, 1999 through July 31, 2000, not to exceed a total of aA , 000; (2) $17,595. 83 per month, for the period from August 1, 2000 through July 31, 2001, not to exceed a total of 1211, 151; (3) $18,;123 .75 per month, for the period from August 1, 2001 through Jury 31, 2002 , not to exceed a total of 1217,485; and C. For on-Carl: (1) 11 ,200 .00 per month for on-call coverage, not to exceed, an annual total of 114,400, and (2) 450.Q per occurrence when Contractor is required to cope to the Hospital during on-call hours for a surgical procedure; and d. in addition, County shall pay Contractor an amount NOT TO EXCEED 255,000y . 00 to cover expense of Malpractice Insurance coverage for treating n Count¢.y r. s patients . In the event that Contractor worts less than a gull month at Contra Costa Regional Medical Center and Contra Costa Health Centers, County shall prorate payments to Contractor for that Month, plus