HomeMy WebLinkAboutMINUTES - 02231993 - 1.93 r r
TO: BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director Contra
By: Elizabeth A. Spooner, Contracts AdministratCosta
DATE: February 11, 1993 0 County
SUBJECT: Approval of Unpaid Student Training Agreement #26-169-1 with The
Trustees of the Leland Stanford Junior University
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Chair, Board of Supervisor, to execute on
behalf of the County, Unpaid Student Training Agreement #26-169-1
with The Trustees of the Leland Stanford Junior University for the
period October 1, 1992 through September 30, 1995 for the provision
of clinical experience for Physician Assistant students.
II. FINANCIAL IMPACT:
None
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
Unpaid Student Training Agreement #26-169 was approved by the Board
of Supervisors on July 19, 1988.
The purpose of this agreement is to provide Physician Assistant
students with the opportunity to integrate academic knowledge with
application skills. As a teaching hospital, Merrithew Memorial
Hospital can provide the requisite field education, while at the same
time, taking advantage of the students' services to patients.
CONTINUED ON ATTACHMENT: YES SIGNATURE: /
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEN TI N OF BOARD C MITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED
OTHER
VOTE OF SUPERVISORS
X UNANIMOUS (ABSENT ) 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 (370-5100) OF SUPERVISORS ON THE DATE SHOWN..
CC: Health Services (Contracts) ATTESTED
Risk Management Phil Batchelor,C.MA of thilRoard 6f
Auditor-Controller Suvervisors and CountyAdmiristr2tor
Contractor
M382/7-03
BY DEPUTY
.!.__Contra. Costa County UNPAID STUDENT TRAINING AGREEMENT � 0 2 Y
Number 26-169-1
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: THE BOARD OF TRUSTEES OF THE LEIAND STANFORD JUNIOR UNIVERSITY
Capacity: Private Educational Institution
Address: 703 Welch Road, Palo Alto, California 94304-1760
3. Term. The effective date of this Agreement is October 1. 1992 and it terminates
September 30, 1995 , unless sooner terminated as provided herein.
4. Termination. This Agreement may be terminated by either party, at its sole discretion,
upon thirty-day 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 conditions set forth in the attached
Program Plan which is incorporated herein by reference.
6. Independent Contractor Status. This Agreement is by and between two independent
contractors and is not intended to and shall not be construed to create t
relationship of agent, servant, employee, partnership, joint venture, or associate,
7. Indemnification. policy,
xcept for those activities of participants covered by the Count 's Volunteer
a. ?�lhe Contractor shall defend, save harmless and indemnify the ounty and its
officers, agents and employees from all liabilities and claims for damages for
death, sickness or injury to persons or property, including without limitation,
all consequential damages,from any cause whatsoever arising from or connected
with the operations or the services of the Contractor hereunder, resulting from
the conduct, negligent or otherwise, of the Contractor, its agents or employees.
b. The County shall defend, save harmless and indemnify the Contractor and its
officers, agents and employees from all liabilities and claims for damages for
death, sickness or injury to persons or property, including without limitation,
all consequential damages, from any cause whatsoever arising from or connected
with the operations or the services of the County, resulting from the conduct,
negligent or otherwise, of the County or its employee
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 CONT
y �r y
Designee r��
Recommended y Department i c a l
(Designate official capacity)Schoo1
By
Designee
i
I
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 Resolution adopted by the Contra Costa County Board of
Supervisors 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 26-169-1
Contractor: THE BOARD OF TRUSTEES OF THE LELAND STANFORD JUNIOR UNIVERSITY
County Department Health Services (Hospital and Clinics Division)
CONTRA COSTA COUNTY PARTICIPANT
(Printed Name)
By
(Designee) (Signature)
PROGRAM PLAN
FOR
CLINICAL EXPERIENCE FOR PHYSICIANS ASSISTANTS
Number 26-169-1
1. Purpose of the Program. Stanford conducts an educational program for Physician
Assistants which has been approved by the Physician Assistant Examining Committee, State of
California. County's physicians are licensed to practice medicine in the State of California
by the California Board of Medical Quality Assurance. Stanford desires to have students,
enrolled in its Primary Care Associate Program, receive clinical instruction from County, and
County is willing to provide such instruction upon 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. Termination. This Agreement may be terminated by either party, at its sole discretion,
upon 30 days advance written notice thereof to the other, or canceled immediately by written
mutual consent.
3. 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
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 shall:
(1) Have completed all the necessary courses required by Stanford University
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 Health Services
Department facilities, and for maintenance and housing during field
instruction;
(4) Channel educational problems to Stanford University;
(5) Promptly report illnesses and absence from duty; and
(6) Comply with regulation and standards of conduct governing professional
physician assistants 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.
(je_ -)4
Initials:
1 Contractor eoifnDept.
PROGRAM PIAN
FOR
CLINICAL EXPERIENCE FOR PHYSICIANS ASSISTANTS
Number 26-169-1
f. Verify that each student designated for participation pursuant to this Agreement
has obtained medical malpractice insurance 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
Physician Assistants enrolled in Contractor's Primary Care Associate Program. County-
designated physician preceptors agree to maintain a license as physicians in the State of
California and to notify Contractor of any adverse action concerning that license by the
State;
b. Accept for clinical experience those students assigned by Stanford University 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 1. , above;
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 Contractor; and
e. Inform patients of any medical services that are to be rendered to the patient
by Contractor's students, in accordnace with the rules and regulations governing Physician
Assistants.
5. Joint Obligations. Both parties agree to jointly:
a. Plan a student training program including course content and student assignment
schedule so as to provide a sound and effective educational program;
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;
Initials:
2 Contractor tly Dept.
I
PROGRAM PLAN
FOR
CLINICAL EXPERIENCE FOR PHYSICIANS ASSISTANTS
Number 26-169-1
d. Observe and respect patients' rights, privacy and dignity; and
e. Comply with applicable County, state and Federal regulations respecting
disclosure of patients' health information and access to, and removal of, medical records
and/or information contained therein.
7. Contractor. County and Participant Agreement. Notwithstanding the authorization for
reimbursement for actual and necessary expenses (including a flat mileage rate of 15 cents
per mile for use of personal vehicles) of authorized volunteer services set forth in the
final paragraph of the 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:
3 Contractor Go Dept.
-- I
CONTRA COSTA COUNTY
POLICY STA v-._.... _ ON VOLUNTEER PROGR LMS
The use of volunteers in performing specific services is a valuable resource
and provides an avenue for citizen participation in various County prog-a-s
which is recognized as being of public benefit. In recognition of the
benefits which may be derived from volunteer services, it is hereby declared
that it shall be County policy to encourage and promote volunteer programs
determined to be in the public interest.
It is County policy that volunteers will not replace County employees tut
will provide services to supplement or enrich regular County programs and
services.
This policy statement is designed to provide the framework for all County
volunteer programs and activities. The following guidelines are adopted for
volunteer pr--g--ams:
VOLUNTEER PROGRAMS
A ccmplete description of each volunteer program shall be submitted by t e
de-a head to the County Administrator for review and presentation. tc
the Board of Supervisors with his recommendation.
Factors to be considered in evaluating programs are the need for and public
benefit to be derived from the volunteer program, associated County cost and
staff effort required for such a program, the potential for injury to
volunteers, and the possibility for injury to others including injuries
giving rise to possible liability claims.
Regulations and procedures including, but not limited to, such matters as
eligibility, training, supervision and roster control,. may be promulgated by
the County Administrator for guidance of departments to assure proper
administration and control of volunteer services.
VOLUNTEERS
A volunteer is defined as a person who renders services gratuitously and has
been accepted in the volunteer program. The volunteer is not an employee of
the County.
In recognition of the benefit to the County derived from volunteer services,
authorized volunteers serving in programs approved by the Board of
Supervisors shall be provided the benefits indicated below.
1
CONTRA COSTA COUNTY
PCLSCz STATEMEN2 '^ ON Q0LM4'^EER PROGRAMS
1. Injury to volunteer. Authorized volunteers are not under the
purview of the workers ' compensation laws of California. in lieu thereof and
in return for the volunteers waiver of any claim against the County for
illness, injury or other harm arising from acts or occurrences while
providing volunteer services, the County shall provide, in the case cf
authorized volunteer services, through self-insurance, for reimbursement of
medical expenses and minimum permanent disability compensation equal to that
afforded under the workers ' compensation laws of California, provided,
however, that no temporary disability compensation shall be paid and medical
expenses shall be limited to reimbursement for expenditures other-«_se
qualified for reimbursement which are not covered by the volunteer' s health
plan, other available insurance coverage, or other third party
Federal, State or of her payment) .
2. Public Liability. The County through its self-insurance program
shall defend and inde^..rify volunteers upon rec-,est against liability cla_:.,s
initiated by third pa=-'=ies arising cut cf acts or omissions occurring wit
the scope of authorized volunteer services, unless the volunteer acted or
failed to act because of actual malice, fraud, eo=rtien cr cress
negligence. Volunteers using personal automobiles in performing authorized
services must maintain liability insurance at limits whicz as a mi_niwum
comply with the California Financial Responsibility law and must have a valid
driver's license. the protection afforded by the County shall be in excess
only of anv other valid and collectible public liability or automcb ile
liability insurance =aintained by or which provides coverage for the
volunteer. Volunteers may be permitted to operate County vehicles in the
performance of authorized volunteer services .
3 . Exmense Reimbursement, Volunteers shall be reimbursed for act'-,al
and necessary expenses in performance of authorized volunteer services at the
same rates and in accordance with regulations and procedures established for
County employees, except that a flat mileage rate of $0.15 per mile for use
of personal vehicles will be allowed. No reimbursement will be made for any
child care expenses, mileage from the personal residence of the volunteer to
the County facility or service location or for damage to personal vehicles of
volunteers used when performing authorized volunteer services.
2
Replaces
Office of the County Administrator Costa Date 1 7—? —78'
County Section PPrRnrr
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
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 volunteer is injured while performing authorized
volunteer services, the supervisor 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.
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
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:
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)
I.10 de ear (License No . )
is insured with
Company
(Policy 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
VOLUNTEER APPLICATION AND REGISTRATION FORM
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
• Signature on volunteer programs. In return for the
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
Date