HomeMy WebLinkAboutMINUTES - 10041994 - 1.35 TO: BOARD OF SUPERVISORS 1. 5
FROM: Mark Finucane, Health Services Director il'` , t4r Contra
By: Elizabeth A:" Spooner, Contracts Administrator (-`0S+a
DATE: September 16, 1994 Q9 County
SUBJECT: ! Approval of Hospital Agreement #23-076-3 with
John Muir Medical Center
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Health Services Director to execute on
behalf of the County, Hospital Agreement #23-076-3 with John Muir
Medical Center, for the period from July 1, 1994 through June 30,
1995. The Agreement implements the County's designation of John Muir
Medical Center as a Base Hospital for paramedic units assigned to the
County's Emergency Medical Services Zones A and B.
II. FINANCIAL IMPACT:
This Agreement provides annual payments of $50, 000 from County Service
Area EM-1 (Measure H) funds. There is no County General Fund impact.
III. BACKGROUND:
On June 16, 1992 ;. the Board of Supervisors approved Hospital Agreement
#23-076-2 with John Muir Medical Center for the period from June 1,
1992 through June 30, 1994, for Base Hospital Services.
Base Hospitals provide on-line and retrospective medical direction and
control to paramedic units and are required as a part of an EMS system
providing Advanced Life Support. Base Hospitals provide medical
direction without regard to patient destination, and therefore,
provide services for patients who may be transported to facilities
other than John '.lMuir Medical Center. Currently, two Base Hospitals
serve the four County-designated Base Hospital Zones: John Muir serves
Zone A (West County) and Zone B (South County) ; and Mt. Diablo Medical
Center serves Zone C (North County) and Zone D (East County) .
Approval of Hospital Agreement #23-076-3 will allow John Muir Medical
Center to continue as the designated Base Hospital for Zones A and B
through Fiscal Year 1994-95.
CONTINUED ON ATTACHMENT: YES SIGNATURE
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMM DAION OF BOARD C MMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON U M APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
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
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Art Lathrop (646-4690) OCT 4
CC: Health Services (Contracts) ATTESTED
Risk Management Phil Batchelor,Clerk of the Board of
Auditor-Controller Su;^ervisars and Ccunty AdministrMar
Contractor —
Mee2/7-98 BY _��� �w DEPUTY
II
Contta ros'ta County Number 23-076-3
Fund/Org # 7406
HOSPITAL AGREEMENT Account # 2822
(Base Hospital Designation)
1. Contract Identification.
Department:, Health Services (Emergency Medical Services)
Subject: Base Hospital Designation for Zone(s) A and B
2. Parties. The County; of Contra Costa, California (County) , for its department named
above, and the following named Hospital mutually agree and promise as follows:
Hospital: JOHN MUIR MEDICAL CENTER (hereinafter referred to as "Hospital")
Capacity: California non-profit corporation
Address: 1601 Ygnacio Valley Road, Walnut Creek, California 94598
3. Term. The effective 'date of this Cont t is July 1. 1994 and it terminates
June 30, 1995 unless soo er terminated as provided herein.
4. County's Obligations C t "shall designate Hospital as a Base Hospital for the
y 8 440, 1itionsY g P P
paramedic units assigZone(s) A and B, as defined in the Service Plan, subject
to all the terms and,! contained or incorporated herein.
5. Hospital's Obli a :'ons. Hospital shall provide for the direction of advanced life sup-
port and preho ..- tal care assigned to it by the Health Services Department and carry
out that wo " described in the Service Plan attached hereto, which is incorporated
herein by reference, subject to all the terms and conditions contained or incorporated
herein and subject to Hospital's proposal for contract on file in County's Emergency
Medical Services Agency and incorporated herein by reference.
6. Conditions. This Contract is subject to the Conditions and Special Conditions (if any)
attached hereto, which are incorporated herein by reference.
7. Proiect. This Contract implements in part the County's Local Emergency Medical
Services Plan in that it provides for designation of base hospital a
8. J Legal Authority. This Contract is entered into under and s ect to the following
legal authorities: , Health and Safety Code Sectio s 7 et seq. ; California
Administrative Code,-. Title 22, Division 9, Sections 1 et seq. ; Government Code
Sections 26227 and 31000; and County Ordinance Cg �' ivision 48.
.i
9. Signatures. These signatures attest thepar tie agreement hereto:
COUNTY OF CONTRA COS CALIFORNIA
ATTEST: Phil Batchelor, Clerk of the Board
BOARD OF SUPERVISORS of Supervisors and County Administrator
By By
Chairman/Designee Deputy
HOSPITAL
By By
(Designate official business capacity) (Designate official business capacity)
Note to Hospital: (1) Sign above and have a Notary Public execute the acknowledgement form on page two and (2) as to your
signatures, if a corporation, one signature must be the president, vice-president, and the other must be the secretary or
assistant secretary as required by Civil Code 11190 and both signatures must conform to designated representative groups pursuant
to Corporations Code 1313.
. Contra Costa County Standard Form 1/87
APPROVALS/ACKNOWLEDGEMENT
Number 23-076-3
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 representative(s) 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-
i
SERVICE PLAN
Number 23-076-3
1. Services. In consideration of the County's designation of Hospital as the Base
Hospital in Zone(s) A and B, and as the Trauma Base Hospital County-wide, Hospital shall
perform the services identified in this Service Plan. Zone A includes the area served by
ambulance units which are assigned to Kensington, E1 Cerrito, Richmond, San Pablo, and E1
Sobrante. Zone B includes the area served by ambulance units which are assigned to Orinda,
Moraga, Lafayette, Walnut Creek, Alamo, Danville and San Ramon. Services shall be provided
without interruption, 24 hours per day, 7 days per week, 52 weeks per year, for the full term
of this Contract.
a. In accordance with County Emergency Medical Services (EMS) Policies and
Procedures and Paramedic Field Treatment Guidelines, Hospital shall provide overall medical
control and medical supervision of the paramedic program, including, but not limited to, on-
line patient care instruction, review of patient care records, and identification of problems
and issues with referral to'appropriate ambulance provider agency when appropriate. Hospital
shall provide direction to EMT-I's who contact the Hospital for assistance, including
requests for trauma patient destination decisions.
b. The Hospital shall provide an immediate response to each and every request
by ambulance personnel for medical directions or trauma destination determination. The
response shall be by an emergency physician or mobile intensive care nurse (MICN) , using the
radio or the telephone.
C. County'sEMS Field Treatment Guidelines, as set forth in the Prehospital
Care Manual provided to Hospital by County and which is incorporated herein by reference,
shall be utilized when providing medical direction to ambulance personnel. Ambulance
personnel shall be directed to perform only those skills allowed by County's EMS Field
Treatment Guidelines.
d. The Hospital shall obtain patient follow-up information, including an
admitting diagnosis, for all patients for whom there is a request or for whom there was base
hospital contact and who !were delivered to Hospital. In the event Hospital routinely
provides base hospital direction to more than one base hospital zone, such follow-up
information shall be requested for a major receiving hospital in each base hospital zone.
Limited follow-up will beiobtained for all trauma patients and will indicate whether the
patient was admitted, discharged, or expired.
e. The Hospital shall act as trauma base hospital and shall provide medical
direction and control including quality assurance review to ambulances caring for patients
who meet the trauma triage jcriteria established in EMS Policies and Procedures and Paramedic
Field treatment Guidelines.
f. The Hospital shall provide medical direction and control to ambulance units
assigned to other base hospital zones when directed to do so by the County on an as-needed
basis.
2. CommunicationsiEquipment.
a. County shall provide radio communications equipment to Hospital for
purposes of communicating with ambulances. Specific radio equipment purchased by County at
County expense for Hospital shall remain the property of and under control of the County at
all times.
Initials:
1 Hospital County Dept.
SERVICE PLAN
Number 23-076-3
b. The Hospital shall provide, use and maintain all equipment needed to
provide audio documentation of radio and telephone consultations with ambulance personnel
including trauma destination determinations.
C. The Hospital shall promptly notify the receiving hospital of every patient
for whom there is base hospital direction. The Hospital shall provide a telephone which is
immediately available, easily accessible, and for the exclusive use of providing receiving
hospital notification.
d. The Hospital shall operate communications equipment in accordance with
Federal Communications Commission regulations and County EMS Policies and Procedures.
3. Record-Keeping Requirements. The Hospital and its staff shall comply with the
following record-keeping requirements:
a. The Hospital shall utilize the County-approved Base Hospital Report Form
for each patient for whom there is a request for medical consultation, documenting all
patient information reported to the Hospital by ambulance personnel.
b. The Hospital shall tape record all communications with ambulance personnel
involving patient direction.
C. The Hospital shall maintain a Base Hospital Communications Log of all
ambulance contacts involving patient direction or post-call in.
d. The Hospital shall utilize the following County forms and report formats
currently in use:
(1) Paramedic Field Treatment Guidelines;
(2) Base Hospital Report Form;
(3) Pre-Hospital Activity Report Form;
(4) Base Hospital Trauma Triage Report Format;
(5) EMS Notification Form; and
(6) Quality Assurance Prehospital Review, and Response/Resolution Forms.
Said forms and report formats will be provided to Hospital by County. Changes in required
forms and report formats may be made from time to time by written agreement between Hospital
and County's Emergency Medical Services Director. Additional supplies of forms and report
formats are available at County's EMS Agency, 50 Glacier Drive, Martinez, California 94553,
upon request.
e. The Hospital shall retain the records required in Paragraph 3.a. above for
a minimum of seven (7) years.
f. The Hospital shall, in a timely manner, provide data and statistical
reports as may reasonably be required by County. Hospital shall provide base hospital
activity reports and trauma triage logs to County's EMS Agency for each month by the
twentieth day of the following month.
Initials:
2 Hospital County Dept.
SERVICE PLAN
Number 23-076-3
g. The Hospital shall maintain resource information in a manner which is
readily available to base and ambulance personnel. Resource information shall. include, but
is not limited to: Contra Costa County's Prehospital Care Manual, EMS Policies and
Procedures, and the Base Hospital Communications Log.
4. Staffing and Personnel. The Hospital shall comply with the following staffing
and personnel requirements:
a. The Hospital shall designate a Base Hospital Liaison Physician (hereinafter
referred to as "Liaison Physician") , a Base Hospital Coordinator (hereinafter referred to as
"Coordinator") , and such other personnel as may be required to carry out the base hospital
functions under this agreement.
b. The Hospital shall assign the Liaison Physician a minimum of 16 hours per
month, unincumbered by other responsibilities, to oversee the base hospital operation. The
Liaison Physician shall meet the requirements and be accountable for the responsibilities set
forth in the Base Hospital Liaison Physician Requirements and Responsibilities (Exhibit A) ,
which is attached hereto and incorporated herein by reference.
C. The Hospital shall assign the Coordinator, unencumbered by other
responsibilities, adequate time to carry out the requirements of this Contract. The
Coordinator shall meet the requirements and be accountable for the responsibilities
identified in the Base Hospital Coordinator Requirements and Responsibilities (Exhibit B) ,
which is attached hereto and incorporated herein by reference. The Coordinator's ability to
carry out the requirements 'of this Contract, within the time allotted by the Hospital, will
be evaluated during the periodic Base Hospital audits.
d. A Mobile Intensive Care Nurse (MICN) shall be on duty in the Emergency
Department at all times to give radio direction to ambulance personnel. No nurse shall give
radio direction to ambulance personnel unless he/she is currently authorized to do so by the
EMS Medical Director.
e. The Hospital shall advise the County immediately of any change in
employment status of any MICN.
f. A physician licensed by the State of California and assigned to the
Emergency Department shall .be available at all times to provide immediate medical direction
to the MICN and/or ambulance personnel.
g. Hospital Emergency Department physicians shall meet the initial and ongoing
requirements for base hospital physicians set forth in Base Hospital Physician Requirements
(Exhibit C) , which is attached hereto and incorporated herein by reference. The Hospital
shall implement and maintain a base hospital physician requirement tracking system.
h. Hospital physicians and MICNs assigned to the Emergency Department shall
maintain current certification in Advanced Cardiac Life Support.
5. Training/Continuing Education. The Hospital shall comply with the following
training requirements:
Initials:
3 Hospital County Dept.
SERVICE PLAN
Number 23-076-3
a. The Hospital shall provide a base hospital orientation on all phases of
base hospital operations to all Emergency Department physicians and MICNs before assigning
them responsibility for medical control and supervision of ambulance personnel.
b. The Hospital shall provide continuing education to ambulance and base
hospital personnel in accordance with the County Base Hospital Continuing Education and
Ongoing Training Program (Exhibit D) , which is attached hereto and incorporated herein by
reference. If base hospital has been designated as base hospital in more than one base
hospital zone, base hospital shall provide some of the continuing education programs
described below in each base hospital zone.
C. The Hospital shall implement and maintain the following: intubation
scheduling mechanism for paramedics and continuing education tracking system for MICNs.
6. Quality Assurance. The Hospital shall implement and maintain a quality
assurance/improvement program for base hospital operations in the assigned zone(s) .
Hospital quality assurance/improvement program shall interface with the EMS system quality
assurance/improvement plan.
7. Controlled Substances. The Hospital shall provide paramedic units assigned to
Hospital with an initial stock of controlled substances and shall replenish controlled
substances in accordance with County's EMS Controlled Substances Policy, which has been
provided to Hospital by County and which is incorporated herein by reference.
8. Additional Base Hospital Responsibilities. The Hospital shall comply with the
following additional requirements:
a. The Hospital shall assist the EMS Agency in implementing new policies and
procedures issued by the EMS Agency. The County will discuss with the hospital
administration, system changes which are likely to result in additional expenditures of funds
or personnel time by Hospital, above those set forth in this Contract. Such discussion and
agreement regarding any such change will occur prior to the change being implemented.
b. A Base Hospital Committee, which includes the people identified in
Paragraph 4.a. of the Service Plan shall meet regularly to assure adequate communications,
to provide ongoing opportunities for problem solving, and to enhance operations. Attendance
and the proceedings of these meetings shall be documented in writing which shall be available
for inspection by EMS staff upon request.
C. The Base Hospital Liaison Physician and the Base Hospital Coordinator shall
be members of and participate on the County's EMS Medical Advisory Committee (not to exceed
30 hours per year of Coordinator time and of Liaison Physician time) .
d. The Coordinator or designee shall attend all scheduled County Base Hospital
Coordinator meetings (not to exceed 36 hours per year) .
e. The Liaison Physician shall attend scheduled County Pre-Trauma Audit
Committee meetings (not to exceed 36 hours per year) .
Initials:
4 Hospital County Dept.
SERVICE PLAN
Number 23-076-3
f. The Hospital shall provide assistance to County in MICN authorization
testing, EMS orientation and other EMS system activities as requested by County in writing,
30 days in advance (not to. exceed 36 hours per year of Coordinator time) .
g. The Hospital shall act as a resource hospital for ambulance personnel.
9. Payments to Hospital. County shall pay Hospital as set forth below in
recognition of added base hospital responsibilities incurred for providing medical direction
and quality assurance for an expanded paramedic program resulting from the implementation of
County Service Area EM-1 (Measure H) and required under this Agreement:
a. County's payments to Hospital are contingent upon the following:
(1) full participation in the County EMS System Quality
Assurance/Improvement Plan;
(2) full participation in the County Base Hospital Continuing Education
and On-Going Training Program (Exhibit D) ;
(3) submission of required base hospital activity data to County; and
(4) submission of an invoice in the form and manner required by County.
b. Upon approval of Hospital's invoices by the Health Services Director or
his designee, County will pay Contractor as follows:
$ 50.000.00 on or after September 1, 1994.
C. In the event that this Agreement is renewed pursuant to Special Conditions
Paragraph 1. (Renewal Provisions) , upon approval of Hospital's invoices by
the Health Services Director or his designee, County will pay Contractor
as follows:
$ 50,000.00 on or after September 1, 1995.
Initials:
5 Hospital County Dept.
SPECIAL CONDITIONS
Number 23-076-3
1. Renewal Provisions. Paragraph 22 (Non-renewal) of the General Conditions is
hereby modified to read as follows:
"a. This contract may be renewed or extended by mutual agreement of County and
Contractor, expressed in writing, for a maximum of one additional period of one year,
provided the Contractor has satisfactorily performed the services set forth herein.
b. If this contract is renewed or extended pursuant to these provisions,
County shall pay Contractor the amounts specified in Service Plan Paragraph 9. (Payment to
Hospital) , in continued recognition of added base hospital responsibilities required under
this Agreement. "
2. Licensing and Accreditation. Hospital shall keep in effect and, when requested
by the County Health Officer, provide to County proof of the following:
a. Licensure under California Health and Safety Code Section 1250 et seq. ;
b. Accreditation by the Joint Commission on Accreditation for Hospitals;
C. Permit for Basic or Comprehensive Emergency Medical Service pursuant to
the provisions of Title 22, Division 5, of the California Code of
Regulations.
3. Nondiscrimination. Hospital shall provide said direction of advanced life
support, prehospital care and emergency medical care without regard to the patient's race,
color, national origin, religious affiliation, age, sex, or ability to pay.
4. Commitment. Hospital hereby acknowledges that it has the approval and continued
commitment of Hospital administration, medical staff and Emergency Department staff to
participate as a base hospital.
5. Patient Transfers. Hospital shall abide by the Contra Costa County Patient
Transfer Guidelines, which have been provided to Hospital by County and which are
incorporated herein by reference.
6. On-Call System. Hospital shall maintain a backup, on-call system that assures
prompt (within 30 minutes) specialist and admitting physician response and commitment for
care of all patients regardless of the patient's ability to pay.
7. Affirmative Action. Hospital shall comply with all Federal, State and local
government laws and regulations regarding affirmative action. The Hospital shall be an equal
opportunity employer.
8. Patient Destination Determination. Hospital shall not use base hospital
designation in any manner that would circumvent Federal, State or local laws and regulations
regarding destination determination for ambulance patients.
9. Endorsements. Contractor shall not in its capacity as a contractor with Contra
Costa County publicly endorse or oppose the use of any particular brand name or commercial
product without the prior approval of the Board of Supervisors. In its County contractor
Initials:
Hospital County Dept.
1
SPECIAL CONDITIONS
Number 23-076-3
capacity, Contractor shall not publicly attribute qualities or lack of qualities to a
particular brand name or commercial product in the absence of a well-established and widely-
accepted scientific basis for such claims or without the prior approval of the Board of
Supervisors. In its County contractor capacity, Contractor shall not participate or appear
in any commercially-produced advertisements designed to promote a particular brand name or
commercial product, even if Contractor is not publicly endorsing a product, as long as the
Contractor's presence in the advertisement can reasonably be interpreted as an endorsement
of the product by or on behalf of Contra Costa County. Notwithstanding the foregoing,
Contractor may express its views on products to other contractors, the Board of Supervisors,
County officers, or others who may be authorized by the Board of Supervisors or by law to
receive such views.
10. Insurance. General Conditions Paragraph 19. (Insurance) is hereby deleted in its
entirety and replaced with the following Paragraph 19.
1119. Insurance. During the entire term of this Contract and any extension or
modification thereof, the Hospital shall keep in effect insurance policies meeting the
following insurance requirements:
a. Liability Insurance. The Hospital shall provide malpractice insurance
and comprehensive liability insurance, including coverage for owned
vehicles, each with a minimum combined single limit coverage of $5,000,000
for all damages, including consequential damages, due to bodily injury,
sickness.or disease, or death to any person or damage to or destruction of
property, including the loss of use thereof, arising from the act or
omission. of Hospital, its directors, officers, employees, and agents.
b. Workers' Compensation. The Hospital shall provide workers' compen-
sation insurance coverage for its employees.
c. Certificate of Insurance. The Hospital shall provide the County with
a certificate(s) of insurance evidencing liability and workers'
compensation insurance as required herein no later than the effective date
of this Contract. If the Hospital should renew the insurance policy(ies)
or acquire either a new insurance policy(ies) or amend the coverage
afforded: through an endorsement to the policy(ies) at any time during the
term of this Contract, then Hospital shall provide (a) current
certificate(s) of insurance.
d. Additional Insurance Provisions. The Hospital agrees to provide the
County not less than thirty (30) days written notice prior to any material
change or cancellation of insurance coverage. "
Initials:
Hospital County Dept.
2
EXHIBIT A
BASE HOSPITAL LIAISON PHYSICIAN
REQUIREMENTS AND RESPONSIBILITIES
GENERAL DESCRIPTION:
Each Base Hospital shall designate an EMT-P Base Hospital Liaison Physician who shall be
responsible for overall medical control and supervision of the EMT-P prehospital program
within the Base Hospital's. area of responsibility including review of patients care records
and critique with personnel involved. (This process is not to be construed as counseling
another agency's employee.) The Base Hospital Liaison Physician shall be responsible for
reporting deficiencies in 'patient care to the local EMS Agency.
REQUIREMENTS:
The Base Hospital Liaison Physician (EMT-P Base Hospital Medical Director) shall:
1. Be a physician on the hospital staff, licensed in the State of California, experienced
in emergency medical care and regularly assigned to the emergency department.
2. Have experience in and knowledge of base hospital radio operations and local EMS Agency
policies and procedures.
3. Be appointed by the Emergency Department Medical Director with the support of the Base
Hospital Administration.
4. Maintain Base Hospital Physician requirements.
5. Be allotted the necessary time unencumbered by other responsibilities to complete the
requirements of the position (It is estimated that Base Hospital Liaison Physicians
duties require a minimum of 16 hours per month) .
RESPONSIBILITIES:
The Base Hospital Liaison 'Physician shall:
1. Be responsible for overall medical control and supervision of the prehospital program
within the base hospital's area of responsibility including review of patient care
records and critique with personnel involved.
2. Report any incident involving certified EMS personnel (EMT-Is, EMT-Ps, MICNs) , which
may constitute a threat to the public health and safety, no later than the next
business day following the incident or the discovery of the incident. If this report
is made by telephone, a written report is to be submitted within 72 hours.
3. Evaluate paramedic disrupted communication reports and forward a written evaluation of
the report to the EMS Agency within five (5) working days.
4. Review written reports at least on a monthly basis for patients who were seen in the
field by paramedics and who were not transported, but for whom Base contact was made.
5. Evaluate paramedic interfacility transfers involving Base Hospital personnel. Forward
records with comments each month to the EMS Agency. Provide appropriate feed-back to
involved Base Hospital personnel.
1
EXHIBIT A
BASE HOSPITAL LIAISON PHYSICIAN
REQUIREMENTS AND RESPONSIBILITIES
6. Work with EMS Medical Consultants, EMS Director and other EMS staff to identify
prehospital and base hospital needs, to develop plans for solutions, and to evaluate
policies and procedures relative to prehospital care.
7. Participate in the required base hospital quality assurance program.
8. Participate in the County Medical Advisory Committee.
9. Attend the scheduled County Pre-Trauma Audit Committee meetings.
2
EXHIBIT B
BASE HOSPITAL COORDINATOR
REQUIREMENTS AND RESPONSIBILITIES
GENERAL DESCRIPTION:
Each Base Hospital shall identify a Mobile Intensive Care Nurse with experience in and
knowledge of base hospital radio operations and local EMS Agency policies and procedures as
a Base Hospital Coordinator to assist the Base Hospital Liaison Physician in the medical
control and supervision of the prehospital personnel within the base hospital's area(s) of
responsibility.
REQUIREMENTS:
The Base Hospital Coordinator shall:
1. Be a Registered Nurse., licensed in the State of California and experienced in emergency
nursing.
2. Be authorized and maintain authorization as a Mobile Intensive Care Nurse (MICN) in
Contra Costa County.
3. Have experience in and knowledge of base hospital radio operations and EMS Agency
policies and procedures.
4. Be appointed by base'. hospital administration with the support of the Base Hospital
Liaison Physician.
5. Be allotted the necessary time unencumbered by other responsibilities to complete the
requirements of the position.
RESPONSIBILITIES:
The Base Hospital Coordinator shall:
1. Assist the Base Station Liaison Physician in the off-line medical control and
supervision of the prehospital program within the base hospital's area of
responsibility including review of patient care records and critiques with personnel
involved.
2. Be responsible for the base hospital quality assurance program.
3. Facilitate in-hospital clinical training for paramedics as required by the County.
4. Assist or arrange for assistance in providing training to prehospital personnel in
areas identified by the County as necessary for system advancement.
5. Participate on the Medical Advisory Committee.
6. Attend the regularly scheduled County Base Hospital Coordinator meetings.
7. Arrange to provide assistance with the County's EMS orientation and other EMS system
activities as identified in the contract service plan.
EXHIBIT C
CONTRA COSTA COUNTY BASE HOSPITAL PHYSICIAN
DEFINITION:
A Base Hospital physician means a physician who is currently licensed in California, who is
assigned to the Emergency Department of a base hospital and who is knowledgeable and capable
of issuing advice and instructions to prehospital emergency medical care personnel consistent
with standards established by the State of California and by Contra Costa County.
REOUIREMENTS:
All Base Hospital Emergency Department Physicians must:
1. Maintain current certification in Advanced Cardiac Life Support by the American Heart
Association.
2. Complete, prior to first working shift, a base hospital orientation to emergency
medical services including:
a. State legislation and regulations as well as county policies governing EMS
including EMT-I, EMT-P and MICN with scopes of practice.
b. Base physician role and responsibilities.
C. Contra Costa County field treatment guidelines and patient care report
forms.
d. Policies and procedures pertinent to Base Hospital function and medical
control, e.g. , interfacility transfers, disrupted communications. The
base physician will have a working knowledge of all communication
equipment and will be able to function as a medical radio operator.
3. Be Board Certified or Board Eligible in Emergency Medicine or successfully complete
the CAL/ACEP Base Station Physician Course. (Base physicians who successfully
completed the Contra Costa County Base Station Physician Written examination taken
prior to 1986 or the Bay Area Regional Written Exam taken prior to 1991 will have met
this requirement) .
4. Participate in the EMS system by:
a. providing medical consultation to MICNs and advice and instructions to paramedics
and EMT-Is in the field consistent with standards established by the State and
County.
b. attending one field care audit session per year.
C. acting as a resource in quality assurance activities if requested to do so by the
Base Hospital Liaison Physician.
RECOMMENDED:
Respond with a paramedic unit for at least one advanced life support patient contact.
EXHIBIT D
BASE HOSPITAL CONTINUING EDUCATION AND ON-GOING TRAINING PROGRAM
The Base Hospital is responsible for participating in the provision of continuing education
for field and base personnel including testing on cardiac rhythms, skills, or other
appropriate materials in accordance with schedule and. topics approved by the EMS Agency.
Topics will be selected to enhance system understanding, to reinforce understanding of basic
principals of prehospital care, or to introduce new information relative to the practice of
prehospital emergency medical care.
BRN credit through the EMS Agency will be given for the continuing education sessions listed
below as long as all County and BRN requirements for issuing certificates are met by the
participants and complete pertinent information is forwarded to the EMS Agency in a timely
manner.
1. Field Care Audit Sessions - The Base Hospital will provide eighteen (18) hours of
field care audit sessions per year to be scheduled as part of a county-wide continuing
education program. A typical field care audit session is comprised of a minimum of one
(1) hour audit of written or recorded patient care records, one (1) hour relevant
didactic information and an announcement/quiz period. Well managed calls,
controversial calls and trends in care may be reviewed in the call audit section.
Persons presenting the didactic section are to be thoroughly familiar with material
being presented. A description of new protocols, system changes and clarification of
existing policies or protocols are to be provided. A quiz including rhythm
identification and questions on didactic lecture is to be developed, administered and
graded by the Base 'Hospital. The Base Hospital is responsible for providing an
attendance sheet for documentation of attendance, for assuring that those persons
receiving credit have attended the entire session, and for forwarding copies of the
attendance sheet to the EMS Agency and other agencies as appropriate for CE record
keeping. Participants are to be asked to complete a speaker/session evaluation. At
least one Base Hospital physician shall attend each field care audit session for the
entire session.
2. Base Hospital Conference - The Base Hospital will provide a minimum of three (3)
hours of base station conferences each year. These teaching sessions will include
presentations by one or more speakers. Speakers who may not be familiar with roles,
responsibilities and scopes of practice of the prehospital care providers are to be
oriented prior to the presentation. A quiz on the didactic lecture material is to be
developed, administered and graded by the Base Hospital. Documentation of attendance
and evaluation are to be handled as described above.
3. Other Continuing, Education Activities
a. The Hospital shall provide a minimum of one (1) physician-instructed intubation
skills maintenance class each year. This class shall last a minimum of three (3)
hours and shall include didactic lecture and skills testing in a format approved
by the EMS Agency.
b. The Base Hospital may present other CE activities according to County policies
for MICNs and EMT-Ps:
4. Training Activities
a. Clinical Training - The Base Hospital shall provide or facilitate training and
evaluation for paramedics on skills required by the State and/or County when a
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EXHIBIT D
BASE HOSPITAL CONTINUING EDUCATION AND ON-GOING TRAINING PROGRAM
clinical setting is necessary (not to exceed 24 hours of Coordinator time per
year) .
b. Didactic Training - The Hospital shall assist the EMS Agency in providing
didactic training to ambulance personnel in areas identified by the County as
necessary for system advancement (not to exceed 24 hours per year of Coordinator
time) . To the extent possible, didactic training will be integrated into the
regularly scheduled continuing education program identified in b. (1) and b. (2)
of this section. If the didactic training does not lend itself to this format,
additional educational programs may be necessary. The EMS Agency will request
the Base Hospital's assistance in additional didactic training in writing 30 days
in advance and will expect base hospital assistance in providing this training
within any time constraints identified in the base hospital contract.
5. Remedial Clinical Experience - The Base Hospital will provide reasonable clinical
experience for MICNs or, at the request of the EMS Agency, EMT-Ps if this method of
remediation is appropriate to an identified problem. The Base Hospital will send
verification of attendance and evaluation of the clinical experience to the provider
and the EMS agency. The Base Hospital is not responsible for assuring competence in
areas for which remediation has been provided.
2
Contra Costa County Standai-d Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
1. Compliance with Law. Contractor shall be subject to and comply with all Federal, State and local
laws and regulations applicable with respect to its performance under this Contract, including but not
limited to, licensing, employment and purchasing practices; and wages, hours and conditions of
employment, including nondiscrimination.
2. Inspection. Contractor's performance, place of business and records pertaining to this Contract
are subject to monitoring, inspection, review and audit by authorized representatives of the County, the
State of California, and the United States Government.
3. Records. Contractor shall keep and make available for inspection and copying by authorized
representatives of the County, the State of California, and the United States Government, the
Contractor's regular business records and such additional records pertaining to this Contract as may be
required by the County.
a. Retention of Records. The Contractor shall retain all documents pertaining to this Contract
for five years from the date of submission of Contractor's final payment demand or final Cost Report;
for any further period that is required by law; and until all Federal/State audits are complete and
exceptions resolved for this contract's funding period. Upon request, Contractor shall make these records
available to authorized representatives of the County, the State of California, and the United States
Government.
b. Access to Books and Records of Contractor, Subcontractor. Pursuant to Section 1861(v)(1)
of the Social Security Act, and any regulations promulgated thereunder, Contractor shall, upon written
request and until the expiration of four years after the furnishing of services pursuant to this Contract,
make available to the Secretary of Health and Human Services or to the Comptroller General, or any of
their duly authorized representatives, this Contract and books, documents, and records of Contractor
that are necessary to certify the nature and extent of all costs and charges hereunder.
Further, if Contractor carries out any of the duties of this Contract through a subcontract with a value
or cost of $10,000 or more over a twelve-month period, such subcontract shall contain a clause to the
effect that upon written request and until the expiration of four years after the furnishing of services
pursuant to such subcontract, the subcontractor shall make available, to the County, to the Secretary or
to the Comptroller General, or any of their duly authorized representatives, the subcontract and books,
documents, and records of the subcontractor that are necessary to verify the nature and extent of all costs
and charges thereunder.
This special condition is in addition to any and all other terms regarding the maintenance or retention
of records under this Contract and is binding on the heirs, successors, assigns and representatives of
Contractor.
4. Reporting Requirements. Pursuant to Government Code Section 7550, Contractor shall include
in all documents or written reports completed and submitted to County in accordance with this Contract,
a separate section listing the numbers and dollar amounts of all contracts and subcontracts relating to
the preparation of each such document or written report. This section shall apply only if the payment
limit under this Contract exceeds $5,000.
1
Contra Costa County Standard Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
5. Termination.
a. Written Notice. This Contract may be terminated by either party, at their sole discretion,
upon thirty-day advance written notice thereof to the other, and may be cancelled immediately by written
mutual consent.
b. Failure to Perform. The County, upon written notice to Contractor, may immediately
terminate this Contract should the Contractor fail to perform properly any of its obligations hereunder.
In the event of such termination, the County may proceed with the work in any reasonable manner it
chooses. The cost to the County of completing Contractor's performance shall be deducted from any sum
due the Contractor under this Contract, without prejudice to the County's rights otherwise to recover
its damages.
C. Cessation of Funding. Notwithstanding Paragraph 5.a. above, in the event that Federal,
State, or other non-County funding for this Contract ceases, this Contract is terminated without notice.
6. Entire Agreement. This Contract contains all the terms and conditions agreed upon by the parties.
Except as expressly provided herein, no other understanding, oral or otherwise, regarding the subject
matter of this Contract shall be deemed to exist or to bind any of the parties hereto.
7. Further Specifications for Operating Procedures. Detailed specifications of operating procedures
and budgets required by this Contract, including but not limited to, monitoring, evaluating, auditing,
billing, or regulatory changes, may be developed and set forth in a written Informal Agreement between
the Contractor and the County. Such Informal Agreements shall be designated as such and shall not be
amendments to this Contract except to the e.-dent that they further detail or clarify that which is already
required hereunder. Such Informal Agreements may not enlarge in any manner the scope of this
Contract, including any sums of money to be paid the Contractor as provided herein. Informal
Agreements may be approved and signed by the head of the County Department for which this Contract
is made or his designee.
8. Modifications and Amendments.
a. General Amendments. This Contract may be modified or amended by a written document
executed by the Contractor and the Contra Costa County Board of Supervisors or, after Board approval,
by its designee, subject to any required State or Federal approval.
b. Administrative Amendments. Subject to the Payment Limit, the Payment Provisions and
the Service Plan may be amended by a written administrative amendment executed by the Contractor
and the County Administrator or his designee, subject to any required State or Federal approval,
provided that such administrative amendments may not materially change the Payment Provisions or the
Service Plan.
9. Disputes. Disagreements between the County and Contractor concerning the meaning,
requirements, or performance of this Contract shall be subject to final determination in writing by the
head of the County Department for which this Contract is made or his designee or in accordance with
the applicable procedures (if any) required by the State or Federal Government.
2
Contra Costa County Standard Form 1187
GENERAL CONDITIONS
(Purchase of Services)
10. Choice of Law and Personal Jurisdiction.
a. This Contract is made in Contra Costa County and shall be governed and construed in
accordance with the laws of the State of California.
b. Any action relating to this Contract shall be instituted and prosecuted in the courts of
Contra Costa County, State of California.
11. Conformance with Federal and State Regulations and Laws. Should Federal or State regulations
or laws touching upon the subject of this Contract be adopted or revised during the term hereof, this
Contract shall be deemed amended to assure conformance with such Federal or State requirements.
12. No Waiver by County. Subject to Paragraph 9. (Disputes) of these General Conditions, inspections
or approvals, or statements by any officer, agent or employee of the County indicating the Contractor's
performance or any part thereof complies with the requirements of this Contract, or acceptance of the
whole or any part of said performance, or payments therefor, or any combination of these acts, shall not
relieve the Contractor's obligation to fulfill this Contract as prescribed; nor shall the County be thereby
estopped from bringing any action for damages or enforcement arising from any failure to comply with
any of the terms and conditions of this Contract.
13. Subcontract and Assignment. This Contract binds the heirs, successors, assigns and
representatives of Contractor. The Contractor shall not enter into subcontracts for any work
contemplated under this Contract and shall not assign this Contract or monies due or to become due,
without the prior written consent of the County Administrator or his designee, subject to any required
State or Federal approval.
14. Independent Contractor Status. This Contract is by and between two independent contractors and
is not intended to and shall not be construed to create the relationship between the parties of agent,
servant, employee, partnership, joint venture or association.
15. Conflicts of Interest. Contractor, its officers, partners, associates, agents, and employees, shall
not make, participate in making, or in any way attempt to use the position afforded them by this
Contract to influence any governmental decision in which he or she knows or has reason to know that
he or she has a financial interest under California Government Code Sections 87100, et seq., or
otherwise.
16. Confidentiality. Contractor agrees to comply and to require its officers, partners, associates,
agents and employees to comply with all applicable State or Federal statutes or regulations respecting
confidentiality, including but not limited to, the identity of persons served under this Contract, their
records, or services provided them, and assures that:
a. All applications and records concerning any individual made or kept by Contractor or any
public officer or agency in connection with the administration of or relating to services provided under
this Contract will be confidential, and will not be open to examination for any purpose not directly
connected with the administration of such service.
3
Contra Costa County Standard Foam U87
GENERAL CONDITIONS
(Purchase of Services)
b. No person will publish or disclose or permit or cause to be published or disclosed, any list
of persons receiving services, except as may be required in the administration of such service. Contractor
agrees to inform all employees, agents and partners of the above provisions, and that any person
knowingly and intentionally disclosing such information other than as authorized by law may be guilty
of a misdemeanor.
17. Nondiscriminatory Services. Contractor agrees that all goods and services under this Contract
shall be available to all qualified persons regardless of age, sex, race, religion, color, national origin, or
ethnic background, or handicap, and that none shall be used, in whole or in part, for religious worship
or instruction.
18. Indemnification. The Contractor shall defend, indemnify,save, and hold harmless the County and
its officers and employees from any and all claims, costs and liability for any damages, sickness, death,
or injury to person(s) or property, including without limitation all consequential damages, from any cause
whatsoever arising directly or indirectly from or connected with the operations or services of the
Contractor or its agents, servants, employees or subcontractors hereunder, save and except claims or
litigation arising through the sole negligence or sole willful misconduct of the County or its officers or
employees. Contractor will reimburse the County for any expenditures, including reasonable attorneys'
fees, the County may make by reason of the matters that are the subject of this indemnification, and if
requested by the County will defend any claims or litigation to which this indemnification provision
applies at the sole cost and expense of the Contractor.
19. Insurance. During the entire term of this Contract and any extension or modification thereof, the
Contractor shall keep in effect insurance policies meeting the following insurance requirements unless
otherwise expressed in the Special Conditions:
a. Liabilitv Insurance. The Contractor shall provide comprehensive liability insurance,
including coverage for owned and non-owned automobiles, with a minimum combined single limit
coverage of$500,000 for all damages, including consequential damages, due to bodily injury, sickness or
disease, or death to any person or damage to or destruction of property, including the loss of use thereof,
arising from each occurrence. Such insurance shall be endorsed to include the County and its officers
and employees as additional insureds as to all services performed by Contractor under this agreement.
Said policies shall constitute primary insurance as to the County, the State and Federal Governments,
and their officers, agents, and employees, so that other insurance policies held by them or their self-
insurance program(s) shall not be required to contribute to any loss covered under the Contractor's
insurance policy or policies.
b. Workers' Compensation. The Contractor shall provide workers' compensation insurance
coverage for its employees.
C. Certificate of Insurance. The Contractor shall provide the County with (a) certificate(s)
of insurance evidencing liability and worker's compensation insurance as required herein no later than
the effective date of this Contract. If the Contractor should renew the insurance policy(ies) or acquire
either a new insurance policy(ies) or amend the coverage afforded through an endorsement to the policy
at any time during the term of this Contract, then Contractor shall provide (a) current certificate(s) of
insurance.
4
Centra Costa County Standard Form 1187
GENERAL CONDMONS
(Purchase of Services)
d. Additional Insurance Provisions. The insurance policies provided by the Contractor shall
include a provision for thirty (30) days written notice to County before cancellation or material changes
of the above specified coverage.
20. Notices. -All notices provided for by this Contract shall be in writing and may be delivered by
deposit in the United States mail, postage prepaid. Notices to the County shall be addressed to the head
of the County Department for which this Contract is made. Notices to the Contractor shall be
addressed to the Contractor's address designated herein. The effective date of notice shall be the date
of deposit in the mails or of other delivery, except that the effective date of notice to the County shall be
the date of receipt by the head of the County Department for which this Contract is made.
21. Primacy of General Conditions. Except for Special Conditions which expressly supersede General
Conditions, the Special Conditions (if any) and Service Plan do not limit any term of the General
Conditions.
22. Nonrenewal. Contractor understands and agrees that there is no representation, implication, or
understanding that the services provided by Contractor under this Contract will be purchased by County
under a new contract following expiration of termination of this Contract, and waives all rights or claims
to notice or hearing respecting any failure to continue purchase of all or any such services from
Contractor.
23. Possessory Interest. If this Contract results in the Contractor having possession of, claim to or
right to the possession of land or improvements, but does not vest ownership of the land or improvements
in the same person, or if this Contract results in the placement of taxable improvements on tax exempt
land (Revenue & Taxation Code Section 107), such interest or improvements may represent a possessory
interest subject to property tax, and Contractor may be subject to the payment of property taxes levied
on such interest. Contractor agrees that this provision complies with the notice requirements of Revenue
& Taxation Code Section 107.6, and waives all rights to further notice or to damages under that or any
comparable statute.
24. No Third-Party Beneficiaries. Notwithstanding mutual recognition that services under this
Contract may provide some aid or assistance to members of the County's population, it is not the
intention of either the County or Contractor that such individuals occupy the position of intended third-
party beneficiaries of the obligations assumed by either party to this Contract.
25. Copyrights and Fights in Data. Contractor shall not publish or transfer any materials produced
or resulting from activities supported by this agreement without the express written consent of the County
Administrator. If any material is subject to copyright, the County reserves the right to copyright such
and the Contractor agrees not to copyright such material. If the material is copyrighted, the County
reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish, and use such
materials, in whole or in part, and to authorize others to do so.
5