HomeMy WebLinkAboutMINUTES - 06141994 - 1.52 TO: BOARD OF SUPERVISORS J�
FROM: Mark Finucane, Health Services Director U'` Cwt+}ra
By: Elizabeth A. Spooner, Contracts Administrator Costa
DATE: May 31, 1994 County
SUBJECT: Approval of Contract Amendment Agreement #26-890-4 with
John Roark, M.D.
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Health Services Director, or his designee,
(Frank Puglisi, Jr. ) to execute on behalf of the County, Contract
Amendment Agreement #26-890-4, effective March 1, 1994, to amend
Medical Specialist Contract #26-890-3 with John Roark, M.D.
(Specialty: Gastroenterology) , to modify the Contract payment
provisions to allow the Contractor to provide on call and additional
clinic services.
II. FINANCIAL IMPACT:
Cost to the County depends upon utilization. As appropriate, patients
and/or third party payers will be billed for services.
III. REASONS FOR RECOMMENDATIONSIBACKGROUND:
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.
On June 15, 1993 , the Board of Supervisors approved Medical Specialist
Contract #26-890-3 with John Roark, M.D. , for the period from July 1,
1993 through June 30, 1994, to provide professional Gastroenterology
services for patients at Merrithew Memorial Hospital and Clinics.
The need for Gastroenterology services has increased and Dr. Roark
has agreed to increase his time commitment. Approval of Contract
Amendment Agreement #26-890-4 will allow Dr. Roark to be paid for the
additional services he is providing at County's request.
CONTINUED ON ATTACHMENT: YES SIGNATURE: `
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENATI N OF BOARD CO ITTEE
APPROVE OTHER
SIGNATURES)
ACTION OF BOARD ON JIN I A inniAPPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: ----\ NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ,ter ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
.Contact: Frank Puglisi (370-5100) n
CC: Health Services (Contracts) ATTESTEDINN
_ 14 Ion,
Risk Management Phil Batchelor,&ka�die Board of
Auditor-Controller Supervisors and County Administrator
Contractor �(►�n�
M382/7-e8 BY l �f�+ 5U[ �� , DEPUTY
1 . 52
r- Contra Costa County Standard Form 1/87
CONTRACT AMENDMENT AGREEMENT
(Purchase of Services) Number 26-890-4
Fund/Org # 6500
Account #
Other #
1•. Identification of Contract to be Amended.
Number: 26-890-3
Effective Date: July 1, 1993
Department: Health Services - Hospital and Clinics
Subject: Provision of services in Contractor's medical
specialty (Gastroenterology)
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: JOHN ROARK, M.D.
Capacity: Self-employed individual Medical License #G038581
Taxpayer ID# 94-3042490
Address: 3000 Colby Street, #307, Berkeley, California 94705
3 . Amendment Date. The effective date of this Contract Amendment Agreement
is March 1, 1994
4. Amendment Specifications. The Contract identified above is hereby
amended as set forth in the "Amendment Specifications" attached hereto
which are incorporated herein by reference.
5. Signatures. These signatures attest the parties' agreement hereto:
COUNTY OF CONTRA COSTA, CALIFORNIA
ATTEST: Phil Batchelor, Clerk of
BOARD OF SUPERVISORS a Board of Supervisors and County
>.� ministrator
By
Chairman/Designee Deputy
CONTRACTOR
By ByXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Self-employed individual XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
(Designate business capacity A) (Designate business capacity B)
Note to Contractor: For corporations(profit or nonprofit),the contract must be signed by two officers. Signature A must be That of the president or vice-president and
Signature B must be that of The secretary or assistant secretary(Civil Code Section 1190 and Corporations Code Section 313). All signatures must be acknowledged as set
forth on page two.
Contra"Costa County Standard Form 1/87
APPROVALS/ACKNOWLEDGEMENT
Number 26-890-4
APPROVALS
RECOMMENDED BY DEPARTMENT FORM APPROVED
By By
Designee
APPROVED: COUNTY ADMINISTRATOR
By
ACKNOWLEDGEMENT
State of California ACKNOWLED MENT (By Corporation,
P tnership, .or Individual)
County of
The person(s) signing above for Contractor, sonally known to me in the individual or
business capacity(ies) stated, or proved t m on the basis of satisfactory evidence to
be the stated individual or the repre tative ) of the partnership or corporation
named above in the capacity(ies) s ted, person ly appeared before me today and
acknowledged that he/she/they exe ed it, and acknow dged to me that the partnership
named above executed it or ackn edged to me that the co oration named above executed
it pursuant to its bylaws or resolution of its board of 'rectors.
Dated:
[Notarial Seal]
Notary Public/Deputy County Clerk
-2-
AMENDMENT SPECIFICATIONS
Number 26-890-4
In consideration for Contractor's willingness to provide additional
professional services under the Contract identified herein, County
agrees to modify the contract payment provisions. County and
Contractor agree therefore to amend said Contract as set forth
below while all other parts of the Contract remain unchanged and in
full force and effect.
1. Payment. The fee schedule set forth in Paragraph 1. (Payment)
of the Additional Provisions is hereby modified to read as follows:
"a. 800 per week for on-call coverage, including any
procedures performed •when Contractor is on-call; plus
b. 800 per four-hour clinic session; and
C. For surgery, .fifty percent (50%) of the fee stated in the
official fee schedule approved by the Division of
Industrial Accidents, State of California, in effect on
the date of surgery. "
Initials:
Contractor County Dept.