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HomeMy WebLinkAboutMINUTES - 06211994 - 1.5 (2) TO: BOARD OF SUPERVISORS FROM: Mark Finucane, Health Services Director ri Contra By: Elizabeth A. Spooner, Contracts Administrator Costa DATE: June 7, 1994 County SUBJECT: Approval of Unpaid Student Training Agreement #26-269 with the University of California, San Francisco--School of Nursing SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: Approve and authorize the Health Services Director or his designee (Frank Puglisi) to execute on behalf of the County, Unpaid Student Training Agreement #26-269 with the University of California, San Francisco, School of Nursing, for the period from March 28, 1994 through June 30, 1997, for provision of clinical experience for nursing students. II. FINANCIAL IMPACT: None. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: The purpose of this Agreement is to provide the University's students with field education in nursing at Merrithew Memorial Hospital and Clinics. Supervised field work experience is considered to be an integral part of both educational and professional preparation. As a teaching hospital, Merrithew can provide the requisite field education, while at the same time, taking advantage of the students' services to patients. This Agreement is prepared in the standard format approved by County Counsel's Office and has been executed by the University. r CONTINUED ON ATTACHMENT: YES SIGNATURE: f RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEATI NOF BOARD OMMpITYTyE-�E�/ APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON 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 O Contact: Frank Puglisi (370-5100) F SUPERVISORS ON THE DATE SHOWN. CC: Health Services (Contracts) ATTESTED / Risk Management Phil atchelor, Clerk of the Board of ContractorSIIjI81YISQ(S��rQlliI�AQIiU�I�t(et4l M882/7-88 BY e / Li1/ �a , DEPUTY --Contra Costa County I Standard Form UNPAID STUDENT TRAINING AGREEMENT Number 26-269 1. Contract Identification. Dtkn' County Department: Health Service Clinics Division) Subject: Unpaid student �Jjl 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: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF NURSING Capacity: State Educational Institution Address: 521 Parnassus Avenue, San Francisco, California 94143-0604 3 . Term. The effective date of this Agreement is March 28 , 1994 and it terminates June 30, 1997 , unless sooner terminated as provided herein. 4 . Termination. This Agreement may be terminated by either party, at its sole discretion, upon seven-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 Paragraph 1. of the Program Plan, attached hereto and 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 the relationship of agent, servant, employee, partnership, joint venture, or association. 7. Indemnification. Except foruth.- t' ' es. of participants covered by the County's Volunteer policy; qty nd its employees, agents and officers shall be indemniRaction a d armless against any and all claims, demands, or causes a legedly arising out of any act or omission arising as a result of the services provided in this agreement, of any officer, agent, or employee of the other party, or resulting from the conditions of any property owned or controlled by the other party. 8. Legal Authority. This Agreement is entered into under and subject to the following legal authority: California Government Code Sec. 26227. 9. Signatures. These signatures attest the parties' agreement hereto: COUNTY OF CONTRA COSTA, CALIFORNIA CONTRACTOR By By Designee Recommended by Department (Designate official capacity) By Designee (Form approved by County Counsel) Contra Costa County Standard Form UNPAID STUDENT TRAINING PARTICIPANT AGREEMENT The County of Contra Costa and the Participant named below agree as follows: 1. Participant will engage in training for a Contra Costa County Department pursuant to a contract between the County and a contractor sponsoring the participant. 2. Participant agrees that in connection with such training, participant is a volunteer, subject to the County's volunteer policy and regulations, and will obtain no employment rights or employment benefits from the County and waives any claim to any employment rights or benefits from Contra Costa County based upon participant's training services, whether or not authorized under such contract. 3 . Participant further agrees: "I have read the 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. 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 26-269 Contractor UNIVERSITY OF CALIFORNIA, SAN FRANCISCO--SCHOOL OF NURSING County Department Health Services (HosRital and Clinics Division) CONTRA COSTA COUNTY PARTICIPANT (Printed Name) By (Designee) (Signature) PROGRAM PLAN Number 26-269 1. conditions. By this Agreement, County agrees to permit unpaid student training by persons (participants) sponsored by Contractor under the following conditions: a. Services provided under this Agreement are volunteer services, and participants obtain no employment rights with, or employment benefits from, the County, by virtue of this Agreement or service hereunder. Agreement, in the form attached hereto, is required of every participant. b. Upon approval by County's Board of Supervisors this Agreement shall be an authorized volunteer program. The County's volunteer policy and the County Administrator's rules and procedures for authorized volunteer programs, attached hereto, are applicable with respect to this Agreement, and are incorporated herein by reference together with any amendments thereto, subject nevertheless to the terms of this Agreement. C. other contract terms and conditions are expressed in this Program Plan. 2 . Contractor's Obligations. Contractor shall establish and conduct a student training program for Nursing in cooperation with County's Department (hereinafter referred to as County) . In conducting this program, Contractor shall: a. Assign a staff member to represent Contractor and act as liaison with County Department in all matters relating to this Agreement. b. Provide necessary qualified instructors. C. Assume full responsibility for and control of the education of students in the above-mentioned program through one or more members of its own instructional staff. This responsibility will include the classroom teaching and/or the appropriate teaching-guidance of clinical practice. d. Participate with County in planning and implementing the clinical education of students. e. Designate in writing, prior to commencement of each clinical program and sufficiently in advance to allow convenient planning by County, a roster of students assigned to the clinical instruction at County. The number of students assigned to participate in a program shall be; determined by mutual agreement of County and Contractor. f. Provide and be responsible for the care and control of all instructional educational supplies and equipment needed for the maintenance of a sound educational program, not including the clinical supplies and equipment needed in the care of patients which are to be provided by County. Initials: Contractor County Dept. 1 PROGRAM PLAN Number 26-269 g. Assign for such training only those students who are prepared therefor to a degree considered adequate by mutual agreement of the County and Contractor. Designate only students who are in good health at the time of designation as shown by health examination records maintained by Contractor and require each student to undergo such other medical examinations and take such other protective measures County may require. h. Provide secretarial services for processing transcripts, records, preparation of official reports for local, state, and other supervisory groups as needed to prepare schedules, directives, and memoranda. i. Agree to advise each student assigned hereunder that he/she shall be subject to and governed by the policies, rules, and regulations of County while enrolled and participating in the program at County and shall conform to all requirements and restrictions specified jointly by representatives of Trustees and County. j . Require that students be enrolled to attend classes during regular periods Mondays through noon on Saturdays, and recognize that clinical experience is to be conducted in assigned periods when regular staff of County are on duty. k. Make all necessary arrangements with such students, so that each will: (1) Have completed or be in good standing for all the necessary course work required by the Contractor as preparation for placement in the student training program. (2) Agree to execute the County's Unpaid Student Training Participant Agreement upon referral to the training program. (3) Have transportation to and from County's training sites. (4) Refer educational problems to the appropriate instructor(s) in Contractor's School. (5) Comply with the standards of conduct and the County, State, and Federal regulations governing professional personnel at County's clinical training site. 1. Withdraw from the program any student whose performance is unfit or whose conduct prevents constructive relationships at the clinical training site, upon the written and suitably documented request from County's Department. M. Agree that Contractor is bound by the provisions of Executive Order No. 11246 of September 24, 1965 ("Equal Employment Opportunity") . Contractor agrees that it will not discriminate in the selection of any Initials: Contractor County Dept. 2 PROGRAM PLAN Number 26-269 student to receive training pursuant to this Agreement because of race, creed, color, or national origin. In the event of Contractor's non- compliance with this section, this Agreement may be canceled, terminated or suspended in whole or in part by County. 3 . Student's Obligations. While participating in the Student Training Program, student shall: a. Dress according to college and hospital regulations. b. Behave in an appropriate, professional manner while in the clinical area or on the hospital grounds. C. Arrive in the clinical area on time and return from scheduled breaks promptly. d. Establish effective communications with County staff. e. Notify appropriate staff member before leaving clinical area. f. Abide by hospital and ward regulations as applicable to students. g. Ask assistance from instructor while still learning a skill and seek instruction and guidance, as needed, in clinical assignments, and not attempt any procedure which is beyond his/her capabilities. Each student must be checked out by the instructor before attempting a procedure alone. Student will take responsibility for own actions in carrying out clinical assignments. h. Maintain physical and emotional health at a level adequate to performance of clinical assignments. i. Avoid abuse of drugs and alcohol. j . 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. 4. County's Obligations. County shall participate in a student training program in cooperation with Contractor's School. In participating in this program, County shall: a. Assign a staff member from its Department to represent the County and act as a liaison with Contractor's School in all matters relating to this Agreement. This person will define lines of authority and communication for relationships between Contractor's instructors and County personnel. Initials: Contractor County Dept. 3 PROGRAM PLAN Number 26-269 b. Designate an appropriate staff member who is a qualified physical therapist with a minimum of three years of clinical experience as the clinical supervisor who will coordinate and supervise the student's learning experiences at the Hospital. C. Assure that each student is instructed by only qualified physical therapists who have a minimum of one year of clinical experience. d. Accept the placement of such students in training as may be assigned by Contractor in assignment schedules and for a training period as shall be established by mutual agreement of the respective representatives of the County and Contractor. e. Cooperatively, with Contractor's instructor, provide each student with clinical training duties consisting of learning experiences and professional duties needed to accomplish the educational objectives of Contractor's student training program consistent with the operational responsibilities and professional activities of County's Department and the specific clinical training related thereto. f. Make available current copies of publications dealing with policies, rules, and procedures of County Department. g. Provide opportunities for students to participate in learning activities with County which are pertinent to the education program. h. Provide free access to appropriate facilities at Merrithew Memorial Hospital for learning experience therein for such periods of time, such places, and such experiences as shall be mutually agreed upon. i. Permit the program students and Contractor's instructors to use the cafeteria or other dining facilities at their own expense during the times designated by County. j . Provide evaluation of each student's performance. 5. Joint Obligations. County and Contractor shall jointly: a. Plan a student training program 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 outcome and establish mutual agreement for the next consecutive training period. Initials: Contractor County Dept. 4 CONTRA COSTA COUNTY POLICY STATEMENT ON VOLUNTEER PROGRAMS The use of volunteers in performing specific services is a valuable resource and provides an avenue for citizen participation in various County programs 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 but 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 programs: VOLUNTEER PROGRAMS A complete description of each volunteer program shall be submitted by the department head to the County Administrator for review and presentation to 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 fbr 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 POLICY STATEMENT ON VOLUNTEER 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 of 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 otherwise qualified for reimbursement which are not covered by the volunteer' s health plan, other available insurance coverage, or other third party (i.e. , Federal, State or other payment) . 2 . Public Liability. The County through its self-insurance program shall defend and indemnify volunteers upon request against liability claims initiated by third parties arising out of acts or omissions occurring within the scope of authorized volunteer services, unless the volunteer acted or failed to act because of actual malice, fraud, corruption or gross negligence. Volunteers using personal automobiles in performing authorized services must maintain liability insurance at limits which as a minimum 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 any other valid and collectible public liability or automobile liability insurance maintained by or which provides coverage for the volunteer. Volunteers may be permitted to operate County vehicles in the performance of authorized volunteer services. 3 . Expense Reimbursement. Volunteers shall be reimbursed for actual 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 Administrative Bulletin Contra Number 321 Costa Replaces Office of the County Administrator Date 7 —26-78 Coin Section 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 inde-amification against liability claims initiated by third parties . These regulations and procedures are promulgated in accordance with the policy adopted by the Board of Supervisors. II . RULES AND PROCEDURES County departments shall submit to the Office of the County Administrator a description of each volunteer program, the number of volunteers to be assigned, County staff requirements for coordination and County expenditures and funding involved. Such volunteer program definition, following review by the Office of the County Administrator, shall be forwarded to the Board of Supervisors for approval. After Board approval, rules and procedures , as follows, shall be adopted, and copies forwarded to the County Administrator: A. County departments sponsoring volunteer programs shall have a staff member assigned as a volunteer coordinator, who will be respon- sibile for the selection and acceptance of volunteers . Personnel matters regarding the volunteers will be referred to the volunteer coordinator. Volunteers will work directly with other staff members and will be under their supervision for each assignment. Each County department will forward to the County Administrator the name and telephone number of the employee (s) assigned as the volunteer coordinator. Volunteers will be provided with initial orientation and training by the 2 . volunteer coordinator . Where appropriate, confidentiality requirements shall be explained, reading materials assigned and discussion groups held on a regular basis with the volunteers. B. The volunteer coordinator will also be respon- sible for requiring volunteers to fill out, read and sign the application form, and if such volunteer is accepted, the volunteer coordinator will fill out the registration form (just below the application form) showing acceptance of the volunteer, date services commence and terminate , any remarks he may wish to include with respect to the capability of the volunteer and limitations as to tasks to be performed, and lastly the service authorized to be performed by the volunteer. If the volunteer is a minor, the parental consent form shall be completed and signed by the parent or legal guardian. Forms to be used by departments are attached. Departments may continue to use forms developed for volunteer programs which include information needed by the department in addition to that indicated on the attachments . Any obvious or suspected disabilities of a volunteer shall be discussed with the County Safety Officer. If reimbursement of actual and necessary expenses in performing volunteer services is contemplated, volunteer must sign Oath of Allegiance form in accordance with established department procedures when registering to perform authorized volunteer services with the County. The volunteer coordinator shall be responsible for mainte- nance of a log listing pertinent information with respect to all authorized volunteers, including date services commenced and terminated. Records are to be retained at least five years from the date of the last volunteer service for subsequent reference on claims which may be presented by either the volunteer or any third party allegedly injured. 3. If a volunteer is to use his personal vehicle in the course of authorized volunteer services, he will be required to fill out the "Volunteer Auto Insurance Declaration" form. Volunteers must check with their insurance agent or broker to make certain that liability insurance is extended under their Policy while their vehicle is being used for volunteer activities . Auto insurance is required for all volunteers who will use their personal, automobile while performing authorized volunteer services with at least the following limits : $15 , 000 for injury to or death to one person $30 , 000 for injury to or death to two or more persons in one accident .$5 , 000 for property damage The volunteer must furnish a valid California motor vehicle operators license if he is to use a vehicle and the license number together with insurance Policy number duly noted on the Auto Insur- ance Declaration (form attached) . A Certificate of Insurance or other evidence of insurance may be requested and placed on file . Ill . PROCEDURE IN CASE OF ACCID M OR INJURY When a volunteer is injured while performing authorized .volunteer services , the sup e-- ,-isor. 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. 4. When there is an accident resulting in third party personal injury or property damage, the appropriate accident report form shall be completed by the supervisor and forwarded to the volunteer coordinator. The subsequent procedure to be followed shall be' identical to that applicable as in accidents involving County employees . IV. LIABILITY .The County under its self-insurance program upon request shall defend and indemnify the volunteer against liability claims initi- ated by third parties arising from acts or omissions occuring within the . scope of authorized services , unless the volunteer acted or failed to act because of actual fraud, corruption, malice or gross negligence . However, the County shall provide automotive- liability insur- ance protection as excess only of the limits under the volunteer' s personal automotive liability policy. Such Count- insurance protection does not cover any damages to the vehicle or the—volun- teer, evolun- teer, nc u ing any- deductibie p.rovisl on wt1ich must be Dald. Maintenance of such records as determined necessary to assure that adequate insurance protection is afforded shall be a respon- sibility of the department ' s volunteer coordinator. V. REIMBURSEMENT OF EXPENSES Volunteers are eligible to receive reimbursement from the County for certain actual and necessary expenses incurred in the performance of authorized volunteer services . In order to claim expenses , the volunteer must have signed the Oath of Allegiance before any County officer authorized to administer oaths and meet previously described insurance requirements . Volunteers are governed by general County reimbursement policies established for County employees with the exception of mileage which will be reimbursed at a flat rate of $0. 15 per mile . The County will not reimburse volunteers for child care expenses, mileage rom t e vo unteer s residence to the County—designated tacility or service location or damage to the volunteer's personal vehicle , including any deduc—E=e provisions which are paid by t e volunteer. : The volunteer must provide nrormation to the volunteer nteer coordinator with respect to the automobile liability finsurance coverage maintained prior to use of the personal vehicle for volunteer services and reimbursement of mileage claims . J 5. Volunteers are recognized as a valuable resource in perform- ing services which are not provided by the County. The Board of Supervisors has expressed its strong support of volunteer programs. These policies and procedures have been developed for the information and guidance of County staff and volunteers . Acting County Administrator CONTRA COSTA COUNTY VOLUNTEER APPLICATION AND REGISTRATION FORM Name Age Social Security No. Home-Acciress 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 CONTRA COSTA COUNTY VOLUNTEER SERVICES AUTO INSURANCE DECLARATION Date This is to certify that 1, the undersigned, am in possession of a valid California Driver' s License , (Number) My car (—Expiration Date) (Make) I o e F (Year) (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 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 forr-n- 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: