HomeMy WebLinkAboutMINUTES - 06071994 - 1.42 t-yx
To: BOARD OF SUPERVISORS (�
FROM: Mark Finucane, Health Services Director - f Contra
By: Elizabeth A. Spooner, Contracts Administrator
Costa
DATE: May 23, 1994 cougy
SUBJECT: Approval of Contract Amendment Agreement #26-911-2 with
Thomas B. Hargrave III, 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 #26-911-2, effective March 1, 1994, to amend
Medical Specialist Contract #26-911-1 with Thomas B. Hargrave III,
M.D. (Specialty: Gastroenterology) , to increase the Contract Payment
Limit by $6,400, from $60, 000 to a new total Contract Payment Limit of
$66,400.
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 RECOMMENDATIONS/BACKGROUND:
. 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 #26-911-1 with Thomas B. Hargrave III, 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.
Because of a large backlog of patients, the Department has asked Dr.
Hargrave to provide additional clinic sessions, and approval of
Contract Amendent Agreement #26-911-2 will allow Dr. Hargrave to be
paid for the additional clinic services he is providing at the
County's request.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEN TIO OF BOARD COM ITTEE
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
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Frank Puglisi (370-5100)
CC: Health Services (Contracts) ATTESTED
Risk Management phi) tehehn,Cte of the doard of
Auditor-Controller Suvervisors and County Administrator
Contractor
M382/7-ea BY �[L"J DEPUTY
I yZ
Cora Costa County Standard Form 1/87
CONTRACT AMENDMENT AGREEMENT
(Purchase of Services) Number 26-911-2
Fund/Org # 6500
Account #
Other #
1. Identification of Contract to be Amended.
Number: 26-911-2
r
Effective Date: July 1, 1993 D R T
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: THOMAS B. HARGRAVE III, M.D.
Capacity: Self-employed individual Medical License #G44506
Taxpayer ID#569-90-7279
Address: 3300 Webster Street #312, Oakland, California 94609
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 the Board of Supervisors and County
ORAF-T Administrator
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 26-911-2
APPROVALS
RECOMMENDED BY DEPARTMENT FORM APPROVED
By By
Designee
APPROVED: COUNTY ADMINISTRATOR
By
ACKNOWLEDGEMENT
State of California ACKNO DGEMENT (By Corporation,
Partnership, or Individual)
County of
The person(s) signing above for racto personally known to me in the individual or
business capacity(ies) state or proved to on the basis of satisfactory evidence to
be the stated individua r the representati s) of the partnership or corporation
named above in the acity(ies) stated, perso lly appeared before me today and
acknowledged that /she/they executed it, and ackno edged to me that the partnership
named above a sited it or acknowledged to me that the c oration named above executed
it pursua to its bylaws or a resolution of its board o irectors.
ated:
[Notarial Seal]
Notary Public/Deputy County Clerk
-2-
AMENDMENT SPECIFICATIONS
Number 26-911-2
In consideration for Contractor's willingness to provide additional
professional services under the Contract identified herein, County
agrees to increase the amount of its payment to Contractor. 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. Increase in Payment. The fee schedule set forth in Paragraph
1. (Payment) of the Additional Provisions is hereby modified to
read as follows:
"County will pay Contractor an amount not to exceed $66,400,
payable as follows:
" (1) $5, 000 per month for provision of professional
gastroentrology services, not to exceed a total of
$60, 000 during the term of this Contract; and
11 (2) In addition, Contractor will provide two (2) extra four-
hour clinic sessions per month during the months of
March, April, May and June 1994 , usually on the first and
third Tuesday afternoons of each month, for which County
will pay Contractor $800.00 per clinic session not to
exceed a total of $1, 600 monthly, or a total four-month
payment limit of $6,400. 1'
Initials:
Contractor County Dept.