HomeMy WebLinkAboutContract 50057 CITY SECRETARY
CONTRACT
EDUCATIONAL EXPERIENCE PROGRAM
AFFILIATION AGREEMENT
This Educational Experience Program Affiliation Agreement (Agreement) is made and entered
into by and between Cook Children's Medical Center ("Facility") and City of Fort Worth
(`Educational Institution").
This Educational Experience Program Affiliation Agreement includes the following
program(s): Initial EMT(Basic).
PURPOSE
The purpose of this agreement is to specify the general activities planned and the assignment of
responsibilities between the parties. The parties agree that it will be to their mutual interest and
advantage for students and faculty of the Educational Institution to be given the opportunity to
utilize the Facility for educational purposes.
In consideration of the mutual objectives, and in further consideration of the mutual promises
contained herein,the Facility and the Educational Institution agree as follows:
AGREEMENT
A. GENERAL INFORMATION
1. Student Assignments. The specific areas of student assignment for each program
and the number and distribution of students within the Facility will be mutually
agreed upon each academic semester by the Educational Institution and the Facility.
Educational Institution shall identify a contact person for each program who will
be responsible for arranging and confirming student assignments with Facility.
2. Academic Period and Supervision of Students. The students will be in the Facility
during the regular academic periods, and will be under the direct supervision of a
designee of the Facility, or faculty member of the Educational Institution. The
designee of the Facility will (1) be currently licensed by the appropriate Texas
regulatory agency and(2)be competent to perform the duties. The faculty member
of the Educational Institution will (1) be currently licensed by the appropriate
regulatory agency of their state and (2) be competent to perform as faculty
coordinator.
B. FACILITY RESPONSIBILITIES
1. The Facility agrees to provide to the Educational Institution necessary conference
and classroom areas for students, as available.
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The Facility will make available immediate emergency treatment for students and
faculty during the clinical experience,if needed. Thereafter,if necessary,the student
r faculty shall be transferred to an adult care facility. The Facility assumes no
mancial responsibility for the student's or faculty member's medi
reatment after they leave the Facility. The Facility has an establis 1
PECORD
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I Ir.WORTH,TX
policy and procedure related to post exposure of blood borne pathogens and all
students and faculty shall follow said guidelines as appropriate.
3. The Facility will provide students with an orientation of applicable Facility rules,
regulations, and policies.
4. The Facility retains the responsibility, authority and accountability for the care of
patients while students are in the Facility participating in care to patients.
5. The Facility may require the Educational Institution to remove any student or faculty
from continuing in the educational experience at the Facility if Facility determines
that the student or faculty does not meet the professional or other requirements,
qualifications and standards of the Facility. The Facility will consult with the
Educational Institution prior to any such removal, if reasonably possible. The
Facility will provide written explanation for removal to the Educational Institution.
6. The Facility will permit the authority responsible for accreditation of the curriculum
of the Educational Institution to inspect the facilities and services provided pursuant
to this Agreement as necessary for accreditation evaluation, upon reasonable notice
and as reasonably required.
7. The Facility will provide learning experiences including observation, direct care,
interdisciplinary collaboration, and participation in clinic, conferences and
inservices. Students will receive appropriate supervision and regular evaluations of
performance, as applicable.
C. EDUCATIONAL INSTITUTION'S RESPONSIBILITIES
1. Rules and Regulations. The Educational Institution shall require students to be
familiar with and abide by all applicable rules,regulations,policies and procedures
that govern the Facility.
2. Students and Faculty Insurance Coverage. The Educational Institution will provide
evidence that the students and faculty are covered by professional liability
insurance with limits which are not less than $1,000,000 per occurrence and
$3,000,000 aggregate.
3. Prerequisites. The Educational Institution shall require that students:
a. receive instruction in universal blood and body fluid precautions(within the
past year) through Facility and, if involved in patient care activities,
cardiopulmonary resuscitation (a healthcare basic life support/CPR course
within the past 2 years); and
b. comply with the most recent Dallas-Fort Worth Hospital Council
Foundation Community Standards for Drug Screening,Background Checks
& Immunizations currently in place and as amended from time to time
(current standards are attached hereto as Exhibit "A" and incorporated
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herein by reference;updated standards will be mailed to you upon issuance
by the Dallas-Fort Worth Hospital Council Foundation).
4. Dress Code. Students and faculty are responsible for providing the necessary and
appropriate attire required,but not provided by,the Facility. The student shall dress
appropriate to the area they are assigned to and wear a school name tag at all times
while participating in the educational experience at the Facility.
5. Documentation. Prior to commencement of the clinical experience, each student
shall provide Facility with an executed copy of Facility's"Release from Liability,"
provide written documentation of current health insurance, and other written
documentation as required by Section C.3 above. Such documentation is to be
submitted to the Academic Affiliations Coordinator or Director of Medical
Education at Facility(as appropriate).
6. Publication. Students and faculty shall not submit for publication any material
relating to the clinical educational experience without prior written approval of the
Facility and the Educational Institution. This provision shall survive the
termination of this Agreement.
7. Students and faculty shall adhere to the standards of the profession.
D. COMPENSATION
In consideration of the Facility's agreement to provide a setting for the clinical experience of the
Educational Institution, no student or faculty member of the Educational Institution providing
services at the Facility, pursuant to the Agreement, shall receive monetary compensation or
employee benefits from Facility including, but not limited to, paid vacation, worker's
compensation,disability insurance and retirement benefits.
E. CONFIDENTIALITY AND DISCLOSURE OF PATIENT INFORMATION
Both parties acknowledge HIPAA obligations and other regulations implementing the Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C. § 1320(d) ("HIPAA"). The
parties acknowledge that federal regulations relating to the confidentiality of individually
identifiable health information require Facility, as a covered entity, to comply with the privacy
standards adopted by the U.S.Department of Health and Human Services as they may be amended
from time to time. Educational Institution acknowledges that the students are considered part of
the Facility's workforce solely for purposes of HIPAA. Educational Institution will require that
each student agree to maintain the confidentiality of individually identifiable health information
of Facility patients as required by HIPAA and as required by state law. Educational Institution :
recognizes that any breach of confidentiality or misuse of information found in and/or obtained
from patient medical records may result in the termination of this Agreement and/or legal action.
Unauthorized disclosure may give rise to irreparable injury to the patient or to the owner of such
information, and, accordingly, the patient or owner of such information may seek legal remedies
against Educational Institution.
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F. COMPLIANCE
In performing the services required of it under this Agreement, the parties shall comply with all
applicable federal, state, county and city statutes, ordinances and regulations. The Facility shall
meet all Joint Commission accreditation and Texas State Hospital licensing requirements. The
Educational Institution shall meet all requirements necessary for accreditation of the Program.
G. TEXAS LAW TO APPLY
This Agreement shall be construed under and in accordance with the laws of the State of Texas.
In the event judicial intervention is required under this Agreement, venue shall be exclusively in
Tarrant County.
H. NONDISCRIMINATION
The Educational Institution and the Facility mutually agree not to discriminate on the basis of race,
color, age, national origin, gender expression, gender identity,transgender, or sex as provided by
law, nor will either party to this Agreement discriminate on the basis of handicap under the
Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990.
I. INDEMNIFICATION
To the extent allowed by law,the Educational Institution agrees to defend, indemnify and hold
harmless the Facility, its officers,trustees,employees,servants, affiliated organizations, insurers,
agents and assigns from any and all claims, actions,causes of action,demands, suits,liabilities,
losses or expenses in connection with bodily injury,personal injury or property damage resulting
from the acts or omissions of the Educational Institution,its employees, students,agents or
servants. The Facility agrees to defend,indemnify and hold harmless the Educational Institution,
its officers,trustees, employees, servants, affiliated organizations and insurers from any and all
claims, actions, causes of action, demands,suits,liabilities, losses or expenses in connection with
bodily injury,personal injury or property damage resulting from the acts or omissions of the
Facility,its employees, agents or servants. Nothing contained herein shall ever be construed so
as to require Educational Institution to create a sinking fund or to access,levy and collect any tax
to fund its obligations under this paragraph.
J. TERMS OF AGREEMENT
1. This Agreement shall be effective November 1, 2017, and will terminate on
October 31, 2020.
2. Either party may terminate this Agreement upon written notice delivered at least
thirty (30) days prior to the effective date of termination. All students enrolled in
the Program at the time of termination will be allowed to complete their course
work for that term.
3. The persons signing this Agreement warrant that they have full authority to do so
and that their signature shall bind the parties for which they sign.
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4. The parties to this Agreement understand and agree that either party may revise,
modify or terminate this Agreement by written agreement when both parties agree
to such amendment.
K. NOTICE
Any notice required or permitted to be given under this Agreement shall be in writing and sent to
the addresses set forth below. Either party may change the address for notice by notice to the other
Ply
If to Facility: If to Educational Institution:
Cook Children's Medical Center Fort Worth Fire Department
801 Seventh Avenue 509 W. Felix Street
Fort Worth,Texas 76104 Fort Worth, Texas 76115
Attn.: Jennifer Vierkant Attn: Captain Sherri Hauch, EMT-B
Academic Affiliations Coordinator EMS Program Manager
In witness hereof, the authorized representatives of the parties have executed this Agreement as
indicated below and agree to the Terms and Condition of the Educational Experience Program
Affiliation Agreement, as indicated by their signatures below. Each respective school or
department shall be included in the Agreement only as long as the Educational Experience
Program Affiliation Agreement of the Educational Institution is in place, or until terminated by
the school or department pursuant to the Agreement.
"FACILITY" "EDUCATIONAL INSTITUTION"
Cook Children's Medical Center City of Fort Worth
801 Seventh Avenue 509 W. Felix Street
Fort orth,Texas 76104 Fort Worth, Texas 76115
ByBy:
Printe Name: Deborah Rubinson,DNP,RN Printed Name: Valerie Washington
Title: Assistant Vice President of Organizational Title: Assistant City Manager,
and of ssion 1 Development City of Fort Worth
Date: P-6 Q 1 t Date:
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3 KS
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OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,Tx
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EXHIBIT"A"
DALLAS-FORT WORTH HOSPITAL COUNCIL FOUNDATION
Community Standards for Drug Screening,
Background Checks& Immunizations
(Effective as of January 1,2013)
These community standards are general guidelines for drug screenings, background checks,
and immunizations in the North Texas region for schools and hospitals/healthcare agencies.
These requirements will be effective for any students being admitted to programs after
January 1, 2013.
GENERAL GUIDELINES
Prescreening requirements have been introduced into clinical student affiliation agreements. These
prescreening requirements are the same as those required of employees(background checks, drug screens,
and immunizations). The rationale for extending these requirements to clinical students and faculty was the
concept of due diligence and competency assessment of all individuals whose assignments bring them in
contact with patients or employees. Competency extends beyond technical skills to an individual's criminal
history and drug free status. This approach ensures uniform compliance with Joint Commission standards
pertaining to human resource management. Moreover the public is now demanding greater diligence in light
of the national reports of deaths resulting from medical errors and patient safety events.
Timing of Prescreening Requirements:
Drug screens and background checks must be conducted within 30 days prior to the start of a person's first
clinical rotation following enrollment in the college/school or after a break in enrollment. Verification of the
satisfactory results/compliance must be received by the participating hospital/agency prior to the student's
rotation start date. Drug screen and background checks will be honored by all hospitals/agencies for the
duration of the student's enrollment in the clinical program if the participating student has not had a break in
the enrollment at the college/school. A break in enrollment is defined as nonattendance of one full semester
(Fall or Spring)or more.The above information must be verifiable through the college/school. Drug screen and
background checks of faculty will be honored for the duration of the employment of the faculty member at the
college/school. Immunizations must be current prior to a person's first clinical rotation and must be maintained
in current status during all clinical rotations.
Reciprocity:
Students whose schools follow these standards need only meet these requirements prior to the start of their
first clinical rotation. Other DFW Hospital Council members that follow these standards will honor the initial test
results, provided that these results can be verified with the college/school.
Allocation of Cost:
Each institution/school must bear the cost of these requirements or pass them along to their students/faculty
as they see fit.
Verification of Compliance& Recordkeeping:
Verification of the compliance with these standards should be sent to the designated representative of the
clinical agency prior to the clinical rotation start date. Verification is accomplished by sending a letter from the
institution on letterhead stating that these standards have been met by the student/faculty, listing the
student's/faculty's full name and clinical rotation start date. If more than one student is attending a clinical
rotation, a comprehensive list with all the students'/faculty names may be submitted. It is the responsibility of
each college/school to inform these persons of our requirements prior to enrollment in this curriculum.This will
give students/faculty prior notice and an opportunity to decline the clinical training before investing their time
and money in the class.
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Participating Hospitals/Schools:
North Texas Hospitals who have provided input in review of these guidelines and come to agreement on these
standards for the region include: Baylor Health Care System, Children's Medical Center Dallas, Cook
Children's Health Care System, HCA—North Texas Division, JPS Health Network, Methodist Health System,
Parkland Health & Hospital System, Tenet Healthcare, and Texas Health Resources. Schools that provided
input include: Collin College, EI Centro College, and Tarrant County College.
Questions regarding the Community Standards can be directed to the DFWHC Foundation Workforce
Center. Contact information can be found at www.dfwhcfoundation.org.
DRUG SCREENING
Pre-Assignment Drug Screening:
Drug Screening can have up to four steps—
• Collection Process
• Laboratory
• GC/MS Confirmation on all Non-Negatives
• Medical Review Officer on all Non-Negatives
By following these steps you are holding"everyone"to the same standards.
Collection Process:
Method by Urinalysis - we prescribe an unobserved collection of urine for initial screening. Reasonable
suspicion situations will be observed as determined by faculty. The collection process is to be done in a
consistent manner with consistent notice given. Collection can be done as a group either at the campus or at
a designated collection site during the same time period.Alternatively, students(whether on-campus,distance
learning, or late admission) will be given a specific time-limited period to present themselves to the
appointed/approved collection facility. By taking these steps, students/faculty will be held to the same legal
standards as it relates to the collection process.
The discovery process is covered in detail when the students are together for the group meeting prior to the
collection.They are told that the only person they will discuss their medications with is the independent Medical
Review Officer(MRO)who will contact them if needed.
The pre-collection group meeting will cover the community standards,the legal statements on the Non-Federal
Chain of Custody that they will be signing, the time and quantity requirements for specimen collection, privacy
information and give students the opportunity to ask questions.
Laboratory:
All tests will be processed at a certified SAMHSA(Substance Abuse&Mental Health Services Administration)
laboratory. The minimum standard drug screen panel is a Healthcare Professional 10—panel with integrity
checks for Creatinine and PH levels, acceptable and unacceptable test ranges will follow the 49 CFR Part 40
Federal Standards.
URN CREATININE 20.0-300.0
Test Screen GC/MS Units
COCAINE METABOLITES 300 150 ng/ml
AMPHETAMINES(CLASS) 1000 500 ng/ml
BARBITURATES 300 300 ng/ml
BENZODIAZEPINES 300 300 ng/ml
MARIJUANA METABOLITE 50 15 ng/ml
OPIATES 2000 2000 ng/ml
PHENCYCLIDINE 25 25 ng/ml
PROPDXYPHENE/METABOLITE 300 300 ng/ml
METHADONE 300 300 ng/ml
SYNTHETIC OPIATES (includes Oxycontin, 100 100 ng/ml
Oxycodone, Hydrocodone and Morphine)
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SAMHSA laboratories are certified and regulated by the federal government assuring the highest standards.
All Non-Negative Specimens are frozen and maintained in a secure area, with limited access, for one year
in the event that a retest is required. Using the same SAMHSA laboratory for all tests within the group assures
adherence to the same legal standards.
GC/MS Confirmation on all Non-Negatives:
All Non-Negative specimens will be confirmed via GC/MS confirmation.This step is performed at the SAMHSA
laboratory.The result of the GC/MS confirmation is sent to an independent Medical Review Officer„ along with
a copy of the Chain of Custody.
Medical Review Officer(MRO) on all Non-Negatives:
The independent MRO is the impartial "quality assurance" component who advocates for the accuracy and
integrity of the drug testing process. The quality assurance review of the drug testing process for the
specimens, determines if there is a legitimate medical explanation for laboratory confirmed positive GC/MS,
adulterated, substituted and invalid drug test results, ensure the timely flow of test result and other information
to school/college and protect the confidentiality of the drug testing information. The MRO reviews all GC/MS
results from the SAMHSA laboratory. If the result remains positive,the MRO contact the student to determine
if there is a valid prescription for the drug in question. If a valid prescription exists and specimen is within
prescribed limits,the test result is deemed to be"negative"and acceptable. The MRO is a medical doctor who
specializes in the interpretation of drug screen results. Medical Review Officers do not make placement
decisions; they simply pass along information regarding legal versus illegal drug use or consumption. Medical
Review Officers are not required, but are beneficial in making placement decisions. If follow up with MRO is
needed, students are expected to do so within the MRO's or school's specified time limit.
The MRO is completely independent of all parties in the testing process, including the collection,the SAMHSA
laboratory, the school/college and the individual student/faculty. This is the defacto gold standard in drug
testing. The MRO is the ONLY person who can make a final decision about a non-negative drug screen.
An agency reserves the right to remove a student/faculty from the facility for suspicion of substance use or
abuse (including alcohol.) The agency will immediately notify the instructor/college/school to facilitate
immediate removal and drug testing of the individual. The student/faculty will be required to consent to a drug
test at a site identified by the instructor/college/school and the student/faculty or school will be responsible for
the cost. Given the issue of safety and impairment, all reasonable attempts shall be made to contact the
student's/faculty's family,friends, or police to provide transportation. Testing must be completed on the same
business day. In all instances, the agency will provide written documentation of the student's/faculty's
behavior(s)by two or more agency representatives to the college/school. Regardless of testing or test results,
the agency reserves the right to remove from the facility any student or faculty member. A student/faculty may
have drug testing"for cause"at the discretion of the clinical agency. Failure to comply will result in immediate
expulsion from the clinical agency.
An individual with a positive drug screen or who refuses to submit to a reasonable suspicion drug screen will
not be allowed to attend any clinical agency/rotation for a minimum of 12 months. Prior to returning to the
clinical agency/rotation, a student must provide proof of a negative drug screen,acceptable background check
and required immunizations as verified by the college/school.
NICOTINE TESTING - BAYLOR HEALTH CARE SYSTEM INFORMATION - As a health care system
committed to improving the health of those we serve, we are asking our employees to model the same
behaviors we promote to our patients. Beginning January 1, 2012, Baylor will no longer hire individuals who
use nicotine products. Applicants who profess to use nicotine will not have their applications processed.
Anyone who is offered and accepts a position with BHCS will be tested for nicotine during our regular post-
offer pre-employment testing. Applicants who test positive for nicotine will be eliminated from consideration
and pending job offers will be rescinded. At this time, testing for nicotine will not apply to clinical students or
faculty
CRIMINAL BACKGROUND CHECK
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Criminal background checks should review a person's criminal history.The check should include the cities and
counties of all known residences, not just the DFW area. The following criminal histories are examples of
actions that may disqualify an individual from consideration for the clinical rotation. This list is for example
purposes and is not an exhaustive list. (Each criminal record or individual will be assessed according to EEOC
requirements):
• Felony convictions/deferred adjudications
• Misdemeanor convictions or felony deferred adjudications involving crimes against persons(physical
or sexual abuse), illegal use or distribution of drugs
• Misdemeanor convictions or deferred adjudications related to moral turpitude (prostitution, public
lewdness/exposure, theft under$1,500, computer crimes of fraud, etc.)
• Felony deferred adjudications for the sale, possession, distribution, or transfer of narcotics or
controlled substances
• Registered sex offenders
• OiG, GSA and Medicaid Sanctions
• Terrorist Suspect List
• Pending charges and warrants for arrest
For more detailed information, please reference the following:
• Texas Health &Safety Code Section 250.006
(http://www.statutes.legis,state,tx,us/Docs/HS/htm/HS.250.htm)
• Texas Occupation Code Section 301.4535
(http://www.statutes.legis.state.tx.us/Does/OC/htm/OC.301.htm)
• Texas Admin Code: Section 213.28
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NOTES: (1) If a licensing/registry body approves the individual to take the licensing/credentialing
exam, the individual may participate in the clinical rotation.
(2) A school/college may request an exception from the first clinical rotation/agency for a
student with a felony deferred adjudication and no alternative recourse through a
licensing/registry authority, i.e. Board of Nurse Examiners of Texas. Following
approval from the agencies, the student may progress as stated above.
IMMUNIZATIONS
Participating hospitals/agencies require that the following immunizations be current for students/faculty prior
to their first clinical rotation following enrollment in the college/school or after a break in enrollment. Not all
immunizations listed below are required at all facilities.Where there is an exception, it is noted. Immunization
requirements are reviewed periodically by participating hospitals and are subject to change based on hospital
standards, CDC recommendations or Texas Administrative Code rules. Verification of current immunizations
must be received by the participating hospital/agency prior to the student's rotation start date. Immunizations
must be maintained in current status during all clinical rotations. The information must be verifiable through the
college/school.
Here is the list of required immunizations as of September 1, 2012:
• Full Hepatitis B Series and/or immunity to Hepatitis B.
• MMR(Rubeola/Measles, Mumps, Rubella/German Measles)documentation of 2 doses or positive
titers.
• TDaP(Tetanus, Diphtheria& Pertussis) Booster(one dose as adult)within the last 10 years.
• Varicella vaccination or titer.
• Influenza/Seasonal Flu Immunization (required annually during flu season usually from September
through March or April). Exceptions made for medical and religious reasons, but must adhere to
hospital policies.
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• Negative Tuberculin (TB) Test (Annual requirement) (can be either TST or QFT) and/or negative
CXR. If history of positive PPD test or having had TB, must provide documentation of negative chest
x-ray or completed treatment.
• Meningitis — Only needed for Children's Medical Center for lab techs who handle cultures for
meningococcal meningitis.
• Hepatitis A—Only needed for Texas Health Resources for child care workers, nutrition,&psychiatric
depts.
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City of Fort Worth Contract Compliance Manager:
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements.
Name of Employee r
Title