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CLINICAL AFFILIATION AGREEMENT
BETWEEN
CITY OF FORT WORTH AND
METROPOLITAN AREA EMS AUTHORITY
d/b/a MEDSTAR MOBILE HEALTHCARE
This Clinical Affiliation Agreement (the "Agreement"), is entered into, effective this
1 st day of October,2017,by and between the City of Fort Worth("City")and Metropolitan Area
EMS Authority d/b/a Medstar Mobile Healthcare, a governmental agency created through the
adoption of the Uniform EMS Ordinance and the Interlocal Cooperative Agreement between
municipalities under the provisions of Section 773.051 of the Texas Health and Safety Code and
the provisions of Chapter 791 of the Texas Government Code, which operates an emergency
medical services(EMS)agency located at 2900 Alta Mere Fort Worth,TX("Facility"). City and
Facility agree to the following:
PURPOSE
Fort Worth Fire Department, a department of City ("Department") has an Emergency
Medical Technology Program ("Program") through which City provides Department trainees
(hereinafter referred to as "Students" or individually as "Student") academic and clinical
experience. City desires for Facility to provide Students with clinical experience through
Facility's clinical facilities, and Facility is willing to provide such experience.
1.0 RESPONSIBILITIES OF CITY
City shall:
(a) plan the educational activities for the Students' clinical experience at Facility after
consultation with and approval by Facility.
(b) provide qualified teachers from Department to teach the pre-requisite core curriculum
and support courses in the Program•,
(c) provide administrative functions for each Student in the Program.
(d)provide a faculty member at Facility to be available at times for consultation at all times
Students are at Facility to supervise Students participating in the Program.
(e) instruct Students to abide by Facility's patient care policies and guidelines. Information
regarding Facility's applicable policies and guidelines will be available at the time of
student orientation at Facility.
(f) if applicable, provide Facility with the appropriate forms to be used in evaluating the
QM A 2 3 4 performance of Students in the Program.
•e�` (g) s e Students to comply with the regulatory and accreditation standards provided by
RECEIVED
th ility at the time of student orientation at Facility.
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CITY OF FORT WDITIi 1 CITY SOCRETARY
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(h) provide information to each Student regarding the Hepatitis B vaccine, its efficacy,
safety, method of administration and benefits of being vaccinated and suggest that
Students be vaccinated for Hepatitis B.
(i) confirm Students have been tested for tuberculosis within one(1) year of commencement
of the Program and are tested at least annually while participating in the Program and
provide evidence of such testing and the results to Facility prior to commencement of the
Program or upon request of Facility thereafter.
(j) confirm Students have been instructed in Standard Precautions, as recommended and
defined by the Centers for Disease Control and Prevention(CDC), and completed a Basic
Life Support cardiopulmonary resuscitation course prior to the beginning of the Program
and provide evidence of such confirmation to Facility prior to commencement of the
Program or upon request of Facility thereafter.
(k) confirm that City is a self-insured entity and as such, generally, does not maintain a
commercial liability insurance policy and that damages for which City could ultimately
be found liable would be paid directly and primarily by City and not by a commercial
insurance company.
(1) at least two (2)weeks prior to commencement of the Program, provide to Facility a letter
outlining the needs of Students, days and hours Students will be on patient units or
service areas, names of Students and supervising faculty members, and length and dates
of clinical experience.
(m) consider promptly any complaints made by Facility against a Student and participate in
joint problem solving. Patient safety and welfare shall be the primary concern. Student
issues will be documented by the Facility and provided to the designated Faculty member
and/or other representative of City. Facility may require permanent withdrawal of any
Student from clinical training at or through Facility at any time for cause, as determined
by Facility in its sole discretion.
(n) comply with Facility's substance abuse policies and, at Facility's request, remove any
Student or faculty member from the Program if there is reasonable suspicion that the
Student or faculty member has violated Facility's substance abuse policies.
(o) verify that a background evaluation, including a criminal background history in all fifty
(50) states, has been performed on each Student, and verify that there are no negative
findings for each Student prior to commencing any assignment at Facility. For purposes
of this Agreement, a criminal background history shall include any felony conviction
within the last ten (10) years. For purposes of this Agreement, a background evaluation
shall include the Iast ten (10) years and all counties (in Texas and outside of Texas) in
which the Student has been a resident of or employed in.
(p) to the extent allowed by law, City shall hold Facility harmless for all claims, damages,
losses, and expenses, including attorney fees, arising out of any claim for negligence
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resulting from the action or inaction of City, its employees, agents or Students under this
Agreement for which a final judicial or other determination is made that the City, its
employees agents, or Student(s)or is responsible; and
(q) ensure that each Student and faculty member wears a name tag, badge, or other
identifying label at all times while at Facility that clearly identifies the Student or faculty
member's and the City.
2.0 RESPONSIBILITIES OF FACILITY
Facility shall:
(a) provide cooperation to promote success of the Program;
(b) provide equipment and supplies which are necessary for clinical instruction at
Facility;
(c) provide meeting space for Students in the Program;
(d) provide suitable clinical experience situations as prescribed by the curriculum
provided by City;
(e) assist with clinical teaching and supervision of agreed upon number of Students in the
Program;
(f) upon request by City, formally evaluate performance of Students in the Program
using the form provided by City;
(g) retain responsibility for patient care;
(h) reserve the right to determine the manner in which its equipment shall be operated;
(i) to the extent allowed by law, assume no professional or financial liability for injury to
Students or faculty except that which might occur as a member of the public, unless
due to Facility's negligence or gross misconduct; and
(j) provide access to acute emergency care at Student's expense in the event of an
accident or injury to a student on Facility's campus.
3.0 RESPONSIBILITIES OF CITY AND FACILITY
City and Facility shall:
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(a) agree upon the number of Students to be placed in Facility for clinical rotations prior
to the beginning of each semester in which Students are assigned to and accepted by
Facility;
(b) mutually agree, schedule and provide an orientation of faculty and Students to
Facility and assigned units;
(c) understand there will be no exchange of monies between City and Facility for this
Program;
(d) revise or modify this Agreement in writing if both parties agree to the revisions or
modifications; and
(e) comply with all applicable federal, state, and local laws, rules, regulations, and
ordinances.
4.0 TERM AND TERMINATION
This Agreement shall remain in effect for four (4) years beginning October Ist, 2017
("Effective Date") and ending on September 30th, 2021, unless sooner terminated as provided
herein. This Agreement may be terminated by either party upon ninety(90) days written notice
to the other party by certified mail,return receipt requested. The termination shall not take effect
until Students who are enrolled at the time such notice is given have completed the courses in
which they are enrolled.
5.0 NOTICE
Any notice, request or other communication required to be delivered under this
Agreement shall be in writing and shall be deemed to have been given or made if delivered
personally, by overnight delivery service, by United States mail, to the parties at the following
addresses, or at such other addresses as shall be specified in writing by either of the parties to the
other in accordance with the terms and conditions of this subsection.
If to Facility: MedStar Mobile Healthcare
2900 Alta Mere
Fort Worth,Texas 76116
Attention: General Counsel
If to City. Fort Worth Fire Department
509 W. Felix St.
Fort Worth,Texas 76115
Attention:EMS Division
6.0 STATUS OF STUDENTS
City and Facility understand and agree that while faculty and Students are participating in the
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Program, faculty and students are not employees of Facility. Accordingly, faculty and Students
are not entitled to any of the rights or benefits established for Facility's employees, such as
salary, vacation, sick leave with pay, paid holidays, insurance, and/or worker's compensation
coverage. Further, nothing herein shall be construed as creating a partnership or joint venture
between City and Facility, its officers, agents, employees and subcontractors, and doctrine of
respondeat superior has no application as between the City and Facility.
7.0 MISCELLANEOUS
(a) Non-discrimination. City and Facility shall not unlawfully discriminate in their
respective performance of this Agreement against any person because of age,
disability, race, color, religion, sex, sexual orientation, national origin, gender
expression,gender identity,transgender, or familial status.
(b) Entire Agreement. This Agreement constitutes the entire agreement between the
parties on the subject matter and supersedes any and all prior and
contemporaneous oral or written understandings. This Agreement may not be
altered, amended or modified except by a written document executed by both
parties.
(c) Governing Law and Venue. This Agreement shall be governed by the laws of the
State of Texas without regard to its conflict of laws provisions. The venue of any
litigation arising from this Agreement will be in the United States District Courts,
Fort Worth Division of the Northern District of Texas if the litigation arises in
Federal Court or in the District Courts of Tarrant County, Texas if the litigation
arises in State Court. The venue of any dispute resolution activity shall be in Fort
Worth,Tarrant County, Texas.
(d) Severability. Should any clause or provision of this Agreement be held or ruled
unenforceable or ineffective by a court of law, such a ruling will in no way affect
the validity or the enforceability of any other clause or provision contained herein.
(e) No Waiver. No waiver by City or Facility of any breach of any term,provision or
condition contained in this Agreement, or the failure to insist upon strict
performance thereof shall be deemed to be a waiver of such term, provision or
condition as to any subsequent breach thereof or a waiver of any other term,
provision or condition contained in this Agreement. The exercise of any right or
remedy hereunder shall not be deemed to preclude or affect the exercise of any
other right or remedy provided herein.
(f) Confidentiality. Students and faculty shall be responsible for maintaining patient
confidentiality. Students and faculty shall be instructed accordingly to prevent
breaches of patient privacy and to maintain a high standard of quality professional
care.
(g) This Agreement is effective as of the Effective Date set forth above and is
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executed by and between City and Facility through their duly authorized officers,
thereby binding themselves, their successors and assigns and representatives for
the faithful and full performance of the terms and provision of this Agreement.
CITY OF FORT WORTH,
a Texas municipal corporation
i
By.
Valerie R. Washington,Assistant City Manager
Attest: Ap roved as to Form and Legality:
FART
Ci Secreta — '= Assistant City Attorney
U
FACILITY: 7EX
MEDSTAR MOBILE HEALTHCARE
By:
�ouglasHooten, EO
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1295:- N A
OFFICIAL RECORD
CITY SECRETARY
6 FT.!NORTH,TX
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
Title
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX