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HomeMy WebLinkAboutContract 45265 (2)CITY CONT&CT O�l` IA CLINICAL AFFILIATION AGREEMENT BETWEEN CITY OF FORT WORTH AND TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH This Clinical Affiliation Agreement (the "Agreement"), is entered into this 1st day of October, 2013, by and between the City of Fort Worth ("City") and Texas Health Harris Methodist Hospital Fort Worth, a facility which has clinical facilities located at 1301 Pennsylvania Ave, 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 its Department recruits (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 performance of Students in the Program; (g) require Students to comply with the regulatory and accreditation standards provided by the Facility at the time of student orientation at Facility; JAN 2 ni4 1 RECEIVED Nov 1 (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 Facihty prior to commencement of the Program or upon request of Facility thereafter; (1) confiuin 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 basically a self -funded entity and as such, generally, it does not maintain a commercial liability insurance policy and damages for which City would ultimately be found liable would be paid directly and primarily by City and not by a commercial insurance company; (1) provide to Facility at least two (2) weeks prior to commencement of the Program 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, length and dates of clinical experience, and Texas nursing registration numbers of faculty, if applicable; (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, in its sole discretion, may require peunanent withdrawal of any Student from Facility at any time for cause; (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 perfonned 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 last ten (10) years and all counties (in Texas and outside of Texas) in which the Student has been a resident of or employed in; 2 (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 resulting from the action or inaction of City, its employees or agents or any Student under this Agreement for which a final judicial or other determination is made that the City, its employees or agents or any student is responsible for such a claim; (q) confirm students have documentation that MMR, Tdap, and varicella vaccinations have been administered and existence of sufficient titers, and each student has a flu vaccine within one year of commencement of working at Hospital; (r) confirm that the name of any assigned students do not appear on either the Health and Human Services (HHS) — Office of Inspector General (OIG) List of Excluded Individuals/Entities, or the General Services Administration List of Excluded Parties or the Texas Medicaid OIG Sanctions List. Facility reserves the right to re -screen students who have access or will be granted Access to protected health information of Facility's patients or confidential information, as determined to be required by Texas Health Resources or Facility based on the circumstances; and (s) ensure that each Student and faculty member at all times while at Facility wears a name tag, badge, or other identifying label that clearly states the Student or faculty member's identity and the name of 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; upon request by City, formally evaluate performance of Students in the Program using the form provided by City; (f) (g) retain responsibility for patient care; (h) reserve the right to determine the manner in which its equipment shall be operated; 3 (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: (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 1st, 2013 (` Effective Date") and ending on September 30th, 2017, 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: Texas Health Fort Worth 4 1301 Pennsylvania Fort Worth, Texas 76104 Attention: Lillie Biggins, FACHE President Copy to: Legal Department Texas Health Resources 612 E Lamar Blvd., Suite 900 Arlington, Texas 76011 Attention* General Counsel If to City: 6.0 STATUS OF STUDENTS Fort Worth Fire Department 1000 Calvert Street Fort Worth, Texas 76107 Attention: EMS Division City and Facility understand and agree that while faculty and Students are participating in the 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, or familial status. (b) Entire Agreement This Agreement constitutes the entire agreement between the parties 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, construed and enforced in accordance with the substantive laws of the State of Texas (but not including its conflict of laws rules if and to the extent such rules would apply the substantive laws of another jurisdiction). Venue for litigation of any dispute arising under this Agreement or any lawsuit to enforce or interpret this Agreement shall be in an appropriate court located in the county in which Facility is located. The parties agree 5 that the county in which Facility is located is the county in which performance of this Agreement shall take place. (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. City acknowledges that the intent of federal and state privacy laws and Texas Health Resources' ("THR") and Facility policies, is to assure that Confidential Information, as described in Exhibit A, will remain confidential and will be used only by those with appropriate authority as necessary to fulfill the purpose of this Agreement. City acknowledges that students, faculty and other City representatives may access Confidential Information during the performance of their function under this Agreement. As such, City shall ensure that each student executes the Texas Health Resources Student Confidentiality Agreement (Exhibit A), prior to arrival at the Facility; and represents that its agents, employees and representatives (collectively hereinafter "Representatives") will maintain such information as confidential and will not disclose such information to third parties or other Representatives of City, who do not require the information in order to fulfill this Agreement, except as permitted by law or order of the court. Should City, through its Representatives, for any reason otherwise disclose the information, City will immediately notify Facility. City represents that it will train all Representatives concerning this provision of the Agreement. This Agreement is effective as of the Effective Date set forth above and is 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 By: Attest: .4-ea-I} Charles Daniels, Assistant City Manager Approved as to Form and Legality: 6 r lovu City Secreta NO M&C t OUIRED ?-73..str; TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH Asstant City Attorney By:( Lillit1/443iggins, FACHE President Approved As To Form Only: Terri A. DeSio Senior Attorney OFFICIAL RECORD CITY SECRETARY IFS woRTH, TX 7 Exhibit A TEXAS HEALTH RESOURCES/TEXAS HEALTH FORT WORTH STUDENT CONFIDENTIALITY AGREEMENT I understand that while I am participating in an educational program at a Texas Health Resources ("THR") facility, I may have access to Confidential Information. Confidential Information is valuable and sensitive and is protected by law and by THR Policy. The intent of federal and state privacy laws and THR policies is to assure that Confidential Information will remain confidential and will be used only by those with appropriate authority as necessary to accomplish THR s mission. Confidential Information is information about patients, participants of THR benefit plans and programs customers, physicians on the medical staff of a THR hospital, credentialing, peer review, quality review, committee records, personnel records, payroll records, salary and compensation information, logon and password information, employee health information or information related to operations about THR that is not generally available to the public. I may learn of or have access to some or all of this Confidential Information orally, through a computer system or through documents. If I need access to THR's or Facility's computer system I will be assigned a unique logon ID and password, as well as other access control devices such as cards or tokens. I agree that I will keep these logon IDs, passwords, and other access control devices assigned for any purpose secure and confidential. I acknowledge the unique logon ID and password are equivalent to a legal signature. I will be held accountable for any access utilizing my unique logon ID Access cards and other facility security devices will be kept secure. Access to Confidential Information is permitted only as authorized and as required for legitimate purposes in the performance of my student role. I understand that patient information will be available for educational purposes to authorized students enrolled in educational programs affiliated with the THR facility for use within the department maintaining those records. Removal of any part of the patient's medical record or information that identifies a patient is prohibited. Requests for access for formal research purposes require a waiver from the facility's Institutional Review Board. In order to access and compile data for educational studies, I understand I must present a written request and consent of my instructor. Students are prohibited from removing information that identifies a patient from the THR facility. I understand the above requirements and I agree to abide by these requirements. I understand that my violation of this Agreement may result in my being terminated from my participation in the program at a THR facility. Printed Student's Name Student's Signature Date 8