HomeMy WebLinkAboutContract 62145AFFILIATION AGREEMENT
BETWEEN CSC No. 62145
TEXAS HEALTH RESOURCES
AND
THE CITY OF FORT WORTH
This Affiliation Agreement ("Agreement"), is entered into by and between The City of Fort Worth ("City"), a
Texas home -rule municipality, and Texas Health Resources, a Texas non-profit corporation ("THR"). CITY and
THR agree to the following:
PURPOSE
THR is a non-profit health care system with hospitals and medical clinics located in north Texas. One or more
of the THR hospitals and medical clinical facilities are willing to provide students of City with clinical experience,
and such Facilities are listed on Exhibit D which is attached hereto and incorporated herein (individually, the
"Facility" and collectively, the Facilities").
CITY has various programs through which City provides its student's academic and clinical experience.
CITY and THR agree that Facilities will provide academic and clinical experiences to students enrolled in the
programs listed on Exhibit A ("Program").
1.0 RESPONSIBILITIES OF CITY
City shall:
a) plan the educational activities for the Program's clinical experience at Facility after consultation with and
approval by Facility;
b) provide qualified teachers at City 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 to be available for consultation at all times students are at Facility.
e) instruct students to abide by Facility's patient care policies and guidelines, and regulatory and
accreditation standards. Information regarding Facility's applicable policies and guidelines will be
available at the time of student orientation at Facility;
f) require students to comply with all current immunization requirements of THR and any additional
immunization requirements that may be instituted by THR/Facility during students' clinical rotations
THR's current immunization requirements are listed on Exhibit B. City must submit to THR a letter
attesting that each student assigned to a Facility meets the immunization requirements listed on Exhibit
B. THR/Facility will provide a reasonable amount of advance notice of any new or additional requirements
to City and students.
g) confirm and attest that students have passed a drug test in accordance with THR's Drug Free Workplace
policy prior to assignment at THR, which, at a minimum, has conducted a panel screening for presence of
the following: amphetamine, cocaine metabolites, marijuana metabolites, opiates, MDA-analogues,
oxycodones, barbiturates, benzodiazepines, and phencyclidine. Each Student shall be subject to such
policy while assigned to THR.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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h) inform students that THR will require students, at their own expense, to undergo a background evaluation
and criminal background history in all fifty (50) states prior to commencing any assignment at Facility.
For purposes of this Agreement, a background evaluation shall include the following:
i) Social Security Number Verification (and trace to verify the individual correlates with the
S SN);
ii) Criminal background search for a minimum of seven (7) years and of all counties in and
outside of Texas in which the Employee has resided or been employed;
iii) Employment verification to include reason for separation and eligibility for rehire;
iv) Sex Offender Registry;
v) OIG List of Excluded Individuals/Entities;
vi) GSA List of Parties Excluded from Federal Programs (with a negative finding);
vii) U.S. Treasury Terrorist List (with a negative finding);
viii) Applicable State Exclusion List (Medicaid);
ix) Office of Foreign Assets Control (OFAC);
x) Previous Address Locator;
City will ensure appropriate individualized screening of any student whose criminal background report
reflects any felonies, misdemeanors, and the underlying behaviors or conduct of charges, pending charges,
deferred adjudications, and arrests ("Negative Findings"). The process should include a review of 1) Self
reporting of convictions or charges by the candidate or employee in accordance with City application and
ongoing reporting requirements, 2) Nature or gravity of offense or conduct, 3) Nature of the assignment
within Facility and 4) Amount of time passed from the offense, conviction and/or completion of sentence.
The process must yield an analysis of the information and a determination of whether the nexus of the
offense or conduct with the nature and duties of the assignment at Facility creates an unacceptable level
of risk unmitigated by the amount of time passed since the offense, conduct or completion of sentence.
City must disclose to Facility any assigned student whose criminal background report includes any
Negative Findings falling within this section, including the circumstances and results of their internal
review. Facility will have the opportunity to review the Negative Findings and the City results and may,
in its sole and absolute discretion, agree to the assignment, based upon the nature, severity, and number
of Negative Findings, and job applicability of the assigned student.
i) 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;
j) confirm students have been instructed in Standard Precautions recommended by the Centers for Disease
Control and Prevention (CDC) and completed an American Heart Association Basic Life Support ("BLS")
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, 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.
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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
names and registration numbers of any supervising faculty members who will work onsite at the Facility
(if applicable)
m) consider promptly any complaints made by Facility against a student and participate in joint problem
solving. Facility, in its sole discretion, may require permanent withdrawal of any student from Facility at
any time for cause;
n) confirm that each student is aware of and complies with the Employee Health policies and procedures of
Facility;
o) 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 students or agents or any student under this Agreement for which a final judicial or
other determination is made that the City, its students or agents or any student is responsible for such a
claim;
p) remove any student upon THR's request in THR's sole discretion;
q) confirm that each student(s) is age 16 years or older.
2.0 RESPONSIBILITIES OF THR
THR shall:
a) provide suitable clinical experiences and assist with clinical teaching and supervision of students;
b) provide equipment and supplies which are necessary for clinical instruction at Facility;
c) provide meeting space for students in the Program if meeting space is available at the Facility;
d) upon request by City, formally evaluate performance of students in the Program using the form provided
by City;
e) retain responsibility for patient care;
f) 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 THR's negligence or gross
misconduct; and
g) 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 THR
City and each THR 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; Any Facility may decline to
accept students in a given semester.
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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 the City and the THR 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 and state laws, rules and regulations.
4.0 TERM AND TERMINATION
This Agreement shall remain in effect for three (3) years beginning 10/16/2024 and ending 10/16/2027
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.
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 THR: Texas Health Resources
THR University
Attn: Contract Specialist
600 E. Lamar Blvd., Suite 232
Arlington, Texas 76011
Email: THRAffiliationAizreements(a,texashealth.or2
If to City: Fort Worth Fire Department
Attn: Gina Nix, EMS Education
505 W. Felix St.
Fort Worth, TX 76115
Email: 2ina.nixafortworthtexas.2ov
Phone: (817) 392-6874
With copy to: City Attorney's Office
100 Fort Worth Trail
Fort Worth, Texas 76102
6.0 STATUS OF STUDENTS
City and Facility understand and agree that while faculty and students are participating in the Program,
faculty and students are not employees of Facility and are not entitled to any rights or benefits of
employees. Nothing herein shall be construed as creating a partnership or joint venture between City and
THR, its officers, agents, employees and subcontractors, and doctrine of respondent superior has no
application as between City and THR.
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7.0 MISCELLANEOUS
7.1 Prior Agreements. This Agreement supersedes any prior clinical affiliation agreements between
City and any THR Facility.
7.2 Adding Additional Clinical Programs. In the event that City and THR agree to include additional
programs under this Agreement, the parties shall sign a written amendment reflecting updates to
Exhibit A.
7.3 Non -Discrimination. City and Facility shall not unlawfully discriminate in their respective
performance of this Agreement.
7.4 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.
7.5 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 that the county in which Facility is located is the county in which
performance of this Agreement shall take place.
7.6 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.
7.7 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.
7.8 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 C, 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 (see Exhibit C), prior to arrival at the
Facility; and represents and warrants 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 warrants that it will train all Representatives concerning this
provision of the Agreement.
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7.9 Multiple Counterparts. This Agreement may be executed in any number of counterparts, each of
which shall be deemed an original and all of which shall together constitute one and the same
instrument. Facsimile and electronic (pdf) signatures shall be treated as if they are original
signatures.
[SIGNATURE PAGE FOLLOWS]
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date(s) set forth below.
FORT WORTH FIRE DEPARTMENT:
nwr am-"-V &ff
By: Dana Burghdoff (OctY7, 2024 i :07 CDT)
Printed Name: Dana Burghdoff
Title: Assistant City Manager
TEXAS HEALTH RESOURCES
By: Ml 4 e ct 18, 202412:27 CDT)
Printed Name: Mark Morales
Title: VP Chief Talent Officer
For City of Fort Worth internal processes:
Approval Recommended:
James Davis (Oct CDT)
By:
Name: James Davis
Title: Fire Chief
Attest:
By:
Name: Jannette Goodall
Title: City Secretary
Oct 17, 2024
Date
Oct 18, 2024
Date
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.
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By:
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Sao o=A Name: Brenda Ray
o nETitle: Purchasing Manager Fire
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Approved as to Form and Legality:
Contract Authorization:
M&C: N/A
Date M&C Approved: N/A
Form 1295: N/A
By:
Name: Andrea Phillips
Title: Assistant City Attorney
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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EXHIBIT A
PROGRAMS
THR and City agree that this Clinical Affiliation Agreement shall apply to the following programs of City: (List
agreed upon programs.)
NOTE. Any added programs require approval by THR Leadership which may cause a delay in the process.
EMS
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EXHIBIT B
THR IMMUNIZATION REQUIREMENTS
Each assigned to a Facility shall meet the requirements and qualifications described herein at the personal expense
of the student.
Hepatitis B vaccine. Each Student shall have completed the full Hepatitis B vaccine schedule prior to
placement.
Flu vaccinations. Student must have a flu vaccine within one (1) year of commencement of working at
THR and annually if continuing to work at THR. Flu vaccinations may also be required during outbreak
of influenza in the community or when designated by THR.
TB testing. Each Student will have been tested for tuberculosis within one year of commencement working
at THR. IGRA testing may be utilized in lieu of TB skin testing. If the Student's documentation indicates
positive IGRA or TST, the Student may provide evidence of negative chest x-ray (conducted within
previous year) and documentation of no symptoms of active TB must be provided. Medical clearance
indicating Student is safe to work in hospital environment must be provided at time of assignment for
positive TB test or positive IGRA results even if x-rays result are negative.
MMR, TDAP, and varicella vaccinations. Each student shall have documentation of the current Centers
for Disease Control recommendations for Healthcare Workers for MMR, TDAP, and varicella
vaccinations or has the existence of sufficient titers for MMR and/or varicella.
Other vaccines. Each student provided to THR in the following departments: childcare centers, psychiatric
departments or facility and nutritional services are required to have Hepatitis A vaccine series. Hepatitis
A and B combined vaccine may be given, if indicated. Students working in the microbiology lab must
have documentation showing that the Meningococcal vaccine has been administered.
EXHIBIT C
TEXAS HEALTH RESOURCES
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
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EXHIBIT D
THR PARTICIPATING FACILITIES
HOSPITALS
Q
THA - Texas Health Presbyterian Hospital
Q
THFW - Texas Health Harris Methodist
Allen
Hospital Fort Worth
Q
THAL - Texas Health Harris Methodist
Q
THHEB — Texas Health Harris Methodist
Hospital Alliance
Hospital Hurst -Euless -Bedford
Q
THAM - Texas Health Arlington Memorial
Q
THK - Texas Health Presbyterian Hospital
Hospital
Kaufman
Q
THAZ - Texas Health Harris Methodist
Q
THP - Texas Health Presbyterian Hospital
Hospital Azle
Plano
Q
THC - Texas Health Harris Methodist
Q
THRW -Texas Health Hospital Rockwall
Hospital Cleburne
Q
THCDS — Texas Health Center for
Q
THS - Texas Health Harris Methodist Hospital
Diagnostics & Surgery Plano
Stephenville
Q
THCF - Texas Health Hospital Clearfork
Q
THSH - Texas Health Specialty Hospital Fort
Worth
Q
THD - Texas Health Presbyterian Hospital
Q
THSL - Texas Health Harris Methodist
Dallas
Hospital Southlake
Q
THDN - Texas Health Presbyterian Hospital
Q
THSW - Texas Health Harris Methodist
Denton
Hospital Southwest Fort Worth
Q
THE - Texas Health Hospital Frisco
Q
THUC — Texas Health Breeze Urgent Care
Q
THFM - Texas Health Presbyterian
Hospital Flower Mound
BEHAVIORAL HEALTH
Q
THBHS - Texas Health Seay Behavioral
Q
THRWC - Texas Health Recovery & Wellness
Health Plano
(Mansfield — Addiction Recovery Center by
Texas Health
Q
THBHSP - Texas Health Springwood
Behavioral Health HEB
NEIGHBORHOOD
CARE
& WELLNESS
Q
THB - Texas Health Neighborhood Care &
Q
THWP - Texas Health Neighborhood Care &
Wellness Burleson
Wellness Willow Park
Q
THPS - Texas Health Neighborhood Care &
Q
THVCC —Texas Health Virtual Care Channel
Wellness Prosper
THPG
Q
THPG - Texas Health Physicians Group
SYSTEM
Q
THR — System Services
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