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CONMCT
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CLINICAL AFFILIATION AGREEMENT
BETWEEN
CITY OF FORT WORTH AND
AREA METROPOLITAN AMBULANCE AUTHORITY
This Clinical Affiliation Agreement (the "Agreement"'), 's entered nto this l st day of
October, 2013, by and between the City of Fort Worth "City" and Area Metropolitan Arnbulanc
Authority d/b a Medstar, a facility which has clinical facilities located at 3010 South Grave, Fart
Worth, I-X ("Facifity"). City and Facility agree to the following:
PURPOSE
Fort Worth Fire Department, a department of City ("Department"") has are Emergency Medical
"fcchnolo y 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.
I10 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 tunes for conSultatic n. at all times
Students are at Facility, to supervise Students participating in the Program.
(e) inst ct Students to abide
Facility's patient care po ici,e�s and guidelines. Information
regarding Facility's applicable policies and guidelines will be available at the time of student
orientation at Facility.
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 tation standards provided by the
Facility at the time of student orientation at Facility,
FFICIAL RECORD
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(h) provide information to each Student regarding the Hepatitis B vaccine, Its efficacy, safety,
method of administration and beneflits 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 Prograrn or
upon request ofFacility thereafter,
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 begirming 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
h ity would ult"mately be found
commercial liability 'insurance po icy and damages, for which C" I
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)con.sider 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 permanent withdrawal of any
Student from Facility at any time for cause.
and at Facility's request,, remove any Student
(n) comply with Facillity's substance abuse policies,
or faculty member from the Program 'if there is reasonable suspicion that the Student or faculty
member has violated Facility's substance abuse policies.
i(o) verify that a background evaluation, 1`11CILiding: 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 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.
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(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 and-
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(q) ensure that each Student, and faculty member at all times while at Facility wears a narne 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
Cityi
(e) assist with clinical teaching and supervision of agreed upon number of Students in the
Program;
upon request by City, formally evaluate plerformance 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
provide access, to acute emergency care at Student's expense in the event of an accident or
in j ury to a student on Facility's campus.
10 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, ana 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
enro I led.
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
301 South Grove
Fort, Worth,, Texas 76104
Attention*. Clinical Coordinator
If to City: Fort Worth Fire Department
1000 Calvert Street
Fort Worth,, Texas 76107
Attention.- EMS Division
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6,0 STATUS OF STUDEN r ro5,
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 res,pondeat superior has no application as
between the C,ity and Facility.
7,0 MISCELLANEOUS
(a), Non-discrimination. City and Facility shall not unlawfully discriminate in their
respective, performance of thin Agreement against any person, because of age, disability,
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race, color, religion, sex, sexual orientation, national onal origin, or fa,milial 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.
phis Agreement may note 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
inc,luding 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.
(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, *s'
I , provi ion 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. ne 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) Confidential ity. 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.
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'I'his Agreement 'is effective as of the Effective Date set above and 'is executed by and between
City and Facility through their duly authorized offlicers, thereby binding th,ems v , their successors
and assigns, and representatives for the faithful and, full performance oi`the terms and provision ofthis
Agreement.
CITY OF FORT WORTHI
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a Texas munlelpal corporation
iarles, Daniels, Assistant City Manager
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Attest.* Vol 00 , Approved as to Fonn and Legality.,
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