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HomeMy WebLinkAboutContract 45265 SIN Am CITY SE CRETAW, [ oyp.,� N �, COWRACT •Man CLINICAL AFFILIATION AGREEMENT BETWEEN C'IT'E'OF F T'WORTH AND TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH This Clinical Affiliation Agreement (the "Agreement"':), is entered into this l s,t 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 loco ted at 1'.301 Pennsylvania.nia 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 'rechnology Program "Program"') through which City provides 'its Department recruits (hereinafter referred to as "'Students" or ndiv d ally as "'Student") ,academic and clinical e Per enc . City desires for Facility to provide Students with clinical experience through Facility's clinical facilities, and Facility s willing t provide such experience. 110 RIES" ONSIBILITIES OF CITY City shall (a) plan the educational activities for the Students' clinical experience at Facility after consultation w"th and approval. by Fac�'lit (b) provide qualified teachers from Department t teach the pre-requisite core curriculum and ,support arses in the Program, (c) provide administrative functions for each Student in,the Program, (d) provide a faculty member at Facility t o be available, at times for consultation at all tires 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 he available at the time of student orientation at Facility,*(f) if applicable, provide Facility with the appropriate forms to he 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 strident orientation at Facility JAN 0 2 2014 E C E I V E D 1AI �,,r j (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. (1) 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; C1 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, card opulmonary resuscitation course prior to the begii-tning, of the Program and provide evidence of such confirmation to Facility prior to commencement of the Program or upon vi 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 corn lair made by Facility against a Student and participate in joint problem solving. Patient safety and wel-fare shall be the primary concern. Student issues will be documented by the Facility and provided to the designated Faculty member and/o�r other representative of it y. "ac it ty I I in its sole discretion may require permanent withdrawal of any Ci , 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 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 2 J0, (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 doicumentation that MMR, Tdap, and varicella vaccinations have been administered and existence of sufficient titers,1 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 Ind 1viduals/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 meetings ace for Students in the Program-, (d), provide suitable clinical experience situations as prescribed by the curriculum provided by Cityl• (e) assist with clinical teaching and supervision, olf' agreed upon number of Students in the Program'; (01 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 night to determine the mannerin which its equipment shall be operated; 31 to the extent allowed by law, assume no professional or financial liability for injury to 11 � Students or faculty except that which mignt 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 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 I st, 2013 (""Effective Date") and ending on September 30th, 2017, unless sooner terminated, as provided herein. This Agreement may be ten-ninated 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-. L,1111'e Biggins, FACHE Frei. ent Copy to Legal Department Texas Health Resources 612 E. Lamar Blvd.,, Suite! 900 Arlington, Texas 760,11 Attention*. General Counsel If to City. Fort Worth Fire Department 1000 Calvert Street Fort Worth,, Texas 76107 Attention: EMS, Division 6.10 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. 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 j venture between City and Facility, its oifficersI., agents, employees and subicont�ractors, and doctrine of respondent superior has no application as between the City and Facility. 7.01 MISCELLANEOUS (a) Non-d i scriminat ion.. City and Facility shall not unlawfully discriminate 'in their respective performance of this Agreement against any person because of age, dl*sabtll*ty,, 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) Goveming-,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) Confdential.it 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 txhibit & will remain confidential and will be used only by those with appropriate authority as necessary to ft 1611 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 Repres�entat"Ives, for any reason otherwise disclose the information, City will immed iately notify Facility. City represents that it will train all Representatives, concerning this, provision of the Agreement. This A I greement is effective as of the Effective Date set forth above and is executed by and between City and Facility through their duly authorized ofticers, 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 B y A sistant City Manager Charles Daniels, Attest: Approved as to Form and Legality: 6 �WaM1�ksp I I City SecL son reta As tart City Attorney N . E a4 8a. TEXAS HEALTH HARRIS METHOI ITT OS,P,ITAL FORT: WORTH it IN '"'4nwwM� Lillci . iggins, FACHE President Fora Only: Terri A.DeSfo SaniorAtiomew OFFICIAL RECORD CITY SECRETARY FTm WORTH9 TX 7 Exhiliblit A TEXAS HEALTH RESOURCESITEXAS HEALTH FORT WORTH STUDENT CONFIDENTIALITY AGREEMENT I understand that while I any participating in an educational program at a Texas Health Resources ("THR") facility, I may have access to Confidential Information. Confidential Information is valuable and sens,itive and is protected by law and by "I"HR 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 fIR 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 TfIR 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 accountabile for any access utilizing my unique loigon 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 compfle 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 TliR facility. Printed Student's Name .......... Student's Signature Date 8