2. 12/01/1987 to August 1988
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BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FWRIDA 33060
TEL. (305) 743-9036
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
600 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. t3051 294-4641
BRANCH OFFICE
P.O. BOX 379
PLANTATION KEY, FWRIDA 33070
TEL. (305) 852.9253
MEMORANDUM
----------
TO: Commissioner John Stormont
FROM: Shelley Brown, Deputy Clerk
SUBJECT: Baptist Hospital Agreement
DATE: February 24, 1988
On February 16, 1988, the Board of County Commissioners adopted
Resolution No. 085-1988 authorizing the Mayor to execute an
Extension and Amendments to a Memorandum of Understanding with
Baptist Hospital of Miami and directing Emergency Medical
Services Personnel to execute protocols with the various EMS
Service Districts and local hospitals to affect the Memorandum's
temporary relationship for severe, trauma-related emergency
health care in Monroe County.
Attached please find three certified copies of the subject
Resolution for your use and records. I am enclosing two original
copies of the Memorandum of Agreement. It is our understanding
that you will handle obtaining the remaining necessary signa-
tures. Please be sure to return one fully-executed original of
the Agreement to the undersigned7 the other set should remain
with Baptist Hospital.
~!~ ~DWi'-
Seley rown
Deputy erk
Attachments
cc: Mayor Lytton
Commissioner Puto
Reggie Paros, EMS Director
County Administrator
County Attorney
Finance Director
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BAPTIST HOSPITAL
OF MIAM I
Lee S. Huntley
Vice President
March 17, 1988
John C. Stormont
Monroe County Commissioner
Plantation Key Government Center
Tavernier, Florida 33070
Dear John:
Enclosed is a signed copy of the agreement between Monroe County and Baptist
Hospital.
Congratulations, again, on all of your valiant efforts to continue to provide
this service on behalf of your residents.
On a general note, and on behalf of Baptist Hospital, I am looking forward to
developing an ongoing relationship with Monroe County to continue to provide
these services. Personally and corporately, I would be happy to participate
in any way you and the other Monroe County Officials see fit.
On a specific note, I do have one concern and a related request concerning the
attached temporary agreement. Very shortly, I will be communicating with many
individuals including the Medical Staff participating under this agreement and
a variety of hospital employees. Since the agreement is a case-by-case agreement
and subject to funding, I can not emphasize enough the need to have the notification
system and the certificate "identifying Monroe County sponsorship in place at
your community hospitals. In order to enable membe1s of our Medical Staff to
make informed decisions about their participation on a case-by-case basis, it
is important that 1) our Emergency Department be aware of the exact status of
our relationship at any given time, and, 2) it is equally important that the
Monroe hospitals are aware of Monroe County's sponsorship, diligently give
verbal notice and generate a "certificate" for each applicable patient.
I wish you every success on your continued deliberations with the county and
the upcoming tax district.
Sincerely,
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Lee S. Huntley
Attachment
3900 North Kendall Drive
Miami. fL 33176 - 2197
(305) 596 - 6503
MEIIORAlIDUM OF UJlIDERS'rABDIRG
WHEREAS, Monroe County, Florida, finds itself unable to
provide sufficient emergency trauma-related health care to its
visitors and residents at certain time periods of the year, and
WHEREAS, the Board of County Commissioners is continuing to
attempt to address on-going severe trauma-related emergency
health care on behalf of the public health, safety and welfare of
its people by the establishment of an Emergency Service Committee
and has entered into agreement with the Health Council of South
Florida to aid in determining permanent solutions for such
on-going severe trauma-related health care, and
WHEREAS, the Key Largo Volunteer Ambulance Corps and certain
county officials have, in parallel actions, held discussions with
Baptist Hospital of Miami, having indicated its willingness to
aid Monroe County on a temporary basis in its on-going severe
trauma-related emergency health care problems, and,
WHEREAS, Mr. Lee S. Huntley, Vice President at Baptist
Hospital of Miami, has indicated by letter of intent to Monroe
County, Baptist Hospital of Miami's willingness and desire to
enter into a temporary relationship with Monroe County for a
period of sixty (60) days, effective December 1, 1987, and
extended by a period of six (6) months beginning February 1, 1988
under terms modified herein, subject to cancellation notice by
either party as provided below for accepting trauma patients from
Monroe County on certain terms, to help alleviate seasonal
pressures involving severe trauma-related emergency health care
in Monroe County,
A MEMORANDUM OF UNDERSTANDING is hereby entered into between
the Board of County Commissioners of Monroe County, Florida, on
behalf of the people of Monroe County, and Baptist Hospital of
Miami as outlined in the November 25, 1987 letter of intent to
describe a temporary relationship for severe trauma-related
emergency health care, and amendments incorporated herein
modifying the original agreement by deletions and additions,
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pursuant to extension of such initial agreement, wherein both
parties agree to the following:
1. Monroe County acknowledges that Baptist Hospital
of Miami's primary function is to provide services for
patients within its service area.
2. Baptist Hospital of Miami and its Medical Staff
will do everything reasonably possible to make severe
trauma-related emergency health care available to the
visitors and residents of Monroe County, except that
these same individuals acknowledge that, from
time-to-time, demands for emergency or other critical
services saturate Baptist Hospital's limited resources.
At those times where Baptist Hospital of Miami's
resources are saturated so as to prohibit patient
acceptance under this temporary relationship, Baptist
Hospital of Miami will attempt to aid in the placement
of the patient in other facilities.
3. Under the provisions of 2. above, Baptist Hospital
of Miami and selected members of its medical staff will
accept trauma patients who are able to be transported
by air or ground directly from the scene in such a
manner as to arrive within sixty (60) minutes of injury
to Baptist Hospital of Miami's Emergency Department.
It is reinforced that the principal purpose of
this agreement is for facilitating and aid in cases of
severe trauma injury involving from-the-scene transport
to Baptist Hospital Emergency receiving facilities
within a time frame most beneficial to the patient.
Both parties to this agreement understand that time
frames are critically important in such severe trauma
injury, but are subjective by nature, and therefore
necessarily indicated to insure utmost patient
survivability factors.
Under no circumstances will this Memorandum of
Understanding be automatically effective if prospective
patient admission by Baptist Hospital of Miami is
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beyond a twelve (12) hour time frame from occurrence of
any qualified severe trauma related injury. (See
Section 7)
4. Monroe County on its part will contact
representatives of the state of Florida concerning this
relationship and any conflict with EMS regulations to
assure that this relationship would be allowed to
continue under recently enacted regulations.
5. TRANSFER FROM ON-SCENE
Paramedics and EMS personnel operating in or on
behalf of Monroe County will be required to:
A. Contact Baptist Hospital of Miami Emergency
Department physicians, from the scene, prior
to transport, to review the condition of the
patient and the availability of resources to
accept the patient.
In those cases where EMS personnel other than
paramedics are on-scene Monroe County Emergency
Service respondents (Tavernier and Islamorada,
until upgrading to ALS), such contact shall be by
the nearest hospital facility.
B. Initiate a Certificate of Eligibility form to
be completed by Monroe County Officials and
forwarded to Baptist Hospital within 72 hours.
C. Prior to contact with Baptist Hospital of
Miami Emergency Department, the on scene paramedic
will verify:
1. Availability, if required, of Dade County
Air-Rescue One, under Monroe County's
agreement with Dade County, for transport of
patient.
2. That the patient has trauma score 12, coma
score 10, or evidence of shock at the scene
with systolic BP 90.
3. Trauma victim has experienced amputation.
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D.
It is hereby reinforced rhat any official
Monroe County clearance will be from the Monroe
County Office of Emergency Medical Services or
through his representation by an on-scene EMS
personnel who shall certify transfer documents, as
necessary.
Such clearance from a Monroe County hospital
whose service area may be served by paramedic
technicians who are not part of the Monroe County
Emergency Medical Services system shall only
obtain clearance certification as provided in (6.)
below.
6. HOSPITAL RELATIONSHIPS - CASE-BY-CASE
The relationship herein described is between
Monroe County and Baptist Hospital of Miami and does
not extend to Monroe County hospitals, that
relationship being considered to be beyond the scope of
this temporary agreement.
Therefore, any Monroe County Hospital from which
transferal to BaptiJt Hospital is to be accomplished
under this agreement shall be required to complete a
Certificate of Eligibility form, to accompany the
patient, which certifies that, under sending hospital
emergency room physician signature, acting on behalf of
that hospital:
A.
Verification of trauma score upon
receiving such patient, together with trauma
score, coma score, and other evidence of shock, as
qualified in s.C. above, together with other
information required by the Monroe County Office
of Emergency Medical Services, upon release of
such patient for transfer
B.
The expenses associated with the care of
the patient being transferred for treatment
by Baptist Hospital of Miami is being guaranteed
only for Baptist Hospital of Miami by Monroe
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County as outlined elsewhere in this agreement.
Any failure by Monroe County hospitals to observe
their required conditions of this agreement in
respect to their participation in it may cause
incurrment of patient liabilities on their part
which Monroe County might have otherwise incurred,
had there been no failure on their part.
C. Initiate telephone contact with Baptist
Hospital of Miami Emergency Department physician
on call for verbal assessment of the patient
status and ability for transfer.
D. Agree to accept the return transfer of such
patient when, in the opinion of Baptist Hospital
of Miami, Medical Foundation of South Florida
review, or other Utilization review agency that
such patient is medically stable shall be returned
for further care beyond the terms of this
agreement.
E. Verification by signature of Monroe
County Emergency personnel in charge as to severe
trauma related injury justifications, Certificate
of Eligibility, and other information as required.
Telephone verification with the EMS Office
shall be required during normal business hours of
that office. After hours certification shall be by
telephone beeper contact with either the Medical
Director of the District or the Emergency Medical
Services Coordinator.
7. HOSPITAL PROTOCOL
It is acknowledged that patients initially
transported to Monroe County hospital facilities will
be considered on a case-by-case basis for transfer to
Baptist Hospital of Miami, subject to consideration of
the time frames described above; the receiving
physician's acceptance of the patient; and the
availability of Baptist Hospital of Miami resources,
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and other stipulations required elsewhere in this
agreement.
In those cases first transported to nearest
available Monroe County hospital to the scene, Baptist
Hospital of Miami does require:
A. Initial Baptist Hospital of Miami
Emergency Department contact and notification to
assure coordination of further stabilization and
advanced trauma life support (ATLS) actions, so
that such actions be consistent with Baptist
receiving facility requirements
B. Verbal review of the nature of the injuries
of each patient with the Baptist Hospital of Miami
emergency physician and trauma surgeons (see S.C)
C. Communication with the Medical Director of
Service, Dr. H. Richard Nateman (or) the Baptist
Emergency Department physician on duty to assure
the availability of Baptist's facilities and
physician coverage
D. Complete medical record transferred with the
patient to include emergency room report, and
clearance verification on records transmitted with
the patient of the patient criteria in S.C.
8. METRO-DADE AIR RESCUE
All relations with Metro-Dade Air Rescue One are
to be handled at the scene by existing protocols
utilized by Key Largo Fire Rescue/Metro-Dade Air
Rescue.
9. FINANCIAL ASSURANCES
Monroe County agrees to guarantee Baptist Hospital
of Miami and the participating Hospital-based
physicians 80% of reasonable and appropriate charges
for each patient.
Where insurance or other coverage exists or the
patient can defray such costs, Baptist Hospital of
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Miami and its physicians will bill and collect from
those entities.
Baptist Hospital of Miami, on their part, will
make every effort to assure that there is an early
determination of insurance coverage status; will assure
that the Monroe County Office of Emergency Medical
Services be made aware of and routinely updated on the
charges of health care issues on a case-by-case basis;
and will work with Monroe County Social Services
Department for funding source determinations for those
eligible and requiring such aid.
Should circumstances dictate that these funds are
not collectable within ninety (90) days of service,
Monroe County agrees to compensate Baptist Hospital of
Miami and its physicians 80% of those reasonable and
appropriate charges less any reasonably assured
insurance assignments and payments rendered by the
patient or other third party payors.
Baptist Hospital of Miami and its physicians will,
in turn, verify charges and, as necessary, assign
insurance benefits to Monroe County in a manner
acceptable to both parties.
Should health or liability insurance coverage be
less than 80% of the charges, Monroe County agrees to
compensate Baptist Hospital of Miami and its physicians
for the difference between collections and 80% of
charges.
10. FORMS REQUIREMENTS
A. Monroe County, to aid in the effectiveness
of and as requirement for evaluation of this
temporary relationship shall require its Medical
Director of any District involved to implement
criteria and protocols included herein, not to
exclude reporting of patient on-scene score
report, Air-Rescue One or land transport report,
disposition of patient and follow-up of hospital
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treatment logs and reports, to the County
Administrator and Director of Emergency Medical
Services for statistical and effectiveness
determinations.
B. As indicated elsewhere within this Memorandum
of Understanding, Baptist shall require a
Certificate of Eligibility from Monroe County, per
S.B., or the local hospital, under 7.D., and
complete medical record to include emergency room
report transferal with the patient, if from a
Monroe County hospital.
11. INCLUSIONS
Monroe County hereby desires to include under the
terms of this temporary relationship, the patient case
of Linda Houston, previously transported at the request
of Commissioner Stormont and authorized by the County
Administrator.
12 RECOGNITION
Monroe County further desires to retain
designated appointees as further reviewers of the
aspects of this temporary relationship extension the
following individuals: G. Joey Elam, Douglas Cullen,
and Doris Kemp all of Key Largo Volunteer Ambulance
Corps, J. Allison DeFoor II of the Monroe County EMS
Council, Commissioner John C. Stormont, and Howard
Anderson of Mariner's Hospital.
13. CANCELLATION OF AGREEMENT
In the event that a thirty (30) day termination
notice is invoked by either party, or other termination
as indicated below, all obligations incurred on the
part of Monroe County, under the terms of the original
Memorandum of Understanding, or under any amendments
thereto, prior to the date of termination, shall be
fulfilled as per the terms of this understanding, as
amended.
A.
It is understood that, since this agreement
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is between Baptist Hospital of Miami and Monroe
County, and that other services being provided
through Baptist Hospital, such as physician
services by way of example, are not contractual
beyond the terms of this agreement, immediate
termination by Baptist Hospital of Miami is
permitted when circumstances arise wherein those
services not contracted for under this agreement
are no longer available.
B. It is additionally understood that since the
committed financial resources by Monroe County for
the implementation of this agreement are limited
by nature, either Monroe County or Baptist
Hospital of Miami may immediately terminate this
Memorandum of Understanding. However, Monroe
County shall remain liable for costs incurred
during the period of the original Memorandum of
Understanding, and/or amendments thereto.
C. If Monroe County should cause to implement
alternative trauma-related care plans as being
developed by the Health Council of South Florida,
that plan shall superceed the terms of this
agreement, except for Monroe County's financial
obligations incurred under this agreement.
14. MONROE COUNTY REQUIREMENTS
In order to clearly establish those Monroe County
governmental contractual patients under the terms of
this Understanding, Monroe County protocols shall
provide that Emergency Medical Services personnel in
charge shall certify, as representatives of the Office
of Emergency Medical Services, on the Certificate of
Eligibility, that such patient qualifies under the
terms as indicated in (5., 6., or 7.) above, as
applicable.
It is hereby reinforced that such personnel,
acting on behalf of Monroe County Emergency Medical
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Services Office shall be the certifier that the patient
is a "Monroe County Government Memorandum of
Understanding patient" for the effectiveness of this
agreement, even when transferred from a Monroe County
hospital.
15. PATIENT REVIEW /CASE MANAGEMENT
This Memorandum of Understanding presumes to serve
the interests of patients in severe trauma-injury
status. By such assumption, it is recognized that
certain critical care may lead to other long-term care
or rehabilitation care which is beyond the scope of
this agreement.
Therefore, the following patient/case review
procedures are instituted:
A. For all existing and future cases under this
agreement, Monroe County will, on its part,
separately contract with a third party Utilization
Review agency to interface with Baptist Hospital
of Miami, its medical staff and administration in
order to oversee and guide medical and social
needs of the patient and to be able to effectively
utilize available resources of Monroe County under
this agreement.
This review is mandated in that this
Memorandum of Understanding exists between Baptist
Hospital of Miami and Monroe County and does not
extend to various staff physicians and all other
specialty related services which may be required
by the patient.
B. Such Utilization Review shall be
automatically performed in those cases extending
beyond 10 days and/or when a threshold of hospital
incurred costs exceed $15,000.00.
C. Additional independent review may be
initiated by either party to this agreement with
the Medical Foundation of South Florida, with
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costs being borne by Monroe County, for
medical/social determinations as to when the
purpose of this agreement terminates in respect to
patient care.
D. Representatives from either Monroe County
(and/or their designated review agency) or Baptist
Hospital of Miami may request prompt
medical/social/financial case discussion with the
principal representatives and physicians to
discuss the finances of a particular patient, the
proper use of Monroe County and Baptist Hospital
of Miami resources or funds, and any other issues
which might arise.
16. PATIENT TRANSFERABILITY
A. In certain cases under this agreement where
it becomes apparent that the patient is eligible
for certain health care benefits (e.g. Veteran's,
welfare or other), and it is apparent that such
benefits may be utilized by the patient, either
party to this agreement, upon notification to the
other party and concurrence of the patient or his
representative, the attending physician, may
effect transfer of the patient to other receiving
facility for such above benefits, and thereby
terminate obligations beyond those incurred as
part of this agreement.
B. The Social Services Departments of Baptist
Hospital and of Monroe County will independently
and jointly seek available resources for those
patients identified by Baptist Hospital of Miami
which require or are eligible for other financial
coverages or treatment facilities during hospital
admission procedures
C. Any such transfer to alternate facilities
shall be mandated under this agreement when
medically appropriate, subject to 16 A. above.
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D.
Other patient transfer/return to sending
hospital, as per the Certificate of Eligibility
accompanying the patient when transported to
Baptist Hospital, shall be effected by Baptist,
via Monroe County Emergency Medical Services
Ambulance Services, when in their judgement or in
the judgement of the Utilization Review agency and
the attending physician, continued care can be
handled by the hospital initiating original
transfer to Baptist.
17. AGREEMENT IMPLEMENTATION
A.
Contact persons for agreement implementation
for Monroe County are to be as follows:
1. Overall coordinator
County Administrator
Capt. Tom Brown
Junior College Road - Stock Island
Wing II
Key West, Florida, 33040
(305) 294-4641 ext. 100
2. Emergency Medical Services Coordinator
Reggie Paros
EMS Coordinator
10600 Aviation Boulevard
Marathon, Florida, 33050
(305) 743-6619
3. Billing submission for clearance
Reggie Paros
(Above)
4. Payment (after clearance)
Clerk of the Commission
Mr. Danny Kohlage
500 Whitehead Street
Key West, Florida, 33040
(305) 294-4641 ext. 314, 315
5. Social Service aid
Monroe County Social Services Dept.
Louis LaTorre
B.
(305) 294-4641 ext. 506-509
Contact persons for Baptist Hospital of Miami
are as follows:
1. Overall coordinator
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Charles Sperrazza
Administrative Director
Emergency Services
596-6556
2. Baptist Hospital of Miami Medical Services
Dr. H. Richard Nateman
Medical Director
Baptist Hospital of Miami Emergency Services
596-1960 ext. 6292
3. Billing Information
Mr. Tim Wagoner
Patient Accounts Supervisor
596-1960 ext. 6225
4. Social Services
Sandra Bell
Director - Social Services
596-6578
IN WITNESS WHEREOF, the parties below have caused this
Memorandum of Understanding and amendments therein to be
executed by their undersigned officials as duly authorized.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By:
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Mayor/Chairman
Date: r;/-- I ~ - ~ g
( Se a 1 )
Attest: PANNY L. KOLHAGE, Clerk
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BAPTIST HOSPITAL OF MIAMI
By:
Page -13-
Date:
Approved as to form
and legal sufficiency.
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