Item V1BOARD OF COUNTY COMMISSIONERS
County of Monroe A
Mayor Heather Carruthers, District 3
f
T$ne Florida Keys (, S �� Mayor Pro Tem George Neugent, District 2
t� ) ��` ��
�' Danny L. Kolhage, District 1
David Rice, District 4
Sylvia J. Murphy, District 5
County Commission Meeting
November 22, 2016
Agenda Item Number: V.1
Agenda Item Summary #2406
BULK ITEM: Yes DEPARTMENT: County Attorney's Office
TIME APPROXIMATE: STAFF CONTACT: Cynthia Hall (305) 292 -3470
No
AGENDA ITEM WORDING: Approval of a resolution granting authority to terminate
outstanding contracts between the Upper Keys Health Care Taxing District and third parties, and
disposing of unused surplus office equipment.
ITEM BACKGROUND: The Upper Keys Health Care Taxing District (Trauma District), a
municipal services taxing unit (MSTU), was created in 1988 via Ordinance 008 -1988, to provide
revenues to ensure access to critical trauma care at appropriate trauma centers within time frames
established by the American College of Surgeons. The Trauma District had taxing authority, and
collected taxes until 1997. In September 2016, the Advisory Board of the Trauma District passed a
motion recognizing that the Trauma District is no longer necessary in light of various improvements
in health care, and recommended that the Trauma District should be abolished. An ordinance
abolishing the Trauma District will be heard at a public hearing at the December 14, 2016 BOCC
meeting.
The Trauma District currently has several outstanding contracts with third parties (Public Health
Trust of Dade County/University of Miami School of Medicine, Baptist Hospital of Miami, and
Keys Hospital Foundation, Inc. dba Mariners Hospital). The contracts in essence guaranteed
payment to the hospitals, for uninsured or underinsured Monroe County residents transported to and
treated at the hospitals. The contracts have termination clauses requiring either 30 (Baptist,
Mariners) or 60 days' notice (Public Health Trust/University of Miami School of Medicine) to the
third parties in order to terminate. In anticipation that the ordinance to abolish the Trauma District
will be approved in December, the resolution seeks authority to notify the third parties that the
contracts will be terminated. The notices of intent to terminate can be rescinded if the ordinance is
not approved in December.
The resolution also asks for direction in disposing of a few pieces of office equipment, including
computers, that meet the definition of surplus property as defined in the Monroe County Purchasing
Policy.
This resolution is brought forward at the request of Commissioner Murphy.
PREVIOUS RELEVANT BOCC ACTION: Please see further chronology in attached
resolution.
CONTRACT /AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval.
DOCUMENTATION:
Resolution Trauma District 9.28.2016
Trauma Agreement
MOU Baptist 12 -01 -1987
MOU Baptist 2 -16 -1988
MOU Baptist 12 -20 -1988
Addendum to MOU Baptist Hospital of Miami 5 -23 -1989
Reso 246 -1990 and Trauma Care Agreement with Keys Hospital Foundation Inc.
Name change Keys Hospital Foundation Inc. to Mariners Hospital Inc.
FINANCIAL IMPACT:
Effective Date: N/A
Expiration Date:
Total Dollar Value of Contract:
Total Cost to County: $0
Current Year Portion:
Budgeted:
Source of Funds:
CPI:
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: No
Grant:
County Match:
Insurance Required:
Additional Details:
If yes, amount:
None
REVIEWED BY:
Cynthia Hall Completed 11/14/2016 6:14 PM
Bob Shillinger
Budget and Finance
Maria Slavik
Kathy Peters
Board of County Commissioners
Completed
11/15/2016 9:05 AM
Skipped
11/14/2016 6:15 PM
Skipped
11/14/2016 6:14 PM
Completed
11/15/2016 9:16 AM
Pending
12/14/2016 9:00 AM
RESOLUTION NO. -2016
A RESOLUTION OF THE BOARD OF COUNTY COMISSIONORS OF MONROE
COUNTY, CONCERNING THE ABOLISHMENT OF THE UPPER KEYS HEALTH
CARE TAXING DISTRICT, TERMINATION OF ALL CONTRACTSTO WHICH THE
TAXING DISTRICT IS A PARTY, AND DISTRIBUTION OF SURPLUS PROPERTY
BELONGING TO THE UPPER KEYS HEALTH CARE TAXING DISTRICT.
WHEREAS, the Board of County Commissioners of Monroe County ( "BOCC "),
Florida, is authorized by Article VI I I of the Florida Constitution and Chapter 125, Florida
Statutes, to adopt ordinances not inconsistent with general law; and
WHEREAS, Section 125.01(1)(q), Florida Statutes, grants to counties the
authority to establish and abolish municipal service taxing units for the provision of
numerous municipal services; and
WHEREAS, the Upper Keys Health Care Taxing District ( "Trauma District ") was
created by the BOCC via Ordinance No. 008 -1988, as adopted by the BOCC in January
1988; and
WHEREAS, the purpose for the Trauma District was to provide revenues to
ensure access to critical trauma care at appropriate trauma centers within time frames
established by the American College of Surgeons on Trauma, for residents within the
geographical area covered by the Trauma District; and
WHEREAS, in 1997, the BOCC adopted Ordinance No. 050 -1997, terminating
the taxing authority of the district; and
WHEREAS, the ad valorem taxes collected under the Trauma District's taxing
authority now stand at approximately $800,000; and
WHEREAS, on September 9, 2016, the Advisory Board of the Trauma District
passed a motion, recognizing that the Trauma District is no longer necessary in light of
various improvements in health care coverage laws, and recommending that the
Trauma District should be abolished; and
WHEREAS, on September 21, 2016, the BOCC passed a motion authorizing
staff to advertise an ordinance abolishing the Trauma District; and
WHEREAS, the Board of County Commissioners finds it necessary to terminate
all contracts to which the Trauma District is a party; and .
1
WHEREAS, between 1987 and 1998, Monroe County entered into agreements
with the Public Health Trust of Dade County /University of Miami School of Medicine,
Keys Hospital Foundation, Inc. d /b /a Mariners Hospital, and Baptist Hospital of Miami,
Inc., whereby the County agreed to guarantee the costs of transport and treatment
above and beyond insurance proceeds for Upper Keys patients from Trauma District
funds; and
WHEREAS, in light of the dissolution of the Trauma District, it is advisable for the
County to take steps to terminate each of the agreements; and
WHEREAS, the BOCC wishes to dispose of certain personal property owned by
Monroe County heretofore used for Trauma District business, located in the Trauma
District office within the Key Largo Volunteer Ambulance Corps. ( "Ambulance Corps "), a
not - for - profit entity, by transferring title to the personal property (listed below) to the
Ambulance Corps. in accordance with Chapter 12 of the Monroe County Purchasing
Policy.
NOW THEREFORE BE IT RESOLVED by the Monroe County Board of County
Commissioners, as follows:
Section One. The following agreements are hereby terminated, and staff is
hereby authorized and directed to notify the contracting parties that the County is
exercising its right to terminate the respective agreements in accordance with the
various termination or cancellation clauses:
(a) Trauma Agreement dated July 16, 1990 by and between the Public
Health Trust of Dade County, University of Miami School of Medicine, and Monroe
County;
(b) Memorandum of Understanding (MOU) by and between Monroe
County and Baptist Hospital of Miami, Inc. dated 12 -1 -1987, Memorandum of
Understanding (MOU) by and between Monroe County and Baptist Hospital of Miami
dated 2 -16 -1988, Memorandum of Understanding between Baptist Hospital of Miami,
Inc. and Monroe County dated 12 -20 -1988, and Addendum to 12 -20 -1988 MOU, dated
5 -23 -1989;
(c) Trauma Care Agreement dated 4 -18 -1990 by and between Monroe
County and Keys Hospital Foundation, Inc. dba Mariners Hospital, approved by
Monroe County Resolution No. 246 -1990.
Section Two. Disposition of Property Used By The Trauma District.
A. Monroe County is currently in possession of the following
personal property ( "Property "), located within the Trauma District office within the Key
Largo Ambulance Corps. building:
z
4 vertical file cabinets; 2 horizontal file cabinets; 1 inkjet printer; 1 fairly
old (about 7 years) copier /scanner /fax machine; one desk.
B. Each item of Property is estimated to have a fair market value that
is less than five thousand dollars ($5,000.00).
C. The Property has no further use to the County due to
obsolescence, inefficiency, or being uneconomical.
D. The BOCC wishes to donate the Property to the Ambulance Corps
and is advised that the Ambulance Corps wishes to accept the Property. Staff is
directed to execute any paperwork required by the Purchasing Policy in order to transfer
the property to the Ambulance Corps.
E. In addition to the foregoing, Monroe County is also the owner of
and in possession of two computers. One computer (a 1998 Dell DXW4V workstation,
P5MMX200, with monitor and keyboard) is in storage in the Murray Nelson building.
The other (Lenovo Think Centre with Lenovo monitor and keyboard) is currently in use
in the Commissioner's office within the Murray Nelson building. Those computers will
remain the possession of Monroe County, subject to disposal as surplus property in the
future in accordance with Monroe County Purchasing Policy rules. Prior to dissolution,
Trauma District personnel will make appropriate arrangements to safeguard any public
records on them, including protected health information in accordance with HIPAA rules
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida, at a regular meeting of said Board held on the day of November, 2016.
Mayor
Mayor Pro Tern
Commissioner
Commissioner
Commissioner
(SEAL)
Attest: AMY HEAVILIN, Clerk
Deputy Clerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
is
3
Mayor /Chairperson
Agenda Item 9(b)(5)
Finance Committee
July 12, 1990
RESOLUTION NO. PHT 07/90°- 2
RESOLUTION APPROVING AGREEMENT
WITH THE UNIVERSITY OF MIAMI
AND MONROE COUNTY ON BEHALF OF
THE UPPER KEYS HEALTH CARE TAX
DISTRICT FOR TREATMENT OF TRAUMA.
PATIENTS.
WHEREAS, There is no Level I Trauma Center in Monroe County and, from
time to time, trauma victims in the Upper Keys have emergency medical condi-
tions that exceed the capability of hospitals in Monroe County to render
appropriate care and said patients meet the criteria for transport to a Level
I trauma center; and
WHEREAS, the Trust, the University of Miami, Monroe County, and Upper
Keys desire to facilitate the immediate, safe and efficient transfer of Upper
Keys trauma victims to a Level I trauma center and arrange for their
continued care after completion of specialized treatment at the Level I
center; and
WHEREAS, the Trust will bill third parties for services and, if the
Trust does not receive payment in 90 days, Upper Keys Health Care Taxing
District will pay the Trust's prevailing Medicaid per diem rates, and
WHEREAS, the President and the Finance Committee recommend approval:
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC
HEALTH TRUST OF DALE COUNTY, FLORIDA, That this Board hereby approves the
agreement with the University of Miami and Monroe County, a copy of which is
attached hereto and incorporated herein by reference, and authorizes and
directs the President to execute same for and on behalf of the Public Health
Trust.
Agenda Item 9(b)()
Finance Committee
July 12, 1990
Page 2
The foregoing resolution was offered by Mr. High , who
moved its adoption. The motion was seconded by Ms. Ceballos and,
upon being put to a vote, the vote was as follows:
Bernyce Adler
Absent
B. Boyd Benjamin
Aye
Peggy Bieley
Aye
Jose C. Cancela
Aye
Irene Canel- Petersen
Aye
Haydee A. Ceballos
Aye
Tanya Dawkins
Aye
Thelma V. A. Gibson
Aye
Arthur H. Hertz
Aye
Joshua High
Aye
David L. Paul
Absent
Stanley G. Tate
Absent
Elayne Weisburd
Aye
Jay W. Weiss
Aye
Richard J. Weiss
Aye
The Chairman thereupon declared the resolution duly passed and adopted
this 12th day of July I990.
PUBLIC HEALTH TRUST OF DAD E COUNTY, FLORIDA
B 9 "
Irene Canel- Petersen, Secretary
a'
a
a
a
Approved by the County
Attorney as to form
and legal sufficiency.
AGREEMENT
BETWEEN THE PUBLIC HEALTH TRUST, UNIVERSITY OF
MIAMI SCHOOL OF MEDICINE, MONROE COUNTY AND
UPPER KEYS HEALTH CARE TAXING DISTRICT
FOR UPPER KEYS TRAUMA VICTIMS
This agreement is made this day of a 1990,
by and between the Public Health Trust of Dade County, Florida,
an agency and instrumentality of metropolitan Dade County,
Florida (hereafter referred to as the "Trust"), which operates
Jackson Memorial Hospital and as a part thereof a Shock Trauma
Center (hereafter referred to as "Trauma Center the University
of Miami School of Medicine (hereafter referred to as the
"University"); and the the Board of County Commissioners of Monroe
County, Florida (hereafter referred to as "Monroe County"), which
governs and has established and funded by millage assessment the
Upper Keys Health Care Taxing District (hereafter referred to as
"Upper Keys").
WHEREAS, the Trust's Trauma Center is a level one trauma
center as defined by Florida Administrative Code 1OD-66.108;
WHEREAS, pursuant to con with the Trust, physicians on
the faculty of the University provide medical care in Jackson
Memorial Hospital;
WHEREAS, no level one trauma center is located in Monroe
County;
VMEREAS, from time to time trauma victims in the Upper Keys
experience emergency medical conditions that exceed the capabili-
ties of hospitals in Monroe County to render appropriate care and
meet the criteria for transport to a level one trauma center;
WHEREAS,, the Trust, University, Monroe County and Upper Keys
desire to facilitate through an agreement the immediate, safe,
and efficient transfer of Upper Keys trauma victims to a level
one trauma center and to arrange for their continued care after
completion of the specialized treatment available at a level one
trauma center;
Now, therefore, in consideration of the advantages to the
public and to the parties, their physicians and the emergency
medical services personnel with whom they work, the Trust,
University, Monroe County and Upper Keys hereby agree to the
following:
1. Definitions: This agreement applies only to "Upper
Keys Trauma Victims," which term as used herein means only those
persons who meet all the following criteria:
A. They have incurred a single or multi-system life-
threatening injury due to blunt or penetrating means, or burns,
and require immediate medical intervention or treatment; and
B. Their emergency medical condition exceeds the
capabilities of hospitals in Monroe County to render appropriate
care or treatment; and
C. They meet the criteria established by the State of
Florida for transport to a level one trauma center; and
D. Their injuries occur in the Upper Keys Health Care
Taxing District.
2. Field Transports:
A. Monroe County shall establish pursuant to Rule
1OD-66 an approved protocol for field transport of Upper Keys
Trauma victims to the Trauma Center. This protocol and any
revisions to it shall be submitted to the Trust and University
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for their comments at least 'Clen (10) days prior to its submission
B. The parties to this agreement shall adhere to this
protocol for field transports for emergency transportation of
Upper Keys Trauma Victims to the Trauma Center.
3. HosDital Transfers:
A. Monroe County and Upper Keys shall establish a
written protocol setting forth their roles in arranging for
transfers of Upper Keys Trauma Victims from Mariner's Hospital,
Plantation Key, Florida to the Trauma Center. This protocol and
any revisions to it shall be submitted to the Trust and University
for their comments at least thirty (30) days prior to its imple-
mentation.
B. The parties to this agreement shall adhere to this
protocol for hospital transfers of Upper Keys Trauma Victims to
the Trauma Center.
4. Availability: Monroe County and Upper Keys recognize
that the Trauma Center on occasion due to patient volumes has -
been unable to accept and has had to "triage" trauma patients.
The parties agree to address this situation in a written protocol
to govern transport and transfers of Upper Keys Trauma victims. .
5. Transportation Costs: Monroe County shall be respon-
sible and shall pay for all costs of transporting or transferring
Upper Keys Trauma Victims, their effects and medical records to
the Trauma Center.
6. Funding:
A. Monroe County and Upper Keys shall pay the Trust
for emergency and acute care rendered to Upper Keys. Trauma
- 3 -
Victims at the prevailing Florida Medicaid per them rate applicable
to the Public Health Trust without regard to Medicaid rules
limiting the duration of Medicaid coverage, subject to paragraphs
D E and F, below.
M. Monroe County and upper Keys shall pay the University!
physicians who participate in the Trauma Center
'Lhe Florida Medicaid rate applicable to the performance: of their
services subject to paragraphs D. E and F, below.
C. Trust and University physician billing for services
rendered under this agreement shall be handled in the customary
RIT.T.STOT
D. When insurance and other third party coverage
exists, the Trust and University physicians shall charge and seek
payment from those entities. Monroe County and Upper Keys agree
to cooperate with the Trust and University physicians in securing
and providing information regarding insurance and third party
coverage of Upper Keys Trauma victims.
E. If the Trust or University physicians do not
receive from the Upper Keys Trauma victim or third party payor
the charges incurred by the patient within ninety (90) days from
the date of service, Monroe County and Upper Keys shall pay the
Trust and University physicians in accordance with paragraphs A
and B above.
F. If the Trust or the University physicians do
receive payment at any time after the expiration of the aforesaid
ninety (90) day period, from any source, and such payment results
in an overpayment of the patient's bill, the full amount of the
overpayment shall be paid, forthwith, to Upper Keys.
- 4 -
G. The Trust and the University shall pursue all
reasonable and customary means of collection of payments that are
due and owing from the patient and/or third parties.
7. Continued Care:
A. Monroe County and Upper Keys shall provide at
their expense for the prompt transport and transfer from the
Trauma Center to Monroe County the following trauma victims who
are residents of Monroe County:
1. Upper Keys Trauma Victims who at the time of
transport or transfer do not meet the criteria set forth in
paragraphs 1 A, B and C; and
2. Upper Keys Trauma Victims who have completed
the specialized treatment available at the Trauma Center as a
level one trauma center and to whom Monroe County or Upper Keys
is capable of rendering treatment.
B. The parties agree to adopt a protocol to effect
the transport and transfer of patients described in paragraph A,
above.
a. Termination:
I A. Any party may terminate this agreement, with or
without cause, upon mutual written consent or sixty (60) days
written notice to the other parties.
B. Monroe County may immediately terminate this
agree/ment if Upper Keys is without funds to continue funding in
accordance with paragraph six (6) of this agreement.
C. Termination of this agreement for any reason shall
not affect the rights, obligations and liabilities of the parties
arising out of all matters covered by this agreement occurring
prior to termination. The failure of any party to terminate the
- 5 -
contract upon an event giving rise to a right to terminate shall
not be deemed a waiver of any rig
RRO"im
9. Examination of Records:
The parties agree that they all shall have access to
and the right to examine the other parties records, documents
logs and similar papers that pertain to matters covered by this
agreement for any lawful purpose, including but not limited to
quality assurance, utilization review, case management, and
trauma data collection.
10. Independent Contractors6
In no event shall the respective Trustees, Commission-
ers, officers, agents, servants, employees, medical staff or
nurses of any party to this agreement be considered the officers,
agents, servants or employees of any other party.
11. Indemnification:
A. Notwithstanding any provision or undertaking in
this Agreement to the contrary, Monroe County and Upper Keys
shall not be liable or responsible for any act, omission or
neglect of the Trust or University or any of their employees,
agents, affiliates or associates, connected with the provision of
any medical services of care to trauma victims or others, all
such liability and responsibility being that of the Trust or
University. The Trust and University hereby agree to save
harmless and indemnify Monroe County and Upper Keys to the extent
allowed by the laws of the State of Florida from any liability,
loss, cost, claim, or expense, including reasonable attorney's
fees, arising out or connected with any such act, omission or
neglect of the Trust or University, respectively, or their
- 6 -
respective employees, agents, affiliates, or associates.
B. Notwithstanding any provision or undertaking in
this Agreement to the contrary, the Trust and University shall
not be liable or responsible for any act, omission or neglect
arising from the breach of contract or other act relating in any
way to the performance or omission of any act or responsibility
of Monroe County and Upper Keys or any of their employees,
agents, affiliates or associates under this Agreement. Monroe
County and Upper Keys hereby agree to save harmless and indemnify
the Trust and University to the extent allowed by the laws of the
State of Florida from any liability, loss, claim or expense,
including reasonable attorney's fees, arising out of or connected
with any such act, omission or neglect of Monroe County and Upper
Keys, their employees, agents, affiliates, and associates.
12. Severability: If any part of this Agreement should be
determined to be invalid, illegal, inoperative, or contrary to
law or professional ethics, such part shall be reformed, if
possible, to conform to law and ethics; and, in any event, the -
remaining parts of this Agreement shall be fully effective and
operative insofar as reasonably possible.
13. miscellaneous:
A. All modifications to this Agreement must be in
writing and executed by the parties hereto.
B. The validity of this Agreement and any of its
terms and provisions, as well as the rights and duties of the
parties hereunder, shall be interpreted and enforced pursuant
to and in accordance with the laws of the State of Florida.
C. The headings of the various section's of this
Agreement are inserted merely for the purpose of convenience and
- 7 -
specific terms of the section so designated.
D. The rights, remedies and obligations contained in
this agreement pertain solely to the parties to this agreement.
This agreement shall not be construed or deemed to create any
rights or remedies for any person who is not a party hereto.
14. Notices: Any notices provided herein shall be deemed
properly given if delivered in writing via certified mail, return
receipt requested, to the respective parties as follow:
To Trust: Ira C. Clark
President, Public Health Trust
1611 N. W. 12th Avenue
West Wing 0117
Miami, Florida 33136
To University: Mark Mehlen, Executive Director
Clinical Operations and Systems
University of Miami Medical School
P. 0. Box 016960
1135 RMSB (D-35)
Miami, Florida 33101
To Monroe County: John Stormont, Mayor
Plantation Key Government Center
Tavernier, Florida 33070
To Upper Keys: Elaine D. Gorman, Project Director
Upper Keys Health Care Taxing District
Trauma Office
98600 Overseas Highway
Key Largo, Florida 33037
15. Attorney's Fees:
Whenever any party shall incur any suit costs and
reasonable attorney's fees with respect to the enforcement of
the provisions hereof against the other, the prevailing party
shall be entitled to recover from the other all such suit costs
and reasonable attorney's fees.
- 8 -
16. Effective Date: This contract shall be effective
upon the date all parties have formally agreed thereto.
IN WITNESS HEREOF, the parties have caused this Agreement
to be executed by - their duly authorized officials.
BOARD OF COUNTY COMMISSIONERS PUBLIC HEALTH TRUST OF
OF MONROE COUNTY DADE COUNTY, FLORIDA
Y
BY: BY:
Ti7gnatur SA qnature
C. CZ
(Name Typed or Prin ed) (Name Typed or Printed)
TITLE: A o _ck TITLE:
DANNY L. IMLEITAGE, Cleric DATE /1
WITNESS: h
6 4 by Risk Ma�nagc�=t�
A rov
Department
DATE:
pproved y Monroe County
A �rnp
_y's Off ice office as to form
and legal sufficiency
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and legal sufficiency
UNIVERSITY OF MIAMI
SC1-1OOL OF MEDICIN�
BY:
Signature
TITLE:
WITNESS:
DATE: _ �Qb
- 9 -
I
.
MEMORANDUM OF UNDERSTANDING
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 Services
Committee and has entered into agreement with the Health Council
of South Florida to aid in determining 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 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, 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
a
a
Page -1-
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, 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 of Miami'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 placement of
the patient in other facilities, with the understanding
that Monroe County's participation under this temporary
relationship would extend to that institution.
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
a
a
a
Page -2-
manner as to arrive within sixty (60) minutes of injury
4.
5.
6.
7.
to Baptist Hospital of Miami's Emergency Department.
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.
Paramedics and EMS personnel operating in or on
behalf of Monroe County will be required to 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.
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.
Prior to contact with Baptist Hospital of Miami
Emergency Department, the on scene paramedic or EMS
personnel will verify:
a) Availability, if required, of Dade County
Air - Rescue One, under Monroe County's agreement
with Dade County, for transport of patient
b) That the patient has trauma score 12, Coma score
10, or evidence of shock at the scene with
systolic BP 90.
a;
a
Page -3-
8.
c) Trauma victim has been exposed to a hostile
environment (e.g. hot, cold, or noxious fumes).
d) Trauma victim has experienced penetrating trauma
to the head, neck, chest or abdomen.
e) Trauma victim has experienced amputation.
f) Trauma victim has experienced major burns
requiring treatment at a burn center, including
40% BSA, involvement of facial area, possible
airway compromise.
g) Paralysis, drowning or electrocution, or
h) In extenuating circumstances where in the opinion
of the paramedic or EMS personnel in charge, that
the situation warrants air evacuation for reasons
not specifically listed above, in which case the
paramedic or EMS personnel may call for air
evacuation at his discretion confirmed by the
Medical Director or a member of the District
medical Board of the service involved.
i) In all events, the paramedic or EMS personnel on
the scene will verify with the Medical Director
involved the need for effecting this temporary
relationship prior to contact with Baptist
Hospital of Miami Emergency Department.
The relationship described is between Monroe
County and Baptist Hospital of Miami and does not
extend to Monroe County hospitals, that relationship
a,
a
a
Page -4-
being considered to be beyond the scope of this
a
10.
11.
temporary agreement.
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.
Monroe County agrees to guarantee Baptist Hospital
of Miami and the participating Hospital -based
physicians 80% of reasonable charges for each patient.
Where insurance coverage exists or the patient can
defray such costs, Baptist Hospital of Miami and its
physicians will bill and collect appropriately.
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 charges.
Baptist Hospital of Miami and its physicians will,
in turn, 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.
Monroe County, to aid in the effectiveness of and
as requirement for evaluation of this temporary
relationship shall require its Medical Director of any
a
Page -5-
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 treatment logs and reports, to the County
Administrator and Director of Emergency Medical
Services for statistical and effectiveness
determinations.
12. 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.
13. Monroe County further desires to retain as
designated appointees to further review the aspects of
this temporary relationship and to discuss the content
of a relationship extending beyond January 31, 1988
with Baptist Hospital of Miami the following
individuals: G. Joey Elam and Douglas Cullen, both 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.
IN WITNESS WHEREOF, the parties below have caused this
Memorandum of Understanding to be executed by their undersigned
officials as duly authorized.
a
a
a
Page -6-
BOARD OF COUNTY COMMISSIONERS
(SEAL)
Attest:
erk
11PP Gt. rD AS TO FOIa'a�✓;
A,rO R EGAk b Ur riCIff,'Cy
1
OF MONROE COUNTY, FLORIDA
jv
Mayor
Date: � - � i '- ( -87
BAPTIST HOSPITAL OF MIAMI
B SNw.
Date:
Page -7-
MEMORANDUM OF UNDERSTANDING
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
a
a
the Board of County Commissioners of Monroe County, Florida, on
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
a
a
beyond a twelve (12) hour time frame from occurrence of
4.
5.
any qualified severe trauma related injury. (See
Section 7)
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.
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
a
a
agreement with Dade County, for transport of
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 Baptist 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 5.C. above, together with other
information required by the Monroe County Office
a
a
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.
D.
E.
Initiate telephone contact with Baptist
Hospital of Miami Emergency Department physician
on call for verbal assessment of the patient
status and ability for transfer.
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.
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
a
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 (AILS) 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 5.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 5.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.
a
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9. FINANCIAL ASSURANCES
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
a;
a
of and as requirement for evaluation of this
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
5.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
a;
a
as indicated below, all obligations incurred on the
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
a;
a
Services Office shall be the certifier that the patient
15.
is a "Monroe County Government Memorandum of
Understanding patient" for the effectiveness of this
agreement, even when transferred from a Monroe County
hospital.
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.
a
a
B. Such Utilization Review shall be
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
a
a
patients identified by Baptist Hospital of Miami
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
a'
a
(305) 294 -4641 ext. 314, 315
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:
of
Mayor /Chairman
Date:
(Seal)
Attest: DANNY L. KOLHAGE, Clerk
a
a
<�h , k j 0. o . 1('1/1
Approved as to form
and legal sufficiency.
;2
B
Y�-
Attorney's Off ice
Date: q� 110
I
MEMORANDUM OF UNDERSTANDING
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
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 various Health Care Taxing Districts, by
Ordinance and has funded by millage assessment an Upper Keys
Health Care Taxing District for a period of up to five years to
not only provide for out -of- county transport and care for such
on -going severe trauma - related health care, but also to provide
for upgrading of in- county medical facilities so as to relieve
reliance upon out -of- county care for severe trauma related health
care, and
WHEREAS, previously 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, and Monroe County has entered
into previous agreements with Baptist Hospital of Miami, on
previous temporary bases to address its on -going severe
trauma- related emergency health care problems, and
WHEREAS, the Advisory Board of the Upper Keys Health Care
Tax District has recommended to the Board of County Commis-
sioners, acting as the governing body of the Upper Keys Health
Care Tax District their willingness and desire to enter into an
agreement with Baptist Hospital of Miami for a period of six (6)
months, effective January 1, 1989, under terms herein, subject to
cancellation notice by either party as provided below, for
accepting trauma patients from the Upper Keys Health Care Taxing
4.
411
This Memorandum of Understanding will not be
automatically effective if prospective patient
admission by Baptist Hospital of Miami is beyond a
twelve (12) hour time frame from occurrence of any
qualified severe trauma related injury.
The Upper Keys Health Care Taxing District will contact
representatives of the State of Florida concerning this
relationship any any conflict with EMS regulations and
Florida Statutes to assure that this relationship would
be allowed to continue under recently enacted
regulations.
TRANSFER FROM ON -SCENE
Paramedics and EMS personnel operating within the
geographical boundaries of the Upper Keys Health Care
Taxing District will be required to:
A. (1) 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.
(2) In those cases where EMS personnel other than
paramedics are on- scene, patients shall first be
transferred to Mariner's Hospital which shall
contact Baptist Hospital of Miami as provided for
in Section 7.
B. Initiate a Certificate of Eligibility form to be
completed by on -scene paramedic in charge and
forwarded to Baptist Hospital within 72 hours if
not completed and accompanied with medical records
from the scene.
A T__
(2) Or that trauma victim has experienced
amputation proximal to the hand or foot.
6. HOSPITAL RELATIONSHIPS - CASE - BY -CASE
The District Hospital from which transferal to Baptist
Hospital is to be accomplished under this agreement
shall require the signature of an authorized paramedic,
acting on behalf of the Upper Keys Health Care Tax
District, on a Certificate of Eligibility form as shown
in Exhibit A (attached), to accompany the patient,
which form certifies:
A. Verification of trauma score upon receiving such
patient, together with trauma score, coma score,
and other evidence of shock, as qualified in 5.C.
above, together with other medical records
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 are guaranteed by the Upper Keys
Health Care Taxing District in accordance with the
provisions of this agreement.
C. That there has been 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 Monroe
County residents when, in the opinion of Baptist
Hospital of Miami, Medical Foundation of South
Florida review, or other Utilization review agency
Hospital of Miami, subject to consideration of the time
frames described above; the Baptist Hospital of Miami's
receiving physician's acceptance of the patient; and
the availability of Baptist Hospital of Miami resources
on a priority basis, and other stipulations required
elsewhere in this agreement.
In those cases first transported to the District
Hospital, Baptist Hospital of Miami will require:
A. Initial Baptist Hospital of Miami Emergency
Department contact and notification to assure
coordination of further stabilization and advanced
FIN
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 7.C.)
C. Communication with the Medical Director of
Service, Dr. H. Richard Nateman, or his designee
at Baptist Hospital of Miami, 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 5.C., as
well as a Certificate of Eligibility form
appropriately certified.
METRO -DADE AIR RESCUE
All relations with Metro -Dade Air Rescue One are
reasonable and necessary charges for each uninsured
patient.
Where insurance or other coverage exists, or the
patient can defray such costs, or in those cases where
assignments are normally accepted by Baptist Hospital
of Miami, Baptist Hospital of Miami and its physicians
will bill and collect payment from those entities as
payment in full and shall not look to Monroe County in
such instances.
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 Upper Keys Health Care Taxing District 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 determination for those eligible and requiring
such aid.
Should circumstances dictate that these funds are
not collectible within ninety (90) days of service,
provided all information and forms have been correctly
completed and submitted to 3rd party payer, Monroe
County agrees to compensate Baptist Hospital of Miami
and its physicians 80% of those reasonable and
necessary charges as stipulated above.
Baptist Hospital of Miami and its physicians will,
in turn, verify charges and, as necessary, assign
insurance benefits and all causes of action for payment
to the Upper Keys Health Care Taxing District when paid
by Monroe County.
1 !1 VnPMQ PPnTTTRFMRMTG
the geographic area of the Upper Keys Health Care
Taxing District, which shall include reporting of
patient on -scene score report, Air - Rescue One or land
transport report, disposition of patient and follow -up
of hospital treatment logs and reports, to the County
Administrator and the Upper Keys Health Care Taxing
District for statistical and effectiveness
11.
determinations.
B. As indicated elsewhere within this Memorandum of
Understanding, Baptist shall require a Certificate of
Eligibility from Monroe County, per S.B., and complete
medical record to include emergency room report
transferal with the patient if transferred from a
Monroe County hospital.
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 the Upper Keys Health Care Taxing District,
under the terms of this Memorandum of Understanding, or
under any amendments thereto, prior to the date of
termination, shall be fulfilled as per the terms of
this Understanding, and as it may be amended.
A. It is understood that, since this agreement is
between Baptist Hospital of Miami and the Upper Keys
Health Care Taxing District, physician services are not
herein provided, immediate termination by Baptist
Hospital of Miami is permitted when circumstances arise
wherein physician services are no longer available.
B. It is understood that all obligations hereunder
a
subiect to availability of anvrovria
obligations hereunder, except for Monroe County's
financial obligations incurred under this agreement.
12. PATIENT REVIEW /CASE MANAGEMENT
This Memorandum of Understanding is intended to serve
the interests of patients in severe trauma- injury status.
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 and no guarantees of payment are
made in connection therewith.
Therefore, the following patient /case review procedures
are instituted:
A. The Upper Keys Health Care Taxing District and
Baptist Hospital of Miami and its medical staff and
administration agree to participate in a Utilization
review in order to concurrently review and monitor the
medical and social needs of the patient, and
effectively utilize available resources under this
agreement.
The review 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 all cases. The Upper Keys Health Care
Taxing District and Baptist Hospital of Miami shall
monthly review the status of all phases of this
agreement.
C. Additional independent review may be initiated by
either party to this agreement with a utilization
review authority, with costs being borne by the Upper
Keys Health Care Taxing District, for medical /social
determinations as to when the purpose of this agreement
principal representatives and physicians to discuss the
finances of a particular patient, the proper use of the
resources or funds of the Upper Keys Health Care Taxing
District and Baptist Hospital of Miami, and any other
issues which might arise.
13. PATI 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 agree-
ment, upon notification to the other party and
concurrence of the patient or his representative and
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 (acting on behalf of the
Upper Keys Health Care Taxing District) will, during
hospital admission procedures, 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.
C. Any such transfer to alternate facilities shall be
mandated under this agreement when medically
appropriate, subject to 13 A. above.
14. AGREEMENT IMPLEMENTATION
A. Contract persons for agreement implementation for
Monroe County are to be as follows:
2. Upper Keys Health Care Taxing District
Mrs. Alison Fahrer, Chairman
Upper Keys Health Care Taxing District
P.O.Box 447
Islamorada, Florida 33036
(305)664 -4704
3. Billing Submission for clearance
Above 11. on an interim basis
4. Payment (after clearance)
Clerk of the Commission
Mr. Danny Kolhage
500 Whitehead Street
Key West, Florida 33040
(305)294 -4641 ext. 314, 315
5. Social Service Aid
Monroe County Social Services Department
Mr. Louis LaTorre
1315 Whitehead Street
Key West, Florida 33040
(305)294 -4641 ext. 506 -509
B. Contact persons for Baptist Hospital of Miami are
as follows:
1. Overall Coordinator
Dr. H. Richard Nateman
Medical Director
Baptist Hospital of Miami Emergency Services
(305)596 -1960 ext. 6292
2. Billing information
Mr. Richard De Soto
a
a
Assistant Comptroller and Patient Accounts
(305)596 -1960 ext. 6218
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
1 ,
(SEAL)
Attest: DANNY L. KOLHAGE, Clerk
i
5 P jjjr'/'
.�� -
BAPTIST HOSPITAL OF MIAMI
By
Title �•�
Date 6. lb -s
Witnesses
APPROVED AS TO FORM
AND LEGAL SUFFICIENCY
Attorney's Oo ice 1
a
EXHIBITS
A. Certificate of Eligibility
B. Protocol
C. Patient Waiver
I
a
a
Certificate of Eligibility
Upper Keys Health Care Taxing District
Name:
Address:
Phone:
DOB: Sex: Age: SS #:
Insurance: Policy #:
Address:
Type:
Employer:
Relative or responsible party:
Address:
Phone:
Local Doctor:
On -Scene Information:
EMS Unit:
Description event:
Vitals:
Local Hospital:
Date:
Via EMS Unit # or other:
Time:
Trauma Score, Coma Score, RP qualifications:
Attending Physician:
Local Hospital notes:
a'
a
MONROE COUNTY
Upper Keys Health Care Taxing District
Protocol for Baptist Agreement - Trauma
FROM SCENE TRANSPORT
1. Verify Air Rescue - if unavailable, transport to
nearest hospital or Baptist, whichever is closer.
If nearest hospital, FROM HOSPITAL protocol below
controls.
2. Contact Baptist ER or Dr. H. Richard Natemen -
596 -1960.
3. Verify Trauma Score 12, Coma Score 10, Shock with BP
90, amputation for qualification.
4. Complete Certificate of Eligibility if direct
transport.
5. Send Certificate of Eligibility with patient. Copy to
Upper Keys Health Care Taxing District Office.
FROM HOSPITAL
1. Verify Trauma Score, Coma Score, Shock with BP 90,
amputation.
2. Contact Baptist ER or Dr. H. Richard Natemen -
596 -1960.
3. Verbally review with Baptist requirements of
pre- transport care.
4. Confirm Air Rescue availability.
5. Complete Certificate of Eligibility.
6. Obtain EMS eligibility signature
7. Transport with all records and Certificate of
Eligibility via land or Air Rescue (availability).
8. Time frame limited to 12 hours.
9. Send Certificate of Eligibility copy to UKHCTD Office,
a
Trauma Care District Personal Liability and
Wai ver of County and District Liabi Subrog Form
patient
I,
or representative of the patient, hereby covenant and agree with
Monroe County, Florida, and any dependent special districts
thereof, as follows:
1. To personally compensate and reimburse the County and
districts for any and all sums expended on my behalf by the
County or districts which are necessary to obtain short -term
emergency treatment at Baptist Hospital of Miami for severe
trauma related injury and for which the County and districts are
not reimbursed by third parties within 90 days of the date
written below;
2. To subrogate for the benefit and use of the County and
districts the benefits of any proceeds from a contract of insur-
ance or other legal obligation to pay any of the debts arising
from the medical emergency necessitating treatment at Baptist
Hospital of Miami up to the amount expended by the County and
districts on my behalf in obtaining treatment.
3. To release and covenant not to sue Monroe County and any
districts from any and all liability for any injury suffered or
the aggravation of an existing condition arising from either any
trauma scene emergency medical treatment provided by Monroe
County or the districts or from transport provided to Baptist
Hospital of Miami by Monroe County or the districts.
Signed and executed this the day of
19
STATE OF FLORIDA )
COUNTY OF )
Before me personally appeared
a
A MEMORANDUM OF UNDERSTANDING is hereby entered into for a
period of six (6) months, beginning January 1, 1989, with
provisions for interim coverage prior to that date, as mutually
agreed upon on December 14, 1988, between the Board of County
Commissioners of Monroe County, Florida, as governing body of,
and acting on behalf of the people of the Upper Keys Health Care
Taxing District, and Baptist Hospital of Miami for severe trauma -
related emergency health care, wherein both parties agree to the
following:
1. The Upper Keys Health Care Taxing District 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 have
agreed to make severe trauma - related emergency health
care available to the visitors and residents of the
Upper Keys Health Care Taxing District, except that
demands for emergency or other critical services will
saturate Baptist Hospital's limited resources from time
to time, when Baptist Hospital of Miami's resources are
saturated so as to prohibit patient acceptance under
this relationship, Baptist Hospital of Miami will
assist in placement of the Upper Keys patients in other
suitable or appropriate 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
or following stabilization of the patients by Mariner's
Hospital and in accordance with Section 7 herein, at
Baptist Hospital of Miami's Emergency Department.
ADDENDUM
TO
MEMORANDUM OF UNDERSTANDING
WHEREAS, the Board of County Commissioners of Monroe County,
on December 20, 1988, indicated their desire to enter into a
Memorandum of Understanding with Baptist Hospital of Miami for
care of trauma related injuries from the Upper Keys Health Care
Taxing District, by affixing their signature to such Memorandum
of Understanding, and
WHEREAS, Baptist Hospital of Miami desires to add or clarify
certain wordings and paragraphs of that same Memorandum of
Understanding, and
WHEREAS, the Advisory Board of the Upper Keys Health Care
Taxing District has reviewed such recommendations and clarifica-
tions desired by Baptist Hospital of Miami, and
WHEREAS, the Upper Keys Health Care Taxing District Advisory
Board has recommended to the Board of County Commissioners,
sitting as the governing body of the Upper Keys Health Care
Taxing District that such additions and clarifications be at-
tached to and become a part of the Memorandum of Understanding
signed by the Board of County Commissioners on December 20, 1988,
therefore,
The following additions, deletions and corrections are made
and incorporated into the Memorandum of Understanding between the
Board of County Commissioners and Baptist Hospital of Miami.
I. Amend item 4, page 3, covering general terms of the
Memorandum of Understanding to read as follows:
"4. Pursuant to Baptist Hospital of Miami's request
that the Upper Keys Health Care Taxing District will
the only issues which are under the jurisdiction of the
Office of Emergency Medical Services, State of Florida
Department of Health and Rehabilitative Services, and
that their indications are that the contract need not
contain language relating to trauma transport protocols
but that no agreement between the Upper Keys Health
Care Taxing District or Monroe County and any hospital
will negate or modify that the hospital's responsibil-
ity to comply with the Florida Statutes (F.S.), partic-
ularly with reference to section 394.0142."
II. Pursuant to the above recommendation of the Office of
Emergency Medical Services, State of Florida Department of Health
and Rehabilitative Services, modify Section 5, Transfer From
On- Scene, subparagraph C, to read:
"C. Prior to contact with Baptist Hospital of
Miami Emergency Department, the on -scene paramedic will
verify at a minimum:
(a) That the patient has trauma score 12, coma score
10, or evidence of shock at the scene with systolic BP
90.
(2) Of that trauma victim has experienced amputation
proximal
to the
hand or
foot.
(3) Any
other
trauma
triage as may be required in
trauma transport protocols."
III. Section 6, Paragraph E, is hereby added, to read:
11 6. E. Baptist Hospital shall be entitled to
conclusively rely upon the signature of a Monroe County
official on the Certificate of Eligibility (attached as
Exhibit A) as being an authorized paramedic acting on
behalf of the Upper Keys Health Care Taxing District,
admitted without said Certificate of Eligibility, or
signed by other than an authorized person as above."
IV. Amend the second paragraph of Section 9 to read:
"Where insurance or other coverage exists, or
those cases where assignments are normally accepted by
Baptist Hospital of Miami, Baptist Hospital of Miami
and its physicians will charge and collect payment from
those entities. Should health or liability insurance
coverage be less than 807 of the charges, the Upper
Keys Health Care Taxing District agrees to compensate
Baptist Hospital of Miami and its physicians for the
difference between collections and 807 of charges."
V. Add as the first paragraph of Section 11, Cancellation
of Agreement, the following:
"Either party may terminate this agreement, with
or without cause, upon thirty days written notice to
the other party." Then continue with section as
'
written.
VI. Add as a second paragraph in Section 12, Patient
0
Review /Case Management, the following:
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0
"Acknowledging that this agreement is for trauma
c
care, this agreement also covers the acute recovery
CL
phase of the patient's health care needs in circum-
stances when the patient is not yet able to be trans-
c
0
ferred to another facility. Through the efforts of the
Upper Keys Health Care Taxing District, our mutual
Social Services staff and a third party Utilization
Management consultant, Baptist Hospital and the Upper
Keys Health Care Taxing District agree to collaborate
on case review /management aimed toward the discharge
will be used as a focal point to monitor and effect the
plans for discharge of each patient under this agree-
ment."
VII. Modify Section 13, Patient Transferability, paragraph
A, to read:
"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), or to transfer to another facility, and that
it is apparent that such benefits /alternate facility
may be utilized by the patient, either party to this
agreement, upon notification to the other party, and
the concurrence of the patient or his representative,
0
the attending physician and the receiving facility, may
U)
effect the transfer of the patient to the receiving
facility for such above benefits, and thereby terminate
obligations beyond those incurred as part of this
Cq
agreement at the time of transfer."
-
IN WITNESS WHEREOF, the parties below have caused this
4-
0
Addendum to the Memorandum of Understanding dated December 20,
1988, to be executed by their undersigned officials as duly
CL
authorized.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
Mayor/ airman
Date 1-4 __ - - rr
(SEAL)
Attest:
DANNY L. WLHAGE, er
}
RESOLU NO. 246 -1990
A RESOLUTION OF THE BOARD OF COUNTY COMMIS-
SIONERS OF MONROE COUNTY, FLORIDA, AUTHORIZING
THE MAYOR /CHAIRMAN OF THE BOARD TO EXECUTE TRAUMA
CARE AGREEMENT WITH KEYS HOSPITAL FOUNDATION,
INC. D /B /A MARINERS HOSPITAL (THE DISTRICT
HOSPITAL) CONCERNING EMERGENCY TRAUMA- RELATED
HEA LTH CARE.
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, that the Mayor /Chairman of the Board is
hereby authorized to execute a trauma care agreement with Keys
Hospital Foundation, Inc. d /b /a Mariners Hospital, a copy of same
being attached hereto and made a part hereof, concerning
emergency trauma - related health care.
PASSED AND ADOPTED by the Board of County Commissioners of
Monroe County, Florida, at a regular meeting of said Board held
on the 18th day of April A.D. 1990.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
BY:
MN
(Seal)
A t t e s t: DANNY I; KOLIIAGE, Clerk
a
APPf?C)Vp A,S 1'P rook,
TRAUMA CARE AGREEMENT
WHEREAS, the Board of County Commissioners of Monroe County
has, by Ordinance No. 008 -1988 (amended by Ordinances 041 -1988
and 052 -1988) created the Upper Keys Health Care Taxing District
for the purposes of providing certain health and trauma care,
and,
WHEREAS, aforesaid Ordinance provides for the designation of
"the District Hospital" for the purposes of receiving funds from
the Upper Keys Health Care Taxing District, which was
accomplished by Board of County Commissioner's Resolution No.
298 -1989, and
WHEREAS, aforesaid Ordinance provides that funds may be
paid, as aid for off - setting costs of pre- transport treatment, if
unassumabl..e by the patient, to the District Hospital for pre -
transport hospital and physician care, if necessary, prior to
transfer to medical institutions outside of Monroe County, and
WHEREAS, upon recommendation of the Upper Keys Health Care
Taxing District Advisory Board, the Board of County
Commissioners, sitting as the governing body of the Upper Keys
Health Care Taxing District has recommended to the governing body
the need and desirability to enter into this agreement with Keys
Hospital Foundation, Inc., DBA Mariners Hospital for ordinanced
purposes, therefore,
The following Trauma Care Agreement is entered into between
the Board of County Commissioners, acting as the governing body
of the Upper Keys Health Care Taxing District and Keys Hospital
Foundation, Inc., DBA Mariners Hospital:
Section 1. Purpose
a;
The purpose of this agreement is to formalize
an arrangement whereby the Upper Keys Health Care
such care is unassumable by the patient, and as
qualified elsewhere within this agreement.
Se ction 2. P rovisions
a) Mariners Hospital agrees to treat patients, in
its Emergency Room, who qualify for pre- transport
treatment prior to transfer to medical
institutions outside of Monroe County, and who are
being handled under other provisions of the Upper
Keys Health Care Taxing District as to criteria in
place with accepting institutions outside of
Monroe County.
Such criteria shall be, at a minimum:
1) Trauma Score 12, coma. score 10, or
evidence of shock at the scene with
systolic BP 90 or below.
2) or that the trauma victim has
experienced amputation proximal to the
hand or foot.
3) Or any other_ trauma triage as may be
required in trauma transport protocols.
4) And that a Certificate of Eligibility
has been signed by one of the designated
Trauma Transport Officers.
Such care offered by Mariners Hospital shall
be to assure stabilization and other advanced
trauma life support (ATLS) actions sufficient to
enable transportation to other institutions
outside of Monroe County for additional treatment
'or such trauma- related injury which cannot be
provided.by Mariners Hospital.
As part of such emergency room treatment,
a;
complete medical records, to include emergency
room report, with the patient when transferred to
institutions outside of Monroe County. Mariners
Hospital shall also obtain the signature of an
authorized paramedic, acting on behalf of the
Upper Keys Health Care Taxing District, on a
Certification of Eligibility form to accompany the
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patient.
b) Mariners Hospital agrees to bill any
insurance carrier which such trauma- injury related
patients may have, and to bill such trauma- related
r_
injury patients themselves for all balances not
0
covered by insurance.
c) Mariners Hospital agrees to bill Upper Keys
Health Care Taxing District for such trauma-
related injury patients who are not covered by any
insurance carriers and have no means of paying for
their pre- transport trauma - related injury care at
CL
0
0
Mariners Hospital, including but not limited to
Emergency Room fees, ancillary fees to include but
not be limited to laboratory fees, X -ray fees,
Respiratory therapy fees, etc.
d) For those patients listed in c) above, the
Upper Keys Health Care Taxing District agrees to
pay 80% of such patient's accrued charges and
Mariners Hospital to absorb the remaining 20% of
such patient's accrued charges.
e) Mariners Hospital agrees to accept the
assignment of Medicare and Medicaid patients as
payment in full.
f) Mariners Hospital agrees to allow the Upper
r J�
of receipt of bill from Mariners Hospital for any
qualifying patient, not awaiting Medicaid
eligibility.
h) The Board of County Commissioners, acting'as
governing body of the Upper Keys Health Care
Taxing District, to aid in the effectiveness of
and as requirement for evaluation of this
agreement, shall require the Medical Director of
any Monroe County Emergency Services District
involved to implement criteria and protocols
included herein regarding patients transported to
Mariners Hospital under this agreement from within
the geographic area of the Upper Keys Health Care
Taxing District, which shall include reporting of
patient on - scene score report, Air Rescue One or
land transport report, disposition of patient and
follow -up of hospital treatment logs and reports,
to the County Administrator and the Upper Keys
Health Care Taxing District for statistical and
effectiveness determinations.
} The Upper Keys Health Care Taxing District
and Mariners Hospital and its medical staff and
administration agree to participate in a
Utilization Review in order to determine any
disputed medical or social needs of the patient,
to be able to effectively utilize available
resources under this agreement.
Section 3 Termination
a) Either party may terminate this agreement,
with or without cause, upon thirty (30) days
written notice to the other party.
termination, shall be fulfilled as per the terms
of this agreement, and as it may be amended.
IN WITNFSS WHEREOF, the parties below have caused this
C
agreement to be executed by their undersigned officials as duly
a.ithorized.
L
HOARD OF COUNTY COMMISSIONERS
0
OF MOMR.0 . COUNTY, FI.ORID�
BY -
P
Date 0 (�
(SEAL) Y �
Attest DANNY L KOLHAGE, Clerk
_ �•
erk -- —
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KEYS H AL FOUNDATION, INC. 0
DBA& RS T
By ,
Title_ ruet ti'+R'fo tom_
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ACCOUNT NO. 072100000032
REFERENCE 500850 4312787
AUTHORIZATION
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COST LIMIT 7k
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--------------------------------------------
ORDER DATE :
ORDER TIME :
ORDER NO. :
CUSTOMER NO:
March 28, 2002
11: 41 AM
500850
4312787
**PLEASE FILE 2ND***
CUSTOMER: Kyle Saxon, Esq
7 0 0 0 0 1 r4 E" E — e
Catlin Saxon Tuttle And Vans,
Alfred I. Dupont Bldg., #1700
169 E. Flagler Street
Miami, FL 33131
-------------------------------------------------------
DOMESTIC AMENDMENT FILING
CO
NAME: KEYS HOSPITAL FOUNDATION,
INC.
.7
j
EFFICTIVE DATE:
C.
XX ARTICLES OF AMENDMENT
COW11 su
RESTATED ARTICLES OF INCORPORATION
e
M 2
6 2002
PLEASE RETURN THE FOLLOWING AS PROOF OF FILING:
XX CERTIFIED COPY
PLAIN STAMPED COPY
CERTIFICATE OF GOOD STANDING
CONTACT PERSON: Susie Knight -- EXT# 1156
EXAMINER'S INITIALS:
By majority vote of the Board of Directors and the Members of Keys Hospital
Foundation, Inc., at a meeting held on February 27, 2002, at which a quorum was present,
the Board of Directors and the Members adopted the following amendments to the
Articles of Incorporation: with such amendments to be effective as of March 2 .f" , 2002:
1. The name of the corporation in the heading of the Articles of
Incorporation is changed from "KEYS FOUNDATION, INC.." to
"MARINERS HOSPITAL, INC."
2. Article I is amended to read as follows:
ARTICLE I — NAME AND ADDRESS
The name of the Corporation shall be MARINERS HOSPITAL, INC.,
with its principal place of business located at 91500 Overseas Highway,
Tavernier, Florida 33070.
These Articles of Amendment were duly adopted by the Board of Directors and Members
of the Corporation on February 27, 2002, and by the Board of Trustees of Baptist Health
South Florida, Inc., formerly known as Baptist Health Systems of South Florida, Inc., on
March I S" , 2002, and the number of votes cast for the Amendments by the Directors
and Members of the Corporation and by the Board of Trustees of Baptist Health South
Florida, Inc., formerly known as Baptist Health Systems of South Florida, Inc., was
sufficient for approval. The Amendments included in these Articles of Amendment have
been adopted pursuant to Sections 617.1002 and 617.1006, Florida Statutes and there is
no discrepancy between the Articles of Incorporation as previously filed and amended
and the provisions of these Articles of Amendment other than the inclusion of the
Amendments adopted pursuant to Sections 617.1002 and 617.1006, Florida Statutes.
IN WITNESS WHEREOF, the undersigned Chairman and Secretary of the Board
of Directors of the Corporation have executed these Articles of Amendment on February
27, 2002, and the undersigned Chairman and Secretary of the Board of Trustees of
Baptist Health South Florida, Inc., formerly known as Baptist Health Systems of South
Florida, Inc., have executed these Articles of Amendment on March Zr , 2002 ' for the
purpose of amending the Articles of Incorporation of the Corporation. The undersigned
certify that no actions have been taken since the votes of their respective boards to
Articles of Amendment
��
s
To The Articles of Incorporation
="'
`-
cn -
co
r
,.
rn c
of
-_
KEYS HOSPITAL FOUNDATION, INC.
c�
(a Not For Profit Corporation)
By majority vote of the Board of Directors and the Members of Keys Hospital
Foundation, Inc., at a meeting held on February 27, 2002, at which a quorum was present,
the Board of Directors and the Members adopted the following amendments to the
Articles of Incorporation: with such amendments to be effective as of March 2 .f" , 2002:
1. The name of the corporation in the heading of the Articles of
Incorporation is changed from "KEYS FOUNDATION, INC.." to
"MARINERS HOSPITAL, INC."
2. Article I is amended to read as follows:
ARTICLE I — NAME AND ADDRESS
The name of the Corporation shall be MARINERS HOSPITAL, INC.,
with its principal place of business located at 91500 Overseas Highway,
Tavernier, Florida 33070.
These Articles of Amendment were duly adopted by the Board of Directors and Members
of the Corporation on February 27, 2002, and by the Board of Trustees of Baptist Health
South Florida, Inc., formerly known as Baptist Health Systems of South Florida, Inc., on
March I S" , 2002, and the number of votes cast for the Amendments by the Directors
and Members of the Corporation and by the Board of Trustees of Baptist Health South
Florida, Inc., formerly known as Baptist Health Systems of South Florida, Inc., was
sufficient for approval. The Amendments included in these Articles of Amendment have
been adopted pursuant to Sections 617.1002 and 617.1006, Florida Statutes and there is
no discrepancy between the Articles of Incorporation as previously filed and amended
and the provisions of these Articles of Amendment other than the inclusion of the
Amendments adopted pursuant to Sections 617.1002 and 617.1006, Florida Statutes.
IN WITNESS WHEREOF, the undersigned Chairman and Secretary of the Board
of Directors of the Corporation have executed these Articles of Amendment on February
27, 2002, and the undersigned Chairman and Secretary of the Board of Trustees of
Baptist Health South Florida, Inc., formerly known as Baptist Health Systems of South
Florida, Inc., have executed these Articles of Amendment on March Zr , 2002 ' for the
purpose of amending the Articles of Incorporation of the Corporation. The undersigned
certify that no actions have been taken since the votes of their respective boards to
modify or rescind the adoption of the Amended and Restated Articles as provided herein
and that said adoption remains in full force and effect.
(CORPORATE
SEAL)
Attest: /�4
Charlen Regan, SecretarjZ&
the Board of Directors
(CORPORATE
SEAL)
George Cadman, III, Chairman of the Board
of Trustees of Baptist Health South Florida, Inc.,
formerly known as Baptist Health Systems of
South Florida, Inc.
Attes
Rev. David W. Cleeland, Secretary
of Baptist Health South Florida, Inc.,
formerly known as Baptist Health
Systems of South Florida, Inc.
STATE OF FLORIDA
COUNTY OF MONROE
The foregoing instrument was acknowledged before me this day of
February, 2002, by Jay A. Hershoff and Charlen Regan, the Chairman and Secretary,
respectively, of the Board of Directors of Keys Hospital Foundation, Inc. They are
personally known to me.
s
�z 1-1
N tary Pub tic, State of Florida
My Com Iission Expires:
OI=F1 N ARYSF.AL
GISI I.LE SANAMUA
NMARY gUBUC STATE OF FLOODA
COMMISSION NO. CC9
MX CotrIMI55ION EXP. AN. 3_1
a
2
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The foregoing instrument was acknowledged before me this - grA day of March,
2002, by George E. Cadman, III and Rev. David W. Cleeland, the Chairman and
Secretary, respectively, of the Board of Trustees of Baptist Health South Florida, Inc.,
formerly known as Baptist Health Systems of South Florida, Inc. They are personally
known to me.
Notary Public, State of Florida
My Commission Expires:
p OFFICIAL NOTARY SEAL
�
'0
KYLE R SAXON
K. e
CO M USSI ON N U MSER
CC788864
pI ��
�OF fV
PAY COMMISSION EXPIRES
NOV_ 26,2002
3