09/21/1995 Agreement GOON?), 'o
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;Danny I. 1aot1jage
BRANCH OFFICE
CLERK OF THE CIRCUIT COURT BRANCH OFFICE 3117 OVERSEAS HIGHWAY MONROE COUNTY 88820 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050 500 WHITEHEAD STREET PLANTATION KEY, F L O 3051 885 330770
TEL. (305) 289 -6027 KEY WEST, FLORIDA 33040
TEL. (305) 292 -3550
M E M O R A N D U M
TO: Reggie Paros,
Director of Public Safety
Attn: Teresa Burgess,
Emergency Medical Services
FROM: Isabel C. DeSantis, Deputy Clerk ,D,C,t.
DATE: October 11, 1995
At the September 21, 1995 meeting, the Board granted approval and
authorized execution of a Contract between Monroe County and
Professional Emergency Services (PES) to perform as Medical
Director for Monroe County Emergency Medical Services, in the
amount of $38,400.
Attached hereto is a duplicate original of the subject document
for return to the Medical Director.
Should you have any questions concerning the above, please do not
hesitate to contact me.
cc: County Attorney
County Administrator w/o document
Risk Management w/o document
Finance Director
1
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MEDICAL DIRECTOR CONTRACT
THIS CONTRACT, made and entered into effective this 21st day of
September 1995 by and between the Board of County
Commissioners, Monroe County, Florida, hereinafter referred to as the
"COUNTY" and Professional Emergency Services,, hereinafter referred to as
the "MEDICAL DIRECTOR ".
W I T N E S S ,E;, T H : �� pp .11
WHEREAS, the COUNTY provides pre - hospital emergency md..cal
services pursuant to Chapter 401, Florida Statutes, in theSfoll.9aing
geographic areas: Cow Key Channel to Mile' Marker 95 on U. S.1,'"§out1D Bay
Harbor Drive and Lobster Lane; also known as the Lower and Middle keys
Fire and Ambulance District and Municipal Services Taxing District 5, 44d
70 t y
N
WHEREAS, the COUNTY is required by Section 401.2651,1 F1gida
Statutes to employ or contract with a medical director who &t 11 tgh a
licensed physician; a corporation, association or partnership composed of
physicians; or physicians employed by any hospital which delivers
in- hospital emergency medical services and which employs or contracts with
physicians specifically for that purpose; and
WHEREAS, the COUNTY wishes to contract with a MEDICAL DIRECTOR
for the purpose of providing direction to the Emergency Medical Services;
and
WHEREAS, the MEDICAL DIRECTOR is licensed in the State of
Florida and desires to provide professional services as the Monroe County
Medical Director according to the terms and conditions stated herein.
NOW, THEREFORE, in consideration of the mutual understandings
and agreements set forth herein, the COUNTY and MEDICAL DIRECTOR agree as
follows:
1. Scope of the Work
The Medical Director shall perform the services as described in Paragraph
5, in the Notice of Request for Proposals - Medical Director dated May 15,
1995, and as described in the Medical Director's Bid Proposal dated June
15, 1995, both of which are hereto attached and made part of this
Agreement.
2. Term.
This Contract shall become effective on October let, 1995 and shall run
through September 30th, 1997, and shall be renewable thereafter at the
option of the COUNTY for an additional one (1) year period.
3. Termination.
This Contract may be terminated by either of the two parties without
cause, upon not less than ninety (90) days written notice to the other.
However, the Contract can be terminated immediately in the event that
either party fails to fulfill any of the terms, understandings or
covenants of this contract.
4. Purpose.
The purpose of this Contract is to assist the COUNTY in operation of its
emergency medical services system.
5. Duties and Responsibilities:
The Medical Director shall be responsible to the EMS Department of the
Division of Public Safety and report to the Emergency Medical Services
Operations Manager.
The Medical Director shall adhere to the responsibilities as set forth in
Florida Statues 401, Medical Directors. These include supervising and
assuming direct responsibility for the medical performance of the
emergency medical technicians and paramedics operating for that emergency
medical services system. The medical director shall perform duties
including advising, consulting, training, counseling, and overseeing of
services, but not including administrative and managerial functions. The
Medical Director will provide 48 hours of formal training (lecture topics
and dates listed under Scope of Service) which will allow each Monroe
County EMT and Paramedic to fulfill the continuing education requirements
for bi- annual State of Florida recertification.
Additionally, a BLS -C, ACLS course, as well as required HIV -AIDS course
will be given. Annually, the Professional Education Program will be
evaluated for content, location, and dates.
The Medical Director shall adhere to the duties and responsibilities as
set forth in Florida Administrative Code 10D -66, Emergency Medical
Services, Medical Direction.
The Medical Director shall be available 24 hours a day for emergency
consultations with system EMS providers. He /She shall carry a pager and
be supplied a radio by the EMS Department. He /She shall respond in a
timely manner to any pages from the Communications Center. In the event
the Medical Director is unavailable he /she shall appoint a similarly
qualified physician to cover all responsibilities.
The Medical Director may appoint a qualified individual to perform certain
duties and responsibilities as outlined in this agreement, upon approval
of the EMS Operations Manager.
Protocols:
The Medical Director shall provide an annual documented review and
revision of the pre - hospital treatment protocols and shall jointly
approve each protocol prior to implementation. These protocols shall be
developed with consideration to the fiscal impact of such protocols on the
participating agencies and the citizens of Monroe County.
Deviations from these protocols shall be reviewed by the Medical Director
and appropriate corrective action shall be suggested to the EMS provider.
Notification to State and local agencies shall be completed in accordance
with the appropriate laws.
Quality Assurances
The Medical Director shall establish a quality assurance committee to
provide for quality assurance review of all emergency medical technicians
and paramedics operating under his /her supervision and function as an
integral part of the County's Quality Assurance program.
The Medical Director shall periodically review run reports for
completeness and compliance with the established pre - hospital protocols.
Each appointee to the Medical Director's staff shall function as an
observer in an emergency unit a minimum of three hours per month. The
Medical Director shall not be required to provide direct patient care
during this activity.
Local Disasters:
In the event of a local disaster or impending emergency situation with the
possibility of multiple casualties, the Medical Director or an appointee
shall be available for emergency consultation.
State Involvements
The Medical Director shall become involved in the Florida Association of
EMS Medical Directors.
Cost Containments
The Medical Director shall periodically review all policies and
procedures for cost effectiveness. Providing state of the art emergency
medical services to the citizens of Monroe County in the most cost
effective manner should be a top priority of the Medical Director.
Exposure Controls
The Medical Director will assure that a comprehensive plan exists for
prompt medical review of all possible infectious exposures reported by
Monroe EMS personnel, and for post- exposure medical follow -up when
indicated, in compliance with State and Federal requirements.
The Medical Director or designee shall :. be available for consultations with
field personnel to determine the significance of any body fluid exposure
and to suggest appropriate action for such an exposure.
6. Compensation.
(a) Payment for services provided shall be at the annual rate
not to exceed $38,400 DOLLARS to be paid in twelve equal monthly payments.
(b) Original Invoices shall be submitted for review by the
COUNTY on or before the tenth (10th) calendar day of each month. The
COUNTY's Public Safety Division Director or his designee shall verify the
itiformation submitted and then process an original invoice for payment by
the County Finance Office.
(c) Monroe County's performance and obligation to pay under this
contract is contingent upon an annual appropriation by the Board of County
Commissioners.
Public Entity Crime Statement
A person or affiliate who has been placed on the convicted vendor list
following a conviction for public entity crime may not submit a bid on a
contract to provide any goods or services to a public entity, may not
submit a bid on a contract with a public entity for the construction or
repair of a public building or public work, may not submit bids on leases
of real property to public entity, may not be awarded or perform work as a
contractor, supplier, subcontractor, or consultant under a contract with
any public entity, and may not transact business with any public entity in
excess of the threshold amount provided in Section 287.017, for CATEGORY
TWO for a period of 36 months from the date of being placed on the
convicted vendor list.
Ethics Clause
(Person or business entity) warrants that he /it had not employed, retained
or otherwise had act on his /its behalf any former County officer or
employee subject to the prohibition of Section 2 of Ordinance No. 010 -1990
or any County officer or employee in violation of Section 3 of Ordinance
No. 020 -1990. For breach or violation of this provision the County may,
in its discretion, terminate this contract without liability and may also,
it its discretion, deduct from the contract or purchase price, or
otherwise recover the full amount of any fee, commission, percentage,
gift, or consideration paid to the former County officer or employee.
Hold Harmless Clause
Professional Emergency Services shall defend, indemnify and hold the
COUNTY harmless, as outlined on the attached form identified as IND1,
attached hereto and incorporated as part of this contract document.
Insurance
Professional Emergency Services will be responsible for all necessary
insurance coverage as indicated by the attached form identified as MED2
attached hereto and incorporated as part of this Contract Document.
•
IN WITNESS WHEREOF, the parties hereto have set their hands on the
date first written above at
Florida. r , Monroe County,
PROP ;$S I • ' AL EMERGENCY SERVICES
BY* /4 411 --
8 i",'..r I R, D.O.
■N H ess
�.�Q Q , 4/1(ce).
Witness
BOARD Or COUNTY COeMMISSIONERS
Or MOLAR COUNTY, BYe !'L"OR
• J
"Leg 4244
SEAL) MAYOR/ IAMMJ
Attests DANNY L KOLHAGE, Clerk
CLERIC
AOVEDASmFn".
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ZO•d T00 oN TO:ZT S6'90 daS TS2 Z6Z S02:131 *A3Nd011U AINl03*
PURCHASING - DEPT. ID:3052924515 AUG 30'95 12:29 No.011 P.02
REC tiVrit
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u 1995
ruisiN
NOTICE OF =vim FOR PROPOSALS
NOTICE IS HEREBY GIVEN TO WHOM IT MAY CONCERN that on June
20 , 1995 at 10:00 a.m., at the office of the Director of
Purchasing, a committee consisting of the Director of Purchasing,
the County Administrator, the County
his y designeey will open Division
sealed
Director of Public Safety, or
proposals for the following:
MEDICAL D I R E C T O R
Emergency Medical Services, Monroe County, Florida
District 1 and District 5
"SCOPE Or WORK"
The services provided shall be as described in the RFP speci-
fications and shall include but not necessarily be limited to
the following:
1. The Medical Director shall be responsible to the EMS
Department of the Division of Public Safety and report
to the Director of the Division of Public Safety.
2. The Medical Director shall'COmply with the responsibili
ties as set forth in Florida Statues 401, Medical Direc-
tors. These include supervising and assuming direct
responsibility for the medical performance of the emer-
gency medical technicians and paramedics operating for
that emergency medical services system. The medical
director shall perform duties including advising, con-
sulting, training, counseling, and overseeing of servic-
es, but not including administrative and managerial
functions.
3. The Medical Director shall comply with the duties and
responsibilities as set forth in Florida Administrative
Code 10D -66, Emergency Medical Services, Medical Direc-
tion.
4. The Medical Director shall be available 24 hours a day
for emergency consultations from system EMS provider.
He /She shall carry a pager and be supplied a radio by
the Division of Public Safety. He /She shall respond
PURCHASING -DEPT. ID: 3052924515 AUG 30'95 12:29 No.011 P.03
I .
.
in a timely manner to any pages from the Communications
Center. In the event the Medical Director shall be
unavailable he /she shall appoint a similarly qualified
physician to cover all responsibilities.
All proposals must be received by the office of the Director
of Purchasing, 5100 College Road, Public Service Building, Cross
Wing, Room 4002, Stock Island, Key West, Florida 33040 on or
before 10:00 a.m. on .rune 20 ' 1995.
All proposals, including the recommendation of the County
Administrator and the requesting Department Head, will be present-
-
, ed to the Board of County Commissioners of Monroe County, elen
da, for final awarding or otherwise.
The Board will automatically reject the bid of any person or
affiliate who apprears on the convicted vendor list prepared by
the Department of General Services, State of Florida, under Sec -
tion 287.133(3)(d), F.S. (1989).
All proposers must submit two (2) signed originals and one
(1) complete copy of each proposal in a sealed envelope marked on
the outside, "Sealed Proposal for Medical Director, Emergency
Medical Services,. District 1 i 5 ". All proposals must remain
valid for a period of ninety (90) days.
Specifications and /or further information may be obtained by
contacting Teresa L. Burgess, Emergency Medical Services, 490
63rd St., Suite 172, Marathon, Florida 33050, (305) 289 -6004.
The Board reserves the right to reject any and all proposals,
to waive informalities' in any or all proposals, and to
readvertise for proposals.
The Board also reserves the right to separately accept or
reject any item or items of the proposal and to award and /or
negotiate a contract in the best interest of the County.
Dated at Key West, Florida, the 15th day of May
1995.
R.M. COFER
Director of Purchasing
for Monroe County, Florida
R
SERVICES PROVIDED
PES will provide the services as described in the Notice of
Request for Proposals, Medical Director, Scope of Work, 1 -4, and the
Duties and Responsibilities of the Medical Director as outlined in
10D- 66.0505,(4)a -m. Specific methodology,
ideas will be detailed in the following approaches, cost saving
will provide a program for exposure pcontrolAdandlocontinuing
professional education. g
Exposure control must be an'' 'area of focus as the OSHA
requirements continue to change and the fines for non - compliance are
extremely high. It is difficult to remain current in specialized
areas that are changing rapidly. Recognizing this, PES brought on
board an expert in exposure control and we are able to offer these
additional services to the county.
We are pleased to present a comprehensive program for continuing
professional education. Lectures have already begun, given twice at
two stations monthly, and will continue. This is an
benefit' 'to the EMTs and Paramedics since we will the ir
required recertification hours to them at no cost to them.
Hopefully, this will improve morale and decrease employee turnover.
PES proposes that Dr. Sandra Schwemmer continue to serve as the
primary medical director for Monroe County EMS. She will have
overall administrative and clinical responsibility for the
fulfillment of the obligations as specified in 10 66.0505, and an
additional responsibilities outlined in contract with Monroe County. Y
Dr. Michael Stary will serve as secondary medical director. He
will assume the responsibilities of medical director in Dr.
Schwemmer's absence. He will be involved on an ongoing basis with
all matters as they relate to Monroe EMS, so that continuit y of
service will be maintained. He will be directly responsible for the
supervision and direction of all continuing education activities and
will serve as course director for any /all ACLS and other
certification courses.
Liz Woodward will serve as assistant to the medical director and
in this capacity will provide the day to day communication, review
and training of the field personnel and supervisors, coordinate all
quality assurance activities. All of her duties and activities will
be supervised by the medical director and will be subject to
agreement and approval by the Department of Public Safety. l
take charge of the continuing professional education proramSandwthe
exposure control programs outlined herein. As an experienced ER
nurse she will further the relationship with pre - hospital and
hospital emergency medical care.
Dr. Schwemmer, Dr. Stary, and Liz Woodward will be responsible
to the Monroe County EMS and report to the Director of Public Safety,
and be available 24 hours /day.
45
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CONTINUOUS QUALITY IMPROVEMENT
GOAL STATEMENT:
The Medical Director will assure that a comprehensive quality
improvement plan exists and provides for the identification and
monitoring of measurable quality indicators, for remediation of
identified deficiencies, and for ongoing continuous quality review.
METHODS:
1. Medical Treatment Protocols are currently being revised and
significantly reformatted (see attached Index for Medical Treatment
Protocols and Format for Protocols). It is anticipated that a final
draft of the document will be completed and ready for management
review by August 1, 1995. Multi- agency consensus has finally been
reached, and the revised protocols will be utilized by all Monroe
County EMS providers, Ocean Reef to Stock Island.
Trauma Transport Protocols, due for revision this fall, will be
developed specific for Monroe County EMS. A draft of protocols
prepared by PES for another agency was recently accepted by the
State and has already been provided to Monroe EMS. (See attached).
2. The Medical Director will develop a revised list of quality
indicators relative to patient care and documentation, to reflect
changes in the new Monroe County Treatment Protocols. EMS
supervisory personnel will continue to be responsible for auditing
all patient run reports based upon the current indicators and future
identified indicators. Training and technical support will be
provided by PES to supervisory personnel regarding these methods.
3. The Medical Director, or designee, will review all priority 1
patient records, and a random sample of not less than 25 % of all non -
priority 1 patient records.
4. Protocol violations identified by the supervisory personnel
during patient record audits will be immediately
given
Director for action. Patient records withqualitythindicator
violations which do not represent
returned to the field paramedic. Paramedics l with o quality indicator
audit violations will be asked to respond in writing to the
violation.
5. Statistics regarding quality indicator violations will be
generated by the Medical Director's office, and will be used to
identify training needs. The Medical Director or Liz Woodward will
be available to assist with in -field remediation of identified
deficiencies or any problems that might arise out of such violations.
6. One additional patient treatment quality indicator will
be identified, and all patient records that month will be audited
against this indicator to continuously monitor Paramedic field
evaluation and treatment of patients. Statistics will be generated
46'
I .
based upon the findings of these audits and will be provided to the
Director of Public Safety, or designee. These statistics will also
be used to identify potential training needs.
7. The Medical Director, or designee, will accompany EMS supervisors
and EMS crews during patient contacts for not less that 32 hours per
month, in order to perform field assessment of EMS personnel
performance. A written performance assessment of each individual
during each patient ' contact observed will be documented.
attached form). These assessments will be provided to the
Operations Manager.
8. The Medical Director, or designee, will make recommendations to
the Operations Manager regarding possible changes or additions to
current equipment and medications for the purpose of improving crew
safety, enhancing the quality of patient care, or reducing costs to
the system.
9. The Medical Director will review the Pharmacy Policies and
Procedures• and the handling of controlled substances to ensure
compliance with State and Federal agencies regarding the dispensation
and handling of controlled substances. The medication log including
controlled substances will be reviewed monthly by the Medical
Director or Liz Woodward. Any deviations in the controlled substance
inventory, and or log will be reported immediately to the Medical
Director. All requests for controlled substances will be made to the
Medical Director and copies of all Form 222's issued will be kept in
the office of the Medical Director. Any medication substitutions by
Monroe EMS will be cleared through the Medical Director's Office, in
order that the appropriate agencies may be notified, in accordance
with 10D -66.
10. The Medical Director, or designee, will be available to assist
with pre - employment screening of potential EMS employees, and will
make recommendations to Monroe EMS regarding clinical competence.
This has been very valuable in the past and we recommend that it be
continued.
11. The Medical Director will meet EMS Administrative personnel
and /or the Director of Public Safety quarterly to assist with the
development of long range planning with regard to budgetary,
operational, and system development issues, as well as healthcare
changes locally and regionally that may impact the delivery of pre -
hospital emergency medical care.
12. The Medical Director will meet with EMS Supervisory personnel
monthly to review the delivery of pre hospital care
assurance issues and provide assistance, if needed, with quother
healthcare providers (physicians and hospitals) in order to minimize
problems and encourage positive interactions.
47
CONTINUING PROFESSIONAL EDUCATION
GOAL STATEMENT:
The Medical Director will assure that a plan exists for the
development and delivery of a comprehensive continuing professional
education plan, which exceeds all Florida Administrative Code
biennium recertification requirements, and fosters the enhancement of
clinical skills for both EMT's and Paramedics.
METHODS:
1. An annual plan for monthly continuing education offerings has
been developed and was implemented in June 1995. This plan was
designed to allow for the development and enhancement of both EMT and
Paramedic knowledge base and clinical skills. Content areas were
identified by analysis of community demographics, and review of call
volume r and case mix for the previous twelve months. (See attached
schedule).
2. Additional classes needed in order to meet FAC 10D -66,
specifically, BLS -C, ACLS, and HIV /AIDS, will be offered during the
recertification biennium.
The services outlined are beyond the requirements of 10D- 66.0505
and are provided based upon identifying system needs over the years.
48
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EXPOSURE CONTROL
GOAL STATEMENT:
The Medical Director will assure that a comprehensive plan exists for
prompt medical review of all possible infectious exposures reported
by Monroe EMS personnel, and for post exposure medical follow-up p when
METHODS:
1. The Medical Director, or designee, will review all reports of
possible infectious exposure reports within 24 hours of receipt from
the EMS agency.
•
2. Confidential medical recommendations will be provided in writing
to the EMS agency Designated Officer within 48 houts of receipt of
the possible infectious exposure report.
3. Confidential medical recommendations will be provided in writin
to the EMS employee within 48 hours of receipt of the e
infectious exposure report. p possible
4. In the event that an actual exposure is identified, that Medical
Director, or designee, will perform employee post- exposure counseling
regarding recommended medical follow -up.
5. The Medical Director, or designee, will assist the agency Officer in arranging for post exposure medical follow-up,
and will monitor the outcome of such testing.
6. The Medical Director, or designee, will assist the agency as
needed with review and recommendations for changes to the existing
exposure control plan on an annual basis, and as additional OSHA
regulations become enforceable.
7. The Medical Director, or designee, will assist the a en
Designated Officer as needed in the y oy
continuing education programs relative planning
c an
infectious diseases. d
8. All records relative to medical review of possible infectious
exposures and treatment of any actual exposures will be maintained in
the Medical Director's office so as to strictly protect employee
confidentiality. Records will be routinely available for revewb
the agency Designated Officer, and properly authorized agents of
regulatory agencies. g f
By educating EM$ personnel to avoid risk exposure,
consistent medical review of exposures, and p r ingvion
p only
significant exposures for further testing and treatment,we
anticipate there will be fewer reports of injury, and therefore less
potential testing and treatment, all of which will greatly reduce
cost for Monroe County.
4r)
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1
1
COST PROPOSAL
PES will rov'
p ide all services described in
the Scope of Services in this RFP for an
1 annual amount of
$38,400
Breakdown of Annual Expenses:
* Corporate Overhead:
„Wability Insurance $3000.
Paper, supplies, teaching materials
Phone, long distance calls as related 500.
to all aspects of service
1 Beeper Service 1000.
Travel Expenses 500.
** Professional Personnel 1400.
31400.
$38400.
* Includes expenses for Dr. Schwemmer, Dr. Stary and Liz Woodward
* *Professional Services estimated using the following rates:
Liz Woodward @ $25.00 /hr.
Dr. Schwemmer / Stary @ $75.00/hr.
68
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April 22. 1991
1'11' i:Lrn
MONROE COUNTY, FLORIDA
INSURANCE GUIDE
TO
CONTRACT ADMINISTRATION
Indemnification and (cold Harmless
for
Suppliers of Goods and Services
•
"T he `' ender covenants and agrees to indemnify and hold harmless Monroe Count I3oarc
County Commissioners from any and all claims far bodily injury (including y I c f
and property damage (including property owned by Monroe County) and army other losses, injury
damages, and expenses (including attorney's fees) which arise out of, in connection with, or
reason of services provided by the Vendor or any of its Subcontractor(s) in any tier, occasion
by the negligence, errors, or other wrongful act or omission of 'The Vendor or its
in any tier, their employees, or agents. Subcontractors
In the event the completion of the project (to include the work of others is delayed
as a result of the Vendor's failure to purchase or maintain the required insurance, the Vendor sh
indemnify the County from any and all increased Y d or suspended
cased expenses rc ulting from such delay. all
1 h extent of liability is in no way limited to, reduced, or lessened by the insur
contained e1scv }here within this agreement. Y ance requirements
•
•
•
IND1
Adminiativc rnttrudion
t4 709 I
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16
' t
April 22. 1993 ` 1
1s1 Prinlinp
i
MEDICAL PROCESSIONAL LIABILITY
INSURANCE REQUIREMENTS t
FOR
CONTRACT
BEINVE
MONROE C()UN'I'Y, FLORIDA
AND • ?f
Recognizing that the work governed by this contract involves the providing of professional
medical treatment, the Contractor shall purchase and maintain, throughout the life of the contract,
Professional Liability Insurance which will respond to the rendering of, or failure to render
medical professional services under this contract.
The minimum limits of liability shall be:
$ 1,000,000 per Occurrence /$3,000,000 Aggregate
If coverage is provided on a claims made basis, an extended claims reporting period of four (4)
years will be required.
k.
is
f 55
Wmi •ltr:etiveLnlnu1io'° MJ
4709 .1