Resolution 673-1988 Commissioner John Stormont
RESOLUTION NO. 673 -1988
A RESOLUTION OF THE BOARD OF COUNTY COMMIS-
SIONERS OF MONROE COUNTY, FLORIDA, AUTHORIZING
THE MAYOR/CHAIRMAN OF THE BOARD TO EXECUTE
A MEMORANDUM OF UNDERSTANDING BETWEEN MONROE
COUNTY AND BAPTIST HOSPITAL OF MIAMI CONCERNING
EMERGENCY TRAUMA-RELATED HEALTH 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 Memorandum of Understanding
between Monroe County and Baptist Hospital of Miami, 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 20th day of December, A.D. 1988.
BOARD OF COUNTY COMMISSIONERS'
OF MONROE COUNTY, FLORIDA
BY: /eA r '1
MAYOR ✓ '' 'N
(Seal)
Attest:DANNY Lt, KOLHAGE, Clerk
•
7 . '' tad'
C. RK
APPRO ►,AS TO
AND FL. SU MEW
oy
Attorney's Office -
L `. •t
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
District on certain terms as indicated below, to help alleviate
pressures involving severe trauma-related emergency health care
in the geographical boundaries of the Upper Keys Health Care
Taxing District, and to further establish criteria and effective-
ness thereunder, therefore,
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.
The principal purpose of this agreement is to
facilitate and aid in the transportation of severe
trauma cases to Baptist Hospital Emergency receiving
facilities within a time frame most beneficial to the
patient.
2
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.
4. 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.
5 . 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.
C. Prior to contact with Baptist Hospital of Miami
Emergency Department, the on-scene paramedic will
verify:
(1) That the patient has trauma score 12, coma
score 10, or evidence of shock at the scene with
systolic BP 90 .
3
(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
that such patient is medically stable and-is able
to be returned for further care to an appropriate
medical facility in Monroe County, if one exists .
7. HOSPITAL PROTOCOL
It is acknowledged that patients initially
transported to the District Hospital will be considered
on a case-by-case basis for transfer to Baptist
4, _.
•6
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
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 S.C. , as
well as a Certificate of Eligibility form
appropriately certified.
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 and Metro-Dade Air
Rescue.
9. FINANCIAL ASSURANCES
Monroe County agrees to guarantee Baptist Hospital
of Miami and the participating physicians 80% of
4
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.
10. FORMS REQUIREMENTS
A. Monroe County, to aid in the effectiveness of and
as requirement for evaluation of this relationship,
shall require the Medical Director of any Monroe County
Emergency Services District involved to implement
criteria and protocols included herein regarding-
patients transported under this agreement from within
6
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.
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.
11. 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
are subject to availability of appropriateness .
C. If Monroe County and the Upper Keys Health Care
Taxing District should implement alternative
trauma-related care plans pursuant to State Regulations
currently being promulgated, those plans shall
supersede the terms of this agreement, and all -
7
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
terminates in respect to patient care.
D. Representatives from either the Upper Keys Health
Care Taxing District (and/or their designated review
agency) or Baptist Hospital of Miami may request prompt
medical/social/financial case discussion with the
8
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. 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 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 :
1. Overall coordinator
County Administrator
Mr. Thomas W. Brown
Junior College Road - Stock Island, Wing II
Key West, Florida 33040
(305)294-4641 ext. 100
9
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 #1 . on an interim basis
4. Payment (after clearance) r
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
Assistant Comptroller and Patient Accounts
(305) 596-1960 ext. 6218
3 . Social Services
Ms. Sandra Bell
Director - Social Services
(305)596-6578
10
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
Mayor/Chairman
Date
(SEAL)
Attest :
Clerk
BAPTIST HOSPITAL OF MIAMI
By
Title
Date
Witnesses
APPROVED AS TO FORM
AND LEGAL SUFFICIENCY.-
B s, A4, /f_C 1' /) .‘4"
Attorney's Office
11
- •
.„
EXHIBITS
A. Certificate of Eligibility
B. Protocol
C. Patient Waiver
12/16/88
12 -
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: Time:
Via EMS Unit # or other:
Trauma Score, Coma Score, BP qualifications:
Attending Physician:
Local Hospital notes:
5
Baptist acceptance verification: Time Date Who:
Authorized by:
Transfer to Baptist: (via EMS # or other)
COPY OF COMPLETED FORM TO BE SENT TO UPPER KEYS HEALTH CARE
TTAXING DISTRICT OFFICE
12/16/88 - 13 -
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 avail-:;,dlity.
5. Complete Certificate Eligibility.
6 . Obtain EMS eligi . ,y signature
7 . Transport wi . _i 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,
with other required information, within 72 hours.
10 . Patients shipped outside of above protocol and/or
without required verifications will not be accepted by
Baptist. In no event will Monroe County funding be
extended to cover patient expenses, placing
transporting hospital liable for Baptist charges, if
patient is accepted them.
12/16/88 Page - 14
Trare District Personal Liability an'llIl
Waiver of County and District Liability Subrogation Form
I, , patient
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
to me well known and known to me to be the person described in
and who executed the foregoing instrument , and acknowledged to
and before me that he/she executed said instrument for the
purposes therein expressed.
WITNESS my hand and official seal, this day of
, A.D. 19
Notary Public
State of Florida at Large
-i