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HomeMy WebLinkAbout16- Professional Affiliation Agreement - Bozeman Health - Educational Experiences with Community AgenciesBOZEMAN DEACONESS HEA LTH SERVICES d/b/a BOZEMAN HEALTH PROFESSIONALAFFILIATION AG REEMENT FOR EDUCATIONAL EXPERIENCES WITH COMMUNITY AGENCIES This AGREEMENT is entered into this 1�� day of , 20 I to by and between Bozeman Deaconess Health Services, d/b/a Bozeman Health, a Montana nonprofit corporation, hereinafterreferred to as "BDHS" and Bozeman Fire Department hereinafter referred to as "Agency" andsets forth the intent of both parties to mutually cooperate in providing a healthcare professional educational experience for "Professionals." This Agreement shall be effective upon completion of the following conditions: (1) the Agreement has been signed and submitted to BDHS byAgency; (2) the professional has submitted a completed Professional Experience p a c k e t t o BDHS' Student Education Coordinator; and (3) BDHS has notified the professional in writingthat his or her Experience packet has been approved. WITNESSETH WHEREAS, BDHS is an integrated health care delivery system in Bozeman, Montana, and BDI-IS desires to assist professionals of the Agency by offering a healthcare practical experience for such professionals; WHEREAS, each participating professional of the Agency desires to have a practical educational experience under the immediate supervision of a like supervising BDI-IS Employee under the terms and conditions set forth in this Agreement; NOW, THEREFORE, in consideration of the mutual promises set forth herein, it is agreed by and between BDHS and Agency; I. AGENCY RESPONSIBILITES Agency Shall: 1.1 Notify Student Education Coordinator eight (8) weeks in advance with the professional's contact information. 1.2 Schedule time with the Supervising BDHS employee to work with the professional under his/her immediate supervision at BDHS. The agency/professional completes t h e Education Packet with the name of the supervising BDHS employee and dates of experience. 1.3 The Agency or professional shall arrange for each professional to be supervised by an Employee of BDHS. The Employee shall be responsible for supervision of the professional while at BDHS. Employee shall provide a statement indicating he/she willbe supervising professional during the specific dates of rotation. BDHS shall not be responsible for providing or arranging Healthcare Provider supervisors. 1.4 Ensure each participating professional understands that his/her participation in any aspect of a patient's care is dependent upon the patient agreeing to have the Agency's/non- BDHS professional involved. Each professional further understands that he/she is only able to participate in the care of patients who have given informed consent to said participation. 1.5 Require each Professional to wear BDHS guest ID badge during rotation identifying the professional and his/her credentials at all times while at BDHS. 1.6 Require professionals to comply with all BDHS and, if applicable, Patient Care Provider rules and regulations, and policies and procedures. 1.7 Ensure professionals will submit to BDHS the following documentation of immunizations prior to beginning any work at BDHS: a. Individuals born after 1956 are required to submit a copy of immunization record forMMR documenting two doses of live measles vaccine given after fifteen months ofage at least 30 days apart; OR serologic evidence of immunity to Rubeola and a laboratory result documenting a rubella titer of 1:10 (immune). b. Professional must submit a copy of negative PPD skin test OR chest x-ray (current within the previous 12 months), OR a physician's statement indicating incapacity totransmit TB (if chest x-ray is positive). c. Professional will be working in areas or work conditions which place them at risk for blood or body fluid exposure; therefore, must submit proof of three Hepatitis B vaccines, serologic evidence of immunity, OR furnish a signed waiver for theHepatitis B vaccine. d. Individuals who will be working within any BDHS facility durin_� the influenza season will be required to submit proof of influenza vaccination orwear an isolation mask during work hours. 1.8 The Agency will inform each Professional participating under this Agreement that the Professional must provide written verification that a comprehensive criminal background was performed by the Agency and that the professional is not excluded from and has not been sanctioned by a federal health program. Alternatively, the Professional must consent to a criminal background check through BDHS. The results of the comprehensive criminal background check, if provided to BDHS by the Agency, will be delivered to the Director of Education by either the Fire Chief or other Agency representative. 1.9 The Agency will instruct all professionals assigned to BDHS in the privacy and confidentiality of (i) any HIPAA protected health information (ii) individual identifiableinformation contained in or derived from patient records, or (iii) any informationconcerning the business of BDHS that BDHS treats as proprietary or confidential. In addition, professionals shall comply with BDHS privacy and confidentiality policies. 1.10 The Agency shall: a. Designate a faculty member to coordinate with a designee of BOHS in planning the Program for the professionals. b. Designate the professionals who will be particlpating 111 the Program at BONS facilities in such numbers as are acceptable to BOHS. c. Be responsible for all supervision, evaluation, and discipline of professionals in the program. d. Maintain all personnel and competency records of professionals. e. Send only such professionals who do not, to the Agency's knowledge, have any type of acute or chronic condition that would put the professional or any patient or BOHS employee at risk. f. Require professionals to conform to all applicable BOHS policies, procedures, and regulations and to all additional requirements and restrictions agreed upon by designees of Agency and BOHS. Professional will receive an Education Experience packet to complete and must return the fully completed packet to the Student Education Coordinator no later than two (2) weeks prior to the beginning of the education experience. Failure to complete packet in a timely manner may prohibit participation in a professional education experience at BONS. g. Comply with a request by BOHS to withdraw a professional from the Program within (5) days of receipt of such notice. However, if professional's performance endangers the health and welfare of patients or employees of BOHS, Agency will withdraw the professional immediately. h.Notify professionals that they are responsible for: 1. Providing the necessary and appropriate uniforms which may be designated, but not provided by BONS; 2. Arranging for their own transportation and living accommodations; 3. Reporting to BONS facilities at agreed times; 4. Retaining financial responsibility for emergency medical care received during the Program; 5. Maintaining the confidentiality of patient information; and 6. Maintaining the confidentiality of proprietary information. 2.1 BOHS will provide the opportunity for professionals to participate in agreed upon services provided by BDHS. 2.2 BONS and Healthcare Providers will retain full responsibility for care of the patients and will maintain administrative and professional supervision of professionals insofar as their presence and program assignments affect the operation of BONS and its care, direct and indirect, of patients. To the extent possible, BDHS will provide for the orientation of BDHS' participating professionals as to BDHS philosophies, rules, regulations, and policies of BDHS. As applicable, attendance at such orientation will be required before any professional will be permitted to participate in the program. Professional is given an Education Experiencepacket which contains the BDHS Guidelines for Educational Experiences, PowerPoint,HIPAA Privacy Agreement, Exam, and Checklist of required documents to be submitted. 2.3 BDHS will limit access to professionals' files and personal information and will maintain files and personal information in confidence. 2.4 Upon request, BDHS will provide proof of liability insurance in an amount that is customary to the community. 2.5 BDI-IS will provide written notification to the Agency promptly if a claim arises involving a professional. 2.6 BDHS will resolve any situation in favor of its patients' welfare and may restrict a professional to the role of observer or, in its discretion, prohibit the professional from participating in the program at BDHS when a problem may exist until the incident can be resolved by the staff in charge of the professional or the professional is removed. 3.1 The participating professionals are not entitled to any benefits provided by BDHS to its employees, including, but not limited to, group health insurance, dental insurance; unemployment insurance benefits, workers' compensation and/or disability insurance. 3.2 BDHS is not responsible for any injuries to the professional while he/she is traveling to and from BDHS or pal licipating in the activities, which are the subject of this Agreement. The professional will be responsible for any charges for medical care if they are not covered under the professional's personal health insurance. In no event shall BDHS be responsible for providing workers' compensation or liability coverage for the professionals of the Agency. 3.3 The participating professionals are not entitled to any procedures afforded to HealthcareProvider members or allied health professionals, or employees of BDHS, including, without limitation, procedures set forth in the Healthcare Provider Bylaws and relatedmanuals or BDHS employment policies. III. LIABILITY AND INSURANCE The professional shall, at either his/her own cost and expense, or throuLh the Auenc, . secure and maintain in effect at all times during which this Agreement is in effect general liability and public officials errors and omissions coverage through the Montana Municipal Interlocal Authority with limits of liability in an amount of not less than $750,000 dollars per occurrence and $1.5 million dollars annual aggregate ($ $750,000/$1.5m) and will provide evidence of such coverage upon request. Each party shall be responsible for its own acts and omissions. �MERNIGNIMI1O1� 11 +1 1 5.1 Agency agrees to indemnify and hold harmless (and at BDHS' request, defend) BDHS and all other persons or organizations cooperating in the conduct of the health care program commonly known as Bozeman Deaconess Health Services including physicians and surgeons and each of their employees, agents and partners (all of which persons and organizations are referred to herein collectively as "Indemnitees" or individually as "Indemnitee") from and against any and all claims, losses, damages, liability, costs, expenses, judgements, or obligations whatever, for or in connection with any injury or damage (including, but not limited to, death) to any person or property to the extent resulting from the negligent acts or failure to act or willful misconduct of Agency, its officers, partners, employees, agents or any professional receiving trai ping under this Agreement. The foregoing indemnity and hold harmless obligations include and apply without limitation to injury or damages to Indemnitees, patients, third parties, or any or all of them and their respective property, officers, partners, employees, or agents, regardless of how such injury occurred or is suffered, notwithstanding any alleged contributory negligence on the part of any Indemnitee. NZA-11 U130 6.1 The parties agree that all professionals receiving training pursuant to this Agreement shall be selected without discrimination on account of race, sex, color, religion, national origin, age, physical or mental disability, veteran's status, or sexual orientation. Agency recognizes that as a government contractor BONS is subject to various federal laws,executive orders and regulations regarding equal opportunity and affirmative action thatmay also be applicable to subcontractors. Agency, therefore, agrees that any and all applicable equal opportunity and affirmative action clauses shall be incorporated hereinas required by federal laws, executive orders, and regulations, which include the following: Executive Order 1 1246, as amended; the Vocational Rehabilitation Act of 1973, as amended, the Vietnam Era Veteran's Readjustment Assistance Act of 1974, asamended; Title 41, Part 60 of the Code of Federal Regulations; the Small Business Act,as amended; Executive Order 11625; and the Federal Acquisition Regulation (FAR) at48 CFR Chapter 1, Part 19, Subchapter D, and Part 52, Subchapter 11. The parties expressly understand and agree that: A. This agreement is not intended and shall not be construed to create the relationship of agent, servant, employee, pail nershi p, joint venture or association between Agency and BONS and their employees, partners, professional s or agents, but rather is an agreement by and among independent contractors, those being in Agency and BDHS. B. Agency's professionals are present at the facilities only for educational purposes, and such professionals are not to be considered employees or agents of BONS for any purpose including, but not limited to, compensation for services, employee welfare and pension benefits, workers' compensation insurance, or any other fringe benefits of employment. Neither Agency nor any of Agency's professionals, instructors, employees or agents shall receive any compensation from BONS. VII. PUBLICITY Neither Agency nor BOHS shall cause to be published or disseminated any advertising materials, either printed or electronically transmitted, which identify either party or its facilities with respect to the Program without the prior consent of the other. 9.1 This Agreement is in effect for one (1) year from the date of signing. 9.2 BDHS may terminate this Agreement immediately upon the occurrence of any of the following by giving written notice to Agency and the Supervising Employee setting forth the reason for termination : a. Material Breach of this Agreement; b. Actions or omissions of a professional that BDHS, in its sole discretion, determines to jeopardize the health, safety or welfare of any of BDHS's patients; c. Dishonesty, misrepresentation , or fraudulent conduct of a participating professional; d. Indictment of a participating professional on criminal charges or exclusion or sanction of the professional by a federal health program; e. Disruptive conduct that impairs, or threatens to impair, BONS operations; f A participating professional's loss of his/her Healthcare Provider sponsorship; and g. Tardiness or failure to attend required appointments or clinicals and not communicating schedule changes with supervisor or Student Education Coordinator. In the event BONS, in its discretion, requests that the Agency remove a professional(s) who has engaged in the above conduct from the program, this Agreement shall not beterminated if Agency promptly complies with this request. 9.3 This Agreement may be terminated at any time by either party for any cause or no cause upon fifteen (15) days' notice to the other party. 9.4 Termination of this Agreement by BONS shall not give rise to any procedural rights under the Bylaws of the Healthcare Providers of BONS, the Healthcare Provider's FairHearing Plan, BONS personnel policies or any other source whatever. Furthermore, participating professionals shall have no claim or right of action against BONS, its employees or agents, or the Healthcare Providers as a result of any such termination. 9.5 All notices required under this Agreement shall be deemed to have been fully given when made in writing and delivered by: (i) personal delivery; (ii) deposit in the United States mail, postage prepaid, certified mail, return receipt requested; or (iii) overnightcourier service and addressed as follows: Student Education Coordinator Education Department Bozeman Health 915 Highland Boulevard Bozeman, Montana 59715 With a eopyto: Darei Bentson, Chief Legal Officer Bozeman Health 915 Highland Boulevard Bozeman, Montana 59715 AGENCY Fire Chief, Bozeman Fire Department 34 N. Rouse Ave Bozeman, Montana 59715 10.1 This Agreement cannot be changed or modified except by an instrument in writing executed by both parties. 10.2 The headings of the various articles of this Agreement are inserted for convenience and do not expressly or by implication limit, define or extend the specific terms of the Agreement as designated. 10.3 This Agreement shall be deemed to have been made and shall be construed and interpreted in accordance with the laws of the State of Montana. 10.4 This Agreement, Professional' s Experience packet and Confidentiality Statement signed by the Professional constitute the entire understanding and agreement between the parties hereto and supersedes all prior agreements, arrangements, and understandings between the parties with respect to its subject matter. 10.5 This Agreement shall bind and inure to the benefit of BOHS and Agency, and their authorized assigns. Neither patients, professionals, nor any other third parties are intended as third party beneficiaries under this Agreement, and no action to enforce theterms of this Agreement may be brought by any person who is not a party hereto. IN WITNESS WHEREOF, THE PARTIES HERETO HAVE EXECUTED AND DELIVERED this Agreement as of the day and year first written above. Bozeman He BY: Date: 11 Ilk NAME: �Iw40 C�T� P^l> CI I j� AGENCY:_C'1T-VO-F A0 Z PM Q01 BY: C A` Date: 11-21-14 NAME: - 1 u ieu f�T,� 1 iI►:�IJi���`I AGREEMENT ADDENDUM B Clinical/Non-Clinical Experience Packet The Clinical/Non-Clinical Student Credentialing Packet requirements: ® Clinical Informational letter completed Student Educational Experience Inquiry form ® Copy of Driver's License or Passport ® Curriculum Vitae or Resume ® Immunization Record, current TB skin test, current flu vaccination if between October I& March 31. If signing a flu vaccination Declination Form, must wear a face mask per Policy. ® Current AHA Healthcare Provider (HCP) CPR certification (if required) Signed Confidentiality Agreement ® Signed Computer Security Agreement (Student Education Coordinator will sign in place of Manager) BDHS Specific Guidelines for Students PowerPoint with Exam score of 85% or greater ® BDHS Affiliation Agreement signed by all parties ® Proof of Professional liability insurance with coverage amounts included ® Letter from BDHS Healthcare Provider indicating they will be supervising the student during the specific dates of rotation ® Comprehensive background check P Headshot photo emailed to have BOHS I.D. badge made ® All documentati on is to be submitted to the Student Education Coordinator no later than 3 weeks prior to the beginning of the Clinical/Non-Clinical rotation The Clinical/Non-Clinical Student Credentialing Packet contains: ® Clinical Student Education Experience Informational Letter ® Student Educational Experience Inquiry form ® BDHS Specific Guidelines for Students PowerPoint ® Exam ® Confidentiality Commitment form ® Computer Security Agreement ® Personal Appearance Guidelines ® 5 Moments for Hand Hygiene ® Privacy Policy ® Parking Map ® Instructions to obtain the Comprehensive background check (if not provided by school/college/program)