HomeMy WebLinkAbout22- Professional Affiliation Agreement - Bozeman Health - Educational Experiences
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BOZEMAN DEACONESS HEALTH SERVICES
d/b/a BOZEMAN HEALTH
PROFESSIONALAFFILIATION AGREEMENT FOR
EDUCATIONAL EXPERIENCES WITH COMMUNITY AGENCIES
This AGREEMENT is entered into this _____ day of __________, 2022 by and between Bozeman
Deaconess Health Services, d/b/a Bozeman Health, a Montana nonprofit corporation, hereinafter
referred to as “BDHS” and Bozeman Fire Department, hereinafter referred to as “Agency” and
sets 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 by
Agency; (2) the professional has submitted a completed Professional Experience packet to BDHS’
Student Education Coordinator; and (3) BDHS has notified the professional in writing that his or
her experience packet has been approved.
WITNESSETH
WHEREAS, BDHS is an integrated health care delivery system in Bozeman, Montana, and BDHS
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 BDHS 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 RESPONSIBILITIES
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 the
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 will
be supervising professional during the specific dates of rotation. BDHS shall not be
responsible for arranging BDHS employee supervisors.
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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 for
MMR documenting two doses of live measles vaccine given after fifteen months of
age 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 to
transmit 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 the Hepatitis
B vaccine.
d. Individuals who will be working within any BDHS facility during the influenza season
will be required to submit proof of influenza vaccination or wear an isolation mask
during work hours.
1.8 The Agency will submit to BDHS documentation of results from a comprehensive criminal
background check performed by the Agency for each professional, and documentation that
the professional is not excluded from and has not been sanctioned by a federal health
program. If the Agency has not provided, the professional must consent and process (a
criminal background check) through BDHS’ Website.
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 identifiable
information contained in or derived from patient records, or (iii) any information
concerning 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 BDHS in planning the
Program for the professionals.
b. Designate the professionals who will be participating in the Program at BDHS facilities
in such numbers as are acceptable to BDHS.
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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 BDHS
employee at risk.
f. Require professionals to conform to all applicable BDHS policies, procedures, and
regulations and to all additional requirements and restrictions agreed upon by
designees of Agency and BDHS. 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 BDHS.
g. Comply with a request by BDHS 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 BDHS, 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 BDHS;
2. Arranging for their own transportation and living accommodations;
3. Reporting to BDHS 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.
II. BDHS RESPONSIBILITIES
2.1 BDHS will provide the opportunity for professionals to participate in agreed upon services
provided by BDHS.
2.2 BDHS 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 BDHS 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 Experience
packet which contains the BDHS Guidelines for Educational Experiences, PowerPoint,
HIPAA Privacy Agreement, Exam, and Checklist of required documents to be submitted.
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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 BDHS 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.
III. RELATIONSHIP OF THE PARTIES
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 participating 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 Healthcare
Provider members or allied health professionals, or employees of BDHS, including,
without limitation, procedures set forth in the Healthcare Provider Bylaws and related
manuals or BDHS employment policies.
IV. LIABILITY AND INSURANCE
4.1 The professional shall, at his/her own costs and expense, or through the Agency, secure
and maintain in effect at all times during which this Agreement is in effect Professional
Liability Insurance coverage with limits of liability in an amount of not less than seven
hundred fifty thousand dollars per occurrence and one million five hundred thousand
dollars annual aggregate ($750k/$1.5m) and will provide evidence of such coverage upon
request.
4.2 Each party shall be responsible for its own acts and omissions.
V. INDEMNIFICATION
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
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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 training 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.
VI. NONDISCRIMINATION
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 BDHS is subject to various federal laws,
executive orders and regulations regarding equal opportunity and affirmative action that
may also be applicable to subcontractors. Agency, therefore, agrees that any and all
applicable equal opportunity and affirmative action clauses shall be incorporated herein as
required by federal laws, executive orders, and regulations, which include the following:
Executive Order 11246, as amended; the Vocational Rehabilitation Act of 1973, as
amended, the Vietnam Era Veteran’s Readjustment Assistance Act of 1974, as amended;
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) at 48 CFR Chapter
1, Part 19, Subchapter D, and Part 52, Subchapter H.
VII. STATUS OF PARTIES
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, partnership, joint venture or association between Agency and
BDHS and their employees, partners, professionals 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 BDHS 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 BDHS.
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VIII. PUBLICITY
Neither Agency nor BDHS 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.
IX. TERM AND TERMINATION
9.1 This Agreement may be reviewed on an annual basis. Unless otherwise terminated as
provided herein, this Agreement shall be effective until one or both members terminate the
Agreement upon fifteen (15) days’ written notice.
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, BDHS 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 BDHS, 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 be
terminated 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 BDHS shall not give rise to any procedural rights under
the Bylaws of the Healthcare Providers of BDHS, the Healthcare Provider’s Fair Hearing
Plan, BDHS personnel policies or any other source whatever. Furthermore, participating
professionals shall have no claim or right of action against BDHS, 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) overnight courier
service and addressed as follows:
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Student Education Coordinator
Education Department
Bozeman Health
915 Highland Boulevard
Bozeman, Montana 59715
With a copy to:
Steven Klein, System Director Legal Services
Bozeman Health
915 Highland Boulevard
Bozeman, Montana 59715
AGENCY CONTACT:
Josh Waldo, Fire Chief
Bozeman Fire Department
300 E. Oak St
Bozeman, MT 59715
X. ADDITIONAL DECLARATIONS
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
articles so 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 BDHS 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 the terms of this
Agreement may be brought by any person who is not a party hereto.
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IN WITNESS WHEREOF, THE PARTIES HERETO HAVE EXECUTED AND DELIVERED
this Agreement as of the day and year first written above.
BOZEMAN DEACONESS HEALTH SERVICS
d/b/a BOZEMAN HEALTH
BY:
DATE: ___________________________________
NAME: Kaitlin Drake, System Director of Education
EMAIL: kadrake@bozemanhealth.org
AGENCY: City of Bozeman
BY: _____
DATE: ____________________________________
NAME: Jeff Mihelich, City Manager
EMAIL: jmihelich@bozeman.net
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9/22/2022
9/22/2022
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AMENDMENT #1 to PROFESSIONALAFFILIATION AGREEMENT FOR
EDUCATIONAL EXPERIENCES WITH COMMUNITY AGENCIES
This Amendment to the Provider-Level Education Student Affiliation Agreement
(“Agreement”) between Bozeman Health and Bozeman Fire Department, hereinafter
referred to as “Agency,” is effective as of the last date executed by either party.
WHEREAS, Bozeman Health and Agency entered into an Agreement dated July 19, 2022.
WHEREAS, Bozeman Health and Agency now desire to amend the Agreement.
NOW, THEREFORE, Bozeman Health and Agency agree as follows:
Student Credentialing Packet requirements:
Bozeman Health Student Request Form
Student Information Letter completed
Copy of Driver’s License or Passport
Immunization Record, including:
o Hepatitis B (not required but strongly recommended)
o MMR
o Varicella
o TB skin test - must be current within last 12 months and not expire
during Bozeman Health rotation
o Current influenza vaccination if rotation occurs any time between
October-April. If a declination form is submitted, the student must wear
a surgical mask within 6 feet of others.
o COVID vaccine (per CMS requirements) - If not fully vaccinated,
student must provide a medical or religious exemption form approved by
the school/college/program.
Signed Confidentiality Commitment
Signed Computer Access Security Agreement
Current American Heart Association (AHA) BLS CPR certification (if required
by preceptor)
Completion of Bozeman Health Orientation PowerPoint with Exam score of 85%
or greater
Bozeman Health Affiliation Agreement signed by all parties
Proof of Professional Liability Insurance with coverage amounts included
Comprehensive background check
Headshot photo for Bozeman Health I.D. badge
All Credentialing documentation is to be submitted to the Student Education
Coordinator no later than 30 days prior to the beginning of the rotation.
Student Credentialing Packet contains:
Bozeman Health Student Request Form
Student Information letter
Computer Access Security Agreement
Bozeman Health Orientation PowerPoint
Bozeman Health Orientation Exam
Confidentiality Commitment Form
Student Position Statement
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Instructions to obtain the comprehensive background check (if not provided by
school/college/program)
Bozeman Health Policies:
o Workforce General Obligations Regarding Uses and Disclosures of
Protected Health Information
o Disclosures to Family and Friends Involved With a Patient
o Social Media
o Personal Appearance
o 5 Moments for Hand Hygiene
o Bozeman Deaconess Campus & Parking Maps
IN WITNESS WHEREOF, Bozeman Health and Agency intending to be legally bound
have duly executed this Agreement as indicated by representatives’ initials below.
AGENCY: _________
BOZEMAN HEALTH: __________
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