HomeMy WebLinkAbout25856COUNTY OF FRESNO
DATE: 8/7/2009
THIS EXTRACT IS FOR REFERENCE AND INFORMATIONAL PURPOSES ONLY. ALL BUSINESS AND MANAGEMENT DEClSlONS MUST
BE GOVERNED BY THE UNDERLYING CONTRACT. ANY QUESTlONS MUST INCLUDE THE CONTRACT NUMBER AND BEADDRESSED - - - -4- TO THE COUNTY'S PURCHASING OFFICE AT 456-71 10,
CONTRACT NUMBER: P-09-384-H
CONTRACT TITLE: Pediatric Physician Services
CONTRACT PERIOD: 7/1/2009 thru 6l3012012 ;EFCLUDE
USING AGENCIES: DCH - CCS Medical Therapy Program
TERMS:
DELIVERY TERMS:
DELIVERY TIME:
BUYER:
CONTRACT VALUE:
LOCATION:
Net 45 Days
QJ "" 4
H - Patricia J. Fiaherty
$33,125.00 Annual Maximum
VENDOR NUMBER: 00000958453
NAME /ADDRESS: De La Rosa, Cannen, M.D.
201 7 San Gabriel
Clovis, CA 9361 1
REPRESENTATIVE: Carmen De La Rosa, MD
TELEPHONE: (559) 348-1 000
FAX:
E-MAIL: .
BOARDlGROUPlSTATE CONTRACT NO:
REQUISITION NO'S: I
5621 000166
~ew q Cancellation Reference: 9524352
q ~enewai Short Term Tic Date: ~6/112012
n~djurtment q Evergreen Code: 952
O~dd0n q Kill REPORTS: None
Org: 56201601
Supersedes 2701 04H
COMMODITIES, SERVICES OR MAINTENANCE COVERED UNDER THlS ACTION:
Provide pediabic physician for DCH CCS Medical Therapy Unit as per attached Agreement.
SPECIAL CONDITIONS FOR USE:
'AUTOMATIC RENEWAL: In the absence of notification from vendor to Purchasing, or instructions from County department to Purchasing, this Agreement
will automatically renew for one year on July 1,2010 and July 1,201 1.
DISTRIBUTION REWESTEDlBYmATE ADDITIONAL DISTRIBUTION
o-- -- --- --
CONlRACT FlU: 14 -
EWER
VENDOR:
AUDITOR:
DEPARTMENT. PuMic Health
REQUlSlflONER
Extract Page 1 of 1
AGREEMENT
THIS AGREEMENT is made and entered into this 3rd day of ,2009,
by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
hereinafter referred to as "COUNTY", and CARMEN DE LA ROSA, M.D., a Sole Proprietor, whose
address is 2017 San Gabriel, Clovis, California 9361 1, hereinafter referred to as "CONTRACTOR.
WITNESSETH:
d
WHEREAS, COUNTY, through its Department of Public Health (DPH) California Children's
Services (CCS) Medical Therapy Unit (MTU), is in need of conference physician services to be
performed by a qualified pediatric physician; and
WHEREAS, CONTRACTOR is a qualified pediatric physician who is approved by the State of
California Department of Health Care Services, Children's Medical Services Branch and is able and
willing to provide, pursuant to the terms and conditions to this Agreement, conference physician
services.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1. SERVICES
A. CONTRACTOR shall perform services as a Medical Therapy Conference (MTC)
physician for COUNTY's DPH CCS Medical Therapy Program (MTP). CONTRACTOR shall
provide conference physician services to COUNTY's DPH CCS MTP at COUNTY's CCS MTU and
shall participate up to a total of fifty-three (53) five (5) hour MTC's or sixty-six (66) four (4) hour
MTC's for each twelve (12) month period of this Agreement.
B. As COUNTY's DPH CCS MTC physician, CONTRACTOR shall be responsible
for making the final determination of the child's MTC plan of care.
C. CONTRACTOR shall be a team leader at COUNTY's DPH CCS MTC and shall
be the key resource for medical information provided to the family and other MTC team members.
The MTC team includes but is not limited to the child, parent(s) or guardian(s), Occupational
Therapist (OT), Physical Therapist (PT), Public Health Nurse (PHN), Orthotist, andlor school
personnel.
COUNTY OF FRESNO
Fresno, CA
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I D. In addition, CONTRACTOR shall assure that the MTP provides the child with
1 appropriate medical intervention to allow the child the opportunity to reach maximum physical
function. To reach this goal, CONTRACTOR'S specific responsibilities shall include, but are not
limited to:
1. Review of the child's medical and therapy history.
2. Confm any eligible condition for the MTP through a physical
examination and documentation of clinical findings.
3. Issuing prescriptions (signed therapy plans) for OTIPT related services,
recommending durable medical equipment (DME) as related to MTP eligible diagnosis, andlor
ordering x-rays; identifying needs for specialty referrals; and communicating with other care
providers, as needed.
4. Providing oversight of prescriptions (signed therapy plans) for OT/PT
related services and DME requests submitted by private physicians.
5. Signing each child's MTC "Conference Summary Sheet," and a typed
conference team report that includes team findings, medical evaluations and recommendations. The
"Conference Summary Sheet" shall be prepared by COUNTY'S DPH CCS MTU staff.
6. Discuss with the MTC team the child's medical status, the effect of the
MTP eligible condition on the child's functional level, the child's rehabilitation potential, and the
proposed therapy plan.
7. Answer questions and discuss the proposed plan with the child's family
and other MTC team members.
8. Document findings of the examination in the MTU's medical record via
the dictated medical therapy conference report.
9. Identify follow up recommendations, including but not limited to chart
reviews, x-ray reviews and brace checks, including a return date for another MTC.
10. Provide dispute resolution.
11. Participate in discharge planning for children when:
a. No further service is needed;
COUNTY OF -NO
Fresno, CA
There is a transfer of the child's case to another agency and
duplication of services exist; andlor
A child turns twenty-one (21). One (1) year prior to the child's
twenty-first (21 st) birthday, CONTRACTOR shall participate
with MTC team to plan for after care.
E. In addition to the documentation and discussion required in Section One (I),
Paragraph D.6, D.7 and D.8 of this Agreement, CONTRACTOR shall dictate a formal report of
findings after the examination of each child that shall include, but is not limited to, child's mobility
status, activities of daily living status, OTIPT recommendations, and durable medical equipment
recommendations. After CONTRACTOR'S dictation is typed, CONTRACTOR shall review and sign
the report titled "MEDICAL THERAPY CONFERENCE REPORT."
F. CONTRACTOR shall be licensed to practice medicine in the State of California,
and shall maintain such licensure during each term of this Agreement.
G. CONTRACTOR agrees to at all times perform assigned duties to the best of
CONTRACTOR ability and in accordance with the highest scientific, professional, and ethical
standards of their profession, and at all times will act within the policies, rules, and regulations of
COUNTY, the State of California Department of Health Care Services, and State of California, local
statutes and administrative regulations relating to health.
H. CONTRACTOR shall be available to perform services at times and dates
mutually agreeable to both CONTRACTOR and COUNTY.
2. TERM
This Agreement shall become effective on the 1'' day of July, 2009 and shall terminate
on the 30~ day of June, 2010.
This Agreement shall automatically be extended for two (2) additional twelve (12)
month periods upon the same terms and conditions herein set forth, unless written notice of
non-renewal is given by CONTRACTOR or COUNTY or COUNTY'S DPH Director, or designee, not
later than sixty (60) days prior to the close of the current Agreement term.
COUNTY OF FRESNO
Fresno, CA
TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to COUNTY;
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of
any breach of this Agreement or any default which may then exist on the part of CONTRACTOR.
Neither shall such payment impair or prejudice any remedy available to COUNTY with respect to the
breach or default. COUNTY shall have the right to demand of CONTRACTOR the repayment to
COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of
COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR shall
promptly refund any such funds upon demand, or at COUNTY'S option, such repayment shall be
deducted from future payments owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY'S DPH Director or
designee, upon the giving of thirty (30) days advance written notice of an intention to terminate.
4. COMPENSATION
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation at the rate of One Hundred Twenty-Five and No1100 Dollars ($125.00) per hour for
actual services performed, as described in Section One (1) of this Agreement. In no event shall actual
services performed under this Agreement be in excess of Thirty Three Thousand One Hundred Three
and No/100 Dollars ($33,125.00) for each twelve (12) month period of this Agreement. It is
COUNTY OF FRESNO
Fresno, CA
1 understood that all expenses incidental to CONTRACTOR'S performance of services under this
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7 11 compensation."
Agreement shall be borne by CONTRACTOR.
Payments by COUNTY shall be in arrears, for services provided during the
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preceding month, within forty-five (45) days after receipt and verification of CONTRACTOR'S
invoices by COUNTY'S Department of Public Health. If CONTRACTOR should fail to comply with
any provision of this Agreement, COUNTY shall be relieved of its obligation for further
10 11 (CMS) 1500 form, by this reference incorporated herein, for the prior month's services, addressed to
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l1 11 the County of Fresno, Department of Public Health, P. 0. Box 11 867, Fresno, CA 93775, Attention:
5. INVOICING
CONTRACTOR shall invoice COUNTY monthly on a Children's Medical Services
12 11 CMS Division Manager. Invoices shall include the date(s) and hours services were performed.
16 11 CONTRACTOR'S officers, agents and employees will at all times be acting and performing as an
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6- INDEPENDENT CONTRACTOR
In performance of the work, duties and obligations assumed by CONTRACTOR under
this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
1 9 11 right to control or supervise or direct the manner or method by which CONTRACTOR shall perform
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independent contractor and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner or associate of COUNTY. Furthermore, COUNTY shall have no
2 2 11 thereof. CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
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23 rules and regulations, if any, of governmental authorities having jurisdiction over matters which are I I
its work and function. However, COUNTY shall retain the right to administer this Agreement so as to
verify that CONTRACTOR is performing its obligations in accordance with the terms and conditions
24 1 directly or indirectly the subject of this Agreement.
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COUNTY OF FRESNO
Fresno, CA
Because of its status as an independent contractor, CONTRACTOR shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
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CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its employees
all legally-required employee benefits. In addition, CONTRACTOR shall be solely responsible and
I save COUNTY harmless from all matters relating to payment of CONTRACTOR'S employees,
including compliance with Social Security, withholding and all other regulations governing such
matters. It is acknowledged that during the term of this Agreement, CONTRACTOR may be
providing services to others unrelated to COUNTY or to this Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written
consent of all the parties without, in any way, affecting the remainder.
8. NON-ASSIGNMENT
Neithx ~hallassign~csw~~ ------ - Agreemeil€ilo&&@mr
duties under this Agreement without the prior written consent of the other party.
9. HOLD-HARMLESS
Except for those acts or omissions constituting administrative, educational or medical
services, which are addressed in Paragraph Ten (10) of this Agreement, CONTRACTOR agrees to
indemnify, save, hold harmless, and at COUNTY'S request, defend COUNTY, its officers, agents and
employees from any and all costs and expenses, damages, liabilities, claims and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by CONTRACTOR,
its officers, agents or employees under this Agreement, and from any and all costs and expenses,
damages, liabilities, claims and losses occurring or resulting to any person, fm or corporation who
may be injured or damaged by the performance, or failure to perform, of CONTRACTOR, its officers,
agents or employees under this Agreement. In addition, CONTRACTOR agrees to indemnify
COUNTY for Federal, State of California andlor local audit excwtions resulting from noncompliance
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herein on the part of the CONTRACTOR.
10. INSURANCE
COUNTY will defend and pay on behalf of CONTRACTOR for any loss arising out of
medical professional liability of CONTRACTOR if the occurrence from which the loss arises took
place during the term of this Agreement and arose out of CONTRACTOR'S contractual responsibility
to COUNTY. Such occurrences are limited to the rendering of or failure to render administrative or
educational or medical services to COUNTY patients (for purposes of this Agreement, COUNTY
COUNTY OF FRESNO
Fresno, CA
patients shall refer to CCS MTU designated children) including diagnosis and treatment of medical
conditions of COUNTY patients and do not include rendering or failure to render such services or care
to any of CONTRACTOR'S private patients. The maximum amount COUNTY will be obligated to
pay for any single occurrence on behalf of CONTRACTOR, is the sum of Three Million Dollars
($3,000,000.00). A single occurrence is defined as one (1) procedure or treatment, or a series of
procedures or treatments, performed over a reasonable period of time because of a condition requiring
medical care, examination or treatment by CONTRACTOR. Said Three Million Dollars
($3,000,000.00) per occurrence limit will be applied to all causes of action whether or not brought at
the same time by a plaintiff for professional liability. COUNTY'S obligation to defend and indemnify
shall be subject to and in excess of any valid and collectible professional coverage required by this
Agreement. COUNTY patients are limited to County of Fresno, Department of Public Health's CCS
MTU registered patients who are being examined or treated by CONTRACTOR. No coverage will be
afforded for any services provided for which a private billing is made or authorized by
CONTRACTOR.
Without limiting COUNTY'S right to obtain indemnification from CONTRACTOR or
any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the
following insurance policies throughout the term of this Agreement:
Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million
Dollars ($2,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse and Underground
(XCU), fire legal liability or any other liability insurance deemed necessary
because of the nature of this Agreement.
Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than One Hundred Thousand Dollars ($100,000) per person, Three
Hundred Thousand Dollars ($300,000) per accident and for property damages of
not less than Twenty-Five Thousand Dollars ($25,000), or such coverage with a
combined single limit of There Hundred Thousand Dollars ($300,000).
COUNTY OF FRESNO
Fresno, CA
Professional Liability
If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N.,
L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate.
Worker's Compensation
A policy of Worker's Compensation Insurance may be required by the California
Labor Code.
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under CONTRACTOR'S policies herein.
This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance
written notice given to COUNTY.
Within thirty (30) days from the date CONTRACTOR executes this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above, for all of
the foregoing policies, as required herein, to the County of Fresno, Department of Public Health, P.O.
Box 11867, Fresno, California, 93775, Attention: CMS Division Manager - 2h Floor, stating that
such insurance coverage's have been obtained and are in full force; that the County of Fresno, its
officers, agents and employees will not be responsible for any premiums on the policies; that such
Commercial General Liability insurance names the County of Fresno, its officers, agents and
employees, individually and collectively, as additional insured, but only insofar as the operations
under this Agreement are concerned; that such coverage for additional insured shall apply as primary
insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents and
employees, shall be excess only and not contributing with insurance provided under
CONTRACTOR'S policies herein; and that this insurance shall not be cancelled or changed without a
minimum of thirty (30) days advance, written notice given to COUNTY.
COUNTY OF FRESNO
Fresno, CA
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
herein provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
of A FSC VII or better.
11. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating
to confidentiality.
12. NONDISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religion, color, national origin, ancestry, physical disability, medical condition, sexual
orientation, marital status, age or gender, pursuant to all applicable State of California and Federal
statutes and regulations.
13. RECORDS
All records under the terms and conditions of this Agreement, as described in Section
One (1) of this Agreement, shall be maintained at COUNTY's DPH CCS Administrative and Medical
Therapy Units. All records are the property of COUNTY's DPH California Children's Services. Said
records shall be retained in accordance with COUNTY's medical record procedures.
14. AUDITS AND INSPECTIONS
CONTRACTOR shall at any time during business hours, and as often as COUNTY may
deem necessary, make available to COUNTY for examination all of its records and data with respect
to the matters covered by this Agreement. CONTRACTOR shall, upon request by COUNTY, permit
COUNTY to audit and inspect all such records and data necessary to ensure CONTRACTOR'S
compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No1100 Dollars ($10,000.00),
COUNTY OF FRESNO
Fresno, CA
CONTRACTOR shall be subject to the examination and audit of the State Auditor for a period of
three (3) years after final payment under contract (California Government Code section 8546.7).
15. NOTICES
The persons and their addresses having authority to give and receive notices under this
Agreement and their addresses include the following:
COUNTY
Director, County of Fresno
Department of Public Health
P.O. Box 1 1867
Fresno, CA 93775
CONTRACTOR
Carmen De La Rosa., M.D.
201 7 San Gabriel
Clovis, CA 936 1 1
Any and all notices between COUNTY and CONTRACTOR provided for or permitted
under this Agreement, or by law, shall be in writing and shall be deemed duly served when personally
delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
Mail, postage prepaid, addressed to such party.
16. GOVERNING LAW
The parties agree, that for purposes of venue, performance under this Agreement is to be
in Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
17. SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of
any one provision in the Agreement shall not affect the other provisions.
18. ENTIRE AGREEMENT
This Agreement constitutes the entire agreement between CONTRACTOR and
COUNTY with respect to the subject matter hereof and supersedes all previous negotiations,
proposals, commitments, writings, advertisements, publications and understandings of any nature
whatsoever unless expressly included in this Agreement.
Ill
Ill
COUNTY OF FRESNO
Fresno, CA
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
year first hereinabove written.
ATTEST:
CONTRACTOR:
CARMEN DE LA ROSA, M.D.
1 Carmen De La Rosa, M.D.
Date:
COUNTY OF FRE NO L
Date: P/~/C 9
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
Mailing Address:
2017 San Gabriel
Clovis, CA 9361 1
Phone #: (559) 348-1000
Contact: Carmen De La Rosa, M.D.
COUNTY OF FRESNO
Fresno, CA
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APPROVED AS TO LEGAL FORM:
KEVIN B. BRIGGS, INTERIM COUNTY COUNSEL
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APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER1
TREASURER-TAX COLLECTOR
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COUNTY OF FRESNO
Fresno, CA
REVIEWED AND RECOMMENDED FOR APPROVAL:
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Fund/Subclass:
Organization #:
Account #:
Requisition #: 5621000166
MS
3106ccs
SB542