HomeMy WebLinkAboutAgreement A-15-386 with Saint Agnes Medical Center.pdf Agreement No. 15-386
1 EMS TRAINING AGREEMENT
2 THIS AGREEMENT is made and entered into this day of , 2015,by
3 and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,hereinafter
4 referred to as "COUNTY," and SAINT AGNES MEDICAL CENTER, a non-profit public benefit
5 corporation, whose address is 1303 E. Herndon Avenue, Fresno, California 93720, hereinafter referred
6 to as "PROVIDER."
7 WITNESSETH:
8 WHEREAS, COUNTY, through its Department of Public Health (DPH), Emergency Medical
9 Services Division (EMS Division), is in need of a general acute care hospital to provide an Emergency
10 Medical Technician-Paramedic (EMT-P) supervised clinical training experience(as that term is
11 defined in Title 22, Section 100152, of the California Code of Regulations), including the use of
12 clinical facilities and clinical preceptors for said training, for independent paramedic trainees; and
13 WHEREAS, said EMT-P clinical training experience is mandated by Title 22, Section 100152,
14 of the California Code of Regulations; and
15 WHEREAS, PROVIDER maintains and operates such general acute care hospital facilities and
16 has sufficient available clinical preceptors for furnishing said EMT-P clinical training experience; and
17 WHEREAS, PROVIDER and COUNTY believe that the experience and knowledge gained by
18 paramedic trainees will benefit the care of patients in the pre-hospital setting; and
19 WHEREAS, it is of mutual benefit to the parties hereto that said independent paramedic
20 trainees use such facilities and clinical preceptors of PROVIDER for their EMT-P supervised clinical
21 training experience.
22 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the adequacy
23 and sufficiency of which are hereby acknowledged as being received, the parties hereto agree as
24 follows:
25 1. RESPONSIBILITIES OF PROVIDER
26 A. PROVIDER shall provide a supervised program of clinical training experience to
27 selected paramedic trainees,through clinical preceptors and appropriate facilities, in accordance with
28 the terms and conditions stated in this Agreement, and Title 22, Section 100152 of the California Code
EMT Preceptorship Agreement - 1 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 of Regulations. PROVIDER shall provide clinical preceptors to supervise the clinical training
2 experience program. Such preceptors shall be mutually acceptable to COUNTY's DPH Director or his
3 or her designee ("COUNTY's Director") and PROVIDER's President and CEO, or his or her designee
4 ("PROVIDER's Director"). No more than two (2) trainees shall be assigned to one (1)preceptor
5 during the supervised clinical training experience program at any one time. Clinical experience shall
6 include direct patient care responsibilities, which may include the administration of any additional
7 medications, approved by the DPH Director and the Director of State EMS Authority, to result in
8 competency. Clinical assignments shall include,but are not to be limited to, emergency, cardiac,
9 surgical, obstetric, and pediatric patients.
10 B. PROVIDER's services under this Agreement shall be performed on a non-
11 exclusive basis. Each party shall be free to participate in such other training programs for the same or
12 similar services as each party, in its sole and absolute discretion, elects.
13 C. PROVIDER shall, on a daily basis, complete attendance and shift evaluations on
14 each trainee's performance on forms provided by the COUNTY. PROVIDER will give the completed
15 evaluations to the trainee at the end of each shift, and shall cause each trainee to maintain the
16 evaluations in an EMS Division-approved notebook.
17 D. PROVIDER shall,upon reasonable request, permit the COUNTY and/or any
18 parties responsible for accrediting said paramedic training to inspect the PROVIDER's clinical
19 facilities, services available for supervised clinical training experience program, trainee records, and
20 such other material which pertain to the supervised clinical training experience under this Agreement.
21 E. COUNTY acknowledges that, on the commencement of this Agreement,
22 PROVIDER's facilities, PROVIDER's available clinical experience program, PROVIDER's proposed
23 supervision thereof, and PROVIDER's policies and procedures in connection therewith, are
24 satisfactory for the trainees and are in conformance with the requirements of Title 22, Section 100152
25 of the California Code of Regulations.
26 F. PROVIDER may, in its sole and absolute discretion, refuse to accept or may
27 withdraw any trainee assigned by COUNTY to PROVIDER's supervised clinical training experience
28 program, provided that it gives the COUNTY the reason therefor, in writing, and further provided that
EMT Preceptorship Agreement - 2 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 the basis therefor is not the trainee's race, creed, color, sex, disability/handicap, national origin, age,
2 ancestry, sexual orientation, marital status, religious affiliation, medical condition, political affiliation
3 or union membership.
4 G. PROVIDER shall, at all times, be licensed as a general acute care hospital and
5 shall hold a permit to operate a basic or comprehensive emergency medical service.
6 2. RESPONSIBILITIES OF COUNTY
7 A. COUNTY shall have the right and responsibility for selecting and referring to
8 PROVIDER the individual trainees who will be assigned to PROVIDER's clinical training experience
9 program. Said trainees will not be employees of the COUNTY. Such selection and referral will be
10 made without regard to race, creed, color, sex, disability/handicap, national origin, age, ancestry,
11 sexual orientation, marital status, religious affiliation, medical condition, political affiliation or union
12 membership. On or about four(4) weeks prior to the beginning of each trainee's clinical training
13 experience at PROVIDER's facilities, COUNTY shall forward to PROVIDER the name,health
14 clearance report required under Subparagraph 2.C, herein, and other appropriate information as
15 mutually determined by COUNTY and PROVIDER, of each trainee selected by the COUNTY to
16 participate in PROVIDER's clinical training experience program. PROVIDER shall have the right,
17 prior to arrival of the trainee(s), to request from COUNTY additional reasonable information
18 concerning any or all of the selected trainees.
19 B. Trainees shall be responsible for, and COUNTY shall notify the trainees that the
20 trainees shall be responsible for:
21 1) Following the administrative and patient care policies, procedures,rules
22 and regulations of the PROVIDER.
23 2) Acquiring, paying for, and using the necessary and appropriate uniforms
24 and personal protective equipment when not provided by PROVIDER.
25 3) Arranging for their own transportation and personal living
26 accommodations and costs.
27 4) Adhering to COUNTY's EMT-P clinical training experience program
28 requirements concerning the necessary health clearance, as provided in Subparagraph 2.C. herein.
EMT Preceptorship Agreement - 3 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 5) Obtaining professional liability and worker's compensation insurance in
2 accordance with Paragraph 11 of this Agreement.
3 C. COUNTY agrees that each trainee will comply with the PROVIDER's health
4 clearance requirements herein at the time that he or she commences the PROVIDER's clinical training
5 experience program. Prior to the first clinical training experience of each trainee, COUNTY shall
6 provide PROVIDER with proof that the said trainee(s) assigned to PROVIDER's clinical training
7 experience program meet the following health clearance requirements, and any other health clearance
8 requirements reasonably requested by PROVIDER. Trainees are required to provide documentation of
9 the following:
10 1) Health Examination Form—Trainees are required to have a physical
11 examination by a medical provider attesting to the fact the trainee is medically and physically able to
12 participate in the program.
13 2) Background Check—Trainees will have a Live Scan background check
14 prior to clinical internship. If a trainee's background is flagged due to an issue, PROVIDER will
15 decide whether the trainee will be allowed to have clinical placement in its facility.
16 3) Drup, Screen—Trainees will be required to have a 10-panel drug screen
17 prior to clinical internship. If a trainee has a positive drug screen, PROVIDER will decide whether the
18 trainee will be allowed to have clinical placement. The 10-Panel Drug Screen shall test for the
19 following:
20 a) Amphetamines
21 b) Barbiturates
22 c) Benzodiazepines
23 d) Marijuana
24 e) Cocaine
25 f) Opiates
26 g) Oxycodones
27 h) Phencyclidine(PCP)
28 i) Methaqualone
EMT Preceptorship Agreement - 4 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 j) Methadone
2 4) Immunizations—Trainees shall have the following immunizations:
3 a) Measles, Mumps, Rubella (MMR)
4 b) Pertussis (Tdap)
5 c) Varicella(Chicken Pox)
6 d) Hepatitis B Vaccination Series—Each trainee must have received
7 Hepatitis B vaccination series prior to commencing his/her clinical training experience at PROVIDER's
8 facility. In lieu of vaccination for Hepatitis B, said trainee(s) shall document a Hepatitis B Vaccine
9 Declination form signed by the trainee. Said trainee(s) shall use the Hepatitis B Vaccine Declination
10 form, identified as Exhibit A, attached hereto and by this reference incorporated herein, to meet the
11 above requirements
12 e) Tuberculin Skin Test with negative result for purified protein
13 derivative (PPD)time test. The PPD needs to be done within one year, but must be current throughout
14 clinical and field. If the trainee's PPD will expire during internship, the trainee will be required to have
15 a new PPD before entering clinical internship. If a trainee has a positive PPD or history of a positive
16 PPD, or has been treated with INH, the trainee will be required to have documentation of a negative
17 chest x-ray within the last 12 months and may be requested to have a repeat chest x-ray by the clinical
18 provider.
19 f) Influenza (Flu Immunization)—Trainees are required to have the
20 current influenza immunization for the current flu season. If the trainee wishes not to have the
21 influenza immunization the trainee may decline and sign a declination form with PROVIDER, if
22 available.
23 5) Occupational Safety and Health Administration (OSHA) blood-borne Pathogen
24 standards training.
25 3. JOINT RESPONSIBILITIES
26 A. The period of time for each trainee's clinical training experience at
27 PROVIDER's facilities shall be mutually agreed upon between COUNTY's Director and
28 PROVIDER's Director prior to the beginning of each trainee's clinical training experience.
EMT Preceptorship Agreement - 5 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 Reasonable extensions of time may be agreed to by COUNTY's Director and PROVIDER's Director
2 if a particular trainee requires additional experience.
3 B. The number of trainees to participate in the clinical training experience at
4 PROVIDER's facilities at any given time shall be mutually agreed upon, in writing, by COUNTY's
5 Director and PROVIDER's Director, prior to the beginning of the clinical training experience
6 program, and may be modified from time to time by mutual written agreement between the
7 COUNTY's Director and PROVIDER's Director upon request of either of the parties.
8 C. COUNTY's Director and PROVIDER's Director will utilize the Fresno County
9 Emergency Medical Services Primary Paramedic Training Clinical Handbook curriculum guidelines,
10 as presently established or may be hereafter modified, which are hereby incorporated herein by this
11 reference, for the operational details of PROVIDER's EMT-P clinical training experience program.
12 D. It is expressly agreed and understood by COUNTY and PROVIDER that the
13 trainees under this program are in attendance at PROVIDER's facilities only for educational purposes,
14 and they are not considered to be employees of the PROVIDER or COUNTY, for any purpose,
15 including, but not limited to, compensation for services, employee or pension benefits, provided
16 however the trainees shall at all times be under the sole and direct control and supervision of
17 PROVIDER.
18 4. TERM
19 This Agreement shall become effective on the 1 s1 day of July, 2015 and shall terminate
20 on the 30th day of June, 2018.
21 This Agreement may be extended by COUNTY for up to two (2) additional, successive
22 twelve (12) month periods upon the same terms and conditions herein set forth, and subject to the
23 following provisions within this Section 3. Each such extension period will be contingent upon the
24 evaluation of PROVIDER's performance of its services under this Agreement during the then-current
25 period of this Agreement, by COUNTY's DPH Director or his/her designee. If upon each evaluation,
26 COUNTY's DPH Director or his/her designee determines that the then-current term of this Agreement
27 should be extended pursuant to this Section 4, COUNTY's DPH Director or his/her designee, may
28 provide a written notice of such extension to PROVIDER ninety (90) days prior to each subsequent
EMT Preceptorship Agreement - 6 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 twelve (12) month period. Notwithstanding anything to contrary in this Section 4, either party may
2 elect not to extend this Agreement if written notice of non-extension is given by either PROVIDER or
3 COUNTY or COUNTY's DPH Director or his/her designee, to the other party no later than ninety
4 (90) days prior to the then renewal period.
5 5. TERMINATION
6 A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
7 provided thereunder, are contingent on the approval of funds by the appropriating government agency
8 for the COUNTY's operations. Should sufficient funds not be allocated, the services provided may be
9 modified, or this Agreement terminated at any time by giving the PROVIDER thirty (30) days
10 advance written notice. Notwithstanding anything stated to the contrary in this Agreement,the
11 provisions of this Paragraph 5.A. shall not be construed as imposing any obligations on COUNTY to
12 compensate PROVIDER or any trainee for any service that they may perform or activity that they may
13 undertake in connection with this Agreement.
14 B. Breach of Contract - COUNTY may immediately suspend or terminate this
15 Agreement in whole or in part, where in the determination of the COUNTY there is:
16 1) A failure to comply with any term of this Agreement;
17 2) Improperly performed service;
18 3) A substantially incorrect or incomplete report(s) and/or trainee
19 evaluation(s) submitted to the COUNTY, as determined by reasonable standards set forth by
20 COUNTY and communicated to PROVIDER.
21 C. Without Cause - Under any circumstances other than those set forth above, or
22 for no reason at all, this Agreement may be terminated by PROVIDER's Director or COUNTY or
23 COUNTY's DPH Director, or designee, upon the giving of at least ninety (90) days advance written
24 notice to the other party of an intention to terminate. .
25 6. COMPENSATION
26 The clinical training experience program conducted pursuant to the terms and conditions
27 of this Agreement shall be performed without the payment of any monetary consideration by
28 PROVIDER or COUNTY, one to the other, or by or to any trainee participating in said clinical
EMT Preceptorship Agreement - 7 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 training experience program.
2 The parties hereto acknowledge and agree that their respective covenants made to the
3 other party and benefits received from the other party under this Agreement shall form the basis of the
4 consideration exchanged between them under this Agreement.
5 7. INDEPENDENT CONTRACTOR
6 This Agreement is not intended to and will not be construed to create the relationship of
7 principal-agent, master-servant, employer-employee, partnership,joint venture or association between
8 the COUNTY and PROVIDER; neither is any party an officer of the other. Each of the parties, their
9 officers, agents, and employees, in their performance of this Agreement, shall act in an independent
10 capacity between each other.
11 It is further acknowledged by all parties to this Agreement that the relationship of the
12 trainees receiving the clinical training experience, as identified herein, and the COUNTY and the
13 PROVIDER is one of an independent capacity between the trainees on one hand and the COUNTY
14 and PROVIDER on the other hand. Said trainees are not employees of either COUNTY or
15 PROVIDER, provided however the trainees, when receiving clinical experience pursuant to this
16 Agreement, shall be under the direction and supervision of PROVIDER. The purpose of this
17 Agreement is to provide a mechanism where said trainees can receive EMT-P clinical training
18 experience. In this regard, said trainees shall work with PROVIDER for the benefit of receiving the
19 paramedic clinical training experience identified herein.
20 8. MODIFICATION
21 Any matters of this Agreement may be modified from time to time by the written
22 consent of all the parties without, in any way, affecting the remainder.
23 9. NON-ASSIGNMENT
24 Neither party shall assign, transfer or sub-contract this Agreement nor their rights or
25 duties under this Agreement without the prior written consent of the other party.
26 10. HOLD HARMLESS
27 A. PROVIDER agrees to defend, indemnify and hold harmless COUNTY, its
28 elective and appointive boards, officers, agents, and employees from any and all claims, suits,
EMT Preceptorship Agreement - 8 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 liabilities, expenses, costs, damages, or judgments of any nature, including attorney fees, costs, for
2 injury to, or death of, any persons, and for injury to any property, that are the result of any negligent or
3 wrongful acts or omissions by PROVIDER, its officers, employees, agents or contractors, in
4 performing or failing to perform any services or functions provided for under this Agreement. The
5 foregoing clause shall in no way obligate PROVIDER to provide such protection, indemnification, or
6 defense to the extent of negligent or wrongful acts or omissions by COUNTY, its officers, employees,
7 agents, or contractors, or the trainees.
8 B. COUNTY agrees to defend, indemnify and hold harmless PROVIDER, its
9 elective and appointive boards, officers, agents and employees from any and all claims, suits,
10 liabilities, expenses, costs, damages, or judgments of any nature, including attorney fees, costs, for
11 injury to, or death of, any persons, or for injury to any property, that are the result of any negligent or
12 wrongful acts or omissions by COUNTY, its officers, employees, agents or contractors, or trainees in
13 performing or failing to perform any services or functions provided for under this Agreement. The
14 foregoing clause shall in no way obligate COUNTY to provide such protection, indemnification, or
15 defense to the extent of negligent or wrongful acts or omissions by PROVIDER, its officers,
16 employees, agents, or contractors, or the trainees.
17 11. INSURANCE
18 Without limiting the COUNTY's right to obtain indemnification from PROVIDER or
19 any third parties, PROVIDER, at its sole expense, shall maintain in full force and effect the following
20 insurance policies throughout the term of this Agreement:
21 A. Commercial General Liability
22 Commercial General Liability Insurance with limits of not less than One Million Dollars ($1,000,000)
23 per occurrence and an annual aggregate of Two Million Dollars ($2,000,000). This policy shall be
24 issued on a per occurrence basis. COUNTY may require specific coverage including completed
25 operations, product liability, contractual liability, Explosion, Collapse, and Underground(XCU), fire
26 legal liability or any other liability insurance deemed necessary because of the nature of the
27 Agreement.
28 ///
EMT Preceptorship Agreement - 9 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 B. Automobile Liabilitv
2 Comprehensive Automobile Liability Insurance with limits for bodily injury of not less than Two
3 Hundred Fifty Thousand Dollars ($250,000) per person, Five Hundred Thousand Dollars ($500,000)
4 per accident and for property damages of not less than Fifty Thousand Dollars ($50,000), or such
5 coverage with a combined single limit of Five Hundred Thousand Dollars ($500,000). Coverage
6 should include owned and non-owned vehicles used in connection with this Agreement.
7 C. Professional Liabilitv
8 If PROVIDER employs licensed professional staff(e.g. Ph.D., R.N., L.C.S.W., M.F.C.C.) in
9 providing services, Professional Liability Insurance with limits of not less than One Million Dollars
10 ($1,000,000)per occurrence, Three Million Dollars ($3,000,000) annual aggregate.
11 D. Worker's Compensation
12 A policy of Worker's Compensation Insurance as may be required by the California Labor Code.
13 PROVIDER shall obtain endorsements to the Commercial General Liability insurance
14 naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
15 additional insured, but only insofar as the operations under this Agreement are concerned. Such
16 coverage for additional insured shall apply as primary insurance and any other insurance, or self-
17 insurance, maintained by the COUNTY, its officers, agents and employees shall be excess only and not
18 contributing with insurance provided under the PROVIDER's policies herein. This insurance shall not
19 be cancelled or changed without a minimum of thirty(30) days advance written notice given to
20 COUNTY.
21 Within thirty (30) days from the date PROVIDER executes this Agreement, PROVIDER
22 shall provide certificates of insurance and endorsements as stated above for all of the foregoing
23 policies, as required herein, to the County of Fresno, Department of Public Health, P.O. Box 11867,
24 Fresno, California, 93775, Attention: Contracts Section—6t'Floor, stating that such insurance
25 coverage have been obtained and are in full force; that the County of Fresno, its officers, agents and
26 employees will not be responsible for any premiums on the policies; that such Commercial General
27 Liability insurance names the County of Fresno, its officers, agents and employees, individually and
28 collectively, as additional insured,but only insofar as the operations under this Agreement are
EMT Preceptorship Agreement - 10 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 concerned; that such coverage for additional insured shall apply as primary insurance and any other
2 insurance, or self-insurance, maintained by the COUNTY, its officers, agents and employees, shall be
3 excess only and not contributing with insurance provided under the PROVIDER's policies herein; and
4 that this insurance shall not be cancelled or changed without a minimum of thirty (30) days advance,
5 written notice given to COUNTY.
6 In the event PROVIDER fails to keep in effect at all times insurance coverage as herein
7 provided,the COUNTY may, in addition to other remedies it may have, suspend or terminate this
8 Agreement upon the occurrence of such event.
9 All policies shall be with admitted insurers licensed to do business in the State of
10 California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of
11 A FSC VII or better.
12 12. CONFIDENTIALITY
13 The parties shall comply with all applicable Federal, State of California and/or local
14 laws and regulations relating to confidentiality of patient information.
15 13. NON-DISCRIMINATION
16 During the performance of this Agreement, PROVIDER shall not unlawfully
17 discriminate against any employee or applicant for employment, or recipient of services, because of
18 race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
19 condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
20 sexual orientation, or military or veteran status pursuant to all applicable State of California and
21 Federal statutes and regulations.
22 14. DISCLOSURE OF SELF-DEALING TRANSACTIONS
23 This provision is only applicable if the PROVIDER is operating as a corporation (a for-
24 profit or non-profit corporation) or if during the term of this agreement, the PROVIDER changes its
25 status to operate as a corporation.
26 Members of the PROVIDER's Board of Directors shall disclose any self-dealing
27 transactions that they are a party to while PROVIDER is providing goods or performing services
28 under this agreement. A self-dealing transaction shall mean a transaction to which the PROVIDER is a
EMT Preceptorship Agreement - 11 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 party and in which one or more of its directors has a material financial interest. Members of the Board
2 of Directors shall disclose any self-dealing transactions that they are a party to by completing and
3 signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit B and incorporated
4 herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing
5 transaction or immediately thereafter.
6 15. CHILD ABUSE REPORTING
7 PROVIDER shall utilize a procedure acceptable to COUNTY to ensure that all of
8 PROVIDER's employees, volunteers, consultants, subcontractors, and agents performing services
9 under this Agreement, and trainees, shall report all known or suspected child abuse or neglect to one
10 or more of the agencies set forth in Penal Code Section 11165.9. This procedure shall include having
11 each of PROVIDER's employees, volunteers, consultants, subcontractors and agents performing
12 services under this Agreement, and trainees, sign a statement that he or she knows of and will comply
13 with the reporting requirements set forth in Penal Code 11166. The statement to be utilized by
14 PROVIDER is set forth in Exhibit C,Notice of Child Abuse Reporting Law, attached hereto and by
15 this reference incorporated herein.
16 16. THIRD PARTY BENEFICIARIES
17 The parties hereto agree that the covenants made and benefits received between them,
18 and for the benefit of the COUNTY under this Agreement are only between them and for the benefit
19 of the COUNTY, and that there are no intended third party beneficiaries of this Agreement.
20 17. AUDITS AND INSPECTIONS
21 PROVIDER shall make available to the COUNTY for examination records and data
22 relating to the clinical experience program required to be created and maintained by PROVIDER
23 under this Agreement. PROVIDER shall, upon request by the COUNTY, permit the COUNTY to
24 audit and inspect all such records and data necessary to ensure PROVIDER's compliance with the
25 terms of this Agreement.
26 18. NOTICES
27 The persons having authority to give and receive notices under this Agreement and their
28 addresses include the following:
EMT Preceptorship Agreement - 12 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 COUNTY PROVIDER
2 Director, County of Fresno Nancy Hollingsworth, Chief Executive Officer
3 Department of Public Health Saint Agnes Medical Center
P. O. Box 11867 1303 E. Herndon Avenue
4 Fresno, CA 93775 Fresno, CA 93720
5 Any and all notices between the COUNTY and the PROVIDER provided for or
6 permitted under this Agreement shall be in writing and shall be deemed duly served when personally
7 delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
8 Mail, postage prepaid, addressed to such party.
9 19. GOVERNING LAW
10 The parties agree that for the purposes of venue, performance under this Agreement is to
11 be in Fresno County, California.
12 The rights and obligations of the parties and all interpretation and performance of this
13 Agreement shall be governed in all respects by the laws of the State of California.
14 20. SEVERABILITY
15 The provisions of this Agreement are severable. The invalidity or unenforceability of
16 any one provision in the Agreement shall not affect the other provisions.
17 21. ENTIRE AGREEMENT
18 This Agreement, including Exhibit A, Exhibit B, Exhibit C and Fresno County
19 Emergency Medical Services Primary Paramedic Training Clinical Handbook curriculum guidelines,
20 constitutes the entire agreement between the PROVIDER and COUNTY with respect to the subject
21 matter hereof and supersedes all previous agreement negotiations,proposals, commitments, writings,
22 advertisements, publications, and understandings of any nature whatsoever unless expressly included
23 in this Agreement.
24
25
26
27
28
EMT Preceptorship Agreement - 13 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written.
3
4 PROVIDER: COUNTY OF FRESNO
SAINT AGNES MEDICAL CENTER
5
6 By - GLA01;-'-
7By Q .
J Chairman, Board Supervis
Debbie Cha Chappell PP Name:
8
Title: Vice President, Clinical Services Date:
9 Chairman of the Board, or
10 President, or any Vice President
11 Date: une 16 2015 BERNICE E. SEIDEL, Clerk
12 Board of Supervisors
B `
13 y --
14 Na e: Jonathan Lindeke By
4b2AL LA
15 Title: Secretary Date: �1 l ' ZyiS
16 Secretary (of Corporation), or
any Assistant Secretary, or
17 Chief Financial Officer, or
18 any Assistant Treasurer
19 Date: June 17,2015 PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
20
21
22
23
24 Mailing Address:
1303 E. Herndon Avenue
25 Fresno, CA 93720
Phone No.: (559) 450-3000
26
27
28
EMT Preceptorship Agreement - 14 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
1 APPROVED AS TO LEGAL FORM:
2 DANIEL C. CEDERBORG, COUNTY COUNSEL
3
4 By (�L'
5
6
REVIEWED AND RECOMMENDED FOR APPROVAL:
7
8
1 By
David Pomaville
10 Director
11 Department of Public Health
12
13
14
15
16
17
18
19 JW
20
21
22
23
24
25
26
27
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EMT Preceptorship Agreement - 15 - COUNTY OF FRESNO
Saint Agnes Medical Center Fresno, CA
Exhibit A
HEPATITIS B VACCINE DECLINATION
I understand that due to my occupational exposure to blood or other potentially infectious materials, I
may be at risk of acquiring Hepatitis B virus (HBV) infection. I have been given the opportunity to
be vaccinated with Hepatitis B vaccine. However, I decline Hepatitis B vaccination at this time. I
understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious
disease. If in the future, I continue to have occupational exposure to blood and other potentially
infectious materials, and I want to be vaccinated Hepatitis B vaccine, I can receive the vaccination
series.
Print Name Job Title Department
Signature Date
Appendix A to Section 1910, 1030, Federal OSHA Federal Register/Vol. 56, No. 235/Friday,
December 6, 1991.
1 - COUNTY OF FRESNO
Fresno, CA
Exhibit B
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members of a provider's board of directors (hereinafter referred to as "County Provider"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest."
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the Corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Page 1 of 2
Exhibit B
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3)Disclosure(please describe the nature of the self-dealing transaction you are a party to):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a):
(5)Authorized Signature
Signature: Date:
Page 2 of 2
Exhibit C
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and Saint Agnes Medical
Center(PROVIDER), related to provision of EMT-P supervised clinical training
experience services, require that the undersigned report all known or suspected child
abuse or neglect to one or more of the agencies set forth in Penal Code(P.C.) section(§)
11165.9.
For purposes of the undersigned's child abuse reporting requirements, "child
abuse or neglect" includes physical injury inflicted by other than accidental means upon a
child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined in
P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect (P.0 §11166.) The child abuse report shall be made to any
police department or sheriff's department(not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Children and Family Services' 24-Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a"reasonable suspicion" means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child does
not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. (P.C.
§11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the child abuse
reporting requirements.
SIGNATURE DATE