HomeMy WebLinkAboutThe Regents of the University of California San Francisco-Preventative Medicine Residents_A-24-623.pdf COtj County of Fresno Hall of Records, Room 301
2281 Tulare Street
Fresno,California
601 Board of Supervisors 93721-2198
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FRV,t' Minute Order Toll Free: 1-800-742-1011
www.fresnocountyca.gov
December 3, 2024
Present: 5- Supervisor Steve Brandau, Chairman Nathan Magsig,Vice Chairman Buddy Mendes,
Supervisor Brian Pacheco, and Supervisor Sal Quintero
Agenda No. 59. Public Health File ID: 24-0367
Re: Approve and authorize the Chairman to execute an Agreement with The Regents of the University of
California, on behalf of San Francisco campus,to allow the placement of Preventive Medicine
Residents at the Department of Public Health to advance the Residents' knowledge of the field of
preventive medicine and public health, effective upon execution for a period of five years($0); and
approve and authorize the Director of Public Health, or designee, as signatory on behalf of the Board of
Supervisors on associated Program Letters of Agreement and any Addendum to the Program Letters
of Agreement
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco, and Quintero
Agreement No. 24-623
County of Fresno Page 60
COZj���C
Board Agenda Item 59
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FRE`'�
DATE: December 3, 2024
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Affiliation Agreement with The Regents of the University of California
RECOMMENDED ACTION(S):
1. Approve and authorize the Chairman to execute an Agreement with The Regents of the
University of California, on behalf of San Francisco campus, to allow the placement of
Preventive Medicine Residents at the Department of Public Health to advance the
Residents' knowledge of the field of preventive medicine and public health, effective upon
execution for a period of five years ($0); and
2. Approve and authorize the Director of Public Health, or designee, as signatory on behalf of
the Board of Supervisors on associated Program Letters of Agreement and any Addendum
to the Program Letters of Agreement.
There is no Net County Cost associated with the recommended actions. Approval of the recommended
actions will allow the Department of Public Health (Department)to provide field and clinical experience to
Preventative Medicine Residents (Residents)from University of California, San Francisco, School of
Medicine (UCSF). This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, Residents from UCSF would not be able to
obtain broader clinical learning experiences from the Department.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended
agreement does not provide any compensation between the County and UCSF.
DISCUSSION:
UCSF conducts accredited medical educational programs for resident physicians and fellows and desires to
collaborate with facilities in which these program participants can obtain broader clinical learning
experiences. The Department's collaboration with UCSF will advance the Residents' knowledge of the field
of preventive medicine and public health, while also providing the Department with additional skilled
professional medical personnel to assist with public health activities. The County's Interim County Health
Officer will be the faculty site director who assumes administrative, educational, and supervisory
responsibilities for the Residents during the rotation. This collaboration will help provide the community with
medical providers that possess more comprehensive knowledge and experience to better service the public.
This collaboration will also provide Residents with an opportunity to work in public health and possibly make
a career in this underserved area.
County of Fresno Page I File Number.24-0367
File Number:24-0367
Over a period of three months, Residents will be assigned to various activities within the Department,
structured and supervised by the Department's team of Health Officers and contracted physicians. These
activities will include, but are not limited to, assisting with the Tuberculosis, Communicable Disease
Investigations, Rural Mobile Health, and Harm Reduction programs. Upon completion of the three months,
another set of Residents will rotate into assignment with the Department.
Approval of the second recommended action will allow the Director of the Department, or designee, as
signatory on behalf of the Board of Supervisors on associated Program Letter of Agreement and any
Addendum to the Program Letter of Agreement. The recommended agreement deviates from the County's
standard indemnification language thereby including mutual indemnity in connection with the performance of
the agreement.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Affiliation Agreement with The Regents of the University of California
On file with Clerk- Program Letter of Agreement
CAO ANALYST:
Ron Alexander
County of Fresno Page 2 File Number.24-0367
Agreement No. 24-623
AFFILIATION AGREEMENT
BETWEEN
THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
AND
COUNTY OF FRESNO
THIS AFFILIATION AGREEMENT (the "Agreement") is made and entered into this 3rd day of
Dec., 2024, by and between The Regents of the University of California, a corporation described in
California Constitution Art IX, Sec. 9, on behalf of the University of California, San Francisco, SCHOOL
OF MEDICINE (hereafter "SCHOOL"), and the County of Fresno, a political subdivision of the State of
California(hereafter"AFFILIATE")with reference to the following facts:
WITNESSETH:
WHEREAS, SCHOOL conducts approved and accredited medical educational programs for
resident physicians and fellows(hereafter collectively referred to as "TRAINEES") and desires access to
facilities in which its TRAINEES can obtain broader clinical learning experiences; and
WHEREAS, AFFILIATE maintains facilities which can be used to furnish clinical learning
experiences to TRAINEES and desires to have said facilities so used; and
WHEREAS,the Accreditation Council for Graduate Medical Education("ACGME") establishes
and oversees the requirements for graduate medical education programs, which includes resident
physicians and fellows; and
WHEREAS, it is in the mutual interest and benefit of the parties that TRAINEES obtain their
clinical experience at AFFILIATE's facilities in accordance with the requirements of ACGME
NOW, THEREFORE, in consideration of the foregoing and the mutual covenants set forth
below,the parties agree as follows:
1. RESPONSIBILITIES OF SCHOOL. SCHOOL agrees that it shall:
A. Establish the educational goals and objectives of its clinical experience programs in a
manner consistent with the standards and requirements set forth by SCHOOL and ACGME. Such goals
and objectives shall reflect SCHOOL's commitment to providing the highest quality in education and
training programs to TRAINEES. A list of SCHOOL's educational program(s) that are covered by this
Agreement is attached hereto and incorporated herein as Exhibit 1. A list of SCHOOL's medical
residency programs that may rotate medical residents and fellows through AFFILIATE's clinical facilities
and therefore may require a separate Letter of Agreement ("LOA") with AFFILIATE under applicable
ACGME guidelines is attached hereto as Exhibit 2 and incorporated herein by reference. The parties
agree that from time to time SCHOOL may unilaterally add or delete residency programs from Exhibit 2
to reflect changes in specific programs or circumstances.
B. Ensure that its clinical experience programs provide appropriate supervision for all
TRAINEES, as well as a duty hours schedule and work environment that are consistent with proper
patient care, the educational needs and physical and emotional well-being of TRAINEES, and the
applicable requirements of the ACGME.
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C. Recruit and select TRAINEES who are appropriately credentialed, licensed, or otherwise
authorized to participate in SCHOOL clinical experience program(s) which are the subject of this
Agreement(hereafter collectively referred to as"Program").
D. For each SCHOOL clinical experience program provided for under this Agreement,
SCHOOL shall designate a member of SCHOOL's faculty to provide coordination, oversight and
direction of TRAINEES' educational activities and assignments while at AFFILIATE's facilities
(hereafter "Program Director(s)" or "SCHOOL's Program Director(s)"). The Program Director(s) shall
also act as liaison(s)with AFFILIATE.
E. Cooperate with AFFILIATE in coordinating and reviewing work schedules of
TRAINEES while at AFFILIATE. The parties agree that such schedules shall reflect SCHOOL's
educational mission and shall not be compromised by an excessive reliance on TRAINEES to fulfill
institutional service obligations.
F. Ensure, in cooperation with AFFILIATE, that TRAINEES assume progressively increasing
responsibility according to their levels of education, ability, and experience. SCHOOL shall determine the
appropriate level of responsibility accorded to each TRAINEE.
G. Ensure that each of its medical residency programs establishes formal policies governing
the duty hours for TRAINEES which promote medical education, ensure TRAINEES well-being and
facilitate patient care. SCHOOL's policies regarding duty hours and moonlighting from time to time are
set out at hgps://meded.ucsf.edu/residents-clinical-fellows/gme-resident-and-fellow-resources/housestaff-
information-booklet and incorporated herein by reference (hereafter"UCSF Duty Hours Policy").
H. Provide the names of TRAINEES and their assignments to AFFILIATE sufficiently in
advance to allow for convenient planning of duty schedules.
I. Develop and implement a mechanism for determining evaluation of the performance of
TRAINEES to include,where appropriate, input from AFFILIATE.
J. Maintain records and reports concerning the education of TRAINEES and of
TRAINEES' time spent in the various educational activities referred to in this Agreement, as may be
required by SCHOOL, ACGME and/or for compliance with the regulations, guidelines, and policies of
third-party payors.
K. Require assigned TRAINEES to:
1. Comply with: AFFILIATE's applicable Medical Staff Bylaws & Rules and
Regulations; AFFILIATE's policies, procedures and guidelines; state and federal laws and
regulations; the standards and regulations of The Joint Commission ("TJC") and the ACGME;
and the ethical standards of the American Medical Association;
2. Participate, to the extent scheduled or otherwise requested by AFFILIATE and
approved by SCHOOL, in activities and assignments that are of educational value and that are
appropriate to the course and scope of the Program, consistent with the requirements of the
applicable ACGME;
3. Participate, consistent with the terms of this Agreement, in quality assurance and
risk management activities of AFFILIATE designed to identify, evaluate and reduce risk of
patient injury;
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4. Cooperate in the timely preparation and maintenance of a complete medical
record for each patient in whose care TRAINEES participate, on forms provided by the
AFFILIATE. The medical record shall, at all times,remain the property of the AFFILIATE.
5. Submit to SCHOOL the following:
a.Proof of immunization or positive serology(titer) for rubella, measles,mumps,
and varicella;
b. Evidence of Hepatitis B either positive antibody titers or immunization;
c.Annual proof of negative tuberculosis testing by PPD skin test. Any TRAINEE
who has a positive PPD skin test will be required to provide SCHOOL with
evidence of a negative chest x-ray report taken within one(1)year of his/her
initial date of participation in the Program.
Upon AFFILIATE request, SCHOOL will inform each TRAINEE to submit
copies of said documentation to AFFILIATE.
L. Upon request, provide AFFILIATE with a copy of SCHOOL's corporate compliance
program and UCSF Campus Code of Conduct (see http://colnpliance.ucsf.edu� and assign a SCHOOL
representative to work with AFFILIATE regarding any corporate compliance issues. AFFILIATE
acknowledges and agrees that all SCHOOL faculty and TRAINEES must comply with the requirements
of SCHOOL's corporate compliance program.
M. SCHOOL will monitor the clinical learning environment and will engage AFFILIATE in
addressing negative influences in the learning environment where detected.
II. RESPONSIBILITIES OF AFFILIATE. AFFILIATE agrees that it shall:
A. Maintain adequate staff, facilities, and SCHOOL faculty at AFFILIATE locations
covered by this Agreement to meet the educational goals and objectives of the SCHOOL's Program, and
in a manner consistent with the standards and requirements established by SCHOOL and the applicable
ACGME. A list of AFFILIATE's sites(s) that are provided for under this Agreement is attached hereto
and incorporated herein as Exhibit 3. AFFILIATE may not assign TRAINEES to locations other than
those described in Exhibit 3 without the prior written consent of SCHOOL.
B. For TRAINEES enrolled in SCHOOL's Graduate Medical Education ("GME")
Programs, AFFILIATE shall maintain ongoing compliance with the ACGME Institutional Requirements,
the ACGME Common Program Requirements and the Residency Review Committee requirements for
each clinical experience program, as well as the UCSF® policies regarding residents and ACGME
fellows as posted on the UCSF GME website.
C. Structure on-call schedules for supervising faculty at AFFILIATE's facilities in a manner
that assures the Program Director that faculty supervision is readily available to TRAINEES.
D. Provide services and develop systems to minimize the work of TRAINEES that is
extraneous to their educational program(s).
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E. Ensure that SCHOOL faculty who are supervising medical TRAINEES at AFFILIATE
facilities where medical staff privileges are required, obtain and maintain medical staff privileges at
AFFILIATE's facilities.
F. Ensure that AFFILIATE physicians who are supervising medical TRAINEES at
AFFILIATE facilities where medical staff privileges are required, obtain and maintain medical staff
privileges at AFFILIATE's facilities. AFFILIATE's physicians who are supervising medical trainees at
AFFILIATE's facilities must qualify for, obtain and maintain a faculty appointment with SCHOOL in
accordance with SCHOOL's academic review and appointment procedures. During the period in which
TRAINEE is assigned to the AFFILIATE,the TRAINEE shall be under the ultimate direction and control
of the SCHOOL's Program Director or,in the Program Director's absence,his/her designee(s).
G. Cooperate with SCHOOL to ensure that TRAINEES assume progressively increasing and
appropriate responsibility in accordance with their levels of education, ability, and experience.
H. Conduct formal quality assurance programs and review patient complications and deaths
as follows:
1. All TRAINEES shall receive instruction in appropriate quality
assurance/performance improvement. To the extent possible and in conformance with state law,
TRAINEES shall participate in appropriate components of AFFILIATE's quality
assurance/performance improvement program.
2. AFFILIATE shall have a medical records system that assures the availability of
medical records at all times and documents the course of each patient's illness and care. The
medical records system must be adequate to support the education of TRAINEES and quality-
assurance/performance improvement activities,and to provide a resource for scholarly activity.
I. Designate, in consultation with SCHOOL, an employee of AFFILIATE to coordinate
TRAINEES' duty schedules and activities while at AFFILIATE's sites (hereafter"Site Director(s)"). The
Site Director(s) shall also act as liaison(s)with SCHOOL. Upon execution of this Agreement,the name(s)
of AFFILIATE's Site Director(s) shall be provided to SCHOOL's Program Director(s).
J. Implement duty schedules for TRAINEES in conjunction with SCHOOL's Program
Director and in accordance with SCHOOL's educational goals and objectives and the applicable
requirements of the Program and ACGME, as follows:
1. AFFILIATE shall promote the Program's educational goals by ensuring that
TRAINEES' learning objectives are not compromised by excessive reliance on TRAINEES to
fulfill institutional service obligations. The parties acknowledge and agree, however, that duty
hours must reflect the fact that responsibilities for continuing patient care are not automatically
discharged at specific times. Programs must ensure that TRAINEES are provided appropriate
backup support when patient care responsibilities are especially unusual, difficult or prolonged.
2. AFFILIATE shall ensure that TRAINEE duty hours and on-call time periods are
not excessive. The structuring of duty hours and on-call schedules shall ensure a work
environment that is consistent with proper patient care,the educational needs and physical and
emotional well-being of TRAINEES, and the applicable requirements of the Program and
ACGME.
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3. For TRAINEES enrolled in UCSF GME programs, AFFILIATE shall adhere to
the guidelines for the duty hours and working conditions of medical residents as provided in the
UCSF Duty Hours Policy. AFFILIATE shall monitor residents' hours to ensure ongoing
compliance with ACGME requirements (https://www.accime.orci/specialties/preventive-
medicine/program-requirements-and-fags-and-applications/) and the UCSF Duty Hours Policy. Upon
SCHOOL's request, AFFILIATE shall provide data regarding TRAINEES' duty hours to the
Program Director(s) and/or UCSF Dean's Office.
K. Protect the health and safety of TRAINEES on rotation at AFFILIATE's facilities by
providing each TRAINEE with the following:
1. Orientation of the type and scope provided by AFFILIATE to its new employees,
including, but not limited to, information about AFFILIATE's security measures, fire safety and
disaster protocols, and any additional recommended personnel safety and security precautions;
2. Instruction in AFFILIATE's policies and procedures for infection control,
including the handling and disposal of needles and other sharp objects, and in AFFILIATE's
protocols for on-the-job injuries including those resulting from needlestick injuries and other
exposures to blood or body fluids or airborne contaminants;
3. First aid and other emergency treatment on-site, including, but not limited to,
immediate evaluation for risk of infection and appropriate follow-up care of TRAINEE in the
event of a needlestick injury to or other exposure of TRAINEE to blood or body fluids or
airborne contaminants. In the case of suspected or confirmed exposure to the human immuno-
deficiency virus or hepatitis, such follow-up care shall be consistent with the current guidelines of
the Centers for Disease Control and the community's standard of care. The initial care and
administration of testing and prophylactic therapy shall be paid for by AFFILIATE. Subsequent
care shall be paid for pursuant to the mutual agreement of the parties; and
4. Information concerning availability of parking, meals, lockers, and appropriate
access to on-call rooms and bathroom/shower facilities.
L. Maintain its license as a medical facility and comply with all applicable laws,regulations,
TJC, and ACGME requirements. AFFILIATE shall notify SCHOOL within five(5) days of receipt of
notice that AFFILIATE is not in compliance with any such laws,regulations, TJC and/or ACGME
requirements.
M. Permit inspection of its clinical and related facilities by individuals charged with the
responsibility for accreditation of SCHOOL and/or its educational programs.
N. With respect to any professional services performed by TRAINEES under this
Agreement,AFFILIATE shall notify SCHOOL and its Program Director(s) as follows:
1. Immediately upon initiation of an investigation of a TRAINEE or SCHOOL
faculty member.
2. Within five (5) days after receipt of service of a complaint, summons or notice of
a claim naming a TRAINEE or SCHOOL faculty member.
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3. Prior to making or accepting a settlement offer in any lawsuit or legal claim in
which a TRAINEE or SCHOOL faculty member has been named or in which a settlement is
being proposed on their behalf; or
4. Prior to making a report to the National Data Bank or the Medical Board of
California in which a TRAINEE or SCHOOL faculty member is named.
O. Provide:
1. Adequate and appropriate food services and sleeping quarters for TRAINEES;
2. Patient support services, such as intravenous services, phlebotomy services, and
laboratory services, as well as messenger and transporter services, in a manner appropriate to and
consistent with educational objectives and patient care.
3. An effective laboratory, and radiologic information retrieval system appropriate
for the conduct of the clinical experience programs and provision of quality and timely patient
care.
4. Appropriate security measures to protect TRAINEES in all locations, including
but not limited to, parking facilities, on-call quarters, hospital and institutional grounds, and
related clinical facilities(e.g.,medical office building).
P. Cooperate with and assist SCHOOL in investigating facts which may serve as a basis for
taking any disciplinary or academic action against a TRAINEE, SCHOOL faculty member and/or
SCHOOL employee. SCHOOL shall be responsible for the discipline of TRAINEES, SCHOOL faculty
members and/or SCHOOL employees in accordance with SCHOOL's applicable policies and procedures.
SCHOOL may, but need not, consult with AFFILIATE concerning any proposed disciplinary action.
AFFILIATE agrees to abide by SCHOOL's recommended disciplinary action.
Notwithstanding the foregoing, AFFILIATE shall have the right, for good cause and after
consultation with SCHOOL, to prohibit further attendance at AFFILIATE of any TRAINEE; provided,
however, that AFFILIATE will not take any action against TRAINEES in an arbitrary or capricious
manner. Upon such termination, SCHOOL will use its best efforts to replace the terminated TRAINEE
with another TRAINEE as soon as possible.
Q. AFFILIATE shall provide SCHOOL with a copy of AFFILIATE's corporate compliance
program or any such plan or program that describes AFFILIATE's plan for ensuring ethical and legal
compliance with all federal and state laws. AFFILIATE shall not require any TRAINEE or SCHOOL
faculty member to conduct his/her professional behavior in a manner that would contradict the
requirements of SCHOOL's corporate compliance program.
R. The AFFILIATE will provide a learning environment that promotes the development of
professional competencies of TRAINEES. The AFFILIATE will regularly assess the learning
environment to identify positive and negative influences on the maintenance of professional standards and
conduct, and develop appropriate mechanisms for addressing negative influences in the learning
environment.
III. COMPENSATION.
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Execution of this Agreement shall not be construed to guarantee, set guidelines for or govern any
agreements between the parties regarding compensation to SCHOOL, including compensation intended to
reimburse SCHOOL for the costs it incurs in connection with TRAINEES' salaries,benefits, and/or other
administrative expenses. Any and all financial consideration between SCHOOL and AFFILIATE shall be
the subject of a separate written agreement, signed by both parties and approved in accordance with each
party's applicable policies and procedures.
IV. INDEPENDENT CONTRACTOR.
Nothing in this Agreement is intended to create nor shall it be deemed or construed to create any
relationship between SCHOOL and AFFILIATE hereto other than that of independent entities contracting
with each other hereunder solely for the purpose of affecting the provisions of this Agreement. Neither
SCHOOL nor AFFILIATE hereto, nor any of their respective officers, directors, TRAINEES or
employees shall be construed to be the agent,employee or representative of the other.
SCHOOL and AFFILIATE agree that each of them shall have sole responsibility for the payment
of any and all of its own applicable federal, state, and local income taxes and of any and all other taxes,
charges and levies; and shall comply with all applicable federal, state, and local laws and regulations.
V. STATUS OF TRAINEES.
A. During the period in which a TRAINEE is assigned to the AFFILIATE, the TRAINEE
shall be under the ultimate direction and control of the SCHOOL's Program Director or, in the Program
Director's absence,his/her designee(s).
B. It is expressly agreed and understood by SCHOOL and AFFILIATE that TRAINEES are
present at the AFFILIATE's facilities to participate in activities and assignments that are of educational
value to TRAINEES, and that are appropriate to the course and scope of SCHOOL's Program and
consistent with applicable Program and ACGME requirements.
C. SCHOOL and AFFILIATE shall ensure that TRAINEES have the opportunity to:
1. Participate in a program of learning that fosters continued professional growth
with guidance from the teaching staff.
2. Participate in safe, effective, and compassionate patient care, under supervision
commensurate with their level of advancement and responsibility, as determined by SCHOOL.
3. Participate fully in the educational and scholarly activities of their program and,
as required, assume responsibility for teaching and supervising other TRAINEES and trainees.
4. Participate, as appropriate, in AFFILIATE programs and medical staff activities
and adhere to established practices,procedures, and policies of the AFFILIATE.
5. Have appropriate representation,where possible, on AFFILIATE committees and
councils whose actions affect their education and/or patient care.
6. Submit to the SCHOOL's Program Director, at least annually, confidential
written evaluations of supervisory faculty and of their educational experiences while at
AFFILIATE's facilities.
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VI. ASSIGNMENT OF TRAINEES.
Commencing on the date set forth in Section X. Term, and subject to the provisions in Section II
above, SCHOOL may assign TRAINEES for rotation at AFFILIATE sites.
VII. USE OF NAME.
The parties agree that any use of the "UCSF," or the "University of California" name or other
similar references to the University of California San Francisco, its physicians or facilities, shall be
subject to the prior written approval of The Regents of the University of California in accordance with the
provisions of applicable law, including but not limited to California Education Code Section 92000.
VIII. PROFESSIONAL AND ADMINISTRATIVE RESPONSIBILITY.
Pursuant to Title 22, Section 70713 of the California Code of Regulations, and to the extent
permitted by law and not inconsistent with other provisions of this Agreement,AFFILIATE shall retain
professional and administrative responsibility for the services rendered to its patients.
IX. DISCRIMINATION-PROHIBITION.
SCHOOL and AFFILIATE agree not to engage in unlawful discrimination against or harassment
of any TRAINEE pursuant to this Agreement on the basis of race, color, national origin, religion, sex,
gender, gender identity, gender expression pregnancy, physical or mental disability, medical condition
(cancer-related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or
status as a covered veteran, within the limits imposed by applicable state and federal laws and SCHOOL
policies.
X. TERM.
The term of this Agreement shall commence on the last date that the parties sign the Agreement
and shall continue in effect for five(5)years, or until earlier terminated.
XI. TERMINATION.
A. Termination Without Cause. Notwithstanding any other provision to the contrary, this
Agreement may be terminated without cause at any time by either party upon ninety (90) days' prior
written notice to the other party or upon completion of the TRAINEES'rotation,whichever is greater.
B. Termination For Cause. In the event of a material breach of this Agreement, the
aggrieved party may terminate this Agreement by giving forty-five (45) days' prior written notice of
termination to the breaching party.
XII. INSURANCE.
A. AFFILIATE, at its sole cost and expense, shall insure its activities in connection with this
Agreement and obtain,keep in force and maintain insurance as follows:
1. Professional Medical, and Hospital Liability Insurance with financially-sound
and reputable companies with minimum limits of five million dollars ($5,000,000) per occurrence and a
general aggregate of 10 million dollars($10,000,000). If such insurance is written on a claims-made form,
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it shall continue for five (5) years following termination of this Agreement. The insurance shall have a
retroactive date prior to or coinciding with the effective date of this Agreement and a deductible of no
more than five hundred thousand dollars($500,000). In the event that a claims-made policy is canceled or
non-renewed, then the AFFILIATE shall obtain extended reporting (tail) coverage for the remainder of
the five(5)year period.
2. Comprehensive or Commercial Form General Liability Insurance consistent with
industry standards with minimum limits of(1) one million dollars ($1,000,000) each occurrence; (2) one
million dollars ($1,000,000) Personal and Advertising Injury; and (3) five million dollars ($5,000,000)
General Aggregate. If such insurance is written on a claims-made form, it shall continue for five (5)years
following termination of this Agreement. The insurance shall have a retroactive date prior to or coinciding
with the effective date of this Agreement.
3. Workers' Compensation Insurance in a form and amount covering AFFILIATE's
full liability as required by law under the Workers'Compensation Insurance and Safety Act of the State of
California as amended from time to time.
4. Such other insurance in such amounts which from time to time may be
reasonably required by the mutual consent of the parties against other insurable risks relating to
performance.
5. Employer's Liability Insurance with limits of not less than One Million Dollars
($1,000,000)per occurrence for bodily injury and for disease.
6. Sexual Abuse/Molestation Liability Insurance with limits of not less than Two
Million Dollars($2,000,000)per occurrence,with an annual aggregate of Four Million Dollars
($4,000,000). This policy must be issued on a per occurrence basis.
7. Cyber Liability. Cyber liability insurance with limits of not less than Two
Million Dollars ($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to, alteration of,
loss of, or destruction of intangible property (including but not limited to information or data) that is in
the care, custody, or control of the AFFILIATE.
It should be expressly understood,however,that the coverages required under this
Section XII.A.1 and 2 shall not in any way limit the liability of AFFILIATE.
AFFILIATE, upon the execution of this Agreement, shall furnish SCHOOL with
Certificates of Insurance evidencing compliance with all requirements. Certificates shall further provide
for thirty (30) days' advance written notice to SCHOOL of any modification, change or cancellation of
any of the above insurance coverages.
B. SCHOOL shall maintain insurance or self-insure its activities in connection with this
Agreement by maintaining programs of self-insurance as follows:
1. Professional Medical and Hospital Liability self-insurance with minimum limits
of five million dollars ($5,000,000) per occurrence, with a general aggregate of ten million dollars
($10,000,000). If such insurance is written on a claims-made form, it shall continue for five (5) years
following termination of this Agreement. The insurance shall have a retroactive date prior to or
coinciding with the effective date of this Agreement and a deductible of no more than five hundred
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thousand dollars ($500,000). In the event that a claims-made policy is canceled or non-renewed, then
SCHOOL shall obtain extended reporting(tail) coverage for the remainder of the five(5)year period.
2. Comprehensive or Commercial Form General Liability Insurance consistent with
industry standards with a limit of two million, five hundred thousand dollars ($2,500,000) each
occurrence. If such insurance is written on a claims-made form, it shall continue for five (5) years
following termination of this Agreement. The insurance shall have a retroactive date prior to or
coinciding with the effective date of this Agreement.
3. Workers' Compensation Self-Insurance Program covering SCHOOL's full
liability as required by law under the Workers' Compensation Insurance and Safety Act of the State of
California as amended from time to time.
4. Employer's Liability Insurance with limits of not less than One Million Dollars
($1,000,000)per occurrence for bodily injury and for disease.
5. Sexual Abuse/Molestation Liability Insurance with limits of not less than Two
Million Dollars($2,000,000)per occurrence,with an annual aggregate of Four Million Dollars
($4,000,000). This policy must be issued on a per occurrence basis.
6. Cyber Liability. Cyber liability insurance with limits of not less than Two
Million Dollars($2,000,000)per occurrence for damages and claims that SCHOOL is obligated to pay
because of an actual or alleged privacy breach, confidentiality breach, security breach or online media
activity. Such insurance will include first- and third-party coverage for (i)privacy liability, covering
damages and claims expenses arising out of SCHOOL's failure to prevent unauthorized access, disclosure
or collection of information, or for not properly notifying in the event of authorized disclosure of
protected categories of information; (ii) security liability, covering damages and claims arising out of a
failure of system security(including written policies and procedures)to prevent or mitigate a computer
attack; (iii)breach notice response services, covering crisis management and breach response costs
incurred as a result of a security breach(including legal and forensic expenses,notice fulfillment services,
credit monitoring services,identity restoration services, and/or call center services); (iv)privacy
regulatory claims, covering damages and claims expenses resulting from regulatory claims arising out of
privacy and/or security breaches; (v)Payment Card Industry Digital Security Specification Assessments
resulting from a security breach; (vi) cyber extortion,covering investigation of events and reimbursement
of cyber-extortion expenses and payments directly resulting from a cyber-extortion threat; (vii)
multimedia liability, covering damages and claims expenses arising out of allegations of libel, slander,
copyright infringement, and plagiarism in relation to publishing,transmitting or displaying media content;
and(viii)restoration costs incurred because of the alteration, destruction, damage or loss of digital assets.
7. Such other insurance in such amounts which from time to time may be
reasonably required by the mutual consent of the parties against other insurable risks relating to
performance.
It should be expressly understood, however, that the coverages required under this
Section XII.B.1 and 2 shall not in any way limit the liability of SCHOOL.
SCHOOL, upon the execution of this Agreement, and at any time during the term of this
Agreement as requested by AFFILIATE, shall furnish to AFFILIATE with Certificates of Self-Insurance
evidencing compliance with all requirements. Certificates shall further provide for thirty (30) days'
advance written notice to AFFILIATE of any modification, change or cancellation of any of the above
self-insurance coverages.
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i. The SCHOOL has waived its right to recover from AFFILIATE, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy required by
this Agreement and that waiver does not invalidate the insurance policy.
9. Acceptability of Insurers.Unless satisfied by SCHOOL's self-insurance
programs,the insurance policies required under this Agreement must be issued by admitted
insurers licensed to do business in the State of California and possessing at all times during the
term of this Agreement an A.M. Best,Inc. rating of no less than A: VII.
10. AFFILIATE's Remedy for SCHOOL's Failure to Maintain. If the SCHOOL fails
to keep in effect at all times any insurance or self-insurance coverage required under this
Agreement,the AFFILIATE may, in addition to other remedies it may have, suspend or terminate
this Agreement upon occurrence of that failure, or purchase such insurance coverage.
11. Subcontractors. SCHOOL is not authorized to provide services under this
Agreement using subcontractors
XIII. INDEMNIFICATION.
A. AFFILIATE shall defend, indemnify and hold SCHOOL, its officers, employees, agents,
and TRAINEES harmless from and against any and all liability, loss, expense (including reasonable
attorneys' fees),or claims for injury or damages arising out of the performance of this Agreement but only
in proportion to and to the extent such liability, loss, expense, attorneys' fees, or claims for injury or
damages are caused by or result from the negligent or intentional acts or omissions of AFFILIATE, its
officers, employees, or agents.
B. SCHOOL shall defend, indemnify and hold AFFILIATE, its officers, employees and
agents harmless from and against any and all liability,loss, expense(including reasonable attorneys' fees),
or claims for injury or damages arising out of the performance of this Agreement but only in proportion to
and to the extent such liability, loss, expense, attorneys' fees, or claims for injury or damages are caused
by or result from the negligent or intentional acts or omissions of SCHOOL, its officers, employees,
agents, or TRAINEES.
XIV. COOPERATION IN DISPOSITION OF CLAIMS.
AFFILIATE and SCHOOL agree to cooperate with each other in the timely investigation and
disposition of certain audits, disciplinary actions and third-party liability claims arising out of any
services provided under this Agreement. To the extent allowed by law, AFFILIATE and SCHOOL shall
have reasonable and timely access to the medical records, charts, and/or de-identified quality assurance
data of the other party relating to any claim or investigation related to services provided pursuant to this
Agreement. Provided,however,that nothing shall require either AFFILIATE or SCHOOL to disclose any
peer review documents, records or communications which are privileged under Section 1157 of the
California Evidence Code, under the Attorney-Client Privilege or under the Attorney Work-Product
Privilege. SCHOOL shall be responsible for discipline of TRAINEES and SCHOOL faculty in
accordance with SCHOOL's applicable policies and procedures.
To the extent allowed by law and in accordance with the applicable institution policies,the parties
shall notify one another as soon as possible of any adverse event which may result in liability to the other
party. AFFILIATE shall notify UCSF of any disciplinary concern involving TRAINEES and SCHOOL
personnel that it becomes aware of, including but not limited to allegations of sexual harassment or sexual
violence. The failure to provide notice shall not be deemed a breach of the Agreement, and such failure to
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do so shall not relieve the indemnifying party of its indemnity obligations if such delay does not prejudice
the defense thereof.
It is the intention of the parties to fully cooperate in the disposition of all such audits, actions or
claims. Such cooperation may include, but is not limited to, timely notice, joint investigation, defense,
disposition of claims of third parties arising from services performed under this Agreement, and making
witnesses available; provided, however only to the extent consistent with SCHOOL policies and only so
long as any personnel assistance by SCHOOL does not materially interfere with any SCHOOL
employee's performance of his or her SCHOOL employment responsibilities.
XV. PATIENT RECORDS.
Any and all of AFFILIATE's medical records and charts created at AFFILIATE's facilities as a
result of performance under this Agreement shall be and shall remain the property of AFFILIATE. Both
during and after the term of this Agreement, SCHOOL shall be permitted to inspect and/or duplicate, at
SCHOOL's expense, any individual charts or records which are: (1) necessary to assist in the defense of
any malpractice or similar claim; (2) relevant to any disciplinary action; and/or (3) for educational or
research purposes. Such inspection and/or duplication shall be permitted and conducted pursuant to
commonly accepted standards of patient confidentiality in accordance with applicable federal, state and
local laws, including but not limited to the Health Insurance Portability and Accountability Act
("HIPAA").
XVI. DISCLOSURE OF PROTECTED HEALTH INFORMATION BETWEEN SCHOOL,
AFFILIATE,AND ACGME.
The parties acknowledge and agree as follows:
A. HIPAA and the HIPAA regulations(45 CFR Parts 160 and 164)permit covered entities
to use and disclose Protected Health Information ("PHI") without patient authorization for certain
specified purposes, one of which is for health care operations.
B. Health care operations, as defined under HIPAA, include the training and
educational programs of covered entities, accreditation and credentialing activities.
C. SCHOOL and AFFILIATE are each covered entities as defined by
HIPAA.
D. SCHOOL and AFFILIATE may each disclose PHI to the other as
necessary to carry out its respective training and educational programs, as well as to meet the
accreditation and credentialing requirements of each institution.
E. SCHOOL and AFFILIATE each represent to the other that all members of
its workforce who use, create or disclose PHI, including, as applicable, its faculty, medical staff,
employees and TRAINEES,have received training as required by HIPAA.
F. AFFILIATE shall permit ACGME or accrediting entities, acting on behalf of SCHOOL
as SCHOOL's Business Associates, as defined by HIPAA, to access the PHI maintained by the
AFFILIATE that is necessary for those organization or entities to conduct their accreditations of
SCHOOL.
G. SCHOOL and AFFILIATE may disclose such PHI as is necessary for the healthcare
operations of the other.
XVII. INTERRUPTION OF SERVICE.
Either party shall be excused from any delay or failure in performance hereunder caused by
reason of any occurrence or contingency beyond its reasonable control, including, but not limited to, acts
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of God, acts of war, terrorism, fire, insurrection, labor disputes, riots, earthquakes, or other acts of nature.
The obligations and rights of the party so excused shall be extended on a day-to-day basis for the time
period equal to the period of such excusable interruption. In the event the interruption of a party's
services continues for a period in excess of thirty (30) days, the other party shall have the right to
terminate this Agreement upon ten(10)days'prior written notice to the other party.
XVIII. ASSIGNMENT.
Neither AFFILIATE nor SCHOOL shall assign their rights, duties, or obligations under this
Agreement, either in whole or in part,without the prior written consent of the other.
XIX. SEVERABILITY.
If any provision of this Agreement is held to be illegal, invalid, or unenforceable under present or
future laws effective during the term hereof, such provision shall be fully severable. This Agreement
shall be construed and enforced as if such illegal, invalid, or unenforceable provision had never been a
part of the Agreement, and the remaining provisions shall remain in full force and effect unaffected by
such severance, provided that the severed provision(s) are not material to the overall purpose and
operation of this Agreement.
XX. WAIVER.
Waiver by either party of any breach of any provision of this Agreement or warranty of
representation herein set forth shall not be construed as a waiver of any subsequent breach of the same or
any other provision. The failure to exercise any right hereunder shall not operate as a waiver of such
right. All rights and remedies provided for herein are cumulative.
XXI. EXHIBITS.
Any and all exhibits attached hereto are incorporated herein by reference and made a part of this
Agreement.
XXII. MODIFICATIONS AND AMENDMENTS.
This Agreement may be amended or modified at any time by mutual written consent of the
authorized representatives of both parties. AFFILIATE and SCHOOL agree to amend this Agreement to
the extent amendment is required by an applicable regulatory authority or due to a change in applicable
laws, regulations or programmatic requirements, and the amendment does not materially affect the
provisions of this Agreement.
XXIII. ENTIRE AGREEMENT.
This Agreement contains all the terms and conditions agreed upon by the parties regarding the
subject matter of this Agreement and supersedes any prior agreements, oral or written, and all other
communications between the parties relating to such subject matter.
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XXIV. GOVERNING LAW.
This Agreement shall be governed in all respects by the laws of the State of California without
regard to its conflict of law provision.
XXV. COUNTERPARTS; ELECTRONIC COPIES
This Agreement may be executed in any number or counterparts, each of which shall be deemed
an original, but all such counterparts together shall constitute but one and the same instrument. Delivery
of an executed counterpart of this Agreement by facsimile, electronic signature, .pdf data file or other
scanned executed counterpart by email shall be equally as effective as delivery of a manually executed
counterpart of this Agreement. Each duplicate and counterpart shall be equally admissible in evidence,
and each shall fully bind each party who has executed it. The parties to this document agree that a digital
signature or copy of the original signature may be used for any and all purposes for which the original
signature may have been used. The parties agree they will have no rights to challenge the use or
authenticity of this document based solely on the absence of an original signature.
XXVI. NOTICES.
All notices required under this Agreement shall be deemed to have been fully given when made
in writing and deposited in the United States mail, postage prepaid, certified mail, return receipt
requested, and addressed as follows:
TO SCHOOL: Vice Dean for Education
c/o Kelly Kao
UCSF Office of Medical Education
521 Parnassus Avenue
Mailroom 0104
San Francisco, CA 94143
TO AFFILIATE: Director,Department of Public Health
County of Fresno
PO Box 11867
Fresno, CA 93775
DPHContracts@fresnocountyca.gov
XXVII. SINGULAR AND PLURAL.
Words used herein in the singular,where the context so permits shall be deemed to include the
plural and vice versa.
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The parties have executed this Agreement as set forth below.
THE REGENTS OF THE UNIVERSITY OF COUNTY OF FRESNO
CALIFORNIA
SCHOOL
'' DmuSlanad by: AFFILIATE
By �U�t.t.Ylk,t. ,'IA�AAJti,
Katherine ulian, MD By:
Nathan Magsig
Title: Associate Dean for Graduate Medical
Education Title: Chairman of the Board of Supervisors of
Date: 10/9/2024 the County of Fresno.
Date: 3 J W7
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By Deputy
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U C S F_S to ndard_080505_S OM
AFFILIATION AGREEMENT
BETWEEN
THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
COUNTY OF FRESNO
EXHIBIT 1
This agreement includes the following Programs:
School of Medicine
1. Graduate Medical Education Programs (residents and fellows)
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AFFILIATION AGREEMENT
BETWEEN
THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
AND
COUNTY OF FRESNO
EXHIBIT 2
This agreement includes,but is not limited to,the following medical residency programs for which
Letters of Agreement may be required:
Graduate Medical Education Programs (residents and fellows)
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AFFILIATION AGREEMENT
BETWEEN
THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
AND
COUNTY OF FRESNO
EXHIBIT 3
Whether or not listed below, this Agreement is intended to cover all AFFILIATE facilities, including,but
not limited to:
Fresno County Department of Public Health(DPH) - 1221 Fulton Street,Fresno, CA 93721
Mobile facilities and locations where DPH may conduct business
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University of California
San Francisco
UC§F
School of Medicine Program Letter of Agreement (PLA) for Education
Date 12/3/24
Katherine Julian,M.D.
Associate Dean for
Graduate Medical Education UCSF Program Fresno- Based Preventative Medicine and Public Health Training Program
Designated Institutional Official
Graduate Medical Education Affiliate Site Fresno County Department of Public Health
500 Parnassus Ave,MU-250E
San Francisco,CA 94143-0474
tel.415/476-4562 This agreement between the UCSF program director and the site director defines specific
email:kathy.julian@ucsf.edu educational elements to comply with the general essentials for medical education. This
agreement does not take precedence over legal affiliation contracts.
1. Rais Vohra MD is the Faculty site director who assumes administrative,
educational, and supervisory responsibilities for the residents during the rotation.
2. Education goals and objectives for the rotation have been written and distributed to the
faculty and trainees and have been uploaded to the GME accreditation database.
3. Length of Rotation:
Y1 3 ❑ Weeks or ■❑ Months (select one)
Y2 ❑ Weeks or❑ Months (select one)
Y3 ❑ Weeks or❑ Months (select one)
Y4 ❑ Weeks or❑ Months (select one)
Y5 ❑ Weeks or❑ Months (select one)
Y6 ❑ Weeks or❑ Months (select one)
4. The site director is responsible for teaching, supervision, and formal evaluation of the
resident's performance during the rotations.
5. The UCSF housestaff information booklet governs the policies and procedures for the
resident's education during rotations. Each housestaff member and site director receive
this booklet as part of their orientation. The housestaff information booklet is available at
https://meded.ucsf.edu/qme-resident-and-fellow-resources
6. This letter of agreement is valid for five academic years, December 20 24
20
November 29 (month) (year)
to , unless otherwise modified.
(month) (year)
Signature Signature
Rais Vohra MD George Rutherford MD
Site Director's name Program Director's name
(214) 274-0034 (510) 501-4368
Phone Phone
rvohra@fresnocountyca.gov george.rutherford@ucsf.edu
Email Email
Version 6/7/21 DIO Approval:
Katherine Julian, M.D.
Addendum to Program Letter of Agreement
between
UCSF Fresno-based Training Program in General Preventive Medicine and Public Health
and
Fresno County Department of Public Health (FCDPH)
The overall goal for the placement of Preventive Medicine Residents at the participating Agency
is to advance the resident's knowledge of the field of preventive medicine and public health.
The responsibilities of the Resident will be assigned according to his or her initial skill level and
shall be graduated over the course of the placement. The Agency shall, in general, assign
activities to assist the Resident in attaining the following specific educational objectives:
1. Apply skills in emergency preparedness and response
2. Monitor, diagnose, and investigate community health problems
3. Inform and educate populations about health threats and risks
4. Develop policies and plans to support individual and community health efforts
5. Evaluate population-based health services
6. Characterize the health of a community
7. Design and conduct an epidemiologic study
8. Investigate and respond to a cluster or outbreak
9. Design and operate a surveillance system
10. Analyze evidence regarding the performance of proposed clinical preventive services
for individuals and populations
11. Utilize principles of behavioral health to assess health risk behaviors and implement
population-based programs for behavior change
12. Coordinate patient care effectively in various health care delivery systems
13. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or
population-based care, as appropriate
14. Identify strengths, deficiencies, and limits in one's knowledge and expertise; set learning
and improvement goals and identify and perform appropriate learning activities utilizing
information technology, evidence from scientific studies, and evaluation feedback;
systematically analyze practice using quality improvement methods, and implement
changes with the goal of practice improvement
15. Accountability to patients, society and the profession
16. Communicate effectively with patients, families, and the public, as appropriate, across a
broad range of socioeconomic and cultural backgrounds; communicate effectively with
physicians, other health care professionals and health related agencies; work effectively
as a member or leader of a health care team or other professional group; act in a
consultative role to other physicians and health professionals
For public health agency rotations with clinical components:
1. Implement appropriate clinical care for individuals with conditions of public health
significance
2. Select and provide appropriate evidence-based clinical preventive services
3. Integrate best practices and tools to assess risk behaviors
4. Implement effective approaches to modify individual health behaviors
5. Maintain comprehensive, timely and legible medical records, including electronic
health records (EHR) as needed
Resident supervision at the participating agency:
Supervision and evaluation of the resident while on rotation at the agency shall be the
responsibility of the Site Director. With the review and approval of the Program Director, the
Site Director may assign other qualified supervisors to oversee the resident's work. The
Resident will have access to the Site Director for guidance in the absence of other assigned
preceptors and for assistance in resolving any agency-specific issues affecting the rotation. The
Program Director will have the ultimate authority regarding the acceptability of any given
assignment or activity for the resident.
Resources available to the resident:
The Site Director will make appropriate resources available to the Resident to accomplish the
goals and objectives of the rotation. Such resources may include office space, access to onsite
library, computers, and support services.
Placement locations:
Residents may be assigned to work at any of the Agency's locations at which the educational
objectives and other requirements of this agreement may be met. Specific location assignments
will be made in agreement with the Program Director.
Other issues:
During the course of the Resident's placement at the Agency, her or she shall be given
adequate time to attend required Preventive Medicine Residency Seminars and other activities
by telephone or videoconference, which may include by arrangements, Graduate Medical
Education Grand Rounds, courses at UCSF or the University of California, Berkeley, journal clubs
and other conferences.
George W. Rutherford, M.D. Rais Vohra M.D.
Director, Preventive Medicine Residency Interim Health Officer, Fresno County
Date Date