05-923RESOLUTION
SAINT PAUL, MINNESOTA
Pr�ented By:
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Referred To:
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Council File #
Green Sheet #
Committee: Date
RESOLVED, that the proper City officials are hereby authorized a�d directed to execute a pre-hospital
agreement with Regions Hospital, which includes an indemnification clause, as provided by Saint Paul's
Department of Fire and Safety Services; a copy of said agreement is to be kept on file and of record in the Office
of Financial Services.
Requested by Department of:
re & Safet Se,svices
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Approval Recommended by Director of Financial Services:
Adopted by Council: Date �C'��� ��-���
Adoption Certified by Council Secretary:
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Approved b�/f�l�or: Date _
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By:
Form
By: `
by City
Mayor for
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('15-4 � Z
DepartmenUO�ce/council: Date Inkiated: v � � ��
FR — Fire 15-SEP-0S Green Sheet NO: 3028027
Contad Person & Phone• DeoartmeM Sent To Person In't' I/Date
Sue Jacobson � 0 ire '
�� Assign 1 ire De artment Director
Must Be on Council �qenda by (Date): Number 2 � Att rne
For
Routing 3 avor's �ce Ma odAssistant
Order 4 ouncil
5 itv Clerk Citv Clerk
Total # of Signature Pages _(Clip All Locations for Signature)
Action Requested:
Approval of the attached Council Resolukon authorizing the Deparhnent of Fire and Safety Services to enter into a medical d'uection
pre-hospital ageement with Reaons Hospital.
Recommendations: Approve (A) or Reject (R); Personal Service Contracts Must Mswer the Following Questions:
Planning Commission 1. Has this person/firm ever worked under a contract for this department?
CIB Committee Yes No
Civil Service Commission 2. Has this person/firm ever been a city employee?
Yes No
3. Does this person/firm possess a skill not normally possessed by any
current ciry employee?
Yes No
Explain all yes answers on separete sheet and atWCh to green sheet
Initiating Problem, Issues, Opportunity (Who, What, When, Where, Why):
Execute an agreement in which Regions Hospital will provide continuing medical educarion and quality assurance services to the Saint
Paul Fire Department Pazamedic program In sharing the common goal of quality pre-hospital patiern care which most effectively
integiates medical d'uecrion, quality improvement, education and reseazch, it is deemed to the mutual advantage and benefit of the
respective parties, their constituency and their putpose, to facilitate a medical d'uection relarionslup.
Advantages if Approved:
Allows the Saint Paul Fire Department Pazamedic program to continue to provide emergency ambulance services. Necessary Raining
and quality assurance services would be made avaflable to the City.
Disadvantanes If Approved: . , RECENED ��� � H ���
None. N
SEP � � 2005 i
,
SEP ? 1 2005
DisadvantageslfNotApproved: �'��`�Q /�TT
Lossofparamediclicense. R'� p ! �����
ToWI AmouM of
Transaction: CosURevenue Budgeted:
FundinpSource: Gene�al Fund ActiviNNumber: 05101 ° Q�s�3'?5�$� .� "�'�'�¢"'�
Financial Information: $13.90 per transport
(Explain) SEp 2 8 2005
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Agreement
For
Pre-hospitai Medicai Direction Services
Between the City of Saint Paul and Regions Hospital
THIS AGREEMENT, made and entered into this first day of January, 2005, by and
between the City of Saint Paul, Minnesota, a municipal corporation under the laws of fhe State of
Minnesota, hereinafter referred to as "City," and Regions Hospital, a Minnesota nonprofit
corporation through its Regions Emergency Medical Services Program ("Regions"), whose
address is 640 Jackson Street, Saint Paul, MN 55101-2595, hereinafter referred to as "Provider".
The City and Provider, in consideration of the mutual terms and conditions, promises,
covenants, and payments hereinafter set forth, agree as follows:
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SECTION 1. Definitions.
A. For the purposes of this Agreement, the following words and phrases shall have the
meanings set forth in this Section, except where the context clearly indicates that a different
meaning is intended. Any word or term found in this Agreement that is a term of art under the
Health Insurance Portability and Accountability Act (HIPAA) shali have the HIPAA definition
applied to it.
1. Business records shall mean any books, documents, papers, account records and other
evidences, whether written, electronic, or in other format, belonging to Provider and pertaining
to work performed under this Agreement.
2. Covered entity shail mean a health caze provider who transmits any health information
in electronic form as defined in 45 CFR § 160.103. For purposes of this Agreement, the City
shall be considered a Covered Entity.
3. Designated Record Set shall have the meaning as defined in 45 CFR § 160.103.
4. Guidelines shall mean the document entitled Regions Hospital Basic and Advanced
Life Support Policies and Guidelines for Minnesota.
5. HIPAA means the Standards for Privacy of Individually Identifiabie Health
Information (45 CFR Parts 160 and 164). '
6. Individual means the person who is the subject of the PHI.
7. Medical Director shall mean the physician designated by Provider who shall be
responsible for overseeing the pre-hospital services and who shall a) be currently licensed as a
physician in the State of Minnesota; b) have experience in, and lrnowledge of, emergency caze of
acutely ill or traumatized patients; and, c) be familiaz with the design and operation of local,
regiona[ and state emergency medical service systems.
8. Medica[Direction Coordinator shall mean the person responsible for assisting the
Medical D'uector with the duties and responsibilities described herein.
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9. Minimum Necessnry shall have the meaning as defined in 45 CFR Part 154.502.
10. Minaesota Emergency Medical Services Regulatory Board [EMSRB] shall mean
the regulatory agency that provides oversight of Minnesota's ambulance industry in accordance
with Miuuesota Statutes Chapter 144 E.
11. Peer Review Commiitee shall mean an intemal organization that oversees patient
quality of care issues.
12. Privacy Rule sha11 mean the Standards for Privacy of Individually Identifiable Health
information as defined in 45 CFR Part I60 and Part 164 Subparts A and E.
13. Protected Health Information (Pfl� shall have the same meaning as the term
"Protected health information" in 45 CFR § 164.SO1, limited to the information created or
received by the Busu'tess Associate from or on behalf of a Covered Entity.
14. Quality Assurance and Continuing Quality Xmprovement Program shaA mean the
mechanism for hearing, addressing, and responding to complaints from patients and providers.
15. Required By Law shall have the same meaning as the term "required by law" in 45
CFR § 164.501,
16. Secretary means the U.S. Secretazy of the Department of Heaith and Human Services
17. Supporting documentataon shall mean any surveys, qaestionnaires, notes, research,
papers, analyses, whether in written, electronic, or in other format and other evidences used to
generate any and all work performed and work products generated under this Agreement.
18. Systern Advisory Committee shall mean the users group established by the Provider to
assist with its product evaluations, guide2ines and research activities.
19. Work product shall mean any report, recommendation, paper, presentation, drawing,
demonstration, or other materials, whether in written, electronic, or other format that results from
Provider's services under this Agreement.
SECTION 2. Scope of Services.
A. Provider agrees to provide pre-hospital medical direction services as described in its
proposal dated February 2, 2005 which is incorporated herein and as described herein.
1. Medical Direction
Pzovider shall designate one or more physicians to serve as the pre-hospitat
Medical Director. The duties and obligations of the Medical Director are as follows:
a. lteview and update the triage, treahnent, and transportation policies and
guidelines specified in the $asic and Advanced Life Support Guidelines for
Minnesota Ambulance Services, annually based upon medical audit
outcome, and medical literahue review.
b. Establish standing orders for pre-hospital care. (These standing orders will be
contained in the GuideIines.)
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c. Establish procedures for the administration of inedications. {The procedures will
be contained in the Guidelines.)
d. Establish, collect and report data points used for monitoring system performance.
e. Provide and approve standazds for the selection, orientation, training, and clinical
compliance of EMS personnel involved in patient caze.
i. Selection shall mean the Medical Director shall have input into the selection
of pazamedic, paramedic student, pazamedic captain, up to district level to
include EMS Chief.
ii. Orientation shall mean the Medical Director or lus designee shall have input
into new employee and rank advancement orientarion, provide education and
,,�iformation pertinent to EMS system and patient caze expectations specific to
Basic and Advanced Life Support Polices and Guidelines for Minnesota.
iii. Training shall mean education delivered, but not lunited to, ininimum
h'aining requirements as set forth by the EMSRB.
iv. Clinica! Corazpliance shall mean, but is not lunited to, adhering to the Basic
and Advanced Life Support Guidelines for Minnesota.
f. Conduct an annual review of all medications and medical equipment and_
recommend potential changes.
g. Approve standards for purchasing and upgrading equipment and supplies that
impact patient care.
h. Provide twenty-four (24) hour a day access to the Medical Director through the
on-call NIbC (as defined below).
i. Conduct Ranking O�cer and EMS Administrafion meetings.
j. Assist in disaster plamiing and participate in disaster drill evaluation, as
requested.
k. Designate one of its employees to serve as a Medical D'uection
Coordinator ("MI}C") for the City's EMS program.
2. Qualitv Assurance
Provider sha11 provide Quality Assurance mechanisms for qualiTy care. This shall
include, but is not limited to the foilowing:
a. Provide an EMS Inquiry system for hearing, addressing, and responding to
complaints from patients, families, providers, law enforcement, and hospital
personnel, including, but not limited to, case review and resolution of patient
complaints.
b. Solicit and obtain input from fieid personnel on a variety of issues related to the
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development and operation of Quality Assurance and Continuing Quality
Improvement programs. This may be accomplished through the System
Advisory Committee and/or Peer Review Committee
c. Provide on scene quality assurance through point-of-caze observation and
assistance. - _
d. Conduct run report audits as necessary for QA data collection purposes.
e. Maintain the quality of caze according to the standards and procedures
established under the responsibilities listed above.
3. Education
Provider shall provide the following educational services:
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a. Conduct annual in-service training on and evaluation of Guidelines content of
all Emergency Medical Technicians and EMT-Pazamedics
b. Annually, the Medical Directox or designee shall assess the practicat skills of
each person on the City's ambulance service roster, including each person's
i) variance, ii) Advanced Life Support skills, and iii) Basic Life
Support skills, and shall sign a statement verifying the proficiency of each
individual. The statement sha11 be transmitted to the City and maintained in the
City's files.
c. On-going continuing medical education to comply with EMSRB minimum
requirements for EMT-Basic and EMT-Pazamedic recertification.
d. Review and approve all Saint Paul Fire Department EMS education.
e. Education shall be limited to the items contained in Schedule l.l - Regions
Hospital EMS Education, which is attached and incorporated herein.
f. Establish minimal training facility requirements for the City as contained in
Schedule 1.2 - Regions Hospital Training Requirements for Quarterly CME,
which is attached and incorporated herein.
SECTION 3. Obligations of the City.
A. To assist the Provider in the dischazge of its duties hereunder, the City shall be
responsible for the following:
l. Medical Direction
a. Contact the on-cali IvIDC of any complaint received concerning the delivery of caze.
b. Designate an individual to be a point of contact and accessible to the MDC as
needed.
a Contact the on-call MDC immediately of any medication or procedure (e.g.
intubation) enors that occur.
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d. Contact the on-call MDC immediately of any equipment, vehicle, or
communications failure that impacts patient caze (e.g. stretcher collapse, EKG
monitor malfunction, prolonged arrival time, etc.).
e. Contact the on-call MDC within twenty-four (24) hours of accidents (regazdtess of
damage) to EMS veiucles that aze responding to, on scene, or in route with a patient
- to a receiving facility.
f. Contact the on-call MDC immediately of any gross deviation from standazds of
care.
g. Make sure the City is represented at atl administrative meetings [SAC, EMS
Administtarion, Ranking Officer, and Regions EMS-Saint Paul Fire
Administration].
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h. Inform and include the MDC in the eazly planning of City mass gathering events
that exceed attendance of 10,000.
i. Include the MDC in the eazly planning for selection, orientation, trainiug, and
clinicai compliance as defined on page 3, Scope of Services, Secrion 1, Provider
Responsibility - Medical Direction; item e of this Agreement.
j. Maintain an ambulance company personnel configuration that is approved by the
Nledical Director, adhering minimally to regional EMS community practices,
including, but not limited to:
I. Staff a pazamedic captain and/or out-of-title paramedic captain on ALS
ambulances when administratively possible witrun the Fire Department's
current deployment system.
II. Staff a pazamedic in the patient compartment of all ambulances with ALS
patients.
2. Oualitv Assurance
a. Provide a tooi to customers (i.e. patients) for determining customer satisfaction and
report results to the Medical Director.
b. EMS Chief to notify on-call MDC according to the Guidelines.
c. EMS Chief to conduct a review of run reports for charting compliance as requested
by the Medical Director.
d. EMS Chief to collect, collate, and report required data points, on a monthly basis, to
the Medicai Direction Coordinator.
e. EMS Chief to forwazd all documentation to MDC, as outlined in the Guidelines, for
all cazdiac arrests or advanced procedures, on a weekly basis.
f. Consult with the MDC on anricipated changes in patient caze, new equipment, and
service upgrades.
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g. Respond as required by the Peer Review Committee. All personnel aze required to
participate in the Quality Assurauce programs.
h Maintain the following documentation and records related to its First Responders,
Emergency Medical Y'echnicians, and Patamedics: —
• Immunizations and screenings for Hepatitis B, Tetanus (1 every 10 years),
Iufluenza (optional) and Mantoulc (annual). Documenfation must inc2ude
refusal forms if applicable;
• First Responder, EMT-$asic, EMT-Pazamedic, ACLS, and CPR
certification cazds; ,
• HEPA or N95 respirator fit-testing;
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• Inirial and annual continuing education on biood bome and airborne
pathogens;
• Documentation of other license requirements as required by Niimiesota law;
• Background checks;
• Initial emergency driving training;
• Annual practical skills proficiency statement for each individual.
3. Education
a. Assure that all personnel meet continuing medical education requirements,
including, but not limited to, Critical Thinking Lab, Continuing Medical Education,
Critical Case Reviews, and skills review, as further delineated in Schedule 1.1.
b. Maintain a current roster of EMT-Basics and EMT-Paramedics, their training
records, and data collection forms.
c. Adhere to minimal training facility requirements as defined in Schedule 1.2
SECTION 4. Joint Obligations.
A. City and Provider shall shaze responsibility for the following:
1. Provider shall assist the City in the delivery of current and state-of-the art, pre-hospital
care to all patients.
2. The parties shall meet at least annually to engage in medical oversight and vision
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3. The parties shall collaborate on system guideline development and research specific to
the emergency medical services provided by the City.
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4. The parties shali promote best practices and collaborate on selection, orientation,
education, and clinical excellence for Department EMS personnel.
SECTION 5. Term and Termination.
A. Term. The services rendered by Provider shall be commenced upon execution
of the Agreement and shall be ia effect for three yeazs from that date. The Agreement may be
renewed for additional periods of up to three yeazs with the mutual agreement of the parties.
B. Termination. Subject to the continuing obligations of the City and Provider as set
forth herein:
i. Terminatian Without Cause. The City may terminate this Agreement by providing
Provider written notice of tennination not less than sixty (60) days prior to the date of
tennination. Any termination pursuant to this Secrion may be effective only at the end of the
then current yeaz. Further, no termination pursuant to this Section may be effective prior to the
end of the first twel�ve months of the Agreement.
2. Termination With Cause. Either party may terminate this Agreement with cause upon
default of the other party under any material term of this Agreement and failure to cure such
default within thirty (30) days after receipt of written notice specifying the precise nature of such
defauit. Upon failure to cure default, the Agreement shall be deemed terminated without fiuther
action.
3. Change in Law. In the event any provision of this A�reement is in conflict with
current state or federal laws, regulations or rules, or a subsequent change in state or federal law,
regulations or rules, the parties mutually agree to amend this Agreement in writing to comply
�vith the law, regulation, or rule or, if the parties aze unable to reach agreement through good
faith negotiations within thirty (30) days of becoming awaze of the conflict, either party may
temunate this Agreement effective immediately upon notice in writing to the other party.
4. Mutual Agreement. The parties may ternunate this A�reement by mutual agreement
at any time. Any termination pursuant to this Section may be effective only at the end of the
then current yeaz. Further, no termination pursuant to this Section may be effective prior to the
end of the first twelve months of the Agreement.
SECTIO�i 6. Biliings and Payment.
A. That for Provider's faithful performance of this Agreement, the City hereby agrees to
compensate Provider as follows: '
1. Overall medicai direction services fees
Years 1& 2(15,000 or fewer transports in prior yeaz) $13.90 per transport
Yeazs i& 2(more than 15,000 transports in prior yeaz) $12.51 per transport
Yeaz 3(15,000 or fewer transports in prior yeaz)
Yeaz 3(more than I5,000 transports in prior yeaz)
$13.90 per transport plus
adjustrnentforthethen
current CPI
$12.51 per transport plus
adjustment for the then
current CPI
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2. ALSBLS Integrated CME (ALS and BLS staff trained together)
Yeaz 1 $31,000
Years 2& 3 $31,000 plus adjustrnent for the then
' current CPI
Regions Hospital will offer for the first year of the contract, a 5% rebate from the total
annual cost of ALSBLS Integrated Education. Regions Hospital wili appiy the rebate for
each quarter of that yeaz that Saint Paul Fire delivers all required ALS and BLS personnel
to the Integzated CME within the scheduled 7 sessions per each shift (A, B and C). The
desired result is no "Make-Up" sessions scheduled for that quarter. Prior to the start of
each quarter, both parties will agree upon a"required personnel" list.
3. ACLS Re„„c'�rtification Fee
Yeaz 1
Yeazs 2 & 3
4. Pharmaceutical and medical
Non-consumable supplies
5. Pre-hospitai Guidelines
(pocket version)
$120 per participant
Above fee increased by then current
CPI
Provided at cost; no delivery chazge
Provided at cost
B. The above amounts shall fully compensate Provider for all work and associated costs.
The City wi11 honor no claim for services and/or costs provided by the Provider not specificalIy
provided for in this Agreement.
C. Provider shall submit one annual invoice by the end of January for Medical Direction
and ALS/BLS Integrated services required throughout the current calendaz yeaz. Upon receipt of
the invoice and verification of the chazges by the Project Manager, the City shall make payment
to Provider within thirty (30) days. ACLS recertification, pharmaceutical and medical supplies,
and pre-hospital guidelines fees aze due upon receigt of invoice.
D. In the event the Provider fails to comply with any terms or conditions of the contract
or to provide in any manner the work or services as agreed to herein, the City reserves the right
to withhoId any payment until the City is satisfied that corrective action has been taken or
completed. This opflon is in addition to and not in lieu of the City's right to termination as
provided in the sections of this Agreement.
E. The parties agree that the Compensation has been deternuned in arm's length
bargaining, and is consistent with fair mazket value in arms-length transactions. Furthermore,
the compensation is not and has not been, and will not be, determined in a inanuer that takes into
account the volume or value of any referrals or business otherwise generated for or with respect
to Provider or between the parties for which payment may be made in whole or in part under
Medicare or any state health care program or under any other payor program
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SECTION 7. Work Products, Records, Dissemination of Information.
A Provider agrees to abide stricfly by Chapter 13, Minnesota Govemment Data Practice
Act , and in particulaz Minn. Stat.§§ 13.05, subd. 6 and 11; and 1337, subd. 1(b) and Minn. Stat
§§ 138.17 and 15.17. All of the�data created, collected, received, stored, used, maintainecl, or —
disseminated by the Provider in performing functions under this Agreement is subj ect to the
requirements of the Minnesota Govemment Data Practices Act and Provider must comply with
those reguirements as if it were a governmental entity. The remedies in Minn. Stat. § appiy to
the Provider. If anyprovision of this A�eement is in conflict with the Minnesota Government
Data Practices Act or other Minnesota state laws, state law shall control.
B. The Provider agrees to maintain all business records in such a manner as will readily
conform to the terms of this Aereement and to make such materials available at its office at all
reasonable times dut3ng this Aareement period and for six (6) years from the date of the fixiat
payment under the contract for audit or inspection by the City, the Auditor of the State of
Minnesota, or other duly authorized representative.
C. During the course of the performance of the services under this Agreement, the parties
may have access to or become acquainted with confidential information relating to each other's
business, inciuding, without limitation, patient records, medical information, and/or other
inforn�ation that relates to or identifies parients. The parties acknowledge and understand the
importance of such information including the terms of this Agreement, confidential and agree to
never use, except in perfornun� services under this Agreement, or disclose such information to
any third pariy except as may be required by a court order. In the event disclosure is ordered by
a court or admuustrative order, the part} subject to the order shall immediately notify the other
party. Upon ternunafion of this Agreement, the parties agree to immediately return to the other
part ail records or other tangible documents that contain, embody or disclose in whole or in part,
any confidential information.
D. Each party shall be entitled to injunctive relief to enforce the other party's compliance
with the allegations set forth in this Section, it being understood and agreed that the parties will
noY have an adequate remedy in law at law if such obligations are not complied with fully.
E. Protected Health Information. Provider may use and/or disclose protected health
information in providing the services under this Agreement. The parties are committed to
complying with the Standazds for Privacy o�Individually Identifiable Health Information (the
"Privacy Regulation") 45 C.F.R parts 160 and 164 under the Health Insurance Portability and
Accountability Act of 1996 ("HIPAA") as it is currentiy drafted and-as it may be subsequently
updated, amended, or revised. The Addendum attached hereto as Attachxnent A is incorporated
into this Agreement, and sets forth the terms and conditions pursuant to which protected health
information that is provided by or created or received by, Provider from or on behalf of City will
be handled between Provider and City and with third parties during the term of this Agreement
and after its expiration or tertsilnation.
SECTION 8. Equal Opportunity Employment.
A. Provider will not discriminate against any employee or applicant for employxnent for
work under this Agreement because of race, creed, religion, color, sex, sexual or affectional
orientation, national origin, ancestry, familial status, age, disability, marital status, or status with
regazd to public assistance and will take affirmative steps to ensure that applicants are employed
05-�i�3
and employees aze treated during employment without regazd to the same.
This provision shall include, but not be limited to the following: employment, upgrading,
demotion, or transfer; recnutment advertising, layoff or temrinarion; rates of pay or their forms
of compensafion; and selection for traiiriug, including apprenticeship.
SECTION 9. Compliance With Applicable Law.
A. Provider agrees fo comply with all federal, state, and local laws or ordinances, and all
applicable rules, regulations, and standards established by any agency of such governmental
units, which aze now or hereafter promulgated insofaz as they relate to the Provider's
performance of the provisions of this Agreement. _It shall be the obligation of the Provider to
apply for, pay for, and obtain all permits and/or licenses required.
SECTION 10. Conflict of Interest.
A. Provide� grees that it will not contract for or accept employment for the performance
of any work or sennces with any individual, business, corporation, or government unit that
would create a conflict of interest in the performance of its obligations pursuant to this
Agreement with the City.
B. Provider's acceptance of this Agreement indicates compliance with Chapter 24.03 of
the Saint Paul Administrative Code: "Except as permitted by law, no City official or employee
shall be a party to or have a direct fmancial interest in any sale, lease, or contract with the City."
C. Provider agrees that, should any conflict or potential conflict of interest become
known, Provider will advise the Purchasing Systems Manager of the situation so that a
deternunation can be made about 's Provider's ability to continue performing services under the
Agreement.
SECTION 11. Insurance.
A. Provider shall be required to carry insurance of the kind and in the amounts shown
below for the life of the contract. Insurance certificates should state that the City of Saint Paul,
its employees and officials aze Additional Insureds "AS RESPECTS GENERAL LIABILITY".
Public Liabilitv Insurance
General Aggregate $3,000,000
Products Compieted Operations $1,000,000
PersonaUAdvertising Injuty ' $1,000,000
Occurrence $1,000,000
a) Policy must include an"all services, products, or completed transactions"
endorsement.
2. Automobile Insurance
Combined Single Limit: $1,OOQ000
3. VJorkez's Comoensation and E�lover's Liability
a) Wozker's Compensation per Minnesota Statute
b) Employer's Liability shall have minimum limits of $500,000 per accident;
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$500,000 per employee; $500,000 per disease policy limit.
c) Contractors (Providers) with 10 or fewer employees who do not have VJorker's
Compensation coverage aze required to provide the City with a letter verifying their
number of employees.
4. Professional Liabilitv insurance
a) $1,000,000 per occurrence
b) $2,000,000 aggregate
5. General Insurance Reauirements
a) The policy is to be written on an occurrence basis or as-acceptable to the City.
Certificate of insurance must indicate if the policy is issued on a clauns-made or
occurrence basis. All certificates of insurance shall provide that the City's Division
of Contract and Analysis Services be given not less than thirty (30) days prior
written hotice of cancellation, non-renewal or any material changes in the policy;
including, but not limited to, coverage amounts. Agent must state on the certificate
if policy includes errors and omissions coverage.
b) The Provider shall not commence work until a Certificate of Insurance
covering all ofthe insurance required for this project is approved and the project
manager has issued a notice to proceed. Insurance must remain in place for the
duration of the original contract and any extension periods.
c) The City reserves the right to review Contractor's Provider's insurance policies at
any tixne to verify that City requirements have been met.
d) Nothing shall preclude the City from requiring Contractor Provider to purchase
and Provide evidence of additional insurance.
e) Satisfaction of policy and endorsement requirements for General Liability and Auto
Insurance, of "each occurrence" and "aggregate" lunits, can be met with an
umbrella or excess policy with the same minimum monetary limits written on an
occurrence basis, providing it is written by the same insurance carrier.
SECTION 12. Relationship of the Parties.
A. It is agreed by the parties that, at all times and for all purposes within the scope of the
Agreement, the relationship of the Provider'to the City is that of independent contractor and not
that of employee. No statement contained in this Agreement shall be construed so as to find
Provider an employee of the City, and Provider shall be entitled to none of the rights, privileges,
or benefits of Saint Paul employees.
B. The City will not withhold from the amounts it pays Provider any money for state and
federal income taxes, social security taxes, unemployment tases and worker's compensation
taxes or any other payroll tax. It is the responsibility of Provider to make whatever withholdings
from those payments the law requires.
SECTION 13. Subcontracting.
A. The Provider agrees not to enter into any subcontracts for any of the work
contemplated under this Agreement without obtaining prior written approval of the City.
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SECT`ION 14. Hold Harmless.
A. The Provider shall indemnify, sa�e and hold hazmless, protect, and defend the City, its
officers, agents, and employees from all clauns, acrions or suits of any chazacter brought for or
on account of any claimed or alleged injuries or damages received by any person or properiy,
including the City, resulting from any act or omission by any person employed by Provider in —
carrying out the terms of this Agreement.
SECI'ION I5. Assignment.
A. The City and the Provider each binds itself and its successors, legal representatives,
and assigns of such other party, with respect to a11 covenants of this Agreement; and neither the
City nor the Provider will assign or transfer their interest in this Agreement without the written
consent of the other.
SECTION 16: Default by Provider.
A. In the event Provider fails or neglects to comply with any term or condition of this
Agreement or to provide the services stated herein, City shall have the right, after written notice,
to cease payment hereunder. This remedy shall be in addition to any other remedies, including
ternrination, available to the City in law or equity. The City shall be entitled to recover
reasonable attorney's fees and costs of collection associated with enforcing its rights hereunder.
SECTION 17. Amendment or Changes to Agreement.
A. City ar Provider may request changes that would increase, decrease, or otherwise
moc3ify the Scope of Services. Such changes and method of compensafion must be authorized in
writing in advance by the City.
B. Any alterations, amendments, delefions, or waivers of the provisions of this
Agreement shall be valid only when reduced to wTiting and duly signed by the parties.
C. Modifications or additional schedules shall not be construed to adversely affect vested
rights or causes of action which hace accrued prior to the effective date of such aznendment,
modification, or supplement. The term "this Agreement" as used herein shall be deemed to
include any future amendments, modifications, and additional schedules made in accordance
herewith.
SECTION 18. Notices.
A. Except as otherwise stated in this'Agreement, any notice or demand to be given under
this Agreement shalI be delivered in person or deposited in United States Certified Mail, Return
Receipt Requested. Any notices or other communications shall be addressed as follows:
To City: To Provider:
Saint Paul Fire Department Mr. Patrick McCauley
Atin: Chief Hoiton Regions EMS Program Director
100 East 11'�' Street Regions Hospital
Saint Paul, MN 55101 640 Jackson Street
Saint Paul, MN 55101-2595
SECTION 19. Waiver.
A. Any fault of a party to assert any right under this Agreement sha11 not constitute a
waiver or a termination of that right, this Agreement, or any of this Agreement's provisions.
12
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SECTION 20. Suxvivai of Obligations.
A. The respective obligations of fhe City and Provider under fhese terms and conditions,
which by their nature would continue beyoIId the termination, cancellation, or expiration hereof,
shall survive termination, cancellation or expirarion hereof.
B. If a court or govemmental agency with proper jurisdiction determines that this
Agreement, or a provision herein is unlawful, this Agreement or that provision, shall terminate.
If a provision is so terminated butthe parties legally, commerciaily, and practicably can continue
this Ag;�eement without the ternunated provision, the remainder of this Agreement shall continue
in effect.
SECTION 21. Interpretation of Agreement, Venue.
A. This Agreement shall be interpreted and construed according to the laws of the State
of Minnesota. All litigation related to this Agreement shall be venued in the District Court of the
County of Ramsey, Second Judicial District, State of Minnesota.
SECTION 22. Force Majeure.
A. Neither the City nor the Provider shall be held responsible for performance if its
performance is prevented by acts or events beyond the party's reasonable control, including, but
not lunited to: severe weather and storms, earthquake or other nat�ual occurrences, strikes and
other labor unrest, power failures, electrical power surges or current fluctuations, nucleaz or other
civil militazy emergencies, or acts of legislative, judicial, executive, or administrative authorities.
SEC7'ION 23. Entire Agreement.
A. It is understood and agreed that this entire Agreement supersedes all oral agreements
and negotiations between the parties relating to the subject matters herein.
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IN WITNESS WHEREOF, the parties hereto aze authorized signatories and have
executed this Agreement, the day and yeaz first above written.
For the City of Saint Paul:
Approved as to form:
Assistant City Attorney
Executed.•
Mayor or Designee
��
birector, Office of Financial Services
Tyrone Terrill, Director-
beparkment of Human Rights
For Regions ospit : f 1_ Q_�_
g /�/(/�'��'.
Brock Nelson
Its President and CEO
C^
By �
Davi Graebner
Its VP of Operations
B
. . -one
Its EMS Medical Director
Regions Hospital Tax ID: 41-0956618
Regions Hospital Tax Exempt: ES 30599
Doug s Holton, Clue
Pire d Safety Services
Funding:
Activity # /Dept. Signature
14
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Attachment A:
Business Associate Addendum
_ SECTION 1. ffiPAA Compliance. —
- A. Obligations and Acfivities of Provider as a Business Associate. City and Business
Associate mutually agreed that Business Associate shali carry out its obligations under this
Agreement in compliance with the Privacy Rule and shall protect the privacy of any protected
health information (PHn that is collected, processed or leamed as a result of the services
provided hereunder:
1. Busiaess Associate shall not use or disclose PHI except as permitted under tYus
Agreement or required by law.
^�,
2. Business Associate will take appropriate steps to safeguard and prevent use or
disclosure of PHI except as permitted by this Agreement.
3. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that
is known to Business Associate of a use or disclosure of PHI by Business Associate in
violation of this Agreement.
4. Business Associate shall report to the Department of Fire and Safety Services of City
any use ar disclosure of FHI not provided for by this Agreement.
5. Business Associate shall ensure that any agent, including a subcontractor, to whom it
Provides Protected Health Information received from, or created or received by the
Business Associate on behalf of the City agrees to the same restrictions and conditions
that apply through this Agreement to Business Associate with respect t such
information.
6. Business Associate agrees to make its internal pracrices, books, and records, including
policies and procedures, relating to the use and disclosure of PHI received from, or
created or received by the Business Associate on behalf of the City, available to the
Secretary for purposes of determining the City's compliance with HIPAA.
7. Business Associate agrees to dociunent such disclosures of PHI and information
related to such disclosures as would be required for the City to respond to a request by
an Individual for an accounting of disclosures of PHI in accordance with 45 CFR §
164.528.
8. Business Associate agrees to make Pffi available for appropriate amendments, to make
any amendment(s) to PHI in a Designated Record Set that the City directs or agrees to
and to incorporate those amendments pursuant to 45 CFR § 164.526 at the request of
the City or an Individual, and in the time and mamier the City directs.
B. Permitted Uses and Disclosures. Except as otherwise pemutted undex this
Agreement, Business Associate may only use or disclosure PHI to the City and City's other
identified Business Associate contractors to provide services to the City for the following
purposes, if such use or disclosure of PHI would not violate the Privacy Rule if done by the City
is
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or HIPAA "m;nimucn necessary" policies and procedures of the City:
1. Prepazation of invoices to the Individuals, treahnent, payment, or health caze
operations or otherwise required by HIPAA.
2. Prepazation of reminder notices and documents pertaining to collection of overdue —
Accounts to the Individuals, treatment, payment, or health caze operations or otherwise
required by HIPAA. .
Submission of supporting documenYafion to the Individuats, treatment, payment, or
health caze operations or othenvise required by HIPAA to substautiate the health caze
services provided by the C`ity to its patients or to appeai denial of payments for fhe
same.
4. Other us��or disclosures of PHI as permitted by the Privacy Rule.
C. Obligafions of the City.
1. The City shall notify the Business Associate of any lunitation(s) in its notice of privacy
practices of the City in accordance with 45 CFR § 164.520, to the extent that such
Iimitations may affect Business Associate's use or disclosure of PHI..
2. The City shall notify the Business Associate of any changes in, or revocation of,
pemussion by an Individual to use or disclosure of PHI, to the extent that such
changes may affect Business Associate's use or disclosure of PHI.
3. The City shall notify the Business Associate of any restrictions to the use or disclosure
of PHI that the City has agreed to in accordance with 45 CFR § 164.522, to the extent
that such changes may affect Business Associate's use or disclosure of PHI.
D. Notwithstanding any other provisions of this Agreement, this Agreement may be
terminated by the City, it its sole discretion, if the City detemiines that Business Associate has
violated a texm or provision of the Agreement pertaining to the City's obligation under the
HIPAA privacy rule.
E. Upon termination of this Agreement, for any reason, as directed by the City, Business
Associate shall retum ar destroy all Protected Health Information received from the City, or
created or received by the Business Associate on behalf of the City. This provision shall apply to
PHI that is in the possession of subcontractors or agents of the Business Associate. Business
Associate shall retain no copies oft the Protacted Health Information. �_.
F. In the event that the Business Associate determines that rehirning or destroying the
PHI is infeasibie, Business Associate shall provide to the City notification of the conditions that
make the retum or destruction infeasibte. After City's review and acceptance of Business
Associate's notificarion of conditions of infeasibility, Business Associate shall extend HIPAA
protections of this Agreement to such PHI for so long as the Business Associate possesses in any
form such PHI, at no cost to the City.
�
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SCHEDITLE 11
Regions Hosaital Emer�encv Medical Services Educarion
Regions HospitaI EMS Education is limited to:
All persoanel required by Saint Paul Fire to be credentialed at an EMT'-Basic or EMT-Pazamedic
level of certificafion must adhere to EMSRB continuing education requirements.
1. Quarteriv CME
EMT — Basic and EMT — Pazamedic recertification course hours aze delivered over a two
yeaz educational cycle in the form of quarterly CME. The minimum amount of CME
hours offered over a two year educational cycle is 24. Quarterly education kours may be
divided over the two-yeaz educational cycle as mutually agreed upon by Saint Paul Fire
Department��nd Regions Hospital EMS. It is expected that EMT-Basics and EMT-
Pazaxnedics attend the CME offered within each quarter; including completing any on-
line/web based education.
Beginning July l, 2005 Regions Hospital EMS will offer 7 CME sessions per quarter for
each Shift (A, B, and C) - totaling 21 sessions per quarter - with the expectation that 18-
20 providers will attend each session. This will allow for up to 420 personnel to be
trained each quarter. The seven sessions will be spread out over the quazter and will be
held during the evening (excluding Friday-Sunday). The start and end tune of each
session will be mutually agreed upon by SPF and Regions Hospital EMS.
In addifion to the 21 CME sessions scheduled each quarter, there will be three, all
inclusive, "Make Up" CME sessions (one each for A, B&C shifts) scheduled at the end
of each quarter for any EMT-Basic or EMT-Paramedic who did not attend the required
training during the quarter. This "Make-Up" session will be offered during daytime
honrs. SPF will be responsibte for azranging attendance as necessary.
Regions Hospital EMS recognizes the importance of CME attendance. Therefore, they
wili offer a 5% rebate as outlined in Section 6: Billings and Payment, which results in no
"Make-Up" sessions scheduled £or that quarter.
When an EMT-Basic or EMT-Pazamedic does not attend CME within a given quarter,
Regions Hospital EMS will nnmediately report dus information to the Saint Paul Fire
EMS Chief. It will be the EMS Chief's responsibility to follow up with this, which may
include submission of alternate iraining records to the Medical D'uector for review.
Additional "Make-Up" sessions beyond the three scheduled within a quarter, will not be
provided and the Medical Direction Coordinator is not available for training. Regions
Hospital EMS will assist in suggesting acceptable and alternative training.
In January of each yeaz, a summary of missed CME educational hours will be provided
by Regions Hospital EMS to the Saint Paul Fire EMS Chie£ Again, the EMS Cbief may
submit altemate training records for review, however, the Medical Director will not
approve any atternate Iraiving that exceeds 4 flours. Hours missed in excess of 4 hours or
altemate training that is not approved by the Medical Director will result in the EMT-
Basic or EMT-Paramedic obtaining training independently from flus agreement. The
Medical Director must approve of any trainiug obtained outside of Regions Hospital
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EMS. All training must be concluded and reported by Mazch 1 to the Regions Hospital
EMS education office for the EMSRB recertification process.
Saint Paul Fire Deputy Chiefs will be responsible for scheduling individuals to a CME
session during the quarter, taking into account other training events and vacations. The
Manager of Educarion at Regions Hospital will be responsible for communicating —
attendance status with each Deputy Chief prior to a scheduled traiuiug session.
T'he Saint Paui Fire Deputy Chief on duty will be present at the stazt of each evening
CME session during July — September 2005 in order to iniroduce Regions Hospital EMS.
Included in this introducrion is an explanation of the new training approach and time as
requested by Saint Paul Fire Department Goin� forward, if training is alTered at the
request of Saint Paul Fire Department, a representative from the department will be
present at CME to introduce the changes.
Y �'
Training will take place at a mutuaily agreed upon tranung center, following the
requirements as ouflined in SCHEDtJLE 1.2.
2. Weeklv Critical Case Reviews
Weekly, critical case reviews are offered in which 2-3 companies attend. Critical Case
reviews may be preceded by or followed by a skills check-off.
Because companies aze scheduled, both EMTs and Paramedics attend this educational
event.
The Saint Paul Fire EMS Chief is responsible for tracking attendance and, therefore,
scheduling companies appropriately for Critical Case Reviews. Regions Hospital EMS
will supply the EMS Chief with an attendance sheet upon completion of each session.
ACLS
Pazamedics are required to be ACLS certified. ACLS certification must be renewed
every two yeazs. Regions Hospital EMS offers at least two ACLS recertification classes,
specific to pre-hospital providers, every yeaz. ACLS recertification hours aze included
for recertification through the EMSRB.
The Saint Paul Fire EMS Chief is responsible for tracking attendance and maintaining
records for Pazamedic ACLS certification. Regions Hospitai EMS will supply the EMS
Chief with an attendance sheet upon completion of each course.
4. Critical Thinkine Lab
Pazamedics are required to attend a 4 hour Critical Thinking Lab once every two yeazs.
Specifically, these kours are required for recertification through the EMSRB.
The Saint Paul Fire EMS Chief is responsible for tracldng attendance and, therefore,
scheduling appropriately for Critical Tluuking Lab. Regions Hospital EMS will supply
the EMS Chief with an attendance sheet upon completion of each lab.
5. BLS/CPR
Both EMTs and Pazamedics must maintain current certification in basic life support
(CPR). This requires attending a 2 hour recertification course once every 2 years.
[B]
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Regions Hospital EMS will pro��ide BLS/CPR training as necessary.
The Saint Paul Fire EMS Chief is responsible for maintaining records of BLS/CPR
certification. Regions Hospital EMS wiIl report certification status to the Saint Paul Fire
EMS Chief upon completion of training.
t�
,�.
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SCHEDULE 1.2
Trainine Center Reauirements for Ouarterlv CME
(may also be used for weekly Critical Case Reviews) —
large room
- hold at least 20 students
- desks and chairs to accommodate
- audio visual space with screen that can be viewed by everyone
- climate control; lighting control; proper ouflet access
- wYrite boazd
- dedicated computer and projector with on-line access
- dedicated �'��/VCR-DVD piayer
- AV carts
- good repair with adequate lighting (mutually agreed upon standard)
2 �smaller rooms
- hold at least 10 people
- table space for training/demonstration
- chairs to accommodate
- climate control; lighting control; proper ouflet access
- white board
- good repair with adequate lighting (mutually agreed upon standard)
Office space for at least one instructor
- desk and chair
- phone line
- computer with on-line access
- printer
- climate control; lighting control; proper outlet access
- good repair with adequate lighting (mutually agreed upon standazd)
Break Time Space
- minimally 4 toilets — with sepazate male and female facilities
- kitchen sink '
- snack azea
- coffee maker, counter top space, designated cabinet space
- drinking water
Equipment Storage Space
- secure, lockable storage room with proper shelving
- space to accommodate equipment needs
- located adjacent to or on same level as trainnig rooms
Dedicated Entrance
- Outside lighting
- Security features (e.g. lockabie door)
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other
- daily cleaning service for entire space
- someone to maintain and stock bathroom and break azea (e.g. paper products, cleaning
supplies)
- SPF liaison to assist insEructors — someone who is available before, during and after —
educationai sessions for unexpected issues (e.g. locked door, lighfing issues, etc)
Pazking
- free of charge
- safe location
- very neaz main entrance to training center
-�.`�
21