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Agenda 02/09/2016 Item #16E 4 2/9/2016 16.E.4. � I EXECUTIVE SUMMARY Recommendation to increase the compensation for the County Medical Director by 5% in accordance with the Collier County Emergency Services Medical Director Agreement. OBJECTIVE: To provide a 5%increase as requested by the County Medical Director. CONSIDERATIONS: The Medical Director Agreement was approved by the Board on January 28, 2014, Agenda Item 16K3 and renewed on September 22, 2015, Agenda Item 16E8. Article 4 — Payments to Medical Director allows for a 5% annual increase at the request of the Medical Director and subsequent approval by the Board of County Commissioners, to be retroactive to the first day after the annual anniversary date. FISCAL IMPACT: The 5% increase would total $3,882.38 for FY16 and would be paid from the EMS operating budget Fund 490. LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is approved as to form and legality, and requires majority vote for approval.-JAK GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact resulting from this action. RECOMMENDATION: That the Board of County Commissioners approves the 5% increase to the Medical Director's annual compensation. PREPARED BY: Artie Bay, Supervisor, Emergency Medical Services Admin. Attachment: Medical Director Agreement /"\ Packet Page-626- 2/9/2016 16.E.4. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.E.16.E.4. Item Summary: Recommendation to increase the compensation for the County Medical Director by 5% in accordance with the Collier County Emergency Services Medical Director Agreement. Meeting Date: 2/9/2016 Prepared By Name: BayArtie Title: Supervisor-Accounting,Administrative Services Department 1/22/2016 11:43:47 AM Approved By Name: KopkaWalter Title: Chief-Emergency Medical Services,EMS Operations Date: 1/22/2016 11:51:04 AM Name: PriceLen Title: Department Head-Administrative Svc,Administrative Services Department Date: 1/22/2016 1:57:58 PM Name: KlatzkowJeff Title: County Attorney, Date: 1/28/2016 4:17:30 PM Name: KlatzkowJeff Title: County Attorney, Date: 1/28/2016 4:33:58 PM Name: WellsLaura Title: Management/Budget Analyst, Senior, Office of Management&Budget Date: 1/28/2016 4:43:07 PM Name: CasalanguidaNick Title: Deputy County Manager, County Managers Office Date: 1/31/2016 12:41:03 PM Packet Page-627- 2/9/2016 16.E.4. COLLIER COUNTY EMERGENCY SERVICES MEDICAL DIRECTOR AGREEMENT THIS. MEDICAL DIRECTOR AGREEMENT made this -2.SAN-t day of 2c:oh uoL , 2014, by and between ROBERT BOYD TOBER, INC., hereinafter referred to as MEDICAL DIRECTOR, and COLLIER COUNTY, FLORIDA, hereinafter referred to as the COUNTY. WITNESSETH: WHEREAS, the COUNTY is responsible for emergency services in Collier County, Florida; and WHEREAS, Section 401.265, Florida Statutes, requires the COUNTY as a basic and advanced life support service provider to employ a medical director;and WHEREAS, ROBERT BOYD TOBER, M.D., is a duly licensed physician in the State of Florida who is specially trained in the field of emergency medicine;and WHEREAS,the COUNTY and the MEDICAL DIRECTOR are presently parties under a Medical Consultant Contract, and wish to continue their relationship under the terms and conditions set forth below. NOW THEREFORE,in consideration of the promises and mutual covenants hereinafter set forth,the parties hereto agree as follows: ARTICLE 1-SERVICES The MEDICAL DIRECTOR'S responsibility under this Agreement is to provide professional services as Medical Director for COUNTY in accordance with Chapter 401,Florida Statutes and Chapter 644-1,Florida Administrative Code, Rules of the Department of Health,as more specifically set forth in the Scope of Work and specifications detailed in Article 3. ARTICLE 2—SCHEDULE AND RENEWAL The MEDICAL DIRECTOR shall commence services on the date first written above and complete all services by two (2) years from date written above. This Agreement may be renewed for up to three additional one (1) year terms by the Board of County Commissioners based on satisfactory performance, mutual acceptance and determination that the contract is in the best interest of the COUNTY. The MEDICAL DIRECTOR shall be given one hundred- twenty days (120) notice of the COUNTY's intent to renew the contract or to allow the contract to expire without renewal. Any renewal will be subject to appropriation of funds by the Board of County Commissioners. ARTICLE 3—SCOPE OF WORK This Agreement is personal to Dr. Tober, and as such the duties set forth herein cannot be delegated or assigned except as expressly permitted by Chapter 401, Florida Statutes and Page 1 of 9 Packet Page -629- 2/9/2016 16.E.4. Chapter 64-J-I, Florida Administrative Code, Rules of the Department of Health or as otherwise provided in this Agreement. Exhibit A outlines the specific scope of work and responsibilities of the MEDICAL DIRECTOR.This does not limit duties to the following requirements,which may be subject to revision/addition/deletion upon written agreement by both parties. ARTICLE 4–PAYMENTS TO MEDICAL DIRECTOR The COUNTY shall pay to the MEDICAL DIRECTOR the sum of seventy-five thousand ($75,000) per year, as full compensation for the services rendered herein and no other compensation. The COUNTY will pay the cost of the professional liability insurance and reasonable and necessary legal services as set forth below. The MEDICAL DIRECTOR shall not be eligible for any employee benefits other than this compensation. This sum shall be paid to the MEDICAL DIRECTOR in twelve (12) equal monthly payments commencing with the effective date of the Agreement, with each monthly payment being payable by the 10th of each month. On the date that general wage adjustments (i.e.,cost of living adjustments,special study pay adjustments, etc.) are granted generally to COUNTY employee, the MEDICAL DIRECTOR'S base salary shall be modified to reflect the general wage adjustment granted to other COUNTY employees. In addition,on each annual anniversary date during the term of this Agreement, including any renewal terms, the MEDICAL DIRECTOR will be entitled to a 5% annual increase upon the written notification to County Manager fifteen (15) days prior to the annual anniversary date and subsequent approval by the Board of County Commissioners, with any increase to be retroactive to the first day after the annual anniversary date. ARTICLE 5–REPORTING/ANNUAL CONTRACTOR EVALUATION The MEDICAL DIRECTOR shall report to the County Manager or designee for the — services as MEDICAL DIRECTOR as more specifically defined in this Exhibit A and as set forth in Section 401.265,Florida Statutes. The MEDICAL DIRECTOR will submit a contractor self-assessment along with proposed goals for the next year on an annual basis to the County Manager or designee no later than the first day of June. The County Manager or designee will review the MEDICAL DIRECTOR's self-assessment and may request an independent evaluation and recommendations from a Board authorized Advisory Board. Any performance issue will be taken to the Board of County Commissioners. An updated contractor evaluation plan may be developed in good faith between the MEDICAL DIRECTOR and the County Manager or designee and adopted prior to October 19`of each year for implementation in the next year. ARTICLE 6–TERMINATION This Agreement is subject to termination without cause by either party to this Agreement upon sixty (60) days written notice. Such notice shall be forwarded by certified mail to the addresses set forth in Article 19. This Agreement is subject to immediate termination for cause in the event: Page 2 of 9 Packet Page -630- 2/9/2016 16.E.4. (a) MEDICAL DIRECTOR fails or refuses to prosecute the Scope of Work or any severable part, with the diligence that will insure its completion within the time specified by the COUNTY; (b) MEDICAL DIRECTOR violates law, ordinances, rules, regulations or any governmental authority having jurisdiction; (c) MEDICAL DIRECTOR materially breaches any of the provisions of this Agreement. ARTICLE 7—AVAILABILITY OF FUNDS The COUNTY'S performance and obligation to pay under this Agreement is contingent upon an annual appropriation for its purpose by the Board of County Commissioners. ARTICLE 8—INSURANCE A. Coverage is afforded under the COUNTY'S SELF-INSURED RETENTION PLAN and SPECIFIC EXCESS INSURANCE POLICY as follows: SELF-INSURED RETENTION PLAN $300,000 each occurrence SPECIFIC EXCESS INSURANCE POLICY $2,000,000 each occurrence combined single limit Coverage is afforded to the MEDICAL DIRECTOR and DEPUTY MEDICAL DIRECTOR by endorsement. Coverage for back-up physicians shall be subject to the prior approval of the COUNTY's insurance underwriters. B. Additional Malpractice Coverage shall also be afforded by the COUNTY hereunder as has been historically provided by COUNTY to MEDICAL DIRECTOR for activities while riding as crew member of EMS vehicle as required by this Agreement and by State Law. C. The COUNTY reserves the right, but not the obligation, to purchase separate liability insurance on behalf of the MEDICAL DIRECTOR, the Deputy Medical Director and back- up physicians in lieu of providing the coverage as mentioned above. Such insurance will be limited to those matters arising out of this Agreement. D. The requirements contained herein are not intended to and shall not in any manner limit the liabilities and obligations assumed by the MEDICAL DIRECTOR under this Agreement. ARTICLE 9—REMEDIES This Agreement shall be governed by the laws of the State of Florida. Any and all legal action necessary to enforce the Agreement shall be held in Collier County. Page 3 of 9 Packet Page -631- 2/9/2016 16.E.4. ARTICLE 10—CONFLICT OF INTEREST MEDICAL DIRECTOR shall at all times act in the COUNTY'S best interest. Nothing in this Agreement shall be interpreted as preventing the MEDICAL DIRECTOR from operating any other business or being similarly employed with any other emergency medical service which is lawfully licensed by the COUNTY (within Collier County, Florida) and the State. However the MEDICAL DIRECTOR shall not accept any employment or enter into any contractual relationship which would create a conflict between such interest and the performance of its duties hereunder. To that end, the MEDICAL DIRECTOR shall promptly notify the COUNTY'S representative, in writing, by certified mail, of all other prospective employment, business association, interest or other circumstance which MEDICAL DIRECTOR plans to engage in throughout the term of this Agreement. Such written notification shall identify the prospective business association,interest or circumstance,the nature of work that the MEDICAL DIRECTOR may undertake and request an opinion of the COUNTY as to whether the association, interest or circumstance would, in the opinion of the COUNTY, constitute a conflict of interest if entered into by the MEDICAL DIRECTOR. The COUNTY agrees to notify the MEDICAL DIRECTOR of its opinion by certified mail within thirty (30) days of receipt of notification by the MEDICAL DIRECTOR. If in the opinion of the COUNTY, the prospective business association, interest or circumstance would not constitute a conflict of interest by the MEDICAL DIRECTOR, the COUNTY will so state in the notification and the MEDICAL • DIRECTOR shall,at is option,enter into said association, interest or circumstance and it shall be deemed not a conflict of interest with respect to services provided to the COUNTY by the MEDICAL DIRECTOR under the terms of this Agreement. Nothing in this Agreement shall be interpreted as preventing the MEDICAL DIRECTOR, a contractual employee of the COUNTY, from being employed in any other capacity, including, but not limited to the operation of a medical practice,the employment as a staff member of any hospital, or the serving as a MEDICAL DIRECTOR for any other emergency medical service which is lawfully licensed by the COUNTY (if located within Collier County) and the State. Nor shall anything in this Agreement be interpreted as preventing the MEDICAL DIRECTOR from continuing with any employment or other work in which he was already engaged at the time this Agreement was entered, which employment or work includes without limitation employment and work with NCH,The Wound Care Center and The Neighborhood Clinic. ARTICLE 11 —DISCLOSURE AND OWNERSHIP OF DOCUMENTS The MEDICAL DIRECTOR shall deliver to the COUNTY'S representative for approval and acceptance, and before being eligible for final payment of any amounts due, all documents and materials prepared by and for the COUNTY under this Agreement. The COUNTY and the MED[CAL DIRECTOR shall comply with the provisions of Chapter 119, Florida Statutes (Public Records Law), HIPAA, HITECH, HIPAA Regulations, and any other applicable law relating to records and/or confidentiality of records. To that end, MEDICAL DIRECTOR shall execute the COUNTY's standard Business Associate Agreement. All covenants, agreements, representations and warranties made herein, or otherwise made in writing by any party pursuant hereto, including but not Iimited to any representations made herein relating to disclosure or ownership of documents, shall survive the execution and Page 4 of 9 Packet Page -632- 2/9/2016 16.E.4. delivery of this Agreement and the consummation of the transactions contemplated hereby. ARTICLE 12—INDEPENDENT CONTRACTOR RELATIONSHIP The MEDICAL DIRECTOR is, and shall be, in the performance of all work services and activities under this Agreement, an Independent Contractor, and not an employee, or servant of the COUNTY. All persons engaged in any of the work or services performed pursuant to this Agreement shall at all times, and in all places, be subject to the MEDICAL DIRECTOR'S sole direction, supervision, and control. The MEDICAL DIRECTOR shall exercise control over the means and manner in which it and its employees, agents, subcontractors, Deputy Medical Director and back-up physicians perform the work, and in all respects the MEDICAL DIRECTOR'S relationship,and the relationship of its employees,agents,subcontractors,Deputy Medical Director and back-up physicians, to the COUNTY shall be that of an Independent Contractor and not as employees or agents of the COUNTY. The MEDICAL DIRECTOR, the Deputy Medical Director and all back-up physicians shall comply with all COUNTY policies concerning conduct and security when performing services hereunder. The MEDICAL DIRECTOR does not have the power or authority to bind the COUNTY in any promise, agreement or representation other than specifically provided for in this Agreement. ARTICLE 13—LEGAL EXPENSES OF THE MEDICAL DIRECTOR The County agrees to reimburse the MEDICAL DIRECTOR for any reasonable legal expenses and costs incurred by the MEDICAL DIRECTOR in the performance of his duties or resulting from his holding of the Medical Director's position and title, including without limitation expenses and costs associated with legal opinions or assistance needed in the interpretation, application and compliance with statutes, ordinances and administrative regulations,e.g.,Chapter 401,Chapter 119 and F.A.C. 64-J-1,and litigation expenses. ARTICLE 14—ENFORCEMENT COSTS If any legal action or other proceeding is brought for the enforcement of this Agreement, or because of an alleged dispute, breach, default or misrepresentation in connection with any provisions of this Agreement,each party shall bear its own attorney's fees and costs. ARTICLE 15—AUTHORITY TO PRACTICE The MEDICAL DIRECTOR hereby represents and warrants that he has and will continue to maintain all licenses and approvals required to conduct his business, and that he will at all times conduct his business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to the County Manager of designee upon request. The MEDICAL DIRECTOR further represents and warrants that he will continue to maintain the requisite qualifications, knowledge and experience required of a medical director by Section 401.265, Florida Statutes and Rule 64J-1.004,F.A.C.,and any other applicable laws and regulations. ARTICLE 16—SEVERABILITY If any term or provisions of this Agreement, or the application thereof to any person or circumstances shall, to any extent, be held invalid or unenforceable, the remainder of this Page 5of9 Packet Page -633- 2/9/2016 16.E.4. Agreement, or the application of such terms or provisions to persons or circumstances other than those as to which it is held invalid or unenforceable, shall not be affected, and every other term and provision of this Agreement shall be deemed valid and enforceable to the extent permitted by law. ARTICLE 17—ENTIRETY OF CONTRACTUAL AGREEMENT The COUNTY and the MEDICAL DIRECTOR agree that this Agreement sets forth the entire agreement between the parties,and that there are no promises or understandings other than those stated herein. None of the provisions, terms and conditions contained in this Agreement may be added to, modified, superseded or otherwise altered, except by written instrument executed by the parties hereto. ARTICLE 18—MODIFICATIONS OF WORK The COUNTY reserves the right to make changes in the Medical Director's Exhibit A Scope of Work, including alterations, reductions therein or additions thereto. Upon receipt by the MEDICAL DIRECTOR of the COUNTY'S notification of a contemplated change, the MEDICAL DIRECTOR shall, in writing: (1) provide a detailed estimate for the increase or decrease in cost due to the contemplated change, (2) notify the COUNTY of any estimated change in the completion date, and (3) advise the COUNTY if the contemplated change shall affect the MEDICAL DIRECTOR'S ability to meet the completion dates or schedules of this Agreement. If the COUNTY so instructs in writing, the MEDICAL DIRECTOR shall suspend work on that portion of his duties affected by a contemplated change, pending the COUNTY'S decision to proceed with the change. If the COUNTY elects to make the change, the COUNTY shall initiate an Agreement Amendment and the MEDICAL DIRECTOR shall not commence work on any such change until such written amendment is signed by the MEDICAL DIRECTOR and approved and executed by the COUNTY Board of County Commissioners. ARTICLE 19—NOTICE All notices required in this Agreement shall be sent by certified mail, return receipt requested, and if sent to the COUNTY'S representative shall be mailed to: Leo E. Ochs,Jr.,County Manager 3299 East Tamiami Trail,Suite 202 Naples, FL 34112 And if sent to the MEDICAL DIRECTOR shall be mailed to: ROBERT BOYD TUBER,INC. Collier County Emergency Medical Services 8075 Lely Cultural Parkway,Suite 267 Naples,FL 341 13 Page 6 of 9 Packet Page-634- 2/9/2016 16.E.4. ARTICLE 20—REGULATIONS; LICENSING REQUIREMENTS The MEDICAL DIRECTOR shall comply with all laws, ordinances and regulations applicable to the services contemplated herein, to include those applicable to conflict of interest and collusion. MEDICAL DIRECTOR is presumed to be familiar with all federal, state and local laws, ordinances, codes and regulations that may in any way affect the services offered. MEDICAL DIRECTOR shall keep all required licenses and corporate records current throughout the term of this Agreement,and shall on request provide proof thereof. IN WITNESS WHEREOF, the Board of County Commissioners of Collier County, Florida, has made and executed this Agreement on behalf of the COUNTY and MEDICAL DIRECTOR has hereunto set its hand the day and year above written. ATTEST: BOARD OF COUN COMMISSIONERS DWIGHT E. BROCK,Clerk COLLIER 'SUN LORIDA By: l A"r ' pC - B Angst ait.irsTripr'3<Deputy Clerk M HENNING,C w' signature onigt, WITNESS: tat''' ROBERT BOYD TOBER,INC. Print Name: MGUr & ti2A45 By 0,115, r! Robert Boyd Tober,President Print N.' e: I Appro and land legality: Jeffrey A. a :�ow County A Page 7 of 9 Packet Page -635- 2/9/2016 16.E.4. Exhibit A Scope of Work A. Attend at least once quarterly a scheduled emergency medical services meeting where discussions will involve patient care, quality, mandated Paramedic and EMT training, Paramedic requirements, addition or deletion of equipment available to Paramedics and EMT's. Ample notice for all such meeting will be supplied by the County Manager or designee. B. Except during scheduled vacations or personal emergencies, when the Deputy Medical Director or other approved back-up physician shall be available via radio or telephone communication on a 24 hour a day, 7 day per week basis for on line medical control. Notwithstanding anything to the contrary contained herein,MEDICAL DIRECTOR may use reasonable discretion in determining the appropriateness of his response to calls. C. MEDICAL DIRECTOR shall ride as a crew member on an EMS vehicle a minimum of ten (10) hours annually or as otherwise expressly required by state law to evaluate the skills and maintain a working relationship with EMT's, assigned Paramedics, and probationary Paramedics. D. As part of the quality assurance committee, MEDICAL DIRECTOR shall assist the COUNTY with obtaining patient outcome information from local hospitals. E. MEDICAL DIRECTOR shall participate in regular Quality Assurance meetings with Dispatch personnel. F. MEDICAL DIRECTOR shall review and participate in the development of the Dispatch Protocols followed by COUNTY EMS. G. MEDICAL DIRECTOR shall participate in and direct EMS Advanced Cardiac Life Support (ACLS) classes, and shall assist the County and EMS Chief in arranging additional training to meet the needs of the community and the standards of care for the industry. The MEDICAL DIRECTOR shall, upon request of the County Manager or designee, evaluate COUNTY EMT's and Paramedical personnel during training exercises. MEDICAL DIRECTOR shall review and approve the content of EMS training for medical correctness at the request of the County Manager or designee. H. MEDICAL DIRECTOR shall be physically present in the COUNTY EMS Administrative Offices on as needed basis;in order to confer with the EMS Chief and other designated staff. All official meetings attended by the MEDICAL DIRECTOR which have been approved by the EMS Chief, will be recognized as part of the normal job duties of MEDICAL DIRECTOR. I. As required under Chapter 401, Florida Statutes, and Chapter 64J-1, F.A.C., MEDICAL DIRECTOR shall develop,review and authorize use of ALS and BLS protocols which allow personnel to properly manage medical emergencies. Such protocols shall be specific in nature and shall provide for managing immediately life-threatening medical emergencies. As required by Section 401.265, Florida Statutes, and Rule 64J-1.004, F.A.C, the MEDICAL Page 8 of 9 Packet Page -636- 2/9/2016 16.E.4. DIRECTOR shall supervise and assume direct responsibility for the medical performance of all EMT's and paramedics operating for COUNTY EMS, including both ground and aero medical personnel. MEDICAL DIRECTOR shall develop any other protocols as required by Chapter 401, Florida Statutes, or Chapter 64J-1,F.A.C., as they may be amended from time to time. J. MEDICAL DIRECTOR shall supervise the implementation and maintenance of a quality assurance program as required by Section 401.265, Florida Statutes and Rule 64J-1.004 F.A.C.,to include spot-checking medical reports for completion and correctness. The quality assurance program must cover dispatch,field paramedics,EMT's and Flight Medics. K. MEDICAL DIRECTOR shall review and provide written affirmation of recertification training of COUNTY EMS EMT and Paramedic personnel in accordance with Section 401.2715(3),Florida Statutes. It is understood and agreed between the parties to this Agreement that all of the legal duties and responsibilities of a medical director as set forth in Chapter 401, Florida Statutes, Rule 64J-1.004 F.A.C., and any other applicable laws and regulations, shall remain with the MEDICAL DIRECTOR at all times except during scheduled vacations or personal emergencies, when the Deputy Medical Director or other approved back-up physician shall be available pursuant to and in accordance with Article 3,Paragraph M. L. MEDICAL DIRECTOR shall provide the County Manager or designee with a quarterly report generally describing activities performed, with reference to the requirements of this Agreement. COUNTY shall provide administrative support in order for the MEDICAL DIRECTOR to meet the obligations of this paragraph. Back-up physicians may be used in lieu of the MEDICAL DIRECTOR and/or Deputy Medical Director upon approval of the County Manager or designee. Back-up physicians, when used, shall meet all of the qualifications for a medical director as set forth in Section 401.265, Florida Statutes, and shall be at no additional cost to the COUNTY. M. MEDICAL DIRECTOR will coordinate the provision of coverage at all times not available during the term of this Agreement; during such times, backup coverage may include the Deputy Medical Director or an approved back-up physician. N. MEDICAL DIRECTOR shall perform all other services required of a medical director, and assume all legal duties and responsibilities of a medical director,as provided by Section 401, Florida Statutes, Chapter 64J-1 F.A.C., and any other applicable laws and regulations, all as may be amended from time to time. O. Medical Director shall be available for consultation with the Director of Emergency Management during activations of the County's Emergency Operations Center or eminent emergency situation to assist in a public health emergency, disaster, pandemic, or mass medical event. Such efforts shall be in coordination with the Public Health Director and not in conflict with public health statutory authority. P. Medical Director shall receive prior approval from the County Manager or designee preceding any COUNTY communication with the media. Page 9 of 9 Packet Page -637-