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Agenda 02/11/2014 Item #16K3 2/11/2014 16.K.3. EXECUTIVE SUMMARY Recommendation that the Board of County Commissioners approves, and authorizes the Chair to execute, the proposed Collier County Emergency Services Deputy Medical Director Agreement with Dr. Lee. OBJECTIVE: To enter into a Deputy Medical Director's Agreement with Dr. Lee. CONSIDERATIONS: Dr. Douglas S. Lee has served for many years as the County's assistant medical director. At the Board's March 12, 2013 regular meeting (Item 11-F), Commissioner Hiller brought forward a recommendation that the Board of County Commissioners direct staff to prepare solicitations for the positions of County Medical Director and Deputy County Medical Director. The Board directed staff to prepare a Request for Proposals (RFP) for both positions. The Collier County Public Safety Authority reviewed all proposals from interested and qualified consultants in response to the RFP and presented its rankings to the Board on June 25, 2013 (Item 10- G). The Board voted to direct the Chair to negotiate a contract with Dr. Tober as the Medical Director and Dr. Lee as Deputy Medical Director. On January 28, 2014, the Board approved Dr. Tober's agreement and directed the County Attorney to utilize his agreement as the basis for an agreement for Dr. Lee as Deputy Medical Director. The proposed agreement is substantially similar to Dr. Tober's, except for Dr. Lee's agreement applies retroactively to February 1, 2014 and emphasizes that the Deputy Medical Director's duties are in support of the Medical Director and to take over the Medical Director's duties in his absence. The Agreement also differs in that Dr. Tober is for two years, with three one year renewals, and this Agreement, in keeping with the RFP, is for five years, with three one year renewals. Both agreements contain a 60 day notice of termination provision. Like the Medical Director, the Deputy Medical Director will now report directly to the County Manager: therefore, both the annual performance evaluation and proposed goals of the Deputy Medical Director should be handled by the County Manager. with all performance issues going to the Board of County Commissioners. FISCAL IMPACT: The Agreement calls for a salary of$50,000 per year. GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated with this Executive Summary. RECOMMENDATION: That the Board of County Commissioners approves the proposed Collier County Emergency Services Deputy Medical Director Agreement with Douglas S. Lee. M.D., and authorizes the Chairman to execute same. PREPARED BY: Jeffrey A. Klatzkow, County Attorney Attachments: Proposed Collier County Emergency Services Deputy Medical Director Agreement Packet Page-1058- 2/11/2014 16.K.3. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.K.16.K.3. Item Summary: Recommendation that the Board of County Commissioners approves, and authorizes the Chair to execute,the proposed Collier County Emergency Services Deputy Medical Director Agreement with Dr. Lee. Meeting Date: 2/11/2014 Prepared By Name: NeetVirginia Title: Legal Assistant/Paralegal, CAO Office Administration 2/5/2014 10:18:52 AM Submitted by Title: County Attorney, Name: KlatzkowJeff 2/5/2014 10:18:54 AM Approved By Name: KlatzkowJeff Title: County Attorney, Date: 2/5/2014 2:25:01 PM Name: KlatzkowJeff Title: County Attorney, Date: 2/5/2014 3:06:56 PM Name: IsacksonMark Title: Director-Corp Financial and Mngmt Svs, Office of Management&Budget Date: 2/5/2014 3:07:16 PM Name: IsacksonMark Title: Director-Corp Financial and Mngmt Svs, Office of Management&Budget Date: 2/5/2014 3:33:00 PM Packet Page-1059- 2/11/2014 16.K.3. COLLIER COUNTY EMERGENCY SERVICES DEPUTY MEDICAL DIRECTOR AGREEMENT THIS DEPUTY MEDICAL DIRECTOR AGREEMENT is by and between DOUGLAS S. LEE, M.D., hereinafter referred to as DEPUTY MEDICAL DIRECTOR, and COLLIER COUNTY, FLORIDA, hereinafter referred to as the COUNTY, and shall become effective as of the 1St day of February, 2014. 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, the COUNTY desires to employ a deputy medical director in order aid the medical director in carrying out the duties of the office; and WHEREAS, Douglas S. Lee, 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 DEPUTY MEDICAL DIRECTOR wish to enter into this contract for employment subject to 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 DEPUTY MEDICAL DIRECTOR'S responsibility under this Agreement is to provide professional services in conjunction with the Medical Director for COUNTY in accordance with Chapter 401, Florida Statutes and Chapter 64-J-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 DEPUTY MEDICAL DIRECTOR shall commence services on the date first written above and complete all services by five (5) years from the 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 DEPUTY 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. Page 1 of 9 Packet Page-1060- 2/11/2014 16.K.3. ARTICLE 3—SCOPE OF WORK This Agreement is personal to Dr. Lee, and as such the duties set forth herein cannot be delegated or assigned except as expressly permitted by Chapter 401, Florida Statutes and Chapter 64-J-1, 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 DEPUTY 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. The scope of services for the DEPUTY MEDICAL DIRECTOR, as outlined in Exhibit A, shall be in support of and to further the duties of the Medical Director. If for any reason the Medical Director is unavailable whether by termination of his contract, scheduled vacation or personal emergency, the DEPUTY MEDICAL DIRECTOR shall assume the duties of the Medical Director until further notice. Article 18 may be utilized if an increase in duties is necessary for more than 31 days. ARTICLE 4—PAYMENTS TO DEPUTY MEDICAL DIRECTOR The COUNTY shall pay to the DEPUTY MEDICAL DIRECTOR the sum of fifty thousand ($50,000) 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 DEPUTY MEDICAL DIRECTOR shall not be eligible for any employee benefits other than this compensation. This sum shall be paid to the DEPUTY 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 employees, the DEPUTY MEDICAL DIRECTOR'S base salary shall be modified to reflect the general wage adjustment granted to COUNTY employees. In addition, on each annual anniversary date during the term of this Agreement, including any renewal terms, the DEPUTY 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 DEPUTY MEDICAL DIRECTOR shall report to the County Manager or designee for the services as DEPUTY MEDICAL DIRECTOR as more specifically defined in this Exhibit A and as set forth in Section 401.265, Florida Statutes. The DEPUTY 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 DEPUTY 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 DEPUTY MEDICAL DIRECTOR and the County Manager or designee and adopted prior to October 1st of each year for implementation in the next year. Page 2 of 9 Packet Page-1061- 2/11/2014 16.K.3. 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: (a) DEPUTY 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) DEPUTY MEDICAL DIRECTOR violates law, ordinances, rules, regulations or any governmental authority having jurisdiction; (c) DEPUTY 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 DEPUTY 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 DEPUTY MEDICAL DIRECTOR and any 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. Page 3 of 9 Packet Page -1062- 2/11/2014 16.K.3. D. The requirements contained herein are not intended to and shall not in any manner limit the liabilities and obligations assumed by the DEPUTY 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. ARTICLE 10—CONFLICT OF INTEREST DEPUTY MEDICAL DIRECTOR shall at all times act in the COUNTY'S best interest. Nothing in this Agreement shall be interpreted as preventing the DEPUTY 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 DEPUTY 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 DEPUTY 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 DEPUTY 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 DEPUTY 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 DEPUTY MEDICAL DIRECTOR. The COUNTY agrees to notify the DEPUTY MEDICAL DIRECTOR of its opinion by certified mail within thirty (30) days of receipt of notification by the DEPUTY 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 DEPUTY MEDICAL DIRECTOR, the COUNTY will so state in the notification and the DEPUTY MEDICAL DIRECTOR shall, at his 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 DEPUTY MEDICAL DIRECTOR under the terms of this Agreement. Nothing in this Agreement shall be interpreted as preventing the DEPUTY 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 DEPUTY 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 DEPUTY 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 Lee Memorial Hospital/Lee Memorial Health System and the Neighborhood Clinic. Page 4 of 9 Packet Page-1063- 2/11/2014 16.K.3. ARTICLE 11 —DISCLOSURE AND OWNERSHIP OF DOCUMENTS The DEPUTY 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 DEPUTY MEDICAL 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, DEPUTY 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 limited to any representations made herein relating to disclosure or ownership of documents, shall survive the execution and delivery of this Agreement and the consummation of the transactions contemplated hereby. ARTICLE 12—INDEPENDENT CONTRACTOR RELATIONSHIP The DEPUTY 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. The DEPUTY MEDICAL DIRECTOR and all back-up physicians shall comply with all COUNTY policies concerning conduct and security when performing services hereunder. The DEPUTY 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 DEPUTY MEDICAL DIRECTOR for any reasonable legal expenses and costs incurred by the DEPUTY MEDICAL DIRECTOR in the performance of his duties as set forth herein, including without limitation any 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 DEPUTY 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 or designee upon request. The DEPUTY . MEDICAL DIRECTOR further represents and warrants that he will continue to maintain the Page 5 of 9 Packet Page-1064- 2/11/2014 16.K.3. 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 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 DEPUTY 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 to Exhibit A Scope of Work, including alterations, reductions therein or additions thereto. Upon receipt by the DEPUTY MEDICAL DIRECTOR of the COUNTY'S notification of a contemplated change, the DEPUTY 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 DEPUTY MEDICAL DIRECTOR'S ability to meet the completion dates or schedules of this Agreement. If the COUNTY so instructs in writing, the DEPUTY 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 DEPUTY MEDICAL DIRECTOR shall not commence work on any such change until such written amendment is signed by the DEPUTY 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 Page 6 of 9 Packet Page-1065- 2/11/2014 16.K.3. And if sent to the DEPUTY MEDICAL DIRECTOR shall be mailed to: Douglas S. Lee, M.D. n` 1635 Gordon River Lane Naples, Florida 34104 ARTICLE 20—REGULATIONS; LICENSING REQUIREMENTS The DEPUTY 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. DEPUTY 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. DEPUTY 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, on behalf of the COUNTY, and the DEPUTY MEDICAL DIRECTOR has made and executed this Agreement which shall become effective as of the 1St day of February, 2014. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA By: By: , Deputy Clerk TOM HENNING, CHAIRMAN WITNESSES: Print Name: By: Douglas S. Lee, M.D. Print Name: Approved as to form and legality: Jeffrey A. Klatzkow County Attorney Page 7 of 9 Packet Page-1066- 2/11/2014 16.K.3. Exhibit A Scope of Work A. When the Medical Director is unavailable, the DEPUTY MEDICAL DIRECTOR must attend the quarterly 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 meetings will be supplied by the County Manager or designee. B. Be available as back-up, as needed, during times when the Medical Director is absent due to a scheduled vacation or personal emergency or schedule and ensure that an approved back-up physician is available. C. DEPUTY 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, DEPUTY MEDICAL DIRECTOR shall assist the COUNTY with obtaining patient outcome information from local hospitals. E. DEPUTY MEDICAL DIRECTOR shall participate in regular Quality Assurance meetings with Dispatch personnel. F. DEPUTY MEDICAL DIRECTOR shall review and participate in the development of the Dispatch Protocols followed by COUNTY EMS. G. DEPUTY 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 DEPUTY MEDICAL DIRECTOR shall, upon request of the County Manager or designee, evaluate COUNTY EMTs and Paramedical personnel during training exercises. DEPUTY MEDICAL DIRECTOR shall review and approve the content of EMS training for medical correctness at the request of the County Manager or designee. H. DEPUTY 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 DEPUTY MEDICAL DIRECTOR which have been approved by the EMS Chief, will be recognized as part of the normal job duties of DEPUTY MEDICAL DIRECTOR. I. In the absence of the Medical Director, and as required under Chapter 401, Florida Statutes, and Chapter 64J-1, F.A.C., the DEPUTY 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. In the absence of the Medical Director, and as required by Section 401.265, Florida Statutes, and Rule 64J-1.004, F.A.C, the DEPUTY MEDICAL DIRECTOR shall also supervise and assume direct responsibility for Page 8 of 9 Packet Page-1067- 2/11/2014 16.K.3. the medical performance of all EMTs and paramedics operating for COUNTY EMS, including both ground and aero medical personnel. J. DEPUTY MEDICAL DIRECTOR shall assist the Medical Director in the supervision, 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. DEPUTY MEDICAL DIRECTOR may 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 is available pursuant to and in accordance with Article 3, Paragraph M. L. 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. In the absence of the Medical Director, the DEPUTY 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 an approved back-up physician. N. In support of the Medical Director, the DEPUTY 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. DEPUTY 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. DEPUTY 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 -1068-