Agenda 02/09/2010 Item #16K5
Agenda Item No. 16K5
February 9, 2010
Page 1 of 13
EXECUTIVE SUMMARY
Recommend acceptance of tbe Medical Director's waiver of a 5% annual increase in salary
during Fiscal Year 2010 that is provided for in Dr. Tober's contract for a fiscal impact of
$5,275.00.
OBJECTIVE: Recommendation that the Board accept the Medical Director's waiver of a 5%
annual increase in salary during FYIO, which is provided for in the Collier County Emergency
Services Medical Consultant Contract.
CONSIDERATIONS: This Executive Summary is being brought to the Board at Dr. Tober's
request. On September II, 200 I, Collier County entered into the Collier County Emergency
Services Medical Consultant Contract (Contract) with Robert Boyd Tober, Inc. The Contract, as
amended, is attached as back-up to this item.
Under the contract, Dr. Tober serves as the Medical Director and is responsible for the
implementation of such planning and coordination as may be necessary to deliver advanced life
support by paramedics (including EMS and Fire District personnel). The Contract automatically
renews on a yearly basis unless terminated by the County upon sixty days written notice to Dr.
Tober.
The Contract provides, in pertinent part:
4. COMPENSATION: The County shall pay to the Consultant the sum of
$50,000 per annum, as full compensation for the services rendered herein and no
other compensation. The County will pay the cost of the professional liability
insurance. The Medical Director shall not be eligible for any employee benefits
other than this compensation. This sum shall be paid to the Consultant in twelve
(12) equal monthly payments commencing with the effective date of the Contract,
with each monthly payment being payable by the lOth of each month. The
Consultant will be entitled to a 5% annual increase beginnin(! October 1. 200 I uEon
written notification bv the Emergencv Services Administrator by September IS of
each year. beginning on September IS. 2001. and upon approval by the Board of
County Commissioners.
Due to his length of service the 5% annual increase has resulted in Dr. Tober now receiving
$105,209.28 per annum under the Contract. Tober has contacted the County and has requested
that the automatic 5% salary increase for FYI 0 be waived.
FISCAL IMPACT: Waiving the 5% salary increase will result in a cost savings of $5,275.00
during FYIO from Fund 490 and Cost Center 144610. No increase has occurred yet.
GROWTH MANAGEMENT IMPACT: None.
LEGAL CONSIDERATIONS: This item has been reviewed and approved by the County
Attorney's Office and is legally sufficient for Board action. JAK
RECOMMENDATION: That the Board accepts the Medical Director's waiver of a 5% annual
increase in salary during FYIO, which is otherwise, paid by the Collier County Emergency
Services Medical Consultant Contract.
PREPARED BY: Jeffrey A. Klatzkow, County Attorney
Item Number:
Item Summary:
Meeting Date:
Agenda Item No. 16K5
February 9, 2010
Page 2 of 13
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
16K5
Recommend acceptance of the Medical Directors waiver of a 5% annual increase in salary
during Fiscal Year 2010 that is provided for in Dr. Tobe~s conlract for a fiscal impact of
$5,275.
2/9/20109:00:00 AM
Date
Prepared By
Jeff Klatzkow
County Attorney
1/28/20103:27:56 PM
Date
Approved By
Jennifer White
County Attorney
Assistant County Attorney
County Attorney
1/28/2010 3:46 PM
Date
Approved By
Jeff Klatzkow
County Attorney
1/29/20103:13 PM
Date
Approved By
OMS Coordinator
County Manager's Office
Office of Management & Budget
2/1/20108:32 AM
Date
Approved By
Sherry Pryor
Office of Management &
Budget
Management! Budget Analyst, Senior
Office of Management & Budget
2/2/2010 9:05 AM
Approved By
Date
Mark Isackson
Office of Management &
Budget
Management/Budget Analyst, Senior
Office of Management & Budget
2/2/20109:20 AM
Agenda Item No. 16K5
February 9, 2010
Page 3 of 13
COLLIER COUNTY EMERGENCY SERVICES
MEDICAL CONSULTANT CONTRACT
. ~
THIS MEDICAL CONSULTING CONTRACT made this J.J..:::.... day of
S~-\r 11II\ \).P .' 2001 by and between ROBERT BOYD TOBER, INC.. hereinat"t=r referred to as
Consultant, and COLLIER COUNTY, FLORIDA, hereinafter referred to as the County.
. WITNESSETH
WHEREAS. the County is responsible for emergency services in COLLIER COUNTY,
Flori da; and
WHEREAS, EmCfiCllcy Medical Services, (hereinafter "EMS"). are a logical extension
of existing health care services perfonned by the County in the above described geographic area;
and
WHEREAS. Consultant ROBERT TOBER. M.D., a duly licensed physician in the State
of Florida who is specially trained in the field of emergency medicine; and
WHEREAS, the CountY. and Consultant have previously entered into a Medical
Consulting Contract dated June IB, 1996 which provides for automatic renewal pursuant to
certain conditions; and
WHEREAS. said conditions have been met for renewal of the contract and the patties
hereto manifest their mutual desire to renew same with cenain changes contained herein; and
NOW THEREFORE, in consideration of the promises and the mutual covenants
hereinafter set forth, the parties hereto agree as follows:
I. LICENSE: ROBERT TOBER, M.D. is at the present time a duly licensed
physician in the State of Florida and he has agreed to maintain his license in full force and effect
during the term of this contract. If for any reason during the term of this Contract, the County no
longer contracts with DR. TOBER, or if DR. TOBER should lose his license to practice
medicine. this contract shall immediately become null and void.
Agenda Item No. 16K5
February 9, 2010
Page 4 of 13
1. GENERAL D~: Consultant shall be an independent contraCtor and shall
be directly responsible to the Division Administrator of the Emergency Services Division for the
performances of services as Medical Director as more specifically defined in this agreement and
as set forth in Section 401.265. Florida StatU~l. The Consultant shall be responsible for the
implementation of such planning and coordination as may be necessary to delivet advanced life
support by Paramedics (including EMS and Fire District personnel) trained to the level. of
advanced and basic medical technicians, which may require intravenous administration of
emergency resuscitative drugs and the performance of sophisti=d technical emergency
procedures.
3. TERM OF CONTRACT: The initial term of this contract shall be from October
I, 2000 to September 30. 200 1. The parties agree that the term of the Contract shall be
automatically renewed on a yearly basis from October 1, through September 30 with the same
terms, conditions and obligations as set forth herein. unless terminated by County upon sixty (60)
clays written notice to Consultant.
4. COMPENSA nON: The County shall pay to the Consultant the sum of
$50.000 per annum, as full compensation for the services rendered herein and no other
compensation. The County will pay the cost afthe professional liability ins\JJllTlce. The Medical
Director shall not be eligible for any employee benefits other than this compensation. This sum
shall be paid 10 tbe Consultant in twelve (12) equal monthly payments commencing with the
effective date of the Contract, with each monthly payment being payable by the IOIll of each
month. The Consultant will be entitled to a 5% annual increase beginning October 1, 2001 upon
written notification by the Emergency Services Administrator by September 15'h of each year,
beginning on September IS, 2001, and upon approval by the Board of County Commissioners.
5. PATIENT RECORDS: The County shall make available, within two clays of
request. any and all medical records, reports. documents and other relevant materials. including
::>
Agenda Item No. 16K5
February 9. 2010
Page 5 of 13
audio and visual tapes requested by the Consultant. This includes all run reportS. medical tc:st
results, recordings on tape and any other reasonably available similar infonnation.
6. CONFIDENTIAL COMMUNICATIONS: Except as may be provided by
general law, the County agrees to keep all medical records confidential and allow. no
communication of records or patient information without a written release from the patient or the
Consultant.
7. REPORT: The County agrees to give the Consultant full and detailed rep01tS
regarding any case which it reasonably believes has the potelltial for legal action against the
County or its employees pertaining to EMS.
8. DISCIPLINARY ACTIONS: The County agrees to give the Consultant a full
written report of any and all Emergency Medical Services personnel who are known to have
violated any standing or verbal orders. Consultant shall be given full support for removal of any
program participant as provided for in State regulations governing Advanced Life Support
Providers.
9. DUnES AND RESPONSmILITIES OF TIlE CONSULTANT:
a. He shall be from a broad-based medical specialty such as emergency medicine,
internal medicine, anesthesiology, or other surgical specially, with demonstrated
experience in pre-hospital care and hold an ACLS certificate of successful course
completion or be board cenifjed in emergency medicine.
b. He shall demonstrate and have available for review documentation of active
participation in a regional or statewide physician group involved in pre-hospital care.
c. He shall supervise and accept direct responsibility for the medical perfonnance of
the paramedics working for Collier County EMS.
d. He shall develop medically correct standing orders or protocols relating to life
support systc:m procedures when communication cannot be established with a
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Agenda Item No. 16K5
February 9, 2010
Page 6 of 13
supervising physician or when any delay in patient care: would potentially threaten the
life or health of the patient.
e. He shall issue standing orders and protocols to Collier County EMS to ensure that
it transports each of its patients to facilities that offer a type and level of care
appropriate to the patient's medical condition if available within the service region.
f. He or his appointee shall provide continuous 24-hour-per-day, 7-day-per-week
medical direction which shall include, in addition to the development of protocols and
standing orders, direction to Collier County EMS personnel as to the availability of
"off-line" service to resolve problems, system conflicts, and provide services in an
emergency as that term is defined by section 252.34(3), Florida Statutes.
g. He shall establish a quality assurance committee to provide for quality assurance
review of all paramedics operating under his supervision,
h. He shall audit the performance of system personnel by use of a quality assurance
program that includes but is not limited to a prompt review of patient care records,
direct observation, and comparison of petionnance standards for drugs, equipment,
system protocols and procedures. He shall be responsible for participating in quality
assurance programs that may be developed by the department.
i. He shall ensure and cenify that security procedures of the Collier County EMS
for medications, fluids and controlled substances are in compliance with chapters 401,
499 and 893, Florida Statutes, and chapler 10D-45 of the F10nda Administrative
Code.
j. He shaJl create, authorize: and ensure adherence to, detailed written operating
procedures regarding all aspects of the handling of medications, fluids and controlled
substances by the EMS personnel and comply with all requirements of chapters 401.
499 and 893, Florida SraJures.
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Agenda Item No. 16K5
February 9, 2010
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Ie. He shall notify the Florida Depamnent of Health, (hereinafter the "Department")
in writing when the use of telemetry is not necessary.
I. He shall notify the department in writing of each substitution by Collier County
EMS of equipment or medication.
m. He shall assume direct responsibility for the use by a Collier County paramedic of
an automatic or 5erni-automatic defibrillator and the perfonnance of esophag~a,l
intubation. and on routine interfacility transports, the monitoring and maintenance of
non-medicated I.V.s. He shall ensure that the paramedic is trained to perfonn these
procedures; shall establish written protocols for the performance of these procedures;
and shall provide written evidence to the department documenting compliance with the
provisions of this paragraph.
n. He shall ensure that all paramedics are trained in the use of the trauma scorecard
methodologies as provided in sections 64E-2.0t7 of the P.A.C., for adult
trauma patients and 64E-2.0175, F.A.C., for pediatric trauma patients.
o. He shall participate as a crewmember on an EMS vehicle for a minimum of 10
hours per year and complete a minimum of 10 hours per year of continuing medical
education related to pre-hospital care or teaching or a combination of both.
p. He shall ensure that all Collier County paramedics have all proper certificatio~s
and receive all training necessary to maintain their certification.
10. ADDITIONAL DUTIES: Consultant shall also be responsible for assisting in
the following additional duties:
a. Consultation in the planning for Emergency Medical Services Department to be
provided by the County, including the design of vehicles. equipment. supplies,
distribution resources. emergency medical services personnel ,training and medical
policy, protocol, planning and development.
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Agenda Item No. 16K5
February 9,2010
Page 8 of 13
b. Consultation in the coordination of training of paramedical personnel. including
the determination of training criteria for certification.
c. Organizing, coordinating and participating as an instnlCtor in the in-service
education programs and quality control of the patienl care in day.to-day delivery of
emergency medical services by the County.
d.' Serving as a liaison between the County and the appropriate community hospital~.
medical societies, practicing physicians and training facilities in the area.
e. Providing such assistance as may be requiTed in the preparation and administration
of any grant programs for the establishment and improvement of the system.
f. All duties outlined in Rule 64-E Florida Administrative Code for Emergency
Medical Services Medical Director Ihat arc not specifically set forth herein and as may
be changed from time to time by the department..
g. He shall keep adequate records and supporting documentation. which concern or
reflccl his services under this Contract.
h. Consultant represents that it presently has no interest and shall acquire no interest,
either direct or indirect, which would contlict in any manner with the performance of
services required hereunder.
11. LIABILITY AND REMEDIES IN BREACH OF CONTRACTS: 11 is
recognized that the provision of advanced life support services requires that the County have a
Medical Director. Accordingly, the Consultant shall not refuse to perform these services during
the 1= of this Contract so long as it is able to so perform, and the County shall have the right
to specific performance of the provisions of this contract. In addition. the Consultant shall be
liable to the County for his unreasonable failure or refusal to perform the services required
hereunder.
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Agenda Item No. 16K5
February 9. 2010
Page 9 of 13
. No mOdification, or change in this Agreement shall be valid or binding upon the parties.
unless in writing, and executed by the party or parties intended to be bound by it
Unless othelWise specified, the laws, roles and regulations of the State of Florida shall
govern this Agreement. Any suit or action brought by either party to this Agreement against the
other party relating to or arising out of this Agreement must be brought in the appropriate Florida
State Court in Collier County, Florida.
12. CONFLICI1NG EMPLOYMENT OR CONTRACfUAL RELATIONSHIP:
Nothing in this Contract shall be interpreted as preventing the Consultant from operating
any other business or being similarly employed with any other emergency medical service that is
lawfully licensed by the County (within Collier County. Florida) and the State. However the
Consultant shall not accept any employment or enter into any contractual relationship that would
create a conflict between such interest and the perfonnance of its duties hereunder.
Nothing in this Contract shall be interpreted as preventing the Consultant, a contractual
employee of the County, from being employed in any other capacity. including, but not limited
to the operation of a medical pTllCtice. 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.
13. SUCCESSOR: The Contract shall be binding upon the successors of the County.
This Contract shaH not be assignable by the Consultant.
14. TERMINATION: This Contract may be tenninated by either party, with or
without cause, upon sixty (60) days written notice to the other party of such party's intention to
terminate the Contract.
15. PRO.RATIONS UPON TERMINATION: In the event of the termination of
this Contract. the Consultant's compensation due under Paragraph 4 shall ~ prorated on the basis
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Agenda Item No. 16K5
February 9, 2010
Page 10 of 13
of the number of days elapsed from the effective date of the Conlrllct, divided by thml hundred
siltty.fi VI: (365).
16. MANUALS: All manuals of procedll1'e and instructional material. which are
created or prepared by the Consultant, shall be and remain the property of the Consultant.
17. ADDmONAL LICENSES: Consultant agrees to obtain and maintain
throughout the period of this Agreement, all such licenses as arc required to do business by th~
Consultant in the Stare of Florida and in Collier County, Florida, including, but not limited to, all
licenses required by any State Boards or other Governmental agencies responsible for regulating
and licensing the professional services to be provided and performed by the Consultant, pursuant
to this Agreement.
18. INSURANCE:
The County shall, pay for, and maintain, during the life of this agreement, professional liability
insurance. Collier County shall be named as an additional insured on the certificate of insurance
for the policy.
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Agenda [tern No. 16K5
February 9, 2010
Page 11 of 13
IN WITNESS WHEREOF, the parties. have executed this agreement as of the date first
written above.
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Approved as 10 fonn and
Legal Sufficiency:
BOARD OF COUNTY COMMISSIONERS
OF COllJER COUNTY. FLORIDA
BY~
JAMES ARTER, Ph.D., IRMAN
'!-If-Of
ROBERT BOYD TOBER, INC.
BY: Wlt~
ROBERT BOYD TOBER, PRESIDENT
IlIJockielEMS CaotncllTobcr
McdlaJ eonU1e1200I.Revj,cd
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9
to)
eft
This First Amendment to the Collier County Emergency Services Medical Consultant
Agenda Itel'J>No. ~5
16 K 2 Fe~~~192e~
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FIRST AMENDMENT TO COLLIER COUNTY EMERGENCY SERVICES
MEDICAL CONSULTANT CONTRACT
Contract ("Amendment") is made this 14th day of October, 2008, by and between Robert Boyd
Tober, Inc. ("Consultant"), and Collier County, Florida ("County").
WHEREAS, by agreement dated September I, 2001, the parties entcced into a Collier
County Emergency Services Medical Consultant Contract ("Agreement"), a copy of which is
attached to this Amendment; and
WHEREAS, at a regularly noticed public meeting on September 23, 2008, the Board of
County Commissioners directed that the Agreement be amended to authorize the Consultant to
be directly responsible to the Board of County Commissioners; and
WHEREAS, the parties believe that such an amendment is in the interest of health,
safety and welfare of the citizens of the County.
NOW, THEREFORE, the parties hereby amend Paragraph 2 of the Agreement as
follows:
"Consultant shall be an independent contractor and shall be directly
responsible to the DiviaiEla Admiaisll'lller af ilia BlBergslla) SllI'l-iaes Divisiell
Board of County Commissioners of Collier County, Florida for the performances
of services as Medical Director as more specifically defined in this agreement and
as set forth in Section 40 I, Florida Statutes... ..
Except as specifically set forth herein, all other terms and conditions of the Agreement
remain in full force and effect.
IN WITNESS THEREOF, the parties have executed this First Amendment to the
Agreement as of the date first written above.
Page I of2
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.?~~~H~.E..~R"~k, CLERK
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....'8H~\. , Deputy Clerk
Approval as to fonn
and legal sufficiency:
~~~~, ~
Je y A. kow
County Attorney
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Agenda Item No. 16K5
February 9. 2010
pag136K 2
ROBERT BOYD TOBER, INC.
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By; i~J fZ'.' fi.-p...... j -:.:> q/;../c.'.j'
ROBERT BOYD TOBER, PRESIDENT
By:
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