Agenda 10/14/2008 Item #16K 2Agenda Item No. 18K2
October 14; 2008
Page 1 of 15
EXECUTIVE SUMMARY
Recommendation that the Board of County Commissioners approves the First
Amendment to the Collier County Emergency Services Medical Consultant
Contract, which amends the agreement by having Dr. Tober report directly to the
Board of County Commissioners, and to authorize the Chairman to execute same.
OBJECTIVE: For the Board of County Commissioners (`Board ") to approve the First
Amendment to the Collier County Emergency Services Medical Consultant Contract,
dated September 11, 2001.
CONSIDERATIONS: On September 23, 2008, at the Board's regularly noticed
meeting, the Board directed that the Collier County Emergency Services Medical
Consultant Contract be revised to require the Medical Director to report directly to the
Board (Agenda Item 913). The proposed First Amendment to this Agreement fulfills this
direction by amending Paragraph 2 as follows:
"Consultant shall be an independent contractor and shall be
directly responsible to the Pivi� ^M ater of the—; lei ey
1,;vi ,,,, 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 401,
Florida Statutes... "
FISCAL IMPACT: None.
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact
associated with this Executive Summary.
RECOMMENDATION: That the Board of County Commmissioners approves the First
Amendment to Collier County Emergency Services Medical Consultant Contract, dated
September 1 l , 2001, and authorize the Board's Chairman to execute same.
Prepared by: Jeffrey A. Klatzkow, County Attorney
cia
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4�enda||am0m, 16K2
0cijdber14.2O08
COLLIER COUNTY
gOAPDOF COUNTY COMMISSIONERS
Item Number: 10*2
Item Summary: Recommendation that the Board of County Commissioners approves the First Amendment to
the Collier County Emergency Saw/cso Medical Conso|�antCuntrac/. which amends the
agreement by having Dr. Tobe, report directly tome Board of County Commissinners, and to
authorize the Chairman mexecu:s same and authorize use of new letterhead.
Meeting Date: 10!1412008 9:00 00 )LM
Prepared By
Jeffmatzkpw
Assistant County Attorney
Date
County Attorney
County Attorney Office
9/z012008 11:56s0 xM
Approved By
Jeffmatzxmw
Assistant County Attorney
Date
County Attorney
co,^tyxtto,nevoff/cc
e17o/2008 1:02 pm
Approved By
OMB Coordinator
o[TS Coordinator
onty
County Managers Office
Office o,Management & Budget
s/xo/znoo 3:03 PM
Approved By
John «.Yonkoaxy
v| the Cmcsofmanxsonrient
oaue
county Manager's Office
ofi�eof & su�'set
s.zo/zuooe:ooPM
Approved By
Jameev.Mvuu
CountvNt�anage,
rz»e
Board n(County
manaoerscmco
»/au/ccscr,01 p�
Commissioners
fi/c:/*C:\AocndaTesd2xpotb||4-[kctobcr�'0Z0|4_%ZU200O\!0.96ZOC(}N5ENT%Z0/\O[ND— 10/8/2008
,erida Item No. 15K2
Octooar 14, 2008
r ;age 3 of 15
FIRST AMENDMENT TO COLLIER COUNTY EMERGENCY SERVICES
MEDICAL CONSULTANT CONTRACT
This First Amendment to the Collier County Emergency Services Medical Consultant
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 1, 2001, the parties entered 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 Division ^ d of the Emer -genet' Sen ""°° Divis ""'
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 401, 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 1 of 2
ATTEST:
DWIGHT E. BROCK, CLERK
, Deputy Clerk
as to form
;uffitrncy:
y A. K
y Atto
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Rje 4 of i 5
ROBERT BOYD TOBER, INC.
ROBERT BOYD TOBER, PRESIDENT
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
In
TOM HENNING, CHAIRMAN
Page 2 of 2
^genera Item Ho. I SK2
0ct3ber 14. 2008
Page 5 of 15
COLLIER COUNTY EMERGENCY SERVICES
MEDICAL CONSULTANT CONTRACT
THIS MEDICAL CONSULTING CONTRACT made this I / day of
-5 �1 2001 by and between ROBERT BOYD TOBER, INC., hereinafter referred to as
Consultant, and COLLIER COUNTY, FLORIDA, hereinafter referred to as the County.
WrrNESSETH
WHEREAS, the County is responsible for emergency services in COLLIER COUNTY,
Florida; and
WHEREAS, Emergency Medical Services, (hereinafter "EMS "), are a logical extension
of existing health care services performed by the County in the above described geographic area;
and
WHEREAS, Consultant ROBERT TOBER, M.D., a duly Iicensed 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 I8, 1996 which provides for automatic renewal pursuant to
certain conditions; and
I WHEREAS, said conditions have been met for renewal of the contract and the parties
hereto manifest their mutual desire to renew same with certain 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
lorrger contracts with DR. TOBER, or if DR. TOBER should Iose his license to practice
medicine, this contract shall immediately become null and void,
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�. GENERAL DUTIES: 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 Statures. The Consultant shall be responsible for the
implementation of such planning and coordination as may be necessary to deliver advanced life
suppo,i by Pa1.aMC'.uil.S (Including EM and Fire District peib-onnel) trained to the level of
advanced and basic medical technicians, which may require intravenous administration of
emergency resuscitative drugs and the performance of sophisticated technical emergency
procedures.
3. TERM OF CONTRACT: The initial term of this contract shall be from October
1, '000 to September 30, 2001. 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)
days written notice to Consultant.
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 Iiability 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 10`h of each
month. The Consultant will be entitled to a 57.- annual increase beginning October 1, 2001 upon
written notification by the Emergency Services Administrator by September 15`h of each year,
beginni: - on September 15, 2001, and ipon approval by the Board of County Commissioners.
o• PATIENT RECORDS The County shall make available, within two days of
request, any and ail medical records, r,-Ports, documents and other relevant materials, including
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Ag nda 'tem No. 16K2
October 14, 2003
Page r' of 15
audio and visual tapes requested by the Consultant. This includes all run reports, medical test
results, recordings an tape and any other reasonably available similar information.
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 reports
regarding any case which it reasonably believes has the potential 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. DUTIES AND RESPONSIBILITIES OF THE CONSULTANT:
a. He shall be from a broad -based medical specialty such as emergency medicine,
internal medicine, anesthesiology, or other surgical specialty, with demonstrated
experience in pre - hospital care and hold an ACLS certificate of successful course
completion or be board certified 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.
e. He shall supervise and accept direct responsibility for the medical performance of
the paramedics working for Collier County EMS.
d. He shall develop medically correct standing orders or protocols relating to life
support system procedures when communication cannot be established with a
3
Oct::bEr 14. 2003
f �, e ��S o �' S
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 Ievel of care
appropriate to the patient's medical condition if available within the service region.
f. He or his appointee shall rovide c^0,-14,-
s IA a
} iu iL'ou L- r- „Our- per-uay, 1-day-per-wee{-,
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.
e_ 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 performance 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 certify that security procedures of the Collier County EMS
for medications, fluids and controlled substances are in compliance with chapters 4101,
499 and 593, Florida Statures, and chapter IOD-1,5 of the Florida Administrative
Code.
j• He shall create, authorize and ensure adherence to, derailed written operating
procedures reg -rding 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 Statutes.
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Acenda item No. 15K2
Octirber 14, 2008
Page 9 of 15
k. He shall notify the Florida Department of Health, (hereinafter the "Department ")
in writing when the use of telemetry is not necessary.
1. He shall notify the department in writing of each substitution by Collier County
EMS of equipment or medication.
rn. He shall assume direct responsibility for the use by a Collier County paramedic of
an automatic or semi- automatic defibriflator and the performance of esophageal
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 perform 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.Ot7 of the F.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 certifications
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.
S
Pave?0of15
b. Consultation in the coordination of training of paramedical personnel, including
the determination of training criteria forcertification.
c. Organizing, coordinating and participating as an instructor in the in- service
education programs and quality control of the patient care in day - today delivery of
emergency medical services by the County.
d." Serving as a ha ?son between the County and the appropriate community hospitals,
medical societies, practicing physicians and training facilities in the area.
e. Providing such assistance as may be required 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 that are 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
reflect 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 conflict in any manner with the peribrmance of
services required hereunder.
11. LIABILITY AND REMEDIES IN BREACH OF CONTRACTS: It 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 terms of this Contract so long as it is able to so perform, and the County shall have the right
to specifc performance of the provisions of t ;his contract. In addition, the Consultant shall be
liable to the County for his unreasonable failure or refusal to perforn the ser vices required
hereunder.
6
Agenda (tern No. 16K2
October 14, 2008
Page 11 of 15
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 otherwise specified, the laws, rules 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, Floridd.
12. CONFLICTING EMPLOYMENT OR CONTRACTUAL 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 performance 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 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.
13, SUCCESSOR: The Contract shall be binding upon the successors of the County.
This Contract shall not be assignable by the Consultant.
14. TERMINATION: This Contract may be terminated 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 be prorated on the basis
7
ber 14. 2003
Of the number of days elapsed from the effective date of the Contract, divided by three hundred
sixty -five (365).
16. li'I ,NUALS: All manuals of procedure and instructional material, which are
created or prepared by the Consultant, shall be and remain the property of the Consultant.
17. ADDITIONAL LICENSES: Consultant agrees to obtain and maintain
throughout the period of this A =crhent, all such licenses as are required to do business by the
Consultant in the State 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 lie of this agreement, processional liability
insurance. Collier County shall be named as an additional insured on the certificate of insurance
for the policy.
H
Benda Item No. 16K2
October 14, 2068
Page 13 of 15
IN WITNESS WHEREOF, the Parties have executed this agreement as of the date first
written above.
ATTEST:
DWIGHT E. $ROCK, CLERK
-of Courts -
By
'Attest-4-`to Chairman's
sig"Atw* only.
Witnessed b
Approved as to form and
Legal Sufficiency:
CQI LI_-NE HUBBARD ROBINSON Vsistant County Attorney
Mackic/EMS ConmatTober
Medical Contra:c 2001- Reviscd
BOARD OF COCTMN COIV MISSIO',NTERS
OF COLLIER COU NrT Y, FLORIDA
..rife►
9
t �•
ROBERT BOYD TOBER, INC.
BY: lie
ROBERT BOYD TOBER, PRESIDENT
No.. 13K2
toter i4. 2003
rave 14 of 1-
A. Appointment of member to the Collier County Planning Commission.
Resolution 2008 -289: Appointing Karen Joyce Homiak — Adopted 510
To be heard at 11 :30 a.m.
B. Discussion regarding Medical Director and EMS. (Commissioner Coyle)
Motion for the Collier County Medical Director's contract be revised so
that he reports directly to the BCC — Approved 5/0
C. Executive Manager to BCC Annual Evaluation
Motion by Chairman to direct County Attorney's Office to prepare a
resolution terminating the Executive Manager's Contract — Fails
2 /3(Commissioner Coyle, Commissioner Fiala, and Commissioner
Coletta opposed); Motion for human resources to provide the BCC
copies of the riles of all terminated and past employees going back to
November, 2000 for review and for this item to be brought back at a
future BCC Meeting — Approved 4/1 (Commissioner Halas opposed)
10. COUNTY MANAGER'S REPORT
A. The annual performance appraisal for the County Manager. (Jim Mudd,
County Manager)
Approved — 510
B. Review and approve the FY 2009 annual work plan for the County Manager.
(Jim Mudd, County Manager)
Discussed; Approved w /changes — 5/0
C. A report to the Board regarding the integration of behavior based wellness
incentives into the Collier County Group Health Plan. (Jeff Walker, Risk
Management Director)
Presentation given; Discussed
D. To gain approval from the Board of County Commissioners of a budget
amendment in the amount of $2,002,600 to Fund 517, Group Health and
Life Insurance, to recognize the receipt of reinsurance proceeds and to pay
anticipated claims expenses for the remainder of FY 2008. (Jeff Walker,
Risk Management Director)
Approved - 510
Page 6
September 23, 2008
Acienda !'Lem No. 16K2
October 14. 2008
Page i5 of 15
Board of Collier County Commissioners
Office of the Medical Director
Or Robert Boyd Tober. Ni.D.. FACEP • Collier County Medical Director