Agenda 09/23/2008 Item #16F12Item # 16F12
September 23, 20
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I EXECUTIVE SUMMARY
Recommendation to approve the annual five percent (5 %) increase in Consultant Fees for
the Medical Director of Emergency Medical Services as described in the Emergency
Medical Services Medical Consultant Contract for a total of $105,500 for FY 09 and to
designate Dr. Doug Lee as the Medical Director's Appointee.
OBJECTIVE: That the Board of County Commissioners approves a 5% increase in consultant
fees for FY09, as stated in the Emergency Medical Services Medical Consultant Contract
between Robert Boyd Tober, Inc. and Collier County and to designate Dr. Doug Lee as the
Medical Director's Appointee.
CONSIDERATIONS: The Medical Consulting Contract between Robert Boyd Tober, Inc. and
Collier County was renewed on September 11, 2001, Agenda Item 16F (3) ( "Contract "). On
May 9, 2006, Agenda Item 16F(2), the Board of County Commissioners formally recognized a
one time increase of $25,000 for expanded scope of responsibilities as well as the prior annual
5% increases, which had been approved through the normal budget process.
Section 4 of the Contract states that the Medical Director is entitled to a 5% annual increase
beginning October 1, 2001 upon written notification by the Emergency Services Administrator
This Executive Summary has been provided to the Medical Director by the Director, Bureau of
Emergency Services (aka the Emergency Services Administrator) as the required written
notification. It is the recommendation of the Director, Bureau of Emergency Services, that a 5%
increase for FY 09 be approved in accordance with the above described Medical Consulting
Contract.
Section 91 of the Contract states that the Medical Director or his appointee shall provide
continuous 24- hour - per -day, 7- day - per -week medical direction. Dr. Tober desires to officially
designate Dr. Doug Lee as his designee, to provide medical direction should Dr. Tober be absent
or unavailable.
FISCAL IMPACT: Funds in the amount of $100,500 were budgeted for FY 08 in Fund 490, as
approved by the Board on September 20, 2007. An increase of 5% for FY 09 will total
$105,500, to be budgeted in Fund 490.
LEGAL CONSIDERATIONS: The recommended 5% increase for FY 09 and designation of
Dr. Doug Lee as the official appointee of the Medical Director is legally sufficient under the
Contract. This item is legally sufficient for Board action - JAB
GROWTH IMPACT: There is no Growth Management Impact resulting from this action.
RECOMMENDATION: That the Board of County Commissioners approve the annual five
percent (5 %) increase in Consultant Fees for the Medical Director of Emergency Medical
Services as described in the Emergency Medical Services Medical Consultant Contract for a total
of $105,500 for FY 09 and designate Dr. Doug Lee as the official appointee of the Medical
Director.
PREPARED BY: Artie Bay, Supervisor - Accounting, Emergency Medical Services
Item# 16F12
September 23, 20
Page 2 of 12
Recommendation to approve the annual five percent (5%) increase in Consultant Fees for the
Medical Director of Emergency Medical Services as described in the Emergency Medical Services
Medical Consultant Contract for a total of $105,500 for FY 09 and to designate Dr. Doug Lee as the
Medical Director’s Appointee.
Prepared By:
Department Date
Bureau of Emergency Services 9/5/2008 9:55:13 AM
Approved By:
Department Approval
County Attorney Approved
Date
9/9/2008 4:56 PM
Approved By:
Department Approval Date
Purchasing Approved 9/10/2008 1:31 PM
Approved By:
Department Approval Date
Bureau of
Emergency Approved 9/11/2008 2:14 PM
Services
Approved By
Department
Approval
Date
EMS
Approved
9/11/2008 1:59 PM
Approved By:
Department
Approval
Date
Bureau of
Emergency
Approved
9/11/2008 2:14 PM
Services
Item # 16F12
September 23, 20
Page 3 of 12
Approved By:
Department Approval Date
Office of
Management Approved 9/12/2008 10:48 AM
and Budget
Approved By:
Department Approval Date
County Approved 9/13/2008 11:01 AM
Manager's Office
ATTACHMENTS:
Name: Description: Type:
❑ Annualincrease- consultant fees.doc Executive Summary Executive Summary
❑ Medical Di rectorConsultantContract .pdf Contract Backup Material
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COLLIER COUNTY EMERGENCY SERVICES
MEDICAL CONSULTANT CONTRACT
THIS MEDICAL CONSIILTING CONTRACT made this -.1 / iA- day of
4�t 2001 by and between ROBERT BOYD TOBER, INC., hereinafter 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,
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 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 18, 1996 which provides for automatic renewal pursuant to
certain conditions; and
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:
1. 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 fish 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 snail immediately become null and void.
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2. 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 Statutes. The Consultant shall be 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) 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, 2000 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
$507000 per annum, as full compensation for the services rendered herein and no other
compensation. The Count), 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 payrnents 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 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 15. 2001, and upon approval by the Board of County Commissioners.
5. PATIENT RECORDS: The County shall make available, within two days of
request, any and all medical records, reports, documents and other relevant materials, including
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audio and visual tapes requested by the Consultant. This includes all run reports, medical test
results, recordings on 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.
c. 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
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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 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 40I,
499 and 893, Florida Statutes, and chapter IOD -45 of the Florida Administrative
Code.
j. He shall 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 Statutes.
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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 -
m. He shall assume direct responsibility for the use by a Collier County paramedic of
an automatic or semi - automatic defibrillator and the performance of esophageal
intubation, and on routine interfacility transports, the monitoring and maintenance of
non - medicated IN.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 -2.017 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 desien of vehicles, equipment, supplies,
distribution resources, emergency medical services personnel ,training and medical
policy, protocol, planning and development.
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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 instructor in the in- service
education programs and quality control of the patient 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 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 performance 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 specific performance of the provisions of this contract. In addition, the Consultant shall be
liable to the Countv for his unreasonable failure or refusal to perform the services required
hereunder.
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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, Florida.
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
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of the number of days elapsed from the effective date of the Contract, divided by three hundred
sixty -five (365).
16. MANUALS: 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 Agreement, 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 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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IN WITNESS WHEREOF, the parties have executed this agreement as of the date first
written above.
ATTEST.
DWIGHT E. BROCK, CLERK
of Courts
13yc i!►�.is�ou..Q� � . �..
Attait ao to Chafriaan's
si®aatare on
Witnessed b
Approved as to form and
Legal Sufficiency:
,,�CQLiELIINE HUBBARD ROBINSON
Assistant County Attorney
Mackie/EMS COn=CLrrOber
Medical Conuact'_W 1- Revised
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
i �t °ter.
Ph.D. CH �.
ROBERT BOYD TOBER, INC.
BY:
ROBERT BOYD TOBER, PRESIDENT