MARICOPA COUNTY ATTORNEYS OFFICE FIRST AMENDMENT - PCH SIGNED.PDF

FIRST AMENDMENT
TO
AGREEMENT BETWEEN
MARICOPA COUNTY (MARICOPA COUNTY ATTORNEY'S OFFICE)
AND
PHOENIX CHILDREN'S HOSPITAL
This First Amendment to the Agreement between Maricopa County (Maricopa County
Attorney's Office) and Phoenix Children's Hospital (this "First Amendment") is made as of
, 2019, by and between Maricopa County, through the Maricopa County
Attorney's Office ("MCAO") and Phoenix Children's Hospital ("PCH") (collectively referred to
herein as the "Parties").
RECITALS:
A. WHEREAS, the Parties entered into a certain Agreement regarding professional
services for medical evaluation and examination in cases of child and other sexual abuse, effective
as of April 12, 2017 (the "Agreement").
B. WHEREAS, the Parties desire to amend the Agreement in accordance with the
terms and conditions provided below.
C. NOW, THEREFORE, in consideration of the mutual obligations and agreements
contained herein, and for other good and valuable consideration, the parties hereby covenant and
agree as follows:
1. Capitalized Terms. Any term that is capitalized, but not otherwise defined in this First
Amendment, will have the meaning ascribed to it in the Agreement.
2. Attachment A: List of Providers and Advocacy Centers. The parties agree to replace the
list of providers and advocacy attached to the Agreement as "Attachment A" with the revised
"Attachment A" attached to this First Amendment.
3. Attachment B: Services. The parties agree that Paragraph 2 of Attachment B shall be
replaced with the following paragraph
2. For examinations requested after normal business hours or on designated holidays,
PCH shall examine the child no later than twelve (12) hours from the time of notification,
unless sooner examination is otherwise necessary or designated by the Team or by an
MCAO Special Victims Division Senior Attorney.

4. Attachment C: Compensation and Reimbursement. The parties agree to replace the
compensation and reimbursement terms attached to the Agreement as "Attachment C" with the
revised "Attachment C" attached to this First Amendment.
5. Miscellaneous. Except as specifically modified by this Amendment, all of the terms and
conditions of the Agreement remain in full force and effect.
IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed by duly
authorized officers as of the day and year first written above.
PHOENIX CHAILDREN'S HOSPITAL INC.
By: 101 ( 1
JarèdfrIuenzer, M.D. Date
Oki Operating Officer, PCMG
MARICOPA COUNTY, ARIZONA (for itself and MCAO)
By:
Chairman, Board of Supervisors Date
ATTESTED BY:
BY:
Clerk of the Board Date
APPROVED AS TO FO ' i
BY: IIIIII.11°1111111111 ---- 11 15- 1 1-i
Date

Attachment A: List of Providers and Advocacy Centers
Advocacy Centers:
Mesa Family Advocacy Center
225 E. 1st Street Suite
Mesa, AZ 85201
Childhelp Center of Arizona
2120 N. Central Ave Suite 130
Phoenix, AZ 85004
Southwest Family Advocacy Center
2333 N. Pebblecreek Pkwy, Suite A-200
Goodyear, AZ 85395
Providers/Team members
Lisa Kirsch, MD
Kathryn Coffman, MD
Cynthia Nelson, PNP
Haley Dietzman, FNP
Candy Wampler, FNP
Julie Baumgarth, PNP
Kimberly Dent, PNP
Kim Yeakel, PNP
Rachel Arbuckle, RN
Nicole Galvan, RN
Annie Wilkins, RN
Wendy Dutton, Forensic Interviewer
Amy Heil, Forensic Interviewer
Veronica Anguiano, CPT Associate
Linnea Kettering, CPT Associate
Diane Murioz, CPT Associate Lead

Attachment B: Services
Phoenix Children's Hospital will provide the services set forth below
1. Assess, plan, and evaluate pediatric patients/victims care as stated in the professional
literature and consistent with policies and procedures, standards of care, and clinical
competencies of the Team,
2. The Team will be on call after hours and on weekends to conduct urgent evaluations for
acute sexual assault and sexual abuse. While on call, the Team will respond to the various
advocacy centers listed in Attachment A as requested by law enforcement.
3. For pediatric patients/alleged victims, conduct medical examination, obtain medical history,
perform physical exam, and genital examination including, but not limited to photo
documentation and collection of evidence as specified by the approved sexual assault kit.
Following the clinical assessment the medical provider will report findings to law
enforcement in accordance with applicable law, and maintain the chain of custody.
4. Conduct appropriate laboratory tests, which may include but are not limited to pregnancy
tests and STD tests.
5. Team members will conduct sexual maturity rating services to determine gender and maturity
levels based on evidence shall be provided only at the request of law enforcement. This
service will be charged pursuant to Attachment C.5.
6. Provide fact witness testimony in court regarding cases in which the Provider has physically
examined the child. Provider will attend and participate in defense interviews and pre-trial
preparation. MCAO will make every effort to limit the time impact of these pre-trial
activities, schedule interviews and meetings at mutually convenient times and locations, and
to use Providers' time efficiently.
7, For cases of record review, the Provider will provide expert testimony upon request and will
bill accordingly. Provider will attend and participate in defense interviews and pre-trial
preparation. The Provider will bill for pre-trial preparation hours and defense interviews
with all record review cases. MCAO will make every effort to limit the time impact of these
pre-trial activities, schedule interviews and meetings at mutually convenient times and
locations, and to use Providers' time efficiently.
8. Providers will provide consultation regarding cases of child maltreatment in which the
Provider was the treating medical provider. The Phoenix Children's Hospital understands
the Provider(s) may be asked to participate in additional case staffings.
9. Maintain appropriate medical documentation and confidentiality.
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10. Consult with other specialists as required and adjust process as indicated to ensure
appropriate medical care.
11. Forensic Interviews:
11.1. Forensic Interviews are to be conducted by Phoenix Children's Hospital through
its qualified employees or agents who shall be mutually agreed upon by the parties prior
to engaging in any forensic interview.
11.2. The individuals who will be the subject of the Forensic Interview will be those
who are referred by law enforcement and shall include but are not limited to, minors
who have witnessed or been victims of violence (including child physical abuse) or who
have made allegations of sexual assault or abuse, individuals who are mentally
challenged or disabled, emotionally challenged or disabled, or present with a behavioral
health malady.
11.3. It is understood by the parties that the information derived from a Forensic
Interview may be used to assist the examining physician with the provision of
appropriate health care services for this individual and for use in any investigation or
prosecution of any matter under the jurisdiction of MCAO.
11.4. In addition to conducting the Forensic Interview, Phoenix Children's Hospital
will prepare and produce a report for Maricopa County Attorney's Office documenting
the Forensic Interview, provide fact witness testimony in court regarding the Forensic
Interview, attend and participate in defense interviews and pretrial preparation, consult
with representatives of law enforcement and prosecution, and be available for
consultation as necessary. MCAO will make every effort to minimize the number,
frequency and duration of all defense interviews and pretrial preparatory sessions to
reduce the impact on Team members' regular work schedules.
11.5. On occasion, a Forensic Interviewer may be hired to provide expert witness
testimony in cases in which the Forensic Interviewer did not see the child. Such services
shall be billed according to Attachment C.7.
12. Participate in regularly scheduled activities as requested by MCAO.
13. Records Review and Reporting:
13.1. Subject to the availability and professional discretion of the Team members, at the
request of MCAO, a Provider will review records, to include medical, law enforcement,
and other relevant records of pediatric patients who were not evaluated or treated by the
Team member during the relevant hospitalization. The Team member will provide a
written report for MCAO based on those records. Team members may decline to
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conduct such reviews when doing so would interfere with the Team member's ability to
provide effective care to current patients in the Team member's sole discretion.
13.2. MCAO will provide complete and timely records to be reviewed as described
above to the Team members; such records may include records of the Phoenix
Children's Hospital's facilities or other facilities that have seen the patient that were
separately obtained by MCAO. Unless the Team member is a treating practitioner of the
pediatric patient at the specific time of the review, MCAO will not request the Team
member to access any hospital records directly and MCAO is solely responsible for
obtaining providing applicable records to the reviewing Team member.
13.3. The Team member will provide expert testimony based on the report upon
request. The Team member will bill for pretrial preparation hours and defense
interviews as well as expert testimony, as set out in Attachment C,6.
14. The Phoenix Children's Hospital understands that the Team member(s) may be asked to
participate, upon request and reasonable notice, in larger multi- and inter-disciplinary teams
consisting of healthcare professionals, law enforcement agencies, and attorneys. When
Phoenix Children's Hospital and the Team member(s) agree to participate, this Service shall
be provided at no additional charge, unless otherwise agreed in writing,
The Phoenix Children's Hospital reserves the right to refuse to participate, or allow Team
members to participate, in any record review or expert witness capacity, in which The Phoenix
Children's Hospital or any of its employees or medical staff members are — or may become —
defendants in any legal action filed or threatened by anyone involved in the events giving rise to
the involvement or investigation of law enforcement or MCAO. However, once the Team
member has agreed to conduct a review, neither Phoenix Children's Hospital nor the Team
member may withdraw from the case.
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Attachment C: Compensation and Reimbursement
1. MCAO will reimburse Phoenix Children's Hospital at a rate per case of $865.00 for services
pursuant to Attachment B, Section 3; this does not include sexual maturity rating services
described in Attachment B, Section 5, and Forensic Interview Services described in
Attachment B, Section 11.
2. MCAO will reimburse Phoenix Children's Hospital at a rate of $350.00 per interview for
Forensic Interviews Services provided by Phoenix Children's Hospital as described in
Attachment B, Section 11.
In addition to the rate of reimbursement enumerated in Attachment C, Sections 1 and 2 above,
MCAO will reimburse Phoenix Children's Hospital for:
3. The actual cost of laboratory tests, but MCAO will not be required to reimburse any costs over
$350.00 per case; provided, however, that a minimum/flat fee of $300 per case shall apply to
lab costs in each sexual abuse case. The parties understand that the nature and number of
laboratory tests to be provided is dependent upon many variables, including the person's
presentation and history or the request of the law enforcement agency; therefore, the parties
agree that in those cases that are mutually agreed upon by the parties in advance, additional
laboratory tests may be conducted.
4. Medical records review and consultation with prosecutors during case preparation for cases
that were not originally brought to Phoenix Children's Hospital for services described in
Attachment B, Section 13 above. These services will be charged at a not-to-exceed rate of
$500.00 per hour. Medical records reviews shall include providing MCAO with a written
opinion upon completion and testiing in court as necessary.
4.1. At the request of MCAO for records reviewed as set forth in Attachment B, Section 13
above, the Phoenix Children's Hospital shall provide, through the Team members, expert
witness testimony in court and depositions, attend and participate in joint interviews with
both prosecution and defense counsel present, participate with and assist prosecutors with
pre-trial preparation, consult with representatives of law enforcement, and participate in
case staffing upon reasonable notice and accommodation of the Team member's hospital
schedules
5. Sexual Maturity Rating services to determine gender and maturity levels based on evidence
shall be provided only upon the request of law enforcement at a not-to-exceed amount of
$300.00 per case.
6. Review of non-medical records to determine the existence of risks to the health and well-being
of a child at the request of law enforcement AND with prior approval from MCAO shall not
exceed $300.00 per case.
7. Expert witness in-court testimony by a provider shall be provided upon MCAO request at a
rate of $300 per hour. This fee is only for those cases not originally brought to Phoenix
Children's Hospital for Services described in Attachment B, Section 13.

8. Expert witness in-court testimony by Forensic Interviewer shall be provided upon request by
MCAO at a not-to-exceed amount of $300.00 per hour. This fee is only for those cases not
originally brought to Phoenix Children's Hospital for services under Attachment B, Section 3,
above.
9. Phoenix Children's Hospital assumes sole and exclusive responsibility for payment of any
federal and state income taxes, federal social security taxes and other mandatory governmental
deductions or obligations, including worker's compensation for any and all of its employees,
and agrees to hold County and MCAO harmless for any and all liability which the County of
MCAO may incur because of Phoenix Children's Hospital's failure to pay such taxes or
obligations.
Method of Payment; Invoice and Timeliness Requirements
The Phoenix Children's Hospital will submit a statement or invoice for services performed the
previous month by the 15th of each month. The invoice shall include, at a minimum, the following
information regarding each case for which payment is claimed for the Records Review and
Reporting or Expert Witness Related Services:
• the name of the Provider(s);
• the type of Service provided (Records Review and Reporting, or Expert Witness Related
Services);
• the date(s) on which each Service was provided;
• the number of hours devoted by each Provider to furnishing the Service on each date; and
• the name of the MCAO deputy county attorney or other representative who requested the
Service described on the invoice.
MCAO will, within (30) thirty business days from the date of receipt of the Phoenix Children's
Hospital statement or invoice, process and remit to the Phoenix Children's Hospital a warrant for
payment. Should Maricopa County make a disallowance in the claim, in whole or in part, the
Phoenix Children's Hospital may dispute the disallowance. In the event PCH has not received
payment, PCH will notify Maricopa County of any unpaid invoices within forty-five (45) days of
invoice being sent to facilitate a timely resolution.
The Phoenix Children's Hospital understands and agrees that Maricopa County will not honor any
claim for payment submitted more than six months after the date of service. The Phoenix
Children's Hospital understands and agrees that Maricopa County will not process any claim for
payment for Services rendered prior to the termination date of this Agreement submitted more than
(60) sixty days after such termination date without the approval of MCAO.