MCSO HOSPITAL TRAINING AFFILIATION AGREEMENT.PDF

HOSPITAL TRAINING AFFILIATION AGREEMENT
This Affiliation Agreement (”Agreement”) is made this 23rd day of March, 2016
(“Effective Date”) between Maricopa County by and through the Maricopa County Sheriff’s
Office (“SCHOOL”) and HonorHealth (“HOSPITAL”) (SCHOOL and HOSPITAL may sometimes
herein individually be referred to as a “Party” and collectively as the “Parties”.
In consideration of the terms and conditions hereinafter set forth, and other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, and for their
mutual reliance, the Parties hereto agree as follows:
I. PURPOSE
The purpose of this agreement is to offer on-site clinical experiences at the HOSPITAL for
STUDENTS seeking EMT training. The HOSPITAL provides comprehensive health care services
at its facilities and recognizes the need for on-site experiences and desires to make available
certain personnel, staff and facilities for a clinical experience at HOSPITAL. The Parties agree
to cooperate in providing STUDENTS in EMT training with clinical learning experiences at the
HOSPITAL.
II. TERM, RENEWAL and TERMINATION:
This Agreement shall commence March 23, 2016 and expire on March 22, 2019. The Agreement
is effective upon execution by all of the Parties and shall continue for a period of three (3)
years. This Agreement may be renewed for two additional 3-year renewal periods upon written
agreement of the Parties. The Parties may terminate this Agreement for any reason upon sixty
(60) days written notice. Should this Agreement be terminated prior to its expiration date,
students and/or faculty instructors assigned to HOSPITAL shall be permitted to complete their
rotations pursuant to the terms and conditions of this Agreement.
III. RESPONSIBILITIES OF HOSPITAL:
A. General. HOSPITAL agrees to accept students from SCHOOL for the purposes of receiving
supervised training and experience. HOSPITAL will provide a planned, supervised program of
clinical experience designed in cooperation with SCHOOL, and will provide such clinical
experience at its facilities.
B. Liaison/Staffing. HOSPITAL will designate a Program Liaison to serve as a liaison between
HOSPITAL and SCHOOL and to coordinate the student’s on-site learning experience.
C. Student Rotations. HOSPITAL shall provide students with learning experiences as agreed to
by the Parties.
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D. Supervision. HOSPITAL shall provide or arrange for its staff to provide such supervision of the
educational activities of each student as is reasonable and appropriate to the circumstances
and to the student’s level of training. HOSPITAL agrees that the students are not to provide any
care or service to patients unless under the direct supervision of a practitioner designated by
HOSPITAL. While in the HOSPITAL’s facilities, students will have the status of trainees; are not
to replace HOSPITAL staff; and are not to render unsupervised patient care and/or services. All
services rendered by students will have educational value and meet the goals of the Program.
E. Policies. At least two (2) weeks prior to the beginning of the rotation experience, HOSPITAL
will provide for the orientation of SCHOOL’s participating students and SCHOOL’s on-site
employed faculty instructors, if any, (hereinafter referred to as “faculty instructor”) as to the
HOSPITAL’s rules, regulations, policies and procedures of HOSPITAL that relate to the activities
of the students and/or faculty instructors under this Agreement, including, but not limited to,
use of HOSPITAL’s electronic medical record. HOSPITAL reserves the right to either cancel or
delay the rotation if the orientation is not completed by the aforementioned deadline.
F. Facilities. HOSPITAL shall arrange for students to have access to such facilities and resources
as are available and reasonably necessary for the activities of the students under this
Agreement.
G. Evaluation. HOSPITAL staff will, upon request, assist SCHOOL in the evaluation of the
performance of each student at the termination of such student’s rotation and/or upon a
schedule mutually agreed to by the Parties, by completing evaluations or reports provided by
SCHOOL and returning to SCHOOL copies of such evaluations or reports in a timely fashion.
H. Student Behavior/Termination. HOSPITAL may immediately remove from the premises and
retains the right to suspend or terminate any faculty instructor’s or student’s participation at
HOSPITAL. HOSPITAL will promptly notice the appropriate office of the SCHOOL if such an
action is required and the reasons for such action.
I. Patient Care. HOSPITAL reserves the right to make all decisions affecting patient care.
J. Emergency Health Care. HOSPITAL shall provide students with such access to emergency care
as is provided to its employees during the time such students are assigned to HOSPITAL.
Student and/or faculty instructor shall notify SCHOOL if a student develops an illness or is
involved in an accident while at HOSPITAL. The Parties agree that student shall bear the cost of
all emergency services rendered and SCHOOL agrees to inform students of such.
K. Insurance. HOSPITAL warrants and represents that at its sole cost and expense, shall insure
or self-insure its activities in connection with this Agreement and obtain, keep in force and
maintain a program of insurance as follows:
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(i) Professional Medical and Hospital Liability self-insurance with limits of three
million dollars ($3,000,000) per occurrence;
(ii) General Liability Self-Insurance Program with a limit of three million dollars
($3,000,000) per occurrence;
(iii) Workers’ Compensation Insurance in a form and amount covering HOSPITAL’s
full liability as required by law; and
(iv) Such other insurance in such amounts which from time to time may be
reasonably required by the mutual consent of the Parties against other insurable
risks relating to performance.
L. Patient Privacy Training and Oversight. HOSPITAL shall provide appropriate training to
students on rotation regarding patient privacy and confidentiality. Such training shall satisfy the
requirements of all applicable Federal and state laws and regulations, including, but not limited
to, the Health Insurance Portability and Accountability Act of 1996 and related regulations.
Solely for the purpose of defining the students' role in relation to the use and disclosure of
HOSPITAL’s protected health information, such students are defined as members of the
HOSPITAL's workforce, as that term is defined by 45 CFR 160.103, when engaged in activities
pursuant to this Agreement. However, such students are not and shall not be considered to be
employees of HOSPITAL.
M. Educational Records. To the extent HOSPITAL generates or maintains educational records
related to the participating student, HOSPITAL agrees to comply with the Family Educational
Rights and Privacy Act (“FERPA”), to the same extent as such laws and regulations apply to
SCHOOL, and shall limit access to only those employees or agents with a need to know. For the
purposes of this Agreement, pursuant to FERPA, SCHOOL hereby designates HOSPITAL as a
school official with a legitimate educational interest in the educational records of the
participating student(s) to the extent that access to SCHOOL’s records is required by HOSPITAL
to carry out the Program.
IV. RESPONSIBILITIES OF SCHOOL:
A. General. SCHOOL shall retain full responsibility for the planning, implementation, and
execution of the Program, including programming, administration, accreditation, curriculum,
content, grading and requirements for matriculation, promotion and graduation.
B. Liaison. SCHOOL shall designate an individual to serve as Program Designee. The Program
Designee shall be the liaison between SCHOOL and HOSPITAL to coordinate the academic
experience of the students, and to assist, as necessary, in operating an effective on-site learning
experience. The Program Designee shall work with HOSPITAL to coordinate student activities
and training. The Program Designee shall communicate regularly with HOSPITAL either via
written communication or telephone at mutually agreed upon intervals. SCHOOL shall notify
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HOSPITAL in writing of any change or proposed change in the individual designated to serve as
the Program Designee.
C. Assignment of Students. SCHOOL shall, upon mutual agreement of the Parties, provide to
HOSPITAL at least thirty (30) days prior to the beginning of the rotation:
(i) the number and names of students;
(ii) the schedule of assignments, number of on-site hours, and the date range of the on-
site learning experience;
(iii) a letter confirming the good standing of the student and copies of all required
documentation;
(iv) the name of the Program Designee and contact information; and
(v) a summary of the student’s education and experience and field work, if requested
by HOSPITAL.
D. Qualification of Students and Faculty Instructors. SCHOOL shall refer to HOSPITAL only those
students and faculty instructors who meet all qualifications for the clinical program. SCHOOL
shall designate for participation in the rotation only those faculty instructors and students who
have successfully completed the requirements necessary for their participation in the rotation
and are in good standing with the SCHOOL. If a faculty instructor’s or student’s good standing
status changes while assigned to HOSPITAL, SCHOOL agrees to notify HOSPITAL and to remove
the faculty instructor and/or student from participation in the rotation at HOSPITAL, effective
immediately.
E. Health and Safety Requirements. Before placement, SCHOOL shall provide safety training to
all students and faculty instructors to include OSHA regulations and associated work place
practices. SCHOOL shall instruct students and faculty instructors that they are required to
provide proof to HOSPITAL that they meet the health standard requirements applicable to
hospital employees, which shall include the following:
(i) Proof of immunity by documentation of one of the following for each disease:
Measles a) documentation of two live doses of vaccine (given at least 28 days
apart) and given on or after the student's first birthday
b) lab titer indicating immunity
c) birth before 1957
Rubella a) documentation of one live dose given on or after their first birthday;
b) lab titer indicating immunity
c) birth before 1957
Mumps a) documentation of one live dose given on or after their first birthday
b) lab titer indicating immunity
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c) documentation of physician-diagnosed case of disease, if born before
1957
Varicella a) verbal history of disease
b) lab test indicating immunity
c) 2 doses of varicella vaccine
Hepatitis B a) immunizations
b) titers OR
c) signed waiver/declination
(ii) Tuberculosis (TB) screening:
2-step TB testing via Mantoux method, given 7-10 days apart (only one needs to be
given if they have documentation of negative TB skin test within last year); if positive
reaction (equal to or greater than 10mm INDURATION), chest x-ray is to be performed,
with no evidence of active disease in order to begin learning experiences; if history of
positive reaction, no TB test is given but should have no current signs and symptoms of
TB, with documentation of negative chest x-ray within six months. If a faculty instructor
or a student currently has signs and symptoms of TB, a current and negative chest x-ray
will be required prior to beginning the assigned rotation, internship, or externship
(iii) Drug Screen:
Drug panel 119 urine drug screen must be completed with negative results within thirty
(30) days prior to the-student’s and/or a faculty instructor’s start date (unless the
faculty instructor is continuously employed by SCHOOL and/or student is continuously
enrolled at SCHOOL) with interpretation by a medical review officer as necessary. In
the event the drug screen is not conducted at HOSPITAL, the screening and cut-off levels
of the drug screen must match those of HOSPITAL. SCHOOL must rescreen any faculty
instructor or student upon a leave of absence return or for cause.
(iv) Fingerprint Clearance Card:
All students and on-site faculty instructors who are 18 years or older assigned to
HOSPITAL are required to obtain a current fingerprint clearance card from the Arizona
Department of Public Safety (DPS). This fingerprint clearance card must encompass
state and federal checks for criminal and sex offender offenses. If while a student
and/or a faculty instructor is participating in a rotation at HOSPITAL s/he commits a
criminal offense, SCHOOL will notify HOSPITAL of the offense.
(v) Current Level C CPR card or Basic Life Support (BLS) for healthcare providers
certification.
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(vi) Flu shot:
All students and on-site faculty instructors are required to demonstrate receipt of an
influenza vaccine once per year. If the vaccine is declined, the student and/or faculty
instructor must wear a mask in all patient-care areas while at HOSPITAL at all times.
SCHOOL must submit documentation to HOSPITAL verifying completion of the required health
and safety requirements prior to on-site arrival. This documentation must be in a format
acceptable to HOSPITAL and must be received at least thirty (30) days prior to the student’s
and/or the faculty instructor’s first day at HOSPITAL. Any exception to this provision must be
approved by HOSPITAL before placement of the student or faculty instructor. HOSPITAL retains
the right to remove any student or faculty instructor who does not meet or maintain the
standards set forth herein. SCHOOL shall maintain copies of submitted documentation,
including but not limited to the results of all testing, for a minimum of seven (7) years after the
termination of the rotation. HOSPITAL reserves the right to ask SCHOOL for proof of testing at
any time.
Students and/or faculty instructors who do not comply with the requirements of this Section
IV.(D) will not be eligible to utilize HOSPITAL for rotations, internships, or externships.
HOSPITAL reserves the right to terminate this Agreement in the event of falsification or
misrepresentation of the requirements set forth in this Section IV.(D).
F. Policies. SCHOOL, its employees, agents and faculty instructors, shall comply and shall require
all students, agents and faculty instructors to comply with the bylaws, rules and regulations,
policies and procedures of HOSPITAL.
G. Confidentiality of Patient Information. SCHOOL, its employees, agents and faculty instructors
shall maintain and shall require all students and faculty instructors to maintain the
confidentiality of all patient records and data and obtain appropriate authorization prior to any
disclosure of such records and data. SCHOOL shall provide all students with basic Health
Insurance Portability and Accountability Act (“HIPAA”) training in order to prepare them for
their professional careers in healthcare. SCHOOL agrees that all of its students and on-site
faculty instructors are considered part of the workforce of HOSPITAL while performing
treatment and healthcare operations as defined by 45 CFR 160.103, when engaged in activities
pursuant to this Agreement. However, such students and faculty instructors are not and shall
not be considered to be employees of HOSPITAL for any purpose. Students and faculty
instructors shall be subject to the HIPAA related policies and procedures of HOSPITAL.
H. Insurance. SCHOOL warrants and represents that, at its sole cost and expense, it shall insure
or self-insure its activities in connection with this Agreement and obtain, keep in force and
maintain a program of insurance as follows:
(i) Professional Medical and Hospital Liability insurance coverage or program of self-
insurance with limits of one million dollars ($1,000,000) per occurrence and three
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million dollars ($3,000,000) annual aggregate. If such insurance is written on a
claims-made form, it shall continue for five (5) years following termination or
expiration of this Agreement. The insurance shall have a retroactive date prior to or
coinciding with the effective date of this Agreement. In the event that a claims-
made policy is canceled or non-renewed, the SCHOOL shall obtain extended
reporting (tail) coverage for the remainder of the five (5)-year period (said tail
coverage shall be in amounts and type equivalent to the occurrence based coverage
provided herein).;
(ii) Comprehensive General Liability Insurance (contractual liability included) of not less
than one million dollars ($1,000,000) per occurrence and three million dollars
($3,000,000) annual aggregate. If such insurance is written on a claims-made form,
it shall continue for three years following termination or expiration of this
Agreement. The insurance shall have a retroactive date prior to or coinciding with
the effective date of this Agreement.; and
(iii) Workers’ Compensation Insurance in a form and amount covering SCHOOLS’s full
liability as required by law; and
(iv) Such other insurance in such amounts which from time to time may be reasonably
required by the mutual consent of the Parties against other insurable risks relating
to performance.
I. Dismissal of Students. SCHOOL agrees to allow HOSPITAL to dismiss students and/or faculty
instructors from the clinical experience at HOSPITAL for lack of professional behavior or poor
academic performance if, in the sole discretion of HOSPITAL, such dismissal is warranted.
SCHOOL may terminate a student’s and/or faculty instructor’s participation when, in its sole
discretion, it determines that further participation by the student and/or faculty instructor
would no longer be appropriate. SCHOOL will notify HOSPITAL if such action is required.
J. Accommodations. SCHOOL agrees to make all arrangements for consultation and assistance
with/for its students regarding tuition, housing, transportation, etc.
K. SCHOOL and Program Accreditation. SCHOOL agrees to maintain any relevant school and
Program accreditation. If accreditation is revoked or the Program and/or SCHOOL is placed on
probationary status, SCHOOL agrees to notify HOSPITAL immediately. HOSPITAL reserves the
right to ask SCHOOL for proof of accreditation at any time and to immediately cancel or
terminate learning and/or supervisory experiences and/or this Agreement (without completion
of the on-site learning experience) based upon SCHOOL’s or the Program’s accreditation status.
IV. GENERAL PROVISIONS
A. Patient Care. The Parties agree that HOSPITAL and its employees, and staff have independent
discretion to make professional judgments relating to the delivery of health care services and
that SCHOOL shall neither have nor exercise control or direction the manner in which HOSPITAL
and its employees and staff deliver health care services to patients.
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C. Status of the Parties. The Parties agree that no student or faculty instructor participating in
the Program shall be considered an employee, agent, contractor, or representative of HOSPITAL
for any purpose including, but not limited to, workers compensation, employee benefits, salary,
and professional liability. The Parties further agree that no employee or agent of HOSPITAL shall
be considered an employee, agent, contractor, or representative of SCHOOL for any purpose
including, but not limited to, workers compensation, employee benefits, salary, and
professional liability. The Parties expressly understand and agree that this Agreement is not
intended and shall not be construed to create the relationship of agent, servant, employee,
partnership, joint venture or association among the Parties, but is, rather an agreement by and
among independent Parties.
D. Indemnification.
(i) SCHOOL shall defend, indemnify and hold HOSPITAL harmless from and against any
and all liability, loss, expense, reasonable attorneys' fees, or claims for injury or
damages arising out of the performance of this Agreement, but only to the extent
such liability, loss, expense, reasonable attorneys' fees, or claims for injury or
damages are caused by or result from the negligent acts or omissions or willful
malfeasance of the SCHOOL, its officers, employed faculty, employees, students, or
faculty Instructors (if applicable).
(ii) HOSPITAL shall defend, indemnify and hold the SCHOOL harmless from and against
any and all liability, loss, expense, reasonable attorneys' fees, or claims for injury or
damages arising out of the performance of this Agreement, but only to the extent
such liability, loss, expense, reasonable attorneys' fees, or claims for injury or
damages are caused by or result from the negligent acts or omissions or willful
malfeasance of HOSPITAL, its officers, staff, or employees.
(iii) In the event that any claim, demand, action or suit occurs because of any action or
inaction related to this Agreement and both SCHOOL and HOSPITAL are involved,
then SCHOOL and HOSPITAL agree to cooperate and reasonably assist each other in
the investigation, evaluation, resolution and/or defense of same by their respective
attorneys, employees, agents, or representatives.
E. Discrimination. SCHOOL and HOSPITAL agree not to discriminate in the selection or
acceptance of any student pursuant to this Agreement because of race, color, national origin,
religion, sex, sexual orientation, mental or physical disability, age, veteran's status, medical
condition, ancestry, marital status, or citizenship.
F. Business Associate. The parties agree that in the context of the arrangement contemplated in
this Agreement, SCHOOL does not stand in a business associate relationship with HOSPITAL, as
the term “business associate” is currently defined under HIPAA. No business associate
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relationship is established pursuant to this Agreement because the SCHOOL, and the students
and the faculty instructors perform no actions or activities on behalf of HOSPITAL or its patients
in performance of the clinical training. Solely for the purpose of defining the student’s and/or
faculty instructor’s role in relation to the use and disclosure of HOSPITAL’s protected health
information, students and on-site faculty instructors will be part of HOSPITAL’s “workforce” for
purposes of compliance with the HIPAA when engaged as trainees working under the direct
control of the HOSPITAL’s clinical instructors. However, the students and faculty instructors are
not and shall not be considered to be employees of the HOSPITAL.
G. Force Majeure. Either Party shall be excused from any delay or failure in performance
hereunder caused by reason of any occurrence or contingency beyond its reasonable control,
including, but not limited to, acts of God, acts of war, fire, insurrection, labor disputes, riots,
earthquakes, or other acts of nature. The obligations and rights of the Party so excused shall be
extended on a day-to-day basis for the time period equal to the period of such excusable
interruption. In the event the interruption of a Party's performance continues for a period in
excess of thirty (30) days, the other Party shall have the right to terminate this Agreement upon
ten (10) days' prior written notice to the other Party.
H. Assignment. Neither Party shall assign their rights, duties, or obligations under this
Agreement, either in whole or in part, without the prior written consent of the other Party.
I. Severability. If any provision of this Agreement is held to be illegal, invalid, or unenforceable
under present or future laws effective during the term hereof, such provision shall be fully
severable. This Agreement shall be construed and enforced as if such illegal, invalid, or
unenforceable provision had never been a part of the Agreement, and the remaining provisions
shall remain in full force and effect unaffected by such severance, provided that the severed
provision(s) are not material to the overall purpose and operation of this Agreement.
J. Waiver. Waiver by either Party of any breach of any provision of this Agreement or warranty
or representation herein set forth shall not be construed as a waiver of any subsequent breach
of the same or any other provision. The failure to exercise any right hereunder shall not
operate as a waiver of such right. All rights and remedies provided for herein are cumulative.
K. Amendment. This Agreement may be amended or modified at any time by mutual written
consent of the authorized representatives of both Parties. SCHOOL and HOSPITAL agree to
amend this Agreement to the extent amendment is required by an applicable regulatory
authority and the amendment does not materially affect the provisions of this Agreement.
L. Governing Law. This Agreement shall be governed in all respects by the laws of the State of
Arizona.
M. Notices. All notices required under this Agreement shall be deemed to have been fully given
when made in writing and delivered by: (i) personal delivery; (ii) deposit in the United States
mail, postage prepaid, certified mail, return receipt requested; or (iii) overnight courier service,
and addressed as follows:
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HOSPITAL:
Student Program Specialist
HonorHealth
Workforce Development Department
8125 N. Hayden Rd.
Scottsdale, AZ 85258
SCHOOL:
Maricopa County Sheriff’s Office
Executive Chief of Administration
550 W. Jackson Street, 5th Floor
Phoenix, AZ 85003
Sheriff’s Lake Division
Attn: Sgt. David Ayers--EMT Program
7307 N Bush Highway
Mesa, AZ 85215
N. Entire Agreement. This Agreement contains all the terms and conditions agreed upon by the
Parties regarding the subject matter of this Agreement and supersede any prior agreements,
oral or written, and all other communications between the Parties relating to such subject
matter.
O. Use of Name. Neither Party shall use the name of the other without the prior written
approval from an authorized representative of that Party.
P. Counterpart Signatures. This Agreement may be executed in one or more counterparts
(facsimile transmission or otherwise), each of which counterparts shall be deemed an original
Agreement and all of which shall constitute but one Agreement.
Q. Effect of Laws. If any legislation, regulation or government policy are passed or adopted or if
these laws, regulations or policies are interpreted in a manner that would materially affect
either Party’s participation in or implementation of this Agreement as written, the Party raising
such concern shall provide notice of such law, regulation, policy or provision to the other Party,
and the Parties agree to negotiate in good faith within thirty (30) days to modify the terms of
this Agreement to comply with the applicable law, regulation or policy. If the Parties cannot
agree upon the necessary modification, either Party may terminate this Agreement on thirty
(30) days’ advance written notice.
R. No Exclusion. SCHOOL represents and warrants that SCHOOL and its representatives and
students and faculty instructors are not: (1) currently excluded, debarred, or disqualified by any
federal governmental agency or program or otherwise ineligible from receiving federal
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contracts or assistance; (2) present on the exclusion database of the Office of the Inspector
General or the Government Services Administration; or (3) convicted of a criminal offense
related to the provision of health care or under investigation for any of the above
circumstances.
IN WITNESS WHEREOF, the Parties hereto have signed this Agreement effective as of
the date set forth above.
HOSPITAL MARICOPA COUNTY
___________________________________ ___________________________________
Clint Hickman, Chairman
Title: ______________________________ Maricopa County Board of Supervisors
Date: ______________________________ Date: ______________________________
ATTEST:
___________________________________
Fran McCarroll, Date
Clerk of the Board
APPROVED AS TO FORM:
___________________________________
Deputy County Attorney Date
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