MAYO CLINIC AFFILIATION AGREEMENT.PDF

Clinical Education Agreement
between
MARICOPA COUNTY
and
MAYO CLINIC through its MAYO MEDICAL SCHOOL
This Agreement shall be effective as of the last date signed below. The parties to this
Agreement are MAYO CLINIC through its MAYO MEDICAL SCHOOL (“School”) with
an address of 200 First St. SW, Rochester, MN 55905 and MARICOPA COUNTY, a political
subdivision of the State of Arizona, administered by its CORRECTIONAL HEALTH
SERVICES, with an address of 234 N. Central Ave, Ste. 5000, Phoenix, AZ 85004 (“Clinical
Facility”).
WHEREAS, School is desirous to provide and design specific clinical experiences with
the assistance of the Clinical Facility (the “Program”) for the School’s students (“Students”) as
part of their overall education; and
WHEREAS, Clinical Facility is desirous of providing clinical training to School’s
Students; and
WHEREAS, Clinical Facility is a health care facility which has the resources in
equipment and staff to provide the clinical experiences required by the Program; and
WHEREAS, it is to the benefit of both School and Clinical Facility to cooperate in the
educational preparation of Students, so as to promote excellence in patient care, to ensure
professional competence, and to provide maximum utilization of community resources.
NOW, THEREFORE, IT IS MUTUALLY AGREED that School will place its
students in the Clinical Facility according to the following terms and conditions:
1. Education Program.
1.1 School shall be fully responsible for organizing, establishing and
administering the academic education program.
1.2 The number of Students accepted into the Program and the dates of each
Student’s Program experience shall be arranged by mutual agreement between
Clinical Facility and School. All Students shall be subject to Clinical Facility’s
standards of admission. In the event it becomes necessary to cancel a reserved
space or change a student assignment, School will immediately notify Clinical
Facility.
1.3 School agrees to designate for participation in the Program only Students
who have completed the necessary training, appropriate prerequisites and didactic
work for the Program, and are in good standing with their respective institutions.
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1.4 School shall advise all Students that they are required to have passed a
physical examination, have all required immunizations including a hepatitis B
series, and, when appropriate for specific rotation, have completed background
studies and drug screening. The Student is responsible for costs for all pre-
rotation screenings (including criminal background reports and drug tests).
School shall also provide Clinical Facility with documentation establishing that
each Student has undergone the appropriate pre-screening and a background
study, and is eligible to have direct contact with hospital patients. School shall
maintain all personnel and academic records relating to Students.
1.5 Clinical Facility agrees:
1.5.1 To provide direct supervision of Students by qualified clinicians
(e.g., psychiatrists, physicians, and psychologists) who are on staff at the
Clinical Facility (“Supervising Clinicians”);
1.5.2 That all notes or charting concerning a patient’s treatment or
progress; if written by a Student, will be signed by the Student and
countersigned by a Supervising Clinician; and
1.5.3 To complete written evaluations on each Student on forms provided
by School.
1.6 Clinical Facility assumes full responsibility for the care of its patients. It
is understood that School does not derive direct revenue from patient care
activity at Clinical Facility.
1.7 Clinical Facility and School agree to abide by the limitations set forth in
the Family Educational Rights and Privacy Act (“FERPA”) and
regulations at 34 CFR 99.33 regarding the protection of educational data.
Both parties acknowledge that this Agreement allows access to
educational data, and agree to hold that information in strict confidence.
Both parties agree not to use or disclose educational data received from or
on behalf of either institution except as permitted or required by this
Agreement, as otherwise required by law, or as authorized in writing by
Student.
2. School’s Responsibilities.
2.1 School shall not assign to a Supervising Clinician more than three
Students at any one time during the Program experience.
2.2 School shall notify the Clinical Facility in writing at least thirty days in
advance of its proposed schedule of clinical assignments, and such schedule is
subject to the advance written approval of the Clinical Facility.
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2.3 School shall require all Students and any other personnel furnished by
School to comply with all applicable rules, regulations, policies, and procedures
of the Clinical Facility and to maintain the confidentiality of patient information
in accordance with applicable law, as well as the confidentiality of records and
business operations of the Clinical Facility.
2.4 School, after consultation and remediation efforts with Clinical Facility,
shall promptly terminate the assignment of any Student or other employee of the
School for violation of any rule, regulation, policy, or procedure of the Clinical
Facility, breach of confidentiality, or other misconduct.
3. Clinical Facility’s Responsibilities.
3.1 Supervising Clinicians will provide instruction and supervision of
Students assigned to the Program, in accordance with guidelines agreed upon by
Clinical Facility and School.
3.2 Clinical Facility will provide a suitable environment for each Student’s
clinical experience.
3.3 Clinical Facility shall maintain workers’ compensation insurance or
funded self-insurance for its employees.
3.4 At all times during the term of this Agreement and any renewal or
extension hereof, Clinical Facility shall, at its own expense, comply with
applicable State and Federal laws and regulations including but not limited to
OSHA standards pertaining to Occupational Exposure to Bloodborne Pathogens
with respect to each of School’s employees, agents and Student(s) present at the
Clinical Facility.
3.5 Clinical Facility shall not disclose any records concerning any Student to
any third party except as required by law or authorized in writing by such Student.
3.6 To the extent applicable, Clinical Facility shall, in accordance with 42
U.S.C. §1395(v)(1)(I) and 42. C.F.R. Part 420, Subpart D §420.300 et seq., until
the expiration of four (4) years after the furnishing of Medicare reimbursable
services pursuant to this Agreement, upon proper written request, allow the
Comptroller General of the United States, the Secretary of Health and Human
Services, and their duly authorized representatives access to this Agreement and
to Clinical Facility’s books, documents, and records necessary to certify the
nature and extent of costs of Medicare reimbursable services provided under this
Agreement.
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4. The Parties’ Mutual Responsibilities.
4.1 Neither party shall publicize or otherwise disclose the nature or terms of
this Agreement in any manner except as approved in writing by the other party or
required by applicable law.
4.2 Neither School nor Clinical Facility will unlawfully discriminate against
any Student, employee, or patient in the performance of this Agreement.
4.3 School and Clinical Facility shall each designate a coordinator who shall
be reasonably available for consultation with the other respective coordinator
concerning each Student’s qualifications, clinical experience performance, and the
curriculum of the clinical experience program.
4.4 At all times during the term of this Agreement, all services shall be
performed in accordance with all applicable standards established by law or
ordinance, or established by the rules and regulations of any federal, state, or local
agency, department, commission, association, or other pertinent governing,
accrediting, or advisory body having the authority to set standards for offices
maintained by health care providers.
4.5 To the fullest extent permitted by law, each party shall defend, indemnify,
and hold harmless the other party, its agents, representatives, officers, directors,
officials, and employees for, from and against all claims, damages, losses and
expenses, including, but not limited to, attorneys’ fees, court costs, expert witness
fees, and the cost of appellate proceedings, relating to, arising out of, or alleged to
have resulted from the negligent acts, errors, omissions or mistakes relating to the
performance of this Agreement. Each party’s duty to defend, indemnify and hold
harmless the other party, its agents, representatives, officers, directors, officials,
and employees shall arise in connection with any claim, damage, loss or expense
that is attributable to bodily injury, sickness, disease, death, or injury to,
impairment, or destruction of property, including loss of use resulting there from,
caused by any negligent acts, errors, omissions or mistakes in the performance of
this Agreement including any person for whose acts, errors, omissions or mistakes
a party may be legally liable.
The amount and type of insurance coverage requirements set forth herein
will in no way be construed as limiting the scope of the indemnity in this Section.
The scope of this indemnification does not extend to the sole negligence of
either party.
4.6 School shall give at least ten (10) days advance written notice of any
cancellation, non-renewal, or change in limits of the coverages.
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4.7 School shall maintain workers’ compensation and commercial general
liability insurance or funded self-insurance for its employees.
4.8 School shall be responsible for planning the educational curriculum and
shall maintain appropriate records and reports on each Student’s clinical
experience.
4.9 Both parties agree to cooperate with each other and share information in
the event that any investigation is conducted with respect to a Student’s
experience or performance at Clinical Facility. Students may be asked to sign a
form granting School and Clinical Facility permission to share information
relevant to his or her experience or performance.
5. Health Insurance Portability and Accountability Act. Students shall be
instructed by School before beginning the Program concerning the confidentiality of medical
information of Clinical Facility’s patients and standard precautions. For purposes of compliance
with the Health Insurance Portability and Accountability Act and associated privacy regulations
(“HIPAA”), Students shall be considered part of Clinical Facility’s work force as that term is
defined in HIPAA to include trainees and students. Students are not considered work force or
employees of Clinical Facility for other purposes, including by and not limited to tax or
employment law. Clinical Facility shall provide the necessary training specific to HIPAA.
6. Policies and Procedure Governing Students. Students shall be subject to and
follow all Clinical Facility’s rules, regulations, policies and procedures, including standard
precautions. Students enrolled in the Program will also be governed in accordance with the
policies and procedures established through School.
7. Termination of Student Experience. Clinical Facility may terminate the
participation of a Student in the Program if the Student’s work, conduct or health may, in
Clinical Facility’s judgment, have detrimental effect on its patients, staff, or operations. A
Student generally will not be removed from the Program until Clinical Facility has discussed its
concerns with a representative of the School. However, Clinical Facility reserves the right to
take immediate action to suspend a Student’s participation in response to concerns of patient care
or the safety and respect of its staff. Clinical Facility shall not be arbitrary or discriminatory in
the exercise of this right.
8. Student Health Insurance and Emergency Medical Care. Students shall
maintain health insurance throughout the entire term of their participation in the Program.
Students shall be furnished emergency medical care and treatment, if needed, while on duty at
Clinical Facility with the associated expense to be the responsibility of the Student, unless such
medical care or treatment is due to Clinical Facility’s intentional acts or omissions.
9. Insurance.
School will provide and maintain insurance as described below:
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9.1 Commercial general liability insurance (or completed coverage
under a program of self-insurance) providing coverage on claims
made for occurrences during the term of this Agreement with
limits no less than $2,000,000 per occurrence and $4,000,000
aggregate.
9.2 Professional liability insurance (or comparable coverage under a
program of self-insurance) providing coverage on an “occurrence
basis” for occurrences during the term of this Agreement with
limits no less than $1,000,000 per occurrence and $3,000,000
annual aggregate, and shall name Maricopa County and Clinical
Facility as an Additional Insured.
9.3 The insurance required in Section 9.1 above shall be in full force and
effect prior to the arrival of Students at Clinical Facility. The insurance
provider shall endeavor to provide thirty (30) calendar days prior written
notice to Clinical Facility of any modification or termination of insurance.
In the event any “claims made” policy is procured to meet the insurance
requirements hereunder, “tail” coverage shall also be procured for a period
of two (2) years after termination of such policy. To the extent permitted
by School’s insurance provider, the general liability insurance shall name
as additional insured, Maricopa County, its directors, subsidiaries,
officers, employees, assigns, agents and board members.
All insurance required herein shall be maintained in full force and effect.
Failure to do so may, at the sole discretion of Clinical Facility, constitute a
material breach of this Agreement.
9.4 School shall provide Clinical Facility with Certificate of Insurance
evidencing the above-stated coverage.
9.5 Clinical Facility shall provide and maintain comprehensive professional
and general liability insurance of not less than $1,000,000 per occurrence
and $3,000,000 in the aggregate as well as excess liability insurance of not
less than $1,000,000 for its Staff. A certificate of insurance evidencing
such insurance coverage shall be provided to the School. To the extent
permitted by Clinical Facility’s insurance provider, the general liability
insurance shall name as additional insured, its schools, directors,
subsidiaries, officers, employees, assigns, agents and board members.
10. Independent Contractors. Each party is a separate and independent institution,
and this Agreement shall not be deemed to create a relationship of agency, employment, or
partnership between or among them. Each party understands and agrees that this Agreement
establishes a bona fide training relationship and that the agents, Students, or employees of each
respective party are not employees of agents of the other party.
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11. Term. This Agreement shall be effective as of the last date signed below and is
automatically renewed for subsequent one year terms for a total of five (5) years, unless
terminated as described in Section 12 below.
12. Termination.
12.1 Either party may terminate this Agreement for any reason by giving at
least ninety (90) days written notice to the other party.
12.2 In the event that this Agreement is terminated pursuant to Section 12.1, the
parties hereby agree that no Students participating in an ongoing clinical
experience will be denied the opportunity to complete the affiliation, even
when the effective date of termination occurs prior to the completion date
of the clinical experience. In such event, all applicable provisions of this
Agreement, including the right to terminate any Student, pursuant to
Section 7, shall remain in force during the extension period from the
effective date of termination, until the end of the academic term in which
the Student is enrolled.
13. Amendments. This Agreement may be amended from time to time by written
agreement of the parties.
14. Notices. Whenever written notice is required or permitted to be given by any
party to the other, such notice shall have been deemed to have been sufficiently given if
personally delivered or deposited in the United States Mail in a properly stamped envelope,
certified or registered mail, return-receipt-requested, addressed to:
For Program With Copy to: For Clinical Facility:
Jonathan Torrens-Burton Education Business Services Lisa Gardner
Administrator Maricopa County Correctional
Mayo Clinic Siebens 5 Health Services
Mayo Clinic 234 N. Central Ave., Ste. 5000
200 First Street SW Phoenix, AZ 85004
200 First Street SW Rochester, MN 55905
Rochester, MN 55905
15. Use of Names. No party shall use the name, logo, or likeness of another party, or
another party’s employee or agent in any publicity or advertising material without such other
party’s express prior written consent. All requests for approval for the use of School’s or Mayo
Clinic’s name pursuant to this Section must be submitted to the Mayo Clinic Public Affairs
Business Relations Group, at the following E-mail address: publicaffairsbr@mayo.edu at least 5
business days prior to the date on which a response is needed; however, the existence and scope
of the programs available via this Agreement may be made known to Students as a means of
assistance in completing their training requirements.
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16. Assignment. Neither party shall assign all nor part of this Agreement without
the prior written consent of the other party which consent shall not be unreasonably withheld,
provided, however, that this Agreement may be assigned by either party without consent of the
other to an affiliate or to any third party who succeeds to substantially all of its businesses or
assets. In the event of a valid assignment, this Agreement will insure to the benefit of and be
binding upon each party and its respective successors and permitted assigns.
17. Governing Law. This Agreement shall be construed in accordance with the law
of the State of Arizona.
18. Excluded Individual. Each party shall immediately notify the other party in the
event that it becomes an excluded individual from any federal health care program.
19. Enforceability and Waiver. The invalidity or unenforceability of any term or
provision of this Agreement shall in no way affect the validity or enforceability of any other term
or provision. The waiver by a party of a breach of any provision of this Agreement shall not
operate as or be construed as a waiver of any subsequent breach thereof.
20. Non-exclusive Agreement. Each party may enter into similar agreements with
other training institutions, provided that such agreements do not materially interfere with the
ability of each party to carry out its obligations hereunder.
21. Compliance with Laws. Each party shall comply with all applicable laws,
ordinances, Executive Orders, rules, regulations, standards, and codes of the Federal and State
whether or not specifically referenced herein. Specifically the following apply:
Unless exempted under Federal law, the parties shall not discriminate against any
employee or applicant for employment because of race, age, disability, color, religion, sex or
national origin. The parties shall, to the extent such provisions apply, comply with Title VI and
VII of the Federal Civil Rights Act; the Federal Rehabilitation Act; the Age Discrimination in
Employment Act; American With Disabilities Act.
22. E-Verification of Employees. School warrants that it’s Phoenix Campus is in
compliance with A.R.S. § 41-4401 and further acknowledges that it and its subcontractors, if
any, warrant their compliance with all federal immigration laws and regulations that relate to
their employees and their compliance with A.R.S. § 23-214, subsection A. School further
acknowledges that a breach of such warranty shall be deemed a material breach of the
Agreement that is subject to penalties up to and including termination of the Agreement.
Further, Clinical Facility retains the legal right to inspect the papers of any contractor or
subcontractor employee who works on the Agreement to ensure that the contractor or
subcontractor is complying with the warranty provided above and that the contractor agrees to
make all papers and employment records of said employee(s) available during normal working
hours in order to facilitate such an inspection.
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Nothing herein shall make any contractor or subcontractor an agent or employee of the
contracting government entity.
23. Entire Agreement. This Agreement represents the entire agreement between the
parties with respect to the subject matter hereof, and supersedes all prior agreements and
representations.
24. Authority. The person signing this Agreement warrant that they have full
authority to do so and that their signatures shall bind the parties for which they sign.
~Signatures on following page~
~Remainder left blank intentionally~
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the respective
dates written below.
MAYO MEDICAL SCHOOL MARICOPA COUNTY
By: ______________________________ By: ________________________________
Name: Jonathan Torrens-Burton_______ Name: ______________________________
Title: __Administrator_______________ Title: _Chairman, Board of Supervisors____
Date: ____________________________ Date: _______________________________
MAYO CLINIC ATTESTED:
By: ______________________________ By: ________________________________
Name: John D. Poe__________________ Name: ______________________________
Title: Division Chair, Education________ Title: _Clerk of the Board_______________
Date: _____________________________ Date: _______________________________
MARICOPA COUNTY RISK MANGEMENT
By: ________________________________
Name: ______________________________
Title: _______________________________
Date: _______________________________
APPROVED AS TO FORM BY LEGAL
COUNSEL FOR MARICOPA COUNTY
By: ________________________________
Name: ______________________________
Title: _______________________________
Date: _______________________________
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