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90-WWWWWWRESOLUTION NO. 90-/~//g/~/~/~/~/ A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF BOYNTON BEACH, FLORIDA, AUTHORIZING AND DIRECTING THE MAYOR AND CITY CLERK TO EXECUTE A CONTRACT BETWEEN THE CITY OF BOYNTON BEACH, FLORIDA AND DR. WILLIAM JEFFREY DAVIS, OUTLINING THE WORKING RELATIONSHIPS AND RESPONSIBILITIES OF THE CITY AND THE MEDICAL ~IRECTOR FOR THE CITY'S EMERGENcy MEDICAL SERVIcEs PROGRAM (EMS]; A CORY OF SAID CONTRACT BEING ATTACHED ~ERETO AS EXHIBI~ 'A'; AND pROvIDiNG FoRAN EFFECTIVE DATE. W~REAS, it is the desire of the City Commission for the City to enter into a contract agreement outlining working relationships and responsibilities of the City and the Medical Director for the City's Emergency Medical Services Program (EMS), which is a part of the City's Municipal Fire Department; and WHEREAS, the execution of said Contract is in the best interests of the citizens of Boynton Beach; NOW, THEREFORE, BE IT RESOLVED by the City Commission of the City of'Boynton Beach, Florida, that: Section 1. The Mayor and City Clerk are hereby authorized and directed to execute a certain Contract between the City of Boynton Beach and Dr. William Jeffrey Davis, a copy of which Contract is attached hereto as Exhibit "A". Section 2. This Resolution immediately upon passage. PASSED AND ADOPTED this ~--~day shall take effect 1990. ATTEST: ( Cor~o~ra~ Sen-l) Mayor r EMERGENCY MEDICAL SERVICE DIRECTOR CONTRACT The City of Boynton Beach and Dr. William Jeffrey Davis hereby agree that the terms of this Contract provide an outline of the working relationships and responsibilities of the City and the Medical Director for the City's Emergency Medical Services Program (EMS), which is a part of the City's Municipal Fire Department. The items in this Contract in the following Sections are aimed at identifying the Medical Director's general rela- tionship with the City, his responsibility for supervising the direct medical related activities of the EMS Program, and the Medical Director's responsibility for local training and cer- tification of the Paramedics. The Contract further supports the principle that the Medical Director will receive support from the Fire Department Administration and will direct his requests for equipment and equipment assignments; man power and man power assignments; and supplies to the Fire Department Administration and recognizes that assignments to the Paramedic Program will be made by the Fire Chief in accordance with the overall resources and needs of the Fire Department. 1. The City hereby Contracts with the Medical Director ano the Medical Director accepts this Contract as Medical Director for the City of Boynton Beach Emergency Medical Services Program under the provisions of Section 401.46 of the Florida Statutes. It is recognized that the Medical Director's Contract with the City preserves his right to practice as an independent physician at all times. 2. The Medical Director shall accept responsibility for the medical performance of the Emergency Medical Technicians and Paramedics employed by the City and serving in the Emergency Medical Services Program of the City Fire Department, herein referred to as EMS. The Medical Director shall be responsible directly to thFe Fire Chief through the on-duty supervisors provided~ however, nothing herein shall in any way authorize any limitations or restrictions by the Fire Chief on the professional acts or advice of the Medical Director. -1- 3. The Fire Chief, through the Department Staff and opera- tion procedure:, will establish Department policy for equipment and equipment assignment, and-for supply purchase and use. The Fire Chief shall establish dispatch procedures and priorities. The Fire Chief will establish department policy for man power assignment in conjunction with recommendations made by the Medical Director. 4. The Medical Director shall perform all services required pursuant to Chapter 401.46 (See Appendix "A") of the Florida Statutes and all present rules and regulations of any governmental agencies implementing said Chapter or other established duties required to be performed by said Medical Director. If the services required by Chapter 401.46 or the Department of Health and Rehabilitative Services of the State of Florida are significantly altered, the Medical Director and the City shall jointly review the procedures for carrying out the Medical Director's responsibilities. 5. The Medical Director shall be directly responsible for the medical performance of Emergency Medical Technicians and Paramedics functioning for the EMS and shall have full authority to direct and supervise the medical acti- vities in the field, in training and for certifications. Patient destinations shall be at the sole discretion of the Medical Director. Further the E.M.S. Coordinator shall be the Medical Director's agent for purposes of quality assurance pursuant to Florida State Statute. 6. The Medical Director shall establish and supervise the medical aspect of the EMS Program in the City and super- vise and arrange, through the Fire Chief, such in- service instructional sessions as may be necessary to assure that all medical services performed by the Emergency Medical Technicians and Paramedics are in accordance with proper medical standards and procedures, Cost for supplying necessary in-service instruction material will be assumed by the City and the material will become the property of the City. -2- 10. 11. 12. 7. The Medical Director shall have the services of the Departmental training program, facility and Staff to assist in carrying out training requi.rements fo.r ther- EMS. 8. Provider shall furnish and maintain a policy of pro- fessional liability insurance covering Director when performing the duties as set forth by Florida Statutes of Medical Director for the City of Boynton Beach for the term of this contract. Said professional liability insurance shall cover Director for acts or omissions whileacting in the capacity of Medical Director. 9. The Provider shall indemnify and save harmless the Director from any and all liability for acts or omissions committed by the Director while acting in the capacity as Medical Director. of the Boynton Beach Fire Department, but said indemnification shall be to the extent only ofan¥ amount due and owing from Director which exceed applicable insurance coverages maintained either by Director or by The City of Boynton Beach on behalf of Director. The Provider shall indemnify and save harmless the Director from any and all liability incurred as a result of acts or omission of employees of the Boynton Beach Fire Department. The City will pay the Medical Director eighteen thousand dollaYs ($18,000} per year at the rate of fifteen hundred permonth for twelve {12} months, payable at the end of each month for services outlined in this contract. The City will provide portable radio communications and an Alpha Numeric Pager for the use of the Medical Director. In employee relations matters, the Medical Director, through the terms of this Contract is considered to be a member of the administration and supervisory division of the Fire Department and will be expected to aid the Fire Chief as the Fire Chief carries out grievance -3- 13. procedures, discipline, interviewing paramedics, para- medic school assignments, and union contract administra- tive requirements. A. The Medical Director will be expected to report to the Fire Chief the circumstances relating to any employee decisions for the Emergency Medical Services System such as discipline, decertification or promotion in which theMedica~ Director is involved. B. The Medical Director agrees to participate as required at personnel hearing boards such as the Civil Service Board, grievance procedures of the union contract, etc. as a part of his Department administrative responsibilities of the Department without additional compensation. C. The Medical Director agrees to participate in the oral interview and skills test administered to all new firefighter applicants who have a paramedic cer- tificate prior to their employment. Director retains the right to prevent the hiring of any such individual for the purpose of employment as a para- medic if he or she does not perform satisfactorily during the interview and/or skills test. The con- tent of the skills test will be in accordance with current standardized criteria set up by the American Heart Association and American College of Emergeacy Physicians. D. The Medical Director agrees that anytime a firefighter employed by the City of Boynton Beach wants to attend paramedic classes for purposes of becoming a licensed paramedic they must have written approval by the Medical Director prior to attending and/or enrolling in such classes. From time to time the Medical Director will be expected to attend Department Administrative Staff meetings so that he can give input to the Administrative Staff on the needs and status of the EMS Program and so that he can become involved in and informed of Departmental -4- Standard Operating Procedures relating to: A. Response Procedures B. Equipment and Personnel Allocations C- ~,Department Priorities D. Departmental Procedures for Handling Emergencies E. Working with Other Departments 14. Any staffing changes that result in modifying the Department's current E~M.S. response protocols must be cleared through the Medical Director. 15. Either party~to th~s Contract may, upon giving sixty {60) days written notice to the other party, terminate this Contract and after the effective date Df such notice allparties will be relieved of any further obli- gations under this Contract. 16. This Contract shall be in effect from October 1, 1990 through September 30, 1991. IN WITNESS WHEREOF. the parties hereto have caused these presents to be signed by their duly authorized officers and by the Medical Director on this day of 199 Witness: CITY OF BOYNTON BEACH, FLORIDA Mayor Witness: MEDICAL DIRECTOR Dr. William Jeffrey Davis City Clerk {Corp. Seal) -5- APPENDIX"A" 1. Be responsible for advising the ALS provider as to his assess- ment ofthe competence of each of the provider's paramedics and for making recommendations regarding the medical proce- dures which each paramedic should be authoFized to perform. Such assessment should bemade by utilizing reasonable eval- uative processes and techniques' and should include at least assessment of each paramedic's ability to: a. appropriately, evaluate emergenCy medi,cal patients and determine proper priorities for eme~gencymedical care; b. communicate the findings of such evaluation to a physi- cian who, has agreed, inwriting, ~o:~provide responsible supervision of that paramedic; c. receive and understand proper orders from a physician providing direct supervision~of the-paramedic; d. understand and properly apply any standing orders authorized by the Medical Director; e. understand legal relationship between the paramedic, Medical Director, physician{s] under agreement to provide resoonsible supervision of the paramedic and any other physician; f. insure that any: ALS performed by the paramedic is done with responsible physician supervision; and g. perform the specific medical procedure{s} which the para- medic is specifically authorized by the Medical Director and by the ALS provider to perform. 2, Continually evaluate the medical capability of the baramedics and the ALS provider and advise the ALS provider regarding the appropriate level and standard of care which the ALS pro- vider should seek to achieve. 3. Assist in identifying the specific medical skills and knowledge which paramedics must possess to achieve the desired level and standard of care. 4. Assist in identifying the training and experience necessary for the paramedics to acquire the desired skills and knowledge and, in cooperation with approved educational programs, in assuring that each paramedic receives such training and experience as required. 5. Develop and implement an appropriate process for periodic audit and review of medical procedures performed by para- medics. Such audit and review process must comply with such standards and requirements as may be set forth by the Department from time to time. 6. Develop and authorize or review and authorize for use standing orders which allow t, he paramedics to properly manage certain medical, emergencies when voice communications with the responsible physician is not available. SuCh'standing orders must be specified and must at least provide for man- aging inrnedlately life threatening medical-emergencies though they are not~ required to be so:comprehensive as to include al] possi b] e medical ' emergenci es. 7. Be responsible for the medical correctness of any standing order which he authorizes for use by the paramedics and for properly ~instructing the paramedics regarding the correct use of standing orders. 8. Assist the ALS provider ~n assuring continuous availabilit.v of afc least one responsible ph~,sician. Defcermine the qualifica- tions necessary for a physician to provide responsible super- v'islon of the paramedics. 9. Retain the ultimate authority to permit and/or prohibit any st'stem paramedic to utilize ALS techniques. (Specific authority, 401.35, 381.031(1)(g), 20.05[5) FS. Law imple- mented 401.46, 401.47 FS. Hisl:or.v New 9-10-78.) -7- EMERGENCY MEDICAL SERVICE DIRECTOR CONTRACT The City of Boynton Beach and Dr, William Jeffrey Davis hereby agree that the terms of this Contract provide an outli~e of the working relationships and responsibilities of the City and the Medical Director for the City's Emergency Medical Services Program {EMS}, which is a part of the City's Municipal Fire Department. The items in this Contract in the following Sections are aimed at identifying the Medical Director's general rela- tionship with the City, his responsibility for supervising the direct medical related activities of the EMS Program, and the Medical Director's responsibility for local training and cer- tification of the Paramedics. The Contract further supports the principle that the Medical Director will receive support from the Fire Department Administration and will direct his requests for equipment and equipment assignments; man power and man power assignments; and supplies to the Fire Department Administration and recognizes that assignments to the Paramedic Program will be made by the Fire Chief in accordance with the overall resources and needs of the Fire Department. 1. The City hereby Contracts with the Medical Director and the Medical Director accepts this Contract as Medical Director for the City of Boynton Beach Emergency Medical Services Program under the provisions of Section 401.46 of the Florida Statutes. It is recognized that the Medical Director's Contract with the City preserves his right to practice as an independent physician at all times. 2. The Medical the medical Director:shall accept responsibility for performance of the Emergency Medical Technicians and Paramedics employed by the City and serving in the Emergency Medical Services Program of the City Fire Department, herein referred to as EMS. The Medical Director shall be responsible directly to the Fire Chief through the on-duty supervisors provided, however, nothing herein shall in any way authorize any limitations or restrictions by the Fire Chief on the professional acts or advice of the Medical Director. -1- 3. The Fire Chief, through the Department Staff and opera- tion procedure, will establish Department policy for equipment and equipment assignment, and for supply purchase and use. The Fire Chief shall establish dispatch procedures and priorities. The Fire Chief will establish department policy for man power assignment in conjunction with recommendations made by the Medical )irector. 4. The Medical Director shall perform all services required pursuant to Chapter 4D1.46 {See Appendix "A"} of the Florida Statutes and all present rules ano regulations of any governmental agencies implementing said Chapter or other established duties reouired to be performed by said Medical Director. If the services required by Chapter 401.46 or the Department of Health and Rehabilitative Services of the State of Florida are significantly altered, the Medical Director and the City shall jointly review the procedures for carrying out the Medical Director's responsibilities. 5. The Medical Director shall be directly responsible for the medical performance of Emergency Medical Technicians and Paramedics functioning for the EMS and shall have full authority to direct and supervise the medical acti- vities in the field, in training and for certifications. Patient destinations shall be at the sole discretion of the Medical Director. Further the E.M.S. Coordinator shall be the Medical Director's agent for purposes of quality assurance pursuant to Florida State Statute. 6. The Medical Director shall establish and supervise the medical aspect of the EMS Program in the City and super- vise and arrange, through the Fire Chief, such in- service instructional sessions as may be necessary to assure that all medical services performed by the Emergency Medical Technicians and Paramedics are in accordance with proper medical standards and procedures. Cost for'supplying necessary in-service instruction material will be assumed by the City and the material will become the property of the City. -2- 7. The Medical Director shall have the services of the Departmental training program, facility and Staff to assist in carrying out training requirements-for the EMS. 8. The Medical Director shall be eligible as a member as defined under Section IV. Members of the Agreement be- tween the City of Boynton Beach and the Florida Municipal Liability Self Insurance Program. Coverage under this Agreement shall be limited to the scope of duties as Medical Director for the City of Boynton Beach Fire Dept. as outlined in Florida Statute 41.46. 9. The Provider shall indemnify and save harmless the Director from any and all liability for acts or omissions committed by the Director while acting in the capacity as Medical Director of the Boynton Beach Fire Department, but said indemnification shall be to the extent only of any amount due and owing from Director which exceed applicable insurance coverages maintained either by Director or by The City of Boynton Beach on behalf of Director. The Provider shall indemnify and save harmless the Director from any and all liability incurred as a result of acts or omission of employees of the Boynton Beach Fire Department. 10. The City will pay the Medical Director eighteen thousand dollars {$18,000) per year at the rate of fifteen hundred per month for twelve {12) months, payable at the end of each month for services outlined in this contract. 11. The City will provide portable radio communications and an Alpha Numeric Pager for the use of the Medical Director. 12. In employee relations matters, the Medical Director, through the terms of this Contract is considered to be a member of the administration and supervisory division of the Fire Department and will be expected to aid the Fire Chief as the Fire Chief carries out grievance -3- 13. procedures, discipline, interviewing paramedics, para- medic school assignments, and union contract administra- tive requirements. A, The Medical Director will be expected to report to the Fire Chief the circumstances relating to any employee decisions for the Emergency Medical Services System such as discipline, decertification or promotion in which the Medical Director is involved. B. The Medical Director agrees to participate as required at personnel hearing boards such as the Civil Service Board, grievance procedures of the union contract, etc. as a part of his Department administrative responsibilities of the Department without additional compensation. C. The Medical Director agrees to participate in the oral interview and skills test administered to all new firefighter applicants who have a paramedic cer- tificate prior to their employment. Director retains the right to prevent the hiring of any such individual for the purpose of employment as a para- medic if he or she does not perform satisfactorily during the interview and/or skills test. The con- tent of the skills test will be in accordance with current standardized criteria set up by the American Heart Association and American College of Emergency Physicians. D. The Medical Director agrees that anytime a firefighter employed by the City of Boynton Beach wants to attend paramedic classes for purposes of becoming a licensed paramedic they must have written approval by the Medical Director prior to attending and/or enrolling in such classes. From time to time the Medical Director will be expected to attend Department Administrative Staff meetings so that he can give input to the Administrative Staff on the need~ and status of the EMS Program and so that he can become involved in and informed of Departmental -4- Standard Operating Procedures relating to: A. Response Procedures B. Equipment and Personmel Allocations . C. Department Priorities D. Departmental Procedures for Handling Emergencies E. Working with Other Departments 14. Any staffing changes that result in modifying the Department's current E.M.S. response protocols must De cleared through the Medical Director. 15. Either-party to this Contract may, upon giving sixty ($0) days written notice to the other party, terminate this Contract and after the effective date of such notice all parties will be relieved of any further obli- gations under this Contract. 1§. This Contract shall be in effect from October 1, lggO through September 30, lggl. IN WITNESS WHEREOF the parties hereto have caused these presents to be signed by their duly authorized officers and by the Medical Director on this 1990. Witness: CIT~~C~CH.A~LORI DA Witness: Ci tj//C1 erk (Corp. Seal) MEDICAL DIRECTOR~ ~ ~' /:/' Dr. Wi~iiam Jeffrey -5- APPENDIX"A" 1. Be responsible for advising the ALS provider as to his assess- ment of the competenc~'~of-,each-of-th~rovider, s-~paramedics and for making recommendations regarding the medical proce- dures which each paramedic should be authorized to perform. Such assessment should be made by utilizing reasonable eval- uative processes and techniques and should include at least assessment of each paramedic's ability to: a. appropriately evaluate emergency medical patients anU determine proper priorities for emergency medical care; b. communicate the findings of such evaluation to a physi- cian who has agreed, in writing, to provide responsible supervision of that paramedic; c. receive and understand proper orders from a physician providing direct supervision of the paramedic; d. understand and properly apply any standing orders authorized by the Medical Director; e. understand legal relationship between the paramedic, Medical Director, physician{s) under agreement to provide responsible supervision of the paramedic and any other physician; f. insure that any ALS performed by the paramedic is done with responsible physician supervision; and g. perform the specific medical procedure(s) which the para- medic is specifically authorized by the Medical Director and by the ALS provider to perform. 2. Continually evaluate the medical capability of the paramedics and the ALS provider and advise the ALS provider regarding the appropriate level and standard of care which the ALS pro- vider should seek to achieve. 3. Assist in identifying the specific medical skills and knowledge which paramedics must possess to achieve the desired level and standard of care. 4. Assist in identifying the training and experience necessary for the paramedics to acquire the desired skills and knowledge and, in cooperation with approved educational programs, in assuring that each paramedic receives such training and experience as required. 5. Develop and implement an appropriate process for periodic audit and review of medical procedures performed by para- medics. Such'audit and review process must comply with such standards and requirements as may be set forth by the Department from time to time. -6- 6. Develop and authorize or review and authorize for use standing orders which allow the paramedics to properly manage certaih medical emergencies when voice communications with the responsible physician is not available. Such standing orders must be specified and must at least provide for man- aging immediately life threatening medical emergencies though they are not required to be so comprehensive as to include all possible medical emergencies. 7. Be responsible for the medical correctness of any standing order which he authorizes for use by the paramedics and for properly instructing the paramedics regarding the correct use of standing orders. 8. Assist the ALS provider in assuring continuous availability of at least one responsible physician. Determine the qualifica- tions necessary for a physician to provide responsible super- vision of the paramedics. 9. Retain the ultimate authority to permit ano/or prohibit any system paramedic to utilize ALS techniques. (Specific authority 401.35, 381.031(1)(g), 20.05(5) FS. Law imple- mented 401.46, 401.47 FS. History New 9-10-78.) -7-