HomeMy Public PortalAbout183-2019 - Pelham Specialty Training, I...dent affiliation agreement for EMSCLINICAL AFFILIATION AGREEMENT
BETWEEN
RICHMOND FIRE DEPARTMENT
AND
PELHAM SPECIALTY TRAINING, INC.
This clinical affiliation agreement ("Agreement") is made by and between Richmond Fire
Department ("RFD"), an ALS EMS Provider located in Richmond, Wayne County, Indiana,
and Pelham Specialty, Training, Inc. ("Pelham"), a For -Profit Indiana Corporation, located in
Bloomfield, Greene County, Indiana.
RECITALS
1. RFD is a comprehensive ALS Ambulance Service located in Richmond, Indiana, that
provides a fall complement of medical care to the residents of Wayne County, Indiana,
and the surrounding areas.
2. Pelham is a comprehensive emergency medical technician and paramedic education and
training facility that includes continuing refresher and certification courses at its facilities
located in Bloomfield, Indiana.
3. Pelham desires to provide its Students with the opportunity to participate in clinical care
activities at RFD.
4. RFD desires to allow Pelham Students the opportunity to participate in clinical care
activities at its facilities, within the discretion of a qualified professional to supervise
Pelham students assigned to participate in the clinical experience (preceptors).
Now, therefore, in consideration of the mutual promises contained herein, the parties hereby
agree as follows:
A.GREV ENT.
1: Program Participation.
RFD agrees that Pelham Students may participate in patient care activities through this
clinical affiliation with RFD within the discretion of RFD supervising personnel. RFD
will designate a qualified professional(s) to supervise Pelham Students assigned to
participate in the clinical experience with RFD. All academic aspects of the Educational
Program, including grading, examinations, evaluations, academic record keeping and the
like shall be the sole responsibility of Pelham.
2. RFD Responsibilities.
Contract No. 183--2019
2.1 The parties understand and agree that RFD shall maintain complete control over
the care of patients involved in the Educational. Program as stipulated herein. RFD
has the sole right to determine which patients Pelham Students will work with,
and this right includes the right to cancel any scheduled involvement with any
particular patient.
2.2 RFD agrees to provide, within RFD's sole discretion, such Preceptors, space and
facilities as are reasonably necessary to provide Pelham Students with appropriate
clinical experience at RFD's facilities and to enable the Preceptors to fulfill their
responsibilities. .
2.3 Pelham Students shall be subject to RFD's policies and procedures, including, but
not limited to, those relating to the confidentiality of patient and RFD records and
information. Pelham and RFD shall cooperate to provide Pelham Students with
appropriate orientation in respect to RFD's policies and procedures; the intention
of the parties being to maintain quality communication with appropriate input and
feedback designed to ensure that the expectations of both parties are met.
2.4 RFD and Pelham shall mutually agree upon a schedule of assigning Pelham
Students and Preceptors to participate in clinical experiences at RFD facilities.
2.5 RFD shall provide a list of all preceptors participating in this program along with
their certification numbers (and their PSID (Personal Safety Identification
Number if available) .
3. Pelham Responsibilities.
3.1 Pelham shall provide to RFD a statement of objectives for the Educational
. Program and a description of the types of clinical experiences which Pelham
wishes RFD to make available for Pelham Students.
3.2 Pelham shall provide to RFD a listing of the names of Pelham. Students to be
assigned to the Educational Program.
3.3 Pelham shall present for clinical experience at RFD's, facility only, those Pelham
Students who have satisfactorily completed the necessary academic and clinical
pre --requisites to participate in clinical activities at RFD's facility. Pelham
students will have updated letters identifying their current skill levels for each
clinical assignment.
3.4 Pelham will present for clinical experience at RFD's facility only those Pelham
Students who have met the health screening requirement established by RFD.
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3.5 Pelham will provide guidance and evaluate the performance of Pelham Students
assigned to RFD's facility. Pelham will ensure that all Pelham Students
participating in the Educational Program do so in -a safe and effective manner.
3.6 Pelham will ensure that Pelham Students comply with RFD's policies and
procedures and participate in RFD's quality assessment and improvement
programs upon request.
3.7 Pelham will ensure that Pelham Students comply with all applicable laves, rules,
regulations and standards while participating in the Educational Program,
including, but not limited to those issued by the Center for Medicare Services
(CMS), Indiana State Department of Health (ISDH), Joint Commission on
Accreditation of Health Care organizations (JCAHO), Commission on
Accreditation of Rehabilitation Facilities (CARF) and any other accrediting body
of RFD.
3.8 Pelham shall, at the Student's expense, conduct (or have -conducted) a criminal
background check on each and every student assigned to the Program. This
• criminal background check shall be a state or national level background check and
must be completed within the 12 months immediately preceding Student's
attendance into the program.
Should the background check disclose adverse criminal information as to any
student, Pelham has the authority to, and shall immediately communicate the said
information to RFD: RFD may determine at its discretion to remove said student
from participation in the Program at RFD.
3.9 Pelham students will present for clinical assignments attired in clearly marked
Pelham uniforms and clothing.
4. Insurance and Indemnification.
4.1 Professional Liability Insurance by RFD. During the term of this Agreement,
RFD shall maintain at its own expense professional liability insurance policies or
comparable coverage with limits to qualify RFD and RFD's employees, during
the, course and scope of their employrrient with.RFD, as health care providers
under the terms of the Indiana Medical Malpractice Act.
4.2 Professional Liability Insurance by Pelham. During the term of this Agreement,
Pelham shall maintain at its own expense professional liability insurance policies
or comparable coverage with limits to qualify Pelham and Pelham Students as
health care providers under the terms of the Indiana Medical Malpractice Act.
4.3 General Liability Insurance. During the term of this Agreement, each party
shall maintain General Liability Insurance at its own expense.
4.4 Mutual Responsibilities. Pelham and RFD shall remain responsible for the acts
of their respective employees and/or students and each partly shall promptly notify
the other of any claim made by or expected to be made from a claimant against
either Pelham or RFD, when said claim relates to the subject matter of this
Agreement. Pelham and RFD agree to -cooperate to resolve any such claim.
4.5 Indemnification by Pelham. Pelham shall indemnify and hold harmless RFD,
along with RFD's successors, assigns, directors, officers, employees, insures, and
agents from any claim, demand, loss, liability, cost or expense of whatsoever
nature, kind or description, whether by reason of injury to or death of person
resulting from the negligence of Pelham or Pelham Students arising out of this
. Agreement.
4.6 Indemnification by RFD. RFD shall indemnify and hold harmless Pelham,
along with Pelham's successors, assigns, directors, officers, employees, insurers
and agents from any claim, demand, loss, liability, cost or expense of whatsoever
nature, kind or description, whether by reason of injury to or death of person
resulting from the negligence of RFD or RFD employees arising out of this
Agreement.
5. Exposure and/or Injury.
5.1 Pelham. Pelham shall be solely responsible for ensuring compliance by Pelham
Students of applicable safety, environment of care, infection control policies and
procedures of RFD and other applicable OSHA/CDC rules, regulations and
standards. RFD shall not be liable for any .communicable disease, blood borne
pathogen or other exposures or injuries sustained by Pelham Students
participating in the Education Program, and Pelham agrees to indemnify and hold
RFD harmless from any and all claims, charges, causes of action and damages of
any kind associated with any such exposures or injuries.
5.2 RFD. If any Pelham Student should be exposed to a communicable disease,
blood borne pathogen or other exposures while participating in the Education
Program, Pelham Students should follow all reporting requirements and
procedures of both Pelham and -RFD relative to such an occurrence.
5.3 Emergency Department. If any Pelham Student should sustain an injury while
participation in the Education Program, the Pelham Student should follow all
reporting requirements and procedures of Pelham and RFD .relative to such an
occurrence. Additionally, the Pelham Student should be encouraged to seek
medical treatment with an acceptable Emergency Department.
6. Term and Termination.
6.1 Term. The term of this Agreement shall commence on the day of
• , 2019, ("Effective Date") and shall continue for a period of one
(1) year,unless otherwise terminated as provided herein. Thereafter, this
Agreement shall automatically renew for successive one (1) year periods unless
otherwise terminated as hereinafter described.
6.2 Early Termination. Either party may terminate this Agreement at any time, with
or without cause, by giving the other party thirty (3 0) days prior written notice
and, upon the expiration of such period, this Agreement shall be terminated.
6.3 Denial and Revocation. Notwithstanding anything else in. this Agreement to the
contrary, RFD shall have the right, for any reason RFD deems sufficient, to refuse
to permit any Pelham Student to be assigned to the Educational Program or to
terminate the assignment of any Pelham Students and/or Preceptors who are
assigned to the ' Educational Program.
7. • Miscellaneous Provisions.
7.1 Notice. Any notice required to be given by this Agreement shall be in writing and
be deemed given if delivered in person or by United States certified mail; return
receipt requested, and addressed to the party at its address set forth herein above;
or, to such other address as either party may from time to time designate by
written notice to the other party.
7.2 Entire Agreement. This Agreement contains the entire agreement between the
parties as to the subject matter of this Agreement and there have been and are no
other agreements, representations or warranties between the parties other than
those set forth herein. No oral statements or prior written materials not
specifically incorporated therein shall be of any force or effect.
7.3 Severability. In the event any provision of this Agreement is held to be
unenforceable or void for any reason, the remainder of.this Agreement shall be
unaffected and shall remain in full force and effect in accordance with its terms.
7.4 Assignment. Pelham and RFD shall not assign this Agreement without the prior
written approval of they other.
7.5 Governing Law. This Agreement shall be interpreted, governed and construed in
all respects by the laws of the State of Indiana.
7.6 waiver. Failure to. insist upon strict compliance with any of the terms, covenants,
or conditions of this Agreement shall not be'deemed a waiver of such terms,
covenants, or conditions.
7.7 - Amendments. This Agreement may be amended only by an instrument in writing
signed by the parties hereto.
7.8 Recitals. The recitals set forth above are incorporated by reference as if more
fully set forth at length herein.
7.9 Counterparts. This Agreement may be executed in two or more counterparts,
each of which shall, in the aggregate, be considered one and the same instrument.
7.10 Exclusion. The parties hereto now certify on behalf of themselves and their
respective employees that they have never been debarred, excluded or otherwise
determined to be ineligible from participation in any. federally -funded health care
program, including but not limited'to Medicare, Medicaid, and CHAMPUS, and
no proceedings are pending or have been threatened which might have the result
of debarment, exclusion or determination of ineligibility.
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IN WITNESS WHEREOF, the parties have signed this Agreement or caused the same to be
signed by their duly authorized officer on the dates set forth below.
City of Richmond, Indiana, by and
through its Board of Public Works and
Safety for the:
Richmond Fire Department: PELIUM SPECIALTY TRAINING, INC:
By. By.
.Authorized Representative Authorized Representative'
Vicki Robinson, President
Date: /-.��� Date: A� '7
-By:
AaAy. P lmer , -Member
By:
Matt Evans, Member
Approved:
;Dav-- 'S or
Date-