HomeMy WebLinkAbout2013-245 Agrmt - PSR Physician Services
Agreement for Provision of Services
of EMS Supervising Physician
This Agreement is made on the date last written below by and between PSR Physician
Services, an Oregon limited liability company ("Physician") and Ashland Fire & Rescue
("Agency').
Recitals
A. Physician provides that Paul S. Rostykus, MD is licensed to practice medicine in the
State of, and is qualified and approved as a Supervising Physician by the Oregon
Health Authority per OAR 847-035-0020.
B. Agency would like Physician to provide Supervising Physician services per OAR 847-
035-0025.
C. All services hereunder shall be performed exclusively by Paul S. Rostykus, MD.
Agreement
1.0 Scope of Services
Physician shall perform the following services:
(i) The duties of Supervising Physician as described in OAR 847-035-0025,
including the ability to delegate responsibilities to the Agency as provided therein.
(ii) Coordinate Agency activities with other EMS agencies in Jackson County.
(iii) Evaluate and make recommendations concerning Agency's EMS training
programs, equipment, and apparatus.
(iv) Coordinate with Agency administration the implementation of disciplinary
measures that would limit or modify an EMS provider's scope of practice or
duties.
2.0 Term
The term of this Agreement shall be one (1) year, commencing July 1, 2013 and ending
June 30, 2014. Either party may terminate this Agreement at any time for any reason upon
sixty (60) days advance written notice to the other.
3.0 Physician Insurance
Physician shall maintain professional malpractice insurance with coverage limits of not
less than one million dollars ($1,000,000.00).
4.0 Agency Duties
Agency shall commit sufficient staff, resources, and other support to enable Physician to
carry out its duties as Supervising Physician pursuant to OAR 847-035-0025 and other
requirements of Oregon law, including, but not limited to:
(1) Provision of a designated Agency liaison to provide single-point communication
with the Agency and to help carry out the provisions of this Agreement.
(ii) Provide means and support for documentation and record keeping to enable
Physician to perform his duties hereunder.
(iii) Provide timely response to the recommendations of Physician.
(iv) Provide in-service training programs to help meet the recertification requirements
of Agency's EMS providers.
Page 1 - 2013-2014 Agreement for Provision of EMS Supervising Physician Services
(v) Maintain an effective quality assurance program for Agency operations.
(vi) Maintain professional malpractice insurance for Agency's EMS providers with
coverage limits of not less than one million dollars ($1,000,000.00).
5.0 Compensation
Agericy shall pay Physician $7,361 per year as compensation for the services
performed under this Agreement. Payment shall be made no later than the 30th of September
of the term of this Agreement, unless other arrangements have been mutually agreed to.
6.0 DEA Controlled Substances
If Agency provides EMS care at the level of AEMT, EMT-Intermediate or Paramedic
which involves the use of DEA (Drug Enforcement Administration) Controlled Substances, the
Agency will obtain a DEA Registration in the name of Paul S. Rostykus, MD and will comply
with all regulations and policies regarding Controlled Substance use.
7.0 Miscellaneous
7.1 Independent Contractor. Physician is an independent contractor and not an
employee of Agency.
7.2 Assignment. This Agreement may not be assigned by either party.
7.3 Nonwaiver. Waiver by either party of strict performance of any provision of this
Agreement shall not be a waiver of or prejudice the party's right to require strict
performance of any other provision.
7.4 Attorney Fees. If suit or action or arbitration is instituted in connection with any
controversy arising out of this Agreement, the prevailing party shall be entitled to
recover in addition to costs such sums as the arbitrator or court may adjudge
reasonable as attorney fees at trial, on petition for review, and on appeal.
7.5 Applicable Law and Jurisdiction. This Agreement shall be governed by and
construed in accordance with the laws of the state of Oregon. Jurisdiction shall be
in state or federal court in Jackson County, Oregon.
Ashland Fire & Rescue
By X,0, K".", Date / ( l l3
Title r-t R c_ CGIq (4t
PSR Physician Services, an Oreg Limited Liability Company
By Date
Paul S. Rostykus, - Member
Ind as to forrry
Page 2 - 2013-2014 Agreement for Provision of EMS Supervising Physician Services
PSR Physician Services, LLC
436 Grandview Drive
Ashland, OR 97520
541 601-9709 drrostykus@jcems.net
June 1, 2013
Ashland Fire & Rescue
455 Siskiyou Blvd.
Ashland, OR 97520
John Karns,
Enclosed are two copies of the Agreement for Provision of EMS Supervising Physician Services
for Ashland Fire & Rescue for the 2013-2014 year. Please review this agreement, sign and return
one copy to me. Changes for this year include Term, Compensation and new item 6.0 regarding
DEA Controlled Substances.
The total fee for Supervising Physician services by Paul S. Rostykus, MD, MPH for Ashland Fire
& Rescue for the year July 1, 2013 through June 30, 2014 is $7,361 due by September 30, 2013.
Please contact me if you have any questions.
Thank you.
Sincerely,
law
Paul S. Rostykus, MD, MPH
EMS Supervising Physician
Jackson County Ambulance and Fire Agencies
CITY L Page 1 / 1
C I T Y OF CITY F~tC(~ M DATE PO NUMBER
ASHLAND
7/10/2013 11689
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 006381 SHIP TO: Ashland Fire Department
482-2770
PSR PHYSICIAN SERVICES, LLC, DR. PAUL ROSI (541
436 GRANDVIEW DR 455 5 AND, OU BLVD
ASHLAND, OR 97520 ASHLLAND, OR 97520
FOB Point: Req. No.:
Terms: Net 30 davs Dept.:
Req. Del. Date: Contact: Greq Case
Special Inst: Confirming? No.
NO
Quantity Unit Description Unit Price Ext. Price
1.00 Vr Ambulance Service EMS Medical Director 7,361.00 7,361.00
contract renewal
SUBTOTAL 7.361.001
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 7,361.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 110.07.13.00.60415 7,361.00
VENDOR
A thorized Signature COPY
FORM#3 CITY OF
-ASHLAND
A rey.iesr.for Purchase Order 3
REQUISITION Date of request: Re
Vendor Name PSR Physician Services LLC
Address, City, State, zip 436 Grandview Drive , Ashland OR
RECEIVED
Contact Name & Telephone Number
Fax Number Paul Rostykus MD 541- 601 9709
~ ~U~ 3iF~ ZQj3 SOURCING METHOD
>'ryj 5 t9N z
❑ Exempt from Competitive Bidding
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ra
❑ AMC 2.50 Date approved by Council: 4?" x aj,g
❑ Written quote or proposal attached
❑ Small Procurement
Less than $5,00 0 ❑ Request for Proposal (Copies on file)
❑ Direct Award Date approved by Council:
❑ VerbalMritten quote(s) or proposal(s)
Intermediate Procurement lR Sole Source f O -
GOODS & SERVICES Ed Applicable Form (#5,6, 7 or 8) t r$5,000 to $100,000 Written quote or proposal attached L plltNr) Ay,
❑ (3) Written quotes and solicitation attached Form #4, Personal Services $5K to 75K Contr 1
PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement
$5,000 to $75,000 ❑ Form #0, Request for Approval ❑ Agency
❑ Less than $35,000, by direct appointment ❑ Witten quote or proposal attached Date original contract approved by Council:
❑ (3) Written proposals/written solicitation Date approved by Council: (Dale)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
Item # Quantity Unit Description of MATERIALS Unit rice Total Cost
TOTAL COST
❑ Per attached quotelproposal $
Project Number Account Number )/0-67.13•00.60i-'b
Account Number Account Number
'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
ITDirector Date Support -Yes/No
By signing thisr ' ition f erlify that the City's public contracting requirements hay C been satisfied...
Employee Signature: Department Head Signature: f ' l'•u1 kA_
t (Equal to or greater than $5,000)
City Administrator:
(Equal to or later than $25,000)
Funds appropriated for current fiscal year: YE / NO ✓ hul ~s k. .'I - (
Fina c Director- (Equal lo orgreaterthan $5,000) Date
Comments:
,
Form #3 - Requisition
CITY OF
FORM #4 ASHLAND
DETERMINATIONS TO PROCURE
PERSONAL SERVICES
$5,000 to $75,000
To: Dave Kanner, Public Contracting Officer
From: John Karns, Fire Chief
Ashland Fire & Rescue
Date: 7/01/2013
Re: DETERMINATIONS TO PROCURE PERSONAL SERVICES
In accordance with AMC 2.50.120(A), for personal services contracts greater than $5,000, but less
than $75,000, the Department Head shall make findings that City personnel are not available to
perform the services, and that the City does not have the personnel or resources to perform the
services required under the proposed contract. However, the City Attorney, the Public Contracting
Officer, or Local Contract Review Board, can require a formal solicitation for bids to ensure that the
purposes of this chapter are upheld.
Background
In accordance with the state of Oregon OAR 333-250-0047 Ashland Fire & Rescue is required to
Ambulance Service EMS Medical Director Operational Requirements
(1) The licensee must have a single EMS Medical Director except:
(a) When the licensee operates in non-contiguous counties, then the licensee may have one
EMS Medical Director in each non-contiguous county of operation; or
(b) Where a county or regional EMS system prescribes that multiple agencies within a county or
region must have a governmentally appointed EMS Medical Director, that agency may have a
different EMS Medical Director in contiguous counties. In this event, the signed agreement or
contract may be between the EMS Medical Director and the county or regional EMS system.
Physician shall perform the following services:
(i) The duties of Supervising Physician as described in OAR 847-035-0025,
including the ability to delegate responsibilities to the Agency as provided therein.
(ii) Coordinate Agency activities with other EMS agencies in Jackson County.
(iii) Evaluate and make recommendations concerning Agency's EMS training
programs, equipment, and apparatus.
(iv) Coordinate with Agency administration the implementation of disciplinary
measures that would limit or modify a First Responder or EMT's scope of practice or duties.
Agency shall pay Physician $7,361 per year as compensation for the services
performed under this Agreement.
The term of this Agreement shall be one (1) year, commencing July 1, 2013 and ending
June 30, 2014. Either party may terminate this Agreement at any time for any reason upon
sixty (60) days advance written notice to the other.
PaulS. Rostykus, MD who is licensed to practice medicine in the
State of Oregon, and is qualified and approved as a Supervising Physician by the Board
of Medical Examiners ('Board") pursuant to OAR 847-035-0020
Pursuant to AMC 2.50.120(A), has a reasonable inquiry been conducted as to the availability of
City personnel to perform the services, and that the City does not have the personnel and resources
to perform the services required under the proposed contract?
Paul S. Rostykus, MD is the qualified and approved as a Supervising Physician for all of
Jackson county and represents all three Ambulance Service Areas for the county. Paul S.
Rostykus, MD is the sole provider of these services .
Pursuant to AMC 2.50.120(A), has a reasonable inquiry been conducted as to the availability of
City personnel to perform the services, and that the City does not have the personnel and resources
to perform the services required under the proposed contract?
[Provide clear and concise information to support this determination.]
Form #4 - Department Head Determinations to Procure Personal Services, Page 2 of 2, 6/1012013
FORM #7 CITY OF
ASHLAND
SOLE-SOURCE DETERMINATION AND WRITTEN FINDINGS
PERSONAL SERVICES
Less than $75,000.
To: Dave Kanner, Public Contracting Officer
From: John Karns, Fire Chief
Ashland Fire & Rescue
Date: 7/01/2013
Re: Sole Source Determination and Written Findings for Personal Services
In accordance with AMC 2.50.090(F), the Department Head shall determine in writing that there
is only one provider of a product or service of the quality and type required available.
Estimated total value of contract: $7,361 per year as compensation for the
services performed under this Agreement.
Project name: Supervising Physician Services Contract
Description of project: Ambulance Service EMS Medical Director contract renewal.
Background:
In accordance with the state of Oregon OAR 333-250-0047 Ashland Fire & rescue is required to:-
Have an Ambulance Service EMS Medical Director
Operational Requirements
(1) The licensee must have a single EMS Medical Director except:
(a) When the licensee operates in non-contiguous counties, then the licensee may
have one EMS Medical Director in each non-contiguous county of operation; or
(b) Where a county or regional EMS system prescribes that multiple agencies within
a county or region must have a governmentally appointed EMS Medical Director,
that agency may have a different EMS Medical Director in contiguous counties. In
this event, the signed agreement or contract may be between the EMS Medical.
Director and the county or regional EMS system.
Physician shall perform the following services:
Form #7 - Sole Source -Personal Services - Less than $75,000, Page 1 of 3, 6/1012013
(i)The duties of Supervising Physician as described in OAR 847-035-0025,
including the ability to delegate responsibilities to the Agency as provided therein.
(ii} Coordinate Agency activities with other EMS agencies in Jackson County. (iii)
Evaluate and make recommendations concerning Agency's EMS training
programs, equipment, and apparatus.
(iv} Coordinate with Agency administration the implementation of disciplinary measures
that would limit or modify a First Responder or EMT's scope of practice or duties.
Agency shall pay Physician $7,361 per year as compensation for the services
performed under this Agreement.
The term of this Agreement shall be one (1) year, commencing July 1, 2013 and ending
June 30, 2014. Either party may terminate this Agreement at any time for any reason upon
sixty (60) days advance written notice to the other.
Paul S. Rostykus, MD who is licensed to practice medicine in the
State of Oregon, and is qualified and approved as a Supervising Physician by the
Board of Medical Examiners ("Board") pursuant to OAR 847-035-0020
Identify the prospective Contractor in your background statement.]
Findings:
[The findings below must include actual information supporting the determinationl.
Market Research Overall finding:
Paul S. Rostykus, MD is the qualified and approved as a Supervising Physician for all of
Jackson county and represents all three Ambulance Service Areas for the county. Paul S.
Rostykus, MD is the sole provider of these services .
[In accordance with ORS 279B.075 these are the examples ofrIndings that should be addressed.
Select at least one of the findings and prepare the determination as it specifically relates to the
good or service being procured. More than one finding can be addressed. The rindinks are as
follows.
Pursuant to ORS 279B.075 (2)(a): Provide findings supporting your determination that the
efficient utilization of existing goods requires the acquisition of compatible goods or
services from only one source.
Paul S. Rostykus, MD is the qualified and approved as a Supervising Physician for all of
Jackson County and represents all three Ambulance Service Areas for the county. Paul S.
Rostykus, MD is the sole provider of these services.
Pursuant to ORS 279B.075 (2)(b): Provide findings supporting your determination that
the goods or services required for the exchange of software or data with other public or
private agencies are available from only one source.
Pursuant to ORS 27913.075 (2)(c): Provide findings supporting your determination that the
goods or services are for use in a pilot or an experimental project.
Form #7 - Sole Source -Personal Services - Less than $75,000, Page 2 of 3, 6/10/2013
Pursuant to ORS 27913.075 (2)(d): Any other findings that support the conclusion that the
goods or services are available from only one source.
Paul S. Rostykus, MD is the qualified and approved as a Supervising Physician for all of
Jackson County and represents all three Ambulance Service Areas for the county. Paul S.
Rostykus, MD is the sole provider of these services.
Form #7 - Sole Source -Personal Services - Less than $75,000, Page 3 of 3, 6/10/2013