HomeMy WebLinkAbout2012-195 Agrmt - PSR Physician SRVCs Agreement for Provision of Services
of EMT 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 employs 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. Physician represents
that Paul S. Rostykus, MD is (i) currently'licensed to practice medicine under ORS
Chapter 677 and is actively registered and in good standing with the Board; (ii) is
currently engaged in the practice of medicine; (iii) is a resident of and is actively
practicing in the area in which the emergency service is located; (iv) possesses the
knowledge of skills assigned by standing order to Emergency Medical Technicians and
First Responders as defined at Oregon law; and (v) possesses thorough knowledge of
laws and rules of the State of Oregon pertaining to Emergency Medical Technicians and
First Responders as required by Oregon law.
B. Agency would like to employ Physician to perform services as the Supervising
Physician pursuant to OAR 847-035-0020.
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:
(1) 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.
Page 1 —2012-2013 Agreement for Provision of Services of EMT Supervising Physician
2.0 Term
The term of this Agreement shall be one (1) year, commencing July 1, 2012 and ending
June 30, 2013. 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:
(i) 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 First Responders and EMTs.
(v) Maintain an effective quality assurance program for Agency operations.
(vi) Maintain professional malpractice insurance for Agency's First Responders and
EMTs with coverage limits of not less than one million dollars ($1,000,000.00).
5.0 Compensation
Agency shall pay Physician $7,267 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.
Page 2—2012-2013 Agreement for Provision of Services of EMT Supervising Physician
6.0 Miscellaneous
6.1 Independent Contractor. Physician is an independent contractor and not an
employee of Agency.
6.2 Assignment. This Agreement may not be assigned by either party.
6.3 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.
6.4 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.
6.5 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 �-6'r�-�` hC--G Date -7 / I I / 12-
Title rttQF &/IIFc
PSR Physician Services, an Oregon Limited Liability Company
By- Date 7/11/2012
Paul S. Rostykus, MD - Member
N as to form
Page 3—2012-2013 Agreement for Provision of Services of EMT Supervising Physician
PSR Physician Services, LLC
436 Grandview Drive
Ashland, OR 97520
541601-9709 drrostykus@jcems.net
July 1, 2012
Ashland Fire&Rescue
455 Siskiyou Blvd.
Ashland, OR 97520
John Karns,
Enclosed are two copies of the Agreement for Provision of Services of EMT Supervising
Physician for Ashland Fire& Rescue for the 2012-2013 year. This agreement is an addendum to
the agreement for 2011-2012, with changes to two sections: Term and Compensation. Please
review this addendum, sign and return one copy to me.
The total fee for Supervising Physician services by Paul S. Rostykus, MD, MPH for Ashland Fire
& Rescue for the year July 1, 2012 through June 30, 2013 is$7,267 due by September 30, 2012.
Please contact me if you have any questions.
Thank you.
Sincerely,
)
At
Paul S. Rostykus, MD, MPH
Supervising Physician Jackson County EMS
Page 1 / 1
�. ASHLAND CITY RECar,, ;: ATE PO NUMBER
20 E MAIN ST. 7/24/2012 11034
ASHLAND, OR 97520
(541)488-5300
VENDOR: 006381 SHIP TO: Ashland Fire Department
PSR PHYSICIAN SERVICES, LLC, DR. PAUL ROSI (541)482-2770
436 GRANDVIEW DR 455 SISKIYOU BLVD
ASHLAND, OR 97520 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net 30 days Dept.:
Req.Del.Date: Contact: John Karns -Greq Case
Special Inst: Confirming? No
Quantity Description - Unit Price Ext.Price
EMT Supervisinq Physician for 7,267.00
Ambulance/Paramedics FY 2013
Aqreement for Provision of Services
of EMT Supervisinq Physician
Term: July 1, 2012 to June 30, 2013
SUBTOTAL 7,267.00
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 7,267.00
ASHLAND, OR 97520
Account Number Project Number. Amount Account Number Project Number Amount
E 110.07.13.00.604150 7,267.00
Autftofized Signature VENDOR COPY
FORM #3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request:
Required date for delivery: E L
Vendor Name PSR Physician Servires I IC
Address,City,State,Zip 436 Grandview Drive Ashland Or. 97520
Contact Name&Telephone Number Paul Rostykus MD 541601-9709
Fax Number
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form#13,Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Wdtlen quote or proposal attached
❑ Written quote or proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ DireclAward Date approved by Council: Contract#
❑ Verbal/Wrilten quote(s)or proposal(s) ❑ State of Washington
Intermediate Procurement Sole Source Contract#
GOODS&SERVICES Applicable Form(0,6,7 or 8e, ❑ Other government agency contract
$5,000 to$100.000 Written quote or proposal attached Agency
❑ (3)Written quotes attached Special Procurement Contract If
PERSONAL SERVICES ❑ Form#9,Request for Approval Intergovemmental Agreement
$5.000 to$75,000 ❑ Written quote or proposal attached ❑ Agency
❑ Less than$35,000,by direct appointment Date approved by Council: Date original contract approved by Council:
❑ 3 Written proposals attached Valid until: Dale (Dale)
Description of SERVICES Total Cost
EMT Supervising Physician services for ambulance / Paramedics $ ,?67:00
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
❑ Per attached quote/proposal TOTAL COST
Project Number ___ Account Number j[D -
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 fh' form,I certify that the City's public contracting requirements have been satis ied.
Employee Signature:__— Department Head Signature:
ual to or greater han$5,000)
Additional signatures(if applicable): �-� Ol
Funds appropriated for current fiscal year. 1 ES / NO /Z—
l/ Finance Director-(Equaltoorg erthan$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: 7-17/2012
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.
Form#4-Department Head Determinations to Procure Personal Services,Page 1 of 2,7/17/2012
Agency shall pay Physician $7,267 per year as compensation for the services
performed under this Agreement.
The term of this Agreement shall be one (1) year, commencing July 1, 2012 and ending
June 30, 2013. 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
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 .
Form#4-Department Head Determinations to Procure Personal Services,Page 2 of 2,7/17/2012
CITY OF
FORM #7 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: 7-17/2012
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: $7,267 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:
(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.
Form#7-Sole Source-Personal Services—Less than$75,000,Page 1 of 2,7/1712012
(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 $7,267 per year as compensation for the services
performed under this Agreement.
The term of this Agreement shall be one (1) year, commencing July 1, 2012 and
ending June 30, 2013. 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
Findings: .
[The findings below must include factual 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 .
fln accordance with ORS 279B.075, these are the examples offindinzs that should be addressed.
Select at least one of the rndino and prepare the determination as it specifically relates to the
good or service beinz procured. More than one finding can be addressed. The findings are as
follows.
Pursuant to ORS 27913.075 (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 27913.075 (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. N/A
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. N/A
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 2 of 2,7/17/2012