HomeMy WebLinkAbout2015-200 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 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 Oregon Medical Board ("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 EMS Providers as defined at Oregon law and rule; and (v) possesses thorough
knowledge of laws and rules of the State of Oregon pertaining to EMS Providers 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:
(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, 2015 and ending June 30, 2016.
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).
Page 1 - 2015-2016 Agreement for Provision of Services of EMS Supervising Physician
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
EMS Providers.
(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
Agency shall pay Physician $7,696 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 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.
7.0 DEA Registration
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.
Ashland Fire & R Ucu By 6 'L
_l Date 7 / t om
Title t C- i r- AP VED A FORM
PSR Physician Services, an Oregon Limited Liability Company Ach ityAttomey
D78 2
r
By Date f
Paul S. Rost kus, MD - Member
Page 2 - 2015-2016 Agreement for Provision of Services of EMS Supervising Physician
PSR Physician Services, LLC
436 Grandview Drive
Ashland, OR 97520
541-601-9709 rostykusmd@mind.net
July 1, 2015
Fire Chief
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 2015-2016 year. Please review this agreement, sign and return
one copy to me. Changes for this year include minor terminology editing, Term and
Compensation.
The total fee for Supervising Physician services by Paul S. Rostykus, MD, MPH for Ashland Fire
& Rescue for the year July 1, 2015 through June 30, 2016 is $7,696 due by September 30, 2015.
Please contact me if you have any questions.
Thank you.
Sincerely,
1
Paul S. Rostykus, MD, MPH
EMS Supervising Physician
Jackson County Ambulance and Fire Agencies
CITY OF
FORM #4 ASHLAND
DETERMINATIONS TO PROCURE
PERSONAL SERVICES
$59000 to $759000
To: Dave Kanner, Public Contracting Officer
From: John Karns, Fire Chief Ashland Fire & Rescue
Date: 07-15-2015
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 sgrvices:
(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, 7/17/2015
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 2.50120(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, 7/17/2015
CITY OF
ASHLAND
Council Communication
August 4, 2015, Business Meeting
Jackson County Supervising Physician Direct Award Request
FROM:
John Karns, Fire Chief, Ashland Fire & Rescue, karnsj@ashland.or.us
SUMMARY
This is a request to continue directly awarding sole source contracts to PSR Physician Services for
supervising physician services for up to five additional fiscal years at a cost of $7696.00 to $10,000.00
per fiscal year.
BACKGROUND AND POLICY IMPLICATIONS:
As with all emergency medical service (EMS) providers in Jackson County, Ashland Fire & Rescue is
required to work under direction of a county designated supervising physician per OAR 333-250-0047.
Paul S. Rostykus, MD, is licensed to practice medicine in Oregon, is qualified and approved as a
supervising physician and has been chosen by Jackson County Health and Human Services to act as
the supervising physician for Jackson County. Paul S. Rostykus, MD, is the sole provider for
supervising physician services in Jackson County for EMS providers.
COUNCIL GOALS SUPPORTED:
None.
FISCAL IMPLICATIONS:
The City of Ashland will pay PSR $7,696 for FY 2016. This cost is budgeted in AF&R's EMS
Division budget. Annual increases have averaged 3%.
STAFF RECOMMENDATION AND REQUESTED ACTION:
Staff recommends approval of continuing direct award of sole source contracts to PSR Physician
Services for up to five additional fiscal years.
SUGGESTED MOTION:
I move to approve the request to continue directly awarding sole source contracts to PSR Physician
Services for the supervising physician program for the next five years.
ATTACHMENTS:
Form #8, Sole Source Determination and Written Findings
Page 1 of I
FORM #8 CITY OF
ASHLAND
SOLE-SOURCE DETERMINATION AND WRITTEN FINDINGS
PERSONAL SERVICES
Greater than $75,000
To: City Council, Local Contract Review Board
From: John Karns, Fire Chief
Date: July 28, 2015
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:
FY 2016 - $7,696.00,
FY 2017 to FY 2020 - Estimate $7,696.00 to $10,000.00 per fiscal year
Project name: Supervising Physician
Description of project: Supervising Physician Services for EMS
Background:
All EMS providers in Jackson County are required to operate under the guidance of a
Supervising Physician. Jackson County Health and Human Services has chosen 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 Oregon Medical Board pursuant to OAR 847-035-
0020, as the Supervising Physician for Jackson County. Paul S. Rostykus will be the sole
provider for Supervising Physician services in Jackson County.
Findings:
[The endings below must include factual information supporting the determination].
Market Research Overall finding:
Paul S. Rostykus, MD is the qualified and approved Supervising Physician for all of Jackson
County and represents all three Ambulance Service Areas and EMS first responders.
Form #8 - Sole Source -Personal Services - Greater than $75,000, Page 1 of 3, 7/29/2015
[In accordance with ORS 279B. 075 these are the examples of findings 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 Endings are as
. ollows.
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.
N/A
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.
In accordance withthe state of Oregon OAR 333-250-0047, Ashland Fire & Rescue is required to
comply with the 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
Form #8 - Sole Source -Personal Services - Greater than $75,000, Page 2 of 3, 7/29/2015
PUBLIC NOTICE:
Pursuant to OAR 137-047-0275 (2), a Contracting Agency shall give public notice of the
Contract Review Authority's determination that the Goods and Services or class of Goods and
Services are available from only one source in a manner similar to the public notice of
Competitive Sealed Bids under ORS 279B.055(4) and OAR 137-047-0300. The public notice
shall describe the Goods or Services to be acquired by a Sole Source Procurement. The
Contracting Agency shall give such public notice at least seven days before Award of the
Contract.
After the Sole Source Procurement has been approved by the City Council, the following public
notice will be posted on the City's website to allow for the seven (7) day protest period.
Date Public Notice first appeared on www.ashland.or.us - ltfapproved by council, August i, 201-51
PUBLIC NOTICE
Approval of a Sole Source Procurement
First date of publication: ltfupproved by Council, .luoasr 5 20151
A request for approval of a Sole Source procurement was presented to and approved by
the City Council, acting as the Local Contract Review Board, on l y approved by Council
Ittgus7-l, 2015/.
It has been determined based on written findings that the following Personal Services are
available from only one source.
Paul S. Rostykus, MD is the qualified and approved Supervising Physician for
Jackson County and represents all three Ambulance Service Areas and EMS first
responders. The approval of this sole source procurement allows the Fire Department
to continue contracting directly with PSR Physician Services for these services.
The contract terms, conditions and specifications may be reviewed upon request by
contacting the Fire Chief, John Karns, at 541 -488-2770.
An affected person may protest the determination that the personal services are available
from only one source in accordance with OAR 137-047-0710. A written protest shall be
delivered to the following address: City of Ashland, John Karns, Fire Chief, 455 Siskiyou
Blvd, Ashland, Or 97520. The seven (7) day protest period will expire at 5:00pm on [If
posted on August 5th the expiration date will be August 12, 2015].
This public notice is being published on the City's Internet World Wide Web site at least
seven days prior to the award of a public contract resulting from this request for approval
of a Sole Source procurement.
Form #8 - Sole Source -Personal Services - Greater than $75,000, Page 3 of 3, 7/2912015
Page 1 / 1
CITY OF r°•
ASHLAND i DATE PO NUMBER
20 E MAIN ST. 7/28/2015 13032
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 006381 SHIP TO: Ashland Fire Department
PSR PHYSICIAN SERVICES, LLC, DR. PAUL ROSI (541) 482-2770
ATTN: PAUL ROSTHYKUS MD 455 SISKIYOU BLVD
436 GRANDVIEW DR ASHLAND, OR 97520
ASHLAND, OR 97520
FOB Point: Ashland, Oregon Req. No.:
Terms: Net 30 days Dept.:
Req. Del. Date: Contact: Kimberley Summers
Special Inst: Confirming? NO
Quantity Unit Description Unit Price Ext. Price
THIS IS A REVISED PURCHASE ORDER
EMT Supervisinq Phvsician Services for 7,696.00
Ambulance - FY 2016
Note: Seekinq Council approval on
Auqust 4, 2015 to continue directly
awardinq sole source contracts to PSR
Physician Services.
SUBTOTAL 7,696.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 7,696.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 110.07.13.00.60415 7,696.00
i
Authorized Signature VENDOR COPY
FORM #3 CITY OF
ASHLAND
REQUISITION Date of request: 07-15-2015
Required date for delivery:
Vendor Name PRR Physirian Raniirac I I C'
Address, City, State, Zip 436 Grandview Ashland. Oregon 97520
Contact Name & Telephone Number 541-601-9709
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: ❑ Written quote or proposal attached
❑ Written quote or proposal attached Attach co of council communication If council approval required, attach co of CC
❑ Small Procurement Cooperative Procurement
Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ Direct Award Date approved by Council:
Contract #
❑ Verbal/Written quote(s) or proposal(s) -(Attach copy of council communication) ❑ State of Washington
Intermediate Procurement Sole Source Contract #
GOODS & SERVICES Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
$5,000 to $100,000 Written quote or proposal attached Agency
❑ (3) Written quotes and solicitation attached Form #4, Personal Services $5K to $75K Contract #
PERSONAL SERVICES ❑ Special Procurement Intemovemmental Agreement
$5,000 to $75,000 ❑ Agency
❑ Form #9, Request for Approval
❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council:
❑ (3) Written proposals/written solicitation Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Date - (Attach copy of council communication)
Description of SERVICES Total Cost
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
1 12 1 1 $7,696
FY 2016 EMT Supervising Physician Services for Ambulance
TOTAL COST
Per attached quote/proposal $ 7,696.00
Project Number---------- Account Number 110.07.13.00.604150
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:
IT Director Date Support -Yes/ No
By signing this requisition form, I certify that Ztheft's public contracting requirements have been satisfied.
Employee: P ,1,~~ Department Head:
Department Manager/Supervisor: City Administrator: ( (Equalko or greaterthan $5,000)
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year NO Joy/!
Finance Dire tor- (Equal to or greater than $5,000) a
Comments:
Form #3 - Requisition