HomeMy WebLinkAboutAgenda - 06-08-2004-5fORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 8, 2004
Action Agenda
Item No.
SUBJECT: Contract Renewal with UNC Family Medicine and Health Department
DEPARTMENT: Health
ATTACHMENT(S):
Contract
PUBLIC HEARING: (Y/N) No
INFORMATION CONTACT:
Rosemary Summers, ext 2411
TELEPHONE NUMBERS:
Hillsborough 732-8181
Chapel Hill 968-4501
Durham 688-7331
Mebane 336-227-2031
PURPOSE: To consider a contract renewal with UNC Family Medicine and Health Department
for Physician Services,
BACKGROUND: This contract covers all physician services far the Health Department,
including communicable disease consultation, clinic supervision and direct clinical services,
mandated oversight of all nurse practitioners, and consultation on protocol development and
quality assurance. The contract also includes oversight of two nurse practitioners at the Chapel
Hill-Carrboro City Schools (paid for by the CHCCS). Back-up services are also included in the
contract for vacation and sick coverage, The contract amount is $132,1 12 far the year, a 5%
increase over the current year. The increase primarily covers an increase in medical
malpractice that UNC Family Medicine has experienced, The Health Department's malpractice
coverage increased 8% for the coming year. The physicians will begin providing 24-hour call
consultation and supervision for the Health Department's nurse practitioners in January when
the Department begins providing primary care services, Last year, the Health Department had
over 11,000 clinical visits and more than 2,500 home visiting contacts.
FINANCIAL IMPACT: The contract for FY 2004-2005 is $132,112, a 5% increase over the
current year as noted above, and represents ,70 full time equivalent (FTE) of a physician's time
including medical back-up. Chapel Hill-Carrboro City Schools will be reimbursing the Health
Department $4,776 for oversight of the two nurse practitioners in the school system. These
amounts have been included in the Health Department's requested budget for FY 2004-2005,
RECOMMENDATION(S): The Manager recommends that the Board approve the contract
renewal and authorize the Chair to sign pending approval of the FY 2004-2005 budget and
county attorney review,
May 19, 2004
STATE OF NORTH CAROLINA
COUNTY OF ORANGE
AGREEMENT
2
TH15 AGREEMENT, made and entered into this first day of July 2004, by and between
The University of North Carolina at Chapel Hill, hereinafter referred to as "The University,"
for its Department of Family Medicine in the School of Medicine, hereinafter referred to as
the "Department" and the Orange County Health Department, hereinafter referred to as
the "OCHD."
WITNESSETH:
WHEREAS, the Department desires to provide Medical Director services and to
participate in the provision of medical care for the citizens of the community, andj
WHEREAS, the OCHD is the operator of two outpatient facilities known as the Orange
County Health Department, located in Chapel Hill and Hillsborough, North Carolina.
NOW, THEREFORE, in consideraticn of the premises and the following mutual
covenants and conditions and any sums to be paid, the OCHD and The University
agree as follows:
The Department will render professional consultation as Medical Director. As
Medical Director, the Department shall:
a. act as the principal advisor to the Health Director and Personal Health
Services Director in matters of medical policy,
b. advise the Health Director and Personal Health Services Director on the
medical implications of alternatives in clinical program functioning and
management;
c. represent the OCHD in interagency relationships which involve medical
expertise at the request of the Health Director;
AGREEMENT Between UNC School of Medicine
And Orange County Health Department
Page 2 of 10
d. advise and interpret the regulatcry requirements related to medical
aspects of the OCHD'S functions;
e, provide coordination for medical components of the clinical programs of
the OCHD;
f, advise and assist staff in epidemiological investigations;
g, be responsive to community public health concerns directly and in
consultation with the Health Director and Division Directors;
h. assist the Health Director and Personal Health Services Director in
establishment of medical procedures and quality/quantity control
mechanisms;
i. assist in data analysis towards identification of public health concerns;
j. work with the Health Director and Division Directors on formulation of
responses to public health concerns;
k, assist with evaluation of medical programs and services, including
recommendations for constructive change;
L. maintain close contact and availability through on-site visits and phone
consultation to discharge responsibilities at the OCHD;
m, participate in Division Head management meetings and Division level
meetings when requested and appropriate;
n. attend Board of Health meetings when requested;
o. provide medical direction to the school health programs in both school
systems in the County and medical consultation to both OCHD and school
staff working in the school health programs;
p, discharge the above listed responsibilities through and with knowledge
aforehand of the Health Director;
r, other miscellaneous duties as necessary..
2, The Department shall provide agreed upon medical direction and clinician
services in compliance with State and Federal guidelines and program rules far
3
the following programs: family planning (FP), prenatal care (PNC), child health
AGREEMENT Between UNC School of Medicine
And Orange County Health Department
Page 3 of 10
(CH), adolescent health (ADOL), tuberculosis (TB), sexually transmitted disease
(STD), general communicable disease control (GEN), adult health preventive
services (AH/HP), and Primary Care (PC). Clinical duties shall include:
a. Collaborative development and approval of clinic protocols; for the mutual
benefit of the Department, OCHD and its prenatal patients, it is agreed by
both parties that prenatal patients will be managed according to OCHD
established protocols. These will be reviewed annually and be consistent with
protocols used at UNC Department of OB/GYN and Family Medicine outlying
clinics,
b. Primary medical supervision of the nurse practitioners who are employees of
the OCHD;
c. Co-signing charts of patients seen by new nurse practitioners of the OCHD
within five (5) working days for at least the first six months of their practice,
and face-to-face consultation on a weekly basis for the first month after
approval and at least monthly for the succeeding five months;
Routine medical services during scheduled on-site clinic times as requested,
including documentation of clinical services per OCHD protocol;
e. Medical consultation visits to OCHD patients during scheduled on-site clinic
times;
f. Continuing education consultation for nurse practitioners and other staff to
include regular informal consultation and periodic formal sessions as
appropriate;
g, After-hours medical consultation far primary care patients: HealthLink will
provide initial triage of after-hours calls, OCHD Clinicians (3 FNPs and 1 MD)
will provide medical consultation on a rotating basis for clients referred by
HealthLink (1 week/month/clinician), Medical Director or designee will provide
after-hours consultation to on-call FNP as needed.
h, Medical supervision of two School Nurse Practitioners employed through the
Chapel Hill/Carrboro City Schools as outlined in Addendum A of this
agreement.
3, The Chair of the Department shall designate the name of the Medical Director
and the names of any physicians who will provide clinical services. The Medical
Director shall be board certified in Family Medicine or an equivalent certification,
AGREEMENT Between UNC School of Medicine 5
And Orange County Health Department
Page 4 of ~ 0
a, Any changes in these designations will be mutually agreed to by the Chair of
the Department and the Health Director
b, The Department and OCHD shall indicate their mutual agreement to the
designation of the Medical Director and any other physicians involved as
described above by signing the "Designation of Medical Director" attachment
to this contract,
4. This agreement covers any and all clinics conducted by OCHD in the program
areas listed in #2 above,
5. Clinics are operational during the normal business hours of 8:00 a.m. to 5:00 p.m„
Monday through Friday, One clinic day per site will operate on a flexible evening
schedule (e.g. 10:30 AM - 7:30 PM) to provide greater access to care. Clinics may
run beyond their scheduled time. The Department is responsible for medical activities
conducted during the entirety of these hcurs.
6. On-site physician attendance shall occur for a total of 20 hours per week in the
clinical setting, Days and times of this coverage will be mutually agreed to by the
Department and OCHD, Although Medical Director or back-up physician attendance
is not required on premises at other times, it should be available as stipulated above,.
At least 8 hours of direct administrative/consultative time shall be available to OGHD
staff weekly, On-site back-up coverage is expected during vacations and other
anticipated absences, Physicians are responsible for notifying OCHD of schedule
changes. If physician attendance is impossible due to unremediable circumstances,
physician phone coverage will be provided and nurse practitioner charts will be signed
within five (5) working days,
7, The Medical Director or other designated physicians will be available for phone
consultation during all business hcurs and after-hours coverage, and emergency
AGREEMENT Between UNC School of Medicine 6
And Orange County Health Department
Page 5 of 10
phone consultation shall be available as needed during non-business hours through a
pager system. Phone coverage will also be provided for consultation and direction for
communicable disease/epidemic control. At the request of the Health Director, the
physician will provide on-site medical supervision during communicable disease
incidents.
8. The Department agrees to provide the equivalent of ,70 FTE to carry out the duties
described above. The clinical and administrative services will be provided primarily
by the Medical Director, with other designated physicians providing back-up
coverage, Substitutions in designated physician back-up will be the responsibility of
the Department in consultation with the Health Director. Vacation leave, continuing
education, and other assignments requiring back-up coverage will be mutually agreed
upon by the Chair of the Department and the Health Director, The Medical Director
will report activities and services performed to OCHD as requested by the Health
Director.
9, The Department will maintain current registration and licensure and shall provide
copies to the OCHD as appendices to the Designation of Medical Director
attachment to this contract,
10. The Department will assure that physicians covered under this agreement are in
compliance with OSHA guidelines regarding bloodborne pathogens including
Hepatitis B and TB status as well as documentation of immunization against
measles, mumps, rubella and varicella. In the event of a bloodborne pathogen
exposure, the Department will be responsible for providing follow-up according to
its policies and procedures governing exposure incidents.
AGREEMENT Between UNC School of Medicine 7
And Orange County Health Department
Page 6 of 10
11. The University will be responsible for the negligence of its employees and agents
to the extent of the North Carolina Tort Claims Act. Further, the University will
provide adequate professional liability insurance for the University and personnel
who provide the services described in the agreement. The insurance limits will
be stated in a Confirmation of Insurance submitted at the time the contract is
commenced.
12. The Department will offer medical consultation in accord with the accepted
methods and procedures.
13. The OCHD agrees to pay the Department in return for the above services equal
monthly installments of ELEVEN THOUSAND AND NINE DOLLARS
($11,009.00) for a total of $132,108.
14. The University shall bill the OCHD on a monthly basis with the first bill being
dated July 1, 2004 and the OCHD shall pay the University within thirty (30) days
of receipt of the University's bill. Any adjustments to the billing shall be taken
into account in the next succeeding bill or as soon thereafter as reasonably
practicable.
15. The OCHD agrees to furnish all supplies, equipment, office space and a
computer as needed by the Medical Director; to include the Medical Director in
all appropriate conferences, meetings, correspondence and publications
necessary to appropriately discharge the Medical Director's duties within
budgetary constraints..
16. In the event that the Medical Director and back-up physician become unwilling or
unable to perform the duties required by this Agreement, The University and
AGREEMENT Behveen UNC School of Medicine
And Orange County Health Department $
Page 7 of 10
OCHD shall attempt to mutually agree upon replacement. If such mutual
agreement is not achieved, then this Agreement shall terminate and any
payment due as of the date of termination shall be paid.
17. This Agreement shall run for a period of TWELVE (12) months, from the 1st
day of July, 2004, to the 30th day of June, 2005, and shall be renewable
annually thereafter upon written notice executed by both parties.
18, This Agreement or its renewals may be terminated at any time without penalty by
either party provided that written notice of such termination is furnished to the
other party at least ninety (90) days prior to termination, In the event of such
termination, any payment due shall be prorated to the date of termination,
19. The OCHD hereby agrees with The University that, in its educational and/or
employment practices, the OCHD will comply with such non-discrimination law
as may be applicable to it in the performance of this Agreement. The
Department hereby agrees to abide by pertinent rules and regulations of the
OCHD, Orange County, and the North Carolina Department of Health and
Human Services in the conduct of service,
20, No provision of this Agreement shall be construed or interpreted as creating a
pledge of the faith and credit of the County of Orange or OCHD within the
meaning of any constitutional debt limitation, No provision of this Agreement
shall be construed or interpreted as creating a delegation of governmental
powers nor as a donation by or a lending of the credit of the County of Orange or
OCHD within the meaning of the Constitution of the State of North Carolina,
This Agreement shall and does not directly or indirectly or contingently obligate
AGREEMENT Between UNC School of Medicine
And Orange County Health Department 9
Page 8 of 10
the County of Orange or OCHD to make any payments beyond those
appropriated in the sole discretion of the County of Orange or OCI-iD for any
fiscal year in which this Agreement shall be in effect. No deficiency judgment
may be rendered against the County of Orange or OCHD in any action for
breach of a contractual obligation under this Agreement and the taxing power of
the County of Orange is not and may not be pledged directly or indirectly or
contingently to secure any moneys due under this Agreement,
21. This Agreement contains the entire understanding of the parties and shall not be
altered, amended, or modified, except by an agreement in writing executed by
the duly authorized officials of both parties.
22. The laws of North Carolina shall govern the validity and interpretation of the
provisions, terms, and conditions of the Agreement,.
AGREEMENT Between UNC School of Medicine
And Orange County Health Department
Page 9 of 10
IN WITNESS WHEREOF, the parties have hereunto signed this Agreement in their
official capacities of the day and year listed below.
FOR AND ON BEHALF OF FOR AND ON BEHALF OF
ORANGE COUNTY HEALTH DEPARTMENT THE UNIVERSITY OF NORTH
CAROLINA
AT CHAPEL HILL
Rosemary L, Summers, MPH, DrPH Nancy Suttenfield
Health Director Vice-Chancellor for
Finance and Administration
DATE: DATE:
Warren P, Newton, MD
Chair, Family Medicine
DATE:
FOR AND ON BEHALF OF THE COUNTY OF ORANGE
Barry .Jacobs, Chair
Orange County Board of Commissioners
DA
10
ORANGE COUNTY FINANCE DIRECTOR:
"This instrument has been pre-audited in the manner required by the Local Government
Budget and Fiscal Control Act."
Ken Chavious
Finance Director
DA
AGREEMENT Between UNC School of Medicine
And Orange County Health Department
Page 10 of 10
Designation of Medical Director
Attachment to Contract between the Department of Family Medicine, University of North
Carolina, School of Medicine and the Orange County Health Department far July 1,
2004 through .tune 30, 2005.
The following physicians are designated by the Department of Family Medicine to fulfill
the terms of the attached contract:
Michael Fisher, MD Medical Director
Lauren Lingle MD Physician
_ Clark Dennison MD Physician
Andrew Hannipel, MD Physician
Margaret Nusbaum, DO Physician
Copies of current registration and licensure for these physicians are attached.
Signed:
Warren Newton, Chair
Department of Family Medicine Date
Agreed:
11
Rosemary Summers, Health Director
Orange County Health Department Date
May 19, ?004
12
Addendum A to
Agreement between UNC and OCHD
For Medical Director Services
Whereas, the Chapel Hill/Carrboro City Schools (CHCCS) employ two (2)
School Nurses who are licensed and qualified Nurse Practitioners (Head Start Program
azid Carrboro Elementary School), and;
Whereas, the Chapel Hill/Carrboro City Schools (CHCCS) seek to have the two School
Nurses provide limited nurse practitioner services to students at their respective sites,
and;
Whereas, the two School Nurse Practitioners require medical supervision, and;
Whereas, the Orange County Health Department (OCHD) maintains a Memorandum of
Agreement with the Chapel Hill/Carrboro City Schools to provide medical direction to
school nurses by the OCHD Medical Director, and;
Whereas, the Department of Family Medicine of the UNC School of Medicine
(Department) provides Medical Director services to OCHD tluough the attached contract
and is agreeable to expanding the contract to provide medical supervision to the CHCCS
School Nurse Practitioners.
Therefore, the above parties agree to the following:
1, OCHD Medical Director (or other mutually agreed upon UNC Faznily Practice
physician) will provide medical supervision to the CHCCS School Nurse
Practitioners from August 15, ?004 to June 15, ?005
(10 months).
?. CHCCS will maintain medical malpractice insurance equal to or exceeding a S1
million per incident and a $.3 million upper limit coverage for its School Nurse
Practitioners azrd will furnish proof of insurance to the OCHD and the
Department.
3. CHCCS will submit all nurse practitioner protocols to OCHD for review by the
Medical Director or designee prior to implementation of the protocols.
4, CHCCS will provide OCHD with copies of the Nurse Practitioner's current
license.
5. OCHD will amend its agreement with CHCCS to include the medical supervision
of its School Nurse Practitioners by the OCHD Medical Director or designee with
its corresponding period of coverage and costs..
6, CHCCS will pay OCHD for medical supervision of its School Nurse Practitioners
the aznount of $4776/year (? hours/wk x 6 months; 2 hours/mo x. 4 months) in
one lump payment by September .30, ?004..
May 19, 2004
13
7. OCHD will pay Department for the above services in twelve monthly installments
of $.398, an amount which is incorporated in the monthly payment agreement of
the attached contract.
8, This agreement is in effect from .July 1, 2004 through .June .30, 2005.
SiBnatures•
Rosemary Summers, MPH, DrPH Date
Orange County Health Director
Neil Pedersen, PhD Date
CHCCS Superintendent
Warren Newton, MD Date
Chair, Faznily Medicine
Orange County Finance Director:
"This instrument ha been pre-audited in the manner required by the Local Government
Budget and Fiscal Control Act."
Ken Chavious Date
Finance Director
Barry ,Tacobs, Chair Date
Orange County Board of Commissioners