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ORDINANCE NO. 15,517
AN ORDINANCE DISPENSING WITH THE
REQUIREMENT OF COMPETITIVE BIDDING
AND AUTHORIZING THE CITY MANAGER TO
AWARD A CONTRACT FOR THE PURCHASE
OF EMERGENCY MEDICAL CONSULTANT
SERVICES.
WHEREAS, the Board of Directors may dispense with the
requirement of competitive bidding in exceptional circumstances
where such procedure is not feasible; and
WHEREAS, The City of Little Rock, through its Ambulance
Authority, desires to provide the highest quality of emergency
medical care in the MEMS transport of injured and critically ill
persons, but the members of the Board of Directors are not
qualified to direct the medical operations of such an Authority;
and
WHEREAS, the Arkansas Emergency Physician's Foundation
(AEPF), is an organization comprised of physicians having
specialty training in the delivery of emergency medical care;
and
WHEREAS, no similar group exists which can advise the
City regarding the delivery of emergency medical services, the
needs of particular hospitals, or the validity of complaints
from patients, physicians, and hospitals.
NOW THEREFORE, BE IT ORDAINED BY THE BOARD OF DIRECTORS
OF THE CITY OF LITTLE ROCK, ARKANSAS:
SECTION 1. The Board of Directors hereby finds that
competitive bidding should be dispensed with for the contract
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for emergency medical consultant services as an exceptional
situation exists and competitive bidding is not feasible.
SECTION 2. The City Manager is hereby authorized to
accept and award the contract for $1,000 per month, plus certain
identified additional expenses, attached as an exhibit to this
ordinance, for emergency medical consultant services to AEPF,
not to exceed the budget, payable from general funds of the
City.
PASSED: July 19, 1988
ATTEST:
Y'Paa-f-1 Y CLERK JANE CZECH
APPROVED AS TO ORM:
MARK STODOLA, CITY ATTORNEY
APPROVED:
ASSIST NT MAYOR F. G. VILLINES
30`1
AGREEMENT
FOR THE FURNISHING OF
EMERGENCY MEDICAL ADVICE AND SERVICES
This Agreement is entered into this ,a21 day of 1K/7 ,
1988, between the City of Little Rock, Arkansas , (the "City" )
and the Arkansas Emergency Physicians Foundation, Inc .
("AEPF") , a non-profit corporation organized and existing under
the laws of the State of Arkansas .
EXPLANATORY STATEMENT
The purpose of this Agreement, and the intent of the
parties hereto, is to set forth the terms , conditions and
obligations , under which AEPF will provide certain emergency
medical advice and service (including evaluations, quality
control, medical audits, and certain operating protocols) to
the City and its Little Rock Ambulance Authority (the
"Authority" ) , in accordance with the provisions of Ordinance
Number 14, 511 as amended (the "Ordinance" ) , of the City of
Little Rock, Arkansas , and Ark. Stat. Ann. Section 19-5903 .
RECITALS
WHEREAS, the City, pursuant to the authority granted in
the Ordinance as amended, and Ark. Stat . Ann. Section 19-5903 ,
may enter into a contract with AEPF, or any other similar
organization, for the providing of medical advice and control
for the City' s emergency ambulance service; and
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WHEREAS, AEPF was created by concerned physicians in the
Central Arkansas area for the purpose of improving the quality
of emergency medical care and services, as well as the general
advancement of emergency medical services through research,
education, and other activities; and
WHEREAS, the City, has determined that it is advisable to
enter into a contractual arrangement with AEPF to utilize the
expert advisory services and fact finding capacities of AEPF in
carrying out the City's regulatory responsibilities in the area
of ambulance and emergency medical services.
NOW, THEREFORE, in consideration of the mutual promises,
assurances, and other matters set forth in
parties agree as follows:
1. Furnishing of medical advice and
ambulance and emergency medical services.
the following duties and functions for the
with the provisions of the Ordinance, as ai
Stat. Ann. Section 19 -5903:
this Agreement, the
services for
AEPF shall perform
City, in accordance
vended, and Ark.
(a) Protocol development. AEPF shall develop
written clinical protocols to be followed by the Authority and
its personnel. These protocols shall identify all procedures
to be normally employed in response to various clinical
conditions. The written protocols shall also set forth when
certain procedures may be initiated by emergency medical
personnel only upon verbal authorization from a medical control
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physician as designated by AEPF. To the maximum extent
possible, each protocol shall identify the tasks of various
emergency medical personnel functioning together as an
emergency team executing a uniform protocol set. In addition,
to the extent that equipment and supplies are to be employed in
the rendering of the various procedures which are included in
the protocols, such equipment shall be specifically identified,
with specifications provided, and where conformity with
specific types or brand names is medically appropriate (to
ensure safety through better familiarity with equipment),
allowable types of brand names of equipment and supplies shall
be specifically identified.
AEPF shall continually monitor and expand the clinical
specificity in range of clinical conditions and patient types
dealt with by the protocols, and shall conduct a formal review
of all current protocols at least once each year. If findings
from medical audits or other developments warrant more frequent
review and revision it shall be undertaken. Where a change in
protocol, procedure, or team member task definition may
reasonably require additional training of pre - hospital care
personnel prior to implementation of that change, AEPF shall
specifically require such training be made available prior to
the implementation of the change, and the nature of such
training shall be described with a reasonable length of time
defined to allow the Authority to conduct such training prior
to implementation of the change.
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(b) Medical Audits. In order to evaluate and
critique emergency medical services within the City, medical
audits shall be conducted in accordance with the terms of this
Agreement. The types of medical audits to be performed are set
forth in paragraph 1(c) of this Agreement. The AEPF shall
conduct such number of medical audits each month as it shall
deem necessary; provided that every paramedic employed by the
Authority shall be the subject of at least one medical audit
every three months. In addition, AEPF shall perform medical
audits when requested by the City Manager (or comparable City
official), the Chairman of the Authority, any member of the
Little Rock Board of Directors, any licensed paramedic, any
licensed physician whose patient has been treated or
transported by Authority personnel, or any Little Rock member
of the Authority Board, in accordance with the terms and
conditions of this contract.
any "run"
treatment
necessary
employees
Authority
audit.
AEPF shall promulgate the standards to be followed,
report forms to
to each patient
to assist in th
and agents, and
shall cooperate
be used in rendering medical
transported, or other information
medical audits. The City, its
all employees or personnel of the
fully with AEPF during a medical
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The medical audits provided for in this contract shall be
conducted by a licensed physician designated by the AEPF
medical director. A medical audit conducted pursuant to this
contract shall be completed by the designated physician within
30 days after he receives the request from the medical director
of AEPF. The medical audit shall be presented to the medical
director of AEPF in a summary manner, and shall set forth such
matters and details as AEPF shall require. AEPF and the
Authority may discuss any matters in the medical audit at an
open hearing of either AEPF or the Authority and either may
request that a more detailed audit be conducted.
(c) Types of Medical Audits.
(1) Incident Audit. An incident audit involves
investigating a single transport of one or more patients for
which an audit has been requested. This audit is initiated by
a request to the AEPF, in writing, from a person specified in
paragraph 1(b) of this Agreement. Upon receipt of a request
for an audit pursuant to this subparagraph, the MEMS Executive
Director will send a letter advising of the request for medical
audit along with an approved MEMS Authorization for Release of
Medical Records form to the patient or his authorized
representative within a reasonable time. Upon receipt of the
signed authorization, MEMS shall promptly request release of
the records by the involved hospital. All costs of copying
said records shall be paid by MEMS. If the patient or
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authorized representative refuses to sign an authorization for
release of medical records, AEPF will conduct its audit using
only those records which are available. If the AEPF physician
is unable to draw a conclusion with regard to the treatment
from the available records, a letter stating the same will be
sent to the person requesting the audit.
(2) System Audit: A system audit involves the
review of a particular diagnostic coded illness /injury to
determine generally if appropriate treatment during transport
is being administered by MEMS personnel. The purpose of a
system audit is to determine if particular training or a change
of protocols is needed. The documents reviewed are limited to
MEMS generated documents.
(3) Paramedic Audits: (A) General Paramedic
Medical Audit. A general paramedic medical audit involves the
routine, three month review of an individual, but numerically
identified, paramedic to determine if the paramedic adequately
performs certain procedures and follows protocols and
instructions accurately. The documents reviewed are limited to
MEMS generated documents. Problems identified in this
paramedic audit can initiate a disciplinary paramedic medical
audit. Written reports of such audits shall be placed in the
paramedic's personnel file. The paramedic shall be given a
copy of the audit report.
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(B) Disciplinary Paramedic Medical Audit. A
disciplinary paramedic medical audit is a review of an
identified paramedic whose job performance has been
questioned. This review may be initiated in the following
ways: (i) a poor performance rating awarded in a general
paramedic medical audit, (ii) a poor performance rating awarded
in an incident audit, (iii) a request by the Executive Director
of the Authority based upon a good -faith belief that a danger
to a patient's safety or medical condition was created by such
paramedic's action, or (iv) as an appeal by a paramedic of some
other action.
The records involved shall include all MEMS - generated
records, but may also include review of hospital patient
records and contacts with the attending physician if MEMS is
able to obtain appropriate patient authorizations for release
of medical records.
(d) Review of medical audit findings. Any adverse
finding or recommendation arising from any type of medical
audit shall be communicated in writing to the Executive
Director of the Authority for review and appropriate action.
In the event that any such adverse finding or recommendation
involves any matter which could affect the license of an
Emergency Medical Technician or Paramedic pursuant to the EMS
Disciplinary Policy, adopted by the EMS Division of the
Arkansas Department of Health, including any amendments to such
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Policy, such finding or recommendation shall also be
communicated in writing to the License Officer. Any references
or comments in regard to personnel shall only be discussed by
the City, the Authority Board, or AEPF, in a closed executive
session.
All summaries
contract and the review
with AEPF and Authority
process procedures. In
no physician who is not
provide medical control
of audits conducted pursuant to this
of such audits by AEPF, shall conform
standards and City of Little Rock due
addition, it is expressly agreed that
then currently approved by AEPF to
to the Authority may be assigned to
conduct a medical audit.
(e) Confidentiality Policy of MEMS and AEPF. The
quality of care information generated and gathered by MEMS anJ
AEPF is for the internal management of MEMS. All patient
indentifiers on medical records shall be removed. NO
INFORMATION SHALL BE RELEASED, EXCEPT AS AUTHORIZED BY THIS
AGREEMENT, UNTIL IT HAS BEEN FIRST REVIEWED BY THE OFFICE OF
THE CITY ATTORNEY. ANY PARTY FAILING TO FOLLOW THIS PROCEDURE
IS ACTING OUTSIDE THE SCOPE OF AUTHORITY PROVIDED BY THIS
CONTRACT, AND IS TAKING PERSONAL ACTION EXPRESSLY FORBIDDEN BY
MEMS, AEPF, AND THE CITY.
(f) Personnel testing and certification. AEPF shall
develop specific guidelines for certification of emergency
medical service personnel employed by the Authority, and shall
also develop procedures for the review and processing of
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applicants for initial employment in any such capacity. The
provisions of Section 12 of the Ordinance shall be followed.
In lieu of the procedures for testing and certification
outlined in Sections 12(B) and (G), the AEPF may accept
certifications from the National Registry of Emergency Medical
Technicians - Paramedics and from the National Registry of
Emergency Medical Technicians - EMT.
AEPF shall be assisted by the City and the Authority
in ascertaining and verifying the background, training,
previous certification (if any), and experience of any
applicant for initial certification, or recertification. Such
testing and approval by AEPF, or its designee, shall include
all tests to be administered to applicants, or those applying
for recertification, required pursuant to Section 12 of the
Ordinance. Such tests shall be standardized but shall be
changed periodically to assure accurate testing. The dates,
times, and places for the administering of all tests provided
for under this paragraph shall be determined by AEPF, and
appropriate notice shall be given to all applicants. Such test
for applicants, and those for recertification, shall be held at
least semi - annually. AEPF shall maintain accurate records of
test results and other matters in relation to all tests
administered hereunder for five years.
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(g) Approving and monitoring medical control
coverage. AEPF shall develop and administer such educational
programs, materials, and /or tests, as it deems necessary and
appropriate to ensure that physicians who desire to direct
patient care in the field by radio communications are
appropriately knowledgeable of the Authority, its medical
protocols, attendant procedures, personnel capabilities, on
board equipment, and medical supplies so that patient care is
normally rendered in a uniform manner consistent with the
approved medical protocol for that patient's condition, unless
extenuating circumstances reasonably call for an informed
departure from any such medical protocol. When any physician
has successfully complied with such standards and requirements
approved by the Board of Directors of AEPF, the Board shall
officially indicate its approval of the physician to provide
medical control of field activities of the Authority and the
medical director of AEPF shall so inform that physician in
writing. Such letter of approval shall serve as official
authorization to that physician for the provision of medical
control of field activities conducted by the Authority.
(h) Procurement. AEPF shall also assist in any
procurement efforts of the Authority, and shall identify those
items of equipment which will be necessary as a result of the
medical standards and protocols developed by AEPF pursuant to
this contract. To the maximum extent possible, AEPF shall give
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the Authority sufficient advance notice and an opportunity to
comment, on any change in equipment proposed as a result of
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protocol development or other matters under this contract.
2. Compensation. In consideration of AEPF's service and
advice under this contract, the City agrees to cause the
Authority to pay to AEPF the sum of $1,000.00 per month. The
City shall also cause the Authority to pay AEPF the sum of
$50.00 per hour with a maximum of $250.00 for each medical
audit requested pursuant to the first paragraph of Section 1(b)
above plus actual expenses incurred by AEPF for each such
audit. Such additional payments to be made only in the event
that the documented costs and expenses for the additional
special audits requested for any month exceeds the regular
monthly payment of $1,000 to AEPF. The monthly payment shall
be paid by the 10th day of each month. Payments for each
medical audit will be paid within 15 days after receipt of each
invoice. It is expressly understood that there shall be no
additional funds available, and these payments shall be payment
in full by the City to AEPF for all services under this
contract.
3. License and Contract Officer. The City hereby
designates the City Manager as the License Officer under the
Ordinance and the Contract Officer for this Agreement. The
Contract Officer shall make all judgments concerning
compliance with this Agreement, approval of payments, and all
other matters in regard to this Agreement on behalf of the City.
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4. Term of the Agreement. This contract shall be for a
period of one year from the date of the execution hereof.
Amendments, modifications, or other changes shall be made only
with the mutual written agreement of the medical director of
AEPF and the Contract Officer designated in paragraph 4
hereof. Unless written notice is provided by either party to
the other 30 days prior to the expiration hereof, this contract
shall automatically be renewed for an additional year, on each
anniversary date.
5. Counterparts. This contract may be executed in
counterparts, and each counterpart shall be deemed to be an
original.
IN WITNESS, WHEREOF, the parties have executed this
Agreement on this day of , 1988.
Attest:
ARKANSAS EMERGENCY PHYSICIANS
FOUNDATION, INC.
M
resident
CITY OF LITTLE ROCK, ARKANSAS
BY:
Tom Dalton,
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y Manager
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AEPF and the Contract Officer designated in paragraph 4
hereof . Unless written notice is provided by either party to
the other 30 days prior to the expiration hereof , this contract
shall automatically be renewed for an additional year, on each
anniversary date.
5 . Termination. The City or AEPF may terminate the
Agreement by providing thirty (30) days written notice of
termination to the other with a copy to the Authority.
6 . Counterparts . This contract may be executed in
counterparts, and each counterpart shall be deemed to be an
original .
IN WITNESS, WHEREOF, the parties have executed this
Agreement on this z2ze day of 3(417 , 1988 .
ARKANSAS EMERGENCY PHYSICIANS
FOUNDATION, INC. i‘
BY: 74 7t11 / �C '�
Dr . , President
Attest:
CITY OF L •ijor ROCK, ARKANSAS
BY: /-
'A
O.; Dalton, City Manager
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Attest :
caZA4_, (1/}vidi
City Clerk —V
Acknowledged:
Little Rock Ambulance Authority
BY:
Joh eaapp, Ex‘cuti.)frector
0672j
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