HomeMy WebLinkAbout20-0224 Advocate ShermanAFFILIATION AGREEMENT
BETWEEN
CITY OF ELGIN
AND
ADVOCATE SHERMAN HOSPITAL
an Illinois not -for -profit corporation
THIS AFFILIATION AGREEMENT (the "Agreement') is entered this aLl r day
of F��3e=h e V by and between CITYOF ELGIN, an Illinois not -for -profit corporation
("Facility") and ADVOCATE SHERMAN HOSPITAL, an Illinois not -for -profit corporation
("the School").
WHEREAS, the School desires to utilize Facility set forth in Exhibit A for the purpose
of providing practical learning and clinical experiences for programs set forth in Exhibit B in
connection with students of the School.
NOW, THEREFORE, it is understood and agreed upon by the parties hereto as follows:
This Agreement is entered to enable School to place School's students at Facility for
clinical experiences.
A. SCHOOL RESPONSIBILITIES:
1. Provision of foundational curriculum to students. The School shall have the total
responsibility for planning and determining the adequacy of the practical learning and
clinical educational experience of students in theoretical background, basic skill,
professional ethics, attitude and behavior, and will assign to the Facility only those
students who have satisfactorily completed the prerequisite didactic portion of the
School's curriculum.
?.Insurance.
A. Student professional and general liability insurance.
Require students participating in the practicum to maintain a personal student
professional liability insurance policy. Such policy shall have limits for professional
liability insurance of not less than One Million Dollars ($1,000,000.00) per occurrence or
claim and Three Million Dollars ($3,000,000.o0) in the aggregate; and general liability
coverage of at least One Million Dollars ($1,000,000) per occurrence or claim and Two
Million Dollars ($2,000,000) in the aggregate covering the acts of such student while
participating in the program. If request, School shall provide proof of coverage to the
Facility by providing certificates of insurance evidencing coverage prior to student
participation in the practical learning and clinical educational experience. In the event
required insurance coverage is not provided or is canceled, the Facility may terminate the
placement of the student(s).
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(i) Where Worker's Compensation or other obligation for payment of benefits
may arise, this Agreement shall neither enlarge nor diminish such obligation.
(ii) In the event required insurance coverage is not provided or is canceled, the
Facility may terminate the placement of the student(s).
B. Student Health Insurance. School shall require students participating in the
practical learning and clinical educational experience to maintain comprehensive health
insurance. In the event required insurance coverage is not provided or is canceled, the
Facility may terminate the placement of the student(s).
C. Facility Insurance. Facility shall maintain during this Agreement
professional liability insurance in amounts not less than One Million Dollars
($1,000,000.00) per occurrence or claim and Three Million Dollars ($3,000,000.00) in the
aggregate, and general liability insurance in amounts not less than One Million Dollars
($1,000,000) per occurrence or claim and Two Million Dollars ($2,000,000) in the
aggregate. Further, Facility shall maintain workers compensation insurance in amounts
not less than that required by statute. Facility may be self -insured.
3. Designation of liaison to Facility; communications relating to clinical placements.
The School will designate a faculty or other professional staff member to coordinate and
act as its liaison to the Facility. The assignments to be undertaken by the students
participating in the practical learning and clinical experience will be mutually arranged
and a regular exchange of information will be maintained by on -site visits when practical,
and by letter or telephone in other instances.
The School shall notify the Facility in writing of any change or proposed change of the
person(s) responsible for coordinating clinical placements with the Facility.
4. Evidence of student certifications, vaccinations, etc. As required by the School
shall provide evidence that each student has met all requirements, which may include, but
are not limited to, CPR certification, proof of absence of TB, hepatitis B vaccination,
Tdap vaccination, annual Flu vaccination, and OSHA compliance for prevention of
transmission of blood borne pathogens and TB and general HIPAA training. Facility may
update these requirements upon written notice to School. Any student not meeting
applicable requirements shall not be eligible to participate in a clinical rotation.
5. Criminal background check and drug screen compliance. Where applicable, a
criminal background check and a drug screen, as required by and acceptable to the
Facility, are required of each placed student prior to participation in the practical learning
and clinical educational experience. It is the School's responsibility to ensure that the
background check and drug screening have been completed and that students with
unacceptable results will not participate at sites where students with such results are
forbidden by Facility's policy.
6. School notices to students. The School shall notify each student prior to his/her arrival
al the Facility that he/she is required to:
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Worker's Compensation or other obligation for payment of benefits may arise, this
Agreement shall neither enlarge nor diminish such obligation.
2. Qualifications of School faculty. The School represents that relevant faculty
members are appropriately qualified, certified and/or licensed. The School will provide
the Facility with copies of evidence of qualifications, certifications or licensures, upon
request.
3. Assignment of Agreement. This Agreement may not be assigned without the prior
written consent of the other party, which will not be unreasonably withheld.
4. Excluded Providers. Each party represents that neither it nor any of its employees and
agents is excluded as a provider under Medicare or Medicaid or under any other federal or
state health care program.
5. Severability. If any provision of this Agreement or the application thereof to any
person or situation shall, to any extent, be held invalid or unenforceable, the remainder of
this Agreement, and the application of such provision to persons or situations other than
those to which it shall have been held invalid or unenforceable, shall not be affected
thereby, but shall continue to be valid and enforceable to the fullest extent permitted by
law.
6. Non -Discrimination. The parties hereto shall abide by the requirements of Executive
Order 11246, 42 U.S.C. Section 2000d and the regulations thereto, as may he amended
from time to time, the Illinois Human Rights Act, and the Rules and Regulations of the
Illinois Department of Human Rights. There shall be no unlawful discrimination or
treatment because of race, color, religion, sex, national origin, age, order of protection
status, marital status, ancestry, military status, unfavorable discharge from military
service, sexual orientation or physical or mental disability in the employment, training, or
promotion of students or personnel engaged in the performance of this Agreement.
7. Employment status. No School employee or agent of School under this Agreement
shall in any way be considered an employee or agent of the Facility nor shall any such
student, School employee or agent be entitled to any fringe benefits, Worker's
Compensation, disability benefits or other rights normally afforded to employees of the
Facility.
g. Notice to Parties. Any notice, demand or request required or permitted to be given
under the provisions of this Agreement shall be in writing and shall be deemed to have
been duly given under the earlier of (a) the date actually received by the party in question,
by whatever means and however addressed, or (b) the date sent by email or facsimile
(receipt confirmed), or on the date of personal delivery, if delivered by hand, or on the
date signed for if sent by an overnight delivery service, to the following addresses, or to
such other address as either party may request, in the case of the School, by notifying the
Facility, and in the case of the Facility, by notifying the School:
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(a) Follow the administrative policies, standards, and practices of the Facility.
(b) Obtain medical care at his/her own expense for any injuries or illnesses
sustained as a direct or indirect result of his/her affiliation with the Facility.
(c) Provide his/her own transportation and living arrangements.
(d) Report to the Facility on time and follow all established regulations during the
regularly scheduled operating hours of the Facility.
(e) Conform to the standards and practices established by the School while
functioning at the Facility.
(f) Obtain prior written approval of the Facility and the School before publishing
any material relating to the practical learning and clinical educational experience.
(g) Meet the personal, ethical and professional standards required of employees of
the Facility and consistent with the applicable professional Code of Ethics and
the applicable standards of relevant accrediting or regulatory bodies.
B. FACILITY RESPONSIBILITIES:
I. Provision of facilities for supervised clinical experiences. Subject to the ability of
Facility to accommodate School's request, which Facility shall determine in its sole
discretion, the Facility agrees to make the appropriate facilities available to the School in
order to provide supervised practical learning and clinical educational experiences to
students. Such facilities shall include an environment conducive to the learning process
of the students as intended by the terms of this Agreement and conforming to customary
Facility procedures. Facility shall provide faculty and students with an orientation to
Facility, including HIPAA training.
2. Facility rules applicable to students during clinical assignments. Students are to
remain subject to the authority, policies, and regulations imposed by the School and,
during periods of practical learning and clinical educational experience, students will be
subject to all rules and regulations of the Facility and imposed by the Facility on its
employees and agents with regard to following the administrative policies, standards, and
practices of the Facility.
3. Patient care. Any direct contact between a student and a patient shall be under the
proximate supervision of a member of the staff of the Facility. The Facility shall always
remain responsible for patient care.
4. Emergency treatment of students. Emergency outpatient treatment will be available
to students while in the hospital for practical learning and clinical educational experience
in case of accident or illness. In case of emergency at a non -hospital site, standard
procedure will be followed. It is the student's responsibility to bear the cost of the
emergency treatment.
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5. Designation of liaison to School; communications relating to practical learning and
clinical educational experiences. The Facility shall designate a liaison responsible for
coordinating the practical learning and clinical educational experience. That person shall
maintain contact with the School's designated liaison person to assure mutual
participation in and surveillance of the practical learning and clinical educational
experience. The Facility shall notify the School in writing of any change or proposed
change of the person(s) responsible for coordinating the practical learning and clinical
educational experience.
6. Identity and credentials of Facility supervising personnel. The Facility shall
designate and submit in writing to the School, the name and professional and academic
credentials of the individual(s) overseeing student(s) experiences.
7. School tour of Facility. The Facility shall, on reasonable request and subject to legal
restrictions regarding patient health information, permit a tour of its clinical facilities and
services available and other items pertaining to practical learning and clinical educational
experiences, by representatives of the School and agencies charged with responsibility for
approval of the facilities or accreditation of the curriculum.
8. Provision of relevant Facility policies. The Facility shall provide the student(s) the
Facility's applicable administrative policies, standards and practices relevant to the
practical learning and clinical educational experience.
9. Release of Information. The Facility shall comply with all applicable laws for release
of information and shall take all measures necessary to ensure the confidentiality of any
and all information in its possession regarding the School's students who train at the
Facility pursuant to this agreement.
C. OTHER RESPONSIBILITIES:
I. Compliance with patient privacy laws. The School agrees to abide by and require
that its faculty and students abide by all applicable state and federal laws, rules and
regulations regarding patient privacy, including but not limited to, the Standards for
Privacy of Individually Identifiable Health Information as required under the Health
Insurance Portability and Accountability Act (HIPAA). Students shall be required to
comply with the Facility's policies and procedures regarding the confidentiality of patient
information and the use of all such information. The parties will notify one another if
there are known breaches of this confidentiality Further, School shall require that students
and faculty de -identify all documents created and/or utilized for educational purposes
outside of Facility. This shall include, at a minimum, removal of patient name, date of
birth, address, medical record number, insurance information, social security number and
other personal information that could be used to identify a patient.
2. Determination of instructional period. The course of the practical learning and
clinical educational experience will cover a period as arranged between the School and
the Facility. The beginning dates and length of experience shall be mutually agreed upon
by the School and the Facility.
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3. Determination of number of participating students. The number of students
eligible to participate in the practical leaming and clinical educational experience will be
determined and may be changed by mutual agreement of the parties. Notwithstanding the
foregoing, the Facility and the School agree and understand that the availability of
practical learning and clinical educational experiences at Facility during the term of this
Agreement may periodically be affected by a variety of factors. In such event, Facility
may reduce the number of students eligible to participate in the practical learning and
clinical educational experience with prior notice to the School and adequate time for the
School to reassign the student(s)10 another clinical site. The Facility agrees further to
accommodate students of the School who are similarly displaced from other clinical
affiliates of the School to the extent that clinical space is available at the Facility.
4. Evaluation of students' clinical experiences. Evaluation of the practical leaming
and clinical educational experiences of the students will be accomplished jointly by the
School and the Facility. Appropriate School and the Facility staff will communicate on a
regular basis for the purpose of reviewing and evaluating current practical learning and
clinical educational experiences offered to students.
5. Removal of students.
(a) The School has the right to remove a student from a practical learning and
clinical educational experience. The School shall notify the Facility of such removal in
writing.
(b) The Facility may immediately remove any student participating in a practical
learning and clinical educational experience from the Facility's premises for behavior that
the Facility deems to be an immediate threat to the health or welfare of its patients, staff
members, visitors, or operations. In such event, the Facility shall notify the School in
writing of its actions and the reasons for its actions as soon as practicable. If the Facility
desires to remove a student for any other reason, it shall notify the School in writing of
the reasons for the removal and shall consult with the School before removing the
student.
D. TERM OF AGREEMENT:
The term of this Agreement shall be for five (5) years and terminate on December 31,
2025. Either party may terminate this Agreement at any time, with or without cause,
upon ninety (90) days prior written notice to the other party. If this Agreement is not
renewed for a subsequent term, students who are participating in the practical learning
and clinical educational experiences at the time of termination shall be allowed to
complete such assignment under the terms and conditions herein set forth.
E. ADDITIONAL TERMS:
1. Stipulations as to liability. Subject to applicable state law, neither party to this
Agreement shall be legally liable for the consequences, whether bodily injury or property
damage, occasioned by an act, omission, or neglect chargeable to the other party. Where
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14. Entire Agreement. This Agreement supersedes any and all other agreements, either
oral or written, between the parties hereto with respect to the subject matter hereof. No
changes or modifications of this Agreement shall be valid unless the same are in writing
and signed by the parties. No waiver of any provisions of this Agreement shall be valid
unless in writing and signed by the parties.
15. Execution. This agreement may be executed in counterparts, each of which shall be
an original and all of which shall constitute one and the same agreement. For the
purposes of executing this agreement, any signed copy of this agreement transmitted by
fax machine or e-mail shall be treated in all manners and respects as an original
document. The signature of any party on a copy of this agreement transmitted by fax
machine or e-mail shall be considered for these purposes as an original signature and shall
have the same legal effect as an original signature. Any such Faxed or e-mailed copy of
this agreement shall be considered to have the same binding legal effect as an original
document. At the request of either party any fax or e-mail copy of this agreement shall be
re -executed by the parties in an original form. No party to this agreement shall raise the
use of fax machine or e-mail as a defense to this agreement and shall Forever waive such
defense.
IN WITNESS WHEREOF, the parties have caused this Agreement to be executed in their
respective corporate names by duly authorized officers, all on the day and year first set forth
above.
For and on behalf oF.
C ttlVOOCA�AT�T,,,EE, SHERMAN HOSPITAL
_iZd.A .�lw
gnature 3lgnature
Printed Name Richard G. Kozal Printed Name: AAA. - 4iA • /�
Title
Ci Mana er Title: 6 /C%
�/� / 5-- -�lN•^
Date: !/✓ Date. ry ad R D
Attest
Kimberly A. De v . Clerk
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EXHIBIT A
NAME/LOCATION OF FACILITY SITES
Elgin Fire Department
(Headquarters Station /)
550 Summit St
Elgin, IL 60120
Elgin Fire Department
(Station 2)
650 Big Timber Rd
Elgin, IL 60123
Elgin Fire Department
(Station 3)
2455 Royal Blvd
Elgin, IL 60123
Elgin Fire Department
(Station 4)
599 S. McLean Blvd
Elgin, IL 60123
Elgin Fire Department
(Station 5)
804 Villa St
Elgin, IL 60120
Elgin Fire Department
(Station 6)
707 W. Chicago St
Elgin, IL 60123
Elgin Fire Department
(Station 7)
3270 Longcommon Pkwy
Elgin, IL 60124
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If to the Facility:
City of Elgin
Ll1-1-1, T y y
f�Loi✓ -L, �a.z✓
Attention: ch%fer C,>yry,,,,
Email Cgym,,r,— e e, c , y cr 7.t
Telephone: (k12)Yit _ c;r>;'
With a Copy to:
Facility Legal Counsel at:
Ci of Elgin
150 Dexter ourt
_Elgin, It. 60120
Attention: Legal Department
Facsimile: (L4D1-5665
If to the School:
Greater Elgin Area EMS System
Advocate Sherman Hospital
1425 N Randall Road
Elgin, IL 60123
Attention: Program Director
or to such other addresses as the parties may specify in writing from time to time.
9. Governing Law. This Agreement shall be construed and enforced in accordance with
the laws of the State of Illinois, without regard to the conflict of law's provisions thereof.
10. Counterparts, This Agreement may be executed in one or more counterparts, each
of which shall be deemed to be an original, but all of which together shall constitute one
and the same instrument.
11. No Third -Party Beneficiaries. This Agreement shall inure exclusively to the benefit
of and be binding upon the parties hereto and their respective successors, assigns,
executors and legal representatives. Nothing in this Agreement, expressed or implied, is
intended to confer on any person other than the parties hereto or their respective
successors and assigns any rights, remedies, obligations or liabilities under orb reason of
this Agreement.
12. Agreement binding on parties' successors and assigns. This Agreement shall be
binding upon the School and the Facility, their successors, employees, agents and assigns,
during the initial term of this Agreement and any extensions thereof.
13. Captions for reference only. The captions contained in this Agreement are for
convenience of reference only and do not define, describe, or limit the scope or intent of
this Agreement or any of its provisions.
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EXHIBIT B
NAMES OF PROGRAMS
Sherman Paramedic Education Program
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to