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Ordinance 2001-26
ORDINANCE NO. /)t[)/-:{)?
AN ORDINANCE OF THE CITY OF WYLIE, TEXAS, ESTABLISHING A
REGULATED AMBULANCE SERVICE SYSTEM BY IMPLEMENTING
THE MASTER CONTRACT FOR PARAMEDIC AMBULANCE
SERVICES BETWEEN EAST TEXAS MEDICAL CENTER D/B/A EAST
TEXAS MEDICAL CENTER EMERGENCY MEDICAL SERVICE
("ETMC-EMS") AND THE CITY OF WYLIE, TEXAS AND OTHER
SOUTHEAST COLLIN COUNTY COALITION MEMBERS INCLUDING
THE CITY OF LA YON, LUCAS, MURPHY, PARKER, SACHSE, AND ST.
PAUL WITH THE INITIAL TERM OF THE AGREEMENT EFFECTIVE
ON THE DATE OF FINAL EXECUTION AS INDICA TED ON THE
CONTRACT AND ENDING SEPTEMBER 30, 2003; PROVIDING FOR A
PENALTY FOR THE VIOLATION OF THIS ORDINANCE; PROVIDING
FOR REPEALING, SAVINGS AND SEVERABILITY CLAUSES;
PROVIDING FOR AN EFFECTIVE DATE OF THIS ORDINANCE; AND
PROVIDING FOR THE PUBLICATION OF THE CAPTION HEREOF.
ARTICLE 1. PuRPOSE AND INTENT
It is the purpose of this Uniform EMS Ordinance to:
1.01 Establish a regulated ambulance service system which can provide clinical quality of care,
with reasonable, reliable response time standards, and with the goal of furnishing the best possible
chance of survival, without disability or preventable complication, to each ambulance patient.
1.02 Establish a sole-provider ambulance system, because it is unreasonable to have unnecessarily
high rates to make needed improvements to ambulance service in the service area, when a more
efficiently designed system can achieve the same results at lower cost. The most efficient design
to achieve the goals of high-quality service, at the lowest cost, consistent with the quality of care
required, is the implementation of the system described herein.
1.03 Provide a method to develop specific performance standards, adequate review, and either
continuation of service or an appropriate procedure to obtain alternate proposals from other
providers.
1.04 To provide more effective medical oversight by recognizing a multi-jurisdictional Medical
Control Board of licensed physicians expert in emergency medicine and related specialties as the
entity empowered hereunder to oversee and regulate all clinical aspects of the emergency medical
system which affect patient care within this jurisdiction.
Page 1 of9
ARTICLE 2. DEFINITIONS
The following words and phrases as used in this article, shall have the following meanings:
2.01 Advanced Life Support Ambulance: Any vehicle which is equipped to provide treatment
of life-threatening emergencies through the use of advanced airway management, intravenous
therapy, and other advanced prehospital care procedures, and which is equipped to transport sick
or injured persons to or from health care facilities.
2.02 Administrator: That unit of local government designated in the lnterlocal Agreement
which has accepted responsibility for providing administrative and clerical services necessary to
the orderly issuance, renewal, suspension, revocation, or restriction of licenses, certifications and
permits pursuant to authorization by the Medical Control Board, which licenses, certifications,
and permits shall be accepted as valid throughout the Regulated Service Area, including this
jurisdiction.
2.03 Ambulance: Any privately or publicly owned motor vehicle or helicopter that is specially
designed or constructed and equipped and is intended to be used for and is maintained or operated
for the transportation of patients.
2.04 Ambulance Patient or Patient: Any person being transported in a reclining position within
the Regulated Service Area to or from a health care facility except when the transportation
originates outside the Regulated Service Area.
2.05 Ambulance Service Contractor: That entity which is then currently under contract to
provide all Ambulance and Ambulance Patient services within this jurisdiction and throughout the
Regulated Service Area, except those services specifically exempted by Article 6 of this
ordinance.
2.06 Approved Emergency Room/Department: A health care facility which possesses a Level
4 or higher trauma categorization as defined by the Texas Department of Health.
2.07 Approved User Fee: Those membership fees, mileage charges, subsidy payments, if any,
and total average bill (exclusive of mileage charges) approved for this jurisdiction by the City
Council from the Uniform Schedule of Price/Subsidy Options.
2.08 Base Station Physician: A physician licensed to practice medicine in the State of Texas,
and certified by the Medical Control Board as knowledgeable of the prehospital emergency
medical protocols, EMS radio procedures and the general operating policies of the Ambulance
Service Contractor, and from whom ambulance personnel may take medical direction by radio or
other remote communications device.
2.09 City Council: Thatgroup of officials elected to govern the affairs of this City.
Page 2 of9
2.10 Contract Service Area: The geographic area encompassing the Regulated Service Area
plus unincorporated areas of Collin County and such counties as may choose to contract with the
Ambulance Service Contractor pursuant to a contract incorporating clinical standards required
hereunder, and incorporating financial provisions with those contained in the contract with the
Ambulance Service Contractor.
2.11 Emergency Medical Technician (EMT): An individual who is a "specially skilled
emergency medical technician" under Chapter 773, Texas Health and Safety Code, or its
successor.
2.12 EMS System: That network of individuals, organizations, facilities and equipment
including, but not limited to, East Texas Medical Center Emergency Medical Service, whose
participation is required to generate a clinically-appropriate, pre-planned system-wide response to
each request for prehospital care and/or interfacility transport, so as to provide each patient the
best possible chance of survival without disability, given available financial resources.
2.13 Extraordinary Adjustment: That adjustment justified on the basis of either an increase in
the System Standard of Care whose cost of implementation and ongoing compliance exceeds the
then-remaining balance of the "Upgrade Reserve", or on the basis of an unusual increase in the
cost of a factor of production when such increase in cost is industry wide and the result of causes
beyond the Ambulance Service Contractor's reasonable control.
2.14 First Response, First Responder, First Response Organization: That service and those
units (e. g., fire department, 1 st responders) which provide initial stabilization and trained
assistance on-scene and, when required, en route to medical facilities, as well as certain
extrication and rescue services. In accordance with Priority Dispatch Protocols, a 1 st response
unit is routinely sent to all presumptively-classified life-threatening calls within the ETMC EMS
servtce area
2.15 Helicopter Rescue Unit: Any rotary wing aircraft providing basic or advanced life support
services and patient transportation originating from the scene of emergency incidents which occur
within the Contract Service Area.
2.16 Interlocal Agreement: That certain agreement between the Cities of Lavon, Lucas,
Murphy, Parker, Sachse, St. Paul, Wylie and such other cities which shall participate in the
Southeast Collin County EMS Coalition for EMS services, adopted effective , 2001,
pursuant to Section 791.001 et seq. of the Texas Government Code annotated and known as the
lnterlocal Cooperation Act and called herein Interlocal Agreement.
2.17 Master Ambulance Service Contract: That ambulance service contract between the
Southeast Collin County EMS Coalition and the Ambulance Service Contractor.
2.18 Medical Audit: An official inquiry into the circumstances involving an ambulance run or
request for ambulance service, conducted by the Medical Director or a licensed physician
designated by the Medical Director, or by the Medical Control Board.
Page 3 of9
2.19 Medical Control: That direction given ambulance personnel by a base station physician
through direct voice contact, with or without vital sign telemetry, as required by applicable
medical protocols promulgated by the Medical Control Board, and by Chapter 773, Texas Health
and Safety Code, or its successors.
2.20 Medical Control Board or MCB: That board of physicians established and empowered by
this Uniform EMS Ordinance to update from time-to-time the System Standard of Care and to
monitor compliance with that System Standard of Care.
2.21 Medical Director: An emergency physician, expert in the prehospital practice of
Emergency Medicine, appointed by the Ambulance Service Contractor.
2.22 Medical Protocol: Any diagnosis-specific or problem-oriented written statement of standard
procedures, or algorithm, promulgated by the Medical Control Board as the proper standard of
prehospital care for a given clinical condition.
2.23 Member Jurisdiction: The individual corporate limits of the individual cities which are
members of the Southeast Collin County Coalition.
2.24 Mutual Aid Agreement: A written agreement between one or more providers of
ambulance service whereby the signing parties agree to provide backup ambulance service to one
another under conditions and pursuant to terms specified in the agreement.
2.25 Paramedic: A person qualified as a certified "paramedic emergency medical technician: as
defined by Chapter 773, Texas Health and Safety Code, or its successor.
2.26 Person: Any individual, firm, partnership, association, corporation, governmental entity, or
other group or combination acting as a unit.
2.27 Regulated Service Area: The combined corporate limits or legal boundaries of all
jurisdictions which adopt this Uniform EMS Ordinance.
2.28 Senior Paramedic in Charge: That person among the certified personnel assigned to an
ambulance, not the driver, who is a certified paramedic designated by the Ambulance Service
Contractor as the individual in command of the ambulance.
2.29 Special Event: Any public event located within the Regulated Service Area, for which
standby ambulance service is arranged in advance, and for which an Ambulance ( or Ambulances)
are hired by the sponsor ofthe event or other interested party.
2.30 Specialized Mobile Intensive Care Unit: A vehicle which is specially constructed,
equipped, staffed, and employed in the interfacility transport of patients whose requirements for
enroute medical support are likely to exceed the clinical capabilities of a paramedic level
ambulance.
Page 4 of9
2.31 System Standard of Care: The combined compilation of all priority dispatching protocols,
pre-arrival instruction protocols (i.e., ambulances), protocols for selecting destination hospital,
standards for certification of pre-hospital care personnel (i.e., telephone call takers, ambulance
personnel, and on-line medical control physicians), as well as standards governing requirements
for on-board medical equipment and supplies, and licensure of ambulance services and first
responder agencies. The System Standard of Care shall simultaneously serve as both a regulatory
and contractual standard.
ARTICLE 3. AUTHORITY TO OPERATE -- EXCEPTIONS
3.01 No person shall operate or cause to be operated an Ambulance nor furnish, conduct,
maintain, advertise or otherwise be engaged in the business or service of the transportation of
Ambulance Patients within the Regulated Service Area, or provide Special Events standby
coverage, unless such person is the Ambulance Service Contractor. No person shall knowingly
solicit ambulance services as regulated herein except the Ambulance Service Contractor.
3.02 However, the prohibitions set forth in Paragraph 3.01, above, shall not be applicable to an
Ambulance or Ambulance Service provider:
a. Which is rendering assistance to patients in the case of a major catastrophe or
emergency with which the Contractor's ambulances are insufficient or unable to cope; or
1S
b. Transporting a patient who is picked up from a location beyond the Regulated Service
Area and transported to a location within the Regulated Service Area; or is
c. Transporting a patient who is picked up from a location beyond the Regulated Service
Area and transported to a location beyond the limits of the Regulated Service Area and
only incidentally passing through the Regulated Service Area.
3.03 The Ambulance Service Contractor may use another ambulance service provider for non-
emergency transfers to and from the Member Jurisdictions, if the Ambulance Service Contractor
is unable to perform the service due to unavailability or due to exceeding the number of transports
as set forth in Paragraph 3.04, below.
3.04 The Ambulance Service Contractor shall have the option to transport non-emergency
transports to and from the Member Jurisdictions but will limit the number of such transports that
the Ambulance Service Contractor's generally dedicated unit for the Contract Service Area to no
more than five (5) per month.
3.05 All emergency and non-emergency calls and requests for ambulance services originating
within the Member Jurisdictions will be dispatched through or to the Ambulance Service
Contractor's dispatch center.
PageSof9
3.06 Violations of this Article are hereby declared to be public nuisances and shall be prohibited
and abated in actions at law or in equity.
ARTICLE 4. MEDICAL CONTROL BOARD
4.01 System Standard of Care Adopted. The System Standard of Care as defined herein is
hereby adopted as the minimum requirement for compliance with this ordinance, and the Medical
Control Board is hereby recognized as the clinical standards-setting body for this jurisdiction.
4.02 Physician Participation. Any hospital within this jurisdiction which operates an emergency
room or emergency department meeting the requirements of an Approved Emergency
Room/Department shall be eligible to appoint its physician director of said emergency room or
department (or hislher physician designee) to membership on the Medical Control Board, and
such representative shall have full voting rights when the MCB has been notified in writing by an
officer of the hospital.
4.03 Coordination of Activities. The Medical Director appointed by the Ambulance Service
Contractor shall serve as ex-officio, non-voting chair of the Medical Control Board, and shall be
responsible for arranging meetings, creating the agenda, keeping minutes, ensuring compliance
with this ordinance, and developing a process for monitoring compliance with the System
Standard of Care, subject to approval by the Medical Control Board.
4.04 Duties and Responsibilities. Responsibilities of the Medical Control Board shall be as
follows:
a. To set the System Standard of Care and provide periodic revisions. The System
Standard of Care shall address minimum requirements and reconunended higher
standards governing the licensure of organizations, the certification of individuals, and
the permitting of vehicles employed within the EMS System, and shall be developed in
accordance with the following table of contents:
(i) Prevention, CPR and other Public Information Programs
(ii) Telephone Access (emergency and routine)
(iii) Control Center Operations
(iv) First Responder Services
(v) Ambulance Services
(vi) On-Line Medical Control
(vii) Quality Improvement and Clinical Research
b. Authorize the issuance, denial, revocation, suspension, or restriction of licenses, permits
and certifications issued pursuant to this ordinance.
c. Licenses, certifications and permits in good standing issued by any jurisdiction within
the Regulated Service Area pursuant to written authorization by the Medical Control
Board shall be recognized and accepted as valid by this jurisdiction.
Page 6 of9
4.05 Selection of Patient Destination. Medical Protocols approved by the Medical Control
Board shall establish protocols for selection of the destination hospital, which protocols shall be
strictly followed by paramedic personnel and on-line medical control physicians, except when a
departure from protocol is justified on the basis of special considerations of patient care or
practical barriers to implementation (e.g., blocked roads, hospital divert status, etc.). In
developing such "transport protocols, It the Medical Control Board shall strictly adhere to the
following priorities of consideration, and shall recognize these priorities in the sequence
presented:
First Consideration: patient care and safety;
Second Consideration: patient/family choice;
Third Consideration: fairness in distribution of patients among hospitals.
In this regard, the following rules shall apply:
(a) Non-Emergencies. All "non-emergency patients" (as defmed by
patient-assessment protocols approved by the Medical Control Board) shall be
transported to the destination selected by the patient, the patient's family, or the
patient's personal physician, without exception.
(b) Non-Life-Threatening Emergencies. Patients experiencing a "non-life
threatening emergency" (as defmed by patient-assessment protocols approved by
the Medical Control Board) shall be transported to the facility of choice designated
by the patient, the patient's family, or the patient's personal physician, or if no such
preference is stated, to the nearest hospital approved by the Medical Control Board
for receipt of patients experiencing non-life threatening emergencies.
(c) Life-Threatening Emergencies. Patients experiencing life-threatening
emergencies (as defmed by patient-assessment protocols approved by the Medical
Control Board) shall, in accordance with transport protocols approved by the
Medical Control Board, be delivered to the "nearest appropriate facility," taking
into consideration the patient's condition and location, the patient's medical
requirements, and the respective capabilities of hospitals within and, for some
types of patients, outside) the "Contract Service Area." Such transport protocols
shall not be inconsistent with then-currently-approved trauma system protocols
(when available).
(d) Enforcement. Inappropriate and unjustified deviations from these
patient-destination protocols by a paramedic without direct authorization by a Base
Station Physician or inappropriate and unjustified instructions regarding such
deviation by a Base Station Physician shall be subject to sanction by the Medical
Control Board provided such sanctions are applied in accordance with due process
procedures approved by the City Attorney. Such sanctions may include reprimand,
suspension of certification, or revocation of certification, depending upon
frequency and severity of error.
Page 7 of9
4.06 Binding Arbitration Available. In the event any hospital desires to dispute a policy of the
Medical Control Board affecting patient distribution, that hospital may at its option institute
procedures for binding arbitration as follows:
a. The hospital wishing to contest the specified policy shall present its position in
writing to the Medical Control Board, including one or more proposed remedies
acceptable to the hospital.
b. If the Medical Control Board rejects all remedies proposed by the hospital, the
hospital may appoint a physician expert in the medical specialty to which the
contested policy is related to serve as a member of an arbitration team, provided that
such physician shall have no affiliation, direct or indirect, with any hospital or
physician group practicing within the Contract Service Area.
c. The Medical Control Board shall then appoint a physician expert in the medical
specialty to which the contested policy is related to serve as a member of the
arbitration team, provided that such physician shall have no affiliation, direct or
indirect, with any hospital or physician group practicing within the Contract Service
Area.
d. The two appointed members of the arbitration team shall then jointly appoint a third
physician expert in the medical specialty to which the contested policy is related to
serve as the third member of the arbitration team, provided that such physician shall
have no affiliation, direct or indirect, with any hospital or physician group practicing
within the Contract Service Area.
e. The arbitration team shall then review such written documentation related to the
dispute as may be available, and shall conduct such site visit inspections and on-site
interviews as the team deems appropriate, and shall render a decision on the
disputed matter either in favor of the Medical Control Board or in favor of the
hospital initiating the arbitration process, and such decision shall be fmal. The
arbitration team shall not have authority to impose any resolution which was not
proposed by either the Medical Control Board or the hospital initiating the
proceedings.
f. The actual and reasonable cost of the arbitration process, including consulting fees
and travel reimbursement, shall be paid by the hospital initiating the arbitration
process.
ARTICLE 5. COMPLIANCE WITH LAW
All persons and entities regulated under this ordinance shall comply with the laws of the state and
reference to permits, licenses, minimum equipment and minimum qualifications of operators and
attendants and all state and federal laws and regulations applicable to its ambulance operation.
Page 8 of9
ARTICLE 6. FAILURE TO PAY SERVICE CHARGES - PRolDBITED
6.01 It shall be unlawful for any person, with intent to defraud, to request or accept the service of
any ambulance within the City, having no intention of paying for such service.
6.02 Failure, by the person requesting or accepting the services of an ambulance, to pay to the
person furnishing such service the customary charge therefor within ninety (90) days after demand
for payment is made, shall be prima facie evidence of intent to defraud and prima facie evidence
that such person had no intention of paying for such services when the same were requested or
accepted.
6.03 Demand for payment, as used in this article, shall be written demand, sent by registered or
certified mail addressed to the person requesting or accepting such services and to the address
given by or on behalf of such person at the time the services were requested or accepted. Intent
to defraud or intention not to pay for such services may be shown by direct evidence.
ARTICLE 7. VIOLATIONS - PENALTIES
Any person who shall violate any provision of this article shall be deemed guilty of a misdemeanor
and upon conviction thereof shall be fined as provided in Section of the municipal
code. Each day such violation shall continue or be permitted to continue, shall be deemed a
separate offense. It shall not be necessary for the complaint to negative any exception contained
in this article concerning any prohibited act, but any such exception made in this article may be
urged as a defense by any person charged by such complaint. Since this ordinance has a penalty
for violation, it shall become effective after its publication in the newspaper on
20 .
PASSED this I ~ day of 4lft\Q
, A.D. 2.Q1.
Attest:
Approved as to form:
Richard Abernathy, City Attorney
Page 9 of9
CONTRACT
FOR
PARAMEDIC AMBULANCE SERVICES
SOUTHEAST COLLIN COUNTY EMS COALITION
CONSISTING OF THE CITIES OF
LAVON, LUCAS, MURPHY, PARKER, SACHSE, ST. PAUL AND WYLIE
EAST TEXAS MEDICAL CENTER d/b/a
EAST TEXAS MEDICAL CENTER EMERGENCY MEDICAL SERVICE
ORIGINAL
A36\6203\22\ 198996-5/1710 1
ARTICLE V - INSURANCE AND INPEMNIFICA TION ...................................................17
5.01 INSURANCE REQUIREMENTS ....... ...............................................................................................17
5.02 INDEMNIFI CA TI ON...................................................................................................................... ...18
ARTICLE VI - MAJOR DEF AUL T AND REPLACEMENT PROVISIONS ...................19
6.01 MAJOR DEFAULT DEFINED ..........................................................................................................19
6.02 DECLARA TION OF MAJOR DEFAULT AND TRANSFER OF SERVICE ..................................19
6.03 MAJOR DEFAULT ............................................................................................................................20
6.04 DEFAULT NOT DANGEROUS TO PUBLIC HEALTH AND SAFETY ........................................20
6.05 "LAME DUCK" PROVISIONS .........................................................................................................20
6.06 PERFORMANCE PENALTY ............................................................................................................20
ARTICLE VII - TERM AND RENEWAL .............................................................................21
7.01 TERM OF AGREEMENT ..................................................................................................................21
7 .02 RENEWAL TERMS ...........................................................................................................................21
AR TI CLE VIII - REPORTS. ...... ......................................................... ..... ...... ...... ...................22
8.01 VERIFICATION OF USER-FEE CHARGES....................................................................................22
8.02 RESPONSE TIME COMPLIANCE ...................................................................................................22
ARTICLE IX - GENERAL PROVISIONS ............................................................................24
9.01
9.02
9.03
9.04
9.05
9.06
9.07
9.08
9.09
9.10
9.11
9.12
9.13
9.14
9.15
9.16
9.17
9.18
9.19
9.20
9.21
9.22
CHARACTER AND COMPETENCE OF PERSONNEL..................................................................24
J
PERMITS AND LICENSES............................................................................................... ~.............. .24
ASSIGNMENT ......................................................................... ..........................................................24
RIGHTS AND REMEDIES NOT W AIVED.......................................................................................24
ATTORNEY FEES .............................................................................................................................24
NON-DISCRIMINATION ........................................ ......................... .... .............................................24
COMPLIANCE WITH LAWS ...........................................................................................................25
SEVERABILITY.. ... ............. ............... ...... ..... ........ .............. .... ................................ ........ ................. .25
HEADINGS ................................................................ ............. ............. ............... ........ .......................25
CHOICE OF LAW .................. .................................................................. ...........................................25
ENTIRE AG REEMENT .... ............... ............................................................................ ......................25
AMENDMENT ............................................................... ...................... ... ............. ............................ ..25
NO WAIVER ................................................................ ............................ ............ ..............................25
INCORPORATION OF SCHEDULES ..............................................................................................26
CORRESPONDENCE ............................................................................. .... ......... ..............................26
INDEPENDENT CONTRACTOR ............... ....... ... ...... .............................. ........................................26
FORCE MAJEURE............................. ..... ...... ........ ........... ... .................. ............................. ................26
ACCESS TO RECORDS ....... ................. ......... ............ ................... ........... ........ ..... .................. ..........27
ENTIRE AGREEMENT; MODIFICATION ......................................................................................27
CHANGE IN LA W .................................................................................... ............ ...... ................ .......27
CONSENTS, APPROVALS AND EXERCISE OF DISCRETION ...................................................27
THIRD PARTIES........ ........................ ............. ................. ....... ......................................................... .28
ii
9.23 PAID IN-SERVICE TRAINING ........................................................................................................28
9.24 PARAMEDIC SKILL LEVELS .....,...................................................................................................28
9 .25 TERMINATION CONTRACTS..................:......................................................................................28
9 .26 COUNTERPARTS......................... ............... ............................................. .......... .............................. .28
SCHEDULE A EMS ORDINANCE
SCHEDULE B COMMITMENT TO 1ST RESPONDER SUPPORT AND QUALITY
CARE
SCHEDULE C QUALITY IMPROVEMENT PROGRAM
iii
CONTRACT
FOR
PARAMEDIC AMBULANCE SERVICES
This Contract for Paramedic Ambulance Services (hereinafter referred to as "Contract" of
"Agreement") is entered into by and between the Southeast Collin County EMS Coalition,
consisting of the following Texas cities: Parker, Sachse, Wylie, St. Paul, Murphy, Lucas
and Lavon (hereinafter referred to as "Coalition") and East Texas Medical Center d/b/a East
Texas Medical Center Emergency Medical Service, a Texas not-for-profit corporation
(hereinafter referred to as "ETMC-EMS"). Coalition and ETMC-EMS are collectively referred
to as the "Parties."
NOW, THEREFORE, for and in consideration of the premises and agreements herein
contained and other good and valuable consideration, including the award of exclusive market
rights, the receipt and adequacy of which are hereby forever acknowledged and confessed, the
Parties agree as follows.
ARTICLE I
DEFINITIONS
The following definitions shall apply to terms as used throughout this Agreement:
Agreement means this Contract.
Ambulance Patient means any person being transported to or from a health care facility
in a reclining position from any point within the "Regulated Service Area."
Ambulance Service Contract means an agreement between ETMC-EMS and any local
governing unit incorporating clinical standards and financial provisions consistent with
those set forth in this Agreement.
Ambulance Service Contractor means East Texas Medical Center Emergency Medical
Service (ETMC-EMS). .
ANI/ALl means Automatic Number Identifier/Automatic Location Identifier and is one
of the enhancement features of 911 system that aids in identification of incoming calls.
CAD means Computer Assisted Dispatch including but not limited to primary dispatch
data entry and automated time-stamping, 911 data interface, demand pattern analysis,
system status management, automated patient locator aids, response time reporting and
documentation, and (when installed) automated vehicle tracking.
Contract Service Area means the geographic area encompassing the Regulated Service
Area plus unincorporated areas of Collin County and such other counties as may choose
to contract with ETMC-EMS pursuant to a contract incorporating clinical standards and
financial provisions consistent with those contained in this Contract.
A36\6203122\ 198996-5/17/0 1
CPR and 1st Response Support Program Fund means that certain bank account
established by ETMC-EMS pursuant to this Contract, into which account late-run penalty
payments are deposited on a monthly basis as provided for herein. Expenditures of such
funds shall be limited to funding direct, out-of-pocket costs of citizen Cardiopulmonary
Resuscitation and rotated training and 1st Response support program costs. None of these
funds shall be used to fund wages or salaries of personnel employed by ETMC-EMS, or
to fund ETMC-EMS 's administrative or overhead costs.
EMS System means that network of individuals, organizations, facilities and equipment,
including but not limited to ETMC-EMS, whose participation is required to generate a
clinically- appropriate, pre-planned system-wide response to each request for pre-hospital
care and/or interfacility transport, so as to provide each patient the best possible chance
of survival without disability and given available financial resources.
Extraordinary Adjustment is an adjustment justified on the basis of either: (1) an
increase in the System Standard of Care whose cost of implementation and on-going
compliance exceeds the then-remaining balance of the "Upgrade Reserve"; or, (2) an
unusual increase in the cost of a factor of production when such increase in cost is
industry wide and the result of causes beyond ETMC-EMS' reasonable control.
1st Response, 1st Responder, 1st Response Organization refers to that service and
those units (e.g., fire department 1st responders) which provide initial stabilization and
trained assistance on-scene and, when required, en route to medical facilities, as well as
certain extrication and rescue services. In accordance with Priority Dispatch Protocols, a
1 st Response unit is routinely sent to all presumptively-classified life-threatening calls
within the ETMC-EMS service area.
Contract (aka Contract for Ambulance Services; aka the "Agreement"; aka the
"Contract") is this Contract document labeled Contract For Paramedic Ambulance
Services and is an agreement between the Coalition and East Texas Medical Center
Emergency Medical Service. .
Medical Control Board means that board of physicians established and empowered by
the Uniform EMS Ordinance to update from ~ime-to-time the System Standard of Care,
and to monitor compliance with that System Standard of Care.
Medical Director means that Medical Director which shall be an emergency physician,
expert in the pre-hospital practice of Emergency Medicine, appointed by ETMC-EMS.
Member Jurisdiction means the individual Coalition member's corporate limits.
MICU means Mobile Intensive Care Unit as defined in the Texas Health and Safety
Code.
A36\6203'&2\198996-5/17/01
2
Mutual Aid means the paramedic ambulance service provided within the Contract
Service Area by neighboring providers other than ETMC-EMS at the request of ETMC-
EMS, pursuant to an agreement governing the exchange of service assistance when
requested. Such a unit shall be judged by ETMC-EMS to have acceptably trained
personnel and equipment, and approved by the Medical Control Board.
PSAP means Public Service Answering Point and is an auxiliary service in the 911
system.
Regulated Service Area means the combined corporate limits of all Member
Jurisdictions that adopt the Uniform EMS Ordinance.
Response Area of the Southeast Collin County EMS Coalition means the corporate
limits ofthe Member Jurisdictions of the Southeast Collin County EMS Coalition.
Southeast Collin County EMS Coalition means an interlocal cooperative group
consisting of the participating city goverrunents of Lavon, Lucas, Murphy, Parker, Sachse
S1. Paul and Wylie, currently representing a combined population of approximately
33,464 residents.
Subscription Ambulance Membership Plan means an optional plan by which citizens
in the Member Jurisdictions can contract with ETMC-EMS for prepaid, medically
necessary, ambulance transport services.
System Standard of Care means the combined compilation of all priority-dispatching
protocols, pre-arrival instruction protocols (i.e., ambulances), protocols for selecting
destination hospital, standards for certification of pre-hospital care personnel (i.e.,
telephone call-takers, ambulance personnel and on-line medical control physicians), as
well as standards governing requirements for on-board medical equipment arid supplies,
and licensure of ambulance services established by the Uniform EMS Ordinance. The
System Standard of Care shall simultaneously serve as both a regulatory and contractual
standard.
Uniform EMS Ordinance means that Ordinance set forth in Schedule A.
(BALANCE OF PAGE INTENTIONALLY LEFT BLANK)
A36\6203\22\ 198996-5/17/01
3
ARTICLE II
MUTUAL RESPONSIBILITIES AND UNDERSTANDINGS
2.01 FRANCHISE MODEL SYSTEM
a. ETMC-EMS shall provide services under this Contract through a franchise model
system and shall furnish its own facilities, vehicles, on-board equipment, radio
systems and computer-aided dispatch hardware and software as provided in this
Contract. Except as otherwise set forth herein, ETMC-EMS shall serve as the
retail provider of 911 ambulance services, routine transport services and related
ambulance services, financed primarily or exclusively on a fee-for-service basis,
with or without subsidy according to the agreement of each member jurisdiction
and participating jurisdiction.
b. ETMC-EMS may charge user fees for services rendered under this contract that
are consistent with the provisions of this Contract.
c. Except for subsidies paid to ETMC-EMS under the Subsidy/Price Agreement
with each jurisdiction, ETMC-EMS shall look for compensation for its services
under this Contract solely through the following sources:
(i) Third party payors;
(ii) Persons or entities who use ambulance serv1ces or other persons
responsible for such ambulance services; and
(iii) Contract purchasers of ambulance services.
2.02 ALL MICU, FULL-SERVICE SYSTEM. All ambulances rendering services pursuant
to this Contract shall be an MICU and shall be staffed and equipped to render paramedic-
level care. '
2.03 "FIXED-PRICE TERM AGREEMENT FOR REQUIREMENTS." This Contract is
a "fixed-price term agreement for requirements," with provisions for inflation adjustment
and adjustment for externally-imposed upgrades to the System Standard afCare. At such
time that ETMC-EMS assumes full responsibility for dispatch, the Coalition guarantees
that every medical request including but not limited to 911 cases originating within the
Member Jurisdictions, except 911 calls originating from an area within the County which
has contracted for 911 ambulance services with a provider other than ETMC-EMS, shall
be transferred to ETMC-EMS (along with ANI/ALl data as. available) for telephone
interrogation, pre-arrival instructions (if appropriate) and the dispatch and delivery of
ambulance service.
2.04 EQUIPMENT AND FACILITIES. All equipment, facilities and medical supplies
acquired or supplied for the performance of the work that is the subject of this Contract
shall be furnished by ETMC-EMS at ETMC-EMS's own expense.
2.05 SUBSCRIPTION AMBULANCE MEMBERSHIP PLAN.
a. Basic Objects of Program. ETMC-EMS shall offer for sale to residents of all
member jurisdictions and participating jurisdictions under this Contract, a
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4
subscription ambulance membership plan which fee for the first year of coverage
under the plan will not exceed forty-eight ($48) dollars per household. The fee
for the subscription ambulance membership plan is subject to an annual inflation
adjustment equal to 100% of the percentage increase in the CPI over the most
recent 12-month period for which published figures are then available as
approved by the Board of Directors of ETMC-EMS. Additionally, ETMC-EMS
may offer discounts for renewal of subscription ambulance membership plans.
b. Legal Obligations. The subscription ambulance membership plan offered to
residents of the member jurisdictions and participating jurisdictions under this
Contract shall comply with federal and state law relating to subscription
ambulance membership programs.
c. Medicaid Recipients. Persons whose medical expenses are covered under
Medicaid are not eligible to participate under the subscription ambulance
membership plan.
d. Additional Benefits. ETMC-EMS may, at its option, offer to persons who
purchase subscription ambulance membership plans under this subsection,
additional benefits.
e. Periodic Membership Drives. ETMC-EMS shall hold an open enrollment
period during each calendar year for the subscription ambulance membership
program and residents in the member jurisdictions and participating jurisdictions
shall be entitled to apply for participation in the subscription ambulance
membership program during that period.
f. Beneficial Extension of Service. Each person requiring or requesting ambulance
service shall receive the quality of care and transportation required' under the
System Standard of Care, without regard to membership status in the subscription
ambulance membership program.
g. Financial Assistance for Plan Purchase. A member jurisdiction or participating
jurisdiction may purchase or may assist its residents in purchasing and paying for
subscription ambulance membership' plans in accordance with a written
agreement between the member jurisdiction or participating jurisdiction and
ETMC-EMS.
2.06 FINANCIAL INCENTIVE PROVISIONS. The following incentives for achieving
response time reliability above the minimum requirements set forth in Section 3.02 shall
apply:
a. CPR and 1st Response Support Program Fund. ETMC-EMS shall establish a
CPR and I st Response Support Program Fund. Expenditures from the fund will
be used as set forth in Schedule B. ETMC-EMS shall develop and periodically
update a CPR and 1 st Response Support Program plan, a current copy of which
shall be submitted to the Coalition as a matter of public record. Furthermore,
ETMC-EMS shall submit to the Coalition on a quarterly basis a detailed
accounting of deposits to and expenditures from the CPR and 1 st Response
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5
Support Program Fund. In this regard, the Coalition shall have reasonable access
to ETMC-EMS's records as necessary to verify that deposits to the CPR and 1st
Response Support Program Fund are kept current at all times, and that
expenditures from the CPR and 1 st Response Support Program Fund are in
accordance with requirements of this Paragraph.
b. Late-Run Penalties. For each whole minute an ambulance response time extends
beyond the applicable time-frame specified in Section 3.02 hereof, ETMC-EMS
shall pay into the CPR and 1 st Response Support Program Fund late-run penalty
fees in the amounts shown below to be calculated for each transport, not to exceed
$150 per incident.
Presumptively-Classified Life-Threatening Calls ........................ .... $IO/min.
Presumptively-Classified Non Life-Threatening Calls ................... ........ $ 5/min.
Presumptively-Classified Routine Transports ................................... ..... $ 2/min.
Scheduled Routine Transports .............................................................. ... $ 2/min.
Representatives of the Medical Control Board shall periodically verify (by
sampling technique) the accuracy of ETMC-EMS's response time reporting.
ETMC-EMS's requests for application of exemptions to response time
requirements and late-run penalties shall be subject to review and approval by the
Medical Control Board or a designated standing committee appointed for that
purpose.
c. Exemptions. No requests for ambulance service shall be exempt from response
time compliance and calculations or from late-run penalties, except as follows:
(i) Requests not resulting in a patient transport;
(ii) Requests during a period of unusually severe weather conditions, such that
response time compliance is either impossible or could be achieved only at
a greater risk to the public than would result from delayed response;
(iii) Late runs resulting as a consequence of inaccurate or incomplete
information obtained by 911 control center personnel during telephone
interrogation of a caller;
(iv) Late runs resulting from errors in a 911 control center conveyance of
infonnation to the ETMC-EMS control center, either orally or by way of
data transmission, provided, however, that this exemption shall not be
applicable to any late run in which the caller was directly interrogated by
ETMC-EMS's control center personnel and the caller gave accurate and
complete information;
(v) Requests during a declared disaster, locally or in a neighboring non-
participating jurisdiction, in which ETMC-EMS is rendering assistance.
During such periods, ETMC-EMS shall use best-efforts to simultaneously
maintain coverage within Member Jurisdictions as well as provide disaster
assistance;
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(vi) In cases where multiple paramedic-capable units are dispatched to a single
incident, the first-arriving paramedic unit shall "stop the clock", and
response times of later-arriving units shall be excluded from response time
statistics and late-run penalties; or
(vii) During periods of unusual system overload, which shall mean that at least
two (2) emergency responses are occurring simultaneously within the
service area, responses in excess of the first emergency request shall not be
included in response time calculations or be subject to late-run deductions.
No other causes of late response (e.g., equipment failure, vehicular accident
regardless of origin, or other causes within ETMC-EMS's reasonable control)
shall serve to justify exemption from response time requirements; and
2.07 USE OWN EXPERTISE AND JUDGMENT. ETMC-EMS is specifically advised to
use its own best judgment in deciding upon the methods to be employed to achieve and
maintain the levels of performance required hereunder. Such "methods" include
compensation programs, shift schedules, personnel policies, supervisory structures,
vehicle deployment techniques, and other internal matters which, taken together,
comprise ETMC-EMS's own strategies and tactics for performing its obligations under
this Agreement.
2.08 EXCLUSIVITY. ETMC-EMS is awarded exclusive rights and responsibilities for
provision of all emergency and non-emergency ambulance services, including special
events coverage, originating within the Member Jurisdictions, regardless of the manner in
which the request for service is conveyed. Notwithstanding the foregoing, in the event
that the Required MICU (as defined in Section 3.01) is on a transfer or otherwise
unavailable, ETMC-EMS may use another EMS service provider for non-'emergency
transfers to and from the Member Jurisdictions, if ETMC-EMS is unable to perform the
service due to unavailability or due to exceeding the number of transports as set forth in
the next sentence. ETMC-EMS shall have the option to transport non-emergency
transports to and from the Member Jurisdictions but will limit the number of such
transports that ETMC-EMS's Required MICU will transport to no more than five (5) per
month. Such non-emergency transports by the Required MICU will only be transported
when other Coalition Members' ambulances are available.
All emergency and non-emergency calls and requests for ambulance services originating
within the Member Jurisdictions will be dispatched through or to ETMC-EMS' dispatch
center.
2.09 SELECTION OF PATIENT DESTINATION. Medical Protocols approved by the
Medical Control Board shall establish protocols for selection of the destination hospital,
which protocols shall be strictly followed by paramedic personnel and on-line medical
control physicians, except when a departure from protocol is justified on the basis of
special considerations of patient care or practical barriers to implementation (e.g.,
blocked roads, hospital divert status, etc.). This Contract is entered into by both parties
pursuant to a mutual assumption that transport protocols approved by the Medical
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7
Control Board shall strictly adhere to the following priorities of consideration, and shall
recognize these priorities in the sequence presented:
a. First Consideration: patient care and safety;
b. Second Consideration: patient/family choice; and
c. Third Consideration: fairness in distribution of patients among hospitals. In
this regard, the following rules shall apply:
(i) Non-Emergencies. All "non-emergency patients" (as defined by patient-
assessment protocols approved by the Medical Control Board) shall be
transported to the destination selected by the patient, the patient's family,
or the patient's personal physician, without exception.
(ii) Non Life-Threatening Emergencies. Patients experiencing a "non life-
threatening emergency" (as defined by patient-assessment protocols
approved by the Medical Control Board) shall be transported to the facility
of choice designated by the patient, the patient's family, or the patient's
personal physician, or if no such preference is stated, to the nearest
hospital approved by the Medical Control Board for receipt of patients
experiencing non-life-threatening emergencies.
(iii) Life-Threatening Emergencies. Patients experiencing life-threatening
emergencies (as defined by patient-assessment protocols approved by the
Medical Control Board) shall, in accordance with transport protocols
approved by the Medical Control Board, be delivered to the "nearest
appropriate facility", taking into consideration the patient's condition and
location, the patient's medical requirements and the respective capabilities
of hospitals within and, for some types of patients, outside the "Contract
Service Area." Such transport protocols shall not be inconsistent with
then-currently-approved trauma system protocols (when available).
(iv) Enforcement. Inappropriate and unjustified deviations from these
patient-destination protocols by a paramedic without direct authorization
by a Base Station Physician or inappropriate and unjustified instructions
regarding such deviation by a Base Station Physician shall be subject to
sanction by the Medical Control Board provided such sanctions are
applied in accordance with due process procedures approved by the
Coalition's attorney. Such sanctions may include reprimand, suspension
of certification, or revocation of certification, depending upon frequency
and severity of error.
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8-
ARTICLE III
SCOPE AND QUALITY OF SERVICES
3.01 AMBULANCE SERVICES TO COALITION. ETMC-EMS shall provide emergency
and non-emergency ambulance service to the entire Response Area of the Coalition, and
shall provide staff and MICUs as set forth in this Contract, including but not limited to at
least one fully staffed MICU dedicated solely for response to the entire Response Area of
the Coalition (the "Required MICU"). ETMC-EMS shall only use the Required MICU
for non-emergency transfers to and from the Coalition.
Baylor Garland
Baylor Richardson
Columbia Medical Center PIano
Garland Community
Lake Pointe Medical Center
North Central Medical
Presbyterian Allen
Presbyterian PIano
Sunbridge NH Wylie
Medical Center PIano
In the event that no ambulance provided for in this Contract is available for service, or
additional ambulances are needed, each member of the Coalition will be required to rely
upon mutual aid plans for their city.
3.02 RESPONSE TIME RELIABILITY. ETMC-EMS will maintain a response time on all
transports ETMC-EMS provides under this Agreement as set forth below:
Within the Response Area of the Southeast Collin County EMS Coalition:
a. Life-Threatening Emergency Calls will have a response time 90% or better of 8
minutes and 59 seconds.
b. Non Life-Threatening Emergency Calls will have a response time 90% or better
of 12 minutes and 59 seconds.
These commitments shall be calculated on a per one-hundred transport basis, and shall be
calculated annually at the end of ETMC-EMS fiscal year. The response time
commitments set forth above shall constitute contractually binding performance
requirements under this Contract. In this regard, the following definitions and protocols
shall be employed for purposes of response time measurement, compliance reporting, and
late run penalty assessment-.
a. Definition. Response time is herein defined as the elapsed time between the
moment a request for ambulance service is received at ETMC-EMS's ambulance
control center (i.e., the moment callback number and location are acquired, either
by voice or by ANI! ALl 911 data transmission and confirmed) and the moment a
first-arriving, fully-equipped and staffed ETMC-EMS paramedic ambulance,
paramedic-level Mutual Aid unit, paramedic-level 1st Response team, or
advanced life support capable medical helicopter arrives at the scene; provided
that in order to "stop the clock" such first-arriving unit shall be operated by
ETMC-EMS or by a Mutual Aid unit or 1st Response Organization approved by
the Medical Control Board and operating under subcontract to ETMC-EMS. For
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9
scheduled patient transfers, "time call received" shall be the agreed-upon
appointment time of patient pickup.
b. Use of Mutual Aid Providers. Subject to a finding by the Medical Control
Board that the clinical quality of care provided by a proposed MICU staffed
Mutual Aid provider, helicopter ambulance service, or 1 st Response organization
participating in ETMC-EMS's 1st Response Support Program and operating at the
paramedic level, is deemed substantially equivalent to the quality of care required
under this Contract, such paramedic units operated by Mutual Aid providers, 1 st
Response organization, and helicopter ambulance services responding at ETMC-
EMS's request to locations within the Contract Service Area shall be deemed to
"stop the clock" on behalf of ETMC-EMS.
c. Method of Measurement. Response time standards shall be established and
response time performance shall be measured in terms of "fractile distributions"--
not average response time measurements.
d. Call Classification. For purposes of response time measurement, the applicable
standard shall be based on each request's presumptive run code classification (i.e.,
life-threatening emergency, non life-threatening emergency, unscheduled routine
transport and scheduled routine transport) as established at the time the call is
dispatched by a person trained in the use of and correctly employing Medical
Priority Dispatch Protocols proposed by the Medical Director and approved by
the Medical Control Board. (Retrospective classification of priority code shall not
affect measurement of response time compliance.)
e. En route Upgrades and Downgrades. If a presumptive run code classification
is upgraded to a higher priority while the ambulance is en route (as a result of
information provided by a physician or law enforcement officer at the scene), the
applicable run code designation shall be the upgrade priority and response time
shall be measured from the moment of upgrade. If a presumptive run code
classification is downgraded to a lower priority while the ambulance is en route
(as a result of information provided by a physician), the applicable run code
designation shall be the downgraded priority and response time shall be measured
from the original time of call receipt.
f. 911 Interface Requirements. Upon ETMC-EMS assuming full responsibility
for dispatch, ETMC-EMS shall be free to employ, at its own expense, such CAD
hardware and software and 911 system interface arrangements as ETMC-EMS
deems most conducive to efficient operation and response time reliability. The
Coalition shall cooperate fully with ETMC-EMS's reasonable requests to
establish telephone call-transfer linkages and, where appropriate, 911 computer
system interface arrangements (e.g., with ETMC-EMS functioning as a secondary
PSAP), as requested by ETMC-EMS. 911 personnel shall transfer medical calls
and callers to the ETMC-EMS Control Center as per protocols approved by the
Medical Control Board.
3.03 CUSTOMER SERVICE AND MEMBERSHIP PROGRAM. Except for changes
adopted by the Board of Directors of ETMC-EMS, ETMC-EMS shall comply with
A36\6203\22\ 198996-5/17/01
10
customer-service and accounts receivable management practices as provided in this
Contract.
3.04 DISASTER ASSISTANCE. During a declared disaster, locally or in a neighboring
jurisdiction, the normal course of business under this Contract shall be interrupted from
the moment the disaster occurs. Immediately upon such notification, ETMC-EMS shall
commit such resources as are necessary and appropriate, given the nature of the disaster,
and shall assist in accordance with disaster plans and protocols applicable in the locality
where the disaster occurred. The disaster-related provisions of this Contract are:
a. During such periods, ETMC-EMS shall be released from response time
performance requirements, including late run penalties, until notified by the
Coalition that disaster assistance may be terminated. At the scene of such
disasters, ETMC-EMS personnel shall perform in accordance with local disaster
protocols established by that community.
b. When disaster assistance has been terminated, ETMC-EMS shall resume normal
operations as rapidly as is practical considering exhaustion of personnel, need for
restocking and other relevant considerations.
c. During the course of the disaster, ETMC-EMS shall use best efforts to provide
emergency coverage throughout the "Contract Service Area" and shall suspend
non-emergency transport work as necessary, informing persons requesting such
non-emergency service of the reason for the temporary suspension.
3.05 NO AMBULANCE DEPLOYMENT RESTRICTIONS. Every member jurisdiction
and participating jurisdiction shall have access to the resources of the EMS System, as
dictated by fluctuations in consumer demand for service, weather conditions and disaster
events. To ensure such flexibility in responding to shifting needs, ETMC-EMS will
refrain from contractually committing any of its ambulances to the exclusive benefit of
any jurisdiction.
3.06 GRANDFATHER CLAUSE. Nothing in this Contract shall be construed as preventing
ETMC-EMS from honoring and fulfilling contractual commitments in effect as of the
commencement date of this Contract, even if provisions of such contracts are in conflict
with provisions set forth immediately above, provided, however, that no such existing
contract containing provisions in conflict with the provisions of this Contract shall be
extended or renewed unless amended to remove the conflicting provisions.
3.07 SACHSE AMBULANCE AND DEPLOYMENT. In addition to the required ETMC-
EMS ambulance for the Response Area, the City of Sachse will staff an ambulance (with
MICU capabilities) donated by ETMC-EMS to provide primary ambulance service and
response for the City of Sachse ("Sachse Ambulance"). When the Sachse Ambulance is
deployed and/or unavailable to the City of Sachse, the first back-up ambulance will be
requested through ETMC-EMS which will be ETMC-EMS Required MICU when
available. The next back-up ambulance shall be within the Coalition when available.
3.08 WYLIE AMBULANCE AND DEPLOYMENT. The City of Wylie is currently
staffing an ambulance (with MICU capabilities) donated by ETMC-EMS ("Wylie
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II
Ambulance") and will continue to do so. Such Wylie Ambulance shall be used to
provide back-up ambulance service to the Coalition. ETMC-EMS shall pay a one
hundred ($100.00) dollar stipend, per transport, to the Coalition member city (but
specifically excluding the City of Sachse, unless the City of Sachse unit is backing up
either ETMC-EMS Required MICU or the Wylie Ambulance and such transport is
initiated from outside the City of Sachse's corporate limits) who provided the transport
but only when ETMC-EMS calls for back-up in the event ETMC-EMS's unit is out of
service, subject to Section 3.11, below.
3.09 DONATED AMBULANCES. With regard to both the Sachse and Wylie Ambulances
(collectively, the "Donated Ambulances"), as set forth in Sections 3.07 and 3.08 above:
a. Sachse and Wylie shall retain ownership of the Donated Ambulances, with
ownership surviving this Contract.
b. ETMC-EMS shall provide reimbursement for professional liability insurance at a
combined cost not to exceed a total of $1 ,500 per year and normal and customary
equipment necessary for the operation of such Donated Ambulances.
c. ETMC-EMS shall provide all EMS supplies for the operation of the Donated
Ambulances (as described in 3.07 and 3.08, above).
d. Selected cities of the Coalition will staff and operate the Donated Ambulances.
e. The Coalition operating the Donated Ambulances shall provide for automobile
liability insurance coverage.
f. ETMC-EMS shall be responsible for any maintenance or repair to the drive train
of the Donated Ambulances, unless such repairs are showing to be caused by the
unreasonable neglect and/or abuse of the Donated Ambulances by the Member
Jurisdictions.
g. ETMC-EMS shall provide the Coalition with another ambulance unit during any
time that the Donated Ambulances are out of service. ETMC-EMS will provide
such replacement ambulance for a period of up to ten (10) days, but no longer.
After ten (10) days, ETMC-EMS will negotiate a mutually acceptable short term
lease for such replacement ambulance with lease payments not to exceed ten
dollars ($10) per month.
h. If the Coalition requests additional resources from ETMC-EMS, the Parties agree
to renegotiate in good faith the annual total subsidy to be paid ETMC-EMS in
order to provide sufficient resources for the services described in such Contract.
If the Parties are unable to reach such a mutual agreement, the current provisions
shall remain in effect.
3.10 USE OF NON-COALITION OR NON-ETMC-EMS AMBULANCES. In the event a
Coalition Member utilizes an ambulance of an entity that is not a Coalition Member nor
an ETMC-EMS unit, and a Coalition ambulance or an ETMC-EMS ambulance was
A36\6203l22\ 198996-5/17/01
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available, then such Coalition Member shall reimburse ETMC-EMS for ETMC-EMS's
loss of revenue for such trip, excluding transfer.
3.11 CLEAN TICKET PROVISION. The One Hundred ($100) Dollar stipend as set forth
in 3.08(b) above, is expressly conditioned upon the Coalition Members fully and
accurately completing the trip ticket and related paper work in accordance with the
policies and procedures that ETMC-EMS requires of its own personnel in the completion
of such trip ticket ("Clean Ticket"). ETMC-EMS will provide adequate
training/education to personnel filling out trip tickets.
3.12 CLINICAL STANDARDS AND QUALITY IMPROVEMENT. The initial standards
of clinical quality, as well as the clinical upgrade schedules to occur on or before listed
deadlines throughout the term of this Contract shall constitute contractually binding
performance requirements under this Agreement.
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13
ARTICLE IV
CONSIDERATION
Consideration for this Contract is an award of exclusive market rights subject to exemptions set
forth in Schedule A to this Contract for the term of the Contract.
4.01 AUTHORIZATION OF USER-FEE CHARGES. ETMC-EMS shall charge user fees
for services originating within each Coalition Member Jurisdiction. Each Coalition
Member may assist its residents in purchasing and paying for membership rights by
incorporating voluntary provisions for billing and payment in conjunction with residential
water bills.
4.02 USER-FEE AUTHORIZATION. ETMC-EMS IS hereby authorized to charge for
ground ambulance services user-fees as follows:
The maximum total average of all bills generated for ambulance service originating with
the Coalition (exclusive of mileage charges), shall not exceed $643.54.
4.03 ANNUAL INFLATION ADJUSTMENTS. The Coalition shall annually permit
adjustment of the ETMC-EMS Maximum Total Average Bill (as discussed in 4.02), the
first such adjustment being authorized on October 31, 2001. Any increase made to the
Maximum Total Average Bill in such adjustment shall not exceed the percentage change
in the Consumer Price Index on a nationwide basis over the most recent twelve (12)
month period for which published figures are available. ETMC-EMS has the discretion
to accept all or a portion of the maximum allowable inflation adjustment and may apply
those amounts in the manner determined by ETMC-EMS provided that such adjustment
does not exceed the maximum allowable adjustment under this Contract.
4.04 ADJUSTMENT FOR EXCESS BILLINGS. In the event ETMC-EMS's actual total
average bill (exclusive of mileage charges) for services rendered in a Member
Jurisdiction or Participating Jurisdiction during the preceding contract period is found to
be inadvertently in excess of the level permitted by the then-applicable "SubsidyIPrice
Agreement", the Coalition shall delay the effective date of the inflation adjustment
increase in that jurisdiction by a number of days sufficient to fully offset the amount of
overpayment, as proposed by the Coalition and approved by the Board of Directors of the
Coalition.
4.05 EXTRAORDINARY ADJUSTMENTS FOR EXTERNALL Y IMPOSED
UPGRADES. ETMC-EMS may periodically apply for extraordinary rate adjustments to
offset the actual and reasonable marginal costs of implementing and maintaining clinical
upgrades required by the Medical Control Board and approved by the Coalition.
Adjustment shall be subject to optional review and confirmation or denial by the
Coalition.
4.06 EXTRAORDINARY ADJUSTMENTS FOR UNUSUAL COST INCREASES. As
may be justified by circumstances beyond ETMC-EMS's reasonable control (e.g.,
industry wide insurance cost increases of major magnitude, restoration of OPEC's pricing
powers, etc.), ETMC-EMS shall be eligible for temporary but renewable (as justified and
approved by the Coalition) "extraordinary rate adjustments" when the governing body of
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the Coalition finds that the cause of such extraordinary increase in the cost of one or more
factors of production necessary to produce quality pre-hospital care is due to an unusually
large, rapid increase in the cost to ETMC-EMS of that factor of production, in which this
increase is industry wide, not the result of poor purchasing practices and not the result of
increased consumption of the factor of production. Provided, however, all such
approvals of Extraordinary Adjustment shall be subject to optional review and
confirmation or denial by the Coalition.
4.07 ANNUAL SUBSIDY. The Coalition agrees to pay ETMC-EMS an annual subsidy for
services described herein, the total of such subsidies for Years 1 - 3 being as follows:
Year 1
Year 2
Year 3
69,585.00
75,516.00
86,604.00
Such subsidy payments shall be made on a quarterly basis with twenty-five (25%)
percent of the annual subsidy being due at the begilming of each quarter. As such, the
quarterly payments are due on October 1, January 1, April 1, and July 1 of each contract
year. Any payments which are due and owing as of the execution of this Agreement shall
be paid within thirty (30) days of the execution by ETMC-EMS ofthis Agreement.
The share of the subsidies to be paid by each Coalition member shall be as agreed to by
the Coalition.
In the event the Initial Term of this Agreement is continued into one or more renewal
terms, the Parties agree to negotiate in good faith relative to subsidy amounts for the
renewal term(s), if any. If the Parties cannot mutually agree on such subsidy amounts for
any renewal term, ETMC-EMS may terminate this Agreement upon sixty (60) days prior
written notice, without penalty. I
The amounts set forth above represent the amounts due ETMC-EMS assuming the
Coalition members remain the same as of the effective date of the Contract. The
Coalition further agrees to reimburse ETMC-EMS for any ETMC-EMS loss in revenue
due to any current Coalition member no longer participating in this Agreement. EACH
COALITION MEMBER WHO WITHDRAWS FROM THE COALITION,
CEASES TO PARTICIPATE OR CONTRACTS WITH ANOTHER EMS
PROVIDER, AGREES TO MAKE ETMC-EMS WHOLE FOR SUCH LOSS OF
REVENUE FOR THE DURATION OF THE CONTRACT (WHICH INCLUDES
SUBSIDY AND PATIENT TRANSPORT REVENUE RELATED TO SUCH
COALITION MEMBER) TO ETMC-EMS. Such Coalition member agrees that its
termination or withdrawal from the Coalition irreparably harms ETMC-EMS and
knowingly and specifically agrees that its agreement to make ETMC-EMS whole as the
result of such termination or withdrawal is an essential provision in this Agreement. The
Coalition agrees to the maximum extent permitted by law to hold harmless ETMC-EMS
from such loss of revenue and loss of subsidy. In the event such Coalition member
refuses to reimburse ETMC-EMS for such loss of revenue or loss of subsidy, ETMC-
EMS shall have all rights allowed by law to pursue money damages, including its
attorneys' fees in seeking to collect such loss of revenue and subsidy from the Coalition
Member. Additionally, the failure to pay such monies to ETMC-EMS is a material
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15
breach of this Agreement and notwithstanding any other provisions to the contrary,
ETMC-EMS may terminate this, Agreement upon sixty (60) days prior written notice,
without penalty.
4.08 ETMC-EMS shall have the exclusive right to bill and collect any third party payor or
individual for services rendered by ETMC-EMS, and for any transports rendered by the
Coalition.
4.09 COUNTY FUNDS. Any funds received from Collin County shall be in addition to the
amounts received by ETMC-EMS as set forth in Section 4.07, above.
4.10 ADDITIONAL UNITS. The Parties acknowledge that the Member Jurisdictions are
growing rapidly and the need for future EMS services may arise in the future. ETMC-
EMS will periodically evaluate the services rendered and determine ETMC-EMS's
capability and performance. As the result of such evaluation, ETMC-EMS may consider
such information in evaluating the need to donate additional units or other alternatives to
the Coalition as sound business practices would dictate, and as the Parties mutually agree.
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16
ARTICLE V
INSURANCE AND INDEMNIFICATION
5.01 INSURANCE REQUIREMENTS. At all times during the term of this Contract and
throughout any extension periods thereof, ETMC-EMS shall obtain and pay all premiums
for ETMC-EMS's owned and operated ambulances. For liability arising solely from the
actions or inactions of ETMC-EMS or ETMC-EMS's personnel, all such policies shall
name the Coalition and the Medical Control Board as "additional insureds". ETMC-
EMS shall furnish the Coalition with an Accord Certificate of Insurance indicating that
the types and amounts of insurance required hereunder are in full force and effect and
that the insurance carrier shall give the Coalition thirty (30) days' written advance notice
of any cancellation, change, termination, failure to renew or renewal, or any change in
coverage of any such policy or policies reflected on said certificate. Nothing in this
Article V shall be deemed to prohibit the use of a program of insurance being "self-
insurance" as that term is normally used as being a formally organized system of
covering risks or to be a limitation upon the insured as to the deduction it may cause to be
provided in connection with any of its respective insurance policies. ETMC-EMS's
Insurance coverage shall meet the following minimum requirements:
a. WORKER'S COMPENSATION. Worker's Compensation Insurance as
pem1itted by the laws of the State of Texas.
b. COMMERCIAL GENERAL LIABILITY. Commercial general liability
insurance in an amount not less than one million dollars ($1,000,000) per
occurrence combined single limits (CSL) for all claims resulting from bodily
injury (including death) and/or property damage arising out of the operations of
the ambulance service authorized hereunder.
c. AUTOMOBILE LIABILITY. The following coverage is required: '
(i) Uninsured Motorist. Uninsured/underinsured motorist coverage,
covering all automobiles and including all owned, hired, or leased vehicles
in an amount equal to or greater than the minimum liability limits required
by law.
(ii) Employer's Non-owned Auto Coverage. Employer's non-owned
liability in an amount equal to the liability limits set forth in Subsection b.,
immediately above.
d. AMBULANCE LIABILITY. A policy covering the liability created by
ambulance operation to a limit called for in Subsection b. hereof. It is further
understood that, due to the nature of this risk, it is presently necessary to obtain
this coverage through the Assigned Risk Pool and that policy form must be
accepted as offered.
e. MALPRACTICE. Malpractice insurance in an amount not less than one million
dollars ($1,000,000) for each claim.
A36\6203\22\ 198996-5/17/01
17
f. EXCESS LIABILITY INSURANCE UMBRELLA. Excess liability insurance
umbrella policy providing two million dollars ($2,000,000) coverage per
occurrence and four million dollars ($4,000,000) annual aggregate coverage in
excess of all other liability policies prescribed herein.
g. SUBMISSION OF POLICIES. Said insurance policies required hereunder may
be submitted to the Coalition. Satisfactory evidence that such insurance is at all
times in full force and effect shall be furnished to the Coalition.
h. EFFECT OF CANCELLATION OR TERMINATION. The cancellation or
other termination of any policy of insurance required hereunder shall give the
Coalition the right to revoke and terminate this Contract for ambulance service
granted hereunder, unless another insurance policy complying with the provisions
of this section shall be provided and be in full force and effect at the time of such
cancellation or other termination.
1. "OCCURRENCE" FORM REQUIRED. All coverage furnished hereunder
shall be written on an "occurrence" basis, not a "claims made" basis, provided,
however, a combination of "claims made" coverage and "extended reporting
endorsement" ("tail coverage") for an indefinite period following expiration of
this Contract shall be considered equivalent to "occurrence" coverage.
Furthermore, nothing in this provision shall be construed as prohibiting partial
self-funding of defined aspects of coverage, provided self-funding financial
arrangements and risk-management aspects are approved by the Coalition, which
approval shall not be unreasonably withheld.
5.02 INDEMNIFICATION. ETMC-EMS covenants and agrees that it will indemnify and
hold harmless the Coalition, and each Member Jurisdiction and their officers and
J
employees, from any claim, loss, damage, cost, charge or expense arising out of any act,
action, neglect or omission by ETMC-EMS during the performance of this Contract,
except that neither ETMC-EMS, East Texas Medical Center Regional Healthcare System,
nor any of their subcontractors, or assignees, will be liable under this section for damages
arising out of injury or damage to persons or property directly caused or resulting from
the negligence of the Coalition, or any Member Jurisdiction or any of their officers,
agents, representatives or employees. .
(BALANCE OF P AGE INTENTIONALLY LEFT BLANK)
A36\6203\22\ 198996-5117/01
18
ARTICLE VI
MAJOR DEFAULT & REPLACEMENT PROVISIONS
6.01 MAJOR DEFAULT DEFINED. Conditions and circumstances that shall constitute a
major default by ETMC-EMS shall include but not be limited to the following:
a. Supplying to the ,Coalition during the contracting process, false information or
information so incomplete as to effectively mislead;
b. Willful falsification of data supplied to the Coalition or to the Medical Control
Board during the course of operations, including by way of example but not by
way of exclusion, dispatch data, patient report data, response time data, financial
data, or willful downgrading of presumptive run code designations or deliberate
omission of any other data required under this Contract;
c. Deliberate and unauthorized scaling down of operations to the detriment of
performance during a "lame duck" period;
d. Failure to maintain equipment in accordance with generally accepted maintenance
practices;
e. Willful attempts by ETMC-EMS to intimidate or otherwise punish non-
management employees who desire to interview with or to sign contingent
employment agreements with successful bidders following a subsequent bid
cycle;
f. Chronic and persistent failure ofETMC-EMS's employees to conduct themselves
in a professional and courteous manner and to present a professional appearance;
I
g. Failure by ETMC-EMS to cooperate with and assist the Coalition in its transfer of
ETMC-EMS's operations after a major default has been declared by the Coalition,
as provided for in 6.02, next, even if it is later determined that such default never
occurred or that the cause of such default was beyond ETMC-EMS's reasonable
control;
h. Failure to substantially and consistently meet or exceed the various clinical and
response time standards required hereunder;
1. Intentional over billing in violation of provisions of this Contract.
6.02 DECLARATION OF MAJOR DEFAULT AND TRANSFER OF SERVICE. In the
event the Coalition determines that a major default has occurred, and if the nature of the
default is, in the opinion of the Coalition, such that public health and safety are
endangered, ETMC-EMS shall be given written notice specifying the particular
complaints and identifying them as appropriate by date, place, etc. with a reasonable
opportunity (defined as 72 hours for deficiencies dangerous to public health and safety
and thirty (30) days for any other deficiencies) to correct said deficiency. In the event
ETMC-EMS fails to correct said deficiency within the time as set forth above, ETMC-
EMS may thereafter be found to be in default (as set forth in Section 6.03). In such
A36\6203122\ 198996-5/17/0 1
19
event, ETMC-EMS shall cooperate with the Coalition to effect a prompt and orderly
transfer to the Coalition of ETMC-EMS's and the Coalition's responsibilities as set forth
in Section 6.03.
6.03 MAJOR DEF AUL T. In the event of a major default and the failure to cure same as set
forth in Section 6.02, ETMC-EMS shall transfer its responsibilities within seventy-two
(72) hours thereafter upon such finding of a major default by the Coalition.
Notwithstanding the foregoing, ETMC-EMS does not waive its rights to challenge such
declaration and may dispute such issue in a court of law and, if successful, recover all its
damages as allowed by law.
6.04 DEFAULT NOT DANGEROUS TO PUBLIC HEALTH AND SAFETY. If the
Coalition declares ETMC-EMS to be in major default on grounds other than performance
deficiencies dangerous to public health and safety, ETMC-EMS may dispute and legally
resolve the Coalition's claim of major default prior to transfer of ETMC-EMS's
operations by the Coalition.
6.05 "LAME DUCK" PROVISIONS. Should ETMC-EMS fail to prevail in a future
procurement cycle, the Coalition shall obviously depend upon ETMC-EMS to continue
provision of all services required under this Contract until the new contractor assumes
service responsibilities. Under these circumstances, ETMC-EMS would, for a period of
several months, serve as a "lame duck" contractor. To ensure continued performance
fully consistent with the requirements of this Contract throughout any such "lame duck"
period, the following "lame duck" provisions shall apply:
a. Throughout such "lame duck" period, ETMC-EMS shall continue all operations
and support services at substantially the same levels of effort and performance as
were in effect prior to the award of the subsequent contract to a competing firm;
b. ETMC-EMS shall make no changes in methods of operation that could
reasonably be considered to be aimed at cutting ETMC-EMS's service and
operating costs to maximize profits during the final stages of this Contract; and,
c. The Coalition recognized that, if a competing firm prevails in a future
procurement cycle, ETMC-EMS may reasonably begin to prepare for transition of
service to the new contractor during the "lame duck" period, and the Coalition
shall not unreasonably withhold its approval of ETMC-EMS's requests to begin
an orderly transition process, including reasonable plans to relocate staff, scale
down certain inventory items, etc., so long as such transition activities do not
impair ETMC-EMS's performance during the "lame duck" period and so long as
such transition activities are prior-approved by the Coalition.
6.06 PERFORMANCE PENALTY. To provide protection to the Coalition, a Seventy-Five
Thousand Dollar ($75,000) performance penalty will be assessed ETMC-EMS, pursuant
to the provisions for declaration of major default set forth herein.
A36\6203\22\ 198996:.5117/01
20
ARTICLE VII
TERM AND RENEWAL
7.01 TERM OF AGREEMENT. The initial term of this Agreement shall commence on the
date of final execution, indicated herein, and end on September 30, 2003 ("Initial Term").
7.02 RENEWAL TERMS. This Agreement shall automatically continue in force from the
end of the Initial Term for one (1) year renewal terms (each renewal term referred to as
"Renewal Term") unless either of the parties shall give written notice to the other of its
desire that this Agreement not pass into a succeeding Renewal Term but shall terminate
at the end of the then current term. Such notice of termination shall be received one
hundred eighty (180) days prior to the end of the current term. There will be no limit to
the number of extensions.
(BALANCE OF P AGE INTENTIONALLY LEFT BLANK)
A36\6203\22\ 198996-5117/0 1
21
ARTICLE VIII
REPORTS
8.01 VERIFICATION OF USER-FEE CHARGES. By May 1 of each contract year,
ETMC-EMS shall furnish to each Member Jurisdiction and Participating Jurisdiction an
annual audited financial report documenting the following information for the previous
contract year:
a. Gross revenues (exclusive of mileage charges) generated for the transport of
patients by ETMC-EMS ground ambulance service originating with that
jurisdiction;
b. Total number of individual patients transported (one-way) by ETMC-EMS
ground ambulance service originating within that jurisdiction;
c. Certification that charges for loaded mileage and membership fees have or have
not been billed at or below the amounts then authorized by the uniform schedule
of charges for mileage and membership fees (verification by sampling data shall
be acceptable);
d. Subsidy payments received from that jurisdiction;
e. An accounting of late-run penalty payments to and expenditures for the "CPR and
1st Response Support Program Fund". Such statement shall certify that
expenditures of such funds have been used solely to fund direct, out-of-pocket
costs of citizen CPR and related training and ETMC-EMS's 1st Response support
program costs, and that none has been used to fund wages or salaries of personnel
employed by ETMC-EMS or to fund ETMC-EMS's administrative overhead
costs.
8.02 RESPONSE TIME COMPLIANCE. Within ten (10) days after the close of each
calendar month, ETMC-EMS shall provide to each Member Jurisdiction and
Participating Jurisdiction and to the Medical Control Board, an accounting of response
time performance relative to every transport for ambulance service originating within
that jurisdiction, presented in the following foIinat:
(BALANCE OF P AGE INTENTIONALLY LEFT BLANK)
A36\6203\22\ 198996-5/17/0 1
22
Life-Threatening Non Life-Threatening Unscheduled Routine Scheduled Routine
Response Time EmerJ' encies Emergencies Transfers Transfers*
# % Cum % # % Cum % # % Cum % # % Cum %
O-:::;lm59s
1 - < 2m59s
2 - < 3m59s
3 - < 4m59s
4 - < 5m59s
Etc. Etc. Etc. Etc. Etc.
:::; 120 min.
* i.e., scheduled 24 hours or more in advance of requested time of pickup.
(BALANCE OF PAGE INTENTIONALLY LEFT BLANK)
A36\6203\22\1 98996-5/1 7/01
23
ARTICLE IX
GENERAL PROVISIONS
9.01 CHARACTER AND COMPETENCE OF PERSONNEL. All persons employed by
ETMC-EMS in the performance of work under this Contract shall be competent and
holders of appropriate permits in their respective trades or professions. The Coalition
may demand the removal of any person employed by ETMC-EMS who chronically
misconducts himself or is chronically incompetent or negligent in the due and proper
performance of his duties, and such person shall not be reassigned by ETMC-EMS for
production of services under this Contract without the written consent of the Coalition,
provided, however, that the Coalition shall not be arbitrary or capricious in exercising its
rights under this provision, and shall be required to document in writing the specific
reasons for exercising rights relative to any given employee, and shall also give that
employee an opportunity to defend himself in the presence of ETMC-EMS's chief
executive officer and Medical Director and the Directors of the Coalition's governing
board prior to removal.
9.02 PERMITS & LICENSES. ETMC-EMS shall be responsible for obtaining all necessary
permits and licenses required for initiation and completion of its work under this
Contract.
9.03 ASSIGNMENT. ETMC-EMS will have the right to assign this Agreement to any
related or affiliated entity of the East Texas Medical Center Regional Healthcare System
without any party's prior consent. Otherwise, this Agreement shall not be assigned or
transferred without the expressed written consent of the Coalition. Such written consent
shall not be unreasonably withheld.
9.04 RIGHTS AND REMEDIES NOT WAIVED. ETMC-EMS agrees that the work
specified in this Contract shall be completed without further consideration of the market
rights provided for herein and that the acceptance of work and the payment of user fees
and subsidy amounts (if any) shall not be held to prevent maintenance of an action for
failure to perform such work in accordance with this Agreement. In no event shall
payment by a Member Jurisdiction (if any such payments are made) hereunder constitute
or be construed to be a waiver by the Coalition of any default or covenant or any default
which may then exist on the part of ETMC-EMS, and the making of such payment while
any such default exists shall in no way impair or prejudice any right or remedy available
to the Coalition with respect to such default.
9.05 ATTORNEY FEES. If either the Coalition or ETMC-EMS institutes litigation against
the other party to secure its rights pursuant to this Contract, the prevailing party shall be
entitled to the actual and reasonable costs of litigation and reasonable attorney's fees in
addition to any other relief to which such party may be entitled.
9.06 NON-DISCRIMINATION. ETMC-EMS agrees as follows:
a. ETMC-EMS will not discriminate against any employee or applicant for
employment because ofrace, religion, color, national origin, disability, sex or age,
ETMC-EMS will take affirmative action to ensure that applicants are employed
and that employees are treated during employment without regard to their race,
A36\6203\22\ 198996-5/17/01
24
religion, color, national origin, disability, sex or age. Such action shall include,
but not be limited to the following: (i) employment, upgrading, demotion or
transfer; (ii) recruitment or recruitment advertising; (iii) layoff or termination; (iv)
rates of payor other forms of compensation; and (v) selection for training,
including apprenticeship. ETMC-EMS agrees to post in conspicuous places,
available to employees and applicants for employment, notices to be provided
setting forth the provisions of this non-discrimination clause.
b. ETMC-EMS will, in all solicitations or advertisements for employees placed by
or on behalf of ETMC-EMS, state that all qualified applicants will receive
consideration for employment without regard to race, religion, color, national
origin, disability, sex or age.
9.07 COMPLIANCE WITH LAWS. The services furnished by ETMC-EMS under this
Contract shall be rendered in substantially full compliance with applicable federal, state
and local laws, rules and regulations. It shall be ETMC-EMS's responsibility to
determine which laws, rules and regulations apply to the services rendered under this
Contract and to maintain compliance with those applicable standards at all times.
9.08 SEVERABILITY. In the event any provision hereunder is determined to be illegal,
invalid or unenforceable under applicable law, said provision shall be deemed deleted
from this Agreement as if never contained herein and the remainder of this Agreement
shall remain enforceable.
9.09 HEADINGS. The Paragraph headings, articles, sections and captions contained in this
Contract are solely for the convenience of the Parties and shall in no manner be construed
as part of this Agreement.
9.10 CHOICE OF LAW. This Agreement shall be governed by the laws of the State of
Texas, and, in the event of litigation with respect to this Agreement or any of its terms,
venue shall rest in Collin County, Texas.
9.11 ENTIRE AGREEMENT. This Agreement supersedes any and all other agreements,
whether oral or in writing, between the Parties hereto with respect to the subject matter
hereof, and no other agreement, statement or promise relating to the subject matter of this
Agreement that is not contained herein shall be valid or binding unless in \vriting signed
by all Parties.
9.12 AMENDMENT. This Agreement may be amended by a writing upon the agreement of .
both Parties so as to conform to the law or any changes in the law and/or regulations
applicable to the terms of this Agreement. If the Coalition refuses to amend the
Agreement in accordance with this Section, such action shall be considered a breach of
this Agreement and the Agreement may be terminated by ETMC-EMS.
9.13 NO WAIVER. The failure of either party to insist at any time upon the strict observance
of perfom1ance of any provision of this Agreement or to exercise any right or remedy as
provided in this Agreement shall not impair any right or remedy of such party or be
construed as a waiver or relinquishment thereof with respect to subsequent defaults or
breaches. Every right and remedy given by this Agreement to the Parties hereto may be
A36\6203\22\ 198996-5/17/01
25
exercised from time to time and as often as may be deemed expedient by the appropriate
party.
9.14 INCORPORATION OF SCHEDULES. Schedule A, Uniform EMS Ordinance and
Schedule B, Commitment to 1st Responder Support and Quality Care, Schedule C,
Quality Improvement Program are expressly incorporated within this Contract as though
written and contained directly within the text of this Contract.
9.15 CORRESPONDENCE. All notices hereunder by either Party to the other shall be in
writing, delivered personally, by certified or registered mail (postage prepaid), return
receipt requested or by overnight courier services (charges prepaid) and shall be deemed
to have been duly given when delivered personally, when deposited in the United States
mail or delivered to the overnight courier, addressed as follows:
If to ETMC-EMS:
Anthony Myers, Vice President
East Texas Medical Center Emergency Medical Service
P. O. Box 387
Tyler, Texas 75710
If to Coalition:
Attention:
or to such other persons or places as either Party may, from time to time, designate by
written notice to the other.
9.16 INDEPENDENT CONTRACTOR. In performing this Contract, ETMC-EMS is acting
as an independent contractor with respect to the Coalition and neither ETMC-EMS nor
any ETMC-EMS staff shall be considered employees of the Coalition. It is agreed and
acknowledged by the Parties that, as an independent contractor, ETMC-EMS retains the
right to contract with and provide EMS services to entities and individuals other than the
Coalition, and nothing in this Agreement shall be interpreted as limiting or restricting in
any way ETMC-EMS's right to do so. In no event shall this Agreement be construed as
establishing a partnership or joint venture or similar relationship between the Parties
hereto, and nothing herein shall authorize either Party to act as agent for the other, except
to the extent herein provided. The Coalition shall be liable for its own debts, obligations,
acts and omissions, including the payment of all required withholding, social security and
other taxes and benefits with respect to all Coalition personnel. Neither ETMC-EMS nor
any ETMC-EMS staff shall be subject to any Coalition policies solely applicable to the
Coalition's employees or be eligible for any employee benefit plan offered by the
Coalition.
9.17 FORCE MAJEURE. Neither Party shall be liable or deemed to be in default for any
delay or failure in performance under this Agreement or other interruption of service
deemed to result, directly or indirectly, from the acts of God, civil or military authority,
A36\6203\22\ 198996-5117101
26
acts of public enemy, war, accidents, fires, explosions, earthquakes, floods, failure of
transportation, strikes or other work interruptions by either Party's employees, or any
other similar cause beyond the reasonable control of either Party.
9.18 ACCESS TO RECORDS. As an independent contractor of the Coalition, ETMC-EMS
shall, in accordance with 42 U.S.C., S l395x (v)(I)(I) (Social Security Act S 1861 (v)(I)(I)
and 42 C.F.R., Part 420, Subpart D, S420.300, et seq., until the expiration of four (4)
years after the furnishing of Medicare reimbursable Services pursuant to this Contract,
upon proper written request, allow the Comptroller General of the United States, the
Department of Health and Human Services and their duly authorized representatives
access to this Agreement and to ETMC-EMS's books, documents and records (as such
terms are defined in 42 C.F.R., S420.301) necessary to verify the nature and extent of
costs of Medicare reimbursable Services provided under this Contract. In accordance
with such laws and regulations, if Medicare or Medicaid reimbursable services provided
by ETMC-EMS under this Contract are carried out by the means of a subcontract with an
organization related to ETMC-EMS, and such related organization provides the services
at a value or cost of $10,000 or more over a twelve (12) month period, then the
subcontract between ETMC-EMS and the related organization shall contain a clause
comparable to the clause specified in the preceding sentence. No attorney-client,
accountant-client or other legal privilege shall be deemed to have been waived by
ETMC-EMS or the Coalition by virtue of this Contract.
9.19 ENTIRE AGREEMENT; MODIFICATION. This Contract contains the entire
understanding of the Parties with respect to the subject matter hereof and supersedes all
prior agreements, oral or written, and all other communications between the Parties
relating to such subject matter. This Contract may not be amended or modified except by
mutual written agreement.
9.20 CHANGE IN LA'V. Notwithstanding any other provision of this Agreement, if the
governmental agencies (or their representatives) which administer Medicare, any other
payor or any other federal, state or local government or agency passes, issues or
promulgates any law, rules, regulation, standard or interpretation, or any court of
competent jurisdiction renders any decision or issues any order, at any time while this
Agreement is in effect, which prohibits, restricts, limits or in any way substantially
changes the method or amount of reimbursement or payment for Services rendered under
this Agreement, or which otherwise significantly affects either Party's rights or
obligations hereunder, either Party may give the other notice of intent to amend this
Agreement to the satisfaction of both Parties, to compensate for such prohibition,
restriction, limitation or change. If this Agreement is not so amended in writing within
ten (10) days after said notice was given, this Agreement shall terminate as of midnight
on the tenth (lOth) day after said notice was given.
9.21 CONSENTS, APPROVALS AND EXERCISE OF DISCRETION. Except as may be
herein specifically provided to the contrary, whenever this Agreement requires any
consent or approval to be given by either Party, or either Party must or may exercise
discretion, the Parties agree that such consent or approval shall not be unreasonably
withheld or delayed, and such discretion shall be reasonably exercised in good faith.
A36\6203\22\ 198996-5117/01
27
9.22 THIRD PARTIES. None of the provisions of this Agreement shall be for the benefit of
third parties or enforceable by any third party. Except as provided above, any agreement
to pay an amount and any assumption of a liability herein contained, expressed or
implied, shall only be for the benefit of the Parties hereto and such agreement or
assumption shall not inure to the benefit of any third party, including an obligee.
9.23 P AID IN-SERVICE TRAINING. ETMC-EMS will provide each ETMC-EMS EMT
and Paramedic 'with sixty (60) paid hours for continuing education each year.
9.24 PARAMEDIC SKILL LEVELS. Effective
EMS Paramedic skill levels will be implemented as follows:
,200_, ETMC-
a. Texas State EMS-P Certification
b. Basic TraUlnaLife Support
c. Driver Training
d. Advanced Cardiac Life Support
-e:--- - u Advanced-Pediatric Emergency Care
9.25 TERMINATION OF CONTRACTS. In the event any of the Member Jurisdictions
signing below as a principal of this Contract have individual contracts with East Texas
Medical. Center. Emergency Medical Service for ambulance service as of the
Commencement Date of this Agreement, such contractual arrangements and agreements
shall terminate contemporaneously with the execution of this Agreement.
9.26 COUNTERP ARTS. This Contract may be executed in multiple counterparts, and is
effective on the last date of execution indicated below.
City of Lavon, Texas
I
East Texas Medical Center
d/b/a East Texas Medical Center
Emergency Medical Service
or J
rinted Name: 111
JI- 7-0/
~ (date)
. '/VbFr
7J~f
City anager
Printed Name:
(date)
A36\6203\22\ 198996-5/17/0 1
28
~'Texa' 1(~7-0{
Mayor .,..-;-:- C dJ. ( date)
Printed Name: /6H r t-dS
~tl~/
City Manager / A (date)
Printed Name: ~/,V OA /T. SjfiJ 4/)::J
,
~ /3 tJ/
Ci'ty Manager J1 . $;i (date)
Printed Name:. -/1 1t;I1Jlln
City of Wylie, Texas
Mayor
Printed
A36\6203\22\ 198996-5/17/01
29
City of Murphy, Texas
~yY~;{Lu
Mayor (date)
Printed Name: ~ 0 y .~ 13 B A/T LB
'//;J
City Manager
Printed Name:
( date)
City of St. Paul, Texas
~j)~ %7/P1
Ma f (date)
rintedName: .00 Yc c to C.e4 ~ ~
'1 /11
City Man'ager
Printed Name:
( date)
City of Parker, Texas
j)~rld IfA/)?nl~~ '_,2~J;l/
11ayor (date)
Printed Name: L7 h' ~ Ie' hid ~ ~ t!! ~
B'1/~hry Y/1Cm~
(or #eNtll?7/h?~41~V 4 -..2f--t'/
City Mahager 1 L~ / (date)
~~ PrinredName:~;?~~~
rJiI-IE WYLIE NEWS
Cotetln~ W"IIe, Saellse, ftllltl,ll, DlIIlllte luttoundln~ aled
110 N. 111111111(.1 SI.
1',( J, Illl~ .l(j!}
W}'lir. TC~Il~ 7.'iOYR
(972) 442-5515
rnx (972) 442-43 I R
s'rATE Oli' TEXAS
COUNTY Oli' COLLIN
Uefol'e me, the underslglled outhurUy, Oil tbls doy petsonolly appeared thod ElIgbtock, of TilE WYLIE
NEWS, n lIe\V5l'nper tegulnrly published 'n.ColIlI. County.lexas atid bovtng general drculatlon h. Collin
COUllty, 'texns, ,,'110 being by .lIe duly 81Vorri de,JOsed oud says thut the totegohig oUoched
'-~ {JnR. ,# ~ 6a/ d- ~
nns publ! hed III 5nldlle"'Sl'nIJet on e tollo\vlng dates, to-wit!
,~ c2 ~
, 200", and
f 2001
(Jf/ff---
Cl;. --;-';gbr~~k '
Subscl'lbed nml S\VOI'n to befote me thfs the :~
to cea-tlrJ' ",hide whlless my hsnd and sen' or office.
day of
62~
f 2001
Notary PubUc 'II aud Cot'
The State or 'texas
1\1y COIIIlUiss'OIl ExpJres .3J 3) rY-!
,
l'IIE WYLIE NEWS
t;;,-;'ct/lIg'Wyiie, Sachse, ftltltl,l,y lIlIl/lhe slIttllllllllillg lItClI
110 N. Ballard SI.
/'( J. nll~ .1(i9
Wylir. TCl(Il~ 75()9R
(972) 442-5515
rnx (972) 442-4.1 I R
STATE OF TEXAS
COUNTY OF COLLIN
Before tile, the undersigned authority, on this day personally oppeared Chad Engbt'ock, of THE WYLII~
NEWS, n newspaper regularly published In Collin County, Texas and having general drculaUonln Collin
COUllty, Texas, who being by me duly sworn deposed alld says that the foregoing attached
Sj JL Old. WO \ - :}~
I
\"as published In said newspaper on the following dates, to-wit:
.'~''''
~+-. ~~
, 2001 ~ and
, 2001 .
~
Chad Engbrock
Subscribed nnd sworn to before me this the 1 +h
to cel'Uf.}' which ".Jtness my band and seal of office.
day of
~. Od-..
, 200 f ,
My Commission Expires
~ C6~~J1
ORDINANCE NO.-l
2001-26
AN ORDINANCE
OF THE CITY OF
WYLIE. TEXAS,
ESTABLISHING A REG-
ULATED AMBULANCE
SERVICE SYSTEM BY
IMPLEMENTING THE
MASTER CONTRACT
FOR PARAMEDIC
AMBULANCE SER-
VICES BETWEEN EAST
TEXAS MEDICAL CEN-
TER DIBI A EAST
TEXAS MEDICAL CEN-
TER EMERGENCY
MEDICAL SERVICE
("ETMC-EMS") AND
THE CITY OF WYLIE,
TEXAS AND OTHER
SOUTHEAST COLLIN
COUNTY COALITION
MEMBERS INCLUDING
THE CITY OF Ll\VON,
LUCAS. MURPHY,
PARKER, SACHSE,
AND ST PAUL WITH
THE INITIAL TERM OF
THE AGREEMENT
EFFECTIVE ON THE
DATE OF FINAL EXE-
CUTION AS INDICAT-
ED ON THE CON-
TRACT AND ENDING
SEPTEMBER 30, 2003;
PROVIDING FOR A
PENALTY FOR THE
VIOLATION OF THIS
ORDINANCE; PROVID-
ING FOR REPEALING,
SAVINGS AND SEVER-
ABILITY CLAUSES;
PROVIDING FOR AN
EFFECTIVE DATE OF
THIS ORDINANCE;
AND PROVIDING FOR
THE PUBLICATION OF
THE CAPTION HERE-
OF
JOHN MONDY, MAYOR
ATTEST:
,BARBARA SALINAS
-J- CITY SECRETARY
. _ 18-lt-312
rI'lIE WYLIE NEWS
Coveting Wylie, Sacllse, ftlutrhy allll the surrounding ntei
I '0 N. B:tllmd SI.
P.O. l111lt ~(19
Wylie, Tc:'\n~ 7509R
(972) 442-5515
Fox (972) 442-43 I R
S'I'ATE OIi' TEXAS
C()UNTY OF COLLIN
Uefol'e me, the undersigned outhorlty, 011 this doy persollolly oppeared Cllod Etlgbtock. of THE WYLIE
NEWS, 0 lIewslJoper I'egulorly published tn, Collin Coullty. Texas atid hovlllg general circulation In Colli"
COUlltJ, 'teXAS, ,...ho being by rne duly slVorri deposed and soys that the foregoing attached
57/L Ordinance 2001-26
,t'DS published '11 snld lIen'spolJer on tlte following dotes; to-wit:
June 20
. 20(H', ond
.2001
((ltk
Subsel'lbed oud 5'VOI'1I to before me tbls tbe 2nd
to eel'flr,)' ,vhlch watness my hand nnd senl of offlce.
July
KATHLEEN S. NOBLE
Notary Public
State Of Texas
My Com Exp. 03.()3,2004
.2001
Notary PubUc hi dud fo..
The State of Texas
1\1y COlluuissioll Expire
ORDINANCE
NO. 21101-26
AN ORDINANCE OF
THE CITY OF WYLIE,
TEXAS, ESTABLISHING
A REGULATED AMBU-
LANCE SERVICE SYS-
TEM BY IMPLEMENT-
ING THE MASTEr",
CONTRACT FOR PARA-
MEDIC AMB ULANCE
SERVICES BETWEEN
EAST TEXAS MEDICAL
CENTER D/B/A EAST
TEXAS MEDICAL CEN-
TER EMERGENCY
MEDICAL SERVICE
C'ETMC-EMS") AND
THE CITY OF WYLIE,
TEXAS AND OTHER
SOUTHEAST COLLE'I
COUNTY COALITION
MEMBERS INCLUDING
THE CITY OF LAVON,
LUCAS, MURPHY,
PARKER, SACHSE, AND
ST. PAUL WITH THE
INITIAL TERl"!1 OF THE
AGREEMENT EFFEC-
TIVE ON THE DATE OF
FINAL EXECUTION AS
INDICATED ON THE
CONTRACT Al',fD END-
[NG SEPTEMBER 30,
2003: PRt=:\rIl)II\IG FC)R
A PENALTY FOR THE
V[OLATION OF THIS
ORDINANCE; PROVID-
ING FOR REPEALING,
SAVINGS AND SEVER-
ABILITY CLAUSES.
PROVIDING FOR AN
EFFECTIVE DATE OF
THIS ORDINANCE,
AND PROVIDING FOR
THE PUBLICATION OF
THE CAPTION HERE-
OF
DULY PASSED AND
APPROVED by the City
Council of the City of
Wylie, Texas, this 12th day
of June, 2001.
John Mondy, Mayor
. Barbara Salinas,
1city Secretary 4-1 t-339
