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FD Dominican University Nursing DeptDominican University of California Memorandum of Understandine between San Rafael Fire Den_ artment and Dominican University Nursing Department This Memorandum of Understanding ("Understanding" or "Agreement") is made this _day of F -6-'-N .2017 by and between Dominican University of California ("SCHOOL"), located at 50 Acacia Avenue, San Rafael, CA 94901 California, and the City of San Rafael and specifically its San Rafael Fire Department, located in San Rafael, CA 94901 ("HOST AGENCY"). WHEREAS, the purpose of this Understanding is to guide and direct the parties respecting their working arrangements and agreements in furtherance thereof to provide clinical and academic learning experiences for students in the SCHOOL, and simulation facilities for paramedic trainees in the HOST AGENCY. WHEREAS, this Understanding is intended and shall be interpreted to meet the SCHOOL's accreditation standards related to affiliation agreements with clinical affiliates which require at a minimum: • The HOST AGENCY will provide student, and faculty if applicable, access to appropriate resources for student education. • The SCHOOL is ultimately responsible for the education program, academic affairs, and the assessment of students. • The SCHOOL is primarily responsible for the appointment and assignment of faculty/preceptors with responsibility for student teaching. • Specification of the responsibility for treatment and follow-up when a student is exposed to an infectious or environmental hazard or other occupational injury. • The shared responsibility of the SCHOOL and HOST AGENCY for creating and maintaining an appropriate learning environment. • Confirmation that the SCHOOL's department heads (or clerkship directors) Have authority to ensure faculty/preceptors and student access to appropriate resources for student education when those department heads are not also the clinical service chiefs at affiliated institutions. WHEREAS, neither party intends for this Understanding to alter in any way its respective legal rights or its legal obligations to any third party. 1 of 11 LA-3-0%1- NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the parties identified in this Memorandum of Understanding agree to the following: Responsibilities of the SCHOOL 1. The SCHOOL will provide the HOST AGENCY with access to the Clinical Simulation Center on a space available basis for the purpose of supporting the HOST AGENCY Paramedic Academy. 2. The SCHOOL will provide logistical and technical support, and simulation expertise (if available) for the Paramedic Academy when utilizing SCHOOL resources, for the purpose of: a. safeguarding SCHOOL resources; and b. supporting an adequate simulation learning environment for the Paramedic Academy. 3. SCHOOL will provide the above mentioned time and resources up to two times per calendar year. 4. The SCHOOL will collaborate with the HOST AGENCY to facilitate scheduling and logistics of "Ride Along" opportunities. 5. The SCHOOL will provide the HOST AGENCY with a primary contact person for management of the "Ride Along" scheduling and logistics, and to ensure compliance with SCHOOL responsibilities in this regard. 6. The SCHOOL will plan and determine the adequacy of the educational experience of the students in theoretical background, basic skill, professional ethics, attitude and behavior and shall assign to the HOST AGENCY only those students who have satisfactorily completed the prerequisite didactic portions of the SCHOOL's curriculum. 7. The SCHOOL will retain ultimate responsibility for the education and assessment of its students. The SCHOOL's representative for this Agreement shall be a faculty member appointed and assigned by the SCHOOL, who will be responsible for student teaching and assessment provided pursuant to this Agreement. 8. The SCHOOL will advise all students assigned to the HOST AGENCY facilities regarding the confidentiality of patient/client records and patient/client information imparted during the training experience. The SCHOOL will also advise all students that the confidentiality requirements survive the termination or expiration of this Agreement. 9. The SCHOOL will require all participating students to maintain health insurance and provide proof of health insurance to the SCHOOL, which shall provide the same to HOST AGENCY upon request. The HOST AGENCY may request the student provide proof of health insurance prior to beginning of the training experience. 2 of I 1 10. The SCHOOL will require all participating students to have completed an appropriate criminal background check, and to have documented appropriate immunizations on file with the SCHOOL. If applicable, the HOST AGENCY shall notify the student of any requests for evidence of criminal background test or immunization. The SCHOOL will inform the student of his/her responsibility to provide evidence to the HOST AGENCY of any required criminal background checks or immunizations, when requested. The HOST AGENCY shall notify the SCHOOL of its requirements of an acceptable criminal background check and required immunizations. The SCHOOL will also inform students that they may be required to undergo a drug test or other similar screening tests pursuant to the HOST AGENCY'S policies and practices, and that the cost of any such test will be paid by the student, if not the HOST AGENCY. 11. The SCHOOL will advise students that they are required to comply with HOST AGENCY rules, regulations, and procedures. 12. The SCHOOL will advise students that they are required to inform HOST AGENCY if unable to attend scheduled event. 13. The SCHOOL will advise students that they are not to perform any invasive or ACLS procedures on a patient. Students may perform vital signs checks and basic life support if directly supervised and instructed to do so by qualified personnel from HOST AGENCY. 14. If requested by the HOST AGENCY, the SCHOOL will provide instruction to the HOST AGENCY'S staff with respect to the SCHOOL's expectations regarding assessment of the SCHOOL'S students at the HOST AGENCY. 15. The SCHOOL warrants and represents that it provides for its students and faculty occurrence -based professional liability insurance with limits of at least $1,000,000 per occurrence and $3,000,000 annual aggregate; occurrence -based commercial general liability insurance with limits of at least $1,000,000 per occurrence and $2,000,000 annual aggregate. The SCHOOL warrants and represents that it provides for its faculty occurrence -based auto liability insurance with limits of at least $1,000,000 per occurrence and workers' compensation insurance with state statutory limits. If requested by the HOST AGENCY, the SCHOOL shall provide a certificate of insurance demonstrating coverage for students completing clinical training at the HOST AGENCY. B. Responsibilities of the HOST AGENCY 1. rhe HOST AGENCY will provide Course instructors for all didactic and simulation experiences within the Paramedic Academy. 2. The HOST AGENCY will schedule, organize and plan the Paramedic Academy dates based upon space available at the SCHOOL, if utilizing SCHOOL resources. 3of11 3. The HOST AGENCY will pay the contracted rates for any Standardized Patients utilized in the Paramedic Academy. 4. The HOST AGENCY, will, in exchange, provide "Ride -Along" opportunities for up to 100 SCHOOL students per academic year. 5. In addition, the HOST AGENCY will provide academic presentations on mutually agreed upon topics of interest to SCHOOL students up to two times per academic year. 6. The HOST AGENCY has a responsibility to maintain a positive, respectful, and adequately resourced learning environment so that sound educational experiences can occur. Therefore, the HOST AGENCY will provide students and faculty/preceptors with access to appropriate resources for student education including: a) access to patients at HOST AGENCY facilities in an appropriately supervised environment, in which the students can complete the SCHOOL's curriculum; b) secure storage space for students' personal items when at the HOST AGENCY. 7. The HOST AGENCY will retain full authority and responsibility for patient care and quality standards, and will maintain a level of care that meets generally accepted standards conducive to satisfactory instruction. While in HOST AGENCY's facilities, students will have the status of trainees; are not to replace HOST AGENCY staff; and, are not to render unsupervised patient care and/or services. All services rendered by students must have educational value and meet the goals of the medical education program. HOST AGENCY and its staff will provide such supervision of the educational and clinical activities as is reasonable and appropriate to the circumstances and to the student's level of training. 8. The HOST AGENCY shall provide, or facilitate access to, emergency care, at the student's expense, for any student who becomes sick or injured by conditions arising out of or in the course of that student's participation in experience at the HOST AGENCY. 9. The HOST AGENCY staff will, upon request, assist the SCHOOL in the assessment of the learning and performance of participating students by completing assessment forms provided by the SCHOOL and returned to the SCHOOL in a timely fashion. 10. The HOST AGENCY will take responsibility for student completion of HIPPA Confidentiality Agreements and Ride Along Waivers. 11. The HOST AGENCY agrees to comply with applicable state and federal workplace safety laws and regulations. In the event a student is exposed to an infectious or environmental hazard or other occupational injury (i.e., needle stick) while at the HOST AGENCY, the HOST AGENCY, upon notice of such incident from the student, will provide such emergency care as is provided its employees, including, where applicable: 4of11 examination and evaluation by HOST AGENCY's emergency department or other appropriate facility as soon as possible after the injury; emergency medical care immediately following the injury as necessary; initiation of the HBV, Hepatitis C (HCV), and/or HIV protocol as necessary; and HIV counseling and appropriate testing as necessary. In the event that HOST AGENCY does not have the resources to provide such emergency care, HOST AGENCY will refer such student to the nearest emergency facility. The SCHOOL will define, for its students, who bears financial responsibility for any charges generated. 12. Upon request, the HOST AGENCY will provide proof that it maintains liability insurance in an amount that is commercially reasonable. 13. The HOST AGENCY will provide written notification to the SCHOOL promptly if a clairn arises involving a student. The HOST AGENCY and SCHOOL agree to share such information in a manner that protects such disclosures from discovery to the extent possible under applicable federal and state peer review and joint defense laws. 14. The HOST AGENCY will resolve any situation in favor of its patients' welfare and restrict a student to the role of observer when a problem may exist until the incident can be resolved by the staff in charge of the student or the student is removed. The HOST AGENCY will notify the SCHOOL'S course director if such an action is required. The removal of a student from the clinical learning experience shall be subject to the non- discrimination provisions included in Section C. 4. of this Agreement. 15. The HOST AGENCY shall identify a site coordinator from among its medical staff who will communicate and cooperate with the SCHOOL's clerkship director to ensure faculty/preceptor and student access to appropriate resources for the clinical training experience. 16. The HOST AGENCY will furnish and permit instructors and students free access to appropriate equipment and supplies for providing services to the HOST AGENCY's clients. 17. The HOST AGENCY will provide space for conferences for students and faculty as available. 18. Allow students and faculty to utilize the HOST AGENCY's eating facilities at the students' and faculty's' sole expense, as available. 19. The HOST AGENCY will share with students its mission statement and its philosophy for providing high-quality clinical learning experiences. 20. The HOST AGENCY will clearly stipulate the full range of medical services and methods of treatment that are offered and clearly the describe the populations that are served. 5of11 C. Mutual Responsibilities 1. Representatives for each party will be established on or before the execution of this Agreement. 2. The parties will work together to maintain an environment of high quality patient care. At the request of either party, a meeting or conference will promptly be held between SCHOOL and HOST AGENCY representatives to resolve any problems or develop any improvements in the operation of the clinical training program. 3. The SCHOOL will provide qualified and competent individuals in adequate number for the instruction, assessment, and supervision of students using the SCHOOL facilities. The HOST AGENCY will provide qualified and competent staff members in adequate number for the instruction and supervision of students using the HOST AGENCY facilities. 4. The SCHOOL and the HOST AGENCY will not discriminate against any employee, applicant or student enrolled in their respective programs because of age, creed, gender identity, national origin, race, sex, sexual orientation or any other basis protected by law. 5. The SCHOOL, including its faculty, staff, students, and preceptors, and HOST AGENCY share responsibility for creating an appropriate learning environment that includes both formal learning activities and the attitudes, values, and informal 'lessons" conveyed by individuals who interact with the student. The parties will cooperate to evaluate the learning environment (which may include on-site visits) to identify positive and negative influences on the maintenance of professional standards, and to conduct and develop appropriate strategies to enhance the positive and mitigate the negative influences. HOST AGENCY shall require its employees who interact with students to adhere to the expectations set forth in Exhibit A, and communicate student violations to the SCHOOL. SCHOOL agrees to require its students to adhere to the expectations set forth in Exhibit A. 6. HOST AGENCY may immediately remove from the premises and retains the right to suspend or terminate any student's participation at the HOST AGENCY. The HOST AGENCY will immediately notify the appropriate office of the SCHOOL if such an action is required and the reasons for such action. The SCHOOL may terminate a student's participation when, in its sole discretion, it determines that further participation by the student would no longer be appropriate. The SCHOOL will notify the HOST AGENCY if such action is required. 7. The parties agree to defend, indemnify, and hold harmless each other against all claims, suits, liabilities and costs, including but not limited to, reasonable attorneys' fees, 6 of I I for claims or suits arising out of or related to the negligence or intentional wrongful acts or omissions of the institutions or their employees. D. Term and Termination This Understanding is effective upon execution by both parties, and will continue indefinitely or until terminated, but must be reviewed, and have renewed signatures by both parties every three years. This Agreement may be terminated at any time and for any reason by either party upon not less than ninety (90) days prior written notice to the other party. Should notice of termination be given under this Section, students already scheduled to train at HOST AGENCY will be permitted to complete any previously scheduled clinical assignment at HOST AGENCY. E. Employment Disclaimer Fhe students participating in the program will not be considered employees or agents of the HOST AGENCY or SCHOOL for any purpose. Students will not be entitled to receive any compensation from HOST AGENCY or SCHOOL or any benefits of employment from HOST AGENCY or SCHOOL, including but not limited to, health care or workers' compensation benefits, vacation, sick time, or any other benefit of employment, direct or indirect. HOST AGENCY will not be required to purchase any form of insurance for the benefit or protection of any student of the SCHOOL. F. Health Insurance Portability and Accountability Act. Students participating in clinical training pursuant to this Agreement are members of the HOST AGENCY's workforce for purposes of the Health Insurance Portability and Accountability Act (HIPAA) within the definition of "health care operations" and therefore may have access to patient medical information as provided for in the Privacy Rule of HIPAA. Therefore, additional agreements are not necessary for HIPAA compliance purposes. This paragraph applies solely to HIPAA privacy and security regulations applicable to the HOST AGENCY and, as stated in paragraph E, above, does not establish an employment relationship. G. Compliance with the Family Educational Rights and Privacy Act ("FERPA") In addition to the foregoing obligations, if SCHOOL provides HOST AGENCY with any legally confidential information including but not limited to confidential personnel information or "personally identifiable information" from student education records as defined by the Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g, and the implementing regulations in Title 34, Part 99 of the Code of Federal Regulations ("FERPA"), HOST AGENCY hereby certifies that collection of this information from SCHOOL is necessary for the performance of the HOST AGENCY'S duties and responsibilities on behalf of SCHOOL under this Agreement. HOST AGENCY further agrees to handle information protected by FERPA in the same manner it would protect the confidentiality of patient records and/or the personally identifiable information of its employees. 7of11 H. No Agency Relationship Between the Parties. Nothing in this Agreement is intended to or shall be construed to constitute or establish an agency, employer/employee, partnership, franchise, or fiduciary relationship between the parties; and neither party shall have the right or authority or shall hold itself out to have the right or authority to bind the other party, nor shall either party be responsible for the acts or omissions of the other except as provided specifically to the contrary herein. I. Assignment This Agreement will not be assigned by either party without the prior written consent of the other. J. No Special Damages In no event shall either party be liable hereunder (whether in an action in negligence, contract or tort or based on a warranty or otherwise) for any indirect, incidental, special or consequential damages incurred by the other party or any third party, even if the party has been advised of the possibility of such damages. K. No Payments No payments shall be made between the parties or to the students in connection with this Agreement. L. Severability The invalidity of any provision df this Agreement will not affect the validity of any other provisions. M. Entire Agreement This Agreement contains the entire Agreement of the parties as it relates to this subject matter and may be modified only by mutual agreement of the parties. Any such amendment must be in writing, dated and signed by the parties. N. Notices All notices provided by either party to the other will be in writing, and will be deemed to have been duly given when delivered personally or by prepaid first class mail addressed as follows: 8of11 If to SCHOOL, addressed to: Dominican University of California Attn: Nicola Pitchford, Vice President for Academic Affairs/Dean of the Faculty 50 Acacia Avenue San Rafael, CA 94901 If to HOST AGENCY, addressed to: San Rafael Fire Department Chief Christopher Gray City of San Rafael P.O. Box 151560 San Rafael, CA 94915-1560 O. Execution This Understanding is effective when signed by all parties. The individuals executing this Understanding are authorized to sign on behalf of their institutions and certify that their institutions have accepted the terms of the Memorandum of Understanding between San Rafael Fire Department and Dominican University Nursing Department and further agree to comply with its terms. SCHOOL : B L� Y- _. Nicola Pgdch Vice President fdemic Affairs/ Dean of the Faculty HOST AGENCY By: - Name: ch Its: City Manager Date: 1Date: . 2- By: F e,IZ Name: Christopher Gray Its: Chief, San Rafael Fire Department Date: DZ l '�T' 2v 1 % Wn, r fit E�. EXHIBIT A: TEACHER -LEARNER EXPECTATIONS The SCHOOL holds in high regard professional behaviors and attitudes, including altruism, integrity, respect for others and a commitment to excellence. Effective learning is best fostered in an environment of mutual respect between teachers and learners. In the context of Nursing education the term "teacher" is used broadly to include peers, resident physicians, full-time and volunteer faculty members, clinical preceptors, nurses, and ancillary support staff, as well as others from whom students Ieam. GUIDING PRINCIPLES: Duty: Medical educators have a duty to convey the knowledge and skills required for delivering the profession's standard of care and also to instill the values and attitudes required for preserving the medical profession's social contract with its patients. Integrity: Learning environments that are conducive to conveying professional values must be based on integrity. Students and residents learn professionalism by observing and emulating role models who epitomize authentic professional values and attitudes. Respect: Respect for every individual is fundamental to the ethic of clinical practice. Mutual respect is essential for nurturing that ethic. Teachers have a special obligation to ensure that students and residents are always treated respectfully. RESPONSIBILITIES OF TEACHERS AND LEARNERS: Teachers should: Treat students fairly and respectfully • Maintain high professional standards in all interactions • Be prepared and on time • Provide relevant and timely information • Provide explicit learning and behavioral expectations early in a course or clerkship • Provide timely, focused, accurate and constrictive feedback on a regular basis and thoughtful and timely evaluations at the end of a course or clerkship • Display honesty, integrity and compassion • Practice insightful (Socratic) questioning, which stimulates learning and self-discovery, and avoid overly aggressive questioning which may be perceived as hurtful, humiliating, degrading or punitive 10 of 11 • Solicit feedback from students regarding their perception of their educational experiences • Encourage students who experience mistreatment or who witness unprofessional behavior to report the facts immediately Students should: • Be courteous of teachers and fellow students • Be prepared and on time • Be active, enthusiastic, curious learners • Demonstrate professional behavior in all settings • Recognize that not all learning stems from formal and structured activities • Recognize their responsibility to establish learning objectives and to participate as an active learner • Demonstrate a commitment to life-long learning, a practice that is essential to the profession of medicine • Recognize personal limitations and seek help as needed • Display honesty, integrity and compassion • Recognize the privileges and responsibilities coming from the opportunity to work with patients in clinical settings • Recognize the duty to place patient welfare above their own • Recognize and respect patients' rights to privacy • Solicit feedback on their performance and recognize that criticism is not synonymous with "abuse" Relationships between Teachers and Students Students and teachers should recognize the special nature of the teacher -learner relationship which is in part defined by professional role modeling, mentorship, and supervision. Because of the special nature of this relationship, students and teachers should strive to develop their relationship to one characterized by mutual trust, acceptance and confidence. They should both recognize the potential for conflict of interest and respect appropriate boundaries. DOMINICAN UNIVERSITY ajC:AUFORNIA ,d9c Academic Affairs Agreement/Contract/Memorandum of Understanding (MOU) Signature Routing Sheet Title: Memorandum of Understanding between San Rafael Fire Department and Dominican University Nursing Department No. of copies: 1 1. Department /Program Faculty Lead Barbara McCamish}�, /1 Name Signature 2. Department /Program Director Andrea Boyle Name Signature / sf 3. School Dean Ruth Ramsey Name r Signature 4. Business Officer (if anew agreement, contract, MOU; or if required by the agency) Tammi Jackson Vice President for Finance _ Signature and Administration revised 030216 -?-Hr� Date Date Date Date CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Fire Project Manager: Danielle Ferrigno Extension: 3138 Contractor Name: Dominican Contractor's Contact: Barbra McCamish 45-458-3764 Contact's Email: Barbara.mccamish@dominican.edu ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTIONI COMPLETED REVIEWER DEPARTMENT DATE Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor 1/11/2016 N DF b. Email contract (in Word) & attachments to City Atty c/o Laraine.Gittens@cityofsanrafael.org ❑ 2 City Attorney a. Review, revise, and comment on draft agreement 1/11/2017 N LAG and return to Project Manager 1/11/2017 N LAG b. Confirm insurance requirements, create Job on PINS, send PINS insurance notice to contractor 3 Project Manager Forward three (3) originals of final agreement to Click here to ❑ contractor for their signature enter a date. 4 Project Manager When necessary, * contractor-siened agreement ❑ N/A agendized for Council approval *PSA > $20,000; or Purchase > $35,000; or Or ❑ Public Works Contract> $125,000 Date of Council approval Click here toenter a date. PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 5 Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form J 6 City Attorney Review and approve hard copy of signed �agreement V&11 7 City Attorney I Review and approve insurance in PINS , and bonddl (for Public Works Contracts) �/� 11-7 8 City Manager/ Mayor Agreement executed by Council authorized official L I 9 City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager W -3-