³scope of work, scope of work. 2. services 3. compensat ion

1Last revised: 11/18/20

AGREEMENT FOR PROFESSIONAL SERVICESJAIL INMATE AND DETAINED YOUTH MEDICAL SERVICES

THIS AGREEMENT (“Agreement”) is made and entered into this 1st day of July, 2021, by and between the County of Tuolumne, a political subdivision of the State of California, (“County”), and ______________, a [INSERT TYPE OF COMPANY], (“Contractor”), pursuant to the following terms and conditions.

W I T N E S S E T H:

1. TERM

The term of this Agreement shall commence on July 1, 2021 and terminate on June 30, 2026 unless extended as provided by this Agreement.

This Agreement may be extended for three (3) one-year extensions by written amendment signed by both parties.

2. SERVICES

Contractor shall perform Jail Inmate and Detained Youth medical services as describedin Exhibit A, “Scope of Work,” which is attached hereto and incorporated herein by reference. Contractor shall provide all staffing and materials necessary to perform the Scope of Work.

3. COMPENSATION

Contractor shall be compensated for services performed in an amount not to exceed [INSERT $ AMOUNT] per fiscal year. The Contractor’s hourly rates are listed in Exhibit B, “Cost Proposal.” The County shall pay Contractor within thirty (30) days of receipt of an approved invoice.

4. INSURANCE

A. The Contractor shall provide at its own expense and maintain at all times the following insurance with insurance companies licensed in the State of California and shall provide evidence of such insurance, at least as broad as the coverage described below, to the County as may be required by the Risk Manager of the County. The Contractor’s insurance policy(ies) shall be placed with insurer(s) with acceptable Best’s rating of A:VII or with approval of the Risk Manager. The Contractor shall provide notice to the Risk Manager of the County by registered mail, return receipt requested, thirty (30) days prior to cancellation or material change for all of the following stated insurance policies:

i. Workers’ Compensation Coverage – Workers’ Compensation insurance as required by the State of California, with Statutory Limits, and Employer’s

of 33Last revised: 3/27/15

Liability Insurance with limits of no less than $1,000,000 per accident for bodily injury or disease.

ii. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an “occurrence” basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a

general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit.

iii. Automobile Liability - ISO Form Number CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, hired, (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage.

iv. Professional Liability (Errors and Omissions): Insurance appropriate to the Contractor’s profession for protection against claims alleging negligent acts,errors or omissions which may arise from Contractor’s operations under thisAgreement, whether such operations be by Contractor or by its employees, subcontractors, or subconsultants, with limit no less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. Contractor agrees to maintain the required coverage for a period of three (3) years after the expiration of this Agreement and any extensions thereof.

v. Medical Professional Liability insurance with a minimum limit of liability of $1,000,000 per occurrence with an annual aggregate of $3,000,000.

If the Contractor maintains broader coverage and/or higher limits than the minimums shown above, the Entity requires and shall be entitled to the broader coverage and/or the higher limits maintained by the contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the Entity.

B. Policy Endorsements: Each general liability and automobile liability insurance policy shall be endorsed with the following specific provisions:

i. The County, its elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional insureds (“County additional insureds”).

ii. This policy shall be considered, and include a provision it is, primary as respects the County additional insureds, and shall not include any special limitations to coverage provided to the County additional insureds. Any insurance maintained by the County, including any self-insured retention the County may have, shall be considered excess insurance only and shallnot contribute with it.


iii. This insurance shall act for each insured and additional insured as though a separate policy had been written for each, except with respect to the limits of liability of the insuring company.

iv. The insurer waives all rights of subrogation against the County additional insureds.

v. Any failure to comply with reporting provisions of the policies shall notaffect coverage provided to the County additional insureds.

C. Deductibles and Self-Insured Retentions: Any deductibles or self-insured retentions must be declared to and approved by the Risk Manager. At the County’s option, Contractor shall demonstrate financial capability for payment of such deductibles or self-insured retentions.

D. Unsatisfactory Policies: If at any time any of the policies or endorsements be unsatisfactory as to form or substance, or if an issuing company shall be unsatisfactory, to the Risk Manager, a new policy or endorsement shall be promptly obtained and evidence submitted to the Risk Manager for approval.

E. Failure to Comply: Upon failure to comply with any of these insurance requirements, this Agreement may be forthwith declared suspended or terminated. Failure to obtain and/or maintain any required insurance shall not relieve any liability under this Agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the indemnification obligations.

5. HOLD HARMLESS/INDEMNIFICATION

Contractor shall indemnify, defend, save, protect and hold harmless County, its elected and appointed officials, officers, employees, agents and volunteers (collectively, “County”) from any and all demands, losses, claims, costs, suits, liabilities and expenses for any damage, injury or death (collectively, “Liability”) arising directly or indirectly from or connected with the services provided hereunder which is caused, or claimed or alleged to be caused, in whole or in part, by the negligence or willful misconduct of Contractor, its officers, employees, agents, contractors, consultants, or any person under its direction or control and shall make good to and reimburse County for any expenditures, including reasonable attorney’s fees, the County may make by reason of such matters and, if requested by County, shall defend any such suits at the sole cost and expense of Contractor. Contractor’s obligations under this section shall exist regardless of concurrent negligence or willful misconduct on the part of the County or any other person; provided, however, that Contractor shall not be required toindemnify County for the proportion of Liability a court determines is attributable to the negligence or willful misconduct of the County.

If such indemnification becomes necessary, the County Counsel for the County shall have the absolute right and discretion to approve or disapprove of any and all counsel employed to defend the County. This indemnification clause shall survive the termination or expiration of this Agreement.


6. INDEPENDENT CONTRACTOR

It is understood that Contractor, in the performance of the services agreed to be performed, shall act as and be an independent contractor and shall not act as an agent or employee of the County. Contractor shall obtain no rights to retirement benefits or other benefits which accrue to County’s employees, and Contractor hereby expressly waives any claim it may have to any such rights. All employees, agents, contractors, subcontractors hired or retained by the Contractor are performing in that capacity for and on behalf of the Contractor and not the County. The County shall not be obligated in any way to pay any wage claims or other claims made against the Contractor by any such employee, agent, contractor or subcontractor, or any other person resulting from the performance of this Agreement.

7. ASSIGNMENT

This Agreement is for the professional services of the Contractor and it shall not assign, subcontract or sublet any part of this Agreement without the express prior written consent of County. Any assignment without the express prior written consent of the County is VOID.

8. NOTICE

Any and all notices, reports or other communications to be given to County or Contractor shall be given to the persons representing the respective parties at the following addresses:

CONTRACTOR: COUNTY:[INSERT CONTACT INFO] Health & Human Services Agency Director

County of Tuolumne20075 Cedar Road NorthSonora, CA 95370

Fax: (209) 533-5711

9. COMPLIANCE

Contractor shall comply with all federal, state and local laws, codes, ordinance and regulations applicable to Contractor’s performance under this Agreement, including, but not limited to, laws related to prevailing wages. Specifically, Contractor shall not engage in unlawful employment discrimination, including, but not limited to, discrimination based upon a person’s race, religion, color, national origin, ancestry, physical handicap, medical condition, marital status, gender, citizenship or sexual orientation, as prohibited by state or federal law.

All services performed by Contractor under this Agreement shall be in strict conformance with all applicable federal, state and/or local laws and regulations relatingto confidentiality, including, but not limited to, California Civil Code section 56 et


seq., Welfare and Institutions Code sections 827, 5328, 10850 and 14100.2, Health andSafety Code sections 11977 and 11812, 22 California Code of Regulations section 51009, and 42 Code of Federal Regulations section 2.1 et seq.

10. NON-DISCRIMINATION

Contractor shall provide services without discrimination based on race, creed, color, ethnic or linguistic identification, gender or sexual preference, disability or handicap orany other basis prohibited by law.

11. PUBLIC RECORDS ACT

Contractor is aware that this Agreement and any documents provided to the County may be subject to the California Public Records Act and may be disclosed to members of the public upon request. It is the responsibility of the Contractor to clearly identify information in those documents that it considers to be confidential under the California Public Records Act. To the extent that the County agrees with that designation, such information will be held in confidence whenever possible. All other information will beconsidered public.

12. ENTIRE AGREEMENT AND MODIFICATION

This Agreement contains the entire agreement of the parties relating to the subject matter of this Agreement and supersedes all prior agreements and representations with respect to the subject matter hereof. This Agreement may only be modified by a written amendment hereto, executed by both parties, however, matters concerning the scope of services which do not affect the agreed price may be modified by mutual written consent of the Contractor and the Health & Human Services Agency Director. If there are exhibits attached hereto, and a conflict exists between the terms of this Agreement and any exhibit, the terms of this Agreement shall control.

13. ENFORCEABILITY AND SEVERABILITY

The invalidity or enforceability of any term or provisions of this Agreement shall not, unless otherwise specified, affect the validity or enforceability of any other term or provision, which shall remain in full force and effect.

14. TERMINATION AND RIGHTS UPON TERMINATION

A. This Agreement may be terminated upon mutual written consent of the parties, or as a remedy available at law or in equity. In the event of the termination of this Agreement, Contractor shall immediately be paid all fees earned as of the effective date of termination.

B. Either party may terminate this Agreement for convenience upon 120 calendar days’ written notice to the other party. Upon termination for convenience, Contractor shall be entitled to compensation for services performed acceptably up to the effective date of termination, as set forth in Exhibit B.


C. Should Contractor default in the performance of this Agreement or materially breach any of its provisions, County, at its option, may terminate this Agreement by giving written notification to Contractor. The termination date shall be the effective date of the notice. For the purposes of this subsection, default or material breach of this Agreement shall include, but not be limited to,any of the following: failure to perform required services in a timely manner, willful destruction of County property, dishonesty, or theft.

15. NO WAIVER

The failure to exercise any right to enforce any remedy contained in this Agreement shall not operate as to be construed to be a waiver or relinquishment of the exercise of such right or remedy, or of any other right or remedy herein contained.

16. DISPUTES

Should it become necessary for a party to this Agreement to enforce any of the provisions hereof, the prevailing party in any claim or action shall be entitled to reimbursement for all expenses so incurred, including reasonable attorney’s fees.

It is agreed by the parties hereto that unless otherwise expressly waived by them, any action brought to enforce any of the provisions hereof or for declaratory relief hereunder shall be filed and remain in a court of competent jurisdiction in the County of Tuolumne, State of California.

17. CAPTIONS

The captions of this Agreement are for convenience in reference only and the words contained therein shall in no way be held to explain, modify, amplify or aid in the interpretation, construction or meaning of the provisions of this Agreement.

18. NUMBER AND GENDER

In this Agreement, the neutral gender includes the feminine and masculine, the singularincludes the plural, and the word “person” includes corporations, partnerships, firms or associations, wherever the context so requires.

19. MANDATORY AND PERMISSIVE

“Shall” is mandatory. “May” is permissive.

20. SUCCESSORS AND ASSIGNS

All representations, covenants and warranties specifically set forth in this Agreement, by or on behalf of, or for the benefit of any or all of the parties hereto, shall be binding upon and inure to the benefit of such party, its successors and assigns.


21. COUNTERPARTS

This Agreement may be executed simultaneously and in several counterparts, each of which shall be deemed an original, but which together shall constitute one and the same instrument.

22. OTHER DOCUMENTS

The parties agree that they shall cooperate in good faith to accomplish the object of thisAgreement and, to that end, agree to execute and deliver such other and further instruments and documents as may be necessary and convenient to the fulfillment of these purposes.

23. CONTROLLING LAW

The validity, interpretation and performance of this Agreement shall be controlled by and construed under the laws of the State of California.

24. AUTHORITY

Each party and each party’s signatory warrant and represent that each has full authorityand capacity to enter into this Agreement in accordance with all requirements of law. The parties also warrant that any signed amendment or modification to the agreement shall comply with all requirements of law, including capacity and authority to amend or modify the Agreement.

25. NEGOTIATED AGREEMENT

This Agreement has been arrived at through negotiation between the parties. Neither party is to be deemed the party which prepared this Agreement within the meaning of California Civil Code section 1654. Each party represents and warrants that in executing this Agreement it does so with full knowledge of the rights and duties it may have with respect to the other party. Each party also warrants and represents that it has received independent legal advice from its attorney with respect to the matters set forth in this Agreement and the rights and duties arising out of this Agreement, or that such party willingly foregoes any such consultation.

26. NO RELIANCE ON REPRESENTATIONS

Each party warrants and represents that it is not relying and has not relied upon any representation or statement made by the other party with respect to the facts involved or its rights or duties. Each party understands and agrees that the facts relevant, or believed to be relevant to this Agreement, have been independently verified. Each party further understands that it is responsible for verifying the representations of law or fact provided by the other party.


27. WARRANTY

County has relied upon the professional ability and training of Contractor as a material inducement to enter into this Agreement. Contractor hereby warrants that all work shall be performed in accordance with generally accepted professional practices and standards as well as the requirements of applicable federal, state and local laws, it being understood that acceptance of Contractor’s work by County shall not operate as awaiver or release.

28. FUNDING AVAILABILITY

It is mutually agreed that if the County budget of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the County shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement. Contractor’s assumption of risk of possible non-appropriation is part of the consideration for this Agreement. County budget decisions are subject to the discretion of the Board of Supervisors.

If funding for any fiscal year is reduced or deleted by the County budget for purposes of this program, the County shall have the option to either cancel this Agreement with no liability occurring to the County, or offer an Agreement amendment to Contractor toreflect the reduced amount.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the day and year first written above.

COUNTY OF TUOLUMNE

By: Ryan Campbell, Chair Board of Supervisors

CONTRACTOR

By: [INSERT INFO]

ATTEST:

By: Heather Ryan Seal Clerk of the Board

APPROVED AS TO LEGAL FORM:

By: Sarah Carrillo, County Counsel


1 Minimum Standards for Local Detention Facilities. Title 15. Crime Prevention and Corrections, Division 1, Chapter 1, Subchapter 4, Article 11.2 Minimum Standards for Juvenile Facilities. Title 15. Crime Prevention and Corrections, Division 1, Chapter1, Subchapter 5, Article 8.

Exhibit ASCOPE OF WORK

CONTENTSA. BACKGROUND AND PURPOSE......................................................................................9B. CONSENT FOR HEALTH CARE.................................................................................... 10C. RECEIVING SCREENING............................................................................................... 10D. HEALTH APPRAISAL, EXAMINATION, AND COMMUNICABLE DISEASE SCREENING.................................................................................................................................12E. DAILY TRIAGING OF COMPLAINTS...........................................................................12F. SICK CALL........................................................................................................................13G. MEDICAL/SURGICAL INPATIENT CARE, EMERGENCY ROOM, OR ACUTEHOSPITAL SERVICES................................................................................................................ 14H. EMERGENCY SERVICES................................................................................................14I. COMMUNICABLE DISEASE.......................................................................................... 15J. SPECIALTY SERVICES...................................................................................................17K. SEXUAL ASSAULTS....................................................................................................... 17L. ANCILLARY SERVICES................................................................................................. 17M. DENTAL CARE.................................................................................................................18N. HEALTH CARE RECORDS............................................................................................. 18O. PHARMACEUTICALS AND MEDICAL SUPPLIES..................................................... 19P. CLINIC SPACE/EQUIPMENT......................................................................................... 20Q. MENTAL HEALTH SERVICES.......................................................................................20R. SUBSTANCE USE DISORDER SERVICES....................................................................21S. MISCELLANEOUS SERVICES AND OTHER TITLE 15 REQUIREMENTS.............. 22T. STAFFING PLAN..............................................................................................................25U. PERSONNEL SERVICES................................................................................................. 26V. PROGRAM SUPPORT SERVICES.................................................................................. 28

A. BACKGROUND AND PURPOSE

Title 15 of the California Code of Regulations mandates that appropriate health care services are provided to adult inmates1 and detained youth2 in correctional facilities. The County operates two correctional facilities – the Sheriff J.H. Dambacher Detention Center through its Sheriff’s Office and the Mother Lode Regional Juvenile Detention Facility (MLRJDF) through its Probation Department. The County Public Health Department is responsible for the administration of inmate/youth health care services for both correctional facilities. The purpose of this Contract is for County and Contractor (CONTRACTOR) to collaborate in meeting Title 15 health care services requirements.

CONTRACTOR shall be responsible as the sole supplier and/or coordinator of the health care delivery system for the Sheriff J.H. Dambacher Detention Center and Mother Lode Juvenile Detention Facility. The Tuolumne County Health Officer will have


responsibilities to assure that the contracted agency meets acceptable standards of care in accordance with the established Quality Assurance process which is coordinated between the contracting entity and the Tuolumne County Health Department as agent for TuolumneCounty. Similarly, the involvement of the Behavioral Health Director will provide cooperative review for Behavioral Health care.

CONTRACTOR shall be responsible for all medical care, including psychiatric care, outpatient care, and inpatient care as described under Section 1.11, for all inmates at the Sheriff J.H. Dambacher Detention Center. This responsibility of Provider for medical careshall commence with the commitment of an inmate to the custody of the administration of the Sheriff J.H. Dambacher Detention Center and ends with the discharge of the inmate.

Health care services must be provided in compliance with the standards set forth by the California Medical Association’s Institute for Medical Quality.

Provider shall have no responsibility for security at the Sheriff J.H. Dambacher Detention Center, or for the custody of any inmate at any time, such responsibility being solely that of the Sheriff J.H. Dambacher Detention Center. Provider shall have sole responsibility in all matters of medical and dental judgment. Provider shall have primary, but not exclusive,responsibility for the identification, care and treatment of inmates requiring medical care and who are security risks or who present a danger to themselves and others. On these matters of mutual concern Tuolumne Sheriff’s Office staff shall support, assist and cooperate with provider, and Provider shall support assist and cooperate with Tuolumne County Sheriff’s Office whose decision in any non-medical matter shall be final. All decisions involving the exercise of medical judgment are still the responsibility of the Provider.

B. CONSENT FOR HEALTH CARE

All examinations, treatments and procedures are governed by informed consent in the language spoken by the inmate/youth. Any competent adult inmate may refuse medical care. Informed consent for health care examinations and treatment of detained youth shall be obtained in accordance with 15 CCR §1434.

C. RECEIVING SCREENING

1. Provider shall perform a comprehensive Health Assessment on each Inmate within fourteen (14) calendar days of the arrival of the inmate at the Sheriff J.H. Dambacher Detention Center. Such assessment shall be performed by a qualified medical professional. At a minimum, the comprehensive Health Assessment shall include:

i. A review of the Receiving Screening results.

ii. Additional data and exam necessary to complete a standard history and physical;


iii. Screening tests for venereal disease and Human Immunodeficiency Virus (HIV); Hepatitis A, B or C; as well as urinalysis, will be performed, as clinically indicated;

iv. Additional lab work as directed by the physician, for particular medical or health problems;

v. Additional tests as required, based on the original screening tests;

vi. Recording of height, weight, pulse, blood pressure and temperature;

vii. The health assessment of females will also include an inquiry about menstrual cycle and unusual bleeding, the current use of contraceptive medications, the presence of an IUD, breast masses and nipple discharge and possible pregnancy.

viii. Any abnormal results of the health assessment shall be reviewed by a physician for appropriate disposition. This review will occur during the physician’s next scheduled visit or sooner if clinically indicated.

2. Medical screening will be performed by trained correctional staff on all inmates/youth, including transferees, immediately upon arrival at TuolumneCounty facilities.

Visual observation and inquiry for medical and mental health problems and developmental disabilities. Inquiry regarding current illnesses or medications, communicable diseases, drug or alcohol abuse, seizure disorders, suicidal ideation, gynecological problems, possibility of current pregnancy, recent history of childbirth, miscarriage or abortion.

i. Observation of:

1. Behavior - consciousness, mental status, appearance, conduct, tremors and sweating

2. Body deformities and ease of movement. Presence of medical prosthesis

3. Condition of skin - trauma markings, bruises, lesions, jaundice, rashes and infestations, needle marks or other indications of drug use

4. Slowness of speech or lack of comprehension of questions suggestive of developmental disabilities

ii. Disposition:

1. Referral to appropriate health care staff, for follow-up and treatment


2. Emergency room for evaluation and treatment for those conditions that are beyond the capability of on-site health services staff

3. Recommendations for housing (i.e., general population, isolation, or special observation)

All findings will be recorded on the "Intake Health Screening" form. The individual performing the screening will document all answers noting; “Yes”, “No”, “Refuses to Answer”, or “Unable to Answer”, to all questions on the form. A copy of the "Intake Health Screening" form will be included in the inmate/youth’s medical record.

CONTRACTOR shall identify the need, schedule, coordinate and pay for all supporting diagnostic examinations, both inside and outside the Sheriff J.H. Dambacher Detention Center and Juvenile Detention Facility. CONTRACTORshall also provide and pay for all laboratory services, as indicated.

CONTRACTOR shall provide the necessary follow-up for health problems identified by any of the screening tests or laboratory tests. This would include inpatient or outpatient hospitalization, appropriate monitoring and prescription of appropriate medications, consultations with specialty physicians, etc.

D. HEALTH APPRAISAL, EXAMINATION, AND COMMUNICABLE DISEASE SCREENING

1. Adult Inmates: A complete gender specific health inventory and communicable disease screening will be completed on all inmates within fourteen (14) days of arrival at the Jail. Communicable disease screening shall include at a minimum, screening for tuberculosis and other diseases in accordance to the findings of the health inventory. The completed history form and the "Intake Health Screening" form will be reviewed with the inmate by a qualified health services professional.

Positive findings shall be recorded on the problem list. A follow-up plan of action will be developed and documented in the health record. Positive findings and conditions requiring further evaluation and/or treatment will bereferred to the appropriate medical provider.

Health Care Maintenance: A complete physical examination will be performed on all inmates by qualified health care personnel within six (6) months from the date of incarceration.

2. Detained Youth: A complete health appraisal and medical examination shall be completed for all youth within ninety six (96) hours of admission tothe MLRJDF, excluding holidays, and result in a compilation of identified problems to be considered in classification, treatment, and the multi-disciplinary management of the youth while in custody and in pre-release planning. The health appraisal and medical examination shall be in accordance with 15 CCR §1432.


E. DAILY TRIAGING OF COMPLAINTS

1. Inmate/youth's written and/or verbal health complaints and requests will be collected and triaged by qualified health services staff. Urgent requests will be seen by the on-site medical provider or nursing staff. During the times that health care services staff are not on-site, health trained correctional staffwill solicit sick call requests and determine, based on the nature of the complaint and pre-determined written guidelines, whether the on-call healthcare staff is contacted, inmate/youth is sent to emergency room, or scheduled for next sick call. Emergency requests will be seen immediately and transported as required. All sick call requests will have the following notations; date and time reviewed, signature of the health services staff, anddisposition. (i.e., scheduled for sick call, referred to mental health provider, transferred to off-site treatment facility.) All sick call requests will be filed in the inmate/youth's medical record.

2. The Medical Director will oversee the triage system utilized in each facility.CONTRACTOR has specific triage guidelines to assist nursing staff in responding to a variety of medical complaints. (i.e., dental pain, alcohol withdrawal, pregnancy, diabetes, seizures.) To assure that staff is adequately trained to perform these tasks, CONTRACTOR provides a comprehensive orientation program. All nurses will be required to attend a regional certified physical assessment course designed for correctional nurses. These regional programs are sponsored by CONTRACTOR.

F. SICK CALL

1. Routine sick call will be conducted by a physician and/or qualified health care personnel (physician or RN operating under Standardized Procedures) at the Sheriff J.H. Dambacher Detention Center five (5) days per week (Monday - Friday) and at the MLRJDF five (5) days per week to be determined. Health services staff will make every effort to conduct sick call in housing areas to minimize inmate/youth movement.

2. Procedures for inmate/youth access to medical care will be posted in booking areas in English and Spanish. These notices will also be posted in all inmate/youth housing areas. In addition, verbal advisement of the sick call procedure will be given at the time of booking.


3. All sick call encounters will be documented in the inmate/youth medical records to include date and time seen, assessment of the medical provider utilizing the SOAP (Subjective, Objective, Assessment, Plan) format, treatment plan, advisement for follow-up, and signature of the treating provider.

G. MEDICAL/SURGICAL INPATIENT CARE, EMERGENCY ROOM, OR ACUTE HOSPITAL SERVICES

Inmates/youth requiring acute hospital services such as critical and intensive care/monitoring and general surgery will be referred to Adventist Health Sonora. CONTRACTOR will assume all health related costs, subject to the per episode catastrophic limit described in Section 2.08(g) of the Contract, for inmates/youth (excluding security) from the time of booking, medical clearance, and physical placement of an inmate/youth into the jail facility. Contractor and County will coordinate to facilitate Medi-Cal Inmate Program (MCIP) eligibility of inmates and Medi-Cal payment for Medi-Cal services. Escapees and inmates/youth transferred to other custodial jurisdictions will not be CONTRACTOR's responsibility. No referrals will be made to any facility without the approval of the physician or on-call medical personnel (with the exception of life-threatening emergencies). The Medical Director will be responsible for liaison with hospital medical staff to transfer inmates/youth back to custody as soon as it is medically feasible. All hospitals will be reimbursed based upon PC 4011.10 rates, as described in Exhibit C to the Contract.

CONTRACTOR shall identify the need, schedule, and coordinate any inpatient hospitalization of any inmate of the Sheriff J.H. Dambacher Detention Center. The Provider shall pay for all inpatient medical care to the limits specified in the contract, but not inpatient psychiatric care subject to the defined catastrophic limits. Catastrophic limits of fifteen thousand dollars ($15,000) per episode shall also apply to all outpatient and specialty care and ambulance services.

H. EMERGENCY SERVICES

1. All health services staff shall be familiar with the common medical emergencies that may occur in Tuolumne County facilities, and know the appropriate first aid procedures necessary to treat them. In addition, the names, addresses and telephone numbers of on-call medical personnel, ambulance company and local hospitals will be readily available. If a medical emergency is reported, the on-site health services staff will respondimmediately with the appropriate equipment to assess the patient's conditionand determine the course of treatment. If, in the opinion of health service staff, the patient requires treatment that is beyond on-site capabilities, he/she will notify the Facility Administrator or designee to request and specify mode of transportation (i.e., ambulance or patrol car). Adventist Health Sonora will be utilized.

2. Medical professional staff will be on-call, 24 hours per day, seven days per week, to respond to medical and custody staff for routine or emergency situations as they arise.


3. Except for those services covered under Medi-Cal, Contractor’s responsibility in cases where extensive medical treatment is necessary shall be limited to fifteen thousand dollars ($15,000) per episode in outside medical expenses per individual inmate medical/surgical or psychiatric inpatient episode. Episode means a single admission and discharge from a hospital. This shall include the medical and psychiatric component costs forpersons placed in a facility strictly for providing psychiatric inpatient care services.

4. Contractor and County will coordinate to facilitate Medi-Cal Inmate Program (MCIP) eligibility of inmates and Medi-Cal payment for Medi-Calservices.

5. Patient Transport

CONTRACTOR will be responsible for all emergency transportation costs. Tuolumne County will be responsible for all routine transportation costs. CONTRACTOR will authorize all emergency transportation costs with the exception of life-threatening emergencies.

6. Emergency First Aid/Staff and Visitors

i. CONTRACTOR will provide emergency first aid services to Countystaff and visitors within the confines of the facility. Health services staff will stabilize and arrange for transfer to an appropriate off-site facility.

ii. First aid kits will be available in designated areas of each facility. First aid kits will be approved by the Medical Director or designee for content, location and inspection.

I. COMMUNICABLE DISEASE

1. Communicable disease screening, continuing medical surveillance, case management and reporting shall occur pursuant to written procedures and guidelines. These procedures and guidelines are established and approved by the Medical Director, Regional Manager, and the Facility Administrator in accordance with state and local regulations and accepted community standards and practice. Universal precautions shall be practiced by all staff in Tuolumne County facilities.


2. Inmates/youth will be screened for communicable diseases during the Reviewing Screening process, Health Inventory & Communicable Disease Screening and sick call. Inmates/youth identified as having or suspected of having a communicable disease will be treated in accordance to written standardized procedures, or by the direct order of the physician. Tuberculosis (TB) testing will be performed as part of the health appraisal/examination described in Section D of this Exhibit.

3. Immunizations for Detained Youth

For youth, within two (2) weeks of the health appraisal/examination described in Section D of this Exhibit, CONTRACTOR shall verify each youth has up-to-date immunizations utilizing the County-approved databaseand shall provide immunizations as necessary to ensure each youth is current on immunizations, appropriate to age. County shall ensure CONTRACTOR has sufficient access to the aforementioned database to meet this requirement.

4. Treatment/Case Management

Treatment and case management of an inmate/ youth identified as having orsuspected of having a communicable disease will be individualized in accordance with direct medical provider orders, written protocols, and standardized procedures and/or guidelines approved by the Medical Director.

i. Infection Control Guidelines for the Jail and MLRJDF.ii. Exposure to Pathogenic Organism by CONTRACTOR staff

iii. Infection Control: Potential Exposureiv. AIDS, Hepatitis B, and Hepatitis C Isolation Guidelines

5. Reporting Custody

Health services staff will report incidence of communicable disease exposure to the officer in charge of the facility in accordance with CONTRACTOR "Communicable Disease Reporting Requirements" procedure.

6. Public Health Reporting

Health services staff shall report reportable communicable diseases to the Tuolumne County Public Health Department utilizing the "Confidential Morbidity Report Card”. Minimal information to be reported is: name, address, telephone number, occupation, diagnosis, age, sex, date of onset and diagnosis, and name and telephone number of the reporting physician. The inmate/youth will be informed that the communicable disease will be reported to Tuolumne County Public Health and that he/she may be contacted for follow-up by a Tuolumne County Public Health Nurse.


7. Control and Treatment of Ectoparasites

i. Ectoparasitic infestation will be treated on an individual basis promptly and thoroughly to prevent the spread of communicable conditions within the facility. An inmate/youth, complaining or suspected of being infested, will be examined by on duty health services staff. When lice or nits are found, the medical personnel will be responsible for overseeing the treatment.

ii. Individuals suspected of having scabies will be isolated and placed on priority list for next sick call.

J. SPECIALTY SERVICES

CONTRACTOR will utilize specialists as medically indicated when such services cannot be provided on-site. Based on CONTRACTOR experience, qualified and diligent health care services staff on-site can significantly reduce the number of referrals to specialty clinics. The most utilized specialty clinics are obstetric and orthopedic. CONTRACTOR will continue to utilize the same community based specialists. All referrals to specialists and off-site clinics will be approved by the Medical Director.

K. SEXUAL ASSAULTS

Policy and procedures shall be developed and implemented for treating victims of sexual assaults and for reporting such incidents to local law enforcement when they occur in the facility.

The evidentiary examination and initial treatment of victims of sexual assault shall be conducted at a health facility that is separate from the custodial facility and is properly equipped and staffed with personnel trained and experienced in such procedures.

L. ANCILLARY SERVICES

1. CONTRACTOR will provide laboratory, x-ray and other required ancillary services. Laboratory services are currently provided through a statewide contract laboratory. All specimens will be collected and handled by on-site health services staff in accordance with accepted laboratory standards and transported to the laboratory for processing.

2. Grossly abnormal test results will be communicated to the health services staff immediately. All other results will be forwarded to the health services staff on a daily basis or as soon as possible.

3. Routine x-ray services will be provided on-site through a contract with a national x-ray company. Specialized studies such as MRI, CAT scans, EEG and ultrasound will be provided through Adventist Health Sonora. For both specialty and ancillary off-site services, the RN will coordinate with the Facility Administrator or designee to ensure efficient scheduling. Every attempt will be made to ensure that transportation and security costs arekept to a minimum.


M. DENTAL CARE

1. Dental screening will be performed as part of the routine health assessment. Dental services will be provided in the community under a separate contract. CONTRACTOR will not be financially responsible for dental services.

2. A record of dental treatment will be maintained in each patient's health care record.

N. HEALTH CARE RECORDS

1. The Medical Director and Regional Manager will be responsible for the maintenance of individual health care records. All records will be maintained in compliance with California State regulations and consistent with community standards of practice. The "Problem Oriented Medical Record" format is utilized throughout CONTRACTOR system.

2. The individual health care record will contain, at minimum, the following information:

i. Identifying information (e.g. name, alias, ID #, date of birth)

ii. Completed "Receiving Screening" form

iii. Medical Evaluation Report

iv. All findings, diagnosis treatments and dispositions

v. Problem list

vi. Medication Administration Record

vii. Laboratory, x-ray and diagnostic studies

viii. Signed Informed Consent

ix. Refusal forms

x. Place, date and time of all health encounters

xi. Dental consultations/treatments

xii. Psychiatric evaluations and treatments

xiii. Hospital Discharge Summaries

xiv. Transfer forms

xv. Individual treatment plans as required

xvi. Allergy alert

xvii. Immunization records (required for youth only)

3. Maintenance of Records

i. All health services staff will be responsible for maintaining current, accurate, and legible health care records.


ii. Health care records shall be maintained in secure locked storage cabinets within the medical section. Access to health care records shall be limited to licensed health services staff and health care records personnel.

iii. Consent and Refusal forms will be completed as necessary and enclosed in the health care record.

iv. The health authority or his/her designee will share information with the Facility Administrator as necessary to deliver health care treatment and to preserve the health and safety of inmates/youth and staff in accordance with state regulations.

v. The physician-patient confidentiality privilege will apply to all health care records. All requests for health care information will require written consent of the inmate/youth’s legal guardian or subpoena. Alcohol and drug abuse information is confidential under federal regulations and may only be disclosed by specific written consent of the inmate/youth’s legal guardian.

vi. CONTRACTOR will utilize the standardized "Inter-Facility Transfer of Medical Information" form to provide for continuity of care for those inmates/youth being transferred to anotherjurisdiction.

vii. Existing health care records and health care records prepared by CONTRACTOR shall be the property of Tuolumne County and maintained by CONTRACTOR throughout the course of the Contract. County shall be responsible for any destruction of all health care records.

viii. All adult inmate health care records shall be kept for a minimumof seven (7) years. All detained youth health care records shall be kept at least until seven (7) years after the youth has reached the age of majority.

O. PHARMACEUTICALS AND MEDICAL SUPPLIES

1. The Regional Manager will be responsible for purchasing of all supplies through purchasing agreements developed by CONTRACTOR corporate staff. CONTRACTOR has established formularies for pharmaceuticals and medical supplies which will be utilized. For adult inmates, pharmaceuticals may be ordered on an individual prescription basis or pulled from current available stock. For youth, pharmaceuticals will only be ordered on an individual prescription basis. The length of time allowable for a physician’s signature on verbal orders for youths’ prescriptions shall not exceed seven (7) days.

2. All pharmaceuticals will be stored, inventoried, and administered in accordance with all applicable laws, guidelines relating to pharmaceutical


practices, including but not limited to Title 15 CCR §§ 1216 and 1438, incorporated by reference as if fully set forth herein.

3. Administration of Medication. Medications will be principally administered on a two-times-a-day regimen.

i. For adult inmates, CONTRACTOR nursing staff shall be responsible for administering medications.

ii. For detained youth, County shall provide trained non-licensed personnel to deliver medications acting on the order of a prescriber. CONTRACTOR shall provide training to MLRJDF non-licensed personnel regarding safe administration techniques and common side effects of medications.

4. CONTRACTOR’s contracted Pharmacy will perform annual reviews of CONTRACTOR on-site storage, inventory, monitoring of controlled substances, and review of ordering practices.

P. CLINIC SPACE/EQUIPMENT

Adequate space, equipment, supplies, materials, and publications as determined by the health authority will be provided for the delivery of health care. CONTRACTOR will purchase all medical equipment and supplies required for Tuolumne County facilities. As previously mentioned, CONTRACTOR has statewide contracts with pharmaceutical and supply vendors that service CONTRACTOR sites. CONTRACTOR will safeguard all existing County owned equipment and replace as needed.

Q. MENTAL HEALTH SERVICES

1. Outpatient mental health services shall include screening, evaluation, diagnosis, treatment and referral services, and will be available to all inmates/youth in Tuolumne County facilities. All mental health outpatient services shall be provided by qualified mental health staff assigned through the Tuolumne County Behavioral Health Department. Inmates/youth requiring services beyond the on-site capability at the facility shall be referred to appropriate off-site providers as directed by Behavioral Health staff.

2. All new inmates/youth shall be observed and queried for signs or presence and history of mental illness, including suicidal behavior/ideations, and use of medication for psychiatric treatment as part of the intake health screening. Any inmate/youth exhibiting or testifying to presence or history of mental illness is referred to Tuolumne County Behavioral Health staff forfurther evaluation. CONTRACTOR health services staff will administer psychotropic medications as prescribed by the Psychiatrist.

3. Tuolumne County will provide for licensed mental health worker to be on-site as needed to provide the required services. Tuolumne County will provide on-call services and staff to return to the facility to evaluate


inmates/youth placed on suicide watch, and in restraints. All services provided by Tuolumne County will meet Title 15 standards.

4. CONTRACTOR will provide a psychiatrist on a weekly basis to order psychotropic medications. CONTRACTOR will administer, order, and storeall psychotropic medications. CONTRACTOR will provide equipment to provide psychiatric services via telepsychiatry. CONTRACTOR will not be financially responsible for psychiatric hospitalizations.

1.1. CONTRACTOR will notify the Tuolumne County Behavioral Health Director if an inmate/detained youth needs assessment for possible inpatient psychiatric care.

1.16. CONTRACTOR shall identify the need, schedule, and coordinate psychiatric, psychological and counseling services rendered to inmates inside the Sheriff J.H. Dambacher Detention Center in consultation with the county Behavioral Health Department.

R. SUBSTANCE USE DISORDER SERVICES

1. Inmates/youth booked into Tuolumne County facilities who are intoxicated shall be placed in housing designated for intoxicated individuals and monitored by health care services and custody staff in accordance with established written policies and procedures approved by the Medical Director and Facility Administrator. Inmates/youth will be evaluated on an individual basis by health care services staff to determine the need for medically supported detoxification during incarceration.

2. The clinical management of chemically dependent inmates/youth shall include diagnosis of chemical dependency by a physician or qualified healthservices staff. An individualized treatment plan will be developed and implemented, and a referral for community resources will be given upon release when appropriate.

3. Inmates/youth exhibiting signs of drug or alcohol withdrawal will be evaluated by health services staff. During the time health services staff are not on-site and correctional staff suspect an inmate/youth is experiencing withdrawal symptoms, they should transport the inmate/youth to Adventist Health Sonora for medical clearance.

i. Inmates/youth identified by self or deputies as substance abusers shall be evaluated by health care services staff to determine medical status.

ii. Evaluation, treatment, and referral shall be carried out in accordancewith direct physician orders, or approved CONTRACTORProtocols/Standardized Procedures.

iii. Substance using pregnant inmates/youth shall be evaluated by healthservices staff upon admission to the facility. Evaluation, treatment, and referral shall be in accordance with direct physician orders.


iv. Inmates/youth who are unresponsive and/or whose condition is deemed by on-duty health services staff as unsuitable for housing in the jail shall be transported to Adventist Health Sonora for treatment.

v. Inmates/youth who have been treated for substance dependency during their incarceration shall be counseled and referred to community resources upon release from the facility.

S. MISCELLANEOUS SERVICES AND OTHER TITLE 15 REQUIREMENTS

1. Pregnant and Lactating Inmates/Youth

i. Comprehensive counseling and assistance are provided to pregnant inmates/youth in keeping with their expressed desires in planning for their unborn child, whether desiring abortion, adoption service, or to keep the child.

ii. All females shall be queried whether pregnant, recent delivery, miscarriage, or abortion as part of intake health screening completedupon admission to the facility. When pregnancy is determined, the patient will be scheduled for routine obstetric care with an off-site specialist. Prenatal and postnatal care shall be provided in accordance with the treatment plan established by off-site OB/GYN specialist.

iii. Opioid dependent pregnant inmates/youth will be treated by direct orders of the responsible physician. CONTRACTOR will coordinatewith Behavioral Health to locate a licensed treatment center for the treatment of such patients.

iv. Pregnant and lactating inmates/youth will be given educational information and counseling regarding levels of activity, safety precautions and nutrition. Services shall be provided in accordance with Penal Code Section 6030(e). Inmates/youth desiring termination of pregnancy or adoption services shall be scheduled forcounseling.

v. Use of restraints on pregnant inmates/youth shall be limited in accordance with Penal Code Section 6030(f) and Welfare and Institutions Code Section 222.

2. Medical Diets

i. Food/dietary services in Tuolumne County facilities adhere to the standards outlined in Title 15 Article 12 for inmates or Article 9 for youth.

ii. In general, sufficient variety is offered so that individuals with specific dietary restrictions can meet their nutritional needs in an appropriate fashion. Simple instructions from the health services


staff on how to properly select from the menu is offered. CONTRACTOR will coordinate for the provision of special diets with the County's food service coordinator.

3. Food Service Workers

Inmates/youth assigned to work in food service areas shall receive a kitchen clearance examination prior to beginning work in the kitchen area. Included in this clearance will be tuberculosis (TB) screening. The food service director shall be responsible for monitoring the health and cleanliness of all inmate/youth food handlers.

4. Preventative Care/Education

Medical preventative maintenance, screening and education will be provided to inmates/youth in Tuolumne County facilities. Health education materials are provided to all inmates/youth upon request. In addition, individual patient education is provided on a regular ongoing basis during patient/staff encounters. Topics included, but not limited to are:

i. Sexually transmitted diseases

ii. HIV/AIDS counseling

iii. General health issues (alcohol, drug abuse education, prenatal care, diet and nutrition)

iv. Tuberculosis

For detained youth, CONTRACTOR shall assure that age- and sex-appropriate health education and disease prevention programs are offered. The education program shall be updated as necessary to address current health priorities and meet the needs of the confined population.

5. Inmates/Youth in Isolation/Administrative Isolation

To prevent depression, suicidal behavior and/or a digression of physical wellbeing, inmates/youth placed out of the general population in isolated cells for any reason shall be evaluated by health services staff at least three (3) times per week to assess their physical and mental status. Evaluation will include notation of any bruises or self-inflicted injuries and comments on the inmate/youth's general attitude and outlook. A notation will be placed in each inmate/youth's health care record after observation, to include date, time, findings, and name of evaluator.

6. Restraints

i. Inmates/youth shall be placed in restraints by custody staff only withthe approval of the Facility Administrator, designee, or designated physician.

ii. Restraint devices shall only be used on inmates/youth who display any of the following:

a. Behavior resulting in the destruction of property;

b. Intent to harm themselves;


c. Intent to harm others; and/or,

d. Gravely disabled.

iii. Continued retention of restraints shall be reviewed by the Facility Administrator or designee as specified in Title 15 §1058 for inmates

or §1358 for youth.

iv. A medical opinion on placement and retention of restraints shall be secured as soon as possible, as specified in Title 15 §1058 for

inmates or §1358 for youth. Medical clearance for continued retention of restraints and mental health consultation shall also be secured as specified in Title 15 §1058 for inmates or §1358 for

youth.

7. Continuity of Care

i. Inmate/youth patients will receive continuity of care from admissionto discharge while in Tuolumne County facilities, including referral to community care when indicated.

ii. Health providers will obtain information regarding previous care when undertaking the care of a new patient. When the care of the patient is transferred, appropriate health information is shared with the providers in accordance with consent requirements.

iii. A "Transfer of Medical Information" form will be completed and accompany inmate/youth being transferred to another detention institution. Limited amounts of essential medications taken while in custody in a Tuolumne County facility or a prescription may be given to the inmate/youth upon discharge by order of the physician.

8. Standardized Procedures

Standardized procedures have been developed through the collaborative efforts of nursing, medicine and administration. Nursing staff must be properly trained and approved by the responsible physician prior to utilizing standardized procedures. Only RN's will be authorized to operate under standardized procedures. These procedures will be reviewed at least once annually.

9. Direct Orders

i. Treatment by qualified health trained personnel other than a physician or dentist is performed pursuant to direct orders written and signed by personnel authorized by law to give such orders.

ii. All orders shall be recorded in the health care record. Verbal orders shall be documented as such in the record and countersigned by the responsible physician.


10. Special Needs/Individual Treatment Plans

i. A written individualized treatment plan shall be developed by qualified health services staff for inmates/youth requiring close medical supervision and/or who have received services for significant health care concerns, including chronic and convalescent care to include directions to health services and other staff regardingtheir roles in the care and supervision of these inmates/youth.

ii. Treatment plans shall include at minimum, housing, dietary, medication, observation and monitoring, and follow-up referral as appropriate.

iii. The Facility Administrator or designee shall be included in the development of treatment plans which include custody (e.g. housing,observation, transportation).

iv. Program planning shall include pre-release arrangements and/or referrals for continuing medical and mental health care, together with participation in relevant programs as appropriate upon return tothe community.

11. Prosthesis

Medical and dental prosthesis, including eyeglasses and hearing aids, are provided when the health of the inmate/youth would otherwise be adversely affected as determined by the responsible physician. All medical prosthesis will be cleared by custody staff.

12. Access to Health Care Services

Information regarding access to health care services shall be communicated verbally and inwriting to inmates/youth upon their arrival at the facility. Provision shall be made to communicate this information to non-English speaking inmates/youth. Verbal explanations of the sick call procedure shall be communicated to all detainees at the time of booking.

T. STAFFING PLAN

1. The CONTRACTOR staffing pattern described in Exhibit B of the Contract is based on the average population described in Section 3.01 of the Contract. The CONTRACTOR Regional Manager will be responsible for overseeing the operations at the Sheriff J.H. Dambacher Detention Center and MLRJDF. The Charge RN will perform sick call operating under standardized procedures, perform all required communicable disease screening and health evaluations, administer medications as required, maintain the medical record system and communicate with the Medical Director concerning any medical problems. The LVN's/RN's will administer medications (only for adult inmates), and will ordersupplies and pharmaceuticals, respond to booking, man downs, and communicate with the on-call Medical Director. Medications prescribed or administered with telephonic approval must also be signed for within one week of issuance.


2. Provider shall be responsible for providing nursing coverage on site for sixteen

(16) hours each day as detailed in Exhibit B Staffing Pattern.

3. The Tuolumne County Medical Director will be on-site to see all consults, review and co-sign charts once per week. The Medical Director will be on-call twenty-four hours a day, seven days a week.

4. The Tuolumne County Health Officer may be contacted by the health care professional for telephone consultations, as available.

U. PERSONNEL SERVICES

1. Recruitment Practices

CONTRACTOR’s Corporate Recruiter will coordinate on-going personnel recruitment for the Sheriff J.H. Dambacher Detention Center and MLRJDF.

Provider must recruit, interview, hire, train and supervise all health care staff and such health care staff must be adequate to meet all conditions and specifications of this contract.All health care staff providing services under this contract must be licensed to practice in the State of California. The County reserves the right to approve or reject any medical carepersonnel of the provider. At a minimum, a Program administrator shall be provided who shall have general responsibility for the successful delivery of health care for the Sheriff J.H. Dambacher Detention Center, pursuant to this solicitation and final contract.

2. Compliance With Employment Regulations and Confidentiality Requirements

CONTRACTOR shall comply with all federal, state and local laws, codes, ordinance and regulations applicable to CONTRACTOR’s performance under this Contract, including, but not limited to, laws related to prevailing wages. Specifically, CONTRACTOR shall not engage in unlawful employment discrimination, including, but not limited to, discrimination based upon a person’s race, religion, color, national origin, ancestry, physical handicap, medical condition, marital status, gender, citizenship or sexual orientation, as prohibited by state or federal law.

All services performed by CONTRACTOR under this Contract shall be in strict conformance with all applicable federal, state and/or local laws and regulations relating to confidentiality, including, but not limited to, California Civil Code section 56 et seq., Welfare and Institutions Code sections 827, 5328, 10850 and 14100.2, Health and Safety Code sections 11977 and 11812, 22 California Code of Regulations section 51009, and 42 Code of Federal Regulations section 2.1 et seq..

3. License/Certification Requirements

CONTRACTOR requires copies of licensure and verification of credentials prior to hiring health care personnel. Copies of licensure are maintained on-site and at the corporate office. Expiration dates for all license categories are maintained at the sites and at the corporate office. Reports are sent to Program Managers, from the corporate office prior to expiration of licensure to ensure ongoing compliance. Copies of licenses and/or records for


all medical personnel will be furnished to the Tuolumne County Health Officer as requested.

4. Training for County Personnel-Correctional Officers

CONTRACTOR has provided Standards in Training and Corrections (STC) certified training courses concerning medical issues in correctional facilities to each of CONTRACTOR contract sites. In addition, CONTRACTOR on-site staff routinely provides training for new recruits as part of their orientation procedure or at other times as requested by Sheriff and Probation management staff. Tuolumne County custody staff mayattend regional STC classes offered by CONTRACTOR in surrounding counties.

5. Orientation of New Personnel

i. All health care personnel employed by CONTRACTOR will complete the "Orientation for New Employee" form within the first two weeks of employment. This form will cover the outline of the CONTRACTOR Orientation Program. The orientation program has been developed in conjunction with the CONTRACTOR Program Management Team.

ii. Each employee will be familiar with every section listed on the "Orientation for New Employee" form and initial each section as it is completed to indicate understanding of that section. This will ensure that each new employee has a thorough understanding and knowledge of their job and what is expected of them as CONTRACTOR employees.

iii. All new employees will work with experienced staff prior to working alone in the correctional setting. Each staff member is provided a specific job description.

6. Continuing Education

Needs assessment for staff training and continuing education is conducted by the CONTRACTOR Program Management Team. CONTRACTOR’s Quality Assurance Consultant is utilized to coordinate this process. Program Managers elicit input from line staff as part of this ongoing process. CONTRACTOR provides for continuing education in two ways. First, CONTRACTOR through their staff needs assessment process, identifies those topics which can best be covered by CONTRACTOR sponsored regional training programs.

7. In-Service Training

Needs assessment for staff in-service training is also coordinated through the CONTRACTOR Management Team. Program Managers are responsible for coordinating the provision of an in-service training program at each site. In addition to specific in-service training programs at each location, staff meetings are utilized to provide ongoing in-service training. Videos are provided to each location to cover specific topics as identified by the Quality Assurance Consultant and the Program Management Team.


8. Performance Review

The CONTRACTOR Administrative Manual describes the performance review process. Each new employee has a six month probationary period. Upon satisfactory completion of this period, each employee receives an evaluation from his or her direct supervisor. The evaluation is completed utilizing the CONTRACTOR "Employee Evaluation" form and based upon the employee's specific job description. This process is repeated on an annual basis. Areas of concern are highlighted and recommendations for improvement are included and monitored. Unsatisfactory performance is documented and employees who face the possibility of termination will be counseled. All terminations must be approved byChief Operating Officer.

9. Inmate/Youth Workers, Medical Research, Utilization of Volunteers, Collection of Forensic Evidence

CONTRACTOR policy prohibits the use of inmate/youth workers, utilization of volunteers, or the use of inmates/youth as subjects for medical research. In addition, CONTRACTOR policy prohibits health care staff from participating in the collection of forensic evidence.

V. PROGRAM SUPPORT SERVICES

1. Third Party Billing Services

i. On-site Services: As part of the inmate/youth booking process, information concerning inmate/youth insurance coverage will be asked by deputies conducting the inmate/youth health screening. Health services staff will follow-up on positive responses. When possible, copies of inmate/youth insurance cards will be made. Tuolumne County charges inmates for health services in accordancewith PC 4011.2, CONTRACTOR will coordinate with Tuolumne County Sheriff staff to implement this program. CONTRACTOR understands that the County would retain these funds to offset the contract cost.

ii. Off-site Services CONTRACTOR will notify all off-site service providers of any insurance availability. Contractor and County will coordinate to facilitate Medi-Cal Inmate Program (MCIP) eligibilityof inmates and Medi-Cal payment for Medi-Cal services. Off-site service providers will be instructed to bill other third party payers prior to billing CONTRACTOR. This will include inmates/youth requiring treatment for ongoing workers’ compensation claims or injuries covered by automobile insurance. CONTRACTOR’s compensation is based on CONTRACTOR anticipated net off-site costs. Any insurance payments would be received by off-site serviceproviders.


2. Quality Assurance Program

i. CONTRACTOR shall provide a Comprehensive Quality Assurance (QA) Plan that includes a description of any subcommittees (i.e. inmate death review), representatives on committees, frequency of meetings, data tracking and trends, and outcomes. The Comprehensive Quality Assurance Plan will be reviewed and mutually agreed upon by the County. The Provider shall facilitate quarterly QA meetings that include the Providers Medical Director, and representation from Public Health, Public Health Officer, Behavioral Health, Sheriffs and Probation Departments. At least semi-annually, the QA Committee shall include peer review. A copyof the work plan, data elements tracked and reported, frequency and participants of QA meetings including the subcommittee shall all be included in the Comprehensive QA Plan. Quarterly statistic summaries of quality assurance shall be shared with the QA Committee.

3. Cost Containment Program

i. CONTRACTOR takes a global approach to correctional health care cost containment. CONTRACTOR is interested in providing services that are both cost-effective medically and also reduce Sheriff and Probation departments’ transportation and security costs.

ii. On-Site Services

a. CONTRACTOR intends to provide chest and extremity x-ray services on-site.

b. It is CONTRACTOR’s intent to provide, wherever medicallyappropriate, on-site services rather than off-site services. Typically, CONTRACTOR attempts to provide on-site suturing, and medical observation services, as indicated.

iii. Off-Site Service Referrals

a. All off-site service referrals that are not life-threatening emergencies are reviewed by the physician or physician on-call prior to a referral being made. Communication between the off-site service provider and the on-site Medical Director or Regional Manager, if a referral is made, is also an essential part of CONTRACTOR cost-containment program.Hospital based physicians and community based specialists need to be made aware of the medical support services that are available in Tuolumne County facilities. Referrals need to be specific in terms of treatment authorization. Prior authorization for any additional services must be approved by the on-site Medical Director with the exception of life-threatening emergencies. Elective procedures that can be safely delayed are not routinely approved.


b. CONTRACTOR will notify the Facility Administrator of any inmates/youth with medical conditions that are likely to require lengthy hospitalizations.

iv. Off-Site Referral Review Process

a. CONTRACTOR shall provide a referral process including Post release services and methods to determine that referrals to outside providers are not to be related to the contracted Provider and shall provide required medical/surgical inpatient hospital care, off-site medical specialty care, off-site medical clinic care, emergency room care, diagnostic services such as laboratory, radiology, etc., which cannot be provided on-site, and other health-related ancillary services for those inmates who have been medically cleared or booked and physically placed in the jail or the Juvenile Detention Facility. The referral process must include

b. CONTRACTOR shall provide a plan for sharing reports and graphs depicting year to date costs as compared to the previous year to date costs for pharmaceuticals, medical supplies, off-site emergency room charges, off-site specialist,ambulance, ancillary charges, inpatient charges, and lab charges. The plan shall include frequency of reporting and reporting details to be agreed upon by the County.

v. Pharmacy Formulary, Purchasing, and Inventory Systems

a. CONTRACTOR shall provide a plan that includes formulary, prescribing practices and inventory control.

vi. Ancillary Service Contract Rates

a. CONTRACTOR shall provide a list of available services (laboratory, x-ray, pharmaceuticals, medical supplies, medical record supplies and forms,etc.)

vii. Staff Productivity, Management Outsourcing. Staffing Innovations

a. Staffing costs are the largest percentage of any correctional health care budget. CONTRACTOR staffing patterns are designed to be as cost-effective as possible. Staff is motivated to work hard to maintain competitive wages and isalso rewarded by participating in the company profit sharing plan. CONTRACTOR contributions to the plan are increasedbased on the overall company success.

4. Management Information System

i. On-site statistical reporting shall be based on a variety of source documents and aggregated daily. CONTRACTOR shall provide a plan specifying the data that will be gathered and generated.


CONTRACTOR will provide additional categories of information based on county requests.

ii. As indicated in previous sections, workload and financial statistics are routinely analyzed and provided to CONTRACTOR management staff. Workload data will be submitted to the Sheriff/Probation departments on a monthly basis.

5. Complaint Procedure

i. CONTRACTOR will respond to all complaints initiated by inmates/youth through the appropriate Tuolumne County grievance procedure concerning medical, dental, or mental health services. TheCONTRACTOR will be responsible for providing a written response to each inmate/youth grievance within the time parameters specified by appropriate County department. The RN will be responsible for eliciting responses from service providers, if regional, for each grievance and summarizing in his or her report. The Contractor will be responsible for reviewing the grievances as part of the on-going monitoring process.

ii. All inmate/youth grievances relating to medical, dental, and psychiatric services will be reviewed by the Medical Audit Committee.

6. Policies and Procedures

CONTRACTOR will develop and maintain policy and procedure manuals for Tuolumne County, which will be updated as needed and reviewed minimally on an annual basis. They will be reviewed and approved by the appropriate County department (Sheriff/Probation) and Public Health Department.

Without limiting the responsibility of the Provider to make its own medical care judgments, or the discretion of the Sheriff J.H. Dambacher Detention Center administration to perform its responsibilities under law, those areas include, but are not limited to:

Drug and syringe security;

Alcohol and drug medical detoxification;

Identification, care and treatment of inmates with special medical needs including

but not limited to, individuals with hepatitis, epilepsy, physical disabilities, those

infected with Human Immunodeficiency Virus (HIV), and those with any other

diseases that can be sexually transmitted;

Suicide prevention;

The use of physical restraints; and

Identification, care and treatment of individuals suffering from any mental illness,

disease or injury, including, but not limited to, those presenting a danger to

themselves or others.


Neither obligations nor the rights of the Provider under this contract may be assigned by the provider without the express written consent of Tuolumne County, whose consent shallnot be unreasonably withheld.

7. Strategic Planning and Consultation

CONTRACTOR participates with County officials in administrative meetings as scheduled. In addition, CONTRACTOR encourages regular contact with Corporate Management staff for any concerns that are not being resolved satisfactorily or timely at the program level.

Provider shall provide a consultation service to Tuolumne County Sheriff on any and all aspects of the health care delivery system at the Sheriff J.H. Dambacher Detention Center, including evaluations and recommendations concerning new programs, architectural plans,staffing patterns for new facilities, alternate pharmaceutical and other systems, and on any other matter relating to this contract.


Exhibit BCOST PROPOSAL

³scope of work, scope of work. 2. services 3. compensat ion

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