Res 127-2003 10/7/2003RESOLUTION NO. A- -OZ 03
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF WICHITA
FALLS, TEXAS, AUTHORIZING THE EXECUTION OF A
MEMORANDUM OF AGREEMENT BETWEEN THE CITY OF WICHITA
FALLS AND THE NORTH CENTRAL TEXAS MEDICAL FOUNDATION
FOR THE PROVISION OF MEDICAL SERVICES TO THE WICHITA
FALLS-WICHITA COUNTY PUBLIC HEALTH DISTRICT; FINDING AND
DETERMINING THAT THE MEETING AT WHICH THIS RESOLUTION
WAS PASSED WAS OPEN TO THE PUBLIC AS REQUIRED BY LAW.
WHEREAS, the City of Wichita Falls ("the City") and Wichita County, Texas ("the
County"), pursuant to the provisions of the TEXAS HEALTH & SAFETY CODE, section
121.041, et seq., created the Wichita Falls -Wichita County Public Health District ("the
District"); and
WHEREAS, the City and the District provide Title V maternal care, a TB clinic, a
sexually transmitted disease clinic, an immunization clinic, and pediatric clinic in the
City and the County; and
WHEREAS, the City Manager, by authority granted by the District, shall contract
for the provision of licensed physicians to staff the clinics cited above; and,
WHEREAS, the City Manager, subject to the approval of City Council, intends to
enter into a written agreement with the North Central Texas Medical Foundation to staff
the clinics cited above.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF WICHITA FALLS, TEXAS, THAT:
SECTION 1. That certain Memorandum of Agreement, a copy of which is
attached hereto, by and between the City of Wichita Falls and the North Central Texas
Medical Foundation for the provision of medical services for the Wichita Falls -Wichita
County Public Health District, is hereby approved, and the City Manager is authorized
to execute said Agreement on behalf of the City of Wichita Falls.
SECTION 2. It is hereby officially found and determined that the meeting at
which this resolution was passed was open to the public as required by law.
PASSED AND APPROVED this the 7th day of October, 2003.
MAYOR
ATTEST:
City Clerk
MEMORANDUM OF AGREEMENT
This Agreement is made and entered by and between the North Central Texas Medical
Foundation, hereinafter referred to as "Foundation," and the City of Wichita Falls, Texas, a home
rule municipal corporation, hereinafter referred to as "City," and on behalf of the Wichita Falls -
Wichita County Public Health District, hereinafter referred to as "District" to be effective upon
approval of the Wichita Falls City Council and subsequent execution by the Wichita Falls City
Manager or his designee.
WITNESSETH:
WHEREAS, the District recognizes the need to retain professional medical services to
meet the needs of programs identified in Exhibit "A" and incorporated herein.
WHEREAS, the District needs the assurance of an established continuous source for the
provision of health care to meet the aforementioned needs of the District; and
WHEREAS, the Foundation currently operates the Family Practice Residency Program
(hereinafter referred to as "Residency") which can provide the medical care to meet the
aforementioned health care needs; and
WHEREAS, the Foundation is a non-profit corporation which is certified by the State
Board of Medical Examiners to engage in the practice of medicine; and
WHEREAS, the faculty physicians of the Residency (herein "Faculty Physicians") are
competent physicians legally qualified to practice medicine under the laws of the State of Texas;
and
WHEREAS, the resident physicians of the Residency (herein "Resident Physicians") are
legally qualified to practice medicine under the laws of the State of Texas under the direct
supervision of the Faculty Physicians of the Residency; and
WHEREAS, the Residency agrees to provide the required Faculty Physician supervision
for all Resident Physicians when performing the duties established in the Agreement; and
WHEREAS, Dale C. Moquist, M.D., Director of the Residency and also Faculty
Physician, was previously appointed as Medical Director and Roy L. Carr, M.D., Faculty
Physician, was previously appointed as Associate Medical Director; and
WHEREAS, the Local Public Health Reorganization Act, Chapter 121 Health and Safety
Code, and Texas Board of Health Rule, 25 Tex. Admin. Code §85.12, require the appointment
and service of a Health Authority; and
WHEREAS, the District recognizes the need to retain professional services to meet the
requirements for Health Authority as described in Exhibit "B" and incorporated herein; and
WHEREAS, Roy L Carr, M.D., was previously appointed as Health Authority and Dale
C. Moquist, M.D., was previously appointed as Associate Health Authority for the District and
said Faculty Physicians meet the requirements of Section 121.022 of the TEXAS HEALTH AND
SAFETY CODE and are willing to render professional services for the District as provided herein.
NOW, THEREFORE, City hereby engages the services of the Residency, and in
consideration of the mutual promises herein contained, the parties agree as follows:
I.
SCOPE OF WORK
The scope of work and responsibilities and requirements are included but are not limited
to those set out in Exhibits "A" and "B" attached hereto and made a part hereof for all purposes,
which are intended as guidelines and may be amended by mutual agreement.
II.
TERM
The term of this Agreement shall be a two-year period beginning on October 1, 2003 and
ending on September 30, 2005. This Agreement may be terminated by City as provided herein.
III.
MEDICAL DIRECTOR
3.01 Medical Director. Dale C. Moquist, M.D., will serve as Medical Director and
Roy L. Carr, M.D., as Associate Medical Director for the District providing medical direction
and quality control of medical services for the District Director and staff including but not
limited to those services set forth in Exhibit "A". The Medical Director is responsible to the
District Director and will work in cooperation with the District Director.
3.02 Health Authority. Roy L. Carr, M.D., has been appointed as Health Authority
and Dale C. Moquist, M.D., as Associate Health Authority and will serve the District by carrying
out the duties as included but not limited to those set out in Exhibit "B". Health Authority is
responsible to the District Director and will work in cooperation with the District Director and
will provide assistance in ensuring adherence to state and local laws relating to public health.
Health Authority will perform all duties of a Health Authority as provided by law and has taken
and subscribed to the official Health Authority oath and filed a copy of the oath and appointment
with the Texas Board of Health as required by Chapter 121 of the Health and Safety Code and
according to Article I of this agreement.
IV.
COMPENSATION/OWNERSHIP OF DOCUMENTS
4.01 Compensation. In consideration for the services to be rendered under this
Agreement, including all expenses, the Foundation shall be paid a fee not to exceed $10,183.33
per month. It is agreed by the Foundation, the City and the District that in consideration of the
aforementioned monthly stipend, the Foundation shall conduct on a weekly basis a Tuberculosis
Clinic as a part of the services to be rendered pursuant to this agreement of the parties, and that
the Tuberculosis Clinic shall be conducted at no additional cost to the City or the District.
Foundation may invoice City on a monthly basis. Such invoices shall be itemized to show
services performed, expenses and corresponding charges.
It is further agreed by the parties that the entity rendering services to maternity patients
for whom payment is made by Medicaid, shall be entitled to the payments made for the services
rendered. Foundation shall keep accurate records of its services and expenses incurred in the
performance of this Agreement and shall make the same available to City and/or District for
inspection and copying upon five (5) days notice thereof. These records shall be kept by
Foundation for four (4) years following the expiration of this Agreement. The Foundation shall
furnish to the District an itemized report of annual expenditures no later than the thirtieth (30th)
day following the expiration of each fiscal year for which services are provided under this
Agreement.
4.02 Fiscal Funding. Foundation and City recognize that the continuation of any
Agreement after the close of any given fiscal year of the City of Wichita Falls, which fiscal year
ends on September 30 of each year, shall be subject to Wichita Falls City Council approval. In
the event the Wichita Falls City Council does not approve the appropriation of funds for this
Agreement, the Agreement shall terminate at the end of the fiscal year for which funds were
appropriated, and the parties shall have no further obligations hereunder.
4.03 Maximum Compensation upon Termination by City or Professional. In the
event of termination by City, with or without cause, and subject to the terms of §3.02 herein, the
Foundation shall be compensated only for actual expenses and fees incurred by Foundation in
providing those services acceptable to District, which are within the scope of work under this
Agreement to date of notice of termination. Expenses do not include overhead such as utilities,
rent, insurance, etc., and shall not exceed the total amount due under this Agreement.
4.04 Ownership of Documents. All client or patient records created as a result of the
District's services shall be the property of the District. The Foundation shall own all records of
patients seen as part of the Title V services to be rendered as part of the Family Residence
Program services. The Foundation acknowledges the District's right to permit access to Title V
patient records or provide copies for audit examination, evaluation, inspection, litigation, or other
circumstances to the Texas State Department of Health. Notwithstanding any provision herein to
the contrary, if requested by the Residency, the District may, in its sole discretion, share certain
patient information with the Residency. However, the District shall first obtain a release of
medical information from the client, patient, or someone authorized to act on his or her behalf,
permitting the transfer of information to the Residency.
4.05 Examination of Books and Records. The Foundation agrees that the District, the
Texas Department of Health and the federal government shall have the right to examine the
books, records and accounts of the Foundation at a time mutually convenient to both parties to
the extent that they relate to transactions affecting the Foundation's compensation as set forth in
this agreement. Any questions or deficiencies identified by the District in the Foundation's
records will be conveyed in writing to the Foundation. The Foundation will resolve the questions
or deficiencies in writing to the District within thirty (30) days of receipt of a question or
deficiencies. A determination by the District of either an inadequate or inappropriate resolution
of the questions or deficiencies may result in the withholding of funds, suspension or
cancellation of this Agreement. Any such withholding of funds or suspension will remain in
effect until the findings are properly remedied as determined by the District. The right to
examine the Foundation's books as they relate to this Agreement shall survive termination of this
Agreement.
V.
SUCCESSORS AND ASSIGNS/AGENTS OR ASSISTANTS
5.01 Successors and Assigns. City and Foundation each bind themselves, their
successors, executors, administrators and assigns to the other party to this Agreement. Neither
City nor Foundation will assign, sublet, subcontract or transfer any interest in this Agreement
without the written consent of the other party. No assignment, delegation of duties or subcontract
under this Agreement will be effective without the written consent of City. Subject to the
provision regarding assignment, this Agreement shall be binding on the administrators, legal
representatives, successors, and assigns of the respective parties.
5.02 Use of Agents, Servants, Employees or Independent Contractors. Subject to
the foregoing, to the extent reasonably necessary for the Foundation to perform its duties
hereunder, Foundation may engage, at the sole expense of the Foundation, the services of any
agents, servants, employees or independent contractors which it may deem proper, and it may
further employ, engage, or retain the services of such other persons or corporations to aid or
assist it in the proper performance of its duties. Foundation shall be compensated only for actual
expenses and fees for supplies and materials incurred by Foundation in providing services to the
City that are within the scope of work under this Agreement. The cost of the services of such
agents, servants, employees or independent contractors shall be borne by Foundation at its sole
cost and expense. Foundation further agrees that the subletting of any portion or feature of the
work or materials required in the performance of this Agreement shall not relieve Foundation
from its full obligations to City as provided by this Agreement, regardless of whether such
subletting is agreed to by City.
All out-of-pocket expenses are to be borne by the Foundation, with exception for
materials set forth in Exhibit "A" attached.
It is expressly understood and agreed that any agent, servant, employee, or independent
contractor retained or employed by Foundation is the agent, servant, or other employee of
independent contractor of Foundation and that Foundation shall be solely responsible for the acts
and omissions of such person or entity to the exclusion of the City. It is expressly agreed that
City has no right of control over any agent, servant, employee or independent contractor.
VI.
FACILITIES
Facilities. Foundation shall be responsible for providing all necessary facilities,
personnel, equipment, materials or other items necessary to perform the services required of it
hereunder; provided, however, City shall cooperate with Foundation by providing space it has
available for meetings, medical evaluation and treatment, and administrative space as mutually
agreed.
VII.
INSURANCE AND CERTIFICATES OF INSURANCE
Foundation shall obtain, at its own expense, Professional Errors and Omissions insurance,
which will pay for injuries arising out of errors or omissions in the rendering, or failure to render,
professional services under the Agreement, for the term of the Agreement and up to two years
after the Agreement is terminated, with limits of $200,000/$600,000 per occurrence/aggregate
for non-residents and limits of $100,000/$300,000 for residents. Foundation shall not start work
under this Agreement until Foundation has obtained at its own expense all of the insurance
required hereunder, and such insurance has been approved by the City Manager. Any
subcontractor of the Foundation shall be required to carry the same insurance as the Foundation.
To establish procurement of Professional Errors and Omissions insurance, Foundation shall not
work under this Agreement until (1) it has furnished to the City a Certificate of Insurance for
each physician providing medical services pursuant to the provisions of this Agreement, and (2)
the insurance has been approved by the City Manager of the City of Wichita Falls. It is the
express duty of the Foundation to notify the City Manager of any change in the Professional
Errors and Omissions insurance coverage affecting any physician providing medical services
pursuant to the provisions of this Agreement. Such notice shall be in writing and furnished to the
City Manager, City of Wichita Falls, Texas, P.O. Box 1431, Wichita Falls, Texas 76307, within
five (5) business days of the Foundation's receipt of notice of change.
VIII.
INDEMNIFICATION
Foundation does hereby covenant and agree to waive all claims, release, indemnify,
defend and hold harmless the City and the District and all of their officials, officers, agents,
employees, volunteers and invitees in both their public and private capacities, from any and all
liability, claims, suits, demands or causes of action, including all expenses of litigation and/or
settlement which may arise by reason of injury to or death or debt of any person, or for loss of,
damage to or loss of use of any property arising, directly or indirectly, out of Foundation's
services in accordance with the Agreement; and such indemnity will apply whether the claims,
suits, losses, damages, causes of action or liability, arise in whole or in part from the negligence
of Foundation or any of its officers, officials, agents, employees or invitees, whether such
negligence is contractual, comparative negligence, concurrent negligence, gross negligence or
any other form of negligence.
The City and the District shall be responsible for the negligence of their respective
employees in the performance of their duties under the provisions of this Agreement.
IX.
INDEPENDENT CONTRACTOR
Foundation covenants and agrees that he or she is an independent contractor and not an
officer, agent, servant or employee of City; that Foundation shall have exclusive control of and
exclusive right to control the details of the work performed hereunder and all persons performing
same, and shall be responsible for the acts and omissions of its officers, agents, employees,
contractors, subcontractors and consultants; that the doctrine of respondeat superior shall not
apply as between City and Foundation, its officers, agents, employees, contractors,
subcontractors and consultants, and nothing herein shall be construed as creating a partnership or
joint enterprise between City and Foundation.
X.
TERMINATION
10.01 Option. City may, at its option, without cause, and without prejudice to any other
remedy it may be entitled to at law, in equity, or otherwise under this Agreement, terminate
further work under this Agreement, in whole or in part, by giving at least thirty (30) days prior
written notice thereof to Foundation with the understanding that all services being provided by
Foundation shall cease upon the date such notice is received.
10.02 Cause. City reserves the right to terminate this Agreement immediately upon
breach of any term or provision of this Agreement by Foundation; or if at any time during the
term of this Agreement, Foundation shall fail to commence the work in accordance with the
provisions of the Agreement or fail to diligently provide services in an efficient, timely and
careful manner and in strict accordance with the provisions of this Agreement, or fail to use an
adequate number or quality of personnel or equipment to complete the work or fail to perform
any of its obligations under this Agreement, then City shall have the right, if Foundation shall not
cure any such default after thirty (30) days written notice thereof, to terminate this Agreement
and complete the work in any manner it deems desirable, including engaging the services of
other parties therefore. Any such act by City shall not be deemed a waiver of any other right or
remedy of City.
10.03 Costs. If after exercising any remedy provided herein, the cost to City of the
performance of the balance of the work is in excess of that part of the Agreement sum that has
not therefore been paid to professional hereunder, Foundation shall be liable for and shall
reimburse City for such excess.
XI.
EQUAL OPPORTUNITIES
Foundation shall not discriminate against any employee or applicant for employment
because of race, age, color, religion, sex, disability, ancestry, national origin or place of birth.
Foundation shall take action to ensure that applicants are employed and treated without regard to
their race, age, color, religion, sex, disability, ancestry, national origin or place of birth. This
action shall include but not be limited to the following: employment, upgrading, demotion or
transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms
of compensation; and selection of training, including apprenticeship.
XII.
APPLICABLE LAW
Foundation shall at all times observe and comply with all federal, state and local laws,
ordinances and regulations, which in any manner affect Foundation or the work, and shall
indemnify and save harmless City against any claim arising from the violation of any such laws,
ordinances and regulations whether by Foundation or its employees. If Foundation observes that
the work is at variance therewith, Foundation shall promptly notify City in writing. If Foundation
performs any work knowing it to be contrary to such laws, ordinances, rules and regulations, and
without such notice to City, Foundation shall bear all costs arising therefrom.
XIII.
SEVERABILITY
The provisions of this Agreement are severable. If any paragraph, section, subdivision,
sentence, clause, or phrase of this Agreement is for any reason held to be contrary to the law or
contrary to any rule or regulation having the force and effect of the law, such decision shall not
affect the remaining portions of the Agreement.
XIV.
NON -WAIVER
It is expressly understood and agreed that, in the execution of this Agreement, City does
not waive nor shall City be deemed hereto to have waived any immunity or defense that would
otherwise be available to it. It is further agreed that one or more instances of forbearance by City
in the exercise of its rights herein shall in no way constitute a waiver thereof.
XV.
DRUG -FREE WORKPLACE
The Foundation, its agents, servants, and employees shall be subject to the drug -free
workplace requirements as set forth in Exhibit "C."
XVI.
SMOKE -FREE ENVIRONMENT
The Foundation shall at all times prohibit the use of tobacco products, whether smoking
or smokeless, within any and all space occupied or used by the Foundation pursuant to this
Agreement.
XVII.
PARAGRAPH HEADINGS
The descriptive headings of the several Articles, Sections and Paragraphs contained in
this Agreement are inserted for convenience only, and shall not control or affect the meaning or
construction of any of the provisions hereof.
XVIII.
ENTIRE AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in writing,
between the parties hereto with respect to the subject matter hereof, and no other agreement,
statement, or promise relating to the subject matter of this Agreement, which is not contained
herein, shall be valid or binding. The parties agree that this Agreement and its attachments
constitute the entire understanding of the parties.
XIX.
BREACH OF OBLIGATION
This Agreement is entire as to all of the services to be rendered under it. Breach of any
obligation to be performed shall constitute a breach of the entire Agreement and shall give the
non -breaching party the right to terminate this Agreement.
XX.
GOVERNING LAwNENUE
The validity of this Agreement and of any of its terms or provisions, as well as the rights
and duties of the parties hereunder, shall be governed by the laws of the State of Texas. The
parties agree that it is performable in Wichita County, Texas, and that exclusive venue shall be in
Wichita County, Texas.
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates
indicated below.
Foundation
Date: By:
Dale C. Moquist, M.D.
City of Wichita Falls, Texas
Date: By:
Jim Berzina, City Manager
P. O. Box 1431
Wichita Falls, Texas 76307
Approved as to Form:
Bill Sullivan, City Attorney
EXHIBIT "A"
MEDICAL DIRECTOR
Tuberculosis Clinic
Contractor Responsibilities
• Conduct weekly TB clinic (average time required in clinic per week four (4) hours)
• Admit patients to service
• Physical examination of patients
• Review chest x-rays
• Review lab reports
• Issue medical orders for treatment, diagnostic testing and referral if necessary
• Chart review on enrolled patients
• Review and approve District protocols and policies annually
• Phone consultation between clinics concerning urgent lab reports and medication
reactions
• Participate in annual Quality Assurance review
Health District Responsibilities:
• Supply adequate staff, equipment and supplies to maintain clinical and surveillance
activities
• Administer and read TB skin test according to established protocols
• Perform contact investigation and follow up for each identified case
• Prepare charts for clinics to ensure all labs and needed x-rays are ready for physician
review
• Prepare clients for physician including initial interview, obtain vital signs, height weight
and vision screen
• Perform all lab draws
• Monitor all DOT clients for signs and symptoms of medication reaction or toxicity
• Client education concerning disease process and medication
• Provide translators for non-English speaking clients
• Provide TB medications and vitamins through state program
• Conduct annual Quality Assurance review
Sexually Transmitted Disease Clinic
Contractor Responsibilities
• Medical management of patients referred by PHN
• Review lab results (Includes both in -office and phone consultations)
• Chart review (Physician must review all client records)
• Perform cryotherapy for treatment of condyloma
• Phone consult on all syphilis cases, any deviation from normal protocol and any child
under the age of 14
• Review and approve District protocols and policies annually
• Participate in annual Quality Assurance review
Health District Responsibilities
• Supply adequate staff, equipment and supplies to manage STD clinic
• Perform exams according to approved protocols for all patients and consult with
physician when medically appropriate
• Perform all lab draws
• Educate client concerning high -risk behaviors, disease process, treatment and
medications
• Provide translators for non-English speaking clients
• Ensure appropriate space for physician to review charts
• Conduct annual Quality Assurance review
Immunization Clinic
Contractor Responsibilities
• Phone consults for unusual circumstances and variance reports
• Review and approve District protocols and policies annually
• Participate in annual Quality Assurance review
Health District Responsibilities
• Provide education to all clients receiving immunization
• Consult with physician regarding any protocol variance or untoward incident related to
vaccine administration
• Insure proper consent is received for immunizations
• Insure Immunizations are given according to policy and procedure
• Conduct annual Quality Assurance review
Maternity Clinic
Contractor Responsibilities
• Provide outpatient obstetrical care appropriate to Title V standard of care
• Review and approve District protocols and policies annually
• Coordinate patient care according to District Maternity Policy and Procedure
• Phone consultation between clinics concerning urgent lab and sonogram reports
• Participate in annual Quality Assurance review
Health District Responsibilities
• Supply adequate staff, equipment and supplies to carry out activities detailed in the
District Maternity Policy and Procedure Manual
• Perform all Initial Intake activities as detailed in District Policy and Procedure Manual
(MTY 13.00.00), or as it may be amended from time to time
• Conduct annual Quality Assurance review
Child Health Clinic
Contractor Responsibilities
• Conduct pediatric clinic (1 weekly at main site and 2 monthly at MLK site)
• Complete pediatric assessment
• Nutritional evaluation
• Developmental/behavioral status assessment
• Chart review
• Review Lab results
• Issue prescription/s and provide referrals as needed
• Review and approve District protocols and policies annually
• Phone consultation between clinics concerning urgent patient care matters
• Participate in annual Quality Assurance review
Health District Responsibilities
• Supply adequate staff, equipment and supplies for clinic operation
• Prepare charts for patient visits
• Assist physician as stand-by for exams
• Provide translators for non-English speaking clients
• Perform appropriate activities as detailed in District Policy and Procedures for Child
Health Services
• Provide patient and parent with age appropriate education
• Schedule referral appointments and provide follow up
• Conduct annual Quality Assurance review
Laboratory
Contractor Responsibilities
• For purposes of CLIA certification, the Medical Director also serves as "Medical
Director" of the Laboratory. The District contracts with a pathologist who serves as
"Laboratory Consultant." The Laboratory Consultant is responsible for Laboratory QA
activities.
Pharmacy
Contractor Responsibilities
• Serves as member of Therapeutics Committee
• Annual formulary review
EXHIBIT "B"
HEALTH AUTHORITY
The Foundation shall comply with the provisions of V.T.C.A., Health and Safety Code
§ 121.024 and as it may be amended from time to time, which at the time of the execution of this
Agreement provides:
law.
§ 121.024 Duties
(a) A health authority is a state officer when performing duties prescribed by state
(b) A health authority shall perform each duty that is:
(1) necessary to implement and enforce a law to protect the public health; or
(2) prescribed by the board.
(c) The duties of a health authority include:
(1) establishing, maintaining, and enforcing quarantine in the health
authority's jurisdiction;
(2) aiding the board in relation to local quarantine, inspection, disease
prevention and suppression, birth and death statistics, and general
sanitation in the health authority's jurisdiction;
(3) reporting the presence of contagious, infectious, and dangerous epidemic
diseases in the health authority's jurisdiction to the board in the manner
and at the times prescribed by the board;
(4) reporting to the board on any subject on which it is proper for the board to
direct that a report be made; and
(5) aiding the board in the enforcement of the following in the health
authority's jurisdiction:
(A) proper rules, requirements, and ordinances;
(13) sanitation laws;
(C) quarantine rules; and
(D) vital statistics collections.
In addition to the foregoing, Roy L. Carr, M.D., the Health Authority, or his designee,
shall be available twenty-four hours a day, seven days a week, to any emergency personnel who
may be exposed to a contagious disease while performing his or her duty, to make a
determination as to whether mandatory testing for a contagious disease should be initiated.
EXHIBIT "C"
DRUG -FREE WORKPLACE ACT CERTIFICATION
1. The Foundation certifies that it will provide a drug -free workplace by:
(a) Publishing a statement notifying employees that unlawfully manufacturing,
distributing, dispensing, possessing or using a controlled substance in the Foundation's
workplace is prohibited and specifying the actions that will be taken against employees
for violation of such prohibition.
(b) Establishing a drug -free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The Foundation's policy of maintaining a drug -free workplace;
(3) Any drug counseling, rehabilitation, and employee assistance programs
that are available; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace.
(c) Making it a requirement that each employee to be engaged in the performance of
the Agreement be given a copy of the statement required by paragraph (a).
(d) Notifying the employee in the statement required by paragraph (a) that, as a
condition of employment under the Agreement the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a violation
occurring in the workplace no later than five (5) days after such a
conviction.
(e) Notifying the District within ten (10) days after receiving notice under
subparagraph (d)(2), from an employee or otherwise receiving actual notice of such
conviction.
(f) Taking one of the following actions, within thirty (30) days of receiving notice
under subparagraph (d)(2), with respect to any employee so convicted:
(1) Taking appropriate _personnel action against such an employee, up to and
including termination; or
(2) Requiring such an employee to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a
federal, state or local health, law enforcement, or other appropriate agency.
(g) Making a good faith effort to continue to maintain a drug -free workplace through
implementation of paragraphs (a), (b), (c), (d), (e), and (f).
2. The Contractor's headquarters is located at the following address. The addresses of all
other workplaces maintained by the Contractor are provided on an accompanying list.
Name of Contractor: Dale C. Moquist, M.D.
North Central Texas Medical Foundation
Street of Address: 1301 Third Street
City: Wichita Falls
County: Wichita
State: Texas
Zip Code: 76301
Signed by:
Dale C. Moquist, M.D.
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