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HomeMy WebLinkAboutDavid Sami, MD - 2021-04-01 PROFESSONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND Dgvjd Sgmd, rnD FOR INDEPENDENT MEDICAL EVALUATIONS WITH RESPECT TO WORKERS' COMPENSATION CLAIMS THIS AGREEMENT("Agreement") is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY,"and 4vto A. T*w W, an individual,hereinafter referred to as"PHYSICIAN." WHEREAS, CITY desires to engage the services of a physician to provide independent medical evaluations with respect to workers' compensation claims; and Pursuant to documentation oil file in the office of the City Clerk, the provisions of the Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service contracts have been complied with;and PHYSICIAN has been selected to perform said services, NOW,THEREFORE,it is agreed by CITY and PHYSICIAN as follows: 1. SCOPE OF SERVICES PHYSICIAN shall provide all services as described in Exhibit "A," which is attached hereto and incorporated into this Agreement by this reference. These services shall sometimes herehinfter be referred to as the"PROJECT." PHYSICIAN hereby designates SAMt My , who shall represent it i and be its sole contact and agent in all consultations with CITY during the performance of this Agreement. c APPROVED AS TO FORM/!�CM• htt Ql , Y' AICHAEL E.GATES CITY ATTORNEY 12-7181AMR Standard Contract- Revised I CITY OF HUNTINGTON BEACH 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly with PHYSICIAN in the performance of this Agreement. 3. TIME OF PERFORMANCE Time is of the essence of this Agreement. Tile services of PHYSICIAN are to commence on April I 2Q2 I . (tire "Commencement Date"). This Agreement shall automatically renew three(3)years from the Commencement Date,unless terminated as provided herein. The(lire for performance of the tasks identified in Exhibit"A"are generally to bo shown in Exhibit"A" This schedule may be amended to benefit the PROJECT if mutually agreed to in writing by CITY and PHYSICIAN. In the event the Commencement Date precedes the Effective Date, PHYSICIAN shall be bound by all terms and conditions as provided herein. 4. COMPENSATION In consideration of the performance of the services described herein, CITY agrees to pay PHYSICIAN, on a time and materials basis at the rates specified in Exhibit"B," attached hereto and incorporated by reference into this Agreement, a fee, including all costs and expenses, not to exceed Twenty-nine Thousand Nine-Hundred Dollars($29,900.00). 5. EXTRA WORK In the event CITY requires additional services not included in Exhibit "A", or changes in the scope of services described in Exhibit"A," PHYSICIAN will undertake such work only after receiving written authorization from CITY. Additional compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained. 12-318711M8 Standard Contract- Revised 2 i i it 6. METHOD OF PAYMENT PHYSICIAN shall be paid pursuant to the terms of Exhibit "B." 7. DISPOSITION OF PLANS ESTIMATES AND OTHER DOCUMENTS PHYSICIAN agrees that title to all materials prepared hereunder,including,but not limited to; all original drawings, designs, reports, both field and office notices, calculations, computer code,language, data or programs,maps, memoranda, letters and other documents,shall belong to CITY, and PHYSICIAN shall turn these materials over to CITY upon termination of this Agreement or upon PROJECT completion,whichever shall occur first. These materials may be used by CITY as it sees fit. 8. HOLD HARMLESS PHYSICIAN hereby agrees to protect,defend,indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims,damages,losses,expensesJudgmenls,demands and defense costs(including without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in co unction with PHYSICIAN's (or PHYSICIAN'S subcontractors, if any) negligent (or alleged negligent)performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by PHYSICIAN,its officers,agents or employees except such loss or damage which was caused by the sole negligence or willful misconduct of CITY. PHYSICIAN will conduct all defense at its sole cost and expense and CITY shall approve selection of PHYSICIAN's counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act aslimitationupontlieamotmtofindenunification to be provided by PHYSICIAN. 12.3187/fME Standard Contract- Revised 3 1 I 9. PROFESSIONAL LIABILITY INSURANCE PHYSICIAN shall obtain and furnish to CITY a professional liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for i PHYSICIAN's professional liability in an amount not less than One Million Dollars ($1,000,000.00) per occurrence and in the aggregate. The above-mentioned insurance shall not contain a self-insured retavion without the express written consentof CITY;however an insurance policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. A claims-made policy shall be acceptable if the policy further provides that; A. The policy retroactive date coincides with or precedes the initiation of the scope of work (including subsequent policies purchased as renewals or replacements). B. PHYSICIAN shall notify CITY of circumstances or incidents that might give rise to Riture claims. PHYSICIAN will make every effort to maintain similar insurance during the required extended period of coverage following PROJECT completion. If insurance is terminated for any reason,PHYSICIAN agrees to purchase an extended reporting provision of at least two(2) years to report claims arising from work performed in connection with this Agreement. I If PHYSICIAN fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the CITY with required proof that insurance has been procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to forthwith terminate this Agreement. Such termination shall not affect PHYSICIAN's right to be paid for its time and materials expended prior to notification of termination. PHYSICIAN waives 12-1 187/IMB Standard Contract- Revised 4 i the right to receive compensation and agrees to indemnify the CITY for any work performed prior to approval of insurance by the CITY. 10, CERTIFICATES OF INSURANCE Prior to commencing performance of the work hereunder, PHYSICIAN shall furnish to CITY certificates of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement;the certificate shall: A. provide the name and policy number of each carrier and policy; B. state that the policy is currently in force; mid C. promise that such policy shrill not be suspended, voided or canceled by either party, reduced in coverage or in limits except after thirty(30) days' prior written notice;however,ten(10)days' prior written notice in the event of cancellation for nonpayment of premium. PHYSICIAN shall maintain the foregoing insurance coverage in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverage shall not derogate from PHYSICIAN's defense, hold harmless and indemnification obligations as set forth in this Agreement. CITY or its representative shall at all times have the right to demand the original or a copy of the policy of insurance, PHYSICIAN shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required. 11. INDEPENDENT CONTRACTOR PHYSICIAN is, and shall be, acting at all times in the performance of this Agreement as an independent contactor herein and not as as employee of CITY. PHYSICIAN shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, 12-3 WINE Standard Contact -Revised 5 social security, state disability insurance compensation, unemployment compensation and other I payroll deductions for PHYSICIAN and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or Ore services to be performed hereunder. 12, TERMINATION OF AGREEMENT All work required hereunder shall be performed in a good and workmanlike manner. CITY may terminate PHYSICIAN's services hereunder at any ti me with or without cause, and whether or not the PROJECT is fully complete. Any termination of this Agreement by CITY shall be made in writing, notice of which shall be delivered to PHYSICIAN as provided herein, In the event of termination, all finished and unfinished documents,exhibits,report, and evidence shall, at the option of the CITY, become its property and shall be promptly delivered to it by PHYSICIAN. 13. ASSIGNMENT AND DELEGATION This Agreement is a personal service contract and the work hereunder shall not be assigned, delegated or subcontracted by PHYSICIAN to any other person or entity without the prior express written consent of CITY. If an assignment, delegation or subcontract is approved, all approved assignees, delegates and subcontractors ,just satisfy the insurance requirements as set forth in Sections 9 and 10 hereinabove. 14. COPYRIGHTS/PATENTS Cyl'Y shall own all rights to any patent or copyright on any work,item or material produced ac a result of this Agreement. 15. CITY EMPLOYEES AND OFFICIALS PHYSICIAN shall employ no CITY official nor any regular CITY employee in the woiic performed pursuant to this Agreement. No officer or employee of CITY shall have any 12-7187t[Mg Standard Contract-Revised 6 i i financial interest in this Agreement in violation of the applicable provisions of the California Government Code. 16. NOTICES Any notices, certificates, or other communications hereunder sliall be given either by personal delivery to PHYSICIAN's agent(as designated in Section 1 hereinabove)or to CITY as the situation shall warrant,or by enclosing the same in a sealed envelope,postage prepaid,and depositing the same in the United States Postal Service, to the addresses specified below. CITY and PHYSICIAN may designate different addresses to which subsequent notices, certificates or other communications will be sent by notifying the other party via personal delivery, a reputable overnight carrier or U.S. certified mail-return receipt requested: TO CITY: TO PHYSICIAN: �{ City of Huntington Beach D41VW -4. JRrxl ATTN: Risk Manager 31A S. G4-A SSEc�. Cv. ; roo 2000 Main Street 0"W 6-9F eA 9z9(0(V Huntington Beach,CA 92648 17, CONSEN•I When CITY's consent/approval is required tinder this Agreement, its consent/approval for one transaction or event shall not be deemed to be a consent/approval to any i subsequent occurrence of the same or any other transaction or event. 18, MODIFICATION No waiver or modification of any language in this Agreement sliall be valid unless in writing and duly executed by both parties. t2-3187nMP Standard Contract - Revised 7 19. SECTION HEADINGS The titles, captions, section, paragraph and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative or matters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement. 20. INTERPRETATION OF THIS AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so Indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 21. DUPLICATE ORIGINAL The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of 12-3187/1ME Standard Contract - Revised 8 i the date of its execution and delivery, be deemed an original, Each duplicate original shall be deemed an original instrument as against any party who has signed it. 22, IMMIGRATION PHYSICIAN shall be responsible for fill compliance with the immigration and naturalization laws of die United States and shall, in particular, comply with the provisions of the United States Code regarding employment verification. 23. LEGAL SERVICES SUBCONTRACTING PROHIBITED PHYSICIAN and CITY agree that CITY is not liable for payment of any subcontractor work involving legal services,and that such legal services are expressly outside the scope of services contemplated hereunder. PHYSICIAN understands that pursuant to Huntington Beach City Charter Section 309, (lie City Attorney is the exclusive legal counsel for CITY and CITY shall not be liable for payment of any legal services expenses incurred by PHYSICIAN. 24. ATTORNEY'S FEES In the event suit is brought by either party to construe, interpret and/or enforce the terns and/or provisions of this Agreement or to secure the performance hereof, each party shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its altorney's fees from the non-prevailing party. 25. SURVIVAL Terms and conditions of this Agreement,which by their sense and context survive the termination of this Agreement, shall so survive. 26. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 12.3187/IMB Standard Contract-Revised 9 i I 27. SIGNATORIES Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact,held by the signatory or is withdrawn. PHYSICIAN'S initials 28. ENTIRETY The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation,and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations,inducements,promises,agreements or warranties,oral or otherwise, have been made by that party or anyone acting on that party's behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, inducement, promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreement. This Agreement, and the attached exhibits,contain the entire agreement between the parties respecting tho subject matter of this Agreement and supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof. 29. EFFECTIVE DATE This Agreement shall be effective on the date of its approval by the City Attorney. This Agreement shall expire when terminated as provided hereof. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. 12-7187/IMF,Standard Contract - Revised 10 P YSICIAN to A CITY OF HUNPINOTON BEACH,a n,PE"wrrar:IMna.sHAM lnunioipal corporation of the State of California signature Tor of Htumn Resources APPROVED AS TO FORM: amity Attorney Receive and File 2Qfa40j� City perk 77 7..21_� 12-7197/IMB Standard Contract-Revised I I I PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF IUNTINOTON BEACLI AND ogvi� SQmi , mf) FOR INDEPENDENT MEDICAL.EVAL.UATONS WITH RESPECT TO WORKERS' COMPENSATION CLAIMS i Table of Contents 1 Scope of Services.....................................................................................................1 2 City Staff Assistance................................................................................................2 3 Time of Performance...............................................................................................2 4 Compensation ..........................................................................................................2 5 Extra Work...............................................................................................................2 6 Method of Payment..................................................................................................3 7 Disposition of Pians,Estimates and Other Documents...........................................3 8 Hold Harmless .........................................................................................................3 9 Professional Liability Insurance..............................................................................4 10 Certificates of Insurance......................................................................:...................5 11 Independent Contractor............................................................................................5 12 Termination of Agreement.......................................................................................6 13 Assignment and Subcontracting..............................................................................6 14 Copyrights/Patents...................................................................................................6 15 City Employees and Officials..................................................................................6 16 Notices .....................................................................................................................7 17 Consent ....................................................................................................................7 18 Modification.............................................................................................................7 19 Section Headings .....................................................................................................8 20 Interpretation of this Agreement..............................................................................8 21 Duplicate Original....................................................................................................8 22 Immigration..............................................................................................................9 23 Legal Services Subcontracting Prohibited...............................................................9 24 Attoney's Fees.........................................................................................................9 25 Survival....................................................................................................................9 26 Governing Law........................................................................................................9 27 Signatories................................................................................................................10 28 Fantirety.....................................................................................................................10 29 Effective Date..........................................................................................................10 12-3187nsa8o t EXHIBIT "A" STATEMENT OF WORK: 1) AOE—COE EXAMS (exams for the determination of industrial causation). 2) Evaluation for necessity of appropriate medical treatment. 3) Assessment of employee's present ability to return to work, whether frill duty or modified. 4) Advise on condition of maximum medical improvement status. S) Determine nature and extent of permanent disability, including factors of apportionment and need for fitture medical care. 6) Resolve utilization review disputes. 7) Determine the need for spinal surgery pursuant to Labor Code section 4062(b). PHYSICIAN shall perform the evaluation in fiill accordance with the standards defined by the Division of Workers' Compensation of the State of California and the AMA Amides to the Evaluation of Permanent Impairment,Fifth Edition. This requires a report of the injury,prior status,clinical chronology, current status, and past medical history. The physical examination will document all pertinent positive, negative, and non-physiological findings. For extremity injuries,measurements must be documented bilaterally. Additionally, PHYSICIAN agrees to: (i)provide that medical exams will be set within thirty (30)days of the date of appointment request,and (ii) prepare.a written report of findings within thirty(30) days of the date of exam or evaluation and provide a copy to the parties within said time fYanre, I I 12-3187nnao EXHIBIT "B" Payment Schedule 1. Missed Appointments • Fee: $503.75 • Code: ML200 Applies when: • Interpreter does not appear for evaluation. • Injured worker leaves before completion of the evaluation. • Cancellation within 6 business days of the scheduled appointment. 2. Comprehensive Medical-Legal Evaluations • Fee: $2,015.00 • Code: ML201 • Applies to the initial evaluation or the first evaluation in an 18-month period. • The evaluation includes review of up to 200 pages of records. • It must involve an examination of the employee. • Review of records in excess of 200 pages is reimbursed at a rate of$3.00 per page. 3. Follow-up Medical-Legal Evaluations • Fee: $1,316.25 • Code: ML202 • Applies to any subsequent comprehensive evaluation within 18 months of the initial evaluation. • This fee includes review of up to 200 pages of records that were not reviewed as part of the initial evaluation. • Review of records in excess of 200 pages (records not reviewed at initial evaluation) reimbursed at a rate of$3.00 per page. 4. Supplemental Medical-Legal Evaluations • Fee: $650.00 • Code:M203 • Does not involve an examination of the patient. • Results in preparation of a narrative medical report. • Review of records in excess of 50 pages reimbursed at a rate of$3.00 per page. • Fees for a supplemental report are not allowed if: o Records reviewed were provided to the physician for review before the initial or follow-up evaluations. o Supplemental report addresses an issue the parties asked the physician to address in a prior med-legal evaluation. 12-3187n5880 1 5. Medical-Legal Testimony • Fee: $455.00 per hour(or physician's usual and customary fee, if lower) • Code: ML204 • Physician is entitled to bill a minimum of 2 hours for deposition. • If the deposition is canceled within fewer than 8 calendar days prior notice, physician is entitled to bill 1 hour of time. 6. Medical-Legal Review of Sub Rosa Evidence • Fee: $325.00 per hour(or physician's usual and customary fee, if lower) • Code: ML205 • No minimum time allotment. • Physician must capture time spent reviewing evidence to the nearest quarter-hour, verified under penalty of perjury. • The fee does not include production of a medical-legal report. The fee for time spent reviewing the recording will be included in the billing for the initial, follow-up or supplemental medical- report. 7. Court-Ordered Evaluations • When a medical-legal evaluation is ordered by a Workers' Compensation Judge,the Judge has authority and discretion to apply the appropriate modifier to that evaluation. 8. The parties agree that the City is not obligated to pay compensation to the PHYSICIAN except for agreed upon medical services and care. Failure of PHYSICIAN to provide a written medical report within 30 days of the date of the exam subjects PHYSICIAN to non- payment for services rendered. 9. PHYSICIAN billing shall conform to the requirements listed in section 9795 of Title 8 of the California Code of Regulations. Charges for services rendered will be reviewed in accordance with section 9795 to determine appropriate level of service. 10. City shall pay PHYSICIAN within forty-five (45) days following receipt from PHYSICIAN of invoices for services rendered and for which payment has not previously been made, provided that PHYSICIAN shall submit all invoices within ninety (90) days after the date of service. 12-3187/75880 2 AID OMIC OPHTHALMIC MUTUAL INSURANCE COMPANY A Fisk R&Wnfon Gmup CERTIFICATE OF PROFESSIONAL LIABILITY INSURANCE Certificate Issued to: David Abraham Sami, MD 392 South Glassell Street Suite 100& 101 Orange,CA 92866 Name and Address of Insured: David Abraham Sami, MD 392 South Glassell Street Suite 100& 101 APPROVED AS TO FORM Orange,CA 92866 By:—� MICHAEL E. GATES Policy Number: OMC0013401 CITY ATTORNEY Retroactive Date: 01/01/2016 CITY OF HUNTINGTON BEACH Policy Period: 01/0 1/2021 to 01/01/2022 Class: Surgery Class 3 l nsu red'Type: Ophthalmologist Primary Limits of Liability: ® Separate ❑ Shared $1,000,000 each Claim $3,000,000 aggregate Coverage is issued on a claims-made and reported basis. This Certificate of Insurance is issued as a matter of information only and confers no rights upon the holder. By its issuance, OMIC does not modify or extend the provisions of its policy and does not waive any of its rights thereunder. In the event this coverage is terminated, OMIC will attempt to give written notice to the party listed above to whom this Certificate is issued,but failure to give notice will impose no obligation upon OMIC. Notice of termination will 4 given to the Insured as provided in the policy. Certificate Issued by: Ophthalmic Mutual Insurance Company Date: 12/14r20_11 655 Beach Street San San Francisco CA 94109-1336 Authurited Representatike