HomeMy WebLinkAboutJonathan Macy, MD - 2021-04-01 PROFESSONAL SERVICES CONTRACT HETWEEN
THE CITY OF I1UNT1NGTON BEACII AND
in a G —
FOR
INDH.PENDF..NTMEDICALEVALUATIONS WITH
RESPECT TO WORKERS' COMPENSATION CLAIMS
THIS AGREEMFiN"I ("Agreement") is made and entered into by and between the City of
Huntington Beach, a municipal corporation of the State of Californin, bereinnfter referred to as
"CITY", and JorfAJT)pro M iRC IndlVi(h1al, hcrcin(1Rer referred to ns"PI IYSIC[AN."
WHRREAS, CITY desires to engage the services of a physicilu, to provide independent
nxdical evahlations will, respect to workers' compels tion claims; and
Pursunnl to documentation oil file in the office of the City Clerk, (be provisions of the
luntington Beach Municipal Cole, Chapter 3.03, relating to procurement of professional service
contl'aets Ililvc been COinplied with; and
PHYSICIAN has been selected to perform said services,
NOW,THEREFORE, it is agreed by CITY and PHYSICIAN as follows:
1. S(0111 QF SL'•RVICF..S
PHYSICIAN shall provide all services ns described in Exhibit "A," which is
attached hereto and incorporated into this Agreement by this reference. These services shall
sometimes bercinnftcr be referred to as the "PROJECT."
PHYSICIAN hereby designates__ 5EL F _ _ who shall represent it
and be its sole Contact and agent in all consultations with CITY (luring the perfornnnncc of this
Agreement.
APPROVED AS TO FORM/!DCIEP.I((t�
eY
IICHAEL E.GATES
CITY ATTORNEY ;
CITY OF HUNTINGTON BEACH
17.-3187/IME Slnndard Conlracl - Revised 1
2. CITY S'fA_Fi' ASSISTANCE
CITY shall assign a staff coordinator to work directly with PHYSICIAN in the
peri'onnancc of this Agreement.
3. TIME 01; PERFORMANCE
Time is of the essence of this Agreement. Tile services of PHYSICIAN are to
commence on _Apra 1_�_,.2��_ (tile ,Conuncllocmeat Dade"). This Agreement shall
automatically renew lilt ce (3) yenrs from the Conunencentent Date,, unless terminated as provided
herein. The lime for performaulce of the(asks identified in Exhibit"A" are generally to he shown
in J,,xhibil "A." This schcduic may he amended to benefit the PROJECT if mutually agreed to in
writing by CITY and PHYSICIAN.
In (Ile event the Commenccutent I)ate 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 111lYSICIAN, on it time and materials basis at the rates specified in Exhibit "B," attached
hctcto and incorporated by reference into this Agreement, n fee, including all costs and expenses,
not to excced'hventy-nine Thousand Nine-Hundred Dollars($29,900,00).
5. EN'11LA WORK
In the event CITY requires additional services not included in Exhibit "A", or'
changes in the Scope of services described in Exhibit"A," PIYSICIAN 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,
12-7187/11AB Standard Contract - Revised 2
6. MFTI{OD OF PAYMENT
PIYSICIAN shall be paid pursuant to the terms of xhibit "U "
7. DISPOSITION OF l'L.ANS L'STlMATGS AND OTIIIiR DOCUMENTS
PJiYSICIAN agrees that title to all materials prepared bereurider, including,but not i
lil•.liled to: all original drawings, designs, reports, both field mud office notices, calculations,
colliplrter 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 Agicerirent or upon PROJECT completion, whichever shall occur first. These materials may
be used by CITY As it secs lit.
g, HOI,1) IIAR.YILESS
PHYSICIAN hereby agrees to protect,defend, indeulnify And hold harmless CITY,
its officers, elected or appointed officials, eurployees, agents And volunteers from Arid against Any
And all claims,damages,losses,expcnses,judguicnl m s,demands and defense costs(including without
liulitation, costs and fees of litigation of every nature or liability of ally kind ur satire) Arising out
of or in coluleclinn with PHYSICIAN's (or PHYSICIAN'S subcontractors, if Any) negligent (or
alleged negligent) pc!fmntAlice of this Agrcenient or its failure to comply with Ally of its obligations
contained in this Agrcerileut by PHYSICIAN, its officers, agents o,emPloyccs except such loss or
damage which was caused by the sole negligence or willful misconduct ofCITY. PI IYSICIAN will
conduct till defense At its sole cost And expense and CITY shall approve selection of PHYSICIAN's
couuscl. This indenmity shall Apply to All claims and liability regmrdless of whether Ally insurance
policiesareapplicable. The pol icy Iinlitsdonotactnsl imitation upoll tile,amomll of'indemnification
to be provided by PHYSICIAN.
12a I8'UIMB Standard Contract - Revised 3
9, Nl(01.1 SSIONAL LIABILITY INSRANCG
PHYSICIAN still][ obtain and furnish to CITY a professional liability insurance
policy covering the work performed by it hereunder. 'Phis policy sliall provide coverage for
PHYSICIAN's professional liability in an amount not less than One Million Dollars
($I,000,000.001, per occurrence mul tit the aggregate. The above-mentioned insurance shall not
contain a self-insured retention without the express written consentoPCITY;however nn insurance
policy "deductible" of Tell Thousand Dollars ($10,000.00) or less is permiucd. A claims-made
policy shall be acceptable if the policy blither provides that:
A. The policy retroactive dale coincides with or precedes the initialion of the
scope of work (including subsequent policies purchased as renewals or
iepincements).
13. PHYSICIAN shall notify CITY of cileumstamces or incidents that might
Live rise to future claims,
PHYSICIAN will make every effort to maintain similar insurance during the
required extended period of cuvcrtlge fallowing P] OC)I CT completion, If insurance is terminated
for ally reason,PI IYSICIAN agrees to purchase an extended reporting provision of al least two (2)
years to report claims arising from work performed in cnunection with (his Agreement.
If PHYSICIAN fails or refuses to produce or maintain the insurance required by
Ihis section or fails or refuses to furnish the CffY with required proof lhal insurance has been
procured and is in force and paid -'or, the Cfl'Y shall have the right, at the CITY's election, to
forthwith terminate this Agreement. Such termination shall not affect 11HYSICIAN's right to be
paid for its lime and materials expended prior to nolilienlion of terminalian. PHYSICIAN wnivcs
12.3187/1MC Sta ldard Contract - Revised 4
the righi to receive conipensntion and agrees to indeinnify the CITY for any work performed Prior
to approval of insurance by the CITY.
10. CLR'I'6'lCA"1RS OF INSURANCA
Prior to commencing performance of the work Hereunder, PHYSICIAN shall
furnish to CITY certificates of insurance subject to approval of the City Attorney evidetlekt; the
foregoing insurance coverage:as raluirml by this Agrncuicnt; the certificate shall:
A. provide the name and Policy number of each carrier and policy;
B. state that the Policy is currently in force; and
C. promise that such policy shall not be suspended, voided of canceled by
either party, reduced in coverage or in limits except after (billy (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 currying the foregoing insurance coverage shall not dcrogalc
from PHYSICIAN's defense, hold harmless and iudenulilicalion obligations as set forth in this
Agreement. CITY or its representative shall at all times have Ihu right to demand the original or a
copy of the policy of insurance. PHYSICIAN shall pay, in a prompt and tiniely manner, (lie
prcmiuuts on the insurance hcrcinabove required.
I I. INAEPE:N1)P.NT comri AC PIER
PHYSICIAN is, and sliall be, acting at all limes in the performance of (his
Agreement as an independent contractor herein and not as an cniNoyce of CITY. PI-IYSICIADI
shall semu•e at its own cost and expense, and be responsible for any and all payment of all taxes,
12-31 R7/IMC Standard Connaet - Revised 5
social security, state disability insurance compensation, unenlployulent compensation and other
payroll deductions for PHYSICIAN and its officers, agents and employees Find ill business
licenses: if nny, in connection will) the PROJECT and/or the services to be performed hereunde'.
12. TFTMI TNATION OF AGREEMENI.
All work required hereunder shall be performed in a good Find workmanlike
manner. CITY ,lay terminate PHYSICIAN's services hereunder at any tlllle with 01-wilh011t cause,
and whether or not the PROJECT is filly complete. Any lernlinalion of this Agreement by CITY
shall be made ill writing, notice of wilich shall he delivered to PHYSICIAN as provided licrein.
Ill the event of termination, all finished and unfinished docuulcnts, exhibits, report, and evidence
shall, Fit the option of the CITY, become its properly and shall be promptly delivered to it by
PHYSICIAN.
13. ASS IGNM}.'.N!' AND-DELEGA'1'1UN_
This Agreement is a personal service contract and the work hereunder shall not be
assigned, delegated or subco,uacled by I'IIYSICIAN to any other person or e,lily wilbutlt the
prior express written consent of CITY. If an assil;nnieut, delegation or subconlracl is approved,
all approved assignees, delegates and subcontractors nuts( satisfy the insurance requirements as
set forth in Sections 9 and 10 hereinabove.
14. COPYRICrIrMd`AFBN'1'S
CITY shall own all rights to nny patent or copyright on any work, item or materiul
produced as a result of this Agrceincnt.
1 S. C11'Y h;MPLOYEES AND OhFI_ CIALS
1'1-IYSICIAN shall employ no CITY offieinl nor any regular CITY employee in the
work performed pursumlt to this Agreement. No officer or employee of CITY shall have any
12-31 MIME?Standard Contract-Revised 6
financial interest in this Agreenlcul ill violation of the applicable provisions of the California)
Government Code.
16. NOTICES
Any notices, cc,tificutes, or 011ie"conununications hereunder shall be given either
by personnl delivery to PHYSIC[AN's ngent (as designatecl in Section I hereinabovc)or to CITY
Rs the sILLIatlon Shall Wal'I'llot,Or by cnelosiog the same in a scaled envelope,postage p:•cpnicl, and
depositing the same in tine United States Postal Service, to the addresses specified below. CITY
and PHYSICIAN may designate different addresses to which subsequent notices, certificates or
other coluuulnications will be sent by notifying the other party via personal delivery, a reputable
overnigllt carrier or U.S. certified mail-retrutt receipt requested:
f0 CITY: TO PHYSICIAN:
Jonathan I.Macy,M.0
City of Iiuntinglon Beaell 8635 west Third Street —
Suite 36OW
A'I'IN: Risk Mannger Los Anyolos,CA9oone - —
2000 Main Street
Huntington Beach, CA 92649
17, CONSLNT
R'hcn CITY's cmtsent/approval is rcgtlived under this Agreement, its
consenl/aupr Ova I for Otte transaction or event shall nut be deemed to be a consent/approval to ally
subsequent occurrence of the same or any other transaction or event.
18. MODIFICATION
No waiver or modification of any Innguage in this Agreement shall be valid unless
in wrilil:g are duly executed by both pa rtics.
12-7187AM8 Standard Contract- Revised 7
19. SECTION HGADINGS
The titles, captions, section, paragraph And subject headings, and descriptive
phr.ises at the beginning of the various sections in this Agreement Are merely descriptive and are
inchide<{ solely for conveuicnce of reference only and are not representative of mailers included
or excluded front such provisions, And do not interpret, define, limit of describe, or construe the
intent of the parties or affect file consvildion or interpretation orally provision of this Agreement.
?.(?. INTL RYI ETATIO\ OF TI lk3 A EBEBIVII
The language of All parts of this Agreement shall in all eases be construed as a
whole, according to its fair meaning, find not sit-icily for or against any of the parties. If any
provisiout of this Agreement is held by an arbitrator or court of coolpe;ent jurisdiction to be
unenforceable, void, illegal or invalid, such holding shall not invalidate or affect (lie rcniaiuiug
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 masculitrc or
neuter gender and singular or pluml 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
eonunission of any eel contrary to law, and wherever fhere is tiny conflict between Any provision
contained herein and any present or futuc statute, law, ordinance or regulation contrary to which
the parties have no right to contract, then the Intlot' shall prevail, and the provision of this
Agreement which is hereby affected shall be curtailed and limited only to (lie extent necessary to
bring it within the requireurents of lire law.
21. DUPLICATE ORIGINAL
,file original of this Agreement and one or moro copies hereto!nlVe been prepared
and signed in counterparts as duplicate originals, each of which so exccute(l shall, irrespective of
12-11a7/IMI: standar(l Contract - Revised 8
the date of its execution and delivery, be deenied till urigivai. Each duplicate original shall be
decried an original instrument as against any party who has signed it.
22, IMMIGRATION
PHYSICIAN shall be responsible for fill compliance will, the immigration and
naturalization laws of the United States laid slmll, in particular, comply with the provisions of the
United.Slale.t•Code regarding eniPloynicnt verification.
23. LEGAL SERVI(:ES SU[3CONTIZACI'ING PR
OHlBFrED
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 fiereunder. PIIYSIC[AN understands that pursuant to Hunlinylon
Beach C'ky Charter Section 309, (lie City Attorney is the exclusive legal counsel for CITY and
CITY shall not be liable for payment of any legal sc!•vices expenses incurred by PHYSICIAN.
24. \]'"fOIZNEY'S HHk:S
In the event suit is brought by either party to construe, interpret anti/ar enforce the
terms and/or Provisions of this Agreement o!' to secure the perforulanec hereof, each party shall
bear its own attorucy's fees, such that the prevailing party sliall not be entitled to recover its
altunicy's fees flnni the non-prevailing party.
25. SURVIVAL
Terals 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 luwx of dic
Slate of California.
12-3187/IMH Standard Contract- Revised 9
I
27. SIGNATORIES
i
Eacll undersigned represents and warrants that its signattue herein below has the
power, authority and right to bind their respective parties to each of the terms of this Agreement,
and shall indemnify CI"I'ti' fully for any injuries or damages to CITY in the event (tint such
authority or power•is not, in fact, held by the signatory or is withdrawn.
1111YSICIAN's initials iM
28. ENTIRIi,Ty
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 lick lowlcdgc and
agree that no representations, induceutents,promises,agreements or warranties,oral or otherwise,
have been made by that party a• anyone acting on that parly's behalf, which are not embodied in
this Agrccment, and that that early has not executed ibis Agreement iu reliance on any
representation, inducement, promise, agreement, warranty, fact 01 cn'er1l11slallee not expressly set
forth in this Agreement. This Agreement, and the attached exhibits, contain the entire agr+ocnlenl
between the parties respecting the suhiect matter of this Agreement and supersecle id] prior
understandings and agreements whether oral or in writing between file parties respecting the
subject matter hereof.
29. rrrECTIVL,I�ATL
'Phis Agrccment shall be effective o» the dale of its t+pproval by the City Attorney.
'nis Agreement si;all expire when terminated as provided hereof.
IN WITNLSS WI ILRLOF, the parties herclu have caused this Agruutumit to be exceeded
by and through their authorized officers.
(2.7187AMP"Stnadoll'd Contract - Revised 10
PHYSICIAN
J OrtA7�4AP M� G`'I_ CITY or HurrrmcTON BEACH, a
municipal corporation
of of the State of Califrn7lia
TPPARNT rNKIUAN't NM19
Ui for of Human Resources
APPROVHD AS T FORM:
City ttomey
Receive and Pile)
0'�l, � fGGZIQ�.tJ
City Clerk -7Ilk
12.118711ME Standard Conlnu>t- Rcviscd i
PROF13SSIONAL SERVICES CONTRACT LIETWEEN
THE CITY OF I-1UNT1NG I ON REACH AND
�LQpgthan mar.v
FOR'
INDFPENDP.NTMEDICAI, EVALUATONS. WITH
RESPECTTO WORKERS' COMPENSATION CLAIMS
Table of Contents
IScopc of Services.....................................................................................................1
2 City Staff Assistance................................................................................................'
3 Tintc of Performancc ................................................................................... ............,
4 Compensation ..........................................................................................................2
5 Lxua Work...............................................................................................................2
6 Method of Payment..................................................................................................3
7 Disposition of Plans, Estimates and Other Documents ...........................................3
8 Mold IlarmIcss .........................................................................................................3
9 I'rofessional Liability Insut'ance...............................................................................I
10 Certificates of Insumuce..........................................................................................5
I I lnclepcndent Contractorr............................................................................................5
12 Termination of Agreement.......................................................................................6
13 Assignment ntd Subcontracting..............................................................................6
14 Copyrights/Patents...................................................................................................6
15 City Employees and Oft"acials..................................................................................6
16 Notices .....................................................................................................................7
17 Consew........................................................................................................I............7
18 Modification.............................................................................................................7
19 Section Ileadings .....................................................................................................9
20 Interpretation of this Agreement..............................................................................8
21 Duplicate Original....... ............................................................................................a
22 Immigration..............................................................................................................9
23 Legal Services Subcontracting Prohibited...............................................................9
24 Altorney's Fees.........................................................................................................9
25 Survival....................................................................................................................9
26 Governing Law........................................................................................................9
27 Signatorics.............................................................................................................. 10
28 Entirety.....................................................................................................................10
29 Effective Date..........................................................................................................10
12-3187/75880
F,XHIBIT "A"
STATEMGNT01" WORK:
1) AOI —COFs 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 full duty or
modified.
4) Advise on condition of nulxinnun medical improvement s(alus,
S) I)ctermino nature and extent of pernlanehu disability, including factors of apportionment
and need for fittule medical care.
G) Resolve utilization review disputes.
7) Determine the need for spinal surgery pursuant to LHbur Code section 4062(b).
III1)'SIC!AN shall perform the evaluation in flull accordance with the standards defined by the
Division of Workers' Compensation of the State of California and the AMA Guides to the
Evaluation of Permanent hnpairnlent, Fifth Edition. This requires a report of the injury, prior
status, clinical chronology, current status, and past nhedical history. The physical examination
Will dOemlhCllt al! pertinent positive, negative, and noll-physiological findings. For extremity
injuries, measurements must be documented bilaterally. Additionally, PHYSICIAN agrees to;
(h) provide (hat medical exams will be set within Thirty (30) days of the dale of appointment
rcqucst, 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 flanle.
II
i
I
1 2-1 1 8717S880
EXHIBIT "B"
Payment Schedule
I. Missed Appointments
• Fee: $503.75
• Code: M1.200
AlilVies whem
• Interpreter does not appear for evaluation.
• Injured worker leaves before completion of the evaluation.
• Cancellation within 6 business clays oi'the scheduled appointment.
2. Comprehensive Yledical-Legal Ievaluations
• Fee: $2,015.00
• Code: MI 201
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, hollow-up Medical-Legal Evaluations
Fee: $1,316.25
• Code: M1:202
• 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: i19203
• 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 meet-legal evaluation.
12-3187l75880 I
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 I hour of time.
G. Medical-Legal Review of Sub Rosa Evidence
Fcc: $325.00 per hour (or physician's usual and customary fee, if lower)
• Code: Ml 205
• 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-OzAci-ed Evaluations
• When a medical-legal evaluation is ordered by a Workers' Compensation Judge, tile.
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) clays 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
0 omic
OPHTHALMIC MUTUAL
INSURANCE COMPANY
A Risk Re Wnl m G-WP
CERTIFICATE OF'PROFESSIONAL LIABILITY INSURANCE
Certificate Issued to:
Jonathan I. Macy, MD
8635 West 3rd Street
Suite 360-W
Los Angeles,CA 90048
Name and Address of Insured:
Jonathan I. Macy.MD
8635 West 3rd Street
Suite 360-w
Los Angeles, CA 90048 APPROVED AS TO FOI,
Policy Number: OMC0007597 yr;
Retroactive Date: 07!01/1982 EL E.
Policy Period: 04,01/2021 to04101/2022 /~ CITYATTORNEy
GTy OF;HUPMNMG44 it
Class: Surgery Class 3
Insured Type: Ophthalmologist
Primary Limits of Liability: ® Separate ❑ Shared
S1,000,000 each Claim
S3,000,000 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 O.b1IC. Notice of termination will be given to the insured as provided in the policy.
Certificate Issued by:
Ophthahnic Mutual Insurance Company Date:03/0 5 120 2 1
655 Beach Street
San
San Francisco CA 94109-1336
Authorized Representative