contract

TUCSON HOSPITALS MEDICAL EDUCATION PROGRAM

RESIDENT AGREEMENT

Tucson Hospitals Medical Education Program, Inc. (THMEP) offers, and

«FirstName» «LastName», «JobTitle» hereby accepts appointment as a first year transitional resident.

I THMEP Agrees:

1. To commence the period of appointment on July 1, 2007 and terminate it on

June 30, 2008.

2. To provide a stipend of $42,700 per annum.

3. To provide financial and educational benefits as described in the attachment to this

agreement (Attachment #1).

4. To provide professional liability insurance of at least $1,000,000 single limits per

occurrence, including "tail coverage".

5. To provide a suitable environment for medical education and a training program that

meets the standards of the "Essentials of Accredited Residencies in Graduate Medical

Education" prepared by the Accreditation Council for Graduate Medical Education.

6. To provide goals and objectives for the residency program and a description of

residents' responsibilities.

7. That the term of the residency appointment is for one year, renewable annually where applicable. Progression to the next year will be determined by satisfactory performance and compliance with program policies and resident responsibilities.

8. To provide a statement of policies for duty hours, sickness or injury, parental leave, vacations and the effects of leave of absence, for any reason, on satisfying the criteria for completion of a residency program, as attached to this agreement. (Attachment #2)

9. To provide a statement of practice privileges in other activities outside the educational program ("moonlighting") as attached to this agreement. (Attachment #3)

10. To guarantee a grievance and due process procedure as attached to this agreement. (Attachment #4)

11. To provide a policy on physician impairment and substance abuse (Attachment #5), and counseling (Attachment #8).

12. To provide policies and procedures on sexual harassment (Attachment #6) and on residency closure or reduction in size (Attachment #7).

1. To perform satisfactorily and to the best of his/her ability, the customary responsibilities of a Resident.

2. To participate in safe, effective and compassionate patient care under supervision from the teaching staff.

3. To participate fully in the educational activities of the program and, as required, assume responsibility for teaching other residents and/or medical students.

4. To develop a personal program of self study and professional growth with guidance from the teaching staff.

5. To adhere to established practices, procedures and policies of the participating institutions.

6. To participate in program committees and activities, especially those that relate to patient care review and continuous quality improvement..

9. To complete the rotation evaluation forms and other documents requested at the conclusion of each rotation.

10. To protect oneself and one's patients by consistently and conscientiously observing universal precautions and other infection control measures, including self immunization against hepatitis B.

III The Parties have entered into this Agreement in good faith and acknowledge their respective ethical and legal obligations to fulfill this Agreement until its expiration date, except in the case where the Resident is unable to do so because of incapacitating illness. The Parties further agree that under no circumstances will either Party terminate this Agreement prior to its expiration date without prior notice and without providing the other Party the opportunity to discuss freely any differences, dissatisfactions or grievances that may exist.

1. Health and Accident Insurance: THMEP pays the premium for the resident and one dependent. Maternity benefits are also provided as part of the insurance.

2. Dental Insurance: THMEP pays the entire premium for the resident and his/her immediate family:

5. Professional Liability Insurance, while performing duties that are normally included in the training program. (Includes "tail coverage")

11. Optional Benefits: In addition to these benefits, residents may participate in tax-sheltered annuities, additional life insurance and disability coverage, by payroll deductions.

Living quarters (other than call rooms) and laundry are not provided. Meals are provided when on call.

1. ACGME mandated limits on work hours are strictly enforced, as outlined in the THMEP manual (online and provided to each resident). Each resident is expected to comply with these mandated limits.

Residents will be “off-duty” at times other than regular hours and assigned call.

THMEP holidays are Christmas, New Year’s Day, Memorial Day, July 4, Labor Day and Thanksgiving. The procedure for these days is as follows:

Residents are given a total of four weeks paid vacation each year within the following limitation:

NOTE: You must schedule seven days of vacation at one time to include a Saturday and Sunday. A maximum of 14 days may be taken providing it is the last seven day of one service and the first seven days of the following service.

Special absences may be arranged for by permission of the Program Director. This pertains to time necessary for National Boards, sickness in the family, and other important matters. During such absences, the remainder of the staff will keep the house covered by rearrangement of the schedule by the resident.

Vacation time may be used for maternity/paternity leave. Thereafter further time off is permissible but without pay. A complication of pregnancy or the post-partum period resulting in longer absence from the program will be regarded as a “sickness” under our disability program.

There is no specific number of days of allowed “sick leave”. See effect of prolonged sickness on program length below.

More than four weeks of total time away from the residency in any one year (regardless of cause) may require extension of the training program to allow the program director to certify “satisfactory completion” of one year of graduate training. This can only be decided on an individual basis and hard and fast rules cannot be made for this eventuality.

POLICY FOR PRACTICE PRIVILEGES IN ACTIVITIES OUTSIDE THE EDUCATIONAL PROGRAM (“MOONLIGHTING”)

Participation in graduate medical education is considered a full-time commitment. Thus, in general “moonlighting” is discouraged and certainly where it may interfere with the performance of your assigned patient care responsibilities and educational exercises. Should you decide to moonlight outside the THMEP educational program the following policies apply:

1. Permission must be obtained for the specific activity from the residency Program Director. He has the prerogative to deny the request.

2. The number of hours spent on moonlighting activities must be reported monthly to the Program Director.

3. The total number of hours permitted for both the residency and moonlighting combined may not exceed 80 hours per week averaged over a four week period.

4. THMEP will not provide medical liability insurance for any moonlighting activities.

5. You must have a regular Arizona medical license to participate in such moonlighting.

Disciplinary action as a result of unsatisfactory performance or misconduct may be taken by the Program Director. Unsatisfactory performance includes, but is not limited to such activities as refusal to complete medical records, interpersonal relationships that interfere with patient care, persistent tardiness and violation of THMEP'S rules and regulations. Misconduct includes but is not limited to such activities as falsifying medical records, sexual harassment and activities that endanger patient welfare. The initial determination of unsatisfactory performance or misconduct by a resident shall be left to the sole discretion of the Program Director.

Disciplinary action includes but is not limited to probation, suspension, or termination, written notice of which shall be provided to the resident, setting forth the specific grounds for the disciplinary action being taken. At the time such written notice is given to the resident, reference will also be made to the procedural rights of the resident as embodied in this document.

a) Probation continues for a period of two months or until completion of the program, whichever period of time is shorter.

b) At the expiration of the probationary period, performance is evaluated by the Program Director to determine:

b) Upon suspension of a resident, the Program Director will initiate a complete investigation of the circumstances surrounding the suspension. The Program Director will then determine whether the resident should be:

Prior to termination the Program Director will provide the resident with written notice of intent to terminate and the opportunity to refute the allegations of unsatisfactory performance or misconduct. The notice shall include a specific date, time and place to meet personally with the Program Director and shall set forth the particular and specific claims alleged against the resident.

Whenever possible, written notice of intent not to renew a resident’s agreement of employment will be provided within four months prior to the end of the current agreement of employment. If circumstances do not allow for notification of non-renewal within this period, written notice will be provided as soon as circumstances reasonable allow.

Note: Disciplinary Actions become a part of the resident's permanent record, unless removed by the Program Director or by action under the "Informal Review" or the "Appeal Procedure".

1. Any disciplinary action that is imposed may be informally reviewed by written request to the Program Director within seven (7) days of the date of notification of the action.

2. The resident and the Program Director will attempt to resolve the matter to their mutual satisfaction within three (3) days of receipt of the appeal.

3. If the matter cannot be resolved to their mutual satisfaction, the Program Director will call an informal hearing to make a recommendation to the Program Director. The hearing panel, to be selected by mutual agreement of the Program Director and the resident, will consist of two residents and three members of the THMEP teaching staff, one of whom will act as the Chairman of this panel. Both the Program Director and the disciplined resident will be in attendance at this hearing. The panel will make a recommendation in writing to the Program Director at the conclusion of the hearing.

1. Within seven (7) days of the date of notification of the Program Director's Informal Review decision, the resident may request a review of the decision before a Grievance Committee by written notice. The notice must set forth the basis of this request.

a) The Chairman, who will be a member of the THMEP teaching staff, selected by mutual agreement between the resident and the Program Director.

b) One resident and one THMEP teaching staff member selected by the resident and

c) One resident and one THMEP teaching staff member selected by the Program Director.

3. Both the Program Director and the resident may challenge members of this Grievance Committee based on demonstrable bias or prejudice.

4. The Grievance Committee will meet within seven (7) days of receipt of the resident's written request, unless this time period is extended by mutual agreement between the resident and the Program Director.

5. Both the resident and the Program Director may attend the Grievance Committee hearing with one representative or attorney each, to advise them only. Representatives and attorneys shall not participate in any proceedings before the committee. The resident and the Program Director may request the attendance of witnesses, ask questions of any witness, and present any reliable evidence for consideration by the committee.

6. The Grievance Committee will render its decision in writing within three (3) days of completion of the hearing and communicate this decision to both the resident and the Program Director.

1. Within three (3) days of receipt of this decision, the resident may appeal the Grievance Committee's decision to the Board of Directors of THMEP.

2. The Board of Directors will meet within seven (7) days of receipt of the resident's written appeal unless this time period is extended by mutual agreement between the resident and the President of the Board of Directors.

3. Both the resident and the Program Director may attend the appeal hearing before the Board of Directors with one representative or attorney each, to advise them only. The resident and the Program Director may present any reliable evidence for consideration by the Board.

4. The Board of Directors will render its decision in writing within three (3) days of completion of the appeal hearing and this decision shall be final.

1. If a resident has a grievance of whatever nature, this should be discussed informally with the Program Director.

2. If such informal discussion does not resolve the residents' grievance, the protocol described under C - 2 through 6 and D above may be followed.

Attachment #5

TUCSON HOSPITALS MEDICAL EDUCATION PROGRAM

OVERVIEW..................................................................................................... 3

PHILOSOPHY................................................................................................. 3

GENERAL INFORMATION

Confidentiality/Records........................................................................ 3

OVERVIEW

The objective of the Resident Support and Impaired Resident (RS/IR) program is to retain valued residents who have problems that affect their job performance. These programs have been developed to assist residents in coping with stressful clinical or personal situations.

THMEP recognizes that most problems can be successfully corrected when they are identified in the early stages and referral is made to an appropriate level of care. This applies if the problem is one of physical or mental illness, emotional stress, financial, marital or family distress, alcohol or drug, events triggered by adverse clinical outcomes, malpractice events, or professional relationships. Unless the situation endangers a patient, visitor, or family member, residents may voluntarily access these programs. Otherwise, participation will result from a non-voluntary referral. All communications are confidential.

GENERAL INFORMATION

Confidentiality/Records

All records are the property of the THMEP RS/IR Program. All records will be kept strictly confidential to the extent provided for by statute or regulation, and will not be noted in any official THMEP record. Information may only be released with the written permission of the resident in accordance with state or federal regulation, or in response to a court order. Records will be kept for a period of five years.

Eligibility

The RS/IR Program is available to all THMEP residents. Residents may contact Optum Care24 at 1-888-887-4114 for an appointment or referral.

Residency Program Director

The residency Program Director is responsible for documenting resident performance and conduct, and when needed, to take appropriate action for correction, as provided by this program. The Program Director will not attempt to diagnose the medical or behavioral problem that is causing the inappropriate behavior, but will facilitate the formal or informal referral to assist the resident at the residency program’s expense. The residency Program Director will facilitate the referral of a resident to the RS/IR Program before, during, or after a disciplinary step.

SERVICES

Management Consultation

The residency Program Director may initiate the Employee Assistance Program (EAP) and request a confidential consultation concerning a resident. The Employee Assistance Program may also provide support/counseling to the Program Director regarding critical incident stress management, communication skills, conflict resolution, grief and change transition, and other issues.

RESIDENT SUPPORT SYSTEM

Residents may contact THMEP to obtain a referral or schedule an appointment to meet with a counselor for an initial assessment or evaluation of need through the EAP @Optum Care24. Counseling services are available at no charge to residents. The EAP referral services include individual, couple or family counseling, alcohol and drug abuse evaluation and rehabilitation referral, and referral for other addictions such as gambling, sex, work, etc. Other services include: financial counseling, legal service, divorce counseling and support groups, parenting information healthcare burnout information, caregiver concerns and resources for the elderly, grief and loss counseling, and care for the caregiver

Critical Incident Stress Management Debriefing

In the event of a critical incident involving a THMEP resident and a participating institution, any staff member of physician may request a debriefing, counseling and support through the EAP. All personnel directly involved are invited to participate. Debriefings are conducted by the critical incident stress management team. Individual debriefings are also available.

Behavioral Issues Counseling

In a situation where the behavior or action of a resident jeopardizes the care of a patient or creates conflict with staff, the resident may be referred to the Employee Assistance Program for services such as conflict resolution, mediation, assessment, and short term counseling. Residents may elect to utilize counseling through THMEP, or arrange for their own private follow-up. Disciplinary processes will be in accordance with THMEP “Disciplinary Action and Appeals” policy and/or the Bylaws of a hospital’s Professional Staff.

Impaired Resident System

This has been developed for the purpose of protecting patients from a resident who may be guilty of unprofessional conduct, or otherwise unable to safely engage in the practice of medicine. The program is conducted in collaboration with the Arizona Medical Board (BOMEX), and in accordance with Arizona State Statute ARS Article 3, 32-1451.

Self-Referral

Self-referral is encouraged and is consistent with the policies of BOMEX. All referrals are confidential except reporting as required by ARS 32-1451. A self-referral occurs when a resident contacts the residency Program Director or other members of the THMEP administration directly. A self-referral is recorded in the resident’s file, but information may not be released except as provided by the Bylaws of the Professional Staff of the involved institution.

Non-Voluntary Referral

Non-voluntary referrals are made when the resident is found to be in violation of THMEP or institutional conduct guidelines such as: prohibiting practice while under the influence of alcohol or illegal drugs, or the use, possession, sale, purchase, transfer, or negotiation for sale of drugs on institution property or the institution’s Bylaws of the Professional Staff. Referrals may result from alcohol or drug testing programs or law enforcement programs. BOMEX reporting will occur in such cases, and in accordance with ARS statute 32-1451. Referrals may also result from the resident acting in violation of any hospital policy, rule, regulation, or standard of performance that, in the option of the hospital medical staff leadership, or Professional Staff Office leadership, might endanger the safety or well-being of a patient or those involved in the care of the patient. Referred residents will be entered into the Impaired Resident System for tracking purposes, in accordance with BOMEX regulations. The resident will be required to agree to the terms requested including reporting of treatment progress and random alcohol and drug testing. Should a resident refuse to agree to the terms, fail to successfully complete the program, or violate the terms of the agreement, then termination of employment and privileges or other disciplinary action may be implemented BOMEX and/or other appropriate licensing agencies will be notified. All referrals are recorded in the resident’s file.

When a resident voluntarily enrolls in or is referred to the Impaired Resident System, the resident will be required to meet certain conditions in order to continue privileges/employment with THMEP. Referrals may result for reasons including, but not limited to a violation of any THMEP or hospital policy, rule, regulation or standard of performance or conduct, that could, at the discretion of the THMEP or hospital medical staff leadership, endanger the safety or well being of a patient, colleague, or member of the staff.

Residents entering into the Impaired Resident System must agree to the following:

1. Voluntarily report to BOMEX or appropriate licensing agency and fully comply with all recommendations.

2. Entry into BOMEX or licensing agency approved program (family/significant other participation is strongly recommended).

3. Completion of a consent for release of information from the treatment facility to Impaired Resident System as appropriate

4. 12 Step Group Meeting participation (Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous as indicated) as recommended by treatment facility or as follows:

(a) Daily meetings for first 90 days; a minimum of 3 weekly (or more as recommended by the group therapist; and at least two weekly meetings for the remainder of the period (at least five years).

(b) Verification of meeting attendance by meeting leader to be returned to THMEP and/or Hospital Professional Staff office.

(d) If the resident has a relapse, the meeting schedule starts over at the time of the relapse.

6. Random urinalysis and/or breathalyzer for ____ years (at least five) for drug screen.

7. Regular contact/meetings with THMEP and/or Professional Staff office or designee with frequency of meetings to be determined by the hospital medical director.

8. This contract remains in effect for ____ years (at least five) for drug screen.

9. This contract remains in effect for ____years (at least five) from date signed.

Note: Compliance with all of the above listed conditions has been shown to substantially enhance a resident’s chance for a successful recovery.

I understand that failure to comply with the above conditions or a positive drug screen will result in immediate termination of privileges/employment.

_________________________________ _________________________ Witness Resident Signature

will not be tolerated from employees, patients, visitors, physicians, volunteers,

Sexual harassment includes any insinuation, by anyone, either explicitly or implicitly that an employee’s submission to sexual advances or refusal to do so will affect the employee’s employment status, evaluation, advancement, assigned duties, wages, benefits, or any other condition of employment. Sexual harassment also includes unwelcome sexual flirtations, touching, advances, propositions, verbal abuse of a sexual nature, suggestive or degrading comments about an individual’s dress or body or the display of sexually suggestive objects or pictures in the workplace, whether engaged in by leaders, employees, or others doing business with the hospitals. Prompt corrective action will be taken by appropriate supervisory personnel whenever they become aware of the sexual harassment in the workplace.

Any individual who believes that he or she has been the victim of sexual harassment should report such activity to his or her supervisor or Program Director. Alternatively, the grievance procedure may be used by any employee to process a complaint of sexual harassment. Reports of sexual harassment will be kept confidential and anonymous, except to the extent that some disclosure may be necessary for purposes of investigation or corrective action. Retaliation against anyone making a complaint of sexual harassment is strictly prohibited.

At any time, should THMEP decide to close the residency program, currently enrolled residents would be permitted to complete their residency if desired; if the resident elects to transfer to another program every effort will be made by THMEP to assist the residents in that endeavor.

Please note – the language is required by the Accreditation Council for Graduate Medical Education (ACGME), and should not be construed to suggest any plans for closure of this program.

In addition to our policies for managing any problems under the current “physician impairment” protocol (addendum #5), confidential counseling is readily available in the following manner:

a) Discussion with the residency program director or the executive director of THMEP at the resident’s discretion or

b) Selection of a psychiatrist or counselor on a confidential basis without prior discussion with either of the above mentioned directors.

The directors have appropriate psychiatrists and/or psychological counselors available and their professional fees are covered by THMEP’S medical insurance program.