HomeMy WebLinkAboutCONSENT MOA preceptor service 615 Sheridan Street
Port Townsend, WA 98368
aefl son www.JeffersonCountyPublicHealth.org
Consent Agenda
Public Healt
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Josh D. Peters, County Administrator
FROM: Apple Martine, Public Health Director
Denise Banker, Community Health Division Director
DATE: Oc i. 1 1, 2C2
SUBJECT: Agenda item — Memorandum of Agreement with Washington State University
through its College of Nursing; Upon signature - until termination; No monetary
exchange.
STATEMENT OF ISSUE:
Jefferson County Public Health (JCPH), Community Health Division, requests Board approval of the
Memorandum of Agreement with Washington State University (WSU) for preceptor service to advanced
students of medicine in need of practicum course work.
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
Students of WSU will be supervised by JCPH medical providers for a duration agreed upon between
supervisors at WSU and JCPH providers. This cooperative relationship between service institution and
educational intuition is mutually beneficial.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
There is no fiscal impact.
RECOMMENDATION:
JCPH management requests approval of the Memorandum of Agreement between JCPH and WSU for
preceptor service; Upon signature - until termination; No monetary exchange.
REVIEWED BY:
10(4/3•4
Josh . Peters, County Administrator Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always working for a safer and healthier community
N-26-033
CONTRACT REVIEW FORM ( Clear Form I
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Washington State University Contract No: N-26-033
Contract For: Affiliation Agreement- Nursing Term: Upon sig - until terminated
COUNTY DEPARTMENT: Public Health
Contact Person: Denise Banker
Contact Phone: #438
Contact email: dbanker@co.jefferson.wa.us
AMOUNT: N/A PROCESS: Exempt from Bid Process
Revenue: Cooperative Purchase
Expenditure: Competitive Sealed Bid
Matching Funds Required: Small Works Roster
Sources(s) of Matching Funds _ Vendor List Bid
Fund# — RFP or RFQ
Munis Org/Obj Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMPLIANCE WITH JCC 3.55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: ■ N/A:
►°/1 /2o2(
gnature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: t — N/A: L C �. i U / /'Z 02.
Cr
S- nature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche):
Electronically approved by Risk Management on 10/12/2026.
STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 10/7/2026.
DPA Luther reviewed and approved on 10-07-2026.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
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WSU Contract Number CCN005622
MEMORANDUM OF AGREEMENT
BETWEEN
JEFFERSON COUNTY
AND
WSU COLLEGE OF NURSING
This Memorandum of Agreement (this "Agreement") Between Jefferson County Public Health,
615 Sheridan St. Port Townsend, WA. 98368 ("Agency") and Washington State University by
and through its College of Nursing("University').The Agency and the University agree as follows.
WHEREAS, the University, through its School of Nursing requires the use of clinical laboratory
experiences for students in its nursing program, and
WHEREAS, the Public Health Department of the Agency offers clinical laboratory facilities
which meet criteria established by the Board of Nurse Examiners for the State of Washington for
agencies affiliating with nursing education programs, and
WHEREAS, the Agency recognizes that clinical practice under appropriate guidance and
supervision is essential for student development of effective nursing skills,clinical judgment,and
a sense of professional responsibility, and
WHEREAS, it is recognized that a cooperative relationship between a service institution and an
educational institution can be mutually beneficial,
BE IT AGREED that the Agency and the University desire to enter into an agreement whereby
students in the University nursing program shall receive experiences in practicum courses in the
Agency. This Agreement shall be governed by the following conditions:
I. THE UNIVERSITY SHALL:
A. Retain control of, and responsibility for, all phases of the nursing education
program.
B. Cooperate with the Agency in making arrangements for the practicum not less
than six months prior to the start of each academic term. Arrangements shall be
mutually determined by agreement of the parties and may be altered by mutual
agreement.
C. Cooperate with the Agency in planning, scheduling and implementing an
orientation program for faculty responsible for the practicum.
D. Provide an orientation for students to assigned units.
E. Provide the Agency with the following written information two weeks prior to the
start of each practicum:
1. Specific days and hours students will be on patient units or service areas.
Revised 6/4/2020,7/25/22,02/13/23
2. Names of students and responsible faculty.
3. Objectives of the practicum.
4. If requested by Agency in writing, student or University, with written
consent from the student, shall provide documentation of professional
liability insurance for students. Both parties acknowledge that failure or
refusal of a particular student to provide proof of the insurance
requirements, set forth at paragraph I, J (below), may result in the Agency
refusing access to any of its facilities(including digital databases,electronic
mail,etc.)to the particular student until such proof of insurance is provided.
5. State nursing registration number of faculty.
6. Other appropriate information as requested.
F. Provide qualified faculty in a faculty-student ratio of at least 1:10.
G. Plan individualized experiences for students in consultation with appropriate
Agency personnel based on the objectives of the practicum and available learning
opportunities.
H. Inform faculty and students of the Agency requirement that they abide by the
written administrative, nursing and medical policies or procedures of the Agency
while using its facilities. Upon written request by Agency, and within 15 calendar
days of such request, University shall provide written proof, including copies of
any written communications between itself and the its student/faculty members, of
its efforts to inform students/faculty members of the requirements under this
section. Failure to provide such proof may result in Agency denying entry to any
of its facilities(including digital databases,electronic mail, etc.)by each student or
faculty member for which proof has not been provided.
Verify that all faculty and students who may be at risk for occupational exposure
to blood or other potentially infectious materials be:
1. Trained in accordance with the Occupational Safety and Health
Administration's(OSHA) Occupational Exposure to Blood borne
Pathogens Final Rule 29 CFR Part 1910.1030, as published in the
Federal Register Friday, December 6, 1991.
2. Trained in the modes of transmission, epidemiology and symptoms of
Hepatitis B virus(HBV)and Human Immunodeficiency(HIV) and
other blood borne pathogens.
3. Trained in the methods of control that prevent or reduce exposure
including universal precautions,appropriate engineering controls,
work practices, and personal protective equipment.
4. Provided information on the Hepatitis B vaccine,its efficacy,safety,
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method of administration, and benefits of being vaccinated.
5. Vaccinated for HBV or have begun the vaccination series for HBV or
have signed a refusal to acquire HBV vaccination.
J. Upon written request by Agency, and within 15 days of receipt of such request,
University shall provide written proof of its verification regarding the training
requirements set forth herein for each student and faculty member who may be at
risk for occupational exposure to blood or other potentially infectious diseases.
Failure to provide such proof shall result in the Agency denying access to its
facilities(including digital databases, electronic mail, etc.)by each student or
faculty member for which proof has not been provided. Inform students of the
Agency requirement that students obtain and maintain appropriate general and
professional liability insurance coverage in the amounts of at least$1,000,000 per
occurrence and$3,000,000 in the aggregate, with insurance carriers or self-
insurance programs approved by Agency, in accordance with Agency's bylaws,
rules and regulations. A copy of the certificate of insurance shall be provided to
the Agency(in which the Certificate Holder is identified as"Jefferson County).
Upon written request of Agency, and with 15 days of receipt of such request,
University shall provide written proof of its efforts to inform students that they
obtain and maintain the insurance policies set forth herein. Failure to provide the
requested proof may result in Agency denying access to any of its facilities
(including digital databases, electronic mail, etc.)by each student for which proof
has not been provided.
K. University and its officers, employees, and agents, while acting in good faith and
within the scope of their official duties, are covered by the State of Washington
Self-Insurance Liability Program(RCW 4.92.130) and the Tort Claims Act(RCW
4.92.060 et seq.) and successful claims against University and its employees,
officers, and agents in the performance of their official University duties in good
faith under this Agreement will be paid from the tort claims liability account as
provided in RCW 4.92.130. See Addendum A.Upon written request from Agency,
University shall provide a certificate of insurance evidencing such coverage.
H. THE AGENCY SHALL:
A. Retain full responsibility for patient care and for control of established standards
of patient care.
B. At least six months prior to each academic term,provide the University with the
maximum number of students (from all educational programs) that can be
assigned to each patient unit and service area during each eight-hour assignment
period.
C. Provide an orientation for faculty assigned to the Agency prior to the practicum
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subject to conditions in Article I. Section C.
D. Assist the University faculty in orientation of students to the Agency at a mutually
agreed upon time.
E. Provide,within Agency limitations, conference rooms and lockers requested.
F. Provide any special clothing required for participation in learning activities in
selected patient units and service areas of departments of the Agency.
G. Reserve the right and authority to request the withdrawal of any faculty or student
who does not adhere to appropriate dress code, behavior standards, administrative
and medical policies, does not maintain professional liability insurance; or cannot
provide safe care due to physical or mental illness.
H. Permit University faculty to conduct nursing research in accordance with
established policies and research protocols of the Agency with prior written
approval.
I. Comply with all applicable federal and state health and safety laws and
regulations.
J. Prohibit the disclosure of personally identifiable information, as defined by the
Family Educational Rights and Privacy Act, of a student without the prior consent
of the student, and to limit Agency's use of such information only for the purpose
for which it obtained such information.
K. Require and provide an orientation to the faculty and students before direct patient
contact is allowed. Orientation by the Agency shall include information regarding:
1. The Agency's Exposure Control Plan for blood borne pathogens and the
means by which students and faculty can obtain a copy of the written plan.
2. The engineering controls used within the Agency's work site.
3. The personal protective equipment available in each of the Agency's work
areas.
4. The identification of tasks and patient-related activities which increase the
risk of exposure to HBV, HIV, and other blood borne pathogens.
5. What constitutes an exposure.
6. The established procedure to follow after an exposure to blood or body
fluids occurs including the methods of reporting the incident and the
medical follow-up required.
L. Provide appropriate and readily accessible personal protective equipment at no
cost to faculty and students to use in the work site during the clinical training
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program.
M. Maintain coverage in the amounts of at least$1,000,000 per occurrence and
$3,000,000 in the aggregate,with its membership in the Washington Counties Risk
Pool. A copy of the certificate of membership in the risk pool shall be provided to
the University.
III. IT IS MUTUALLY AGREED THAT:
A. Indemnification. The University shall indemnify and hold the Agency,its officers,
officials, employees, agents and volunteers (and their marital communities)
harmless from any claims, injuries, damages, losses or suits, arising out of or
resulting from the negligent acts,errors or omissions of the University, its officers,
employees, agents and registered volunteers, acting in good faith and within the
scope of their official duties in performance of this Agreement, except for injuries
and damages caused by the negligence of the Agency. Agency agrees to indemnify
and hold harmless University against any and all liability for personal injury,
including injury resulting in death, or damage to property, or both, resulting from
the negligent acts and/or omissions of its employees. Should a court of competent
jurisdiction determine this Agreement is subject to RCW
4.24.115 if liability for damages occurs arising out of bodily injury to persons or
damages to property caused by or resulting from the concurrent negligence of the
Agency and the University,its officers,officials, employees, agents and volunteers
(and their marital communities) the University's liability shall be only for the
University's negligence. This section shall survive the expiration or termination of
this Agreement.
Public Records. To the extent any record, including any electronic, audio,paper or
other media,is required to be kept or indexed as a public record in accordance with
the Washington Public Records Act, Chapter 42.56 RCW, as may hereafter be
amended, the University agrees to maintain all records constituting public records
and to produce or assist the Agency in producing such records, within the time
frames and parameters set forth in state law. The University further agrees that upon
receipt of any written public record request, University shall, within two business
days,notify the Agency by providing a copy of the request per the notice provisions
of this Agreement;
B. Disputes. The parties agree to use their best efforts to prevent and resolve disputes
before they escalate into claims or legal actions. Any disputed issue not resolved
pursuant to the terms of this Agreement shall be submitted in writing within 10
days to the University Risk Manager and Agency Risk Manager,whose decision in
the matter shall be final,but shall be subject to judicial review.If either party deems
it necessary to institute legal action or proceeding to enforce any right or obligation
under this Agreement, each party in such action shall bear the cost of its own
attorney's fees and court costs. Any legal action shall be initiated in the Superior
Court of the State of Washington for Jefferson County. The parties agree that all
questions shall be resolved by application of Washington law and that the parties
have the right of appeal from such decisions of the Superior Court in accordance
with the laws of the State of Washington. The University hereby consents to the
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personal jurisdiction of the Superior Court of the State of Washington for Jefferson
County.
IV. DURATION OF THIS AGREEMENT,TERM,MODIFICATION:
A. This Agreement is effective as of the date last signed below.
B. This Agreement shall remain in effect until terminated. Either party may
terminate this Agreement,with or without cause,by written notice to the other
party at least sixty(60) days prior to the commencement of the next academic
term. Students enrolled in the practicum at the time notice is given shall have the
opportunity to complete the course of study in progress.
C. The parties to this Agreement may amend this Agreement as deemed necessary
provided,however,that no amendment to this Agreement shall be valid unless in
writing and signed by the duly authorized representatives of the parties.
D. All the terms, conditions and provisions agreed upon by the parties to this
Agreement are incorporated in this document.
(SIGNATURES FOLLOW ON THE NEXT PAGE)
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SIGNATURE PAGE
JEFFERSON COUNTY WASHINGTON [OTHER PARTY HERE]
Board of County Commissioners
Jefferson County, 615 Sheridan St. Port Townsend,
Washington 98368 }
By: Ais-f,--- NA4-, .-
gnature
By:
Greg Brotherton, Chair Date
Name: Heather Davison
SEAL:
Title: Senior Contract Manager, PACS_
Date: 10/5/2026
ATTEST:
Carolyn Gallaway, Date
Clerk of the Board
Approved as to form only:
OAF
.a, 10-07-2026
Jeremiah B. Luther, WSBA 61918 Date
Civil Deputy Prosecuting Attorney
Addendum A
a) Washington State University and its officers,agents,employees and registered volunteers,when acting
in good faith and within the scope of their official duties, are covered by the State of Washington's
Self-Insurance Liability Program (SILP) and the Tort Claims Act (RCW 4.92.060 et seq.), and
successful claims against Washington State University and its covered entities in the performance of
this Agreement will be paid from the tort claims liability account as provided in RCW 4.92.130.
b) Anything in this Agreement to the contrary notwithstanding, the parties expressly acknowledge and
agree that (1) Washington State University's liability and indemnification obligations hereunder are
subject to the coverage limits (as to type and amount) as described in the SILP, and (2) Washington
State University will only provide a defense to Jefferson County if the Office of the Attorney General
for Washington determines that (a) coverage for the costs of the same are within the scope of the
coverage afforded to Washington State University by the SILP and the Tort Claims Act, or (b)
notwithstanding a lack of coverage for such defense costs, it is appropriate for Washington State
University and the State of Washington to do so.
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