ARTICLE I - NAME, PURPOSE AND GEOGRAPHIC SERVICE AREA A. Name The name of this association shall be the Berrien County Medical Control Authority. B. Membership and Purpose The Berrien County Medical Control Authority is an association created jointly by the governing boards of the following member hospitals: Lakeland Community Hospital, Watervliet; Lakeland Regional Healthcare at Niles and St. Joseph, Inc. The purpose of the Berrien County Medical Control Authority is to establish medical control over the emergency medical services system in Berrien County, the City of Hartford and Hartford Township of Van Buren County, and Howard Township of Cass County in accordance with the rules and regulations promulgated pursuant to Public Act 179 of the Public Acts of Michigan, 1990, as amended; to do all things necessary or appropriate to maintain the Michigan Department of Community Health approval of the Medical Control Authority as an authorized medical control entity; to promote the provision of high quality pre-hospital medical care services; to promote health education, personal safety, and accident prevention activities; and generally, to do any acts necessary to carry out these specific purposes. C. Structure and Organization 1. Medical Control Authority Board of Representatives The business of the Berrien County Medical Control Authority shall be managed by a designated Board of Representatives (see ARTICLE II below). 2. Berrien County Medical Control Advisory Council The Berrien County Medical Control Advisory Council shall act in an advisory capacity to the Medical Control Authority Board of Representatives in all matters related to Emergency Medical Services (EMS) in the county (see ARTICLE III below). 3. Professional Standards Review Organization (PSRO) The Berrien County Medical PSRO shall act as the Quality Assurance (Q/A) of the Berrien County Medical Control Authority. They will be responsible for directing county wide medical review that supports the minimum standard of medical care protocols and operational procedures established by the Board of Representatives. The PSRO shall report appropriate general medical staff 1
matters to the Berrien County Medical Advisory Council for conduct and review. (See Article IV.) D. Geographic Service Area The area under the medical control of the Berrien County Medical Control Authority shall be the whole of Berrien County, the City of Hartford and Hartford Township of Van Buren County, and Howard Township of Cass County, of the State of Michigan. ARTICLE II - AUTHORITY BOARD REPRESENTATIVES The business of the Berrien County Medical Control Authority shall be managed by a designated Board of Representatives. All representatives to the Board shall have voting privileges. A. Representatives The governing boards of each participating hospital shall appoint one member of its administrative staff as a voting representative. B. Terms of Membership (Hospital) Representatives shall serve until such time as they resign or are replaced. Representatives from participating hospitals shall be reappointed every three (3) years. Notification to be made by March of the year term expires. A representative may resign at any time by sending written notice to the Chairperson or Secretary. A representative may be replaced with or without cause by appropriate action of the entity which appointed the representative. In that event, the Authority Board shall be notified of this replacement in writing prior to its next regular meeting. Any vacancies thus occurring shall be filled by the body that appointed the representative who resigned or was replaced. Any representative can be removed by a 2/3 majority vote of the Berrien County Medical Control Authority Board of Representatives. C. Duties / Responsibilities 1. The Berrien County Medical Authority Board shall appoint a 911 Advisory Committee representative. The representative shall serve until such time as they resign or are replaced. 2. A Berrien County Medical Control Authority Board member will be appointed to participate in exercises conducted by the Emergency Preparedness Division of the county. 2
D. Regular Meetings Regular meetings of the Berrien County Medical Control Authority Board of Representatives (Authority Board) may be held at such times, not less often than four (4) times a calendar year, as the Authority Board determines. Meetings will beheld at the time and place fixed by the Authority Board. Notice of all Authority Board of Representatives meetings, except as herein otherwise provided, shall be at least ten (10) days before the meeting. Any business may be transacted at a regular Authority Board meeting. Agenda items must be submitted to the Secretary of the Board not later than ten (10) days prior to the scheduled Authority Board meeting. Public notice of regular Authority Board meetings shall be given to the extent required by law. E. Officers 1. The designated Representatives of the Berrien County Medical Control Authority Board shall elect officers, to include at a minimum, a chairperson, secretary, and a treasurer. Terms of office shall be one (1) year. Elections will be held at the fourth quarterly meeting of the year. 2. It shall be the duty of the chairperson to preside at all meetings of the Authority Board of Representatives, appoint all committees unless otherwise provided for, and have general supervision of all affairs of the Authority Board. 3. The secretary shall keep an accurate record of the meetings of the Authority Board. He/She shall maintain a typewritten record of the minutes of all meetings. He/She shall see that all notices are duly given in accordance with the provisions of these bylaws, be the custodian of the Authority Board records, and, in general, perform all duties which may be assigned to that office by the chairperson. 4. The treasurer shall keep an accurate record of all financial transaction. He/She shall, at the conclusion of his/her term of office, deliver all ledgers, books, and papers belonging to the Authority Board to his/her successor in office. F. Purpose and Function 1. The Berrien County Medical Control Authority Board shall adopt and enforce bylaws, minimum standards of medical care, protocols, and operational procedures for all Advanced Life Support and Basic Life Support services and personnel within the authorized area of authority, to include: a. Patient treatment protocols. b. Patient care quality review procedures. 3
c. Assurance of availability and efficacy of training and continuing education programs. d. System telecommunication procedures. e. Agreement for the coordination of services (mutual aid). f. Procedures for enforcement of standards, protocols, and procedures. g. If limited or advanced life support is provided: (1) Procedure for withdrawal and restoration of hospital cooperation when necessary to assure compliance of the providers with standards, protocols, or procedures, or to protect the public health, safety, or welfare. (2) Procedures for pharmaceutical security, control, and exchange. 2. The Berrien County Medical Control Authority Board shall submit the standards, protocols, and procedures to the MDCH, EMS Division, for review and approval prior to their implementation. 3. All persons and all advanced, limited advanced, basic life support services, and emergency non-transporting units (E-units), first responder units, when providing emergency medical care within the region of authority of an MDCHapproved Medical Control Authority, shall comply with the minimum standards of medical care, protocols, and operational procedures adopted by the Berrien County Medical Control Authority Board. All such standards and protocols will be distributed initially to each hospital or ambulance service involved in the pre-hospital emergency medical services system in Berrien County, and the City of Hartford, Hartford Township of Van Buren County and Howard Township of Cass County. As others join the system or updates or revisions to the standards and protocols are made, they will be made available to affected hospitals and transport services. It shall be the responsibility of the individual ambulance services to make these documents available at the operational level to all personnel. 4. If the Berrien County Medical Control Authority Board believes any advanced, limited advanced, basic mobile emergency care service, emergency nontransporting unit, first responder unit, or any person associated with such a service is or has been in violation of a minimum medical care standard, protocol, or operational procedure adopted by the Berrien County Medical Control Authority Board, the Authority Board shall initiate voluntary 4
enforcement procedures. These procedures shall be determined by a majority vote of the Berrien County Medical Control Authority Board. If it is determined the service or person is unable to demonstrate voluntary compliance, the Medical Control Authority Board shall request the MDCH, in writing, within 14 days of the incident, to investigate the matter and to initiate compliance procedures if deemed appropriate by the Department. 5. If the Medical Director of the Berrien County Medical Control Authority Board believes that a violation of minimum medical care standards, protocols, or operational procedures by an advanced, limited advanced basic mobile emergency care service, emergency non-transporting unit, first responder unit, or any person associated with such a service seriously affects that public health, safety, or welfare of individuals receiving emergency care or services, the Medical Director or the Medical Control Authority Board chairperson shall immediately advise the MDCH by telephone or telegram of all facts concerning the violation. If the MDCH determines that the violation does seriously affect the public health, safety, or welfare of individuals receiving emergency care or services, the Department may issue an emergency order suspending the service or person or take other appropriate action. 6. Each participating hospital with telecommunication activities in support of medical control of limited and advanced mobile emergency care services within the jurisdiction of the Berrien County Medical Control Authority shall be responsible for maintaining all telecommunication records. Such records may be in the form of detailed written logs or electronic recordings and shall be maintained for not less than 60 days. Such designation shall be made for not less than one (1) year. 7. Lakeland Hospital, St. Joseph, shall serve as the primary resource facility for coordination of inter-regional medical control telecommunications and regional medical control as promulgated by the Medical Control Authority Board and approved by the Department. Such designation shall be made for not less than one (1) year. 8. The Berrien County Medical Control Authority Board shall determine whether or not to a allow a service to progress to the Limited Advanced Life Support or Advanced Life Support level in all or part of the medical control area. Services wishing to operate at these levels must apply for medical control by completing an application form and appearing before the Authority Board. 9. On matters of medical practice and medical licensure, decisions will be made by a committee of the physician representatives on the Berrien County Medical Control Authority Board, and then brought to the Authority Board as a whole for endorsement. The Medical Director may assume unilateral responsibility on matters of direct patient care when immediate action is 5
required and the Medical Director determines that the public health, safety, or welfare is in jeopardy. G. Procedures for Arbitration of Conflicts H. Fees Conflicts among members of the Authority which cannot be resolved through normal channels shall be submitted to the EMS Advisory Commission, MDCH. 1. All ordinary and necessary expenses of the Authority Board of Representatives shall be paid by equal contributions from each of the member hospitals. 2. Cost for county-wide administrative duties of the Medical Director shall be shared by member hospitals as approved by the Medical Control Authority Board. Ambulance services and emergency life support services may voluntarily contribute to this expense. 3. Expenses incurred in providing assistance in maintenance of Ambulance Services licensure and/or in certification of Emergency Medical Technicians are the responsibilities of the individual license holder. 4. If education or training over and above that which is required to maintain state licensure is required of an individual by this Board, the Board will be responsible for providing said education or training, or at its discretion, for reimbursing an individual who obtains this required education/training. 5. One hospital will be responsible for the administration of the Berrien County Medical Control Authority Board Account. I. Parliamentary Procedures 1. Meetings will be conducted by the chairperson according to Roberts' Rules of Order. 2. Written minutes will be kept of all meetings. 3. A quorum shall consist of a simple majority of the designated representatives then serving. 4. The Authority Board shall have the power to make, amend, and repeal the bylaws of this Authority by an affirmative vote of a majority of the representatives at any annual, regular, or special meeting of the Authority Board. All changes will be submitted to MDCH for approval. 6
5. The chairperson shall have the power to appoint advisory committees as needed, which may include nonmembers of the Authority Board, both providers and consumers. ARTICLE III MCA MEDICAL DIRECTOR 1. Medical Director The Medical Director shall be appointed by the Berrien County Medical Authority Board, with the advice of the Advisory Council, on a yearly basis. The Medical Director must meet the following requirements: a. Licensed to practice in Michigan and currently employed as an Emergency Department Physician in a participating hospital. b. Currently certified in Advanced Cardiac Life Support (ACLS) by the American Heart Association. c. Currently certified, or will become certified within six months of appointment, by American College of Surgeons in Advanced Trauma Life Support (ATLS). d. Certified or eligible to take boards administered by the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM) e. Currently certified or will become certified in Pediatric Advanced Life Support (PALS). f. Completed or in the process of completing NIMS 100, 200, 300, 400 and 700. g. Completed or in the process of completing Core Disaster Life Support (DCLS) or Basic Disaster Life Support (BDLS) h. Participate every 2 years in not less than 1 MDCH, Section of EMS approved educational program relating to medical control issues 7
The Medical Director shall also serve as chairperson of the Berrien County Medical Control Advisory Council, and fulfill the Job Description (see page 15). 3. Deputy MCA Medical Director The Deputy MCA Medical Director shall be appointed by the Berrien County Medical Control Authority. The Deputy MCA Medical Director must meet the following requirements: a. Licensed to practice in Michigan and currently employed as an Emergency Department physician in a participating hospital. b. Currently certified in Advanced Cardiac Life Support (ACLS) by the American Heart Association. c. Currently certified, or will become certified within six months of appointment, by American College of Surgeons in Advanced Trauma Life Support (ATLS). d. Currently certified or will become certified in Pediatric Life Support (PALS). e. Certified or eligible to take boards administered by the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM). f. Completed or in the process of completing NIMS 100, 200, 300, 400 and 700. g. Completed or in the process of completing Core Disaster Life Support (DCLS) or Basic Disaster Life Support (BDLS) h. Participate every 2 years in not less than 1 MDCH, Section of EMS approved educational program relating to medical control issues The Deputy MCA Medical Director shall also serve as a member of the Berrien County Medical Control Advisory Council,, and, in the absence of the Medical Director, the Deputy shall assume those duties. 8
ARTICLE IV - BERRIEN COUNTY MEDICAL CONTROL ADVISORY COUNCIL The Berrien County Medical Control Advisory Council shall be responsible to the Berrien County Medical Control Authority Board. The Berrien County Medical Control Advisory Council shall carry out the duties and responsibilities as outlined by the Berrien County Medical Control Authority Board and report all activities to the Authority Board on a regular basis. A. Physician Representatives 1. MCA Medical Director The Medical Director appointed by the Berrien County Medical Control Authority Board shall serve as Chairperson to the County Medical Control Advisory Council. The Medical Director shall be a voting member as determined by Roberts Rules of Order. 2. Deputy MCA Medical Director The Deputy MCA Medical Director shall be a voting member of the Berrien County Medical Control Advisory Council. 3. Hospital ED Medical Directors The MCA hospital ED Medical Directors or their physician representative shall be voting members of the Berrien County Medical Control Advisory Council B. Nurse Members Each participating hospital shall appoint a registered nurse from each site where it operates an Emergency Department to the Advisory Council. Each nurse or their appropriate medical representative shall have one vote on the council. Each nurse must meet both the following requirements: 1. Licensed by the State of Michigan and currently working as an Emergency Department nurse or Emergency Department Manager in a participating hospital. 9
2. Currently certified in Advanced Cardiac Life Support (ACLS) by the American Heart Association. C. Ambulance Service Members The ambulance authority of each ambulance service within Berrien County, the City of Hartford and Hartford Township of Van Buren County, and Howard Township of Cass County, may appoint one voting member to the Berrien County Medical Control Advisory Council. Each ambulance member must meet one of the following requirements: 1. Serve as Director of the ambulance service. 2. Currently licensed by the State of Michigan as an Emergency Medical Technician (EMT) and be an active member of his/her service. D. Medical First Response Service Any Medical First Response Service in Berrien County, the City of Hartford and Hartford Township of Van Buren County, and Howard Township of Cass County may appoint one voting member to the Berrien County Medical Control Advisory Council. Each First Response Service representative must meet the following requirement: 1. Current licensure as a Medical First Responder as a minimum. E. Terms of Membership Members shall serve until such time as they resign or are replaced. Notification of Ambulance Service membership shall be made annually by the respective service to the Berrien County Medical Control Advisory Council. Any member may resign at any time by sending written notice to the Chairman or Secretary of the Berrien County Medical Control Advisory Council. A member may be replaced with or without cause by appropriate action of the entity which appointed the member. In that event, the Berrien County Medical Control Advisory Council shall be notified of this replacement in writing prior to its next regular meeting. Any vacancies thus occurring shall be filled by the body that selected the member who resigned or was replaced. Recommendation to the Berrien County Medical Control Authority Board to remove a Council member may be made by a simple majority of the Berrien County Medical Control Advisory Council. G. Regular Meetings 10
Regular meetings of the Berrien County Medical Control Advisory Council may be held at such times, not less often than four (4) times a calendar year, as the Council determines. Meetings will be held at the time and place fixed by the Berrien County Medical Control Advisory Council. Notice of all Council meetings, except as herein otherwise provided, shall be given at least ten (10) days before the meeting. Any business may be transacted at a regular Berrien County Medical Control Advisory Council meeting. Public notice of regular Berrien County Medical Control Advisory Council meetings shall be given to the extent required by law. Yearly publication of the upcoming years meeting schedule will occur at the end of each year. H. Officers 1. The MCA Medical Director shall serve as chairperson of the Berrien County Medical Control Advisory Council. 2. It shall be the duty of the chairperson to preside at all meetings of the Berrien County Medical Control Advisory Council, appoint all committees unless otherwise provided for and have general supervision of all affairs of the Council. 3. The designated members of the Berrien County Medical Review Council shall elect a secretary. Term of office shall be one (3) years. The election is to be held during the third quarter of the year. 4. The secretary shall keep an accurate record of the meetings of the Berrien County Medical Control Advisory council. He/She shall maintain a typewritten record of the minutes of all meetings. He/She shall see that all notices are duly given in accordance with the provisions of these bylaws, be the custodian of the Council records, and, in general, perform all duties which may be assigned to that office by the chairperson. Copies of all minutes shall be sent to the secretary of the Berrien County Medical Control Authority Board. I. Purpose and Function The Berrien County Medical Control Advisory Council shall serve as a working body of the Berrien County Medical Control Authority Board. Functions to be carried out by the Berrien County Medical Control Advisory Council include: 1. Make recommendations to the Berrien County Medical Control Authority Board to support and upgrade minimum standards of medical care, protocols, and operational procedures for all mobile emergency care services and personnel within the authorized area of authority. ARTICLE V - COMMITTEES 11
A. Professional Standards Review Organization Membership There shall be a Continuous Quality Improvement Committee consisting of the following members: 1. One (1) paramedic from each ALS ambulance service under BCMCA jurisdiction 2. One (1) nurse or their appropriate medical representative from each emergency department (i.e. Niles, St. Joseph and Watervliet). 3. MCA Medical Director 4. MCA Deputy Medical Director 5. One (1) representative of medical first responders / Basic Ambulance Services under BCMCA jurisdiction. B. The Professional Standards Review Organization Responsibilities The committee shall conduct an ongoing quality improvement program, including chart review, to ensure that minimum standards of care are being met in Berrien County. Findings and recommendations are to be forwarded to the Medical Control Advisory Board for review. C. Chairperson The MCA Medical Director will appoint a physician Chairperson from the membership of the PSRO. D. Meetings The committee will meet monthly. Yearly publication of the upcoming years meeting schedule will occur at the end of each year. E. Term of Membership Committee members terms shall be until resignation or replacement occurs. for a minimum of two (2) years. It is recommended that the representatives for the Medical First Responders / Basic Life Support service rotate at least every two (2) years, to assure fair representation by each service. F. In-house Quality Assurance for Advanced Life Support Services All EMS Agency Services will be responsible for their own quality assurance programs. 12
1. They are responsible for sending one (1) representative from their respective services to the monthly Professional Standards Review Organization meetings. 2. Their Service Directors are responsible to make quarterly Q/A reports to the Berrien County Medical Control Advisory Council. 13
BERRIEN COUNTY LICENSED HOSPITALS The following constitute the hospitals participating in the Berrien County Medical Control Authority. LAKELAND COMMUNITY HOSPITAL, WATERVLIET 400 Medical Park Drive Watervliet, Michigan 49098 (269) 463-3111 LAKELAND REGIONAL HEALTHCARE AT NILES AND ST. JOSEPH 1234 Napier Ave. St. Joseph, Michigan 49085 (269) 983-8300 The following are licensed hospitals in Berrien County not participating. LAKELAND SPECIALTY HOSPITAL AT BERRIEN CENTER 6418 Deans Hill Road Berrien Center, Michigan 49102 (269) 471-7761 14
JOB DESCRIPTION MCA Medical Director The Medical Director shall: 1. Serve as physician advisor for basic, limited, and advanced EMT training and refresher training courses in the Medical Control area. 2. Serve as chairperson of the County Medical Control Advisory Council. 3. In conjunction with the County Medical Control Advisory Council, establish protocols for pre-hospital care and ensure these are disseminated to all E.D. and pre-hospital personnel, as well as included in training programs. 4. Certify pre-hospital providers to work in the Medical Control area (beyond minimum MDCH licensure) after satisfactory completion of in-service training. 5. Evaluate pre-hospital care in conjunction with the County Medical Control Advisory Council by: a. Reviewing run reports. b. Obtaining feedback from other E.D. physicians c. Spending time on the ambulances observing EMT's performance (or designating other physicians and/or nurses to do this) 6. In conjunction with the County Medical Control Advisory Council, institute suspension procedures for failure to comply with protocols or radio orders, failure to meet predetermined skill levels, negligence, misconduct, and other offenses as determined by the Medical Control Authority Board. 7. In conjunction with the County Medical Control Advisory Council, implement an orientation program for E.D. personnel to familiarize them with the protocols, standards, and operations of the pre-hospital BLS system. 8. Serve as liaison to the local medical society. 9. Meet on a quarterly basis with E.D. Medical Director of participating hospitals. 10. Attend regional and state seminars and meetings, which provide a forum for the exchange of information among BLS and ALS medical directors. Revised 05/26/04 07/13/12 15