INMATE HEALTH CARE SERVICES AGREEMENT THIS INMATE HEALTH CARE SERVICES AGREEMENT ("Agreement") is made and entered into on this Ist day of November, 2022 (the “Effective Date”) by and between the CITY OF JACKSONVILLE, a consolidated political subdivision and municipal corporation existing under the Constitution and laws of the State of Florida, for the Jacksonville Sheriff's Office ("JSO" or “City”) and ARMOR HEALTH OF DUVAL COUNTY, LLC., a Florida limited liability company (hereinafier referred to as ("Contractor"). RECITALS: WHEREAS, the Department of Comections of the Jacksonville Sheriff's Office (the "Department") houses inmates at three (3) facilities: (i) the Pre-Trial Detention Facility; (fl) the Montgomery Correctional Center; and (iii) the Community Transition Center (collectively, the “Facilities” or individually, “Facility”); and WHEREAS, JSO and Contractor entered into a five (5) year services agreement on November 1, 2017 (City Contract No. 10361) (the “Original Agreement") 10 provide comprehensive medical, mental health, dental, pharmacy and related health care and administrative services to inmates at the Facilities in accordance with applicable laws and regulations and the Governing Standards (as defined in this Agreement) (collectively, the “Health Care Services” or “Services”; and WHEREAS, the Original Agreement expires on November 1, 2022, and JSO and Contractor desire to enter into anew five (5) year agreement for Contractor to provide Health Care Services to inmates at the Facilities, subject tothe terms and conditions contained herein; WHEREAS, JSO’s authority to enter into this Agreement with Contractor to provide the Health Care Services is pursuant to the procurement medical services exemption set forth in Section 126.107 of the Jacksonville Ordinance Code and Administrative Award Bid No. AD-0010-23 dated October 24, 2022 NOW THEREFORE, for and in consideration of the covenants and promises hereinafter, ‘made, the parties hereto agree as follows: ARTICLEI RECITALS AND CERTAIN DEFINITIONS. SECTION 1.01 The recitals set forth above are true and correct and incorporated herein by reference. All capitalized words and phrases in this Agreement shall have the meanings ascribed to them below and in this Agreement.(2) Contractor's Representatives shall mean a regional leader and one full-time Health Services Administrator designated by Contractor, who will be its primary representatives and have responsibility for the ensuring that Contractor provides the Services in compliance with the terms of this Agreement, instituting and implementing any and all corrective action to resolve ‘areas of non-compliance or deficiencies, and facilitating any dispute resolution, and shall be responsible for ail persons providing services under this Agreement. (b) HSM shall mean a Health Services Compliance Manager (HSCM) designated by JSO who will be its senior representative and who shall require Contractor and JSO to meet all contract requirements; monitor Contractor's and JSO”s compliance and any corrective action to resolve areas of non-compliance or deficiencies; recommend or assess liquidated damages based on non-compliance; and facilitate any dispute resolution. (©) _ Director shall mean the Jacksonville Sheriff's Office Director of Corrections. @ Governing Standards shell mean the following standards: state and federal laws, the medically accepted community standards, the American Correctional Association ("ACA") Standards, the National Commission on Correctional Health Care ('NCCHC") Standards, the Florida Corrections Accreditation Commission ("FCAC"), the Florida Model Jail Standards (EMIS), Prison Rape Elimination Act (“PREA) standards, and ell other applicable standards. (©) Force Majeure Event means the following events or circumstances, but only to the extent that they delay or preclude the City or Contractor from performing any of its obligations (other than payment obligations) under this Agreement: (a) an act of God, tomado, hurricane, flood, lightning, fire, explosion (except those caused by the negligence of the Contractor, its agents, and assigns), landslide, earthquake, an existing epidemic or pandemic declared to be a current national, state or local declaration of emergency, and extremely abnormal and inclement weather; (b) acts of a public enemy, acts of war, terrorism, insurrection, riots, civil disturbances, or national or intemational calamities; (c) an injunction, or a legal or equitable proceeding brought against the City or Contractor, (d) a change in law; and (e) any act, event, or condition that is determined by mutual agreement of the City and the Contractor to be of the same general type es the events of Force Majeure identified in this Section (@) through (c) above. Notwithstanding anything else contained herein, Force Majeure shall not be deemed to include any act, event, or condition over which a Party relying thereon (including any Person for whose performance such Party is responsible) reasonably has any influence or control, or any act, event, or condition arising out of labor strikes, labor shortages, or similar labor difficulties, or changing economic conditions or economic hardships. (© Inmates shall mean those individuals under the custody and control of the Department and physically accepted into the Facilities and shall include persons with the status of pre- arraignment detainee, post-arraignment detainee, and persons sentenced to and/or incarcerated at the Facilities. Inmates do not include those individuals in the home detention or those individuals under the supervision of the Pre-Trial Services Unit or the Reentry Center. (2) Medical Director shall mean a physician appointed by Contractor and reasonablyacceptable to JSO. The Medical Director shall assist with monitoring and supervising the performance of all clinical personnel performing services under this Agreement. The Medical Director shall plan, implement, direct and control all clinical aspects of the services rendered under this Agreement in consultation with Contractor's utilization review system and Corporate Medical Officer. The Medical Director shall be familiar with ACA, FCAC, FMIS and NCCHC accreditation standards. The Medical Director shali also provide services as a physician under this Agreement. (b) Services or Health Care Services shall mean the comprehensive medical, mental health, dental, pharmacy and related health care and administrative services to be provided by Contractor under this Agreement as more fully described in Asticle IIL. () Sheriff shall mean the Sheriff of Duval County and designated representatives within the Jacksonville Sheriff's Office. The Director shall provide and update a list of designated representatives to Contractor. Designated representatives include, as a minimum, the Sheriff, the Director of the Department of Corrections, the Chief of the Jails Division, the Chief of the Prisons Division and the HSCM. @)__ Implementation Date shall mean November 1, 2022, and shall be the date that Contractor begins providing the Services under this Agreement. QUALIFICATIONS, LICENSES AND ACCREDITATION SECTION 2.01 QUALIFICATIONS All of the Services provided by Contractor under this Agreement shall meet or exceed the Governing Standards. However, if the Governing Standards materially change from those in place at the time this Agreement is fully executed, the parties shall promptly meet to make any and all needed changes to properly and equitably ensure the ability to meet the changes in Governing Standards. SECTION 2.02 LICENSES Contractor warrants that it has, and shall maintain throughout the term of this Agreement, all licenses necessary to provide the Services. Contractor further warrants that all of its employees, independent contractors, and subcontractors rendering the Services have and will continue to possess all licenses and certifications necessary to render any and all Services provided by ‘that employee, independent contractor or subcontractor. Contractor will obtain and maintain ail relevant permits and licenses required to perform the Services, including, but not limited to, licenses and permits for radiology, pharmacy, and bio- hazardous waste disposal services.SECTION 2.03 ACCREDITATION Contractor shall maintain its FCAC and NCCHC accreditations and meet all ACA accreditation standards and requirements and all Florida Model Jail standards at each of the Facilities. Failure to maintain applicable accreditation standards due to the failure of Contractor to comply with Governing Stendards shall result in liquidated damages as set forth in Article VII. ARTICLE Il SCOPE OF SERVICES SECTION 3.01 | GENERAL ENGAGEMENT 1. Contractor shall provide the Services at all Facilities, unless otherwise specified by ISO, which Services shall include, but not be limited to, the following Services: 8) Medical screenings at JSO"s Pre-Trial Detention Center 24 hours per day, 7 days per week; b) Comprehensive medical, mental health, dental, and related health care and administrative services for the Inmates; ce) Medical screenings of Inmates upon arrival at JSO’s Pre-Trial Detention Center; 4) Comprehensive health assessments of Inmates within 14 days of admission to the Facilities; ©) Regularly scheduled sick call; D Nursing coverage; g) Regular provider visits at cach Facility; h) Infirmary care (if implemented at a later date as agreed between JSO and Contractor); i) Referrals for Hospitalization; i) Referrals for Medical specialty services; k) _ Emergency medical care; 1) Inmate worker clearances; m) Detoxification; 2) Medical records management; 0) Pharmacy services; p) Health education and training services; @) — Aquality assurance program; 1) Administrative support services; and, 3) Other services, including those more specifically set forth in this Agreement. Specific sections in this Agreement shall be deemed appropriate standards and shell not be deemed or construed to establish the maximum type, level or amount of service Contractor will provide.2. Contractor shall provide specialty services, including, but not limited to, HIV testing at each Facility when deemed appropriate by Contractor's Medical Director and to the extent agreed upon by the HSCM. To the extent specialty care cannot be rendered on site, Contractor will make appropriate arrangements for the provision of such care through physicians, providers, clinics and hospitals of UF Health Jacksonville (“UF Health Jacksonville”) or, in rare cases, the physicians, providers, clinics and hospitals of UF Health Gainesville (“UF Health Gainesville”) as provided in Section 7.08 of this Agreement Specialty services provided by Contractor shall include meeting the unique needs of female inmates, including, but not limited to, methadone, buprenorphine or other opiate to prevent withdrawal in pregnant patients, obstetrical services during pregnancy, continuation of oral contraceptives upon request, and referrals to UF Health Jacksonville for other specialty services as appropriate. 3. Contractor shall provide emergency medical treatment to Inmates, and emergency care to visitors and the Department's staff as necessary and appropriate on site. Thereafter, Contractor shall arrange for the admission of such Ininates, who in the opinion of the Medical Director requires hospitalization, to UF’ Health Jacksonville or UF Health Gainesville as provided in Section 7.08 of this Agreement. 4. Physician/midlevel services must be sufficient to meet the required needs of each Facility and to assure medical evaluation/follow-up within five (5) days of a routine, forty-eight (48) hhours of an urgent (seventy-two (72) hours on weekends and holidays), or immediately by a physician, midlevel or EMS for an emergent post nursing triage referral (including weekends and holidays). In addition, Contractor shall provide provider on-call services twenty-four (24) hours per day, seven (7) days per week, and Contractor's physicians/midlevels shall provide for consultation and on-site services at each Facility, as necessary. SECTION 3.02 ADMINISTRATIVE 1 Periodic Reports, Contractor shall submit such periodic reports to the HSCM concerning and reflecting on the overall operation of the health care services program in general and on the health status in particular of the Inmates on a basis to be determined by mutual agreement of Contractor and JSO. Contractor shall fully cooperate with ISO to: (1) respond to reporting requests from the HSCM, accrediting bodies, governing authorities and/or any court for any reason whatsoever within a timely manner, understanding that the timeliness of such responses should not jeopardize patient care; and, (2) support compliance or monitoring of any provision or section of this Agreement, without any additional charge, fee or assessment to JSO. Contractor shall use best efforts, without jeopardizing patient care, to make a company representative available to attend court hearings. 2. Annual Quarterly Reports, Contractor shall forward annual statistical reports to the HSCM. in accordance with Governing Standards, upon request of the HSCM.3. Monthly Reports, Contractor shall submit monthly statistical and narrative reports by the fifteenth (15th) day of each month to the Director and the HSCM. Said monthly reports shall contain data for the previous month including, but not limited to, the following: a) Inmates! requests for various services; b) Inmates seen at sick call; ©) Inmates seen by: i. Physician; ii, Dentist; fii, Psychiatrist iv. Psychologist; vy. Advanced registered nurse practitioner and/orphysician assistants; vi. Otherlicensed mental health professionals; 4) Admissions: i, Infirmary, including patient days and average length of stay; ii, Mentalhealth; iii, Off-site hospital; ©) Medical specialty consultation referrals; 1) Intakemedical screenings; g) Fourteen (14) day health assessments; h) Medical grievance summary; i) Psychiatric evaluations (initial and follow-up); i) Diagnosticstudies; k) Reportof third party reimbursement, pursuit and recovery; 1D) Pharmacy Expenses (as defined in Section 7.08) m) Percentage of inmate population: i. Dispensed psychotropic medication; ii, Onprescription medication; n) Inmates testing positive for: i, Sexually transmitted diseases; ii, HIV/AIDS; fii, Tuberculosis; iv. Methicillin-resistant Staphylococcus aureus (MRSA) 0) Inmate mortality; p) Number of hours worked by employed and contracted staff by providing access to Armor employees and agency daily roster reports, @) Any additional information requested by the HSCM or JSO, in which case Contractor will make every reasonable effort to provide such additional information within ten (10) business days. 4, Daily Reports, Contractor shell submit a narrative report to the HSCM daily (Monday through Friday excluding weekends and holidays) capturing data for the prior 24 to 72 hours by no later than 11:00 a.m. that includes the following topics:a) Transfers to off-site hospital emergency departments; 6) Communicable diseasereporting; c) Suicide data (i.e., attempts and precautions taken); 4d) Status of inmates in local hospitals and infirmaries; e) Daily Staffing Report of Armor employees and agency staffby name and title of person; Completed medical grievance report; {g) Status report on 14day health assessments and annual health assessments; h) Inmates hospitalized in absentia; i) Medication passes that did not occur; j) Late urgent referrals HCP; K) Late chronie care clinic; 1) Late chronic care HCP; m) Late urgent referrals psychiatrist; n) Late TB screening and overdue PPD reading; 0) Late sick call RN; p) Late sick call provider; and 4g) -Late urgent referrals dentist. 5. Monthly Medical Audit Committee ("MAC") Meetings, Contractor shall meet monthly with JSO's designated representatives conceming existing health related procedures within the Facilities, and for the purpose of making changes, ftom time to time, of such procedures and other practices reasonably related thereto es Contractor and JSO shall deem advisable, The HSCM or designee shall schedule the meeting. The parties shall exchange agendas at Jeast seven (7) days prior to the meeting. The HSCM or designee will prepare minutes of the meetings which must be approved at the next monthly meeting. Contractor's Regional Vice President or Health Services Administrators or designee will attend segregation/classification meetings, and other interdisciplinary meetings necessary to maintain detention/medical teamwork. 6. On-Call, Cellular, Contractor shall provide the Medical Director, on-cell physician or advanced level practitioner, Director of Nurses, on-call psychiatrist, Regional Vice President and Health Services Administrators with twenty-four (24) hour, seven (7) day a week cell phone service or equivalent reimbursement program for cell phone service. Contractor shall provide the SCM with a monthly call out list and updates as they occur. These individuals must return any call within a reasonable amount of time, preferably within thirty (30) minutes. The on-call provider physician or midlevel shall be available twenty-four (24) hours a day, seven (7) days ‘a week and shall be notified of and respond in person, if necessary, to adverse medication reactions, deaths, when court-ordered, or when requested by the HSCM or designee. The on- call provider, physician or midlevel shall respond within the shorter of the medically appropriate time frame, the time specified by the court, or within twenty-four (24) hours, Contractor's designee for Section 3.02(12) shall be available twenty-four (24) hours day, seven (7) days a week accessible via cell phone. Contractor’s Behavioral Health Director, or his or her designee, shall be on-call for behavioral health issues and shall determine, in accordance with the Governing Standards, whether to contact a psychiatrist immediately or the next clinic day if and when medically appropriate.7. Written Job Descriptions. Written job descriptions and post orders defining specific duties and responsibility for all assignments must be available at each site. Copies of staffing schedules encompassing all staff are to be posted by Contractor in designated areas and submitted to the HSCM or designee on a weekly basis with written daily updates regarding changes. 8 Court Appearances. Information concerning any court or legal documents affecting Inmates and Contractor must be provided by emailing or faxing such documents to the HSCM or designee within a reasonable amount of time, preferably within four (4) hours. Contractor shall email or fax information concerning any court appearances to the HSCM or designee and to the Office of the General Counsel at their respective email addresses or fax numbers within a reasonable period of time after receipt of notice of the same, preferably within four (4) hours. Contractor shall use best efforts, without jeopardizing patient care, to make a company representative available to attend court hearings. Time spent by Contractor employees dealing with these court appearances shall count as service included in this Agreement. Contractor shall supply the HSCM or designee and the Office of the General Counsel with any follow up reports and/or documentation ‘requested by the Court or the Office of the General Counsel. Contractor will review and evaluate all court ordered medical, dental and mental health care and take appropriate action to address such medical, dental, and mental health care concems brought to Contractor's attention by the Court, or teke appropriate action to vacate or modify the court's order. Contractor will notify the HSCM and the Office of the General Counsel of the action taken onsuch court orders. Contractor shall also make available its own legal counsel to attend court hearings involving the medical care and treatment of inmates where appropriate. All costs associated with assistance of this type will be the.responsibility of the Contractor. 9. Policies and Procedures, Contractor shall design and implement policies, procedures and protocols for the Services, subject to the approval of the Director or designee. The policy and procedure manual will be updated annually in accordance with Governing Standards as well as federal law and state statutes. Policies and procedures shall address medical, dental and mental health treatment, and also include, at a minimum, policies for outside referrals, transportation, emergency care and disaster management. Contractor shall submit all policies and procedures to the HSCM or designee. Upon request, Contractor will provide input on any of JSO's policies, procedures or protocols. If there are any material changes in Governing Standards, JSO and Contractor agree to promptly meet to equitably amend this Agreement fo ensure such material changes are accommodated by the Contractor and ISO. 10. Civie Groups. Upon mutual agreement of JSO and Contractor, Contractor shall discuss the services provided under this Agreement with local civic groups or visiting officials. 11. [swe Resolution, The Director, the HSCM or their designees shall contact Contractor's regional leader or Health Services Administrator in the event administrative issues arise. In any matter designated urgent by the Director, the HSCM or their designees, Contractor or JSO, depending on the issue, shell address the issues immediately. In any matter JSO or Contractordesignates as a non-urgent administrative matter, the Contractor or JSO, depending on the issue shall respond within the reasonable time frame designated. Both parties shall work expeditiously to resolve issues between the parties, regardless of source. 12, Records and Reports. Contractor shall maintain such books, records and documents to reflect the expenditure of all funds under this Agreement in accordance with generally accepted accounting principles, Contractor shell prepare and provide JSO with copies of the Contractor's consolidated annual financial statement and such other reports relating to this Agreement as SO may reasonably require during the period of this Agreement, at no costtoJSO. Contractor shall provide JSO with sufficient documentation to enable JSO to perform contract monitoring and to verify Contractor's performance in accordance with the terms of this Agreement. Any specific information that Contractor claims to be a trade secret or otherwise exempt from Article 1, Section 24, Florida Constitution, and Chapter 119, Florida Statutes (the “Florida Public Records Act”) must be clearly identified as such by Contractor om all copies fumnished to JSO. ‘ISO agrees to notify Contractor of any third-party request to view such information, but it is a Contractor's obligation to obtain a court order enjoining disclosure. If Contractor fails to initiate a court action to enjoin disclosure within five (5) business days of Contractor's receiving notice of the request, JSO may release the requested information, Such release shall be decmed for purposes of this Agreement to be made with Contractor's consent and will not be deemed to be a violation of law, including but not limited to laws concerning trade secrets, copyright or other intellectual property. 13. Access to Facilities and Records, Contractor shall provide JSO, the Director, the HSCM and their designees with (a) access to all information in the Facilities and outside the Facilities, as is reasonably necessary for JSO to perform contract monitoring, and (b) access to any financial books, documents, papers and records of Contractor as are related to this Agreement. JSO and its designees shall have access to all JSO related records of Contractor and to all documents as may be necessary for JSO's designee to perform monitoring under this Agreement. 14. Facilities and Housekeeping. a, JSO may prohibit entry to any Facility, or remove thereftom, any of Contractor's subcontractors, independent contractors or employees who do not perform their duties in a professional manner, who violate the security regulations and procedures of the Department, or ‘who present a security risk or threat as determined in the sole discretion of ISO. The Department reserves the right to search any person, property or article entering or leaving any facility. Contractor's employees, independent contractors, and subcontractors, their desks, lockers, personal effects, and vehicles parked at the Facilities are subject to search atany time, b. Upon notification by Contractor of a new employee, the Department shall provide Contractor's new employees, including per diem employees, with an orientation tothe Facility and to security requirements prior to being allowed access tothe facility. cc. Contractor shall maintain and update the on-site medical library in English at eachFacility for use by the health care staff. The library shall include at a minimum the following materials: basic reference texts related to the diagnosis and treatment in primary care setting, a current medical dictionary, a pharmacology reference book, and a current Physician's Desk Reference book. At the expiration or termination of the Agreement, the library shall become the property of JSO. 4 Contractor’s staff shall leave conference rooms and other common areas in good/same condition after use. The Department will provide Inmate workers to clean and maintain floors, windows, walls, vents, and all bathroom end shower facilities and fixtures. ©) ISO shall provide food/dietary services to Inmates, maintain the premises and fixtures, and provide linens for the Inmates. 1) Contractor shall prepare inspection reports on the maintenance of each Facility’s clinics on a quarterly basis. Copies of all inspection reports shall be provided to the Director and to the HSCM. £) At its expense, Contractor shall dispose of all medically generated medical biohazardous waste in accordance with applicable state and federal laws, local ordinances, and OSHA standards, Contractor shall comply with OSHA blood borne pathogens standards; required ‘raining; and record keeping for occupational exposures, 15. Zelephone Calls, Contractor shall reimburse ISO for any toll or long distance charges made by the Contractor. Any such charges may be offset against Contractor's monthly invoices. 16. Staff Health Education, Contractor will conduct an ongoing health education program for personnel of the Department at each Facility. This health care education program will include, at the Department's request, programs necessary to: a) Maintain alll certifications; b) Administration of first aid; ©) Recognize the need for emergency care in life-threatening situations (e.g, heart attack); 4) Recognize acute manifestations of certain chronic illnesses (eg. asthma, seizures), intoxication and withdrawal, and adverse reactions to medications; ©) Recognize other chronic medical or disabling conditions; £) Recognize signs and symptoms of mental illness, suicide prevention, precautions and procedures with respect to infections and communicable diseases (e.g. AIDS, MRSA, TB, etc.); 2) Appropriate referral of inmatesto health professionals; h) Substance abuse; i) Respond to medical emergencies (e.g. cardiopulmonary resuscitation) or disaster; 3) Medical biohazardous waste disposal procedures; and 10k) All training required by Governing Standards and additional topics upon mutual agreement ofthe Department and Contractor. JSO shall reimburse the Contractor for any non-Contactor personnel and costs incurred to provide such training, provided such costs are pre-approved in writing by the Director orhisdesignee. 17. Inmate Health Education, Contractor shall maintain, subject to the Director's approval, an inmate health education and training program to include literature and videos for placement ‘throughout the Facilities, especially in special program areas and in program intensive housing units, Posters will be provided for heaith education on sexually transmitted diseases and substance abuse. Upon approval of the Director, Contractor shall provide formal educational sessions to Inmates on topics including but not limited to: personal hygiene, nutrition, physical fitness, stress management, sexually transmitted diseases, chemical dependency, communicable diseases (eg. tuberculosis (TB), Acquired Immune Deficiency Syndrome (AIDS)), effects of smoking, hypertension/cardiae, epilepsy, diabetes, dermatology, rehabilitation, pregnancy, blood borne pathogen and education sessions identified inNCCHC standards, 18 Inmate Services. Contractor shall provide Inmates with a verbal (in a language understood by the Inmate) and written explanation of the procedures to access medical, dental, and mental health services. Contractor must review and update the medical section of the Inmate Handbook annually. The Inmate Handbook will be published and distributed by JSO. Contractor’s obligations under this Section shall include, without limitation, making all verbal and written communications compliant with the Americans with Disabilities Act and all other applicable laws and regulations. 19. Data Security Requirements, Contractor shall comply with the Data Security Requirements provided in Exhibit G to this Agreement. 20. Records and Documentation. All manuals, policies and procedures, medical (health, mental health, and dental) records, statistical data, logs, and other records/documentation (whether written or other media form such as CD-ROMS, flash drives, or DVDs) developed, purchased or maintained by Contractor or ISO or for one or more of the Facilities (excluding original proprietary records normally maintained by Contractor at its off-site corporate headquarters), in the custody of the Contractor are the property of ISO. The Director or his designee may review such records at any time. A copy of medical records, including, but not limited to records used as proofs for obtaining or maintaining accreditations, must be provided to the Director, the HSCM, or JSO's designees at any time, upon their written request. Upon expiration or termination of the Agreement, all records, regardless of the format in which they are maintained, shall be surrendered to ISO. When surrendered, closed hardcopy records will be indexed and boxed in chronological order by Contractor for each Facility. 21. Media Requests, If media requests concerning the Services or the Facilities are received by Contractor, Contractor shall immediately notify the Director and the Jacksonville Sheriff's Office's Public Information Officer. Contractor shall be responsible for responding to the media only after coordinating its response with the Jacksonville Sheriff's uOffice's Public Information Officer. 22. Property. A list of ISO owned medical equipment is attached hereto as Exhibit A. Contractor shall maintain repair and/or replace all furniture and equipment where the cost is $500 or less, whether such items are Contractor owned or leased or JSO owned. JSO shall be responsible ‘when the cost exceeds $500. 23. Emergeney Notification, Contractor shall notify the Director and the HSCM of any Inmate hospitalizations, all unusual illnesses, all emergency cere, all Inmate deaths, and all potential media concerns immediately SECTION 3.03 INTAKE MEDICAL SCREENING Ll. Contractor shall provide sufficient qualified staff to perform Inmate medical screenings ‘based on structured inquiry and observation, twenty-four (24) hours aday, seven (7) days a week. Contractor shall initiate a medical screen each Inmate within five (5) hours of the time an Inmate is made available for the intake medical screening, unless for reasons beyond Contractor's control Contractor is prevented from timely accessing Inmates in a consistent and timely manner (e.g., intake is shut down, a large number of arrestees are presented at one time or in close proximity, and medical emergency within the facility requiring the attention of the booking area medical stall) in which case Contractor shall medically screen each Inmate as soon thereafter as reasonably possible. 2. Inmates entering the Facilities on prescription medications shall continue to receive such medications in a timely fashion as prescribed, or Contractor shall provide an acceptable altemate medication as clinically indicated. 3. Booking at JSO’s Pre-Trial Detention Center. On each shift, Contractor shall have a minimum of one (1) licensed registered nurse (RN) together with one (1) licensed practical nurse (LPN) on duty at JSO's Pre-Trial Detention Center. At least one (1) RN and one (1) LPN must havecertified/documented mental health training/experience to perform mental health and intake medical screenings, meeting, at a minimum, the requirements outlined in the Governing Standards that include, but arenot limited to: 8) Behavior, including state of consciousness, mental status and stability, appearance, conduct, tremors, sweating; b) Notation ofbody deformities, trauma, markings, ease of movement; ©) Condition of skin and body orifices, including rashes and infestations, jaundice, lesions and needle marks or other indications of drug abuse; 4) Condition of eyes, ears, nose and throat; ©) Tuberculosis screening; 1 COVID-19 screening/testing (tests will be paid for by ISO); ) Recording of vital signs; b) Documentation of chronic and current illnesses and health problems including 12communicable diseases as well as medical; mental and dental histories; current medications; substance abuse history; and, for females, a summary of gynecological problems and pregnancies; 2) History of suicide attempts or suicidal ideations; h) Screening for sexual assaultive behavior/past sexual victimization; and i) Pregnancy tests. Contractor and JSO acknowledges that the mental health and intake medical screening requirements listed in subsections a) through i) above may change based on amendments to the Governing Standards. If such requirements change during the Agreement term, Contractor agrees to perform such requirements in accordance with the Governing Standards after receiving notice from JSO of such changes. JSO will provide notice to Contractor of any such changes to the above requirements as soon as practicable. 4. Inmates must be medically cleared before they are sent to general population. Unconscious, seriously injured, seriously ill, or acutely intoxicated patients shall be refused admittance into the Facility and referred to UF Health Jacksonville or UF Health Gainesville for medical treatment as provided in Section 7.08. If an Inmate requiring medical clearance from a hospital before admittance is subsequently returned to a Facility, then upon the Inmate's, retum to the Facility, Contractor must medically assess the Inmate and review the hospital clearance authorization paperwork before accepting the Inmate into the Facility. Contractor shall maintain a medical clearance log of those Inmates who required medical clearance before booking. The log will be submitted monthly for review and discussion at the Monthly Medical Audit Committee meeting. 5. Contractor shall use its best efforts to have each inmate excoute Releases of Information to enable Contractor to receive records from prior health care providers to ensure continuity of care. Contractor shall pull records which are available from previous incarcerations in the Facilities and combine those medical records, SECTION 3.04 HEALTH ASSESSMENT 1. Fach Inmate shall be given a health assessment, including appropriate screening and testing by qualified health care personnel under the supervision of a licensed physician within fourteen (14) calendar days after admission to a Facility. Failure of Contractor to provide any required health assessment to an Inmate as provided in this Section 3.04 may shall result in a penalty as provided herein. Example: Inmate Smith booked 12/01/22, needs History and Physical (“H&P”) no later than 12/14/22. For calculation purposes, Day 1 is the day after booking date and the day the H & P is completed does not count as a penalty day. Example: Inmate Jones booked on 12/01/22, H & P completed 12/20/22. H& P should 2Bhave been completed on or before 12/15/22 (12/02/22 - 12/15/22). Therefore, penalty may be assessed for the period from 12/16/22 through and including 12/19/22, which is 4 days. The day the H & P is completed is not counted in the assessment of penalty days. ‘The health assessment shall be conducted in accordance with Governing Standards, shall be documented on a form approved by JSO, and shall include the following, at a minimum: 2) __ Review of intake screening forms; b) Collection of additional data regarding complete medical, dental, psychiatric and immunization histories; ©) Appropriate laboratory and diagnostic tests to detect communicable diseases (e.g venereal disease, chicken . pox, etc.) if indicated, or upon Inmate request; @ Tuberculosis screening (PPD test or chest x-ray); ©) Vital signs (height, weight, pulse, blood pressure, respirations, temperature); f) Gynecological assessment for females; 2) Physical examination including comments about mental status and dental screening; h) Assessment of mental health; i) _ Initiation of therapy and immunizations when appropriate; i) Pregnancy test for all females, if not already documented; K) Other tests and examinations as appropriate; and 1) _ Review of medical records from other providers. 2 Inmates referred for treatment as a result of the health assessment must be seen promptly by the appropriate health care professional (e.¢., physician, mental health professional or dentist) ‘unless the heelth care provider making the referral orders the Inmate to physician sick call on another day or an outside referral is needed, in which case the Inmate should be seen within a reasonable period of time. SECTION 3.05 PHARMACY 1, Contractor shall obtain all necessary pharmacy and DEA licenses to provide pharmaceutical services consistent with local, state and federal laws and all applicable Governing Standards, Contractor's pharmacy services shall beno less than a Type "B" Modified Class II Institutional Pharmacy under the control and supervision of a certified consultant pharmacist licensed in the State of Florida. The certified consultant pharmacist shall conduct quarterly pharmacy and therapeutic committee meetings. Contractor's initial formulary is attached as Exhibit B. Contractor shall provide to,the HSCM an updated report quarterly showing any formulary changes made by Contractor. 2. Contractor shall ensure that prescribed medications are provided to Inmates a) within a reasonable time of being written, unless otherwise specified by a prescriber, for non-STAT 14medications, and b) within four (4) hours of the order being given for STAT medication(s) 3. The Medical Director shall determine which medications shall be available on-site for emergencies or when it is medically appropriate that a more immediate initial dose be provided. The Contractor shall keep sufficient supplies of medications on-hand to ensure that Inmates with HIV or AIDS receive their medications on atimely basis. 4. When Inmates who are taking prescription medications are released from custody, participate in conditional release programs or leave on a writ, Contractor shall have available all dispensed prescriptions for the Inmate for no less than three (3) days dosage or the remainder of the medication, unless otherwise directed by the physician or released without reasonable advanced notice to provide such medications, The physician may require more than three (3) days of medication to be filled if it is clinically indicated, in Contractor's discretion, that: a) The prescription should be filled in a sufficient quantity to ensure that the Inmate can continue medication until such time as the Inmate is able to be seen by an outside provider, or b) —Thecurrentprescription iscompleted. Contractor shall use its best efforts to secure a pharmacy agreement that allows Inmates enrolled in the pharmacy program or jail linkage program's the ability to obtain thirty (30) days of HIV medication upon release from Facilities. Contractor shall use its best efforts to pursue any programs that reduce pharmacy costs without jeopardizing patient care. 5. Contractor shall record the administration of all prescription and "PRN" medications in Contractor's electronic medical record (EMR). Contractor shall document that each Inmate has received all medications. In the event an Inmate's ordered medication was not administered, Contractor shall document the reason that the medication was not administered and shall conduct, appropriate follow up to provide the Inmate such medication in accordance with approved policies governing medication administration. Contractor shall document all follow up efforts 6. Contractor shall employ or enter into a contract with a licensed, qualified pharmacist. Contractor's pharmacist shall attend (in person or electronically) the quarterly Continuous Quality Improvement Committee meetings. Contractor's pharmacist shell perform third party drug utilization review as requested by the Continnous Quality Improvement Committee and HSCM. 7. Contractor's certified pharmacist shall conduct monthly inspections of all Facility areas, where medications are maintained. The inspection shall include a review of the medications storage, a review of the medical records/medication administration record forms, and a review of the medication expiration dates. JSO's designees shall have the right to inspect and review the storage of medications, pharmacy and medication records. 8. Contractor’s certified pharmacist shall ensure the destruction and disposal of medications 15as required by law. Contractor's certified pharmacist shall prepare a monthly report of these activities and any findings which shall be shared with the Medical Director, Contractor's regional leader and Health Services Administrator, and the HSCM, A copy of the monthly report shall be maintained by Contractor in each Fecility. 9. Contractor shall provide the HSCM with copies of all State of Florida inspections and audits within 5 business days of receipt by Contractor. SECTION 3.06 LABORATORY 1. Contractor shall provide or arrange for all laboratory services in accordance with the Governing Standards. Such laboratory services shall be at Contractor's expense except for expenses for services provided by UF Health Jacksonville or UF Health Gainesville as provided herein. Laboratory services shall also include the provision of supplies, the delivery and pick- up of labs and results being sent to and from UF Health Jacksonville at least once daily from Monday through Friday, the installation of a printer at each Facility to provide test results as facsimile copies of results are not acceptable, and the capability to provide and receive laboratory reports within twenty-four (24) hours, subject to UF Health’s willingness to comply and medical necessity. 2. Urgent or stat laboratory work shall be sent within four (4) hours to UF Health Jacksonville. Results shall be telephoned immediately to the requesting physician, and a written report shall be sent to the physician within four (4) hours of the laboratory work being picked up. 3. A provider shall review, initial and date all results by the next provider clinic visit. Contractor's provider shall utilize his best efforts to review laboratory results that were sent over a weekend or holiday as soon as possible. Upon a review of the results, Contractor's provider shall determine the appropriate clinical treatment of the Inmate. In the event the provider's clinical observations of the patient do not correlate with the laboratory results, the provider shall clinically assess the patient, provide appropriate follow-up care, and reorder laboratory testing as clinically appropriate. SECTION 3.07 RADIOLOGY SERVICES 1 Contractor shall provide or arrange for radiology services through UF Health Jacksonville unless otherwise agreed upon between JSO and Contractor. Radiology services shall include x-rays, fluoroscopy, MRI's, CAT scans, ultrasounds, and any other special studies. Radiology services shall also include radiology supplies. The cost for radiology services provided by UF Health Jacksonville or UF Health Gainesville shall be paid by JSO. 2. Contractor and JSO acknowledge that, at some time during the term of this Agreement, 16