I Recognition	XVII University Spending Account
II Association Security	XVIII Administrative Responsibilities
III Check Off	XIX Salaries
IV No Discrimination	XX Vacations
V Grievance Procedure	XXI Holydays
VI Discharge	XXII Unpaid Leaves
VII No Strike Or Lockout	XXIII Continuing Education
VIII Bulletin Boards	XXIV Lay-Off Allowance/Reduction In % Effort
IX Fringe Benefits	XXV Resignation/Requests For Reduction In % Effort
X Group Life Insurance	XXVI Assignment Of Contract
XI Total Disability Benefits Plan	XXVII Management Rights
XII Pension Plan (TIAA AND CREF)	XXVIII Effect Of Legislation - Separability
XIII Medical Insurance	XXIX Duration Of Contract
XIV Tuition Exemption	Letter Of Agreement
XV Dental Insurance	Exhibit A
XVI Affiliation Committee Meetings	Exhibit B
	Exhibit C

WHEREAS, the parties hereto desire to establish the standards and conditions of employment under which the professional staff, hereinafter referred to as the "Staff", shall work at the Affiliate during the term of this Agreement; and

WHEREAS, it is the intent and purpose of the parties hereto that this Agreement promote and improve the mutual interests of the patients, the Affiliate and its staff and to set forth herein their agreement covering rates of pay, hours of work and conditions of employment.

NOW, THEREFORE, in consideration of the mutual covenants and obligations herein contained, the parties agree as follows:

ARTICLE 1 - RECOGNITION

1. The Affiliate recognizes the Association as the sole and exclusive collective bargaining representative for all staff members in the hereinafter described bargaining unit as set forth in the certification of the New York State Labor Relations Board, dated June 28^th, 1972, in Case No. SE 45778, which is as follows:

1. All full-time and regular part-time salaried physicians of the medical staff, including chiefs of services and assistant directors of departments; dentist; biochemists, bacteriologists, and speech pathologists, having a Ph.D. degree or substantially equivalent doctoral degree, excluding sessional physicians, residents and fellows, consultants, directors and associate directors, supervisors and all other employees.

2. Whenever the word "staff member" or "employee" is used in this Agreement, it shall be deemed to mean the members of the bargaining unit covered by this Agreement, as defined in Article I hereof.

ARTICLE 2 - ASSOCIATION SECURITY

1. All employees on the active payroll as of February 1, 1996 who are members of the Association shall maintain their membership in the Association in good standing as a condition of continued employment.
2. All employees on the active payroll as of February 1, 1996 who are not members of the Association shall become members of the Association thirty (30) days after the effective date of this Agreement, and shall thereafter maintain their membership in the Association in good standing as a condition of continued employment.
3. All employees hired after February 1, 1996 shall become members of the Association on the thirtieth (30th) day following the beginning of such employment and shall thereafter maintain their membership in the Association in good standing as a condition of continued employment.
4. For the purpose of this Article, an employee shall be considered a member of the Association in good standing if he/she tenders his/her periodic dues, initiation fee and legitimate assessments uniformly required as a condition of membership.
5. An employee who has failed to maintain membership in good standing as required by this article, shall within twenty (20) calendar days following receipt of a written demand from the Association requesting his/her discharge, be discharged if, during such period, the required dues and initiation fee have not been tendered.
6. The Association agrees that it will indemnify and hold the Affiliate harmless from any recovery of damages sustained by reason of any action taken under this Article.
7. The above paragraphs pertaining to Association security shall not be applicable in those cases where an employee presently, or in the future, has tenure of title or tenure of salary with Columbia University, or in those cases where an employee receives compensation through the University for thirty percent (30%) or less of his/her effort. Anyone falling into these categories may become members of or maintain membership in the Association if they so desire.

ARTICLE 3 - CHECK OFF

1. Upon written authorization, the Affiliate agrees that dues and initiation fees of the members Association, according to the schedule which the Association agrees to furnish the Affiliate, including such assessments which the Association shall levy and give notice thereof, in writing, to the Affiliate, shall be deducted from the salaries of said members of the Association on the first payroll date of each month. The Affiliate further agrees to remit such dues, initiation fees and assessments so checked off, to the Association, at Harlem Hospital Center, within fifteen (15) days thereafter.
2. It is specifically agreed that the Affiliate assumes no obligation, financial or otherwise arising out of the provisions of this Article, and the Association hereby agrees that it will indemnify and hold the Affiliate harmless from any claims, actions or proceedings by any staff member arising from deductions made by the Affiliate hereunder. Once the funds are remitted to the Association, their disposition thereafter shall be the sole and exclusive obligation and responsibility of the Association.
3. The Affiliate agrees to furnish the Association each month with the names of newly hired staff members, their addresses, social security numbers, classifications of work, their dates of hire, and names of terminated staff members, together with their dates of termination, and names of staff members on leave of absence.

The Affiliate agrees that it will not discharge any staff member except for just cause. This clause shall not be constructed as a waiver of the arbitration proceeding of this Agreement. The Association shall reserve the right to arbitrate any actions taken by the Affiliate in accordance with Article 5.

During the term of this Agreement there shall be no strike, work stoppage, slowdown or lockout. Any staff member who participates in any strike, work stoppage or slowdown shall be subject to discharge by the Affiliate, which discharge shall be subject to arbitration procedures set forth herein.

The Affiliate shall provide bulletin boards which shall be used for the purpose of posting proper Association notices. Such bulletin boards shall be placed conspicuously and at places readily accessible to staff members in the course of their employment.

ARTICLE 11 - TOTAL DISABILITY BENEFITS PLAN

The Long Term Disability Plan, which shall be considered a part of this Agreement, the same as if written herein, is contained in the publication Working at Columbia.

Employees will continue to be covered by the Pension and Annuity Agreement as heretofore except as modified below:

1. Incentive payments (including Ratification Incentive) are pensionable. The Faculty Practice Plan bonus is not pensionable.
2. Columbia pension contributions for employees hired after June 30, 1997, shall be accrued at the University-wide rates for Officers as follows:

Effective July 1, 1997, bargaining unit employees hired after June 30, 1997 who attain age 40 or older and with five (5) years of service or tenure will receive Columbia Pension contributions of seven and one-half percent (7-1/2%) for compensation below the social security wage base and twelve and one-half percent (12-1/2%) for compensation above the wage base.

Effective July 1, 1997, bargaining unit employees hired after June 30, 1997 who attain the age of 55 or older and with fifteen (15) years service will receive Columbia Pension contributions of twelve and one-half percent (12-1/2%) below the social security wage base and seventeen and one-half percent (17-1/2%) above the wage base.

 

1. The Aetna Medical Plan will be extended to Employees who are members of the bargaining unit effective August 1, 1988 on the same terms as for other Officers. The provisions for this program are contained in Working at Columbia.
2. Effective January 1, 1998, in addition to the Aetna Modified Indemnity Plans (A.B.C.) the medical plan for bargaining unit employees shall be modified as follows:

1. HMO Plans identified by the University with less than 4% enrollment will be eliminated (H.I.P., Kaiser, N.Y.L. Care, and Aetna Indemnity). U.S. Healthcare will still be an option.
2. The Cash Credit waiver amount will be increased from $65 to $75 per month.
3. Columbia University may offer a new health plan which will either be a University-wide PPO or a new Oxford plan with catastrophic out of plan coverage. Level of employee contribution will be set by Columbia University.

3. Same Sex Domestic Partner coverage is available effective January 1, 1994.

Tuition Exemption benefits remain as heretofore except that for spouse of employees hired on or after August 1, 1988, there will be a cap of seven points per semester for matriculated graduate students. For graduate student children of employees hired on or after August 1, 1988, there will be a 5% tuition exemption for each year the employee has been employed to 10 years or maximum of fifty percent (50%) of tuition exemption.

The Affiliate shall provide the GHI MI Plan with orthodontics known during 1987 negotiations as Dental Plan B to all covered employees who elect the participate, provided each such employee agrees to pay one-half (1/2) the premium cost therefore either for single or family coverage.

1. The Association may have representation at Affiliation Committee Meetings which are opened and, upon invitation by the Associate Dean/Medical Director of the Affiliate, may attend closed meetings.

As per the By-Laws of the Faculty Practice Plan, there shall be three representatives of UDA with voting rights of the Board of the Columbia University Harlem Faculty Practice plan.

2. As soon as practicable, a Committee comprised of equal representation of both Employer and Union shall be formed and shall meet as often as deemed necessary to:

Review Faculty Practice collections and make recommendations by November 1997. To that end, the Committee may want to consider the following options:

• Establishing pilot project in the Department of OB/GYN and Surgery
• Engaging an outside collection agency in the pilot project
• Establishing incentives for FPP Coordinators

UDA members are eligible to enroll in the University Spending Account Program.

ARTICLE 18 - ADMINISTRATIVE RESPONSIBILITIES

1. Staff members shall be responsible for signing all charts and forms on a timely basis legally requiring a physician’s signature and necessary for the various types of reimbursement.
2. Standards for time keeping accountability which may be required by the Affiliation as well as those currently in effect shall be followed by staff members provided said standards are reasonable and prudent.
3. Compensatory days are to be granted and taken within sixty (60) days of accrual.
4. Various departmental agreements regarding on-call are attached hereto as Exhibit C.
5. In the event that routine departmental operating needs require that any terms or conditions of employment of any physician(s) be changed, either temporarily or permanently, said proposed changes including the reasons therefore, must first be discussed by and between the Director of Service or his or her designee and the staff physicians or physicians in the department.

Such changes shall include, without limiting the generality of the foregoing, days and/or hours of work, shifts, days off, on-call times, locations of work, etc.

The Director of Service and the staff should attempt to reach a mutually-satisfactory arrangement and said proposed changes may be implemented as agreed.

If no mutually-satisfactory arrangement is made, the matter shall be referred to the Union and the Medical Director, for further decision. If the matter is still not resolved after such meetings, the changes shall be implemented subject only to the principles of optimum patient care and fairness to staff. The foregoing shall be subject to Article 5.

1. 1. Effective July 1, 1997, all members of the bargaining unit shall have a five percent (5%) reduction in their current (FY 1997) salary. Effective July 1, 1998 there shall be an additional five percent (5%) reduction in salary (10% below FY 1997 salary).

   2. A $1500/FTE ratification incentive payment will be paid to each member of the bargaining unit by the end of July, 1997. An additional $500/FTE ratification incentive payment will be paid by the end of July, 1998.

2. The wage increases set forth in paragraph 1 hereof shall not be in addition to any Communicare and Managed Care funded salary increases received from either the City of New York or the State of New York.
3. There shall be five pay levels for staff members: I, II, III, IV and V. Salary rates shall be dependent upon these levels. The minimum rates for 100% effort in these levels are:

	February 1, 1996	July 1, 1997	July 1, 1998
Level I*	$ 87,058	$ 82,705	$ 78,352
Level II*	$ 91,412	$ 86,841	$ 82,271
Level III**	$ 95,766	$ 90,978	$ 86,189
Level IV**	$100,660	$ 95,627	$ 90,594
Level V***	$105,560	$100,282	$ 95,004

* Assistant Attending
**Associate Attending
***Attending

4. The minimum salary for starting Ph.D.’s (at 100% effort) covered by the Collective Bargaining Agreement shall be $40,000.

1. Effective July 1, 1997, each member of the bargaining unit will be eligible to earn a Department Incentive that will range from 0 to 6% of that individual’s FY97 salary rate. The incentive will depend on the clinical workload of the member’s department, or pro rated if the member belongs to more than one department. Workload shall be measured in visit equivalents following the methodology used in the CU-HHC contract for the calculation of visit equivalents. The amount of payment shall be pro-rated on linear basis from 90% to 130% of the FY 95 Department workload. For example, if the FY 98 Departmental workload for Anesthesiology is 56,014 visit equivalents (the same as the FY 95 level) then each member of that Department will receive a 1.5% Departmental Incentive payment based on his/her FY97 salary rate. See Exhibit A.

2. Effective July 1, 1997, each member of the bargaining unit will be eligible to earn a Affiliation Incentive that will range from 0 to 4% of the member’s then current salary depending on the workload performed by the Affiliation. The amount of the payment shall be pro-rated on a linear basis from 9.5% to 110% of the FY95 Affiliation workload measured as indicated in 5(A) above. For example, if the FY98 Affiliation workload is 930,870 visit equivalents (the same as the FY 95 level) then each member of the bargaining unit will receive 1.33% of his/her FY97 salary rate. See Exhibit B.
3. Department and Affiliation Incentives will be paid quarterly, within 60 days after the end of the quarter, based on the results of that quarter. Payments will be adjusted quarterly based on over or under payments of the prior quarter(s) within the fiscal year with final quarter adjustment against the annual target.

6. The parties will meet starting July 15, 1997 for the purpose of seeking to agree upon the targets and incentive structure for an individual incentive payment up to 7%, with a payment range of 90% to 130% of the agreed-upon targets, which is to be effective July 1, 1998. These discussions will include accounting for the issues of impediments and teaching and administrative responsibilities. If the parties do not reach an agreement by April 30, 1998, the contract will be reopened (with the no strike no lockout provision of the collective bargaining agreement suspended) for the sole purpose of negotiating an Individual Incentive opportunity and the issues of impediments, fines, and teaching and administrative responsibilities as they relate to the individual incentives, to be effective July 1, 1998. All other terms and conditions of the contract remain in full force and effect until June 30, 1999.

1. Effective FY98 and FY99, 50% of all Faculty Practice revenues received in excess of $7.2 million for that fiscal year will be available for distribution with three-quarters of the amount to be distributed to bargaining unit members as directed by the union.

2. Payment will be made once a year by August 31, 1998 and August 31, 1999.
3. By August 15, 1997, FPP will provide a monthly "Date of Service" activity report for each member of the bargaining unit and for each department with a three-month time lag. Columbia University will also provide a monthly "visit equivalent" report for each department within 30 days after the end of a month. In addition, as part of the development of Individual Incentives, parties will address productivity by providing monthly reports (visit equivalents) for each member.

8. When promoting an individual from one level to another, the Director of Service shall consider achievement in the following areas:

Certification / Qualification
Experience
Clinical Performance
Departmental Responsibilities
Scholarly Productivity
Teaching
Hospital Activities
Length of service
Satisfaction of Time Requirements
Performance Evaluations
Performance of Medical Record Documentation

9. Promotions shall normally take place on July 1, of each year. In March of each year, the Affiliation Office will send to each Director of Service a list of all physicians and their current levels with a request for recommendations for promotions. These recommendations will be due in the Affiliation office no later than April 1^st. No recommendations of the Director shall be unreasonably denied. Promotions in level are not contingent upon promotions in hospital title or academic rank. Conversely, promotions in these ranks do not necessarily mandate promotions in level.
10. If a staff member believes that a promotion has been unreasonably denied, delayed or not considered, he/she may raise this issue with the Director of Service. If the issue is not resolved to the mutual satisfaction of the Director and the staff member, an appeal can be made to the Associate Dean whose decision in this matter is final and binding.

1. Staff members shall be entitled to the following vacation allotment:

LENGTH OF SERVICE	EARNED VACATION RATE MAXIMUM ALLOWANCE
Date of Hire to 20 years of service	2 days per completed month up to 23 days
Twenty (20) years or more service	2 & ½ days per completed month of up to 28 days

2. As vacation is earned on a month-to-month basis during active service, it may be used by the staff member. However, the total allowance earned by the staff member’s anniversary date must be used by June 30^th of the following year; it may not be accumulated nor may the staff member receive pay in lieu of unused vacation days. Such vacation may not be used before it has been accrued.
3. Vacation pay will be based upon a staff member’s current base salary.
4. Staff members who have received a promotion to a new department or have transferred to a new department, may carry a maximum of 23 earned vacation days to their new department.
5. Staff members who work less than 100% effort shall receive vacation on a prorated basis.

1. The holiday schedule will conform to the holiday schedule of New York City Health and Hospital Corporation at Harlem Hospital. Only staff members scheduled to work on a holiday shall be eligible for holiday compensation. If an employee is scheduled to work, as a part of the regular schedule on a holiday, that employee shall be entitled to equivalent compensatory time off on some other day as arranged in the Department.
2. Current holidays are:

New Year’s Day Dr. Martin Luther King, Jr.'s Birthday Lincoln's Birthday* Washington's Birthday Memorial Day Independence Day

Labor Day Columbus DayElection Day Veteran’s Day Thanksgiving Day Christmas Day

* Lincoln’s Birthday will be considered a "floating holiday."

Staff members shall be entitled to the following leaves:

1. Maternity Leave

Maternity shall be treated just as any other non-occupational disability circumstances and shall not exceed six months in duration. Medical expenses incurred during pregnancy and maternity shall be covered for all eligible staff members under the Aetna Medical Plan as would any other disability.

2. Personal Leave

A staff member may be granted a leave of absence without pay, not to exceed six months. Such leaves require the prior approval of the Director of Service, the Medical Director and the Vice President for Personnel Management or their designees. Such leaves may be granted for, but not limited to, the following: illness in the family, education, or compelling personal needs. The University reserves the right to require written substantiation of the conditions prompting the need for such a leave of absence. A staff member who has been granted a leave of absence for personal reasons must be returned to the same position upon completion of the leave or to a position of equivalent rank and salary.

1. Staff members who are employed for sixty percent (60%) of effort or more shall be entitled to up to ten (10) days for educational leave each fiscal year to attend professional conferences. This leave shall be with pay and the staff member shall receive up to $2,500 to cover documented expenses for attendance at said conference. However, in the event a staff member is delivering a paper at said conference, he/she shall receive up to $2,750 to cover documented expenses.
2. Staff members who are employed for fifty percent (50%) to fifty-nine percent (59%) of effort shall be entitled to up to ten (10) days for educational leave each fiscal year to attend professional conferences. This leave shall be with pay but said staff members shall receive no reimbursement for expenses. However, in the event a staff member is delivering a paper at said conference he/she shall receive up to $2,750. to cover documented expenses.
3. The schedule charted herein serves to clarify sections 1 and 2 above.

% OF EFFORT	NO PAPERS PRESENTED	PAPERS PRESENTED
0-49%	None	None
50-59%	10 days	10 days and $2,750. Maximum for Documented Expenses
60% or more	10 days and $2,500. Maximum for Documented Expenses	10 days and $2,750. Maximum for Documented Expenses

4. Notwithstanding that a staff member may be less than 100% of effort, there will be no prorating of the aforementioned amounts based upon percentage of effort worked except a indicated in sections 1, 2, and 3 above. The percentage of effort in effect at the time that the request to attend the conference is made to the Director of Service will be used in calculating the level of continuing education benefit.
5. Where conferences do not take the corporate American Express credit card issued to employees, staff members will receive, upon request, travel advances of up to 75% of the amount of anticipated expenses.
6. Staff members are obligated to render a full and documented accounting of their expenses within 15 calendar days of their return from the conference.
7. In order to receive this benefit, the staff member must attend a conference only in the entire United States, Canada and Puerto Rico and must receive appropriate approval of his/her Director of Service, and the Medical Director of the Affiliation.
8. Continuing education leaves shall not be cumulative and shall not be carried from one fiscal year to another except that there shall be a carryover of $350.00 per year.
9. Effective July 1, 1990, each employee shall be entitled to receive $200. toward the cost of medical books, professional dues or other related educational expenses upon approval of documented expenses.

ARTICLE 25 - RESIGNATION AND REQUESTS
FOR REDUCTION IN PERCENTAGE OF EFFORT

1. Whenever an Employee resigns, he/she will have the responsibility to give one (1) month’s notice to the Employer.
2. Whenever an Employee requests a reduction in percentage of effort on his/her own initiation, he/she shall request the change one (1) month in advance of its intended effective date.

This Agreement shall be binding on all the parties hereto, their legal representatives, assignees and successors in interest and shall survive changes of name or reorganization.

Except as in this Agreement otherwise provided, the Affiliation retains the exclusive rights that are ordinary and customary functions of management. None of these rights shall be exercised in a capricious or arbitrary manner, and they shall remain subject to the grievance procedure.

It is understood and agreed that all agreements herein are subject to all applicable laws now or hereafter in effect; and to the lawful regulations, rulings and orders of regulatory commissions or agencies having jurisdiction. If any provision of this Agreement is in contravention of the law or regulations of the United States or of the State of New York, such provision shall be superseded by the appropriate provision of such law or regulation, so long as the same is in force and effect; but all other provisions of this Agreement shall continue in full force and effect.

ARTICLE 29 - DURATION OF CONTRACT

This Agreement shall be effective February 1, 1996 and shall continue in full force and effect until June 30, 1999.

This letter of Agreement is issued simultaneously with the execution of the Collective Bargaining Agreement between Columbia University’s Affiliate at Harlem Hospital Center and United Doctors Association.

It is our mutual understanding that in the event the Affiliate has difficulty in recruiting a prospective doctor, because of the Union shop provision contained in the Collective Bargaining Agreement, such difficulty will be communicated to the United Doctors Association. After such notification, if representatives of each party are convinced that the doctor refuses to take employment with the Affiliate because of the Union shop provision, then the United Doctors Association agrees not to unreasonably withhold their consent to a case by case modification of said provision.

IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed and have set their hands and seals thereto executing this Agreement by duly authorized agents as of February 1, 1993.

Edward Healton, MD
Senior Associate Dean/Assistant Vice President
Columbia University
College of Physician and Surgeons
506 Lenox Avenue

Dear Dr. Healton:

This letter shall serve to clarify and confirm certain items contained in or referred to in Article I of the Memorandum of Agreement between the parties.

In calculating the salary reductions referred to in Article I, should a physician have a reduction in his/her percentage of effort during the term of this Agreement, the reductions shall be taken on the reduced salary. For example, Doctor X was earning $100,000 per annum at 100% of effort on 6/30/97. At some time thereafter his/her percentage of effort is reduced to 75%. Thus, his or her reduction of 5% shall be based on the lower salary of $75,000 and be $3,750, leaving the base salary for the balance of the Fiscal Year 1998 at $71,250 ($75,000 - $3,750).

This agreement shall be enforceable through the grievance procedure.

If the foregoing meets with your approval, please sign where indicated.

Very truly yours,

/s/

Herman Anderson, MD

AGREED:

Edward Healton, MD

Base:                       95% of FY 97 salary

Incentive Opportunities

Bonus Opportunity

Ratification Incentive: $1500/FTE if ratified by 3 July 1997

Base:                     90% of FY 97 salary

Incentive Opportunities

Bonus Opportunity

Ratification Incentive: $500/FTE if ratified by 3 July 1997.

There is attending on call coverage sufficient to supervise all elective approved anesthetizing locations (AALs) at a 1 to 1 or 1 to 2 ratio of attending physicians and certified registered nurse anesthetists (CRNAs). This usually permits 4 or 5 (sometimes 6) locations in the main operating room, one or two AAL in obstetrics, one AAL for endoscopy and a float person for emergencies and codes.

Personnel are assigned the day before and all such assignments are flexible. The high stress of our work, along with the uncertainty of ones duties places an additional emotional burden on the already overworked staff. For this reason, CRNAs and physician anesthesiologists are paid more that other providers with "similar" educational backgrounds at other institutions. I respectfully request that the professionals in our department be given the same courtesy and respect to equal dignity.

OPHTHALMOLOGY ON-CALL INTER-SERVICE CONSULTATION

POLICY STATEMENT: All emergency and urgent requests for consultations from other services must be evaluated by the on-call resident immediately (for emergency request) or within 3 hours (for urgent requests).

PURPOSE: In order to ensure that Ophthalmology consultation services are available on a 24 hour basis.

RESPONSIBILITY: The first on-call resident has a responsibility for carrying out this policy and ensuring that it takes place by calling the second on-call resident, attending on-call or second on-call attending serving as admitting officer of the day in that order.

PROCEDURES: The first on-call resident carries out the consultation seeking assistance when needed in the order of responsibility as indicated.

CONTROLS: Resident coordinator and associate director responsible for ensuring the implementation of this policy.

The schedule makers should keep a tally of number of days on call within each of the three priorities and file this record with the Confidential Secretary for future reference.

The First On-Call Resident after completion of the first six months of residency may leave the hospital premises only if a return can be made within 20 minutes. The Emergency Room, Telephone Operator and Nurse on 9N must be notified when the resident is leaving for home and where he/she can be reached.

Considerable time and effort is spent in the development of on-call and rotation schedules. All schedules are to be presented to those affected for approval before final schedule is given to the Confidential Secretary for typing and distribution. Only in the case of last minute emergencies should any chance in these final schedules take place. All changes must be approved by the Director before notifying the various sections of the hospital concerned. These include:

1. Departmental Administrator
   
2. Nurses Station, 9 North
   
3. Adult Eye Clinic Head Nurse
   
4. Appointment Clerks of the Adult Eye Clinic, Children’s Eye Clinic and the Department of Public Health Eye Clinic
   
5. The Emergency Room, Adult and Children’s
   
6. Switchboard Operators

Any changes in resident’s or attending’s schedules will be made through the Confidential Secretary who will indicate these changes on the Resident’s Bulletin Boards in both the Adult Eye Clinic, 9N Nurses Station and Administrative Office.

Departmental schedules are necessary for coordinating our efforts and cannot be effective if they are not accurate.

I. Work Day:

House staff should be on duty from 7:15 AM (ward rounds) until 5:00 PM. The night schedule covers the period from 5:00 PM until 8:00 AM. The switchboard operator and the area to which you are assigned should be informed of your whereabouts (the phone number in case of paging system failure). All absences from the hospital grounds must be cleared with the Chief Orthopedic Resident or the Attending on call. The work day on Saturday begins at 8:00 AM and ends at noon. Sundays and Holidays begin at 8:00 AM and end at 8:00 AM the following day. Each ending shift must communicate with the on coming shift to insure proper continuity of care.

II. Ward Activities:

Ward rounds should be made by the House Staff prior to 7:45 AM Monday through Saturday, and before 9:00 AM on Sunday. Blood work, x-ray requests, consultations, fluids, transfers, etc., to be done that day should be arranged for at this time. Every patient must be seen and problems must be sought out. Seriously ill and post-operative patients and complaints must be checked thoroughly. The senior resident must report problems on his ward to the Attending in charge.

Other ward work such as working up patients, setting up or adjusting traction, changing dressings, applying or removing casts, supervising exercises of patients, chart summarizations, chart rounds, etc., should be done during the day or early evening when other duties such as clinic, operating room or Accident ward do not interfere. Attendings covering the ward should make rounds with the residents and interns at least once daily. Grand ward rounds are Wednesday at 4:00 PM. Complete work-up x-ray and as much laboratory data as possible should be available in the morning for each patient admitted during the preceding 24 hours, preferably between 8:00 and 9:00 AM.

Discharge summaries are the responsibility of the senior resident. They are to be completed prior to discharge of the patient. A final note must be written in the chart. Be sure to record when the patient can attend work or school. A check should be made to see that pertinent laboratory test results, x-ray reports, operative reports and consultation requests are on the chart and the appropriate action is taken. All discharges must be approved by the Attending surgeon.

Transfer summaries to be given to the patient are the responsibility of the orthopedic resident. The chart must be simultaneously summarized as for a routine discharge.

1. Attending faculty will continue providing in-house coverage of all clinical functions (24-hours per day, 7 days per week, each day of the year).

2. There will be no changes made from our present system of compensation for on-call duties.

3. For the purpose of assuring that there be fair, safe, and reasonable rest periods between clinical activities, the following changes (pertinent to in-house night call) have been discussed, and agreed upon, by the Faculty Members and the Director of the Department of Obstetrics and Gynecology:

   1. When Attending Faculty members have been on-call in the hospital all night, they will be expected to have clinical responsibilities for a period of time that ends no later than 12:00 noon the following day.

   2. Exceptions to the above statement may be based on particular scenarios, such as in the following examples:

      1. When an Attending takes night-call on Friday or Saturday nights (when no scheduled clinical activities would normally follow the next day), a compensatory half-day may be taken off at a later date during the following two-week period of time. This compensatory time must be requested, in writing, within one week of the publishing of the call schedule, and must be used within two weeks of the call night in question. no compensatory time may be taken in advance of that particular call night. Only half-day blocks of time will be allowed in this regard.

      2. If an Attending is on night-call (Sunday through Thursday), and is scheduled to work in one of our late-evening out-patient clinics, a similar half-day of compensatory time will be allowed at a later date, using the above guidelines.

      3. If an Attending is scheduled for night call on Monday through Thursday and has no clinical duties scheduled at the Harlem Hospital Center or its satellite clinics for the day following the call, then no half-day compensation time will be given at a future date.

4. This agreement will be effective as of August 1, 1990 if and when it is found to be acceptable to the United Doctors of Harlem organization. We would need to have a written notice of acceptability from that body before assuming that we may proceed with the elements of this agreement. No such activity can be executed by the Department without such a written document.