Attachment I - Maritime Medical Support Services.pdf

Performance Work Statement (PWS) Maritime Medical Support Services

1. GENERAL

1.1 Scope

The contractor shall provide medical support services via telephone and secure electronic data transmission capability (to include images) including medical treatment advisement and programmatic support recommendations to the Government’s United States Public Health Service (USPHS) medical officers—Physicians Assistants (PAs), Nurse Practitioners (NPs), and Registered Nurses (RNs)—working aboard National Oceanic and Atmospheric Administration (NOAA) ships while underway or in foreign ports. When in U.S. ports, patients are referred to military facilities or public hospitals: medical support services performed for NOAA ships in US ports are NOT included within the scope of this contract. The Government will make ALL final decisions regarding patient care.

1.2 Mission/Background

The NOAA fleet consists of 16 ships representing over 500 berths for officers, crew, and scientists.

The ships are designated as oceanographic, fisheries, and hydrographic survey ships and are operated by NOAA’s Office of Marine and Aviation Operations (OMAO) and led by academic institutions and NOAA scientists to conduct operations throughout the world’s oceans. See Figure 1.

NOAA Research Ship Fleet Characteristics. Historically, over the past five years one ship has been removed from the fleet. NOAA projects that two to three ships will be added/removed over the contract period (base and option periods).

NOAA provides medically trained personnel to provide occupational medicine and urgent/ emergent medical care aboard these ships while underway and to provide occupational health services in its marine centers. There are four (4) NOAA ships that have permanent USPHS medical officers stationed aboard (one ship currently inactive for a total of 3): (1) Oscar Elton Sette, (2) Ronald H.

Brown (3) Okeanos Explorer, and (4) Hi’ialakai (inactive). These ships have limited Advanced Cardiac Life Support (ACLS) capability (drugs, equipment, supplies, and one trained medical officer), a pharmacy, and urgent care medical supplies to provide medical care while underway. The Government may determine at any time that other NOAA ships require USPHS medical officers for a given tour on a temporary and as-needed basis.

All NOAA ships have one or more Medical Persons in Charge (MPIC), individuals with two weeks United States Coast Guard (USCG) approved training equivalent to a basic emergency technician aboard at all times while underway. NOAA Health Services trains its own MPICs through a USCG approved curriculum and provides all medical supervision and oversight. One USPHS medical officer on each coast (rotating) has an on-call phone on a 24/7 basis to support all NOAA ships and MPICs.

This designated on-call medical officer is the first point of contact for an MPIC in need of medical instruction and or advice. If the MPIC is unable to reach the NOAA Health Services medical officer on call within two minutes in a serious emergency she or he is instructed to call the contractor’s 24/7 phone number for immediate assistance. In all other circumstances the contractor will be contacted by a USPHS medical officer for advisement.

All NOAA ships have a standard formulary: the formulary for ships with medical officers is more comprehensive than the ships with MPICs only. There is a designated space aboard each ship for the provision of medical evaluation and treatment. Medical evacuations at sea are uncommon and are arranged by NOAA.

NOAA ships may be contacted on ships’ cell phones when in a U.S. port and by Iridium line, voice over internet protocol line, or Inmarsat line when underway from any phone anywhere. Typically, calls will be initiated by the Government. However, when the contractor needs to make contact, the following options are available.

Iridium phone line – this is an 808 area code line for each ship. Historically this has been the most commonly used option.

Voice Over Internet Protocol (VOIP) line – this is an Internet-based phone line out of Oregon (541 area code).

Inmarsat line – though this option may be expensive, it is an option if no other phone line is available. This Inmarsat capability is configured (authorized) by the telephone company that provides the contractor’s phone service.

1.3 Impact

Sound medical advice and support from the contractor help prevent complications in the treatment of patient medical conditions in a shipboard environment in domestic and international waters. It can also support justification for the Government’s decisions to divert/evacuate ships. Alternately, the medical support services may also support the Government in averting unnecessary and costly ship diversions/evacuations. The medical support services identified in this Performance Work Statement (PWS) are required to enable the Government to make the best medical decisions possible, minimizing the risk of serious injury or death at sea while also minimizing the costs associated with unnecessary medical actions.

1.4 Place of Performance/Hours

The performance of work described in this PWS requires global access via telephone and secure electronic data transmission capability (to include images) from the contractor’s facility to the NOAA fleet of ships operating in and out of United States ports and various locations in the Atlantic, Pacific, Arctic Oceans, and the Gulf of Mexico. See Figure 1. NOAA Research Ship Fleet Characteristics. The contractor shall be available during regular business hours, Monday through Friday, for tasks described below in PWS paragraphs 2.2 and 2.3. The contractor shall be available on a 24/7 basis for the services described below in paragraphs 2.1.1 and 2.1.2.

1.4.1 Non-Emergency Line. The contractor shall provide a telephone number for administrative and programmatic issues that are non-emergency in nature (PWS paragraphs 2.1.2., 2.2., and 2.3.)

1.5 Confidentiality

The contractor shall adhere to all professional and legal standards of confidentiality of records consistent with the needs and requirements related to specific medical services including Health Insurance Portability and Accountability Act (HIPPA).

In order to protect patient confidentiality, the NOAA Director, Office of Health Services (DOHS) will assist the COR by acting as the point of contact for specified items as described herein. All parties are reminded that this in no way detracts or changes the responsibilities and limitations described in the contract including, but not limited to, CAP 1352.201-70, Contracting Officer’s Authority and CAR 1352.201-72. Contracting Officer’s Representative (COR). The NOAA DOHS will be identified in a separate letter at time of award and may be changed at any time by the Government via letter without prior notice to the contractor.

1.6 Invoice Summary

The contractor shall submit to the COR with its monthly invoice a summary of work performed by CLIN during the period including, but not limited to the following: the number of both emergency and non-emergency calls (broken down by received/made and the original incident/follow-up) and the telephone option utilized (i.e. iridium phone line, VOIP line, or Inmarsat line); the number of incidences of case management services performed (broken down by the original incident/follow-up); and the number of Individualized Assessments (IA) reviewed/fitness for duty status recommendations made.

2. TASKS

2.1 Unlimited 24/7 Access to Medical Advice and Case Management Services - Contract Line Item

Numbers (CLINs) 0001, 1001, 2001, 3001, and 4001)

2.1.1 Emergency Line. Medical advice calls to the contractor will be maintained by NOAA medical officers on an as-needed basis. The contractor shall provide and maintain an emergency telephone line with one or more board certified emergency physicians with maritime medicine experience (attending) to respond immediately to requests for medical advice calls on a 24 hours a day, seven-days a week (24/7) basis (PWS paragraphs 2.1.1. and 2.1.2) Medical advice calls shall always be answered promptly (within 10 rings or less). Under no circumstance will unanswerable, unanswered, interrupted, or dropped calls be acceptable (e.g., busy line, technical problem). The contractor shall note that ships may be 3,000 plus miles out at sea with the nearest evacuation point a 2-3 day sail away and that the emergency phone line shall have the capacity to meet all requirements of the PWS. Historically, the average number of calls have been approximately five calls or less made per month with number fluctuating month to month: this number represents new cases and does not include follow-up calls that may be required.

The attending shall provide consultation, assessment, recommendation(s) for treatment, and, when applicable, advice regarding whether a medical at-sea patient evacuation is deemed necessary. The Government will make the final decision regarding patient care.

The contractor shall provide immediate medical consultation directly to the medical officer who initiated the contact. For each case the contractor shall communicate information regarding the request for consultation and medical status to the NOAA DOHS within 24 hours, and thereafter on an as-needed basis, consistent with all applicable laws regarding such disclosures, until the case is closed. This communication shall be by email and sent to (director.health.services@noaa.gov). Initial notification of the request for consultation and medical status shall be sent to the NOAA DOHS within one week of closure of the case.

2.1.2 The contractor shall provide case management services for patients treated at any onshore medical facility upon the request of the NOAA medical officers. This involves the contractor communicating with the patients’ healthcare providers or emergency medical facilities to monitor patients’ conditions, appropriateness of care, prognosis, fitness for travel determination, and further case management services as appropriate.

2.2 Medical and Administrative Consultations (CLINs 0002, 1002, 2002, 3002, and 4002)

2.2.1 The contractor’s appointed medical director, or assistant medical director as applicable, shall be available to the NOAA DOHS for consultation and/or discussion regarding medical, administrative, or other related issues as necessary. The contractor shall respond within a timely period and provide updates as necessary. Historically, the average number of calls have been approximately three calls or less made per month, with numbers fluctuating month to month.

2.3 Quarterly Reviews (CLINS 0003, 1003, 2003, 3003, and 4003)

2.3.1 The medical director, or assistant medical director as appropriate, shall conduct a quarterly review evaluating as shipboard medical care provided by the USPHS medical officers and first responders whose ships were underway during the quarter.

2.3.2 A minimum of 5% of patient care medical visits from each sick call log shall be selected for review by the contractor no later than two weeks after submission of the sick call logs. In addition to review of this 5%, a medical case review of every visit where controlled substances were prescribed shall also be done by the contractor.

2.3.3 The NOAA DOHS shall be notified of this selection of medical visits after submission of the medical sick call logs. The NOAA DOHS will designate a NOAA medical officer to collect the requested information and communicate the information to the contractor.

2.3.4 A written summary of the quarterly chart review shall be sent to the NOAA DOHS of designated NOAA medical officer no later than three weeks after receipt of all medical documentation for cases requested. This summary shall include, but not be limited to, the following:

-Quarter and year for which the review is being provided

- Medical officer and ship name being reviewed

- Patient name

- Date of review

- Name of reviewer (contractor employee)

- Comments that address the quality of documentation provided, the degree to which the medical standard of care was met, other considerations in the differential diagnoses or in the physical exam, and other pertinent instructions, recommendations, or guidance that would improve the patient care outcome.

2.4 Not-fit for Duty Consultations (CLINs 0004, 1004, 2004, 3004, and 4004)

2.4.1 NOAA documents fitness for duty evaluations via an established policy and written format called the Individualized Assessment (IA) process when an employee might be considered not medically qualified for an extended period of time per medical standards and functional job requirements. The contractor shall review NOAA IAs and make a recommendation(s) regarding employees’ fitness for duty status. This recommendation shall be made in writing and sent to NOAA DOHS no later than one week after receipt of the IA. Historically, the average number of IAs has been approximately 15 or less per year with numbers fluctuating year to year.

3. KEY PERSONNEL

This is a non-personal services commercial contract. All personnel assigned to perform under this contract shall be employees of the contractor and not construed to be or identified as employees of the Government. The contractor shall ensure that no employer-employee relationship develops among Government and contractor personnel. The contractor shall ensure that the conduct and appearance of its employees while working under this contract in no way reflect discredit upon

NOAA.

All personnel shall be able to read, write, speak, and understand the English language. All personnel shall communicate on technical issues and possess the oral and written communication skills and investigative skills required to perform work in accordance with this PWS.

The contractor shall not employ persons for work on this contract if such employee is considered by the Contracting Officer (CO) to be a potential threat to the health, safety, security, general well-being, or operational mission of NOAA.

Failure to Provide Qualified Personnel: Repeated failure or excessive delay by the contractor to provide qualified personnel that meet the stated requirements may be deemed sufficient reason by the CO to terminate work under this contract in whole or in part for cause.

After award, any changes to personnel, as described in this section, shall be approved by the COR.

Key personnel (see CAR 1352.237-75 KEY PERSONNEL) will be appointed by the COR and, accordingly, will be appointed by letter.

3.1 Medical Director Services.

The contractor shall provide an emergency physician who will have overall responsibility for the medical services described in this PWS, to include maintaining communications with the Government and arranging all services. The contractor shall provide clinical oversight through direct communication with USPHS medical officers for medical care provided onboard ships. Additionally, the contractor shall provide an assistant medical director to act for the medical director when he/she is not available.

Minimum/General Experience: Board Certification (American Board of Medical Specialties) and one year experience in maritime medicine.

3.2 Emergency Physician Services.

The contractor shall respond immediately to requests for medical advice calls on a 24/7 basic as described in paragraph 2.1.1.

Minimum/General Experience: Board Certification (American Board of Medical Specialties) and one year experience in maritime medicine.

4. QUALITY

4.1 Quality Control.

Quality Control is the responsibility of the contractor. The contractor is responsible for the delivery of quality services/supplies to the Government.

4.2 Quality Assurance.

Quality assurance is a program for the systematic monitoring and evaluation of contract performance to ensure that standards of quality are being met. Quality assurance is the responsibility of the Government. The Government will evaluate the contractor’s performance in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is a Government only document primarily focused on what the Government must do to assure that the contractor has performed in accordance with the requirements of the contract.

4.3 Performance Requirements Summary (PRS).

The contractor service delivery requirements are summarized into performance objectives that relate directly to standards of performance required to meet mission essential needs. The performance threshold briefly describes the minimum acceptable overall levels of service required for each service. These thresholds are critical to mission success.

Performance Requirements Summary Performance Objective for Required Service

PWS

Para #

Standard Maximum Allowable Deviation from Requirement

Incentive/ Remedy

Unlimited 24/7 Access to Medical Advice and Case Management Services

2.1.1 Under no circumstance will

unanswerable, unanswered, interrupted, or dropped calls be acceptable (e.g. busy line, technical problem)

0% Non-compliance with this standard represents a potential for contract termination for cause.

Confidentiality 1.5 The contractor shall adhere to all professional and legal standards of confidentiality of records consistent with the needs and requirements related to

0% Non-compliance with this standard represents a potential for contract termination for cause.

specific medical services including HIPPA.

Not-Fit for Duty Consultations

2.4.1 Fit for duty status

recommendation shall be sent to the NOAA DOHS no later than one week after receipt of the IA.

Two calendar days’ deviation per

IA.

Deduction of 20% payment for each day late.

Quarterly Reviews

2.3.2 A minimum of 5% of

patient care medical visits from each sick call log shall be selected for review by the contractor no later than 2 weeks after submission of the sick call logs.

Five calendar days’ of deviation

Deduction of 1% payment for each day late.

Quarterly Reviews

2.3.4 Written summary of the

quarterly chart review sent to the designated NOAA medical officer no later than 3 weeks after receipt of all medical documentation for cases requested.

One calendar day of deviation.

Deduction of 1% payment for each day late.

5. DELIVERABLES

DELIVERABLE LIST

TITLE FORMAT REQUIRED DATE FREQUENCY DISTRIBUTION

Invoice Summary (PWS paragraph 1.6)

Shall be Microsoft Office or Adobe compatible, submitted via electronic mail.

Report may be in contractor format but must first be approved by the

NOAA DOHS.

Initial: With initial invoice.

Subsequent: Monthly with invoice.

Initial and monthly thereafter.

NOAA DOHS,

COR, CO

Written Request for Consultation and Medical Status (PWS paragraph 2.1.1)

Shall be sent via fax (or Microsoft Office or Adobe compatible, submitted via electronic mail if doing so is deemed secure by the

Initial: Within 24 hours of each case, and thereafter on as as-needed basis. A short summary of the case shall be sent to the NOAA DOHS within

Initial and as required for changes.

NOAA DOHS

Government).

Summary may be in contractor format, but must first be approved by the NOAA

DOHS.

one week of closure of the case.

Subsequent: Same as above for each case.

Written Summary of Quarterly Chart Review (PWS paragraph 2.3.4)

Shall be sent via secure electronic mail. Summary may be in contractor format, but must first be approved by the

NOAA DOHS.

Initial: Within 3 weeks after receipt of all medical documentation for cases requested.

Subsequent: Within 3 weeks after receipt of all medical documentation for cases requested thereafter.

Initial and quarterly thereafter.

NOAA DOHS

Fitness for Duty Status Recommendations (PWS paragraph 2.4.1)

Email. Initial: No later than one week after receipt of the IA.

Subsequent: No later than one week after receipt of subsequent IAs.

Initial and as required for changes.

NOAA DOHS

QCP (PWS

paragraph 4.1)

Shall be Microsoft Office or Adobe compatible, submitted via electronic mail.

Report may be in contractor format but must first be approved by the

NOAA DOHS.

Initial: Within 14 calendar days of contract award.

Subsequent: Within 5 working days when changes are necessary.

Initial and as required for changes.

NOAA DOHS,

COR, CO

NOAA Ship Hull # Class Year Built Homeport Length Gross Complement Draft (ft) Notes:

Transferred m(ft) Tonnage

Hi'ialakai R334 Tagos 3,7 Nov-84 Honolulu, HI 68.3(224) 1914 50 35 43 16' 10" Research, fishery survey, coral reefs *inactive* Tacoma Feb-04

Oscar Elton Sette R335 Tagos 13-18 Aug-98 Honolulu, HI 68.3(224) 1486 42 30 43 15 Research, fishery survey, coral reefs Halter Marine Jan-03

Okeanos Explorer R335 Tagos 13-18 Oct-88 Davisville, RI 68.3(224) 1486 46 43 16.83 (bow thruster retracted) Halter Marine Aug-08 40 20.08 (bow thruster lowered)

Gordon Gunter R336 Tagos 13-18 May-89 Pascagoula, MI 68.3(224) 1486 35 30 43 15 Halter Marine Aug-98

Fairweather S220 Aerojet-Jax SY Jan-68 Ketchikan, AK 70.4(231) 1591 57 30 43 15.5 Apr-68

Rainier S221 Aerojet-Jax SY Apr-68 Seattle, WA 70.4 (231) 1800 59 22 42 14.3 Oct-68

Nancy Foster R352 YTT Sep-90 Charleston, SC 56.7(187) 894 37 15 40 11.2 May-04

Ronald H. Brown R104 AGOR-24 Apr-97 Charleston, SC 83.5(274) 3180 60 60 52.5 19 Halter Marine Jul-97

Oregon II R332 Aug-67 Pascagoula, MI 51.8(170) 729 31 33 34 15 Halter Marine Mar-75

Thomas Jefferson S222 Halter Marine Jan-92 Norfolk, VA 63.4(208) 1767 38 45 45 15 Mar-09

Oscar Dyson R224 FSV Aug-04 Kodiak, AK 63.6(208.6) 2218 39 40 49.2 19.4 Halter Marine May-05

Henry B. Bigelow R225 FSV Jul-06 Woods Hole, MA 63.6(208.6) 2218 41 40 49.2 19.4 Halter Marine Jul-07

Pisces R226 FSV Jun-09 Pascagoula, MI 63.6(208.6) 2218 39 40 49.2 19.4 Halter Marine Aug-09

Bell M. Shimada R227 FSV Jan-10 Newport, OR 63.6(208.6) 2218 39 40 49.2 19.4 Halter Marine Aug-10

Ferdinand R. Hassler S220 SWATH May-11 New Castle, N.H. 38(123) 14 12 53.8 12.6 Halter Marine Jun-12

Reuben Lasker R228 FSV Nov-13 San Diego, CA 63.6(208.6) 2218 39 40 49.2 19.4 MMC May-14

Yr built= Yr delivered Compliment = Sum of Officers/Engineers/Crew plus maximum # scientists Yr trf= Commissioned by NOAA, transfer from US Navy or other. * ABS Registered Gross Tonnage

Atlantic, World wide ops Ocean, Atmosheric Research

Endurance (Days)

Beam (ft)

Figure 1. NOAA Research Ship Fleet Charachteristics

Fisheries service - Pacific Coast

Coastal Mapping - Atlantic and Gulf coasts, Caribbean Sea and Great Lakes

Alaska Coastal waters

Maine to North carolina, Georges Banks - Primary North East US waters from Gulf of Mexico,Carribbean, South Atlantic

Fisheries service - Pacific Coast

Operates primarily: Gulf of Mexico, Atlantic Coast,Carribean sea; Primarily does Hydrographic Surveys

Hydrographic survey platform, pri-ops near shore, Alaska coastal

Research, mapping, ROV - research conducted in both Atlantic, Pacific, and Gulf of Mexico.

Research, fishery survey, coral reefs _Gulf of Mexico, Carribbean

Hydrographic survey platform, pri-ops near shore, Alaska coastal

Operates primarily: Gulf of Mexico, SE Atlantic Coast,Carribean sea

US Atlantic, gulf Coast and Carribean ocean research and survey.

Appendix A-1 NOAA Fleet General Information

NOAA Ship Hull # Class Year Built Homeport Length Beam (ft) Gross Max Complement Notes:

Transferred m(ft) Tonnage Draft Sold

McArthur II R330 Tagos 3,7 Nov-85 Seattle, WA 68.3(224) 1914 37 (Tacoma) May-03

Oct-14 Hi'ialakai R334 Tagos 3,7 Nov-84 Honolulu, HI 68.3(224) 43 1914 15 47 Research, fishery survey, coral reefs

(Tacoma) Feb-04 Oscar Elton Sette R335 Tagos 13-18 Aug-98 Honolulu, HI 68.3(224) 1486 33 Research, fishery survey, coral reefs

(Halter Marine) Jan-03 Ka'imimoana R333 Tagos 13-18 Feb-89 Honolulu, HI 68.3(224) 1486 33

(Halter Marine) Apr-96 Oct-14

Okeanos Explorer R335 Tagos 13-18 Jun-89 Honolulu, HI 68.3(224) 1486 46 (Halter Marine)

Gordon Gunter R336 Tagos 13-18 May-89 Pascagoula, MI 68.3(224) 1486 35 (Halter Marine) Aug-98

Fairweather S220 Aerojet-Jax SY Jan-68 Ketchikan, AK 70.4(231) 1591 58

Rainier S221 Aerojet-Jax SY Apr-68 Seattle, WA 70.4 (231) 1800 55

Nancy Foster R352 YTT May-91 Charleston, SC 56.7(187) 894 35 May-09

Ronald H. Brown R104 AGOR-24 Apr-97 Charleston, SC 83.5(274) 3180 59 (Halter Marine)

Delaware II R445 Oct-68 Woods Hole, MA 47.2 (155) 610 30 Mar-75 Jun-13

Oregon II R332 Aug-67 Pascagoula, MI 51.8(170) 729 30 Mar-77

Thomas Jefferson S222 Jan-92 Norfolk, VA 63.4(208) 1767 31 Mar-09

Miller Freeman R223 May-67 Seattle, WA 65.5(215) 1515 45 May-74 Jan-14

David Starr Jordan R444 Nov-65 San Diego, CA 52.1 993 33 May-11

Oscar Dyson R224 FSV Jan-05 Kodiak, AK 63.6(208.6) 2218 39 (Halter Marine)

Henry B. Bigelow R225 FSV Jun-06 Woods Hole, MA 63.6(208.6) 2218 39 (Halter Marine)

Pisces R226 FSV Jun-09 Pascagoula, MI 63.6(208.6) 2218 39 (Halter Marine)

Bell M. Shimada R227 FSV 2008 Newport, OR 63.6(208.6) 2218 39 (Halter Marine) Aug-10

Ferdinand R. Hassler S220 SWATH 2010/11 EDD New Castle, N.H. 38 14 (Halter Marine)

Reuben Lasker R228 FSV 2012 San Diego, CA 63.6(208.6) 2218 (MMC) Nov-13

Yr built= Yr delivered Compliment = Sum of Officers/Engineers/Crew plus maximum # scientists Yr trf= Commissioned by NOAA, transfer from US Navy or other. * ABS Registered Gross Tonnage

Fisheries service - Pacific Coast

Coastal Mapping - Atlantic and Gulf coasts, Caribbean Sea and Great Lakes Fisheries service - Pacific Coast

Operates primarily: Gulf of Mexico, Atlantic Coast,Carribean sea; Primarily does Hydrographic Surveys

Marine Fishery and Ocean research, trawl gear testingWestern US Coastal waters and Alaska, Bering Sea Inactivated within a year

Alaska Coastal waters

Maine to North carolina, Georges Banks - Primary North East US waters from Gulf of Mexico,Carribbean, South Atlantic

Operates primarily: Gulf of Mexico, SE Atlantic Coast,Carribean sea

Research National Marine Sanctuaries west coast, sampling

Research, fishery surevys, coral reefs

Recently Homeported , HI

Research, fishery survey, coral reefs _Gulf of Mexico, Carribbean Hydrographic survey platform, pri-ops near shore, Alaska coastal Hydrographic survey platform, pri-ops near shore, Alaska coastal US Atlantic, gulf Coast and Carribean ocean research and survey.

Atlantic, World wide ops Ocean, Atmosheric Research

Operates primarily: Gulf of Maine, Georges Bank, Southern NE to Cape Hatteras, NC