RELEASE AND WAIVER OF LIABIITY RELATING TO COVID-19
The SARS-CoV-2, also known as coronavirus disease (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization (“W.H.O.”). The San Mateo Medical Center (SMMC) endeavors to provide care for all patients in the safest way possible while maintaining safety for our healthcare personnel, including residents, interns, and students. However, there are risks inherent in working in a healthcare setting and treating patients.
As a clinical or dental resident, intern, or student, this waiver of liability is to advise you of these risks and the mutual responsibilities for you and SMMC, should you choose to participate at one of our site locations.
RISKS OF WORKING IN HEALTHCARE SETTING:
- Exposure to suspected or confirmed patients or others with COVID-19.
- Community spread of COVID-19 is higher at some of our sites in San Mateo County.
- With community spread in all counties, it is difficult to determine where exposure may have happened, if exposure should happen.
- There is no known cure or vaccine at this time if exposure should happen.
- Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death.
- Access to, the use of adequate personal protective equipment (PPE) and organizational COVID-19 policies and procedures related to safety and patient care- Clinical work that residents, interns, or students perform during the pandemic response must be considered in assessment of a trainee’s qualifications for program completion. Where possible, credits should be given for work performed during this time.
RESIDENT, INTERN, OR STUDENT RESPONSIBILITIES:
- Follow and adhere to PPE use and all organizational COVID-19 policies and procedures related to safety and patient care. PPE (personal protective equipment) Training and Respirator Fit Testing for Trainees is the Responsibility of Training School.
- If I become ill or suspect or have confirmed exposure to COVID-19, I will immediately alert my supervisor at SMMC and contact my educational institution/program.
- I voluntarily agree to participate as a resident, intern, or student and understand the risks I am placing myself in if I participate in a program at one of the SMMC sites.
- I knowingly and voluntarily assume all risks associated with my participation as a resident, intern, or student, including but not limited to, exposure or infection of COVID-19, and as a result, possible serious and potentially life-threatening illness and even death. My experience as a resident, intern or student is of such value to me that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to participate in the learner experience at SMMC.
I hereby attest that I have NOT had any known exposure to any person (patient, family member, other personal contact) who has been diagnosed with COVID-19 in the 2 weeks prior to starting this current clinical rotation at SMMC.*
I have received the Safety Agreement with regard to COVID-19 as part of my Expectations packet at the start of my rotation.
I will abide by the hospital’s universal masking policy at all times.
I will do my best to maintain social distancing of 6’ as much as possible in my interactions with others while on the premises of the hospital.
I understand that I can speak to any medicine attending, resident, intern, my preceptor(s) or clerkship director if I have any questions regarding safety or if I feel uncomfortable or concerned for my safety with regard to any patient I am asked to see, even if the patient is not believed to have COVID. I understand that it is my duty to speak up if I am uncomfortable so that corrective action may be taken as appropriate.
I understand that as a part of the safety agreement between SMMC and my medical school, I will NOT be permitted to see formal PUI or COVID-confirmed patient or any patient who requires the use of PPE (e.g. MDRO, CRE, TB).
* Note that if you have had known contact to any person with diagnosis of COVID-19 (whether they were symptomatic or asymptomatic) in the 2 weeks prior to starting your rotation at Highland, you will be required to self-isolate for 14 days and thereby delay the start of your rotation.
WAIVER AND RELEASE OF LIABILITY:
- I hereby forever release and waive my right to bring any claim or lawsuit against SMMC and its officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID- 19 related to my participation as a resident, intern or student at SMMC sites.
- I understand that this means that I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.
I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE: