REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
February 25, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Revenue Affiliation Agreement for California State University, San Bernardino Physician Assistant Students to Obtain Clinical Training at Arrowhead Regional Medical Center
End
RECOMMENDATION(S)
Recommendation
Approve revenue Affiliation Agreement, including non-standard terms, with Trustees of the California State University on behalf of California State University, San Bernardino for physician assistant students to obtain clinical training at Arrowhead Regional Medical Center for the five year period, commencing on the latter of the date that the agreement is fully executed or its physician assistant program obtains all necessary accreditation and meets all requirements to operate such program under state and federal laws.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The Affiliation Agreement with the Trustees of the California State University on behalf of California State University, San Bernardino (CSUSB) will provide reimbursement to Arrowhead Regional Medical Center (ARMC) for the provision of teaching and support of physician assistant students at ARMC.
BACKGROUND INFORMATION
This Affiliation Agreement will allow CSUSB Physician Assistant (PA) students to obtain clinical training at Arrowhead Regional Medical Center.
CSUSB is opening a new PA school at the university and are interested in having ARMC as one of its training site partners. As there is a shortage of trained PAs in the County and Inland Empire, supporting this new program will benefit the long-term efforts to ensure the county has an adequate employment pool to serve the patient population for San Bernardino County.
CSUSB has agreed to pay ARMC $350 per week for each student for an estimated amount of $35,000 annually.
The Agreement with CSUSB was negotiated by the parties and includes the following non-standard contract terms:
1. The Agreement does not require CSUSB to meet all of the County’s insurance standards as required pursuant to County Policies, 11-05, 11-07, and 11-07SP
• County policy requires contractors to carry appropriate insurance at limits and under conditions determined by the County's Risk Management Department and as set forth in County policy and in the County standard contract.
• Potential Impact: The County has no assurance that CSUSB will be financially responsible for claims that may arise under the Agreement, which could result in expenses to the County.
2. CSUSB limits its indemnity obligation to claims that arise out of the performance of the Agreement, but only in proportion to and to the extent such liability, loss, expense, attorney’s fees, or claims are caused by or result from the negligence or intentional acts/omissions of CSUSB, its officers, agents, or employees.
• The County standard contract general indemnity provision requires the contractor to indemnify, defend, and hold County harmless from third-party claims arising out of the acts, errors or omissions of any person.
• Potential Impact: CSUSB’s indemnity obligation is more limited compared to the standard County general indemnity obligation. In the event a claim arises that falls outside the scope of that limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement. It should be noted that although CSUSB does not have any duty to indemnify the County for any malpractice claims of the PA students, the Agreement does impose an obligation on CSUSB to ensure that the PA students are covered by a malpractice insurance policy with limits of $2 million per occurrence and $4 million general aggregate that includes the County as an additional insured under that policy.
3. The County is required to indemnify CSUSB for claims that arise out of the performance of the Agreement, but only in proportion to and to the extent such liability, loss, expense, attorney’s fees, or claims are caused by or result from the negligence or intentional acts/omissions of the County its officers, agents, or employees.
• The County standard contract does not impose an indemnity obligation on the County.
• Potential Impact: To the extent a claim arises that falls within the scope of the County’s indemnity obligations, the County may be financially responsible for retaining a law firm to defend CSUSB and paying any resulting settlement/judgment.
4. The Agreement imposes certain insurance requirements on the County, including requiring the County to maintain general liability and professional liability insurance or a program of self-insurance with minimum limits of $1 million for each occurrence and $2 million general aggregate, and naming CSUSB as an additional insured under the general liability policy.
• The County standard contract does not impose any insurance obligations on the County.
• Potential Impact: The County will need to be mindful of these obligations to ensure it complies with the insurance requirement so as to not be in breach of the Agreement.
ARMC recommends approval of this Agreement with CSUSB, including the non-standard terms, as it provides for safety, health and social services needs of County residents by allowing CSUSB PA students the opportunity to learn and allows ARMC patients access to more medical professionals in a timely manner.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5465) on January 13, 2025; Risk Management (Greg Ustaszewski, Staff Analyst II, 386-9008) on January 22, 2025; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on January 30, 2025; Finance (Jenny Yang, Administrative Analyst, 387-4884) on February 3, 2025; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on February 3, 2025.