REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
October 21, 2025
FROM
JOSHUA DUGAS, Director, Department of Public Health
SUBJECT
Title
Revenue Agreements with Education Agencies for County-provided School Nursing Services
End
RECOMMENDATION(S)
Recommendation
Approve revenue agreements to provide school nursing services, including non-standard terms, in an aggregate amount estimated to be $55,200, for the period of October 21, 2025 through June 30, 2026, with the following education agencies:
1. Baker Valley Unified School District
2. Lucerne Valley Unified School District
3. Mt. Baldy Joint Elementary School District
4. Trona Joint Unified School District
(Presenter: Joshua Dugas, Director, 387-9146)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
This item will not impact Discretionary General Funding (Net County Cost). The Department of Public Health (DPH) will receive revenue in an aggregate amount estimated to be $55,200, for the period of October 21, 2025 through June 30, 2026, for health screening services provided to each of the education agencies (Schools) listed in the Recommendation. Adequate appropriation and revenue have been included in DPH’s 2025-26 budget.
BACKGROUND INFORMATION
California Education Code sections 49452 et seq. requires that students in public schools receive health screening services to identify health conditions that can affect their learning and progress. DPH has been providing nursing services in schools for more than 45 years, including nursing consultations and screenings for hearing, vision, and scoliosis. Nursing services also include referrals and follow-up services based on screening results and, when otherwise unavailable, consultations and educational services for disease control and immunization concerns. Historically, DPH has provided nursing services for school districts that do not employ their own nurses.
DPH estimates it will perform approximately 3,300 screenings collectively at specified school sites. The Schools will reimburse the County at a rate of $178.63 for each hour worked by DPH staff while performing those screenings. Based on the reimbursement rate and expected number of screenings, the amount of reimbursement is estimated to be $55,200.
The agreements contain non-standard terms that require approval by the Board of Supervisors (Board) per County Policy 11-05. The non-standard terms include the following:
1. The County is required to indemnify the Schools against third party claims for any and all claims arising from the County's negligent acts or omissions.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify the Schools, the County could be contractually waiving the protection of sovereign immunity. Claims that may otherwise be barred against the County, time limited, or expense limited could be brought against the School without such limitations and the County would be responsible to defend and reimburse the School for costs, expenses, and damages, which could exceed the total agreement amount.
2. The agreements do not require the Schools to meet the County’s insurance standards as required pursuant to County Policy 11-07.
• The County Policy requires contractors to carry appropriate insurance at limits and under conditions determined by the County’s Risk Management Department and set forth in the County standard contract.
• Potential Impact: The agreement does not include County standard insurance requirements. The Schools are self-insured entities, requiring the County to rely on the Schools’ assurance that it will be financially responsible for claims that may arise through the term of the agreement, potentially resulting in expenses to the County that exceed the total agreement amount.
DPH recommends approval of the agreements, including the non-standard terms, so that the required services and screenings can be provided to the students. DPH will not provide services until agreements have been fully executed.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Daniel Pasek, Deputy County Counsel, 387-5455) on September 25, 2025; Risk Management (Gregory Ustaszewski, Staff Analyst, 386-9008) on September 17, 2025; County Finance and Administration (Iliana Rodriguez, Administrative Analyst, 387-4205) on October 2, 2025.