REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 18, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Revenue Affiliation Agreement with Loma Linda University for and by its School of Allied Health Professions, Physician Assistant Program
End
RECOMMENDATION(S)
Recommendation
Approve Revenue Affiliation Agreement with Loma Linda University for and by its School of Allied Health Professions, Physician Assistant Program, including non-standard terms, to provide physician assistant students with clinical training and experience at Arrowhead Regional Medical Center, for a rate of $350 per week for each physician assistant student, for a term of five years from the date of execution.
(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). Arrowhead Regional Medical Center (ARMC) will receive reimbursement at a rate of $350 per week for each physician assistant student who participates in a clinical rotation under the Revenue Affiliation Agreement (Agreement) with Loma Linda University for and by its School of Allied Health Professions, Physician Assistant Program (LLU). Actual reimbursement will vary depending on the number of students participating. Adequate appropriation and revenue have been included in ARMC 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
This Agreement will allow ARMC to provide clinical training for physician assistant students from LLU. In turn, these students will assist in the delivery of patient care at ARMC under supervision.
A key component of ARMC’s mission is to provide education to students in a variety of disciplines. ARMC has a number of agreements with universities and colleges, junior colleges, and technical and trade schools to provide on-site clinical training for students in a variety of fields. This clinical training is necessary for students to obtain their degrees, licenses, and/or certifications.
The patient volume and diverse case mix create a comprehensive educational environment for LLU physician assistant students. Through this Agreement, physician assistant students will receive onsite clinical training and experience and critical skills required to obtain their degrees.
The Agreement includes non-standard contract terms or omits the standard County contract terms as follows:
1. LLU limits its indemnity obligations to claims that arise from the act, failure to act or the negligence of LLU, its faculty, employees and students.
• 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: LLU'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 LLU's limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement.
2. The Agreement imposes insurance obligations on the County, including requiring the County to maintain hospital professional, workers’ compensation, and general lability insurance policies, and to provide LLU 30 days advance notice prior to cancellation of such policies.
• The standard County contract does not impose any insurance requirements on the County.
• Potential Impact: The County must be mindful of the insurance requirements and ensure compliance with those requirements to avoid being in breach of the Agreement terms.
3. The County is required to indemnify LLU for claims that arise out of the negligence of the County, its employees or authorized agents.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify LLU, 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 LLLU without such limitations and the County could be responsible to defend and reimburse LLU for costs, expenses, and damages, which could exceed the total Agreement amount.
ARMC recommends approval of this Agreement, including the non-standard terms, to provide clinical training for LLU physician assistant students, who will assist in the delivery of medical care to County residents and help expand the pool of qualified healthcare professionals in the community.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455) on October 21, 2025; Risk Management (Stephanie Pacheco, Staff Analyst II, 386-9039) on October 22, 2025; ARMC Finance (Chen Wu, Budget and Finance Officer, 580-3165) on October 24, 2025; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on October 29, 2025.