REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
October 8, 2024
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Affiliation Agreement with The Regents of the University of California, Irvine on Behalf of the University of California, Irvine, School of Medicine for Specialized Clinical Training
End
RECOMMENDATION(S)
Recommendation
Approve Affiliation Agreement, including non-standard terms, with The Regents of the University of California, Irvine on behalf of the University of California, Irvine, School of Medicine to allow an Arrowhead Regional Medical Center Neurology resident physician to obtain specialized clinical training in Neuroscience Critical Care, in the amount of $350, effective October 8, 2024, through February 7, 2025.
(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 cost of $350 is funded by State Medi-Cal, Federal Medicare, private insurances, and other departmental revenue. Funding sources may change in the future pending any legislative activity related to the repeal and/or replacement of the Affordable Care Act. Adequate appropriation and revenue have been included in the Arrowhead Regional Medical Center (ARMC) 2024-25 budget.
BACKGROUND INFORMATION
This Affiliation Agreement with The Regents of the University of California, Irvine on behalf of the University of California, Irvine, School of Medicine (Agreement) will allow an ARMC Neurology resident physician to obtain specialized training in Neuroscience Critical Care at the University of California, Irvine, School of Medicine (UCI).
Resident physicians typically acquire specialty clinical knowledge at other medical facilities. These medical facilities offer the opportunity for resident physicians to gain experience caring for patients, and performing procedures, in specialties that ARMC may not offer or have too few patients to provide appropriate experience. UCI requires a fee of $350 per resident per rotation prior to the commencement of the rotation to offset administrative expenses.
ARMC operates several accredited residency programs. Each program has specific requirements as to the numbers and types of patients to whom a resident physician must provide care. To meet these requirements, with respect to volume and type, it is necessary to secure educational opportunities at other facilities to supplement those available at ARMC.
The Regents of the University of California, Irvine’s (Regents) standard Agreement contains terms negotiated by the parties that deviate from the standard County contract terms as follows:
1. The Agreement imposes insurance requirements on the County, including maintaining general, professional, workers' compensation insurance policies or programs of self-insurance at certain policy limits as specified in the Agreement. It also requires the County to furnish Regents a certificate of self-insurance, which must specify that the County will provide Regents at least thirty (30) days written advance notice prior to any modifications, changes, or cancellations of the coverage.
• 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 so as to not be in breach of those terms.
2. The Agreement does not include certain County insurance requirements.
• The County standard contract requires contractors to carry appropriate insurance at limits and under conditions determined by the County's Risk Management Department.
• Potential Impact: Without all of the standard provisions addressed above, the County has no reassurance that Regents will maintain adequate and sufficient insurance to provide coverage to the County in the event of a claim. Insufficient coverage could result in expenses to the County.
3. Regents limits its general indemnity obligations to claims that arise out of the performance of the Agreement, but only in proportion to and to the extent such claims are caused by or result from the negligent or intentional acts or omissions of Regents, its officers, employees, agents, or faculty members.
• 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: Regents’ 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 the limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement.
4. The County is required to indemnify Regents for claims that arise out of the performance of the Agreement, but only in proportion to and to the extent such claims are caused by or result from the negligent or intentional acts or omissions of the County, its officers, employees, agents, or residents.
• The County standard contract does not impose an indemnity obligation on the County.
• Potential Impact: In the event a claim arises that falls within the scope of the County’s indemnity obligation, the County would be financially responsible for paying for the defense of Regents and any resulting settlement/judgment.
5. Venue is in the state or federal courts of California.
• The standard County contract requires venue for disputes to be in the San Bernardino County Superior Court, San Bernardino District.
• Potential Impact: UCI is located in Orange County and the headquarters of Regents is in Alameda County. In the event a claim arises, Regents may file an action in Orange or Alameda County, which would result in expenses to the County in defending the action that might not have been incurred if the action was venued in San Bernardino County Superior Court, San Bernardino District.
ARMC recommends approval of this Affiliation Agreement, including the non-standard terms, with the Regents to enable an ARMC neurology resident physician to obtain specialized clinical training in Neuroscience Critical Care at UCI, which will then result in the resident having specialized skills in the delivery of medical care ARMC.
The Agreement with Regents provides for the safety, health and social service needs of County residents by ensuring that an ARMC resident physician receives specialty clinical training and experience, resulting in the delivery of specialized medical care to ARMC patients.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5465) on September 4, 2024; Risk Management (Gregory Ustaszewski, Staff Analyst II, 386-9008) on September 9, 2024; Purchasing (Veronica Pedace, Buyer III, 387-2464) on September 9, 2024; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on September 13, 2024; Finance (Jenny Yang, Administrative Analyst, 387-4884) on September 17, 2024; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on September 23, 2024.