REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
March 14, 2023
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Non-Financial Affiliation Agreement for Residency Rotations at City of Hope National Medical Center
End
RECOMMENDATION(S)
Recommendation
Approve a non-financial Affiliation Agreement, including non-standard terms, with City of Hope National Medical Center for Arrowhead Regional Medical Center General Surgery resident physicians to obtain clinical experience for a five-year period effective upon execution.
(Presenter: William L. Gilbert, Director, 580-6150)
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
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost) as the affiliation agreement with City of Hope National Medical Center (City of Hope) is non-financial in nature.
BACKGROUND INFORMATION
The resident affiliation agreement (Agreement) with City of Hope will allow Arrowhead Regional Medical Center (ARMC) General Surgery resident physicians to rotate at City of Hope to enhance their skills and training. ARMC operates several physician residency programs accredited by the Accreditation Council of Graduate Medical Education. The residency programs have specific requirements as to the numbers and types of patients to whom a resident physician must provide care. ARMC has worked with City of Hope to educate residents physician of multiple disciplines since 2017 under Affiliation Agreement No. 17-879, effective December 5, 2017 through December 4, 2022, approved by the Board of Supervisors on December 5, 2017 (Item No. 9).
This Agreement provides for the safety, health and social service needs of county residents by ensuring ARMC resident physicians receive specialty clinical training and experience, which will then enable them to deliver specialized medical care to ARMC patients. These medical facilities offer the opportunity for resident physicians to gain experience caring for patients and performing specialized procedures that ARMC may not offer or have too few patients to provide appropriate experience.
The Agreement is based on ARMC’s standard affiliation agreement, with terms negotiated by the parties, including the following non-standard contract terms:
1. The County agrees to indemnify City of Hope for claims arising out of the Agreement caused by the negligence or intentional acts of the County, ARMC, its officers, employees, agents and its resident physicians.
• The standard County contract does not require the County to contractually indemnify the contractor for any reason.
• Potential Impact: By agreeing to indemnify City of Hope, 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 City of Hope without such limitations and the County would be responsible to defend and reimburse City of Hope for costs, expenses, and damages.
2. City of Hope’s indemnification obligation is limited to the negligence or willful misconduct of City of Hope, its officers, employees, agents, and medical staff.
• The County general indemnity provision requires the contractor to indemnify, defend, and hold the County harmless from third party claims arising out of the acts, errors or omissions of any person.
• Potential Impact: In the event a claim arises that falls outside the scope of City of Hope’s limited indemnification obligation, the County could be solely liable for the costs of defense and damages.
3. The Agreement does not include certain standard County insurance requirements, including the provisions relating to additional insured, waiver of subrogation, severability of interests, acceptability of insurance carrier, insurance review, and failure to procure coverage.
• 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 City of Hope will maintain adequate and sufficient insurance to provide coverage to the County in the event of a claim, which may render the County liable for such expenses.
ARMC recommends approval of this Agreement, including the non-standard terms, to ensure that its resident physicians receive the necessary accredited training and experience to provide specialized medical care to the County’s residents.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on February 10, 2023; Risk Management (Victor Tordesillas, Director, 386-8623) on March 2, 2023; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on February 17, 2023; Finance (Jenny Yang, Administrative Analyst, 387-4884) on February 21, 2023; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on February 23, 2023.