REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
July 23, 2024
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Non-Financial Affiliation Agreement with Karma Doctors & Associates, P.C. for Specialized Clinical Training in Repetitive Transcranial Magnetic Stimulation and Addiction Medicine
End
RECOMMENDATION(S)
Recommendation
Approve Non-Financial Affiliation Agreement, including non-standard terms, with Karma Doctors & Associates, P.C. to allow resident physicians to obtain specialized clinical training in repetitive transcranial magnetic stimulation and addiction medicine for the period of July 23, 2024 through July 22, 2026.
(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) as this Affiliation Agreement (Agreement) with Karma Doctors & Associates, P.C. (Karma) is non-financial in nature.
BACKGROUND INFORMATION
This Agreement will allow Arrowhead Regional Medical Center’s (ARMC) resident physicians to obtain specialized training in repetitive transcranial magnetic stimulation and addiction medicine at Karma.
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.
ARMC operates several accredited residency programs. Each program has specific requirements as to the numbers and types of patients to which a resident physician must provide care. To meet these requirements, with respect to volume and type, it is necessary to provide educational opportunities at other facilities to supplement those available at ARMC.
The Agreement contains the following non-standard contract terms:
1. The County is required to indemnify Karma for any claims caused by the negligence or willful misconduct of ARMC and for the professional negligence of the residents that participate in rotations at Karma.
• The County’s standard contract does not contractually require the County to indemnify the contractor.
• Potential Impact: By agreeing to indemnify Karma, 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 Karma without such limitations and the County would be responsible to defend and reimburse Karma for costs, expenses, and damages.
2. Karma limits its indemnity obligations to claims caused by the negligence or willful misconduct of Karma, its officers, employees, subcontractors, and volunteers.
• 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: Karma’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 Karma’s limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement.
3. Karma is not required to comply with all of the County’s standard insurance requirements, including the provisions relating to severability of interest, additional insured, acceptability of insurance, insurance review, waiver of subrogation 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 Karma will maintain adequate and sufficient insurance to provide coverage to the County in the event of a claim. Insufficient coverage could leave the County financially liable for the claims.
The Agreement with Karma provides for the safety, health and social service needs of County residents by ensuring that ARMC resident physicians receive specialty clinical training and experience, resulting in the delivery of specialized medical care to ARMC patients.
ARMC recommends approval of this Affiliation Agreement, including the non-standard terms, with Karma to enable ARMC resident physicians to obtain specialized clinical training in repetitive transcranial magnetic stimulation and addiction medicine.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455) on June 25, 2024; Risk Management (Gregory Ustaszewski, 386-9008) on June 27, 2024; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on June 27, 2024; Finance (Jenny Yang, Administrative Analyst, 387-4884) on June 27, 2024; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on June 27, 2024.