REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE COUNTY OF SAN BERNARDINO
AND RECORD OF ACTION
July 14, 2020
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
CalMedForce Program Grant Awards and Agreements
End
RECOMMENDATION(S)
Recommendation
1. Accept grant award and approve CalMedForce Awardee Grant Agreement with Physicians For A Healthy California in the amount of $150,000 annually, for a four year grant program in the total amount of $600,000, for the period of July 1, 2020, through September 30, 2024, for training of primary and emergency physicians in California and funding for graduate medical education at Arrowhead Regional Medical Center’s Obstetrics and Gynecology Residency Program.
2. Accept grant award and approve CalMedForce Awardee Grant Agreement with Physicians For A Healthy California in the amount of $100,000 annually, for a three year grant program in the total amount of $300,000, for the period of July 1, 2020, through September 30, 2023, for training of primary and emergency physicians in California and funding for graduate medical education at Arrowhead Regional Medical Center’s Internal Medicine Residency Program.
3. Accept grant award and approve CalMedForce Awardee Grant Agreement with Physicians For A Healthy California in the amount of $120,000 annually, for a three year grant program in the total amount of $360,000, for the period of July 1, 2020, through September 30, 2023, for training of primary and emergency physicians in California and funding for graduate medical education at Arrowhead Regional Medical Center’s Family Medicine Residency Program.
4. Accept grant award and approve CalMedForce Awardee Grant Agreement with Physicians For A Healthy California in the amount of $150,000 annually, for a four year grant program in the total amount of $600,000, for the period of July 1, 2020, through September 30, 2024, for training of primary and emergency physicians in California and for graduate medical education at Arrowhead Regional Medical Center’s Emergency Medicine Residency Program.
(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.
Operate in a Fiscally-Responsible and Business-Like Manner.
Create, Maintain, and Grow Jobs and Economic Value in the County.
FINANCIAL IMPACT
Approval of the item does not impact Discretionary General Funding (Net County Cost) as the $1,860,000 awarded grant funds detailed below do not require matching funds. The grant funding will be used to support direct costs including resident and faculty salaries, simulation training, ultrasound equipment and training, faculty development, and resident and faculty travel expenses for presenting at local, regional, and national conferences as part of the program’s scholarly activity requirements. Approval of the necessary budget adjustment to Arrowhead Regional Medical Center (ARMC) is not requested at this time, but will be included on a future quarterly countywide budget report presented to the Board of Supervisors (Board) and will be included in future recommended budgets.
|
Year |
Obstetrics and Gynecology |
Internal Medicine |
Family Medicine |
Emergency Medicine |
Annual Grant Total |
|
1 |
$150,000 |
$100,000 |
$120,000 |
$150,000 |
$520,000 |
|
2 |
$150,000 |
$100,000 |
$120,000 |
$150,000 |
$520,000 |
|
3 |
$150,000 |
$100,000 |
$120,000 |
$150,000 |
$520,000 |
|
4 |
$150,000 |
|
|
$150,000 |
$300,000 |
|
Total |
$600,000 |
$300,000 |
$360,000 |
$600,000 |
$1,860,000 |
BACKGROUND INFORMATION
Approval of Recommendations will accept four CalMedForce grants awarded by Physicians For A Healthy California (PHC), as specified in the grant applications, to support the specific Residency programs funded by the grants. More specifically, approval of the grant award agreements will allow ARMC to use the funding from the grants to support the educational training of the Obstetrics and Gynecology, Emergency Medicine, Internal Medicine, and Family Medicine Residency Programs.
The California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) was approved by voters and allocates $40 million of funding towards Graduate Medical Education (GME) to sustain, retain, and expand California residency positions in primary care and emergency medicine. All accredited residency programs in the state meeting the guidelines set forth in Proposition 56 are eligible to apply for funding. The University of California is the designated recipient of the funding and has contracted with PHC to administer the annual $40 million in grants allocated from Proposition 56.
The grant applications were approved by County CEO on October 25, 2019, pursuant to County Grant policy 05-13. On November 25, 2019, ARMC was informed that all four applications for the respective residency programs were approved and were awarded four individual grants.
ARMC did not receive the grant award contracts from PHC until June 3, 2020. PHC is unable to change the start date as it has to coincide with the academic year, which starts July 1. PHC has approved ARMC to submit the signed agreements after the Board’s approval is obtained without any affect to the award amounts. This item is being retroactively presented at this time as this is the first date available after the required administrative, operational, and legal reviews.
PHC is authorized by Proposition 56 and the University of California to issue grants for the purpose of increasing the number of primary care and emergency physicians trained in California (Purpose). Use of the grant funding will support and provide for the safety, health and social services needs of County residents, as the goal of the grant funding is to sustain, retain, and expand graduate medical education programs to achieve the Purpose, based on demonstrated workforce needs and priorities.
The grant agreements incorporate several terms and conditions that are not part of the County’s standard contract provisions, as discussed below.
Travel Restrictions
The agreements incorporate by reference the State’s travel restrictions in AB 1887, which prohibits the use of state funds to travel to certain states that authorize discrimination or repeal existing laws prohibiting discrimination based on sexual orientation, gender identity and gender expression.
• The County’s standard contract does not contain any travel restrictions.
• Potential Impact: ARMC may not be able to use any grant fund for travel to states listed on <https://oag.ca.gov/ab1887>, unless one of the seven exceptions of AB 1887 apply. The exceptions can also be found in the link. ARMC must be mindful of this when using the funds for travel.
Indemnification
The agreements require each party to defend, indemnify, and hold the other harmless against all claims of liability, expenses, and losses (including attorney’s fees) for damages, but only in proportion to the indemnifying party’s own negligence or intentional acts or omissions.
• The County’s standard contract does not contain any indemnification obligations on the County.
• Potential Impact: The County would have to indemnify PHC, but only in proportion to the County’s fault. By agreeing to this, the County could be contractually waiving the protection of sovereign immunity. Claims that may otherwise be barred against the County may potentially be brought against PHC, and the County may be required to defend and indemnify PHC.
Audit/Site Visit for Inspections
The agreements require that ARMC permit PHC, the California State Auditor or Controller, or their representatives, access to records on the source of income and expenditures of its medical education program for audit, inspection, and examination, and to accommodate requests for site visits to ARMC.
• The County’s standard contract does not permit the other party to audit the County’s compliance or to inspect the County’s records.
• Potential Impact: The County may incur fees and costs to accommodate any request to conduct a site visit and/or inspection/audits.
ARMC recommends approval of the grant awards and agreements, including the non-standard terms, as their approval will enable ARMC to increase funding for four residency programs, which include Obstetrics and Gynecology, Internal Medicine, Family Medicine, and Emergency Medicine.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on June 4, 2020; ARMC Finance (Chen Wu, Budget and Finance Officer, 909-580-3165) on June 8, 2020;Finance (Yael Verduzco, Administrative Analyst, 387-5285) on June 25, 2020; and County Finance and Administration (Matthew Erickson, County Chief Financial Officer, 387-5423) on June 28, 2020.