REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 22, 2023
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Grant Applications to the California Department of Health Care Access and Information for the Song-Brown Primary Care Residency Program Grant
End
RECOMMENDATION(S)
Recommendation
1. Approve and authorize the submission of the following grant applications to the California Department of Health Care Access and Information, for the Song-Brown Primary Care Residency Grant Program, each in the amount of $625,000, for the combined total amount of $1,250,000, for the grant performance period of June 30, 2024, through August 31, 2027:
a. Family Medicine
b. Internal Medicine
2. Authorize the Director of Arrowhead Regional Medical Center to execute and electronically transmit the grant applications referenced in Recommendation No. 1, including any subsequent non-substantive amendments, subject to review by County Counsel.
3. Direct the Director of Arrowhead Regional Medical Center to transmit the grant applications referenced in Recommendation No. 1, and any subsequent non-substantive amendments, to the Clerk of the Board of Supervisors within 30 days of the transmission or execution of the documents.
(Presenter: William L. Gilbert, Director, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of the item will not result in the use of Discretionary General Funding (Net County Cost). The California Department of Health Care Access and Information (HCAI) does not require a match from the County to receive an award under the Song-Brown Primary Care Residency Program Grant (Song-Brown Program). If the funds are awarded by HCAI, Arrowhead Regional Medical Center (ARMC) will return to the Board of Supervisors (Board) for award acceptance and any necessary budget adjustments.
BACKGROUND INFORMATION
In accordance with the Song-Brown Health Care Workforce Training Act (Song-Brown Act), Health & Safety Code Sections 128200, et. seq., the California Healthcare Workforce Policy Commission (Commission) will consider applications to support the training of primary care physicians. After review of the applications, the Commission makes recommendations for grant awards to the Director of HCAI. HCAI works to increase and diversify California’s healthcare workforce through the Healthcare Workforce Development Division using funding initiatives such as the Song-Brown Program.
The Song-Brown Program funds institutions that train primary care physicians to provide health care in California’s medically underserved areas. HCAI gives priority to competitive proposals from programs that demonstrate success in the following areas:
• Graduating individuals who practice in medically underserved areas
• Enrolling members of underrepresented groups in medicine to the program
• Locating the program’s main training site in a medically underserved area
• Operating a main training site at which the majority of the patients are Medi-Cal recipients
ARMC has applied for and received Song-Brown Program funding since 2020. The proposed funding in the current item will help provide offsets to resident salaries, faculty development, resident conference travel, and other direct educational costs for operating the resident physician training program. ARMC is asking the Board to approve the submission of grant applications for its Family Medicine and Internal Medicine Residency Training Programs to HCAI.
The Family Medicine grant will assist ARMC’s funding for five existing Family Medicine positions to support the hospital’s effort to increase primary care physicians in the underserved regions of San Bernardino County. Additionally, the Internal Medicine grant will assist with funding for five existing resident positions for the Internal Medicine Department.
ARMC seeks to train racially and ethnically diverse resident physicians who are competent and culturally sensitive and who desire to practice in underserved areas after completing residency. Residents are exceptionally trained in their sub-specialty rotations with the goal of being competent to practice in areas of physician shortages without tertiary care centers. Residents are exposed to low-income patients in the inpatient and outpatient setting and learn about the difficulties many individuals face with complex care needs and very limited resources.
The grant applications require Board approval under County Policy No. 05-13 as the applications are binding on the County and by applying, the County agrees to certain grant terms as part of the application and any subsequent award. Those terms include the following:
1. HCAI has the right to audit the County’s expenditure of the grant funds to ensure compliance with the grant program requirements.
• The County standard contract does not permit a contractor to audit the County’s compliance.
• Potential Impact: HCAI has the right to review and copy the County’s records relating to the County’s use of the grant funds, and to the extent HCAI determines that the County failed to perform under the terms of the award agreement, HCAI may recover any and all amounts provided under the grant.
2. The County is required to indemnify, defend, and hold harmless the State, its officers, agents, and employees from any claims arising out of the County’s performance under any award Agreement. There is no reciprocal indemnification requirement on the HCAI or the State of California.
• The County’s standard contract does not include any indemnification or defense by the County.
• Potential Impact: The County would be responsible to defend and reimburse the State for the County’s acts or omissions under certain circumstances for costs, expenses, and damages, which could exceed the total amount the State awards the County under this grant program.
Approval of Recommendation No. 2 would authorize the ARMC Hospital Director to electronically sign and submit the Song-Brown Program grant applications, on behalf of the County, to the HCAI, as well as any non-substantive amendments necessary, subject to County Counsel review. ARMC will seek Board approval in the event the County is awarded grant funds in accordance with County Policy 05-13 and as required by the HCAI.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on August 11, 2023; Risk Management (Victor Tordesillas, Director, 386-8623) on July 28, 2023; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on July 31, 2023; Finance (Jenny Yang, Administrative Analyst, 387-4884) on July 31, 2023; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on July 31, 2023.