REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
Augst 5, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Referral Agreements with Loma Linda University Medical Center and Loma Linda University Healthcare for Patients Requiring Specialized Outpatient Care
End
RECOMMENDATION(S)
Recommendation
Approve Referral Agreements with the following entities, including non-standard terms, for the referral of County patients who require specialized outpatient services, for the period of August 5, 2025 through August 4, 2030:
1. Loma Linda University Healthcare
2. Loma Linda University Medical Center
(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 costs for patient care services will be funded by State Medi-Cal, Federal Medicare, private insurances, and other departmental revenue. Funding sources may change in the future pending and legislative activity related to the repeal and/or replacement of the Affordable Care Act. Adequate appropriation and revenue have been included in the County departments’ 2025-26 budget, including, but not limited to, Arrowhead Regional Medical Center (ARMC), Sheriff/Coroner/Public Administrator, and Probation Department, and will be included in future recommended budgets.
BACKGROUND INFORMATION
Approval of these Referral Agreements (Agreements) will allow patients from ARMC and other County departments to refer certain patients to Loma Linda University Medical Center and Loma Linda University Healthcare (collectively, Loma Linda) to receive specialized healthcare services on an outpatient basis that are not available at any County healthcare facility. These Agreements provide for the safety, health, and social service needs of county residents by ensuring the provision of specialized outpatient services.
The Agreements outline the responsibilities for both the County and Loma Linda in the referral of patients, for specialized outpatient services at Loma Linda. Loma Linda will pursue payment for services rendered via State Medi-Cal, Federal Medicare, and private insurances. If there is no available payor, the County is obligated to pay the agreed upon rates for the care of the indigent patient. Approval of these Agreements is in the best interest of the County as it provides for specialized care not available at ARMC.
The Agreements were negotiated by the parties, which include the following non-standard contract terms:
1. Loma Linda is not required to add the County as an additional insured on its insurance policies.
• The County standard contract requires the contractor to add the County as an additional insured on its insurance policies.
• Potential Impact: Without being named as an additional insured, the County will not be treated as an insured party under Loma Linda’s insurance policies. In the event of an insurable claim, the County will not receive all the benefits of an insured party but will be treated as a claimant under the policy.
2. Loma Linda’s indemnity obligation is limited to any claims resulting from the negligent acts or failures to act of Loma Linda, its trustees, officers, medical staff, agents or employees.
• The County standard contract 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: Loma Linda’s indemnity obligation is more limited in the Agreements compared to the standard County general indemnity obligation. In the event a claim arises that falls outside the scope of Loma Linda’s limited indemnity obligation, the County may be solely liable for the costs of defense and damages.
3. The County is required to indemnify Loma Linda from any claims that result from the negligent acts or failures to act of the County, its officers, medical staff, agents, or employees.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify Loma Linda, 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 Loma Linda without such limitations and the County would be responsible to defend and reimburse Loma Linda for costs, expenses, and damages.
ARMC recommends approval of the Agreements, including the non-standard terms, as they are in the best interest of the County to have an expedient and fiscally responsible method for referral to the closest facility able to provide the specialized care.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on July 8, 2025; Risk Management (Greg Ustaszewski, Staff Analyst, 386-9008) on July 10, 2025; Sheriff/Coroner/Public Administrator (Carolina Mendoza, Chief Deputy Director, 387-0640) on July 18, 2025; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on July 11, 2025; Probation (Thomas Kamara, Director of Probation Administration, 387-5822) on July 21, 2025; and County Finance and Administration (Jenny Yang, 387-4884, Erika Rodarte, 387-4919, and Iliana Rodriguez, 387-4205, Administrative Analysts ) on July 18, 2025.