REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 9, 2022
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 both Family Medicine and Internal Medicine grant applications, including non-standard terms, to the California Department of Health Care Access and Information for the Song-Brown Primary Care Residency Program Grant, in the combined amount of $1,775,000, for the grant performance period of June 30, 2023, through August 31, 2026.
2. Authorize the Director of Arrowhead Regional Medical Center to execute and electronically transmit the grant applications, 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, and all supporting documents, to the Clerk of the Board of Supervisors within 30 days of the transmission of the grant application.
(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 (formerly known as Office of Statewide Health Planning and Development (OSHPD)) works to increase and diversify California’s healthcare workforce through the Healthcare Workforce Development Division (HWDD) using funding initiatives such as the Song-Brown Program.
The Song-Brown Program funds institutions that train primary care medical professionals to provide health care in California’s medically underserved areas. Competitive proposals demonstrate a commitment to Song-Brown Program goals and success in meeting the three statutory priorities:
• Attracting and admitting underrepresented minorities and those from underserved communities
• Training Physician Residents in underserved areas
• Placing graduates in underserved areas
The proposed funding 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 two existing resident positions and three expansion 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 non-standard County contract terms, including the following:
1. Minimum insurance coverage type and limits are not specified.
• The County’s standard contract has an extensive list of insurance requirements relating to various insurance coverage and limits, and requires contractors to add the County as an insured and waive subrogation rights.
• Potential Impact: The terms and conditions of any award issued do not include any insurance requirements. This means the County has no assurance that the State will have the financial support of an insurance company for any claims that may arise under any subsequent award Agreement, which could result in the County bearing financial responsibility if the State does not, or is unable to, fulfill its obligations. Additionally, to the extent the State has the proper insurance coverage, the policy will not provide direct coverage to the County as a named insured.
2. The County is required to indemnify, defend, and save 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 the approval of a Board Resolution at a later date to accept an award under this program 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 July 15, 2022; Risk Management (Victor Tordesillas, Director, 386-8623) on July 20, 2022; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on July 20, 2022; Finance (Jenny Yang, Administrative Analyst, 387-4884) on July 21, 2022; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on July 21, 2022.