REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
September 23, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Revenue Affiliation Agreement with Marshall B. Ketchum University
End
RECOMMENDATION(S)
Recommendation
Approve Revenue Affiliation Agreement with Marshall B. Ketchum University, including non-standard terms, to provide physician assistants students with clinical training and experience at Arrowhead Regional Medical Center, for a rate of $350 per week for each physician assistant student, for the term of five years from the date of execution.
(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 the Revenue Affiliation Agreement with Marshall B. Ketchum University (MBKU)will not result in the use of Discretionary General Funding (Net County Cost). Arrowhead Regional Medical Center (ARMC) will receive reimbursement at a rate of $350 per week for each physician assistant student who participates in a clinical rotation under the agreement with MBKU. Actual reimbursement will vary depending on the number of participating students.
BACKGROUND INFORMATION
This Agreement will allow ARMC to provide clinical training for physician assistant students from MBKU in the field of orthopedics. In turn, these students will assist in the delivery of patient care at ARMC under supervision.
A key component of ARMC’s mission is to provide education to students in a variety of disciplines. ARMC has a number of agreements with universities and colleges, junior colleges, and technical and trade schools to provide on-site clinical training for students in a variety of fields. This clinical training is necessary for students to obtain their degrees, licenses, and/or certifications.
The patient volume and diverse case mix create a comprehensive educational environment for MBKU physician assistant students. Through this Agreement, physician assistant students will receive specialty clinical training and experience and critical skills required to obtain their degrees.
The Agreement includes non-standard contract terms or omits the standard County contract terms as follows:
1. The County agrees to indemnify MBKU for claims arising out of the negligence, willful misconduct, or breach of the Agreement by the County.
• The standard County contract imposes no indemnity obligations on the County.
• Potential Impact: By agreeing to indemnify MBKU, 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 MBKU without such limitations and the County could be responsible to defend and reimburse MBKU for costs, expenses, and damages.
2. MBKU limits its general indemnity obligations to claims that arise due to the negligence, willful misconduct, or breach of the Agreement by MBKU, its officers, directors, employees, students, and agents.
• 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: MBKU'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 MBKU's limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement.
ARMC recommends approval of this agreement, including the non-standard terms, to provide clinical training for MBKU physician assistant students, who will assist in the delivery of medical care to County residents and help expand the pool of qualified healthcare professionals in the community.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5465) on August 19, 2025; Risk Management (Greg Ustaszewski, Staff Analyst II, 386-9044) on August 25, 2025; ARMC Finance (Chen Wu, Budget and Finance Officer, 580-3165) on August 29, 2025; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on September 4, 2025.