REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
March 29, 2022
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Amendment to Agreement with the California Emergency Medical Services Authority for Medical Staffing Resources
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 5 to Agreement No. 20-1246 with the California Emergency Medical Services Authority for medical staffing resources to increase the contract amount by $20,000,000, from $5,000,000 to $25,000,000, with no change to the contract term of December 2, 2020, through the end of the Governor’s emergency declaration issued on March 4, 2020.
2. Authorize the Auditor-Controller/Treasurer/Tax Collector to post budget adjustments, as detailed in the Financial Impact section, to fund the cost of providing medical staffing resources (Four votes required).
(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 this item will not result in the use of Discretionary General Funding (Net County Cost). The additional cost of $20,000,000 is funded by department salary savings resulting from staffing vacancies that have occurred during the fiscal year. The recommended budget adjustments, as reflected in the table below, are needed to provide the Arrowhead Regional Medical Center (ARMC) with sufficient appropriation authority in 2021-22 for costs associated with providing medical staffing resources.
The necessary budget adjustments are as follows:
|
Fund Center |
Commitment Item/GL Account |
Description |
Increase (Decrease) Amount |
|
9110004200 |
51001010 |
Regular Salary |
($20,000,000) |
|
9110004200 |
52002335 |
Temporary Help |
$20,000,000 |
BACKGROUND INFORMATION
In response to the COVID-19 pandemic, the Governor issued a Proclamation of State of Emergency dated March 4, 2020, and Executive Order N-39-20 dated March 30, 2020. In accordance with the Emergency Declaration and Executive Order, the State, by and through the California Emergency Medical Services Authority (Services Authority), launched the California Health Corps initiative to expand California’s healthcare workforce to ensure adequate staff for treatment sites experiencing staffing impacts due to the pandemic. As a result of that initiative, the Services Authority provided healthcare facilities the opportunity to access temporary staffing resources under three staffing services agreements, California Health Corps Staff Services Agreement, California Medical Assistance Team Staff Services Agreement, and California Contracted Medical Staff Services Agreement.
On December 1, 2020, based on the authority delegated to him by the County Board of Supervisors (Board), the County Chief Executive Officer (CEO) executed three staffing services agreements with the Services Authority to enable ARMC to access the temporary staffing resources offered by the State. The term of the agreements were from December 1, 2020 through the end of the Governor’s emergency declaration declared on March 4, 2020, for the aggregate not-to-exceed amount of $3,000,000. On December 15, 2020 (Item No. 36), the Board ratified these agreements.
At the request of the State, all three agreements were combined and submitted under one agreement number with the Services Authority (Agreement No. 20-1246), for tracking purposes. Although all three staff services agreements were executed by the CEO under Agreement No. 20-1246, ARMC has only utilized the services of the California Contracted Medical Staff.
Agreement No. 20-1246 has been approved and amended four times by the CEO based on the delegated authority granted by the Board and later ratified by the Board. On January 14, 2021, the CEO executed Amendment No. 1 to Agreement No. 20-1246 to expand the available classification positions and to amend the hourly rates for some of the positions. The Board subsequently ratified Amendment No. 1 on February 9, 2021 (Item No. 23).
On November 10, 2021, the CEO executed Amendment No. 2 to Agreement No. 20-1246 to amend the hourly rates for the various positions, specify overtime and holiday pay requirements, and increase the contract amount by $2,000,000, from $3,000,000 to $5,000,000. The Board subsequently ratified Amendment No. 2 on December 7, 2021 (Item No. 20).
On January 14, 2022, the CEO executed Amendment No. 3 to Agreement No. 20-1246 to update staffing classifications and hourly rates. The Board subsequently ratified Amendment No. 3 on February 8, 2022 (Item No. 68).
On February 28, 2022, the CEO executed Amendment No. 4 to Agreement No. 20-1246 to expand the types of staffing classifications available and to amend the hourly rates. The request for ratification of Amendment No. 4 will be presented to the Board on March 29, 2022.
Amendment No. 5 will increase the contract amount for Agreement No. 20-1246 from $5,000,000 to $25,000,000. This additional increase is necessary because ARMC has experienced and continues to experience significant shortages of its own personnel due to the COVID-19 pandemic, and the agreement helps ARMC mitigate such shortages. For compliance, ARMC must maintain certain patient to nurse ratios across all patient care departments. For example, the intensive care unit (ICU) requires a ratio of one nurse to every two patients; labor and delivery requires a ratio of one nurse to every one patient during active delivery; and the Trauma unit is one nurse to one patient during resuscitation. The Emergency Department (ED) ratio is one nurse to four patients, or one nurse to two patients for ICU patients in the ED. Beginning January 2022 to present, the State has provided an average of up to 50 staff positions a day to cover shortages and maintain ratios, helping to sustain critical hospital operations. These positions are guaranteed 12-hour shifts, four to six days a week.
The State generally has up to nine-month delays issuing invoices for this particular agreement, and invoices are still pending from the State for the services rendered since the latest surge. Furthermore, the State has informed ARMC that they plan to continue authorization of the Medical Staff Services Agreement through June 2022. From January to present, the hospital has expended an average of $904,431 per week for staffing services rendered under this agreement. The current contract balance is $547,726 as of January 1, 2022. Therefore, $10,000,000 is requested to cover pending invoices from January 2022 to now, and an additional $10,000,000 is requested to cover anticipated expenditures under this agreement through June 2022.
ARMC recommends approval of the amendment to provide for the safety, health and social service needs of County residents by ensuring all expenditures are covered related to staffing provided by the Services Authority to mitigate COVID-19 related personnel shortages.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on March 25, 2022; Auditor-Controller/Treasurer/Tax Collector (Vanessa Doyle, Deputy Chief Controller, 387-5669) on March 17, 2022; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on March 15, 2022; and County Finance and Administration (Diana Atkeson, Deputy Executive Officer, 387-5423) on March 15, 2022.