REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 18, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Revenue Affiliation Agreement with Western University of Health Sciences for Physician Assistant Clinical Training
End
RECOMMENDATION(S)
Recommendation
Approve Revenue Affiliation Agreement with Western University of Health Sciences, including non-standard terms, to provide physician assistant students with clinical training and experience at Arrowhead Regional Medical Center, reimbursed at a rate of $350 per student per week, for the term of five years from the date of full 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 this item 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. Actual reimbursement will vary depending on the number of students participating. Adequate appropriation and revenue have been included in ARMC 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
This Revenue Affiliation Agreement (Agreement) will allow ARMC to provide clinical training for physician assistant students from Western in the field of anesthesiology, diagnostic radiology, emergency medicine, family medicine, internal medicine, neurology, neurosurgery, obstetrics/gynecology, psychiatry, surgery, and vascular surgery. In turn, these students will assist in the delivery of patient care at ARMC under supervision of the medical staff.
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 Western physician assistant students. Through this Agreement, physician assistant students will receive specialty clinical training and experience and critical skills required to obtain their degrees.
This Agreement will supersede and replace Master Affiliation Agreement No. 99-1225 and Physician Assistant - Sub agreement No. 99-1227, which are evergreen agreements entered into between Western and the County in 1999 for Western’s physician assistant students to participate in clinical training at ARMC. The Agreement will update the contractual requirements to meet current County contract standards, except for the deviations discussed below.
The Agreement includes non-standard contract terms or omits the standard County contract terms as follows:
1. Western limits its indemnity obligation to claims that arise from any negligence, willful misconduct, or breach of the Agreement by Western, its employees, agents, and students.
• 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: Western'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 Western's limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement.
2. The Agreement imposes insurance obligations on the County, including maintaining insurance policies or programs of self-insurance for hospital professional liability, general liability, and workers’ compensation. It also requires the County to furnish its Certificate of Insurance to Western and give Western 30 days advance written notice of any cancellations.
• The County standard contract does not impose any insurance requirements on the County.
• Potential Impact: The County will need to be mindful of the insurance obligations imposed on the County and ensure compliance to avoid being in breach of the Agreement.
3. The County must indemnify Western for claims that arise out of the negligence, willful misconduct or breach of the Agreement by the County, its employees, or agents.
• The County standard contract does not impose any indemnity obligations on the County.
• Potential Impact: By agreeing to indemnify Western, 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 Western without such limitations and the County could be responsible to defend and reimburse Western for costs, expenses, and damages, which could exceed the total Agreement amount.
ARMC recommends approval of this Agreement, including the non-standard terms, to provide clinical training for Western 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 September 22, 2025; Risk Management (Stephanie Pacheco, Staff Analyst II, 386-9039) on September 25, 2025; ARMC Finance (Chen Wu, Budget and Finance Officer, 580-3165) on October 24, 2025; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on October 27, 2025.