REPORT/RECOMMENDATION TO THE BOARD OF DIRECTORS
OF INLAND COUNTIES EMERGENCY MEDICAL AGENCY
AND RECORD OF ACTION
August 19, 2025
FROM
DANIEL MUÑOZ, Interim EMS Administrator, Inland Counties Emergency Medical Agency
SUBJECT
Title
Grant Agreement with Public Health Institute for the Emergency Medical Services Buprenorphine Use Pilot Program
End
RECOMMENDATION(S)
Recommendation
Acting as the governing body of the Inland Counties Emergency Medical Agency:
1. Approve Subcontract Agreement with Public Health Institute, including non-standard terms, to accept funds in the amount of $75,000, for the Emergency Medical Services Buprenorphine Use Pilot Program, for the term of August 19, 2025 through March 31, 2027.
2. Authorize the Auditor-Controller/Treasurer/Tax Collector to post necessary budget adjustments to the Inland Counties Emergency Medical Agency’s 2025-26 budget, as detailed in the Financial Impact section, for the Emergency Medical Services Buprenorphine Use Pilot Program grant (Four votes required).
(Presenter: Daniel Muñoz, Interim EMS Administrator, 388-5807)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The one-time, total grant award for the completion of all program deliverables is $75,000. The total grant award will be received in four installments over 2025-26 and 2026-27. Appropriation and revenue adjustments for 2025-26, in the amount of $52,500, are as follows:
|
Fund Center |
Commitment Item / GL |
Description |
Action |
Amount |
|
1118002686 |
40509094 |
Federal - Grants |
Increase |
$52,500 |
|
1110002686 |
54404040 |
Equipment |
Increase |
$52,500 |
The remainder of the grant award, in the amount of $22,500, will be included in the Inland Counties Emergency Medical Agency (ICEMA) 2026-27 recommended budget. No matching funds are required with this grant subcontract.
BACKGROUND INFORMATION
ICEMA is the Local Emergency Medical Service Agency (LEMSA) for San Bernardino, Inyo, and Mono Counties. ICEMA administers State and local codes and regulations governing the provision of emergency medical care to the sick and injured at the scene of an emergency and during transport to a care facility.
In 2023, the Public Health Institute (PHI) engaged ICEMA, as the LEMSA, to partner in efforts to locally address the national opioid, namely Fentanyl, crisis. On March 26, 2024 (Item No. 76), the Board of Directors (Board) approved Grant Subaward Agreement No. 24-245 with PHI for the implementation of the Emergency Medical Services Buprenorphine Use Pilot (EMSBUP) program, in the amount of $375,000, for a term of March 26, 2024 through June 15, 2024. The Grant Subaward Agreement was for training and supplies to implement the EMSBUP program and for outcome data relating to the program’s effectiveness.
The EMSBUP program model allowed EMS providers to offer Buprenorphine, a medication to counter opioid withdrawal, to patients suffering from an opioid use disorder (OUD). Upon initial contact between EMS providers and patients, patients were offered long-term treatment options to address their OUD. Buprenorphine was initially given to patients on site and continually provided during the treatment process to counter opioid withdrawal.
The EMSBUP program’s focus was to support ICEMA and EMS providers by providing treatment and access points for patients with an OUD. EMS agencies participating in the EMSBUP program addressed substance use disorder as a treatable emergency condition, utilizing paramedics to identify and treat patients who would benefit from medication-assisted treatment.
ICEMA worked with EMS agencies and substance use navigators at hospitals to track patient outcome data and report data to PHI. The data was used to measure EMSBUP program effectiveness, treatment system gaps, and identify opportunities in better treating patients of underserved demographics.
After the conclusion of Grant Award Agreement No. 24-245, participating EMS providers have continued offering Buprenorphine to patients suffering from an OUD, operating under an ICEMA local optional scope of practice. The Subcontract Agreement (Agreement) being recommended is to resume reporting patient outcome data.
The Agreement is PHI’s subcontract which includes terms that differ from the standard ICEMA contract and omits certain standard contract terms. The PHI subcontract contains the following non-standard terms:
1. The Agreement requires each party to indemnify the other, and the Sierra Health foundation (Funding Agency) arising out of ICEMA’s performance of the subcontract.
• The ICEMA standard contract does not include any indemnification or defense by ICEMA of the Contractor.
• Potential Impact: By agreeing to indemnify PHI and the Funding Agency, ICEMA could be contractually waiving the protection of sovereign immunity. Claims that may otherwise be barred against ICEMA, time limited, or expense limited could be brought against the Contractors without such limitations and ICEMA would be responsible to defend and reimburse the Contractors for costs, expenses, and damages, which could exceed the total Agreement amount.
2. The Agreement does not require PHI to meet ICEMA’s insurance standards as required pursuant to County Policy 11-07.
• The County Policy requires contractors to carry appropriate insurance at limits and under conditions determined by the County’s Risk Management Department and set forth in the County standard contract.
• Potential Impact: ICEMA has no assurance that PHI will be financially responsible for claims that may arise from the parties’ performance of the subcontract, which could result in expenses to ICEMA that exceed the total Agreement amount.
3. The Agreement limits the liability of both parties in that neither party will be liable to the other for any indirect, incidental, special, consequential, or punitive damages, whether caused by negligence or otherwise.
• The ICEMA standard contract does not include a limitation of liability.
• Potential Impact: Claims could exceed the liability cap and the contract amount leaving the County financially liable for the excess.
4. The subcontract requires binding arbitration.
• The ICEMA standard contract does not include a binding form of dispute resolution.
• Potential Impact: ICEMA could be bound by a decision in arbitration and not have the opportunity to have the dispute adjudicated in court. Arbitration decisions are not appealable.
5. The subcontract requires that in any legal proceeding including arbitration, the prevailing party will be entitled to recover court costs and attorney fees.
• The ICEMA standard contract requires each party to bear its own costs and attorney fees, regardless of who is the prevailing party.
• Potential Impact: If either party institutes any legal proceedings related to the Agreement, the prevailing party will be entitled to recover reasonable attorneys’ fees, which could exceed the total Agreement amount.
ICEMA recommends approval of the Agreement, including the non-standard terms, because the benefits to ICEMA, EMS providers, and patients in using the EMSBUP program and receiving the subaward grant funds outweighs other considerations.
Either party may terminate the Agreement with 30 days written notice. Approval of this Agreement will provide ICEMA funds to support ongoing training of EMS agencies and tracking relevant data. Pursuant to County Policy 05-13, Board approval is needed to accept the grant award and approve the Agreement with PHI.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by County Counsel (John Tubbs II, Deputy County Counsel, 387-5455) on July 24, 2025; Risk Management (Greg Ustaszewski, Staff Analyst II, 386-9008) on July 24, 2025; Auditor-Controller/Treasurer/Tax Collector (Charlene Huang, General Accounting Manager, 382-7022) on July 24, 2025; and County Finance and Administration (Carl Lofton, Administrative Analyst, 387-5404) on July 31, 2025.