REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
January 28, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Non-Financial Affiliation Agreement with Bear Valley Community Healthcare District for Resident Physician Clinical Rotations
End
RECOMMENDATION(S)
Recommendation
Approve Non-Financial Affiliation Agreement, including non-standard terms, with Bear Valley Community Healthcare District for a clinical rotation in rural medicine for Arrowhead Regional Medical Center emergency medicine resident physicians, for the period 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 this item will not result in the use of Discretionary General Funding (Net County Cost) as this Affiliation Agreement (Agreement) with Bear Valley Community Healthcare District is non-financial in nature.
BACKGROUND INFORMATION
This Agreement will allow Arrowhead Regional Medical Center’s (ARMC) emergency medicine resident physicians to obtain specialized training in rural medicine at Bear Valley Community Healthcare District (Bear Valley).
Resident physicians typically acquire specialty clinical knowledge at other medical facilities. These medical facilities offer the opportunity for resident physicians to gain experience caring for patients and performing procedures in specialties that ARMC may not offer or have too few patients to provide appropriate experience.
ARMC operates several accredited residency programs. Each program has specific requirements as to the numbers and types of patients to which a resident physician must provide care. To meet these requirements, with respect to volume and type, it is necessary to provide educational opportunities at other facilities to supplement those available at ARMC.
The Agreement includes non-standard contract terms or omits the standard County contract terms as follows:
1. The County agrees to indemnify Bear Valley for claims arising out of the negligence or willful misconduct of ARMC and the professional negligence of ARMC’s residents, except where the act or omission that caused harm was undertaken at the direction or supervision of Bear Valley, its officers, employees, agents, and volunteers.
• The standard County contract imposes no indemnity obligations on the County.
• Potential Impact: In the event a claim arises that falls within the scope of the County’s indemnity obligations, the County will be required to hire attorneys and incur costs in defending Bear Valley and paying any resulting settlement/judgment.
2. Bear Valley limits its general indemnity obligations to claims that arise due to the negligence or willful misconduct of Bear Valley, its officers, employees, subcontractors, agents, and volunteers.
• 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: Bear Valley'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 Bear Valley's limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement.
3. The Agreement does not require Bear Valley to meet the County’s insurance standards as required pursuant to County Policies, 11-05, 11-07 and 11-07SP.
• County policy requires contractors to carry appropriate insurance at limits and under conditions determined by the County's Risk Management Department and as set forth in County policy and in the County standard contract.
• Potential Impact: The County has no assurance that Bear Valley will be financially responsible for claims that may arise under the Agreement, which could result in expenses to the County that exceed the total Agreement amount.
ARMC recommends approval of this Agreement, including the non-standard terms, with the Bear Valley to enable ARMC resident physicians to obtain specialized clinical experience in rural medicine to help provide for the safety, health and social service needs of County patients.
PROCUREMENT
Not Applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5465) on December 19, 2024; Risk Management (Greg Ustaszewski, Staff Analyst II, 386-9008) on December 26, 2024; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on January 6, 2025; Finance (Jenny Yang, Administrative Analyst, 387-4884) on January 8, 2025; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on January 8, 2025.