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
Transfer Agreement and Amendments to Transfer Agreements for Patients Requiring Specialized Hospital Services
End
RECOMMENDATION(S)
Recommendation
1. Approve Transfer Agreement, including non-standard terms, with Loma Linda University Children’s Hospital, for the transfer of County patients who require specialized hospital services for the period of December 1, 2025 through November 30, 2030.
2. Approve Amendment No. 1 to Agreement No. 23-808 with Loma Linda University Health Care, for the transfer of County patients who require specialized hospital services, extending the term of the Agreement by approximately four years and four months for a total term of August 5, 2023 through November 30, 2030.
3. Approve Amendment No. 1 to Agreement No. 23-809 with Loma Linda University Medical Center, for the transfer of County patients who require specialized hospital services, extending the term of the Agreement by approximately four years and four months for a total term of August 5, 2023 through November 30, 2030.
(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 costs for patient care services will be funded by State Medi-Cal, Federal Medicare, private insurances, and other departmental revenue. Funding sources may change in the future pending any legislative activity related to the repeal and/or replacement of the Affordable Care Act. Adequate appropriation and revenue have been included in the Arrowhead Regional Medical Center (ARMC) 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
Approval of the Transfer Agreement (Agreement) with Loma Linda University Children’s Hospital (LLUCH) and Amendment No. 1 to Agreement Nos. 23-808 and 23-809 (collectively “amendments”) with Loma Linda University Health Care (LLUHC) and Loma Linda University Medical Center (LLUMC), respectively, will allow for transfer of patients from County departments, including ARMC and Sheriff, to LLUCH, LLUMC, and LLUHC (collectively, Loma Linda) for specialized hospital services or higher level of care that is not available at any County healthcare facility. The Agreement and amendments provide timely access to specialized or advanced inpatient medical care.
The Agreement with LLUCH outline the responsibilities of both the County and Loma Linda in the transfer of inpatients requiring specialized hospital services. LLUCH provides pediatric services, while LLUMC and LLUHC provide adult specialty care. Each facility will pursue payment for services rendered via State Medi-Cal, Federal Medicare, and private insurance. If there is no available payor, the county is obligated to pay the agreed-upon rates for the care of indigent patients.
The Agreement with LLUCH was negotiated by the parties and deviates from the standard County contract terms as follow:
1. Loma Linda’s indemnity obligation is limited to any claims resulting from the negligent acts or failures to act of LLUCH, its trustees, officers, medical staff, agents or employees.
• 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: LLUCH’s indemnity obligation is more limited in the agreements compared to the standard County general indemnity obligation. In the event a claim arises that falls outside the scope of LLUCH’s limited indemnity obligation, the County may be solely liable for the costs of defense and damages.
2. The County is required to indemnify LLUCH from any claims that result from the negligent acts or failures to act of the County, its officers, medical staff, agents, or employees.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify LLUCH, 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 LLUCH without such limitations and the County would be responsible to defend and reimburse LLUCH for costs, expenses, and damages.
On July 25, 2023 (Item No. 20), the Board of Supervisors approved Agreement Nos. 23-808 and 23-809 with LLUHC and LLUMC, respectively, for the period of August 5, 2023 to August 4, 2026 to enable the transfer of County patients to LLUHC and LLUMC for higher level of inpatient care. Approval of the amendments are recommended so that all three agreements with Loma Linda will expire at the same time.
ARMC recommends approval of the Agreement, including the non-standard terms, and amendments to ensure that County residents continue to have timely access to specialized and higher levels of medical care not available at ARMC.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455) on October 21, 2025; Risk Management (Stephanie Mead, Staff Analyst II, 386-9044) on October 22, 2025, Finance (Chen Wu, Finance Budget Officer, 580-3165) on October 24, 2025; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on October 29, 2025.