REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
October 8, 2024
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Agreement with Baxter Healthcare Corporation for the Lease of the Exactamix Compounder Equipment and Abacus Software License
End
RECOMMENDATION(S)
Recommendation
Approve Exactamix Compounder Lease and Abacus Software License Agreement with Baxter Healthcare Corporation, including non-standard terms, to be used to formulate intravenous nutrition solutions, in the amount of $75,843.60, for the agreement term of November 1, 2024, through October 31, 2029.
(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). The total cost of $75,843.60 is funded by State Medi-Cal, federal Medicare, private insurance, 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) 2024-25 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
The Agreement will allow ARMC to continue to utilize the Baxter Healthcare Corporation (Baxter) Exactamix Compounder (Compounder) equipment and Abacus software license for the accurate preparation of patient-specific total parenteral nutrition (TPN), also known as intravenous feeding, formulations for both adult and neonatal patients. The Compounder and Abacus software enable the pharmacy to compound neonatal and adult parenteral solutions safely and efficiently. The Compounder mixes parenteral ingredients to formulate intravenous nutrition solutions that are tailored to the individual patient. The Abacus software, which is designed to work only with the Compounder, performs complex formulation calculations, and provides clinically important ingredient compatibility and dose warnings to the pharmacist.
The Exactamix Compounder Lease and Abacus Software License Agreement (Agreement) is Baxter’s standard commercial contract, which includes terms that differ from the standard County contract, and omits certain County standard contract terms. While the parties negotiated certain contract terms to County standards, Baxter would not agree to all County standard terms. The non-standard and missing terms include the following:
1. Baxter’s maximum liability to the County is limited to the amounts paid by the County, in the 12 months prior to the claim, excluding indemnification obligations, gross negligence, willful misconduct, and violations of law.
• The County standard contract does not include a limitation of liability.
• Potential Impact: Claims could exceed the liability cap and the Agreement amount leaving the County financially liable for the excess.
2. Payment terms are net 30 days with late payment interest of 1.5% per month.
• County standard payment terms are net 60 days with no interest or late payment penalties.
• Potential Impact: County standard processing time is 60 days or more. Failing to pay within 30 days of the invoice date may result in a material breach of the Agreement, which could allow Baxter to terminate the Agreement and seek other legal remedies, including charging the County interest at a rate of 1.5% per month of the unpaid amount, which could exceed the Agreement amount.
ARMC recommends approval of the Agreement, including non-standard terms, to provide for the safety, health and social needs of County residents by providing accurate and safe preparation of patient-specific TPN to improve patient outcomes and quality of life for County residents.
PROCUREMENT
The Purchasing Department supports this non-competitive procurement based on equipment/system compatibility. The Compounder and Abacus software are currently used at ARMC. ARMC has been utilizing the Compounder to meet the intravenous nutritional needs of the patients since October 18, 2016. Staff have been trained on and have experience with the use of the Compounder and Abacus software.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Bonnie Uphold, Supervising Deputy County Counsel, 387- 5455) on September 5, 2024; Purchasing (Veronica Pedace, Buyer III, 387-2464) on September 5, 2024; Risk Management (Loretta Acuña, Staff Analyst II, 386-9039) on September 5, 2024; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on September 13, 2024; Finance (Jenny Yang, Administrative Analyst, 387-4884) on September 17, 2024; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387- 5423) on September 23, 2024.