REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
May 19, 2026
FROM
JOSHUA DUGAS, Acting Director, Department of Behavioral Health
SUBJECT
Title
Affiliation Agreement with Loma Linda - Inland Empire Consortium for Healthcare Education for the Residency/Fellowship Training
End
RECOMMENDATION(S)
Recommendation
Approve affiliation Agreement with Loma Linda - Inland Empire Consortium for Healthcare Education, including non-standard terms, for their residents and/or fellows to obtain clinical experience with the Department of Behavioral Health, in the amount not to exceed $2,738,016, for the period of July 1, 2026 through June 30, 2031.
(Presenter: Joshua Dugas, Acting Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote and Fulfill the Countywide Vision.
Create, Maintain and Grow Employment Opportunities and Economic Value in the County.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The Department of Behavioral Health (DBH) will reimburse Loma Linda (Loma Linda) - Inland Empire Consortium for Healthcare Education (LLIECHE) for the salary and benefits of four resident and/or fellow positions. The recommended total reimbursement amount of $2,738,016 will be funded by Behavioral Health Services Act (BHSA) funds. Consistent with industry standards, the placement site, DBH will reimburse the residency training program, LLIECHE, for the time residents and fellows spend providing services. Through this Agreement, four full-time equivalent (FTE) positions will be funded annually, at an average cost of $136,901 per FTE. Adequate appropriation and revenue have been included in DBH’s 2026-27 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
As the San Bernardino County’s (County) designated Mental Health Plan, DBH is mandated to maintain a qualified network of psychiatric providers to ensure timely access to mental health services, pursuant to California Department of Health Care Services, Title 9, sections 1810.225In order to meet this need, DBH has partnered with Loma Linda to create a training system for current residents and fellows in the LLIECHE program.
LLIECHE provides DBH with both residents and fellows who are current physicians training to specialize in a particular field of medicine. Fellows have completed their residency and are furthering their training within a specialty. The recommended Agreement allows for up to four residents and/or fellows at any given time to rotate through DBH’s clinical programs. These rotations occur on a monthly basis, with a maximum of 48 monthly rotations available each year. Assignments may include any combination of residents and fellows across the DBH system of care, providing exposure to a diverse range of clinical settings while maximizing training opportunities.
The County has experienced a severe shortage of psychiatrists, with future projections of increased shortages indicating an ever-growing need for additional residents and/or fellows as those trained through the LLIECHE program. One of the objectives listed within the County Workforce Education & Training component of the BHSA Integrated Plan (IP) is to increase the number of physicians in the public mental health field. BHSA requires counties to submit three-year IPs for Behavioral Health Services and Outcomes. The BHSA IP is a three-year prospective global spending plan describing a county behavioral health department’s plan to utilize State funding to meet statewide and local outcome measures, reduce disparities, and address the unmet needs in their community.
This program allows recruitment from the current residents and/or fellows at LLIECHE, helping to meet the demand for skilled physicians to serve residents of the County, strengthening recruitment for DBH’s system of care, by addressing the need for physicians, while maximizing the participation of residents/fellows in the training program.
The Agreement was negotiated by the parties to include the following non-standard terms:
1. The County is required to indemnify LLIECHE, its residents and fellows for claims, demands or judgments against LLIECHE arising out of the operation of the program, including the acts or omissions of LLIECHE’s residents and fellows.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify LLIECHE, its residents and fellows, 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 LLIECHE without such limitations and the County could be responsible to defend and reimburse LLIECHE for costs, expenses, and damages.
2. The Agreement does not include certain standard County insurance requirements, including that the County be named as an additional insured, and requires the County to provide Professional Liability and General Liability coverage for LLIECHE residents and fellows.
• The County standard contract requires contractors to carry appropriate insurance at limits and under conditions determined by the County’s Risk Management Department.
• Potential Impact: Without being named as an additional insured, the County may be prohibited from submitting a legitimate claim against LLIECHE policies. Additionally, the County is obligated to maintain insurance on behalf of the LLIECHE residents and fellows, which results in an increased cost and liability for the County.
DBH recommends the approval of the Agreement, including the non-standard terms, to allow DBH to maintain the collaborative partnership with LLIECHE to provide essential mental health services. DBH has the option to recruit from the current residents and/or fellows at LLIECHE, helping to meet the demand for skilled physicians for a seamless delivery of services and continuous training to meet the specific needs of the county residents and DBH.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health (Diana Barajas, Administrative Supervisor I, 383-3940) on April 1, 2026; County Counsel (Kristina Robb, Deputy County Counsel, 387-5455) on April 17, 2026; Risk Management (Arrissia Beaven, Staff Analyst II, 386-9030) on April 21, 2026; and County Finance and Administration (Iliana Rodriguez, Administrative Analyst, 386-8392) on May 4, 2026.