REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
May 19, 2026
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Template Agreements with the American College of Radiology for Accreditation of Medical Imaging Modalities
End
RECOMMENDATION(S)
Recommendation
1. Approve Practice Site Accreditation Survey Agreement Template, with the American College of Radiology for the quality survey and accreditation of medical imaging equipment at Arrowhead Regional Medical Center and its Family Health Centers, in an amount not to exceed $100,000, for a period of May 19, 2026 through May 18, 2031.
2. Approve the Mammography Accreditation Survey Agreement Template, including non-standard terms, with the American College of Radiology for the quality survey and accreditation of the mammography equipment at Arrowhead Regional Medical Center and its Family Health Centers, in an amount not to exceed $25,000, for the period of May 19, 2026 through May 18, 2031.
3. Authorize the ARMC Chief Executive Officer to execute Practice Site Accreditation Survey Agreements with the American College of Radiology, including non-standard terms, for the quality survey and accreditation of medical imaging equipment at Arrowhead Regional Medical Center and its Family Health Centers, subject to review by County Counsel.
4. Authorize the ARMC Chief Executive Officer to execute the Mammography Accreditation Survey Agreements with the American College of Radiology, including non-standard terms, for the quality survey and accreditation of mammography equipment at Arrowhead Regional Medical Center and its Family Health Centers, subject to review by County Counsel.
(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 aggregate cost of $125,000 is 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’s (ARMC) 2025-2026 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
ARMC’s main hospital and Family Health Centers (FHCs) operate numerous imaging equipment, including, but not limited to, ultrasound equipment, mammography equipment, computed tomography (CT), nuclear medicine and magnetic resonance imaging (MRI), that are required to be regularly surveyed and accredited by the American College of Radiology (ACR) for use. The accreditation helps assure all patients are provided with the highest level of image quality and safety by documenting that ARMC meets the requirements for medical imaging equipment.
In order to conduct the survey and accreditation, ACR requires a one-time agreement each time it conducts a survey, which then accredits the equipment for a period of three years. These agreements are required for any new medical imaging equipment installed at ARMC and its FHCs, and every three years for renewal of accreditation of existing medical imaging equipment. ACR utilizes different agreements based on the type of equipment that is being accredited, which includes the following:
• Practice Site Accreditation Survey Agreement, utilized for the accreditation of computed tomography (CT), nuclear medicine, magnetic resonance imaging (MRI), X-ray, and ultrasound equipment;
• Mammography Accreditation Survey Agreement, utilized for the accreditation of mammography equipment, (collectively referred to as Agreements)
There are slight variations in the terms of the Agreements used by ACR depending on the type of equipment accredited; however, the non-standard terms are the same for each agreement.
The agreements with ACR are based on its standard commercial agreements, which are non-negotiable, and deviate from the standard County agreement terms as follows:
1. The agreements are silent on governing law and venue.
• The County standard agreement requires California governing law and venue in San Bernardino County Superior Court, San Bernardino District.
• Potential Impact: Because the Agreements are silent on governing law and venue, there is uncertainty over which state's laws will govern the interpretation of the agreements and lead to ambiguity in the interpretation of the agreement terms and the venue of any dispute. ACR is based in Virginia. The Agreements could be interpreted under any state law depending on where the claim is brought, including Virginia or California. Any questions, issues or claims arising under these Agreements could require the County to hire outside counsel competent to advise on the applicable state law, which may result in fees and expenses to the County.
2. The Agreements do not contractually require ACR to defend or indemnify the County under any circumstance.
• The County standard agreement 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: ACR is not required to defend, indemnify or hold the County harmless from any claims, including indemnification for claims arising from ACR’s negligent or intentional acts. If the County is sued for any claim, the County may be solely liable for the costs of defense and damages. County Counsel cannot advise on whether and to what extent Virginia law may allow the County to require ACR to defend or indemnify it absent an express provision in the agreement.
3. The Agreements do not address attorneys' fees and costs.
• The County standard agreement requires each party to bear its own costs and attorney fees, regardless of who is the prevailing party.
• Potential Impact: There is no provision in the Agreements addressing each party's responsibility for paying attorneys' fees. County Counsel cannot advise on, whether and to what extent, state law of another jurisdiction may affect a party's requirement to pay the prevailing party in a legal action where no specific provision is provided in the agreement.
4. The Agreements do not require ACR to meet the County insurance standards.
• The County standard agreement requires contractors to carry appropriate insurance at limits and under conditions determined by the County's Risk Management Department.
• Potential Impact: The Agreements do not include County standard insurance requirements. This means that the County has no assurance that ACR will be financially responsible for claims that may arise from the ACR’s improper conduct.
5. The Agreements require the County to release ACR from liability arising out of its survey and accreditation activities; for making a report, statement, recommendation; failing to make a report, statement, or recommendation; the loss, damage, or destruction of records; or other matters based on negligence, antitrust, misconduct, defamation, personal injury or economic loss, catastrophic events.
• The County standard agreement does not release an agreement for any potential liability.
• Potential Impact: In the event the County suffers a claim that falls within the scope of the carveout of liability, the County could be solely financially responsible for the damages.
ARMC has now determined that due to the volume of medical imaging equipment that requires accreditation, mammography, computed tomography (CT), nuclear medicine, magnetic resonance imaging (MRI), X-ray, and ultrasound equipment, ARMC will require an amount not-to-exceed $125,000 over a five-year period beginning May 19, 2026 to accredit all of its equipment during that time.
ARMC is requesting Board approval for the Practice Site Accreditation Survey Agreement Template and the Mammography Accreditation Survey Agreement Template, along with delegated authority for ARMC’s Chief Executive Officer to sign these agreements on behalf of the Board, in order to reduce delays in equipment accreditation and prevent equipment from becoming unusable due to lapses in accreditation.
The delegation of authority is necessary as ARMC generally has only a one-month period to return a signed agreement to ACR after receipt. Should there be any substantive changes to the agreement terms beyond the non-standard terms above, ARMC will present an item to the Board for approval.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Daniella Hernandez, Deputy County Counsel, 387-5455) on May 12, 2026; Purchasing (Veronica Pedace, Buyer III, 387-2464) on March 17, 2026; Risk Management (Stephanie Pacheco, Staff Analyst II, 386-9039) on March 20, 2026; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on April 27, 2026; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on April 28, 2026.