REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 17, 2026
FROM
JANKI PATEL, Acting Director, Department of Public Health
SUBJECT
Title
Revenue Agreements with Education Agencies for County-provided School Nursing Services
End
RECOMMENDATION(S)
Recommendation
Approve revenue agreements with the following public schools, including non-standard terms, to provide school nursing services at an aggregate amount estimated to be $123,833.82, for the period of November 17, 2026 through June 30, 2029, with the option to extend for two additional one-year periods:
1. Lucerne Valley Unified School District
2. Mt. Baldy Joint Elementary School District
(Presenter: Janki Patel, Acting Director, 387-9146)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Improve County Government Operations.
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not impact Discretionary General Funding (Net County Cost). The Department of Public Health (DPH) will receive revenue in an aggregate amount estimated to be $123,833.52, for the period of November 17, 2026 through June 30, 2029, for health screening services provided to each of the education agencies (Schools) listed in the Recommendation. Adequate appropriation and revenue have been included in DPH’s 2026-27 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
California Education Code sections 49452 et seq. require public school students to receive health screening services to identify health conditions that may affect their learning and academic progress. For more than 45 years, DPH has provided school nursing services, including nursing consultations and screenings for hearing, vision, and scoliosis. DPH nursing services also provide referrals and follow-up services based on screening results and, when otherwise unavailable, consultations and educational services related to disease control and immunization concerns. Historically, DPH has provided nursing services to school districts that do not employ their own nurses.
Under these agreements, DPH estimates it will perform approximately 1,954 health screenings annually collectively at specified school sites. The Schools will reimburse the County for nursing services at a rate of $183.33 per hour worked by DPH staff performing screenings, with the rate increasing annually by three percent (3%) throughout the duration of the agreement.
Based on the services, reimbursement rate, and expected number of screenings, total reimbursement is estimated to be $123,833.52, representing approximately 675 service hours.
The agreements contain non-standard terms that require approval by the Board of Supervisors (Board) per County Policy 11-05. The non-standard terms include the following:
1. The County is required to indemnify the Schools against third-party claims for any and all claims arising from the County's negligent acts or omissions.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify the Schools, 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 the School without such limitations and the County would be responsible to defend and reimburse the School for costs, expenses, and damages, which could exceed the total agreement amount.
2. The agreements do not require the Schools to meet the County’s insurance standards as required pursuant to County Policy 11-07.
• The County Policy requires contractors to carry appropriate insurance at limits and under conditions determined by the County’s Risk Management Department and set forth in the County standard contract.
• Potential Impact: The agreement does not include County standard insurance requirements. The Schools are self-insured entities, requiring the County to rely on the Schools’ assurance that it will be financially responsible for claims that may arise through the term of the agreement, potentially resulting in expenses to the County that exceed the total agreement amount.
DPH recommends approval of the agreements, including the non-standard terms, so that the required services and screenings can be provided to the students. DPH will not provide services until agreements have been fully executed.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Adam Ebright, Deputy County Counsel, 387-5455) on October 28, 2026; Risk Management (Arrisia Beaven, Staff Analyst II, 386-9030) on November 4, 2026; and County Finance and Administration (Guy Martinez, Principal Administrative Analyst, 387-5428) on October 30, 2026.