REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 27, 2023
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Affiliation Agreement with Redlands Community Hospital to Obtain Specialized Clinical Training
End
RECOMMENDATION(S)
Recommendation
Approve Affiliation Agreement, including non-standard terms, with Redlands Community Hospital for Arrowhead Regional Medical Center Neurosurgery Resident Physicians to obtain specialized clinical training for the period of July 1, 2023 through June 30, 2026.
(Presenter: William L. Gilbert, Director, 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 Arrowhead Regional Medical Center (ARMC) will be reimbursed by Redlands Community Hospital (RCH) for services provided by ARMC neurosurgery resident physicians at RCH for the three-year period. The total cost reimbursed will be dependent on the number of residents physicians assigned to RCH. Adequate appropriation and revenue have been included in the Arrowhead Regional Medical Center (ARMC) 2023-24 recommended budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
The Affiliation Agreement with RCH would enable ARMC neurosurgery residents to obtain specialized clinical training in neurosurgery. The volume and patient mix at RCH will provide a suitable educational opportunity to the ARMC neurosurgery residents. The accreditation bodies for medical residency programs have specific requirements. In order to meet these requirements, it is customary for hospitals that operate residency programs to provide their residents with educational opportunities at other facilities to supplement those available at their sponsoring hospital.
The Affiliation Agreement was negotiated by the parties to include the following non-standard contract terms:
1. The County must indemnify RCH, with counsel reasonably approved by RCH, for any claims for injury or damages resulting from or in any way connected with the performance or failure to perform the obligations under the Affiliation Agreement by the County, its employees, and agents, and the physician residents.
• The County standard contract does not contractually require the County to indemnify the vendor.
• Potential Impact: By agreeing to indemnify RCH, 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 RCH without such limitations and the County would be responsible to defend and reimburse RCH for costs, expenses, and damages.
2. RCH’s indemnification obligation is limited to claims for injury or damages that result from or is in any way connected with the performance or failure to perform the obligations under the Affiliation Agreement by RCH, its officers, directors, agents, employees, and those physicians that supervise the residents.
• The County standard contract general indemnity provision requires the contractor to indemnify, defend, and hold the County harmless from third party claims arising out of the acts, errors, or omissions of any person.
• Potential Impact: In the event a claim arises that falls outside the scope of RCH’s narrow indemnification obligation, the County would potentially be solely liable for the cost of defense and any resulting settlement/judgment.
3. Either party may terminate the Affiliation Agreement with 90 days written notice.
• The County standard contract permits the County to terminate the contract with 30 days written notice with no further obligation.
• Potential Impact: ARMC will need to be mindful of the extended notice period for termination of the Affiliation Agreement.
ARMC recommends approval of this Affiliation Agreement, including non-standard terms, to provide clinical training and experience to ARMC neurosurgery resident physicians, which will result in the provision of specialized medical care to County residents.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387- 5455) on May 12, 2023; Risk Management (Victor Tordesillas, Director, 386-8623) on June 1, 2023; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on June 2, 2023; Finance (Jenny Yang, Administrative Analyst, 387-4884) on June 5, 2023; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387- 5423) on June 7, 2023.