REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 23, 2026
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Grant Agreements with California Department of Health Care Access and Information to Support Arrowhead Regional Medical Center’s Family Medicine and Internal Medicine Residency Programs
End
RECOMMENDATION(S)
Recommendation
1. Approve Grant Agreement, including non-standard terms, with the California Department of Health Care Access and Information for the Song-Brown Primary Care Residencies Grant to support the training of family medicine residents, in the amount of $625,000, for the period of June 30, 2026 through August 31, 2029.
2. Approve Grant Agreement, including non-standard terms, with the California Department of Health Care Access and Information for the Song-Brown Primary Care Residencies Grant to support the training of internal medicine residents, in the amount of $625,000, for the period of June 30, 2026 through August 31, 2029.
3. Authorize the ARMC Chief Executive Officer to electronically execute and submit the Grant Agreements referenced in Recommendations Nos. 1 and 2, including all required supporting materials, as well as any non-substantive amendments necessary, on behalf of the County, subject to review by County Counsel.
4. Direct the ARMC Chief Executive Officer to transmit the executed Grant Agreements referenced in Recommendations Nos. 1 and 2, and any subsequent non-substantive amendments, to the Clerk of the Board of Supervisors within 30 days of execution by all parties.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
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 result in the use of Discretionary General Funding (Net County Cost). The Grant Agreements through the Song-Brown Primary Care Residency Grant Program (Program) will result in up to $625,000 in revenue for each residency program to Arrowhead Regional Medical Center (ARMC). The grant awards do not require matching funds. Adequate appropriation and revenue have been included in the ARMC 2026-27 recommended budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
Family Medicine and Internal Medicine Residency training programs sponsored by Arrowhead Regional Medical Center play a vital role in expanding healthcare access in underserved communities that are located in the County of San Bernardino. Resident physicians provide patient care in various hospitals and in community clinics located throughout the County. They provide preventive and acute care services to individuals who may otherwise face barrier to high quality healthcare. These training programs also help address physician workforce shortages in other ways. Research consistently shows that physicians are more likely to practice in the communities where they complete their residency training programs, making graduate medical education an important long-term strategy for improving healthcare access in medically underserved and rural communities.
On August 19, 2025 (Item No. 12), the Board approved and authorized the submission of a grant application to the Department of Health Care Access and Information (Department) for the Program in the amount of $625,000 per residency program to fund residency positions in family medicine and internal medicine at ARMC.
In December 2025, ARMC was notified by the Department that it was being awarded grant funds from the Program in the amount of $625,000 per residency program for a three-year period, beginning on June 30, 2026. The proposed funding will help provide offsets to resident salaries, faculty development, resident conference travel, and other direct educational costs for operating family medicine and internal medicine residency training programs. The training programs enable resident physicians to provide primary care services in medically under-served communities in the county.
In order for the County to accept the grant funds through the Program, the Department requires the parties to enter into separate Grant Agreements, which are non-negotiable, and include the following non-standard contract provisions:
1. The County must indemnify, defend and hold harmless the State, its officers, agents, and employees from any claims arising out of the County’s performance under the agreements for any third-party claims for injuries caused by the County.
• The standard County contracts for the provision of goods and services do not impose a contractual indemnification obligation on the County.
• Potential Impact: The County will be required, at the County’s cost, to defend and indemnify the State for claims caused by the County’s performance under the agreements and for any third-party claims for injuries caused by the County.
2. The State has the ability to audit the County’s records for a period of up to three years after the termination/expiration of the agreements to ensure that the grant funds are spent in accordance with the terms of the grant program and agreements.
• The standard County contracts for the provision of goods and services do not include the ability of a contractor to audit the County’s records.
• Potential impact: In the event that any State audit determines that the County utilized grant funds for a prohibited purpose, the County will be considered in breach of the agreements and may be required to return any funds spent by the County back to the State.
3. The Grant Agreements do not require the State to meet the County’s insurance standards as required pursuant to County Policies 11-07 and 11-07SP.
• County policy requires that a contracting party carry appropriate insurance at limits and under conditions determined by the County’s Risk Management Department and as set forth in County policy and in the County standard contract.
• Potential Impact: The County has no assurance that the State will be financially responsible for claims that may arise under the Grant Agreements.
ARMC recommends approval of the Grant Agreements, including the non-standard provisions, to support the family medicine and internal medicine residency programs and provide quality primary care services to County residents.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Daniella Hernandez, Deputy County Counsel, 387-5455) on May 26, 2026; Risk Management (Stephanie Pacheco, Staff Analyst II, 386-9044) on May 26, 2026; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on May 29, 2026; County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on June 2, 2026.