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 Desert Regional Medical Center, Inc dba Desert Regional Medical Center for Participation in Clinical Rotations
End
00
RECOMMENDATION(S)
Recommendation
Approve Affiliation Agreement, including non-standard terms, with Desert Regional Medical Center, Inc dba Desert Regional Medical Center, to allow Arrowhead Regional Medical Center’s neurosurgery resident physicians to participate in clinical rotations at Desert Regional Medical Center, Inc dba Desert Regional Medical Center, 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 Desert Regional Medical Center, Inc dba Desert Regional Medical Center (DRMC) for services provided by ARMC Neurosurgery Residents for the three-year period. The total cost reimbursed will be dependent on the number of resident physicians assigned to DRMC. 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 (Agreement) with DRMC would enable ARMC neurosurgery resident physicians to obtain specialized clinical training in neurosurgery. The volume and patient mix at DRMC 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 Agreement is DRMC’s standard affiliation agreement, negotiated by the parties, with the following non-standard County contract terms:
1. The Agreement does not require DRMC to meet the County insurance standards.
• 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: The Agreement does not include County standard insurance requirements. This means that the County has no assurance that DRMC will be financially responsible for claims that may arise under the Agreement, which could result in expenses to the County.
2. DRMC’s indemnity obligation is limited to claims arising out of the acts, errors, or omissions of DRMC, its employees, agents, and volunteers.
• The general indemnity provision in the County standard contract 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: DRMC’s indemnity obligation under the Agreement is more limited than under the standard County contract. In the event a claim arises that falls outside the scope of DRMC’s indemnity obligation, the County may be solely reposnsible for the cost of defending the claim and paying any resulting settlement/judgment.
3. The County agrees to indemnify DRMC from any claims that arise out of the acts, errors, or omissions of the County and the ARMC neurosrugery residents.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify DRMC, 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 DRMC without such limitations and the County would be responsible to defend and reimburse DRMC for costs, expenses, and damages.
4. Either party may terminate the Agreement with 60 days written notice, except that any residents undergoing training at DRMC at the time of the notice of termination shall be given the opportunity to complete the rotation for that academic year.
• The County standard contract allows 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 Agreement.
ARMC recommends approval of this 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 26, 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 8, 2023.