REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
January 10, 2023
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Agreement with Inari Medical, Inc. for the Purchase of Medical Devices for Treatment of Pulmonary Embolisms
End
RECOMMENDATION(S)
Recommendation
Approve Agreement with Inari Medical, Inc. for the purchase of medical devices for the treatment of pulmonary embolisms in the not-to-exceed amount of $792,000 for the period of January 10, 2023 through January 9, 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). The cost of $792,000 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 are included in the Arrowhead Regional Medical Center (ARMC) 2022-23 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
This Agreement will provide ARMC with specialized devices from Inari Medical, Inc. (Inari), for the treatment of pulmonary embolisms (PE). The Inari device is a 24F (8mm) device with curved and straight catheters available for use with patients with massive or submassive PE, a blood clot that can cause partial or total blockage of blood flow in the affected vessel. These devices function by removing clots through both mechanical and aspiration mechanisms of action, capturing and removing large clot burden from big vessels, treating in a single session, and eliminating the need for thrombolytics and Intensive Care Unit stays. This will provide more efficient care and safe treatment for patients throughout San Bernardino County.
The PE equipment used in past procedures was a thrombectomy system, which was found to be difficult in treating a clot due to limited manipulation, and more importantly, has a very small caliber. Patients diagnosed with massive or sub-massive PE will present with pulmonary arteries that are dilated, and this device would leave the large clot untreated. Many patients that underwent pulmonary angiograms would require a second reintervention the following day, which would increase the future risk of pulmonary hypertension, requiring additional procedures and treatment. The Inari device is much more effective at removing a large clot intact, and the device may be used until the clot is resolved.
ARMC recommends approval of this three-year Agreement for purchase and use of Inari devices over the term to provide for the safety and health needs of County residents for treatment in the removal of PE as these products have been shown to improve patient care and health outcomes. This Agreement was negotiated for a three-year term because the vendor was not able to provide a five-year pricing commitment.
PROCUREMENT
This is a non-competitive procurement based on the product’s unique functional specifications, as these are the only products available to treat PE by removing clots through both mechanical and aspiration mechanisms of action. The Purchasing Department recognizes the specialized nature of these products as an acceptable non-competitive justification.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on December 1, 2022; Purchasing (Ariel Gill, Buyer, 777-0722) on December 6, 2022; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on December 13, 2022; Finance (Jenny Yang, Administrative Analyst, 387-4884) on December 13, 2022; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on December 14, 2022.