To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Emergency Medical Services Level II Trauma Center Redesignation Agreement with Santa Rosa Memorial Hospital
End
Recommended Action:
Recommended action
Authorize the Director of Health Services to execute an agreement with Santa Rosa Memorial Hospital for Level II Trauma Center Redesignation for a May 1, 2022 through April 30, 2030 term, with an option to extend for four years through April 30, 2034; and to make non-substantive changes to the agreement prior to execution.
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Executive Summary:
Pursuant to state law, the County of Sonoma Emergency Medical Services (EMS) Agency is responsible for oversight and regulation of the local EMS system. The Board of Supervisors has designated the Sonoma County Department of Health Services as the local EMS Agency for Sonoma County and authorized agreements for EMS administrative services with Mendocino County. This two-county regional organization is formally known as the Coastal Valleys Emergency Medical Services Agency (CVEMSA).
The CVEMSA trauma care program serves to ensure an organized system of medical care for critically injured patients in Sonoma and Mendocino counties. The program includes designation and regulatory oversight of trauma centers that provide high-level definitive medical care and rehabilitation services. This item requests approval of an agreement with Santa Rosa Memorial Hospital for the County to accept revenue for trauma center designation and regulatory oversight for an initial eight-year term from May 1, 2022 through April 30, 2030. CVEMSA has an option to extend the term of the agreement for an additional term of four years through April 30, 2034.
Santa Rosa Memorial Hospital has provided designated Level II trauma services to Sonoma County residents, visitors, and patients for over 30 years. The hospital’s current designation as a Level II Trauma Center expires on April 30, 2022. CVEMSA confirms that Santa Rosa Memorial Hospital meets all state and local trauma center criteria and recommends approval of the proposed agreement to ensure that the life-saving trauma care services continue.
On March 22, 2022, the agreement was presented to the Board of Supervisors. During that meeting the Board directed staff to make revisions to the contract and return to address concerns expressed by neighbors of the Santa Rosa Memorial Hospital. This Board Item presents the agreement with the proposed changes.
Discussion:
Trauma care is a key component of the regional Emergency Medical Services (EMS) system. The trauma care program’s goal is to ensure an organized system of medical care for critically injured patients and includes the designation of trauma centers that provide high-level definitive medical care and rehabilitation services. Santa Rosa Memorial Hospital was originally selected for designation as a level II trauma center following an extensive multi-year process that began in 1998 and concluded in 2000. This process involved release of a request for proposals (RFP), receipt and evaluation of responses, and the preparation of an Environmental Impact Report. Specifically, the County evaluated qualifications of the hospitals by using an outside team of trauma care experts to review the quality of medical care and trauma services. Upon conclusion of the RFP process and the environmental study, Santa Rosa Memorial Hospital (SRMH or Hospital) was selected and designated as a level II trauma center in 2000.
The Hospital was redesignated in March 2010. Its current designation expires at the end of April 2022. The terms of the initial and subsequent designations were contingent upon periodic reviews by the American College of Surgeons (ACS) and maintenance of ACS verification of meeting level II trauma center standards. Santa Rosa Memorial Hospital has consistently maintained the required ACS verification and conditions stipulated in the terms of the Conditions of Designation established by CVEMSA.
In anticipation of the expiration of the current designation at the end of April 2022, CVEMSA staff have met over the past year with representatives of the Hospital and other healthcare/hospital personnel in the region to assess the options for re-designation of SRMH and/or determine if any other hospital was interested in seeking that designation. Throughout those meetings, no hospital other than Santa Rosa Memorial has indicated a desire to provide level II trauma center services. CVEMSA staff have also had outreach to and met with interested citizens, including those who live near the Hospital. Some citizens expressed concerns over existing operational noise associated with some medi-vac helicopter flight paths, but generally supported continuation of the Hospital’s level II trauma center designation to ensure continued availability of critical emergency care and response capabilities for the community. Caltrans regulates helicopter flight paths, which are beyond the scope of the proposed agreement and CVEMSA’s authority. Nevertheless, staff reached out to Santa Rosa Memorial Hospital to invite them to work with and develop a response to neighbors who have expressed complaints and concerns related to existing operation of the hospital, particularly related to noise from helicopter flights, if possible. At the time this staff report was produced, no update was available on the hospital’s progress in this regard.
Overall, uninterrupted continuation of SRMH’s existing services and designation as a level II trauma center will prevent or mitigate the loss of or reduction in existing local emergency response capabilities critical for the public health, safety, and welfare. For these reasons, CVEMSA staff propose a continued agreement with Santa Rosa Memorial Hospital so the Hospital will maintain its long-standing designation as a level II trauma center in accordance with the terms and provisions of the agreement.
More specifically, the provisions of the proposed agreement include the following: 1) providing the scope of services consistent with state laws and regulations and CVEMSA policies for level II trauma centers; 2) providing appropriately trained and qualified medical professionals and associated critical care/trauma services; 3) continued compliance with the mitigation plan developed through the environmental impact study in 2000; 4) maintaining ACS verification as a level II trauma center; and 5) continued participation in the regional trauma audit oversight program.
The proposed agreement also requires the Hospital to pay fees to cover CVEMSA’s costs associated with redesignation (one-time fee of $55,000) and administering the trauma center program (no more than $173,918 annually, subject to a cost of living adjustment). There is no net county cost associated with the requested action.
Approval of the agreement is a project that is exempt from compliance with the California Environmental Quality Act under 14 CCR 15269(c)) the statutory exemption for emergency projects, as the time that it would take to preform environmental review of the contract extension would extend beyond the term of the exiting contract, causing it to lapse and leaving two counties and the region as a whole without vital trauma service capabilities needed to respond to medical crisis and emergencies; and separately under 14 CCR 15301, the categorical exemption for continued operation of existing facilities where there will be no or negligible expansion of use, and where there no exceptions to the categorical exemption apply. The proposed extension would continue operation of the same hospital, under the same or similar terms, to ensure there is no break in essential trauma services.
County staff presented to the Board on March 22, 2022 the Level II Trauma Services agreement. During the presentation public comments included EMS Aircraft noise and air-quality concerns from neighbors living within close proximity to the hospital. Following the Board meeting, Providence Santa Rosa Memorial Hospital agreed to conduct both a noise and air-quality study within the initial 18-month contract term and the contract was amended to reflect these changes. Furthermore, the hospital agreed to post study results on their website for a period of 180 days. The hospital also agreed to provide a public link on their website to improve public access to report any flight inquiries and/or concerns. Additionally, hospital agrees to continue to provide the regularly scheduled, quarterly meetings of the neighbors, EMS Aircraft providers, hospital and EMS Agency. In these meetings EMS aircraft data and EMS inquiries and concerns are discussed.
Proposed summary of changes to Trauma Center Contract
• Section 5 of the Agreement expanded to address preparation of both a noise study and an air quality study
• Hospital responsible for funding the studies
• Both studies required to be prepared by qualified professionals
• Scope of work and study area for the studies are subject to approval by the EMS Agency prior to consultants commencing study work, where EMS Agency will not unreasonably withhold approval.
• Noise study will (1) evaluate current Caltrans identified helicopter flight paths and at least two alternative paths, and (2) identifies which of the approved or alternative paths generates the least noise for persons residing in the vicinity of the hospital. Either party may seek Caltrans approval for any alternative flight path if the study’s recommendations so warrant.
• Air quality study will (1) examine the potential of trauma related flights to and from the hospital to affect air quality in the residential areas in the vicinity of the hospital, and (2) identify recommendations, if any, to respond to the study’s conclusions.
• Studies must be completed and delivered to EMS Agency within 18 months of execution of the Agreement, but that deadline may be extended by up to 6 months by the EMS Agency for good cause shown by the Hospital.
• Final studies will be posted on the Hospital’s public website for a minimum of 180 days. The study will be a public record in the possession of the EMS Agency.
• Hospital and County may amend the agreement to incorporate noise attenuation and air quality improvement measures and recommendations consistent with the studies and to the extent allowable by law, recognizing that the parties do not have authority over flight paths.
• Creates an opportunity for interested community members to provide comments on any proposed amendments developed by the Hospital and EMS Agency to address findings and recommendations of the sound and air quality studies required under this Agreement.
• Includes a provision for notifying Bay Area Air Quality Management District, Federal Aviation Administration, and Caltrans of the availability of the final studies.
• Quarterly meetings remain required as part of existing mitigation measures under the Agreement. The Agreement does not include provisions for modifying quarterly meetings with neighbors. However, EMS Agency will continue to explore measures to improve meetings going forward.
Contract language was also amended to include mutual termination of the contract without cause.
Staff is returning to the Board of Supervisors to recommend approval of the Level II Trauma Services contract with Providence Santa Rosa Memorial Hospital. If approved, contract moves forward and the residents, neighboring residents and visitors of Sonoma County will continue to be assured that highly trained and specialized medical care professionals will be immediately available to provide life-saving interventions on patients suffering from acute injuries and illness. This is a time-sensitive contract that if not renewed prior to April 30, 2022 will expire and services will be jeopardized.
Strategic Plan:
N/A
Prior Board Actions:
On March 16, 2010 the Board approved an agreement with Santa Rosa Memorial Hospital for Level II Trauma Center services.
April 21, 1998 - EMS Agency report on trauma center Request for Proposals and Designation process.
Fiscal Summary
|
Expenditures |
FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
|
Budgeted Expenses |
$228,918 |
$179,136 |
$184,510 |
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
$228,918 |
$179,136 |
$184,510 |
|
Funding Sources |
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|
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General Fund/WA GF |
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State/Federal |
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Fees/Other |
$228,918 |
$179,136 |
$184,510 |
|
Use of Fund Balance |
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Contingencies |
|
|
|
|
Total Sources |
$228,918 |
$179,136 |
$184,510 |
Narrative Explanation of Fiscal Impacts:
The proposed agreement also requires the Hospital to pay fees to cover CVEMSA’s costs associated with re-designation (one-time fee of $55,000) and administering the trauma center program (no more than $173,918 annually, subject to a cost of living adjustment). There is no net county cost associated with the requested action. There are sufficient appropriations for FY 21-22 and the expenses for FY 22-23 will be included in the recommended budget.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Agreement with Santa Rosa Memorial Hospital
Attachment 2 - Community Meeting Questions and Responses - January 24, 2022
Related Items “On File” with the Clerk of the Board:
None