To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Bryan Cleaver, 565-6505
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Emergency Medical Services Trauma Center Services Agreement
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Recommended Action:
Recommended action
Authorize the Director of Health Services, or designee, to execute an agreement with Adventist Health, Ukiah Valley Hospital, to accept revenue for providing Emergency Medical Services Level IV Trauma Center regulatory oversight for the period June 1, 2020 through May 31, 2030.
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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 Adventist Health, Ukiah Valley Hospital, to accept revenue for trauma center designation and regulatory oversight through May 31, 2030.
Discussion:
Trauma care is a key component of the CVEMSA system. The goal of the trauma care program is to ensure an organized system of medical care for critically injured patients. This program includes the designation of trauma centers that provide high-level definitive medical care and rehabilitation services. To gain designation as a trauma center, a licensed hospital must apply to the local EMS Agency. The local EMS Agency reviews the application for compliance with California Code of Regulations Title 22 requirements, conducts a site review, and approves the application, if appropriate.
Three hospitals in the CVEMSA two-county region have been designated as trauma centers: Santa Rosa Memorial Hospital, designated as a Level II trauma center; Willits Hospital Inc. dba Frank R Howard Memorial Hospital, designated as a Level IV trauma center; and Adventist Health, Ukiah Valley Hospital, designated as a Level IV trauma center. CVEMSA provides trauma center regulatory oversight to both hospitals through current revenue agreements.
One of the greatest challenges to any trauma system is structuring a configuration of acute care hospitals that meets the needs of the population and geography of a given region. Variations in population density, geographical barriers to transport, and the location, capabilities, and commitment of existing hospitals and physician staff are among the determinants and limitations of system design. The Coastal Valleys EMS region combines the challenges of serving suburban and rural areas, geographical barriers, variable weather patterns, and a changing physician demographic.
Most Level IV trauma centers expand the trauma system to sparsely populated, geographically isolated, and often medically underserved rural communities. These hospitals are typically the only source of medical care for many miles and function as an initial point of evaluation and treatment for injured patients. Travel time, patient condition, and inclement weather can prohibit patient delivery directly to a higher-level trauma center from the field, resulting in major trauma patients being taken to rural facilities for initial evaluation, stabilization, and identification of patients requiring transfer to a higher level of care for more comprehensive care. The primary focus of Level IV trauma centers is a well-organized resuscitation team and well-defined transfer plans.
The proposed agreement provides for reimbursement to Sonoma County for regulatory oversight and costs associated with administering the trauma center program. First year revenue for the agreement is $20,000 and for each consecutive year of the agreement, reimbursement will be the prior year amount adjusted by the amount of the applicable Consumer Price Index, but not more than CVEMSA’s estimated cost to administer the program. The agreement revenue amount has been established to fully cover the County’s cost of providing services.
Development and processing of the agreement has been delayed primarily as a result of the Department’s COVID response. It is important to note that services have not been interrupted as a result of the delay in preparing and processing the agreement and hospital trauma services have remained at normal operations. No patient services have been impacted.
The provisions of the agreement include providing the scope of service consistent with state laws, regulations, and CVEMSA policies for Level IV trauma centers; providing appropriately trained and qualified medical professionals and associated critical care/trauma services, and continued participation in the regional trauma audit oversight program.
Prior Board Actions:
On December 14, 2010 the Board approved an agreement with Ukiah Valley Medical Center for Level IV Trauma Center Services for June 1, 2010 through May 31, 2020.
Fiscal Summary
|
Expenditures |
FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
|
Budgeted Expenses |
20,000 |
21,300 |
21,981 |
|
Additional Appropriation Requested |
640 |
|
|
|
Total Expenditures |
20,640 |
21,300 |
21,981 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
20,640 |
21,300 |
21,981 |
|
Use of Fund Balance |
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Contingencies |
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|
|
|
Total Sources |
20,640 |
21,300 |
21,981 |
Narrative Explanation of Fiscal Impacts:
In FY 21-22, the adopted budget includes $20,000 for the agreement with Adventist Health, Ukiah Valley Hospital. The additional revenue of $640 will be added in the 2nd quarter consolidated budget adjustments. For each consecutive year of the agreement, reimbursement will be the prior year amount adjusted by the amount of the applicable Consumer Price Index.
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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 Adventist Health, Ukiah Valley Hospital
Related Items “On File” with the Clerk of the Board:
None