(213) 240-8101

Honorable Board of Supervisors
September 7, 2000
Page 2

JUSTIFICATION:

On September 26, 1995, the Board most recently approved agreements with Los Angeles Anesthesia Service, Bay Area Anesthesia, Inc., Reliable Health Care Services, and United Anesthesia Associates, Inc. The agreements are slated to expire on September 30, 2000.

The four new agreements will become effective on October 1, 2000, and remain in force through September 30, 2001, with provisions for four one-year automatic renewals, subject to the annual appropriation of funds.

Any other new agreements with interested and qualified CRNA registry providers will become effective upon full execution by the parties, and continue through September 30, 2001, with provisions for four one-year automatic renewals, subject to the annual appropriation of funds.

FISCAL IMPACT:

Fiscal Year (FY) 2000-2001 expenditures are estimated to be $527,437, as follows: $240,000 for Harbor/UCLA Medical Center, $150,000 for Olive View/UCLA Medical Center, and $137,437 for Rancho Los Amigos National Rehabilitation Center.

FINANCING:

Funds are included in the DHS FY 2000-2001 Adopted County Budget for Olive View/UCLA Medical Center and Rancho Los Amigos National Rehabilitation Center, and will be requested as a continuing appropriation in future fiscal years. The estimated expenditures for Harbor/UCLA Medical Center of $240,000 is funded through their Salaries and Employee Benefits appropriation. The funds from Salaries
and Employee Benefits will be shifted to Services and Supplies in the amount of $240,000 through an appropriation adjustment to finance Harbor/UCLA Medical Center=s portion of the agreement. This shift in funding is required to fund the use of CRNA registry services until such time as the County fills its budgeted CRNA items. The recruitment and hiring of qualified CRNAs may take several months, requiring the continued use of registry personnel to provide anesthesia services in the operating room.

FACTS AND PROVISIONS/LEGAL REQUIREMENTS:

For a number of years, the County has contracted with private sector CRNA registries to meet DHS operating room staffing requirements. Under the direct supervision of physicians, CRNAs provide anesthesia to patients in surgery and to obstetrics patients in delivery. CRNAs may also be involved with the pre-operative/post-operative evaluation of patients prior to or after receiving anesthesia.

On September 26, 1995, the Board approved the current agreements with Los Angeles Anesthesia Service, Bay Area Anesthesia, Inc., Reliable Health Care Services, Inc., and United Anesthesia Associates, Inc. All four agreements are scheduled to expire on September 30, 2000.

Honorable Board of Supervisors
September 7, 2000
Page 3

The new agreements will become effective on October 1, 2000 and continue through September 30, 2001, with provisions for four one-year automatic renewals through September 30, 2005, subject to the annual
appropriation of funds. The County may terminate the agreements, with or without cause, with 10 days advance written notice to the contractors.

The agreement is designed to be used only on an as-needed basis and does not obligate the County to order any services from the contractors during the agreement term. In addition, the new agreement acknowledges the County's right to contract with other providers and to perform CRNA services itself, using County personnel. Contract providers will only be used when County staff are not available to provide the services.

The agreement provides for both per diem and traveling CRNAs under the supervision of each DHS facility's Department of Anesthesiology, with the length of job assignments determined at the sole discretion of the facility.

All contractors are required to provide current, active documentation of State-level Registered Nurse and Nurse Anesthetist licensure and national-level CRNA recertification for each of their CRNAs before assignment to a County facility.

The agreement also includes a traveling CRNA component under which contractors are held responsible for all out-of-State travel arrangements and costs, as well as all local housing, commuting, transportation, and parking costs. As such, rates of payment are the same for both per diem and traveling CRNA services.

Under the agreements, the contractors accept a requirement to accept referrals of permanent or temporary employees from the County's Human Resources staff for consideration for employment.

DHS has made a finding that the contract services are of a professional and temporary nature, and that they are required on an intermittent basis.

The agreement includes the new provisions regarding contractor=s responsibility and debarment, and insurance and indemnification

The agreement may be terminated at any time by the County by providing the contractor with 10 days advance written notice.

Attachment A provides additional information.

The agreement (Exhibit I) has been approved as to form by County Counsel.

CONTRACTING PROCESS:

The agreement will be offered to qualified current contractors of temporary CRNA services as well as to other interested and qualified providers of temporary CRNA services on an as-needed basis during the agreement term.

IMPACT ON CURRENT SERVICES (OR PROJECTS):

The recommended agreement will continue the provision of CRNA services at DHS facilities.

Honorable Board of Supervisors
September 7, 2000
Page 4

When approved, this Department requires three signed copies of the Board's action.

Respectfully submitted,

Mark Finucane
Director of Health Services

MF:dz

Attachments

c: Chief Administrative Officer
County Counsel
Executive Officer, Board of Supervisors

BLETALL7.DZ
05/04/2000

ATTACHMENT A
Page 1 of 2

1. TYPE OF SERVICE:

2. AGENCY ADDRESSES AND CONTACT PERSONS:

a. Los Angeles Anesthesia Service b. Bay Area Anesthesia, Inc.

c. Reliable Health Care Services, Inc. d. United Anesthesia Associates, Inc.

3. TERM:

The four new replacement agreements will become effective October 1, 2000 and continue through
September 30, 2001, with provisions for four one-year automatic renewals through September 30, 2005.

4. SERVICE INFORMATION:

Under the supervision of physicians, CRNAs provide anesthesia to patients in surgery and to obstetrics patients in delivery.

5. PERFORMANCE INFORMATION:

Los Angeles Anesthesia Service:

Historically, this has been the most widely utilized provider for these contract services. Based on a recently completed contract monitoring review at Harbor/UCLA Medical Center, the clinical performance was determined to be more than satisfactory.

Bay Area Anesthesia, Inc.:

This is an out-of-State provider that has provided minimal CRNA placements at LAC+USC Healthcare Network under the current contract program.

Reliable Health Care Services, Inc.:

Provides minimal CRNA placements at LAC+ USC Healthcare Network and Harbor/UCLA Medical Center under the current contract program.

United Anesthesia Associates, Inc.:

This is an out-of-State provider that has provided minimal CRNA placements at LAC+ USC Healthcare Network under the current contract program.

ATTACHMENT A
Page 2 of 2

6. REASON FOR RENEWAL:

7. FINANCIAL INFORMATION:

8. ACCOUNTABLE FOR PROGRAM MONITORING:

9. APPROVALS:

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