Title
a. Authorize the Purchasing Manager for Natividad Medical Center (NMC) to extend the Master Agreements between the County of Monterey ("County"), on behalf of NMC, and Per Diem Staffing formerly known as Agostini Nurse Staffing; American Traveler Staffing Professionals, LLC; C&A formerly known as Aureus Nursing; Merion Staffing LLC formerly known as Axis Healthcare Staffing; Randstad North America, LP, formerly Spherion Staffing LLC; Cross Country Staffing, Inc.; Tempus LLC formerly known as Emerald Health Services; Healthcare Pros; Rise Medical Staffing LLC formerly known as Healthcare One Staffing; HRN Services Inc.; Medical Solutions LLC; Medical Staffing Network (MSN) Healthcare LLC, formerly known as Intelistaff Travel; PPR (Professional Placement Resources) Healthcare Staffing; SHC Services Inc. doing business as Supplemental Health Care; Aya Healthcare Inc. formerly known as TG Health Care Services; Premier Healthcare Professionals Inc.; Integrated Healthcare Staffing Inc.; Local Staff LLC doing business as Cross Country Per Diem, and; Cirrus Holdings USA (collectively these businesses are known as, "Nurse Registry Agencies currently providing services at NMC") for an additional one year term from July 1, 2014 through June 30, 2015, pursuant to the terms and conditions of RFP #10093; and
b. Authorize additional funding of $1,000,000 for Fiscal Year 2013-14, bringing the total aggregate amount to $3,000,000 for Fiscal Year 2013-14 for all contracts issued pursuant to RFP #10093, with authority to open purchase orders and distribute these funds for Fiscal Year 2013-14 among all contractors under the Master Agreements in any manner of allocation determined to be appropriate by NMC and County; and
c. Authorize a total aggregate amount of $3,000,000 for Fiscal Year 2014-15, for all contracts issued pursuant to RFP #10093, with authority to open purchase orders and distribute these funds for Fiscal Year 2014-15 among all contractors under the Master Agreements in any manner of allocation determined to be appropriate by NMC and County; and
d. Authorize the Purchasing Manager for NMC to enter into a Consent to Assignment and Assumption Agreement, utilizing the template presented, with Nurse Registry Agencies that succeeded to all rights, title, and interest in, and all obligations under, the County's Master Agreements (RFP #10093), subject to further review and approval by County Counsel and County Auditor-Controller; and
e. Authorize the Purchasing Manager for NMC to enter into Amendment No. 3 to the Master Agreement (RFP #10093), utilizing the template presented, with each of the Nurse Registry Agencies currently providing services at NMC, extending each Master Agreement to June 30, 2015 and appending as an exhibit, as relevant, any revised rate sheet for Fiscal Year 2014-15 that may be negotiated between the County and the Nurse Registry Agency, subject to further review and approval by County Counsel and County Auditor-Controller.
Report
It is recommended that the Board of Supervisors:
a. Authorize the Purchasing Manager for Natividad Medical Center (NMC) to extend the Master Agreements between the County of Monterey ("County"), on behalf of NMC, and Per Diem Staffing formerly known as Agostini Nurse Staffing; American Traveler Staffing Professionals, LLC; C&A formerly known as Aureus Nursing; Merion Staffing LLC formerly known as Axis Healthcare Staffing; Randstad North America, LP, formerly Spherion Staffing LLC; Cross Country Staffing, Inc.; Tempus LLC formerly known as Emerald Health Services; Healthcare Pros; Rise Medical Staffing LLC formerly known as Healthcare One Staffing; HRN Services Inc.; Medical Solutions LLC; Medical Staffing Network (MSN) Healthcare LLC, formerly known as Intelistaff Travel; PPR (Professional Placement Resources) Healthcare Staffing; SHC Services Inc. doing business as Supplemental Health Care; Aya Healthcare Inc. formerly known as TG Health Care Services; Premier Healthcare Professionals Inc.; Integrated Healthcare Staffing Inc.; Local Staff LLC doing business as Cross Country Per Diem, and; Cirrus Holdings USA (collectively these businesses are known as, "Nurse Registry Agencies currently providing services at NMC") for an additional one year term from July 1, 2014 through June 30, 2015, pursuant to the terms and conditions of RFP #10093; and
b. Authorize additional funding of $1,000,000 for Fiscal Year 2013-14, bringing the total aggregate amount to $3,000,000 for Fiscal Year 2013-14 for all contracts issued pursuant to RFP #10093, with authority to open purchase orders and distribute these funds for Fiscal Year 2013-14 among all contractors under the Master Agreements in any manner of allocation determined to be appropriate by NMC and County; and
c. Authorize a total aggregate amount of $3,000,000 for Fiscal Year 2014-15, for all contracts issued pursuant to RFP #10093, with authority to open purchase orders and distribute these funds for Fiscal Year 2014-15 among all contractors under the Master Agreements in any manner of allocation determined to be appropriate by NMC and County; and
d. Authorize the Purchasing Manager for NMC to enter into a Consent to Assignment and Assumption Agreement, utilizing the template presented, with Nurse Registry Agencies that succeeded to all rights, title, and interest in, and all obligations under, the County's Master Agreements (RFP #10093), subject to further review and approval by County Counsel and County Auditor-Controller; and
e. Authorize the Purchasing Manager for NMC to enter into Amendment No. 3 to the Master Agreement (RFP #10093), utilizing the template presented, with each of the Nurse Registry Agencies currently providing services at NMC, extending each Master Agreement to June 30, 2015 and appending as an exhibit, as relevant, any revised rate sheet for Fiscal Year 2014-15 that may be negotiated between the County and the Nurse Registry Agency, subject to further review and approval by County Counsel and County Auditor-Controller.
DISCUSSION/SUMMARY:
California has state mandated minimum nurse-to-patient ratios for every unit in general acute care hospitals such as NMC. These nurse-to-patient ratios were phased in, beginning 2004, and require: One licensed nurse for every two patients in the intensive care, critical care, and neonatal intensive care units, in post-anesthesia recovery, labor and delivery, and when patients in the emergency room require intensive care. One licensed nurse for every three patients in step-down units. One licensed nurse for every four patients in ante-partum (not active labor), postpartum (1:4 mother-baby couplets) pediatric care, and in the emergency room, telemetry, and other specialty care units. One licensed nurse for every five patients in medical-surgical units. One licensed nurse for every six patients in psychiatric units. In addition, under Emergency Medical Treatment and Labor Act (EMTALA) regulations, NMC cannot refuse to provide treatment to patients who arrive at the hospital with an emergency medical condition or are in active labor.
NMC must predict how many nurses will be needed during multiple shifts of the day and staff accordingly. Nurse staffing needs cannot always be met by regular NMC staff. NMC utilizes the services of nineteen (19) Nurse Registry Companies. NMC continuously assesses staffing needs based on volume. Research was conducted into using a GPO (Group Purchasing Order) for these services, but learned better quality of nurses would be found by continuing to use the nurse registries. In order continue receiving these state mandated staffing levels, NMC would like to continue the master agreement and all current nurse registry services for the July 2014 to June 2015 fiscal year and add $3,000,000 to cover the services for that year. NMC intends to go out for a new RFP for Nurse Registries during the next year. NMC is also requesting an additional $1,000,000 to cover services rendered in 2013-2014 fiscal year due to higher than expected use of the services.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved this Amendment No. 3 as to legal form and risk provisions. Auditor-Controller has reviewed and approved this Amendment No. 3 as to fiscal provisions. The Amendment No. 3 has not been reviewed and approved by Natividad Medical Center's Board of Trustees, but due to scheduling issues and the end of the fiscal year, Natividad Medical Center's Board of Trustees will review and approve Amendment No. 3 just after the Board of Supervisors authorizes Amendment No. 3. The CAO-Budget and Analysis Division has advised to inform the BOS the spending authority (appropriations) associated with NMC's FY 2014 Adopted Budget has been exceeded and approval and authorization for modification of NMC's appropriation budget should be presented to the BOS. Since NMC is an Enterprise Fund, this does not prevent continued expenditures, but it is considered good public policy, transparency and fiscal management. The Amendment has also been reviewed and approved by Natividad Medical Center's Finance Committee 5.29.14 and Board of Trustees 6.6.14.
FINANCING:
The total cost for Amendment No. 3 is $4,000,000 (adding $1,000,000 for FY 2013-14 and $3,000,000 for FY 2014-15) and is included in the Natividad Medical Center Fiscal Years 2013-15. The total aggregate amounts for all contracts issued pursuant to RFP #10093 from 2008 to June 30, 2015 would be $14,171,279. NMC is confirming its appropriations position and if its spending authority has been exceeded will return to the Board. There is no impact to the General Fund.
Prepared by: Janine Ray-Bouyea, 783- 2701
Approved by: Harry Weis, Chief Executive Officer, 783-2553
Attachments: Template to Amendment No. 3, Template to Assignment and Assumption Agreement, Original Agreement, Spend Sheet
Attachments on file with the Clerk to the Boards Office