DATE: April 8, 2025
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director of Public Health
SUBJECT: Designation of St. Agnes Medical Center and Kaweah Delta Medical Centers as Cardiac ST Elevation Myocardial Infarction (STEMI) Receiving Centers and Kaweah Health Medical Center as a Level III Trauma Center
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute an Agreement with Saint Agnes Medical Center for designation as a Cardiac ST Elevation Myocardial Infarction (STEMI) Receiving Center, effective upon execution through June 30, 2027, which includes two optional one-year extensions ($0);
2. Approve and authorize the Chairman to execute an Agreement with Kaweah Delta Health Care District, dba Kaweah Health, for designation as a Cardiac ST Elevation Myocardial Infarction (STEMI) Receiving Center, effective upon execution through June 30, 2027, and includes an unlimited number of optional one-year extensions ($0); and
3. Approve and authorize the Chairman to execute a retroactive Agreement with Kaweah Delta Health Care District, dba Kaweah Health, for designation as Level III Trauma Center, effective July 1, 2024 through June 30, 2027, and includes an unlimited number of optional one-year extensions ($0).
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will designate Saint Agnes Medical Center (Saint Agnes) as a Cardiac STEMI Receiving Center. Approval of the second recommended action will designate Kaweah Health Medical Center (Kaweah Health) as a Cardiac STEMI Receiving Center. Approval of the third recommended action will continue the designation of Kaweah Health as a Level III Trauma Center (Level III). The recommended agreements are required by the California Code of Regulations for designated STEMI and trauma centers and outline the responsibilities of both the County, Saint Agnes, and Kaweah Health. This item is countywide and includes services outside County jurisdiction but within the Central California Emergency Medical Services Agency area of response.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the first recommended action, Saint Agnes would not be designated as a STEMI Receiving Center and both Saint Agnes and County will be out of compliance with 22 CCR § 100270. Should your Board not approve the second and third recommended actions, Kaweah Health would not be designated as a STEMI Receiving Center or Level III trauma center and both Kaweah Health and County will be out of compliance with 22 CCR § 100270 and 22 CCR § 100137.05.
RETROACTIVE AGREEMENT:
The third recommended agreement is retroactive to July 1, 2024 due to the County of Tulare and Kaweah Health allowing a previous Level III Trauma Center designation agreement lapse as of June 30, 2023. There will be a recognized 1-year gap where no agreement existed between Tulare County and Kaweah Health. The EMS Agency has made the State EMS Authority aware of this gap, which does not impact their trauma center status as long as a new agreement is in place. A new agreement is being established with the County of Fresno directly, serving as the approving authority for the local EMS Agency.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. There are no costs associated with the recommended agreements.
DISCUSSION:
The Department of Public Health is the designated Local Emergency Medical Services (EMS) Agency for Fresno, Kings, Madera, and Tulare counties, pursuant to Health and Safety Code, section 1797.200. The Local EMS Agency is responsible for planning, implementation, and evaluation of the emergency medical services system, which includes the designation of Cardiac STEMI centers and Trauma Centers.
The first recommended action will approve an agreement with Saint Agnes Medical Center for designation as a Cardiac STEMI Receiving Center. State regulations were put into place starting in 2019 for the regulation of prehospital emergency medical services related to the requirements of STEMI Critical Care System.
The second recommended action will approve an agreement with Kaweah Health Care District for designation of Kaweah Health Medical Center as a Cardiac STEMI Receiving Center. State regulations were put into place starting in 2019 for the regulation of prehospital emergency medical services related to the requirements of STEMI Critical Care System.
The third recommended action will approve an agreement with Kaweah Health Health Care District to continue its designation of Kaweah Health Medical Center as a Level III Trauma Center. Last designation was completed by County of Tulare in 2018, which lapsed in 2023. As the Local EMS Agency overseeing Tulare County, this agreement is being brought under the umbrella of Fresno County. Two other trauma centers have been previously approved in the four-county EMS region, which include Community Regional Medical Center (CRMC) as a Level I Trauma Center and Valley Children’s Hospital (VCH) as a Level II Pediatric Trauma Center.
In August 2024, the EMS Division staff became aware that the Agreement between Tulare County and Kaweah Health Medical Center had expired a year earlier. There will be a recognized 1-year gap where no agreement existed between Tulare County and Kaweah Health Medical Center. The EMS Agency has made the State EMS Authority aware of this gap, which does not impact their trauma center status as long as a new agreement is in place. The EMS Agency was not willing to create a retroactive agreement back to July 1, 2023.
As a Cardiac STEMI Receiving Center, Saint Agnes Medical Center and Kaweah Health Medical Center will be authorized by the EMS agency to receive patients who are experiencing an acute myocardial infarction or heart attack directly from the field by ambulance or helicopter. The designation requires Saint Agnes and Kaweah Health to maintain a preparedness level to receive and respond to STEMI patients that require a higher level of care than a STEMI Referring Hospital or other healthcare provider. As a designated STEMI Receiving Center, the State regulations set a minimum requirement of hospital services that must be immediately available 24/7, which includes a Cardiac Catheterization Team and activation for treatment and triage of STEMI patients. A significant amount of training and education is also required for hospital staff.
As a Level III Trauma Center, Kaweah Health Medical Center is authorized by the EMS Agency to receive critically injured patients transported directly from the field by ambulance or helicopter. The Level III designation requires Kaweah Health to maintain a preparedness level to receive and respond to trauma that is significantly higher than non-trauma hospitals. As a designated trauma center, the State regulations set a minimum requirement of hospital services that must be immediately available, which include surgical and anesthesiology services and response performance to critical trauma in the emergency department. A significant amount of training and education is also required for hospital staff.
The second and third recommended agreements with Kaweah Health automatically extend for an unlimited number of one-year increments after the initial term, unless a 30-day advanced written notice of non-renewal is given by either of the parties. The proposed agreements may be terminated without cause by either party upon the giving of a 30-day advance written notice of an intention to terminate or the County may immediately terminate any agreement due to breach of contract. The proposed agreements contain a mutual hold harmless clause.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Saint Agnes Medical Center
On file with Clerk - Agreement with Kaweah Health (STEMI)
On file with Clerk - Agreement with Kaweah Health (Trauma)
CAO ANALYST:
Ronald Alexander