Inter-Departmental Correspondence

Health System



March 8, 2011


April 12, 2011







Honorable Board of Supervisors


Jean S. Fraser, Chief, Health System
Susan Ehrlich, MD, MPP, Chief Executive Officer
San Mateo Medical Center


Agreement with Howard Belfer, MD



Adopt a Resolution authorizing the:


President of the Board to execute an Agreement with Howard Belfer, MD, to provide neurology services for the term April 1, 2011 through March 31, 2014, in an amount not to exceed $375,000; and



Chief of the Health System or designee to execute contract amendments which modify the County’s maximum fiscal obligation by no more than $25,000 (in aggregate), and/or modify the contract term and/or services so long as the modified term or services is/are within the current or revised fiscal provisions



Neurology service is a non-surgical specialty area that addresses many of the root causes for neurological disorders, nerve damage, and pain. In particular, the discipline serves as a basis of differential diagnoses for most core medical specialty areas: uneven balance and gait as it relates to brain tumors; apnea and sleep disorders; the impact of seizures captured through EEG and EMG readings; back problems related to spinal nerve damage, and brain disorders, including chemical imbalances and mental status. San Mateo Medical Center (SMMC) has a continuous need for neurology services and Dr. Belfer offers the hospital the benefits of an experienced practitioner familiar with the complex nature of the County patient base.



Contractor is providing clinic services, test interpretation and call coverage for neurology. The productivity is being measured by the current Medicare Resource-Based Relative Value Scale (RBRVS) Relative Value Units (RVUs), an industry-wide measurement of medical care that indicates the level of productivity being met by an individual practitioner. Dr. Belfer works with another neurologist, Dr. Michael Siegel, to provide 24/7 call coverage for the neurology patients of SMMC.


The Agreement and Resolution have been reviewed and approved by County Counsel as to form. The Contractor’s insurance has been reviewed and approved by Risk Management. County Administrative Memorandum B-1 provides that contracts for physicians are exempt from the Request for Proposals process.


The Contractor has assured compliance with the County’s Contractor Employee Jury Service Ordinance, as well as all other contract provisions that are required by County ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination and equal benefits.


This Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing basic neurology services to the patients at SMMC. It is anticipated that 100% of all neurology services provided will adhere to the infection control standards as defined by the Joint Commission and Title 22 of the State of California Code of Regulations, which will result in reduced risk of healthcare-associated infections.


Performance Measure:


FY 2009-10

FY 2010-11

Reduce the risk of healthcare-associated infections and adhere to infection control standards as defined by Joint Commission, Title 22, and other applicable standards.





The term of this Agreement is April 1, 2011 through March 31, 2014. The maximum amount of the Agreement is $375,000. Funds in the amount of $31,250 are included in the SMMC FY 2010-11 Adopted Budget. Funds in the amount of $125,000 are included in the SMMC FY 2011-12 Recommended Budget. Similar arrangements will be made for future budget years.


Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care are covered by the County’s General Fund contribution to SMMC.