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Council approves code of conduct changes
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Although Councilmember Steven Nascimento’s ordinance related to campaign finances did not gain approval at Tuesday’s meeting, his other resolution aiming to refine the council’s Code of Conduct was approved in a 3-2 vote.

The ordinance, which adds a section to the existing Code of Conduct on ex-parte communications, was voted in with opposition from Councilmembers Amy Bublak and Bill DeHart.

According to Nascimento, the change would reflect existing rules, simply creating a reminder for new and current Councilmembers.

“These are existing rules that we have to abide by,” said Nascimento. “But since it is not in our Code of Conduct, I was not aware of it until I attended a recent conference. If I wasn’t aware of it, I thought it would be good to include for future reference.”

By adding a section on ex-parte communications, the Council will have specific guidelines on how they should respond should a quasi-judicial circumstance come forth. Nascimento says that although the Council has not had any quasi-judicial circumstances in recent years, the addition would help council members know what to do and how to act under such conditions.

“It provides a means of how we should conduct ourselves should we be in that situation,” said Nascimento.

City Attorney Phaedra Norton clarified the meaning of ex-parte communications as being a communication between governmental decision makers and third parties outside of official meetings. Under the ordinance, Councilmembers would be required to disclose the matters discussed during the unofficial meeting, as a means to ensure council transparency.

In the case of a conditional use permit appeal, should one involved party that is either for or against the appeal come and speak to a councilmember outside of an official meeting, the Councilmember would then be required to disclose to the other involved party what had been discussed. According to Norton and Nascimento, the required disclosure would help keep all parties informed of developments, while providing them time to respond.

Councilmember Bill DeHart seemed hesitant to accept the ordinance, saying that he didn’t fully understand its implications.

“I feel like I’m being set up,” said DeHart. “I always talk to people on both sides of the issue.”

Both Nascimento and Councilmember Forrest White explained to DeHart that the law already requires the Councilmembers to disclose such information, but that by adding it to the Code of Conduct, it would be easier for Councilmembers to know exactly how they should respond.

“We’re not reinventing the wheel,” said White. “We’re just saying that the wheel has already been invented, and we just have to abide by it.”

Turlock resident John Beckman commended the Council for considering the item, saying it promotes council transparency.

“This one is a pretty good idea,” said Beckman. “It’s about full disclosure, however, I would strike the language that says ex-parte communications should be avoided because it is allowed by our constitution.”

Noting Beckman’s suggestion, Nascimento agreed to remove the sentence within the amendment that suggested Councilmembers avoid such communications, while suggesting the Council move forward with the item.

Councilwoman Bublak, who said she believes the measure could help in their push for complete transparency, said that she would like more time for the ordinance to be reviewed, as she requested it be more specific about whom the Council members are allowed to speak to, and what must be disclosed after such instances.

After amending the ordinance to remove the sentence regarding “avoiding” such situations, the Council voted to approve the resolution, with Bublak and DeHart voting ‘no.’

On Tuesday, the City Council also:

-          Received a presentation from the Future Business Leaders of America from Pitman High School and Dutcher Middle School

-          Were updated on capital projects and building activity within the City

-          Voted to place a continuance on an ordinance regarding campaign contributions

-          Adopted the East Stanislaus Integrated Regional Water Management Plan

The next City Council meeting will be held at 6 p.m. on Feb. 25 at City Hall, located at 156 S. Broadway.

Costa, Gray propose congressional bill to address critical physician shortage in rural areas
Costa and Gray
San Joaquin Valley congressional members Rep. Jim Costa, D-Fresno, left, and Rep. Adam Gray, D-Merced, are shown discussing their bill H.R. 2106 in a virtual press conference on Tuesday.

BY TIM SHEEHAN

CV Journalism Collaborative

Two San Joaquin Valley congressional representatives have introduced a bill that could help address the vast shortage of doctors in the region, particularly in underserved areas. 

Rep. Jim Costa, D-Fresno, and Rep. Adam Gray, D-Merced, say the Medical Education Act would, if passed, establish a program of grants to support expanded medical education programs in underserved areas of the nation.

The Valley could be one of the key areas that would benefit from the legislation. California has about 90 primary care doctors per 100,000 residents statewide, the federal Health Resources & Services Administration reported in November 2024. 

That’s more than the ratio in some states, and less than some others. The nationwide ratio is about 84 doctors per 100,000 residents.

But in the San Joaquin Valley, home to about 4.3 million people, doctors are much more scarce – about 47 primary care physicians per 100,000 residents, according to Dr. Tom Utecht, chief medical officer at the Fresno-based Community Health System.

That number is “a little over half of what is necessary to take care of a population,” Utecht said Tuesday in a video press conference. “We have the lowest physicians-per-capita rate in all of California, in the San Joaquin Valley.”

Introduced last month, the Medical Education Act is something of a placeholder for the time being until the Congressional Research Service can weigh in with financial estimates of what is needed in different parts of the country, Costa said. 

A companion version was introduced in March in the U.S. Senate by Sen. Tim Kaine, D-West Virginia, and Sen. Alex Padilla, D-Los Angeles.

At this point, the legislation does not specify how much money will ultimately be sought or how grants would be structured.

Costa said the shortage of doctors in the region “is combined with language barriers, cultural barriers and distances … and that would really go for rural parts of our country regardless where folks live.”

“If you live in rural areas, it’s just more difficult to have access to good quality health care,” he added.

Costa said the legislation, if it can survive a Republican-controlled House and Senate and a Republican president, “would be transformative because it would invest expanded resources to minority-serving institutions and colleges located in rural and underserved areas to establish schools of medicine and osteopathic medicine.”

The bill would also create an avenue for more historically Black colleges and universities, as well as Hispanic-serving institutions, to establish medical education programs, Costa said.

Gray noted that when he was in the state Legislature, he and colleagues “worked to get hundreds of millions of dollars in funding to expand the UC Merced campus, to ultimately secure the funding to put the first medical education building up on campus.”

Gray added that the UC San Francisco’s medical education program in Fresno “is an important part of creating the (medical) workforce of the future for the valley, but more importantly, solving this access to care issue that plagues Valley communities.”

At UC Merced, director of medical education Dr. Margo Vener said there has been a surge of interest in the university’s program that funnels students through an undergraduate program for their bachelor of science degree through a medical school degree in collaboration with UC San Francisco.

“All the students that we are enrolling are from the Valley and for the Valley, because they want to really make a difference in promoting health in their communities,” Vener said. That, she added, is likely to eventually translate to those would-be doctors to stay in the Valley to practice medicine.

“The data suggests that two factors really strongly influence where physicians stay to practice,” Vener said. “One of them is where they’re from, which, of course, is why we’re recruiting students from the Valley for the Valley just to stay (and) be doctors for their community. And the other factor is where you went to residency. Those are the two biggest drivers.”

That’s something that was underscored by Dr. Kenny Banh, assistant dean of undergraduate education at UCSF Fresno. “Regional campuses such as UC Merced and UCSF Fresno not only grow doctors, but they take those doctors, physicians and medical students from their communities in the region, and train them in those regions to go back to be physicians in those areas,” he said.

While the costs of the Costa-Gray legislation are yet to be determined, Banh said there are also costs associated with doing nothing to expand medical education.

“There’s health care costs, regardless of how we work it, if we don’t invest in having an adequate supply of physicians,” Banh said. “There’s a cost on the human that can’t access care” and doesn’t get to a doctor until a condition is not treatable “or with significantly worse morbidity and mortality outcomes.”

“And that cost is borne by health systems taxpayers, one way or the other,” Banh added.

But even if the Costa-Gray bill were to pass in this congressional session, the payoff of home-grown medical schools producing a bumper crop of physicians in the Valley or other deprived parts of the country would be years down the road.

“I think it’s really important to understand why we need to invest now for our future, because it takes so darn long” for a student to go from being a college freshman to a practicing doctor, surgeon or specialist, UC Merced’s Vener said. 

After a four-year bachelor’s degree, a student must then complete four years of medical school, which in turn is followed by a residency of three to five years.

“Then often people will do a fellowship to become, for example, a cardiologist or a gastroenterologist or something like that,” she added.

“If you start investing in just one student now, it’s going to take such a long time before they really are there to take care of you at that moment when you need them to be your gastroenterologist, your cardiologist, your emergency physician, or, dare I say, your family doctor,” Vener said.

That, she said, is why it’s also necessary to expand residency programs that can attract would-be physicians into the region in hopes that they will remain once they complete their training. “We need those doctors now, and that’s why this effort is important,” Vener said, “because this is what will both inspire people to stay, but also inspire people to really come and embrace the communities and serve them.”

In a related development, state Assemblymember Esmeralda Soria, D-Fresno, recently introduced a bill for the University of California system to develop a comprehensive funding plan for expanding the current SJV Prime+ BS-to-MD partnership between UC San Francisco and UC Merced, with the goal of transitioning the program to a fully independent medical school operated by UC Merced.

“We have seen firsthand the impacts of medical workforce shortages throughout the Central Valley,” Soria said in a prepared statement. “AB 58 would help ensure the Legislature is equipped with the information needed to secure appropriate funding for the medical education provided for our community at UC Merced.”

— Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.