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Council closes day center in split vote
Community begs Council to keep program open
Navigation center closing 1
On the same night that the Turlock City Council voted to close the Navigation Center, Tatiana Pacino and a friend were camped out in front of City Hall trying to stay warm for the night (jOE CORTEZ/The Journal).
Joe Cortez
Turlock Journal
Published: Jan 27, 2024, 7:04 AM

Tatiana Pacino, a member of Turlock’s unhoused community, was nestled inside a doorway outside City Hall Tuesday night. With a sleeping bag and several blankets, she’d created a pallet to keep herself safe from the winter chill, and despite temperatures dipping into the low 40s, she looked quite cozy.

Meanwhile, about 50 yards away, inside the Turlock City Council chambers, the council voted 3-2 in favor of closing the We Care Day-Use Navigation Center, where the city’s unhoused can spend daytime hours while the overnight shelters are closed.

Mayor Amy Bublak, along with councilmembers Pam Franco (District 4) and Rebecka Monez (District 2) — both of whom are up for reelection in 2024 — voted to close the facility, citing financial concerns and the overall effectiveness of the center.

Councilmembers Cassandra Abram (District 3) and Kevin Bixel (District 1) voted to keep the center open, agreeing that closing the center felt like a step in the wrong direction.

Navigation Center closing 3
Councilmembers listen to community members speak out for and against keeping the Navigation Center Pilot Program open during Tuesday’s Turlock City Council meeting. FROM RIGHT: Councilmembers Cassandra Abram and Kevin Bixel voted to keep the program open, while Councilmember Pam Franco, Mayor Amy Bublak and Councilmember Rebecka Monez voted to close it (JOE CORTEZ/The Journal).

“There are real concerns that we got to hear about from our downtown business owners that are very valid and very concerning and very disturbing, and those need a targeted approach,” said Abram. “But closing this center is moving us backward.”

The city approved the navigation center pilot program last April at a cost of $178,220. The center, located in a portion of the United Samaritans Foundation facility at 220 S. Broadway, opened on June 7. The pilot program was slated to expire on Nov. 30, but the city extended it for an additional two months. It will now will expire on Wednesday.

A report prepared by city staff sited cost, safety issues, questions about the program’s effectiveness, and negative public comments as reasons to end the program.

However, a staff report from last Nov. 14 favored extending the program for another 13 months, stating, “The day-use navigation center six-month pilot program has shown success with providing service to an average of 30 to 50 people daily, as well as providing one-location services, such as case management, housing, and medical services … in addition to providing a safe place for people to stay during the day.”

It was recommended the facility be open five days a week for 10.5 hours per day at a cost of $454,244 over the 13 months.

That item was pulled from the Nov. 14 agenda and no action was taken.

“We think, based on our observations of how much the center was being used, that this is not a good use of money right now,” said city manager Reagan Wilson.

Navigation Center closing 2
Tatiana Pacino leads classes at the Navigation Center that help other unhoused individuals deal with their emotions through the creative process. Pacino said she doesn’t know what she’ll do now during the daytime hours (JOE CORTEZ/The Journal).

Abram pointed out in her closing remarks Tuesday that the city currently has Permanent Local Housing Allocation funds — money for which the city applied back in 2022 — that could be used to help keep the center open. But according to Wilson, the $1.3 million in PLHA funds could not be used to keep the navigation center open.

Section 401(a)(2) of the state Housing and Community Development’s PLHA allocation guidelines states that funds can be used for “operating and capital costs for navigation centers.”

If unused by March 31, a chunk of the city’s PLHA funds would be forfeited back to HCD.

Franco, who spoke most vociferously for closure, pointed out that she supported the navigation center in two prior votes and had hoped it would’ve been filled to its 101-person capacity.

“But when there’s only 10 to 15 people there and it’s going to cost us approximately $450,000 for a year for 25 people, I think the citizens of Turlock are going to have a problem with that,” Franco said. “I understand the human aspect of it. Like I said before, I voted for it originally. But I also took an oath to take care of public funds, and $450,000 for 25 people is not a good use of public funds, in my opinion.”

According to data provided by We Care, an average of 27 people utilized the facility per day in June when the center first opened. Six months later, in December, that number had nearly doubled to an average of 51 per day.

Wilson was skeptical of the navigation center’s numbers.

“The numbers being kept track of are not consistent with unique individuals,” said Wilson.

On Thursday, during an unannounced visit to the navigation center, the Turlock Journal observed 30 people in the facility at about 10 a.m.

During Tuesday’s meeting, Stanislaus State professor Andrew Conteh urged the council not to think about money, but to think about the issue from a human rights perspective.

“As you continue these discussions, don’t focus a lot on the monetary aspects,” said Conteh. “Look at the homeless as human beings. They are entitled to fundamental human rights. If you take that into consideration, it’s going to be easier for you to come to workable conclusions.” 

Another who lobbied to keep the navigation center open was Turlock Unified School District board member Mary Jackson, a former member of the city council. She reminded the council that the phrase “In God We Trust” adorns the wall directly behind the councilmembers.

“This council needs to really think about, instead of wearing a bracelet that says, ‘What Would Jesus do?’ to do what he would do,” said Jackson. 

Julie Fox, a former We Care board member, urged the council to realize that Turlock is an ever-changing city.

“Years ago, Turlock was small town,” Fox said. “In the ’70s we had about 14,000 people. We are now at almost 71,000. What that means is what life used to be like here is not the way it is.

“Closing the navigation center, what does it mean for the people of Turlock? More excrement on the street. More public urination. More homeless on the street. And if that’s the direction we want to go, close it.”

While a phalanx of navigation center supporters strode to the podium during the meeting, calls for its closure came mainly from downtown business owners or those associated with downtown business interests. Much of the debate centered upon a recent incident in which a man was seen masturbating in front of Bella Forte Boutique on West Main Street. 

“I just want to say that I know that there’s been a lot of good done,” said Main Street Antiques co-owner Lori Smith, who asserted that there had been two other incidents of indecent exposure in the previous 10 days. “I think the question here is: is it accomplishing what it was meant to do? … I have talked to the homeless before. I try to get to know them. I know them by name. I have had them tell me in the past, ‘We came to Turlock because we heard Turlock likes homeless.’ We see new faces every day, and we’ve been in business 27 years. It used to be once in a while. Every day there are new faces, so you can’t tell me they’re all from Turlock.”

Downtown business owners reported to the city that they have not seen a significant decrease in homeless issues since the navigation center opened.

“I think the pivotal word in our staff report was ‘ongoing’ criminal problems,” said Abram. “The problems existed before the navigation center. Without having that place to go, people will go back into the parks, the alleyways, the business centers, to wherever they were before.”

Ron Bridegroom, a fixture at city council meetings, reminded the council that in 2007 the city and the California State University, Stanislaus conducted a Turlock homeless study. Bridegroom read from the report, which urged service providers to work together, shelters to admit the impact they have on neighborhoods, and for the implementation of a data-collection system.

“(Nearly) 20 years later, these observations and recommendations are just as valid, while the homeless situation in Turlock has gotten significantly worse,” Bridegroom said. “Back in 2007, I think the point-in-time count was 97. Last year it was 233, I believe.

“In my opinion, without transparency and accountability of the service providers, and their willingness to cooperate with the city and each other toward the goal of reducing homelessness in Turlock, and making public safety a priority, and without requiring the taking of responsibility on the part of the homeless, we will continue the pattern of failure that we’ve seen for the past two decades.”

Bublak seemed to shift the responsibility to county government.

“You pay taxes for a city to provide public safety, water, sewer and roads,” said Bublak. “It’s probably going to make the county mad, but the county gets the money from the state and the federal. And they have to supply that information. They give all the mental health and homeless stuff to the City of Modesto and maybe to Ceres; around there. They’re supposed to provide that. This isn’t our obligation. Now, I understand that these are our citizens … but there’s got to be a better way to do this.”

Of course, Turlock isn’t the county’s only concern. Modesto, the county’s largest city, has 70 percent of the unhoused population despite having just 39 percent of the county’s population — a crisis that requires far more funds and attention.

According to We Care, the navigation center has provided a bevy of services during its eight months in operation, including: mental health counseling through La Familia with 89 reported case management appointments; therapeutic art classes used by 40 individuals; haircuts for 37 individuals; mobile medical clinic services for 61 individuals; free cell phones for 17 individuals; drug, alcohol, and grief support group meetings for 14 individuals; and case management and housing referral services for an unreported number of individuals.

“Outside of the seven individuals housed by We Care since June, we had four individuals gain housing on their own,” case manager Corey Mai told the council. “We were also able to reunite four individuals with family they had out of state and find organizations that helped cover the cost of transportation to reunite them with those family members. We had 11 individuals start at different drug treatment facilities.”

Mai went on to point out that the center has offered case management to 148 unduplicated individuals, including Pacino, who was sleeping outside during Tuesday’s meeting.

The 36-year-old Pacino, who became homeless fleeing domestic abuse, was at the navigation center during the Journal’s visit on Thursday. An artist, Pacino leads classes that help other unhoused individuals deal with their emotions through the creative process. Without the center, Pacino said she knows what will happen during the daytime hours.

“There will be people in front of the (downtown) businesses,” she said.

 
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.
Published: Apr 2, 2025, 4:48 AM

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.