As the Texas Medical Association digests and analyzes the full impact for Texas of the U.S. Supreme Court decision in Roe vs. Wade, President Gary W. Floyd, MD, issued the following statement today in response to the ruling.
“TMA remains committed to protecting the privacy and sanctity of the patient-physician relationship. TMA is unwavering in its stance against intrusions by government or other third parties that impede the patient-physician relationship, and any criminalization of acceptable and appropriate medical practices that may jeopardize that relationship or patients’ safety.
“Especially in high-risk situations, patients need to know their physicians will be there to care for them, and TMA will continue to work with state lawmakers to ensure a safe practice environment for physicians and their patients.”
On May 6-7, 2022, healthcare and service professionals, from physicians to social workers, met for the inaugural Texas Street Medicine Symposium at the Tarrant County Medical Society. The event was a success, and now, Fort Worth is making a bid to host the 2023 International Street Medicine Symposium.
Street medicine is centered around bringing comprehensive medical care to people who are experiencing unsheltered homelessness. The symposium, which had representatives from Fort Worth, Austin, and San Antonio, was an opportunity for street medicine teams and affiliate organizations to share ideas and opportunities.
“The practice of Street Medicine is often tied closely with state and local policies,” says Joel Hunt, PA. Hunt, who was one of the Symposium’s lead organizers, is the director of Acclaim Physician Group’s Street Medicine program. “Texas has a large, diverse population, and many Street Medicine teams spread across the state. Our goal was to give these teams a space to meet and share their experiences in hopes that best practices could be applied statewide.”
The meeting, which had around 70 attendees, was a collaborative effort between JPS Foundation, Acclaim Physician Group, Integrative Emergency Services, and TCMS. Street Medicine International founder Jim Withers, MD, spoke at the event, and a range of topics and resources were covered to empower those who interact with the homeless community, from opioid abuse treatments to housing access.
The event was well received, and participants left informed and challenged, but Hunt isn’t resting on his laurels – he is preparing to send in an application to host the 2023 International Street Medicine Symposium in Fort Worth. If his bid is accepted, the symposium, which will take place next fall, would bring hundreds of healthcare and social workers to Fort Worth for its duration. Hunt will need to turn the application in to the Street Medicine Institute by June 24, 2022.
“We hope to leverage our success with hosting this conference to put forth a strong application,” says Hunter Scarborough, MD, Hunt’s co-organizer for the Texas Symposium and an emergency medicine physician at JPS Health Network. “Fort Worth has the advantages of an easily accessible airport, big city amenities, and a local government supportive of health care and housing measures for persons experiencing homelessness.”
Hunt believes this event would energize and inform Tarrant County’s current street medicine initiatives.
“Showcasing the great work this community is doing would be fantastic,” he says. “Bringing in international experts to share their knowledge, wisdom, and experiences would allow us to in turn apply them to continue to improve our community.”
Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna and Pfizer vaccines and at times the Johnson & Johnson. Children five and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.
TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches and organizations in the community who are interested in hosting a pop-up clinic. It’s easy and free to host a clinic.
In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.
Pop-Up COVID-19 locations:
Everman Public Library Saturday, June 25: 10 a.m. to 2 p.m. 100 North Race St. Everman, TX 76140
Austin Company-Health Expo Saturday, June 25: 11 a.m. to 4 p.m. 2029 North Main St. Fort Worth, TX 76164
Greater Saint Stephen First Church Monday, June 27: 1 p.m. to 5 p.m. 3728 East Berry St. Fort Worth, TX 76105
Vaxmobile – Saint John Cathedral Thursday, June 30: 9 a.m. to 4 p.m. 2501 East Berry St. Fort Worth, TX 76105
Worth Heights Community Center Thursday, June 30: 3 p.m. to 6 p.m. 3551 New York Ave. Fort Worth, TX 76110
Lamar High School Friday, July 1: 10 a.m. to 2 p.m. 1400 W. Lamar Blvd. Arlington, TX 76012
Tarrant County Public Health CIinics:
Northwest Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 3800 Adam Grubb Road Lake Worth, TX 76135
Bagsby-Williams Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 3212 Miller Ave. Fort Worth, TX 76119
Southeast Public Health Center Monday to Friday: 9 a.m. to 12 p.m. and 1 to 6 p.m. 536 W Randol Mill Arlington TX, 76011
Main Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 6 p.m. 1101 S. Main Street Fort Worth, TX 76104
Southwest Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 6551 Granbury Road Fort Worth, TX 76133
Watauga Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 6601 Watauga Road Watauga, TX 76148
The Vaxmobile is a partnership between Tarrant County Public Health and Trinity Metro to bring COVID-19 vaccines to underserved communities throughout Tarrant County. The 60-foot bus converted to a fully equipped mobile vaccine clinic, will make weekly stops in the areas with the lowest vaccination rates on Thursdays. Vaccinations are also available at the six Tarrant County Public Health clinics listed above every day of the week.
For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.
Tarrant County Public Health will begin administering the COVID-19 vaccine to children six months to five years of age at all TCPH clinics, public pop-up clinics, and the Vaxmobile starting on Wednesday, June 22, 2022.
Both the Pfizer and Moderna vaccines will be available to protect this age group. Infants six months through four years of age receiving the Pfizer vaccine series will need to get two doses, three weeks apart, and a third at least two months later. The dosage of Pfizer for infants is one-tenth of the dosage for adults. The Moderna vaccine series for infants six months through five years of age will consist of two doses, four to eight weeks apart, and it will be a quarter of the dosage of Moderna for adults. A third dose of Moderna has been approved for immunocompromised infants in this age group, at least one month after the second dose.
The CDC now recommends the COVID-19 vaccine for children and adolescents six months of age and older. COVID-19 has become one of the top 10 causes of pediatric death, and tens of thousands of children and teens have been hospitalized because of the virus. While children and adolescents are typically at lower risk than adults of becoming severely ill or hospitalized from COVID-19, the effects of the virus are unpredictable. Vaccination is the best way to protect children from COVID-19.
The COVID-19 vaccine is safe and effective. Before it was authorized for children across age groups, scientists and medical experts reviewed safety and effectiveness data from clinical trials involving thousands of children.
Tarrant County Public Health Clinics:
Northwest Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 3800 Adam Grubb Road Lake Worth, TX 76135
Bagsby-Williams Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 3212 Miller Ave. Fort Worth, TX 76119
Southeast Public Health Center Monday to Friday: 9 a.m. to 12 p.m. and 1 to 6 p.m. 536 W Randol Mill Arlington TX, 76011
Main Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 6 p.m. 1101 S. Main Street Fort Worth, TX 76104
Southwest Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 6551 Granbury Road Fort Worth, TX 76133
Watauga Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 6601 Watauga Road Watauga, TX 76148
COVID-19 causes respiratory illness with cough, fever and shortness of breath and may lead to bronchitis and severe pneumonia. For more information go to the TCPH coronavirus page or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m. and Saturday 10 a.m. to 2 p.m.
This article was originally published in the May/June 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
As a high schooler attending a medical magnetschool, my first patient interaction came early, but the lesson I learned that day has influenced the type of physician I hope to become. Nervously, I greeted my first patient, Laura, and informed her that I would be assisting the nurse that day. I helped with her bath and brushed her hair with care, just as I brushed my own mother’s hair when she was hospitalized. Laura was blind and her tracheostomy tube prevented her from speaking, but despite that initial disconnected feeling, I was told, “The goal should be to take care of the patient as if she were your own family member.” That goal was to serve with compassion and empathy. These words have remained with me each time I have interacted with a patient. I took lessons such as this one with me after graduating and made it my mission to maximize my impact on others while serving my community.
Over spring break this year, I participated in a medical mission trip to Guatemala with 35 of my peers. Over the course of five days, we traveled by air, sea, and land to visit Santa Maria de Jesus, Magdalena Milpas Atlas, Monterrico, and San Juan, where we saw over 600 patients. Upon arrival at the pop-up clinic locations that were normally schools or church community rooms, there was often an impressively long line that formed before doors opened. Patients waited hours to be seen each day, and that was a humbling sight.
As a first-generation American raised in the U.S.-Mexico border region and a native Spanish speaker, I served as a link between patients, physicians, and medical students. My responsibilities were to initially take patient’s vital signs and blood glucose readings and then discuss their medical history and chief complaints so I could give the information to the attending physicians volunteering with us. Other days, I had the opportunity to work with a student partner and conduct full patient interviews. We would present our differential diagnoses to one of the attending physicians and work alongside the patient to create the best plan of care. On one of these days, I noticed that a patient came in particular distress. Upon my initial analysis, I noticed that he had what I call “working hands.” Large, dry, and calloused, they resembled the hands of my construction laborer father. As soon as I introduced myself by saying, “Buenos días, mi nombre es Aiyana,” his demeanor changed entirely. One moment he was shyly nodding and following the motions, and the next he looked up, seemingly comforted by familiar words. He, like many others, opened up and provided critical information necessary for his recovery. This change in demeanor occurred patient after patient, and I began realizing how incredible it was to contribute to the enhancement of patient care that would otherwise be limited by communication barriers. I am proud of my work as a translator, but I learned that there is far more that goes into quality of care than a shared language. Though some physicians and students were limited by language, I witnessed spectacular uses of eye contact, hand motions, diagrams, and body language – all of which portrayed a genuine desire to connect with and educate patients. Everyone seemed to have an impeccable awareness of their patients’ needs and feelings, despite their differences.
As soon as I introduced myself by saying, “Buenos días, mi nombre es Aiyana,” his demeanor changed entirely. One moment he was shyly nodding and following the motions, and the next he looked up, seemingly comforted by familiar words.
It is a privilege to be entrusted to care for the life of another human being and I do not plan on taking such a responsibility lightly. It is important to acknowledge that one does not need to travel to faraway lands to serve those in need, as many underserved individuals are likely residing minutes away from us right now. In the future, I will continue to participate in mission trips abroad in addition to serving the local community, wherever I go!
As part of their “Conversation With” series, which highlights leaders in the North Texas community, D CEO Healthcare sat down with TMA President Dr. Gary Floyd to discuss a range of topics – from restoring trust in medicine to transgender care and legislative priorities. Here’s an excerpt:
“When the public health emergency is declared over, over a million people will lose coverage in Texas. We’ve been trying to work with our legislators about targeted plans to extend coverage. We would like to continue to cover children from birth through six months and expand it to have 12 months of eligibility; We would like to cover pregnant moms postpartum for 12 months. We are trying to improve payment for delivering Medicaid services that haven’t been changed in over 20 years.”
In a recent advisory calling attention to health care worker burnout, U.S. Surgeon General Vivek Murthy, MD, highlighted the broad response the situation calls for: “We must ensure that every health worker has access to affordable, confidential, and convenient mental health care.”
If finances are keeping you or someone you know from seeking treatment for depression, anxiety, substance use, or other conditions, the Texas Medical Association’s PBF Wellness Fund is here to help overcome that barrier.
Through the fund, physicians with a valid Texas medical license can receive financial support for treatment of conditions that impair their ability to practice medicine safely. In addition, qualifying physicians can receive financial support to cover their family’s living expenses while undergoing treatment.
In the surgeon general’s report, Addressing Health Worker Burnout, Dr. Murthy proposed a variety of approaches to aid the 35% to 54% of physicians and nurses, and 45% to 60% of medical students and residents, reporting symptoms of burnout. He called for individuals, health care organizations, academic institutions, government, and more to help address the problem.
Related to mental health, the advisory calls for such actions as:
Eliminating punitive policies for seeking care for mental health and substance-use disorder;
Normalizing conversations about mental health challenges, including suicide, in health care learning environments to foster a culture of support and awareness; and
Ensuring access to mental health services for health care workers and their families, including the use of telemedicine.
Contact TMA if you or someone you know could benefit from the PBF Wellness Fund. Email Chris Johnson, PBF director, or call her at (512) 370-1602 with questions. Or complete an application. TMA strives to protect the anonymity of fund recipients.
Contributions from physicians and their spouses support the fund. If you want to help, you can contribute via secure, online donation, or send a check to PBF Wellness Fund, Attn: TMA Finance Department, 401 W. 15th St., Austin, TX 78701-1680.
The PBF is a 501(c)(3) organization, so charitable contributions are tax-deductible to the full extent permitted by federal law.
By Hujefa Vora, MD, TCMS Publications Committee Chair
Last month, I wrote about choices. We all seem to encounter hundreds, if not thousands, of choices every day. And who really knows how the slightest choice affects the next set of choices that present themselves before us. Our choices at times can appear meaningless to us. As I prepare for my day, I choose my scrubs from my closet. Unconsciously, I make the decision to wear the blue ones. I decide to just grab a granola bar for breakfast as a matter of convenience on my way out the door rather than to sit down with my wife at the dining table for the coffee and omelet and communion I am truly craving. On my way to work, I decide to stop and fill up some gas, though my truck still has a quarter tank. The floor nurse messages me that my patient’s family has decided to try and meet with me around lunchtime today rather than meet me for my morning rounds. I let her know that I am not sure that this will work, as there are likely to be another few hundred choices that I have to make before I get there. I will try. That seems to be all I can do in any given situation. At any rate, I decide to go by and see the patient first this morning. This will give me a moment of clarity without the interference that sometimes follows families into a room. I make the choice to turn left rather than right—I will start my day in the ICU and make my way back to the orthopedic facility later. I know that I will make it to all of the patients before the end of my day. My choices thus far have been mundane rather than the life and death decisions which we are glorified with when others speak of our profession.
The choices I made that morning were not anything but ordinary. And yet, as we find sometimes, they guided me exactly to the place where I was needed most.
As I arrive at the hospital, the cafeteria’s coffee machine calls my name. The granola bar wasn’t quite enough. I chose a decaf vanilla latte. Now the coffee machine is not that place, but it is certainly the place I needed most. Caffeine would make it better, but that goes without saying. My coffee and I meander onto the unit. The nurses are busy at their bedsides, assessing the patients at the start of their morning. As I walk toward the central nurses’ station, I note the rhythms of the telemetry monitors. Muffled underneath is the low hum of air flowing through endotracheal tubes. The aroma of the coffee hides the scent of hand sanitizer and bleach. Just the granola bar was a poor choice, but the choice of coffee from the cafeteria more than compensates for that. It is all entrancing, calming, and yet chaotic. The ICU has its own music. Occasionally, the better choice of words is controlled chaos. My moment is broken by a flourish from the room 20 feet in front of me. The rhythm is broken as a woman flies out of the room, hurtles towards me, and demands her nurse. For a moment, I hesitate. I then realize that the blue scrubs I chose this morning happen to be the same blues worn by our ICU nurses. I follow her into the room. The patient is bucking the ventilator. In his bed, he is strapped down, but from the spasms in his shoulders and neck, his arms look like they will try and pry loose. I hit the Code button on the hospital bed. The ICU machine is awakened by a cacophony of deafening alarm bells. Three nurses barrel into the room with a crash cart. A few simple, unplanned choices have guided me to this moment.
“The choices I made this morning were not anything but ordinary. And yet, as we find sometimes, they guided me exactly to the place where I was needed most.”
There were no decisions this morning prior to this moment that required my four years of college, four years of medical school, or three years of residency. And yet, they were a doctor’s decisions and choices. The next few choices were those of a seasoned physician with more than 20 years of working in hospitals and ICUs.
I don’t have any history, as this is not the room of the patient I have yet to visit this morning. All I have is the information the nurses start barraging me with. The patient is seizing, so IV benzodiazepines are administered. Another choice. The patient starts to calm, spasming muscles relaxing. Calm washes over the scene for a moment. Everyone, including the patient, pauses to breathe. The momentary silence is broken by the sobbing of the patient’s wife, I presume. She asks if the doctor has been called. Without skipping a beat, I reassure her that the intensivist is on his way. The wife stutters out a prayer, then thanks me for my actions. My choice in that moment is not to correct her, but rather affirm to her that we will take good care of her husband until the intensivist arrives. I remain in the room for several more minutes until the intensivist comes in to relieve me. He assesses the situation, thanks me for intervening while he was indisposed with another patient situation, and then allows me to walk back out of the room. As I leave, he pokes his head out of the glass door and shoves a cup into my hand. “Don’t forget your coffee.”
Every choice we make in our days is governed by several principles. I am about to speak in generalities, a choice I am making in this moment. We are physicians. Our lives revolve around this choice. Being a physician is not just a job, not simply some way to make money, but rather a life choice, because being a physician is not my job, but it is my Life. We are called upon, above all else, to do no harm—our choice is to take this oath and live by it. No matter the moment, the situation, the patient comes first, above all else. We apply our knowledge, our skills, and our hearts to every patient individually, understanding that it is our oath and the choices that have followed thereafter that define our most noble profession at its core. As a physician, it should always be my choices, and my patients’ choices, which guide me to those moments and through those moments when I am needed most. One might say that I am pro-choice. I choose to agree. My name is Hujefa Vora, and I choose the word “choice” as this, The Last Word.
This article was originally published in the May/June 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
While the origin of this quote is debated, I find that it sets the scene perfectly. The point is that you need to be engaged to have a say in the process. I frequently use this phrase when discussing issues related to women’s health and LGBTQ care when government officials or other people in power try to dictate how I practice medicine. In less than a year, various entities in the Texas government have tried to dictate this at least three different times. There just is not enough space in my exam room for all of us. And sadly, I feel that they are only just getting started.
I consider practicing medicine to be a profound privilege, and it is one that is only obtained after many years of hard work, study, and usually a huge financial commitment. For those who do not know, I did not come to medicine straight out of college. I chose to pursue studies in ballet and pre-medical course work while getting my undergraduate degree, then followed my passion to an opportunity to teach and dance professionally. After a few years, I decided it was time to go back to the pursuit of a career in medicine. However, I did not get there the first try and had to make a further commitment to improve my application to get into medical school the second time. Having studied ballet in college, I definitely felt a little out of my element in medical school. I still recall a time when a professor in a small group learning session referred to me as the “lowest common denominator” due to my nontraditional background. Despite this, I continued in my studies to obtain the title of Doctor of Medicine. To practice medicine, however, you do not stop there; you must take the next road in the journey of medical education, and I went on to study obstetrics and gynecology in residency for another four years of training. So, in total, I have spent 12 years in education to become the doctor that I am today. That does not include the hundreds of hours of study that one must continue after residency to maintain the privilege of being a doctor as well as to provide the best and most up-to-date care to one’s patients. Despite all of that, for obstetricians and gynecologists, our field is continually under the microscope for various areas of the care we provide, and outside influences are always trying to tell us how to do our job.
As mentioned earlier, there have been three times when the government of Texas has tried to dictate how I can practice medicine. On September 1, 2021, Senate Bill 8, prohibition of doing an abortion after a heartbeat is detectable, was implemented. This has led to many far-reaching consequences that do not have anything to do with abortion, such as concerns regarding management of ectopic pregnancy, management of premature rupture of membranes before viability, and lethal fetal anomalies not identified until 18–20 weeks.
“I consider practicing medicine to be a profound privilege, and it is one that is only obtained after many years of hard work, study, and usually a huge financial commitment.”
On December 2, 2021, Senate Bill 4 became effective, further placing non-evidence based restrictions on medication abortions as well as requiring physicians and healthcare facilities to report complications that occur from medically induced abortions. This essentially forces physicians and healthcare facilities to report our patients who are already going through a challenging time. In addition, we must justify the use of the same medications used for abortion when used for other medical reasons and sometimes delay the care for patients in the process.
On February 18, 2022, the attorney general of Texas wrote an opinion letter equating transgender care with child abuse. This was followed by a letter from the governor on February 22, 2022, to the Texas Department of Family and Protective Services, asking them to “conduct a prompt and thorough investigation of any reported instances of these abusive procedures in the state of Texas.” While these are officially opinions only, they have led the transgender community to fear seeking evidence-based care. Furthermore, some physicians and healthcare entities who provide this care have shut down or halted the care of these patients. These opinions have further isolated an already at-risk population from the care they need and deserve.
We have all trained, studied, and worked too hard to let those who have not done the same dictate the care we provide. Would we allow outside influences to decide who gets cancer treatment or cardiac care based on the opinion of a person without proper medical education and training? The truth is, no, we would not accept that. Unfortunately, when it comes to the issues of reproductive health and LGBTQ care, an attitude of “that does not affect my practice, so I do not need to say anything” is taken. Yet, there are far-reaching implications that we must consider. No matter your opinion on any of these issues, we as physicians need to fight back on these interferences in the patient-physician relationship. I will continue to provide the evidence-based and compassionate care that my patients deserve. I will also continue to bring myself to the table of advocacy, so that neither my practice nor my patients end up on the menu.
In his role as the Co-Advocacy Chair of AMA-MSS Region 3 that includes medical schools in Arkansas, Kansas, Louisiana, Mississippi, Oklahoma and Texas, the first-year medical student has helped organize nationwide campaigns for the organization.
“I was extremely honored to receive this award alongside other incredible leaders in AMA-MSS Region 3,” Singh said. “Receiving this award inspires me to continue growing my involvement in the AMA-MSS and be an advocate for medical students, physicians, and patients.”
Singh has been a part of the MSS Region 3 Resolution Review Committee, the Logistics and Resources committee for the AMA-MSS N-21 Conference and the Committee on Legislation and Advocacy (COLA) since 2021. He was also one of the authors on four different resolutions presented at the AMA N-21 Conference held in November 2021.
“Through the Texas Medical Association (TMA)-MSS, I was part of the Ad-Hoc Committee to review resolutions for TexMed 2022 and I was primary author for one resolution and helped draft two other resolutions,” Singh said.
Singh is the current AMA delegate for the TCU School of Medicine. During National Advocacy week in October 2021, he helped organize a “Call Your Rep” event as well as social events to increase AMA engagement at the medical school. He also attends monthly Tarrant County Medical Society meetings to provide updates about the medical school, the AMA-MSS and TMA-MSS chapters he’s involved in.
“It really gives me the opportunity to connect and build relationships with local physicians in Fort Worth and all across North Texas,” said Singh. “I believe that there is power in a collective voice and organized medicine provides medical students and physicians the opportunity to advocate for change on a local, regional, and national level. This motivates me to work harder and give back by mentoring other students to find their voice through the AMA-MSS on healthcare advocacy topics they are passionate about.”
Tarrant County Physician Online 