Medical News – Tarrant County Physician Online

DEA Proposed Rules Address Telehealth Prescribing Post PHE

Originally published by Texas Medical Association on March 8, 2023.

Physicians found new flexibility in prescribing controlled substances via telemedicine during the COVID-19 pandemic.

Now that the public health emergency is ending, the Drug Enforcement Administration (DEA) has proposed new rules for prescribers it says could preserve some of those flexibilities “with appropriate safeguards.”

Among other things, the new rules – if finalized – would allow physicians and health care professionals to prescribe, without a face-to-face visit, a 30-day supply of Schedule III and Schedule IV non-narcotic controlled drugs, after which an in-person follow-up would be needed for any refill. This class of drugs is the least likely to result in drug abuse, according to DEA. The proposal also would allow for prescribing a 30-day supply of buprenorphine to treat opioid use disorder without an in-person evaluation or referral.

“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” Department of Health and Human Services Secretary Xavier Becerra said in the announcement. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in person.”

The agency emphasized that the rules do not affect telehealth services that do not involve controlled substance prescriptions. The Texas Medical Association is reviewing how the proposed regulations could interact with other federal and state regulations, says Shannon Vogel, TMA’s associate vice president of health information technology.

DEA has released summaries for both healthcare professionals and patients explaining how the proposed rules would affect prescription practices.

“This is a very good thing that they’re doing and a necessary thing” for access to care, said Mesquite pain management specialist C.M. Schade, MD, a former president of the Texas Pain Society.

Before the pandemic, physicians were limited in their telemedicine prescribing ability by the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, he says. The act requires physicians to conduct at least one in-person medical evaluation of the patient before prescribing a controlled substance by means of the “internet,” which is defined to include telehealth.

“COVID did great things for telehealth, and one of them was breaking through the Ryan Haight Act,” Dr. Schade said.

Some policymakers and behavioral health advocates have expressed concern, however, that patients who need continuous medication therapy may have challenges obtaining an in-person visit within 30 days.

The rules were proposed on Feb. 24 and public comments are due on March 31. The agency has no set timeline for publishing the rules, though it is likely that will come before the PHE ends on May 11.

Physicians with questions and comments about the DEA changes or relevant state regulations can contact Ms. Vogel.

Linda Siy, MD, named Texas Family Physician of the Year

Linda Siy, MD, of Fort Worth, Texas, has been awarded the highest honor among Texas family doctors by the Texas Academy of Family Physicians. She was named the 2022 Texas Family Physician of the Year during TAFP’s Annual Session and Primary Care Summit in Grapevine on Oct. 29. Each year, patients and physicians nominate extraordinary family physicians throughout Texas who symbolize excellence and dedication in family medicine. A panel of TAFP members chooses one as the family physician of the year.

“It truly is an honor to join the ranks of those who have received this distinction, and I’m very humbled to be considered with those distinguished colleagues who previously were Family Physicians of the Year,” Siy said as she accepted the award.

Siy has been a family physician for over 30 years, and currently practices at John Peter Smith Health Network at the Northeast Medical Home in Tarrant County, a practice she’s been a part of since 1995. She is also faculty at the University of Texas Southwestern School of Medicine, the University of North Texas Health Science Center/Texas College of Osteopathic Medicine, and the Texas Christian University Burnett School of Medicine.

Throughout her years in organized medicine, Siy has served on many committees and councils for both TAFP and the American Academy and has been president of the TAFP Foundation since 2017. She serves on the Acclaim Multispecialty Group’s Physician Board of Directors, and previously served as president of the Tarrant County Medical Society and TAFP’s Tarrant County chapter.

Siy has spent her career in medicine treating her loyal and multi-generational families of patients, many of whom are underserved, suffer from housing and food insecurity, and struggle with mental health and substance abuse. Many of her nominators mentioned her willingness to speak up and ask the questions others are too afraid to ask, as well as her dedication to teaching the next generation of family physicians.

“I think what’s kept me in the game for so long at the place where I work now are those rewarding relationships with your patients, with your staff, with your colleagues,” Siy said of her career in family medicine. “It’s really not a job. It’s a calling.”

Free pop-up medical, vision and dental clinic coming to Dallas in December

HSC & Remote Area Medical have partnered again to bring free care to those who are underserved and uninsured.

The University of North Texas Health Science Center at Fort Worth and Remote Area Medical – RAM® — a nonprofit provider of pop-up clinics that delivers free quality dental, vision and medical care to those in need — are bringing the free clinic to Dallas on Dec. 3 and 4.

After a successful clinic in North Fort Worth last year, the organizations decided to partner again and bring the clinic to Dallas, allowing them to serve a larger population in an accessible location.

Services offered at RAM will include dental cleanings, fillings, extractions and X-rays; eye exams, glaucoma testing and eyeglasses prescriptions with glasses made on site; women’s health exams; and general medical exams. RAM services are on a first-come, first-served basis, free of charge, and no ID is required. A clinic of this magnitude is not possible without the help of volunteers — both medical and general.

“With the help of 329 volunteers, last year’s clinic transformed the lives of more than 400 people,” said Jessica Rangel, HSC executive vice president of health systems. “We are anticipating needing more volunteers this year. This is a unique opportunity to serve for everyone. Whether you’re a physician assistant, dentist or community member, there is a role for you at RAM.”

This year’s event will be held at the Kay Bailey Hutchison Convention Center, 650 S. Griffin St., in Dallas.

“It is critical that we show our neighbors and friends we care and are there to support them,” HSC President Sylvia Trent-Adams said. “Our collaboration with RAM provides us with the opportunity to make a positive impact in our community.”

For more information about RAM’s pop-up clinics, to donate or to volunteer, visit www.ramusa.org or www.unthsc.edu/ram, email Katy Heesch at Katy.Heesch@unthsc.edu or call 817-735-2000. 

October Walk with a Doc Tomorrow

Join our local chapter of Walk with a Doc tomorrow for a fun morning walking, talking about health, and meeting people in our community.

Here is what you need to know about the event:

• It will take place on October 8, 2022

• The hour-long event will begin at 8:30am

• Walkers will start at LVTRise – 8201 Calmont Ave., Fort Worth, TX 76116 For more information, call Kate Russell, OMS-III, at 903-316-9392, or email her at KatherineRussell@my.unthsc.edu.

CALL FOR MUSICAL PHYSICIANS: Join Fort Worth’s First Medical Orchestra

by Allison Howard

This article was originally published in the July/August 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Physicians, dust off your instruments—Fort Worth’s first medical orchestra is looking for healthcare workers who have a dual passion for music and medicine.

The group, which is being organized by retired physical therapist and flautist Susan Fain, is expected to begin rehearsing this fall. While the details are still being ironed out, Susan says that everything is falling into place.

“We are collaborating and negotiating for a space, conductors, and music,” she says. “And it looks really good.”

Susan, who holds doctoral degrees in both physical therapy and flute performance, was first inspired about 10 years ago when she heard the Doctors Orchestral Society of New York. She soon discovered there were over 30 such orchestras throughout the U.S., and she saw it as the perfect opportunity to marry her passions.

“In medicine you’re helping people, and in music, you really are helping people,” she says. “You’re helping yourself, learning to create, and all of that discipline is across both professions.”

She believes this could be a step toward work-life balance for those who love sharing music with others but have set their instruments aside due to lack of opportunity. Now, she is ready to create that opportunity, and she is thrilled to do so in a city that is rife with a passion for the arts.

Susan, whose career was divided between practicing physical therapy, pursuing music, and raising her five children, has played flute in both civic and professional orchestras. And her experience organizing events and groups is extensive, ranging from planning classical concerts to putting together a small orchestra (where she served as the conductor!). Now, retired from physical therapy and ready to devote herself fully to her love of music, she is thrilled to start this next endeavor.

“I want to be like Esther – ‘You might have been born for such a time as this,’” Susan says. “To bring the two halves of my life together and make them both count.”

It seems she isn’t the only one that feels that way. As the word spreads there has been a lot of interest; so far, 10 instrumentalists have committed to the orchestra, and more have expressed a desire to get involved.

Ultimately, Susan’s goal is to form a full orchestra that will perform a handful of concerts each year to raise support for local charities. She believes it will enrich the community and be a chance to cut through much of the noise created by the constant challenges in the practice of medicine.

“Performing is like creating an oasis for the audience,” she says. “This is a moment where you can forget the outside world, and all the things going on in society that we struggle with, and we can sit for a moment and just stop and reflect on truth and beauty. That, to me, is what it’s all about.”

For more information about the Fort Worth Medical Orchestra, contact Susan Fain at sdfain1@gmail.co m or 405-830-2107.

Fort Worth OB/GYN: More parents seeking birth control for young patients

TCMS President Dr. Shanna Combs spoke with Andrea Lucia of CBSDFW about the rising rates of birth control requests in light of the recent Supreme Court ruling. Here is an excerpt:

Politics is not something Doctor Shanna Combs brings up with patients.

Increasingly, though, it is something they bring up with her.

“It was a little disconcerting at first in September when I started having parents be like, ‘So… Senate Bill 8,'” she said chuckling.

Dr. Combs is an OBGYN who specializes in treating children and adolescents. She’s long prescribed birth control to help manage their periods.

“It can make them lighter. It can make them less painful and, you know, basically make life livable if you have really bad periods,” she said.

You can find the full interview here.

TCU Medical Student Receives Award for Advocacy Work with AMA

By Prescotte Stokes III

Published by TCU School of Medicine on May 17, 2022. You can find the original here.

TCU School of Medicine student Anand Singh received the New Member Outstanding Involvement Award in AMA-MSS Region 3 by the American Medical Association – Medical Student Section.

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.”

TCU Medical Student Launches Barbershop Talk Therapy in Fort Worth

Antonio Igbokidi, a second-year medical student at TCU School of Medicine, brings Black men together to discuss mental health at a Fort Worth barbershop.

By Prescotte Stokes III

Originally published by TCU School of Medicine on May 10, 2022.

Creating a space for African American men to come together and have open dialogue about mental health is something that Antonio Igbokidi, a second-year medical student at TCU School of Medicine, had been trying to organize since he arrived in Fort Worth in July 2020.

However, he didn’t want to use a random space for this kind of communal gathering. He wanted it to be a place where Black men could let their guard down and speak freely. Igbokidi turned to a place that has been one of the cornerstones of the African American community since the early 19^th century, a barbershop.

“When I think about my childhood and my dad he spoke a lot more at the barbershop than he did at home,” Igbokidi said.

Igbokidi held his first Barbershop Talk Therapy session at Lake Como House of Fades Barbershop in Fort Worth in April. The event was done in collaboration with the Fort Worth ISD Family Action Center.

Igbokidi, who serves as the as the National Diversity Research Committee Co-Chairperson for the Student National Medical Association (SNMA), wanted the men involved to come out of the session feeling a sense of camaraderie.

“It’s all about figuring out ways to get men of color to have raw, vulnerable and organic conversations about mental health,” Igbokidi said. “Figuring out how to destigmatize and demystify mental health.”

Igbokidi was joined by members of the TCU School of Medicine SNMA Chapter as well as Brian Dixon, M.D., assistant professor at TCU School of Medicine.

Dr. Dixon is a psychiatrist with his own private practice in Fort Worth. He helped guide the discussion among the two dozen of men that came to the barbershop.

“It’s always fun to be in the classroom but to see one of my students actually out in the community doing some amazing work connecting people is amazing,” Dr. Dixon said.

For two hours, Igbokidi and Dr. Dixon, led the discussion where the participants talked freely about issues among Black men, young and old, in their community. The group shared their thoughts on crime, love, relationships, fatherhood, jobs and more.

“As a psychiatrist I’ve heard a lot in my day,” Dr. Dixon said. “But today was really poignant because it came from Black men and people who look like me. I’m really glad that they were felt safe enough to be in this space and share and that they trusted me with that honesty.”

Igbokidi also collaborated with the Black Heart Association to offer free screening for cardiovascular disease for anyone attending the session. Michael and Tara Robinson, co-founders of the Black Heart Association, were happy to be a part of something to help ease the hearts and minds of Black men.

“Everything flows through the heart whether it be mental or emotional,” Michael said. “As African American men we’re raised in a culture where we’re taught to be strong. Even as young boys there’s not a space for us to have safe conversations and be vulnerable.”

The men were able to get their glucose levels, cholesterol, blood pressure and risk of heart disease checked. The Black Heart Association has a mobile heart center where they go to barbershops, and other places, around Tarrant and Dallas Counties and offer free screenings for heart disease.

“We know that mental health plays a part in heart disease so this event was like the perfect marriage between what we do and what Toni is doing,” Tara said.

Igbokidi plans to continue the mental health sessions with his next stop being in the historic Stop 6 neighborhood in Fort Worth.

“I’ll have these same conversations whether or not they are larger or smaller,” Igbokidi said. “Just being able to have these conversations is going to bring healing. It’s going to bring understanding and it’s going to allow the communities to become stronger.”

HRSA Reopens Reporting Time for Period 1 Provider Relief Fund Recipients

Due largely to AMA and specialty society advocacy, the Health Resources and Services Administration (HRSA) has decided to reopen the reporting time for recipients of Period 1 Provider Relief Funds.

Those physicians who received more than $10,000 in provider relief funds and failed to submit their period 1 report should act immediately. Between Monday, April 11 and Friday, April 22, 2022, at 11:59 pm ET, physicians who have not submitted their Period 1 report may submit a late Reporting Period 1 report request. Physician practices should receive information about how to submit a request directly from HRSA via email.

If a physician did not submit a Period 1 report and does not hear from HRSA, they may initiate communication by calling (866) 569-3522. During this reopening period, the physician must choose an extenuating circumstance(s) that prevented compliance with the original reporting deadline. While attesting to an extenuating circumstance is required, no supporting document or proof is required.

If HRSA approves the extenuated circumstances form, the physician will receive a notification to proceed with completing the Reporting Period 1 report shortly thereafter. They will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal.

Texas Launches $23 Million Substance Use Disorder Prevention Campaign

By Joey Berlin

Federal data estimate that during 2020, more than 11 million Texans were living with substance use disorder. A new $23 million public awareness campaign from the Texas Health and Human Services Commission (HHSC) is aiming to keep that number from growing.

The campaign, which HHSC announced in a March 8 release, will focus on “reducing stigma, building community connection and resilience, and changing social norms to prevent substance use.”

HHSC awarded contracts totaling $23.2 million to two entities as part of the campaign:

$16.7 million to FleishmanHillard, a public relations and marketing agency, which will focus the campaign on Texas youth, young adults, and families who are most at risk, as well as community leaders who can reach them; and
$6.5 million to the Center for Health Communication at The University of Texas at Austin to develop an interactive digital tool to improve the referral process for existing substance use disorder treatment, prevention, and recovery services, and to conduct research to support messaging for the prevention campaign.

HHSC says the campaign aims to reach about 2.5 million Texans. The funds are coming from nearly $253 million HHSC received in federal substance abuse prevention and treatment funds during 2021, including from the American Rescue Plan Act.

This article was originally published by the Texas Medical Association on March 15, 2022.