Tarrant County – Tarrant County Physician Online

2026 Tarrant County Medical Society President Cheryl L. Hurd, MD

Feature Article

By Allison Howard Hunter

This article was originally published in the January/February 2026 issue of Tarrant County Physician.

Dr. Cheryl Hurd, a psychiatrist committed to both clinical care and medical education, believes that organized medicine is the foundation that supports every other part of medical practice. But she’ll be the first to admit that she didn’t realize its importance early on.

“I was a student member of TMA, but I never did anything,” she says. The same was true during her residency in Arizona. But after years of participation, Dr. Hurd’s advice for medical students and residents is simple: Don’t just join—get involved.

When she returned to Texas and entered private practice, it was as the only psychiatrist in her medical group. Feeling alone, she rejoined TMA and immediately found connection in colleagues, committees, and a whole psychiatry track of support she didn’t know she was missing. “The camaraderie was huge,” she says. “I finally didn’t feel like the only one.”

Dr. Hurd’s involvement in organized medicine also offered practical benefits: TMLT insurance, CME funding, and—most importantly—the chance to advocate. Advocacy, she says, is what allows physicians to push back against excessive regulation, protect physician-led teams, and fight for the future of the profession.

She’s candid about the challenges physicians face. “Healthcare is regulated more than almost any other industry,” she says. Yet advocacy has delivered real wins: tort reform, increased medical education funding, and—critically for her field—expanded mental health funding in Texas even during budget-cut years.
“That’s why advocacy matters,” she says. “It protects us, it protects our patients, and it keeps our profession alive.”

And, as she found, those who advocate for you also have your back at the toughest of times, sometimes in ways that are less obvious than legislative wins. In 2020, when physicians were on the front lines of the COVID-19 pandemic and PPE was scarce, putting healthcare professionals at greater risk, Dr. Hurd was surprised to receive a box from TCMS.

“I opened it up and it was five hundred N-95 masks,” she says. “Just this whole box of N-95s. And then there was an email. It was from TCMS, saying, ‘Hey, we’re trying to help you.’ And they sent it to every single member; they sent every member a box because they wanted to protect us.”

Dr. Hurd credits that support as the reason she got even more involved, leading to her serving as our 2026 TCMS president. She saw in TCMS a reflection of her own ideals—a mission to care for patients, physicians, and the physician-patient relationship.

But it is the physicians like Dr. Hurd who give our medical society its heart, inform its values, and guide its vision.

“Dr. Hurd is the intelligent and compassionate doctor that you would wish to take care of your dearest loved ones,” says Helene Alphonso, DO, a friend and mentee of Dr. Hurd. “As a mentor, she nurtures lifelong learning at every level of medical education. She advocates for her patients and fellow physicians with countless hours and innovative solutions. . . . We can’t wait to see how her leadership in the Tarrant County Medical Society will shape the future.”

Though Dr. Hurd is now passionate about all things medicine, growing up, she did not want to be a doctor—or a teacher or a dancer or even a veterinarian (though she does have a major love for animals). No—at six years old, Dr. Hurd was determined that she was going to be a lawyer. She held on to this dream all the way through college, where she earned both a bachelor’s and a master’s degree in English from SMU, still convinced that law school was her next step.

It was during those years of study that Dr. Hurd met her husband, Howard. They had a good plan: he would go to medical school, and she would go to law school. Still, she decided to defer for a year because his education was taking him to Houston, while Dr. Hurd’s was taking her to Austin. As newlyweds, this separation was hardly appealing, and with law school only taking three years against medical school’s four, the choice was easy for her to make.

Dr. Hurd had planned to work in editing or proofreading for the year, but with a competitive job market and no connections in a new city, she had a frustrating lack of success. One day, she asked her husband if she could join him for his classes to give her something to focus on aside from the unfriendly job market, so he brought her along. She was immediately enthralled.

“A couple of weeks into his school, and I’m sitting there in the classroom taking more notes than he is,” Dr. Hurd says, laughing. “And I just thought, ‘Wow—this is fascinating. Why did I never study this?’”

Quickly, her decision was made—medicine was her future. In a short time, a passion grew into something she knew would sustain her in the years ahead.
Dr. Hurd and her husband were both accepted to Texas Tech’s School of Medicine, so they made the move to Lubbock. A couple of years later, Howard matched to a general surgery residency in Temple, Texas, so she transferred to A&M College of Medicine to complete her clinical rotations. When she graduated in 1998, she began her psychiatry internship at Good Samaritan Regional Medical Center in Phoenix, Arizona. Her training was unique—a joint internal medicine and psychiatry program that allowed her to combine the specialties that most interested her.

After her internship and four years of residency, Dr. Hurd was more than ready to begin practicing as a fully qualified psychiatrist. She and her husband knew they wanted to come back to Texas—the question was simply where they would land. Having their friends and family here was a huge draw for the young couple, but they were also motivated by positive legislation for medicine.

“With tort reform in 2003—that’s when I graduated residency—I was thinking it would really be nice to not have escalating malpractice costs,” Dr. Hurd says. “They’d still get money if I actually did something wrong, but the goal was that all the frivolous lawsuits would go away. And by and large, they have.”

They settled in Brownwood, Texas, where Dr. Hurd set up a psychiatry solo-practice collaborating with a larger organization of specialists. She was the only psychiatrist in the area, and she also consulted at the county hospital. At first this kept Dr. Hurd quite busy, but her practice slowed down after the financial crash of 2008. Soon she moved to Fort Worth, where she joined UNT Health Science Center and UNT Health, although her clinical assignment was at JPS. She later transitioned to Acclaim Physician Group when it was formed, and she stayed there until 2022. Throughout that time, her role grew from serving as the consult medical director to being the psychiatry program director and vice chair of education.

Though she was involved in education through TCOM and JPS, she maintained an active full-time practice. However, when she began serving as TCU Burnett School of Medicine’s psychiatry clerkship director, she stepped back from her role at JPS and joined Connections Wellness in a part-time role.

“At Connections Wellness, I still have a clinical job where I see patients and precept students,” says Dr. Hurd. “And then I had my role as psychiatry clerkship director. I do the behavioral health year-one lectures, clinical skills, and things like that. So, I’m all things psychiatry at the School of Medicine.”

Though Dr. Hurd treasures her role within medical education, she did not seek it in the early days of her career. When opportunities first arose in education, she turned them down in favor of focusing on her clinical practice.

“I thought, ‘No, I’m just going to go out and save the world one patient at a time,’” she remembers. “‘I’ll do clinic and just be a doctor, be a practicing physician. That’s what I was trained for.’ When I started at JPS, I just thought I’d be a psych consultant like I was at the county hospital down in Brownwood. So, I show up, do my orientation, and they’re like, ‘Here’s your team.’

“I went, ‘Team? What team?’ I had a resident, I had an intern, I had students. I just tried to base my precepting on some of the best preceptors I’ve had in my training. So that’s how I got involved and learned that I really loved it.”

Much like her discovery of medicine, Dr. Hurd considers this unexpected assignment another act of serendipity—one that was to her benefit, as it was (and is) for the many residents and medical students who have been under her tutelage.

Her colleague, Debra Atkisson, MD, has seen Dr. Hurd make a big impact both in education and practice throughout her career.

“I have known her for more than fifteen years and have observed her dedication to her patients and the medical students and residents she has taught,” says Dr. Atkisson. “She has provided our community and the state of Texas with outstanding education about psychiatry. . . . We are very fortunate to have Dr. Hurd serve as our president for Tarrant County Medical Society.”

Dr. Hurd has had variety in the roles she has held throughout her career, but they have all hinged on one overarching goal: supporting mental health for physicians and patients alike. This has involved making petitions both to TMA and the Texas Medical Board, being involved in mental health legislation through First Tuesdays, and serving on councils and boards supporting mental health—including TMA’s Physician Health and Wellness Committee, where Dr. Hurd served for the maximum nine-year term, including two years as vice chair and two years as chair.

Though progress has been made in mental health support and treatment, she sees that much more lies ahead.

“I want to continue to work on reducing the stigma and also try and get more involvement in the community itself to support and encourage and grow mental health access.”

But the problem goes beyond the average patients—physicians struggle greatly when it comes to accessing mental health.

“We’re the last ones to go seek help,” she says. “There used to be punishment for physicians with their licensure when they were under treatment. So, they didn’t seek treatment, or they felt like they couldn’t be honest about treatment. And there’s been a huge effort to flip that narrative and get physicians to understand it’s actually okay to get treatment, and this is thanks to both the TMA and the Texas Society of Psychiatric Physicians, after much work and many, many years.”

As she begins her term as TCMS president, Dr. Hurd does so with the goal of continuing this mission.

“One of my goals is to get the community more informed of opportunities for mental health support,” she says. “We are also trying to work on increasing access and bringing more behavioral health and mental health programs to the area.”

Those who know her believe Dr. Hurd will thrive in this role and ably utilize the opportunities it provides.

“I knew of her leadership at the Texas Medical Association, where she served on the Physician Health and Wellness Committee,” says Angela Self, MD, who has been friends with Dr. Hurd for many years. “She works tirelessly for her patients and for the practice of medicine. . . . She sacrifices many hours volunteering, advocating for the improvement of healthcare for physicians and patients across the country.”

As Dr. Hurd looks toward the future, she does so remembering the many physicians who have impacted her career. Carol Nati, MD, was a great mentor for Dr. Hurd, especially during her time at JPS. Dr. Atkisson encouraged her to get involved with TCU’s School of Medicine and Connections Wellness, and Greg Phillips, MD, helped give Dr. Hurd the drive she needed to get more involved with TCMS. Dr. Hurd credits these physicians—alongside many others, and her ever-supportive family— for helping her become the doctor she is today.

Though medicine always keeps her busy, Dr. Hurd loves spending time with her husband; their two children, Dawna and Perry; and their dogs (they always have several, and there is usually a rescue in the mix). If she has a spare moment, you’ll probably find her reading a book—all genres are welcome!—or joining in a multiplayer computer game that her husband got her involved in years ago. She’s now the only one in her family that plays, but through it, she has developed a network of friends spanning the globe.

“It’s kind of fun to have long-term friendships that are not based on just your circle,” says Dr. Hurd. “It gets us out of our comfort zones in those boxes we live in, where we only do things with people who are pretty much like us.”
Dr. Hurd is eager to widen her scope of friends and colleagues even further in the year ahead as she partners with physicians and other change-makers to make a difference for medicine in Tarrant County and beyond.

“I’m excited to see what we accomplish for medicine in 2026,” she says. “There’s a lot of work to be done!”

Project Access Tarrant County: 2025 in Review and Building Toward 2026

Project Access Tarrant County Update

By Kathryn Keaton

This article was originally published in the January/February 2026 issue of Tarrant County Physician.

Another year has come and gone at Project Access Tarrant County (PATC), and as we close out 2025, we reflect on a year marked by both meaningful growth and strengthened community collaboration. Through the efforts of our volunteer physicians, hospital partners, and community collaborators, PATC continued its mission of bridging gaps in specialty and surgical access for uninsured residents of Tarrant County.

Patients Served and Clinical Impact
In 2025, PATC supported 243 patients through specialty and surgical care that would otherwise have been treated through emergency departments or would have gone untreated. These services included surgical care in general surgery, gynecology, colorectal surgery, urology, orthopedic surgery, cardiology, gastroenterology, ENT, and ophthalmology, as well as other non-surgical specialties. Despite continued high demand, we eliminated our gynecology waiting list, leaving only general surgery with a significant waiting period.

“I never thought this type of help existed for people in my condition. Even though I work, I don’t have health insurance and cannot afford medical care. I do all kinds of jobs; I don’t look for handouts. I am beyond thankful.” – Joe, 74, prostatectomy

Provider Engagement & Volunteer Leadership
None of PATC’s impact is possible without our network of volunteers. In 2025, over 60 physicians donated their expertise as well as ten hospitals and surgery centers. Our ancillary partners are vital as well, providing required imaging, anesthesia, pathology/labs, physical therapy, and other services. Volunteers see patients in their own offices and choose the maximum number of patients they see annually.

“Volunteering for Project Access is easy. PATC sends physicians the workup needed for patients vetted for our specialty. We just show up and treat the patient!” – Omar Selod, DO; Physical Medical and Rehabilitation and Project Access Tarrant County volunteer

Program Innovation & Process Improvements
In 2025, PATC expanded our technological capabilities. We broadened our patient communication tools to reduce no-shows and improve follow-up adherence and continued integration of CareMessage for appointment reminders, health and disease education, and multi-lingual patient support. In addition, we introduced Salud en Tus Manos (Health in Your Hands), in-person classes that address a variety of social drivers of health issues that our patients face. Thirty-one patients attended four classes held over 2025, and more curriculum is being added for 2026.

“Because of this class, I feel more confident in asking my doctor questions so I can better understand my diabetes care.” – Yolanda, Salud en Tus Manos “How to Communicate with Your Doctor” attendee

Community Value & Financial Stewardship
The collective value of donated care in 2025 is estimated at $1.5 million, reflecting both the generosity of our volunteers and the community’s investment in equitable access. Despite these high service levels, operational efficiency has kept PATC’s cost per surgical procedure coordination at approximately $1,500.

By facilitating specialty care, PATC reduces unnecessary emergency department utilization, prevents costly complications, and supports patient well-being beyond the clinical encounter, underscoring the value of collaboration and reflecting strong stewardship of both financial and human resources.

“The emergency department is the least efficient and most expensive way to deliver gynecologic care. Hemorrhaging women are transfused and sent home, only to return the next month when their menses return. Project Access identifies these suffering women and connects them with the definitive care—usually hysterectomy—they need. My role as the volunteer surgeon is made incredibly easy. Project Access coordinates the facilities, supplies, OR staff, and nursing—all I have to do is operate.” – Michelle Arevalo, MD; Obstetrics and Gynecology and Project Access physician volunteer

Challenges and Lessons Learned
While 2025 brought significant milestones, we also encountered challenges—including our wait list in general surgery, variable engagement across certain ZIP codes, and continued navigation barriers tied to social determinants of health. We are using these insights to expand patient education efforts and approach partnerships from a data-informed angle.

2026 Goals & Momentum
As we enter 2026, PATC is focused on expanding our capacity to meet growing needs. Our priorities include recruiting new physician volunteers—especially general surgeons—as well as expanding patient education related to social drivers of health.

With continued support from physicians and partners across the county, we anticipate a year of elevated impact and strengthened patient outcomes. We thank our physician community for their commitment and look forward to what we can achieve together in 2026.

“This experience changed my mentality—that there are people that may not know someone but still care about them. Sometimes people aren’t willing to donate five minutes of their time, so the doctors giving their services and time is incredible.” – Marisa, 48, hysterectomy

2025 Gold-Headed Cane Recipient David P. Capper, MD

Feature Article

By Allison Howard Hunter

This article was originally published in the November/December 2025 issue of Tarrant County Physician.

When asked about the best aspect of practicing medicine, Dr. David Capper doesn’t miss a beat. “It’s the people,” he explains. “I think it really just boils down to the opportunity to have in-depth relationships with people.” This makes perfect sense when you look at the trajectory of Dr. Capper’s career—it’s always about the people, whether it’s the unhoused, the underserved, or the dying. From his involvement in street medicine to his longtime work in hospice care, Dr. Capper’s passion for people has led his peers to select him as the 2025 Gold-Headed Cane recipient. For those who know him, it doesn’t come as a surprise.

“David truly embodies the spirit of the Gold-Headed Cane,” says 2024 Gold-Headed Cane recipient Stuart Pickell, MD, a longtime friend of Dr. Capper’s. “I once heard of a patient he treated for skin lesions caused by an arthropod infestation. Not only did David provide medical care, but he also arranged—and personally paid—for the patient’s home to be exterminated. That story captures who he is at his core: physician, colleague, advocate, educator, ethicist, disciple.”

Dr. Capper’s life can be defined by many excellent things, but he defines himself by what is most important to him: his faith in Jesus. As a longtime Christian, Dr. Capper says his motivations ultimately come from his desire to honor God by serving others. He cites Matthew 5:16 as his guiding scripture: “Let your light shine before others, that they may see your good deeds and glorify your Father in heaven.” (NKJV)

He is humbled to receive the Gold-Headed Cane, which he has a unique tie to: his father, Robert Capper, MD, himself received the recognition in 2005.
“It’s not something you strive for,” says Dr. Capper. “What I thought about the Gold-Headed Cane over the years is that it’s a recognition of the peers of a physician whose life was committed to the profession and those professional values. And so, it’s very humbling, and it’s honoring.”

Dr. Capper has long had a passion for service, but he wasn’t always sure that medicine would be his medium. Though his father was a physician and his mother a nurse, he didn’t decide to pursue medicine until he was near the end of his collegiate career.

“I had an extremely high regard for my father and his peers,” he says. “The people that I was introduced to through my parents that were physicians were of the highest integrity, and I thought that’s the way physicians all were. And I didn’t quite see myself in that same category.”

It wasn’t until an emergency appendectomy between his junior and senior years of college that his path became clear. In a way, this was a blow—Dr. Capper was the captain of his football team, and he had recently gotten an All-American honorable mention, yet he would not be able to play the first half of the season. But being forced to slow down gave him the opportunity to spend a lot of time praying about his future. By the end of his stay, Dr. Capper felt a clear calling to become a physician in spite of his reservations. And instead of being intimidated by the excellence of the physicians he knew, he used it as a standard to strive for.

After Dr. Capper completed his undergraduate degree in liberal arts from Austin College and fulfilled his prerequisites, he began his tenure at the University of Texas Medical School at Houston. This was an enriching time that opened Dr. Capper’s eyes to the many possibilities of medicine.

He graduated from medical school in 1982 and was accepted into Good Samaritan Hospital’s internal medicine residency program in Portland, Oregon. It had a multidisciplinary pain program and was home to one of only two hospices in the state, both of which Dr. Capper credits as being formative to his education.

Throughout his medical training, Dr. Capper did extensive mission work, with the goal of eventually working in foreign medical missions. During this time, he met his wife, Dianne, who shared his passion for ministry. When he completed his residency, they planned to pursue mission work together, but a number of life circumstances kept them from taking the leap.

They ended up moving to Tyler, Texas, where Dr. Capper filled in as an emergency room physician. The family eventually came to Fort Worth, where he worked in the Harris Methodist Hospital Emergency Department and then joined E. Richard Holden, MD, a hematologist who needed help in his practice. Ultimately, Dr. Capper pivoted his ministry mindset to a local one—for the most part. Though he never went into foreign mission service full time, he has participated in over 30 short-term mission trips, the majority of which had a medical basis.

In the years since, Dr. Capper has worked in a variety of positions. He would not consider himself a traditional internist—he has a background in emergency medicine, pain management, geriatrics, cardiology, and palliative care that have played extensive roles in his career.

“I don’t know what I’m going to do when I grow up,” he says, laughing. “I’ve worn so many different hats and continue to do so.”
Throughout his extensive career, Dr. Capper has been heavily involved in medical education for both students and residents, was among the founders of a hospitalist program, worked in private practice, had a leadership role in an independent physician association, was the medical director of a PPO, and served as the medical director of one hospice program and CEO of another. He was among the founding members of a charitable clinic and helped to start JPS’s street medicine program, serving as their de facto medical director in its earliest years. He has worked as a nocturnist and helped to start several medical organizations.

Through the many roles he has held, one he has continually been drawn to is the critical but challenging practice of palliative and hospice care. While there is nothing easy about this field, he values the opportunity to help complex patients manage their conditions and terminal patients pass their last days with the greatest possible dignity and comfort.
Currently, Dr. Capper serves as the CMO of Community Healthcare of Texas, where he also oversees both their hospice and supportive care programs. He is on the faculty of both the TCU Burnett School of Medicine and the Texas College of Osteopathic Medicine (TCOM).

Dr. Capper has been impacted by many people throughout his career, but his greatest support has always come from Dianne, who has worked in ministry alongside him—all while raising their six children and, for a time, their foster daughter.

“I can’t have this conversation without talking about my wife,” Dr. Capper says. “She has supported me and managed our family in my life of craziness; it’s really remarkable.”
He is also grateful for his many siblings and their spouses—he is one of seven—and his parents for the impact they have had on him.
“I have a phenomenal family,” Dr. Capper says. “And you talk about influence on your life. . . . There’s a natural motivation when you have such great people who are encouraging you to do well.”

He views his parents as his ultimate medical heroes and says that their hearts of compassion were critical in the formation of his own worldviews. There are many other mentors and friends he would like to acknowledge for the impact they’ve had on him, and a few are the late John Richardson, MD; Drew Ware, DO; Michael Ross, MD; John Burke, MD; and Bob Keller, MD.

Dr. Capper is grateful for the impact his colleagues have had on his life, and many of those he has worked alongside over the years return the sentiment.
“David is a solid, conscientious physician, and I always felt secure knowing that he was helping my patients when I was away,” says Greg Phillips, MD, a friend and former colleague. “His work in our community helping the underserved and uninsured is without equal.”

Dr. Capper stresses that for patients who are underserved, it is critical to meet them where they are.

“The old saying goes that healthcare is local, right?” he says. “And it’s also true for disenfranchised communities.”

After Dr. Capper began practicing medicine in Texas, he and a group of dentists, physicians, and nurses worked together to start Beautiful Feet’s charitable clinic. It was 1988; JPS only had one central clinic, and the Fort Worth city-run clinics were in the process of being shut down, leaving a gaping hole in the community. The new clinic saw its first patients in 1989, and they have been going strong since. Dr. Capper has served as the group’s volunteer medical director since their doors opened.

“Dr. Capper has been leading [the] . . . clinic through Beautiful Feet Ministries for over 40 years, targeting the homeless and poor living in the Historic Southside of Fort Worth,” says Sarah Myers, Beautiful Feet Ministries co-director. “Through this clinic, countless people have benefited from Dr. Capper’s expertise and compassion.”

Approximately 80 percent of the clinic’s patients are unhoused, which creates unique challenges for continuation of care. His longtime work with this population made Dr. Capper an ideal fit for heading up JPS’s work in street medicine. Later brought on to oversee the palliative care program at JPS, his role grew from working as the volunteer medical director to eventually becoming the staff medical director of their unhoused program.

Though he stepped away from the position in 2022, Dr. Capper is proud of the strides JPS has made in street medicine.

“When we were able to get the 1115 waiver grants—well, I’m not proud of a lot of things, but I am proud of what we were able to structurally do with that,” says Dr. Capper. “And that allowed us to create a program that really addressed the needs of Tarrant County homelessness.”

Though there is a great need for medical care among the unhoused, Dr. Capper has had a broader outreach than that. He helped to form Project Access Tarrant County (PATC), Tarrant County Academy of Medicine’s (TCAM) program that provides specialty charitable care for those who have no resources outside of emergency rooms and primary care charity clinics. He has been on the PATC board since the organization was formed in 2011.

“Dr. Capper was integral to the creation and success of Project Access,” says PATC Director Kathryn Keaton. “His knowledge of charitable care is second to none and is only exceeded by his passion for accessible, comprehensive care for every individual in Tarrant County.”

Dr. Capper is heavily involved in charity care, but he still makes time to focus on a sister cause: medical ethics. He has been on a number of ethics committees, including TCAM’s ethics consortium, and he currently chairs the ethics committee at Medical City Fort Worth.

Because of his work in palliative and hospice care, this has continued to be a significant focus throughout his career.

“You have a lot of potential ethical conflicts in this world,” he says, “so I started going to conferences 20 years ago and then eventually entered a master’s program in biomedical ethics.”

He graduated with his master’s from Trinity International University this past December, and he plans to keep teaching medical ethics not only to physicians but to the public at large.

“So many of these conflicts that we deal with in clinical ethics, they come back to just people living their lives,” Dr. Capper says. “How many of these ethical conflicts could be avoided if people only took a knowledgeable approach to their own advance care planning?”

Like many things, Dr. Capper believes it comes back to education—one of his greatest passions.

Dr. Capper knew he liked to teach early in his career. When he had an extended year in his residency as the chief resident, it was a heavily teaching-focused position. He loved sharing with and learning from other doctors to make the group better as a whole.

When he moved to Fort Worth, teaching at TCOM—which his father had also done—was a natural transition. He works in their geriatric medicine department, and he also joined TCU’s faculty when the medical school was started in 2018; he serves as the chair of clinical sciences. He had also been involved in teaching residents at JPS and Medical City Fort Worth.

He has three charges for those who are just starting out on their careers: physicians must consciously subjugate their own desires for the good of the patient; they have to recognize the unique role of the profession and the responsibilities it entails; and they should always practice with humility.
“We must realize we are no better than our fellow human beings and treat them with respect, no matter what the circumstances of a fellow human being are.”

Dr. Capper does not limit his teaching to the classroom; he marries his love of education with caring for the underserved most Saturdays when he oversees the student-run clinic at Beautiful Feet. As he works with students, he encourages them to make sure they have the right perspective when caring for their patients.

“My warning to the future of medicine is that we need to come back to more of a standard that is time immemorial,” he says. “We shouldn’t bend to the culture; we still need to hold true to ultimate or eternal values.”

Ultimate and eternal values drive Dr. Capper in all that he does. When he isn’t working, he has often spent time ministering to others alongside his family; years ago, when his children were growing up, they did family mission trips together every summer instead of family vacations.

He is incredibly proud of the people they have become, and whenever he and Dianne have the chance, they love spending time with their children, their children’s spouses, and their ten grandchildren, as well as close friends they have worked and served alongside over the years.

Looking back over his career, Dr. Capper is grateful for the path his life has taken.

“You have a relationship with people that exceeds that of any other relationships between people and a profession,” he says. “It’s not just contractual but covenantal; it’s about making a difference.”

Tarrant County Public Health: Health Advisory Alert

An original message by Tarrant County Public Health announced on June 9, 2023.

Tarrant County Public Health (TCPH) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians about a confirmed measles case in a Hood County resident in a Tarrant County Hospital. TCPH has worked closely with the facility to identify exposure to some patients and staff that occurred before measles was suspected. All exposed people have been contacted and advised to watch for signs and symptoms through June 22nd. TCPH collaborated with the facility and Texas Department of State Health Services (DSHS), to investigate and respond to this measles case and exposures.

Below is a forwarded HAN from DSHS with background information about the current measles case, information on measles and the importance of early recognition, diagnosis, and appropriate treatment. TCPH recommends that clinicians be on the alert for cases of measles that meet the case definition.

Due to the highly contagious nature of this disease, additional cases may occur. We advise clinicians to follow the recommendations below and report any suspected cases immediately to Tarrant County Public Health’s 24-hour reporting line at (817)321-5350, preferably while the patient is present.

Background

A young child who is a resident of Hood County was recently diagnosed with measles. The child had no history of travel to an area where measles is spreading and no known exposure to a person with measles. The child has been treated and is recovering.

This is the first confirmed case of measles in Texas since travel-related outbreaks in 2019, which led to 23 cases. Completion of the two-dose series of the measles vaccine is highly effective at preventing measles, however even vaccinated people may occasionally become infected.

Measles is a highly contagious respiratory illness. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area. The illness usually starts a week or two after someone is exposed with symptoms like a high fever, cough, runny nose and red, watery eyes. A few days later, the telltale rash breaks out as flat, red spots on the face and then spreads down the neck and trunk to the rest of the body. A person is contagious about four days before the rash appears to four days after. People with measles should stay home from work or school during that period.

The best way to prevent getting sick is to be immunized with two doses of the measles- containing vaccine, which is primarily administered as the combination of measles-mumps- rubella (MMR) vaccine. DSHS and the Centers for Disease Control and Prevention recommend children receive one dose at 12 to 15 months of age and another at 4 to 6 years. Children too young to be vaccinated or who have only had one dose of vaccine are more likely to get infected and more likely to have severe complications if they do get sick.

Recommendations For Health Care Professionals:

Healthcare providers should consider measles in patients presenting with the following symptoms, particularly those who have traveled abroad or had contact with known measles cases:

• Fever ≥101°F (38.3°C) AND
• Generalized maculopapular rash lasting ≥3 days AND Rash begins at the hairline/scalp and progresses down the body
• Cough, runny nose, conjunctivitis OR Koplik spots (bluish-white specks or a red-rose background appearing on the buccal and labial mucosa usually opposite the molars)

Immediately report any suspected cases of measles to Tarrant County Public Health at our 24 hour hotline (817)321-5350) (dshs.texas.gov/idcu/investigation/conditions/contacts). If possible, please report while the patient is present to facilitate testing and the public health investigation, including follow-up of potential exposures.

Infection Control Precautions

Airborne precautious should be followed to reduce possible exposures in healthcare settings.
In urgent/emergency healthcare settings, suspected cases should be masked with a surgical mask and triaged quickly from waiting areas into a room with a closed door, airborne isolation precautions recommended. In other outpatient settings, suspected cases should be scheduled at the end of the day, if possible. Healthcare workers caring for patients suspected of having measles should use airborne infection control precautions. (www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html)
Since measles is so highly transmissible and can spread in health care settings, people who work in places like a doctor’s office or emergency room should have evidence of measles immunity to prevent any potential outbreak. (https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07- measles.html#f21).

Diagnostic Testing

Testing for measles should be done for all suspected cases of measles at the time of the initial medical visit:
Measles PCR and serology (IgM and IgG) testing is available at both the Texas DSHS Laboratory in Austin and at commercial laboratories.
The Texas DSHS Laboratory can perform PCR testing on throat swabs (preferred) or nasopharyngeal swabs placed in viral transport media and serology on serum specimens.
DSHS strongly encourages providers to submit PCR specimens to the DSHS Laboratory because genotyping will be performed on positive PCR specimens, which can be helpful during outbreaks.
Providers should work with their local health department or DSHS regional office to coordinate testing at the DSHS laboratory to ensure specimens are submitted correctly and meet testing requirements.
Unless coordinated in advance, specimens may only be received during normal business hours Monday through Friday.

Recommendations for Public Health:

Control and Prevention Measures

Measles vaccination may prevent disease in exposed people if given within 72 hours of exposure. People 6 months and older who have not been fully vaccinated would be eligible for vaccination under those circumstances. It may provide some long-term protection but should be followed with a second vaccination at least one month later. Immune globulin (IG) may be indicated for some people but should not be used to control an outbreak.
Pregnant women, people with severe immunosuppression, and anyone with a previous anaphylactic reaction to a vaccine component should not get a measles vaccine.

Controlling Outbreaks in Group Settings

People with confirmed or suspected measles should stay home from school, work, and other group settings until after the fourth day of rash onset.
During an outbreak, people without documented immunity from vaccination or previous measles infection should be isolated from anyone with measles to protect those without immunity and control the outbreak. Additional information on school exclusion and readmission can be found at dshs.texas.gov/idps- home/school-communicable-disease-chart

Recommendations for the Public

If you think you have measles or have been exposed to someone with measles, isolate yourself from others and call your healthcare provider before arriving to be tested so they can prepare for your arrival without exposing other people to the virus. Measles is extremely contagious and can cause life-threatening illness to anyone who is not protected against the virus.

For More Information:

TCMS Gold-Headed Cane Nominations Open for 2023

Physicians, nominations are now open for the 2023 Gold-Headed Cane Award, which is given annually to an outstanding TCMS member who has made a significant impact on our medical community.

To be eligible for the award, a nominee must be a current member of TCMS and have been a TCMS member for at least 15 years.

All current TCMS members have the opportunity to nominate one candidate for this award. You can make your nomination or learn more here.

All nominations must be received by July 31, 2023.

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Physician Wellness

Tarrant County Physician Wellness Program: Addressing Burnout and Promoting Resiliency

by Casey Green, MD

THE TARRANT COUNTY MEDICAL SOCIETY IS launching a new wellness initiative available to medical society members and their families. We recognize the challenges associated with an ever-changing landscape in healthcare exacerbated by the COVID-19 pandemic that contribute to stress, burnout, and job dissatisfaction.

Modeled on the successful program at Travis County Medical Society, the Tarrant County Medical Society Wellness Program seeks to proactively address those among us who may be struggling. We have a mission to enhance the health of physicians, their families, and the communities in which we all live and work.

Physician burnout, the apparent catalyst to this situation, is considered a psychological response that may be experienced by doctors exposed to chronic situational stressors in the healthcare practice environment. It is often characterized by overwhelming exhaustion, feelings of cynicism and detachment from work, and a sense of ineffectiveness and lack of accomplishment.1

Physicians experiencing burnout, according to the medical literature, exhibit a wide array of signs, symptoms, and related conditions, including fatigue, loss of empathy, detachment, depression, and suicidal ideation. Nearly 25 percent of physicians surveyed last year were experiencing clinical depression. There were also significantly increased rates of depression among their family members.2

The most cited reasons for burnout include too many bureaucratic tasks, decreasing autonomy, increased work hours, and recent additional contributing factors related to COVID-19. Of those physicians experiencing burnout, more than half report it is strongly affecting their daily life and more than two thirds acknowledge impairments in relationships.2

Physicians often have to deal with difficult and tragic situations and losses. This continued exposure to human suffering can have a significant impact on mental and emotional wellbeing over time that often goes unrecognized.

Burnout is not always related to stressors arising in a work environment or to an individual’s character traits. Family issues, personal and professional relationships, financial pressures, insufficient work-life balance, or other external stressors may also contribute. Efforts aimed at the identification, treatment, or prevention of burnout must, therefore, approach the issue from a broad enough perspective to take all of these factors into account.

Too many physicians are reluctant to seek help for fear that they will be perceived as weak or unfit to practice medicine by their colleagues or employers, or because they assume that seeking such care may have a detrimental effect on their ability to renew or retain their state medical license.

The TCMS Wellness Program has developed relationships with community therapists who work with physicians or their family members to help them back on the path to wellness. These services will be confidential and paid for by this program for the first four sessions for any members or their families.

The goal of this new initiative is to provide information and resources to support physicians and their families in order to encourage and inspire each other to practice physical, mental, emotional, spiritual, and social wellness. The program is in its final formation steps, and we hope to meet these needs with workshops, mentorship, education, and other activities to promote healing, growth, and resiliency. We are excited about the future and will share more details as the program grows.

You can find more information about how to access the program at www.tcms.org/TMAiMis/Tarrant/Wellness or call 972-449-0762.

References

1. Maslach, C., Jackson, S.E. (1981). The Measurement of Experienced Burnout. Journal of Occupational Behavior, 2(2):99-113. See also, Maslach C, Jackson SE, Leiter MP. (1996). Maslach Burnout Inventory Manual. 3rded. and Maslach C, et al. (2001). Job Burnout. Annu Rev Psychol, 52:397–422

2. Kane L. ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023. Medscape. Published January 27, 2023. Available at: https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058.

STUDENT ARTICLE: ADVOCACY FOR PATIENTS’ MENTAL HEALTH

by AIYANA PONCE, OMS-II

This article was originally published in the March/April issue of the Tarrant County Physician.

HISTORICALLY, STIGMA AGAINST MENTAL HEALTH, ACCESS to care, and discrimination contribute to worsened health outcomes. This is especially true for certain racial or ethnic groups such as those made up of Black and Hispanic individuals, as there are culturally negative views on mental health symptoms and/or treatment, a fear of mistrust of the medical community due to historical discrimination or mistreatments, or lack of access to mental health services.

To help address this, the Lay Mental Health Advocates (LMHA) program was created. This free, virtual training program is designed to teach laypersons the fundamentals needed to advocate for someone who is dealing with mental illness. LMHA focuses on teaching mental health advocacy by understanding how social determinants worse mental health and play key roles in overall health outcomes for marginalized communities. The social determinants of health are defined by the U.S. Department of Health and Human Services as “the conditions in the environments where people are born, love, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

LMHA began as a volunteer project during my time as a research trainee at the National Institute of Allergy and Infectious Diseases before beginning medical school. In addition to conducting experiments in a traditional laboratory setting, I was a fellow of the National Institutes of Health Academy. This program allowed me to meet other trainee scientists equally as passionate about patient advocacy. Ultimately, the goal of this program was to implement a volunteer project that addresses health disparities in the local community.

We saw a need for interventional programs to fill the mental health gap that is particularly prevalent among marginalized communities. Our program consists of a weekly online workshop led by psychiatry residents or attendings from Duke University Hospital and local community leaders. they include interactive role-playing advocacy practice, case study reviews, and other informative components. Our eight-week-long program was modeled after the Johns Hopkins Medicine Lay Health Advocate Program and the Mental Health Allyship Program. Through LMHA, advocates can identify several different mental health conditions, gain a greater understanding of the factors that exacerbate health disparities, understand how to provide effective emotional support, and gain confidence in the role they can play in the lives of their community members by BEING mental health advocates.

The pilot program took place during Spring of 2021, and we had 100 participants whose ages ranged from 18-58. We are now on track to our third workshop series, with participants from across the county. In addition to that, we are currently expanding our team, working on our non-profit application, and establishing a volunteer program to work with the Duke Behavioral Health Inpatient Unit.

Watching this program grow beyond anything my team had imagined has been very rewarding. I wanted to share this journey with those of you reading to encourage you to continue advocating for yourself, your patients, and your community. If you ever see a problem that needs to be addressed or a gap that needs to be filled, just go for it- you never know what may come of it.

References:

1. https://www.psychiatry.org/patients-families/stigma-and-discrimination

2.https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020–08964-3#ref-CR28

3 . https://health.choc.org/understanding-the-role-of-cultural-stigma-on-seeking-mental-health-services/

4.https://health.gov/healthypeople/priority-areas/social-determinants-health

Addressing Conscientious Objection in Healthcare

Insights from the 2023 Healthcare in a Civil Society Forum

by Liz Ramirez

The Tarrant County Academy of Medicine Ethics Consortium, in partnership with Tarrant County Medical Society, hosted Healthcare in a Civil Society on Saturday, February 25, 2023. The annual forum’s central theme focused on “Conscientious Objections in Health Care: Patient Autonomy and Provider Integrity.”

TCMS President Stuart Pickell, MD, joined Steve Brotherton, MD, as HCS moderator and welcomed their keynote speaker, Farr Curlin, MD, at the University of North Texas Health Science Center.

“Dr. Curlin is an internationally known expert on physician conscience and conscientious objection,” said Dr. Pickell. “He is particularly concerned with the moral and spiritual dimensions of medical practice, the doctor-patient relationship, and the moral and professional formation of physicians. His areas of expertise are medicine, medical ethics, doctor-patient relationship, religion and medicine, and conscience.”

On the panel, Dr. Curlin was accompanied by panelists Maxine M. Harrington, JD; Alan Podawiltz, DO; and UNTHSC President, Sylvia Trent-Adams, Ph.D., RN. In the discussion, Preston “Pete” Geren, JD, moderated a panel about educational topics like state intrusion into practice, the effect of providers performing unethical acts, and how medical educators can train students to recognize moral injury.

Participants had the opportunity to interact in small groups and prepare questions for the panelists during the breakout session, where panelists discussed the impact of government and institutional intrusion into medical practice, its effect on healthcare providers, and what providers can do to address it.

“While this event targets medical professionals, anyone who has an interest in the doctor-patient relationship- how it has evolved, where it is heading and implications for the future of healthcare- will find this program helpful,” said Dr. Pickell.

The Tarrant County Academy of Medicine Ethics Consortium believes anyone in the community with an interest to improve healthcare can benefit from this program. The event wouldn’t be possible without the support of Blue Cross Blue Shield, Cook Children’s Medical Center, JPS Health Network, and the University of North Texas Health Science Center.

COVID-19 Vaccine Clinics for the Week of January 14

January 13, 2023 – (Tarrant County) – 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, Pfizer, and Novavax vaccines. Infants six months 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 that 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:

Baker Chapel AME Church
Saturday, Jan. 14: 10 a.m. to 2 p.m.
1050 E. Humboldt St.
Fort Worth, TX 76104

Advent Health Care Center of Burleson
Tuesday, Jan. 17: 9 a.m. to 11 a.m.
301 Huguley Blvd.
Burleson, TX 76028

Vaxmobile-Southside Community Center
Thursday, Jan. 19: 9 a.m. to 4 p.m.
959 E. Rosedale St.
Fort Worth, TX 76104

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 5 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 5 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

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.

COVID-19 Vaccine Clinics for the Week of January 7

January 5, 2023 – (Tarrant County) – 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, Pfizer, and Novavax vaccines. Infants six months 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.