Tarrant County – Tarrant County Physician Online

PRESIDENT’S PARAGRAPH

How Much Does It Cost NOT to Provide Healthcare Services to the Undocumented?

by Stuart Pickell, MD, TCMS President

This article was originally published in the May/June issue of the Tarrant County Physician.

Note from the author: Although I have sourced much of the content in this article, some of the information comes from off-the-record conversations I have had with people who are or have been in leadership positions within the hospital district. In exchange for their honest assessment, I promised not to quote them.

I SUSPECT THAT, IF ASKED, THE average Tarrant County taxpayer would oppose spending tax dollars to fund healthcare for undocumented residents. I suspect also that they have at best a partial understanding of the issue borne out of media mischaracterizations and confirmation biases- on both ends of the political spectrum. Would that we could focus our attention on the information we need- as opposed to the information we want- when we make policy decisions that impact the community.

Harvard psychologist William James, in his presidential address to the American Philosophical Association, stated, “We are making use of only a small part of our possible mental and physical resources.”¹ From this case the notion that we use only 10 percent of our brains, a myth so perpetuated by self-help books throughout the 20th century that by 2014, a survey revealed that roughly 50 percent of teachers around the world believed the myth to be true. ² But James was not asserting that we use only a small part of our brain; he contended that we do not engage it fully. What he described is consistent with what we now know about attention and flow states. To solve problems, our brains work best when we focus our attention. This is also true for communities. If we want to address community concerns seriously, we must focus our attention not just to what we see on the surface, but on the currents that run underneath it. However, when it comes to healthcare and undocumented residents, you can’t finish the question before the knives come out and the war paint goes on. But this question is more nuanced than a soundbite debate regarding immigration. Let me provide some context and propose a path forward.

The County Health System

JPS is the “safety net” facility for those who “fall through the cracks” in our healthcare system. The county health system traces its origin to 1877 when the then-future mayor Jogn Peter Smith donated five acres of land south of town to provide medical care to city and county residents.³

The first public hospital opened in 1906. Associated with the Fort Worth Medical College, it was called the City-County Hospital and was free to all accident victims and others by agreement.⁴ In 1914, a new hospital was built across the alley from the medical college which, by this time, was affiliated with TCU. This building, at 4th and Jones, still stands and is now the Maddox-Muse Center. By the 1930s, the city had outgrown this facility and a new City-County Hospital was built on the land originally donated by John Peter Smith. In 1954, the hospital changed its name to honor the land donor.

Until the 1950s, faith-based healthcare institutions managed many of the hospitals and health networks in Texas. Fort Worth’s first hospital was St. Joseph (1885).⁵ The demand for reliable access to healthcare services for the indigent drove initiatives to create a taxing mechanism to improve healthcare resources in growing Texas communities. This resulted in a Texas state constitutional amendment in 1954 permitting the creation of county-wide hospital districts in counties with a population of at least 900,000 to better serve those communities. ⁶ Tarrant County formed its hospital district in 1959, centered around JPS. As needs increased, the facility grew, and in 2008, it acquired St. Joseph Hospital, which was torn down in 2012 to create space for ongoing expansion.

Because the hospital districts fall along county lines, they come under county jurisdiction and are overseen and managed by the county commissioners court. By statute, every Texas county must have a county judge and four county commissioners, each representing a district consisting of one-fourth of the county’s population. Every county, from Harris County’s 4.7 million residents to Loving County’s 83 residents, has four commissioners and a county judge. The commissioners courts are responsible for setting policy and determining budgets, many of which are dedicated to roads and bridges, law enforcement, and the hospital districts. ^7,8 According to the Texas Health & Safety Code, the county must “provide health care assistance… to each of its eligible county residents.” ⁹ But who is “eligible”?

JPS has enjoyed excellent executive leadership, as evidenced by their ranking in Washington Monthly as the best teaching hospital in the county. ¹⁰ Yet while the executive team has significant authority to create a vision, establish priorities, and execute the network’s mission, it’s the Board of Managers- the JPS governing authority- that funds it and determines eligibility criteria. This board consists of representatives appointed to two-year terms by the commissioners court.

In 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act deeming undocumented residents ineligible for many federal, state, and local public benefits, but it allowed states to expand benefits if they wanted to. ¹¹ This created some uncertainty at the state level. In September 2003, a Texas law went into effect that deemed undocumented immigrants eligible for non-emergency care subsidized with local funds. According to the Fort Worth Star-Telegram, the JPS Board of Managers interpreted this law to be a mandate and voted to allow undocumented immigrants to enroll in JPS Connection starting in January of 2004. ¹² The following month, Senator Jane Nelson wrote a letter to then Attorney General Greg Abbott seeking clarification regarding the statute. ¹³ Five months later, the Attorney General rendered his opinion that the code “permits, but does not require, a hospital district to provide nonemergency public health services to undocumented persons who are otherwise ineligible for those benefits under federal law.”¹⁴ A few weeks later, the JPS Board of Managers rescinded their expansion policy, although those who had already enrolled were permitted to remain in the system.

Cracks in the System

Texas has the ignominious distinction of leading the nation in uninsured residents. At 18 percent, our uninsured rate is over twice the national average. ¹⁵ There are many factors, including Texas’ decision not to accept federal funding for Medicaid expansion (as of July, Texas will be one of only 11 states that has not accepted it) and a knowledge gap on the part of currently eligible people who don’t know how to enroll.^16,17 But another driving factor is undocumented residents, the number of whom living in Texas is anyone’s guess.

Castigating immigrants, documented or not, as “the problem” obfuscates the bigger picture. We live in a transportation hub that provides ready access to much of the world. Immigration is considered a good thing. People come here because our expanding economy offers them jobs. Immigrants constitute 23 percent of the Texas workforce. A 2019 DFW survey revealed that immigrants made up 46 percent of our workforce in construction, 30 percent in manufacturing, and 26 percent in restaurant and food services. They contributed $119 billion to the Texas economy in personal income. Furthermore, 71 percent speak English, about 59 percent own homes, and 79 percent have lived in Texas for at least 10 years. ¹⁸ A recent national study focused on the experiences of undocumented immigrants revealed that immigrants typically pay more into the health system through taxes and premiums than they use in the form of healthcare services. ¹⁹ They do the same for the Social Security trust fund, something the Social Security Administration has known for years.²⁰

And yet, at least in Tarrant County, undocumented immigrants struggle to access healthcare. they go to JPS at a discounted rate (typically 40-80 percent), but because of their legal status they often forego routine care even if they can swing a hammer of lift a beam or scrub a floor- they keep working for fear of losing their jobs. For the undocumented, the fear of discovery and deportation is real. They don’t just fall through the cracks; they hide in them. This works until a chronic problem becomes and urgent one, and they can no longer work and must seek care. With the average three-day hospitalization costing $30,000, the patient will still owe $6,000-$12,000 after discounts, which most cannot afford.²¹ Since they cannot enroll in federal programs, JPS will end out absorbing the cost.

JPS probably provides a lot of uncompensated care that we don’t know about. It would be illegal not to provide care in an urgent/emergent situations- not to mention unethical- so why don’t we focus our attention on the cost of NOT taking care of undocumented residents?

The fact is, no one wants to talk about this because its political kryptonite. State legislators say this is a county issue. The county commissioners say it’s the Board of Managers’ decision, but the Board of Managers is appointed by and serves at the pleasure of the county court. Everyone says it’s a federal issue, and yet when Medicaid expansion comes up the state turns it down. Geez.

I attended First Tuesdays at the capitol on March 6th, where I had the opportunity to sit down with the legislative aid for a Republican senator. When Medicaid expansion came up, she admitted, of the record, that Texas should accept it, but that this issue is a non-starter for her senator. Why? As Robert Frost put it,

Before I built a wall I’d ask to know what I was walling in, or walling out. ²²

Likewise, before we say we’re not going to provide basic healthcare services, shouldn’t we want to know all the facts? The JPS Health Network’s report regarding healthcare planning for Tarrant county states that its critical for the system to “continue to shift the emphasis from hospital care- for medical and behavioral health issues- to ambulatory care to decrease the need for preventable and costly inpatient care.” ²³ But our current policy creates a Gordian Knot in which a sizeable number of Tarrant County residents are forced to do the opposite. So, they wait until they can no longer work, at which point the problem may require a hospitalization and a more expensive “fix.”

A Proposal

What we need is to get past the political campaign slogans and focus our attention on the actual problem. Immigration reform is a valid concern and should be addressed, but it’s not the issue here. Our issue is local, and it impacts the people with whom. we live and work, and those we hire to work for us. The undocumented residents in Tarrant County aren’t leaving anytime soon. Furthermore, they contribute to the economy and pay taxes. What we need, then, is a task force to examine seriously and assess honestly all the issues that contribute to the problem. They should focus their attention not on the surface concerns that we find in a political campaign ad but on the underlying currents, the factors that make this problem more nuanced than can be contained in a soundbite. This task force should be apolitical by intention (to the extent that anything can be) and include people who care about the community, economic development, fiscal responsibility, and, of course, healthcare. TCMS is well positioned to help lead this initiative. We represent a variety of political viewpoints, but we share a common concern for taking care of our patients individually and collectively.

Factors this task force should consider include:

How Harris, Bexar, Dallas, and Travis Counties are managing this issue.
The number of people living in Tarrant County who are barred from county healthcare services.
The impact undocumented residents have on the community, including:
- Their contribution to the economy
- How much they pay in taxes
- How much we are spending urgently treating preventable conditions.

Money is a finite commodity, so it, too, must be included in the conversation. Tax dollars should be spent wisely. County Judge Time O’Hare pledged to do this during his campaign, especially regarding the hospital district.²⁴ He also promised to cut taxes, fund law enforcement, and eliminate waste, fraud, and abuse. ²⁵ This alignment of priorities suggests that hospital district funding may be in peril.

But it doesn’t need to be. A serious study may reveal that we are “wasting money” by NOT providing these services, especially when we factor in the cost of uncompensated urgent and emergent care and the loss of worker productivity. We won’t know unless we ask. Furthermore, the surge in property values, and therefore property taxes, has afforded the state a $32.7 billion surplus. ²⁶ Many constituencies are vying for that money- the taxpayers themselves, law enforcement, teachers- and all should be given serious consideration. But could we not give serious consideration also to addressing the healthcare needs of some of the most vulnerable individuals in our community by allowing undocumented residents to access the county healthcare network?

Once we know what we’re dealing with, we can begin to chart a course forward, riding the underlying currents rather than fighting them until we arrive at a destination that demonstrates hospitality, compassion, and fiscal responsibility. We may even find that the most fiscally responsible thing we could do is to offer basic primary care to these populations through a creative collaboration between JPS and other community resources. But we won’t know unless we ask.

References:

James W. The Energies of Men. Science. 1907; (Vol. 25, No 635 (March 1, 1907)): 332-323.
Howard-Jones PA. Neurosciences and education: myths and messages. Nature reviews Neuroscience. 2014; 15 (12):817-824. doi:10.1038/nrn3817
History of JPS. Accessed March 25, 2023, https://www.jpshealthnet.org/about-jps/history
Site of the Fort Worth Medical College. Historical Marker for the Fort Worth Medical College. https://www.hmdb.org/m.asp?m=53215
Park KB. St. Joseph Hospital. Texas State Historical Association. Accessed March 25, 2023, https://www.tshaonline.org/handbook/entris/st-joseph-hospital
McKinley RD. Texas Hospital Districts: Past, Present, and Future. Affairs DoP; 2019. August 2019.
What Is a County Commissioner? Texas Association of Counties. Accessed March 19, 2023. https://www.county.org/About-Texas-Counties/About-Texas-County-Officials/Texas-County-Commisioner
What Does a County Commissioner Do in Texas? Texas Association of Counties. Accessed March 19, 2023. https://www.county.org/About-Texas-Counties/About-Texas-County-Officials/Texas-County-Commissioner
Health and Safety Code, Texas State Legislature §61.022 (2023). https://statutes.capitol.texas.gov/ Docs/SDocs/HEALTHANDSAFETYCODE.pdf
Editors T. Introducing the Best Hospitals for America. Washington Monthly 2020.
Personal Responsibility and Work Opportunity Reconciliation Act of 1996. 1996.
Allison A. Local, state policies may contribute to higher cervical cancer death rate for Hispanic women in Tarrant County. Fort Worth Report. November 22, 2021. https://fortworthreport. org/2021/11/22/local-state-policies-may-contribute- to-higher-cervical-cancer-death-rate-for-hispanic- women-in-tarrant-county/
Nelson J. Senator Jane Nelson to Attorney General Greg Abbott, February 4, 2004. In: Abbott AGG, editor. Letter from Senator Jane Nelson to Attorney General Greg Abbott seeking a clarifying opinion regarding the eligibility of undocumented residents for health care services under the Health and Safety Code Section 285.201 as added by Chapter 198, Acts of the 78th Legislature, Regular Session, 2003. ed 2004.
Abbott G. Opinion No. GA-0219. 2004.
Percentage of Population Without Health Insurance Coverage by State: 2019 and 2021. United States Census Bureau. Accessed March 25, 2023, https://www.census.gov/library/visualizations/ interactive/population-without-health-insurance- coverage-2019-and-2021.html
Status of State Medicaid Expansion Decisions: Interactive Map. Kaiser Family Foundation. Updated February 16, 2023. Accessed March 25, 2023, https:// www.kff.org/medicaid/issue-brief/status-of-state- medicaid-expansion-decisions-interactive-map/
Barton K. Tarrant County residents have access to free health care, but some say awareness is a barrier. Fort Worth Report. October 11, 2021. Accessed March 19, 2023. https://fortworthreport.org/2021/10/11/ tarrant-county-residents-have-access-to-free-health- care-but-some-say-awareness-is-a-barrier/
Garcia Z. Immigrants are crucial to Texas’ economy. FWD.us. Updated February 23, 2022. Accessed March 19, 2023. https://www.fwd.us/news/ texas-immigrants/
Ku L. Who Pays for Immigrants’ Health Care in the US? JAMA Netw Open. Nov 1 2022;5(11):e2241171. doi:10.1001/ jamanetworkopen.2022.41171
Goss S, Wade A, Skirvin JP, Morris M, Bye KM, Huston D. Effects of Unauthorized Immigration on the Actuarial Status of the Social Security Trust Funds. Actuarial Note. April 2013. Accessed April 2, 2023. https://www.ssa.gov/oact/NOTES/pdf_notes/ note151.pdf
Why health insurance is important: Protection from high medical costs. Accessed March 27, 2023, https://www.healthcare.gov/why-coverage-is- important/protection-from-high-medical-costs/
Frost R. Mending Wall. North of Boston. 1914;
Health Care Planning for Tarrant County and the Role of JPS Health Network. 2018. February 27, 2018. https://www.tarrantcountytx.gov/ content/dam/main/administration/JPS/CBRC%20 Report%20FINAL%20%202%2021%2018.pdf
Allison A. Commissioners court elections could shift priorities of JPS Health Network during pandemic. Fort Worth Report. February 2, 2022.
Judge Tim O’Hare website. https://www. electtimohare.com/
Harper KB, Schumacher Y, Fort A. How could Texas spend its record $32.7 billion surplus? The Texas Tribune. March 13, 2023. Accessed March 27, 2023. https://www.texastribune.org/2023/03/13/ texas-budget-surplus/

ALLIED HEALTH SCHOLARSHIP PRESENTED TO 17 STUDENTS

The Tarrant County Scholarship Committee grants scholarships for allied health students.

Tarrant County Medical Society (TCMS) and TCMS Alliance Foundation’s Scholarship Committee awarded 17 estimable students a total of $36,250.

Every year, the Scholarship Committee meets to review Allied Health Scholarship applications. As the final selection process, the Committee interviewed finalists to learn more about each individual’s story and why they are pursuing a career in allied health. Its aim is to award qualifying students in financial need to aid them in their educational and professional careers.

“Making the road easier for even one person has many rewards, but to be able to provide scholarships to several people is beyond gratifying,” said TCMS Alliance Foundation President and Scholarship Committee member Debbie Massingill. “Many students come from non-medical backgrounds. You are giving them a ‘you’re doing great’ when many have heard ‘you can’t do that.’”

The Allied Health Scholarship Committee is comprised of TCMS physicians and Alliance members. Since 1972, the Committee has awarded allied health students to help aid their education. “The desire, dedication, and hard work of so many students who wish to become healthcare providers give me hope for the future of medicine,” said Massingill.

All applicants must attend colleges in Tarrant, Parker, or Johnson counties, such as Tarrant County Community (TCC), University of Texas at Arlington (UTA), Texas Christian University (TCU), Weatherford College, Southwestern Adventist University, Hill College, Tarleton State University, or Texas Wesleyan University.

2023 Allied Health Scholars:

Tolani Adebowale of Weatherford College; Victoria Alexander of Weatherford College; Makenzee Benson of TCU; Sarah Broder of TCU; Leah DeLeon of UTA; Peyton Elvington of Weatherford College; Carolina Flores of TCC; Megan Harmon of UTA; LaToya L. Jones of UTA; Ruby Le of TCC; Courtney Lemons of Weatherford College; Kayla Robinson of UTA; Alexandria Snider of UTA; Alexandra Sonsini-Hornick of TCU; Emily Tanner of Weatherford College; Erin Tanner of Weatherford College; Ashley Wheeler of TCU.

The Tarrant County Medical Society is a professional organization dedicated to improving the art and science of medicine for the residents of Tarrant County since 1903. TCMS serves over 4,000 physicians, residents, medical students, and Alliance members and is a component society of the Texas Medical Association. To learn more, visit here.

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Media Contact:
Elizabeth Ramirez, Communications Coordinator;

eramirez@tcms.org / (817) 632-7519

Student Article: Representation in Medicine

by Lindsey Thomas, OMS-II

I chose to practice medicine because of my love for science, personal family connections in the field, and even the embellished view of Medicine in the media. However, the most impactful factor was that I had a female African American physician during a time of vulnerability and academic transition. I was balancing health challenges while also deciding what I was going to do in college, and it was my hematologist who provided the example of what I wanted a future for myself to look like. Seeing her success in a field that was dominated by a different demographic propelled my passion to be a physician. She showed me that I could also strive for greatness among the barriers set by society. Throughout my work as a medical assistant and now as a medical student, I have seen firsthand the disparities faced by physicians of color compared to other physicians, and I want to be part of the movement to change the narrative.

One way I knew I could make my aspirations a reality was by joining TCOM’s chapter of Student National Medical Association, or SNMA. On the national level, SNMA strives to serve underrepresented communities as well as produce physicians with cultural humility. One of the ways I’ve been able to further the organization’s mission is by my participation in the Mini Medical School events. We have partnered with the Fort Worth ISD’s after school program to give age-appropriate presentations on a medical topic at the elementary schools in the district. The students have particularly liked our superhero-themed presentation on the lobes of the brain and our introduction to the organs. Some of the elementary schools have already started to incorporate this basic anatomy instruction into the curriculum, so many of these students are able to answer questions during the presentation. The students are predominantly from underserved areas, and it is our hope that having medical students that are from similar backgrounds will inspire them to dream big. Additionally, we speak with high school and undergraduate students interested in joining the medical profession and advise them on achieving their goals. Through SNMA, I can reach students in a personable way and be a figure of possibility to young students that look like me.

As I continue through medical school, I aspire to use the knowledge I gained from student organizations like SNMA to give back to my community and to be a voice of advocacy in the need for diversity in medicine. The practice of medicine is constantly evolving and the people who are delivering healthcare should be evolving as well.

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:

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.

Public Health Notes

Health Equity Through a Public Health Lens

by Catherine Colquitt, MD, Tarrant County Public Health Medical Director, and Yvette M. Windgate, ED.D.

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

As we turn the page on 2022 and our “tripledemic” surge recedes, let’s take a moment to reflect on health equity and disparities through the crucible of COVID-19.

Healthy People 2030 defines health disparities as “a particular type of health difference closely linked to social economic, and/or environmental disadvantage.” It further asserts that health disparities “adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, physical disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion.”1 Our collective goal is health equity, described by Healthy People 2030 as “the attainment of the highest level of health for all people.” Achieving health equity requires valuing everyone equally, with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”1

In the early 2000s, U.S. Surgeons General began to issue reports on disparities in tobacco use and access to mental health care based on racial and ethnic demographics. Since those ground-breaking reports, issues including infant mortality, pregnancy-related seats, chronic disease prevalence, and overall measures of physical and mental health have been examined through the prism of health equity. Part of the impetus of the Affordable Care Act (ACA) was to provide strategies for securing access to healthcare for traditionally underserved groups. Impactful gains were made in numbers of persons insured and access to higher quality care. However, those gains were somewhat eroded in the former presidential administration by cuts to funding for AVA navigators and outreach efforts, and the authorization of state waivers, which allowed some states to decline Medicaid expansion by instead offering their own wavers.

COVID-19 further impacted healthcare coverage losses through lost jobs and wages, resulting in increasing economic hardships, housing difficulty, and food insecurity, disproportionately affecting Black and Hispanic workers, especially those in essential in-person jobs (i.e., transportation, manufacturing, grocery, pharmacy, retail, warehouse, food processing, and healthcare). Due to healthcare workforce shortages and operational changes (e.g., video clinic visits requiring patients to have internet access), these same groups also experienced challenges to healthcare access.

During COVID-19, certain groups (i.e., Alaskan Native, American Indian, Black, and Hispanic individuals) experienced higher death and illness rates than their White or Asian counterparts, likely due in part to their work in essential jobs, higher prevalence of preexisting comorbidities for poor COVID-19 outcomes, use of public transportation, and crowding at work or home.

Additionally, according to the Kaiser Family Foundation’s survey data (The Undefeated), Black adults are more likely than White adults to report certain negative healthcare experiences, such as a provider not believing them, or refusing a test, treatment, or pain medicine the patient believed he or she needed. the Undefeated survey data revealed that Black and Hispanic individuals were less likely to have been vaccinated against COVID-19 as of April 2021. While vaccination rates against COVID-19 have risen on all ground, the gaps between White, Asian, Black, and Hispanic demographic groups have not narrowed. The effect of the health disparities laid bare by COVID-19 has been profound and predated the pandemic. For example, in 2018, the average life expectancy was four years lower in Black individuals than in White individuals, with the lowest life expectancy in Black men. That unfortunate trend continues today. In Tarrant County, the 76109 zip code in Fort Worth, a majority White neighborhood, holds a life expectancy of 82.4 years. Nearby 76104, host to historically Black neighborhoods, like Morningside, has a life expectancy of 66.7, and it is even lower for Black men at 64 years.

What can we do to address these disparities and improve the health of our county and county? The Biden administration has prioritized initiatives aimed at addressing health disparities at the federal level through several executive orders and proclamations. Locally, Tarrant county Public Health (TCPH) has created a Community Health Equity and Inclusion (CHEI) division to promote health literacy and address health equity issues concerning county residents, with the greater goal of decreasing health disparities and inequities in Tarrant County. The CHEI division educates residents and public health professionals regarding health disparity and inequity issues and engages community partners (i.e., Fatherhood Coalition of Tarrant County, Mental Health Connection of Tarrant County, My Health My Resources of Tarrant County, United Way of Tarrant County, and Brave/R Together) to find solutions that promote diversity and health equity.

TCPH continues to collaborate with community partners on annual events, such as the African American Health Expo, the North Texas Wellness Fair, and the Senior Synergy Expo. We are also participating in community celebrations, school events, and COVID-19 testing and vaccination pop-up clinics. Recently, TCPH and fifty-sic agencies- including hospital systems, institutions of higher education, city and county governmental entities, charitable organizations, and faith-based organizations- have joined forces as the Tarrant County Unity Council. This council’s purposes are:

To identify and address health equity challenges for those disproportionately affected.
To build, leverage, and expand fair resource allocation to safe, affordable, and accessible health, housing, transportation, and communication that advance racial equity and address other inequitable social conditions, with the purpose of reducing or eliminating health disparities and health inequities.

References:

Health Equity in Healthy People 2030, https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030
L Hamel et al, Kaiser Family Foundation: Key Findings from the KFF/Undefeated Survey on Race and Health 10/2020
Life Expectancy by ZIP code in Texas, https://www.texashealthmaps.com/lfex
Tarrant County Public Health, Family Health Services, Community Health Equity and Inclusion, Community Involvement, https://www.tarrantcounty.com/en/public-health/family-health-services/health-equity–community-outreach/previoud-activities.html?linklocation=Button%20List&linkname=Community%20Involvement
Tarrant County Unity Council, https://www.tarrantcounty.com/en/public-health/family-health-services/health-equity–community-ooutreach/tarrant-county-unity-council.html

PRESIDENT’S PARAGRAPH

by Stuart Pickell, MD, TCMS President

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

Why Do We Not Have a Pediatric Residency Program in FORT WORTH?

WHEN I MOVED BACK TO FORT WORTH in 2001, I wondered why we had so few graduate medical education (GME) programs. I came to understand, from those who should know, that Fort Worth simply wasn’t an “academic” city. We had one of the finest osteopathic medical schools in the country, several excellent medical centers, and a fine children’s hospital, but relatively few residency positions for a city our size. In 2011, the Texas Legislature, concerned that the physician workforce would not keep pace with Texas’ rising population, established a goal of 1.1 residency training positions for every Texas medical school graduate. Physicians often remain near where they train, so the reasoning was and continues to be sound. Achieving and maintaining this goal helps to build and sustain the physician workforce.

Fortunately, with no help from Tarrant County, Texas achieved its goal in 2017 (see Table 1). However, the impending graduation of student from new medical schools in the next two years will increase the demand for PGY-1 positions. the Burnett TCU School of Medicine will graduate its first class in May. A year later the Sam Houston University College of Osteopathic Medicine and the University of Houston College of Medicine will graduate their first classes. By 2024, to maintain the minimum 1.1 ratio, Texas will need to increase the number of residency positions by 5 percent, and to maintain its current 1.16 ratio, it will need to increase the number of positions by 10.8 percent.

In the last few years, Tarrant County’s medical community began meeting the challenge by starting several new residency programs. This is a welcome, albeit long overdue, development. Baylor Scott and White and Texas Health Resources have led the way to these recent changes by starting programs in internal medicine, ob-gyn, emergency medicine, and general surgery- this in addition to the programs already established at John Peter Smith and Medical City. The elephant in the room is pediatrics.

Why does Fort Worth, the 13th largest city in the country and home to the 13th largest children’s hospital, not have a pediatric physician residency program? I include the word “physician” because Cook children’s does have a pediatric residency program for nurses. In fact, it has one of the only 34 such programs in the country, but it does not have a program to train physicians- and its the only children’s hospital that has a program for nurses and not physicians. But as the population grows, won’t we need more pediatricians? Regional growth trends suggest we will. For instance, in just the last five years:

• The U.S. population increased by 2.7 percent

• The Texas population increased by 5.8 percent

• The Fort Worth population increased by 9.3 percent

• Fort Worth went from being the 16th to the 13th largest city in the country

• The number of PGY-1 pediatric residency positions in Texas increased from 211 to 213, or 0.95 percent

Looking at the 30 largest cities in the United States, Fort Worth is the only one that doesn’t have a pediatric residency program. Jacksonville, FL, which ranks just ahead of Fort Worth in population, for now, has a pediatric residency program, and it doesn’t even have a medical school. Fort Worth has two medical schools.

Within Texas you will find residency programs in the larger cities – Houston, San Antonio, Dallas, and Austin – but you will also find them in El Paso, Corpus Christi, Lubbock, Temple, Galveston, and Amarillo. The only other cities in Texas that have a medical school and no pediatric residency program are College Station, Edinburgh and Conroe. So, why not Cook Children’s?

I’ve asked this question to more than a few people affiliated with Cook Children’s – some who would like to see a physician GME program and others who would not. While they disagree on the proposition, they generally agree on the historical timeline and current sentiment. Cook Children’s, the result of a merger of Fort Worth’s two children’s hospitals in the 1980s, had a unique vision from its inception. Like many large children’s hospitals, it offered state-of-the-art care for pediatric patients, but it also vowed that patients would only be treated by board-certified pediatricians, i.e., no students or residents. Since most of Fort Worth’s hospitals didn’t have GME programs, Cook Children’s was not an outlier.

What made Cook Children’s particularly unique was its size and resources combined with its lack of GME entanglements. Cook Children’s leveraged this latter feature to recruit physicians who wanted to be clinicians, not educators. A vocal minority of the current medical staff have embraced this feature and do not want it to change. There is also a vocal minority who knew Cook Children’s wasn’t an academic institution when they joined but believe now that it should be. Many others – probably a majority, although no formal vote has been taken – would be fine with a GME program if one existed, but they could go either way.

In recent years, the subject has been revisited several times. About five years ago, Cook Children’s hired Germane Solutions, a GME consulting firm, to examine the viability of a GME program and assist in its development. Their findings are proprietary, but the consensus of the people with whom I talked is that Cook Children’s is positioned to have an outstanding GME program if it wants one. Furthermore, it would enhance the hospital’s national profile and be a financial boon to the local economy. But the success of a GME program hinges on having a medical staff who supports it. One vocal minority does, the other does not. And while the support doesn’t need to be unanimous to make it work, it wasn’t clear that enough of the middle majority supported it to the point it would reach the critical mass needed to make it worth pursuing.

Some theorize that demand for more pediatric residency positions among graduating medical students is lacking, and there is some truth to this claim. In the 2021 match, there were 1.47 pediatric PGY-1 positions for every graduating U.S. medical student who applied for one. But this doesn’t tell the whole story. Between 2016 and 2021, a concerning trend emerged. While nationally the number of pediatrics PGY-1 positions increased by 6 percent there was a 14 percent decrease in the number of U.S. medical graduates applying for them.

Fortunately, foreign medical graduates have filled the void, resulting in a match-fill rate consistently over 98 percent, which makes pediatrics appear both desired and competitive. But shouldn’t the decreased domestic interest in pediatrics provoke more questions? Why are U.S. medical students not considering pediatrics?

One perennial concern is low pay relative to other specialties, including pediatric subspecialties. As one of my residency attendings used to quip, “Little people, little money.” This must be on the minds of even the most altruistic of medical students for whom the average student loan debt upon graduation is over $200,000. But perhaps students everywhere are picking up on a trend that Cook Children’s is actively embracing- a hidden curriculum embedded in the cook Children’s philosophy as evidenced by the presence of a residency program for nurses but not physicians, that the future of primary care pediatrics is really nursing.

“Baylor Scott and White and Texas Health Resources have led the way to these recent changes . . . this in addition to the programs already established at John Peter Smith and Medical City. The elephant in the room is pediatrics.”

I hope this is not the case, because while value the contributions that nurses and APPs bring to the clinical care team, their training is qualitatively and quantitatively different from that of a physician. These teams should be supervised by physicians, and those physicians need to be trained… somewhere.

Why no Cook Children’s? Medical staff aside, they have the resources. So, how many attendings does Cook Children’s need to reach the critical mass necessary to start a residency program for physicians as well as nurses. A hospital with their resources could have a large residency program. To make a comparison, Children’s Hospital of Los Angeles is roughly the same size as Cook Children’s could start with eight, the same size as Texas Tech’s program in Lubbock. considering that physicians often practice where they train, could Cook Children’s not do this for the community’s sake?

The Cook Children’s Health Care System and its flagship hospital are. a well-kept secret that will not reach its full potential until It becomes an academic training facility with education and research affiliations. To illustrate this, U.S. News & World Report ranks the top 50 children’s hospitals in 10 different specialties. Most hospitals comparable to Cook Children’s rank in nine or 10 of these specialties, often in the top 30. Cook Children’s ranks in only six, the highest being neurosurgery at 20. The others come in at 38, 41, 43, 48 and 50.

The hospital website states: “As one of the fastest growing areas in the United States, Cook Children’s is continually looking ahead to meet the needs of a very diverse population.” No one will argue with this. Cook Children’s is one of the finest children’s hospitals in the United States. As a city and as a medical community we should be- and are- proud of it. But can it not look further ahead and become home to one of the finest pediatric residency programs as well? Becoming an academic center will enhance its national profile and bolster the pediatric workforce in Texas by exposing students to high-quality pediatric primary care and specialty services early in their training, while providing an exceptional place for them to continue their training and work after they graduate.

Most things worth doing require effort. Starting a new residency program is no exception. Some physicians to me that now is not the right time, that in the wake of COVID-19 they don’t have the bandwidth for it. But will there ever be a “right” time? wll there ever be a time when the stars in heaven align, and there is a unanimous agreement that the time has arrived?

First century rabbi Hillel the Elder once said, “If I am not for myself, who will be for me? If I am only for myself, what am I? If not now, when?” Indeed. Given the need and the benefit to the community, perhaps now is the right time after all.

References:

1. The Texas Hospital Association’s educational series on hospital finance: “Graduate Medical Education, Part 5” – https://www.tha.org/wp- content/uploads/2022/04/Financing_GME_FI- NAL.pdf

2. Data for 2011-2019 may be found in a paper written by the Academic Quality and Workforce of the Texas Higher Education Coordinating Board: “The Graduate Medical Education (GME Report: An Assessment of Opportunities for Graduates of Texas Medical Schools to Enter Residency Programs in Texas.” This was a report to the Texas Legislature per Texas Education Code, Section 61.0661, October 2020, p.x.

3. See: The Kaiser Family Foundation website: https://www.kff.org/other/state-indicator/total-medical-school-graduates/

4. See: https://www.residencyprogramslist.com/ in-texas

5. “The Graduate Medical Education (GME) Report: An Assessment of Opportunities for Graduates of the Texas Medical Schools to Enter Residency Programs in Texas.” October 2020, P. 17

6. Cook Children’s Hospital consistently ranks between the 10th and the 18th largest children’s hospital in the United States depending on whether we are looking at licensed beds, staffed beds, and when the reporting was obtained.

7. See U.S. Census data at: https://www.census. gov/
8. See data from the National Residency Matching nrmp.org/
9. Not surprisingly, every U.S. city with more than one medical school has a pediatric residency program, except Fort Worth.
10. Information obtained for this article synthe- sizes conversations I had with 10 different people, all of whom are knowledgeable of Cook Children’s Medical Center (CCMC) and the movement to develop a physician residency program. Because of the sensitive nature of this topic, I promised that I would not reveal their names or quote them directly but would make a good faith effort to com- municate their understanding of the issue. They did not all agree on whether CCMC should pursue a residency, but they did agree on the major points outlined in the article. Of the 10, eight are or were employed by CCMC, almost all in leadership posi- tions. Three of those have retired and five remain on staff. The other two, both physicians, are lead- ers in the medical community and/or at CCMC and in a position to speak to this topic.
11. See: https://educationdata.org/average-medi- cal-school-debt
12. See https://health.usnews.com/best-hospitals/ pediatric-rankings
13. See: https://www.cookchildrens.org/about/ history/
14. Mishnah Avot 1:14. See: https://www.sefaria. org/Pirkei_Avot.1.14?lang=bi

Student Article: Continuing the Passion for Science in Medicine

This article was originally published in the January/February 2023 issue of the Tarrant County Physician.

by Homero Coss, OMS-II

OFTEN ONE OF THE FIRST QUESTIONS I AM ASKED WHEN I mention that I am in medical school is, “How did you know you wanted to become a doctor?” Sometimes I scramble to find the most inspirational and motivating answer, as there were many reasons why I chose the career path that I did, However, at the core of every underlying reason was first, my love for science, and second, the desire to put that love into good use. Throughout my undergraduate years, I made sure to put scientific research at the forefront of my priorities. I took additional classes to help develop my skills as a researcher and participated in local symposiums whenever I could. Going into medical school, I kept research and the scientific process in mind as I learned about each body system. Given my medical education, I could delve further into the pathologies and the application of their respective treatments, and, if there were any developing treatments, I could keep an open mind about them and seek an opportunity to participate in the field research (if my busy school schedule let me). Thankfully, this past summer, my school presented the perfect chance to participate in the Pediatric Research Program (PRP) with Cook Children’s Hospital.

The PRP selects a group of second year medical students to take part in research “that aligns with their specialty interest.” There are also additional benefits such as being provided a mentor who guides you along the way and opportunities to present work at local/regional/national conferences. I chose neurology as y number one field of interest, so I was assigned a case study with a pediatric neurologist as my research mentor. I was excited and eager at the prospect of beginning work, especially since I had been assigned to Cook Children’s. The idea of being in an environment that was dedicated to helping children with challenging diseases brought a sense of fulfillment to my foundational goal of helping people heal.

Writing a case study was a novel experience, but I was fortunate to have a dedicated mentor who aided me through the process and helped me understand clinical information that my then year-one-medical-student mind could not comprehend. My mentor further allowed me to shadow her periodically throughout the summer, which was a nourishing experience to my medical education. I was able to interact with many pediatric patients who were affected by a variety of neurological disorders, especially congenital ones. This provided me with an appreciation for specialist physicians since they offer a great sense of hope and security to their patients- something I had associated more with primary care. What was even more admirable was my own mentor pursuing her research and developing case studies to help spread awareness of the pathologies that affect her patients.

Regarding my own project, I was able to learn more about the neurovascular complications of Marfan syndrome and the importance of considering it as a possible cause of stroke. I thoroughly enjoyed the process of gathering information and researching literature since it showed me how physicians from different parts of the country can come together and use their scientific nature to bring light to issues and possibly come to solutions. I look forward to working on more case studies and research projects as a medical student because it reaffirms my belief in using scientific methods and research to better the lives of patients and reach new heights in treatments.

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.