When Jocelyn Galindo, 30, gave birth to her daughter in 2020, the first thing on her mind was her child’s health.
During her stay at a Fort Worth hospital, she was referred to Cook Children’s Neighborhood Health Center Northside at 4405 River Oaks Blvd. for her daughter’s pediatric care through adolescence.
The clinic was a few blocks away from her home — Galindo felt it was a perfect fit.
During those early visits, the clinic’s staff were supportive and caring to her daughter as Galindo navigated her first years of motherhood. But, in recent years, the quality of the clinic hasn’t been the same, said Galindo.
“Oh my gosh, the access has changed drastically,” she said. “They’re not really supportive.”
Some Tarrant County residents, including Galindo, say what began as well-intentioned health centers has been marred by a lack of staff support, increasingly shorter visits with pediatricians and long wait times to schedule appointments.
Now, Cook Children’s Health Care System is working to rebuild parental trust as it looks to improve its seven neighborhood health centers across Tarrant County, including the Northside location.
The centers are built in neighborhoods identified through strategic market analysis as having inadequate access to primary care for children, Kim Brown, director of public relations at Cook Children’s, previously told the Report.
“We understand and acknowledge the concerning reports of long wait times at our neighborhood health centers, and we must emphasize that our promise to care for every child who needs our services never wavers,” Cook Children’s said in a statement.
Short appointments, long waits leave some parents frustrated
Cook Children’s launched its clinics initiative nearly three decades ago to focus on health care access for all children.
In July 1997, Cook Children’s opened its first neighborhood health center as a mobile practice clinic in Fort Worth’s Northside, which city officials have identified as one of the highest-need areas in Fort Worth. Over the next 20 years, the health system established six other neighborhood clinics across Tarrant County.
Each Cook Children’s clinic costs roughly $6 million to fully operate on a yearly basis. The majority of the clinics’ patients are covered under state Medicaid and CHIP. The health system reports roughly 120,000 visits a year across all seven neighborhood centers, said Christina Reed, director of operations for Cook Children’s Neighborhood Health Centers.
“The neighborhood centers evolved over the decades between walk-in models to all kinds of different methods,” said Veronica Tolley, vice president of primary and specialty care at Cook Children’s. “We’ve tried some things that didn’t work and some things that have. In the end, what we’ve done best is be a consistent presence in the communities in some shape, form or another.”
Cook Children’s goal is to improve community access to pediatric services, but Galindo said it doesn’t always feel that way.
Galindo’s struggles begin with the first step of visiting the clinic: setting up an appointment. During her early visits, the Northside clinic’s staff would help set up the following visit.
Now, Galindo has to do it on her own and often waits two to three months for time slots to become available for the next appointment, she said.
“I know as a parent I’m responsible for my children’s care, but it’s frustrating not being able to set an appointment right then and there,” said Galindo.
Galindo also alleges visits with pediatricians and providers at the Cook Children’s clinic feel like an “in and out service.” Pediatricians spend less than five minutes with her daughter, she said.
“I ask questions to make the stay longer, but there’s support that we need from them,” said Galindo. “It makes me feel like we’re part of an assembly line.”
Sofia Saucillo Garcia, 44, has been taking her children to Cook Children’s Northside clinic since the birth of her first son over 20 years ago. In those early years, the clinic was supportive and helpful but the quality has gone down in recent years, she said.
Last year, Garcia’s daughter was due for immunizations in January, but she wasn’t able to secure an appointment until July, she said. She only takes her children to the Northside clinic because of its proximity.
“Because it’s close to my home, I just tolerate it,” she said. “Luckily my kids don’t get sick that often, so I don’t have to worry about it too much.”
Not every experience with the clinics is negative.
Fort Worth resident Kizzy Ruffin has taken her foster children to Cook Children’s Neighborhood Health Center Arlington at 1525 S. Cooper St. for several years. Ruffin has never had any problems scheduling an appointment.
The clinic’s lead pediatrician, Dr. Angela Cabarcas, and the staff are great with the children, she said.
“(Cabarcas) is a great doctor,” said Ruffin. “She tells you what’s going on, she takes her time and she does not rush in and out of the room. I don’t have any problems with none of them. You can’t go in there with an attitude with these people, they’re just doing their jobs.”
Navigating industry-wide challenges
Several of the parental concerns about the quality of the neighborhood clinics are rooted in health care challenges beyond Cook Children’s control, Reed said. Long wait times are fueled by staffing shortages that affect the industry post-COVID-19 pandemic, she added.
“Accessing health care is already challenging enough, but now there’s not enough providers in the country,” she said.
Across the U.S., staffing and operating budgets remain barriers to serve patients as effectively as possible at community clinics. These facilities often have heavy workloads and little financial flexibility that create low-resource environments and high-patient volume, said Omolola Adepoju, clinical associate professor at the University of Houston College of Medicine.
“Because patients often present with co-occurring medical and social needs, community health centers often have a taller order by providing both medical care and social need referrals,” she said. “Patients may also present with lower health literacy and multiple conditions, indicating the need to invest additional resources to properly manage patients.”
The insufficient number of primary care providers poses a “serious public health threat” and leaves nearly one-third of the population vulnerable to preventable chronic diseases and emerging threats, according to a 2023 report from the National Association of Community Health Centers.
Limited funding and higher burdens also make it difficult to attract providers to serve in community clinics. For these health settings to thrive, Medicaid reimbursement for primary care needs must increase so as to attract providers and telemedicine options, said Adepoju.
Medicaid reimbursement is a form of payment that health care providers receive for the services they offer to people under the health insurance plan. Medicaid has been known to have a low reimbursement rate that leads to providers often spending more money caring for patients than they receive in payments.
In 2020, hospitals received only 88 cents for every dollar spent caring for Medicaid patients, which amounted to a $24.8 billion underpayment, according to The Commonwealth Fund.
What comes next?
Cook Children’s aims to address patients’ concerns by adding providers to its various locations. Over the last year, the health system added nine new primary care physicians and advanced practice providers, with three specifically joining the Northside clinic in recent months.
“Families don’t want (long waits) and I don’t blame them,” said Reed. “It’s our job to step in in a way that’s empathetic and that’s respectful to help alleviate as much as we can.”
The health system will maximize existing resources by extending clinic hours during the lunch hour and after school until 7 p.m. There are also plans to grow virtual care options by offering video visits, portal messaging and virtual check-ins for patients.
Cook Children’s also plans to address accessibility concerns with two new neighborhood clinics opening in 2025: one in northeast Fort Worth and another in west Fort Worth’s Las Vegas Trail neighborhood.
“We’re committed to continuous improvement and appreciate your patience as we work towards a future where every child in our community has access to the quality care they deserve,” Cook Children’s said in a statement. “We thrive on the input from our families and community to understand how best to support their health and well-being.”
Even with the problems she has experienced at Cook Children’s Northside health center, Galindo continues to take her daughter, and now also her infant son, to the clinic. They remain patients solely out of convenience, said Galindo.
“Cook Children’s is in my children’s plan, and they’re so close, so I would have to look for another one,” she said. “I wouldn’t be opposed to looking for another, but it deters me when I have this clinic down the road.”
Galindo hopes Cook Children’s stands by their promise to improve the clinics. She’s curious to see if her experiences will change in the coming months.
“The fact that they’re even considering these things shows how much they want to continue to make an impact in the community and listen to people … that’s exciting,” she said.
David Moreno is the health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact him at david.moreno@fortworthreport.org or @davidmreports.
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