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Hospitals limit pediatric dentists’ access for procedures that require anesthesia

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2 years ago

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Two hospitals in south Mississippi have limited local pediatric dentists’ access to their facilities, potentially preventing hundreds of kids from receiving necessary dental care, according to one dentist.

Though the hospitals — Merit Health Wesley and Forrest General Hospital — are located in Hattiesburg, experts say this is an issue happening throughout the state and around the country.

In Mississippi, where over half of the adult population has had one or more permanent teeth removed because of gum disease or tooth decay, the effects of limiting pediatric dentists’ access to hospitals where they can safely put children to sleep for procedures could be devastating.

And one solution recently adopted by the Centers for Medicare and Medicaid Services hasn’t yet been implemented in Mississippi.

In order for young children or children with special needs to tolerate dental procedures, most dentists agree that at least moderately sedating them is necessary, said Dr. Huel Harris, who’s been practicing pediatric dentistry in Hattiesburg for nearly four decades. However, it’s not easy — or always safe — to do in an office setting.

But after Merit Wesley and Forrest General decided to limit access to their operating rooms, a decision Harris suspects can be traced back to low reimbursement rates the hospitals receive from Medicaid, he and other pediatric dentists in the area have no safe way to put patients to sleep.

Harris was previously seeing about 40 kids a month for procedures that necessitated the use of an operating room and even had a standing weekly block at Forrest General for decades, where an anesthesiologist or nurse anesthetist sedated his patients.

Now, he’s not allowed to see any patients at Merit Wesley, and only about three patients every few months at Forrest General.

“If you look at myself and my other fellow pediatric dentists in the Hattiesburg area, we probably treated between 1,500 to 2,000 kids last year,” he said. “They now will not have a way to get the stuff done.”

He’s concerned that hospitals closing their doors to dentists could result in riskier situations for pediatric patients — or no care at all.

Current regulations say with enough training, dentists can sedate patients to a certain degree. But they cannot put patients to sleep.

Harris was told that Forrest General needed the space for “more necessary things,” he said.

In a statement provided to Mississippi Today, a Forrest General spokesperson said the hospital would be providing one day a month for pediatric dental cases. She refused to answer further questions.

Spokespeople from Merit Wesley said the hospital was prioritizing its resources on cardiac, orthopedic and bariatric surgery as well as breast and gastrointestinal cancer removal, citing limited availability of surgical suites and staffing.

But according to Harris, the hospitals’ reasoning is rooted in money.

Harris’ patients are predominantly insured by Medicaid. When a dental procedure is performed in a hospital setting, hospitals submit a facility charge for use of their operating room, and anesthesiologists submit a separate charge for their service.

Medicaid on average reimburses dental procedures at low rates compared to other medical procedures. Generally, Medicaid’s reimbursement to dentists for procedures they perform only covers about 30% of the procedure cost.

Matt Westerfield, spokesperson for the state Medicaid agency, said the department will explore whether it should adopt a new dental billing and payment system that would pay more for hospital dental operating room cases requiring general anesthesia with the hopes of increasing payments to facilities.

Though private insurers and state Medicaid divisions across the country are not required to recognize this new system, the American Academy of Pediatric Dentistry encourages it.

“The optimal oral health of all children needs to be a priority in all states,” the statement from the organization reads. “Operating room access for dental care is a pervasive issue across the country, in part due to costs to facilities and lack of reimbursement. This restricted access impacts both the oral and overall health of vulnerable children, as well as limits potential treatment options.”

Denny Hydrick, the executive director of the Mississippi State Board of Dental Examiners, declined to “speculate” regarding whether pediatric dentists need hospital space to perform operations and said he had not heard of this issue affecting other parts of the state.

Members of the Mississippi Academy of Pediatric Dentistry executive board either could not be reached or declined to be interviewed. Other Hattiesburg-area pediatric dentists followed suit — one mentioned hopes that the issue would be worked out among the involved entities.

No matter how potent, pediatric dental anesthesia and sedation largely requires special permitting.

In Mississippi, there are three levels of permits. A Class 3 permit allows dentists to lightly sedate patients. They’re completely awake but slightly subdued through laughing gas, or nitrous oxide, combined with anti-anxiety drugs like Valium. The Class 2 permit allows dentists to put patients in a moderately sedated state. In this state, a patient might drift off to sleep, but they’re breathing on their own and can respond to pain.

According to Dr. David Curtis, a longtime dentist who’s previously served on the Mississippi Academy of Pediatric Dentistry board and currently serves on the state dental examiners board, the sedation permitted in a Class 2 permit requires a great amount of skill.

But no dentist can acquire a Class 1 permit, which gives license to fully put patients to sleep in an unresponsive state. Only an oral surgeon or anesthesiologist can do that.

And in a hospital setting, trained anesthesia personnel can sedate patients and intervene during complications. That’s not the case in a dental office, Curtis said.

“If you get in over your head, which has happened around the country, you can get into serious trouble very, very fast,” he said. “If you’re in a hospital operating room, you have nurses and an anesthesiologist, and if you get into trouble they can get you out.”

A 2013 study found that 44 people under 21 have died nationwide from causes related to dental anesthesia between 1980 and 2011. A year after the study was published, a young girl died in Hawaii after undergoing sedation in a dental office.

And while anesthesiologists can be brought into dental offices to perform the sedation, that’s not always an option, Harris said — there’s a shortage of health care professionals nationwide, and it can be expensive.

Even oral surgeons can be hesitant to put people to sleep in their offices, Harris said, and when they do, they prefer to have a nurse anesthetist present.

He said the biggest difference between sedating adults and children is size. The larger someone is, the easier it is to find the right dose, he said.

“When someone is very small, the dose difference can be critical,” Harris said.

Curtis said while some dentists are comfortable moderately sedating patients in their offices, he’s not.

“There’s never been any question about whether dentists can do what they’re trained to do,” he said. “What comes into question is … if you get in over your head, you’re in trouble. Fortunately it doesn’t happen often, but when it does, it’s tragic.”

Research shows that low-income people are more likely to have poor oral health. That’s why in Mississippi, one of the poorest states in the nation, the consequences of limiting pediatric dentists’ access to operating rooms could be especially dire, Harris said.

During his 35-year career, Curtis said operating rooms have been readily available up until a few months ago. Since then, nearly every week he hears of another Mississippi hospital cutting access, he said.

“I’ve been doing this a long time, and it’s a problem everywhere,” Curtis said. “Not just in Mississippi, but across the nation.”

Harris said many of his young patients need extensive work — including crowns, fillings and extractions — to mitigate severe dental disease.

Left untreated, severe dental issues in kids can turn into abscesses and create long-lasting issues. The next best solution is sending kids to oral surgeons, which Harris said he’s already started doing. However, that’ll likely result in kids getting their teeth pulled instead of getting restorative treatments like crowns.

“That’s going to snowball, and they may get overwhelmed,” Harris said. “We’ll just be kicking the can down the road.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

1964: Mississippi Freedom Democratic Party was formed

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5 hours ago

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April 26, 2025

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mississippitoday.org – @MSTODAYnews – 2025-04-26 07:00:00

by Jerry Mitchell, Mississippi Today
April 26, 2025

April 26, 1964

Aaron Henry testifies before the Credentials Committee at the 1964 Democratic National Convention.

Civil rights activists started the Mississippi Freedom Democratic Party to challenge the state’s all-white regular delegation to the Democratic National Convention. 

The regulars had already adopted this resolution: “We oppose, condemn and deplore the Civil Rights Act of 1964 … We believe in separation of the races in all phases of our society. It is our belief that the separation of the races is necessary for the peace and tranquility of all the people of Mississippi, and the continuing good relationship which has existed over the years.” 

In reality, Black Mississippians had been victims of intimidation, harassment and violence for daring to try and vote as well as laws passed to disenfranchise them. As a result, by 1964, only 6% of Black Mississippians were permitted to vote. A year earlier, activists had run a mock election in which thousands of Black Mississippians showed they would vote if given an opportunity. 

In August 1964, the Freedom Party decided to challenge the all-white delegation, saying they had been illegally elected in a segregated process and had no intention of supporting President Lyndon B. Johnson in the November election. 

The prediction proved true, with white Mississippi Democrats overwhelmingly supporting Republican candidate Barry Goldwater, who opposed the Civil Rights Act. While the activists fell short of replacing the regulars, their courageous stand led to changes in both parties.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Mississippi River flooding Vicksburg, expected to crest on Monday

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20 hours ago

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April 25, 2025

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mississippitoday.org – @alxrzr – 2025-04-25 16:04:00

by Alex Rozier, Mississippi Today
April 25, 2025

Warren County Emergency Management Director John Elfer said Friday floodwaters from the Mississippi River, which have reached homes in and around Vicksburg, will likely persist until early May. Elfer estimated there areabout 15 to 20 roads underwater in the area.

A truck sits in high water after the owner parked, then boated to his residence on Chickasaw Road in Vicksburg as a rising Mississippi River causes backwater flooding, Friday, April 25, 2025.

“We’re about half a foot (on the river gauge) from a major flood,” he said. “But we don’t think it’s going to be like in 2011, so we can kind of manage this.”

The National Weather projects the river to crest at 49.5 feet on Monday, making it the highest peak at the Vicksburg gauge since 2020. Elfer said some residents in north Vicksburg — including at the Ford Subdivision as well as near Chickasaw Road and Hutson Street — are having to take boats to get home, adding that those who live on the unprotected side of the levee are generally prepared for flooding.

A rising Mississippi River causing backwater flooding near Chickasaw Road in Vicksburg, Friday, April 25, 2025.
Old tires aligned a backyard as a deterrent to rising water north of Vicksburg along U.S. 61, Friday, April 25, 2025.
As the Mississippi River rises, backwater flooding creeps towards a home located on Falk Steel Road in Vicksburg, Friday, April 25, 2025.

“There are a few (inundated homes), but we’ve mitigated a lot of them,” he said. “Some of the structures have been torn down or raised. There are a few people that still live on the wet side of the levee, but they kind of know what to expect. So we’re not too concerned with that.”

The river first reached flood stage in the city — 43 feet — on April 14. State officials closed Highway 465, which connects the Eagle Lake community just north of Vicksburg to Highway 61, last Friday.

Flood waters along Kings Point Road in Vicksburg, Friday, April 25, 2025.

Elfer said the areas impacted are mostly residential and he didn’t believe any businesses have been affected, emphasizing that downtown Vicksburg is still safe for visitors. He said Warren County has worked with the U.S. Army Corps of Engineers and the Mississippi Emergency Management Agency to secure pumps and barriers.

“Everybody thus far has been very cooperative,” he said. “We continue to tell people stay out of the flood areas, don’t drive around barricades and don’t drive around road close signs. Not only is it illegal, it’s dangerous.”

NWS projects the river to stay at flood stage in Vicksburg until May 6. The river reached its record crest of 57.1 feet in 2011.

The boat launch area is closed and shored up on Levee Street in Vicksburg as the Mississippi River rises, Friday, April 25, 2025.
The boat launch area (right) is closed and under water on Levee Street in Vicksburg as the Mississippi River rises, Friday, April 25, 2025.
City of Vicksburg workers shore up the bank along Levee Street as the Mississippi River rises, Friday, April 25, 2025.
The old pedestrian bridge spanning the Mississippi River in Vicksburg, Friday, April 25, 2025.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Mississippi Today

With domestic violence law, victims ‘will be a number with a purpose,’ mother says

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21 hours ago

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April 25, 2025

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mississippitoday.org – @MSTODAYnews – 2025-04-25 15:07:00

by Mina Corpuz, Mississippi Today
April 25, 2025

Joslin Napier. Carlos Collins. Bailey Mae Reed. 

They are among Mississippi domestic violence homicide victims whose family members carried their photos as the governor signed a bill that will establish a board to study such deaths and how to prevent them. 

Tara Gandy, who lost her daughter Napier in Waynesboro in 2022, said it’s a moment she plans to tell her 5-year-old grandson about when he is old enough. Napier’s presence, in spirit, at the bill signing can be another way for her grandson to feel proud of his mother. 

“(The board) will allow for my daughter and those who have already lost their lives to domestic violence … to no longer be just a number,” Gandy said. “They will be a number with a purpose.” 

Family members at the April 15 private bill signing included Ashla Hudson, whose son Collins, died last year in Jackson. Grandparents Mary and Charles Reed and brother Colby Kernell attended the event in honor of Bailey Mae Reed, who died in Oxford in 2023. 

Joining them were staff and board members from the Mississippi Coalition Against Domestic Violence, the statewide group that supports shelters and advocated for the passage of Senate Bill 2886 to form a Domestic Violence Facility Review Board. 

The law will go into effect July 1, and the coalition hopes to partner with elected officials who will make recommendations for members to serve on the board. The coalition wants to see appointees who have frontline experience with domestic violence survivors, said Luis Montgomery, public policy specialist for the coalition. 

A spokesperson from Gov. Tate Reeves’ office did not respond to a request for comment Friday.

Establishment of the board would make Mississippi the 45th state to review domestic violence fatalities. 

Montgomery has worked on passing a review board bill since December 2023. After an unsuccessful effort in 2024, the coalition worked to build support and educate people about the need for such a board. 

In the recent legislative session, there were House and Senate versions of the bill that unanimously passed their respective chambers. Authors of the bills are from both political parties. 

The review board is tasked with reviewing a variety of documents to learn about the lead up and circumstances in which people died in domestic violence-related fatalities, near fatalities and suicides – records that can include police records, court documents, medical records and more. 

From each review, trends will emerge and that information can be used for the board to make recommendations to lawmakers about how to prevent domestic violence deaths. 

“This is coming at a really great time because we can really get proactive,” Montgomery said. 

Without a board and data collection, advocates say it is difficult to know how many people have died or been injured in domestic-violence related incidents.

A Mississippi Today analysis found at least 300 people, including victims, abusers and collateral victims, died from domestic violence between 2020 and 2024. That analysis came from reviewing local news stories, the Gun Violence Archive, the National Gun Violence Memorial, law enforcement reports and court documents. 

Some recent cases the board could review are the deaths of Collins, Napier and Reed. 

In court records, prosecutors wrote that Napier, 24, faced increased violence after ending a relationship with Chance Fabian Jones. She took action, including purchasing a firearm and filing for a protective order against Jones.

Jones’s trial is set for May 12 in Wayne County. His indictment for capital murder came on the first anniversary of her death, according to court records. 

Collins, 25, worked as a nurse and was from Yazoo City. His ex-boyfriend Marcus Johnson has been indicted for capital murder and shooting into Collins’ apartment. Family members say Collins had filed several restraining orders against Johnson. 

Johnson was denied bond and remains in jail. His trial is scheduled for July 28 in Hinds County.  

He was a Jackson police officer for eight months in 2013. Johnson was separated from the department pending disciplinary action leading up to immediate termination, but he resigned before he was fired, Jackson police confirmed to local media. 

Reed, 21, was born and raised in Michigan and moved to Water Valley to live with her grandparents and help care for her cousin, according to her obituary. 

Kylan Jacques Phillips was charged with first degree murder for beating Reed, according to court records. In February, the court ordered him to undergo a mental evaluation to determine if he is competent to stand trial, according to court documents. 

At the bill signing, Gandy said it was bittersweet and an honor to meet the families of other domestic violence homicide victims.

“We were there knowing we are not alone, we can travel this road together and hopefully find ways to prevent and bring more awareness about domestic violence,” she said.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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