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Hospitals limit pediatric dentists’ access for procedures that require anesthesia

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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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On this day in 1866

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November 20, 2024

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mississippitoday.org – Jerry Mitchell – 2024-11-20 07:00:00

Nov. 20, 1866

Credit: Courtesy of Howard University

Ten members of the First Congregational Society of Washington, D.C., met in the home of Deacon Henry Brewer. They decided to create a seminary to train Black clergymen. Within a year, the institution, which later became known as Howard University, embraced a broader mission and became an educational hub for the nearly 4 million freed from slavery. 

In 1867, the institution welcomed its first students, educating Black doctors, teachers and pastors. Charles Hamilton Houston, a vice dean at the Howard University School of Law, brought cases to fight segregation in higher education. He mentored Howard alum, Thurgood Marshall, who successfully argued the Brown v. Board of Education decision that ended segregation in public schools.

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

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All eyes on Mississippi’s Rep. Guest as his committee considers releasing Gaetz report

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16 hours ago

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November 19, 2024

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mississippitoday.org – Taylor Vance – 2024-11-19 16:00:00

President-elect Donald Trump’s announcement to nominate former U.S. Rep. Matt Gaetz as attorney general has, again, thrust Mississippi Congressman Michael Guest, chairman of the House Ethics Committee, into the national spotlight. 

Guest’s committee will potentially vote at its Wednesday meeting whether to release an ethics report on Gaetz. The committee, which was investigating Florida’s Gaetz over allegations of sexual misconduct and illicit drug use, was set to release the report before Gaetz abruptly resigned from Congress.

Guest is a Republican who represents Mississippi’s 3rd Congressional District and has chaired the bipartisan House committee that investigates whether House members have committed ethics violations since January 2023. 

Gaetz resigned last week shortly after Trump announced he planned to nominate him to lead the Department of Justice, despite having been previously investigated by the department for alleged sex trafficking crimes. The department declined to pursue criminal charges against Gaetz. 

After the resignation, House Speaker Mike Johnson announced that he does not want the House to make the committee’s report public because Gaetz is no longer in office. 

Guest declined to comment to Mississippi Today about recent developments with the committee’s investigation into Gaetz. But the Mississippi Republican told Politico that the panel will make its own decision about releasing the report, regardless of Johnson’s opinion that it should be kept under wraps. Lawmakers on both sides of the aisle have called for the report to be provided to senators before a confirmation vote on Gaetz and-or to the public.

Guest is the former district attorney of Rankin and Madison counties. He also gained national attention when he introduced a resolution last year to expel New York Congressman George Santos from the House. 

Some U.S. senators such as Republican John Cornyn of Texas have publicly called for the Ethics Committee to hand over its report of the Gaetz investigation. Neither of Mississippi’s two U.S. senators, Roger Wicker and Cindy Hyde-Smith, sit on the Senate Judiciary Committee, but they will get to vote on the nomination if it reaches the full Senate. 

Wicker, a Republican from Tupelo, told Mississippi Today that the Senate has the constitutional obligation to “provide the president with advice and consent on executive and judicial branch nominations” and he takes that responsibility seriously. He did not comment on Gaetz.

“I think that we are in a position to give President-elect Trump good advice on what is likely to work,” Wicker said.  We are going to fulfill our constitutional role, and we are going to do so as friends of the president-elect and as members of a team who want him to be as successful as possible.”

Hyde-Smith, a Republican from Brookhaven, did not respond to a request for comment. 

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

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Exploring all the many facets of Mississippi College’s decision to end football

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November 19, 2024

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mississippitoday.org – Rick Cleveland – 2024-11-19 15:47:00

Fred McAfee runs for yardage in the snow in Mississippi College’s 3-0 victory over Jacksonville State in the 1989 Division II National Championship game at Florence, Ala. The championship was later vacated because the Choctaws far exceeded NCAA Division II scholarship limitations. (Photo courtesy Mississippi Sports Hall of Fame)

Monday’s news that Mississippi College – soon to be Mississippi Christian University – will no longer field a football team seemed to come out of nowhere. “Shocking” is the word many have used to describe the news.

Rick Cleveland

“I feel like I just lost a family member,” said Mississippi Sports Hall of Famer Fred “Fast Freddie” McAfee, one of the two most famous football players in Mississippi College history. “I remember playing my last regular season game against Delta State before an overflow crowd. I remember winning a national championship. I just can’t believe it has come to this.”

Many readers might wonder who the other most famous Mississippi College player was. That would have been the remarkable Edwin “Goat” Hale, a College Football Hall of Famer who in 1916 led the Choctaws to a 74-6 victory over Ole Miss. You read that correctly. Mississippi College 74, Ole Miss 6. MC also defeated Mississippi State, Southern Miss, Tulane and many other southern football powers early in the 20th century.

Mississippi College competed in football for 117 years. There’s a lot of history there, both good and bad, including that 1989 NCAA Division II National Championship, later vacated for scholarship violations. McAfee, a star player on that team, says he never was on more than a half scholarship in his four years at MC.

Fred McAfee was a special teams ace.

And McAfee, who later made All-Pro in the NFL, surely didn’t receive any NIL (name, image and likeness) money, which is one stated reason why Mississippi College made its decision to drop the sport. We will get to that.

First, this: There are many losers with this decision: the coaches, who no longer have a job; long-time Mississippi College football fans who no longer have a favorite team; and even Delta State, which loses its arch-rival. Delta State football coach Todd Cooley, whose Statesman defeated MC 20-14 on Nov. 16 in what apparently is the last football game MC will ever play, called the MC decision “very disappointing” and added, “I just hate it for the players and the coaches.”

But make no mistake: The biggest losers are the MC football players, who really do play for the love of the game. They must decide if they love it enough to play it somewhere else and, if so, then find a school that will take them.

Dr. Blake Thompson, the Mississippi College president in his seventh year at the helm, says he hurts for those players but at the same time strongly believes that the decision to drop football – along with the name change – are in the best, long-term interest of the school. One primary reason is economics.

“I don’t have the exact numbers in front of me, but we’re looking at close to $2 million that we can save to put into our other sports programs, upgrade our facilities, and also put into other areas, including, of course, academics,” Thompson said. “We have a long standing tradition of academic excellence. We have the highest incoming ACT scores of any school in the state. We’re proud of that.”

Dr. Blake Thompson

Thompson continued, “We also have bold aspirations for the future. I like the model of schools like Belmont University (Nashville), which doesn’t play football but has become quite competitive at the Division I level in baseball and basketball and other sports. Dallas Baptist, like us a faith-based school, has become a Division I baseball power.”

Thompson, who formerly worked at Ohio State, is in the middle of a seven-year term on the powerful NCAA Division II Presidents Council, and, consequently, is familiar with all aspects of of college athletics. “We’ve tried to look at the overall landscape of college athletics and determine where we stand and where we want to stand in that landscape,” he said. “We want to excel in everything we do. Sometimes, that requires tough decisions.”

One firm decision, Thompson says, “We are not in a place where we are going to be paying players. We are not going to play in that space.”

Over its last 10 full seasons, MC has won just 28 games, lost 74. Since the 1989 “championship” season MC has won 144, lost 200 and tied four. Those numbers will never be confused with Thompson’s goal of “excellence” in all MC does. None of that changes the fact, Thompson says, that this has been a gut-wrenching, quite emotional decision.

“My commitment since I got here seven years ago has been to care for these students,” he said. “All scholarship arrangements will be the same through the end of this school year. For those players who want to remain in school here, we will work with them, find scholarship money where we can from other sources. For those who want to continue playing football, we will help them every way we can with the transfer portal.”

The rest of the Gulf South Conference, including Delta State, faces a different and difficult situation. MC’s decision now leaves the league with only four football playing members: Delta State, No. 1 ranked Valdosta State, West Alabama and West Florida. The GSC was once known as the SEC of Division II football conferences. And, indeed, the four remaining football members all play the sport at a high level and all have won at least one national championship. But can four teams really be called a conference?

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

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