Mississippi Today
Mississippi moms and babies are dying. This training teaches first responders how to save their lives.
Mississippi moms and babies are dying. This training teaches first responders how to save their lives.
Matt Greer of Brookhaven was driving home from his shift at the Mississippi Center for Emergency Services, where he works as a flight nurse, when he got a call from his younger sister. A few days earlier, she had given birth to a healthy baby girl after an uncomplicated pregnancy. Now, she told him she had a headache.
He asked her to check her blood pressure: 140/90.
For most patients, that reading isn’t concerning. For a pregnant or postpartum woman, however, it’s an indication of preeclampsia. Greer told her to go to the hospital and eventually she did, getting treatment to prevent seizure and stroke.
But Greer thinks things might have gone very differently had he not completed a new training run by the Mississippi Center for Emergency Services just a few weeks before his sister called.
The STORK Program equips first responders and medical professionals without specialized obstetrics training – including emergency room doctors and nurses – to handle pregnancy and delivery complications like hypertension and hemorrhage. Doctors at the University of Mississippi Medical Center recognized that in a rural state with dwindling options for obstetrical care, women are likely to deliver outside of dedicated labor and delivery wards, and to need care from people who don’t see pregnant patients every day. So they created the STORK training.
Greer has years of experience as a nurse, and his sister is a nurse, too. But without STORK, he would not have known how to interpret her blood pressure reading.
“I would have blown it off,” he said. “Without that fresh on my mind … I would have said, ‘that’s not too bad. You’ll be alright.’”
Chronic health conditions like obesity and diabetes plus poor access to prenatal care contribute to Mississippi’s worst-in-the-nation outcomes for moms and babies, and can’t be treated during a single interaction with a health care provider. But potentially lethal hypertension and hemorrhage are not complicated to manage – if a provider knows what to watch for and what to do.
And even inside hospitals, that can be a big “if.”
“Obstetrics is most people’s kryptonite,” said Dr. Rachael Morris, associate professor of maternal fetal medicine at UMMC, who created and leads the training. “Unless you’re an obstetrician, even a well-trained E.R. physician or mid-level provider is going to tell you that you bring a pregnant lady into my E.R., and everyone’s going to freak out.”
The STORK Program’s half-day training includes lectures and simulations to change that dynamic. (STORK stands for Stabilizing OB and Neonatal Patients, Training for OB/Neonatal Emergencies, Outcome Improvements, Resource Sharing, and Kind Care for Vulnerable Families.) The training is funded with a grant from the W.K. Kellogg Foundation, which also allows participants to receive a bag of supplies they can use during deliveries. The program is run by MCES, a division of UMMC that houses critical care transport services – including helicopter teams – and the state’s communications system for hospitals and first responders, Mississippi MED-COM.
“In Mississippi, infant and maternal mortality rates for people of color are among the highest in the nation and many families have to travel considerable distance to access care, creating obstetric emergencies,” said Wesley Prater, Kellogg Foundation program officer. “Our support of UMMC ensures providers across the state have the proper training to stabilize mothers and babies who need critical care.”
So far, about 150 people from around the state – a mix of registered nurses, physicians, medical residents, firefighters and paramedics – have completed the training over 11 classes since it launched in June. The team has 18 more trainings on the calendar.
With the state likely to tally an additional 5,000 births annually thanks to the abortion ban that took effect in July, obstetric services in the state are actually shrinking. The labor and delivery ward at Greenwood-Leflore Hospital closed in the fall. The Delta lost its only neonatal intensive care unit this summer. The NICU at Merit Health Central, which serves predominantly Black and low-income Jackson neighborhoods, also closed.
Already, more than half of the state’s counties are maternity care deserts: No labor and delivery ward. No OB-GYNs. No certified nurse midwives.
Women in rural areas face long drives to the nearest labor and delivery ward. Sometimes, that means they can’t make it there at all. Instead, they may give birth in an emergency room, at home while waiting for first responders to show up, or on the side of the road.
The STORK program staff hope training participants will be able to handle those situations effectively, saving lives along the way.
“These patients are going to be coming into really small hospitals and delivering or having problems,” said Dr. Tara Lewis, assistant professor of emergency medicine at UMMC and a former labor and delivery nurse.
Lewis joined the program to help tailor it to the needs of emergency room staff in small, rural hospitals.
“If providers don’t know how to make the diagnosis of what problem is going on, then they’re not going to know how to take care of them.”
PHOTOS: First responders trained on how to deliver babies
“You look like a really good uterus,” Morris told a burly Flowood firefighter and paramedic who had joined three of his colleagues to attend a STORK training at MCES on a recent Wednesday morning.
She had just given a presentation on managing hypertension and hemorrhage, and now it was time to demonstrate how to assist during a delivery.
The paramedic held a rubber baby as Morris demonstrated how a baby’s head will generally turn to one side as it leaves the birth canal, and how to use a finger to gently loosen the umbilical cord if it has looped around the neck.
In addition to the Flowood firefighters, attendees included a pediatric emergency room nurse at UMMC, a women’s health nurse in Meridian, and an emergency room nurse at Magee General Hospital who has assisted with three deliveries in the last year alone.
“That’s a lot considering it’s a small hospital with no labor and delivery resources,” she said.
There are regular STORK trainings at MCES open to people from all over the state. But the free training is also conducted at hospitals, so participants don’t have to travel and can see how to apply what they learn where they work.
After Morris finished her presentation, Emily Wells, a nurse practitioner and member of UMMC’s neonate transport team, explained how to care for newborns in the moments after birth. Since Jan. 1 of this year, the team has transported 390 babies to higher levels of care, and participated in 20 emergency room deliveries.
She described the recent delivery of a “rest stop baby,” who was born in a Toyota Camry en route to a hospital during a cold snap.
“Cold babies die,” she said, so the team had cranked up the heat inside the car and done everything they could to keep the baby warm.
In a hospital, the baby would be placed in an incubator. But in a pinch, any kind of plastic bag – maybe one that had been used to hold supplies now in use – could be placed around the baby’s body to conserve heat.
A woman had just delivered a baby at 26 weeks in her car, and now both had made it to the emergency room of their small-town hospital. She had delivered the placenta, too, but was still bleeding.
What should happen next? Half of the training participants gathered around their patient – a life-size mannequin lying on a hospital bed shouting “I’m bleeding” – and discussed what to do.
“At 26 weeks, I think the placenta abrupted,” Morris explained.
Blood trickled from the mannequin’s vagina, soaking a pad underneath her body. This was an important lesson, Leslie Cannon, now an educator with STORK after 25 years as a labor and delivery nurse, pointed out: In patients who aren’t pregnant, life-threatening hemorrhage often looks like a dramatic gush.
“Hemorrhage postpartum, it’s this trickle,” she said. “It’s a huge deal, because that trickle just keeps going.”
That’s important to keep in mind especially because it’s often not obvious when a woman is at serious risk because of bleeding.
“A young, healthy pregnant lady is going to look really good — until she’s about dead,” Morris had warned of hemorrhaging patients.
The students administered tranexamic acid to slow the bleeding.
As Morris had explained during her lecture, a student reached an arm into the uterus to sweep for pieces of retained placenta, which can cause life-threatening bleeding. (“It’s not a comfortable thing to do,” Morris warned.) Another student massaged the mannequin’s belly to cause the uterus to contract.
Eventually, the trickle slowed and stopped. Morris estimated the patient had lost a liter of blood.
Before everyone left, Morris and Wells gave out their cell phone numbers. Kace Ragan, project manager for STORK, explained that participants get supply bags that include QR codes they can scan to request refills — as long as the grant funding holds out — and report their experiences during deliveries.
Morris urged the attendees to text or call her with questions any time. Morris treats some of the most challenging pregnancies in the state and serves as obstetric COVID director at UMMC, meaning she’s spent the last two years witnessing devastating loss.
And yet, she told the training participants, she has “the luxury” of working in a hospital with plenty of resources and specialized training.
“Y’all are in the trenches doing things that I have to do, too, but with so much less,” she said.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
IHL deletes the word ‘diversity’ from its policies
The governing board of Mississippi’s public universities voted Thursday to delete the word “diversity” from several policies, including a requirement that the board evaluate university presidents on campus diversity outcomes.
Though the Legislature has not passed a bill targeting diversity, equity and inclusion initiatives in higher education, the Institutions of Higher Learning Board of Trustees approved the changes “in order to ensure continued compliance with state and federal law,” according to the board book.
The move comes on the heels of the re-election of former President Donald Trump and after several universities in Mississippi have renamed their diversity offices. Earlier this year, the IHL board approved changes to the University of Southern Mississippi’s mission and vision statements that removed the words “diverse” and “inclusiveness.”
In an email, John Sewell, IHL’s communications director, did not respond to several questions about the policy changes but wrote that the board’s goal was to “reinforce our commitment to ensuring students have access to the best education possible, supported by world-class faculty and staff.”
“The end goal is to support all students, and to make sure they graduate fully prepared to enter the workforce, hopefully in Mississippi,” Sewell added.
On Thursday, trustees approved the changes without discussion after a first reading by Harold Pizzetta, the associate commissioner for legal affairs and risk management. But Sewell wrote in an email that the board discussed the policy amendments in open session two months ago during its retreat in Meridian, more than an hour away from the board’s normal meeting location in Jackson.
IHL often uses these retreats, which unlike its regular board meetings aren’t livestreamed and are rarely attended by members of the public outside of the occasional reporter, to discuss potentially controversial policy changes.
Last year, the board had a spirited discussion about a policy change that would have increased its oversight of off-campus programs during its retreat at the White House Hotel in Biloxi. In 2022, during a retreat that also took place in Meridian, trustees discussed changing the board’s tenure policies. At both retreats, a Mississippi Today reporter was the only member of the public to witness the discussions.
The changes to IHL’s diversity policy echo a shift, particularly at colleges and universities in conservative states, from concepts like diversity in favor of “access” and “opportunity.” In higher education, the term “diversity, equity and inclusion” has traditionally referred to a range of efforts to comply with civil rights laws and foster a sense of on-campus belonging among minority populations.
But in recent years, conservative politicians have contended that DEI programs are wasteful spending and racist. A bill to ban state funding for DEI in Mississippi died earlier this year, but at least 10 other states have passed laws seeking to end or restrict such initiatives at state agencies, including publicly funded universities, according to ABC News.
In Mississippi, the word “diversity” first appeared in IHL’s policies in 1998. The diversity statement was adopted in 2005 and amended in 2013.
The board’s vote on Thursday turned the diversity statement, which was deleted in its entirety, into a “statement on higher education access and success” according to the board book.
“One of the strengths of Mississippi is the diversity of its people,” the diversity statement read. “This diversity enriches higher education and contributes to the capacity that our students develop for living in a multicultural and interdependent world.”
Significantly, the diversity statement required the IHL board to evaluate the university presidents and the higher learning commissioner on diversity outcomes.
The statement also included system-wide goals — some of which it is unclear if the board has achieved — to increase the enrollment and graduation rates of minority students, employ more underrepresented faculty, staff and administrators, and increase the use of minority-owned contractors and vendors.
Sewell did not respond to questions about if IHL has met those goals or if the board will continue to evaluate presidents on diversity outcomes.
In the new policy, those requirements were replaced with two paragraphs about the importance of respectful dialogue on campus and access to higher education for all Mississippians.
“We encourage all members of the academic community to engage in respectful, meaningful discourse with the aim of promoting critical thinking in the pursuit of knowledge, a deeper understanding of the human condition, and the development of character,” the new policy reads. “All students should be supported in their educational journey through programming and services designed to have a positive effect on their individual academic performance, retention, and graduation.”
Also excised was a policy that listed common characteristics of universities in Mississippi, including “a commitment to ethnic and gender diversity,” among others. Another policy on institutional scholarships was also edited to remove a clause that required such programs to “promote diversity.”
“IHL is committed to higher education access and success among all populations to assist the state of Mississippi in meeting its enrollment and degree completion goals, as well as building a highly-skilled workforce,” the institutional scholarship policy now reads.
The board also approved a change that requires the universities to review their institutional mission statements on an annual basis.
A policy on “planning principles” will continue to include the word “diverse,” and a policy that states the presidential search advisory committees will “be representative in terms of diversity” was left unchanged.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Closed St. Dominic’s mental health beds to reopen in December under new management
The shuttered St. Dominic’s mental health unit will reopen under the management of a for-profit, Texas-based company next month.
Oceans Behavioral Hospital Jackson, a 77-bed facility, will provide inpatient behavioral health services to adults and seniors and add intensive outpatient treatment services next year.
“Jackson continuously ranks as one of the cities for our company that shows one of the greatest needs in terms of behavioral health,” Oceans Healthcare CEO Stuart Archer told Mississippi Today at a ribbon cutting ceremony at its location on St. Dominic’s campus Thursday. “…There’s been an outcry for high quality care.”
St. Dominic’s 83-bed mental health unit closed suddenly in June 2023, citing “substantial financial challenges.”
Merit Health Central, which operates a 71-bed psychiatric health hospital unit in Jackson, sued Oceans in March, arguing that the new hospital violated the law by using a workaround to avoid a State Health Department requirement that the hospital spend at least 17% of its gross patient revenue on indigent and charity care.
Without a required threshold for this care, Merit Health Central will shoulder the burden of treating more non-paying patients, the hospital in South Jackson argued.
The suit, which also names St. Dominic’s Hospital and the Mississippi Department of Health as defendants, awaits a ruling from Hinds County Chancery Court Judge Tametrice Hodges-Linzey next year.
The complaint does not bar Oceans from moving forward with its plans to reopen, said Archer.
Oceans operates two other mental health facilities in Mississippi and over 30 other locations in Louisiana, Oklahoma and Texas.
“Oceans is very important to the Coast, to Tupelo, and it’s important right here in this building. It’s part of the state of Mississippi’s response to making sure people receive adequate mental health care in Mississippi,” said Lt. Governor Delbert Hosemann at the Nov. 21 ribbon cutting.
Some community leaders have been critical of the facility.
“Oceans plans to duplicate existing services available to insured patients while ignoring the underserved and indigent population in need,” wrote Hinds County Sheriff Tyree Jones in an Oct. 1 letter provided to Mississippi Today by Merit Health.
Massachusetts-based Webster Equity Partners, a private-equity firm with a number of investments in health care, bought Oceans in 2022. St. Dominic’s is owned by Louisiana-based Catholic nonprofit Franciscan Missionaries of Our Lady Health System.
Oceans first filed a “certificate of need” application to reopen the St. Dominic’s mental health unit in October 2023.
Mississippi’s certificate of need law requires medical facilities to receive approval from the state before opening a new health care center to demonstrate there is a need for its services.
The Department of Health approved the application under the condition that the hospital spend at least 17% of its patient revenue on free or low-cost medical care for low-income individuals – far more than the two percent it proposed.
Oceans projected in its application that the hospital’s profit would equal $2.6 million in its third year, and it would spend $341,103 on charity care.
Merit Health contested the conditional approval, arguing that because its mental health unit provides 22% charity care, Oceans providing less would have a “significant adverse effect” on Merit by diverting more patients without insurance or unable to pay for care to its beds.
Oceans and St. Dominic’s also opposed the state’s charity care condition, arguing that 17% was an unreasonable figure.
But before a public hearing could be held on the matter, Oceans and St. Dominic’s filed for a “change of ownership,” bypassing the certificate of need process entirely. The state approved the application 11 days later.
Merit Health Central then sued Oceans, St. Dominic and the State Department of Health, seeking to nullify the change of ownership.
“The (change of ownership) filing and DOH approval … are nothing more than an ‘end run’ around CON law,” wrote Merit Health in the complaint.
Oceans, St. Dominic’s and the Mississippi Department of Health have filed motions to dismiss the case.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
How Mississippi’s Supreme Court Runoff Election Could Impact Criminal Cases
Mississippi voters have dealt defeat to one conservative state Supreme Court justice and forced a moderate justice into a Nov. 26 runoff, with the final outcome possibly making the court more open to considering the rights of criminal defendants.
The nine-member court is largely conservative but justices have recently split in high-profile decisions that sharply affected state politics, including a ruling that shut down citizen-led ballot initiatives in Mississippi and allowed some state control over local criminal cases in its majority-Black capital. The court has also rendered rulings that have made the state increasingly unfavorable to defendants appealing their cases.
“The ability of death row inmates in particular, and inmates in general, to access the courts has been recently curtailed significantly,” Matthew Steffey, a professor at Mississippi College School of Law, told The Marshall Project – Jackson and Bolts following the Nov. 5 election.
Justice Dawn H. Beam joined the majority in those decisions, acquiring a reputation of being hostile to appeals by criminal defendants, and she ran for reelection this fall as the Republican Party’s favored candidate. However, she lost in the state’s 2nd District on Nov. 5 to David P. Sullivan, a defense attorney who has worked as a public defender.
Judicial races in Mississippi are nonpartisan and Sullivan has given few explicit signals about his judicial outlook. He has supported at least some criminal justice reforms and would be the third justice with experience as a defense attorney on this court. Some reformers nationwide have pushed for more professional diversity on the bench.
Even if Sullivan turns out to be more centrist or independent than Beam on criminal law, any overall shift in power on the court depends on the outcome of a runoff election next week.
Two-term Justice Jim Kitchens and challenger Jenifer B. Branning will face each other in the Nov. 26 runoff election after neither won more than 50% of the vote on Nov. 5. The runoff will take place across the 22 counties that make up the Supreme Court’s central district, including Hinds County, home to Jackson. Throughout the campaign, the state GOP targeted Kitchens with attacks, while Branning, a Republican state senator with a conservative voting record, is endorsed by the party.
Kitchens is one of two reliably moderate-to-liberal high court justices. Justices from among an additional group of four sometimes veer away from the majority, as well, but can be more unpredictable, and this group does not vote as a bloc.
Quinn Yeargain, a Michigan State University law professor who closely watches state courts, recently analyzed the court’s voting patterns and found Beam was consistently more conservative than Kitchens in recent cases. Yeargain told The Marshall Project – Jackson and Bolts that conservative and liberal voters often have few signals about how to select a candidate in judicial races. “It’s very hard to label the justices,” they said.
Sullivan — whose father was a Mississippi Supreme Court justice from 1984 to 2000 — called himself a “conservative” throughout his campaign. But he has also touted the value of judicial independence and criticized Beam for campaigning on her endorsement by the state Republican Party.
“I think that rubbed a lot of people the wrong way,” Sullivan told the Sun Herald newspaper, speaking of Beam’s use of the endorsement. “Judicial races are nonpartisan for a reason. A judge’s impartiality could be called into question.”
Sullivan has broad legal experience, but much of his career has focused on private criminal defense while also doing some public defense work. He told The Marshall Project – Jackson and Mississippi Today that he supported a new administrative rule handed down in 2023 by the state Supreme Court to require continuous legal representation for poor criminal defendants from the beginning of their cases. An investigation by The Marshall Project, ProPublica and the Northeast Mississippi Daily Journal last year found, however, that many courts were unready at the time to implement the new representation rules.
During the campaign, Sullivan told The Marshall Project – Jackson and Mississippi Today that more work is needed to improve public defense.
Kitchens has also advocated for public defense reforms during his two terms on the court. He told a committee of legislators last year that the “playing field is far from level” between prosecutors and poor defendants.
On other criminal justice issues, he has sometimes dissented from opinions upholding death sentences. His decisions have scrutinized prosecutorial conduct and inadequate legal representation.
Branning, the Republican senator, has a voting record on criminal justice issues that suggests a harsher approach toward criminal defendants. She has supported higher mandatory minimum sentences and reclassifying misdemeanors as felonies, has opposed expansion of parole and was among only a few lawmakers who voted against legalizing medical marijuana.
She also supported increasing the jurisdiction of a controversial, state-run police force inside the majority-Black city of Jackson as well as increasing state control over many felony cases in Jackson. The Supreme Court unanimously curtailed much state power over these felony cases, but a majority left some control intact, with Kitchens and another judge dissenting.
Branning did not respond to questions from The Marshall Project – Jackson and Mississippi Today during the Nov. 5 campaign about her possible judicial outlook.
Kitchens was a prosecutor and then in private practice before joining the bench. Branning is a practicing attorney who typically handles civil cases.
The winner of the Nov. 26 runoff will join Sullivan on a court that in recent years has been restricting the ability of people who say the legal system has wronged them to seek relief, legal experts told The Marshall Project – Jackson and Bolts this month.
Krissy Nobile, director of the state’s Office of Capital Post-Conviction Counsel, said it’s become “increasingly more difficult to correct a wrongful conviction.” Her office provides legal counsel for indigent people on death row.
She said a number of recent cases showed the barriers the high court has erected for criminal defendants appealing their convictions, and demonstrated indifference to civil rights violations. Kitchens disagreed with the majority, in full or in part, in all but one of the appeals, which the court unanimously denied.
In a case earlier this year, the Court ruled to monetarily fine an incarcerated person for filing any future post-conviction relief petitions that lacked merit. Kitchens joined a dissenting opinion condemning the fine. In another, the court denied a man who argued that his lawyers were ineffective and that they did not challenge prosecutorial misconduct or false forensic evidence presented by a medical examiner with a checkered past. The court’s majority denied the motion, and in the process, overturned a precedent that allowed ineffective counsel as an adequate reason to give a case another look in some types of appeals. Kitchens dissented, along with two other justices.
“For decades in Mississippi, the Court held that it would correct errors if there was a violation (of) a person’s fundamental rights,” Nobile said. But she added this has changed considerably. Now, if you land a terrible lawyer who rushes your case, “You are out of luck,” she said, “even if your core constitutional rights have been clearly violated.”
For the court’s majority, Nobile added, “The legal technicalities now trump a person’s constitutional rights.”
The runoff is the nation’s final supreme court race of the year. Thirty-two states held elections for their high courts earlier this year, resulting in a muddled picture, with liberals and conservatives each gaining ground in different places, Bolts reports.
Mississippi’s runoff outcome will heavily depend on turnout and the composition of the electorate. In the Supreme Court’s central district, voters split narrowly between Democrat Kamala Harris and Republican Donald Trump in the presidential election on Nov. 5, but the runoff is just two days before Thanksgiving and will likely see a large dropoff in turnout. Branning received 42% of the vote in the first round, and Kitchens received 36%, with three other candidates making up the rest.
There will also be a runoff the same day in the Gulf Coast area between Amy Lassiter St. Pé and Jennifer Schloegel for an open seat on the state Court of Appeals. The Court of Appeals hears both criminal and civil cases that have been appealed from lower courts. The Mississippi Supreme Court can hear cases directly on appeal or can assign cases to the Court of Appeals.
Observers agreed that against the national legal backdrop, neither a Kitchens victory nor a Branning victory would lead to a seismic change since neither outcome would flip the court’s conservative lean. Still, a modest shift could impact some of the most controversial cases, such as a rare 5-4 decision that upheld the death sentence in Willie Manning’s case.
A Kitchens win, coupled with Sullivan’s upset earlier this month, would deal the Republican Party rare setbacks in a state where it has been dominant and could put moderate forces in a position to grow their numbers further in future elections.
“You might end up with a normal conservative court,” law professor Yeargain said, “instead of one of the most conservative courts in the country.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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