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Mississippi moms and babies suffer disproportionately. Medicaid expansion could help.

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Mississippi moms and babies suffer disproportionately. Medicaid expansion could help.

Note: This article is part of Mississippi Today’s ongoing Mississippi Health Care Crisis project.Read more about the project by clicking here.

During her 14 years working as an OB-GYN in Greenville, Dr. Lakeisha Richardson has seen five patients diagnosed with breast cancer during their pregnancies.

Most of them did not have health insurance prior to pregnancy, so going to the doctor for annual checkups was neither affordable nor routine. They missed out on clinical screenings and the chance to learn whether they were at higher risk of breast cancer.

Pregnancy does not cause breast cancer, but it can make it grow and spread more quickly, and breast cancer associated with pregnancy has a lower survival rate. For Richardson’s patients without health insurance, pregnancy brought Medicaid coverage that allowed them to go to the doctor for prenatal visits, and that was when their cancer was diagnosed.

One of Richardson’s patients died from breast cancer a few weeks after giving birth.

“Legislators think, women are healthy, they’re going to have a baby, and they can come off Medicaid,” Richardson said. “They don’t think that other illnesses and disease processes can exist in pregnant women.”

Mississippi doctors like Richardson see thousands of patients every year who have no health insurance, and thus limited access to affordable health care, until they become pregnant and qualify for Medicaid. If the patient has a chronic condition like diabetes or hypertension, getting treatment during pregnancy is critical – but not necessarily sufficient to prevent problems like preterm delivery, low birth weight, birth defects, and even stillbirth.

Access to routine care prior to conception increases the chance a person can have a healthy pregnancy and delivery. But in Mississippi, where one in six women of reproductive age is uninsured, preconception health care is far from universal. Under current Medicaid eligibility policy, adult women can get coverage only when they are pregnant or have kids at home and very low household income.

“If they have a preexisting disease like diabetes or hypertension, if they’re uninsured they’ve probably been off their meds for a while, so they’ll come in with elevated blood pressure, elevated glucose that have been uncontrolled for months or years,” Richardson said. “If it takes them a while to get their Medicaid and they’re already late to prenatal care, they have growth restrictions for the baby.”

It’s no secret that Mississippi is a sick state. More than one in seven Mississippians are living with diabetes, a higher rate than almost any other state. More than 700,000 Mississippians have hypertension, and the state has the country’s highest rate of deaths due to high blood pressure, as well as the country’s highest adult obesity rate, at just under 40%.

But perhaps nowhere are the consequences of sickness – sickness that is largely preventable – more evident than in the unnecessary suffering of Mississippi’s mothers and babies.

The state has the country’s highest percentage of babies born at a low weight. It has the highest percentage of preterm deliveries, which can result in costly NICU stays and long-term health consequences. Mississippi has the country’s highest rate of stillbirth. And more babies here die before their first birthday than anywhere else in the U.S.

Nationally, the leading cause of infant mortality is birth defects. But in Mississippi, the causes are more preventable: premature birth and pregnancy or delivery complications as well as sudden infant death syndrome (SIDS).

Within each of these statistics, Black women and babies suffer much more than their white counterparts.

Expanding Medicaid would not on its own solve Mississippi’s maternal and infant health crisis, which State Health Officer Dr. Daniel P. Edney has identified as a top priority. Health insurance is not the same as access to health care, and access to health care alone is not enough to ensure all Mississippians have healthy food, opportunities to exercise, and safe neighborhoods.

But OB-GYNs interviewed across the state said that lack of access to health care prior to conception is a problem they see every day. They may see a patient get her diabetes or hypertension under control when she has Medicaid coverage during her pregnancy, only to lose coverage and return to self-managing her conditions. They won’t see her again unless she gets pregnant again, and then the process of treating her chronic condition must start all over again.

“We work really hard and optimize their diabetes during pregnancy, and then they’ll be a gap in care between and patients come back for the next pregnancy and it’s like we’re starting from square one again,” said Dr. Sarah Novotny, a maternal-fetal medicine specialist at the University of Mississippi Medical Center.

An analysis by the consulting firm Manatt found that expanded Medicaid eligibility to adults with incomes below 138% of the federal poverty line would likely cut enrollment in pregnancy Medicaid by about half – meaning that it would provide more consistent coverage and access to care for about 10,000 women each year who can currently have health insurance only during and right after their pregnancies.

Dr. Jaleen Sims has worked as an OB-GYN at Jackson-Hinds Comprehensive Health Center since 2019. The federally qualified health center offers services on a sliding scale, so it’s affordable for people without insurance.

“I serve the underserved population that experiences the most suboptimal outcomes , the highest comorbidity rates, the highest mortality rates – those are my patients,” she said.

She estimates that more than half of her patients who are pregnant with their first child have not had health insurance as adults before getting pregnant.

Medicaid offers full coverage for pregnant women with incomes 194% of the federal poverty level, or $4,603 monthly for a family of four. That ensures that low-income and working-class women can get health care during their pregnancies. About 60% of births in Mississippi are covered by Medicaid, the second-highest percentage in the country, after only Louisiana.

Hinds County has both the state’s largest number of Medicaid-covered births, at an average of 2,300 annually from 2016 to 2020, and one of the state’s highest per capita rates of pregnancies covered by Medicaid. Some people with pregnancy Medicaid have another form of insurance, too, but generally the rate of Medicaid coverage during pregnancy gives an indication of how many people lacked insurance before they conceived.

Sims sees patients with hypertension, diabetes, obesity, lupus – “those chronic medical conditions that you really want to have under very, very good control before you get pregnant.”

Diabetes is a good example of a condition that can cause problems during pregnancy– but doesn’t have to.

Sometimes Sims sees patients who got treatment for diabetes during a previous pregnancy, but stopped seeing going to the doctor when that coverage ended. Instead, they’ve tried to manage it on their own.

“Then before you know it, they’re out of the medication, they’re just kind of living,” she said. “They’re like, ‘Well, I don’t check my finger sticks, I don’t have my insulin, I don’t have my medicine. Now I don’t really know where I am at this point.’”

During pregnancy, doctors try to keep blood sugar tightly controlled. That becomes harder to accomplish when the patient’s condition isn’t well managed when they arrive for their first prenatal visit.

If blood sugar is elevated during the first 10 weeks when the fetus’s organs are developing, the risk of birth defects is higher, Novotny said, even if blood sugar is controlled later in the pregnancy.

“A lot of times women haven’t been in care, they find out they’re pregnant, sign up for Medicaid, and by the time they come to us, it’s often the end of the first trimester, when damage may already be done,” she said.

Spina bifida and heart problems are the most common birth defects associated with diabetes. People with diabetes are also at risk for preterm delivery.

Dr. Emily Johnson, an OB-GYN in the Jackson area, said it’s important for people to know that chronic conditions and risk factors during pregnancy can be managed with very good outcomes. Early communication between provider and patient is critical.

“I think them knowing that information helps them have a little autonomy that they can be responsible for their blood pressure and they know what they’re supposed to call me for,” she said. “Communicating about the risk can help them take a little ownership of it and in some way provide some reassurance.”

For many uninsured women in Mississippi, getting signed up for Medicaid is one of the first rituals of pregnancy. But getting approved is a hurdle that for some people can delay their prenatal care by days or weeks.

Providers said they largely see patients get approved within a month or so. A mistake on the paperwork, however, can delay approval.

Matt Westerfield, spokesperson at the Division of Medicaid, told Mississippi Today that according to a recent analysis by the Office of Eligibility, the average approval time for pregnancy Medicaid from Aug. 2021 to Aug. 2022 was about 24 days. That's slightly higher than the average approval time in 2021 for all eligibility categories of 20 days, according to documents Mississippi Today obtained through a records request.

Even a delay of a few weeks can make a difference, given the importance of early prenatal care. Dr. Kushna Damallie, an OB-GYN at The Woman’s Clinic in Clarksdale, said he would like to see a patient as soon as she misses a period. But that often doesn’t happen.

“One of the biggest hurdles we have in our practice is late prenatal care, no prenatal care, or insufficient prenatal care,” Dumallie said.

Westerfield told Mississippi Today that the Division of Medicaid doesn't track when women go to their first prenatal visit or what percentage take place during the first trimester of pregnancy.

Richardson said early prenatal care is particularly important for women with a condition called an incompetent cervix, in which weak cervical tissue can cause very early delivery. Black women are more at risk for this condition. One treatment to help ensure a successful delivery is a cervical cerclage, in which providers stitch the cervix closed, usually around 12 to 14 weeks of pregnancy. If that doesn’t happen in time, the risk of miscarriage is higher.

In August of this year, Richardson had a patient who was in the hospital because her water had broken well before viability. The patient had known she needed to get treatment for her incompetent cervix but had not been able to get an appointment early enough.

“She moved from another state, so she didn’t have her Mississippi Medicaid and so she couldn’t get in anywhere to be seen,” Richardson said.

OB/GYN Dr. Nina Ragunanthan poses for a portrait inside of Delta Health Center in Mound Bayou, Miss., Thursday, July 14, 2022.

While Medicaid expansion is a taboo topic among Republicans in the legislature, extending Medicaid coverage for postpartum women has bipartisan support. A measure to extend coverage from 60 days to 12 months postpartum passed the Senate resoundingly in the last session, before House Speaker Philip Gunn killed it.

Today, Mississippi is one of just two states that has neither expanded Medicaid eligibility nor extended postpartum coverage.

Senate Republicans including Sen. Kevin Blackwell, R-Southaven, who sponsored the measure, have vowed to reintroduce the measure in the next session, though Gunn still opposes it.

Gunn recently said he believed postpartum Medicaid extension would help only a few thousand women in Mississippi, referring to his calculation that only 60% of the 5,000 new births expected annually after the state’s abortion ban would be covered by the program and dismissing the 21,000 people already covered by pregnancy Medicaid each year.

When discussing crisis pregnancy centers, which already get a $3.5 million tax credit from the state and which Gunn wants to expand to $10 million, he offered no information about the number of people they serve and how, probably because that data is not being collected by the state.

Providers largely say they’d welcome any opportunity to lengthen the amount of time their patients have health insurance. Novotny, the maternal-fetal medicine specialist, said 12 months of coverage postpartum would give her patients a chance to control their diabetes for a longer period before becoming pregnant again.

Some providers were not aware of continuous coverage provisions during the pandemic. But those who knew about it said their patients benefited from longer access to care.

“They’ve been able to continue the management of their chronic diseases so that when they’re ready to get pregnant again, they are in a good place,” Sims said.

But postpartum Medicaid does nothing to improve access to health care before conception.

Some advocates are concerned that the conversation about postpartum Medicaid could distract from the need to address Mississippi’s health care crisis more broadly.

Nakeitra Burse, a public health consultant and advocate focused on maternal health, said some of the discussion of postpartum Medicaid seems to reflect a belief that pregnancy can be separated from the rest of a life.

“A person’s already experiencing obesity, diabetes, high blood pressure, and then you add pregnancy on top of that, then pregnancy also becomes a condition,” Burse said. “So you’re trying to treat all these things at one time, when people don’t even just have the opportunity to make the healthy decisions for themselves because they don’t have access to care.”

When patients do get access to care during pregnancy, making it to a doctor’s appointment isn’t as easy as it sounds.

“A lot of that decision making means: Do I miss work to go to the doctor? Do I go to the doctor over my child? It’s a lot of push and pull and give and take for the decision making that shouldn’t have to happen, if we had opportunity or access to quality health care.”

Dr. Nina Ragunanthan, an OB/GYN in Mound Bayou, pointed out that the focus on pregnancy and postpartum coverage, rather than expanding access to health care for everyone, implies that women are more deserving of care if they are giving birth than if they are not.

“I think it's really important not to just pigeonhole a woman as a child bearing vessel,” she said. “Access to care for that woman as an autonomous, independent person, regardless of whether she plans to get pregnant or not, is very important.”

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

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mississippitoday.org – Molly Minta – 2024-11-21 14:32:00

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.

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Closed St. Dominic’s mental health beds to reopen in December under new management

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mississippitoday.org – Gwen Dilworth – 2024-11-21 13:54:00

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.

A hallway inside Oceans Behavioral Hospital in Jackson, Miss., is seen on Thursday, Nov. 21, 2024, during the facility’s grand opening. Credit: Eric Shelton/Mississippi Today

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. 

Stuart Archer, CEO of Oceans Healthcare, speaks during the grand opening of Oceans Behavioral Hospital in Jackson, Miss., on Thursday, Nov. 21, 2024. Credit: Eric Shelton/Mississippi Today

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.

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How Mississippi’s Supreme Court Runoff Election Could Impact Criminal Cases

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mississippitoday.org – Caleb Bedillion, The Marshall Project and Daja E. Henry, The Marshall Project – 2024-11-21 11:00:00

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.” 

Branning, left, and Kitchens at the Neshoba County Fair in August 2024. Credit: Eric Shelton, Mississippi Today

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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