Mississippi Today

Mississippi podiatrists want ‘ankle privileges.’ Other doctors may stand in their way

Published

12 months ago

February 1, 2024

What is a foot?

Underneath the skin, tendons such as the Achilles and muscles such as the tibialis posterior run from the lower leg toward the heel and toe, complicating any attempt at a simple definition.

Mississippi podiatrists are fighting for a new law that they claim would reflect that anatomical reality by expanding their scope of practice to include the ankle. They say the proposal would allow them to offer more comprehensive care for diabetes complications, preventing amputations, and to treat conditions such as Achilles tendonitis and ankle fractures, expanding patients’ access to care.

The ankle itself is comprised of one foot bone – the talus – and two leg bones, the tibia and the fibula. And Mississippi is now just one of two states where podiatrists lack “ankle privileges,” as the American Podiatric Medical Association puts it.

“That’s the whole thing—they think you’re a foot specialist so you’re just supposed to stop at the talus?” said Dr. Charles Caplis, the owner of Foot Specialists of South Mississippi and vice president of the Mississippi Podiatric Medical Association, who came to the Capitol Tuesday morning to talk with lawmakers about the proposal.

But they are facing opposition from the Mississippi Orthopaedic Society, whose members currently have an effective monopoly on ankle surgeries in the state.

“The Mississippi Orthopaedic Society believes all practitioners who provide surgical care should meet the uniform educational and training standards established by the [American College of Graduate Medical Education],” wrote Dr. Bryan Fagan, the society’s president, in an email to Mississippi Today. “The safest option for citizens of Mississippi is to ensure their foot and ankle surgeons are educated, trained, and credentialed by the same standards as every other medical and surgical specialty.”

Podiatrists in Mississippi and beyond say they’re not surprised by that position, which claims they lack the right training and experience to perform ankle surgeries. The American Medical Association generally opposes scope of practice expansions that allow professionals other than doctors of medicine and osteopathic medicine to perform more services.

In Massachusetts, the only other state with similar restrictions on podiatrists’ scope still in place, the big hurdle has also been opposition from the orthopedists who perform foot and ankle surgery, said Dr. James Christina, executive director of the American Podiatric Medical Association.

“It is about competition for the same patients essentially,” he said.

On Tuesday, Caplis and Dr. Steven Georgian, a podiatrist in Lucedale, stood in the Capitol rotunda to make the argument that the status quo for lower leg care in Mississippi isn’t working. Georgian, who completed his training in Ohio and Pennsylvania, moved back to Mississippi because he wanted to fight for ankle privileges.

Nearly 15% of Mississippi adults have diabetes, the second-highest rate in the country. The disease can damage blood vessels, increasing the risk of wounds that won’t heal, and nerves, creating numbness in the feet that makes it harder for people to realize they have a cut or blister– all putting people at risk of amputation. Mississippians have high amputation rates, and nationally Black patients are three times likelier to lose a limb than others. Within five years of an amputation, patients are likely to die.

With an expanded scope of practice, podiatrists say they could treat those issues more comprehensively and reduce amputations.

Bringing Mississippi’s laws in line with other states would also help bring more podiatrists to the state, they argue, which would improve access for people with diabetes. In 2020, there were only 67 licensed podiatrists in the entire state, according to the Mississippi State Board of Medical Licensure, and not all of them practice.

Christina, of the national association, shared data showing that Mississippi has one podiatrist for every 32,500, while Florida, “which has a very good ankle law,” has one for every 10,300. (Neighboring Alabama, which just changed its law last year to include the ankle, has one for every 30,000.)

State code currently limits the practice of podiatric medicine to “conditions of the human foot.” The proposal would add the words “and ankle, and their governing and related structures, including the muscles or tendons of the lower leg governing the functions of the foot and ankle.” It would also label podiatrists as physicians.

And it would require any podiatrist performing “conservative and surgical treatments” to have received training at an accredited program.

Christina said that when podiatrists first began performing surgeries, they stuck to the foot. But their training has evolved to include ankle surgery, which also makes sense anatomically.

“The foot and ankle become a little bit tough to distinguish,” he said.

Caplis offered a rebuttal to the idea that podiatrists aren’t equipped to perform ankle surgery: Maybe that was true in the past, but it no longer is. Podiatrists get four years of graduate medical education and spend three years in a hospital-based residency that includes training in surgery.

“Medicine advances,” he said. “It’s called society, and civilization. We’re not asking for more than what we’re trained to do.”

This isn’t the first time Mississippi podiatrists have sought to expand the legal limits of their work.

Angela Weathersby, executive director of the state podiatry association, said they began the push in around 2017, and a similar proposal was nearly over the finish line before the pandemic. Now, they’re trying to rebuild momentum.

Sen. Hillman Frazier, D-Jackson, has supported it in the past because he thinks it could help reduce amputations.

“Save a limb, save a life,” he said.

John Higgins traveled to the Capitol from Biloxi on Tuesday to stand with Caplis and Georgian. As a diabetic, he saw doctor after doctor to treat wounds on his legs. They sent him to the podiatrist for what they thought was a callus. But there turned out to be an ulcer underneath. Higgins also had Charcot foot, a type of nerve damage that can cause joint bones in the foot to collapse and increase the risk of infection.

Caplis said that on two different occasions, Higgins was admitted to the ER and a surgeon wanted to amputate his leg. Instead, Higgins went to see Caplis and was able to keep the limb.

That’s a common pattern, Caplis said.

“You go get admitted and they want to cut it off,” he said. “And then I’m having to say, ‘No, no, no, okay. He just needs to be stabilized for a minute. We can work on this.’”

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

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Podcast: Ohio State won it all, but where would Ole Miss have been with Quinshon Jundkins?

Published

4 hours ago

January 22, 2025

Staff Editor

mississippitoday.org – Rick Cleveland and Tyler Cleveland – 2025-01-22 12:00:00

Lots to talk about on the days after the national championship game, but in Mississippi, especially in Oxford, much of the talk is about what might have been had Judkins stayed at Ole Miss. Also, the Clevelands discuss Egg Bowl basketball, the grueling SEC schedule, the NFL playoffs, and John Wade’s saga at Southern Miss.

Stream all episodes here.

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

Mississippi Today

With EPA support, the Corps is moving forward with the Yazoo Pumps

Published

5 hours ago

January 22, 2025

Staff Editor

mississippitoday.org – Alex Rozier – 2025-01-22 11:00:00

Barring any legal challenge, it appears the South Delta is finally getting its pumps.

The U.S Army Corps of Engineers announced last Friday it’s moving forward with an altered version of the Yazoo Pumps, a flood relief project that the agency has touted for decades. The project now also has the backing of the Environmental Protection Agency, whose veto killed a previous iteration in 2008 because of the pumps’ potential to harm 67,000 acres of valuable wetland habitat.

In a Jan. 8 letter, the EPA wrote that proposed mitigation components — such as cutting off the pumps at different points depending on the time of year, as well as maintaining certain water levels for aquatic species during low-flow periods — are “expected to reduce adverse effects to an acceptable level.”

South Delta residents have called for the project to be built for years, especially after the record-setting backwater flood in 2019. State lawmakers from the area rejoiced over last week’s news.

“It’s been a long time coming,” said Sen. Joseph Thomas, D-Yazoo City, explaining that most in his district support the pumps. “I’m sure there are some minuses and pluses (to the project), but by and large I think it needs to happen.”

Sen. Briggs Hopson, R-Vicksburg, recalled that almost half of his district was underwater in 2019.

A car is nearly submerged in flood water in Issaquena County Friday, April 5, 2019. Credit: Eric J. Shelton, Mississippi Today/Report For America

“I’m very pleased that the Corps has issued this (decision),” Hopson told Mississippi Today on Tuesday.

Before the Corps’ latest proposal, the future of the pumps was in limbo for several years. Under President Trump’s first administration, the EPA in 2020 said the 2008 veto no longer applied to the proposal because of Corps research suggesting that the wetlands mainly relied on water during the winter months — a less critical period for the agriculture-dependent South Delta — to survive, and that using the pumps during the rest of the year would still allow the wetlands to exist.

The EPA then restored the veto under President Biden’s administration. But in 2023, the Corps agreed to work with the EPA on flood-control solutions which, as it turned out, still included the pumps.

While the public comment period is over and the project appears to be moving forward, the Corps has yet to provide a cost estimate for the pumps, which are likely to cost at least hundreds of millions of dollars. A 19,000 cubic-feet-per second, or cfs, pumping station in Louisiana cost roughly $1 billion to build over a decade ago, and the Corps is proposing a 25,000 cfs station for the South Delta.

Corps spokesperson Christi Kilroy told Mississippi Today that the project will move onto the engineering and design phase, during which the agency will come up with a price estimate. Mississippi Today asked multiple times if it’s unusual to wait until after the public has had a chance to comment to provide an estimate, but the agency did not respond.

South Delta residents in attendance for a listening session on flooding in the area. Credit: Staff of Sen. Roger Wicker

Under the project’s new design, the pumps will turn on when backwater reaches the 90-foot elevation mark anytime during the designated “crop season” from March 25 to Oct. 15. During the rest of the year, the Corps will allow the backwater to reach 93 feet before pumping.

In last Friday’s decision, the Corps wrote that the project would have “less than significant effects (on wetlands) due to mitigation.” The project’s mitigation includes acquiring and reforesting 5,700 acres of “frequently flooded” farmland to compensate for wetland impacts.

In a statement sent to Mississippi Today, the EPA said that the “higher pumping elevations” — the Corps’ previous proposal started the pumps at 87 feet — and the “seasonal approach” to pumping will reduce the wetlands impact.

However conservationists, including a group of former EPA employees, are not convinced. The Environmental Protection Network, a nonprofit of over 650 former EPA employees, wrote in August that the latest proposed pumping station “has the potential to drain the same or similar wetlands identified in the 2008 (veto) and potentially more.”

“Similar to concerns EPA identified in the 2008 (veto)… EPN’s concerns with the potential adverse impacts of this version of the project remain,” the group wrote.

A coalition of other groups — including Audubon Delta, Earthjustice, Healthy Gulf and Mississippi Sierra Club — remain opposed to the project, arguing that hundreds of species rely on the wetlands during the “crop season” for migration, breeding and rearing.

A radio tower surrounded by flood water near Mayersville Miss., Friday, April 5, 2019. Credit: Eric J. Shelton, Mississippi Today/Report For America

“This action is a massive stain on the Biden Administration’s environmental legacy and undermines EPA’s own authority to protect our nation’s most important waters,” the coalition said in a statement last Friday.

When asked about potential legal challenges to the Corps’ decision, Audubon Delta’s policy director Jill Mastrototaro told Mississippi Today via email: “This project clearly violates the veto as we’ve documented in our comments. We’re carefully reviewing the details of the announcement and all options are on the table.”

In addition to the pumps, the project includes voluntary buyouts for those whose properties flood below the 93-foot mark, which includes 152 homes.

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

Mississippi Today

On this day in 1906

Published

9 hours ago

January 22, 2025

Staff Editor

mississippitoday.org – Jerry Mitchell – 2025-01-22 07:00:00

Jan. 22, 1906

Willa Beatrice Brown served as a lieutenant in the U.S. Civil Air Patrol. Credit: Wikipedia

Pioneer aviator and civil rights activist Willa Beatrice Brown was born in Glasgow, Kentucky.

While working in Chicago, she learned how to fly and became the first Black female to earn a commercial pilot’s license. A journalist said that when she entered the newsroom, “she made such a stunning appearance that all the typewriters suddenly went silent. … She had a confident bearing and there was an undercurrent of determination in her husky voice as she announced, not asked, that she wanted to see me.”

In 1939, she married her former flight instructor, Cornelius Coffey, and they co-founded the Cornelius Coffey School of Aeronautics, the first Black-owned private flight training academy in the U.S.

She succeeded in convincing the U.S. Army Air Corps to let them train Black pilots. Hundreds of men and women trained under them, including nearly 200 future Tuskegee Airmen.

In 1942, she became the first Black officer in the U.S. Civil Air Patrol. After World War II ended, she became the first Black woman to run for Congress. Although she lost, she remained politically active and worked in Chicago, teaching business and aeronautics.

After she retired, she served on an advisory board to the Federal Aviation Administration. She died in 1992. A historical marker in her hometown now recognizes her as the first Black woman to earn a pilot’s license in the U.S., and Women in Aviation International named her one of the 100 most influential women in aviation and space.

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