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

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1 year ago

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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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On this day in 1870

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2 hours ago

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February 26, 2025

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mississippitoday.org – Jerry Mitchell – 2025-02-26 07:00:00

On this day in 1870

by Jerry Mitchell, Mississippi Today
February 26, 2025

Feb. 26, 1870

This document shows Wyatt Outlaw’s commission into the Union League on July 5, 1867.

Wyatt Outlaw, a Union veteran and the first Black town commissioner of Graham, North Carolina, was seized from his home and lynched by members of the Ku Klux Klan known as the White Brotherhood, which controlled the county. 

Outlaw served as president of the Alamance County Union League of America, which opposed the White Brotherhood and had advocated establishing a school for Black students — something Klansmen had vowed to burn down. 

When the Klan tried to terrorize the town’s Black citizens, Outlaw and two other Black constables opened fire on the hooded men. Sometime later, more than 60 hooded Klansmen invaded his home with torches, swords and pistols. They beat down Outlaw’s door with axes. 

When his 73-year-old mother confronted them, they knocked her down and kicked and stomped her. As the mob dragged Outlaw away, his 6-year-old son screamed, “Oh, Daddy! Oh, Daddy!” 

The Klansmen walked Outlaw bare-chested and barefoot to the Alamance County Courthouse, where they lynched him and placed a note on his chest: “Beware! Ye guilty parties — both white and black.” 

Eighteen Klansmen were indicted for Outlaw’s murder, but charges were later dropped. Other Klan violence led to other deaths and injuries. Outlaw’s lynching, followed by the assassination of state Sen. John W. Stephens at the Caswell County Courthouse, prompted Gov. William Woods Holden to declare martial law in the area. As a result of his stand, the governor was impeached. 

Decades later, in 1914, officials gathered to commemorate a new Confederate monument. Jacob Long, a longtime lawmaker, praised “the achievements of the great and good of our own race and blood” just steps from where he and other Klansmen reportedly lynched Outlaw. The monument still stands. 

There is no monument to honor Outlaw. A play telling his story debuted in nearby Burlington in 2016.

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

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House panel approves casino tax increase, a shot over bow on blockage of online sports betting

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15 hours ago

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February 25, 2025

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mississippitoday.org – Geoff Pender – 2025-02-25 17:59:00

House panel approves casino tax increase, a shot over bow on blockage of online sports betting

by Geoff Pender, Mississippi Today
February 25, 2025

In an obvious shot at the Senate and at least part of the casino lobby for the state not legalizing online gambling, the House Ways and Means Committee on Tuesday approved a tax increase on casinos.

Ways and Means Chairman Trey Lamar said his bill, which would increase taxes on Mississippi casinos from 12% to 16%, is to recoup the tens of millions of dollars a year Mississippi is “losing” from not legalizing online betting. He said, “if everybody’s honest with themselves, online sports betting is already going on” illegally, but the state is not generating any taxes from it.

He said his bill, which now heads to the full House, is also aimed at shedding light on why the online betting bills the House has passed in recent years die in the Senate. Some Mississippi casinos, particularly smaller ones that might struggle to contract or build online betting infrastructure, have opposed the move.

“The goal post continues to be moved on the other end of the building (the Senate),” Lamar told committee members. “We’re going to tax it appropriately. There needs to be some further light shed on this topic … (Illegal online gambling) has reached pandemic level … It’s my understanding that a small handful of casinos are standing in the way of that legislation. “

Lamar said he’s been given estimates ranging from $26 million a year to $80 million a year the state could generate in revenue from online gambling — so he estimates it at about $50 million. Neighboring Tennessee, which legalized online gambling, is making about $140 million a year.

Currently Mississippi casinos pay 12% in taxes, 8% going to the state and 4% to local governments and schools. Lamar said increasing the state’s share to 12% would generate an estimated 50% a year.

Senate Gaming Committee Chairman David Blount criticized Lamar’s tax increase on Tuesday, and the House’s major tax overhaul proposal, which would eliminate the income tax, but raise gasoline and sales taxes.

“The House is fixated on raising sales taxes, increasing the gasoline tax and raising taxes on Mississippi businesses,” Blount said. “I don’t support a 50% tax increase on Mississippi businesses (casinos) that are vital to our state. The House wants to raise taxes on everything Mississippians buy and every time they go to the gas station, and they want to raise taxes on one of the largest employers in our state.”

The move marks the first time in at least a decade that there’s been serious talk of raising the casino tax in Mississippi. The state’s relatively low and stable tax rate on gambling has been credited with helping the industry grow over years. However, some in the industry say gross gambling revenue growth has been stagnant in recent years because of illegal online gambling in Mississippi or legal online gambling in neighboring states.

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

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Handling of child care revisions ‘alienates’ providers, advisory board member says

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20 hours ago

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February 25, 2025

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mississippitoday.org – Simeon Gates – 2025-02-25 12:59:00

Handling of child care revisions ‘alienates’ providers, one owner says

by Simeon Gates, Mississippi Today
February 25, 2025

Members of the Child Care Advisory Council and child care providers, who had raised issues earlier about new proposed regulations, are voicing more concerns after the state Department of Health shared revisions.

Over 200 child care providers attended a meeting Friday of the Child Care Advisory Council along with members of the advisory council and Nicole Barnes, director of the child care bureau at the Health Department, to discuss the new proposed revisions to child care regulations in the state.

The advisory committee had a week to review the new proposed revisions, which have not been released to the public. They also weren’t shown during the meeting.

Advisory council members Vincent Burke and Roberta Avila spoke on the need for a clearer process for discussing and passing changes to child care regulations. Burke suggested giving council members at least 30 days to review regulation changes. “We feel uninformed as an advisory board,” he said.

Avila explained her point in an email after the meeting. “There is a need for clarity of the process in discussing and approving changes to the Licensure Regulations,” she said.

The council voted to meet again in March to further discuss the new regulations.
During the open comment period, several providers raised concerns about the licensing agency’s conduct. Debbie Ellis, who owns and operates The Learning Center in Greenwood, criticized the licensing agency’s handling of the regulation changes, saying that it was “disrespectful” and “alienates” child care providers.

Two other providers who are also part of the advisory council, Regina Harvey and Lesia Daniel, spoke before the meeting about the advisory council’s role.

“Regulations should not be released to the public until the advisory board has had a chance to read them and advise,” said Harvey, who runs SMART Beginnings Preschool in Ocean Springs. “This is what the board is supposed to be — made up of industry leaders and providers. My experience so far is that this is not happening.”

Daniel, owner of Funtime in Clinton, said that having a week to look at all the new revisions wasn’t practical. “The document is hundreds of pages and so taking the time to compare each section to the current regulations to identify the proposed changes is a waste of everyone’s time. To me, that communicates a lack of respect to providers.”

Barnes explained in the meeting that the revisions were done to comply with the Child Care and Development Block Grant’s health and safety standards. There are no federal child care regulations.

The licensing agency filed its first round of proposed regulation changes in November. Many child care providers criticized the previous revisions and how the licensing agency debuted them. They also felt the licensing agency wasn’t considerate of their perspectives.

The licensing agency acknowledged they did not get input from the Child Care Advisory Council or the Small Business Regulatory Committee. Providers said they were not notified of the revisions until weeks after they were filed, when they should’ve been notified three days after they were filed. The licensing agency maintains that it followed the Mississippi Administrative Procedures Act. 

The controversy over regulations comes at a crucial time for the child care industry. Labor shortages, high prices, and more are contributing to a child care crisis in the U.S.

The licensing agency is set to bring the proposed revisions to the Board of Health in April, as well as all public comments from providers. According to Barnes, the new regulations would take effect in May if the Board of Health approves them.

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

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