Mississippi Today

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

Published

9 months ago

February 1, 2024

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

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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Mississippi Today

Already dire lack of affordable housing for low-income Mississippians on verge of worsening

Published

4 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Simeon Gates – 2024-11-04 11:00:00

In Mississippi, where there’s already a dearth of 50,000 or more affordable homes for extremely low-income residents, that number could grow in the next five years.

Housing units available under the federal Low Income Tax Credit program could lose their affordability by 2030 –a number estimated nationwide to be 350,000 with 2,917 in Mississippi, alone; 496 in the state already have.

The federal program responsible for most of the nation’s affordable housing is expiring.

The Low Income Housing Tax Credit, introduced as part of the Tax Reform Act of 1986, provides for developers to buy, build and restore low-income housing units. Under the deal, the housing only needs to stay low-rent for 30 years. Construction began in the early 1990s.

Some LIHTC housing will remain affordable due to other subsidies, nonprofits, state law and individual landlords.

“I think the low-income housing tax credit has done everything that it can to address the need for affordable housing around the state,” said Scott Spivey, executive director of the Mississippi Housing Corporation, a state office that administers the program and works with the state government and those in the affordable housing industry to create and support affordable housing

Spivey supports the proposed Affordable Housing Credit and Improvement Act, a federal bill that would expand upon the low-income housing tax credit in several ways, including giving developers more credit for certain projects for low-income households and changing tenant eligibility rules.

The bill was introduced in the House and the Senate last session, and is co-sponsored by Mississippi Sens. Cindy Hyde-Smith and Roger Wicker and in the House by Reps. Mike Ezell, and Michael Guest. As of this spring, both bills are in committee.

While housing has become a major issue for Americans, getting legislation passed has been challenging. “Everybody knows that housing is an issue, but it gets caught up with everything else…and it kind of gets lost in the shuffle,” said Spivey.

This issue is especially important in Mississippi, where demand for housing is high across all incomes.

“All the market studies that we see that come with the applications tell us that there’s a huge need for affordable housing across the state at all the income bands” said Spivey.

According to the National Low Income Housing Coalition, almost a third of Mississippi renters are extremely low income; 65% of them are severely cost burdened, meaning they spent more than half their income on rent. The majority of these households are seniors, disabled people, single caregivers of young children, people enrolled in school, or other.

Director of Housing Law at the Mississippi Center for Justice, Ashley Richardson said housing problems worsened after Mississippi stopped participating in the federal rental assistance program in 2022.

MCJ’s work on housing includes a statewide eviction hotline, investigating instances of housing discrimination, and more.

Richardson praised the LIHTC program, but echoed Spivey’s concerns. “Even with the affordable housing we do have in Mississippi, we are still at a lack,” she said.

The National Housing Preservation Database estimates Mississippi is short 52,421 affordable and available rental homes for low-income people. The National Low Income Housing Coalition puts the figure at 49,478.

Richardson wants the state to deal with issues like providing more tenant protections and rental assistance. There’s also a need to improve homes that are rundown or in poor condition, and many housing nonprofits are running out of funding.

Spivey said people should talk to their property managers and learn about their rights. MHC’s website has resources for homebuyers and renters.

As the housing crisis goes on, there are options for people struggling to find and keep affordable housing and an effort to take action at the federal and state levels.

Some aspiring low-income homeowners may qualify for Habitat for Humanity, a program that builds homes for families in need. Families who qualify work on the homes alongside volunteers, pay an affordable mortgage and receive financial literacy education.

New applicants must meet the qualifications, including a good debt-income ratio, 125 hours of sweat equity and taking classes on financial literacy, home repairs, and being a good neighbor.

Merrill McKewen, executive director for Habitat for Humanity Mississippi Capital Area, emphasized the importance of housing to individuals and communities.

“There are untold studies that have been done that, you’ve gotta have a safe, decent, affordable place to live. The children are better students, the parents are better employees…it grounds you to a community that you can contribute to and be a part of. It is the American dream, to own a home, which is what we’re all about,” she said.

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

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Mississippi Today

Mississippi Election 2024: What will be on Tuesday’s ballot?

Published

4 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Bobby Harrison – 2024-11-04 10:00:00

Mississippians will go to the polls on Tuesday, Nov. 5, to elect federal and state judicial posts and some local offices, such as for election commissioners and school board members.

Polls will be open from 7 a.m. to 7 p.m. on Tuesday. To find your polling place, use the secretary of state’s locator, or call your local county circuit clerk.

The following is a list of the candidates for federal and judicial posts with brief bios:

President

Kamala Harris, current vice president and Democratic nominee for president. Her running mate is Tim Walz.
Donald Trump, former president and current Republican nominee. His running mate is J.D. Vance.
Robert Kennedy Jr. remains on the ballot in Mississippi even though he has endorsed Trump. His running mate is Nicole Shanahan.
Jill Stein is the Green Party candidate. Her running mate is Rudolph Ware.
Five other candidates will be on the Mississippi ballot for president. For a complete list of presidential candidates, see the sample ballot.

U.S. Senate

Ty Pinkins is the Democratic nominee. He is a Rolling Fork native and attorney, representing, among other clients, those alleging unfair working conditions. He served 21 years in the U.S. Army, including combat stints, other overseas deployment and posts in the White House,
Roger Wicker is the Republican incumbent senator. He resides in Tupelo and has served in the U.S. Senate since late 2007 after first being appointed to fill a vacancy by then-Gov. Haley Barbour. He was elected to the post in 2008. He previously served in the U.S. House and as a state senator. He is an attorney and served in the United States Air Force.

House District 1

Dianne Black is the Democratic nominee. She is a small business owner in Olive Branch in DeSoto County.
Trent Kelly is the Republican incumbent. He was elected to the post in a special election in 2015. He previously served as a district attorney and before then as a prosecuting attorney for the city of Tupelo. He is a major general in the Mississippi Army National Guard.

House District 2

Bennie Thompson is the Democratic incumbent. He was first elected to the post in 1993. Before then, he served as a Hinds County supervisor and as alderman and then as mayor of Bolton.
Ronald Eller is the Republican nominee. He grew up in West Virginia and moved to central Mississippi after retiring from the military. He is a physician assistant and business owner.

House District 3

Michael Guest is the Republican incumbent and is unopposed.

House District 4

Mike Ezell is the Republican incumbent first being elected in 2022. He previously served as Jackson County sheriff.
Craig Raybon is the Democratic nominee. Raybon is from Gulfport and began a nonprofit “focused on helping out the community as a whole.”

Central District Supreme Court

Jenifer Branning currently serves as a member of the state Senate from Neshoba County.
Byron Carter is a Hinds County attorney and previously served as a law clerk for Supreme Court Justice Armis Hawkins.
James Kitchens is the incumbent. He has served on the state’s highest court since 2008.
Ceola James previously served on the Court of Appeals.
Abby Gale Robinson is a Jackson attorney. She previously was a commercial builder.

Southern District Supreme Court

Dawn Beam is the incumbent, having been first appointed in 2016 by then-Gov. Phil Bryant and later winning election to the post. She is a former chancellor for the Hattiesburg area.
David Sullivan is an attorney in Harrison County and has been a municipal judge in D’Iberville since 2019. His father, Michael, previously served on the state Supreme Court.

Northern District Supreme Court seats

Robert Chamberlin of DeSoto County is unopposed.
James Maxwell of Lafayette County is unopposed.

Court of Appeals 5^th District seat

Ian Baker is an assistant district attorney in Harrison County.
Jennifer Schloegel is a Chancery Court judge for Harrison, Hancock and Stone counties.
Amy St. Pe is a Municipal Court judge in Gautier.

Court of Appeals District 2

Incumbent Latrice Westbrooks is unopposed.

Court of Appeals District 3

Incumbent Jack Wilson is unopposed.

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

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Mississippi Today

On this day in 1750

Published

7 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-11-04 07:00:00

Nov. 4, 1750

A painting of Jean Baptiste Point DuSable by Thomas Blackshear II. Credit: National Postal Museum

Jean Baptiste Point DuSable, the “Father of Chicago,” was born.

A man of African descent, he became the first known settler in the area that became the city of Chicago. He married a Potawatomi woman, Kitiwaha (Catherine), and they had two children.

According to records, the property included a log cabin with two barns, a horse-drawn mill, a bakehouse, a poultry house, a dairy, a smokehouse, a fenced garden and an orchard. At his trading post, DuSable served Native Americans, British and French explorers and spoke a number of languages.

“He was actually arrested by the British for being thought of as an American Patriot sympathizer,” Julius Jones, curator at the Chicago History Museum told WLS, but DuSable beat those charges.

In Chicago today, a school, street, museum, harbor, park and bridge bear his name. The place where he settled near the mouth of the Chicago River is now a National Historic Landmark, part of the city’s Pioneer Court.

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

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