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

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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 and vice president of the Mississippi Podiatric Medical Association, who came to the Capitol Tuesday morning to talk with lawmakers about the proposal.

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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 surgical care should meet the uniform educational and standards established by the [American College of Graduate Medical Education],” wrote Dr. Fagan, the society’s president, in an email to Mississippi . “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 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.

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“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 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. 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.

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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.

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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.”

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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 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.

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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 to say, ‘No, no, no, okay. He just needs to be stabilized for a minute. We can work on this.’”

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

Mississippi Today

On this day in 1955

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mississippitoday.org – Jerry Mitchell – 2024-09-21 07:00:00

Sept. 21, 1955

Moses Wright points at J.W. Milam as one of the kidnappers of his great-nephew, Emmett Till. Ernest Withers defied a judge’s orders and took this . Credit: Wikipedia

Moses Wright took the witness stand and identified the who kidnapped and killed his great-nephew, Emmett Till. 

“It was the first time in my I had the courage to accuse a white man of a , let alone something terrible as killing a boy,” Wright said later. “I just wanted to see justice done.” 

He worked as a sharecropper and was also a minister, whom the locals called “Preacher.” The two white men who abducted Till — J.W. Milam and his half-brother, Roy Bryant — threatened to kill Wright if he said anything. 

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“How old are you, Preacher?” Milam asked. Wright replied 64. “If you make any trouble, you’ll never to be 65,” Milam said. When the teen’s body was recovered from the Tallahatchie , Wright identified Till. Despite threats, Wright still took the witness stand. When the prosecutor asked him to point out Till’s abductors, he stood up, pointed his weathered finger at Milam and said, “There he is. That’s the man.” 

He testified that Bryant identified himself as “Mr. Bryant.” It may have been the first murder trial in Mississippi where a Black man testified against a white man. Even after the trial, the threats continued, and Wright left to join his in Chicago, where he had already sent them.

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

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Mississippi River mayors agree to unify ports from the Corn Belt to the coast 

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mississippitoday.org – Delaney Dryfoos, The Lens and Elise Plunk, Illuminator – 2024-09-20 16:19:36

BATON ROUGE, La. — Mayors from 10 states along the Mississippi River convened in Louisiana’s capital this to announce a cooperative agreement between the working river’s ports. 

In town for the annual Mississippi River Cities & Towns Initiative meeting, the mayors also called upon the next U.S. president to prioritize several federal policy changes to support the 105 cities represented by the initiative. 

On Wednesday, mayors from the Midwestern Corn Belt joined mayors from Louisiana to sign the Mississippi River Ports Cooperative Endeavor Agreement. The agreement is the first to ensure cooperation between the ports in the heart of the corn belt and the coastal ports of Louisiana that export 60% of the nation’s agricultural products.

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Vicksburg, Mississippi, Mayor George Flaggs praised the move in a statement on Friday, adding that he and the other mayors there were paying particular attention to environmental issues along the river such as the ongoing drought.

“This agreement ensures that ports from St. Louis to St. Paul will federal designation, a significant step that will bolster commerce and strengthen the economic impact of the entire Mississippi River region,” Flaggs said.

The inland ports between St. Louis and St. Paul were not federally recognized until 2022, said Robert Sinkler, executive coordinating director of the Corn Belt Ports. With the support of the Mississippi River cities initiative, the Corn Belt Ports initiative launched in 2019 to advocate for federal recognition of those ports.

Now, the corn belt and coastal ports will take on commerce-related policy actions together, for the first time in Mississippi River history, said Sinkler. The river moves nearly one trillion dollars in product through its ports annually, according to MRCTI. Maintaining the navigation capability on the river is a key part of the agreement. 

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Drought disrupts commerce and drinking water along the Mississippi River corridor

For the third year in a row, the Midwest is under extreme drought conditions, which have led to low water levels that threaten to disrupt barge transports carrying fuel and grain. The 16-month drought spanning from 2022 to 2023 cost the nation $26 billion. The drought of 2012 cost the Mississippi River corridor $35 billion.

Belinda Constant, mayor of Gretna, Louisiana, said that droughts often cost more than floods, but do not qualify as “major disasters” worthy of relief from the Federal Emergency Management Agency. 

“We still are not able to capture federal disaster declarations for drought or intense heat,” Constant said. 

While drought is not considered a “major disaster” by FEMA, the president can declare one. declared a federal emergency last September in Louisiana when the effects of drought caused salt water to intrude up the Mississippi River and threaten drinking water.

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FEMA is not set up to relief for intense droughts or extreme heat, which are expected to become more extreme, according to the Fifth National Climate Assessment. The federal does offer support through other agencies, such as farm losses through the U.S. Department of Agriculture. 

Constant asked the next U.S. president to update FEMA regulations to include droughts and extreme heat. Earlier this summer, dozens of labor and environmental groups filed a petition to push FEMA to declare extreme heat and wildfire smoke as “major disasters,” on par with other natural disasters such as floods and tornadoes. 

Constant said the next administration should also create a mechanism to incentivize or compensate manufacturers and farmers who recycle water or reduce water usage during dry periods. 

Louisiana is again dealing with drought. As of Sept. 13, 2024, the saltwater wedge had reached river mile 45, corroding drinking water below Port Sulphur and inching toward Pointe a la Hache, Louisiana. Earlier this week, the U.S. Army Corps of Engineers began construction on an underwater sill near Myrtle Grove to help slow the creep of saltwater intrusion for the third summer in a row.

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But the drought impacts all communities along the Mississippi River, not just those in southern Louisiana. And 50 cities with a total population of 20 million people depend on the Mississippi River for their drinking water.

“Memphis depends on the of the corridor to power our international port and fuel our multi-billion-dollar outdoor recreation and tourism industry,” said Paul Young, mayor of Memphis, Tennessee. The tournament fishing industry is worth billions in revenue. 

“It is vital we work to safeguard the Mississippi River together,” he added.

Tugboats maneuver barges south along the Mississippi River in Vicksburg, Thursday, Oct. 27, 2022. Near record low water levels are affecting shipping and tourism. Credit: Vickie D. King/Mississippi Today

Advocating for the Mississippi River corridor as a whole

The 105 cities represented by inititiuave also called on the next U.S. president to advocate for the corridor both at home and internationally. “We are asking the next president to please work with us to enact a federal Mississippi River program through which we can deploy infrastructure spending at a multi-state scale,” said Hollies J. Winston, mayor of Brooklyn Park, Minnesota. 

On the global stage, the initiative has advocated for the Mississippi River corridor at five United Nations climate meetings. Bob Gallagher, mayor of Bettendorf, Iowa, called on the next President to ensure that the nation remains a part of the Paris Agreement to sustain the corridor’s $500 billion in revenue.

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“Serving as a past co-chair of MRCTI along with being from an agricultural state, I know firsthand that U.S. participation in the Paris Accord helps us compete and move our commodities and goods across the world to other markets,” said Gallagher. 

Pulling out of the Paris Agreement could trigger tariffs for goods coming from a non-signatory nation. Leaving the international climate accord would place farmers and manufacturers at a potential disadvantage in the global market, said Gallagher.

In 2017, President Donald Trump announced that the U.S. would withdraw from the Paris Climate Accord. In 2021, on President Biden’s first day in office, the U.S. rejoined the international agreement to limit temperature increases.

“We can’t afford to make any policy decisions that will jeopardize the $164 billion in agricultural commodities the Mississippi River makes possible every year,” said Gallagher. 

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Mitch Reynolds, mayor of La Crosse, Wisconsin, and the initiative’s co-chair, said that the advocacy work of the initiative is paramount to defending the health of the river and its communities. 

The Mississippi River Ports Cooperative Endeavor Agreement unites the communities along the corridor in a shared commitment to protect, restore and manage the river’s resources sustainably, said Sharon Weston Broome, mayor of Baton Rouge, Louisiana, and host of the initiative’s 13th annual meeting.

“We urge the next administration to increase its focus on the river, its impact on the national and its continued need for stewardship,” said Broome.

This story is a product of the Mississippi River Basin Ag & Water Desk, an independent reporting network based at the University of Missouri in partnership with Report for America, with major funding from the Walton Family Foundation. MRCTI is also a Walton grantee. 

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Mississippi Today environmental reporter Alex Rozier contributed to this report.

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

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Jerry Mitchell: Why Medgar Evers should represent Mississippi in U.S. Capitol Statuary Hall

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mississippitoday.org – Jerry Mitchell – 2024-09-20 11:32:07

Editor’s note: and the Mississippi Humanities Council cosponsored an – “Reimagining Statuary Hall” – on Sept. 18 at The Station in Fondren. Several speakers suggested accomplished Mississippians to represent the in Statuary Hall at the U.S. Capitol. Currently, statues of staunch segregationists Jefferson Davis and J..Z. George represent Mississippi. What follows is Mississippi investigative reporter Jerry Mitchell’s pitch from the event.


Medgar Evers Credit: National Park Service

Medgar Evers dove onto the sand at Normandy. In the weeks following the D-Day invasion of June 6, 1944. He joined a million soldiers fighting to expand the beachhead. The Luftwaffe strafed and bombed them, hoping to push them back into the sea.

He was also part of the Red Ball Express, which provided fuel, food and other critical supplies as Allied troops pushed back the German forces.

As Allied forces freed more of France from Nazi occupation, Evers enjoyed without the color line. He could eat in any restaurant he desired. He even fell in love with a French girl.

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After battling the Nazis, he returned to Mississippi and fought racism all over again in the form of Jim Crow, which barred Black Americans from restaurants, restrooms and voting booths. When he tried to vote in his hometown of Decatur, Mississippi, he and other Black war were turned away by an armed white mob.

After graduating from Alcorn College, he worked for his mentor, Dr. T.R.M. Howard, and was involved in passing out bumper stickers across the Delta that read, “Don’t Buy Gas Where You Can’t Use the Restroom.”

In January 1954, he tried to enroll at the University of Mississippi School of Law — only to be turned away. NAACP officials considered taking up his case but were so impressed with him they decided instead to hire him as the first field secretary for the Mississippi NAACP.

He investigated violence against African Americans, the 1955 assassinations of the Rev. George Lee and Lamar Smith, who were killed because they helped Black Mississippians register to vote.

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He worked with Dr. Howard on the lynching of Emmett Till and helped find new witnesses.

The economic threats and violence became so great that Dr. Howard and others left Mississippi, but Medgar Evers stayed.

He helped James Meredith enroll at , and he logged 40,000 miles a year traveling the roads, sometimes flooring it past 100 to escape those hell-bent on harming him. 

His telephone rang at all hours with threats. Some were short and emphatic: “We’re going to kill you, N-word.” Others described how they planned to torture him.

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Evers told a CBS reporter, “They say I’m going to be dead soon, that they’re going to blow up my house, that they’re going to blow my head off. If I die, it will be a good cause. I’m fighting for America just as much as the soldiers in Vietnam.”

After the white mayor of Jackson chastised the civil rights movement in Mississippi in spring 1963, Evers won his FCC bid for “equal time” to respond. He talked on television about the mistreatment of Black Mississippians and in so doing he became even more of a target. The Evers’ home was firebombed.

Hours after President Kennedy told the nation that the grandchildren of those enslaved are “not yet freed from the bonds of injustice,” Evers was shot in the back as he stepped onto his own driveway in Jackson, Mississippi. His wife, Myrlie Evers, heard the shot, ran outside, saw the blood and screamed. When the children heard the scream, they ran outside and saw their father.

“Daddy, get up,” his 8-year-old daughter, Reena, said. “Daddy, get up.”

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He never did.

On Evers’ birthday in 1964, Congress passed the Civil Rights Act

Three decades later, his family finally saw his assassin convicted.

“All I want to say is, ‘Yay, Medgar, yay!’” Myrlie Evers declared as she wiped away tears. “My God, I don’t have to say accused assassin anymore. … what he failed to realize was that Medgar was still alive in spirit and through each and every one of us who wanted to see justice done.”

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That justice inspired others. To date, 24 have been convicted in civil rights cold cases.

A year after Evers’ killer went to prison, Myrlie Evers became chairman of the national NAACP and helped rescue the civil rights organization from the brink of bankruptcy.

She continues to break boundaries. She became the first lay person to deliver the inaugural invocation at Barack Obama’s second inauguration.

She cheered when Mississippi removed the emblem from the state flag, and she told me the reason we keep repeating its history is we don’t know our history.

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Putting Medgar Evers in Statuary Hall would honor a fallen soldier in the war against hate and would help ensure that we know our history so that we don’t repeat it.

Jerry Mitchell on his Statuary Hall pick; Medgar Evers

READ MORE: Other Southern states removed white supremacist statues from Washington. Will Mississippi?

READ MORE: J.Z. George’s descendant advocates for removing the statue of the Confederate icon from the nation’s Capitol

READ MORE: Mississippi’s Jefferson Davis statue has new neighbor in U.S. Capitol: Arkansas civil rights leader

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

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