Mississippi Today

Shortage of OB-GYNs is leaving Mississippi moms-to-be stranded for care

Published

1 year ago

September 18, 2023

Kayla Dominick of Meridian knew something was not right – her periods were irregular and she felt constant pressure in her pelvis. She found a local OB-GYN who accepted Medicaid, and he performed an ultrasound of her uterus.

When it was recommended she undergo follow-up testing, including a uterine biopsy, she called the office to ask the doctor or nurse some questions and share concerns about the procedure. After leaving several messages and never hearing back, she decided to find another doctor.

Kayla Dominick and her son Noah in March 2023. Credit: Courtesy of Kayla Dominick

But that didn’t prove simple: There are only 11 licensed OB-GYNs in Lauderdale County, home to Meridian, and its surrounding five counties, according to data from the Office of Mississippi Physician Workforce. Of those 11, only six reportedly practice obstetrics, or deliver babies.

At the same time, almost 28,000 women of reproductive age are living in that six-county area, according to U.S. Census data.

By comparison, in Rankin County, also home to about 28,000 women of reproductive age, there are 42 licensed OB-GYNs.

Mississippi as a whole is experiencing a shortage of these specialists. A recent WalletHub study ranked Mississippi as the worst state to have a baby. It came in 50th in the “midwives and OB-GYNs per capita” category, which it used data from the U.S. Bureau of Labor Statistics to determine. It also incorporated the state’s maternal and infant mortality rates – some of the worst in the nation – into the ranking.

More than half of Mississippi counties are considered maternity care deserts, or have no hospitals providing obstetric care, no OB-GYNs and no certified nurse midwives.

But the small number of OB-GYNs – particularly those still practicing obstetrics – in a metropolitan area like Meridian shows how tenuous the current workforce landscape is.

Dr. Norman Connell, market medical director for the OB Hospitalist Group and a Vicksburg-based OB-GYN, said about five years ago, the Meridian area had around 12 or 13 obstetric providers, most of them with privileges at both hospitals. Now, there are six providers on staff at both Ochsner Rush and Anderson Regional Medical Center.

In 2021, as a result of the drop in providers, both hospitals signed an agreement with Connell’s company to supply OB-GYN hospitalists, or providers from across the state, or even out of state, who work solely in an inpatient hospital setting.

Ochsner Rush Health in Meridian, Miss., Thursday, August 17, 2023. Credit: Eric Shelton/Mississippi Today

“The population of Meridian didn’t shrink, but the area lost over half of the OB providers in a few short years,” Connell said.

Connell said the doctors at his company allow the local OB-GYNs to stay in their clinics more often and see patients they need to see.

“In addition to that, we’re also the doctor for patients who don’t have physicians on staff there … and for people who haven’t gotten prenatal care and show up with an obstetric problem,” he explained.

The group also has contracts with seven other hospitals all over the state, from Magnolia Regional Health Center in Corinth to Mississippi Baptist Medical Center in Jackson.

For Dominick, finding another doctor who accepts Medicaid and who would perform the procedure was a challenge – a surprising one for the native of New Orleans, where health care services are abundant.

“In the New Orleans area, we have an urgent care (clinic) on almost every corner, open 24/7,” she said of the abundance of health care services.

Dominick, like many other women in Meridian, took to a Facebook group for Meridian moms to ask for OB-GYN recommendations. There are several posts in the group from women looking for OB-GYN recommendations, either because they need a new one or because the one they’ve been seeing is too busy for routine appointments like check-ups.

“Best obgyns to go to im tired of waiting to get an appointment at my doctors office I shouldn’t have to sit there for three hours when there’s 3 people in the waiting room or waiting 6 months to even get in,” one woman wrote.

Dr. Virginia Nelson, an obstetrician-gynecologist, poses for a portrait inside of her medical group practice, the Nelson Center For Women, in Meridian, Miss., Thursday, August 17, 2023. Credit: Eric Shelton/Mississippi Today

Dominick eventually landed an appointment with Dr. Jennifer Nelson, who has been an OB-GYN in the area for more than 20 years. Nelson, however, recently quit practicing obstetrics after spending the prior two years on call at the hospital 24 nights a month.

Nelson was absolutely exhausted, scrambling from the hospital to the clinic and back.

She remembers one night when several other OB-GYNs at the hospital were out of town, and she was sick with the flu. She wound up working anyway.

Anywhere from 40% to more than 75% of OB-GYNs experience burnout, studies show – in the middle to upper one-third of medical specialties.

On top of the physical and mental burnout from around-the-clock work, she had many high-risk patients to see in her clinic – patients who required a lot of time, she said, and often with insurance that did not reimburse well. About half of her patients were on Medicaid, she said.

Medicaid payments for physician services are well below Medicare payments, which are below commercial insurance rates. Mississippi also has one of the lowest average commercial reimbursement rates for both inpatient and outpatient services in the nation, according to a Milliman white paper.

“It’s expensive to do OB here. I ran my numbers one month – if every one of my OB patients had been Medicaid … I would not have been able to pay my overhead with my nurses, and that’s with me working for free, totally taking my salary out of it,” she said. “I would have been about $100,000 short.”

In her clinic now, she treats Medicaid patients when they are referred to her clinic and, on a case-by-case basis, unreferred patients. She said because the clinic is not designated a “rural health clinic” by the federal government, Medicaid reimbursements for services are very low.

“The (gynecology) side is very low reimbursement for general services if you don’t have a rural health clinic designation,” she explained.

Further compounding the issue is how sick the patient population in the area – and across the state – is.

“We have the sickest patient population, so they’re litigious, time consuming – I did a lot of high-risk pregnancies. It’s a lot of coming up at two in the morning to check on people who are super sick,” she said.

Mississippi leads the nation in areas such as obesity, high blood pressure and diabetes – all conditions that make pregnancy more dangerous and require more time and services from OB-GYNs and other maternal health practitioners. These conditions often lead to worse outcomes for women and babies.

As OB-GYNs stop practicing or retire, both in Mississippi and nationwide, they aren’t being replaced at the same rate. And it’s unknown how last year’s Dobbs decision that overturned Roe v. Wade is affecting the OB-GYN workforce in Mississippi, though other states with similar restrictive abortion laws have seen providers leave because of enhanced legal risks.

Dr. Michelle Owens, a maternal fetal medicine specialist who worked at the University of Mississippi Medical Center for nearly 20 years, said she suspects because the state’s laws have always been so restrictive in regards to abortion, Dobbs is not having an immediate effect on providers who live here.

“I think if anything, if people are concerned about the restrictive nature of practice of obstetrics and gynecology as it pertains to terminations services, that it (Dobbs) would probably be more influential on preventing people who want to provide that care. Those people aren’t going to come here (to Mississippi),” she said.

In a state with such a severe shortage, one must consider the ramifications of that, she said.

“The more we say we're in favor of allowing or condoning government interference in exam rooms, we have to also recognize there are some unintended consequences to those decisions – they don’t just happen in a vacuum,” she said.

There’s currently only one OB-GYN residency program in the state at the University of Mississippi Medical Center, and the program graduates six residents each year. Of the most recent graduates, only two stayed in Mississippi – prior years’ numbers average about the same.

Dr. Elizabeth Lutz, an associate professor of obstetrics and gynecology, is the residency program director at the University of Mississippi Medical Center. Credit: Courtesy of UMMC

On top of that, there have been changes in how OB-GYNs work over the last decade nationally. Traditionally OB-GYNs worked at private clinics and had privileges at hospitals. Now, however, many OB-GYNs are hospitalists, or OB-GYNs who work solely in the inpatient setting, according to Dr. Elizabeth Lutz, associate professor of obstetrics and gynecology and the residency program director at the University of Mississippi Medical Center.

And more OB-GYNs today wind up completing fellowships, or going into a subspecialty such as maternal fetal medicine.

“Nowadays, closer than 30 to 40% of OB-GYN residents go into fellowship – that’s grown dramatically,” said Lutz, associate professor of obstetrics and gynecology and the residency program director at the University of Mississippi Medical Center.

Both Ochsner Rush, where Nelson previously had privileges, and Anderson in Meridian began contracting with the OB Hospitalist Group in 2021 to fill in the gaps created by the shortage. About eight OB-GYNs from across the state – and even some from out of state – work shifts at both hospitals.

Anderson averages about 1,020 births per year, according to a hospital spokesperson. Ochsner Rush averages just under 1,000 births annually.

“Due to a shortage of OB-GYN’s in east central Mississippi, Anderson Regional Health System partners with a OB Hospitalist group to supplement our three practicing OB-GYN’s in providing 24-hour obstetrics coverage every day,” said Dr. Keith Everett, chief medical officer at Anderson Regional Health System.

Both hospitals also employ advanced practice nurses called certified nurse midwives – Ochsner Rush has four on staff – who manage the care of low-risk patients. The midwives are also skilled at counseling and education of patients in areas such as nutrition, childbirth preparation and breastfeeding.

The use of certified nurse midwives in Mississippi is rare: there are fewer than 30 in the state, and only a few hospitals, including the two in Meridian, allow them to deliver babies.

Connell said he thinks the company’s role in the area – and in the state – will only continue to grow.

“I think Meridian paints a picture of (why this work is important),” he said. “... It’s a work in progress. We’re at the very beginning of making things better.”

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 1867

Published

23 hours ago

November 23, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-11-23 07:00:00

Nov. 23, 1867

Extract from the Reconstructed Constitution of the State of Louisiana, 1868. Credit: Library of Congress

The Louisiana Constitutional Convention, composed of 49 White delegates and 49 Black delegates, met in New Orleans. The new constitution became the first in the state’s history to include a bill of rights.

The document gave property rights to married women, funded public education without segregated schools, provided full citizenship for Black Americans, and eliminated the Black Codes of 1865 and property qualifications for officeholders.

The voters ratified the constitution months later. Despite the document, prejudice and corruption continued to reign in Louisiana, and when Reconstruction ended, the constitution was replaced with one that helped restore the rule of white supremacy.

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

Mississippi Today

Crystal Springs commercial painter says police damaged his eyesight

Published

2 days ago

November 22, 2024

Staff Editor

mississippitoday.org – Mina Corpuz – 2024-11-22 12:21:00

CRYSTAL SPRINGS – Roger Horton has worked decades as a commercial painter, a skill he’s kept up with even with the challenge of having what his wife has called “one good eye.”

It hasn’t stopped him from being able to complete detailed paint jobs and create straight lines without the help of tape. But last year following a head injury, he and others said people have been pointing out a change in his work. Horton says the sight in his right eye is clouded, like he is looking underwater.

Affected vision, short term memory and periods of irritability – potential symptoms of concussion – followed after he was arrested last September. During an encounter with several police officers, Horton alleges more than one slammed his head into a cruiser and placed handcuffs on so tight that he started to bleed.

“(The officer) was kind of rough with me and all, and he takes my head and I said, ‘What’d I do?’” he recalled recently.

Horton ended up being convicted of two misdemeanor charges and has paid off the fines, but a year later he still has questions about the arrest and treatment by the police.

To date, he has not seen a doctor to evaluate his eye and check for vision or cognitive issues. Horton and his wife Rhonda don’t have a car, and transportation to doctor’s appointments in the Jackson area remains a challenge.

The Hortons have lived in Crystal Springs all their lives, and they have lived in the home the past five years that belonged to Rhonda’s mother.

More than a quarter of all people in Crystal Springs live below the poverty line, and that includes the couple. Rhonda Horton said it’s hard to make a living because there aren’t a lot of jobs, but they support themselves as painters.

That’s how they met Yvonne Florczak-Seeman, who lived in Illinois and purchased her first historical property in Crystal Springs in 2019. She splits her time between the two states.

“We painted that porch bar and the rest is history,” Rhonda Horton said, adding that they went on to complete detailed work on mantles, kitchen cabinets and a cigar room at Florczak-Seeman’s North Jackson Street residence.

Over the years, the couple built a relationship with Florczak-Seeman, who is seeking to open a women’s empowerment center called the Butterfly Garden, in the building next to city hall.

Yvonne Florczak-Seeman poses for a portrait at her business, The Butterfly Garden, in Crystal Springs, Miss., Tuesday, Oct. 1, 2024. Credit: Eric Shelton/Mississippi Today

Florczak-Seeman has supported the couple numerous times, including helping them pay a late water bill and offering them work. She called them talented painters and hired them again to paint the interior of the future center, located at East Railroad Avenue.

In pieces, Rhonda Horton told Florczak-Seeman about her husband’s arrest and later the injuries she said he sustained from it. Florczak-Seeman had questions about the encounter and other potential injustices at play, so she offered to help.

“I just want them to pay for what they’ve done not just to him, but everybody,” Rhonda Horton said. “That’s what I want, justice.”

The Arrest

On Sept. 24, 2023, Horton was walking home from a friend’s house when officers approached him. One grabbed his arms to handcuff him, and he remembers them cutting his wrist and causing it to bleed.

Then, he said, a second officer slammed his head into the top of the police car, followed by another officer who slammed his head again. During the encounter, a bag of marijuana that Horton said he found fell out of his pocket onto the ground.

An officer put Horton in the back of the cruiser and took him to the station where Horton asked to speak to the police chief and call his wife. He said the police took his phone and clothes.

Afterward, he was taken to the Copiah County Detention Center in Gallman.

Police Chief Tony Hemphill disputed Horton’s allegation of mistreatment, saying he did not sustain any injuries that required hospitalization. He said Horton’s wrist was cut while he resisted arrest.

“He was not brutalized and targeted,” Hemphill said. “If he had just complied, he wouldn’t have had to come up there (to jail) that night.”

Two police reports from the night of the September 2023 arrest detail how officers had responded to a possible assault and were given the description of a white man. While in the area, they encountered Horton — the only person who fit that description.

Hemphill said a mother called police after her daughter told her she was assaulted. He said officers approached Horton on the street and tried to talk with him to rule him out as a suspect.

That’s when Horton began “fighting, pulling away, and kicking against (the officer’s) patrol vehicle, trying to run,” according to a police report from the night and Hemphill. Horton denies doing any of that.

The next day police took Horton from the county jail to the Crystal Springs police station. There, police informed him a teenage girl reported being assaulted. After learning about the assault allegation, Horton remembered feeling shocked and saying it couldn’t be true because he was not on the street where the alleged incident took place.

Hemphill confirmed the police investigated the assault allegation and found it not credible, meaning Horton wouldn’t face any related charges. He said he communicated this to Horton and his wife early on and since then, which the couple disputes.

As Horton was being arrested and detained, his wife grew worried because she had just spoken with him on the phone and expected him to arrive home shortly. Rhonda Horton and her adult son started calling Roger’s phone, each not getting an answer.

Then during one of the calls by her son, someone who did not identify himself answered Roger’s phone and said, ‘Your daddy’s dead’ and then hung up, Rhonda Horton said.

She was starting to assume the worst had happened. Rhonda Horton wouldn’t have confirmation her husband was alive until he called from the county jail in the early morning.

The next morning as she talked with the police chief, Rhonda Horton asked the chief about who answered the phone and told her son that Roger was dead. The chief told her the person who answered must have been from the county.

Hemphill later told Mississippi Today that he did not know about the call and that type of behavior by his staff “is not going to be tolerated.” Similarly, Copiah County Sheriff Byron Swilley said he had not heard about it and could not say whether a member of his department made the comment to Rhonda and Roger Horton’s son.

A Sept. 25, 2023, citation signed by Hemphill, shared with Mississippi Today, summoned Roger Horton to municipal court for the misdemeanor charges of possession of marijuana and resisting arrest and directed him not to have contact with the alleged victim in the assault case. No contact orders are typically for cases such as domestic violence and sexual assault and they are set by a judge.

LaKiedra Kangar, who works in municipal court services, said the no contact order was put in place because of the assault allegation. She confirmed Horton was not charged with the offense following the police department’s investigation of the allegation.

Weeks passed. Roger Horton went to court for the misdemeanor charges, to which he pleaded guilty. Felony assault charges were not part of the hearing. Municipal Court Judge Matthew Kitchens ordered Roger to pay over $900 in fines for the misdemeanors.

Horton was able to pay for some of the fine through at least 10 hours worth of court-ordered community service, which he said involved painting buildings for the city.

Months later after learning about Horton’s arrest and how he said the police treated him, Florczak-Seeman said she wanted to know more. Horton didn’t have access to his arrest documents, so she accompanied him and his wife to the police department to ask for them.

The first visit, Horton asked but did not receive the arrest report. Florczak-Seeman asked if he had a fine for any of the charges, which police said Horton did even after completing some community service hours. Florczak-Seeman paid for the remaining balance and had him work for her for two days to pay that off.

This year, they went to the police department a second time so Horton could ask for his arrest paperwork. An officer told him he didn’t need it and that the rape allegation had been investigated and found not to be credible, Horton told Mississippi Today.

Florczak-Seeman asked why Horton couldn’t receive the report. She said Hemphill asked if she was Horton’s attorney, and Florczak-Seeman clarified she was his representative.

The chief left for a few minutes and returned with two pieces of paper and handed them to Horton. Hemphill told Mississippi Today he did not recall whether he was the one who handed the report to Horton.

Florczak-Seeman took the document from Horton and began to read it as they stood in the lobby. She said she was horrified to see the name of the alleged, underage victim and her address in the report.

Hemphill said the victim’s personal information should have been restricted and not doing so was an oversight.

After reading the report, Florczak-Seeman went down the street to the mayor’s office at city hall to explain what happened, and how she believed the mayor had grounds to fire the police chief because he provided that document to Roger with the alleged victim’s information.

Crystal Springs Mayor Sally Garland Credit: Crystal Springs website

Mayor Sally Garland confirmed she had a conversation with Florczak-Seeman about the police chief’s employment.

She said she reviews all complaints about city officials, and Garland said she goes to the department head to get a better understanding of the situation. If she determines there are potential grounds for termination, a hearing would be scheduled with the Board of Aldermen, and the group would vote on that decision.

Garland did not find grounds for termination, and Hemphill remains police chief.

A Strange Visit

The Hortons and Florczak-Seeman hadn’t given much thought about the 2023 arrest, until weeks ago when a teenaged girl suddenly showed up in Florczak-Seeman’s yard.

At the end of September at the North Jackson Street home, Florczak-Seeman heard screaming and found the teenage girl who came onto her property. She asked what was wrong, and the teenager said she was chased by a dog, which Florczak-Seeman and Rhonda Horton did not see.

The teenager asked for a soda, and Rhonda Horton went inside to get one. Florczak-Seeman asked where the teenager lived, and she gave an answer that Florczak-Seeman said conflicted with what two girls who were standing nearby on the public sidewalk said she told them.

Then Florczak-Seeman asked the teenager’s name and recognized it as the name of the alleged victim on Horton’s arrest record. Immediately, Florczak-Seeman said she turned to Horton and told him to stay back, and she told the teenager to get off her property, which she did.

At the moment, they were not able to verify whether the teenager was the alleged victim from the report. Neither the Hortons nor Florczak-Seeman had seen her before, and they only knew her name from the arrest report.

“That didn’t make sense at all,” Rhonda Horton told Mississippi Today.

Florczak-Seeman called 911 to report the situation and ask for police to come, which they did not. Hemphill told Mississippi Today a dispatcher informed him about the call with Florczak-Seeman, including details with the teenage girl and how she wanted to report the girl for trespassing.

Florczak-Seeman is one of the people who have noticed a difference in Horton’s vision. It’s clear when comparing the detailed and clean paint job Roger completed at her Jackson Street property in 2019 and the center where he painted last year.

During an interview at the center in October, Florczak-Seeman pointed to the ceiling and noted spots that Horton did not paint. She remembers telling him about them and realized that he couldn’t see them.

“The spots on my ceiling are still not painted, and they’re not painted as a reminder of the injustices that happened in this situation and why I got involved,” Florczak-Seeman said.

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

Mississippi Today

Job opening: Jackson Reporter

Published

2 days ago

November 22, 2024

Staff Editor

mississippitoday.org – Mississippi Today – 2024-11-22 15:00:00

Mississippi Today, a Pulitzer Prize-winning newsroom focused on investigative and accountability journalism, is building a dedicated team of reporters to provide in-depth coverage of Jackson, Mississippi.

As the state’s largest and capital city, Jackson matters greatly to us and all Mississippians. Launched in 2016 as the state’s flagship nonprofit newsroom focused on Mississippi government and policy, Mississippi Today is focusing our lens beyond the statehouse and to the city of Jackson, serving our readers with the watchdog reporting they’ve come to expect from Mississippi Today. Our newsroom, with a proven record of providing impactful government accountability, aims to serve the city more directly with this team.

Our Jackson team will focus on sharp investigative reporting, watchdog accountability journalism and meaningful cultural storytelling. We aim to both elevate the voices of those working for positive change in the community while offering a balanced perspective on the city’s obstacles and triumphs. Our goal is to deliver impactful, honest journalism that will inform, inspire and empower Jackson’s citizens.

The team will be led by Pulitzer Prize winner Anna Wolfe, an investigative reporter with a decade of experience covering Jackson.

Roles and Responsibilities:

We are purposefully casting a wide net, hoping to connect with journalists of many different backgrounds who may be uniquely qualified to help us launch this team. If you’re a reporter with any of the following experience or attributes, this team may be for you.
Investigative reporting focused on uncovering systemic issues within government and politics. The bigger the impact of your reporting on government leaders or systems, the better.
Political reporting covering not only high-profile candidates for offices, but experience delving into issues and ideas that affect a community. We hope to delve deeply into a deep distrust in the city’s institutions.
Cultural reporting that highlights the often-overlooked success stories of citizens who are making a positive impact on their communities.
Strong understanding of Jackson (or similar large urban centers) and the unique challenges facing the city and its residents.
Commitment to the mission of balanced, impactful journalism that centers and respects the voice of the community.
Collaborative mindset and ability to work within a team-oriented newsroom.

The starting salary for this position is $58,000. Compensation is commensurate with experience level.

Expectations:

Work with a small team of journalists who are focused on social inequities and racial equality in our area.
Willingness to collaborate closely with a small team of like-minded journalists.
Get people to talk, find willing sources and protect them while telling sensitive and timely stories.
Build trust: Many people who have been impacted by inequities in Mississippi have been victims of predatory practices and forces. This will require empathy, patience and savvy.
Work with our Audience Team and data and visual journalists to create compelling story presentations.

Qualified candidates should have:

Experience working as a reporter in a newsroom.
Ability to work quickly, with accuracy and good news judgment.
Comfortability in digital or multimedia journalism spaces.
Ability to independently develop and cultivate sources.
Ability to use social media for research and to engage readers.

What you’ll get:

The opportunity to work alongside award-winning journalists and make significant contributions to Mississippi’s top nonprofit, nonpartisan digital news and information sources.
Highly competitive salary with medical insurance, and options for vision and dental insurance.
Use of appropriate technology and equipment.
29 days paid time off.
Up to 12 weeks of parental family leave, with return-to-work flexibility.
Simple IRA with 3 percent company matching. Group-term life insurance provided to employees ($15,000 policy).
Support for professional training and attending industry conferences.

How to Apply:

We’re committed to building an inclusive newsroom that represents the people and communities we serve. We especially encourage members of traditionally underrepresented communities to apply for this position, including women, people of color, LGBTQ people and people who are differently abled. Please apply here.

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