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State’s first family medicine obstetrics fellowship hopes to increase access to maternal care in rural areas

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The state’s first fellowship to train family physicians to care for pregnant and postpartum women is poised to start next July.

The proposed fellowship will train two to three family physicians a year in obstetrics, which the medical community hopes will provide rural and underserved areas with prenatal, delivery and postpartum care.

More than half of Mississippi’s counties are considered maternity care deserts, meaning there are no practicing OB-GYNs and no hospitals that deliver babies. For family physicians looking to practice obstetrics, the lack of training programs and difficulty getting affordable malpractice insurance coverage are challenging.

Aside from two hospitals that have been able to cut through the red tape and use family physicians in maternal care, nearly all pregnancies are handled by OB-GYNs, who are in short supply in Mississippi and mostly practice in urban areas. 

The state is an outlier when it comes to how little it uses family physicians in obstetrics. Across the country, family physicians play a significant role in providing obstetric care to expectant mothers. Neighboring Alabama, for instance, boasts five fellowships in obstetrics for family physicians.

Family physicians deliver babies in more than 40% of U.S. counties, and “are the sole maternity care clinicians delivering babies in 181 (maternity care deserts) … serving more than 400,000 women” nationwide, according to a report by the American Academy of Family Physicians.

Dr. James Lee Valentine and Dr. Melissa Stephens of EC Health Net, a family medicine residency program in Meridian, are designing the new one-year training program to focus on increasing access to rural maternal care.

“The fellowship will train family physicians to be able to go into some of our rural, underserved communities, and provide obstetric care for these women close to home, who may have limited access and are facing challenges,” Stephens said.

University of Mississippi Medical Center is home to the only OB-GYN residency in the state, which graduates five or six residents each year. Of those, an average of two residents remain and practice in Mississippi.

On the other hand, a record 37 family physicians graduated in 2023 from residencies in Mississippi – more than any year in the past five years, according to the Office of Mississippi Physician Workforce.

Meanwhile, the state’s maternal and infant mortality rates are worsening. Valentine and Stephens see the fellowship as one way to combat that.

 “These patients sometimes don’t get any (prenatal care) and they show up in the emergency room, delivering … that’s got to change,” Valentine said. “And I’m not saying that we ought to put family practice doctors out there doing all kinds of GYN surgeries and all that, but we got to deliver better prenatal care to our patients in the rural areas.”

The fellowship will set physicians up on three-month rotations between EC Health Net in Meridian, South Sunflower Hospital in Indianola, and Wayne General Hospital in Waynesboro. Valentine and Stephens hope to also add a stint at a larger hospital studying gynecological surgeries.

South Sunflower and Wayne General are the only two hospitals in the state currently using family medicine OBs, despite the bureaucratic challenges. The family physician OBs at these two hospitals are attending the majority of births in their counties.

Dr. Kelvin Sherman, the only practicing family medicine OB at Wayne General, delivers between 180 and 280 babies a year from Wayne County and some neighboring counties. In 2022, 256 babies were born in Wayne County, which has no practicing OB-GYN, alone.

Sherman, who did his obstetrics fellowship in Alabama, said in his experience, women who are farther from obstetrical care tend not to seek help when experiencing symptoms because they can’t justify the long drive or using the county’s only ambulance. Having a family doctor nearby can make a huge difference in pregnancy outcomes.

“If they’ve got some place to go that’s 15 minutes away, then maybe they go get something checked on and find out that ‘Yeah, you are in preterm labor, but it’s early and we can stop it, and we can prolong your pregnancy and you can have a healthier baby – a baby that goes home with you rather than having to deliver early a small baby that ends up in the NICU that stays sick a lot in the first few years of life,’” he explained. 

Sherman is breaking ground not only as one of the state’s only family medicine OBs, but also by working closely with a certified nurse midwife, a rarity in Mississippi – a state with no certified midwife program. Opening the doors to certified midwives could increase the amount of care available to women.

Advanced nurse practitioners are also qualified to give prenatal care. But in Mississippi, restrictive and expensive collaboration agreements limit the care nurse practitioners can provide

Sherman’s partnership with the certified nurse midwife is the kind that Wayne General CEO Andrew Porter hopes the new fellowship will facilitate.

“The FMOB (a family medicine physician who practices obstetrics) can really be a multiplier,” Porter said. “They can be the captain of a ship that has these other providers working under them and it just multiplies the amount of care that can be provided to patients.”

South Sunflower in Indianola has three family physician OBs on staff who average about 250 births a year in a county that had 263 live births in 2022.

Courtney Phillips, CEO of South Sunflower Hospital, poses for a portrait at South Sunflower County Hospital in Indianola, Miss., Friday, Oct. 20, 2023. Credit: Eric J. Shelton/Mississippi Today

The hospital has been using the family medicine OB model since it opened in the 1930s, according to hospital CEO Courtney Phillips. It’s a lifeline today, where the next closest hospital is 30 miles away, and even there, there aren’t enough OB-GYNs to take care of all the deliveries.

“So, even though the next closest hospital to deliver is 30 miles away, they may have to travel all the way to Grenada if we weren’t here, which is close to 80 miles away,” Phillips explained. 

The family medicine obstetrics model is used sparsely because while family physicians receive an unrestricted license to practice medicine, the problem lies in getting insurance and privileges at a hospital.

 “There’s a big difference between licensure and credentials,” Stephens, a family medicine physician at EC Health Net in Meridian, said.

While the licensure board allows physicians to practice according to their training without restriction, physicians also need to apply for malpractice insurance coverage, which requires proving competence to the malpractice carrier, and then proving competence to get credentialed by the hospital they are joining. Both became difficult in Mississippi after the explosion of liability insurance costs in the 1990s.

Medical liability premiums skyrocketed across the U.S. at the turn of the century, but particularly in Mississippi – known by 2001 as the “lawsuit capital of the world,” according to a 2011 case study by the American College of Obstetricians and Gynecologists – and affected physicians’ ability to practice specialties like obstetrics or neurosurgery. Mississippi was “perhaps the hardest hit of the ‘red alert states,’” a term used to denote high medical liability regions, the case study said. 

Valentine, who worked in obstetrics throughout the 1980s and had proven his competency to the board through documentation of all the procedures he performed and deliveries he attended, suddenly couldn’t afford his malpractice insurance premium when what he refers to as the “malpractice crisis” hit. 

“My malpractice insurance went up about 180% premium-wise in a year’s time,” he said. “I couldn’t justify losing money to practice OB, and then take the risk on top of that. It was almost like they were trying to push us out.”

As it stands, Mississippi family physicians interested in obstetrics have few options: pursue an official training program in another state – which often results in those physicians deciding to either leave the state altogether or stay in the state and forego obstetrics – or train unofficially in Mississippi but without the guarantee of affordable malpractice insurance or a hospital that will grant them privileges.

South Sunflower Hospital in Indianola, Miss., Friday, Oct. 20, 2023. Credit: Eric J. Shelton/Mississippi Today

South Sunflower, according to Valentine, is able to utilize family physicians in obstetrics affordably because of its highly regarded staff that helps them get coverage and credentials.

“Places like Indianola, they have a track record,” he said. “Dr. Wade Dowell has been … a champion for family medicine, doing OB and doing general family medicine for years, and so he’s got a track record, and the doctors he’s trained there – they do a good job.”

Valentine and Stephens hope the new fellowship will offer a similar standard that will help family physicians receive credentials and coverage in obstetrics at an affordable rate – though it’s never a guarantee.

“Whether every hospital in the state of Mississippi will recognize that, whether every hospital will open their doors, I don’t know,” said Valentine. “But from the standpoint of being qualified … we want to make sure that our fellowship is substantial enough that when they leave our fellowship, whether it’s one year or two years, they’re ready to practice obstetrics at the level they’re trained to do that.”

The fellowship is one proposed solution to changing the maternal health landscape of Mississippi. But experts believe programs like it are critical in shifting the pendulum.

“It’s not going to be a cure-all for some of the obstetrics needs, and issues like infant mortality, but it’s a step,” Porter, the Wayne General CEO, said. “It’s people who are acknowledging that we have a crisis here in the state and are trying to do something about it. Here in Waynesboro, Mississippi, and the surrounding area of Meridian, and those in the Delta, we're trying to take the matter into our own hands and come up with some solutions.”

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

Mississippi Today

Early voting proposal killed on last day of Mississippi legislative session

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mississippitoday.org – @MSTODAYnews – 2025-04-03 13:02:00

Mississippi will remain one of only three states without no-excuse early voting or no-excuse absentee voting. 

Senate leaders, on the last day of their regular 2025 session, decided not to send a bill to Gov. Tate Reeves that would have expanded pre-Election Day voting options. The governor has been vocally opposed to early voting in Mississippi, and would likely have vetoed the measure.

The House and Senate this week overwhelmingly voted for legislation that established a watered-down version of early voting. The proposal would have required voters to go to a circuit clerk’s office and verify their identity with a photo ID. 

The proposal also listed broad excuses that would have allowed many voters an opportunity to cast early ballots. 

The measure passed the House unanimously and the Senate approved it 42-7. However, Sen. Jeff Tate, a Republican from Meridian who strongly opposes early voting, held the bill on a procedural motion. 

Senate Elections Chairman Jeremy England chose not to dispose of Tate’s motion on Thursday morning, the last day the Senate was in session. This killed the bill and prevented it from going to the governor. 

England, a Republican from Vancleave, told reporters he decided to kill the legislation because he believed some of its language needed tweaking. 

The other reality is that Republican Gov. Tate Reeves strongly opposes early voting proposals and even attacked England on social media for advancing the proposal out of the Senate chamber. 

England said he received word “through some sources” that Reeves would veto the measure.

“I’m not done working on it, though,” England said. 

Although Mississippi does not have no-excuse early voting or no-excuse absentee voting, it does have absentee voting. 

To vote by absentee, a voter must meet one of around a dozen legal excuses, such as temporarily living outside of their county or being over 65. Mississippi law doesn’t allow people to vote by absentee purely out of convenience or choice. 

Several conservative states, such as Texas, Louisiana, Arkansas and Florida, have an in-person early voting system. The Republican National Committee in 2023 urged Republican voters to cast an early ballot in states that have early voting procedures. 

Yet some Republican leaders in Mississippi have ardently opposed early voting legislation over concerns that it undermines election security. 

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

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Mississippi Legislature approves DEI ban after heated debate

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mississippitoday.org – @MSTODAYnews – 2025-04-02 16:34:00

Mississippi lawmakers have reached an agreement to ban diversity, equity and inclusion programs and a list of “divisive concepts” from public schools across the state education system, following the lead of numerous other Republican-controlled states and President Donald Trump’s administration.  

House and Senate lawmakers approved a compromise bill in votes on Tuesday and Wednesday. It will likely head to Republican Gov. Tate Reeves for his signature after it clears a procedural motion.

The agreement between the Republican-dominated chambers followed hours of heated debate in which Democrats, almost all of whom are Black, excoriated the legislation as a setback in the long struggle to make Mississippi a fairer place for minorities. They also said the bill could bog universities down with costly legal fights and erode academic freedom.

Democratic Rep. Bryant Clark, who seldom addresses the entire House chamber from the podium during debates, rose to speak out against the bill on Tuesday. He is the son of the late Robert Clark, the first Black Mississippian elected to the state Legislature since the 1800s and the first Black Mississippian to serve as speaker pro tempore and preside over the House chamber since Reconstruction.

“We are better than this, and all of you know that we don’t need this with Mississippi history,” Clark said. “We should be the ones that say, ‘listen, we may be from Mississippi, we may have a dark past, but you know what, we’re going to be the first to stand up this time and say there is nothing wrong with DEI.'”

Legislative Republicans argued that the measure — which will apply to all public schools from the K-12 level through universities — will elevate merit in education and remove a list of so-called “divisive concepts” from academic settings. More broadly, conservative critics of DEI say the programs divide people into categories of victims and oppressors and infuse left-wing ideology into campus life.

“We are a diverse state. Nowhere in here are we trying to wipe that out,” said Republican Sen. Tyler McCaughn, one of the bill’s authors. “We’re just trying to change the focus back to that of excellence.”

The House and Senate initially passed proposals that differed in who they would impact, what activities they would regulate and how they aim to reshape the inner workings of the state’s education system. Some House leaders wanted the bill to be “semi-vague” in its language and wanted to create a process for withholding state funds based on complaints that almost anyone could lodge. The Senate wanted to pair a DEI ban with a task force to study inefficiencies in the higher education system, a provision the upper chamber later agreed to scrap.

The concepts that will be rooted out from curricula include the idea that gender identity can be a “subjective sense of self, disconnected from biological reality.” The move reflects another effort to align with the Trump administration, which has declared via executive order that there are only two sexes.

The House and Senate disagreed on how to enforce the measure but ultimately settled on an agreement that would empower students, parents of minor students, faculty members and contractors to sue schools for violating the law.

People could only sue after they go through an internal campus review process and a 25-day period when schools could fix the alleged violation. Republican Rep. Joey Hood, one of the House negotiators, said that was a compromise between the chambers. The House wanted to make it possible for almost anyone to file lawsuits over the DEI ban, while Senate negotiators initially bristled at the idea of fast-tracking internal campus disputes to the legal system.   

The House ultimately held firm in its position to create a private cause of action, or the right to sue, but it agreed to give schools the ability to conduct an investigative process and potentially resolve the alleged violation before letting people sue in chancery courts.

“You have to go through the administrative process,” said Republican Sen. Nicole Boyd, one of the bill’s lead authors. “Because the whole idea is that, if there is a violation, the school needs to cure the violation. That’s what the purpose is. It’s not to create litigation, it’s to cure violations.” 

If people disagree with the findings from that process, they could also ask the attorney general’s office to sue on their behalf.

Under the new law, Mississippi could withhold state funds from schools that don’t comply. Schools would be required to compile reports on all complaints filed in response to the new law.

Trump promised in his 2024 campaign to eliminate DEI in the federal government. One of the first executive orders he signed did that. Some Mississippi lawmakers introduced bills in the 2024 session to restrict DEI, but the proposals never made it out of committee. With the national headwinds at their backs and several other laws in Republican-led states to use as models, Mississippi lawmakers made plans to introduce anti-DEI legislation.

The policy debate also unfolded amid the early stages of a potential Republican primary matchup in the 2027 governor’s race between State Auditor Shad White and Lt. Gov. Delbert Hosemann. White, who has been one of the state’s loudest advocates for banning DEI, had branded Hosemann in the months before the 2025 session “DEI Delbert,” claiming the Senate leader has stood in the way of DEI restrictions passing the Legislature. 

During the first Senate floor debate over the chamber’s DEI legislation during this year’s legislative session, Hosemann seemed to be conscious of these political attacks. He walked over to staff members and asked how many people were watching the debate live on YouTube. 

As the DEI debate cleared one of its final hurdles Wednesday afternoon, the House and Senate remained at loggerheads over the state budget amid Republican infighting. It appeared likely the Legislature would end its session Wednesday or Thursday without passing a $7 billion budget to fund state agencies, potentially threatening a government shutdown.

“It is my understanding that we don’t have a budget and will likely leave here without a budget. But this piece of legislation …which I don’t think remedies any of Mississippi’s issues, this has become one of the top priorities that we had to get done,” said Democratic Sen. Rod Hickman. “I just want to say, if we put that much work into everything else we did, Mississippi might be a much better place.”

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

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House gives Senate 5 p.m. deadline to come to table, or legislative session ends with no state budget

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mississippitoday.org – @MSTODAYnews – 2025-04-02 16:13:00

The House on Wednesday attempted one final time to revive negotiations between it and the Senate over passing a state budget.

Otherwise, the two Republican-led chambers will likely end their session without funding government services for the next fiscal year and potentially jeopardize state agencies.

The House on Wednesday unanimously passed a measure to extend the legislative session and revive budget bills that had died on legislative deadlines last weekend. 

House Speaker Jason White said he did not have any prior commitment that the Senate would agree to the proposal, but he wanted to extend one last offer to pass the budget. White, a Republican from West, said if he did not hear from the Senate by 5 p.m. on Wednesday, his chamber would end its regular session. 

“The ball is in their court,” White said of the Senate. “Every indication has been that they would not agree to extend the deadlines for purposes of doing the budget. I don’t know why that is. We did it last year, and we’ve done it most years.” 

But it did not appear likely Wednesday afternoon that the Senate would comply.

The Mississippi Legislature has not left Jackson without setting at least most of the state budget since 2009, when then Gov. Haley Barbour had to force them back to set one to avoid a government shutdown.

The House measure to extend the session is now before the Senate for consideration. To pass, it would require a two-thirds majority vote of senators. But that might prove impossible. Numerous senators on both sides of the aisle vowed to vote against extending the current session, and Lt. Gov. Delbert Hosemann who oversees the chamber said such an extension likely couldn’t pass. 

Senate leadership seemed surprised at the news that the House passed the resolution to negotiate a budget, and several senators earlier on Wednesday made passing references to ending the session without passing a budget. 

“We’ll look at it after it passes the full House,” Senate President Pro Tempore Dean Kirby said. 

The House and Senate, each having a Republican supermajority, have fought over many issues since the legislative session began early January.

But the battle over a tax overhaul plan, including elimination of the state individual income tax, appeared to cause a major rift. Lawmakers did pass a tax overhaul, which the governor has signed into law, but Senate leaders cried foul over how it passed, with the House seizing on typos in the Senate’s proposal that accidentally resembled the House’s more aggressive elimination plan.

The Senate had urged caution in eliminating the income tax, and had economic growth triggers that would have likely phased in the elimination over many years. But the typos essentially negated the triggers, and the House and governor ran with it.

The two chambers have also recently fought over the budget. White said he communicated directly with Senate leaders that the House would stand firm on not passing a budget late in the session. 

But Senate leaders said they had trouble getting the House to meet with them to haggle out the final budget. 

On the normally scheduled “conference weekend” with a deadline to agree to a budget last Saturday, the House did not show, taking the weekend off. This angered Hosemann and the Senate. All the budget bills died, requiring a vote to extend the session, or the governor forcing them into a special session.

If the Legislature ends its regular session without adopting a budget, the only option to fund state agencies before their budgets expire on June 30 is for Gov. Tate Reeves to call lawmakers back into a special session later. 

“There really isn’t any other option (than the governor calling a special session),” Lt. Gov. Delbert Hosemann previously said. 

If Reeves calls a special session, he gets to set the Legislature’s agenda. A special session call gives an otherwise constitutionally weak Mississippi governor more power over the Legislature. 

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

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