In last ditch effort to stay open, Holly Springs hospital ends inpatient care
Alliance Healthcare System in Holly Springs is Mississippi’s first rural emergency hospital – the first in a trend some say indicates the further decline of health care access in the one of the country’s poorest and sickest states.
Hospitals were able to apply for the new federal designation mere weeks ago, when the Mississippi Department of Health rolled out its rules for “rural emergency hospitals.” The federal government finalized the program in November.
Rural emergency hospitals are a step below critical access hospitals, which must have 25 or fewer inpatient beds, provide emergency services, keep its patients for less than 96 hours and be located at least 35 miles from another hospital.
The resources at rural emergency hospitals are even fewer — they must end all inpatient care and transfer patients to larger hospitals within 24 hours of the patient coming to the emergency room.
The hospital has already begun getting rid of all its inpatient beds and discharging current patients, as reported by the South Reporter, Marshall County’s community newspaper, on Wednesday. The acute care center is currently licensed for 40 beds, though its daily census doesn’t go much higher than four or five patients a day, according to hospital CEO Dr. Kenneth Williams.
The hospital has partnered with North Mississippi Medical Center and will transfer its patients there if necessary, he said.
He also said Alliance is one of just a handful of hospitals across the country approved for the designation so far.
As of Thursday, spokespeople from the state Department of Health said Alliance’s new hospital designation hadn’t been approved by the Centers for Medicare and Medicaid Services. But according to Williams, it had been approved by both required parties, CMS and the state Health Department, on Wednesday.
“I haven’t even had a chance to share this with my staff,” he said Thursday. “Yesterday was an exciting day for me to have that designation. I’m looking forward to the future to see how it works out.”
Rural emergency hospitals also can’t provide swing bed services, which means if a hospital operates a nursing home, that has to close. Alliance does not operate a nursing home.
Both rural emergency and critical access hospital designations are meant to ease financial stress — if a hospital qualifies as either, in exchange, they get paid more for their services. Rural emergency hospitals also get monthly payments from the federal government.
The program is aimed at preventing the closure of rural hospitals and creating a way they can increase financial viability and maintain operations. The idea is that rural hospitals at risk of closure already struggle with low patient counts and low payments for inpatient care.
But it’s meant as a last resort for hospitals that are barely surviving because of the limited amount of services a rural emergency hospital can offer.
State Health Officer Dr. Dan Edney considers it a closure when a hospital converts to an REH because of the loss of services. He tweeted in early February about the state’s first “loss” of a hospital, which is around the time Alliance applied for the designation with the Centers for Medicare and Medicaid Services and the Mississippi Department of Health. He compared rural emergency hospitals to triage units.
Williams, on the other hand, sees them as “expanded outpatient hospital systems.”
Rep. John Faulkner, a Democrat who represents Holly Springs, was not immediately available for comment Friday morning.
Williams bought the hospital two decades ago when he heard it was struggling. During its first years under Williams, he said the hospital was making money. Then in 2006, it lost almost $2 million with the arrival of Medicare Advantage plans, which are privatized versions of Medicare that often deny needed care and underpay hospitals.
Holly Springs is a certified retirement community, which means most of the hospital’s patients are on Medicare.
They’ve had good years and bad years since, but it’s been mostly downhill, especially since the pandemic began.
“I knew that our hospital couldn’t exist under the payment system it is under right now,” Williams said.
A little more than a decade ago, Alliance tried applying to become a critical access hospital. They were rejected because of the hospital’s proximity to Memphis.
Now, Williams says the federal rules are a little more relaxed, and he decided to apply at the recommendation of his partner, Quentin Whitwell, who operates hospitals in north Mississippi and serves as legal counsel for Alliance Healthcare, and the hospital’s financial team.
“With REH, the robust outpatient services the clinic brings to the community will be enhanced, along with continued 24/7 coverage, and the costly services will be reduced while receiving an annual subsidy,” Whitwell said when reached by text Thursday. “We are glad it worked out.”
Few Mississippi hospitals are making money, especially in the state’s more rural regions. The problem is multifaceted, but experts say the crisis has resulted from a combination of state leaders’ refusal to expand Medicaid, insurance companies’ low reimbursement rates and the pandemic forcing costs up in all areas, including staffing.
“The funding of health care in rural America is going down,” Edney previously told Mississippi Today in an interview. “There is no one coming to the rescue.”
Williams said many of the challenges hospitals are facing lead back to insurance payments and managed care plans, like Medicare Advantage.
He could’ve closed the hospital back in 2012, Williams said, when it first applied for critical access status, but he’s done everything he can to keep it open, including some layoffs and reorganizing their staff.
But at some point, “you cut muscle instead of fat,” Williams said.
One report from the Center for Healthcare Quality and Payment Reform puts a third of rural Mississippi hospitals at risk of closure, and half of those within a few years.
“Too many small rural hospitals are closing,” Williams said. “Big hospitals are struggling, whether or not they admit it, but you can get by if you’re doing high-end procedures.
“But just to take care of a regular patient who has congestive heart failure, with diabetic ketoacidosis, who is sick, they (insurance companies) don’t want to pay you for it.”
According to data from the CHQPR, Alliance Health has been losing money for the past few years, both overall and specifically taking care of patients.
And just in case the rural emergency hospital structure doesn’t work, Alliance is still applying for the critical access designation, too. If the new designation doesn’t stabilize the hospital, it can revert to its original status as an acute care facility or, if it is approved for the critical access hospital designation, it can convert to that, instead.
“Would I prefer to have us continue to operate the way that we were, having patients be admitted? Absolutely,” Williams said. “It is unfortunate that we had to make this move, but it is the right move based on the reality of health care and this payment system.”
According to Edney, Mississippi can likely expect more conversions to rural emergency hospitals – or, as he refers to them, “closures” – in the coming months.
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‘Out to get Jackson’: Bill to create separate courts, police for part of capital city advances over protest
Legislation that has brought hours of bitter debate, has inspired broad negative national attention and has racially divided the Mississippi Legislature about its capital city of Jackson took a penultimate step towards reaching the governor’s desk Thursday night.
The Senate passed House Bill 1020, which would create separate, appointed courts for downtown and more affluent, whiter parts of Jackson — the Blackest large city in the nation. The Senate also passed a companion measure that will expand state police jurisdiction in the city.
The vote, over objections from the Jackson legislative delegation and every Black senator, was 31-15. The measure will be taken up by the House, where it is expected to pass, on Friday, likely the last day of the 2023 legislative session. If passed in the House, the measure will reach Gov. Tate Reeves’ desk for signature or veto.
If it becomes law, judges for this area will be appointed by the Mississippi Supreme Court chief justice, not elected like everywhere else in Mississippi. People who call for help there will reach a separate 9-1-1 system for the state-run Capitol Police. Those arrested there, even for misdemeanor crimes such as DUI, will be held in a state prison, not a city or county lockup.
White, Republican legislative leaders say they’re fed up with crime in the capital city and are trying to help. City and legislative leaders from Jackson say it’s an unconstitutional state takeover that smacks of Jim Crow separate-but-equal governance.
READ MORE: House revives state police expansion and bitter fight over Jackson ‘takeover’
Weeks of haggling between House and Senate leaders and changes to the measures — including making the separate circuit and municipal-type court systems temporary through 2026 and 2027 — did little to allay opposition.
“It’s almost as if folks resent Jackson — politically, economically, socially, racially — and we’ve been out to get Jackson,” said Sen. John Horhn, D-Jackson. “That’s what it feels like, in this Legislature, like we’re out to get Jackson. It’s not that we see a problem and we’ve got to help our capital city. It’s almost as if we’re doing everything we can to ensure it fails and gets flushed down the Pearl River.
“… State government has basically left Jackson to its own devices for many years now,” Horhn continued. “… You take as much of the resources as you can out of the city, and then you blame us when things go wrong … We will not be a great state if we don’t have a great city. We will not be a great state if we don’t have a great capital city, and we will not be a great state if Black folks and white folks don’t learn to get along and do things for our mutual benefit.”
Some lawmakers questioned the legality and constitutionality of the measures.
“There will be two systems of justice for people in Jackson,” said Sen. David Blount, D-Jackson. “If you’re in this neighborhood, you have one type of justice. If you’re in this neighborhood, you have this type. It’s fundamentally un-American and unconstitutional. Not only do you have a different kind of justice, people in this part of town have one 9-1-1 system. People in this part have this 9-1-1 system. How is that equal protection under the law? We have almost completely segregated politics in Mississippi right now, let’s be honest.”
Senate Judiciary Chairman Brice Wiggins, R-Pascagoula, helped haggle out a final version of HB 1020 and argued for its passage. He told his colleagues about inviting two women from New Mexico to come appear before his committee a couple of years ago. He said they stayed in a downtown Jackson hotel the night before the meeting.
“They said they were scared to walk to the Capitol,” Wiggins said. “… I could see it in their faces. They thought they were going to be harmed. They had to take a cab. They couldn’t walk downtown to the Capitol.”
“This is not about race,” Wiggins said. “This is about helping the citizens of Jackson … We have to stop the divisive race baiting when all we are trying to do is help our fellow Mississippians.”
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State board names interim superintendent a day after Senate rejection of Robert Taylor
The State Board of Education has named Mike Kent to serve as interim state superintendent for the next three months after the Legislature rejected Robert Taylor, whom the state board originally selected last November.
Taylor, a Mississippi native, had worked in North Carolina public schools in various positions since 1992. He was on the job for just over two months before the Legislature rejected his nomination on Wednesday.
The state superintendent oversees Mississippi’s 870 public schools and is appointed by the Board of Education. Kent will serve in the role through June 30 before a long-term interim superintendent will take over, according to a press release. The board will set a timeline for a search for a permanent superintendent at a later date, according to the release.
Kent has served as an interim deputy superintendent at the Mississippi Department of Education since 2012, working on leadership training for principals and superintendents, overseeing districts currently in state takeover, facilitating school district consolidations, and implementing changes to the accountability model. Prior to this role, he was the superintendent of the Madison County School District for over 10 years.
“Mike Kent has deep roots and experience in Mississippi’s public school system at the state and district level and is respected throughout the state for his wisdom and effective leadership,” Rosemary Aultman, chair of the State Board of Education said in a statement. “The Board is confident he will provide continuity in leadership of the Mississippi Department of Education during this transition.”
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Lawmakers appropriate extra $620 million for roads as they work to finish budget
Mississippians over the next two years could see a boom in new major road projects after lawmakers agreed to give the Mississippi Department of Transportation an extra $620 million Thursday as legislators worked to finish budget work and end the 2023 session.
For two decades, lack of funding and rising repair costs have forced MDOT to focus mostly on maintenance instead of new projects or major expansions. But under a measure originally offered by the Senate, $450 million over the next two years will go to traffic “capacity” projects to build or expand major thoroughfares that have been on MDOT’s planning list for years.
The agreement also earmarks $100 million for the state’s Emergency Road and Bridge Repair program to help local governments with roads and bridges that have fallen into disrepair. It provides $40 million to MDOT to match federal dollars and provides $30 million for “multi-modal” projects, including $10 million for work at state ports.
Senate Transportation Chairwoman Jennifer Branning, R-Philadelphia, noted that even more road funding is included in other bills passed in the final hours of the legislative session. She said the long-deferred capacity expansion projects are crucial.
“I am really pleased with this focus on infrastructure,” Branning said. “Expansion with these projects is critical. Moving freight and goods is so critical to the success of our state.”
Late in the legislative session, Gov. Tate Reeves held a press conference and called on lawmakers to earmark $1.3 billion for road work, and essentially let him choose which projects to build. Legislative leaders, who were already discussing increased infrastructure spending, viewed it as an election-year campaign move for the TV cameras.
Senate Appropriations Chairman Briggs Hopson said MDOT told him the increased funding “is about all they can handle for right now” to manage large projects. But he said he hopes the Legislature can continue with increased road funding next year.
The funds for highway fund were part of the overall deal legislative leaders reached late Wednesday. The plan was for the Legislature to vote on that agreement Thursday and perhaps end the session. But legislators will be returning for at least Friday.
Despite that, House Speaker Philip Gunn said, “the budget is on track.”
Gunn said it just takes time to write, print and proofread the budget bills. So, instead of waiting until late on Thursday night to take up those bills, lawmakers opted to come back Friday. It is possible that legislators also will have to work Saturday.
The largest budget bill still pending if the approximately $2.8 billion appropriation for kindergarten through 12th grade education. Reaching agreement on that bill has delayed for almost a week an overall budget deal. But Gunn said the deal reached Thursday placing an additional $100 million in the public education classrooms is still in place.
READ MORE: Mississippi lawmakers resolve impasse over K-12 spending
Among the bills passing both chambers Thursday was a proposal to earmark $71 million in federal COVID-19 relief funds for infrastructure improvements for rural water associations. The legislation marks the second consecutive year legislators designated federal COVID-19 relief funds for rural water associations.
There also are some general bills pending for legislators to consider as the session wraps up.
Legislators are working with an unprecedented amount of revenue thanks in large part to COVID-19 relief funds that have poured into the state spurring the economy. Those funds are making it possible to increase funding for transportation, education and for other items.
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Department of Health will choose state’s next burn center, Legislature says
Finally, the Legislature has come to a conclusion about the state’s next burn center — and they’ve decided not to make a decision at all.
House Bill 1626, which details how much is appropriated to the Mississippi State Department of Health, passed both chambers on Thursday. The bill allocates $4 million toward the state’s next burn center and gives the state health department the responsibility of choosing the burn center’s home.
The move comes amid months of speculation about whether the state’s next accredited burn center would be housed at the University of Mississippi Medical Center or Baptist Medical Center. Both institutions are vying for public support to open their own.
The bill also includes an additional $1 million to the state’s burn care fund, which pays for uncompensated care for burn victims who receive care at Mississippi’s next burn center, as well as travel expenses to out-of-state burn facilities.
It’s the latest move in a series of approvals and reversals, months after the state’s last burn center shuttered. Merit Health Central in south Jackson closed the state’s only accredited burn center in October, citing challenges related to the pandemic and staffing.
Earlier this legislative session, bills to reestablish a burn center in Mississippi died. In February, the House Appropriations Committee approved awarding the University of Mississippi Medical Center $4 million to create a burn center.
Then, in a surprising reversal, the full House of Representatives voted to name Mississippi Baptist Medical Center — where the former medical director of the burn center at Merit Health Central practices — as the home of the state’s next burn center.
However, the bill died in the Senate because it was not passed by a key deadline. Lt. Gov. Delbert Hosemann, who presides over the Senate, said at the time that the issue could come up later in an appropriations bill.
Now, at the end of the session, lawmakers are washing their hands of making a decision at all.
Both Baptist Medical Center and UMMC have submitted applications for burn center designation to the state health department.
Mississippi Today previously reported that even though UMMC officials publicly said they were recently treating pediatric burns, internal emails revealed otherwise.
Spokespeople from the Mississippi Department of Health did not answer questions by press time.
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Fannie Lou Hamer’s last surviving child dies at 56
Jacqueline Hamer Flakes, the last living child of civil and voting rights advocate Fannie Lou Hamer, died this week and will be buried April 8 in Ruleville.
Flakes, who died March 27 at the age of 56 in her hometown of Ruleville, had been traveling and speaking about her mother’s legacy. She had just returned from an engagement at a museum in Seattle.
Flakes, who had been battling breast cancer, was admitted to North Sunflower Medical Center on March 24 after complaining of weakness.
Ruby McWilliams, who helped raise Flakes and her older sister, Lenora, after Hamer’s death, said in a news release that doctors sent her home on hospice and “friends and family were in and out to see her.”
Hamer and her husband Pap adopted Flakes, whom they nicknamed “Cookie”, and her sister Lenora, known as “Nook”, when their mother, Dorothy Jean, died in May 1967 of a cerebral hemorrhage six months after Flakes was born.
The Hamers had also adopted Dorothy Jean, Fannie Lou’s niece, when she was an infant and the then-6-month-old Virgie Lee 10 years later.
Hamer, who worked throughout the Deep South as a field secretary for the Student Nonviolent Coordinating Committee to help poor Black Mississippians register to vote, died of hypertension and breast cancer in 1977 and Pap Hamer died in 1992.
Flakes attended Ruleville High School and Mississippi Delta Community College. She worked as a relief dispatcher for the Ruleville Police Department and later the Sunflower County Sheriff’s Department. She moved to Michigan in 1997 where she also worked as a dispatcher. She returned to Ruleville in 2009 and in 2015 went to work at city hall as the water clerk, replacing her sister, Lenora who retired after 26 years. Lenora died in July 2019.
When Virgie Ree died in 2017, Flakes stepped in as spokesperson for her mother’s legacy. In 2021, she was interviewed for the documentary film, “Fannie Lou Hamer’s America”, produced by her cousin and Hamer’s niece, Monica Land. The following year, Flakes published a book about her mother, “Mama Fannie,” by Concierge Publishing Services.
In June, she spoke in Winona, where a historical marker was unveiled at the jail site where Hamer and several others, including two teenagers, were beaten in June 1963.
Flakes has two sons, Shadney and Trenton.
Visitation will be from 4-6 p.m. April 7 at Byers Funeral Home in Ruleville. Services will be at 2:30 p.m. April 8 at New Jerusalem Missionary Baptist Church with burial at Mount Galilee Cemetery, both in Ruleville.
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News outlets take court action opposing former governor’s effort to shield records
Mississippi Today and two other news outlets have allied to oppose former Gov. Phil Bryant’s effort to block the public from viewing emails and text messages that could shed new light on an ongoing investigation involving the misuse of federal welfare dollars.
In a Thursday filing in Hinds County Circuit Court, Mississippi Today, the Daily Journal, and the Mississippi Free Press have moved to protect the public’s right to access government records.
The news organizations, which are represented by the Mississippi Center for Justice and the Center for Constitutional Rights, want to argue before a court that documents relating to communications from Bryant’s time as governor should not be kept secret if they surface in the course of civil lawsuits that are ongoing over the welfare scandal.
“Although these records relate to one of the largest governmental abuses in this State’s recent memory, Bryant seeks to keep them hidden from the public,” argued the news organizations in Friday’s court filing. “The public in Mississippi has an interest in these records and what they could disclose about the scandal.”
READ MORE: The motion filed on behalf of the news outlets
In a joint statement, the editors of the news organizations said that the press has an obligation to fight on behalf of the public’s right to access government records and the correspondence of public officials.
“One of the basic duties of a free press is to hold public officials accountable and ensure that the government remains as open and transparent to the people it serves as possible. We are taking action in court as part of our ongoing efforts to get at the truth of one of the largest public scandals in our state’s history,” said Adam Ganucheau of Mississippi Today, Sam R. Hall of the Daily Journal and Donna Ladd of the Mississippi Free Press.
The state of Mississippi has sued numerous individuals and organizations in an effort to recover welfare funds that were allegedly misspent. Some of the targets of these civil lawsuits have also pleaded guilty in state and federal court to crimes linked to their use of public welfare dollars. None has served time to date.
Bryant has neither been charged criminally nor sued. Still, several defendants in lawsuits have asked him to turn over emails and text messages as part of an effort by those defendants to claim the former governor allegedly directed them to perform unlawful acts.
Bryant has denied these allegations and asked a judge to find that he doesn’t have to provide copies of text messages, emails, and other responsive records. Bryant has selectively released some of his own text messages in a court filing, but does not want to release more, as a pending subpoena could require him to do.
If Judge E. Faye Peterson does force the former governor to turn over more of his communications to the court, he has asked the judge to place them under a protective order that would block the public from examining the documents.
In Thursday’s motion, the three news organizations asked Peterson to allow them to present arguments in opposition to Bryant’s request for a protective order.
“Transparency is the path to meaningful accountability in a functioning democracy, and Mississippians are owed both,” said Vangela M. Wade, president and CEO of the Mississippi Center for Justice. “When reporting on this landmark case, our news outlets should not be prevented from reviewing relevant records created by elected officials while in office.”
Decades of state court cases have upheld the right of the press to step into ongoing litigation where matters of public access are in question, even when a news organization is not a party to that litigation.
Editor’s note: Vangela M. Wade, president and CEO of the Mississippi Center for Justice, is a member of Mississippi Today’s board of directors.
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