By Jerry Mitchell
Mississippi Center For Investigative Reporting
State cuts to the health care system over the past decade are costing lives now in the battle against a coronavirus pandemic, says the former chancellor over the University of Mississippi Medical Center.
“No question about it,” said Dr. Dan Jones, the Sanderson Chair in Obesity, Metabolic Diseases and Nutrition at the University of Mississippi Medical Center.
In 2013, the state Legislature rejected plans to expand Medicaid coverage to hundreds of thousands more Mississippians. Five rural hospitals have closed since then, and 42% of rural hospitals remain financially “vulnerable,” according to a study released in February.
In contrast, neighboring Arkansas expanded Medicaid funding and has seen one rural hospital close.
The Mississippi Legislature has also cut the state Department of Health, which had 2,358 employees at the end of 2012. By the end of last year, the department had declined to 1,812 — a loss of more than 500 employees.
In recent years, the department has shut down most of its regional offices and a number of its local health clinics across the state — a move the department attributed to low patient turnout.
“We must learn from this pandemic and be better prepared for a future epidemic crisis,” said Dr. Lucius Lampton, a family physician in Magnolia, who serves on the state Board of Health. “The first step is to better fund public health and rural health in our state. And not with bells and whistles but with just core public health and core hands-on medicine and hospital care.”
A spokeswoman for Gov. Tate Reeves did not respond to requests for comment.
Jones said in Mississippi, and across the nation, “we are going in the wrong direction. Small rural hospitals have closed. The number of beds in Mississippi have been reduced.”
Such reductions have consequences, he said. “On an ordinary day, that’s OK, but when a crisis comes, we just don’t have the surge capacity. The communities that used to have hospitals don’t have hospitals anymore.”
Those living in communities without immediate access to physicians may delay seeking care, he said. “There’s not the local doctor you trust. There’s not the local hospital you trust.”
Lampton echoed those concerns.
“The crisis in rural health care is chronic neglect and underfunding,” he said. “No one cares about saving our health infrastructure in a rural area until we need it. Rural physicians and hospitals care for the sickest of our patients and those most marginalized. We must do better as a state and nation.”
Many in the rural medical community feel like “we are the Polish cavalry having to battle German tanks,” he said.
And like those Polish forces, he said, Mississippi’s medical officials are no match.
In the data through April 9, black Mississippians, who make up 38% of the state’s population, are dying at about twice the rate as white Mississippians. Of the 82 COVID-19 deaths so far in the state, 67% have been African American and the remaining 33% white.
“Because of health disparities, COVID-19 is becoming a ‘black plague’ in Mississippi and elsewhere, especially for people of color,” said Dr. Rick deShazo, author of “The Racial Divide in American Medicine.”
Among Mississippi’s fatalities, six times more African Americans suffered from diabetes, three times more suffered from obesity, and twice as many suffered from cardiovascular disease, hypertension or renal disease.
Most of those being admitted to the intensive care unit at UMMC are requiring dialysis, which is in keeping with the early numbers from Seattle and Wuhan, China, which show that 50% to 75% of patients requiring intensive care need dialysis, said Dr. Javed Butler, chairman of UMMC’s Department of Medicine.
Of those that need dialysis, 70% won’t survive, he said.
Derrick Johnson, president and CEO of the NAACP, said these historical preexisting health issues and historical gaps of access to health care are playing key roles in the deaths.
He pointed out that many African Americans have jobs that won’t allow them to work from home. As a result, they come into contact with more people, unable to practice social distancing, he said.
Dr. Robert Smith of Jackson, who pioneered community health centers nationally, said the higher death rate for African Americans bears out why the centers were created in the first place.
The higher death rate also proves what he has believed and taught for so long. “When we get better care for black folks,” he said, “we get better care for all Americans.”
Moss Point, a predominantly African-American town of less than 14,000 on the Gulf Coast, has already seen five deaths — more than any other Mississippi town.
“Two of our community pillars have been lost,” Mayor Mario King said. “We’ve had a pastor’s wife and a pastor’s brother put on ventilators. We’re so thankful that they are both doing better, but it’s hitting everybody in Moss Point.”
The mayor would have attended funeral services, but there have yet to be any.
“Those who are dying are dying alone, and after dying alone, they are visited by the family alone in graveside services,” he said. “The people who love and care about them can’t say goodbye.”
He fears there will be more deaths. “It’s going to be more devastating in coming days, weeks and months,” he said. “It means our health system will need to bridge a lot of fear.”
Even before COVID-19 struck their town, those in the city where nearly a quarter of the population lives in poverty died at much higher rates for cancer, renal failure, and heart disease and failure, he said.
Refusing to expand Medicaid to help treat the poor is at best irresponsible, he said. “At its worst, we are killing our own people.”
Last year, the American Heart Association reported that counties where states expanded Medicaid saw a lower cardiovascular mortality rate compared to places that didn’t expand Medicaid. Rural areas and places with high poverty rates benefitted the most.
Overall, counties with Medicaid expansion saw an average of 1,800 fewer deaths per year, the study showed.
Critics of such expansion say expanding Medicaid contributes to rising health care costs, costing states more than they anticipated.
DeShazo, professor emeritus of medicine at UMMC and adjunct professor of medicine at the University of Alabama at Birmingham School of Medicine, said health disparities are fixable.
“These include things like poverty, access to care, racial discrimination, rural location and educational status,” he said. “The latter seems the determinant most closely correlated with health.”
Health care professionals have known for years the roles that diabetes and related factors play “in the quality of life and longevity in African Americans in our state,” he said. “What does this show about the importance of improving the rates of diabetes, hypertension and obesity in all Mississippians? And with COVID-19, what does this show us about the cost of ignoring them?”
Jerry Mitchell is an investigative reporter for the Mississippi Center for Investigative Reporting, a nonprofit news organization that is exposing wrongdoing, educating and empowering Mississippians, and raising up the next generation of investigative reporters.