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How Dr. Scott Benton’s decisions tore these families apart

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How Dr. Scott Benton's decisions tore these families apart

This story is the third part in Mississippi Today's “Shaky Science, Fractured Families” investigation about the 's only child abuse pediatrician crossing the line from medicine into law enforcement and how his decisions can tear families apart.Read the full series here.

Caryn Jordan, Columbia

Caryn Spell and her daughter Sawyer pose for a portrait inside of their home Columbia, Miss., Monday, December 12, 2022.

When Caryn Jordan took her 10-month-old daughter to Forrest General Hospital on March 29, 2020, she never imagined the state would take her child from her.

She said she also never considered that a pediatrician who would accuse her of child abuse wouldn't do the necessary testing to determine if a genetic disease caused her daughter's fractures.

The nightmare started when Jordan was putting her daughter Sawyer in her high chair. She noticed one leg was warm and swollen. She tried to get Sawyer to stand up, but the child couldn't handle pressure being applied to the swollen leg.

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At Forrest General Hospital, Jordan said doctors told her an X-ray revealed a fracture on Sawyer's leg and that the hospital would have to transfer Sawyer to the University of Mississippi Medical Center (UMMC) in Jackson because they were not equipped to put a cast on an infant. The hospital had contacted Child Protective Services, she said she later realized.

An official with Forrest General Hospital said when there is suspected abuse or neglect, the hospital social worker is consulted and further screening is done.

“CPS is notified when circumstances warrant,” said Suzanne Wilson, the director of emergency services and transfer center at the hospital.

Wilson said not all suspected abuse cases are transferred out of the facility, but those requiring a specialist's care are transferred, as well as those in need of pediatric services not provided at the hospital.

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After performing a full body X-ray on Sawyer at UMMC, doctors told Jordan her daughter had a broken leg and 11 fractures across her body in various stages of healing.

Jordan was baffled. Sawyer had rarely left their home, aside from frequent doctor visits due to stomach issues and a salmonella infection. Her mind raced for answers.

Then Jordan got a call from Dr. Scott Benton, a pediatrician at UMMC who specializes in child abuse pediatrics. He told her that Sawyer looked like she had been thrown against a wall or in a car accident, she said. Another mother told Mississippi Today that Benton also accused her of throwing her baby against the wall.

“He spoke to me like I was this abusive, disgusting mother,” Jordan said. “I don't think I've ever been that angry.”

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Benton, who Jordan said she never saw in person, determined abuse caused her injuries. Jordan said to her knowledge, Benton, who told her on the phone he was out of town at the time, never saw Sawyer in person.

Jordan would not be taking Sawyer home. She was told to the hospital, and Sawyer went into the custody of Child Protective Services.

Jordan and her daughter Sawyer at UMMC in March 2020.

Back home in Columbia, Jordan turned all of her energy into getting Sawyer back, a fight that cost her everything. She was only able to work part time due to frequent court dates and doctor's visits. She drained her savings and lost her health insurance. Her relationship with her boyfriend imploded. She moved back in with her parents.

“Could the fractures have occurred during birth?” she wondered. At one point, Sawyer got stuck in the birth canal. She had to be pushed back inside and delivered through an emergency cesarean section, Jordan said.

“Might Sawyer have a brittle bone disease called osteogenesis imperfecta?” Jordan thought. The group of inherited genetic disorders affects how the body makes collagen and causes fragile bones. A Facebook group she joined for parents whose children had the disorder encouraged her to request a bone density test.

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But when Jordan proposed the idea, Benton replied in text messages that she shared with Mississippi Today: “There is no validated and approved bone density test for infants.”

While bone density tests are not typically performed on infants, there are alternative methods, Jordan said a pediatrician at Children's Hospital New Orleans told her in June 2020. They include a skin biopsy or genetic testing to look for anomalies in certain genes involved in encoding collagen.

In shared with Mississippi Today, the New Orleans doctor tells Jordan that Sawyer's symptoms and injuries are consistent with what is seen in a child with brittle bone disease, and that often the fractures are painless and left undiscovered for some time.

But Jordan was unaware Benton had performed a genetic osteogenesis imperfecta panel test on Sawyer on March 31, nor was she given the results. That test detected a variant of uncertain significance in her COL1A1 gene, which is involved in collagen production, according to Sawyer's medical records from UMMC.

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Dr. Mahim Jain, director of the Osteogenesis Imperfecta Clinic at Kennedy Krieger Institute and an assistant professor in the Department of Pediatrics at Johns Hopkins University School of Medicine, said issues with the COL1A1 gene are a major cause of OI.

“A variant of uncertain significance doesn't really say, ‘Yes, it is disease causing' or ‘no, it's not.' It means that there's more work to be done to try to sort out if it is causing the condition,” Jain told Mississippi Today.

Benton's report on Sawyer's genetic test recommends genetic counseling and targeted testing of her parents to better understand the implications of this variant, but no further testing was done and no explanation was given as to why, according to the medical records.

Jordan said she became aware of the test and its results only after her case was concluded.

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Benton declined to answer questions about Jordan and her daughter's case, even though Jordan submitted a form to UMMC authorizing hospital employees to discuss her daughter's medical records with Mississippi Today.

Benton told a group of public defenders in a recorded presentation about sex crimes, however, that before he came to UMMC in 2008, parents and anyone who was suspected of being associated with a child's injury was “kicked out of the hospital.”

Dr. Scott Benton explains to a group of public defenders in a recorded presentation how he changed UMMC's protocol to better understand patients' history and his approach to talking to parents and caregivers of children he suspects have been abused or neglected.

He said he reversed that policy so he could be sure to get a full history from parents and not overlook any possible medical explanations for a child's injuries.

“That was part of their protocol (at the time). And I said ‘Alright, who am I supposed to get the history from? Who am I supposed to (talk to) to figure out if there's a medical explanation for some of these bleeding findings?'” he told the group. “So we quickly reversed that.”

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For the first three months while Sawyer was with a foster family, Jordan said she wasn't allowed to see her, despite CPS visitation policy that states contact between the child and his or her parents must be arranged within 72 hours of that child being placed into foster care.

Shannon Warnock, a spokeswoman for CPS, said the agency can't comment on specific cases, “including any exceptional circumstances that warrant policy adjustments.”

In December 2020, nine months after Jordan went into CPS custody, Jordan's parents got a foster care license and got custody of Sawyer.

In doing so, that meant Jordan had to move out. She found a one-bedroom apartment she could afford.

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Ultimately, the youth court judge concluded Sawyer was abused but it was unclear who inflicted the injuries, so she was returned to Jordan on April 5, 2021.

In the aftermath, Jordan has been diagnosed with post-traumatic stress disorder, an anxiety disorder and depression. She mourns the milestones she missed during the 15 months Sawyer was taken from her.

“I missed my daughter's first birthday,” Jordan said. “I missed her first Easter. I missed her first step. I missed a lot of firsts. And these are things I can never get back.”

The separation also affected Sawyer, now an outspoken 3-year-old who sometimes rolls her eyes at her mother and loves to dance.

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Sawyer has to carry KeKe, a fuzzy blanket covered in llamas, with her wherever she goes, Jordan said. The baby blanket was the only one of her belongings she was able to keep while in state custody. She still has separation anxiety, and Jordan often has to reassure her she will not leave her again.

Jordan recently scheduled additional testing for Sawyer in New Orleans to confirm if she has the brittle bone disease. She said she waited because of the cost, and because for a long time, the idea of taking Sawyer to a doctor left her terrified.

The two now live in a two-bedroom house in Columbia with a large backyard. They're trying to start over and create a new normal.

“Ever since they closed our case, I've just tried to be a mom,” Jordan said.

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Lindsey Tedford, Tupelo

Blake Tedford, from left, 10-month-old Cohen Tedford, Lindsey Tedford and 3-year-old Cullen Claire Tedford pose for a family portrait at Ballard Park in , Miss., Friday, March 25, 2022.

Lindsey Tedford of Tupelo rushed her 3-week-old son Cohen to the local emergency room at North Mississippi Medical Center on June 13, 2021. While her husband was holding their newborn and bent down to pick up a pacifier from the floor, Cohen had hit his head on the nearby crib, the parents told the nurses in the emergency room.

Cohen had bruising under both eyes and on his nose but was otherwise fine, the doctors told her.

The hospital never performed CT or MRI scans, medical records from the visit show.

But when Cohen was at a pediatric cardiologist appointment about two and a half months after the crib accident, the doctor noticed something concerning. Cohen's head circumference had increased since his two-month checkup with his pediatrician. He scheduled an ultrasound two weeks later, and the results were “concerning for a brain bleed,” according to the baby's medical records.

The doctor sent them to the North Mississippi Medical Center for a CT scan. It confirmed the ultrasound results: Blood had collected between the skull and the surface of the brain, and Cohen had a possible skull fracture.

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The results triggered a chain of events that led to the Tedfords losing custody of Cohen for nearly five months. The state's only child abuse pediatrician, Dr. Scott Benton, accused them of child abuse and diagnosed Cohen with “nonaccidental trauma.”

In recent months, doctors at Le Bonheur Children's Hospital in Memphis have diagnosed Cohen, now over a year old, with a bleeding disorder called idiopathic thrombocytopenic purpura, or ITP. Subdural hematomas and intracranial hemorrhage — both diagnoses Cohen received at UMMC — are rare complications of ITP.

Back in September of 2021, the North Mississippi neurosurgeon recommended operating on the brain bleed as soon as possible. Lindsey asked the doctor to transfer Cohen to Le Bonheur in Memphis and left the hospital to go home to get clothes for the trip. On her way back, she got a frantic call from her husband Blake: they had taken Cohen in a helicopter, and he didn't know where they were taking him, she said.

“As soon as Blake left to go out of the room to follow the people taking Cohen to the helicopter, (people from Child Protective Services) were waiting on him to question him.”

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Eventually a nurse manager told him Cohen was sent to the University of Mississippi Medical Center in Jackson, she said.

A spokeswoman for North Mississippi Medical Center said the hospital aims to care for potential victims of child abuse “with love and respect.”

“We report child abuse to Child Protective Services in accordance with Mississippi regulations and treat as medically appropriate,” the spokeswoman said when asked how the hospital handles cases of suspected abuse and neglect. “UMMC maintains a Pediatric Sub-Specialty Clinic in Tupelo, which offers non-traumatic medical examinations and treatment for cases of suspected abuse and neglect.”

Cohen Tedford when he was hospitalized in 2021.

The Tedfords said they made phone calls to UMMC as they drove to Jackson. They eventually found Cohen in the emergency room.

They didn't hear from Child Protective Services again until almost two weeks later — the day before Cohen was discharged into CPS custody.

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CPS policy and state law do not require parents be informed they are being investigated for possible child abuse in any specific time frame.

“The Foster Care Policy manual does say that a parent ‘will be notified prior to, or as soon as safely possible, that his/her child is being placed in custody,' but there is no specific time period for notifying the parent of the child's removal,” said Shannon Warnock, a spokesperson for CPS.

She said the agency could not comment on specific cases.

Following more tests, Cohen was transferred to the pediatric intensive care unit. Neurology, hematology and ophthalmology consulted on his case.

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Blood work revealed he was anemic, but medical records note a hematologist “… felt that anemia was most likely secondary to subdural hematoma.”

No other tests or scans were abnormal, according to the records.

About five days into Cohen's hospital stay, Dr. Scott Benton introduced himself to her and her husband as the “staff forensic pediatrician,” Lindsey said.

“I didn't know what that meant,” she said. “He said, ‘I'm going to record this session,' and didn't tell us a whole lot, just started asking questions.”

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The couple relayed how Cohen had hit his head on his crib at 3 weeks old. Benton said the bleeding couldn't have been caused by that, Lindsey said.

When she showed him pictures of Cohen's bruised face and the bassinet, he said that didn't “impress” him, she recalled.

Lindsey also told Benton about Cohen's “traumatic” birth, but she said he told her the same — it didn't impress him. During 17 hours of labor, both her and his heart rates dropped on several occasions, and she lost consciousness.

Cohen was born with the umbilical cord wrapped around his neck.

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Benton declined to answer questions about Lindsey and her son's case, even though she submitted a form to UMMC authorizing hospital employees to discuss her son's medical records with Mississippi Today.

Lindsey attempted to get the recording of her conversations with Benton from the Children's Safe Center, the medical center Benton oversees, but was unable to reach an employee, she said. Another mother who attempted to get similar recordings was told she must have an attorney to do so.

At UMMC, a surgeon drilled small openings called burr holes into Cohen's skull to relieve pressure from the bleeding. He recovered and was discharged from UMMC.

The Tedfords appealed to a CPS case worker to allow Cohen to stay with Blake's mother, who lived about 20 minutes from their home. CPS tentatively agreed, pending a successful home visit.

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On Sept. 22, 2021, officials from Child Protective Services took the baby back to Tupelo. The hospital had diagnosed his injury as “nonaccidental trauma to child.”

For months, the Tedfords' lives were divided between two houses. CPS had also removed their then-3-year-old daughter Cullen Claire from the home under a safety plan, and she was staying with Lindsey's parents.

“She kept asking, ‘Why can't I go home with my mommy and daddy? Is my brother ever going to get better?' We couldn't tell her, ‘You can't come home because these people think we're abusing you,'” said Lindsey.

Cohen wasn't sleeping well away from his home, either, and his grandmother was in a state of constant exhaustion.

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Over the next several months, CPS the Tedfords' home, and the couple took (and passed) a polygraph test at the end of October, Lindsey said.

At a December safety plan review, Cullen Claire's court-appointed guardian recommended returning her home because of the detrimental impact on her mental health — contingent on Lindsey receiving a mental evaluation because of the postpartum depression she revealed to Benton at the hospital in their conversation.

Several court dates for Cohen in early January passed with no action from CPS or the prosecution. They finally went back to court at the end of January.

“Our lawyer presented dismissal, saying there was basically not enough evidence to say these people abused their children,” recalled Lindsey. “He said, ‘This has been going on for five months now, nothing's happened, we haven't been to trial, and we just now got medical records. How long is this going to go on, and this family is broken?'”

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When the judge asked the prosecution if they would be ready for trial in the next month, the attorneys said no.

Cohen's court-appointed guardian also recommended the child return home. The judge ruled in the Tedfords' favor, but stated Cohen should remain under a CPS safety plan involving periodic home visits. The plan ended March 2, 2022.

Life for the Tedfords is, on the outside, back to normal. But a lot has changed.

In addition to the health scare with Cohen and frequent trips to Memphis for his doctor appointments for ITP, his sister Cullen Claire, now 4, is struggling.

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“We're looking into child therapy for her. She tells us all the time that she doesn't think we love her, that no one likes her. She's struggled at school,” Lindsey said, starting to cry. “It's definitely caused a lot of trauma.”

Lindsey has also been to therapy to work through what happened.

She said any time there's a minor accident — bumps, falls and scrapes — she gets worried.

“What would it take for my kids to go back into CPS custody?” she wonders.

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Lauren Ayers, Madison

Lauren Ayers and her 3-year-old son, Eli Ayers, pose for a portrait at their home in Flora, Miss., Thursday, March 24, 2022.

After an afternoon at the playground on July 24, 2018, Lauren Ayers of Madison came home with her 10-week-old twins and almost 2-year-old son.

Ayers' husband was in Oklahoma for work, so she was left alone with the three . She made spaghetti for her older son and herself. After they ate, she started the bedtime routine for the twins, Eli and Conner. She changed Conner's diaper, swaddled him and laid him in his bassinet in her bedroom.

She put the other twin, Eli, on the plastic diaper changing pad on top of the dresser where she changes the boys' diapers in their nursery. She had Eli's onesie undone, so the lower half of his body was pressed directly against the uncovered pad.

The three children's screams and cries created a cacophony in her home. Eli was kicking and thrashing on the changing pad.

Over the sound of the cries, she heard a clicking noise behind her and turned around, with Eli still on the changing table. Her older son sometimes liked to stand on the glider and rock back and forth, and she'd often have to intercept him before he fell. This time, though, he was playing with a retractable tape measure.

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Turning back around, she was horrified to see Eli had scooted himself backwards and had fallen, landing on the crown of his head on the hard floor.

She remembers the resounding thud. When she ran over to pick him up, he was crying, but then became limp and lost consciousness.

“I thought he had broken his neck … I couldn't find my phone, I was running outside and screaming for anybody to help me,” Ayers recalled. “I finally remembered where my phone was and ran in and called 911. He was unconscious, but he was breathing.”

Ayers' neighborhood in Flora was new at the time, and she said she was either so upset she wasn't being clear about where she lived or the emergency response officials weren't sure where she was. She offered to meet them at Mannsdale Upper Elementary School, about a mile from her house.

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“I loaded everybody up, got there … three different fire departments came,” she said. “I kept asking this off-duty firefighter … ‘What do we need to do?' And he said, ‘Look, if anything's wrong with him, you want him in the care of an ambulance.'”

With Ayers' husband out of town and her family in Destin, her best friend came to the school along with her husband.

When no ambulance had arrived 30 minutes later, “the off-duty firefighter was like, ‘You've got to get him to a hospital,'” she said. “So my best friend's husband drove us (to the University of Mississippi Medical Center).”

Ayers' friend stayed with her and Eli, who had regained consciousness, when he arrived in the emergency room.Two of Ayers' other friends were also in the emergency room with them, along with her in-laws.

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Eli Ayers plays with his toys at his home in Flora, Miss., Thursday, March 24, 2022.

“Thank God people could come back in the ER (because) they were witnesses of everything that happened … They tried to get an IV in him … They stuck him probably over 12 times,” Ayers described. “They couldn't get blood from him.”

The nurses started a procedure called “milking,” said Ayers, where they would put both hands on Eli's legs and arms and squeeze the skin in opposite directions in an attempt to get blood to flow.

They checked his stats, ran tests and admitted him to the pediatric intensive care unit for the night. A neurosurgeon reassured Ayers and her family that while the injury was bad, Eli would recover.

A scan the next morning showed Eli's brain bleed had not gotten any larger, so he was moved to a regular room. That day, Ayers said the nurse told her the forensic pediatrician wanted to go over what happened. Ayers had no idea what a forensic pediatrician was.

Ayers attempted to get a recording of her conversation with Benton to share with Mississippi Today, but was told by the Children's Safe Center, the medical center Benton oversees, that she would have to get an attorney to obtain it.

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But she well remembers how began.

“He goes on to explain his (Eli's) injuries and then asked if I remembered (the actress) Natasha Richardson. And I was like ‘Yea, yea, from the ‘Parent Trap','” she said. “And he goes, you know, ‘she had the skiing accident … This is the same injury your child has.'”

Richardson suffered a head injury and died two days later in 2009.

Ayers was shocked. She thought maybe Benton was about to tell her something was very wrong.

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Benton abruptly closed his notebook and looked at her, she said.

“He said, ‘You're under a lot of pressure right now. You have three kids, you were home alone — postpartum (depression) is a real thing,'” she remembered. “‘Tell me what really happened.”

Benton's notes from Eli's medical records show his certainty that the baby was not injured the way Ayers said.

“The fractures are discontinuous (do not connect) and appear to represent separate impact sites,” his notes show. “… Bilateral fractures are not reported in single fall incidents except where the skull fractures are continuous across sutures or in cases of bilateral out bending from a posterior impact causing symmetrical fractures.”

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He goes on to note his concerns are whether Eli was developmentally able to kick or slide himself backwards and whether his skull fractures are “consistent” with Ayers' account of what happened.

An occupational therapist who later evaluated Eli noted he was “quite active for age and may be slightly ahead with developmental milestones.” Ayers also took a of Eli scooting himself backwards off a diaper changing pad, which she provided to Mississippi Today. In the video, he is wearing the same onesie outfit he was wearing in photos from the hospital.

She said Benton then told her he believes she threw the baby against a wall.

Yet the “most traumatizing part” of the first meeting with Benton, she said, was when he “strips that baby naked, and he's looking, I guess, for signs of abuse.”

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He started taking pictures of the bruises and needle marks from when Eli was admitted in the ER. Ayers asked what he was doing, and he said he believed she had inflicted the bruises.

He argued with her that the bruises were not from attempts to draw blood, and that “milking” was against hospital policy.

Eli Ayers, center, plays with his brothers Drew Ayers, left, and Conner Ayers at their home in Flora, Miss., Thursday, March 24, 2022.

“I kept saying, ‘Don't you see the needle marks?' I was screaming at the nurses, ‘These are needle marks, you see them and you gave them to him!'” said Ayers.

Her friend had written down the names of the nurses who treated Eli in the emergency room, and Ayers begged Benton to talk to them. Ayers found a nurse who showed Benton records that when Eli first came to the hospital, no bruising or marks were noted.

A pediatric general surgeon who reviewed Eli two days later noted “bruising to left hand with visible venous access attempt noted” and “IV to right .”

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Benton backed off, she said. But Ayers' anxiety had only increased.

“At that point I was like, ‘They're going to take this baby from me,'” she said.

Benton declined to answer questions about Ayers and her son's case, even though Ayers submitted a form to UMMC authorizing hospital employees to discuss Eli's medical records with Mississippi Today.

At the next meeting with Benton, Ayers had family members with her, including her father-in-law, a pharmacist. One of Eli's tests had come back showing he had slightly elevated liver enzymes, which Benton believed indicated trauma to the abdomen.

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Ayers' father-in-law asked to review the test results.

“He (my father-in-law) literally looked at him and said, ‘Dr. Benton, with all due respect, these are stress-related elevated enzymes,'” she recalled. “‘These are not trauma-level numbers.'”

Benton said Eli would need to do a CT with contrast that requires fasting and radiation. Radiation exposure is particularly concerning in children because they are more sensitive to radiation. And because they have a longer life expectancy than adults, that results in a larger window of opportunity for them to experience radiation damage.

Ayers and her father-in-law objected to the CT, noting Ayers' husband, Drew, had a kidney condition that made dehydration particularly dangerous, and there was a Eli might have the same issue.

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But Benton insisted, and they relented.

In the paperwork under “clinical history” for the CT scan, it states: “Reported new bruising on the abdomen. Concern for blunt trauma to abdomen.” There had never been any mention of abdominal bruising in the medical records or to Ayers up until that point, and the CT was performed two days after Eli came to the hospital.

The scan came back normal.

“No evidence of blunt trauma to the abdomen. No acute fractures or dislocations,” the report stated.

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Eli was discharged but subjected to another full body X-ray several weeks after he left, according to records. A case worker from Child Protective Services visited Ayers' home and cleared Eli to return. Several weeks later, a Madison County sheriff's investigator also interviewed Ayers.

The case was closed that day, the incident report stated.

What haunts Ayers even four years later is wondering what happens to mothers without the resources she had: the ability to hire an attorney, a family member in the medical field to sit in on meetings with Benton and the support of friends and family who were in the emergency room and hospital with her.

“This man should have some more oversight … if you're going to subject a 10-week-old to all these tests, two MRIs, a CT, X-rays, you should have your evidence in order,” said Ayers, who said she struggled “with some pretty dark days” after the accusations from Benton and the experience in the hospital.

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Ayers filed a complaint with the Mississippi State Board of Medical Licensure in March of last year. In her complaint, she highlighted the unexplained “new bruising to abdomen” on the notes for his CT – bruising that was never mentioned anywhere else in his medical records.

“I would say, about 10 doctors signed off that my child (the patient) had ZERO bruising anywhere on his body upon admittance to the hospital … Scott Benton couldn't ethically order this CT with contrast on my child bc (because) his liver enzymes weren't actually elevated enough to need it,” she wrote. “ … Before I take matters further, I'd really like someone to call me, asap.”

She never heard anything back.

Editor's note: Kate Royals, Mississippi Today's community health editor since January 2022, worked as a writer/editor for UMMC's Office of Communications from November 2018 through August 2020, writing press releases and features about the medical center's schools of dentistry and nursing.

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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 1884

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May 4, 1884

of Ida B. Wells, circa 1893 Credit: Courtesy of National Park Service

Crusading journalist Ida B. Wells, an African-American native of Holly Springs, Mississippi, was riding a train from Memphis to Woodstock, Tennessee, where she worked as a teacher, when a white railroad conductor ordered her to move to another car. She refused.

When the conductor grabbed her by the arm, “I fastened my teeth in the back of his hand,” she wrote.

The conductor got from others, who dragged her off the train.

In response, she sued the railroad, saying the company forced Black Americans to ride in “separate but unequal” coaches. A local judge agreed, awarding her $500 in damages.

But the Tennessee Supreme Court reversed that ruling three years later. The upended her belief in the court system.

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“I have firmly believed all along that the was on our side and would, when we appealed it, give us justice,” she said. “I feel shorn of that belief and utterly discouraged, and just now, if it were possible, would gather my race in my arms and fly away with them.”

Wells knew about caring for others. At age 16, she raised her younger siblings after her and a brother died in a yellow fever epidemic. She became a teacher to her .

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

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Mississippi Today

From dummy bill to Hail Marys: How Mississippi’s Medicaid expansion efforts failed

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mississippitoday.org – Geoff Pender – 2024-05-04 06:00:00

As the 2024 Mississippi legislative session gaveled open in January, it appeared to be the start of a new era. Many Capitol observers expected it to mark an end of several years of intense GOP in-fighting between the House and Senate — led by former Speaker Philip Gunn and Lt. Gov. Delbert Hosemann, respectively.

It also appeared a boon for an issue that had loomed for a decade over Mississippi's poor, sickly population and struggling hospitals: Medicaid expansion and the billions of federal dollars available to address this, but for red-meat Republican “anti-Obamacare” politics led by Gunn and Gov. Tate Reeves.

Newly-elected House Speaker Jason White said Medicaid expansion would be on the table in his House and vetted with pragmatism, not politics. This appeared to align with Hosemann's stated openness to such policy. For years he had been the lone statewide Republican leader to even leave the Medicaid expansion door open, and he had suffered political slings and arrows from Gunn and Reeves and others in his own party. He had to fend off a serious primary challenge from the right last year that appeared to have tacit approval from Reeves.

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Now it appeared two like-minded, reasonable Republican politicians would together, eschew the far-right politics that had hamstrung efforts to address the state's crisis for years and work something out.

That didn't happen.

Early on, it became clear the two leaders and their lieutenants were not communicating much on Medicaid expansion (and other issues). They were on different trajectories and not only not on the same page, but not in the same book. And Reeves was working to sabotage any expansion efforts, particularly with rank-and-file members of the Senate over which he had presided as lieutenant governor for eight years.

The House held an open hearing on Medicaid expansion with testimony from experts — a sea change for a topic that had been taboo for legislative Republicans for much of the last decade. In February, with an overwhelming bipartisan vote, the House passed a Medicaid expansion plan, calling it a “moral imperative.”

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But the Senate was circumspect and secretive about whatever work it might be doing on Medicaid expansion. It had an expansion bill, but it was only a “dummy” bill containing code sections and no details. Right up to a mid-March deadline for its passage, the Senate leadership refused to detail any plans, leaving members, the House and the public in the dark and health experts worried whatever the Senate came up with could include elements that were unfeasible, costly and counterproductive.

It appeared that, despite Hosemann for years saying he was open to discussion on expansion, the Senate had not laid much groundwork for it.

As the clock ticked into late March, the Senate let its own dummy bill die, but eventually released details of its own proposal, which it used as a “strike-all” to rewrite its own version into the still-alive House bill a full month after the House had passed it.

READ MORE: Speaker White on Medicaid expansion negotiations: ‘Come for the savings, stay for the compassion'

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‘Expansion lite' with a poison pill

The Senate proposed what it called “Medicaid expansion lite” in late March. It would only cover the poorest of the poor — about 40,000 Mississippians to the 200,000 or so the House plan would cover. It would not meet federal criteria for Medicaid expansion, so the Senate plan would continue to turn down over $1 billion a year in federal Medicaid money Mississippi could use for the program, plus another nearly $700 million over the first two years to set it up and cover any state costs.

The Senate plan also contained what experts quickly pointed out would be a poison pill — a strict work requirement for enrollees with bureaucracy to police it. The federal government under the Biden administration had struck down previously approved work requirements and refused to grant any new ones. The Trump administration had granted some, but only as a means to rein in participation in already expanded Medicaid programs, not as a means to implement new expansion states.

The House plan had also included a work requirement, but House leaders realized it would likely never fly, so its plan would allow expanded coverage for the working poor to take effect even if the feds didn't approve the work stipulation.

READ MORE: ‘A matter of life and death': Hundreds rally at Capitol for full Medicaid expansion 

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Hosemann and his Senate Medicaid Chairman Kevin Blackwell quickly made clear, publicly, that the Senate would not budge on a strict work requirement. They appeared to paint the Senate into this corner even as experts were saying it could prevent expanding Medicaid coverage indefinitely. Blackwell repeatedly said, “No work requirement, no expansion.”

They also, at least for a while, appeared pretty firm on only expanding coverage to those below the federal poverty level, thus ensuring the state would not receive billions of extra federal Medicaid dollars.

Hosemann, Blackwell and other Senate leaders expressed optimism that the Biden administration would be so pleased with longtime Medicaid expansion holdout Mississippi making an effort that it would approve a work requirement, or that the conservative federal 5th Circuit Court would approve it if litigated. Or, that Trump would be reelected and his administration approve it — never mind that this would mean anti-Medicaid expansion Trump expanding Medicaid in Mississippi over the wishes of its Republican governor, whom he supports.

Senate leaders made clear early on they barely had sufficient votes for their plan, and would not be able to pass anything nearly as expansive as the House proposal. Vote counting and whipping on the issue was important. An expansion bill would require a three-fifths vote of both chambers to pass, and more realistically a two-thirds vote to be able to override a threatened Reeves veto. Both the House and Senate have a three-fifths or better majority of Republicans, but with Medicaid expansion, a few far right members in each would never be onboard, meaning both White and Hosemann needed Democrats onboard as well.

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Following Georgia's (bad) example?

Mississippi is one of the last 10 holdout states on Medicaid expansion. Lawmakers here had 40 other states, 20 by Republicans, to look to for best practices and tips on expansion and stacks of studies. There's a saying among health experts: If you've seen one state's Medicaid program, you've seen one state's Medicaid program.

The initial House proposal had a few minor twists, but otherwise was pretty standard fare for expansion, implementing many things other states have successfully done and, importantly, taking advantage of the billions of federal dollars available to provide health care for poor Mississippians.

The Senate, however, did not appear to emulate any other expansion states' plans or consult much with experts. Instead, it appeared to more closely model Georgia, whose efforts at an expansion-lite plan have been deemed by health experts and advocates a disastrous, expensive failure to date.

Senate Medicaid Committee Chairman Sen. Kevin Blackwell, R-Southaven, left, confers with Mississippi House Medicaid Committee Chairman Rep. Missy McGee, R-Hattiesburg, center, and a Senate legislative attorney on Wednesday, May 1, 2024, in the hallways of the state Capitol in Jackson, Miss. (AP /Rogelio V. Solis)

The Peach State attempted to cover only some of its poorest citizens — thus not receiving enhanced federal Medicaid money — and its insistence on a work requirement has it tied up in court against the federal government. To date, the program is providing coverage to only a few thousand of the 400,000 Georgians who lack health coverage. And of the millions spent so far, more than 90% has gone to administrative and consulting fees for setting up its work requirement monitoring bureaucracy and on legal fees, but not on providing health care.

The initial Mississippi Senate plan, experts said, closely resembled Georgia's, except for being a little worse — more strict on work monitoring. As health experts and Mississippi House leaders have noted, insuring people with income over the federal poverty level pretty much means they or someone in their household has a job, hence the income.

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So, the Mississippi House and Senate got a late start on negotiations, largely due to the Senate dragging its feet on getting a proposal out. And they started out very far apart.

For those thinking House and Senate relations would be better with the new administrations taking office, they weren't. The GOP leaders in both chambers openly sparred over numerous major pieces of legislation and recriminations had been flying. Some lawmakers on both sides said it was the worst they had seen in years, although many lawmakers and observers say that most every session.

READ MORE: Hospitals, business leaders suffering FOT — Fear of Tate — on Medicaid expansion

The final nine days of negotiations

Both White and Hosemann had vowed to have negotiations on a final Medicaid expansion bill open to press and public, given its monumental importance.

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The first conference meeting between House and Senate negotiators was held in public on April 23 — just six days before an April 29 deadline to agree a plan.

Senators Nicole Boyd, R-Oxford (center) and chairman Kevin Blackwell (right), listens as Sen. Brice Wiggins, R-Pascagoula, makes a point on the cost of Medicaid expansion, during a public meeting held at the state Capitol, Tuesday, April 23, 2024. Credit: Vickie D. King/Mississippi

Blackwell, speaking for the Senate, warned House negotiators not to take a my-way-or-the-highway stance. They didn't. They offered a compromise, a “hybrid” plan drafted with help of consultants in effort to allay Senate concerns that expansion would pull people off the federal private insurance exchange. Similar to what some other states have done, the House compromise would cover the poorest Mississippians with traditional Medicaid, but use government subsidized private insurance on the exchange to cover the balance of working poor people.

The compromise would still allow the state to draw down the billions of federal Medicaid dollars available for expansion.

The Senate negotiators didn't reciprocate with any counter offer of compromise, saying only they would take the House counter back to Hosemann and other Senate leaders for consideration and casting doubt that they could gin up support for it.

That was the last of the open to the public negotiation hearings on expansion. House Medicaid Chairwoman Missy McGee scheduled another one, hoping for more public parlay with Senate negotiators and to get response on the House's counter proposal, but Senate negotiators didn't show up for the meeting.

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The clock continued ticking on deadlines for passing legislation and the end of the 's four-month session closing in.

READ MORE: House agrees to work requirement, Senate concedes covering more people in Medicaid expansion deal

Pingpong and Hail Marys

The Senate responded with its first counter offer, a hybrid similar to what the House had pitched that would garner the extra billions from the feds, but still with a strict work requirement. And despite offering a “compromise” to the House that he and two other Senate negotiators agreed to, Blackwell expressed doubt it could garner enough votes in the GOP supermajority Senate.

The House countered with a plan that would expand Medicaid with or without the work requirement, but would require the state continue to try to get such a requirement implemented. The Senate demurred.

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In all the pingponging back and forth, the Senate would not back down on its demand for a work requirement, even if it prevented coverage from ever being expanded.

With only minutes to spare before an April 29 at 8 p.m. deadline to file an agreement, the House GOP leadership caved on the work requirement. It appeared a final deal had been struck.

But this angered the House Democratic Caucus, whose members said they had been clear with the leadership they would not go along with this. Most of the caucus — reportedly at least 29 members — vowed to vote against the proposal, enough to endanger its passage.

Democratic House leaders said they would not vote for a program that might never go into effect and would be “Medicaid expansion in name only.” They also shrugged off Republican efforts to blame Democrats for killing expansion, saying they were not to blame for the Republican supermajority not being able to work together or get a major initiative passed.

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READ MORE: Why many House Democrats say they'll vote against a bill that is ‘Medicaid expansion in name only'

Speaker White said he would still have had the votes in the House to pass the compromise, even with the loss of a significant number of Democrats. But the speaker said he opted to send the proposal back to negotiations after being told by Senate leaders that the Senate only had 28 votes — not enough to pass it by a needed three-fifths majority. 

This prompted a GOP Hail Mary. The House and Senate both voted to recommit the measure on May 1, which bought another 24 hours to try to negotiate a deal. Then on that same night, Speaker White and the House leadership floated a new proposal: Let voters decide the issue. Put it to a statewide referendum, and let voters decide not only whether to expand Medicaid, but also whether to try to include a work requirement.

READ MORE: These Republicans wanted a Medicaid work requirement but couldn't get approval. So they got creative.

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But late Wednesday night, Hosemann threw cold water on that proposal. He said the idea of a referendum had been run by senators and “was not well received.” He also appeared to call the issue dead for this year, issuing a better-luck-next-year statement.

But with the leadership expecting to end the 2024 legislative session as early as Friday, House Democrats tried one last Hail Mary on Thursday. House Minority Leader Robert Johnson III met directly with Senate Republican leaders and offered a final compromise.

Instead of the Senate's most recent plan, which would have required the state to request a federal waiver to implement a work requirement every year until it is approved, Johnson said House Democrats would agree to mandate the waiver request for just one year. Instead of potentially keeping expansion in limbo indefinitely with a work requirement, if it were to be rejected once, Johnson reasoned, lawmakers could revisit the issue.

But Johnson's last ditch pitch wasn't picked up by the Republican leadership in either chamber.

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The final negotiations — to use that term loosely — on Medicaid expansion appeared to suffer from the same lack of communication between the House and Senate that the early efforts saw.

The Medicaid expansion measure, House Bill 1725, died Thursday night at an 8 p.m. deadline as the 2024 session neared its end.

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

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Mississippi Today

Legislature, flush with cash, passes budget, completing work for 2024 session

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mississippitoday.org – Bobby Harrison – 2024-05-03 16:56:24

The Mississippi Legislature completed its work for the 2024 on Friday with the passage of a $7 billion state budget – 5.8% larger than the budget it passed last year.

The $7 billion reflects the amount spent on recurring expenses. The budget last year, one-time funds, federal relief funds and other one-time money for specific projects, actually was more than the budget passed this year.

The completion of the budget late Friday ended the bulk of lawmakers' work for the 2024 session, but legislators will return briefly Saturday to take care of procedural issues. Plus, the Legislature might reconvene on May 14 to deal with any veto from Gov. Tate Reeves.

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One of the final actions on Friday was approving a massive bill that provides state money for projects throughout the state. The legislation funds tourism projects, work on local governmental office buildings and other projects for individual legislators.

Th total amount of the projects was $227.4 million.

In the past, projects were often funded by borrowing. But in recent years, thanks in large part to an infusion of federal COVID-19 funds and other federal funds, Mississippi, like most other states, has been flush with cash, allowing those projects to be funded with cash instead of long-term debt.

Senate Finance Chair Josh Harkins, R-Flowood, told senators paying for the projects with cash will not continue in future years. State revenue has begun to slow.

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Harkins told senators there were more than $1 billion in requests on the local level for projects.

Sen. Angela Turner Ford, D- Point, asked Harkins how it was decided which projects to fund.

Harkins said the focus was on infrastructure projects and other projects where it was viewed the greatest need was.

 In addition to the pet projects for lawmakers, other capital spending included:

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  • $110 million for projects.
  • $45 million for community college projects.
  • $160 million for work on improving state Highway 7 in Lafayette County.
  • $90 million for work on U.S. I-55 in DeSoto County.
  • $50 million for work on state office buildings throughout the state.

In total, $820 million was committed in surplus funds for building projects throughout the state. Plus, $110 million in surplus funds was pumped into the Public Employees Retirement System to shore up the pension plan.

In terms of the budget to operate agencies, House Appropriations Chair John Read, R-Gautier, said state agencies are receiving an average 5% year-over-year increase in .

That increase includes money to pay for increases in the premiums for the state employee plan and to pay for a .5% increase for each state agency in the contribution to the state retirement plan.

Lt. Gov. Delbert Hosemann said before the session began that dealing with financial issues facing PERS was one of the top priorities.

“We tackled the PERS issue,” Hosemann said, though, some argued that the legislative solution did not resolve all the financial issues facing the system.

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Senate Appropriations Chair Briggs Hopson, R-Vicksburg, said the state budget provides funds to allow state agencies to deal with inflation.

“The budget is reflective of the times,” Hopson said. “State agencies are not immune to inflation. In order to services at the same level, we have to spend additional funds.”

The budget includes an additional $240 million in funding for K-12 schools.

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

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