TIME

Arkansas, Mississippi Gay Marriage Bans Overturned

Both states had voter-approved constitutional amendments pass in 2004

(LITTLE ROCK, Ark.) — Arkansas and Mississippi became the latest two states Tuesday to have their gay marriage bans overturned by federal judges, but there are no rushes to the altar as both orders are on hold so the states can consider appeals.

Like several states, Arkansas and Mississippi had voter-approved constitutional amendments pass in 2004 that defined marriage between one man and one woman.

In Arkansas, U.S. District Judge Kristine Baker ruled in favor of two same-sex couples who had challenged the amendment. They argued the ban violated the U.S. Constitution and discriminated based on sexual orientation.

“The fact that Amendment 83 was adopted by referendum does not immunize it from federal constitutional scrutiny,” Baker wrote in her ruling.

Besides the amendment, Mississippi has a 1997 law that bans same-sex marriage.

But U.S. District Judge Carlton Reeves wrote in his ruling, “The Fourteenth Amendment operates to remove the blinders of inequality from our eyes. Though we cherish our traditional values, they must give way to constitutional wisdom. Mississippi’s traditional beliefs about gay and lesbian citizens led it to defy that wisdom by taking away fundamental rights owed to every citizen. It is time to restore those rights.

“Today’s decision may cause uneasiness and concern about the change it will bring,” he wrote. “But “‘(t)hings change, people change, times change, and Mississippi changes, too.’ The man who said these words, Ross R. Barnett, Jr., knew firsthand their truth.”

Barnett Jr. is an attorney and son of segregationist Mississippi Gov. Ross Barnett, who was in office from 1960 to 1964.

The ruling was similar in Arkansas.

The state’s marriage laws and the amendment violate the U.S. Constitution by “precluding same-sex couples from exercising their fundamental right to marry in Arkansas, by not recognizing valid same-sex marriages from other states, and by discriminating on the basis of gender,” Baker wrote.

Baker put the ruling on hold, anticipating an appeal to the 8th U.S. Circuit Court of Appeals, based in St. Louis.

A spokesman for Democratic Attorney General Dustin McDaniel said McDaniel was reviewing the ruling and would decide after the Thanksgiving holiday whether to appeal in consultation with Republican Attorney General-elect Leslie Rutledge in Arkansas.

Mississippi officials had already said they planned to appeal any ruling that overturned the law.

Judges across the country have ruled against bans similar to Arkansas’ since the U.S. Supreme Court struck part of a federal anti-gay marriage law in June 2013, and gay marriage is legal in more than half of the U.S.

Jack Wagoner, a lawyer for the Arkansas couples who had told the judge last week that same-sex marriage would eventually be legal nationwide, said he was pleased with her decision.

“She’s on the right side of history,” Wagoner said. “It’s pretty clear where history’s heading on this issue.”

Another lawyer, Cheryl Maples, said eyes would turn now to the Arkansas Supreme Court, which heard arguments last week in a similar but separate case.

“If the state Supreme Court strikes down on state constitutional issues, then it’s gone as far as it can go,” Maples said.

Justices are weighing whether to uphold a decision in May striking down the 2004 amendment and earlier state law as unconstitutional. The decision led to 541 same sex couples getting married in the week before the state Supreme Court suspended his ruling.

Justices have not indicated when they will rule in that case.

Lawyers in McDaniel’s office had argued in federal court that same-sex marriage was not a fundamental right guaranteed by the constitution. McDaniel has said he personally supports allowing gay couples to marry but will stay in court defending the ban, which voters approved by a 3-1 margin.

One of Mississippi’s plaintiff couples, Jocelyn “Joce” (JOH’-see) Pritchett and Carla Webb, live in Mississippi and married in Maine in 2013. Pritchett said Tuesday that she, Webb and their two young children were dancing around their living room after hearing about Reeves’ ruling.

“If gay marriage can be legal in Mississippi, the whole country can feel hope,” Pritchett said.

 

TIME Lobbying

Governors Lean Heavily on Industry-Funded Group on Offshore Drilling

Chevron's Jack/St. Malo Oil Platform Departs From Kiewit Offshore
Birds fly as pedestrians watch tug boats transport the Chevron Corp. Jack St. Malo semi-submersible drilling and production platform to the Gulf of Mexico from Kiewit Offshore Services in Ingleside, Texas, U.S., on Nov. 15, 2013. Eddie Seal—Bloomberg/Getty Images

Energy lobbying firm worked through industry-funded advocacy group to provide research and resources

It was a brisk February morning, and the governors of Alabama, Mississippi, Virginia and North Carolina were seated around a ring of tables draped with pleated beige fabric in the ornate Nest Room of Washington, D.C.’s Willard InterContinental Hotel. Sitting across the tables was Interior Secretary Sally Jewell, whom the governors had invited so they could make their case for expanding offshore energy production. It was a long-awaited meeting for the governors, and they’d armed themselves with specific “asks” — that Jewell’s department open access to oil and gas drilling in the Atlantic, for instance, and improve “regulatory certainty” for energy companies operating rigs off the coasts.

The get-together this past winter was but one small push in the type of broader political campaign that occurs every day in countless Washington conference rooms, watering holes and hotel suites. For the past three years, a group of eight, mostly Republican governors from coastal states has been lobbying the Obama administration to expand access to the nation’s offshore oil and gas deposits, working through an organization called the Outer Continental Shelf Governors Coalition.

While the message from the governors that morning would have come as no surprise to Jewell, less clear, perhaps, was that the governors were drawing on the research and resources of an energy lobbying firm acting on behalf of an oil industry-funded advocacy group.

Indeed, the background materials handed to the governors for the meeting, right down to those specific “asks,” were provided by Natalie Joubert, vice president for policy at the Houston- and Washington D.C.-based HBW Resources. Joubert helps manage the Consumer Energy Alliance, or CEA, a broad-based industry coalition that HBW Resources has been hired to run. The appeal for regulatory certainty, for example, came with a note to the governors that Shell, a CEA member, “felt some of the rules of exploration changed” after it began drilling operations in the Arctic.

The governors’ efforts have produced more than just talking points. This summer, the coalition won a major victory when the Interior Department said it would accept applications to probe the Atlantic seabed for oil and gas with seismic tests, a significant step toward allowing drilling off the East Coast — drilling that has been off-limits for decades. While the federal government ultimately controls where offshore drilling is allowed, the Obama administration has made clear it will allow production where the public — and public officials — support development.

And so it appears as if CEA’s considerable investment of time and resources has paid off. Indeed, a review of thousands of pages of public documents, obtained by the Center for Public Integrity through records requests, shows that much of the governors coalition work has been carried out by HBW Resources and CEA, a group that’s channeled millions in corporate funding to become a leading advocate at the state level for drilling.

The governors coalition is just one of many groups, such as the American Legislative Exchange Council (in which CEA is actively involved), that allow powerful corporate interests to gain a direct line to state policy makers not available to common citizens or other stakeholders, all under the banner of a generic advocacy organization.

“It would be alarming I think for many people if they found out that some of the biggest polluters were running a governors group, but less so if it’s a nonprofit,” said Nick Surgey, director of research at the Center for Media and Democracy, a liberal advocacy group. “That one step removed stops the alarm bells going off, but it should really concern people.”

The documents suggest that CEA staff attended the February meeting with Jewell, but Interior Department spokeswoman Jessica Kershaw did not respond to a question asking whether Jewell knew of CEA’s involvement, saying only that the department speaks with “a broad group of stakeholders,” and considers “all points of view.” She said Jewell told the governors that the department “is committed to working with them and their participation in the planning process is fundamental for any kind of coastal development.”

The Center requested interviews with staff of each of the governors — additional coalition members include the chief executives of Alaska, Texas, South Carolina and Louisiana — but none made anyone available, though Alaska responded to questions in writing.

There’s been little effort to explain CEA’s relationship with the coalition, which is currently chaired by North Carolina Gov. Pat McCrory. The coalition’s website made no mention of CEA until recently, when one page was edited — after the Center began reporting this article — to acknowledge the organization provides “information and administrative support.” In March, when the Center first asked who staffs the coalition, Ryan Tronovich, a spokesman for McCrory, said the governors provide the staff (records show Tronovich actually consulted with CEA to answer the Center’s questions). When the Center asked again after learning of CEA’s involvement, Tronovich said in an email that he “should have been more clear,” and compared CEA’s help to that given by an intern. (The Republic Report, an investigative news website, first reported a possible connection with CEA in February when it noted that a coalition letter appeared to have been written by Joubert.)

In an interview, David Holt, president of CEA and managing partner of HBW Resources, said CEA provides assistance to the coalition at the governors’ request. He said both the coalition and CEA have an “all-of-the-above” energy policy that supports renewable as well as fossil fuels. He also characterized his organization’s role as supportive of the coalition in the same way any number of stakeholders may be.

But there’s no evidence that any other group has played a substantive role in the coalition, or that environmental organizations have been invited to any of its meetings. Earlier this month, the McCrory administration organized a meeting with federal officials to discuss Atlantic drilling; no other governors were there, but staff representing the governors of South Carolina and Virginia did attend. McCrory administration staffers told journalists and environmental organizations that the meeting was closed to interest groups so as not to “allow for the potential of the appearance of influence.” In fact, CEA and other industry groups did attend the meeting. Nadia Luhr, the legislative counsel for the North Carolina Conservation Network, wrote a letter to the administration protesting the circumstances of the meeting. She had not previously been aware of CEA’s role in the coalition, but indicated she wasn’t surprised.

“It’s just another example,” she said, “of industry having a voice where no one else does.”

Rebirth of an industry

Each May, tens of thousands of people gather in Houston for the Offshore Technology Conference, the industry’s premier event, and in 2011 they were looking for a fresh start. A year earlier, the Deepwater Horizon rig had exploded in the Gulf of Mexico just weeks before the conference, killing 11 people and leading to the largest oil spill in the nation’s history. In the aftermath, Obama placed a moratorium on deep-water drilling and canceled plans to allow drilling in the waters off Virginia.

Nevertheless, the 2011 conference was bigger than ever, with exhibit booths displaying the latest in drilling technology sprawling over nearly 600,000 square feet of Houston’s Reliant Park complex, which encompasses a cavernous exhibition center, an indoor arena that seats nearly 6,000 people, and covered outdoor booths. There were policy discussions and technical events with titles like “Active Heating for Life of Field Flow Assurance.” The first day kicked off with a panel hosted by Holt and an executive with Noble Energy that featured officials from the five inaugural states of the coalition — Texas, Alaska, Virginia, Mississippi and Louisiana — who decried the federal government for standing in the way of development.

It was there that the governors of those five states announced their coalition, with a stated goal of improving dialogue between the states and the federal government. The coalition’s first chairman was Louisiana Gov. Bobby Jindal, who as a congressman in 2006 sponsored a bill that would have removed the federal moratoriums on drilling in the Atlantic and Eastern Gulf. In 2010, as governor, Jindal railed against Obama’s deep-water moratorium — a moratorium that had been lifted by the time the 2011 conference was held. The governor has been a reliable friend to the oil industry, which has contributed more money to his campaigns than any other sector — more than $1.4 million over the past decade, according to the Center for Responsive Politics and the National Institute on Money in State Politics.

Jindal’s office did not respond to an interview request or to questions about the coalition’s formation. Sharon Leighow, a spokeswoman for Alaska Gov. Sean Parnell, the second chairman of the coalition, said in a written response that the founding governors, not CEA, had decided to form the coalition. When asked how CEA got involved, she wrote: “Unknown.” (Parnell recently lost a bid for re-election.)

CEA president Holt said the governors approached his group because it represents not only energy companies, but also other sectors like airlines, trucking and construction. “They knew of us and asked CEA because we represent the whole economy,” he said.

Some environmental advocates have a dimmer view of why the group was formed that May. “The Outer Continental Shelf Governors Coalition is a Trojan horse,” said Richard Charter, who has fought against offshore drilling for decades and is now a senior fellow at the Ocean Foundation, which supports marine conservation. Oil companies and other industry groups, including CEA, started a campaign a decade ago to repeal the Atlantic moratorium by lobbying officials and the public state-by-state, he said, and the coalition is the culmination of that effort. “They want to create the appearance that a bunch of coastal states are clamoring for ‘drill here, drill now.’”

Throughout its three-and-a-half-year life, the governors coalition has focused on the Interior Department’s “Five-Year Program” — the arcane, bureaucratic process the department uses to plan the nation’s offshore drilling regimen — lobbying at each incremental turn for the department to open more areas to drilling and to ease restrictions where drilling is underway. The coalition has also pushed for the federal government to share more drilling revenue with the states.

The Center requested documents related to the governors coalition from the three states that have chaired the coalition. Louisiana and Alaska provided thousands of pages, though Alaska’s response was heavily redacted. North Carolina has yet to respond to the request, which was submitted in April.

Whatever the origins of the coalition, the documents show that Holt was an early driving force. In May 2011, he and his colleagues at CEA designed a logo for the group. In July, he sent an email to Chip Kline, deputy director of Jindal’s Office of Coastal Activities,congratulating Louisiana on being named the coalition’s first chair, stressing that the governors would add a “meaningful voice” to the energy debate. When they were planning the coalition’s first meeting, alongside a Republican Governors Association gathering in Jackson Hole, Wyoming, and RSVPs weren’t coming in as hoped, Holt fired off a message saying, “REALLY need to have this OCSGC meeting to get things rolling.”

Voice of the consumer?

The Consumer Energy Alliance calls itself “The Voice of the Energy Consumer.” The group was formed in 2006, operating initially out of a small office park in Houston. Its first board of directors included executives with Shell, Hess and a wind power company, as well as geologists and representatives of “consumer” industries such as trucking. Also on the board: Jim Martin, chairman of the 60 Plus Association, which bills itself as the conservative alternative to the elderly advocacy group AARP, but which is also part of the well-financed political network led by Charles and David Koch, the billionaire industrialists with major stakes in oil and gas.

Holt, 48, who speaks with folksy Texan charm, has been the alliance’s only president. Before starting CEA, he had worked in government affairs for Hart Energy, an industry publishing company, and before that, he says, as legal counsel to the top oil and gas regulator in Texas.

The alliance says it seeks to improve understanding of the nation’s energy needs and advocates for lower energy prices through an “all-of-the-above” policy of increased domestic energy production. Over the past eight years, the group’s membership has grown to about 240 corporate entities, including groups from “energy consuming” industries like transportation and construction, as well as energy companies. CEA also claims to have some 400,000 individual members who have signed petitions or taken other actions that are described on its website. (In October, however, Wisconsin regulators rejected a petition CEA had filed in an electricity rate case there after an investigation by the Madison Capital Times revealed that some of the 2,500 people whose names had been used were unaware they appeared on the petition, and actually opposed CEA’s stance. CEA said it stood by the 2,500 signatures, but had actually requested that the petition be withdrawn before it was rejected.)

In 2011, the year the governors coalition was formed, CEA’s annual revenue ballooned to $3.8 million from just $737,000 the previous year, and it’s remained above $3 million since then. Holt says the majority of CEA’s members are from “consuming” sectors and that its funding comes from all members. He wouldn’t say who pays what, however, and tax records show that in 2011 and 2012, the most recent years available, at least 30 percent of the money came from just three entities: the American Petroleum Institute, the American Fuel and Petrochemical Manufacturers and America’s Natural Gas Alliance, each a prominent oil and gas industry group.

More than $1 million of that revenue goes as a management fee to HBW Resources, an energy-focused lobbying and consulting firm that Holt formed in 2008 along with Michael Whatley — a former chief of staff for Sen. Elizabeth Dole — and Andrew Browning, who had worked as a lobbyist and in the Department of Energy. With the exception of a few regional directors, CEA’s staff is comprised of HBW staff, and to the layman, it’s hard to tell the difference between the two.

HBW’s Washington, D.C., office sits in a giant truncated pyramid of a building, with sloped outer walls, that overlooks Farragut Square on the city’s lobbyist-dense K Street. The firm has offices in five other cities in the U.S. and Canada and has its fingers in many pies. Its 18 employees manage not only CEA, but also the Energy Producing States Coalition, a group of state lawmakers that work on energy policy, and the National Ocean Policy Coalition, a collection of energy companies, commercial fishing organizations and other business interests that opposes the Obama administration’s oceans policy. Whatley is also the vice president of Nebraskans for Jobs and Energy Independence, ostensibly a group of Nebraskans who support the construction of the Keystone XL pipeline. The firm lobbies on behalf of just a handful of clients, including Noble Energy and The Babcock and Wilcox Company, which makes nuclear reactors and other industrial power equipment.

HBW employees have contributed tens of thousands of dollars to dozens of political campaigns. Notably, they gave $1,600 to Democrat Terry McAuliffe — who, following his election as governor of Virginia last year, joined the governors coalition after Whatley and Joubert made a direct appeal to one of his senior advisers during a December meeting. They also gave more than $8,300 to Gov. Nikki Haley of South Carolina within a day of a coalition meeting that Haley attended, in Houston in 2013.

One of the firm’s first major campaigns began in late 2009, when Whatley worked with a Canadian diplomat to help block state and federal attempts in the U.S. to pass low-carbon fuel standards, which could have threatened imports from Canada’s tar sands oil deposits.

The effort previewed what would become a recurring strategy for Whatley and his colleagues: pairing a public advocacy campaign with direct, behind-the-scenes appeals to elected officials, urging them to make similar public comments in their own voices. More recently, CEA has worked through the American Legislative Exchange Council, the conservative state legislators group, to oppose a new federal rule limiting greenhouse gas emissions.

Holt says his organization supports all forms of energy production and is directed by its board, which no longer includes energy companies. “We are a consumer controlled and a consumer funded and a consumer dominated organization,” he said.

Most of its campaigns and communications focus on oil and gas, however. That, coupled with what’s known about its funding, has led some advocacy groups to view CEA as a front group for energy companies, an entity created to give the appearance of an independent and broad-based voice. To these advocacy groups, the governors coalition is just another player in the larger game. “This is a purposed campaign to mislead the public,” said Claire Douglass, campaign director for climate and energy at Oceana, an environmental group that opposes offshore drilling. “The politicians are now doing industry business, not being public servants.”

Gaining speed

The governors coalition’s work inched forward through much of its first year-and-a-half, at least in part because there wasn’t that much it could do. The Interior Department had excluded new areas from the current drilling plan, covering 2012-2017, and it hadn’t yet begun substantive work on the next one. The coalition wrote letters to Congress and the Obama administration (two of which appear to have been edited by Shell and Exxon Mobil), urging open dialogue and pressing on other issues, such as revenue sharing. It held periodic meetings. On December 7, 2012, three Alaska officials — Kip Knudson and Nathan Butzlaff, who led Parnell’s work on the coalition, and state Commerce Commissioner Susan Bell — attended CEA’s holiday party at the Old Ebbitt Grill in Washington, according to emails.

In 2013, the newly-elected McCrory, formerly a Duke Energy executive, joined the coalition, adding an important player in the group’s push for drilling off the South Atlantic coast. The group had a new chairman in Parnell, who before entering office had been ConocoPhillips’ chief lobbyist in Alaska and had worked on energy for Patton Boggs, a D.C. lobbying firm that represented Exxon Mobil.

As part of the coalition’s effort to establish itself, the governors and CEA formalized their relationship with a memorandum of understanding designating CEA as volunteer staffwith specific duties to manage the organization. It held a “strategy session” with the American Petroleum Institute.

In October, the coalition convened at the Beau Rivage Resort and Casino in Biloxi, Mississippi, alongside the annual gathering of the Southern States Energy Board for what would be a formative meeting. The following year would present the first opportunity for the group to weigh in on the next five-year drilling plan, and the governors and CEA wanted to make sure they were prepared to make their case.

Govs. Parnell, McCrory and Bryant, along with staff of the other governors, met for more than an hour in one of the resort’s ballrooms with executives from Exxon Mobil, Shell, Spectrum Geo — a seismic testing company — and other energy groups, including the Southeastern Coastal Wind Coalition, to hear their concerns, according to a meeting agenda.

Briefing documents prepared by CEA include talking points on the economic benefits of drilling, saying, “the key is to echo these messages to Congress and the Obama Administration, encouraging them to pursue a sensible path that allows for Atlantic leasing.” The document adds that “coastal governors, legislators, and other stakeholders should play a lead role in delivering the messages below to the Administration and to Congress.”

According to notes from the meeting prepared by CEA’s Joubert, Randall Luthi, president of the National Ocean Industries Association, an offshore industry group, advised the governors that they could suggest to the Interior Department which areas should be leased, and he “urged the governors to keep their areas of potential interest as broad as possible.” He also warned of “increasing activism by NGOs against seismic activity and cautioned the governors about some of these groups’ false rhetoric.”

The day after the meeting, Tony Almeida, a senior adviser to McCrory, sent an email to Holt saying the governor had agreed to serve as vice-chairman of the coalition. “Great news, Tony!” Holt replied, adding, “Great work yesterday. Pat was outstanding! Lots of key action items. We can’t thank you enough for all your support and leadership on OCSGC. 2014 is going to be… interesting. :)”

An “interesting” year

This year, the debate over drilling in the Atlantic picked up significantly just as the coalition finally gained the sort of direct access to the Obama administration it had been seeking. And, the emails show, CEA played a critical role in helping the governors respond.

Two weeks before the governors’ meeting with Jewell that cold February morning in Washington, officials from Alaska and North Carolina had a series of email exchanges and phone calls with CEA’s Joubert to prepare for the meeting. Joubert advised Donald van der Vaart — North Carolina’s deputy environment secretary, who had been tasked with preparing McCrory — on specific policies, such as what to request regarding seismic testing. Van der Vaart asked Joubert to send talking points, noting that a previous briefing book she had sent was “an amazing resource.”

In that meeting at the Willard, Jewell reportedly told the governors that her job isn’t “to get in the way of development,” but rather “to make sure it’s done right.” She and her staff also noted that environmental organizations had increased scrutiny of seismic testing, so her department would make sure appropriate mitigation measures were in place to protect marine animals.

Just days after the meeting, the Interior Department released a long-awaited environmental assessment that would allow seismic testing, and the governors coalition decided to defer to industry for their response. “Natalie — Would you be able to check with NOIA and/or API to see where they are on their respective reviews/analyses?” wrote Butzlaff, the Parnell staffer, in March, referring to the National Ocean Industries Association and the American Petroleum Institute, and calling Joubert by her first name. Joubert responded that the industry hadn’t yet reached consensus, but that it “has concerns more broadly that setting a precedent for stringent mitigation measures in the Atlantic could affect future measures in the Gulf and the Arctic.”

This past summer, the Interior Department said it would begin reviewing applications for that testing, with those more stringent measures in place. At the same time, it began accepting comments from industry, advocacy groups and other stakeholders on which areas it should open to drilling beginning in 2017.

Representatives of the governors coalition have maintained that it is an open and transparent group that strives to include different viewpoints. But the Center was only able to learn the details of the organization by submitting records requests — which North Carolina still has not provided — and there’s no evidence that opponents of drilling have been invited to any meetings.

Indeed, critics point to that North Carolina meeting earlier this month as the perfect illustration of what’s wrong with the way the governors coalition operates. On Nov. 6, North Carolina hosted a meeting on the five-year planning process that focused on the Atlantic. Officials from the Department of Environment and Natural Resources told journalists and environmental groups that the event was invitation only and that “neither special interest groups nor industry representatives” would be present.

That was true in regard to environmental groups — but apparently not for others. During the event, reporters waited in the halls of Raleigh’s Nature Research Center as state and federal officials listened to panel discussions that featured, among others, a CEA staffer and someone from the Center for Offshore Safety, an industry group.

McCrory did allow reporters in, but not until after the meeting was finished, and industry groups had given their presentations. McCrory’s position hasn’t wavered, and he made that clear, telling reporters that “North Carolina ought to participate in our country’s energy independence.”

TIME diabetes

How Race Affects Diabetes Care—and Leads to Amputations

High Blood Sugar Test
Getty Images

Black diabetics are much more likely to face amputation

Black type-2 diabetes patients are three times more likely to lose a leg to amputation as non-black patients, finds a new report from the Dartmouth Atlas Project. That’s partly because they’re also far less likely to get preventative care like foot exams, cholesterol testing and blood sugar testing.

Researchers looked at Medicare claims from 2007-2011 from patients diagnosed with diabetes and peripheral arterial disease, a condition in which plaque builds up in the arteries and blocks blood flow, primarily in the legs. They found significant disparities, both racial and regional: black patients and the rural Southeast region of the U.S. both saw elevated amputation rates.

Diabetes-related amputation, a last resort, generally results from wounds on the feet and poor circulation. Foot exams and testing for blood sugar and cholesterol levels can help lower the risk of having to resort to extreme measures. But in 2010, 75% of diagnosed black diabetics received a a blood lipids test, while 82% of non-black patients had the test.

An average of 2.4 leg amputations for every 1,000 Medicare patients with diabetes and peripheral arterial disease happen nationally, but regionally, the situation is much more grim. Mississippi, which currently ties West Virginia for the most obese state, also has some of the highest amputation rates—6.2 per 1,000 patients in the city of Tupelo. It’s not just racial: For every 1,000 black Medicare beneficiaries with diabetes, 14.2 amputations occurred in the Mississippi city of Meridian, but only 2.1 occurred among black patients in San Diego.

“The resources needed to prevent amputation are currently severely misaligned,” says co-author Philip Goodney, MD, director of the Center for the Evaluation of Surgical Care at Dartmouth Hitchcock Medical Center. “While we must look for opportunities to expand education and preventive care for all patients at risk for amputation, it seems clear to us that we can make the greatest gains by focusing on African-American patients in the highest risk regions, typically in the poor rural regions of the Southern United States, where the highest amputation rates remain.”

TIME Innovation

Five Best Ideas of the Day: October 8

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Quotas can cause lasting change. Rwanda’s new parliament is more than 60% female.

By Eleanor Whitehead in This Is Africa

2. With open communication and smart procedures, we can contain Ebola.

By Atul Gawande in The New Yorker

3. A simple plan to begin saving for college at kindergarten helps families thrive.

By Andrea Levere in the New York Times

4. Teach For America is sewing seeds for education reform in unlikely places – by design.

By Jackie Mader in Next City

5. How Bitcoin could save journalism and the arts.

By Walter Isaacson in Time

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

MONEY

3 Awesome Cruise Deals to Book in October

October is a smart time to book a river cruise, as companies scramble to fill 2014 sailings and get a jump on next year. Here are three destinations offering terrific deals.

  • 1. The Mississippi

    Courtesy of American Queen Steam

    You don’t have to leave the U.S. to cruise. Popular domestic destinations include the rivers of the Pacific Northwest and the mighty Mississippi, says Mark Murphy of TravelPulse.com. Book by Oct. 31 for half off December sailings from New Orleans to Vicksburg, Miss., and back with American Queen Steamboat Co. The firm has two eight-day options for $1,275 a person (down from $2,550). Stops include the Oak Valley Plantation in Louisiana and the Old Natchez Trace trail in Mississippi. Onboard, dine in one of two restaurants and watch the river from the deck-mounted swing.

  • 2. The Rhine

    Courtesy of AmaWaterways

    You’ll find holiday deals on this Western European river. AmaWaterways is offering up to 40% off cruises from Basel to Amsterdam in November and December. The 13-day trip starts in Zurich, then heads up the Rhine, stopping along the way so you can tour local Christmas markets and sip mulled wine in cities like Cologne, Germany, and Strasbourg, France. The trip, typically $2,800 a person, drops as low as $1,680 if you book before Oct. 15. Prefer to wait for warmer weather? Snag a balcony room on more than 90 AmaWaterways 2015 sailings by the end of the month and get up to $1,500 off.

  • The Mekong

    AAA-10244001761
    Courtesy of Viking River Cruises—B SCHMIDa collection

    This 2,700-mile river runs through Vietnam and Cambodia, passing lush farmlands as well as metropolises like Ho Chi Minh City. A 15-day trip with Viking River Cruises is a great way to explore the area, says Ruth Turpin of Cruises, Etc.  You’ll explore the temple of Angkor Wat, see dance performances in Phnom Penh, and take a culinary tour of the floating markets of Cái Bè. Viking recently slashed its 2015 prices; this cruise, which launches multiple times each month, is now $3,500 (regularly $7,000) when booked before Oct. 31, and includes intracountry airfare and hotels.

  • Don’t Get Caught Short by Extra Costs

    While river cruises are often billed as “inclusive,” you will need to shell out for some expenses. Here are the big ones.

    Getting Aboard
    Budget for flights to and from your cruise, as well as for lodging the night before you depart (you don’t want to miss the ship!) and transportation from your hotel to the boat, says Adventure Life Journey’s Mary Curry.

    Extra Drinks
    Before you imbibe, read the fine print: Rates often include beer and wine with lunch and dinner, but you’ll usually pay extra for premium liquors or any drinks outside of mealtimes, says Scott Kertes of Hartford Holidays.

    All Tips
    Gratuities for staff and guides aren’t usually included, though there are exceptions, such as trips with Tauck. Not sure how much to give? “Budget about $100 per person per week,” says Murphy of TravelPulse.com.

TIME justice

Deadly Butt Injection Lands Mississippi Woman Life Sentence

Tracey Lynn Garner
This Wednesday, Aug. 27, 2014 file photo shows Tracey Lynn Garner during her trial in Jackson, Miss. Rogelio V. Solis—AP

Tracey Lynn Garner was convicted of murder over the fatal silicone injection

The Jackson, Mississippi, woman who administered an unlicensed silicone buttox injection that killed another woman was sentenced Tuesday to life in prison.

Tracey Lynn Garner, 54, was convicted last week of depraved-heart murder, a legal designation that signifies disregard for human life, for the 2012 silicone injection she gave to Karima Gordon, 37. Gordon fell ill immediately after the injection and died days later. Prosecutors argued that Garner was motivated by greed, Reuters reports.

Garner, who is transgender, was previously known by the name Morris Garner.

An investigator testified during the trial that he found a bottle of silicone and syringes labeled “veterinary use only” in Garner’s home.

[Reuters]

TIME abortion

Alabama Judge Rules Abortion Clinic Law Unconstitutional

Just a few days after a court in Mississippi struck down a similar law

An Alabama judge ruled Monday that a law requiring doctors who perform abortions in the state’s five clinics to have admitting privileges at local hospitals is unconstitutional, as it imposes an “impermissible undue burden” that amounts to total prohibition of abortions.

“The evidence compellingly demonstrates that the requirement would have the striking result of closing three of Alabama’s five abortion clinics,” U.S. District Court Judge Myron Thompson wrote in his decision. “Indeed, the court is convinced that, if this requirement would not, in the face of all the evidence in the record, constitute an impermissible undue burden, then almost no regulation, short of those imposing an outright prohibition on abortion, would.”

Supporters of the law, called the “Women’s Health and Safety Act” in Alabama, say abortion doctors need to have admitting privileges at local hospitals in case a patient has medical complications after an abortion. “By striking down the Alabama law that required abortionists to have admitting privileges to nearby hospitals, U.S. District Court Judge Myron Thompson is propping up incompetent, dangerous abortionists at the expense of the health and safety of the women in Alabama,” Kristan Hawkins, president of Students for Life of America, said in a statement. “It is a basic necessity to ensure the safety of women who are seeking abortions and to make sure their doctors are following standard medical procedures. To do anything otherwise would be to the detriment of women in the state.”

But the judge agreed with the plaintiffs, who were represented by lawyers for Planned Parenthood and the ACLU, that these laws have no basis in medicine—they’re opposed by the American Medical Association and the American College of Obstetricians and Gynecologists—and make obtaining an abortion unnecessarily difficult. “This ruling will ensure that women in Alabama have access to safe, legal abortion,” Planned Parenthood president Cecile Richards said in a statement. “And Planned Parenthood will continue to fight for our patients, because a woman’s ability to make personal medical decisions should not depend on where she lives.”

The 5th Circuit of Appeals struck down a similar law in Mississippi last week. “Pre-viability, a woman has the constitutional right to end her pregnancy by abortion,” Judge E. Grady Jolly wrote in his ruling, adding that the law requiring doctors to have admitting privileges “effectively extinguishes that right within Mississippi’s borders.” That court could only declare the law unconstitutional as it applies to Jackson Women’s Health Organization, the last remaining abortion clinic in Mississippi, and could not strike down the entire law, because it had been upheld by a 5th Circuit court in Texas.

 

TIME corruption

America’s Most Corrupt State Is Standing Up for Itself

LSU v Mississippi
Detailed view of the exterior of Vaught-Hemingway Stadium on the Ole Miss campus. Stacy Revere—Getty Images

Officials argue a recent report doesn’t take into account recent anti-corruption efforts

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This post is in partnership with Fortune, which offers the latest business and finance news. Read the article below originally published at Fortune.com.

The entire world must contend with corruption. It costs honest citizens thousands of dollars per year and saps trust in public and private institutions.

We’ve all experienced corruption on at least a small scale at some point in our lives, but actually measuring it is difficult. Recently, Fortune covered a study by two public policy researchers—Cheol Liu of the City University of Hong Kong and John L. Mikesell of Indiana University—who looked the rate at which public employees in each of the 50 U.S. states had been convicted on federal corruption charges from 1976 to 2008 to determine which state was the most corrupt in the union.

Their conclusion? Mississippi, The Hospitality State, has not been all that hospitable to its citizens over the past 30-plus years, according to the study. The state had the highest ratio of public workers who were censured for misuse of public funds and other charges.

The researchers looked at the hard numbers—federal convictions—to control for differences in spending on law enforcement and the rigor of state corruption laws.

While these numbers don’t lie, Mississippi officials were none too pleased to top this list. As the state’s top corruption fighter, Mississippi State Auditor Stacey Pickering argued in an interview with Fortune that the study relied on old data and didn’t take into account the state’s anti-corruption efforts.

“This is dated material that goes back to 1976 until 2008, the year I was sworn into office,” said Pickering.

For the rest of the story, please visit Fortune.com.

TIME Heart Disease

Mississippi Men Learn About Heart Disease — At the Barber

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John Sigler—Getty Images

Barbershops may be the new doctor's office, at least in Mississippi where African American men are learning about high blood pressure...while they get their hair cut

Barber shops and hair salons are great community hubs where residents gather for both grooming and gossip. So public health experts in the Mississippi Delta have decided to exploit these social meccas to connect with groups that don’t often see health care providers, including African American men.

Heart disease and stroke, for example, disproportionately affect this population of men, partly due to genetics, and partly due to lifestyle behaviors. But in places like the Mississippi Delta region, these men also do not get regular heart disease screenings. They do, however, go to barbershops for trims and to catch up on community news. So the Centers for Disease Control and Prevention (CDC) is funding a barbershop initiative called Brothers (Barbers Reaching Out to Help Educate Routine Screenings) located throughout the Mississippi Delta, where heart disease and stroke are the second and fourth leading causes of death in black men.

The Mississippi Department of Health spent a year recruiting and training barber shop workers on how to read a blood pressure screening, and discuss risk factors. During appointments, barbers talk to their clients about heart health, take their blood pressure, and refer them to a physician if they need further counseling. Recruitment was, and continues to be a challenge since some of the barbers were on board with the benefits of educating their clients, but worried about whether the program would hurt their business.

So far, thought, the barbers are being pretty persuasive. The project, which involves 14 barbershops that have so far served 686 men, just released its first set of data. Only 35% of the customers said that they had a doctor and 57% did not have health insurance. Among the men who received blood pressure readings, 48.5% had prehypertension, and 36.4% had high blood pressure. The findings, published in the journal Preventing Chronic Disease, shows that the program provides care to men who need it, as well as gives public health care workers a better idea of how prevalent heart disease is in the region, and how many patients are in need of medical care. The next step for the researchers is to create a community health worker network that could introduce these men to the health care system and help them navigate more regular screenings and better treatment of their condition.

Shifting health care from the clinic to the community isn’t a new idea; in some areas, health screenings and education are conducted in churches. But the faithful are a select group, and the study’s lead author says it’s important to bring services to hard-to-reach populations, such as young black men, to where they are. “We realized in our standard community health screenings–which were happening in churches–that we were not reaching adult black men,” says lead study author Vincent Mendy, an epidemiologist at the Mississippi State Department of Health. “We think the best way to reach them is through barbershops.” The program is part of a partnership between the CDC and the Mississippi State Department of Health, and is funded through September 2015.

Mendy is hopeful that the program will reach more men and bring them into treatment, since a similar 2011 initiative in Texas, funded by the National Institutes of Health, found that barbers helped to lower blood pressure in a population of African American men by 20%. Based on this growing body of research, the CDC is considering relying on community health workers to help improve the health of minority groups that have a disproportionate risk of disease and death in the U.S. — but are often outside of the health care system. Barbershops aren’t clinics, but they do seem to be a good place to get health messages across.

TIME Aids

Girl ‘Cured’ of HIV Has Relapsed

Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi on March 3, 2013.
Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi on March 3, 2013. Jay Ferchaud—University of Mississippi Medical Center/AP

"Certainly, this is a disappointing turn of events"

A 4-year-old girl believed to have been cured of HIV showed detectable levels of the virus, federal officials said Thursday in a blow to anti-HIV efforts.

The Mississippi girl had been off of antiretroviral therapy for more than two years, and doctors believed that she could serve as a model for eradicating HIV in babies born with the virus.

But on Thursday, the National Institute of Allergy and Infectious Diseases said that researchers had found detectable HIV levels in the girl this month.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care and the HIV/AIDS research community,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a statement.

The girl was born with HIV, and doctors administered anti-AIDS therapy nearly immediately after her birth and continued with the treatment for months. After the girl and her mother missed several treatment appointments, doctors found that the girl was still HIV-free — leading them to believe that the early treatment may have successfully eliminated the virus. Still, experts say they knew a relapse was a possibility.

Since HIV was detected in the girl this month, doctors have resumed treatment. But despite her relapse, researchers say her case still provides a valuable understanding of early HIV treatment.

“The case of the Mississippi child indicates that early antiretroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period,” Fauci said in a statement. “Now we must direct our attention to understanding why that is and determining whether the period of sustained remission in the absence of therapy can be prolonged even further.”

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