Support for Arkansas Week provided by the Arkansas Democrat-Gazette.

The Arkansas Times and Little Rock Public Radio.

And hello again, everyone, and thanks very much for being with us.

Little Rock isn't the only Arkansas city, certainly not the only American city in need of revitalizing its urban core.

But it is Arkansas's capital city, and its advocates believe that gives it a special significance.

Their hopes for the project is a matter that we will cover in a few minutes.

But first, an issue that is urban and rural and a distinction that no state covets.

Arkansas's maternal mortality rate.

It is the highest of the 50 states now in the planning stage of the University of Arkansas for Medical Sciences, a midwifery training program, an outgrowth of a maternal health task force empaneled by the governor.

We're joined now by the dean of the UM's College of Nursing, Dr. Patricia Cowan, and also by State Representative Aaron Pilkington Pilkington of Knoxville, excuse me, for whom pre and postnatal maternal care has become really a signature issue.

Mr. Pilkington, let me begin with this.

This is almost too rich to believe, but as it happens, you are on maternal maternity leave.

Yes.

Yes.

I just had my third son two weeks ago and my wife had our third son two weeks ago.

And so right now I'm on family leave helping take care of her and corral our other two sons.

And so, yeah, it's a I'd say it's a very fitting moment for me to be here talking about this because it's, you know, it's so close to what I'm actually experiencing right now.

Well, and that it's an appropriate segway, I suppose, for a personalized Segway into the scope of the problem.

I have to assume that Mrs. Pilkington had clinical advantages that a great many Arkansas women do not.

Yes, she does.

I mean, obviously your family.

Yeah.

Yeah.

No, no, no.

So my wife, you know, was able to, you know, have an OB-GYN and she was able to see we have private insurance.

You know, I was able to pay for it.

But unfortunately for a lot of our Arkansans, a lot of young women in the state, all when really, you know, they lack access to that care, whether it be because they're not covered through Medicaid.

If they're falling in between the gap are they're in a setting or a rural area where they're not able to get to a provider.

And so one of the things that we hope with this new program, UMC is helping to bridge that gap of care, because having these mid-level providers kind of go into not only the urban areas but the rural areas, as you mentioned earlier, will help fill those gaps because, you know, we don't have enough OB-GYNs in the state.

And but the health care economics to have labor and delivery units at every hospital in Arkansas doesn't really work.

So there's a way how do we fix this?

How do we fill the gaps?

And one of the things we've done with primary care is, of course, using advanced nurse practitioners to fill those gaps.

We're looking to do something very similar with these midwives right?

Am I wrong?

This is this.

But the situation is especially acute in rural Arkansas, where access to OB-GYN care.

It's not just hopping in the car or having someone drive you ten miles to your doctor.

Yeah.

I mean, I think sometimes we we forget how hard it is, especially, I mean, a lot of single mothers in the state.

You have a lot of low incomes, dual income families where mom is also working.

So especially if it's, you know, them having to go and drive an hour and a half to go see, you know, begin.

They're not only missing, missing work, but also they're having to take their kids out of child care.

I mean, there's there's a whole slew of things that occur trying to gain access.

And so for them, a lot of times they forgo going and seeing those providers.

And then even if they can manage to figure out navigate that whole process, is there even enough room on a provider schedule to see that patient within a timely manner?

So there's it's very acute in the rural areas, and that's one of the things I hope that we're able to address.

But even I would even say to in some of these more urban areas, just, you know, lack of public transportation, things like that, those contribute to the problems as well.

So it's I mean, I would say it is a Clarksville, Arkansas problem.

It is a Little Rock, Arkansas problem.

It's an Eldorado problem.

It's Jonesboro.

Those are the whole deal.

So there's not even an even in northwest Arkansas, which I think sometimes we think is the one of the best parts of the state.

With so much growth going on, there's still a lot of gaps up there that need to be addressed.

All right.

Over to Dr. Cowan now of the midwifery program.

When can we get it?

Where are you in the planning and in the execution of the program?

So we're early on in the planning.

We are in the process of hiring a consultant to assist us with the curriculum development and accreditation process.

We need to be pre accredited before we can advertise the program and admit students to it.

And that usually is going to be a year or a year and a half process to go ahead and get through.

We've currently gone ahead and put up a position description for director because we'll have to hire a director for the program before we can go ahead and apply for credit.

There are a lot of steps that need to take place.

We have to get the curriculum approved through UMC, the US System Board of Trustees and the Arkansas Department of Higher Education before we can go ahead and apply for accreditation.

So there are quite a few steps still to go through.

As a very practical matter, who can be who would be a midwife, who would be eligible for to enroll in the program.

So we are looking at going ahead and doing a master's level nurse midwifery program.

You would have to be a registered nurse in order to apply for the program.

There are two pathways that could be done associated free to masters or post baccalaureate to masters degree.

Do you find, Doctor, that there might be a certain cultural bias against even the term midwife?

I mean, this here we are in the 21st century.

Every woman deserves an M.D.

as opposed to a midwife.

I do think there are cultural biases against advanced practice nurses, whether those be C.R.A.

nurse midwives or nurse practitioners in some parts of the country.

On the other hand, I know that there are a large bias towards nurse midwives in certain parts of the country.

So Alaska, Vermont, New Hampshire, New Mexico, Oregon have the highest rates of nurse midwife assisted births in the country.

And so those are seen very positively by by different groups.

Okay.

Is is midwifery a safe approach to children?

It is a safe approach.

And so we're really looking at low risk deliveries during this time period, as I think our folks here at UMass have also gone ahead and indicated about a third of complications that occur occur that are unexpected.

So you do not know.

So what typically happens is a nurse midwife has some type of collaboration to go ahead and refer out to an OBGYN for services.

If a C-section, for example.

What's needed to these conditions, though, usually be determined in advance of of anticipated delivery time.

I think some of them can.

And not all.

Not all can.

Typically what we're looking at is low risk that the nurse midwives are dealing with in terms of births.

Now we see nurse midwifery assisted births occurring in home deliveries.

We go ahead and see them occurring in freestanding birthing centers and we also see them occurring in hospital settings.

Mr. Pilkington Yeah, I think as you mentioned earlier, these low, low risk births are kind of primaries for them to do.

I mean, that way we're utilizing our existing OBGYN to really handle the most severe cases, you know, And one of the things that we see is by improving health outcomes, we can reduce the amount of C-sections that we have in the state we dress.

We see an improvement in not only in the health of the baby, but in the health of the mother.

And so by getting early prenatal care, we can address issues earlier on in the pregnancy.

So to the point that she may there's really a relationship there, just like there are with aprons and MDs and DOZ right now.

If there seems to be an issue that's out of their scope, they are supposed to then hand it off to, you know, to a more qualified provider like an M.D.

And I think that's really I mean, what we need to see more is this collaborative approach because in reality, if these low risk person get taken care of closer to home at a birthing center at a local hospital, we should allow that.

That's better for the patient.

But obviously, if they become too risky and we need to have to move to a center like UMC, I mean, we need to have those relationships so that it's an easy move from one to the next.

I mean, trauma is very much same way you could go into the E.R.

from an ATV accident and, you know, you think you're going to be able to get taken care of.

Johnson Regional.

And in reality, they're going to send you to the Trauma one center down at UMC.

So there's just we already have this kind of networks built in for other health care issues.

And I think this is another one that this is a added piece into the larger puzzle of how do we build a maternal health network in Arkansas that functions and that allows us to utilize our current providers at the highest capacity for first concern, obviously is for mother and and infant.

But this and to both of you, this is a public policy issue as well.

The economic implications of this of this situation are just enormous.

Sure.

Yeah.

I mean, if if we don't improve our maternal health here in Arkansas, I think long term we see negative economic effects.

But but additionally, too, I mean, we don't want to see people going out of state to have births are choosing not even to choose Arkansas as a place to come and live because of the maternal health deserts that currently exists in the state, which I sometimes think people feel that this is not maybe the safest place to have a baby.

So by addressing this, it's not only a health care issue, but it's an economic issue as well.

Well, and Dr. Cowen, I say safe, healthy delivery, frankly, is a less expensive delivery.

Am I not correct?

You are correct with that.

So the the the hit on the Medicaid program can be enormous.

Yes.

And that's one of the things, too, about reducing our C-section rates that I mentioned earlier.

If we're able to have earlier interventions, not only educate mothers on how to make sure that they're prepared for when they choose to get pregnant or when they do get pregnant, take steps to make sure they have a healthy pregnancy.

By lowering our chances of C-section rates, I mean, we drastically save the Medicaid budget quite a bit of money and then, of course, to it's also better for baby and child.

So sometimes those are unavoidable.

You know, my first child was a it was a C-section.

We had to have it.

I mean, it's the way it was.

So I'm glad we did.

But there are but obviously, it costs way more than a vaginal delivery, which is preferred by a lot of a lot of providers.

So the hope is, you know, by getting this prenatal care out there, by getting them with some of these nurse midwives and having someone there to kind of help guide them through the process, we can reduce that.

And like you said, save the state some money, which would be fantastic.

All right.

Got to wrap it up there because we're out of time.

Mr. Pilkington and Dr. Cowan, both of you, thank you very much for coming in.

Thank you.

Thank you.

And we'll be right back.

And we are back.

It is axiomatic if you want to put new life in an urban area, you have to put more lives in it.

That is, people who actually live downtown as opposed to just visiting or leaving for the suburbs at the end of the day.

Now, there is a new plan to give a newer vibe to Arkansas's capital city or that center portion of it before the city's board of directors is a proposal to create a special tax district that advocates say would produce additional amenities and lure the sort of private investment needed to double the number of downtown residents.

Joining us now, Gabe Hallstrom, executive director of the Downtown Little Rock Partnership, and Virgil Miller, a member of the city's board of directors.

Gentlemen, thanks very much for coming in.

The city board, Mr. Miller, is expected.

It's I think it's widely expected to to approve the plan as it has been proposed.

Why will it work if it.

Why will it work?

Why is this a plan the city needs?

Well, it's definitely a plan that the city needs.

When you look at any downtown or any city, what do they say?

Downtown is the heart of the city.

Whenever you have visitors that come in where you want to go, well, let's go downtown.

And so our downtown needs to be vibrant.

It needs to be a place where people want to go.

It needs to be a place where people feel safe.

It needs to have some things that people want to see.

And so I'm certainly supportive of this master plan.

I want to make sure that we can do the things that it calls for.

And, Steve, at the end of the day, what does that mean, money?

It means money.

And so the private sector can't do it by itself.

And the public sector can't do it by itself.

And so what we're trying to do is create these private public partnerships.

And we need incentives to do that.

Well, gave those from partnerships part of your title there?

Absolutely.

So, you know, one of the things that came up very early in this process is you started looking at the people who live downtown and then benchmarking that against some of our other peer cities that are similar situated to Little Rock.

And one of the things that we noticed is that downtown Little Rock has the density of about a third to a half that a lot of these other peer cities have.

So population density, population density in the in the downtown area.

And then you started looking further and we came to figure out the occupancy level.

And the occupancy rates of the residential units is upwards of 97%.

So it shows that people want to be down there.

There's just not a product.

There's not enough inventory to do that.

So we need to build inventory and create that inventory.

Why not let the private sector do that alone?

You say it has to be a public private partner.

What about the invisible hand of the market here?

Well, I think that's a great point.

But then you know, as we continue to through the process of the plan, the economic development consulting firm that was brought in to assist with this did an analyzation of the economic development incentive tools that we have available in Little Rock.

And really, that means the entire state.

So what we have here in Arkansas.

And then they started benchmarking us against the surrounding states and then states all across the country.

And they came up with the fact that we're 49th.

So if a developer, a regional or national developer is looking to come in anywhere in the state of Arkansas and they have a certain amount of capital, they want to invest in one of these tertiary markets, then the next thing, once they make that initial contact, they start asking about what kind of incentive programs do you have?

And the answer is pretty quick to get to nothing.

We don't have them.

So if they're going to invest here, they're going to go invest in Tennessee or with Carolina, and they get a much larger incentive package in some of these other states where they're going to go to these other states.

So how do we get on that level playing field?

And what are some of these things that we need to establish and create here in the state in order to do so for Joe Miller?

Well, we have to take a look at all the incentives that are at our disposal and ones that we can offer up as an option.

When you talk about tips or tax increment financing districts of we have a little selling to do because those funds from that generally go towards your school districts and so on to get to that because, well, I mean, let's just throw it out there on the table now because we have to talk to the local school district and we have to get them to see that in the long run, maybe even in the short run, this is going to be better for everyone, because if you create development downtown and if you have people that are living downtown, then you create a broader tax base.

And that's what we're trying to do.

So let's create something where people want to live, where we can get developers to come and develop, get people live there.

What happens then?

People start spending money and generating taxes.

And so that's.

Steve.

At the end of the day, that's what we're trying to do.

But everyone has to understand how this thing works.

And it's not a zero sum game on this.

If we do this, we have to make sure that our school districts and the families and our patrons understand that this is going to help everyone.

I hate to be cliche, it's about it.

But a rising tide will lift all boats.

And that's exactly what we're trying to do here.

I want to come back to that in just a moment.

But first, anyone who's been driven down, you've got the attorney general's office now preparing to move what I think 200 or so employees in the what was just a hulk of a building.

You have restaurants now lining the certainly well, maybe the length of of Main Street.

You have the river market district over there.

Again, why the need for one of the need for any sort of intervention other than market forces.

So one of the other things that we seem to be doing better as it is, there has been a lot of progress in the past decade, in past two decades.

However, when you look at the available land that we have in the downtown area, 23% of that land is owned by the government, by the state, city or federal.

10% of that land in there is surface parking lots.

So there are more places to park in downtown Little Rock than you have people who live down there and work down there combined.

So right now we have about 4400 people that live in downtown.

There's about 43,000 people that work there every day.

And there's more surface parking available for all of those people.

So is there a better use for some of that land?

You know, we've identified through this process a handful of spots that are municipal or state owned pieces of property that what other cities have done have issued RFP for developers to respond to that.

The people that are parking there could go park in adjacent parking decks and then mixed use or multifamily projects could be built in there, which adds to the people that are going to be living downtown and going back.

That is a long way around of Answer your question, why is that important?

One of the biggest things that come up when we talk about this is how do we get a grocery store in downtown Little Rock right in the heart of the city?

Well, retail is going to follow rooftops and people.

And so we have to have that population density in order for the retail like grocery stores to come to that area.

The the matter of tax increment financing, I'm Beebe and you're going to have to talk to a law school director obviously you are.

This comes at a time when you know the state now has the learns act which is helping to subsidize private schools as as never before.

Little Rock School District is laying off employees and its enrollment is shrinking.

I have to think they're going through the roof already at the mention of tax increment because it freezes property tax revenue.

Well, certainly that is going to be challenging, but that is certainly one option that we're looking at.

As you probably also aware of, we're looking at maybe bring in a sales tax increase before the citizens of Little Rock.

And a portion of that has already been identified as funds that can go towards our downtown.

At this point, we're talking about maybe about $100 million going towards that.

And so what we really what we really need is for the final plan to be presented to us.

All the public input has been obtained or the cut off is today as the taping of this program.

And then in about 30 days, we're going to ask for presentation before the city board.

Mid-summer, approximately next month.

Okay.

Next month.

And so I want to as my desire to line up what this downtown master plan is proposing with what we are looking at with regard to our sales tax and see where we can marry up funds that will go towards some of the implementation of this.

Some of the stuff should be fairly quick to do.

I mean, we need to have some wins early.

One of the things I'd love to see is a there's a circular bus going up and down Main Street that connects downtown to our thriving Soma district and have it looping around us.

Something weak.

South Main Yes, South main area.

That's not going to cost a whole lot of money to do it, do that.

But people want to see some things happen as a result of this master plan.

This master plan needs to be implemented certainly in parts of it, regardless if the sales tax passes or not.

And I'm certainly a strong advocate of increasing our sales tax for a number of different things.

Yeah, the headwinds are pretty strong or certainly they have been in the last several years.

Politically, is this doable now?

And if so, why start with Bolster?

So as far as the the tiff or the sales tax?

Well, both.

So I think the certainly the sales tax because, you know, we're coming out of of of the the pandemic, you know, we're still feeling the headwinds of that at just like downtowns all across the country are.

The good news is about Little Rock is we don't hit the high highs and we typically don't have the low lows.

So with the sales tax that was presented two years ago did not pass.

This has been restructured, is being handled a lot differently.

Mean, you know, kudos to the city board of directors for going and meeting with the citizens.

So I feel confident that we're in a good spot.

This has a really good shot at passing this.

If this takes off.

Gentlemen in Ferguson, we'll go to Mr. Miller.

We'll go to you.

Director Miller, what what are we what are the benefits?

What are the immediate what in the in the near term, what can we say?

Or over a 510 year period in terms of amenities, a better looking city?

Well, we want to try to improve our parks, certainly.

But if you ask me what's the most important thing a city can provide its citizens?

I have a top three city is public safety.

Public safety, public safety.

If we can provide that and we have certainly plans to do that, if we get to sales tax based, then that will then spur development in a whole lot of different areas.

Our parks would benefit, our ports would benefit, our infrastructure would benefit.

But people have to feel safe.

I don't care what part of the city, then they have to feel safe.

And so a portion of this would be towards public safety.

And if we can do that and then people want to come downtown, right?

They want to live downtown, but they have to feel safe.

And then the other thing about a sales tax, do they trust the people if if they pass this, do they trust their elected officials to do what they say they're going to do with this?

Have they listened to the public about that?

And that's why it was so important that we had meetings for the public in all seven wards and we're gathering input.

And they'll be even more discussion about this in the weeks to come.

So I feel good about it.

We've got about 20 seconds remaining.

Gabe, You also I think one of the biggest opportunities is the 18 acres of greenspace that's going to be created as a result of the 30 crossing project.

You know, that's something that's staring us in the face and that is an amazing opportunity for the city to create a jewel right in the heart of downtown.

Got to end it there, gentlemen, because we're out of time.

Thanks to both of you for coming in.

Absolutely.

And come back soon.

Yes, sir.

All right.

Thanks, Steve.

And that does it for us for this week.

As always, we thank you for watching and we'll see you next week.

Support for Arkansas Week provided by the Arkansas Democrat Gazette, The Arkansas Times and Little Rock Public Radio.