Mississippi now has two designated burn centers. What happens next?

The state Health Department deemed Mississippi Baptist Medical Center qualified to host a burn center, health system officials announced at a press conference Thursday.

But with almost half of Baptist’s burn center requirements not fully met and millions from the state Legislature in flux, there’s still a long way to go.

Since the state’s only accredited burn center housed at Merit Health Central closed in October, both Baptist and the University of Mississippi Medical Center have been vying for the designation. Merit’s former burn director, Dr. Derek Culnan, now leads the burn unit at Baptist.

UMMC got its approval in April, while Baptist formally received its designation on July 24.

“I came to this hospital and this community and asked them to take us in, and I said, ‘I have thousands of people who need help here, and they need it now, not years from now,’” Culnan said at the press conference. “And (Baptist) said yes.”

Baptist has treated 927 burn patients since last November when they received their first, according to CEO Bobbie Ware. 

“Today is just the beginning of the development of a premier burn program in this region,” Ware said at the press conference.

After some back and forth, the Legislature ultimately gave the state Health Department the responsibility of choosing Mississippi’s next burn center and appropriated $4 million for whatever facility was chosen to defray expenses. However, nothing in the bill prevents the money from going to more than one center. 

But now that two facilities have been approved, no one is quite sure how the money will get split.  

Baptist’s results versus UMMC

Before Baptist received its designation, a team of experts assessed the facility to determine the health system’s compliance with burn center standards. 

The team — Dr. William Hickerson, who helped establish Memphis’ Firefighters Regional Burn Center and served as the past president of the American Burn Association; Terry Collins, a nurse who directs the trauma program for the University of Arkansas for Medical Sciences; and Teresa Windham, a trauma system nurse in the state Health Department’s Bureau of Acute Care Systems — visited Baptist on July 18. 

Out of 155 categories, the team found that Baptist fully met criteria in 90 categories, but fell short in 61. Another three were not applicable, and one ranking was missing. 

The findings of the two facilities’ site surveys show that while UMMC fully met more categories, Baptist partially met more criteria. Fewer than 20 categories were not met at all by both facilities, showing similar levels of compliance.

Hickerson said UMMC and Baptist had differing strengths and weaknesses, but both showed that they could correct their problems.

“A burn center is not necessarily that you build it, and they’ll come, and you’ll have just absolutely wonderful results,” he said. “It’s developing the team and doing things where it’s going to be safe for the patient. And that’s something that can be challenging when you’re starting out with a new team.”

While UMMC appeared to struggle more with ongoing burn education and training and recruitment, Baptist was docked in several categories for a lack of documentation. 

For example, under the continuity of care category, Baptist “partially met” the criteria for providing support for family members or other significant people. However, the facility only had a verbalized plan in place, and the assessment team was “unable to verify the implementation with current documentation.”

Both facilities need stronger policies and procedures around burn care, the reports found, and the burn directors at both health systems only “partially met” requirements. 

Baptist’s team in particular shined in the report— their burn program manager was noted as a strength of their center.

“This team’s just amazing,” Culnan said at the press conference.

However, while Baptist seems to have a more complete staff compared to UMMC at the time of the survey report, it appears that the director, Culnan, is the only attending surgeon. Hickerson said that might be a problem. 

“One individual a team does not make. Dr. Culnan will need assistance to prevent burnout,” Hickerson said. “He’s going to need to go to meetings, he’s going to need to take vacations with the family. So you’ve got to have someone that’s going to be very qualified to step in during those times.”

On the other hand, UMMC has multiple options because of a good working relationship between their plastics and general surgery department, Hickerson said.

One category was missing a ranking: the inclusion of physician specialists on Baptist’s burn team, which Hickerson said was likely a mistake. 

Baptist spokesperson Kimberly Alexander could not answer whether the facility has made any improvements since the site survey, including the addition of more attending surgeons.

The state Department of Health also could not answer by press time why Baptist was approved while meeting just over half of the burn center requirements. 

Hickerson was hopeful that the facilities could correct their shortfalls, and said ideally, there could be collaboration.

“It seems like with both pursuing having a burn center that it would be nice to have a working relationship between the two,” Hickerson said. 

Baptist has 30 days from the date of the site survey report’s submission to develop a corrective action plan that addresses the burn center’s deficiencies. According to Alexander, it has not yet been created. 

Baptist moves from Level 4 to Level 3 trauma center

In addition to its burn center designation announcement, Baptist also unveiled its upgraded trauma center designation at the Thursday press conference. 

Baptist has recently been deemed a Level 3 facility, which means it can “provide initial resuscitation” and treat the majority of trauma injuries but lack neurological services.

Baptist is now also a primary pediatric trauma care facility, a requirement of all trauma centers in Mississippi. It’s not clear why they didn’t have this designation previously, when the health system operated as a Level 4 trauma center, the lowest ranking from the state Department of Health. The agency annually assesses hospitals’ trauma care capacity. 

Mississippi Today found in 2019 that Baptist was qualified to care for patients as a Level 2 trauma center, but the health system was paying $1.5 million annually to opt out through a non-participation fee. Baptist had been paying the state millions since 2008 to avoid treating certain trauma patients. 

Ware defended the decision to Mississippi Today in 2019 by saying it was what Baptist leaders felt the facility had the ability for, based on the availability of specialists. 

UMMC is the state’s only Level 1 trauma center.

Ware said Thursday, though, that the health system decided to pursue the higher designation because leaders finally felt it was prepared for it.

“We just felt we were at a point … with our general surgery and our orthopedic surgeons, they were committed to supporting that,” Ware said. “We were taking care of trauma patients anyway, they come here through our (emergency department). There are people in Mississippi that want to receive care here, and we felt like it was important to be able to confirm that designation and be able to provide their care.”

While it’s not clear if Baptist plans to pursue a Level 1 designation, Ware said they’re continuing to evaluate whether they should attempt to be designated as a Level 2 facility, which would require recruiting neurosurgeons. Ware said leaders have not yet made a decision.

However, Ware said the burn center is their primary focus right now. 

“We’re going to start moving forward with working on our American Burn Association designation and getting our programming in order to be a leading program not just within the state, but within the country and within the world,” Culnan said.

Millions at stake

Both UMMC and Baptist are eligible to receive funds from the $4 million the Legislative has allocated toward the state’s next burn center.

How it’ll be split, though, isn’t yet clear. 

House Bill 1626, which outlines how the Health Department is funded by the state, says $4 million is intended to “defray the expense of establishing and equipping a burn center” in Mississippi. 

It goes on to say that the funds will be disbursed by the state Health Department as a reimbursable grant to the entities where a burn center is established.

Legislators involved in the bill’s creation, however, either could not be reached or were unclear about how the funds would be allocated. The bill’s principal author, Rep. John Read, said he was under the impression the state Health Department would handle the money’s allocation.

“I have not seen anything from the Department of Health yet,” he said.

A spokesperson from the state Health Department initially said the agency would follow the bill’s instructions. After more inquiries, however, a spokesperson replied that because both facilities are now designated as burn centers, they can now both access the funding. However, they’ll have to bid for the funds through a request for proposal, or RFP. 

On Thursday, Ware was unaware of details. Baptist plans to move forward with the development of its burn center through funds derived from operations and other capital funding and grants. 

“I’m sure (the state Health Department) is working on a plan, and they’ll communicate with me when they have more information available,” she said.