At this time, there is no organized center for burn care in the state of Mississippi. An estimated 500 or more people a year suffering acute burn injuries will seek treatment within a patchwork of improvisations without defined guidelines for referral, critical care, or outpatient and long-term management.

A summary of the history of this problem can suggest some options for future solutions.

I became involved in this state’s burn care when the only burn center then in the state closed in 2006. This practice was a private one based in a private hospital and, after decades of service, the center experienced a series of financial and staffing misadventures leading to its demise.

At that time, I was the chief of plastic surgery at the state’s academic medical center which was also the state’s only Level I trauma center. I thought it was self-evident that the medical center would assume responsibility for burn care. Consequently, I drew up a plan to organize a burn center. The plan included facility design, staffing proposals, and educational contexts. The center was conceived by me as an extension of an existing Center for Microsurgery and Complex Reconstruction, an academic practice that was already clinically and financially productive.1

My burn center proposal never got a serious hearing from the university’s administration, and the issue of burn care became lost in a blur of executive turnovers and practice plan reorganizations.2

I left the university in 2007 and started a hospital-based reconstructive surgery practice outside the university’s geographic non-compete limits. In that practice I treated a number of patients with hand burns and other small thermal injuries. While looking for options for referring patients with larger burn injuries, I was introduced to Dr. Fred Mullins.

Dr. Mullins was chief surgeon at the Joseph M. Still Burn Center in Augusta, Georgia. This center was accepting approximately 150 burn patients a year from Mississippi. Dr. Mullins asked me to work with him to develop a clinic to which Mississippi patients could be discharged from Augusta for wound care and secondary procedures. This arrangement worked efficiently through 2008. Dr. Mullins then asked me to work with him to establish a burn center that could provide comprehensive burn care locally.

The JMS Burn and Reconstruction Center opened at a Brandon hospital on July 1, 2009. In 2013 it moved to a larger facility in Jackson. The practice’s name was chosen to emphasize the importance of reconstructive plastic surgery in the overall management of burn victims. Organization of the unit was based on the scope of plastic surgery practice supported by midlevel practitioners, critical care physicians, pediatricians, psychiatrists, and hospitalists. Close cooperation was developed with anesthesia services, and the practice worked with hospital and unit administrators to create nursing teams, operating room teams, dedicated physical and occupational therapy services, dietary services, social work support, and a statewide referral system that functioned within the state’s trauma network. Additional surgeon and mid-level staffing was provided at intervals from the Augusta burn center, which also provided training support and referral options for complicated and overflow cases. In time, the center’s staff grew to include four surgeons, six nurse practitioners, and a research director.

In the first year of practice the center treated 391 acutely burned patients. Over a 10-year period the center treated a total of 5,470 acutely burn patients with a 1.49% mortality rate and a 0.62% transfer rate to the Augusta facility. Within that total there were 1629 pediatric cases. These cases had a lower mortality rate (0.12%) and a higher rate of transfer (1.22%) than the adult cases. Cases increased steadily, and the center admitted 604 acute burn injuries in the tenth year of its practice.3

Surgical procedures related to acute burn treatment averaged 772 cases annually over the 10-year period. In the tenth year of practice, 1001 acute burn procedures were performed. The practice also delivered comprehensive secondary reconstructive care. Over the 10-year period an average of 278 secondary operations were performed annually, with 555 such cases performed in the tenth year. Later reconstructions included scar releases, flap procedures, nerve decompressions and laser treatments.3–9

Burn surgery does not engage the full skill set of plastic surgery. With the support of Dr. Mullins, I expanded the center’s practice to include complex reconstruction cases not related to burns. This expansion built upon many of the existing components of the practice including specialized, efficient operating room teams; occupational therapists certified in hand therapy; and a well-organized clinic that saw 150-180 patients weekly. The non-burn portion of the practice grew rapidly from 290 cases the first year to 1311 cases in the tenth year, averaging 758 cases annually over that time.3

Hand surgery was the greatest area of growth in the non-burn cases. Hand procedures not related to burns averaged 542 cases a year over ten years. These cases increased steadily, and the number of hand cases exceeded 1000 for each of the last three years of the practice decade. Approximately 50% of the hand practice was elective while 50% consisted of treatment of acute injuries. Therefore, the practice was performing over 500 emergency hand cases a year, including replantations, amputations, tendon, nerve, bone and vascular repairs, surgical infections, and extensive soft tissue reconstructions. For comparison the state’s Level I trauma center recently reported managing approximately 200 hand injuries a year during the same period of time.3,10–13

With the addition of an eleventh year of data, the JMS Center admitted 6,050 acute burns and performed 20,898 surgical cases during a period of continuous and growing practice.

Academically the center supported monthly CME conferences, often with guest speakers. Visiting surgeons from China, Singapore, England, Turkey, and other US centers contributed to programs and participated in clinical and experimental research. Weekly service rounds and monthly case reviews and burn practice meetings promoted team dynamics.

Publications from the practice included clinical and laboratory reports as well as papers presented by guest speakers at practice conferences.14–19 Two journals, Microsurgery and Annals of Plastic Surgery, were editorially based in the center.

This model of burn and reconstructive practice was used by Dr. Mullins to expand the Augusta practice into a network of eight centers all of which provided comprehensive burn care and varieties of non-burn surgery. In all these centers, diversity of practice drove growth and engaged wide practitioner capacities.3,20–22

Dr. Mullins died unexpectedly and prematurely in the summer of 2020. The practice and its network concept passed to new management. That management relieved me of my medical directorship in April, 2021 and terminated my employment in November of that year. The practice has gone on to pass through many administrative changes, and most of the network’s centers have closed or are no longer associated with the network. The center in Jackson closed in October, 2022.

What did I learn from my experience with this burn practice?

Personally, I found the opportunity to develop and practice within this burn center to be one of the most satisfying chapters of my career. The burn center was a productive framework for efficiently managing a great variety of cases, and it sustained happy levels of academic activity.

The burn center practice demonstrated that over 500 people annually in this state need treatment for acute burn injuries. The center was also capable of providing care for other apparently underserved patient groups such as hand injury patients. Diversity of practice contributed to practice growth and allowed the center to maintain consistent levels of productivity while numbers of burn cases fluctuated over intervals.3

The burn center practice also showed that participating doctors could enlarge practice to engage wide skill sets. Plastic surgeons could do a variety of non-burn reconstructive cases. Critical care doctors could also practice anesthesia and pain management. General surgeons could deliver burn care while also practicing critical care and non-burn surgical specialties.

What did I learn about the sustainability of burn practice in this state?

As a political point, Dr. Mullins frequently reminded me that private practice was providing burn care in Mississippi while state resources had failed to accept such a responsibility. In the short run, he was right. Ultimately, however, private practice failed for a second time in 20 years to sustain a burn center in Mississippi. Corporate administrators follow profits, often shortsightedly. Surgical practices come and go subject to their own internal dynamics. Neither is accountable to public needs or scrutiny.

While the JMS Center provided many benchmarks for patient care, it did not survive based on private entities.

The next attempt to organize burn care in Mississippi should be based on the state’s academic medical center and trauma network.

This opinion is offered in the face of some discouraging realities. Mississippi’s political culture cultivates a cynical inertia sometimes tinged with corruption. State leadership claims to recognize problems but shies away from actions with measurable outcomes. The state capitol cannot maintain serviceable roads or reliable water supplies. With some of the worst health statistics in the US, and with uninsured care threatening the survival of many of the state’s hospitals, Mississippi refuses federal funds to expand Medicaid.

The problem of burn care, however, is a real and often an immediate one. It is difficult to ignore burn care as hundreds of patients and families each year will face severe injuries and residual complications. With the demonstrated failure of private burn centers, the responsibility for developing burn care in Mississippi falls squarely on public agencies and challenges them to get beyond their limitations and serve their constituents.

The acceptance of that responsibility could be a transformative event for the political and academic medical cultures of the state. State funding and facility investment would demonstrate a commitment to a measurable response to a public need. The medical center’s commitment to a burn center would require organizing efficient operating rooms, care teams, facilities and transfer systems. Everyone involved could grow with this effort as burn care became established within a framework of public responsibility and accountability. A successful state-run burn center would be victory for patient care, political accountability, and professional responsibility. Why not proceed?