The March inspection of the University of Mississippi Medical Center for its burn center designation showed the health system failed to fully meet almost a third of criteria required to host the state’s next burn center, though it was recently deemed qualified to do so anyway.
UMMC communications officials refused to answer Mississippi Today’s questions about the current status of its burn program, including its staff’s training. A Facebook post, however, shows that since the health system’s application to host a burn center was submitted and the subsequent site visit was conducted, more staff have undergone the training required to care for burn patients.
The Mississippi Department of Health said UMMC has submitted a corrective action plan to address the shortcomings, but declined to provide it without a records request. UMMC officials refused to engage with Mississippi Today about such a plan.
The surgeon on the team that performed UMMC’s March site visit said the results of their site visit are not uncommon.
Dr. William Hickerson, who helped establish Memphis’ Firefighters Regional Burn Center and served as the past president of the American Burn Association, said the health system has what it needs to establish a burn center.
“My impression was that they have set things up very well,” he said. “You’re not going to be able to open your doors and say, ‘Bring them (the patients) home.’ This is not the Field of Dreams … You have to have a team approach. Everything has to be in a learned environment, and you start slowly like these guys are and build up now. And I think that that is exactly what we saw and what their plans were that they showed us.”
The Institutions of Higher Learning last month approved UMMC’s request to use $4 million of its own money to create a new burn center. The hospital system will renovate the first floor of the Batson Tower into a new burn unit, with ICU beds and rooms for patients recovering from surgery.
Officials visited UMMC on March 21 to review the health system’s credentials and see if it was qualified to host the state’s next burn center. That team consisted of Hickerson, 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.
In May, Mississippi Today requested the results of that visit.
Originally, a state Health Department attorney said the survey was exempt from disclosure and cited costs that totaled nearly $20,000 for communications regarding the visit.
After Mississippi Today asked the department to cite state law that exempted the survey results, however, a Health Department official attached the survey in an email thread.
The results of the survey showed that out of 155 categories, UMMC either “partially met” or did not meet criteria in 46, or 29.6%, of the categories.
Though UMMC was docked in the report for not having an internal burn education plan in addition to lacking certain required staff, policies and procedures, the survey results showed they excelled in team coordination, specifically between its trauma and burn surgeons.
“This cooperative plan is one of the best these reviewers have witnessed,” the report says.
Since the state’s only burn center housed at Merit Health Central in Jackson closed in October, both UMMC and Mississippi Baptist Medical Center have vied for the designation. Despite gaps in both its application to host a burn center and this site visit, UMMC received its approval in April from the Mississippi State Department of Health.
“I’ve been through several hospitals and several reviews, and we don’t come in to rubber stamp anything. It’s to give an honest opinion of what we see the capabilities are, and we report the findings,” Hickerson said. “I know there’s a competition. I’m on neither side. I’m here to give you the facts of what I see.”
A director of an out-of-state burn center and officials with the American Burn Association declined to comment on how UMMC’s site survey results compare to others who have been approved to host a burn center.
State Health Department spokesperson Liz Sharlot responded to questions about UMMC’s qualifications with an emailed statement that included information about the state’s Trauma System of Care and their goal of enabling “access in Mississippi, rather than out of state, for burn patients and their families.”
Mississippi Today found in February that UMMC had sent at least one burn pediatric patient out-of-state for treatment.
“Keeping this goal a priority, MSDH works with entities seeking a burn center designation to ensure that safe and effective care is provided through a well defined operational plan for clinical care and service delivery,” the Health Department’s statement reads. “Such plans may include corrective actions for any deficiencies noted to allow entities to continue to build their burn care programs. This process includes a revisit or focused visit to ensure corrective actions are taken to maintain a burn center designation.”
Hickerson said that it’s common to check in with burn centers a year after their establishment to ensure they’re in full compliance, but as of his March visit, he believes the health system is capable of hosting a burn center.
“The whole aspect is to make sure that you set something up that is going to be safe for the patients,” he said. “Yeah, they didn’t have a complete check. But they had means that they were gonna fix that.”
At the time of the survey, UMMC was still actively recruiting for staff, including nurses, pharmacists, dietitians and psychiatrists. The report also showed that the health center struggled with ongoing burn education and internal training. At the time of its application, which was submitted earlier this year, an internal burn education program was being developed.
The site survey reports that the burn center medical director, Dr. Peter Arnold, has the required criteria to lead the unit, which can be achieved two ways. The first includes being a surgeon with board certification in surgery or plastic surgery and completing a one-year fellowship in burn treatment. The second route is experience in the care of patients with acute burn injuries for two or more years during the previous five years.
However, it’s unclear how Arnold meets those criteria — Arnold has not completed a one-year burn fellowship and has been at UMMC for the past five years, while the state’s only burn center has been housed at Merit.
Furthermore, the survey also says that as burn center director, Arnold did not perform some of the required job duties, including creating policies and protocols for the burn care system and cooperating with trauma care for patient treatment.
At the time of the report, Arnold was not current in Advanced Burn Life Support (ABLS), the standard training for burn patient providers. He was scheduled to undergo this training in April, but UMMC refused to answer questions about whether that training took place.
The health system’s initial application also showed that none of its staffers were ABLS trained, though a Facebook post from May on the University of Mississippi’s Air Care page showed that 48 clinicians and communication specialists had undergone ABLS training.
Additionally, UMMC staff likely attended ABLS training at the Mississippi Trauma Symposium in May in Biloxi.
Arnold said in May at a presentation about the burn center that one of his goals moving forward was to acquire American Burn Association verification for the center.
“We’re designing everything we’re doing to meet the goals of ABA verification,” he said. “It takes two years after you’re established before they’ll come. And so I think, you know, this is obviously a work in progress, but eyes on the prize.”
During this year’s session, the state Health Department was given $4 million by the Legislature to choose the state’s next burn center. Nothing in the law prevents the $4 million from going to more than one hospital.
Baptist Medical Center has also submitted an application to host the state’s next burn center, which includes its burn center director’s qualifications to lead the unit, two ABLS-trained staffers and an internal burn education plan. Its site visit has been scheduled for July 18.here.