JACKSON, Miss.—Moments after a patient arrived at his burn center, Dr. William Lineaweaver was on the clock. “They come in on a helicopter, and we settle them into an ICU bed,” he said. “We start by going through the airway, checking the cardiovascular status, ensuring the intubation tube is in the right place.”
Lineaweaver related the story of a patient burned in a house fire in the years after the Joseph M. Still Burn Center moved to Jackson’s Merit Central Health in 2013. The patient inhaled smoke; severe burns snaked up their forearms, chest and face. “They were having increasing facial swelling. The fire department arrived, ambulances too. They offered some initial bandaging, and intubated them to protect their airway,” he recalled in an interview.
The first responders then sent the person straight on to JMS Burn Center, the only dedicated burn ward for nearly 200 miles in any direction from Jackson. What came next was a flurry of assessments. “(The patient) had a chest X-ray, looking for progressive lung damage, a bronchoscopy to examine damage to the airway,” he said in a Dec. 12 interview.
Resuscitation was next to restore circulation to vital organs to protect the functions of kidneys and lungs. Lineaweaver’s team tested the patient’s blood for carbon monoxide, while an IV helped replenish fluids. Sharp cuts in the burns helped relieve the pressure of constricted skin, restoring blood flow to extremities at risk of expiration. Then a catheter: Healthy urination is a measure of safe fluid retention.
The job of Lineaweaver and his team at JMS Burn Center was to manage the delicate chaos of a body in a state of breakdown. They maintained pressure and pulse, and washed the patient’s wounds as they prepared for the long phase of repair and recovery ahead.
Less than two hours had passed from the minute of injury to the first moment of calm, as the survivor was wrapped in antibiotic dressing. “At this point,” Lineaweaver said, “the first part of treatment was now established.”
Today, to get this level of treatment, the same patient would need to be airlifted out of Mississippi.
‘Responsibility Comes Back to the State’
For over a decade, Dr. Lineaweaver treated cases just like the one he described at the Joseph M. Still Burn Center at Merit Health Central, a private institution originally located in Brandon, Miss., before moving to Jackson. Following Delta Regional Medical Center’s termination of service at Mississippi Firefighters Memorial Burn Center in 2005, JMS Burn Center emerged in 2008 as the beating heart of Mississippi’s burn-care systems. The center took referrals from across the state, from surface injuries to deadly full-body wounds.
“In the first year of practice,” Lineaweaver wrote in an editorial for the Journal of the Mississippi State Medical Association last month, “the center treated 391 acutely burned patients. Over a 10-year period the center treated a total of 5,470 acutely burned patients with a 1.49% mortality rate and a 0.62% transfer rate to the (original JMS Burn Center in Augusta, Ga.) Within that total there were 1,629 pediatric cases.”
But under the cloud of the COVID-19 pandemic and the fractured medical landscape it helped hasten, Merit announced in September 2022 that JMS would share the same fate as Mississippi’s last dedicated burn center in 2005. It closed in October 2022, and now its predecessor in Georgia is receiving many of the most serious cases that would have otherwise found stellar treatment in their home state. No other facility like JMS exists in Mississippi.
After the JMS Burn Center closed, Lineaweaver met with the Mississippi Free Press in his Madison, Miss., home on Dec. 12, 2022, to reflect on his attempts to establish lasting burn care in Mississippi and what he hoped would come next.
Above all else, Lineaweaver has a warning for a state forced to consider yet again how it will arrange care for its most severely burned residents.
“Since I moved here in 1999, we have twice given private practice the chance to provide consistent burn care to the state of Mississippi,” he said. “Having seen it fail completely twice, I think the responsibility must come back to the state.”
‘A Long Trip by Ambulance’
Lee McCall, CEO of Neshoba County General Hospital, has had more than enough challenges with running a rural hospital during the pandemic. The end of reliable burn care in Mississippi is just another burden with supply chains stretched to capacity, nationwide staffing shortages, and the raw exhaustion of all the excess sickness and death that this decade has brought.
“It’s a huge inconvenience,” McCall admitted in a Dec. 7 interview with the Mississippi Free Press about JMS’ closure. “It’s a disappointment that our state doesn’t have another option at this point.”
Heavily burned patients are not a daily occurrence at Neshoba County General Hospital. But after JMS Burn Center closed, severe burn injuries mean a laborious process of seeking out dedicated care somewhere outside Mississippi.
“First, we hope there’s a bed available at Augusta, (Ga.),” McCall said. “Then we have to figure out how we get the patient there. If it’s safe enough to transfer by ground, that’s a long trip by ambulance. If we can’t transport them by ground, they have to fly. Can you imagine what the cost of that flight’s going to be? There’s a heavy, heavy, heavy financial burden on the patient.”
Lineaweaver explained the broad threat range of burns. “Burns can be anything from a painful but essentially trivial blister to an injury that causes the person to irreparably lose large portions of their skin,” he said. “It can damage eyes and other organs, yes, but also generate an enormously complicated physiological shock response. Not only is the entire stress-hormonal axis thrown into disarray, but the person is also losing fluid through the injury.”
Lineaweaver illustrated the complex balance of repair and recovery needed to keep severely burned patients alive. “That fluid needs to be replaced. Not so much that it’ll complicate the lungs, not so little that it’ll hurt the kidneys,” he said. “Burns can involve inhalation of either smoke or flame that can cause direct injury to the lungs.”
The cascading complications of a burn can kill a human in countless ways. “Some kinds of burns have chemical consequences,” Lineaweaver continued. “Hydrofluoric acid is a very injurious substance to nerves, for example. Carbon monoxide from a burn can be very lethal if it isn’t recognized alongside the burn.”
The responsibility of McCall’s team at Neshoba is not to provide definitive treatment to a seriously burned patient, but to connect them with a dedicated team of doctors and surgeons like Lineaweaver in time to save them.
“The emergency rooms have to figure out where to send the patient,” Lineaweaver said.
That was a relatively simple task with a centrally located, top-class burn center. Now the process is tied up in all the delays and complications that face the rest of Mississippi’s mangled medical landscape. The consequences can be severe.
“The longer the delay between the injury, presentation to the primary emergency site and transfer to the definitive burn site…,” Lineaweaver said, trailing off. “That delay becomes problematic.”
“If there’s special surgery needed, like cutting through the burn scar to maintain circulation, can that be done locally? If it’s a child with a bad burn, does the local ER know how to put a catheter into the bladder? Will the local emergency room monitor the fluids correctly while waiting for the transfer? So many things can get behind schedule while the transfer is being worked out.”
Now, Lineaweaver said, the roughly 500 patients who would have otherwise found their way to JMS for specialized burn care are routed through the state’s overburdened transfer system, with many of the most severe cases sent out of state for their final care setting.
‘The University Declined’
Lineaweaver attributes the abrupt end of JMS Burn Center’s services to the untimely death of Dr. Fred Mullins, medical director of JMS’ original location in Augusta, Ga. Since Mullins’ passing at age 54 in 2020, Lineaweaver wrote, “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.” He cited institutions in Florida and Colorado specifically.
But Lineaweaver attributes the lack of a full-service burn center in Mississippi to a much earlier failure—a missed opportunity to establish a dedicated burn ward at the University of Mississippi Medical Center.
In 2006, upon the closure of Firefighters Memorial, Lineaweaver was involved in a microsurgery reconstructive practice at the University of Mississippi Medical Center in Jackson. Mississippi, much as it does now, lacked a dedicated location to treat complex, life-threatening burns. Lineaweaver says he assumed then that the state’s flagship research hospital and only Level 1 Trauma Center was the obvious choice for a replacement. “I envisioned a burn center as being an expansion of that complex wound center, using a lot of the same business and efficiency principles,” he said.
Lineaweaver began to devise a plan for a state-supported burn center that he believed at the time was inevitable. A truly comprehensive burn-treatment plan included not only acute care but advanced plastic surgery to repair the complex damage that burns can cause.
“I started off completely wrong,” he admitted, “by assuming that UMMC would simply have to do it. So my only concern was demonstrating how it could be done.”
Lineaweaver’s plan would have been an expensive addition to the suite of services available at the sprawling UMMC complex in Jackson, but the Mississippi Legislature displayed an appetite to help, he said.
In 2006, now-retired Rep. Steve Holland, a Tupelo Democrat, introduced House Bill 908, intended specifically to establish a burn center at UMMC with a considerable fund for the ongoing operation of a burn ward at the medical complex.
“The Legislature shall appropriate not less than Ten Million Dollars ($10,000,000.00) annually to the University of Mississippi Medical Center for the operation of the Mississippi Burn Center, in addition to any funds that it appropriates to the medical center from the Mississippi Burn Care Fund,” the bill read.
The legislative record shows a significant groundswell of support for the center in the Mississippi House as its required revenue bill received a three-fifth majority vote to pass in the House of Representatives. The bill languished in committee on the Senate side, however, ultimately dying on the calendar.
But Lineaweaver contends that it was not simply a casualty of an overpacked session or a disinterested committee chairman. “It was an eight-figure (annual) sum of money to start a burn center through (UMMC). And my understanding is the university declined,” Lineaweaver said.
He proposed, in an unpublished 2006 editorial, the merging of his current reconstructive and plastic-surgery practice with a dedicated burn center. His proposal was for a full-spectrum treatment center that could have taken in patients from the moment of severe burns and provide care through the process of physical recovery and cosmetic reconstruction.
But Lineaweaver withdrew the editorial before publishing it, and three years later, published a letter in the April 2009 edition of the Mississippi State Medical Association Journal detailing pressure from then Vice Chancellor Dan Jones.
“Publication of this editorial likely would result in an erosion of confidence in the point of view I have expressed on behalf of the medical center and the state,” Lineaweaver wrote in 2009, quoting from an April 27, 2006, email that he said cited Jones’ words. “It is in conflict with the recommendations of a commission including the governor and chaired by the state health officer,” the quote he attributed to Jones continued.
Dan Jones: No ‘Recurring Commitment’
In an interview on Friday, Jan. 6, Dan Jones disagreed with Lineaweaver’s characterizations of how he responded to the effort to fund a burn center in 2006. Jones said he recalled believing at the time that UMMC “was the best organization to take on responsibility for burn care,” but that he could not get “a recurring commitment” from the Legislature to fund it yearly.
“The challenge with the burn center or burn care is that many of the patients who need treatment are uninsured, and so it’s not as simple as a one-time appropriation to build a facility or to renovate a facility,” said Jones, who is now UMMC professor emeritus of medicine and dean emeritus of the School of Medicine.
The text of H.B. 908 as it passed the House explicitly included language appropriating $10 million to UMMC annually, a commitment of continuing funds to establish and maintain a burn center. But Jones said that the Senate committee where the bill would eventually perish made it clear to him that the recurring funding was off the table.
“The original bill that’s written and the bill that’s negotiated for potential passage are always different things,” Jones said. “When the committees were conferencing the bill, there was a clear indication that the recurring language was not going to survive.”
The Legislature, Jones said, would have ultimately proposed a one-time appropriation that he and others at UMMC believed was not enough to cover the annual cost.
“The situation is different today in that the trauma fund—that covers primarily automobile accidents and so forth—the trauma fund money is now available for care of the burn patients, and so I’m obviously not in a position to know what the financial situation would be today. But the trauma fund money was not available to us in 2006 and 2007,” Jones said. He was referring to the Mississippi Trauma Care System that the State adopted in 1998 and later required hospitals to either participate in or pay a fee for nonparticipation starting in 2008.
Jones declined to comment on his interactions with Lineaweaver in the past, but stressed that he had wanted a burn center at UMMC.
“We were very anxious to have a burn center at our institution. We wanted to do it,” he said. “I told the members of the Legislature that we wanted to provide that care, but that it couldn’t be done unless we had a commitment for recurring financial support.”
In a Dec. 30, 2022, interview with the Mississippi Free Press, Rep. Holland agreed with Lineaweaver that UMMC had put its institutional finger on the scale to prevent the funding bill from passing. But he expressed sympathy for what he suspected was the reasoning.
“I can tell you one reason that (H.B. 908) didn’t pass—and I understand this, because I ran their budget for 18 years—UMMC was scared of it. They said ‘as long as Steve Holland’s there, we know we’ll get our funding, but what’s going to happen the day he leaves?’”
The prospect of a legislative inducement evaporating and leaving the public university on the hook for the full cost of operations, Holland said, made the option a risky financial proposition. “It takes a lot of infrastructure to do a burn center,” the outspoken former legislator said. “It’s not like having a maternity ward. It’s heavily intensive in equipment and specialty healthcare providers.”
Holland acknowledged that a full recounting of the ill-fated UMMC Burn Center plan would have required the input of then-Senate Public Health Chairman Alan Nunnelee, R-Tupelo, later a U.S. representative, who died in 2015. But Holland said UMMC’s trepidation toward the proposed investment made the bill an easy target.
“I think (UMMC) did put some pretty undue pressure on the Senate, and the Senate bought into it because the Senate was already, by that time, Republican leaning,” Holland said.
Mississippi experienced a brief period of Republican Senate control in 2007, and by 2012, the GOP were the majority in both houses of the Legislature—supermajority dominance the party has maintained ever since.
‘Mississippi Needs A Burn Center Yesterday’
Now that the Mississippi Legislature has begun its 2023 session, the prospect for action on burn care in the state is a possibility. Without JMS Burn Center, lawmakers and hospital leadership will again contemplate the possibility of a state-funded program at its central medical institution.
Though he no longer has lawmaking power, Holland is unequivocal in his support of a program like the one that died in 2006, saying that UMMC is the ideal location for a centralized burn ward. “The University of Mississippi Medical Center, in my opinion, has become a magnificent hospital. These years, it’s better than it’s ever been, as far as I’m concerned,” he said.
In fact, Holland regrets no longer being in the Legislature to submit the bill himself.
“Mississippi needs a burn center yesterday,” Holland said. “It behooves me that there’s not some soul down there sympathetic enough to take this great surplus of money that Mississippi has right now and re-establish and perpetually fund one with some kind of source, whether it’s a tax or whatever.”
Lineaweaver was disappointed when his push for a burn center at UMMC failed to bear fruit in 2006. Now, he says another chance has arrived. “Developing a burn service at the trauma center is the obvious, and in some sense necessary, answer to take care of the acute and (long-term) care that people need, including reconstructive surgery, kidney support, and all the other things that come up,” he told the Mississippi Free Press.
“I am 100% in accordance with (Lineaweaver),” Holland responded. “And it’s a shame. Just wait till somebody in the ranks of current leadership has a family member that gets burned. Somebody might get interested. But right now we’ve got poor folks that have zero political clout getting burned every day, and they deserve treatment. It’s a right to ’em as far as I’m concerned.”
Marc Rolph, UMMC’s executive director of communications and marketing, declined multiple requests for interviews with current and former medical-center leadership for this story, but provided a statement response on Jan. 3, 2023.
“When Jackson’s privately run burn center, the only one in the state, announced it was closing last October, UMMC voluntarily stepped up to fill this health care void by ramping up the capabilities of the state’s only academic medical center and Level I Trauma Center to care for burn patients,” Rolph wrote.
“Since then, we have administered potentially life-saving care to dozens of adults and children. We continue to evaluate the needs of Mississippi’s burn victims and how we may be able to provide the vital, complex care they require and we will expand our capabilities in the future as necessary to meet these needs.”
News Editor Ashton Pittman contributed to this report.