Dr. Derek Culnan, Medical Director for the Mississippi Burn, Hand & Reconstruction Center
When Mississippi’s only burn center was set to close in late 2022, the team began searching for the right place to continue operations. They found a home at Baptist.
In October of 2022, the state of Mississippi lost its only fully operational burn center at Merit Health Central. However, upon the closure of the Joseph M. Still Burn Center, the team there did not slow in their mission to provide world class care.
Leading the team at Merit Health Central was Dr. Derek Culnan, Medical Director for the Mississippi Burn, Hand & Reconstruction Center. Dr. Culnan is a 2005 graduate of Rutgers New Jersey Medical School. He has over 17 years of experience as a plastic surgeon with a specialist for burn care.
The search begins
When the news broke, Dr. Culnan and others on the team worked tirelessly to find a new location for operations.
“Beginning in September, the CEO at Central said, ‘We aren’t going to run the burn center here anymore,’ and gave us 30 days’ notice,” said Dr. Culnan. “At the time, we were seeing somewhere in the neighborhood of six to seven hundred clinic visits monthly. I, myself, was doing around 250 surgeries a month. That’s a whole lot of disease burden to have in a state to just shut down.”
Dr. Culnan said he began speaking to hospitals across the state to determine if there was one that could fit a service of their size. This research included hospitals like the University of Mississippi Medical Center (UMMC) and St. Dominic’s, both located in Jackson.
Culnan also wanted to ensure the facility could accommodate as many of the team members in the move as possible. He noted that there are less than 250 doctors across the nation who specialize in burn care and retaining professionals that do this kind of work was essential.
The team anticipated that the location would have to accommodate upwards of 2,000 patients annually for services.
When the search was over, Mississippi Baptist Medical Center, in Jackson, was chosen as the team’s next home.
“This view right here is what kind of, really, closed the deal,” said Dr. Culnan when looking toward the large roundabout in the front of the Baptist for Women entrance. “Because again it comes down to a capacity to provide care and they [Baptist] weren’t saying, ‘Oh, we will find a place to shoe-horn you in,’ they said, ‘We have a place they can pull up.’”
Burn center operations ceased on October 15, 2022, at Merit Health Central. Dr. Culnan was providing outpatient care at Baptist by November 15, and the first operation was performed on November 29.
Since December of 2022, the burn center operating at Baptist has seen 1,251 clinic visits, 612 operation cases, and 535 unique physical therapy cases.
Making Baptist home
The layout for the Mississippi Burn, Hand and Reconstruction Center at Baptist makes it easy for patients to navigate the facility. This was an important factor for Dr. Culnan when finding a new facility.
“I think we are going to do great things here. I think that this hospital has that ability and we are going to give something more to the state than maybe we’ve ever been able to give before. The people around here will come in sick and leave well, that they will not just survive but thrive,” said Dr. Culnan on the move to Baptist.
When walking through the burn center area, clinics and surgical areas are all located within seconds from each other on the same floor. The step-down recovery wing is one floor up and ICU is a floor above that, all with easy access to the elevator. Dr. Culnan said this layout was a key component in determining where the burn center would move their operations.
The Mississippi Burn, Hand and Reconstructive Center at Mississippi Baptist Medical Center is a 34-bed comprehensive specialty center. They have 10 beds dedicated to the ICU and treat a wide variety of burn injuries.
The step-down unit, which is the most recent component care, can accommodate up to 24 patients at any time. The staff is no stranger to admitting patients for all over. Steps outside the doors to the burn center, there is a sectioned off helicopter pad. Dr. Culnan said the helicopter pad provides feasible flight routes in and out based on needs determined by the hospital emergency room.
The team consists of Dr. Culnan, continuing as Medical Director, six advance practice providers, three certified hand therapists, 24 full-time ICU nurses, and many people filling administrative rolls. They have now begun the process of staffing the recently opened step-down unit.
Dr. Culnan said there was a large group of professionals that followed from Merit Health Central. He said the team are working to regain many who had to seek other employment in the interim period.
“Now that we are really up and running, we have gotten burn specialized dietitians, physical therapists, more occupational therapists and nurses that are ready to come. The majority of the staff of burn care wanted to come,” said Robert Sutton, Program and Clinical Director
Ease of access was not the only layout component taken into consideration.
Dr. Culnan said the beauty of Baptist’s facilities provides an extra nudge of security and hope for patients receiving care. He described extra attention to detail and certain aesthetics that were used within the clinic rooms and recovery wing that are intended to make patients feel more comfortable.
“Every time I walk by the chandelier on the way in it reminds me that there is something more to taking care of people,” said Dr. Culnan. “The truth is, it really matters that a patient feels like they’re in an environment with some degree of beauty, of hope that they’re going to get back to something.”
Dr. Culnan said the religious element of Baptist’s mission instills a notion that “good enough” should not be the baseline for care. Instead, he said, it encourages staff and physicians to treat patients in a way they would want to be treated.
“Being cared for in an environment that can often be overlooked, it’s nice to look around and say, ‘Wow, this is actually really pretty,’” said Culnan. “You feel more secure, you may feel like there is hope.”
On one of the doors to the clinic hangs a scripture verse, the Aaronic Blessing.
“The Lord bless thee and keep thee. The Lord make his face shine upon thee, and be gracious unto thee. The Lord lift up his countenance upon thee, and give thee peace.
The verse is on a piece of memorabilia that followed the team from Merit to the halls of the new clinic at Baptist.
Partnership improving care
Moving operations to Baptist not only provided space and streamlined operations, but additional availability to other medical specialties. Merit Health Central faced difficulties in obtaining specialty resources, and ultimately it led to the burn center closure.
“For instance, if you need a urinary catheter and it won’t go in, then you need a urologist, and you need one on call 24-7 for that,” said Dr. Culnan. ”This hospital actually has a complete urology group, so that works in a situation like that.”
Dr. Culnan said if a specialty care doctor is on call just for the burn center, it is a huge financial obligation to a hospital. Since many specialty groups already exist within Baptist Hospital, it has created a much smoother integration of care. Culnan added, there has not been a situation yet that required a specialty they did not have access to while at Baptist.
For Dr. Culnan and the team at the burn center, it is all about the small logistics when making a space work to treat thousands more people yearly. The team looks at elements like ventilation, access to rooms for storage of sterile equipment, and even access to other operating rooms if one is not available within the burn center.
Room to grow and care for all
The burn center continues to treat patients and increase beds to provide care to more and more patients. They are also converting additional unused space into areas usable treatment areas.
A large, currently unused teaching room, will soon be converted to a separate physical therapy space. Currently, the hand/burn therapy clinic is operating in the main Baptist building.
“A major part of dealing with burns, but frankly every major injury, is therapy,” said Dr. Culnan.
Additional operating rooms and ICU units are expected to be up and running in the near future. Many of these areas were shuddered during the COVID-19 pandemic. Culnan said additional resources are critical to the overall health capacity in the state. This is particularly important since much of the state is considered rural and lacks easily accessible healthcare.
Once renovations are complete there will be five dedicated burn center OR’s. Currently they are sharing OR time with Baptist general surgery.
“As of right now, I am taking care of people,” said Dr. Culnan. “I am taking care of whatever comes. I have not turned away any adults.”
Dr. Culnan said the pediatric portion of the burn center is not fully operational, so some children have been routed to Children’s Hospital in New Orleans. In the meantime, the hospital and burn center are stocking up on toys donated by Disney to help make everyone’s stay a little more pleasant.
“If you come to us and you’re burned, we are going to take care of you,” said Sutton. “If you have no insurance, no place to live or if you own a mansion in Madison, you’re going to get the same level of care.”
In the past at Merit, roughly one-third of the patients seen were self-pay. Another third were on Medicaid or Medicare.
Dr. Culnan said in the six months they have been operating, not once has the hospital told him he could not help a patient based on a financial hardship.
“This is a long healing process, and part of that process of healing is having your family with you,” said John David Smith, Vice President of Outreach and Education.
Smith said their mission is to help keep Mississippians in Mississippi when receiving burn care in order to better facilitate what can be a very long recovery process. The central location of Baptist, in Jackson, offers a convenience benefit to patients.
The center is also working to make sure those who need care, receive it. For instance, if someone cannot make it to an appointment or surgery, they have provided gas cards or booked Ubers to get them there.
“I’ve got a stack of gas cards, food vouchers to a ton of local restaurants, retail vouchers and hotels,” said Sutton. “This isn’t just for initial visits; this is for the entire length of care.”
As the burn center moves forward, Dr. Culnan said he aims to provide world class care for the state. One of the things that drew him to Mississippi was the overall need for someone with his specialty.
“I believe that if you swear you are going to take care of the sick and the needy, if you bend your knee to God and say you’re going to do it, you better damn well do it,” said Dr. Culnan. “I think we are going to do great things here.”