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Will Baptist and UMMC battle over burn care?

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Will Baptist and UMMC battle over burn care?

The and Mississippi Baptist Medical Center are vying to run a burn center in Mississippi — and both are seeking lawmakers' help to establish them.

Dr. Derek Culnan, the former medical director of the now-closed JMS Burn and Reconstruction Center at Merit Health Central in , said Merit gave him 30 days' notice that the hospital would shut down the center because of financial strains brought on by the pandemic and recruitment challenges. Culnan continued caring for existing patients and started talking to hospitals about how to open a new center — and fast.

“This is a that has a need for this service, and I wasn't going to quit on the people just because it was hard,” Culnan said.

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The burn center at Merit Health Central — which was the only accredited center in the state — saw around 600 to 800 patients a month, according to employees who worked there.

Culnan, who completed a fellowship in burn surgery where he worked with adults and children at the University of Texas, struck a deal with Baptist in Jackson and got privileges at the hospital. When he was admitted to the staff, he began taking care of patients immediately, he said.

Dr. Derek Culnan, the former medical director of the now-closed JMS Burn and Reconstruction Center at Merit Health Central in Jackson, is trying to establish a burn center at Mississippi Baptist Medical Center in Jackson.

“We're not working at the scale we were working on at Merit quite yet, but I'm operating on somebody essentially every day,” he said.

Culnan, who says he is one of about 250 specially trained burn surgeons in the United States, also performed complex hand surgeries at the former center, which was the only hand replantation center in the state. Replantation is the surgical reattachment of a finger or hand.

Culnan's operation has the backing of House Speaker Philip Gunn, who penned a bill that would award $12 million in one-time money to establish a burn center at Baptist.

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Gunn said he was approached by Baptist and believes Mississippi needs a burn center, regardless of who runs it.

“It will all be worked out. There are a lot of different ways to go about that,” he said.

with Baptist said to move forward with a burn center, they must acquire specialized equipment and additional intensive care capacity. Culnan is currently operating in standard operating rooms.

“As a result, we have reached out to our elected officials and shared that we are willing and capable of operating this service if we were successful in receiving one-time financial support for some of these costs,” said Bobbie Ware, chief executive officer of Mississippi Baptist Medical Center.

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The hospital has not yet submitted its application for accreditation to the state Department of Health, a spokesperson said.

But at the same time, UMMC, the state's only academic medical center, has been in pursuit of a burn center — despite a history of walking away from the opportunity.

After the burn center in Greenville closed in 2005, state lawmakers in 2006 approached then-vice chancellor of the University of Mississippi Medical Center Dr. Dan Jones about establishing a burn center at UMMC. Jones told Mississippi Today he asked lawmakers for a yearly commitment to help UMMC run the program, but lawmakers only offered one-time money.

UMMC walked away, citing financial constraints, but lawmakers nevertheless passed a bill in 2007, sans funding, authorizing the university to create the Mississippi Burn Center.

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In September of last year, University of Mississippi Medical Center officials were mum about whether they planned to pursue opening a burn center following the closure of the center at Merit Health Central. They did say, however, they would increase their capabilities for care of such patients, but offered no specifics.

But UMMC officials have been quietly — and now more overtly — pursuing state funds to establish the burn center. Dr. LouAnn Woodward, vice chancellor for health affairs and dean of the medical school, spoke in front of an appropriations subcommittee at the beginning of the , and a bill by Sen. John Polk brings forward the code section from 2007 that authorized UMMC to create the Mississippi Burn Center. Lawmakers could use Polk's bill to appropriate money and make other amendments to the law.

Polk told Mississippi Today he's made no decision on which hospital he supports establishing a burn center.

“The (burn center) legislation was last looked at in 2007 best I can tell. This is a whole new ,” said Polk. “All kinds of things have changed. We need to bring legislation forward to study it to see if we need to make some changes.”

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It's unclear how much UMMC is asking lawmakers for and if the money would be recurring. UMMC doesn't have any outside funding for the center at the time, Dr. Alan Jones, associate vice chancellor for clinical affairs, said at a press conference Friday.

He referenced the Mississippi Burn Care Fund, which runs anywhere from $500,000 to $1 million each year, and the hope UMMC will have access to that once it receives accreditation from the Health Department, which manages the fund.

UMMC announced it would be establishing its own burn center one day after submitting its application for accreditation to the Health Department. Dr. Peter Arnold, a plastic surgeon, has been named as the medical director.

UMMC officials say Arnold's past experience treating burn patients qualifies him for the position, which regulations say must be filled by a physician who has completed a burn fellowship or who has spent two of the previous five years treating burn patients.

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Emergency Medicine resident Dr. Andrew Garza, left, pharmacist Stephanie Tesseneer, background, and respiratory therapist Charles Patton stock supplies in a trauma room in the Adult Emergency Department at the University of Mississippi Medical Center.

“Dr. Arnold … has had extensive training and experience in caring for patients with acute burns and complex wounds in his nearly 20-year career,” said Jones. “He is assisted at the Mississippi Burn Center by five other highly qualified, expertly trained plastic surgeons, all of whom have significant experience treating pediatric and adult acutely burned patients.”

Jones also told at a press conference Friday that the hospital has “the necessary in place” but will need to make additional hires, including around 30 nurses trained specifically in burn care.

“That won't be immediately. Over time, it will grow,” said Jones.

He also said they will not have to add additional beds to accommodate running a burn center. Currently, burn patients are being treated on a regular unit in the hospital.

Jones said the university has treated about 75 burn patients through the emergency room in the past four months.

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“But as the volume grows, we've identified a dedicated space that's actually ready to go. So after this approval (by the Health Department) has taken place, we'll begin to operationalize,” he said. 

Editor's note: Kate Royals, Mississippi Today's community health editor since January 2022, worked as a writer/editor for UMMC's Office of Communications from November 2018 through August 2020, writing press releases and features about the medical center's schools of dentistry and nursing. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

Look for the “why” when engaging in disagreement

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“Bought sense is better than borrowed sense” lives in my memory, rent-. I've always cringed at it because, at every stage of , some lessons have been costly to learn.

At the Alluvial Collective, we show up to the office, on the screen, or in a community with one overarching : to create or deepen the connections that will collective thriving. That is our “For what.” We get to show up with wisdom purchased over our organization's last 25 years of work and with wisdom borrowed from many generations and traditions. In most traditions, self-reflection and stories reveal the path to where we should go and how we should travel.

As you engage in the National of Conversation, here are a couple of stories and a few thoughts to you show up for each other, our communities, and our country.

What Do You Need

The first story emerges from a book called “Getting To Yes,” about negotiating.

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Two people were arguing over an orange, and after some time, they decided to split it in half, feeling that equal parts were fair, like in elementary school. Before splitting the orange, they never asked each other the reason the other wanted it. As it turns out, one wanted the orange peel to flavor a cake, and the other wanted the orange's “meat” to eat.

In another story, an arriving house guest is deeply offended by their host's demand that they remove their shoes upon entering their family home. The visit goes off the rails and probably off the porch, too.

Each of these stories reminds you of tensions and dilemmas that are all too familiar in our families, towns, and – for me – our leadership discourse.  We have notions about what the other person, or people, want, but at critical points, we need more humanizing insight into what makes it essential to them.

The Cost of Wisdom

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In the second story, the home's foyer had a large rug on its floor that had been in the family for generations. Understanding that, I would have offered to remove my shoes.

We benefit from being curious about the interests, the “for what” the other person engages with, rather than just the “what” or their position. It may seem inefficient, but it pales to the value curiosity brings to relationships. Good relationships are win-win; our team leans on telling and hearing stories to build relationships. They are the wellspring of “for whats” and “whys.”

The truthful stories that your neighbor or coworker tells to you and themselves comprise reality as they see it.  Your stories teach your in-laws and teammates history from your the learned or experienced vantage point. Dialogue and stories make our actions and attitudes make sense.  This is where trust begins to form.

Dialogue over Debates and Diatribes.

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As you begin your week, remember that how we engage matters as much as why. Diatribes and speeches don't make us good neighbors, and debates require someone to lose. We like authentic connections and hearing familiar themes in the stories of others. This week, open and honest dialogue is the strategy; to thrive together should always be the goal. We've paid too much for everything else.

Talk more; proclaim less. It's one of our mottos here at The Center for Practical Ethics (TCPE). Put another way, we might say our goal is to foster conversations rather than diatribes. This task is more difficult than most realize. What we know as ethicists is that merely having conversations isn't enough. There's a wide variety of skills needed for fruitful dialogue to take place, and some are harder to come by than others.

The ideal conversation partner is curious and humble, able to actively listen, knowledgeable about his or her own positions, familiar with basic principles of logical argument, charitable when interpreting claims, and—most importantly—willing to be wrong. Our work centers around equipping with these skills and helping them navigate the complex ethical issues within our society's most contentious disagreements.

This year, National Week of Conversations (NWoC) coincided with Ethics Week here at the University of Mississippi (UM). Many of our events are conversation-based because dialogue is the best way to evaluate the ideas of others and open ourselves up to new information and interpretation of facts, while gaining a better understanding of our own views.

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Two of our events in particular are worth examining more closely to see why NWoC and the work we do at TCPE are critical for sustaining civil society and the myriad public goods we all take for granted. First is our signature Just Conversations event. Students are placed in small groups and given a couple of ethical dilemmas to discuss. Trained student moderators guide the discussion to point out important aspects of the dilemmas, such as logical fallacies, analysis of stakeholders, ethical concepts and assumptions, and varying methods to achieve goals. Students often discover they agree with others—on the dilemma outcome and the details—far more than they expected.

Second, we have invited free speech scholar Sigal Ben-Porath to give a talk about her new book Cancel Wars: How Universities Can Foster Free Speech, Promote Inclusion, and Renew Democracy. Ben-Porath contends that universities are laboratories of democracy where students must learn to engage with disagreement. If the university is to be a place where truth is discovered, it must take seriously its historic social and educational obligation to train students in the skills needed for civil discourse and critical thinking. Her work is especially relevant in our ever more polarized times.

What these events demonstrate is that conversations—that is, engaged and fruitful conversations—must take place at all levels. Students must learn to talk to students just as much as faculty must learn to talk to faculty and administrators to administrators. What's more, these groups must talk to each other because while each of us have a role within academia (faculty, staff, student, dean, vice chancellor, etc.), we are also all citizens who work and live together.

Policies must be made, votes cast, businesses founded, churches attended, friendships established, and life lived. TCPE focuses on the skills of civil discourse by providing opportunities to cultivate those skills through Ethics Week, and highlights conversations that ask us to reflect on the role of universities as part of the NWoC.

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Join us at Noon on Friday, April 19 for a VIRTUAL lunch and learn session exploring tools to make us better listeners, and in turn, better equipped to engage in meaningful conversations across differences.

The session will be led by Dr. Graham Bodie, professor and Interim Chair of the Department of and Communication in the School of Journalism and New Media at the University of Mississippi.

This event is free and open to the public. Register to receive more information.

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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1977

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mississippitoday.org – Jerry Mitchell – 2024-04-19 07:00:00

April 19, 1977

Alex Haley was awarded a special Pulitzer Prize for “Roots,” which was also adapted for television. 

Network executives worried that the depiction of the brutality of the slave experience might scare away viewers. Instead, 130 Americans watched the epic miniseries, which meant that 85% of U.S. households watched the program. 

The miniseries received 36 Emmy nominations and won nine. In 2016, the History Channel, Lifetime and A&E remade the miniseries, which won critical acclaim and received eight Emmy nominations.

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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Q&A: Explaining the health care coverage gap

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mississippitoday.org – 2024-04-18 16:58:45

Lawmakers and advocates regularly refer to Mississippians without insurance who are in the “coverage gap.” But what is the coverage gap, why does it exist and how does it relate to Medicaid expansion?

What is Medicaid?

Medicaid is a federal-state program that provides health coverage to millions of people in the U.S., low-income adults, , pregnant women, elderly adults and people with disabilities. States administer the program, which is funded by both states and the federal government. Mississippi participates in the traditional Medicaid program, but the is debating two differing proposals that would expand Medicaid.

What is the coverage gap?

The coverage gap refers to a certain group of uninsured people in states that have not expanded Medicaid under the Affordable Care Act, the federal health reform enacted in 2010 under the Obama administration. 

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The law sought to make health insurance affordable and accessible to more people and provides subsidies that lower costs for households with incomes between 100% and 400% of the federal poverty level, or between $18,210 and $72,840 in annual income, respectively, for an individual.

The Affordable Care Act also expanded Medicaid eligibility to adults under 64 years of age with income up to 138% of the federal poverty level – or $20,782 annually for an individual in 2024. But a U.S. Supreme Court ruling in 2012 made expansion optional, creating the “coverage gap” in states that did not opt to expand the federal-state program.

Why does it exist?

In Mississippi and the nine other states that have not expanded Medicaid, there is a gap between people whose income is not low enough to qualify for non-expanded Medicaid but less than 100% of the federal poverty level, or about $15,000 a year for an individual, to qualify for subsidized insurance through the federal marketplace. To qualify for Medicaid in Mississippi under current regulations, one's household income must be less than 28% of the federal poverty level, or a mere $7,000 annually for a family of three. Non-disabled childless adults are not eligible for Medicaid unless they have another qualifying

How many people fall into the coverage gap?

Roughly 74,000 Mississippians fall into the coverage gap, according to a recent KFF study. Nationally, the number is 1.5 million people.

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What is Mississippi's uninsured population? 

Mississippi had one of the highest uninsured rates among working-age people in the country in 2022 at 16.4%, according to the U.S. Census 's American Community Survey. 

Are people in the coverage gap employed?

In 2019, of the 178,000 uninsured Mississippians making below 138% of the poverty level, the majority – nearly 61% – were either working or looking for work. Many of those not in the labor force are unable to work due to a mental health or medical condition; lack of transportation; caring for a family member or recent incarceration, among other circumstances. More recent years' data has been skewed because of the pandemic and extended Medicaid coverage for people who would not have otherwise been eligible.

Nationally, according to KFF, the most common jobs of people in the coverage gap are cashiers, cooks, waiters-waitresses, construction/laborers retail salespeople and janitors.

What keeps businesses from offering health insurance to its employees or from offering it with reasonable deductibles?, according to Hilltop Institute at the of Maryland, Baltimore County

Larger employers – those with over 50 employees – are required to offer health insurance to their employees or pay a penalty. For smaller employers, offering health insurance is not mandatory. And because it is often more expensive, smaller employers will offer benefits with higher deductibles and copays in order to reduce their own expenses. So those employed at a small business either may not have the option of health insurance or may choose to opt out because of cost.

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Nearly 69% of private businesses in Mississippi employ fewer than 50 employees, according to the Agency for Healthcare Research and Quality. It's up to 95% when public employees are included, according to Hilltop Institute at the University of Maryland, Baltimore County.

How many people would the House and Senate plans make eligible for Medicaid, and how many of those are in the coverage gap?

The House plan – which is traditional expansion under the Affordable Care Act and would make Mississippi eligible for hundreds of millions of federal dollars – is estimated to cover 200,000 Mississippians. That would include people in the coverage gap and others.

The Senate plan – which is not traditional expansion and does not qualify the state for the federal match – would insure about 40,000 Mississippians. This would include only people in the coverage gap, or only those making up to 99% of the federal poverty level.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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