By Emily Bregel
The Chattanooga Times Free Press (Tennessee)
CHATTANOOGA, Tenn. — Before dawn on a September morning in 1977, just days after Erlanger hospital's burn unit opened, Elizabeth Jones was gasping for breath out her second-story window, a fire raging below on the first floor.
Flames licking her back, Mrs. Jones passed out, tumbling out the window onto the concrete below. With burns over 40 percent of her body — in addition to a broken back, ribs and ankle and a punctured lung — the mother of four was rushed to Erlanger's burn unit, she recounted on Monday.
Thirty years later, Mrs. Jones is fully recovered, but the burn unit that saved her has shut its doors.
"If it had not been for the burn unit, I don't think I would have made it," said Mrs. Jones, now 68 years old. "When I heard it was closing, I just got tears in my eyes."
Last week, Erlanger hospital closed its six-bed burn unit and local reaction has been passionate and, at times, fearful.
Members of the Chattanooga Firefighters Association, the union representing city firefighters, are concerned about the timeliness of treatment for firefighters injured on the job, said the group's secretary and treasurer Rusty Rymer.
"That delay could mean a lot to me and my family. ... We're just trying to understand a little more why they're closing it and what could be done to get it reopened, either now or in the near future," he said.
On Monday, Erlanger officials sought to clarify the changes at the hospital, which officials said will not affect the emergency treatment of burn patients who show up at its doors.
Erlanger's physicians and nurses still will be the first responders to burn patients here; transfers to regional burn centers only will take place for the long-term care of severely burned patients after they have already been treated and stabilized at Erlanger, said Dr. Jim Creel, chief of emergency medicine at Erlanger.
Erlanger patients with burns on more than 20 percent of their bodies will now be transferred to the Joseph M. Still Burn Center in Augusta, Ga., or the Vanderbilt Regional Burn Center in Nashville, after being assessed and stabilized, hospital officials said.
"No one is going to be sitting on the doorstep out here, waiting for a helicopter from Augusta," Dr. Creel said. "We're going to address these people like we've always addressed them in an emergency fashion, and we'll take care of the ones we can take here. Otherwise, we'll facilitate their (transfer) to a higher level" regional burn center.
The February departure of the burn unit's medical director, Dr. Lesley Wong, prompted a re-evaluation of the burn unit's capacity, hospital Chief Executive Officer Jim Brexler said Monday. The hospital's difficulty finding a replacement for Dr. Wong was one of a number of reasons why the burn unit was shut down, he said. Hospital physicians also thought some burn patients, such as those in need of skin grafts, might be better treated elsewhere, he said.
"To bring a major burn physician into the community, one of the things we understand is that a small, little six-bed unit is not the kind of center those physicians come to," Mr. Brexler said.
Erlanger may eventually construct a comprehensive burn center that would be large enough to recruit a specialized burn doctor and handle greater numbers of patients, Mr. Brexler said.
As it is, the 30-year-old burn center only saw about 40 patients in the last fiscal year, compared to about 150 a couple years before, Mr. Brexler said.
State Rep. JoAnne Favors, D-Chattanooga, and a former Erlanger board member, said she thinks the search for a new medical director was called off too quickly.
"I would hope they would revisit that and extend that search," she said. "If they need to shut down, have it be a temporary thing."
Need for Trauma Funding
Across the nation, many burn units are struggling financially, in part because they often treat patients with little ability to pay for their care, said Dr. Jeffrey Guy, director of Vanderbilt's Regional Burn Center in Nashville.
"They are not people who have $500,000 houses. When you look at structure fires, they're people who are poor, living on the fringes. Most do not have insurance," he said.
Trauma centers across the state are in need of funding to support units that specialize in certain injuries, said Craig Becker, president of the Tennessee Hospital Association.
"The burn units are so, so expensive and the reimbursement is just not enough to keep them going," Mr. Becker said. In order to keep the rest of a hospital financially viable, "some of these specialty units are going to be the ones that will be the first to go," he said.
Nationwide, the number of burn centers is declining, from 132 in 2004 to 127 in 2007, according to American Burn Association figures reported by The Associated Press.
But Erlanger hospital's deep financial losses in fiscal year 2008 did not drive the closure of the unit, Mr. Brexler said.
Erlanger hospital had a loss of more than $12 million for the first 11 months of fiscal year 2007-08, compared to a budgeted gain of $15.9 million, hospital records show.
"We deliver $84 million of uncompensated care" annually, Mr. Brexler said. Any savings from closing the burn unit would do little to offset that, he said.
"Erlanger resources are still here for those who are most needy of this care," he added. "The firefighters, the patients who get affected by burns — we are here, we will respond to them and we'll make sure they'll get the absolute best care they should receive."
Mrs. Jones, who now lives in Harrison, lost her home and all her family's belongings that morning in 1977, but she said that everyone in the house — including three children — made it out alive. The cause of the fire was never determined.
"I really credit them (with) saving my life and I'm going to pray very hard that they will find somebody to take this over," she said. "I'm sure there's other things that are factors, but I would very much like to see it open again and be there for other people."
Copyright 2008 Chattanooga Publishing Company
