1. A sudden death

From South Carolina, helicopters airlift burn victims across the border to Augusta. By plane, more patients arrive from Mississippi, Alabama and beyond. Then, inside the largest burn center in the nation, teams of surgeons and nurses go to work.

Augusta's Joseph M. Still Burn Center at Doctors Hospital isn't just the nation's largest burn unit; it's also the hub of a network of burn centers that once stretched from Las Vegas to North Charleston. At its height, this network handled more than 20 percent of the country's most severe burn cases. 

The network's flagship in Augusta admits more than 3,000 badly burned people a year from dozens of states. It achieved this volume in part because it forged a reputation as a national backstop, a burn center in a medium-sized Southern city that took patients that other hospitals turned away.

But a deeper look by The Post and Courier reveals a competing portrait, a tale of ambition, deception and greed. This portrait involves sky-high medical charges, power struggles and alleged coverups. It’s about the rise of a nationally important medical institution in an unlikely city, and then its free-fall after the sudden death in 2020 of Fred Mullins, its driving force.

It also highlights yet another failure in our medical system, where price transparency often is a mirage. In the burn center’s case, a loophole in state workers compensation laws give Georgia hospitals free rein to charge injured South Carolinians staggering sums. One example: A burned worker from the Spartanburg area has medical bills upwards of $30 million.

The burn center’s impacts ripple across the country. Its high charges add pressure on insurers, who pass costs on to employers and ultimately consumers. Critics say it grew in part by steering patients away from closer units, including the Medical University of South Carolina’s burn center in Charleston.

More recently, legal battles over the burn center grew so intense that a judge in Georgia kicked out the chairman and installed Buzzy Johnson, former senior director of the Masters Tournament. Two months into his new job, Johnson told the judge that the company was teetering on bankruptcy or a forced sale. It was the worst mess he’d seen in his 50-year business career.

“Every time I overturn a rock, I find another rock,” he told the judge.

Looking under those rocks, it becomes clear that the burn center’s uncertain future is rooted in questionable decisions in the past. But the pivot point happened in the late spring of 2020, when Fred Mullins suddenly began to bleed.

2. The founder

Skin is more than your body’s shell; it’s your largest organ, protector against infections, regulator of temperature and fluids. When heat breaches this shell, your body faces a cascade of threats: kidney failure, sepsis, a massive loss in blood pressure, shock. Rebuilding badly burned skin may take months or years. Doctors and nurses must excise dead tissue, graft healthy skin over a wound, or use exotic and increasingly expensive skin substitutes made from pig placentas and Icelandic cod.

Because treating burns is so complex and time-consuming, hospitals began forming dedicated wards in the late 1940s. Over time, the health care industry realized these burn teams dramatically increased patients’ odds of surviving. But the units weren’t particularly lucrative, and even into the 1970s many hospitals simply didn’t have the skills or ambition to handle difficult cases. In Augusta, Joseph Still saw an opening.

Still was a hard-working, hard-living surgeon whose booming voice echoed down the hospital's corridors. He was almost always in scrubs, with his hair disheveled. He kept a cot in the hospital, and he often slept on it two or three nights in a row. Even longtime employees confessed that they found Still intimidating. Still was “a big, gregarious, funny guy, great, brilliant,” Billy Walker, a lawyer in Columbia, recalled in a 2017 lawsuit deposition.

For many who knew him, Still's decision to create a burn ward has a mythic quality, that it happened when he encountered a patient in 1978 with no insurance and no one else willing to treat his burns. "His mantra was, 'If you get burned, I’ll take you into my hospital regardless of your ability to pay or station in life,’ ” Walker recalled in the deposition.

Walker and Still became close friends, sometimes taking gambling trips together. They also found a way to bankroll the burn unit’s growth — through lawsuits. 

Walker declined to comment for this story. But in a 2021 interview with Lake Murray Lifestyle magazine, he said he met Still while representing clients burned by exploding gas cans. “It was an epidemic and people had horrific burns,” Walker told the magazine.

His firm, Walker Morgan, sued companies responsible for the burns, sometimes scoring settlements in the millions of dollars. “The problem was you had great doctors doing the burn work, but they weren't getting paid very much." He told the magazine: "We would find the money to pay (for) Dr. Still’s work." 

Still had an unusually aggressive approach to burn care. His overriding goal was to get patients in operating rooms as quickly and often as possible. There, surgeons did one procedure after another to remove and replace dead skin. Patients’ charges added up fast, but Still believed this all-hands-on-deck approach sped healing in the long run. Over time, the unit became a go-to destination for bad burn cases, drawing patients from neighboring South Carolina and as far away as Jamaica. 

Augusta was an unusual place for a burn treatment hub. The Augusta metro area has just 600,000 people, much smaller than the metro areas of Charleston and Greenville. Augusta's downtown has pockets of restaurants and new buildings but still has a left-behind feel. The burn center itself isn't attached to a prominent university. Instead, it's in an unremarkable suburban medical complex dominated by HCA's Doctors Hospital. Augusta is better known for the Masters golf tournament and as the hometown of James Brown, the "Godfather of Soul."

But under Still’s watch, the burn center grew to 58 beds by 2006. By then, Still was 67 years old and in declining health. That year, “he died of massive organ failure, diabetes, you name it,” Walker said in the 2017 deposition. At Still's funeral, former patients packed the church. His daughter, astronaut Susan Still Kilrain, and then-U.S. Congressman Charlie Norwood gave the eulogies.

After Still’s death, his protégé, Fred Mullins, took over.

And Mullins had even grander plans.

3. The expander

Mullins began working at Joseph M. Still Burn Center in 1991 as a physician assistant. Still urged Mullins to go back to medical school, which he did, returning in 2001 as a surgeon and Still’s heir apparent.

On the surface, Mullins was Still's polar opposite: quiet and social only when he had to be. He dipped snuff and seemed most comfortable in jeans and flip flops. But like Still, he was deeply ambitious, both in and out of the operating room.

As his mentor had done, Mullins was quick to get patients on operating tables, an approach that generated a windfall of fees. Mullins spent hour after hour in the hospital. “No one worked harder,” said William Lineaweaver, a surgeon who helped the Augusta network open a burn center in Mississippi.

Outside the hospital, Mullins guided the burn center's expansion, from new units in Texas to an outpatient clinic at North Charleston’s Trident Medical Center. Where Still wanted to conquer the southeast, Mullins wanted more; a running joke in the office suite was that it was their job to take over the world. The center had ties to surgeons in India, Dubai and Bangladesh. At one point, Mullins considered expanding to Jamaica. That plan never materialized, but the burn center steadily built its portfolio across the United States.

Many of the new burn units were in HCA hospitals, as was the case in Augusta's Doctors Hospital and at Trident in North Charleston. Mullins and his surgery colleagues handled patient care; HCA hospitals provided beds and treatment space. It was a symbiotic relationship that generated millions of dollars for the doctors and HCA, the nation's largest for-profit hospital chain. Burns had become big business.

In 2015, Mullins and several colleagues created a company to manage this growing network of burn doctors: Burn and Reconstructive Centers of America.

By 2020, the network had 15 burn centers, including the flagship Joseph M. Still Burn Center. Construction crews had broken ground on a new $75 million burn building in Augusta. It was the largest expansion in the center's history, doubling the number of operating rooms and bringing the number of burn patient beds to 99. New centers were in the works in Richmond, Va., and Nashville, Tenn. Its annual burn symposiums in Augusta drew physicians from as far away as Nepal.

Mullins was 54 years old and at the peak of his career.

He also had throat cancer.

4. Turning point

On June 14, 2020, a Sunday, Mullins was at his farm in Georgia about 20 miles from Doctors Hospital. His cancer was known mainly to a close circle of friends, family and colleagues. He underwent radiation treatments but showed few signs of reducing his surgical and administrative workload. Despite his diagnosis, he had no clear succession plan in place.

Throat cancer comes with a chance of heavy bleeding. Because of the throat’s proximity to important blood vessels, this bleeding can be life-threatening. Radiation treatments can often weaken these blood vessels.

Mullins was in the front yard on a warm and humid day when he noticed the blood. Given his medical training, he likely knew that his life was in danger, close friends told The Post and Courier. He and a yard worker took off toward the hospital, about 25 minutes away. A coroner's report shows that Mullins was pronounced dead in the emergency room, not far from the burn unit where he’d worked for so long.

His death stunned colleagues and patients. Tributes poured in. A patient in Mississippi wrote how “he saved my life and was so kind.” A man burned in Darlington wrote about Mullins’ caring nature and how it gave him confidence to recover. A man from Kentucky burned in an electrical accident said, “When I’m on my death bed I will have forgotten my children’s names but not his.”

Amid the memorials and praise, the burn network began to crumble.

But the cracks had formed long before.

5. The rainmakers

Beginning in 2014, a round of lawsuits targeted Joseph Still's longtime friend Billy Walker and his law firm Walker Morgan. Filed by former clients and a consultant, the lawsuits alleged an elaborate scheme to enrich the lawyers and burn center officials at the expense of their burn patient clients.

According to the lawsuits, staff at the Augusta burn center gave Kevin Johnston, a consultant for the law firm, confidential medical information. Johnston then used this information to sign up promising clients. Johnston told patients they were eligible for free investigations into the circumstances of their injuries.

When the clients sued and settled, Walker Morgan took as much as 40 percent of their settlements, court records show.  In addition to that cut, Walker's firm asked the burn center to send over clients' medical debts. Then, instead of negotiating those bills downward as insurers typically do, the firm paid the burn center's full price out of the settlement money, former clients alleged.

This meant that the burn center got more money than it would have otherwise, the clients claimed. It also meant burn patients ended up with much less to get on with their lives. Walker Morgan did this to ensure it landed "the most profitable Burn Center cases," the lawsuits said. 

In addition, Billy Walker also failed to tell his clients about his close business and personal ties to the burn doctors and staff, the clients alleged.

During the litigation, Walker acknowledged that for a time he co-owned a beach house on Kiawah Island with Fred Mullins; Zaheed Hassan, a burn surgeon; and Susan Bennett, who ran a company that collected the burn center's bills. Walker also said he co-owned a Cessna 650 jet with Mullins, along with shares in a medical waste company. He said he bought Atlanta Falcons tickets for burn unit staff, and that he occasionally did legal work for the burn unit's physicians "as an accommodation."

It all amounted to “a flagrant conflicts of interest,” said John Freeman, a University of South Carolina law school professor who before his death in 2021 was the state's preeminent legal ethicist.

In a 2017 report for the former patients, Freeman wrote that paying Johnston to recruit clients from the burn unit violated the state’s lawyer conduct rules. He said those rules were originally designed to prevent personal injury lawyers from paying kickbacks to ambulance drivers, tow truck drivers and funeral home directors. He called the entire arrangement a “case-running scheme” involving “indefensible professional misconduct.”

The lawsuits eventually were settled, their terms undisclosed. Walker and his former partner, Kirk Morgan, declined to discuss the cases. Johnston told The Post and Courier, “I don’t want to get into it because a lot of people (at the burn center) did good work."

In court filings, Walker Morgan denied doing anything unethical. In those filings, the law firm noted that it had its own ethics expert who cleared them of any conflicts of interest, and that it was common for lawyers to interact with burn patients and their families "as would any lawyer who seeks to provide quality representation to clients."

As for the burn center, personal injury lawsuits weren't its only lucrative revenue source.

A loophole in South Carolina also helped.

6. Predatory practices

In November 2021, the Innovative Fibers factory near Spartanburg hired a contractor to clean plastic dust piling up in the plant. Moments after the cleanup crew began, a cloud of dust ignited below them. Three workers suddenly found themselves inside a flash fire. They leaped over a railing, plunging 17 feet. Somehow they escaped, their clothes all but burned away. Helicopters airlifted all three to Augusta.

Two of the men, Riley Draper and Parker Wideman, had burns over more than two-thirds of their bodies, and the third, William Douglass, was burned over 40 percent. Doctors and nurses in Augusta worked for months to save their lives: Surgeons did dozens of operations; they replaced dead skin with skin cells cultured in Boston. Draper said he was in and out of consciousness for more than four months. But all three survived.

Then they started getting their medical bills.

“The first one I heard about was when I was discharged from the hospital, and that was $16 million,” Draper said earlier this summer. “I was just shocked. Now it’s up to something like $33 million.” Thankfully, Draper said, “I don’t have to pay because it’s covered by workers' comp.”

Under South Carolina Workers' Compensation laws, most companies with four or more employees must insure them against on-the-job injuries. This means when employees do get hurt, insurers typically cover the medical bills. The state caps fees hospitals and physicians in South Carolina can charge for those claims. 

But that cap doesn’t apply when injured workers seek treatment out of state, such as the Joseph M. Still Burn Center in Augusta.

In other words, “there’s no limitation on what they can charge,” said Gary Cannon, executive director of the South Carolina Workers' Compensation Commission. “So insurance companies have to negotiate with the burn center in Georgia. And I’ve heard anecdotally that they’ve been unsuccessful in doing that.”

This helps explain why Georgia burn facilities are much more expensive than burn centers in surrounding states, according to insurance industry data the commission provided The Post and Courier.

For example, a major burn-related surgery in Georgia costs upwards of $34,500. In South Carolina, it's $4,500, or eight times lower. A hospital stay for burns in Georgia costs about $54,000, compared to $30,000 in South Carolina.

MUSC closed a burn unit in 2002. But the hefty charges from Georgia helped persuade lawmakers and MUSC to reopen it in 2020. The competition apparently didn’t sit well with Fred Mullins in Georgia. In 2017, when legislators began discussing the MUSC plan, Mullins told The Post and Courier: “Financially, it’s not feasible.” Charleston was a “bad location because half of it is (surrounded by) water.”

Steve Kahn, a surgeon recruited from Mobile, Ala., to run MUSC’s burn center, took issue with that. Demand for burn care in South Carolina is extremely high, he said, and MUSC already had an advanced trauma center for adults and children. Establishing a burn unit only added to MUSC's capabilities.

More concerning, he and other burn directors said they've had patients who were treated in Augusta but could have gone to much closer burn units. Take what happened to Anthony Coad, 15, earlier this year.

Coad spilled grease on his foot and hand. His parents took him to Trident Medical Center in North Charleston, which houses one of the Augusta burn center's satellite clinics. Although MUSC has a large burn center a short drive away, staff sent Coad to Augusta. Coad's mother, Shanette, said she eventually learned about MUSC's burn center and brought her son there. She felt MUSC did a better job treating her son.

An Augusta burn center spokesperson said the network's surgeons prefer to send patients to units with the Chicago-based American Burn Association's "verification" seal. The Augusta burn center is the only one in Georgia and South Carolina with that status, she said.

But James Holmes, a surgeon and director of the Wake Forest Baptist Burn Center in North Carolina, called this a "smokescreen." He said his unit is verified, and he's seen similar "predatory" referral practices in his state.

"They come in and get burn cases in North Carolina, when we’re readily available for those patients.” 

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7. Internal wounds

Before Fred Mullins' death in 2020, the burn center and its national network appeared to be on solid ground. But the hidden fissures that developed during the center's rapid growth finally became visible when Mullins’ brother, Frank, took over. 

Frank Mullins was a longtime polo player and head of the Aiken Steeplechase Association. His background was in commercial and residential real estate. He was executor of his brother's estate, and under those auspices took the reins of Burn and Reconstructive Centers of America. 

Soon after, the network's physicians began to ask about the company's finances. One of those surgeons was Zaheed Hassan.

Hassan had worked closely with Fred Mullins for two decades. Until Mullins' death, they co-owned the Joseph M. Still Burn Centers Inc. Hassan had agreed to let Mullins do the business side while Hassan focused on his surgical work.

“Dr. Mullins was my friend, and I trusted him to do right by both of us," Hassan would later say in an affidavit.

But after Mullins died, Hassan began to question deals his deceased friend and partner had made over the years. Those questions eventually led to a lawsuit in which Hassan alleged that Fred Mullins “used his control to loot” as much as $30 million from him and his colleagues — a “scheme by Dr. Mullins to cut Dr. Hassan out of the business … and to steal as much of the value as possible for himself and his family.”

Other physicians questioned their remuneration, and the network imploded. Burn centers in Idaho, Las Vegas, Nashville and Florida left the fold, taking millions of dollars in revenue with them. HCA gobbled up most of those burn centers. Amid the defections, Hassan said Frank Mullins was running the business into the ground. The situation, Hassan said, was "as close to an existential crisis" as he'd seen in 22 years with the organization.

The conflicts seemed to metastasize. In Virginia, a Burn and Reconstructive Centers of America employee, Rebecca Mitchell, was creating a new unit at the HCA-owned Chippenham Hospital in Richmond. But she discovered that HCA hid names of staffers without proper training credentials from Virginia regulators, according to a lawsuit she later filed.

After she brought the issue up with executives in Augusta, she was fired, she alleged. She told The Post and Courier that she felt like "a pawn in a much larger game" involving the Augusta burn network's clinics and HCA.

Back in Georgia, Fred Mullins' son, Robert, filed a lawsuit alleging that “Uncle Frank” made a mess of the company, giving himself a $500,000 salary and having the company store his plane, among other allegations. Frank Mullins did not respond to requests for comment.

His nephew's suit, however, opened other doors into the burn center’s practices. During a deposition, Fred Mullins’ son said he used the burn center's jet several times to go college in Mississippi, as well as a trip with his father that included a stop to pick up a dog.

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•••

For the next two years, one CEO after another came and went, including Aloke Mandal, a Johns Hopkins-trained transplant surgeon from California.

Mandal told The Post and Courier he was stunned by the organization's convoluted finances and structure. He said he discovered some surgeons and staff "treated the company like a personal ATM." He said a physician used the corporate jet to fly his family to Florida for a vacation. He found extravagant charges on corporate American Express cards. He asked about physician and executive salaries and was told exact totals would be hard to come by.

He turned his attention to the burn network's billing practices and had even more questions.

One night, he met Frank Mullins and several others for dinner at the Willcox Hotel, a clubby place with tall white columns in downtown Aiken. He'd heard that one surgeon did as many as 15 cases a day. He asked Mullins about it. "Fifteen? Try 40," was his answer, Mandal recalled. As a surgeon, Mandal knew that kind of caseload was next to impossible.

He hired a consultant in Arizona called eCatalyst Healthcare Solutions to review the company’s billing procedures.

"Something rotten was happening in Augusta," he said.

At the time, Susan Bennett held dual roles: as chief operating officer of Burn and Reconstructive Centers of America and owner of the centers’ bill collection company. Mandal and Mullins nixed the contract with Bennett’s company and removed her as chief operating officer.

Not long after that, Bennett’s lawyers asked a judge to intervene.

•••

In Georgia, a state judge can appoint an executive to run a troubled company, much like a federal judge can appoint a receiver in a bankruptcy case. On July 7, 2022, Richmond County Superior Court Chief Judge Daniel J. Craig did just that. The judge ousted Frank Mullins, which meant Mandal was out, as well. In their places, the judge put Buzzy Johnson in charge.

Johnson had just retired as director of the Masters golf tournament and had a sterling reputation in Augusta's business community.

"He was minding his own business one day, and we drafted him into service," the judge quipped during one hearing.

Johnson's annual salary was set at $480,000.

Johnson declined to comment for this story, but in several hearings before the judge, he vented about the burn center’s questionable finances and future.

In one, he told the judge about the burn center’s “culture of expenses, a culture of spending a lot of money” that needed to change fast. Its $5 million Falcon jet was bleeding about $1.3 million out of the company a year. Susan Bennett's bill collection company took a 7.5 percent cut of every dollar collected, about twice as much as normal, he said.

For years, the business worked “as long as your revenues could outrun the previous year’s.” But the burn center and its network lacked proper business controls.

“I’m sticking my fingers in the dike, right now,” he said in another hearing. “I mean, it took 30 years to get here, or however long, and in two months we can’t unravel it.” He told the judge he was scratching his head over accusations that Frank Mullins alone took the company down. "I think there's a lot of people involved."

He feared the burn center and its network was “crumbling before my eyes,” and that it was the “biggest mess I have ever seen in 50 years in practice as a CPA or executive management, and I have seen a lot of things.”

By this summer, the same burn network that once had 17 centers across the country had shrunk to six.

8. 'Money on trauma'

The turmoil created a vacuum, and HCA filled it. One physician group after another left Burn and Reconstructive Centers of America for HCA. HCA now touts how it houses the nation’s largest burn surgery network, a claim the Augusta-based burn network made just two years before.

What this change means to burn patients in South Carolina and nationally remains an open question. HCA’s past record offers little comfort.

During the past two decades, HCA racked up more than $1.7 billion in criminal fines and civil judgments and penalties, a Post and Courier analysis found.

Those sanctions include cases ranging from criminal fraud to violations of the Stark act, which prohibits doctors from referring Medicare and Medicaid patients to businesses in which they have financial interests. Critics have hammered some of HCA's hospitals for charging huge "activation fees" when patients were brought to their emergency rooms. At times, HCA executives unapologetically touted its profit-driven approach.

“We believe that we can make money on trauma,” a top HCA official told The Tampa Bay Times in 2011.

In a statement, HCA said it was proud of the care in Augusta. “We take care of patients regardless of their ability to pay,” and that, “We understand there have been changes" at Burn and Reconstructive Centers of America, but those “changes have not impacted our ability to care for our patients.”

For the time being, the Joseph M. Still Burn Center in Augusta remains under Burn and Reconstructive Center of America's corporate umbrella. A spokesperson declined to answer questions about lawsuits and its interactions with HCA, saying its business and legal matters are confidential.

But last year, Buzzy Johnson spoke openly in court that the burn center was on the edge of bankruptcy or sale to HCA. In early December, Judge Craig ordered that Johnson finish his term as interim CEO on Dec. 31. 

Today, many of the lawsuits filed in the wake of Fred Mullins’ death have been settled for undisclosed amounts.

The new Fred Mullins M.D. Tower is open with its nearly 100 burn-patient beds, but the hub-and-spoke model Mullins envisioned has come apart.

Many of the surgeons and staff who helped build the network have scattered and feel angry and betrayed.

The wounds are deep, as are the lessons: that ambition can create a vitally important institution, in this case a place that treats thousands of badly injured people. And, when not controlled, it can set that creation on fire.

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Tom Corwin and Sandy Hodson contributed to this report.