METH LAB FIRES POSE CHALLENGE FOR DOCTORS

USA's Burn Center has seen spike in number of cases linked to volatile
chemicals used in manufacture of illegal drug

For years, the number of burn victims receiving life-saving medical
treatment in Mobile has held steady at about 400 per year. But in the last
several months, the number of one type of patient has spiked up sharply,
presenting new challenges for doctors and law-enforcement officials alike.

This year alone, the University of South Alabama's Burn Center, the only
specialized burn unit in the area, has treated six patients who were
scorched when highly volatile chemicals exploded or caught fire in homemade
methamphetamine labs, USA burn specialists said.

That's almost one meth lab burn patient a month, far more such patients
than were treated last year, said Rigg Curtis, one of the senior burn
nurses at USA.

"That's how we usually find out what happened to them, because the police
show up," Curtis said.

While hospital burn units elsewhere, particularly in the Northwest, have
dealt with the plague of severely burned meth cookers for more than a
decade, the phenomenon is spreading across Alabama as addiction to the
intense stimulant grows, law officers and medical experts say.

"The trend has finally moved South," Curtis said.

In almost every case, these meth lab burn victims have no health insurance,
but still receive cutting-edge care at USA that often leaves virtually no
scars.

The treatment adds to the staggering costs to taxpayers: Not only do
law-enforcement officials have to bring in specialized hazardous materials
workers to clean up the toxic chemicals found in jerry-built labs, and
court-appointed defense attorneys are usually hired at public expense, but
the burn victims in many cases also require long-term and very expensive
medical attention.

A severely burned meth patient can spend as much as three months in the
hospital, running up mostly unpaid bills of more than $100,000, said Kelly
Johnston, nurse manager at the burn center. Treatment for people burned
over large parts of their bodies can take so long because so many steps are
involved.

Meth-lab burn victims can be particularly difficult to treat, workers say,
because they frequently are in terrible health to begin with -- some are
addicts who've gone without food for days and have handled the dangerous
chemicals for months.

On top of that, they sometimes have two different kinds of burns: freeze or
chemical burns from anhydrous ammonia or other compounds used in the
brewing process, and heat burns from when the chemicals catch fire or explode.

In addition, most of the victims have inhalation injuries from breathing
the smoke or toxic fumes, Curtis said. Making methamphetamine, a
cooked-down, highly concentrated form of an over-the-counter stimulant,
involves heat and complex chemical reactions that can easily lead to
explosions or fires, authorities say.

Burn victims are extremely susceptible to infection. The dead skin must be
trimmed away quickly, then antibiotics are required. Patients also need a
special liquid diet that contains 4,500 calories per day -- more than
double a healthy person's normal requirement -- because their bodies are
working so hard to fight off infection, said Dr. Arnold Luterman, head of
the USA burn center and acting chairman of the surgery department.

After several days, patients are ready for a skin graft. But if they are
burned over large parts of their bodies, there's usually not enough healthy
skin left to cover the burned areas, Luterman said. That's where a
relatively new product, artificial skin, comes in -- even for alleged
criminals who have no way to pay for it.

The artificial skin, known by the brand name Integra, costs about $1,900
per square foot, said Johnston. But it can leave almost no scarring because
it acts as a scaffold that allows the patient's own skin to grow into it.
After several weeks, Integra's layer of silicone is pulled off, and a
super-thin layer of the patient's own skin is applied.

Luterman, shortly after he came to USA in the 1980s, was one of the
original investigators who studied the safety and efficacy of Integra,
manufactured by LifeSciences Corp. The product, made in part from animal
and human cadaver tissue, was finally approved by the U.S. Food and Drug
Administration for widespread use in 1996. Since then, it has virtually
revolutionized burn medicine, Luterman said.

"Years ago, people were dying from burns like this," Luterman said. "Now,
they recover well and have almost no scars."

The recovery process is much less grueling than it once was, patients and
experts say.

"I don't have much pain," said Integra recipient Jeff Whatley of Bay
Minette, who was severely burned all over his lower body in a construction
site accident involving gasoline.

USA declined to reveal the names of any meth lab burn victims, and two who
were identified by the Mobile Register declined to be interviewed. But law
officers and defense attorneys say the fiery accidents are almost
inevitable with meth labs, because the cooks are not trained chemists and
are often handling the six or more compounds in dangerous ways without
proper protection.

And the risk of burns may only get worse, some say.

Most meth labs in this area have been using what's known as the "Nazi"
method of cooking meth, but may soon switch to a more dangerous approach,
said Johnny Joyner, chief of the Bayou La Batre Police Department, which
has dealt with a rash of meth-makers in the last two years. Early last
year, a small building was practically flattened near Bayou La Batre after
a meth lab inside exploded, he said.

The Nazi method of meth cooking, reportedly developed by the German army to
keep soldiers alert and aggressive in World War II, uses anhydrous ammonia,
which must be kept under pressure in liquid form. Because theft of the
ammonia, mostly from farms, has become such a problem, owners and law
enforcement have made it difficult to obtain, Joyner said.

Meth labs, therefore, soon may turn to another method, known as "red P" or
"red phosphorous," Joyner said. Popular in other Southern states, the
technique uses other chemicals and is far more dangerous than the ammonia
method, Joyner said.

"It's probably going to drift down this way before it's over," he said.

Ultimately, once the meth lab burn victims leave the hospital, and once
they serve their time if prosecuted, they can sign up for the artificial
skin simply to make themselves look better -- if they're willing to pay for
it. The FDA this summer approved Integra for scar revision, or smoothing
the hardened, discolored skin that's often left from burns that didn't
receive skin grafts.

That procedure, of course, is considered cosmetic surgery in many cases,
and won't be covered by most insurance policies.