Pubdate: Mon, 11 Apr 2005
Source: Tennessean, The (TN)
Copyright: 2005 The Tennessean
Contact:  http://www.tennessean.com/
Details: http://www.mapinc.org/media/447
Author: Leon Alligood
Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine)

METH LAB EXPLOSIONS PUT HOSPITAL BURN UNITS IN A BIND

In an operating room at Vanderbilt University Medical Center, burn 
specialist Dr. Jeffrey Guy peered at the outstretched arm of his patient. 
The limb is a raw, bloody span of flesh picked clean of damaged skin in 
preparation for grafts.

The patient, who lives outside the Nashville area, was severely injured 
earlier this year when a methamphetamine lab exploded.

Meth injuries are not unique at Vanderbilt's Regional Burn Center. A week 
ago, seven of the critical-care unit's 20 beds were filled by patients 
whose injuries were meth-related, either from making the homemade drug or 
from hurting themselves while under the influence of the highly addictive 
substance, according to Guy.

This patient is unique, however. He's a two-timer.

A few months before his latest injury, the man spent weeks recuperating in 
another hospital's burn unit after a meth lab flared up.

"This time he comes to us for a few months," said Guy, referring to 
Vanderbilt's Regional Burn Center, one of the largest burn injury units in 
the South.

Total estimated bill from both conflagrations: near $1 million. At 
Vanderbilt, the bill is already approaching a quarter of a million and is 
rising at the rate of $10,000 a day.

How much will Vanderbilt be paid for the critical care?

"Zero," Guy said, matter-of-factly.

"What drunk drivers are to emergency rooms, methamphetamine is to a burn 
center. This is uncompensated health care. Vanderbilt is private. We don't 
receive state funds for this type of care."

Meth, a stimulant that has become the drug of choice in many parts of rural 
Tennessee, is typically concocted in homemade laboratories. The object is 
to transform pseudoephedrine, a key ingredient in many over-the-counter 
cold remedies, into methamphetamine.

To do so requires several potentially volatile reactions produced when 
various chemicals, including brake fluid, lye and lantern fuel, are 
combined over heat.

One misstep can bring a meth maker to Guy's operating room.

And, as patients go, meth users aren't good patients.

The influx of meth patients at Vanderbilt's burn unit has risen so 
dramatically that Guy fears the care will harm his unit's mission. The man 
on the operating table is a good example. He had to be brought to 
Vanderbilt on a medical plane at a cost of thousands just for transportation.

"I've got a clinical mission to care for thermally injured patients within 
200,000 square miles," Guy said. "That includes those in meth labs. 
Vanderbilt is always going to do the right thing. The question is, how long 
can we continue to provide that kind of service?"

Unfortunately, burns are a "disease of the economically challenged," he said.

Generally, 35% of all burn cases seen by the Vanderbilt hospital are not 
covered by insurance.

"When we look at meth patients, in excess of 90% of them have no insurance. 
Who pays for that? Society does," Guy said.

According to The Journal of the American Medical Association, trauma 
patients who are meth users are more likely to have longer stays in the 
hospital and the bill they run up is likely to be significantly higher.

In the JAMA study, which examined 212 minimally injured trauma patients, 
the authors concluded meth patients require "an increased use of hospital 
resources, measured by length of stays and charges."

The average length of stay for meth patients compared to the general 
population increased from 1.7 days to 2.7 days. Hospital charges for the 
meth patients were $4,000 higher than the general population.

For burn patients in particular, the rule of thumb is they stay in the burn 
unit one day for every percentage of their body affected by third-degree 
burns. If a patient's injuries cover 60% of his body, a stay of 60 days is 
expected.

"We see only the worst cases," Guy said.

At the recent annual methamphethamine conference in Nashville, Guy told 
accounts of some of the worst, including a man burned so badly in a 
meth-related explosion that his stomach had to be opened due to swelling. 
His intestines were held in place by a tent of plastic stapled to his 
midsection.

On a screen behind him flashed a photo of that man in the burn unit.

"This is what happens when you mess with meth, when meth messes with you," 
said Guy, as audience members flinched.

"This is what every person who cooks meth ought to have to see."

Dan Ramage, a licensed clinical social worker who works in the burn unit, 
said patients injured in meth lab accidents don't cease to be a burden once 
they are discharged. In fact, often the opposite is true because of 
underlying substance abuse problems, marital discord and financial worries 
the person had before the injury.

"This is a much larger problem for the community. Dr. Guy may save the 
person's life and I might provide some counseling services while they are 
in the hospital, but when they leave they face the same problems they used 
to have. Now, some of them also have terrible disfigurement to adjust to," 
Ramage said.

"It's a terrible situation, especially when you consider that most meth 
patients are from rural America. These are good ol' boys who have become 
addicted to this stuff and it's absolutely destroyed their lives, and in 
rural areas there are even fewer mental health and other services than you 
would find in a metropolitan area."

Later this year, the burn unit is expanding to new quarters on the 
Vanderbilt campus. Nine beds will be added.

Guy said he has no hope that the excess beds will remain empty for long. 
Many of them will be filled by patients with burns caused by the production 
of meth, he speculated as he stapled skin grafts to the man in his 
operating room.

"I wish I could say he would be the last," Guy said, "but he won't."

By the numbers

$10,000

The typical cost of care per day for a person in the burn unit at 
Vanderbilt University Medical Center.

75

The percentage of meth labs that Tennessee accounts for in the Southeastern 
United States.

1,259

The number

of meth lab discoveries in Tennessee in 2004.

6

The number of high-frequency percussive ventilators in use at Vanderbilt's 
burn unit. The ventilators breathe up to 500 times a minute for burn 
patients, which promotes healing and keeps the lungs clear.

$10,000

The going price per square foot of lab-created "skin" used in skin grafts.

600

The average number of critical burn patients treated each year at Vanderbilt.
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MAP posted-by: Jay Bergstrom