Hyperbaric therapy forces more oxygen into damaged cells. Even as the evidence remains mixed, the NCGA is poised to make the treatment easier to get.

By Emily Davis

Veterans who have had brain injuries or are struggling with the effects of trauma may soon have a new treatment option if a new bill making its way through the legislature eventually becomes law.

On Tuesday, a Senate Health Care ommittee greenlighted House Bill 50, the North Carolina Veterans Traumatic Brain Injury and Post-Traumatic Stress Disorder Treatment and Recovery Act which would allow medical professionals to prescribe hyperbaric oxygen therapy, or HBOT, to North Carolina veterans who have had traumatic brain injuries and/or have post-traumatic stress disorder.

Jim Hooker, a Navy veteran, has been advocating for hyperbaric chamber treatment for veterans for several years. Patients sit in chambers where the atmospheric pressure is pumped up, pushing a patient’s blood, and the oxygen that blood cells carry, into vessels where the blood doesn’t always reach.

Cells require more oxygen to repair themselves. The increased pressure maximizes tissue oxygenation and stimulates wound repair.

According to Sen. Jim Perry (R-Lenoir), a bill supporter, “It’s like fertilizer for the healing process.”

The bill has been in the works for two years, since Hooker began talking with Rep. Greg Murphy (R-Greenville), a physician, about the treatment. There are questions around how well it works as well as how the treatment would be paid for.

“We have a great number of veterans here and Marines and Army veterans who live and need this therapy in the state,” Hooker said. “And it’s going to be a great accomplishment for the state, the governor to have this bill passed here.”

According to UNC Chapel Hill’s Carolina Population Center, there were over 656,000 veterans living in the state in 2017, and they make up a higher percentage of the adult population than the national average.

Jury still out

TBI and PTSD are neurocognitive disorders that can benefit from the reparative treatment offered with HBOT, Hooker argued.

“I’ve had the honor to work with veterans who have suffered major combat injuries, many of whom have suffered PTSD and TBI as a result of losing limbs among other things, and this therapy is a therapy that works,” Hooker said. “The word of mouth is eventually going to overwhelm this if nothing else does because it works, it just really works. I mean these guys, they get their lives back.”

But the research is not completely clear if or how HBOT might help people with TBI or PTSD.

Some studies have shown that the treatment is definitely effective at creating cognitive and quality of life improvements in TBI and PTSD patients. These studies back up reports from individual veterans who say they’ve experienced some degree of healing from HBOT.

“The reality is that oxygen therapy and all of the studies that have been conducted have shown an improvement, in many cases significant improvements in the condition of patients that receive the therapy, in particular, those veterans who have suffered TBI and PTSD,” Hooker said.

Other research claims any benefits are the result of a placebo effect,, something Hooker acknowledged in an article in the NC Medical Journal.

“The use of hyperbaric oxygen therapy is controversial, but there is some scientific evidence that it can lead to improvements in neuroplasticity, with concomitant improvement in body and motor function, cognition, and emotional system responses.” he wrote.

One of many possible treatments

Murphy worked on the bill in the House of Representatives, which passed it in April, while Sens. Don Davis (D-Goldsboro) and Jim Perry (R-Lenoir) gave it support in the senate.

In the Senate Health Care Committee last week, Sen. Gladys Robinson (D-Greensboro) spoke up in strong support of the bill. In addition to her long-time work with veterans in Guilford County, Robinson’s late brother was a Marine for over 30 years, served in the Vietnam and Korean Wars, and suffered from PTSD.

Robinson said she was perplexed as to why the state had not already made this treatment available for veterans.

“We seem to be behind in terms of some of the medical treatments, like telemedicine and telehealth,” Robinson said. “I don’t know why we are so delayed in implementing health care treatments or medical treatments for special populations, but this is important, this is important for the health of veterans.”

According to Perry, quirks in the law caused the gap in treatment, and this act ensures that veterans are not denied this treatment option. HBOT treatment is available to patients in hospitals and private facilities around the state but is currently not authorized to be prescribed in Veterans Administration and Department of Defense facilities.

“What we’ve seen is increasingly other states have taken interest in HBOT, and I think it’s long time past due for North Carolina to take interest in this,” Davis said.

In addition to North Carolina, there are at least six states that have now passed a law authorizing this therapy for veterans: Oklahoma, Indiana, Arizona, Kentucky, Texas, and as of two weeks ago, Florida.

Public and private dollars

As of now, HBOT for these conditions is often not covered by insurance, according to Murphy, so users often end up paying out of pocket or with the support of a donor group. A separate bill creating a state Hyperbaric Oxygen Therapy Fund is currently in the works, which would establish a special fund within the Department of Military and Veterans Affairs (DMVA) to provide financial assistance to veterans for hyperbaric oxygen therapy. Sens. Davis, Perry and Joyce Krawiec (R-Kernersville) are the primary sponsors.

Davis said that there are still conversations being had around that bill.

“Right now you see DMVA, but we’re actually in the process of weighing where’s the best fit for it, maybe DHHS [Department of Health and Human Services],” said Davis, who served in the Air Force.

The fund would receive appropriations made by the General Assembly along with donations, gifts and earned revenue. As Perry explained, it allows HBOT for veterans to be funded by private donors, not just by state dollars.

“So now those veterans who may not have insurance, may not be able to cover the cost could actually come in and participate with some HBOT treatments,” Davis said.

Today, the bill heads to the Senate floor for final approval by that chamber, after which, it will head to Gov. Roy Cooper’s desk for his signature.